brain stem infarctions


Summary: Infarctions that occur in the BRAIN STEM which is comprised of the MIDBRAIN; PONS; and MEDULLA OBLONGATA. There are several named syndromes characterized by their distinctive clinical manifestations and specific sites of ischemic injury.

Top Publications

  1. Krasnianski M, Muller T, Zierz S, Winterholler M. Gasperini syndrome as clinical manifestation of pontine demyelination. Eur J Med Res. 2009;14:413-4 pubmed
  2. Kremer C, Baumgartner R. Aortic embolism in Claude's syndrome. Cerebrovasc Dis. 2002;13:142-3 pubmed
  3. Peker S, Akansel G, Sun I, Pamir N. Trigeminal neuralgia due to pontine infarction. Headache. 2004;44:1043-5 pubmed
    ..Secondary trigeminal neuralgia due to ischemic lesion of the pons is very rare. Here we report a patient with a pontine infarct transecting the central trigeminal pathways resulting with trigeminal neuralgia. ..
  4. Seo S, Heo J, Lee K, Shin W, Chang D, Kim S, et al. Localization of Claude's syndrome. Neurology. 2001;57:2304-7 pubmed
    ..The findings strongly suggest that Claude's syndrome occurs because of a lesion of the superior cerebellar peduncle just below and medial to the red nucleus. Midbrain infarction and partial oculomotor nerve palsy was common. ..
  5. Pullicino P, Lincoff N, Truax B. Abnormal vergence with upper brainstem infarcts: pseudoabducens palsy. Neurology. 2000;55:352-8 pubmed
    ..Pseudoabducens palsy and CRN are probably both manifestations of abnormal vergence activity. Inhibitory descending pathways for convergence may pass through the thalamus and decussate in the subthalamic region. ..
  6. Hayashi Hayata M, Nakayasu H, Doi M, Fukada Y, Murakami T, Nakashima K. Gasperini syndrome, a report of two cases. Intern Med. 2007;46:129-33 pubmed
  7. Niino M, Uesugi H, Takahashi T, Fukazawa T, Minami N, Tashiro J, et al. Recurrent brainstem lesions mimicking infarctions in an elderly patient with neuromyelitis optica spectrum disorder. Intern Med. 2012;51:809-12 pubmed
    ..In patients with recurrent brainstem lesions, even in the elderly and those with symptoms mimicking infarction, NMO spectrum disorder should be considered as a differential diagnosis...
  8. Foerch C, Berkefeld J, Halbsguth A, Ziemann U, Neumann Haefelin T. Brain stem infarction caused by proximal internal carotid artery stenosis in a patient with a persisting primitive trigeminal artery. Cerebrovasc Dis. 2006;22:200-2 pubmed
  9. Ho H, Thajeb P, Lin C. Ondine's curse in a patient with unilateral medullary and bilateral cerebellar infarctions. J Chin Med Assoc. 2005;68:531-4 pubmed
    ..Reduced respiratory afferent inputs to the dorsal respiratory group of medullary neurons, the nucleus tractus solitarius and reduced "automatic" components of the respiratory drive may play a role in the development of CSA/OC. ..

More Information


  1. Oliveira Filho J, Ay H, Koroshetz W, Buonanno F. Localization of clinical syndromes using DWI: two examples of the "capsular" warning syndrome. J Neuroimaging. 2001;11:44-7 pubmed
    ..DWI's ability to differentiate between acute and chronic infarcts may assist in more accurate localization of clinical syndromes. ..
  2. Anagnostou E, Spengos K, Margeti S, Vassilopoulou S, Paraskevas G, Zis V. Vertical and horizontal integrator failure in a ponto-medullary infarction: A possible role for paramedian tract neurons. J Neurol Sci. 2009;280:118-9 pubmed publisher
    ..The most probable explanation is a damage of paramedian tract neurons, which have been recently recognized as a site of neural integration. ..
  3. Axer H, Grässel D, Brämer D, Fitzek S, Kaiser W, Witte O, et al. Time course of diffusion imaging in acute brainstem infarcts. J Magn Reson Imaging. 2007;26:905-12 pubmed
    ..In contrast, the continuous decline of FA over 3 to 6 months indicates a chronic process of change of histological structures in brainstem ischemia, and may be regarded as an indicator of the chronic phase. ..
