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Putting pontine anatomy into clinical practice: the 16 syndrome
  1. Matthew R B Evans1,
  2. Robert A Weeks2
  1. 1MRC Centre for Neuromuscular Diseases, London, UK
  2. 2Department of Clinical Neuroscience, Ruskin Wing, King's College Hospital, London, UK
  1. Correspondence to Dr Matthew R B Evans, MRC Centre for Neuromuscular Diseases, 8-11 Queen Square, London WC1N 3BG, UK; matthew.evans{at}


The anatomical localisation of brainstem syndromes is the domain of the clinical neurologist, though MRI has made an encyclopaedic knowledge of neuroanatomy less crucial. Isolated pontine syndromes comprise ∼20% of the brainstem lacunar syndromes. Typical presentations such as pure motor hemiparesis and ataxic hemiparesis are easily recognisable but atypical syndromes, particularly when bilateral, may present with puzzling signs. We discuss a patient with an unusual acute bilateral brainstem syndrome, in whom MRI was contraindicated. We use the relevant neuroanatomy to support the likely diagnosis of bilateral caudal pontine tegmentum infarction due to occlusion of a single paramedian pontine tegmental perforating artery.


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  • Contributors MRBE drafted the paper. MRBE and RAW edited the paper and are responsible for the final version. RAW is the neurologist caring for the patient.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Commissioned; externally peer reviewed. This paper was reviewed by Tom Hughes, Cardiff, UK.

  • ▸ References to this paper are available online at

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  • Editors' commentary
    Phil E M Smith Geraint N Fuller

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