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Case 77

Central pontine haematoma

A man who collapsed suddenly during intercourse

This gentleman in his late forties collapsed without warning during sexual intercourse. On arrival at the hospital he was deeply unconcious with pinpoint pupils. He had a history of hypertension but was otherwise fit and well prior to this event. A CT was requested to investigate further.

Findings

There is an abnormal area of central high attenuation within the midbrain and pons (seen on lower slices) consistent with acute haemorrhage. The right temporal horn is slightly dilated consistent with early hydrocephalus secondary to obstruction of CSF flow through the aqueduct and 4th ventricle.

Diagnosis

Central pontine haematoma

Discussion

Usually related to hypertensive disease (approx 10% of intracranial bleeds secondary to hypertension). It is often devastating in its consequences.

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