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 region is a relatively small part of the lower brain, sometimes called the hindbrain.

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 these two structures.

The pons is responsible for a number of autonomic nervous system functions. These are things that happen automatically in your body, like motor function, your response to pain, and your sleep-wake cycle.

This article discusses stroke and its effect on the pons. It also looks at the symptoms, causes, and risk factors of stroke, as well as diagnosis and treatment. 

 Verywell / Hilary Allison

About the Pons

The pons contains nerves and nerve tracts, also called pathways. These nerves and pathways 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 occur in this part of the brain affect only a small area. Still, they can cause a variety of serious symptoms, including:

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

Causes of Pons Stroke

There are two types of pons strokes:

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

Ischemic and hemorrhagic strokes have the same basic result: Once the blood supply to part of the brain is interrupted, brain cells begin to die, causing brain damage. A hemorrhage can also cause damage to nearby brain structures. This is 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 could be damaged from a neck injury, sudden pressure, or an abrupt movement of the head or neck. When this happens, a pons stroke may occur.

A stroke affects the physical and cognitive function of the part of the brain where it occurs. Cognitive functions include memory and thought. The extent of the damage depends on the location and size of the stroke.

Recap

A pons stroke can be caused by a blood clot or a ruptured blood vessel. Both types reduce or halt blood flow to the brain, causing brain damage.

Diagnosis of Pons Stroke

Pontine strokes are diagnosed with a neurologic exam. Some imaging tests can help confirm the diagnosis. These include:

  • 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
  • Computerized tomography (CT) angiogram, a test that uses multiple X-ray images to look for blockage in the arteries

Recap

Pontine strokes are diagnosed after a neurologic exam. An imaging test can confirm the diagnosis.

Treatment of Pons Stroke

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

Treating a hemorrhagic stroke may involve medication and surgery. The immediate goal is to stop the bleeding, address the cause, relieve symptoms, and prevent complications.

In 2018, the American Heart Association and American Stroke Association issued guidelines for stroke treatment. The guidelines strongly recommend the use of tPA in eligible patients. However, doctors must evaluate each patient carefully before using the drug. Factors that play a role in eligibility include:

In certain patients, tPA can be used up to 4.5 hours after the onset of symptoms.

Recovery

Several treatments can help patients recover from a stroke. They include:

  • Blood thinners
  • Fluid management
  • Treatment of heart problems
  • Good nutrition

For many people, long-term rehabilitation will be necessary. This usually includes some combination of therapies such as physical therapy, occupational therapy, speech therapy, and sensory reeducation.

Sensory Reeducation

People who experience loss of sensation after a stroke may benefit from sensory reeducation. This is a type of therapy that 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 similar substance

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

Physical Therapy

Most people who are recovering from a stroke will be enrolled in physical therapy. The goal of this type of therapy 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 for stroke recovery usually begins with simple movements like switching from a prone position to a sitting position. As you progress, 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. This involves retraining your brain with consistent practice. Speech therapy may include exercises that help improve your control over your mouth and tongue muscles. 

Occupational Therapy

Occupational therapy is similar to physical therapy, in that it involves relearning certain motor functions. The goal of occupational therapy, however, is to help you become independent again.

Your occupational therapist will work with you on relearning skills like eating and drinking, dressing, and bathing. Eventually, you will also work on skills like cooking and doing laundry. 

Prevention

There are a number of factors that can put you at greater risk for having a stroke. Many of these are lifestyle choices 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. They include:

Some of the things that put you at greater risk for stroke can't be controlled, such as age and genetics. There are some steps you can take, however, to reduce your risk.

Because high blood pressure is one of the leading causes of stroke, it is important to work with your healthcare provider if you have high blood pressure. Medication and lifestyle changes such as reducing your intake of salt and watching your cholesterol can help you reduce your blood pressure.

Some other ways to prevent stroke include:

If you have diabetes, it is important to make sure it is well-controlled. People with diabetes are 2 times more likely to have a stroke than those without.

Summary

A stroke in the pons region of the brain can cause serious symptoms. These may include problems with balance and coordination, double vision, loss of sensation, and weakness in half the body. 

Pons strokes can lead to brain damage. They are 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, are inactive, or who 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 different types of therapies available that can help you recover and regain your independence.

A Word From Verywell

The faster that you respond to and get emergency treatment for a possible stroke, the better the chances for a robust recovery. This is why healthcare professionals promote the acronym FAST, which ties stroke symptoms to the face, arms, speech, and time to call 911. Ask:

  • Is your face drooping?
  • Can you raise both arms evenly?
  • Are you slurring your words or having trouble speaking?
  • Did you answer yes to any one of these questions? Then it's time to call 911.

Frequently Asked Questions

  • Can you recover from a pontine stroke?

    Yes. Many patients can make a full recovery, though some may have permanent problems with motor function. Recovery often depends on how large the stroke was, how quickly you received medical attention, and whether you are enrolled in physical, occupational, or other types of therapy while you recover.

  • What happens if the pons is damaged during a pontine stroke?


    The damage to the pons that happens during a pontine stroke can cause a range of symptoms. These can include things like 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. Locked-in syndrome is another possible though rare result of a pontine stroke.

  • How common are pontine strokes?

    Pontine strokes are common. Around 7% of all ischemic strokes are pontine strokes. 

  • How long does it take to fully recover from a pontine stroke?

    Recovering from a pontine stroke often depends on the size of the stroke and how quickly you received medical attention. Recovering from a smaller stroke may take only a few months. Larger strokes, however, may require years of rehabilitation.

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11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Stroke Association. Brain stem stroke.

  2. Xia C, Chen H, Wu S, Xu W. Etiology of isolated pontine infarctions: a study based on high-resolution MRI and brain small vessel disease scores. BMC Neurol. 2017;17(1):216. doi:10.1186/s12883-017-0999-7.

  3. Khaku AS, Tadi P. Cerebrovascular disease. [Updated 2021 Sep 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430927/.

  4. University of Maryland Medical Center. Hemorrhagic stroke.

  5. Powers WJ, Rabinstein AA, et al. 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018;49(3):e46-e110. doi:10.1161/STR.0000000000000158.

  6. Varsou O, Stringer M, Fernandes C, Schwarzbauer C, Macleod M. Stroke recovery and lesion reduction following acute isolated bilateral ischaemic pontine infarction: a case report. BMC Res Notes. 2014;7:728. doi:10.1186/1756-0500-7-728.

  7. Hughes CM, Tommasino P, Budhota A, Campolo D. Upper extremity proprioception in healthy aging and stroke populations, and the effects of therapist-and robot-based rehabilitation therapies on proprioceptive function. Front Hum Neurosci. 2015;9:120. doi:10.3389/fnhum.2015.00120

  8. National Institute on Aging. Rehabilitation after stroke.

  9. American Stroke Association. Diabetes and stroke prevention.

  10. Johns Hopkins Medicine. Stroke recovery timeline.

  11. Huang J, Qiu Z, Zhou P, et al. Topographic location of unisolated pontine infarction. BMC Neurol. 2019;19(1):1-6. doi:10.1186/s12883-019-1411-6

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