Sequential pontine and bilateral cerebral peduncle infarction with resultant early Wallerian degeneration of the ponto‐cerebellar fibers

Abstract

AbstractBilateral cerebral peduncular infarction (BCPI) is an extremely rare neurological disorder reportedly associated with locked‐in syndrome. A 60‐year‐old man represented with reduction in conscious level three weeks following a paramedian pontine infarction due to basilar artery thrombosis. Repeated MRI revealed subacute pontine infarction with new infarct involving bilateral cerebral peduncle. MRA showed absent flow‐related signal along the basilar artery consistent with occlusion. Additionally, Wallerian degeneration characterized by symmetrical hyperintense signal on MRI involving the ponto‐cerebellar fibers and both the middle cerebellar peduncles (MCPs) were seen. BCPI is an exceedingly rare type of stroke with characteristic symmetrical signal change involving the cerebral peduncles called “Mickey Mouse Ear” sign. Early Wallerian degeneration of the bilateral MCPs ensuing pontine infarction is also uncommon and is often detected incidentally and exhibits regular and symmetrical signal changes on MRI. Here, a rare encounter of early Wallerian degeneration following sequential pontine and BCPI is described.