Pontine tegmentum hematoma: a case report with the "one-and-a-half "syndrome without pyramidal tract deficit

Azevedo Jr, Dionísio

doi:10.1590/S0004-282X1995000300018

Abstracts

The author reports the case of a 54-year-old male patient with a pontine hematoma and with the one-and-a-half syndrome, cerebellar ataxia and no signs of pyramidal tract involvement. The absence of involvement of the pyramidal tract in the case reported herein is likely due to variation in the vascular anatomy of the pons. The pathophysiologic mechanisms of the one-and-a-half syndrome and of the clinical findings recorded are discussed.

pontine hemorrhage; one-and-a-half syndrome; pyramidal tract

O autor relata o caso de um paciente de sexo masculino de 54 anos com hematoma pontino que se manifestou por síndrome "one-and-a-half" e ataxia cerebelar mas sem sinais de acometimento do trato piramidal. A ausência de acometimento do trato piramidal é decorrente possivelmente de uma variação da anatomia vascular do segmento pontino do tronco cerebral. Os achados clínicos do caso e os mecanismos fisiopatológicos da síndrome "one-and-a-half" são discutidos.

hemorragia pontina; síndrome one-and-a-half; trato piramidal

Pontine tegmentum hematoma. A case report with the "one-and-a-half "syndrome without pyramidal tract deficit

Hematoma tegmentar pontino: relato de caso com a síndrome "one-and-a-half" e sem déficit piramidal

Dionísio Azevedo Jr

Neurology Department, Hospital Servidor Público Estadual, São Paulo-SP, Brazil

SUMMARY

The author reports the case of a 54-year-old male patient with a pontine hematoma and with the one-and-a-half syndrome, cerebellar ataxia and no signs of pyramidal tract involvement. The absence of involvement of the pyramidal tract in the case reported herein is likely due to variation in the vascular anatomy of the pons. The pathophysiologic mechanisms of the one-and-a-half syndrome and of the clinical findings recorded are discussed.

Key words:pontine hemorrhage, one-and-a-half syndrome, pyramidal tract.

RESUMO

O autor relata o caso de um paciente de sexo masculino de 54 anos com hematoma pontino que se manifestou por síndrome "one-and-a-half" e ataxia cerebelar mas sem sinais de acometimento do trato piramidal. A ausência de acometimento do trato piramidal é decorrente possivelmente de uma variação da anatomia vascular do segmento pontino do tronco cerebral. Os achados clínicos do caso e os mecanismos fisiopatológicos da síndrome "one-and-a-half" são discutidos.

Palavras-chave: hemorragia pontina, síndrome one-and-a-half, trato piramidal.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Aceite: 1-março-1995.

Dr. Dionísio Azevedo Jr - Av. 11 de Junho 911/811 - 04041-053 São Paulo SP - Brasil.

1. Adams RD, Victor M. Principles of neurology. Ed 4. New York: McGraw-Hill, 1989.
2. Aleksic S, Budzilovich G. Lateral inferior pontine syndrome: clinico-pathologic study and review of literature. J Neurol Sci 1973, 18:317-322.
3. André C, Castro ALZ, Vincent MB, Mattos JB, Maranhão PA Filho, Novis SAP. Síndrome one-and-a-half: considerações anatomoclínicas a propósito de um caso. Arq Neuropsiquiatr 1989, 47: 385-370.
4. Caplan LR, Goodwin JA. Lateral tegmental brain stem hemorrhages. Neurology 1982, 32:252-260.
5. Carpenter MB. Neuroanatomia humana. Ed 7. São Paulo: Interamericana, 1978.
6. Fontanari JL, Vaitses VDC, Nova-Cruz CER, Tichauer TAT, Lisboa L, Souza ES. Paralisia do olhar conjugado lateral associada a oftalmoplegia internuclear unilateral em hemorragia mesencéfalo-pontina alta. Arq Neuropsiquiatr 1986, 44:383-389
7. Gillilan LA. Anatomy and embryology of the arterial system of the brain stem and cerebellum. In Vinken PJ, Bruyn GW (eds). Handbook of Clinical Neurology, Vol 11 (Vascular diseases of the nervous system). Amsterdam: North-Holland, 1972, p 29-33.
8. Haller KA, Miller-Meeks M.Kardon R. Early magnetic resonance imaging in acute traumatic internuclear ophthalmoplegia. Ophthalmology 1990, 97:1162-1165.
9. Halsey JH, Ceballos R, Crosby EC. The supranuclear control of voluntary lateral gaze. Neurology 1967, 17:928-933.
10. Hirata MTA. Sistema motor ocular. Estudo de pós-graduação. FMUSP. São Paulo, 1987.
11. Kase CS, Maulsby GO, Mohr JP. Partial pontine hematomas. Neurology 1980, 30:652-655.
12. Mangiardi JR, Epstein FJ. Brain stem hematomas: review of the literature and presentation of five new cases. J Neurol Neurosurg Psychiatry 1988, 51:966-976.
13. Masiyana S, Niizuma H, Suzuki J. Pontine hemorrhage: a clinical analysis of 26 cases. J Neurol Neurosurg Psychiatry 1985, 48: 658-662.
14. Newton HB, Miner ME. "One-and-a-half" syndrome after a resection of a midline cerebellar astrocytoma: a case report and discussion of the literature. . Neurosurgery 1991, 29:768-772.
15. O'Lapire SA, Crockard A, Thomas DGT, Gordon DS. Brain-stem hematoma: a report of six surgically treated cases. J Neurosurg 1982, 56:222-227.
16. Pak H, Patel SC, Malik GM, Ausman JI. Successful evacuation of a pontine hematoma secondary to rupture of a venous angiona. Surg Neurol 1981, 15:164-167.
17. Pierrot-Deseilligny CH, Chain F, Serdaru M, Gray F, Lhermitte F. The "one-and-a-half syndrome: electro-oculographic analysis of five cases with deductions about the physiological mechanisms of lateral gaze. Brain 1981, 104:665-699.
18. Vincent MB, Rosso ALZ, Andre C, Cruz MW, Sohler MP, Novis SAP. Síndrome one-and-a-half: a propósito de um caso. Rev Bras Neurol 1990, 16: 121-125.
19. Wall M, Wray SH. The "one-and-a-half syndrome: an unilateral disorder of the pontine tegumentum. A study of 20 cases and review of the literature. Neurology 1983, 33:971-980.

