Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
BMC Neurology
Published in: BMC Neurology 1/2017

Open Access 01-12-2017 | Research article

Etiology of isolated pontine infarctions: a study based on high-resolution MRI and brain small vessel disease scores

Authors: Cheng Xia, Hui-Sheng Chen, Shi-Wen Wu, Wei-Hai Xu

Published in: BMC Neurology | Issue 1/2017

Login to get access

Abstract

Background

In this retrospective study, we investigated the main pathogenesis of the two types of isolated pontine infarction: paramedian pontine infarcts (PPIs) and small deep pontine infarcts (SDPIs).

Methods

Acute ischemic stroke patients, comprising 117 PPI patients and 40 SDPI patients, were enrolled. High-resolution magnetic resonance imaging (HR-MRI) and routine MRI sequences were performed for each patient, and clinical data were collected. The following brain small vessel disease (SVD) features of the MRI scans were each rated (0 or 1) separately: asymptomatic lacunar infarcts, white matter lesions (WMLs), deep and infratentorial cerebral microbleeds (CMBs), and enlarged perivascular spaces in the basal ganglia. The ratings were also summed in an ordinal “SVD score” (range: 0–4). The difference in the SVD score between the PPI and SDPI groups was determined. The presence and location of basilar artery (BA) atherosclerotic plaques (based on HR-MRI) in the two groups was evaluated.

Results

There was a significant difference in the total SVD score and three of the four independent SVD features (asymptomatic lacunar infarcts, WMLs, and deep and infratentorial CMBs) between the two groups. The prevalence of BA plaques relevant to the infarcts in the PPI group was significantly higher than that in the SDPI group, whereas the prevalence of plaques irrelevant to the infarcts was similar between the two groups. The degree of BA stenosis was slightly higher in the PPI group than in the SDPI group. Diabetes mellitus was much more prevalent in the PPI group. The National Institute of Health Stroke Scale score was higher in the PPI group, which is in accordance with the larger infarct size in the PPI group.

