Bewermeyer H, Hojer C, Szelies B, Haupt W F, Neveling M, Heiss W D
Nervenklinik der Universität zu Köln.
Nervenarzt. 1988 Nov;59(11):640-6.
In 38 patients suffering from spontaneous pontine hemorrhages arterial hypertension was the most common risk factor. 31 patients, of whom 30 died, suffered centro-paramedian pontine hemorrhage leading to coma, hypertensive crisis, respiratory failure, cardiac arrhythmia, miosis and tetraparesis. Most cases showed involvement of the mesencephalon [17] and fourth ventricle [14]. The other seven patients demonstrated dorsotegmental [5] or hemipontine [2] hemorrhages with complex neuroophthalmologic signs, other cranial nerve lesions, and ataxia or hemiparesis; all these patients survived, some even without neurological deficit. In most cases, arteriosclerotic hemorrhages of pontine vessels occurred; in rare cases arterial malformations [4] and anticoagulants [4] were responsible for the bleeding. Clinical signs, CT scans and MRT investigations led to the diagnosis. EEG and evoked potentials allowed statements regarding localisation and prognosis. Treatment was limited in most cases to conservative intensive care; in one case a ventricular shunt was implemented, and in two cases pontine hemorrhages in the presence of arteriovenous and cavernous angiomas were removed.
在38例自发性脑桥出血患者中，动脉高血压是最常见的危险因素。31例患者发生脑桥中央旁正中出血，导致昏迷、高血压危象、呼吸衰竭、心律失常、瞳孔缩小和四肢轻瘫，其中30例死亡。大多数病例显示中脑[17例]和第四脑室[14例]受累。另外7例患者表现为背盖部[5例]或半侧脑桥[2例]出血，伴有复杂的神经眼科体征、其他颅神经病变以及共济失调或偏瘫；所有这些患者均存活，有些甚至没有神经功能缺损。大多数情况下发生脑桥血管的动脉硬化性出血；罕见情况下，动脉畸形[4例]和抗凝剂[4例]是出血的原因。临床体征、CT扫描和磁共振成像检查得出了诊断结果。脑电图和诱发电位有助于对定位和预后作出判断。大多数情况下治疗仅限于保守的重症监护；1例实施了脑室分流术，2例存在动静脉和海绵状血管瘤时切除了脑桥出血灶。
