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Inferior medial pontine infarction

Case contributed by Mostafa Elfeky
Diagnosis almost certain


Vertigo, spontaneous nystagmus and imbalance ? central vestibular lesion

Patient Data

Age: 65 years
Gender: Male

A tiny left pontine paramedian lesion is noted with high signal intensity on T2, low signal intensity on T1 and no diffusion restriction, suggestive of old ischemic (gliotic) lesion at the left vestibular nucleus.

Right occipital lobe and right cerebellar hemisphere old infarctions are noted.

No space-occupying lesions identified along the peripheral vestibular pathway.

Case Discussion

The patient presented with chronic vestibular syndrome. MRI study shows an old ischemic lesion along the central vestibular pathway at the inferior medial aspect of the pons, suggestive of chronic microvascular disease or embolic state. Its main blood supply comes from PICA, a branch of vertebral artery 1.

Lesions that affect the medial subnucleus is the most important causes of unilateral central canal paresis. Isolated vestibular nucleus infarction should be considered in the differential diagnosis of central vascular vertigo syndrome 2.

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