Pontine watershed infarction

Excerpt

A 45-year-old man with a history of overweight, smoking, and untreated hypercholesterolemia presented with acute onset vertigo, nausea, right-sided tinnitus, and drowsiness. Clinical examination revealed a Glasgow coma scale of 14/15 (with decreased alertness but arousable by minor stimulation) and skew deviation (i.e., right higher than left eye), in the absence of other abnormalities. MRI showed an acute pontine infarction in the watershed area between the anteromedial/anterolateral and the lateral group of penetrating small arteries and a small size infarction in the lateral pontine tegmentum, together with a focal moderate stenosis of the basilar artery on the level corresponding to the level of the brainstem infarction (Fig. 1). Acetylsalicylic acid 160 mg od was started. Transthoracic and transoesophageal echocardiography, Holter ECG, extensive testing in search for coagulation abnormalities were all normal, whereas duplex scanning revealing the presence of non-stenotic carotid atheromatous plaques. Clinical signs disappeared progressively during the following days.

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