Abstract
Most brainstem infarcts are caused by pontine strokes. When a bilateral pontine or brainstem stroke occurs, it can result in an image called the “heart appearance” sign. Sequential pontine strokes have not yet been described to cause the “heart appearance” sign. We report a case of sequential pontine strokes in a 47-year-old man with no relevant medical history. He presented with acute left-sided hemiparesis. Initial brain MRI showed a right-sided pontine infarction. Two weeks later, the patient’s left side hemiparesis and dysarthria worsened, and he developed right-sided facial paralysis. The brain MRI showed a left-sided pontine infarction that looked like the “heart appearance” sign. The patient had a good recovery. This report highlights a case of atypical pontine stroke recurrence two weeks apart and discusses branch artery disease as a possible etiologic cause.
Highlights
Pontine stroke accounts for most brainstem infarcts [1]
Two weeks after the initial stroke, the patient returned to the ED due to worsening left hemiparesis and dysarthria
MRI showed an expansion of the area of diffusion-weighted increased signal on the right pontine side (Figure 1b); the patient was managed as a stroke expansion
Summary
Pontine stroke accounts for most brainstem infarcts [1]. When a bilateral pontine or brainstem stroke occurs, it can result in an image called the “heart appearance” sign [2]. The following day, MRI showed diffusion-weighted increased signal on the right pontine side as expected to a stroke (Figure 1a). Two weeks after the initial stroke, the patient returned to the ED due to worsening left hemiparesis and dysarthria. MRI showed an expansion of the area of diffusion-weighted increased signal on the right pontine side (Figure 1b); the patient was managed as a stroke expansion. The new brain MRI revealed a left pontine infarction (Figure 1c) with the characteristic “heart appearance” sign. The patient stabilized and had a stable recovery He was discharged one month after the second hospital admission, with left-sided hemiplegia, severe dysarthria and dysphagia, right side ataxia, and a Modified Rankin Scale score of 4. C. New diffusion-weighted increased signal on the left side, similar to the “heart appearance” sign
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