  4. Li H, Kang Z, Qiu W, Hu B, Wu A, Dai Y, et al. Hemoglobin A1C is independently associated with severity and prognosis of brainstem infarctions. J Neurol Sci. 2012;317:87-91 pubmed publisher
    ..These results suggest that elevated HbA1c level may be a potential serologic marker in the evaluation of the severity and prognosis of acute BSIs. There is an urgent need to study control of diabetes mellitus (DM) before and after BSIs. ..
  5. Pfefferkorn T, Eppinger U, Linn J, Birnbaum T, Herzog J, Straube A, et al. Long-term outcome after suboccipital decompressive craniectomy for malignant cerebellar infarction. Stroke. 2009;40:3045-50 pubmed publisher
    ..Infarct- but not procedure-related early mortality is substantial. Long-term outcome in survivors is acceptable, particularly in the absence of brain stem infarction. ..
  6. Chen J, Huang Y, Liu X, Sun H. [Prevalence of REM sleep behavior disorder in patients with brainstem lesions]. Zhonghua Yi Xue Za Zhi. 2013;93:2942-5 pubmed
    ..Treatment with clonazepam at bedtime completely resolved the RBD symptoms. RBD is common in patients with brainstem lesions. And its definite diagnosis is based upon clinical symptoms and PSG examination. ..
  7. Giberti L, Bino G, Tanganelli P. Pregnancy, patent foramen ovale and stroke: a case of pseudoperipheral facial palsy. Neurol Sci. 2005;26:43-5 pubmed
    ..Given the increased embolic risk in labouring women, this study highlights the importance of searching for PFO in case of a stroke during pregnancy. ..
  8. Lee S, Lee K, Kim S, Lee J, Park M. Voluntary Cough and Swallowing Function Characteristics of Acute Stroke Patients Based on Lesion Type. Arch Phys Med Rehabil. 2015;96:1866-72 pubmed publisher
    ..Our results suggest that voluntary coughing exercises could be a helpful therapeutic option for dysphagia to prevent pulmonary complications in some types of patients with stroke. ..
  9. Benavente Fernández A, Carbajal Guerrero J, Serrano Cabrera A, Martinez Fernandez E, Sanz Fernández G, Rodriguez Uranga J, et al. [Bilateral paramedial bulbar infarction secondary to radiotherapy]. Rev Neurol. 2004;38:896-7 pubmed
  10. Libman R, Benson R, Einberg K. Myasthenia mimicking vertebrobasilar stroke. J Neurol. 2002;249:1512-4 pubmed
    ..Stroke mimics continue to present a diagnostic challenge, myasthenia included. Accurate diagnosis is essential to avoid unnecessary hazard, as well as to implement effective treatment for the appropriate diagnosis. ..
  11. Kunert P, Dziedzic T, Czernicki T, Nowak A, Marchel A. Surgery for sporadic vestibular schwannoma. Part II. Complications (not related to facial and auditory nerves). Neurol Neurochir Pol. 2016;50:90-7 pubmed publisher
    ..4% in the last 55 cases. Tumor size, cerebellar syndrome at presentation and experience of the team were the three most important risk factors for PC occurrence. Permanent deficit secondary to PC remained in only 4% of the patients. ..
  12. Cairns K, Stein J. Motor function improvement following intrathecal baclofen pump placement in a patient with locked-in syndrome. Am J Phys Med Rehabil. 2002;81:307-9 pubmed
    ..This case study suggests that intrathecal baclofen pump therapy might improve motor function in select patients with locked-in syndrome. ..
  13. Coert B, Chang S, Do H, Marks M, Steinberg G. Surgical and endovascular management of symptomatic posterior circulation fusiform aneurysms. J Neurosurg. 2007;106:855-65 pubmed
    ..The natural history of the disease was poor in patients with incomplete aneurysm thrombosis after treatment. ..
  14. Tsai T, Seow V, Shen T, Chuang C, Lee Y, Chong C, et al. Painless aortic dissection masquerading as brainstem stroke with catastrophic anticoagulant use. Am J Emerg Med. 2008;26:253.e1-2 pubmed publisher
    ..We present a patient with painless aortic dissection (DeBakey I), which was initially misdiagnosed as brainstem stroke with catastrophic anticoagulant use. Finally, the patient died of multiorgan failure after surgical intervention. ..
