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Arch Neurol. 2008 Oct;65(10):1375-7. doi: 10.1001/archneur.65.10.1375.

Pontine warning syndrome.

Author information

1
Stroke Research Unit, Division of Neurology, Department of Medicine, St Michael's Hospital, University of Toronto, 55 Queen St E, Ste 931, Toronto ONM5C1R6, Canada. saposnikg@smh.toronto.on.ca

Abstract

BACKGROUND:

Little is known about stroke mechanisms in patients with fluctuating symptoms and the role of branch atherosclerotic disease.

OBJECTIVE:

To report a novel stroke presentation associated with a paramedian pontine infarct due to branch disease with a fluctuating course.

DESIGN:

Case report.

SETTING:

Academic research. Patient A 63-year-old man with hypertension, diabetes mellitus, and dyslipidemia was seen with fluctuating right-sided weakness and dysarthria. He had had 2 episodes of complete bilateral horizontal conjugate gaze palsy with unimpaired consciousness lasting for 5 minutes each. His pupils were 4 mm and were equal and reactive to light. Vertical gaze and convergence were preserved. His neurologic status fluctuated between 3 and 15 on the National Institutes of Health Stroke Scale.

MAIN OUTCOME MEASURES:

Results of computed tomographic angiography, perfusion, and magnetic resonance imaging.

RESULTS:

Intravenous tissue plasminogen activator was administered within a 3-hour window. Fluctuations in motor weakness persisted for 12 hours after receiving thrombolytic therapy. Neuroimaging showed an acute left paramedian pontine infarct with a patent basilar artery.

CONCLUSIONS:

Branch disease is a common mechanism in pontine infarctions. We coined the term "pontine warning syndrome" to characterize recurrent stereotyped episodes of motor or sensory dysfunction, dysarthria, or ophthalmoplegia associated with a high risk of imminent basilar artery branch infarction and a permanent deficit resembling those of capsular warning syndrome.

PMID:
18852355
DOI:
10.1001/archneur.65.10.1375
[Indexed for MEDLINE]

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