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Traumatic Brainstem Hemorrhage Presenting with Hemiparesis

  • Se, Young-Bem (Department of Neurosurgery, Hanyang University Guri Hospital) ;
  • Kim, Choong-Hyun (Department of Neurosurgery, Hanyang University Guri Hospital) ;
  • Bak, Koang-Hum (Department of Neurosurgery, Hanyang University Guri Hospital) ;
  • Kim, Jae-Min (Department of Neurosurgery, Hanyang University Guri Hospital)
  • 발행 : 2009.03.28

초록

Traumatic brainstem hemorrhage after blunt head injury is an uncommon event. The most frequent site of hemorrhage is the midline rostral brainstem. The prognosis of these patients is poor because of its critical location. We experienced a case of traumatic brainstem hemorrhage. A 41-year-old male was presented with drowsy mentality and right hemiparesis after blunt head injury. Plain skull radiographs and brain computerized tomography scans revealed a depressed skull fracture, epidural hematoma, and hemorrhagic contusion in the right parieto-occipital region. But, these findings did not explain the right hemiparesis. T2-weighted magnetic resonance (MR) image of the cervical spine demonstrated a focal hyperintense lesion in the left pontomedullary junction. Brain diffusion-weighted and FLAIR MR images showed a focal hyperintensity in the ventral pontomedullary lesion and it was more prominent in the left side. His mentality and weakness were progressively improved with conservative treatment. We should keep in mind the possibility of brainstem hemorrhage if supratentorial lesions or spinal cord lesions that caused neurological deficits in the head injured patients are unexplainable.

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참고문헌

  1. Cooper PR, Maravilla K, Kirkpatrick J, Moody SF, Sklar HF, Diehl J, et al : Traumatically induced brain stem hemorrhage and the computerized tomographic scan : clinical, pathological, and experimental observations. Neurosurgery 4 : 115-124, 1979 https://doi.org/10.1227/00006123-197902000-00002
  2. Crompton MR : Brainstem lesions due to closed head injury. Lancet 1 : 669-673, 1971
  3. Firsching R, Woischneck D, Klein S, Ludwig K, Dohring W : Brainstem lesions after head injury. Neurol Res 24 : 145-146, 2002 https://doi.org/10.1179/016164102101199684
  4. Freytag E : Autopsy findings in head injuries from blunt forces. Statistical evaluation of 1,367 cases. Arch Pathol 75 : 402-413, 1963
  5. Gentry LR, Godersky JC, Thompson B : MR imaging of head trauma : review of the distribution and radiopathologic features of traumatic lesions. AJR Am J Roentgenol 150 : 663-672, 1988
  6. Goscinski I, Kwaitkowski S, Cichonski J, Moskala M : Posttraumatic primary brainstem haematoma. Acta Neurochir (Wien) 134 : 16-20, 1995 https://doi.org/10.1007/BF01428496
  7. Hashimoto T, Nakamura N, Richard KE, Frowein RA : Primary brain stem lesions caused by closed head injuries. Neurosurg Rev 16 : 291-298, 1993 https://doi.org/10.1007/BF00383839
  8. Jacobs L, Kinkel WR, Heffner RR Jr : Autopsy correlation of computerized tomography : experience with 6,000 CT scans. Neurology 26 : 1111-1118, 1976 https://doi.org/10.1212/WNL.26.12.1111
  9. Kang BK, Na DG, Ryoo JW, Byun HS, Roh HG, Pyeun YS : Diffusion-weighted MR imaging of intracerebral hemorrhage. Korean J Radiol 2 : 183-191, 2001 https://doi.org/10.3348/kjr.2001.2.4.183
  10. Klintworgh GK : The pathogenesis of secondary brainstem hemorrhages as studied in an experimental model. Am J Pathol 47 : 525-536, 1965
  11. Lindenberg R : Significance of the tentorium in head injuries from blunt forces. Clin Neurosurg 12 : 129-142, 1966 https://doi.org/10.1093/neurosurgery/12.CN_suppl_1.129
  12. Meyer CA, Mirvis SE, Wolf AL, Thompson RK, Gutierrez MA : Acute traumatic midbrain hemorrhage : experimental and clinical observations with CT. Radiology 179 : 813-818, 1991
  13. Ropper AH, Miller DC : Acute traumatic midbrain hemorrhage. Ann Neurol 18 : 80-86, 1985 https://doi.org/10.1002/ana.410180114
  14. Sganzerla EP, Rampini PM, De Santis A, Tiberio F, Guerra P, Zavanone M, et al : Primary traumatic benign midbrain haematoma in hyperextension injuries of the head. Acta Neurochir Suppl (Wien) 55 : 29-32, 1992
  15. Tandon PN : Brainstem hemorrhage in cranio-cerebral trauma. Acta Neurol Scand 40 : 375-385, 1964 https://doi.org/10.1111/j.1600-0404.1964.tb02762.x
  16. Tsai FY, Teal JS, Quinn MF, Itabashi HH, Huprich JE, Ahmadi J, et al : CT of brainstem injury. AJR Am J Roentgenol 134 : 717-723, 1980
  17. Zuccarello M, Fiore DL, Trincia G, De Caro R, Pardatscher K, Andrioli GC : Traumatic primary brain stem haemorrhage : a clinical and experimental study. Acta Neurochir (Wien) 67 : 103-113, 1983 https://doi.org/10.1007/BF01401670

피인용 문헌

  1. Primary Traumatic Brainstem Hematomas: Consideration for the Causal Relation vol.6, pp.1, 2010, https://doi.org/10.13004/jknts.2010.6.1.18
  2. The Prognostic Factors Related to Traumatic Brain Stem Injury vol.51, pp.1, 2009, https://doi.org/10.3340/jkns.2012.51.1.24
  3. Brainstem Stroke: Anatomy, Clinical and Radiological Findings vol.34, pp.2, 2009, https://doi.org/10.1053/j.sult.2013.01.004