We evaluated a 60-year-old man with hypertension and diabetes who presented with dysarthria and left-sided weakness. Diffusion-weighted magnetic resonance (MR) imaging showed an infarct in the right paramedian pontine distribution (Figure 1). This area is supplied by perforators from the basilar artery. T2-weighted MR imaging revealed a plaque in the midbasilar artery at the level of the pontine perforators (Figure 2). Results of the MR angiogram were normal. The lesion site in the basilar artery and the pontine infarction suggest a causal link.
Mehdiratta M, Caplan LR, Kumar S. Basilar Artery Branch Disease Imaged by Magnetic Resonance Imaging. Arch Neurol. 2007;64(11):1666. doi:10.1001/archneur.64.11.1666