Visualization of Culprit Perforators in Anterolateral Pontine Infarction: High-Resolution Magnetic Resonance Imaging Study

Background: The stroke mechanism for anterolateral pontine infarction (ALPI) is poorly understood. We aimed to investigate the perforator arteries relevant to ALPI using high-resolution MRI (HR-MRI).

Methods: Of 62 patients with ALPI who were admitted to the Asan Medical Center, 13 patients agreed to participate in this study. We used HR-MRI with a 3-Tesla scanner and assessed the perforating branches directly connected with the infarcted area.

Results: Perforating arteries penetrating ALPI were identified in all 13 patients. Perforators arising from the basilar artery (BA) were involved in the stroke mechanism in 9 patients, the superior cerebellar artery (SCA) perforator in 1 patient, and the anterior inferior cerebellar artery perforator in 1 patient. In 2 patients, both BA and SCA perforators were involved.

Conclusions: Using 3-Tesla HR-MRI may allow visualization of the perforating branches presumably related to ALPI. Identification of the relevant cerebral perforating arteries may help us to understand the stroke mechanism in patients with posterior circulation territory infarction.