MRI Pontine Hyperintensity After Supratentorial Ischemic Stroke Relates to Poor Clinical Outcome

Abstract

Background and Purpose-MRI studies in patients with atherosclerosis often reveal ill-defined hyperintensity in the pons on T2-weighted images. This pontine hyperintensity (PHI) does not fulfill the criteria of a brain infarct, and its clinical relevance is not established. We examined the frequency, as well as the radiological and clinical correlates, of PHI in poststroke patients. Methods-Three hundred nineteen patients were studied 3 months after supratentorial ischemic stroke with the use of 1.0-T MRI. Brain infarcts, atrophy, white matter hyperintensities, and PHI were registered. The clinical outcome was assessed 3 and 15 months after the stroke. Results-Of the patients, 152 (47.6%) had PHI. The risk factors for stroke did not differ in patients without or with PHI.PHI was related to a higher frequency (Pϭ0.002) and larger volume (PϽ0.001) of supratentorial brain infarcts, to parietal (Pϭ0.020) and temporal (Pϭ0.002) atrophy, to central atrophy (PՅ0.040), and to white matter hyperintensity grade (PϽ0.001). Brain infarcts that affected the corpus striatum (putamen, caudate, and pallidum) (PՅ0.011) or pyramidal tract (PϽ0.001) were more frequent in patients with PHI. The 3-and 15-month outcomes were worse in patients with PHI (PՅ0.004). The total volume of brain infarcts (OR 1.22), mean atrophy (OR 3.59), and PHI (OR 3.76) were independent correlates of a poor 15-month outcome. Conclusions-PHI after supratentorial ischemic stroke deserves attention because it relates to poor clinical outcome.(Stroke. 2000;31:695-700.)

Brain Stem and Cerebellar Hyperintense Lesions in Migraine

“…12 We are not aware of reports on PHLs in migraine. Most reports on PHLs describe an association with an increased cardiovascular burden, 4,5,7 leukoaraiosis, lacunar infarcts, 5 and poor clinical outcome. 7 A histopathological study reported a good correlation between PHLs and MRI changes.…”

“…Most reports on PHLs describe an association with an increased cardiovascular burden, 4,5,7 leukoaraiosis, lacunar infarcts, 5 and poor clinical outcome. 7 A histopathological study reported a good correlation between PHLs and MRI changes. 4 Symmetrical PHLs (histologically corresponding to myelin pallor and reactive astrocytosis) have a comparable pathophysiology as lesions in subcortical arteriosclerotic encephalopathy, ie, ischemia secondary to small-artery sclerosis.…”

Acute vestibular syndrome in a patient with cerebral autosomal dominant leukoencephalopathy with subcortical infarcts and leukoencephalopathy (CADASIL)

“…In this respect, besides micro-lacunar infarcts, the central pons is particularly susceptible to chronic hypoperfusion related to small vessel disease, as confluent areas of myelin rarefaction are also reported in this region in patients with supratentorial ischemic stroke and leukoaraiosis [4].…”

A Prospective Analysis of Risk Factors for White Matter Disease in the Brain Stem

“…The histopathological findings of WMD in the brain stem were similar to those of WMD in the periventricular and subcortical of the brain [8]. Although WMD in the brain stem was associated with WMD in the periventricular and subcortical areas of the brain [9], WMD in the brain stem was an independent predictor of poor clinical outcome after supratentorial ischemic stroke [10]. WMD in the brain stem was also related to equilibrium problems [11,12].…”