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A rare case of pontomedullary infarction presenting with peripheral-type facial palsy

Seong-Ki Ahn1, Dong Gu Hur, Sea-Yuong Jeon

  • 1Department of Otolaryngology, School of Medicine, Gyeongsang National University, Jinju, South Korea. imaitakao@hotmail.com

Auris, Nasus, Larynx
|June 18, 2010
PubMed

Insights

Peripheral facial palsy (FP) can stem from brainstem lesions. A rare case of pontomedullary infarction causing ipsilateral FP highlights the need to consider central causes for facial nerve dysfunction.

Area of Science:

  • Neurology
  • Neuroimaging
  • Neuroanatomy

Background:

  • Peripheral facial palsy (FP) is typically associated with lesions in the pons.
  • Medullary lesions causing peripheral-type FP are infrequently documented in medical literature.
  • Understanding the precise localization of brainstem lesions is crucial for diagnosing the etiology of facial nerve dysfunction.

Observation:

  • An 83-year-old male patient presented with acute onset of ipsilateral peripheral-type facial palsy.
  • Clinical presentation was linked to a pontomedullary infarction, affecting both the pons and medulla oblongata.
  • Brain diffusion MRI confirmed a hyperintense signal in the left dorsolateral pons and upper medulla.

Findings:

  • The pontomedullary infarction localized to the dorsolateral upper medulla and pontomedullary junction.
  • This specific lesion correlated with the observed ipsilateral peripheral-type facial palsy.
  • The case demonstrates an unusual but definitive link between a medullary lesion and peripheral facial nerve dysfunction.

Implications:

  • Clinicians must consider central nervous system lesions, particularly brainstem infarction, in the differential diagnosis of peripheral-type facial palsy.
  • Advanced neuroimaging techniques like diffusion MRI are vital for identifying subtle brainstem lesions.
  • This finding expands the known anatomical correlates of facial nerve palsy, emphasizing the complexity of the brainstem's role in cranial nerve function.

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