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

Ahn, Seong-Ki; Hur, Dong Gu; Jeon, Sea‐Yuong; Park, Jung Je; Kang, Hung-Soo; Park, Ki-Jong

doi:10.1016/j.anl.2010.03.010

Cited by 11 publications

(13 citation statements)

References 11 publications

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“…The dorsal division receives bilateral upper motor neuron fibers while the ventral division receives input from contralateral fibers only, hence producing two distinct types of facial weakness; central or upper motor which involves the facial corticobulbar-supranuclear pathway, and peripheral, infranuclear, or lower motor neuron which involves the tegmentum of the pons [4,5]. Lesions affecting the corticobulbar tract between the cerebral cortex and the facial motor nucleus in the pontine tegmentum involve the fibers to the ventral division.…”

Section: Discussionmentioning

confidence: 99%

“…The pathophysiology behind such an uncommon condition is linked to focal microangiopathic occlusion of the perforating branches of the prepontine circumferential group [2][3][4][5]. Radiologically, these types of strokes tend to be overlooked by radiologists, as demonstrated in this short series where all 5 cases were initially reported negative for a tegmental pontine stroke [2,3,4]. …”

Section: Discussionmentioning

confidence: 99%

“…Another possible location for a brainstem stroke presenting with LMN CN VII facial palsy, different from the tegmental pons, is the one described by Ahn et al [4]. As the corticobulbar tract descend from the pons into the ventromedial upper medulla, the tract decussates and subsequently ascend to the dorsolateral portion of the medulla; here the fibers synapse with the contralateral facial nucleus, stroke-related isolated LMN CN VII facial palsy can equally occur at this location, although extremely uncommon [4].…”

Section: /4mentioning

confidence: 99%

“…Our primary goal is to describe a perforating prepontine long circumferential artery occlusion affecting the CN VII nucleus. To our knowledge, there are only a handful of cases previously accounted [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

“…Of note, these lesions appear to be radiologically misdiagnosed, despite showing as punctuate ≤5mm in size enhancing lesions on MRI diffusion weighted imaging (DWI) [2][3][4]. Additionally, it seems male gender, hypertension, and hyperlipidemia are all associated risk factors [2,4,5].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Microangiopathic Occlusion of a Perforating Prepontine Long Circumferential Artery Presenting with Lower Motor Neuron Facial Weakness: Clinical and Radiological Correlation

Miran¹

2016

JNSK

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Case Description: A 79-year old male patient with myelodysplastic syndrome associated with severe neutropenia, thrombocytopenia, anemia, hypertension, and hyperlipidemia was admitted for pneumonia secondary to influenza A. Two weeks later he presented with new symptoms of acute dysarthria, and left facial weakness involving his upper and lower face; the following day he developed left arm weakness. Admission computed tomography (CT) and MRI scans revealed an acute ischemic stroke (AIS) in the right posterior frontal cortex. The initial MRI was reported negative for pontine lesions. Anatomically, the cortical infarct could not explain his left lower motor neuron cranial nerve VII (LMN CN VII) facial weakness distribution because in a cortical lesion the upper half of the face would be expected spared due to contralateral cortical innervation. Upon review of the MRI, the initial hyperintensity seen on Fluid-Attenuated Inversion Recovery (FLAIR) was overlooked and later identified as an acute stroke in the vicinity of the perforating prepontine long circumferential artery affecting the CN VII nucleus. Conclusion:In the absence of earache, active infection, and/or inflammation, a sudden onset facial palsy, lower motor neuron distribution, must point to a pontine microangiopathic infarct until proven otherwise. Under these circumstances, maintaining a high level of suspicion is of paramount importance.

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Section: Discussionmentioning

confidence: 99%