Paramedian Pontine Infarction

Kataoka, Satoshi; Hori, Ariyuki; Shirakawa, Tomoyasu; Hirose, Genjiro

doi:10.1161/01.str.28.4.809

Cited by 126 publications

(40 citation statements)

References 38 publications

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“…In pure motor pontine infarcts, the topography of the infarct lesion has been reported to be related to the prognosis; lesions causing severe hemiparesis were generally large and involved the ventral surface of the paramedian caudal or middle pons. 12,24 Moreover, within the PMD group in our study, 14 patients with lower pontine lesions (51.8%) showed deterioration of neurological symptoms within the first 2 days from symptom onset, suggesting that the PMD seen in those patients was related to a change in the infarcted area caused by the development of brain edema or an increase in infarct size. Corticospinal tracts in the midbrain are located in the middle of the cerebral peduncle as compact bundles, and, in the upper pons, they run along the corticopontine fibers in a loosely dispersed manner within abundant and heavily traversing nonpyramidal fiber.…”

Section: Oh Et Al Progressive Motor Deficits In Acute Pontine Infarctionmentioning

confidence: 53%

“…The corticospinal tracts are situated in the dorsolateral part of the pontine base at the level of the upper pons and converge into the anteromedial surface of the upper medulla to form compact bundles. 12,24 Therefore, infarcts in the lower pontine region, usually the paramedian-ventral area, may cause more damage to the corticospinal tracts due to its proximity than upper pontine region infarcts. The diffusion tensor imaging and diffusion tensor tractography of the PMD patient more easily explained the more damage of the corticospinal tract than without PMD (Figure 3).…”

Section: Oh Et Al Progressive Motor Deficits In Acute Pontine Infarctionmentioning

confidence: 99%

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Topographic Location of Acute Pontine Infarction Is Associated With the Development of Progressive Motor Deficits

Bang

Chung

et al. 2012

Stroke

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Background and Purpose-Motor weakness progression is relatively common in acute pontine infarction and frequently associated with increased functional disability. We designed this study to identify the predictors of progression of motor weakness in patients with pontine infarction during the acute phase. Methods-We identified consecutive patients with acute ischemic stroke in the pons. Patients were defined as having progressive motor deficits (PMD) if their motor National Institutes of Health Stroke Scale scores increased by Ն1 unit between the maximal and initial neurological deficits. To define the predictors of PMD in patients with a pontine infarct, clinical, laboratory, diffusion-weighted imaging lesion location, and magnetic resonance angiographic variables were investigated. Results-A total of 190 patients (male:femaleϭ112:78, 66.4Ϯ10.6) were identified, and 49 (25.8%) patients were diagnosed with progressive motor deficits. Logistic multiple regression analysis identified lesion involvement of the lower pons (odds ratio, 3.768; 95% confidence interval, 1.696 -8.371) as an independent risk factor contributing to motor progression. Although 34 patients (17.9%) had significant basilar artery stenosis, there was no relationship between PMD in pontine infarct patients and the presence of basilar artery stenosis. Additionally, female and previous hypertension were associated with PMD (odds ratio, 2.651, 95% confidence interval, 1.211-5.802; odds ratio, 3.051, 95% confidence interval, 1.087-9.673). Conclusions-Our results suggest that lower pons lesions may contribute to progressive motor deficits in patients with isolated acute pontine infarction. Infarct topography is therefore a potential prognostic factor of PMD, because the location of the infarct can affect the extent of ischemic degeneration of the corticospinal tract. (Stroke. 2012;43: 708-713.)

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Section: Oh Et Al Progressive Motor Deficits In Acute Pontine Infarctionmentioning

confidence: 53%

Section: Oh Et Al Progressive Motor Deficits In Acute Pontine Infarctionmentioning

confidence: 99%

Topographic Location of Acute Pontine Infarction Is Associated With the Development of Progressive Motor Deficits

Bang

Chung

et al. 2012

Stroke

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“…Most of the previous studies investigated the clinical signs related to the location of the pontine lesions on magnetic resonance imaging (MRI) [1,2,3,4]. In the present study, 2 groups of patients with isolated pontine infarcts were considered on the basis of lesion location, according to the extent to which the anterior surface of the pons was affected, as follows: paramedian pontine infarct (PPI) and deep lacunar pontine infarct (LPI).…”

Section: Introductionmentioning

confidence: 99%

Basilar Artery Dolichoectasia Is Associated with Paramedian Pontine Infarction

et al. 2008

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Background: Basilar artery (BA) dolichoectasia (dilatative arteriopathy) (BAD) causes arterial elongation and enlargement with subsequent hemodynamic changes leading to thrombosis, microembolization and brainstem compression. Little is known about the association between BAD and the pattern of pontine infarct in patients without BA stenosis. Methods: We studied patients with isolated pontine infarcts recruited from a stroke registry. The patients with pontine infarction were divided into 2 groups based on the location of the lesion on magnetic resonance imaging as follows: paramedian pontine infarct (PPI) and lacunar pontine infarct (LPI). We compared the vascular findings and risk factors in the patients with the 2 types of infarcts. Using modified imaging criteria, we compared the following dolichoectatic components of the BA: (1) ectasia, (2) lateral displacement and (3) height. Results: There were 96 patients (45 women, 51 men). Thirty-five patients had PPI and 61 had LPI. Ectasia of the BA was more frequent in the PPI group than in the LPI group (31.4 vs. 11.5%; p = 0.016). Ectasia of the BA was associated with an elevated odds ratio in the patients with PPI (odds ratio 5.80, 95% CI 1.66–20.21) by multivariate analysis. Conclusion: Ectasia of the BA other than elongation or angulation appears to contribute to the occurrence of PPI. These findings may be helpful in predicting certain types of stroke.

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“…(1,2). INO is most commonly associated with demyelinating or cerebrovascular diseases, then with tumors and infection, or other brain stem symptoms (3)(4)(5)(6). Isolated unilateral (as well as bilateral) INO after minor blunt head trauma has been less frequently reported (7)(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%