J Korean Neurotraumatol Soc.  2010 Jun;6(1):18-22. 10.13004/jknts.2010.6.1.18.

Primary Traumatic Brainstem Hematomas: Consideration for the Causal Relation

• Kim SK
• Hwang SC
• Kim BT

• KMID: 2192355
• DOI: http://doi.org/10.13004/jknts.2010.6.1.18

Abstract

OBJECTIVE
Traumatic primary brainstem hematomas are thought to be a rare phenomenon. The study is to report five cases with review of literatures and to discuss how to write the medical certificates.
METHODS
Five cases were retrospectively reviewed, who had not associated intracranial lesions except the hematoma in the brain stem. All cases were analyzed with external wounds, skull fracture, MRI findings, and outcome.
RESULTS
The hematomas occurred in 1 in pons, 2 in midbrain, 1 in thalamus, and 1 in putamen. All of the cases complained of decreased consciousness and denied any neurological symptoms before trauma. Skull fracture was involved only in 2 cases. The finding of MRI revealed signal changes on the corpus callosum compatible with diffuse axonal injury only in 2 cases. Three cases took twice of MRI, which confirmed the hematoma absorbed. The recovery was uneventful and all of them returned to their jobs.
CONCLUSION
Primary brainstem hematomas are not always accompanied with skull fracture or diffuse axonal injury in MRI. Even though it occurs extremely rare, the cause of the hematomas can be described as a trauma in the medical certificates based on the history and the radiological images.

Keyword

Traumatic hematoma; Brain stem; Primary

MeSH Terms

Brain Stem
Consciousness
Corpus Callosum
Diffuse Axonal Injury
Hematoma
Mesencephalon
Pons
Putamen
Retrospective Studies
Skull Fractures
Thalamus

Figure

• 

  FIGURE 1 Radiological images of case 4. A: Acute small intracerebral hematoma on the left putamen. B: No abnormal intracanial lesion around the scalp wound on the right temporo-occipital area. C: Linear skull fracture on the right occipital extending into the sphenoid. D: Subacute hematoma on the right putamen in T2WI on the brain MRI at post-traumatic 14 days. E: Suspicious high signal lesion in the corpus callosum in FLAIR image compatible with a diffuse axonal injury. F: The hematoma was decreased in the 2-year MRI after trauma. T2WI: T2 weighted image, FLAIR: fluid attenuated inversion recovery.

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  FIGURE 2 Radiological images of case 5. A: Acute hematoma on the cerebral peduncle of the left midbrain. B: No abnormal intracranial lesion around the scalp wound. C: No vascular anomaly around the hematoma in the CT angiography. D: Acute hematoma in T2WI on the brain MRI without any evidence of underlying diseases. E: High signal lesion in the corpus callosum in FLAIR image compatible with a diffuse axonal injury. F: The hematoma was shrunk in the 8-month MRI. T2WI: T2 weighted image, FLAIR: fluid attenuated inversion recovery.

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