[Purely bulbar hematomas].

INTRODUCTION

Purely bulbar hematomas are not common (0.25%-0.50% of all intraparenchymatous hematomas), probably because of the particular characteristics of the anatomy and hemodynamics of the bulbar circulation.

CLINICAL CASES

We selected 18 cases. Three of these were our own and the purely bulbar localization was confirmed by neuroimaging surgical findings and necropsy. Its appearance was related to arterial hypertension, anticoagulant treatment and obvious or occult vascular malformations, although in a considerable proportion (39%) no cause was found. Although arterial hypertension is less important in its etiopathogenesis as compared with other sites of intraparenchymatous hemorrhage, 7 of the patients were hypertensive. The commonest clinical findings were nystagmus (72%), and dysphagia and hypoglossal paralysis (61%). The commonest site was posterior. Arteriography was of little use since this was normal in all the cases in which it was done (72%). The presence of angiographically occult malformations made it advisable to use magnetic resonance and repeat this after the acute phase. Three quarters of the patients were treated medically. Mortality (22%) was lower than the overall rate for posterior fossa hematomas, and the prognosis was better since no survivors had incapacitating sequelae.

CONCLUSION

The specific etiopathogeneses, clinical characteristics and course of bulbar hematomas makes it advisable to do a differential study regarding other types of intracerebral hemorrhage.