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Aetiopathogenesis and long-term outcome of isolated pontine infarcts

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Abstract

Background and purpose

Isolated pontine strokes cause characteristic neurological syndromes and have a good short-term prognosis. The aim of this study was to examine the long-term survival, cumulative recurrence rate and clinical handicap of patients with isolated pontine infarcts of different aetiology.

Methods

One hundred consecutive patients with an isolated pontine infarction were identified by imaging studies and evaluated prospectively. After extensive study, cases were classified according to the aetiopathogenetic mechanisms: stroke due to basilar artery branch disease (BABD), small-artery disease (SAD) and large-artery-occlusive disease (LAOD). During a mean follow-up period of 46 months, stroke presentation and initial course, early and long-term mortality, disability and recurrence were evaluated.

Results

BABD was the most frequent cause of isolated pontine ischaemia (43 %), followed by SAD (34%) and LAOD (21%). Hypertension was the most prominent risk factor, especially among patients with SAD (94.1 %). Neurological impairment on admission was more severe in the LAOD group, followed by BABD. After 1 month patients with LAOD had the highest cumulative mortality (14.3%, p=0.026) and more severe disability (61.1%, p=0.001). Five-year mortality rate was 20.6%, 14% and 23.8% in the SAD-, BABD- and in LAOD-group respectively (p=0.776). Cumulative 5-year recurrence rate was 2.3 % for BABD, 14.3 % for LAOD, and 29.4 % for SAD (p=0.011).

Conclusions

Overall long-term survival of patients with isolated pontine infarcts is good. Initial differences regarding short-term outcome in infarctions of different aetiology resolve with time. Effective secondary prevention among SAD patients may limit stroke recurrence and positively influence long-term prognosis.

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References

  1. Basseti C, Bogousslavsky J, Barth A, Regli F (1996) Isolated infarcts of the pons. Neurology 46:165–175

    Google Scholar 

  2. Bogousslavsky J, Van Melle G, Regli F (1988) The Lausanne Stroke Registry: analysis of 1,000 consecutive patients with first stroke. Stroke 19:1083–1092

    Google Scholar 

  3. Boiten J, Lodder J, Kessels F (1994) Two clinically distinct lacunar infarct entities? A hypothesis. Stroke 24:652–656

    Google Scholar 

  4. Caplan LR (1989) Intracranial branch atheromatous disease: a neglected, understudied and underused concept. Neurology 39:1246–1250

    Google Scholar 

  5. Caplan LR (2000) Penetrating and Branch Artery Disease. In: Caplan LR. Stroke: A clinician’s approach. 3rd edition. Boston: Butterworth-Heinemann, pp 229–245

  6. De Jong G, Kessels F, Lodder J (2002) Two types of lacunar infarcts: further arguments from a study of prognosis. Stroke 33:2072–2076

    Article  Google Scholar 

  7. Estol CJ (2000) Intravenous heparin for acute stroke: What can we learn from the megatrials? Neurology 54:1542

    Google Scholar 

  8. Fisher CM (1967) The dysarthria-clumsy hand syndrome. Neurology 17:614–617

    Google Scholar 

  9. Fisher CM, Cole M (1965) Homolateral ataxia and crural paresis: a vascular syndrome. J Neurol Neurosurg Psychiatry 28:48–55

    Google Scholar 

  10. Fisher CM, Curry HB (1965) Pure motor hemiplegia of vascular origin. Arch Neurol 13:30–44

    Google Scholar 

  11. Glass TA, Hennessey PM, Pazdera L, Chang HM, Wityk RJ, Dewitt LD, Pessin MS, Caplan LR (2002) Outcome at 30 days in the New England Medical Center Posterior Circulation Registry. Arch Neurol 59:369–376

    Google Scholar 

  12. Guidelines for the Management of Patients With Acute Ischemic Stroke: A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association (1994). Stroke 25:1901–1914

    PubMed  Google Scholar 

  13. Helgason CM, Wilbur AC (1991) Basilar branch pontine infarction with prominent sensory signs. Stroke 22:1129–1136

    Google Scholar 

  14. Hier DB, Foulkes MA, Swiontoniowski M, Sacco RL, Gorelick PB, Mohr JP, Price TR, Wolf PA (1991) Stroke recurrence within 2 years after ischemic infarction. Stroke 22:155–161

    Google Scholar 

  15. Irie K, Yamaguchi T, Minematsu K, Omae T (1993) The J-curve phenomenon in stroke recurrence. Stroke 24:1844–1849

    Google Scholar 

  16. Kataoka S, Hori A, Shirakawa T, Hirose G (1997) Paramedian pontine infarction. Neurological/topographical correlation. Stroke 28:809–815

    Google Scholar 

  17. Kim JS, Lee JH, Im JH, Lee MC (1995) Syndromes of pontine base infarction. A clinical-radiological correlation study. Stroke 26:950–955

    Google Scholar 

  18. Kumral E, Bayulkem G, Evyapan D (2002) Clinical spectrum of pontine infarction. Clinical-MRI correlations. J Neurol 249:1659–1670

    Google Scholar 

  19. Lindestrom E, Boysen G, Christiansen LW, Rogvi-Hansen B, Nielsen PW (1991) Reliability of Scandinavian Neurological Stroke Scale. Cerebrovasc Dis 1:103–107

    Google Scholar 

  20. Nadeau S, Jordan J, Mishra S (1992) Clinical presentation as a guide to early prognosis in vertebrobasilar stroke. Stroke 23:165–170

    Google Scholar 

  21. Nighoghossian N, Ryvlin P, Trouillas P, Laharotte JC (1993) Pontine versus capsular pure motor hemiparesis. Neurology 43:2197–2201

    Google Scholar 

  22. Sacco RL, Wolf PA, Kannel WB, McNamara PM (1982) Survival and recurrence following stroke. The Framingham study. Stroke 13:290–295

    Google Scholar 

  23. Toyoda K, Saku Y, Ibayashi S, Saboshima S, Ogasawara T, Fujishima M (1994) Pontine infarction extending to the basal surface. Stroke 25:2171–2178

    Google Scholar 

  24. van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJA, van Gijn J (1988) Interobserver agreement for the assessment of handicap in stroke patients. Stroke 19:604–607

    PubMed  Google Scholar 

  25. Vemmos KN, Takis CE, Georgilis K, Zakopoulos NA, Lekakis JP, Papamichael CM, Zis VP, Stamatelopoulos S (2000) The Athens stroke registry: results of a five-year hospital-based study. Cerebrovasc Dis 10:133–141

    Google Scholar 

  26. Wolf JK (1971) The classical brainstem syndromes. Springfield, IL: Charles C Thomas

  27. Yamamoto Y (1998) Adverse effect of nighttime blood pressure on the outcome of lacunar infarcts patients. Stroke 29:570–576

    Google Scholar 

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Correspondence to Konstantinos Spengos MD.

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Vemmos, K.N., Spengos, K., Tsivgoulis, G. et al. Aetiopathogenesis and long-term outcome of isolated pontine infarcts. J Neurol 252, 212–217 (2005). https://doi.org/10.1007/s00415-005-0639-9

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  • DOI: https://doi.org/10.1007/s00415-005-0639-9

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