What Is a Pontine Stroke and How Does It Affect the Brain?

A pontine stroke is a stroke that occurs in the pons region of the brainstem. The pons is a small part of the lower brain (hindbrain).

Pontine strokes are common. Around 7% of all ischemic strokes are pontine strokes. Recovering from this type of stroke can be a challenging and emotional process that is different for everyone.

This article discusses how a stroke affects the pons. It also looks at the symptoms, causes, and risk factors of a stroke, its diagnosis and treatment, as well as some of the long-term effects of strokes. You will also learn how healthcare providers gauge a person’s recovery from a pontine stroke. 

About the Pons

The cerebral cortex is the outer layer of the brain, and the medulla oblongata is the part of the brain that sends messages to the spinal cord. The pons connects the cerebral cortex and medulla oblongata.

The pons is responsible for many autonomic nervous system functions. These are things that your body does automatically, like regulating your heart rate, responding to pain, and managing your sleep-wake cycle. 

The pons is made up of nerves and nerve pathways that send messages between different parts of the brain. The pons coordinates a number of important functions, including:

• Movement
• Sensory input, such as hearing and taste
• Balance in the head, neck, and body
• Eye movement
• Sleeping
• Dreaming
• Digestion
• Swallowing
• Breathing
• Heartbeat
  

Symptoms of a Pons Stroke

A pons stroke is also called a pontine stroke. Strokes that happen in this part of the brain affect only a small area. 

Some early signs or symptoms of a stroke and the more common symptoms are:

• Balance issues
• Difficulty swallowing
• Dizziness
• Double vision
• Loss of sensation and coordination
• Nausea
• Numbness
• Slurred speech
• Vertigo, or a spinning sensation
• Weakness in one half of the body

Secondary Effects of Pons Stroke

Damage to the pons during a pontine stroke can cause a range of symptoms, such as a loss of sensation or motor control and difficulties with speech or swallowing. 

In severe cases, a person who has had a pontine stroke might need help breathing.

A pontine stroke can cause a rare condition called locked-in syndrome. People with locked-in syndrome are awake, alert, and able to think and understand, but they can only move their eyes.

Causes of Pons Stroke

There are two types of pons strokes:

• Ischemic. An ischemic stroke happens when a blood clot blocks blood flow through an artery to the brain. 
• Hemorrhagic^. A hemorrhagic stroke occurs when a blood vessel breaks, reducing or halting the flow of blood.

Ischemic and hemorrhagic strokes have the same result: Once the blood supply to part of the brain is interrupted, brain cells die and cause brain damage. 

A hemorrhage can also damage nearby brain structures because the bleeding can cause pressure and irritation.

Since the blood vessels that supply blood to the pons and the rest of the brainstem are located in the back of the neck, they can be damaged from a neck injury, sudden pressure, or an abrupt movement of the head or neck. When this happens, a pons stroke can follow. 

A stroke affects the physical and cognitive function of the part of the brain where it happens. 

Cognitive functions include memory and thinking. The extent of the damage depends on the location and size of the stroke.

Diagnosis of Pons Stroke

To diagnose a pontine stroke, a provider can do a neurologic exam and imaging tests of the brain such as:

• Brain magnetic resonance imaging (MRI), a test that uses a magnetic field and radio waves to create images of the brain
• Brain magnetic resonance angiography (MRA), a test that creates images of the arteries in the brain
• Computerized tomography (CT) angiogram, a test that uses multiple X-ray images to look for blockage in the arteries
  

Treatment of Pons Stroke

A stroke is an emergency that needs immediate medical attention. 

The main goal of treating a stroke is to stop the bleeding, address the cause, relieve symptoms, and prevent complications.

A clot-dissolving drug called tissue plasminogen activator (tPA) can be an effective treatment for ischemic stroke. However, it needs to be given within three hours of the onset of stroke symptoms to work. 

Treating a hemorrhagic stroke sometimes can be done with medication and surgery. 

Recovery Timeline

Many patients can make a full recovery from a potion stroke, though others may have permanent problems with motor function.

Recovery from a stroke depends on how large the stroke was, how quickly you got medical attention, and whether you are doing physical, occupational, or other types of therapy while you recover.

While people may only need 3-6 months to recover after a mild stroke, major, large strokes may take years to recover from.

Treatments that can help patients recover from a stroke include:

• Blood thinners
• Fluid management
• Treating heart problems
• Good nutrition

For many people, stroke rehabilitation is a long-term process that includes a combination of strategies like physical therapy, occupational therapy, speech therapy, and sensory reeducation.

Sensory Reeducation

People who have a loss of sensation after a stroke may benefit from sensory reeducation. 

This type of therapy uses touch to stimulate sensory processing in the brain. The goal is to retrain the brain by exposing it to different types of sensory input.

Some exercises used in this type of therapy include:

• Touching things with different textures and sizes
• Identifying objects based on how they feel
• Using your hands to find objects hidden inside a bowl of rice or a similar substance

Although this type of therapy is still new, small studies have shown it can be effective at helping people recover sensation after a stroke.

Physical Therapy

Most people recovering from a stroke will need physical therapy.

The goal of treatment is to relearn the simple motor functions that are needed for day-to-day living, such as standing, walking, sitting, and lying down.

Physical therapy in stroke recovery usually starts with basic movements like switching from a prone position to a sitting position. 

As you progress with your treatment, you will do exercises that help improve your balance and coordination.

Speech Therapy

A speech therapist can help you recover your ability to speak clearly after a stroke. 

This treatment involves retraining your brain with consistent practice. Speech therapy may also include exercises that help improve your control over your mouth and tongue muscles. 

Occupational Therapy

Occupational therapy is similar to physical therapy and involves relearning motor functions. The goal of occupational therapy is to help you become independent again after a stroke.

Your occupational therapist will help you get back skills like eating and drinking, dressing, and bathing. Eventually, you will work on more complex tasks like cooking and doing laundry. 

Prevention

Several factors put you at a higher risk of having a stroke. While there are some things (like your genes) that you do not have control over, there are some stroke risk factors related to your lifestyle that can be changed. 

Risk Factors

The risk factors for a pontine stroke are the same as those for strokes in other areas of the brain and include:

• Aging
• Atrial fibrillation (irregular heartbeat)
• Diabetes
• Drug use
• Family history of stroke
• Heart disease
• High blood pressure
• Obesity
• Sedentary lifestyle
• Smoking
• Unhealthy cholesterol and fat levels
  

Addressing risk factors that you have some control over can help lower your risk of having a pontine stroke.

For example, since high blood pressure is one of the leading causes of stroke, it is important to work with your provider if you have high blood pressure. Medication and lifestyle changes such as cutting back on salt can help you reduce your blood pressure.

Some other ways to lower your risk of a stroke include:

• Eating a nutritious and balanced diet
• Losing weight if needed to be at a weight that supports your health
• Getting regular exercise
• Limiting your intake of alcohol
• Quitting smoking
• Managing chronic health conditions (for example, if you have diabetes, you are two times more likely to have a stroke than people who do not have the condition).
  

Summary

A stroke in the pons region of the brain can cause serious symptoms like problems with balance and coordination, double vision, loss of sensation, and weakness in half the body. Pons strokes can lead to brain damage. 

This type of stroke is diagnosed with a neurologic examination and imaging tests. Some can be treated with a clot-dissolving medication if given soon enough after symptoms begin. People who have certain medical conditions, do not get regular exercise, and smoke or use drugs are at higher risk for any kind of stroke. The risk of stroke also increases with age. 

If you have had a stroke, there are treatments that can help you recover and regain your independence, like physical therapy, but it can take time.