Presentation
Unheralded syncope while eating hot chili.
Patient Data
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A large hematoma is present in the pons, measuring 23 mm in diameter. The pons and medulla are edematous and enlarged. The cerebellar hemispheres are preserved. No surface collection evident, and no intraventricular or subarachnoid hemorrhage evident. No supratenorial abnormality. The vertebral arteries are patent with no evidence of dissection nor aneurysm and no abnormal vascular channels evident. The internal carotid and cerebral arteries likewise are normal in appearance.
Case Discussion
In intensive care the patient was unresponsive with no observable cranial nerve function. Corneal and gag reflexes were also absent on examination. Due to the preservation of his cerebellar hemispheres he was presumed to have locked in syndrome. The cause of the hemorrhage was likely due to the patient's uncontrolled hypertension for which he was non-compliant with his medication.