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Pontine Intracerebral Hemorrhage

A 54 year-old man with poorly controlled hypertension collapsed and was found unresponsive.  On examination, he had small, poorly reactive pupils, no horizontal eye movements, quadriparesis and bilateral Babinski responses.

Outline the Blood in the Pons          Outline the Blood in the 4th Ventricle          Note the Enlarged Temporal Horns

Axial CT scan of the head at the level of the mid-pons.  Note the large white area, which corresponds to acute hemorrhage in the center of the pons.  Also note the extension of the hemorrhage into the adjacent Fourth Ventricle. This is a classic location for hypertensive intracerebral hemorrhage.  Because of its location, the patient is in coma (ascending reticular activating system), has no horizontal eye movement (horizontal eye centers) and is quadriplegic (from involvement of the basis pontis).  Prognosis of these cases is usually grim.

Revised 05/04/06.
The Electronic Curriculum is copyrighted 1998,  Case Western Reserve University School of Medicine.