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case_images: Computed tomography (CT) of the head without contrast showing hypodensity in the right side of pons, not crossing the midline (highlighted within the red circle).
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case_images: Computed tomography of the head without contrast showed hypodensity in central pons suggestive of an acute infarct (Figure 1).
case_images: (A) Volumetric reconstruction of the initial CT angiogram demonstrates severe stenosis of the left intradural vertebral artery (arrowhead). (B) Volumetric reconstruction of the subsequent CT angiogram reveals no significant change.. Abbreviation: CT, computed tomography.
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case_images: Computed tomography angiography revealed severe left intracranial vertebral artery stenosis as well as moderate right cervical internal carotid artery (ICA) stenosis (Figure 2A). Repeat CT angiography showed no change in the high-grade left vertebral artery stenosis and patent basilar artery (Figure 2B).
case_images: Axial diffusion-weighted image at the level of the brainstem from (A) the initial MRI examination demonstrates acute right paracentral pontine infarct; (B) subsequent MRI examination demonstrates larger acute right pontine infarct as well as new acute infarct of the left paracentral pons.. Abbreviation: MRI, magnetic resonance imaging.
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case_images: Magnetic resonance imaging of the brain showed an extensive, irregularly shaped acute infarct of the right paramedian, in addition to chronic moderate small-vessel ischemic disease, a chronic left caudate head infarct with petechial hemorrhage as well as a few scattered cerebral microhemorrhages (Figure 3A). However, the repeat MRI of the brain now showed expansion of pontine stroke to now involving the left paracentral pons in addition to the previous right paracentral pons (Figure 3B).