  15. Arai M, Terakawa I. Central paroxysmal positional vertigo. Neurology. 2005;64:1284 pubmed
  16. Lehmann H, Hengge U, Alswede L, Saleh A, von Geldern G, Hartung H, et al. A 32-year-old man with relapsing-progressive brainstem symptoms. Lancet Neurol. 2006;5:97-102 pubmed
  17. Chang T, Wu Y. A tiny infarct on the dorsolateral pons mimicking vestibular neuritis. Laryngoscope. 2010;120:2336-8 pubmed publisher
    ..The clinical features mimic vestibular neuritis and can easily lead to misdiagnosis. Selective involvement of the left superior vestibular nucleus might explain the resemblance to acute peripheral vestibulopathy. ..
  18. Plotkin A, Sela L, Weissbrod A, Kahana R, Haviv L, Yeshurun Y, et al. Sniffing enables communication and environmental control for the severely disabled. Proc Natl Acad Sci U S A. 2010;107:14413-8 pubmed publisher
    ..We conclude that redirection of sniff motor programs toward alternative functions allows sniffing to provide a control interface that is fast, accurate, robust, and highly conserved following severe injury. ..
  19. Kataoka S, Terasawa H, Tohji H. Sequential bilateral medial medullary infarction due to vertebral artery dissection. Cerebrovasc Dis. 2007;24:309-12 pubmed
  20. Marx J, Iannetti G, Thömke F, Fitzek S, Urban P, Stoeter P, et al. Somatotopic organization of the corticospinal tract in the human brainstem: a MRI-based mapping analysis. Ann Neurol. 2005;57:824-31 pubmed
  21. Tokunaga T, Kita Y, Yamamoto T. [A case of the persistent vegetative state following symmetrical peduncular infarction]. No To Shinkei. 2002;54:57-61 pubmed
  22. Yanagawa Y, Iwamoto S, Nishi K. Pontine infarction induced by injury of the perforating branch of the basilar artery after blunt head impact: case report. Neurol Med Chir (Tokyo). 2008;48:343-6 pubmed
    ..The present elderly patient had hypertension and hyperlipidemia, so arteriosclerosis in the paramedian branch may have contributed to his susceptibility to such injury. ..
  23. Majic T, Aiyagari V. Cerebrovascular manifestations of pheochromocytoma and the implications of a missed diagnosis. Neurocrit Care. 2008;9:378-81 pubmed publisher
    ..g. catheter angiography) and treatment modalities (e.g. beta-blockers to treat hypertension, corticosteroids to treat suspected vasculitis, etc.) can lead to life threatening complications. ..
  24. Hokkoku K, Sonoo M, Murashima H, Iwanami T, Nishiyama K, Kawamura Y, et al. [Clinical features of predominantly sensory stroke due to brainstem infarction]. Rinsho Shinkeigaku. 2011;51:248-54 pubmed
    ..One should always keep this syndrome in mind when assessing patients with acute-onset sensory symptoms. ..
  25. Fukuda M, Aiba T, Takahashi S. Bilateral medial medullary infarction due to bilateral vertebral artery dissection. Clin Neurol Neurosurg. 2004;106:132-5 pubmed
    ..Medial medullary infarction is generally caused by atherosclerosis within a VA or anterior spinal artery. This is the first report of bilateral medial medullary infarction due to dissection of both intracranial VAs. ..
  26. Yoshimura S, Toyoda K, Ohara T, Nagasawa H, Ohtani N, Kuwashiro T, et al. Takotsubo cardiomyopathy in acute ischemic stroke. Ann Neurol. 2008;64:547-54 pubmed publisher
    ..It most often occurred soon after stroke onset and was commonly asymptomatic. Female sex and insular damage were predominant features of the stroke patients who experienced development of takotsubo cardiomyopathy. ..
  27. Fitzek S, Fitzek C, Urban P, Marx J, Hopf H, Stoeter P. Time course of lesion development in patients with acute brain stem infarction and correlation with NIHSS score. Eur J Radiol. 2001;39:180-5 pubmed
    ..b>brain stem infarctions of 11 patients were analyzed...
