Wallerian Degeneration of the Bilateral Middle Cerebella Peduncles Secondary to Unilateral Pontine Hemorrhage

The bilateral and symmetrical Wallerian degeneration (WD) of the middle cerebellar peduncles (MCPs) is rarely reported in pontine hemorrhage. We described a patient with WD of bilateral MCPs secondary to a strip of unilateral and transversal pontine hemorrhage. Magnetic Resonance Imaging showed hyperintensity on T2-weighted, fluid attenuation inversion recovery and diffusion weighted image, and hypointensity on T1-weighted and apparent diffusion co-efficient map, and no enhancement in bilateral MCPs. These abnormal signals existed over 6 months and subsided gradually. The patients didn’t present with new symptoms when WD happened, the initial clinical manifestations related to pontine hemorrhage persisted for more than one year. In conclusion, a single unilateral pontine stroke along “cross” or “trident” line may cause WD of the bilateral MCPs in the below slice. Although this pathological change brings no additional new symptoms, it is related to the short‑term of poor neurological prognosis after pontine stroke. In addition, since this lesion appears restricted diffusion in the imaging, we should avoid misdiagnosing it as new infarction