Presentation and management of mesencephalic hematoma

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Abstract
Patients [2] presenting with a mesencephalic hematoma are reported. Clinical features, particularly paralysis of all vertical eye movements and a marked tendency to fall backwards when standing, allowed accurate localization of these lesions. In 1 case, the etiology was a proven arteriovenous malformation, and the other was suspected to be due to hypertensive arteriolar rupture. Deterioration resulted from further expansion of the mesencephalic mass in 1 patient. A subtemporal approach allowed excellent exposure of the midbrain for evacuation of the hematoma. The other patient developed hydrocephalus due to obstruction of the aqueduct and was treated successfully by placement of a ventriculoperitoneal shunt. Both patients survived, although 1 remains moderately disabled. The importance of initial close observation and supportive care in the stable patient with a mesencephalic hematoma were emphasized. Surgery is indicated for those who show evidence of deterioration from rebleeding or hydrocephalus.