[Lateral inferior pontine syndrome: a case report]

Area of Science:

• Neurology
• Neuroimaging
• Vascular Neurology

Background:

• A 57-year-old male with hypertension and atrial fibrillation presented with recurrent vertigo.
• The patient experienced acute onset of severe vertigo, nausea, and vomiting.

Observation:

• Clinical examination revealed left-sided ptosis, abducens nerve palsy, facial hypalgesia and palsy, and hypacusis.
• Additional findings included impaired facial sweating, limited left palatal elevation, left tongue deviation, and dysarthria.
• The patient exhibited incoordination and dysmetria in the left extremities, with severe vertigo preventing standing.

Findings:

• The clinical presentation, excluding ipsilateral palatal and lingual disturbances, strongly suggested lateral inferior pontine syndrome.
• The lesion was definitively identified in the anterior inferior cerebellar artery (AICA) distribution via horizontal and coronal Magnetic Resonance Imaging (MRI).
• The atypical palatal and lingual symptoms were hypothesized to result from involvement of decussated corticobulbar tracts for cranial nerves X and XII.

Implications:

• This case highlights the diagnostic utility of MRI in identifying AICA territory infarcts presenting with complex neurological deficits.
• Understanding the anatomical variations of cranial nerve pathways is crucial for interpreting atypical presentations of cerebrovascular events.
• The findings contribute to the understanding of pontine syndromes and their neuroanatomical correlates.