
Found Two Bilateral Pontine Hyperintensities In The Pons. Numbness In Upper Lip And Nose. Is It A Stroke? What Could Cause Bilateral Pattern?

My replies are below
Detailed Answer:
Hi,
Thank you for posting your query.
I can understand your concern on account of recurrent symptoms and lack of a clear cut diagnosis.
In my opinion, the most likely possibilities are demyelination or ischemia and not a brain tumour. The explanations are given below:
1. Demyelination: The most common condition to cause these recurrent symptoms and hyperintense lesions on brain is multiple sclerosis (MS), the commonest demyelinating disease of the brain. Myelin refers to the covering of nerves, and in MS, this covering gets damaged, hence, the term demyelination. MS is common in women and in young ages.
However, there needs to be multiple lesions in the brain including involvement of periventricular regions and corpus callosum to make a confirmed diagnosis of MS. So, at this stage, based on the pure involvement of pons, without involvement of other parts of brain (or spinal cord), we can not make a diagnosis of MS.
So, we need to follow you up and do a repeat scan after six months to see if any new lesions in brain have developed or not.
2. Ischemia- refers to lack of blood flow in the brain. This can result in hyperintense lesions in the brain, as in your case, however, typically they affect only one side of pons.
Moreover, ischemia or blood clot in the brain is uncommon at your age, in the absence of risk factors (such as diabetes, high blood pressure, high cholesterol or high homocysteine and smoking).
The MR angiogram of brain would be useful to exclude ischemia, as that would show narrowing of blood vessels in the brain.
3. Tumor- is unlikely as it would not disappear on MRI. You mentioned that one of the MRI s (the second one) showed normal brain and the pons lesion was not seen. This in unlikely to happen in a case of brain tumor, as tumors continue to grow and would increase in size over a period of time.
Also, the symptoms in a case of brain tumor would not resolve in 3-4 weeks, but they would continuously persist. So, I do not think these lesions are tumours including glioma.
Increased LD levels and positive ANA levels are possibly false positives, as they do not explain the clinical symptoms as well as the MRI lesions.
I hope it helps. I would be pleased to offer any help or provide you with any more information, if that can help you in any way.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist

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