Rostral lateral pontine infarction

Abstract

The authors correlated neurologic features of rostral lateral pontine infarct (rLPI) with lesion location on MRI. rLPI is a motor-sensory stroke presenting as crural monoparesis or crural dominant hemiparesis and segmental superficial or deep sensory disturbances. The dorsolateral pontine base causes crural paresis without supranuclear facial palsy.

Somatotopic organization of the corticospinal tract in the human brainstem: A MRI–based mapping analysis

“…The statistical analysis of lesion location in these patients with motor hemiparesis as compared with the 111 patients in our study without paresis proved an area in the upper ventral to medial pons to be significantly associated with motor hemiparesis. This corresponds to earlier imaging studies on brainstem lesions causing corticospinal tract dysfunction 4, 8, 11. The corticospinal tract as depicted in the stereotactic atlas of Schaltenbrand and Wahren21 was affected by the lesion of every patient with motor hemiparesis (Fig 3).…”

“…Anatomical‐functional correlation studies are particularly difficult in the brainstem because of the close proximity of nuclei and fiber tracts. Lesion studies in experimental animals and a few human cases indicate a clear somatotopic order of the pyramidal tract in the internal capsule and at least in the upper brainstem, with fibers directed to the arm running more anteromedially and fibers directed to the leg more dorsolaterally 4, 9–11. Fibers of the arm and leg appear to overlap progressively within the lower brainstem 9, 10, 12.…”

Progressing small vessel pontine infarction includes different etiologies

“…Regarding the feature of pontine infarction, it can be pointed out that the neurological symptoms are various depending on the distribution of the lesion 16. Actually, the neurological deficits were reported to be different between patients whose lesion was localized in the ventral part of pons and patients whose lesion was extended from ventral to dorsal part of pons 8. Recent reports mentioned that the ischemic lesion located in the lower pons showed a tendency of progressing stroke compared with the lesion located in the upper and middle pons 17,18.…”

“…the neurological deficits were reported to be different between patients whose lesion was localized in the ventral part of pons and patients whose lesion was extended from ventral to dorsal part of pons. 8 Recent reports mentioned that the ischemic lesion located in the lower pons showed a tendency of progressing stroke compared with the lesion located in the upper and middle pons. 17,18 Meanwhile, our data showed that there was no relation between worsening of symptoms and localization of ischemic lesion both in horizontally and vertically.…”

“…The ischemic lesions in DWI on admission were drawn with shadowgraph as presented in Figure 1A. According to previous papers 8 and an anatomical text book, pontine lesions were classified into V type (localized on the ventral part of pons) and VD type (extended to the dorsal part of pons). Moreover, the ischemic lesion was vertically classified into upper, middle, and lower pons.…”