Hemiataxia With Ipsilateral Sensory Disturbance Due to a Pontine Infarction

Abstract

A 77-year-old man with essential hypertension abruptly developed marked hemiataxia, and paresthesia and decreased vibration sensation in the left-sided upper and lower extremities. There were no other neurological abnormalities. Cranial diffusion-weighted magnetic resonance imaging demonstrated a localized infarction in the right-sided median zone of the middle pons. Cranial magnetic resonance angiography finding was normal. Under anti-platelet agent, he became asymptomatic within 5 days. Impairment of the descending corticopontine fiber and/or pontine nucleus causes contralateral hemiataxia. Involvement of the medial lemniscus induces paresthesia and disturbance of vibration sensation in the contralateral limbs. In our patient, not only the cerebro-ponto-cerebellar pathway but also the medial lemniscus might be damaged. Hemiataxia with ipsilateral sensory disturbance is commonly regarded as indicating sign of lateral thalamic lesion. However, we emphasize that hemiataxia with ipsilateral sensory disturbance rarely results from infarct lesion in the contralateral median zone of the middle pons.




J Med Cases. 2014;5(3):180-181
doi: http://dx.doi.org/10.14740/jmc1675w