Complex auditory impairment with peduncular hallucinosis due to pontine haemorrhage – a case report

Peduncular hallucinosis is a rare syndrome that develops with upper brainstem and diencephalon lesions. Patients complain of vivid hallucinations that usually occur in hypnagogic states but maintain critical appraisal. Pathological disruption of the reticular activating systems partially explains this clinical phenomenon. We report the case of a 47-year-old man presenting with peduncular hallucinosis associated with central auditory disturbance consisting of bilateral hypoacusis and left-sided paradoxical hyperacusis, secondary to a pontine haemorrhage.

Prognostic factors in pontine haemorrhage: A systematic review

Background Pontine haemorrhage comprises approximately 10% of intracerebral haemorrhages. There is a common presumption that pontine haemorrhage is inherently associated with poor outcome. Purpose The aim of the review was to identify chief predictors of prognosis in (pontine haemorrhage) through systematic review of published literature. Methods A query of PubMed/MEDLINE was conducted in search of studies in English language since, 1980 focusing specifically on outcome in pontine haemorrhage. References for each publication were reviewed for additional studies not detected by the PubMed/MEDLINE probe. Surgical outcome studies were excluded from the review. Findings The query identified 7867 titles, after removal of duplicates and irrelevant studies, 20 titles were included in the review. In a total of 1437 pontine haemorrhage patients included in the 20 studies, the overall rate for early all-cause mortality was 48.1%. Level of consciousness on admission and haemorrhage size were the most consistent predictors of mortality in patients with pontine haemorrhage. Haemorrhage localisation within the pons was also a prognostic factor, but not consistently. Age and intraventricular extension were not found to be powerful prognostic predictors. Discussion/Conclusion Based on this review, level of consciousness on admission and haemorrhage size were the most influential prognostic factors in pontine haemorrhage, whereas age, haemorrhage localisation, and intraventricular haemorrhage did not consistently predict prognosis.