Pontine haemorrhages are uncommon and account for about 10% of all cases of intracerebral hemorrhage (ICH). Hypertension is the most common underlying cause, accounting for about 90% of all cases.
Pontine hemorrhages are associated with high morbidity and mortality. About 40% people with pontine bleeds do not survive. Low GCS at admission and hemorrhage volume greater than 4 ml are predictors of poor outcome and death.
About 30% of patients with pontine hemorrhages develop acute hydrocephalus. In our case too, 38-year old man presented with pontine bleed related to hypertension (as shown by yellow arrows in the CT scan). Bleed was causing compression of the 4th ventricle and lateral ventricles were dilated (as shown by red arrows on CT brain). Hydrocephalus should be treated with placement of external ventricular drain (EVD). If left untreated, hydrocephalus can also be associated with higher morbidity and mortality.