The Prognostic Impact of Clinical and CT Parameters in Patients with Pontine Hemorrhage

Abstract

Background: In patients with pontine hemorrhage (PH), an accurate prognostic assessment is critical for establishing a reasonable therapeutic approach. Methods: The initial clinical symptoms and computed tomography (CT) features were analyzed with multivariate regression analysis in 39 consecutive patients with PH. PHs were classified into three types: (1) large paramedian, (2) basal or basotegmental and (3) lateral tegmental, and the hematomas’ diameters were measured. The patients’ outcome was evaluated. Results: Twenty-seven patients (69%) died and 12 (31%) survived for more than 1 year after PH. The symptom most predictive of death was coma on admission. The large paramedian type of PH predicted a poor prognosis, whereas the lateral tegmental type was associated with a favorable outcome. The transverse hematoma diameter was also related to outcome, with the threshold value found to be 20 mm. Conclusions: We conclude that PH outcome can be estimated best by combining the CT parameters ‘large paramedian PH’ and ‘transverse diameter ≧20 mm’ with the clinical variable ‘coma on admission’. Survival is unlikely if all 3 features are present, whereas survival may be expected if only 1 or none of these features is found.