Clinical and Radiological Features of Wallerian Degeneration of the Middle Cerebellar Peduncles Secondary to Pontine Infarction.

Zhi-yong Zhang; Zhi-qin Liu; Wei Qin; Ya-wen Chen; Zun-jing Liu

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Clinical and Radiological Features of Wallerian Degeneration of the Middle Cerebellar Peduncles Secondary to Pontine Infarction.

Author: Zhi-Yong ZHANG ¹ ; Zhi-Qin LIU ² ; Wei QIN ³ ; Ya-Wen CHEN ¹ ; Zun-Jing LIU ¹
Author Information

1. Department of Neurology, China-Japan Friendship Hospital, Beijing 100029, China.
2. Department of Neurology, Xi'an Central Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi 710003, China.
3. Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China.
Publication Type:Journal Article
Keywords: Magnetic Resonance Imaging; Middle Cerebellar Peduncles; Neurological Prognosis; Pontine Infarction; Wallerian Degeneration
MeSH: Adult; Aged; Diffusion Magnetic Resonance Imaging; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Models, Biological; Prognosis; Retrospective Studies; Wallerian Degeneration; diagnostic imaging
From: Chinese Medical Journal 2018;131(6):665-671
CountryChina
Language:English
Abstract:
BackgroundWallerian degeneration (WD) of bilateral middle cerebellar peduncles (MCPs) can occur following pontine infarction, but its characteristics have not yet been clarified because of the low incidence. Thus, the present study discussed the clinical and radiological features to improve the awareness of this disease.
MethodsClinical and radiological information from consecutive individuals diagnosed with WD of bilateral MCPs following pontine infarction in three hospitals over the past 4 years between October 2012 and October 2016 were retrospectively investigated and compared with a control group (patients with pontine infarction had no secondary WD).
Results:This study involved 30 patients with WD of MCPs, with a detection rate of only 4.9%. The primary infarctions (χ =24.791, P = 0.001, vs. control group) were located in the paramedian pons in 21 cases (70.0%), and ventrolateral pons in nine cases (30.0%). WD of the MCPs was detected 8-24 weeks after pons infarction using conventional magnetic resonance imaging (MRI); all secondary WDs were asymptomatic and detected incidentally. All WD lesions exhibited bilateral, symmetrical, and boundary blurring on MRI. The signal features were hypointense on T1-weighted imaging, hyperintense on T2-weighted imaging and fluid-attenuated inversion recovery, and slightly hyperintense or isointense on diffusion-weighted imaging and apparent diffusion coefficient maps. Secondary brainstem atrophy was found in six (20.0%) cases. A Modified Rankin Scale score 0-2 was found in 10 (33.3%) cases and score >2 in 20 (66.7%) cases at 90 days after discharge, and the short-term prognosis was worse than that in control group (χ =12.814, P = 0.001).
ConclusionsDespite the rarity of bilateral and symmetrical lesions of MCPs, secondary WD should be highly suspected if these lesions occur within 6 months after pontine infarction, particularly paramedian pons. Conventional MRI appears to be a relatively sensitive method for detecting WD of MCPs, which might affect the short-term prognosis.