Other common pontine stroke symptoms include double vision, vertigo, and dizziness. After a pontine stroke, some patients also experience difficulty swallowing, speech deficits, numbness, and even paralysis of one side of the body or both. In some instances, it is possible for a pontine stroke to lead to a rare neurological condition known as Locked-in Syndrome LiS.
Patients with LiS retain pre-stroke cognitive and vital functions but exhibit total or near-total body paralysis. So long as there is no damage to the midbrain, most LiS patients are able to control some eye movements. To correct stroke-related deficits, many stroke survivors will begin a personalized rehabilitation program, which may include medication, physical and occupational therapy to help regain motor functions. Additionally, occupational therapy will help patients regain basic skills, such as getting dressed and cooking meals, which may have been lost as a result of stroke-related impairments.
This post-stroke rehabilitation will begin just days after the stroke for medically stable patients. While these treatment programs may help many stroke survivors make a good recovery, some patients will experience long-term disabilities as a result of a stroke.
For this reason, the ideal cure is prevention. Thankfully, there are plenty of easy ways individuals can reduce their pontine stroke risk moving forward. Strokes are the leading cause of long-term disability in the United States, and nearly , U. S individuals suffer a stroke every year. Fortunately, there are many basic lifestyle adjustments people can make to reduce their stroke risk.
Englewood, Colo: National Stroke Association, Silverstein A. Primary pontile hemorrhage: a review of 50 cases. Confin Neurol. Primary pontine hemorrhage: a new CT classification. Clinical and electroencephalographic manifestations of vascular lesions of the pons.
Orgogozo JM , Bogousslavsky J. Lacunar syndromes. Handbook of Clinical Neurology; Vol Vascular Diseases, Part II. Amsterdam, the Netherlands: Elsevier Science Publishers, : — Anderson C , Stewart-Wynne T. Clinical presentations of stroke: the classic and the less obvious. Aust Fam Physician. Schneider R , Gautier JC. Leg weakness due to stroke: site of lesions, weakness patterns, and causes.
Aphasia in acute stroke. Behavioral abnormalities after right hemisphere stroke. Isolated infarcts of the pons. Primary pontine hemorrhage. Handbook of Clinical Neurology. Vascular Diseases of the Nervous System. Lateral tegmental brainstem hemorrhages.
Bogousslavsky J , Meienberg O. Eye-movement disorders in brain-stem and cerebellar stroke. Arch Neurol. Lee RG , van Donkelaar P. Mechanisms underlying functional recovery following stroke. Cortical plasticity after stroke: implications for rehabilitation. Rev Neurol. Role of adaptive plasticity in recovery of function after damage to motor cortex.
Muscle Nerve. Constraint-induced movement therapy: a new approach to treatment in physical rehabilitation. Rehabil Psychol. Constraint-induced movement therapy: a new family of techniques with broad application to physical rehabilitation—a clinical review.
J Rehabil Res Dev. Taub E , Morris DM. Constraint-induced movement therapy to enhance recovery after stroke. Curr Atheroscler Rep. Neural substrates for the effects of rehabilitative training on motor recovery after ischemic infarct.
Recovery of motor function after focal cortical injury in primates: compensatory movement patterns used during rehabilitative training.
Somatosens Mot Res. Increasing productivity and quality of care: robot-aided neuro-rehabilitation. A novel approach to stroke rehabilitation: robot-aided sensorimotor stimulation. Influence of physiotherapeutic facilitation techniques on motor evoked potentials in centrally paretic hand extensor muscles. Electroencephalogr Clin Neurophysiol. Robertson IH. Cognitive rehabilitation: attention and neglect. Trends Cogn Sci. Rehabilitation of brain damage: brain plasticity and principles of guided recovery.
Psychol Bull. Neuromuscular stimulation for upper extremity motor and functional recovery in acute hemiplegia.
A critical review of neuromuscular electrical stimulation for treatment of motor dysfunction in hemiplegia. Assistive Technology. Biofeedback therapy in poststroke rehabilitation: a meta-analysis of the randomized controlled trials.
Arch Phys Med Rehabil. Biofeedback therapy in stroke rehabilitation: a review. J R Soc Med. Johnson SH. Imagining the impossible: intact motor representations in hemiplegics.
Hummelsheim H , Eickhof C. Repetitive sensorimotor training for arm and hand in a patient with locked-in syndrome. Scand J Rehabil Med. Rubral tremor: clinical features and treatment of three cases. Clin Exp Neurol. Midbrain tremor and hypertrophic olivary degeneration after pontine hemorrhage. Mov Disord. Connections of the red nucleus. Arch Neurol Psychiatr. The rubrospinal and central tegmental tracts in man.
Validity and responsiveness of the minimum data set. J Am Geriatr Soc. Psychometric characteristics of the minimum data set II: validity. MDS data should be used for research. The functional independence measure: a new tool for rehabilitation. Advances in Clinical Rehabilitation. Oczkowski WJ , Barreca S. The functional independence measure: its use to identify rehabilitation needs in stroke survivors.
Interrater reliability of the 7-level functional independence measure FIM. Impairment-specific dimensions within the Functional Independence Measure. The Functional Independence Measure: tests of scaling assumptions, structure, and reliability across 20 diverse impairment categories. Physical Rehabilitation: Assessment and Treatment. Google Preview. Muscles: Testing and Function. Motor Control: Theory and Practical Applications. Relationship between the activity of precentral neurones during active and passive movements in conscious monkeys.
