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Medial Pontine Hemorrhagic Stroke

JL Ruhland, PT, MA, is Staff Physical Therapist, Meriter Health Center, Madison, Wis, and a graduate student in the Department of Kinesiology, University of Wisconsin–Madison, Madison, Wis
PLE van Kan, PhD, is Associate Professor, Department of Kinesiology, Room 3195, Medical Sciences Center, University of Wisconsin–Madison, 1300 University Ave, Madison, WI 53706-1532 (USA) (vankan{at}education.wisc.edu). Address all correspondence to Dr van Kan

Background and Purpose. This case report documents a rare opportunity to observe the motor function of an individual for nearly 6 months following a primary pontine hemorrhage in the medial pontine tegmentum of the brain stem. The purpose of this report is to illustrate how knowledge of the location of the hemorrhage, in conjunction with knowledge of brain-stem structure-function relationships, informs physical therapist examination and intervention. Case Description. RM, a right-handed 81-year-old man with hypertension, had a hemorrhagic brain-stem stroke that severely compromised control of posture and whole-limb movements. Some residual ability to use the right hand and fingers remained, provided the trunk and right upper arm were stabilized. RM had undiminished intellectual abilities and unaltered memory because of sparing of cerebral cortices. RM's cognitive abilities, however, were obscured by severe impairments in interpersonal communication because of extensive damage to cranial nerve structures. Computed tomographic scans verified that the hematoma crossed the midline and was confined to the medial pontine tegmentum. Discussion. We interpret motor deficits resulting from stoke in the medial pontine tegmentum in terms of damage to brain-stem descending motor systems and ascending somatosensory systems. Recognition of cognitive and residual motor abilities following brain-stem stroke can aid in the development of rehabilitation strategies.

Key Words: Brain-stem stroke • Descending motor systems • Motor rehabilitation • Neural control of movement • Primary pontine hemorrhage • Quality of life

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