Vascular pattern and radiological follow up in a case of pontine warning syndrome

Pontine warning syndrome (PWS) is a condition characterized by crescendo transient ischemic attacks due to
pontine ischemia. The reported case described a 72-year-old woman who presented repetitive sudden episodes of
double vision, impaired balance, slurred speech and right-sided weakness. Neurological deficits lasted a few
minutes-hours and disappeared during the first seven days after onset. On the 1st day, MRI revealed acute left
paramedian pontine infarction with focal swelling. Supra-aortic vessel imagining revealed bilateral internal carotid
stenosis of 50%; hypoplasia of the left vertebral artery. On the 7th day, MRI showed a tissue swelling
reduction, and from that day, she had no symptoms. These clinical and radiological features were suggestive of
PWS. Our patient presented a particular vascular pattern that could favour symptoms fluctuation. We performed a
close MRI follow up and it allowed us to observe a clinical stabilization in association with edema reduction.