Clues to pontine pathologies - Clinico-radiological profile

Congress:

ECR 2019

Poster Number:

C-0711

Type:

Educational Exhibit

Keywords:

Neuroradiology brain, Anatomy, CNS, MR, MR-Diffusion/Perfusion, MR-Angiography, Surgery, Education, Congenital, Metabolic disorders, Infection

Authors:

S. T. Prabhakar¹, B. N. Reddy², B. B. Das¹, S. Viswamitra¹; ¹Bangalore/IN, ²Bangalore, ka/IN

DOI:

10.26044/ecr2019/C-0711

DOI-Link:

https://dx.doi.org/10.26044/ecr2019/C-0711

Fig. 1: Pons - dorsal tegmentum anatomy: Various sensory and motor nuclei in pons.

Fig. 2: Various tracts and nuclei in mid pons, basilar artery supply(purple shade).

Fig. 3: Various tracts and nuclei in inferior pons, basilar artery supply(purple shade).

Fig. 4: Brief review of structure and function of pons.

Learning objectives

To understand the basic anatomy of pons. To discuss the clinical and magnetic resonance imaging findings of pontine pathologies.

Background

Pons is the middle bulbous portion which acts as a relay between the cerebellum and cerebral hemispheres. It has various white matter tracts and cranial nerve nucleiwhich are vital for motor and sensory functions. The various spectrum of pathologies from congenital to tumors affects pons. Promptand early diagnosis by MR imaging will help in early intervention and treatment of the diseases.

Findings and procedure details

1200 patients who presented clinically with pontine symptoms were evaluated usingMRI of the brain and the following cases were encountered: Metabolic - congenital disorders: Wernicke’s encephalopathy, Wilson’s disease, Central pontine myelinolysis, Spinocerebellar ataxia, Multisystem atrophy, X-linked adrenoleukodystrophy. Infectious - inflammatory conditions : Multiple sclerosis, acute disseminated encephalomyelitis, neurocysticercosis, tuberculomas. Degenerative conditions : Progressive supranuclear palsy, Wallerian degeneration of the corticospinal tracts. Infiltrating diseases: Sarcoidosis. Vascular conditions: Cavernoma, AVM, infarct. Tumor: Glioma, lymphoma and metastatic lesions. The Brainstem is divided into three parts namely midbrain, pons...

Conclusion

Characteristic MR imaging appearances of pontine lesions with clinical correlation helps in early diagnosis, monitoring disease progression and appropriate management.

Personal information

References

Harnsberger HR, Osborn AG, Ross J et-al. Diagnostic and Surgical Imaging Anatomy. Lippincott Williams & Wilkins. (2006) ISBN:1931884293. Zuccoli G, Gallucci M, Capellades J et-al. Wernicke encephalopathy: MR findings at clinical presentation in twenty-six alcoholic and nonalcoholic patients. AJNR Am J Neuroradiol. 2007;28 (7): 1328-31. Christian Lampl et al (2002) Central Pontine Myelinolysis. Eur Neurology 47;3-10. H U Rehman (2001) Multiple system atrophy. Postgrad Med;77:379-382. Kumral E et al (2002) Clinical spectrum of pontine infarction. Clinical-MRI correlations. J of Neurology, Dec 249(12) 1659-70. Osborne AG....