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February 1964

Spontaneous Hemorrhage in the Posterior Fossa: A Study of Primary Cerebellar and Pontine Hemorrhages With Observations on Their Pathogenesis

Author Affiliations

From the Neurological Unit, Boston City Hospital, and the Department of Neurology, Harvard Medical School.
Present address: Department of Medicine, Queen's University, Kingston, Ont, Canada.

Arch Neurol. 1964;10(2):200-217. doi:10.1001/archneur.1964.00460140086011

Hypertension is the usual cause for primary hemorrhage into the pons or cerebellum in the absence of trauma or of displacement of vessels by pressure from above. Less frequently these hemorrhages accompany a bleeding disorder or a vascular malformation. Their incidence is greater than is generally appreciated, accounting for one fifth of all spontaneous intracerebral hemorrhages.1,2 This figure may reflect only the relative volume and vascularity of these structures in comparison with the cerebral hemispheres.

Cheyne's report in 18123 is the first adequate clinical description of primary pontine hemorrhage. Hillairet in 18584 provided a lengthy account of cerebellar hemorrhage but came to the erroneous conclusion that symptoms of cerebellar disease were found on the side of the body opposite to the damaged hemisphere. The perceptive descriptions at the turn of the century by Gowers5 and Oppenheim6 delineated some of the more important clinical aspects of

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