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Disequilibrium in patients with atherosclerosis

Relevance of pontine ischemic rarefaction

From the Departments of Neurology (Drs. Kwa, Zaal, and Stam) and Radiology(Dr. Verbeeten), Academic Medical Center, University of Amsterdam. The Netherlands.

Address correspondence and reprint requests to Dr. Vincent I.H. Kwa, Department of Neurology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands.

Objective: To examine the clinical relevance of isolated pontine hyperintense lesions(PHLs) on MRI in patients with atherosclerosis.

Methods: Seventeen atherosclerotic patients with isolated PHL on MRI were compared with 17 patients without PHL and were matched for age, sex, and initial manifestation of atherosclerosis. Subjects and observer were blinded to the MRI findings. We assessed symptoms, impairment, and disability with a structured interview and neurologic examination as well as disability scales.

Results: On all items, patients with PHL scored worse that did their controls. We found the largest differences in frequencies of symptoms of disequilibrium, difficulties with speech or swallowing, the Timed Walking Test, and the body care and movement subscale of the Sickness Impact Profile. Except for disequilibrium (p = 0.04), these differences did not reach statistical significance. Abnormal tandem-walking tests were more frequent in patients than they were in controls. Pyramidal signs were equally distributed.

Conclusions: We propose PHL as a cause of symptoms of disequilibrium in patients with atherosclerosis. Symptoms are probably elicited by dysfunction of the corticopontine fibers, the pontocerebellar fibers, or the pontine nuclei.

Received January 22, 1998. Accepted in final form April 10. 1998.

*See Appendix on page 573 for a list of participants.

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