Chapter 39 - Pontine infarcts and hemorrhages

Summary

Atheromatous stenosis of the basilar artery (BA) can cause pontine infarctions by superimposed thrombosis, which occlude the BA itself or the orifices of the branches of the BA. Pontine infarctions can occur following large thromboembolism lodging at the BA lumen. Emboli usually lodge in the distal portion of the BA, occluding the superior cerebellar artery (SCA) or orifices of branches of the distal BA. Lipohyalinosis and branch atheromatous disease of the penetrating small arteries are the major vascular pathologies in most patients who develop pontine infarction. Pontine infarctions are caused by a variety of vascular pathologies that can develop in large brain-supplying arteries. About 10% of all brain hemorrhages occur in the pons. Before the development of computed tomography (CT) scanning, primary pontine hemorrhages (PPH) were considered a uniformly fatal disease characterized by horizontal gaze paresis, pinpoint pupils, high fever, quadriparesis, and rapid onset of coma.