“自发性”桥脑出血

Primary pontine hematomas

本文报告了“自发性”桥脑出血１２例。对其临床表现，神经放射检查及手术治疗诸问题作了较深入分析。出血原因系脑血管畸形，病理证实３例为海绵状血管瘤，２例为ＡＶＭ和２例为畸形血管。我们认为，目前ＭＲＩ检查是术前诊断最主要方法，Ｘ－ＣＴ在急诊检查及术后随诊中起一定作用，而脑血造影对诊断几乎没有帮助。全组术后平均随访２年，结果令人满意。提出，无论哪种类型的血管畸形所造成的桥脑血肿，尤其病灶较大者，手术治疗能够改善临床症状，防止致命的再出血。

Abstract Twelve cases of primary pontine hematomas were reported. There were 3 females and 9 males, Aged from 31 to 55 years (average 39. 5 years) . The duration of symptoms varied from 2 weeks to 2 years. There were no history of systemic hypertension in all patients. Most cases had progressive clinical course . a few were ictal onset. Clinical symptoms and signs involved the cranial nerves,pyramidal tract. and cerebellum in some cases. The signs of increased ICP are rare. CT and MRI showed the mass lesion in the pons ,especially MRI was the main diagnostic apparatus . Angiography was noncontributory .The patients were all treated surgically with an attempt to remove the whole lesion and thoroughly inspect the hematomas cavity.Pathological diagnosis were: cavernous angioma 3 cases , AVM 2 cases , and the rest unclassified. All cases had no repeated hemorrhage during follow up for about 2 years. We suggest in case that the clinical course is deteriorating and there is a mass effect on MRI, a surgical operation should be performed.