Sequential Pontine Strokes With the “Heart Appearance” Sign

Most brainstem infarcts are caused by pontine strokes. When a bilateral pontine or brainstem stroke occurs, it can result in an image called the “heart appearance” sign. Sequential pontine strokes have not yet been described to cause the “heart appearance” sign. We report a case of sequential pontine strokes in a 47-year-old man with no relevant medical history. He presented with acute left-sided hemiparesis. Initial brain MRI showed a right-sided pontine infarction. Two weeks later, the patient’s left side hemiparesis and dysarthria worsened, and he developed right-sided facial paralysis. The brain MRI showed a left-sided pontine infarction that looked like the “heart appearance” sign. The patient had a good recovery. This report highlights a case of atypical pontine stroke recurrence two weeks apart and discusses branch artery disease as a possible etiologic cause.