Clinical analysis of acute bilateral brachium pontis infarction
Objective To investigate the clinical manifestation,imaging,pathogenesis and prognostic factors associated with acute bilateral brachium pontis infarction.Methods Patients with acute bilateral brachium pontis infarction who were admitted to the Tianjin Huanhu Hospital from October 2016 to October 2021 were collected for retrospective analysis.The demographic information,clinical symptoms and signs,imaging and prognosis of the patients were collected.Binary Logistic regression was used to analyze the correlation between age,gender,stroke risk factors,infarct site,vascular condition,National Institutes of Health Stroke Scale(NIHSS)score on admission,stroke progression,and 90-day prognosis of patients with acute bilateral brachium pontis infarction.Results A total of 112 patients with acute bilateral brachium pontis infarction were included.The most common clinical features were ataxia(84.8％,95/112),and vertigo(75.0％,84/112);the first symptom was tinnitus/hearing loss in 23 patients(20.5％,23/112),of whom 4 patients had sudden deafness.Among the 112 patients,isolated bilateral brachium pontis infarcts were found only in 8 cases(7.1％),whereas pontine infarcts in 90 cases(80.4％),midbrain infarcts in 22 cases(19.6％),medullary infarcts in 21 cases(18.8％),and cerebellar infarcts in 86 cases(76.8％).Of the patients who underwent vascular imaging,moderate-to-severe stenosis/occlusion of the vertebrobasilar artery system was present in 89.0％(89/100),and moderate-to-severe stenosis/occlusion of the vertebral arteries and/or basilar arteries was present bilaterally in 65.0％(65/100)of the patients.Pathogenesis was predominantly the large atherosclerotic type(79.5％,89/112).Progressive stroke(OR=7.765,95％CI 2.760-21.841,P＜0.001)and higher NIHSS score on admission(OR=1.196,95％CI 1.085-1.318,P＜0.001)were independent risk factors for poor prognosis in patients with bilateral brachium pontis infarction.Conclusions The first symptom in patients with acute bilateral brachium pontis infarction is dizziness,and acute vestibular and hearing disorders are the characteristic manifestations of brachium pontis infarction.Isolated bilateral brachium pontis infarction is rare in clinic,and most cases are combined with posterior circulation infarction,and the pons and cerebellum are the most likely to be involved.Pathogenesis is predominantly the large atherosclerotic type.Progressive stroke and higher NIHSS score on admission are independent risk factors for poor prognosis of the patients with the disease.
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