Analysis of Clinical Misdiagnosis of Pontine Infarction with Atypical Mani-festations

LYU Jia; LIU Yong; LI Chengxia

doi:10.3969/j.issn.1002-3429.2024.14.007

Abstract：Objective To analyze the atypical manifestations of early pontine infarction and the causes of misdiagno-sis,and to further summarize the preventive measures for misdiagnosis.Methods The case data of 12 patients with misdiag-nosed pontine infarction admitted from January 2021 to December 2023 were retrospectively analyzed.Results Among the 12 patients,8 were males and 4 were females aged 49-75 years.All patients were treated within 24 h after onset.There were 10 patients with history of hypertension,6 patients with history of hyperlipidemia,and 4 patients with history of cervical spine.There were 8 patients with contralateral central faciolingual palsy and limb palsy combined with hemisensory disturbance,11 with mild ataxia,12 with nystagmus,5 with dysarthria,8 with dizziness,6 with nausea and vomiting,8 with abnormal muscle strength during examination,7 with Babinski's sign positive on the paralyzed side,4 with tinnitus,and 3 with transient diplo-pia.No new infarcts were found in head CT examinations in 12 patients.Eight patients were misdiagnosed with cerebral hemi-sphere infarction due to central facial paralysis,limb paralysis and hemisensory disorder,and 4 patients were misdiagnosed with insufficient vertebra basilar artery blood supply due to vertigo,tinnitus and no neurological signs.Brain MRI examination revealed pontine infarction within 24 h after the onset of the disease,and then confirmed the diagnosis of pontine infarction.Misdiagnosis lasted from 24 to 36 h.After diagnosis,12 patients were treated with anti-platelet aggregation and improvement of microcirculation,and their condition was significantly improved at 1 month after treatment.Conclusion The early clinical manifestations of partial pontine infarction are not typical,with no definite localization sign,and the sensitivity and specificity of early CT examination are low,which often leads to the early misdiagnosis and missed diagnosis.Careful inquiry about rele-vant medical history and risk factors,careful examination of the nervous system,and being familiar with the anatomical struc-ture and pathological characteristics of the pontine brain,and prompt MRI or multiple examinations when no responsible cere-bral infarction is found by CT examination are necessary to prevent early misdiagnosis and missed diagnosis.