Conclusion

BA atherosclerosis may be the major cause of PPI, while SVD may be the main mechanism underlying SDPI. HR-MRI combined with the total SVD score should be helpful to explore the pathogenesis underlying isolated pontine infarctions, especially in cases involving low-grade BA stenosis.
Literature
1.
Erro ME, Gallego J, Herrera M, et al. Isolated pontine infarcts: etiopathogenic mechanisms. Eur J Neurol. 2005;12(12):984–8.CrossRefPubMed
2.
Klein IF, Lavallee PC, Mazighi M, et al. Basilar artery atherosclerotic plaques in paramedian and lacunar pontine infarctions: a high-resolution MRI study. Stroke. 2010;41(7):1405–9.CrossRefPubMed
3.
Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol. 2010;9(7):689–701.CrossRefPubMed
4.
Wardlaw JM, Smith C, Dichgans M. Mechanisms of sporadic cerebral small vessel disease: insights from neuroimaging. Lancet Neurol. 2013;12(5):483–97.CrossRefPubMed
5.
Vermeer SE, Longstreth WT Jr, Koudstaal PJ. Silent brain infarcts: a systematic review. Lancet Neurol. 2007;6(7):611–9.CrossRefPubMed
6.
Doubal FN, MacLullich AM, Ferguson KJ, et al. Enlarged perivascular spaces on MRI are a feature of cerebral small vessel disease. Stroke. 2010;41(3):450–4.CrossRefPubMed
7.
Rouhl RP, van Oostenbrugge RJ, Knottnerus IL, et al. Virchow-Robin spaces relate to cerebral small vessel disease severity. J Neurol. 2008;255(5):692–6.CrossRefPubMed
8.
Cordonnier C, Al-Shahi Salman R, Wardlaw J. Spontaneous brain microbleeds: systematic review, subgroup analyses and standards for study design and reporting. Brain. 2007;130(pt 8):1988–2003.CrossRefPubMed
9.
Klarenbeek P, van Oostenbrugge RJ, Rouhl RP, et al. Ambulatory blood pressure in patients with lacunar stroke: association with total MRI burden of cerebral small vessel disease. Stroke. 2013;44(11):2995–9.CrossRefPubMed
10.
Staals J, Makin SD, Doubal FN, et al. Stroke subtype, vascular risk factors, and total MRI brain small-vessel disease burden. Neurology. 2014;83(14):1228–34.CrossRefPubMedPubMedCentral
11.
Klarenbeek P, van Oostenbrugge RJ, Lodder J, et al. Higher ambulatory blood pressure relates to enlarged Virchow-Robin spaces in first-ever lacunar stroke patients. J Neurol. 2013;260(1):115–21.CrossRefPubMed
12.
Xu WH, Li ML, Gao S, et al. In vivo high-resolution MR imaging of symptomatic and asymptomatic middle cerebral artery atherosclerotic stenosis. Atherosclerosis. 2010;212(2):507–11.CrossRefPubMed
13.
Han M, Rim NJ, Lee JS, et al. Feasibility of high-resolution MR imaging for the diagnosis of intracranial vertebrobasilar artery dissection. Eur Radiol. 2014;24(12):3017–24.CrossRefPubMed
14.
Chen ZC, Sun JZ, Shi ZH, et al. Capsular warning syndrome caused by spontaneous middle cerebral artery dissection. CNS Neurosci Ther. 2012;18(8):702–4.CrossRefPubMed
15.
Ryoo S, Cha J, Kim SJ, et al. High-resolution magnetic resonance wall imaging findings of Moyamoya disease. Stroke. 2014;45(8):2457–60.CrossRefPubMed
16.
Siemonsen S, Brekenfeld C, Holst B, et al. 3T MRI reveals extra- and intracranial involvement in giant cell arteritis. Am J Neuroradiol. 2015;36(1):91–7.CrossRefPubMed
17.
Mandell DM, Matouk CC, Farb RI, et al. Vessel wall MRI to differentiate between reversible cerebral vasoconstriction syndrome and central nervous system vasculitis:preliminary results. Stroke. 2012;43(3):860–2.CrossRefPubMed
18.
Obusez EC, Hui F, Hajj-Ali RA, et al. High resolution MRI vessel wall imaging: spatial and temporal patterns of reversible cerebral vasoconstriction syndrome and central nervous system vasculitis. Am J Neuroradiol. 2014;35(8):1527–32.CrossRefPubMed
19.
Li M, Wu SW, Xu WH. High-resolution MRI of radiation-induced intracranial vasculopathy. Neurology. 2015;84(6):631.CrossRefPubMed
20.
Fisher CM, Caplan LR. Basilar artery branch occlusion: a cause of pontine infarction. Neurology. 1971;21(9):900–5.CrossRefPubMed
21.
22.
Caplan LR. Intracranial branch atheromatous disease: a neglected, understudied, and underused concept. Neurology. 1989;39(9):1246–50.CrossRefPubMed
23.
Feng C, Xu Y, Bai X, et al. Basilar artery atherosclerosis and hypertensive small vessel disease in isolated pontine infarctions: a study based on high-resolution MRI. Eur Neurol. 2013;70(1-2):16–21.CrossRefPubMed
24.
Fazekas F, Kleinert R, Offenbacher H, et al. Pathologic correlates of incidental MRI white matter signal hyperintensities. Neurology. 1993;43(9):1683–9.CrossRefPubMed
25.
Gregoire SM, Chaudhary UJ, Brown MM, et al. The microbleed anatomical rating scale (MARS): reliability of a tool to map brain microbleeds. Neurology. 2009;73(21):1759–66.CrossRefPubMed
26.
Klein IF, Lavallée PC, Schouman-Claeys E, et al. High-resolution MRI identifies basilar artery plaques in paramedian pontine infarct. Neurology. 2005;64(3):551–2.CrossRefPubMed
27.
de Leeuw FE, de Groot JC, Oudkerk M, et al. Hypertension and cerebral white matter lesions in a prospective cohort study. Brain. 2002;125(pt 4):765–72.CrossRefPubMed
Metadata
Title
Etiology of isolated pontine infarctions: a study based on high-resolution MRI and brain small vessel disease scores
Authors
Cheng Xia
Hui-Sheng Chen
Shi-Wen Wu
Wei-Hai Xu
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2017
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/s12883-017-0999-7

Other articles of this Issue 1/2017

BMC Neurology 1/2017 Go to the issue

Research article

Association of fibrinogen level with early neurological deterioration among acute ischemic stroke patients with diabetes

Research article

Hospital readmission within 10 years post stroke: frequency, type and timing

Research article

The usefulness of chief complaints to predict severity, ventilator dependence, treatment option, and short-term outcome of patients with Guillain-Barré syndrome: a retrospective study

Research article

Mindfulness-based stress reduction for people with multiple sclerosis – a feasibility randomised controlled trial

Case report

Anti-N-methyl-D-aspartate receptor(NMDAR) antibody encephalitis presents in atypical types and coexists with neuromyelitis optica spectrum disorder or neurosyphilis

Research article

Comorbidity and metabolic syndrome in patients with multiple sclerosis from Asturias and Catalonia, Spain