자발성 뇌교출혈 환자의 예후에 관한 임상 분석

조재영,석종식,민병국,권정택,최덕영,황성남,김영백,박승원 중앙대학교 의과대학 의과학연구소 2002 中央醫大誌 Vol.27 No.1

Patients with spontaneous pontine hemorrhage very often develop setvere disturbances of consciousness,pupilary abnormalities, respiratory and motor. They have high mortality rate. Therefore, I analyzed the correlation between the Glasgow outcome scale(GOS)and clincial manifestations or computed tomographic(CT)findings in 48 patients with spontaneous pontine hemorrhage to clarify factors predicting the prognosis. I examined 48 Patients with spontaneous pontine hemorrhage; 33 males and 15 females, age 54.6±8.99(mean±S.D.;range 39 to 68)brought to our hospital between January 1995 and December 1999, retrospectively. Correlations between the clinical manifestations, CT findings and the GOS was assessed with multivariate regression analysis. The results were as follow: 1) Patients with the pontine hemorrhage were of 8.8% in those with intracerebral hemorrhage. The ratio of male and female was 33 to 15. The incidence of age is eqial to 40,50 and 60. Total mortality was 41.6%. 2) The poor prognostic factor were that; Glasgow coma scale(GCS)3∼8, irregular respiration. pupilary abnormality, quadriplegia, Brain CT typeⅠ(massive), hydrocephalus, extrapontine extension, Intraventricular hemorrhage(IVH). These clinical analysis should be useful in determining the level of care and future resuscitative efforts.

The Predictors of Survival and Functional Outcome in Patients with Pontine Hemorrhage

Jung, Dae-Sung,Jeon, Byung-Chan,Park, Yong-Sook,Oh, Hyung-Suk,Chun, Tae-Sang,Kim, Nam-Kyu The Korean Neurosurgical Society 2007 Journal of Korean neurosurgical society Vol.41 No.2

Objective : Pontine hemorrhages usually result in a much higher morbidity and mortality than any other intracranial vascular lesion. The purpose of this study was to evaluate survival and the contributing factors for patients with pontine hemorrhage. Methods : Of the 41 patients who were admitted to our hospital with their first acute pontine hemorrhage from 1997 to 2005, 35 patients were included in this study. Medical records were reviewed to confirm the accuracy of diagnosis and collect demographic, clinical and radiological data. The patients were divided into two groups, survivors and deceased patients; then the survivors were divided again into a group of patient with good results and those with poor results. The location of the hematoma, maximum anteroposterior [AP] diameter, maximum transverse diameter, hematoma volume, ventricular extension, extension into the midbrain, hydrocephalus and initial Glasgow coma scale [GCS] were evaluated. Results : The two year survival rate was 58.5%. The survival of patients with pontine hemorrhage was affected by initial GCS score and transverse hematoma dimeter. Functional outcome of patients who survived was affected by initial GCS, maximum transverse diameter, maximum AP diameter and hematoma volume. Conclusion : The rate of survival after pontine hemorrhage is associated with the transverse diameter of the hematoma and more importantly the initial GCS. Long-term outcome of survivors is influenced by the initial GCS, transverse diameter, AP diameter and volume. Through the multivariate analysis, initial GCS is the only significant factor on survival. Strictly speaking, initial GCS is not modifiable. However, surgical reduction may be considered to amend theses decisive factors. Additional study for indication, timing and method of surgical management is needed.

자발성 후두와 출혈의 예후인자

최상준,고삼규,김오룡,지용철,조수호 대한신경외과학회 1992 Journal of Korean neurosurgical society Vol.21 No.12

We analyzed 66 posterior fossa hemorrhage for evaluation of contributing factors to the patient prognosis. Among them 41 patients were cerebellar hemorrhage and 25 were pontine hemorrhages. We analyzed the effect of 7 contributing variables to the patient prognosis with multiple logistic regression methods for eliminating the compound effect of mutiple factors. In cerebellar hemorrhages, we found that the significant contributing factors toward positive prognosis were a good initial mentality, the location of the hemorrhages in the hemisphere, an absence of intraventricular hemorrhages, an absence of midline shifting and an absence of quadrigeminal cistern obliteration. In the treatment methods, the prognosis of stereotaxically treated cases were better than other methods. In pontine hemorrhages, a small sized hemorrhage or an absence of intraventricular hemorrhage were significant factors in determining a posivitive prognosis although the number of theses cases was small.

