Yamanaka R, Sato S, Kawasaki S, Sekiguchi K, Sato I, Mori S, Watanabe M, Nishizawa E, Morii K, Takahama H
Department of Neurosurgery, Yamagata Prefectural Central Hospital, Japan.
No Shinkei Geka. 1988 Jan;16(1):57-64.
Forty-three cases of primary pontine hemorrhage were seen in our hospital from 1979 to 1986. We studied the correlations between clinical signs, CT, ABR findings and their outcomes, and then reported surgical results. The case consisted of 30 males and 13 females between 32 to 73 years with an average age of 54.5. Thirty cases were confirmed to have had hypertension prior to the hemorrhage. In ten other cases hypertension was suspected, although their past histories were not obtained. In the remaining three cases, no hypertension was detected. On admission, comatose state, ocular fixation, absence of light reaction, tetraplegia, decerebrate posture, respiratory disturbance, tachycardia and hyperthermia were the signs of unlikely recovery. On the CT, the hematomas of the group of likely recovery patients were less than 25% of the cross section of the pons and lower midbrain in vertical. Greater size of hematomas were seen exclusively among the groups of death and severe disability cases. Acute stage ABR and CT findings showed discrepancy. We suggest, if ABR, CT findings and clinical symptoms were studied more in depth, it is possible to determine a patient's prognosis more precisely. Three cases were treated by Stereotactic Aspiration, three cases by ventricular drainage and the remaining thirty-seven cases conservatively. There was, however, no significant difference in recovery between surgically treated cases and conservatively treated one. We think that surgical indication is doubtful except for limited cases.
1979年至1986年期间，我院共收治43例原发性脑桥出血患者。我们研究了临床体征、CT、ABR检查结果与其预后之间的相关性，并报告了手术结果。病例包括30例男性和13例女性，年龄在32岁至73岁之间，平均年龄为54.5岁。30例患者在出血前被确诊患有高血压。另外10例患者虽未获取既往病史，但怀疑有高血压。其余3例未检测到高血压。入院时，昏迷状态、眼球固定、无光反应、四肢瘫痪、去大脑强直姿势、呼吸紊乱、心动过速和高热是预后不佳的体征。CT检查显示，有可能恢复的患者组血肿面积小于脑桥和中脑下部垂直截面的25%。仅在死亡和严重残疾病例组中发现血肿面积更大。急性期ABR和CT检查结果存在差异。我们认为，如果对ABR、CT检查结果和临床症状进行更深入的研究，有可能更准确地判断患者的预后。3例患者接受了立体定向抽吸治疗，3例接受了脑室引流，其余37例采用保守治疗。然而，手术治疗组和保守治疗组在恢复情况上没有显著差异。我们认为，除少数病例外，手术指征值得怀疑。