Physical conditioning and altered self-concept in rehabilitated hemiplegic patients. Phys Ther. Quality of life in assisted living homes: a multidimensional analysis. Postural strategies associated with somatosensory and vestibular loss.
Vestibular and somatosensory contributions to responses to head and body displacements in stance. Massion J. Movement, posture and equilibrium: interaction and coordination. Prog Neurobiol.
Postural control system. Curr Opin Neurobiol. Postural perturbations: new insights for treatment of balance disorders. Brodal A. Neurological Anatomy in Relation to Clinical Medicine. Saper CB. Brain stem modulation of sensation, movement, and consciousness. Principles of Neural Science. Fluoxetine modulates motor performance and cerebral activation of patients recovering from stroke.
Ann Neurol. Goldstein LB. Effects of amphetamines and small related molecules on recovery after stroke in animals and man.
Kraus MF. Neuropsychiatric sequelae of stroke and traumatic brain injury: the role of psychostimulants. Int J Psychiatry Med. Walker-Batson D. Use of pharmacotherapy in the treatment of aphasia.
Brain Lang. A double-blind, placebo-controlled study of the use of amphetamine in the treatment of aphasia. Amphetamine paired with physical therapy accelerates motor recovery after stroke: further evidence.
Feeney DM. From laboratory to clinic: noradrenergic enhancement of physical therapy for stroke or trauma patients. Brain Plasticity: Advances in Neurology. Philadelphia, Pa: Lippincott-Raven Publishers, : — Manual motor performance in a deafferented man. The mammalian red nucleus. Sign up to receive a free PDF ebook with recovery exercises for stroke, traumatic brain injury, or spinal cord injury below:. Skip to content No products in the cart.
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Support flintrehab. Facebook-f Youtube Pinterest. Get Started. Our Products. The T 1 -weighted image was specifically chosen for the analysis, as it was the sequence with the highest resolution that was also acquired in all three anatomical planes see Additional file 1. Furthermore, the analysis software used to create the mask of the brainstem works best with this sequence, as it creates the masks based on results from a large database of manually segmented T 1 -weighted images.
The reduction in infarct size was also comparable to the decrease calculated between the baseline DWI and the follow-up FLAIR and mirrored the improvement noted in clinical assessments along with the symptoms reported by the patient. This lesion reduction and the clinical improvement are likely to reflect the dynamic process of the following parameters that contribute to pontine stroke: haemodynamic, metabolic, inflammatory and cellular factors.
It is also of note that the patient has managed to resume his usual activities and returned to work within approximately six months from the original onset of symptoms. Although pontine infarction accounts for a small percentage of all ischaemic events [ 1 ], it is an important and interesting condition, especially as its aetiopathogenesis currently remains unclear [ 4 ].
The vascular centrencephalon, however, may provide a further insight into the underlying pathophysiology of infarcts that occur in the pons. This concept refers to the areas of the brain, including the brainstem, that are supplied by end arteries arising perpendicularly from major vessels of the anterior and posterior circulation without any collaterals. Due to this rigid anatomical arrangement, the end arteries are particularly vulnerable to injury narrowing and rupture of the vessel wall from various mechanical stressors such as hypertension [ 9 ].
Most patients with pontine infarcts tend to have generally good motor outcomes [ 10 ], if bilateral pontine lesions are not present [ 2 ], but the overall functional prognosis does depend on a number of factors such as age and cognitive function [ 11 ]. Depending on the location and extent of the lesion, patients can experience significant disability that places a heavy burden on sufferers, their relatives, the clinicians and healthcare resources.
Progression of motor weakness in this condition has also been associated with the topography of the infarct, with lesions in the lower pons being an independent prognostic factor [ 12 ].
Interestingly, several motor recovery mechanisms have been proposed in pontine infarction, including peri-lesional reorganisation via the aberrant pyramidal tract through the medial lemniscus in the brainstem, ipsilateral motor pathways and recovery via the spared corticospinal tract CST that is passing from the pons [ 9 ]. Finally, our findings agree with the results of a systematic review questioning the accuracy of initial MRI in reflecting final infarct size.
Specifically, there is increasing evidence that the reliability of DWI to reflect infarct core is less robust than originally thought, and that a considerable number of infarcts are reduced in size on repeat imaging [ 13 ]. The lesion reduction along with the improvement noted following the initial clinical worsening may be attributable to the development of cerebral oedema associated with the acute infarct during the early stages which then decreases over time.
This case report discusses the significant clinical improvement and lesion reduction noted over a period of approximately five weeks in a patient that presented with worsening neurological symptoms and was found to have an acute isolated bilateral ischaemic pontine infarct. Further studies of pontine stroke, correlating clinical features with MRI over time, will help clinicians give informed advice regarding prognosis.
These studies should be ideally characterised by unique multi-planar capabilities, excellent spatial resolution and advanced multimodal scanning protocols that can incorporate both structural and functional sequences.
Written informed consent was obtained from the patient for publication of this Case Report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
Silverstein A: Acute infarctions of the brain stem in the distribution of the basilar artery. Confin Neurol. Clinical-MRI correlations. J Neurol. PubMed Article Google Scholar. BMC Neurol. Saia V, Pantoni L: Progressive stroke in pontine infarction. Acta Neurol Scand. A clinical-radiological correlation study. Eur J Neurol. Nat Rev Neurol. Jang SH: Motor outcome and motor recovery mechanisms in pontine infarct: a review.
PubMed Google Scholar. Neurol Sci. An evidence-based systematic review. Am J Neuroradiol.
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