BRAIN STEM HEMORRHAGE IN CRANIO-CEREBRAL TRAUMA

Abstract

Brain stem hemorrhage is quite common in cases of fatal head injuries, and was present in 49 (37%) out of a total of 132 cases examined post-mortem. The most common site of these hemorrhages is pons either alone or in association with mid-brain, thalamus and hypothalamus. We have never seen hemorrhages in the medulla oblongata and only rarely in the distal 3rd of the pons. As a rule these hemorrhages are multiple, varying in size from punctiform to the size of the head of a pin or a matchstick. These may become confluent and lead to a massive hemorrhage destroying the whole of the pons. Clinically these patients present the commonly accepted signs and symptoms of disturbance of brain stem function,[long dash]coma, pupillary abnormalities, disturbances of respiration, of thermal regulation, and of muscle tone. A similar clinical picture is also seen though less frequently, in both fatal and surviving cases without brain stem hemorrhage. The so-called classical picture of pontine hemorrhage[long dash]miotic pupils and hyperthermia[long dash]is neither common nor typical of this condition. Pathogenetically these hemorrhages may be caused by a variety of factors. Mechanical strain, compression of the arteries and veins of the brain stem due to tentorial herniation, and fat embolism were found to be pathogenetic factors in this series.