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Association between etiology and lesion site in ischemic brainstem infarcts: a retrospective observational study

Authors Baran G, Ozdemir Gultekin T, Baran O, Deniz C, Katar S, Babacan Yildiz G, Asil T

Received 16 October 2017

Accepted for publication 5 December 2017

Published 13 March 2018 Volume 2018:14 Pages 757—766


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Roger Pinder

Gozde Baran,1 Tugce Ozdemir Gultekin,2 Oguz Baran,3 Cigdem Deniz,3 Salim Katar,3 Gulsen Babacan Yildiz,2 Talip Asil2

1Department of Neurology, Sisli Hamidiye Etfal Research and Training Hospital, 2Department of Neurology, Bezmialem Vakif University, 3Department of Neurosurgery, Istanbul Research and Training Hospital, Istanbul, Turkey

Background and purpose: To assess the anatomical distribution of the ischemic strokes of the brainstem, the effect of anatomical distribution on clinical features and prognosis, and the association between etiology and anatomical involvement.
Methods: A retrospective search of the patient database of our institution was performed for a total of 227 patients who were admitted to the Department of Neurology, Medical Faculty of Bezmialem Vakif University between January 2012 and September 2014. Patients with adequate diagnostic data and 3-month follow-up visit were included in the study.
Results: Twenty-one (9%), 136 (60%), and 65 (29%) patients had an infarction only at the mesencephalon, pons, and medulla, respectively. However, a single patient (0.5%) had an infarction both at the mesencephalon and pons, 3 (1.5%) at the pons and medulla, and 1 (0.5%) at the mesencephalon, pons, and medulla. While anterior involvement was more common in the mesencephalon and pons, posterior and lateral involvement occurred more frequently in the medulla. Large arterial atherothrombosis was the predominant cause of the strokes in all anatomical sites, particularly in infarcts involving the pons. Cardioembolic events were more common in patients with mesencephalic infarcts. Also, ischemia due to dissection was more common in infarctions involving the medulla, especially the lateral medulla. In subjects with simultaneous infarcts at other sites in addition to the brainstem, there was a significantly higher co-occurrence of medullary infarcts with cerebellar infarcts, mesencephalic infarcts with posterior cerebral artery infarcts, and pons infarcts with anterior circulation and multiple infarcts.
Conclusion: Determination of risk factors and infarct localization as well as prediction of etiological parameters may assist in improving survival rates and therapeutic approaches.

Keywords: cerebrovascular disorders, stroke, brain infarction, brain stem infarctions

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