Pontine Infarct Management

Critical Warning Signs

Decreased level of consciousness is the most reliable indicator of tissue swelling and clinical deterioration in pontine stroke 1
Ophthalmoparesis, breathing irregularities, cardiac dysrhythmias, pupillary abnormalities, and loss of oculocephalic responses are signs of pontine compression 1

Initial CT can be normal in up to 25% of cerebellar infarctions, and similar limitations apply to small pontine lesions 1

Rapid diagnosis and early risk stratification are essential to initiate reperfusion therapy and limit infarct size, according to the European Heart Journal 2
ECG monitoring should be initiated immediately to detect life-threatening arrhythmias, and blood sampling for serum markers should be performed but should not delay reperfusion treatment 2
Patients should be placed on bed rest while ischemia is ongoing but mobilized when symptom-free, and supplemental oxygen should be administered if arterial oxygen saturation declines below 90%, as recommended by the Journal of the American College of Cardiology 3
Continuous ECG monitoring is mandatory during the acute phase 2