What are the signs of a pons stroke?

Signs and Symptoms of Pons Stroke

The most common signs of a pons stroke include facial droop, arm weakness, speech abnormalities, dizziness, vertigo, ataxia, and cranial nerve deficits, which should prompt immediate activation of emergency medical services.

General Stroke Recognition

Common Signs and Symptoms

• Facial droop (asymmetrical facial movement when patient smiles or shows teeth) 1
• Arm drift (one arm drifts down when patient holds both arms out with eyes closed) 1
• Abnormal speech (slurred words, wrong words, or inability to speak) 1
• Sudden numbness or weakness, especially on one side of the body 1, 2
• Sudden confusion or trouble understanding 1, 2
• Sudden trouble seeing in one or both eyes 1, 2
• Sudden trouble walking, dizziness, or loss of balance/coordination 1, 2
• Sudden severe headache with no known cause 1, 2

Stroke Recognition Tools

• The FAST (Face, Arms, Speech, Time) method is recommended to identify potential stroke symptoms 1
• The Cincinnati Prehospital Stroke Scale has a sensitivity of 59% and specificity of 89% when scored by prehospital providers 1
• The presence of a single abnormality on these scales indicates a 72% probability of stroke 1, 2

Specific Signs of Pons Stroke

Characteristic Symptoms

• Dizziness, vertigo, and incoordination (common in vertebrobasilar strokes including pons) 1, 3
• Cranial nerve deficits (particularly affecting facial movement) 1, 3
• Ataxia (unsteady gait or coordination problems) 1, 3
• Visual field loss 1
• Hemiparesis (weakness on one side of the body) 1

Unique Features of Pontine Strokes

• May present with fluctuating symptoms that worsen and improve, known as Pontine Warning Syndrome 3
• Blood pressure fluctuations may correlate with neurological symptom changes 3
• Can involve multiple cranial nerves due to the anatomical location of the pons 3
• May present with "locked-in syndrome" in severe cases (consciousness preserved but quadriplegia and inability to speak) 3

Commonly Missed Stroke Symptoms

• Speech problems are frequently documented in stroke cases not correctly identified by EMS (13%-28% of missed cases) 4
• Nausea/vomiting (8%-38% of missed cases) 4
• Dizziness (23%-27% of missed cases) 4
• Changes in mental status (8%-25% of missed cases) 4
• Visual disturbance/impairment (13%-28% of missed cases) 4

Immediate Response to Suspected Stroke

• If stroke is suspected, activate EMS immediately 1
• Note the exact time when symptoms began (critical for treatment decisions) 2
• If the patient wakes with symptoms, the time of onset is defined as the last time the patient was observed to be normal 1
• Family members should accompany patients when possible to verify symptom onset time 1
• Administer supplementary oxygen to hypoxemic stroke patients (oxygen saturation <94%) 1

Risk Assessment

• The presence of acute facial paresis, arm drift, or abnormal speech increases the likelihood of stroke (LR of ≥1 finding = 5.5) 5
• The absence of all three decreases the odds (LR of 0 findings = 0.39) 5
• Early mortality increases with any combination of impaired consciousness, hemiplegia, and conjugate gaze palsy 5

Important Considerations

• Pontine strokes may be caused by basilar artery branch disease 3
• Hypotension/hypoperfusion should be avoided in patients with pontine strokes 3
• Posterior circulation symptoms (like those in pontine strokes) are among the most commonly missed stroke presentations 4
• Time is critical - fibrinolytic therapy administered within the first hours of symptom onset significantly improves outcomes 1, 2