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  • Title: Pontine warning syndrome.
    Author: Saposnik G, Noel de Tilly L, Caplan LR.
    Journal: Arch Neurol; 2008 Oct; 65(10):1375-7. PubMed ID: 18852355.
    Abstract:
    BACKGROUND: Little is known about stroke mechanisms in patients with fluctuating symptoms and the role of branch atherosclerotic disease. OBJECTIVE: To report a novel stroke presentation associated with a paramedian pontine infarct due to branch disease with a fluctuating course. DESIGN: Case report. SETTING: Academic research. Patient A 63-year-old man with hypertension, diabetes mellitus, and dyslipidemia was seen with fluctuating right-sided weakness and dysarthria. He had had 2 episodes of complete bilateral horizontal conjugate gaze palsy with unimpaired consciousness lasting for 5 minutes each. His pupils were 4 mm and were equal and reactive to light. Vertical gaze and convergence were preserved. His neurologic status fluctuated between 3 and 15 on the National Institutes of Health Stroke Scale. MAIN OUTCOME MEASURES: Results of computed tomographic angiography, perfusion, and magnetic resonance imaging. RESULTS: Intravenous tissue plasminogen activator was administered within a 3-hour window. Fluctuations in motor weakness persisted for 12 hours after receiving thrombolytic therapy. Neuroimaging showed an acute left paramedian pontine infarct with a patent basilar artery. CONCLUSIONS: Branch disease is a common mechanism in pontine infarctions. We coined the term "pontine warning syndrome" to characterize recurrent stereotyped episodes of motor or sensory dysfunction, dysarthria, or ophthalmoplegia associated with a high risk of imminent basilar artery branch infarction and a permanent deficit resembling those of capsular warning syndrome.
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