Arquivos de Neuro-Psiquiatria
Print version ISSN 0004-282X
OLIVEIRA-SOUZA, Ricardo de; BEZERRA, Márcio Luciano de Souza; FIGUEIREDO, Wagner Martignoni de and ANDREIUOLO, Pedro Ângelo. Spontaneous tegmento-mesencephalic hematoma: neurobehavioral insights concerning the rostral human brainstem. Arq. Neuro-Psiquiatr. [online]. 1995, vol.53, n.4, pp. 807-814. ISSN 0004-282X. http://dx.doi.org/10.1590/S0004-282X1995000500018.
The tegmentum of the midbrain is a complex area traversed by a number of anatomical and functional systems, including local circuits, ascending activating systems and descending fibers from the cerebral hemispheres. In the present paper we report on the case of a 67-year-old man who suffered a spontaneous central tegmental hemorrhage and was initially supposed to be in coma due to bilateral ptosis and lack of speech and initiative. By the second hospital week, however, he was shown to be able to respond to verbal commands, sit, stand and walk. He died in sepsis one month later. This case shows that the clinical diagnosis of coma may be misleading in certain patients in whom wakefulness is preserved, though concealed from a casual bedside examination due to abulia and ophthalmoplegia.
Keywords : coma; ascending activating system; extrapyramidal system; midbrain.