자발성 뇌교, 소뇌 출혈의 예후 인자

구일권,조수호,김성호,배장호,김오룡,최병연 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.12

1983년 5월부터 1994년 12월까지 본 교실에 내원하여 전산화단층촬영상 자발성 소뇌 혹은 뇌교 출혈로 진단되어 입원가료한 소뇌출현 62례와 뇌교출혈 38례 대상으로 임상경과와 방사선학적 소견, 치료의 방법과 예후를 조사분석 하였다. 소뇌출혈과 관계된 예후인자를 보면, 내원 당시 의식장애가 없을수록, 혈종량이 적을수록, 소뇌반구 혈종일수록, 사구체조 폐쇄와 수두증이 없을수록 좋은 예후를 나타내었다. 혈종량이 적고 사구체조의 폐쇄와 수두증이 동반되지 않을 경우 재출혈등의 합병증이 없다면 보존적 요법만으로 좋은 결과를 볼 수 있었다. 즉, 예후를 추정하고 수술의 적응을 잡는 도구로서 혈종량만을 고려하는 것은 의미가 없으며, 뇌간 압박 소견인 사구체조 폐쇄와 수두증의 합병증 유무가 더 중요하였다. 뇌교 출혈과 관계된 예후인자는 내원 당시의 의식상태가 좋을수록, 혈종량이 적을수록, 사구체조 폐쇄 없을수록 좋은 예후를 나타내었고, 혈종의 위치는 기저·피개 혼합부를 모두 침범한 경우가 가장 나쁜 예후를 나타내었다. The author studied 62 consecutive patients with spontaneous cerebellar hemorrhage and 38 patients with spontaneous pontine hemorrhage diagnosed by computerized tomography scanning from May 1983 to December 1994 and assessed the relationship of outcome to initial GCS score, CT findings, and treatment modality. In cerebellar hemorrhage, good outcome was achieved in patients with high initial GCS score(>13), small hematoma, patent quadrigsminal cistern, absent hydrocephalic change, and the location of the hemorrage in the hemisphere. Although the size of hematoma was an important prognostic factor it had no constant bearing on the level of consciousness, degree of quadrigeminal cistern obliteration, and outcome. Absence of quadrigeminal cistern obliteration predicted a good outcome whether the hematoma was evacuated or not as long as obstructive hydrocephalus, if present. was relieved early. However, partial obliteration of the quadrigeminal cistern was a predictor of good outcome if the hematoma was evacuated within 48 hours after the onset of hemorrhage. Total obliteration of the quadrigeminal cistern inevitably predicted an unfavorable outcome. In pontine hemorrhages a good outcome was achieved in patients with high initial GCS score(<13), small size hematoma(<5cc) and patent quadrigeminal cistern. Especially, the size of the hematoma was an important prognostic factor and guideline for the determination of surgical candidates. Small hematomas(<5cc) responded more positively to conservative management than to surgery. However, early hematoma evacuation(<48hr) had improved the outcome in moderate sized hematomas(5-l0cc). Large hematomas(>10cc) inevitably showed an unfavorable outcome.

다리뇌출혈로 인해 발생한 양방향 수평주시마비 1예

김무상,박인기.Moo-Sang Kim. M.D.. In-Ki Park. M.D. 대한안과학회 2005 대한안과학회지 Vol.46 No.10

Purpose: To report a case of bilateral horizontal gaze palsy associated with pontine hemorrhage. Methods: A 51-year-old man developed a sudden decrease in consciousness. Computed tomography reveal a pontine hemorrhage and infarctions of both basal ganglia. The mentality was recovered after conservative treatment, but he complained of difficulty in moving his eyes. We performed ophthalmic and radiologic evaluations to confirm a diagnosis of bilateral horizontal gaze palsy and to reveal the condition. Results: On ophthalmic examination, his eye showed complete bilateral horizontal gaze palsy, but convergence and vertical eye movements were normal. Radiologic evaluation revealed a pontine hemorrhage, and the hemorrhagic area was consistent the bilateral paramedian pontine reticular formation (PPRF).

