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Secondary Brain Stem Hemorrhages: Predisposing and Modifying Factors

Secondary Brain Stem Hemorrhages: Predisposing and Modifying Factors Abstract TRANSTENTORIAL herniation, a recognized complication of expanding supratentorial lesions, is often heralded clinically by impairment of consciousness and other changes in vital signs, culminating frequently in decerebration and death.1-4 These latter clinical events have been ascribed to secondary hemorrhagic extravasations in the midbrain and pontine tegmentum within the distribution of the mesencephalic perforating arteries (Fig 1 and 2). The purposes of this analysis of a large autopsy population are: first, to discern which of the preceding supratentorial lesions may preferentially lead to secondary brain stem hemorrhage (2° BSH), and secondly, to assess in retrospect the influence of other factors, such as age and sex, upon the frequency of this secondary lesion. Patient Material The data presented in this paper derive from 199 cases of 2° BSH which were extracted from the 7,110 consecutive, completely autopsied cases in the records of the Institute of Pathology, Kings County Hospital Center, References 1. Schwarz, G.A., and Rosner, A.A.: Displacement and Herniation of the Hippocampal Gyrus Through the Incisura Tentorii , Arch Neurol Psychiat 46:297-321 ( (Aug) ) 1941.Crossref 2. Scheinker, I.M.: Transtentorial Herniation of the Brain Stem: A Characteristic Clinicopathologic Syndrome; Pathogenesis of Hemorrhages in Brain Stem , Arch Neurol Psychiat 53:289-298 ( (April) ) 1945.Crossref 3. Cannon, B.W.: Acute Vascular Lesions of the Brain Stem , Arch Neurol Psychiat 66:687-696 ( (Dec) ) 1951.Crossref 4. McNealy, E.E., and Plum, F.: Brainstem Dysfunction With Supratentorial Mass Lesions , Arch Neurol 7:10-32 ( (July) ) 1962.Crossref 5. Attwater, H.L.: Pontine Hemorrhages , Guy Hosp Rep 65:339-389, 1911. 6. Fields, W.S., and Halpert, B.: Pontine Hemorrhages in Intracranial Hypertension , Amer J Path 29:677-687 ( (July-Aug) ) 1953. 7. Johnson, R.T., and Yates, P.O.: Clinicopathological Aspects of Pressure Changes at the Tentorium , Acta Radiol 46:242-249 ( (July-Dec) ) 1956.Crossref 8. Lindenberg, R.: Compression of Brain Arteries as Pathogenetic Factor for Tissue Necroses and Their Areas of Predilection , J Neuropath Exp Neurol 14:223-243 ( (July) ) 1955.Crossref 9. Wolman, L.: Ischaemic Lesions in the Brainstem Associated With Raised Supratentorial Pressure , Brain 76:364-377 ( (Sept) ) 1953.Crossref 10. Howell, D.A.: Longitudinal Brain Stem Compression With Buckling , Arch Neurol 4:572-579 ( (May) ) 1961.Crossref 11. Hassler, O.: Arterial Pattern of Human Brainstem , Neurology 17:368-376 ( (April) ) 1967.Crossref 12. Finney, L.A., and Walker, A.E.: Transtentorial Herniation , Springfield, Ill: Charles C Thomas Publisher, 1962. 13. Corsellis, J.A.N.: Individual Variation in the Size of the Tentorial Opening , J Neurol Neurosurg Psychiat 21:279-283 ( (Nov) ) 1958.Crossref 14. Aronson, S.M., and Okazaki, H.: A Study of Some Factors Modifying Response of Cerebral Tissue to Subdural Hematoma , J Neurosurg 20:89-93 ( (Feb) ) 1963.Crossref 15. Freytag, E.: Autopsy Findings in Head Injuries From Blunt Forces , Arch Path 75:402-413 ( (April) ) 1963. 16. Sunderland, S.: The Tentorial Notch and Complications Produced by Herniation of the Brain Through That Aperture , Brit J Surg 45:422-438 ( (March) ) 1958.Crossref 17. Greenacre, P.: Multiple Spontaneous Intracerebral Hemorrhages; a Contribution to the Pathology of Apoplexy , Bull Hopkins Hosp 28:86-88 ( (Feb) ) 1917. 18. Wilson, G., and Winkleman, N.W.: Gross Pontile Bleeding in Traumatic and Non-Traumatic Cerebral Lesions , Arch Neurol Psychiat 15:455-470 ( (April) ) 1926.Crossref 19. Crompton, M.R.: Intracerebral Haematoma Complicating Ruptured Cerebral Berry Aneurysm , J Neurol Neurosurg Psychiat 25:378-386 ( (Nov) ) 1962.Crossref 20. Dill, L.V., and Isenhour, C.E.: Etiologic Factors in Experimentally Produced Pontile Hemorrhages , Arch Neurol Psychiat 41:1146-1152 ( (June) ) 1939.Crossref 21. Cox, L.B.: Hemorrhage of Brain Stem as Significant Complication of Intracranial Tumors , Med J Aust 1:259-262 ( (Feb) ) 1939. 22. Poppen, J.L.; Kendrick, J.F., Jr.; and Hicks, S.F.: Brain Stem Hemorrhages Secondary to Supratentorial Space-Taking Lesions , J Neuropath Exp Neurol 11:267-279 ( (July) ) 1952.Crossref 23. Moore, M.T., and Stern, K.: Vascular Lesions in Brainstem and Occipital Lobe Occurring in Association With Brain Tumors , Brain 61:70-98 ( (March) ) 1938.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Secondary Brain Stem Hemorrhages: Predisposing and Modifying Factors

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References (26)

