Research Article| Volume 357, ISSUE 1-2, P131-135, October 15, 2015

Assessment of bilateral cerebral peduncular infarction: Magnetic resonance imaging, clinical features, and prognosis


      • BCPI is an extremely rare neurological disorder.
      • It is related to vertebrobasilar artery stenosis with a pathogenesis of hypoperfusion.
      • Its prognosis was poor.
      • The sign of BCPI on DWI was termed Mickey Mouse ears.
      • The pons is the other most common location of infarction beside BCP.



      Bilateral cerebral peduncular infarction (BCPI) is an extremely rare neurological disorder, and related literature is scarce. This study investigated the clinical manifestations, magnetic resonance imaging (MRI) features and prognosis of BCPI.


      We retrospectively reviewed the clinical features, MRI and magnetic resonance angiography manifestations, and prognosis of 14 patients with BCPI, confirmed by diffusion-weighted MRI from 5050 cerebral infarction patients at our medical center from January 2007 to June 2013.


      Eleven of the 14 (78.6%) patients had quadriplegia and 9 (64.3%) had decreased consciousness. At the most severe stage, the National Institutes of Health Stroke Scale scores ranged from grades 4 to 26 (mean grade, 18.9). Eleven (78.6%) cases were caused by large artery atherosclerosis. Besides the bilateral cerebral peduncle, the pons (85.7%) and cerebellum (42.9%) were the other infarct locations. Twelve (85.7%) patients had vertebrobasilar artery occlusion or severe stenosis, and 12 (85.7%) did not have collateral patency of the posterior cerebral artery. Thirteen (92.9%) patients had poor prognosis and 9 of them died.


      BCPI is a very rare disorder and associated with severe vertebrobasilar artery stenosis or occlusion without collateral patency of the posterior communicating artery. It has a very poor prognosis.


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        • Tokunaga T.
        • Kita Y.
        • Yamamoto T.
        A case of the persistent vegetative state following symmetrical peduncular infarction.
        No To Shinkei. 2002; 54: 57-61
        • Asakawa Y.
        • Suzuki K.
        • Takekawa H.
        • Okamura M.
        • Komagamine T.
        • Kawasaki A.
        • et al.
        The ‘Mickey Mouse ears’ sign: a bilateral cerebral peduncular infarction.
        Eur. J. Neurol. 2013; 20: e37-e39
        • Kim J.S.
        • Kim J.
        Pure midbrain infarction: clinical, radiologic, and pathophysiologic findings.
        Neurology. 2005; 64: 1227-1232
        • Adams Jr., H.P.
        • Bendixen B.H.
        • Kappelle L.J.
        • Biller J.
        • Love B.B.
        • Gordon D.L.
        • et al.
        Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke treatment.
        Stroke. 1993; 24: 35-41
        • Caplan L.
        • Wityk R.
        • Pazdera L.
        • Chang H.M.
        • Pessin M.
        • Dewitt L.
        New England Medical Center Posterior Circulation Stroke Registry: I. Methods, data base, distribution of brain lesions, stroke mechanisms, and outcomes.
        J. Clin. Neurol. 2005; 1: 31-49
        • DeGraba T.J.
        • Hallenbeck J.M.
        • Pettigrew K.D.
        • Dutka A.J.
        • Kelly B.J.
        Progression in acute stroke: value of the initial NIH stroke scale score on patient stratification in future trials.
        Stroke. 1999; 30: 1208-1212
        • Banks J.L.
        • Marotta C.A.
        Outcomes validity and reliability of the modified Rankin scale: implications for stroke clinical trials: a literature review and synthesis.
        Stroke. 2007; 38: 1091-1096
        • Markus H.S.
        • van der Worp H.B.
        • Rothwell P.M.
        Posterior circulation ischaemic stroke and transient ischemic attack: diagnosis, investigation, and secondary prevention.
        Lancet Neurol. 2013; 12: 989-998
        • Ogawa K.
        • Suzuki Y.
        • Oishi M.
        • Kamei S.
        Clinical study of twenty-one patients with pure midbrain infarction.
        Eur. Neurol. 2012; 67: 81-89
        • John S.
        • Hegazy M.
        • Cheng Ching E.
        • Katzan I.
        Isolated bilateral middle cerebellar peduncle infarcts.
        J. Stroke Cerebrovasc. Dis. 2013; 22: 645-646
        • Kim S.H.
        • Lee J.Y.
        • Kim do H.
        • Ham J.H.
        • Song Y.K.
        • Lim E.J.
        • et al.
        Factors related to the initial stroke severity of posterior circulation ischemic stroke.
        Cerebrovasc. Dis. 2013; 36: 62-68
        • Petty G.W.
        • Brown Jr., R.D.
        • Whisnant J.P.
        • Sicks J.D.
        • O'Fallon W.M.
        • Wiebers D.O.
        Ischemic stroke subtypes. A population-based study of functional outcome, survival, and recurrence.
        Stroke. 2000; 31: 1062-1068
        • Riles T.S.
        • Eidelman E.M.
        • Litt A.W.
        • Pinto R.S.
        • Oldford F.
        • Schwartzenberg G.W.
        Comparison of magnetic resonance angiography, conventional angiography, and duplex scanning.
        Stroke. 1992; 23: 341-346
        • Khan S.
        • Rich P.
        • Clifton A.
        • Markus H.S.
        Noninvasive detection of vertebral artery stenosis: a comparison of contrast-enhanced MR angiography, CT angiography, and ultrasound.
        Stroke. 2009; 40: 3499-3503
        • Abilleira S.
        • Cardona P.
        • Ribó M.
        • Millán M.
        • Obach V.
        • Roquer J.
        • et al.
        Outcomes of a contemporary cohort of 536 consecutive patients with acute ischemic stroke treated with endovascular therapy.
        Stroke. 2014; 45: 1046-1052
        • Möhlenbruch M.
        • Stampfl S.
        • Behrens L.
        • Herweh C.
        • Rohde S.
        • Bendszus M.
        • et al.
        Mechanical thrombectomy with stent retrievers in acute basilar artery occlusion.
        AJNR Am. J. Neuroradiol. 2014; 35: 959-964
        • Lee S.J.
        • Cho S.J.
        • Moon H.S.
        • Shon Y.M.
        • Lee K.H.
        • Kim D.I.
        • et al.
        Combined extracranial and intracranial atherosclerosis in Korean patients.
        Arch. Neurol. 2003; 60: 1561-1564