  28. Ushida H, Koizumi S, Katoh K, Okada Y. [Systemic lupus erythematosus presenting as a brainstem infarction and hemorrhage during treating retroperitoneal abscess: a case report]. Nihon Hinyokika Gakkai Zasshi. 2001;92:579-82 pubmed
    ..Brain CT scan revealed a brainstem wide infarction and hemorrhage spot. Pulse therapy with steroid was done, however unfortunately the patient was dead after 6 days. ..
  29. Zandio Amorena B, Erro Aguirre M, Cabada T, Ayuso Blanco T. [Cocaine-induced brain stem stroke associated to craneal midline destructive lesions]. Neurologia. 2008;23:55-8 pubmed
    ..Abuse of cocaine is a risk factor for stroke that should be considered not only in young patients. The pathogenic relationship between stroke and midline cocaine related destructive lesions is discussed. ..
  30. Haisa T, Tabei Y, Kondo T, Hasuo K. [Dissection of the vertebral arteries and Babinski-Nageotte syndrome]. No To Shinkei. 2006;58:264-6 pubmed
  31. Katsuno M, Mizunari T, Kobayashi S, Takahashi H, Teramoto A. Rupture of a vertebral artery dissecting aneurysm developing immediately after trapping of a dissecting aneurysm on the contralateral vertebral artery: case report. Neurol Med Chir (Tokyo). 2009;49:468-70 pubmed
  32. Thijs V, Grittner U, Fazekas F, McCabe D, Giese A, Kessler C, et al. Dolichoectasia and Small Vessel Disease in Young Patients With Transient Ischemic Attack and Stroke. Stroke. 2017;48:2361-2367 pubmed publisher
    ..URL: Unique identifier: NCT00414583. ..
  33. Fung H, Chen S, Tang L, Ro L. Triparesis: MRI documentation of bipyramidal medullary infarction. Neurology. 2002;58:1130-1 pubmed
  34. Cherian P, Radhakrishnan K. Triphasic waves in a patient with brainstem hemorrhage modified by hemispheric infarct. Eur J Neurol. 2004;11:789-90 pubmed
  35. Xu K, Puchowicz M, Sun X, Lamanna J. Decreased brainstem function following cardiac arrest and resuscitation in aged rat. Brain Res. 2010;1328:181-9 pubmed publisher
  36. Sviri G, Britz G, Lewis D, Ghodke B, Mesiwala A, Haynor D, et al. Brainstem hypoperfusion in severe symptomatic vasospasm following aneurysmal subarachnoid hemorrhage: role of basilar artery vasospasm. Acta Neurochir (Wien). 2006;148:929-34; discussion 934-5 pubmed
    ..Further studies should be done to evaluate the effects of endovascular therapy on BS perfusion and the impact of BS ischemia on morbidity and mortality of patients with severe symptomatic vasospasm. ..
  37. Nosrati Zarenoe R, Hansson M, Hultcrantz E. Assessment of diagnostic approaches to idiopathic sudden sensorineural hearing loss and their influence on treatment and outcome. Acta Otolaryngol. 2010;130:384-91 pubmed publisher
    ..No significant correlation was found between either the MRI findings or the laboratory findings with regard to treatment or hearing recovery in patients with ISSNHL. ..
  38. Ortiz G, Koch S, Forteza A, Romano J. Ramsay hunt syndrome followed by multifocal vasculopathy and posterior circulation strokes. Neurology. 2008;70:1049-51 pubmed publisher
  39. Barragán J, de León S, Gamo J. [Claude's syndrome. Clinical-radiological correlation]. Neurologia. 2007;22:540-1 pubmed
  40. Garcia Carretero R, Romero Brugera M, Rebollo Aparicio N, Rodeles Melero J. Dysphagia and aspiration as the only manifestations of a stroke. BMJ Case Rep. 2016;2016: pubmed publisher
    ..He had suffered a brain stem stroke and, as a consequence, developed an aspiration pneumonia. What seemed a digestive disorder was indeed a brain stem stroke, therefore we had to deal with the diverse impacts of this condition. ..
