Alternating Progression of Pontine Infarction: A Case Report

Takehisa Hirayama, Ken Ikeda, Kiyokazu Kawabe, Yasuo Iwasaki


We report a patient with rapid progression of crossed pontine infarction. A 59-year-old man noticed occipital headache and dizziness suddenly. Neurological examination showed medial longitudinal fasciculus syndrome on the left side. Brain magnetic resonance imaging (MRI) revealed acute isolated lesion in the left lower midbrain tegmentum. Four hours later, he developed coma, ataxic respiration and quadriparesis with left peripheral facial nerve palsy. MRI disclosed extensive midbrain lesion and alternating lesions in the left upper and the right middle pons. T1-hyperintense lesions existed at the periphery of the basilar artery (BA). Brain magnetic resonance angiography disclosed tapered occlusion at the mid-pontine level of the BA. Arterial walls were irregular in the left vertebral artery and BA. Alternating branch atheromatous occlusion due to BA dissection could contribute to the pathogenesis of crossed pontine infarction.

J Neurol Res. 2013;3(1):42-45


Crossed pontine infarction; Basilar artery dissection; Branch atheromatous occlusion; Paramedian penetrating artery

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