자발성 교뇌출혈환자의 예후인자에 대한 임상적 고찰

이영배,정주호 東國大學校醫學硏究所 2004 東國醫學 Vol.11 No.1

교뇌출혈은 뇌실질내 출혈중 빈도가 비교적 낮은 것으로 알려져 있으나 급격히 악화되는 임상적 경과를 취하며, 여러 가지 치료방법에도 불구하고 높은 사망률을 보이는 예후가 매우 불량한 질환이다. 본 연구는 자발성 교뇌출혈로 진단된 환자들에서 예후에 영향을 미치는 여러 가지 인자들을 비교, 분석함으로서 향후 환자 치료의 지표를 얻고자 시행하였다. 1999년 1월부터 2003년 12월까지 본원에 내원하여 뇌CT 촬영에서 교뇌출혈로 진단되어 입원 가료하였던 환자 38명(남자: 27명, 여자: 11명)을 대상으로 병력기록지와 뇌CT 촬영 소견을 비교 분석하였다. 내원 당시의 의식수준은 글라스고우 혼수계수를 이용하여 구분하였다. 뇌CT 소견에서 출혈의 위치, 혈종의 최대 횡직경, 혈종이 관찰되는 단면 수, 동반 병변의 유무를 조사하였으며, 혈종의 위치는 기저부, 피개부 및 기저-피개 혼합부로 구분하여 분석하였다. 교뇌출혈 환자는 동기간 동안 입원한 자발성 뇌실질내 출혈 환자 475례 중 38례로 약 8%를 차지하였다. 남녀비는 2.5 1 이었으며, 연령 분포는 60대에서 14례로 가장 많았다. 자발성 교뇌출혈 환자의 예후는 내원당시 의식 상태가 좋은 경우, 뇌CT 소견상 혈종의 최대 횡직경이 20 mm 이하인 경우, 혈종의 위치가 피개부인 경우, 혈종이 관찰된 단면수가 적은 경우, 동반 병변으로 뇌실출혈이 없었던 경우 등에서 양호하였다. 자발성 교뇌출혈 환자의 예후에 영향을 미치는 인자로서 내원당시 의식상태, 출혈의 양, 출혈의 위치, 뇌실출혈 동반 여부 둥이 관계되었다. The purpose of this study was to investigate the prognostic factors in patients who suffered from a spontaneous pontine hemorrhage. We analysed 28 spontaneous pontine hemorrhage for evaluation of contributing factors to the prognosis. The contributiong factors are initial conscious state, location, size, number of slice in CT-scanning and combination with other intracranial hemorrhage. A good prognosis was achieved in patients with clear or mild disturbance of consciousness, 20 mm or less in the transverse diameter of the hematoma, localized in the dorsal part of pons, small numbers of slices in which the hematoma was found, and without other intracranial hemorrhage. We suggest that the good prognostic factors in pontine hemorrhage were mild disturbance of consciousness, small amount of hematoma (20 mu or less in the transverse &meter and small numbers of slices of the hematoma), the location of hematoma(dorsal part of pons), and without other associated lesions.

청심연자탕 가감방으로 호전된 교뇌 출혈 이후 발생한 양측 반신부전마비, 연하곤란, 언어장애 치험 1례

양지연,정택수,전경륭,옥소윤,선종주,Yang, Jee-yun,Jeong, Taek-su,Jeon, Gyeong-ryung,Ok, So-yoon,Sun, Jong-joo 대한한방내과학회 2017 大韓韓方內科學會誌 Vol.38 No.2

