A-076 Acute Pontine Infarction and Deep White Matter Lesioning: Poly-etiologic Factors and Clinical Correlation with Neuropsychological Impairment and Neuroradiographic Findings

Abstract

Abstract Objective Pontine infarction may include motor and sensory disturbances, eye movement disorders, cranial nerve palsies, vestibular system symptoms, dizziness, ataxia, transient loss of consciousness, tetraparesis, acute pseudobulbar palsy, and severe sensory-motor deficits (Kumral, Bayülkem, & Evyapan, 2002). Studies of clinical/. neuroradiological correlation are not abundant in the literature (Kim, Lee, Joo, Im, & Lee, 1996). Methods The present case involves a 67-year-old, right-handed Caucasian female with a medical history of hypertension, headaches, hypothyroidism, cardiovascular disease (triple bypass), chronic obstructive pulmonary disease, diabetes mellitus, and abdominal aortic aneurysm. She was referred for neuropsychological testing to evaluate deficits. related to her acute pontine stroke. Results Neuropsychological testing revealed neuropsychological impairment characterized by visual-perceptual motor and visual memory deficits, executive dysfunction, lack of concern/awareness of deficits (anosodiaphoria), decreased impulse control and disinhibition. Bi-hemispheric, cortical/subcortical pathway elements, and a preponderance of right hemisphere involvement correlated with neuroradiographic evidence. MRIs revealed a punctate acute infarct within the right paracentral pons, a. small focus of gradient susceptibility within the parasagittal right parietal lobe, and a left pons and deep ischemic white matter lesioning of the posterior left frontal lobe. Conclusion The present case provided a rare look at poly-etiologic factors associated with acute pontine infarct and associated deep ischemic white matter changes.Neuropsychological testing elucidated the severity and type of neuropsychological impairment which correlated with MRI neuroradiographic findings, and was instrumental in patient interventions. Neurocognitive rehabilitation and formal driving evaluation, given the patient’s visual-perceptual motor and visual memory difficulties and lack of concern/awareness of deficits, protected the patient, family and public.