Publisher
American Medical Association
Copyright
Copyright © 1968 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1968.00480030035003
Publisher site
See Article on Publisher Site

Abstract

Abstract TRANSTENTORIAL herniation, a recognized complication of expanding supratentorial lesions, is often heralded clinically by impairment of consciousness and other changes in vital signs, culminating frequently in decerebration and death.1-4 These latter clinical events have been ascribed to secondary hemorrhagic extravasations in the midbrain and pontine tegmentum within the distribution of the mesencephalic perforating arteries (Fig 1 and 2). The purposes of this analysis of a large autopsy population are: first, to discern which of the preceding supratentorial lesions may preferentially lead to secondary brain stem hemorrhage (2° BSH), and secondly, to assess in retrospect the influence of other factors, such as age and sex, upon the frequency of this secondary lesion. Patient Material The data presented in this paper derive from 199 cases of 2° BSH which were extracted from the 7,110 consecutive, completely autopsied cases in the records of the Institute of Pathology, Kings County Hospital Center, References 1. Schwarz, G.A., and Rosner, A.A.: Displacement and Herniation of the Hippocampal Gyrus Through the Incisura Tentorii , Arch Neurol Psychiat 46:297-321 ( (Aug) ) 1941.Crossref 2. Scheinker, I.M.: Transtentorial Herniation of the Brain Stem: A Characteristic Clinicopathologic Syndrome; Pathogenesis of Hemorrhages in Brain Stem , Arch Neurol Psychiat 53:289-298 ( (April) ) 1945.Crossref 3. Cannon, B.W.: Acute Vascular Lesions of the Brain Stem , Arch Neurol Psychiat 66:687-696 ( (Dec) ) 1951.Crossref 4. McNealy, E.E., and Plum, F.: Brainstem Dysfunction With Supratentorial Mass Lesions , Arch Neurol 7:10-32 ( (July) ) 1962.Crossref 5. Attwater, H.L.: Pontine Hemorrhages , Guy Hosp Rep 65:339-389, 1911. 6. Fields, W.S., and Halpert, B.: Pontine Hemorrhages in Intracranial Hypertension , Amer J Path 29:677-687 ( (July-Aug) ) 1953. 7. Johnson, R.T., and Yates, P.O.: Clinicopathological Aspects of Pressure Changes at the Tentorium , Acta Radiol 46:242-249 ( (July-Dec) ) 1956.Crossref 8. Lindenberg, R.: Compression of Brain Arteries as Pathogenetic Factor for Tissue Necroses and Their Areas of Predilection , J Neuropath Exp Neurol 14:223-243 ( (July) ) 1955.Crossref 9. Wolman, L.: Ischaemic Lesions in the Brainstem Associated With Raised Supratentorial Pressure , Brain 76:364-377 ( (Sept) ) 1953.Crossref 10. Howell, D.A.: Longitudinal Brain Stem Compression With Buckling , Arch Neurol 4:572-579 ( (May) ) 1961.Crossref 11. Hassler, O.: Arterial Pattern of Human Brainstem , Neurology 17:368-376 ( (April) ) 1967.Crossref 12. Finney, L.A., and Walker, A.E.: Transtentorial Herniation , Springfield, Ill: Charles C Thomas Publisher, 1962. 13. Corsellis, J.A.N.: Individual Variation in the Size of the Tentorial Opening , J Neurol Neurosurg Psychiat 21:279-283 ( (Nov) ) 1958.Crossref 14. Aronson, S.M., and Okazaki, H.: A Study of Some Factors Modifying Response of Cerebral Tissue to Subdural Hematoma , J Neurosurg 20:89-93 ( (Feb) ) 1963.Crossref 15. Freytag, E.: Autopsy Findings in Head Injuries From Blunt Forces , Arch Path 75:402-413 ( (April) ) 1963. 16. Sunderland, S.: The Tentorial Notch and Complications Produced by Herniation of the Brain Through That Aperture , Brit J Surg 45:422-438 ( (March) ) 1958.Crossref 17. Greenacre, P.: Multiple Spontaneous Intracerebral Hemorrhages; a Contribution to the Pathology of Apoplexy , Bull Hopkins Hosp 28:86-88 ( (Feb) ) 1917. 18. Wilson, G., and Winkleman, N.W.: Gross Pontile Bleeding in Traumatic and Non-Traumatic Cerebral Lesions , Arch Neurol Psychiat 15:455-470 ( (April) ) 1926.Crossref 19. Crompton, M.R.: Intracerebral Haematoma Complicating Ruptured Cerebral Berry Aneurysm , J Neurol Neurosurg Psychiat 25:378-386 ( (Nov) ) 1962.Crossref 20. Dill, L.V., and Isenhour, C.E.: Etiologic Factors in Experimentally Produced Pontile Hemorrhages , Arch Neurol Psychiat 41:1146-1152 ( (June) ) 1939.Crossref 21. Cox, L.B.: Hemorrhage of Brain Stem as Significant Complication of Intracranial Tumors , Med J Aust 1:259-262 ( (Feb) ) 1939. 22. Poppen, J.L.; Kendrick, J.F., Jr.; and Hicks, S.F.: Brain Stem Hemorrhages Secondary to Supratentorial Space-Taking Lesions , J Neuropath Exp Neurol 11:267-279 ( (July) ) 1952.Crossref 23. Moore, M.T., and Stern, K.: Vascular Lesions in Brainstem and Occipital Lobe Occurring in Association With Brain Tumors , Brain 61:70-98 ( (March) ) 1938.Crossref

Journal

Archives of NeurologyAmerican Medical Association

Published: Sep 1, 1968

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