Publication Dates

Publication in this collection
09 Dec 2010
Date of issue
Sept 1995

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Adams RD, Victor M. Principles of neurology. Ed 4. New York: McGraw-Hill, 1989.

[2] 2. Aleksic S, Budzilovich G. Lateral inferior pontine syndrome: clinico-pathologic study and review of literature. J Neurol Sci 1973, 18:317-322.

[3] 3. André C, Castro ALZ, Vincent MB, Mattos JB, Maranhão PA Filho, Novis SAP. Síndrome one-and-a-half: considerações anatomoclínicas a propósito de um caso. Arq Neuropsiquiatr 1989, 47: 385-370.

[4] 4. Caplan LR, Goodwin JA. Lateral tegmental brain stem hemorrhages. Neurology 1982, 32:252-260.

[5] 5. Carpenter MB. Neuroanatomia humana. Ed 7. São Paulo: Interamericana, 1978.

[6] 6. Fontanari JL, Vaitses VDC, Nova-Cruz CER, Tichauer TAT, Lisboa L, Souza ES. Paralisia do olhar conjugado lateral associada a oftalmoplegia internuclear unilateral em hemorragia mesencéfalo-pontina alta. Arq Neuropsiquiatr 1986, 44:383-389

[7] 7. Gillilan LA. Anatomy and embryology of the arterial system of the brain stem and cerebellum. In Vinken PJ, Bruyn GW (eds). Handbook of Clinical Neurology, Vol 11 (Vascular diseases of the nervous system). Amsterdam: North-Holland, 1972, p 29-33.

[8] 8. Haller KA, Miller-Meeks M.Kardon R. Early magnetic resonance imaging in acute traumatic internuclear ophthalmoplegia. Ophthalmology 1990, 97:1162-1165.

[9] 9. Halsey JH, Ceballos R, Crosby EC. The supranuclear control of voluntary lateral gaze. Neurology 1967, 17:928-933.

[10] 10. Hirata MTA. Sistema motor ocular. Estudo de pós-graduação. FMUSP. São Paulo, 1987.

[11] 11. Kase CS, Maulsby GO, Mohr JP. Partial pontine hematomas. Neurology 1980, 30:652-655.

[12] 12. Mangiardi JR, Epstein FJ. Brain stem hematomas: review of the literature and presentation of five new cases. J Neurol Neurosurg Psychiatry 1988, 51:966-976.

[13] 13. Masiyana S, Niizuma H, Suzuki J. Pontine hemorrhage: a clinical analysis of 26 cases. J Neurol Neurosurg Psychiatry 1985, 48: 658-662.

[14] 14. Newton HB, Miner ME. "One-and-a-half" syndrome after a resection of a midline cerebellar astrocytoma: a case report and discussion of the literature. . Neurosurgery 1991, 29:768-772.

[15] 15. O'Lapire SA, Crockard A, Thomas DGT, Gordon DS. Brain-stem hematoma: a report of six surgically treated cases. J Neurosurg 1982, 56:222-227.

[16] 16. Pak H, Patel SC, Malik GM, Ausman JI. Successful evacuation of a pontine hematoma secondary to rupture of a venous angiona. Surg Neurol 1981, 15:164-167.

[17] 17. Pierrot-Deseilligny CH, Chain F, Serdaru M, Gray F, Lhermitte F. The "one-and-a-half syndrome: electro-oculographic analysis of five cases with deductions about the physiological mechanisms of lateral gaze. Brain 1981, 104:665-699.

[18] 18. Vincent MB, Rosso ALZ, Andre C, Cruz MW, Sohler MP, Novis SAP. Síndrome one-and-a-half: a propósito de um caso. Rev Bras Neurol 1990, 16: 121-125.

[19] 19. Wall M, Wray SH. The "one-and-a-half syndrome: an unilateral disorder of the pontine tegumentum. A study of 20 cases and review of the literature. Neurology 1983, 33:971-980.