gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

Delayed posttraumatic mesencephalic haemorrhage

Späte traumatische Blutung im Mesencephalon

Meeting Abstract

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  • corresponding author B. Hong - Klinik für Neurochirurgie, Universität Magdeburg
  • R. Firsching - Klinik für Neurochirurgie, Universität Magdeburg

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocP 052

The electronic version of this article is the complete one and can be found online at:

Published: April 11, 2007

© 2007 Hong et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Delayed posttraumatic mesencephalic haemorrhage is extremely rare. We report three cases of patients who developed a delayed haemorrhage following closed head injury.

Methods: We reviewed our databank records from the patients who suffered closed head injury and found three patients with delayed posttraumatic mesencephalic haemorrhage. The first patient was a 19-year-old male, who suffered severe head injury after a car accident. The delayed posttraumatic mesencephalic haemorrhage was seen on computerized tomography (CT) scan after three hours. The second patient was a 16-year-old female, who had a delayed mesencephalic haemorrhage 6 hours after the head injury. The third patient was a 78-year-old male, who had temporomesial herniation due to a large acute subdural haemorrhage. After craniotomy, CT scan 63 hours after the injury presented delayed mesencephalic haemorrhage. He had been on salicylate medication prior to the operation.

Results: In all patients CT revealed haemorrhage in the midbrain and the caudal mesencephalon. All haemorrhages were treated conservatively. The first patient was discharged after ten days in coma with severe disturbance of consciousness. The second patient survived after two weeks of coma, and was discharged with moderate disturbance of consciousness and moderate hemiparesis. The third patient remained in persistent vegetative state and on ventilation until death a few months later. The two young patients developed a more favourable outcome with slight to moderate neurological deficits after long-term intensive rehabilitation. No abnormal laboratory findings were found in any patient.

Conclusions: We are not aware of other reports of delayed isolated mesencephalic haemorrhage after closed head injury. Age, hypertension or a disorder of coagulation appeared not related with this phenomenon. The prognosis appears to be poor, particularly in the older patient, and at least related with a long duration of coma.