PubMed1978
The material comprised 40 autopsied cases in which vasogenic lesions in the brain stem were the only area of central nervous system damage or preceded the involvement of the cerebral hemispheres. Only 3 of them had been diagnosed correctly during the life of the patients. The material was divided into three groups: I. 22 cases with very dramatic onset suggesting in neurological appearance injury to the hemispheres, leading in most cases (15 out of 22) to death within 1 week. II. 18 cases in which the survival was from 2 months to 6 years. The vasogenic damage to the brain stem preceded considerably the development of brain softening or supratentorial haemorrhage 12 cases, in 7 cases the brain stem lesion was clinically silent in neurological examination. Fresh infarctions (group I) in the brain stem were located usually in the region of vascularization of the short circumferential and paramedian arteries, mainly in the basal part of the pons and midbrain. In group II single or multiple cavities were situated unilaterally or bilaterally mainly in the pons, at the watershed of the vascularization areas of paramedial and short or long circumflex arteries. The foci in the brain stem were associated in most cases (32 out of 40) with vascular lesions in the remaining areas of the same vascularization region. In the discussion on the pathogenesis the significance of degenerative changes in the walls of the vessels in this region and presence of thrombi in them for the development of necrotic changes has been stressed.