Teaching NeuroImages: Postoperative bifocal stroke of the pontine tegmentum: Why don't you smile anymore?

A 7-year-old boy underwent resection of a posterior fossa medulloblastoma. Two days later, he developed facial diplegia, left abducens nerve palsy, and mild hypalgesia below the neck. MRI documented 2 dot-like ischemic foci in the pons (figure). We diagnosed the unusual bilateral occurrence of Gasperini syndrome, a lesion of the sixth and seventh cranial nerve nuclei and the lateral spinothalamic tract that produces ipsilateral cranial nerve palsies with contralateral hemisensory deficits.1 We hypothesized a mechanism of postoperative spasm of long circumferential branches of the basilar artery. This mechanism should be considered in cases of postoperative neurologic deficits with delayed onset.2

Source: Neurology - May 12, 2014 Category: Neurology Authors: Frassanito, P., Massimi, L., Tamburrini, G., Di Rocco, C., Caldarelli, M. Tags: Childhood stroke, MRI, Clinical neurology examination, Pediatric stroke; see Cerebrovascular Disease/ Childhood stroke RESIDENT AND FELLOW SECTION Source Type: research