Stroke and the Pons Region of the Brain

The pons is a region of the brain located in the brainstem. The pons is relatively small, and it is located in the lower part of the brain, connecting the cerebral cortex with the medulla oblongata. The pons contains nerves and nerve tracts (pathways) that integrate brain functions such as movement and sensory messages between the brain and the body. The pons also coordinates balance in the head, neck, and body and plays a primary role in eye movement, sleeping, dreaming, digestion, swallowing, breathing, and the heartbeat.

In scientific terms, the pons is sometimes known as the hindbrain, a name that is based on the location of the pons in relation to the rest of the brain during the development of the brain in the embryo (developing baby).

A stroke involving the pons can be caused by either a blood clot (ischemic stroke) or a bleed (hemorrhagic stroke).

An ischemic stroke occurs when a blood clot forms, blocking the blood flow through an artery to a certain region in the brain. A hemorrhagic stroke occurs when a blood vessel ruptures, reducing or halting the flow of blood to a region in the brain.

Whether a stroke is ischemic or hemorrhagic, once the blood supply to a region of the brain is interrupted, brain cells begin to die, resulting in brain damage. The bleeding of hemorrhage can also cause damage due to pressure and irritation to nearby brain structures.

The physical and cognitive (memory, thinking) abilities controlled by the area of the brain where a stroke occurs become affected. The extent of damage depends on the location and size of the stroke.

In rare instances, a stroke involving the pons, typically called a pontine stroke, maybe the result of an injury to an artery caused by sudden head or neck trauma. This can happen because the blood vessels that supply blood to the pons and the rest of the brainstem are located in the back of the neck, and may become injured as result of neck trauma or sudden pressure or movements of the head or neck.

Strokes that occur in the pons can cause a variety of serious symptoms, despite the small area of damage involved.

Some of the symptoms of a pontine stroke include a combination of the following:

• Balance difficulty
• Vertigo (spinning sensation)
• Dizziness
• Double vision
• Loss of coordination
• Swallowing difficulty
• Difficulty articulating words
• Numbness
• Loss of sensation
• Weakness in one half of the body
• Nausea

Diagnosis of a pontine stroke requires a thorough neurologic examination. Some diagnostic imaging tests s such as Brain MRI and Brain MRA or CT angiogram can help confirm the diagnosis of a pontine stroke.

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

• High blood pressure
• Diabetes
• Heart disease
• Atrial fibrillation
• Smoking
• Older age
• Family medical history of stroke
• Obesity
• Unhealthy cholesterol and fat levels
• Physical inactivity
• Drug use

Stroke treatment depends on getting medical attention as soon as possible.

Treatment with a clot-dissolving drug, tissue plasminogen activator (tPA) can be effective for the treatment of ischemic stroke only if it is administered within three hours of the onset of stroke symptoms.

During recovery after a stroke, there are several stroke treatments that can help maximize improvement, including mild blood thinners, fluid management, treatment of heart problems and maintaining adequate nutrition.

Recovery from a pontine stroke is possible.

If you have experienced a pontine stroke, once your symptoms stabilize over time, the focus of your recovery will be based on preventing complications such as choking and preventing further strokes from happening.

Strokes in the brain stem do not affect language ability, and this makes it easier to participate in rehabilitation therapy. Vertigo and double vision typically resolve if the stroke is mild or moderate. Physical therapy and rehabilitation are important components of stroke recovery.