Pontine haemorrhage is most often associated with hypertension and arteriovenous malformations.
- large central pontine lesions are often fatal. They may dissect into the tegmentum and the fourth ventricle, and rostrally, into the midbrain. Quadriplegia, coma, small reactive pupils and bilateral paralysis of horizontal conjugate gaze are typical sequelae. Spontaneous downward eye movements - ocular bobbing - imply preservation of rostral brainstem gaze centres.
- smaller unilateral basal pontine lesions show contralateral hemiparesis, often with ataxia in the limbs affected.
- lateral tegmental pontine lesions produce contralateral hemisensory loss, ipsilateral conjugate gaze palsy, and occassionally, an ipsilateral internuclear ophthalmoplegia. Ataxia may be bilateral or unilateral, either ipsilateral or contralateral.
- due to destruction of thermoregulatory fibres from the hypothalamus with widespread pontine destruction, the patient may become hyperpyrexic.
- there may be apneustic breathing