An Analysis of Clinical Characteristics of Rare Bilateral Cerebral Peduncular Infarction

Abstract

Objective: To investigate the anatomical characteristics, clinical manifestations, and imaging features of bilateral cerebral peduncular infarction.Methods: A retrospective analysis was performed on 11 patients diagnosed with bilateral cerebral peduncular infarction in the Affiliated Hospital of Xuzhou Medical University from December 2014 to December 2018. Their clinical and imaging features were analyzed and summarized in combination with the relevant national and international literature.Results: Among all the patients, there were eight cases with a history of hypertension, four cases with a history of diabetes mellitus, and four cases with a history of smoking. Conscious disturbance was observed in nine cases, quadriplegia in seven cases, pseudobulbar paralysis in three cases, and ataxia in one case. Brain magnetic resonance (MR) scans of bilateral cerebral peduncles showed patchy abnormal shadows with a hypointense signal on T1-weighted imaging (T1WI) and apparent diffusion coefficient (ADC) and hyperintense signal on T2-weighted imaging (T2WI), fluid-attenuated inversion recovery (FLAIR), and diffusion-weighted imaging (DWI). Computed tomography angiography (CTA) scans of head and neck showed severe stenosis or occlusion of vertebral artery, basilar artery, or posterior cerebral artery. All the patients received standardized treatment for cerebral infarction. Six patients died while five were left disabled.Conclusion: Bilateral cerebral peduncle infarction may be related to cerebral perfusion insufficiency caused by the stenosis or occlusion of vertebrobasilar artery and its branches. The main clinical manifestations are locked-in syndrome and persistent vegetative state. The specific imaging feature of “Mickey Mouse ear”-like infarction is associated with a poor prognosis.

Sequential pontine and bilateral cerebral peduncle infarction with resultant early Wallerian degeneration of the ponto‐cerebellar fibers

“…BCPI is an exceedingly rare type of stroke with characteristic bilateral symmetrical signal change involving the cerebral peduncles called “Mickey Mouse Ear” sign. The exact prevalence of BCPI is unknown due to paucity of studies 1 . Disordered consciousness, quadriplegia, and locked‐in syndrome are common presentation of BCPI.…”

“…The exact prevalence of BCPI is unknown due to paucity of studies. 1 Disordered consciousness, quadriplegia, and locked-in syndrome are common presentation of BCPI. The blood supply of the cerebral peduncle mainly comes from the PCA and superior cerebellar artery, which is located at the distal segments of the basilar artery.…”

Isolated Bilateral Cerebral Peduncular Infarction Manifesting Pseudobulbar Palsy and Quadriparesis: a Case Report

“…The midbrain vascular system is mainly supplied by the posterior circulation containing the vertebrobasilar artery, posterior cerebral arteries and superior cerebellar arteries [ 11 ]. According to the midbrain vascular system, the blood supply of the cerebral peduncle primarily comes from small branches of the posterior choroidal artery, superior cerebellar artery, and posterior communicating artery, and all branches originate from the vertebrobasilar artery [ 3 11 ]. The etiology and risk factors of BCPI are similar to those of cerebral infarction of posterior circulation [ 11 12 ].…”

“…According to the midbrain vascular system, the blood supply of the cerebral peduncle primarily comes from small branches of the posterior choroidal artery, superior cerebellar artery, and posterior communicating artery, and all branches originate from the vertebrobasilar artery [ 3 11 ]. The etiology and risk factors of BCPI are similar to those of cerebral infarction of posterior circulation [ 11 12 ]. Of the 23 patients with mesencephalon infarct, the etiological factor in 11 (48%) patients was a large artery atherothrombosis (LAA), while a cardioembolic etiology was found in 6 (26%) and only 2 (8.5%) patients were due to small vessel occlusion [ 12 ].…”

Successful basilar artery dilatation in pure bilateral cerebral peduncular infarctions using balloon angioplasty

“…The cerebral peduncle is supplied by perforating branches from the thalamoperforating artery, peduncular perforating artery, thalamogeniculate artery, and circumflex branches of the P1 or P2 segment of the PCA. In addition, it also receives blood from the PcomA and anterior choroidal artery [ 6 , 7 ]. In this case, we considered that the perforating arteries (mainly the thalamoperforating artery) coming from the left P1 supplied the bilateral cerebral peduncles.…”