White Heart in Pons—A Rare Imaging Sign in Bilateral Pontine Infarction

Abstract

An 89-year-old hypertensive male presented to a local hospital with a history of sudden onset dizziness and two episodes of vomiting after having dinner. On neurological examination, he was drowsy with mild weakness in all the four limbs. He progressively developed tetraplegia within 2 hours of admission and was immediately shifted to our tertiary care center in the emergency department, where he suddenly developed loss of consciousness. He became non-responsive with a Glasgow coma scale (GCS) of E2V1M2. His plantar reflex was bilaterally extensor. He urgently required ventilator support. Routine biochemical tests including serum electrolytes, electrocardiogram, and transthoracic echocardiogram were within normal limits. Magnetic resonance imaging (MRI) brain was performed, which showed acute infarct in bilateral pons with characteristic white heart appearance on diffusion-weighted image (DWI), T2-weighted and fluid-attenuated