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Basilar branch disease presenting with progressive pure motor stroke
M Kaps1, W Klostermann, K Wessel
1Department of Neurology, University of Lübeck, FRG.
Acta Neurologica Scandinavica
|December 24, 1997
Summary
Isolated pontine infarcts (VPI) can cause progressive pure motor hemiparesis. While recovery is common, stroke recurrence is possible, highlighting a distinct pathomechanism from typical lacunar syndromes.
Area of Science:
- Neurology
- Neuroimaging
- Vascular Neurology
Background:
- Isolated infarcts of the pons present with distinct neurological syndromes.
- Understanding the pathomechanism, clinical course, and prognosis of pontine infarcts is crucial.
Purpose of the Study:
- To describe 8 cases of pure motor hemiparesis due to ventromedial pontine infarctions (VPI).
- To differentiate VPI from classical lacunar syndromes based on clinical presentation, imaging, and etiology.
Main Methods:
- Case series reporting on 8 patients with VPI.
- Clinical assessment including neurological examination and follow-up.
- Magnetic Resonance Imaging (MRI) for infarct localization.
- Angiography and color Duplex examination for vascular assessment.
Main Results:
- All 8 patients presented with severely progressive pure motor hemiparesis unresponsive to aspirin.
- MRI revealed unilateral (n=6) or bilateral (n=2) ventromedial pontine infarctions.
- Two patients experienced stroke recurrence within 3 months, leading to severe neurological deficits.
- Angiography/Duplex showed atherosclerotic lesions but no basilar artery occlusion.
Conclusions:
- Ventromedial pontine infarctions (VPI) may mimic lacunar syndromes but involve a unique pathogenetic mechanism, likely propagating thrombosis.
- VPI lesions typically extend to the basal pons, differing from lacunar infarcts on MRI.
- Despite initial recovery, VPI carries a risk of stroke recurrence and significant long-term disability.