Objectives: This case study evaluated the effectiveness of Chengsimyeonja-tang-gamibang (Gamicheongsim-tang and Cheongsimsunhwal-tang) in a patient with a pontine hemorrhage and quadriparesis, dysarthria, and dysphagia. Methods: A patient diagnosed with a pontine hemorrhage was treated with Chengsimyeonja-tang-gamibang (Gamicheongsim-tang and Cheongsimsunhwal-tang) acupuncture, and moxibustion. The manual muscle test (MMT), modified Barthel index (MBI), National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), Mini Mental State Examination-Korea (MMSE-K), and Articulatory Functional Ability of Achievement Scale were administered. Results: Improvements in the MMT, MBI, NIHSS, mRS, and K-MMSE were observed after the treatment. The MMT grade increased from Rt. 3/3- and Lt. 3/3- pretreatment to Rt. 4/4 and Lt. 4+/4+ post-treatment. The MBI increased from 10 to 50 post-treatment. The NIHSS decreased from 24 to 6 post-treatment, and the mRS fell from 5 to 4 post-treatment. Finally, the MMSE-K increased from 0 to 24 post-treatment. The Articulatory Functional Ability of Achievement Scale also improved. Conclusion: This study shows that Chengsimyeonja-tang-gamibang can be used to treat the symptoms of patients with a pontine hemorrhage.

교뇌출혈 치험 1례 보고

김세원 ( Sae-won Kim ),장우석 ( Woo-seok Jang ) 대구한의대학교 제한동의학술원 2016 東西醫學 Vol.41 No.2

Objectives:Brain stem is consist of variable structures. So as it is damaged, it can make somewhat significant and different symptoms such as dizziness, diplopia, nystagmus, sensory defect with other stroke symptoms. This study aimed to report 1 case of clinical application of Korean medicine on pontine hemorrhage. Methods:We applied several Korean medicine therapy and evaluated patient``s symptoms with Berg balance scale, Korean vestibular disorders activities of daily living, numeric rating scale, scale of ataxia and so on. Results:We found that all scores of evaluated scales were increased. Conclusions:According to this study, acupuncture, moxibustion, herbal medicine and physical therapy can be effective for recovering of the patient with pontine hemorrhage.

Hyperthermia Plus Tachycardia Is Predictive of Fatal Outcome in Pontine Hemorrhage-A Case Report-

엄동웅,Kyoung Dong Jeon,Jung Soo Kim 대한중환자의학회 2010 Acute and Critical Care Vol.25 No.4

Pontine hemorrhage is characterized by high mortality and morbidity. We report a case of pontine hemorrhage treated by extraventricular drainage (EVD) of cerebrospinal fluid (CSF) and control of intracranial pressure (ICP) at the neuro-intensive care unit (NICU). The patient’s ICP was well controlled, but hyperthermia with tachycardia developed 8 hours after admission, and the patient expired with sudden cardiac arrest. A literature review revealed that high fever (>39oC) developing within 24 hours after onset of hemorrhage with tachycardia (>110 beat/min) is a clinical indicator for high probability of death. Therefore, it is important that not only ICP and neurological changes but also vital signs, especially body temperature and heart rate, be monitored in pontine hemorrhage patients.

원발성 뇌교출혈에 대한 임상적 고찰

이기홍,김승헌,임영진,김태성,김국기,이봉암,임언 대한신경외과학회 1988 Journal of Korean neurosurgical society Vol.17 No.4

We have experienced 80 cases of primary pontine hemorrhage who were admitted to Kyung Hee Medical Center from October 1982 to September 1987. All cases were confirmed by brain CT scan and treated conservatively. The hematomas have classified according to their modes of extension on computerized tomography. The outcome was assessed on their basis of activity of daily living. The results were as follows : 1) Pontine hemorrhage represented 7.8% of all primary intracerebral hemorrhages. 2) Age distribution was ranged from 3rd decade to 7th decade, and 65% of them were in 4th and 5th decade. The ratio of male to female was 5 : 3. 3) 91.2% of patients had history of systemic hypertension and most of them did not received antihypertensive medication. 85% of patients showed the systolic blood pressure on admission above 160㎜Hg. 4) Outcome Ⅰ and Ⅱ according to ADL were only 7.5%. The prognosis was affected by level of consciousness, blood pressure on admission, and size and extent of hemorrhage. 5) Majority of causes of death were injury to brain itself, and the mortality rate was 33.7%.