  41. Ahn J, Kwon H, Ahn H, Sohn Y. A case of myxedema coma presenting as a brain stem infarct in a 74-year-old Korean woman. J Korean Med Sci. 2010;25:1394-7 pubmed publisher
    ..We report this case to alert clinicians considering diagnosis of myxedema coma in patients with severe decompensated metabolic state including mental change. ..
  42. Klein I, Lavallee P, Mazighi M, Schouman Claeys E, Labreuche J, Amarenco P. Basilar artery atherosclerotic plaques in paramedian and lacunar pontine infarctions: a high-resolution MRI study. Stroke. 2010;41:1405-9 pubmed publisher
  43. Wu Y, Lee C, Shia B, Tsai Y, Tsao T. Response to hypercapnic challenge is associated with successful weaning from prolonged mechanical ventilation due to brain stem lesions. Intensive Care Med. 2009;35:108-14 pubmed publisher
    ..Assessing the P.01 response to serial increases in the level of HC may be a safe means to ascertain whether patients with brainstem lesions are ready for ventilator weaning. ..
  44. Leaver A, Refshauge K, Maher C, Latimer J, Herbert R, Jull G, et al. Efficacy of manipulation for non-specific neck pain of recent onset: design of a randomised controlled trial. BMC Musculoskelet Disord. 2007;8:18 pubmed
    ..This paper presents the rationale and design of a randomised controlled trial to compare the effectiveness of neck manipulation and neck mobilisation for acute and subacute neck pain. ..
  45. Khong P, Lazzaro A, Mobbs R. Phrenic nerve stimulation: the Australian experience. J Clin Neurosci. 2010;17:205-8 pubmed publisher
    ..The remaining patients' notes were incomplete. These data suggest that phrenic nerve stimulation can be used instead of mechanical ventilators for long-term ongoing respiratory support. ..
  46. Jang S, Yang D, Lee J. Preservation of the integrity of the corticospinal tract in a patient with medulla infarct. Am J Phys Med Rehabil. 2009;88:256-8 pubmed publisher
    ..In conclusion, we demonstrated that the integrity of CST had been spared in the anterior portion of the medulla infarct by using diffusion tensor tractography and transcranial magnetic stimulation. ..
  47. Bobo W, Murphy M, Heckers S. Recurring episodes of Bell's mania after cerebrovascular accident. Psychosomatics. 2009;50:285-8 pubmed publisher
    ..The use of neuroleptic medications in cases of delirium/mania with catatonic signs may result in marked clinical deterioration, whereas high-dose lorazepam can ameliorate catatonic signs. ..
  48. Zakaria T, Flaherty M. Locked-in syndrome resulting from bilateral cerebral peduncle infarctions. Neurology. 2006;67:1889 pubmed
  49. Ho B, Yu F, Lai C, Lin H. Avellis syndrome as presenting manifestation of ulcerative colitis. J Neurol Sci. 2013;325:160-1 pubmed publisher
    ..Brainstem syndromes are rarely associated with neurological complications of ulcerative colitis and can be the presenting manifestation beyond gastrointestinal symptoms. ..
  50. Galiano R, Peiro C, Parra J, Puchades I, Sancho J. [Isolated bilateral palpebral ptosis and mesencephalic infarction]. Rev Neurol. 2002;35:594 pubmed
  51. Cheng C, Jiang Y, Lu X, Gu F, Kang Z, Dai Y, et al. The role of anti-aquaporin 4 antibody in the conversion of acute brainstem syndrome to neuromyelitis optica. BMC Neurol. 2016;16:203 pubmed
    ..ABS represents an inaugural or limited form of NMO in a high proportion of anti-AQP4 (+) patients. ..
  52. Ahn S, Hur D, Jeon S, Park J, Kang H, Park K. A rare case of pontomedullary infarction presenting with peripheral-type facial palsy. Auris Nasus Larynx. 2010;37:747-9 pubmed publisher
    ..This case suggests that clinicians should take into account the possibility of a central lesion and brainstem infarction, even when patients present with peripheral-type FP. ..
  53. Antoncic I, Dunatov S, Sosic M, Antulov R, Bralic M. Neurogenic pulmonary edema caused by bilateral medial medullary infarction. Neurol Sci. 2015;36:645-6 pubmed publisher