Bilateral pontine infarction

Case contributed by Dr Maximiliano Darakdjian

Presentation

A previously healthy woman presented to ER with dysarthria and acute quadriparesis associated with sensory deficits.

Patient Data

Age: 35 years
Gender: Female
MRI

Brain MRI showed a heart-appearance area with restricted diffusion involving the anteromedial region of the mid-pons bilaterally. Subtle enhancement on T1 C+ of the restricted area is also noted. There is also right PICA infarction. The basilar artery appeared intact on MRI. Findings are compatible with acute/subacute infarct of the posterior circulation. 

Case Discussion

This clinical picture is compatible with bilateral pontine infarct (posterior circulation). The heart-appearance sign is attributed to the involvement of bilateral paramedian and short circumferential pontine arteries.

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