| James is a 65 year old man with a 10 year history of hypertension and Type 2 diabetes. He smokes 5/day. He drinks one bottle of wine per day. He woke up this morning with some weakness and clumsiness in his left hand. A CT scan was normal but now an MRI is shown below. He stopped taking his BP medications 3 years ago as he was depressed. |
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Click to see his scan
What are the characteristic features seen
- There is restricted diffusion on the left side of the pons
- This is rich in corticospinal fibres which will cross over in the medulla below
- Damage to these will cause right sided arm/leg weakness
- It can also affect fibres from the cerebellum causing the limb to be ataxic and clumsy
- The infarct does not cross the midline which is typical of these vascular lesions
- It is caused by occlusion of a pontine perforator branch from the basilar artery
- Commonly seen with hypertension and diabetes
- The CT shows calcification of the basilar artery
3.What is the management
- Ongoing Stroke rehabilitation
- Optimising treatment of his BP and diabetes
- Mood assessment
- Smoking cessation
- Reducing alcohol intake
- Antiplatelet therapy
- Statin would be considered as he likely has vascular disease
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