A Special Case of Bilateral Pontine Infarct with the “Mushroom Appearance” Sign

A 74-year-old woman was admitted to the hospital because of sudden dizziness and right hemiparesis. She has a history of hypertension for 3 years. Three days later, the patient developed left hemiparesis. The magnetic resonance imaging (MRI) showed diffusion-weighted imaging (DWI) increased signal on the bilateral anteromedial pontine region as expected to a stroke, with the characteristic “mushroom appearance” sign [Figure 1]. Cranial computed tomography angiography (CTA) demonstrated that the basilar artery remained intact.Figure 1: DWI shows an increased signal on the bilateral anteromedial pontine regionBilateral pontine infarctions are rare and usually caused by basilar artery occlusion or stenosis. The unique image feature of this case has never been reported before and may be caused by the basilar artery branch disease.[1] This is particularly important to identify the pathogenesis of bilateral pontine infarction and fend off differential diagnoses, such as central pontine myelinolysis, rhombencephalitis, and diffuse pontine glioma.[2] Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initial will not be published and due efforts will be made to conceal his identity. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.