Concerning survival time in primary hematomas of the brain-stem (author's transl)]

The autopsy on a 54-year old man, who had a motorcycle-accident 17 days before and suffered a head injury, showed a large traumatic hemorrhage in the oral pontine region. The lesion must be considered primarily traumatic because of the brain-stem symptoms which appeared immediately after the accident (immediate unconsciousness, extension spasms, miosis) the macroscopic and histological findings (proliferation around the hemorrhage, hematoidin in the centre of the hemorrhage) and the biomechanical circumstances (impact on the occiput). Furthermore, considering the clinical findings and the autopsy results, pathogenetic factors which might have produced secondary hemorrhage seem to be unlikely. It seems as if the timing of death after traumatic hemorrhage in the oral pontine region depends less on the direct lesion in these areas, but on the extension of the hemorrhage to the caudal brainstem with concomittant edema. For the differentiation between primary and secondary brainstem lesions the duration of the survival time is therefore only of relative significance.