Pontine Warning Syndrome in a 102-Year-Old Independent Woman: A Rare Cause of Recurrent Fluctuating Neurological Deficits

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Pontine Warning Syndrome (n=1). Intervention: Dual antiplatelet therapy (aspirin and clopidogrel). Primary outcome: Clinical recovery.

Q: What does this research mean for the field?

Treatment with dual antiplatelet therapy can achieve complete neurological recovery in patients presenting with pontine warning syndrome, even at extreme advanced age. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

Muhammad Azfar Zariq Bin Abu Bakar; Wan Haleena Rusydah Binti Wan Ahmad Shahmirrudin; Jahanzeb Rehan

doi:10.7759/cureus.112701

July 15, 2026CureusOpen Access

Pontine Warning Syndrome in a 102-Year-Old Independent Woman: A Rare Cause of Recurrent Fluctuating Neurological Deficits

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Key result

DAPT achieves complete recovery in a 102-year-old presenting with pontine warning syndrome.

n=1

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Why the study?

Pontine warning syndrome presents with recurrent, transient neurological episodes that carry a high risk of subsequent infarction, underscoring the importance of prompt recognition to guide imaging and management.

Key Points

To describe the presentation, diagnostic challenges, and clinical management of pontine warning syndrome in an independent 102-year-old woman presenting with recurrent fluctuating neurological deficits.
Case report evaluating a 102-year-old female presenting with repeated, stereotyped episodes of unilateral weakness and dysarthria.
Diagnostic workup included initial cranial CT followed by brainstem MRI and clinical monitoring of neurological changes relative to blood pressure fluctuations.
Treatment comprised dual antiplatelet therapy alongside cautious blood pressure control initiated after acute neurological stabilization.
Initial cranial CT imaging was normal; MRI subsequently confirmed an acute pontine infarction corresponding to pontine perforator vascular disease.
The patient experienced transient symptom recurrence following an increase in antihypertensive dosage while systolic pressures exceeded 180 mmHg.
Treatment with dual antiplatelet therapy resulted in complete clinical recovery despite an initial post-ictus NIHSS score of 1.

Study Design

Type

Case Report (n=1)

Structured PICO

P

Population

A 102-year-old independent woman with recurrent, stereotyped episodes of unilateral weakness and dysarthria who developed a confirmed pontine infarct.

I

Intervention

Dual antiplatelet therapy (aspirin 75 mg and clopidogrel 75 mg daily) and blood pressure management (losartan 100 mg, amlodipine 5 mg).

O

Outcome

Clinical recovery and MRI confirmation of acute brainstem infarct.

This case highlights the importance of promptly recognizing pontine warning syndrome, as early localization guides imaging strategy, monitoring, and management.

Limitations

Single case report
Optimal management of pontine warning syndrome remains an area of uncertainty

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Implication

May support dual antiplatelet therapy in pontine warning syndrome; hypothesis-generating and requires prospective confirmation before practice change.

Abstract

Pontine warning syndrome describes recurrent, transient neurological episodes arising from pontine pathology and carries a high risk of subsequent infarction. We report the case of a 102-year-old woman who presented with repeated, stereotyped episodes of unilateral weakness and dysarthria before developing a confirmed pontine infarct. Early CT imaging was normal, and the diagnosis was established only after MRI demonstrated an acute brainstem lesion. Her clinical course reflects previously described patterns of fluctuating deficits linked to pontine perforator disease, intermittent hypoperfusion, and sensitivity to blood pressure changes. She was treated with dual antiplatelet therapy and made a complete recovery. This case highlights the importance of recognising pontine warning syndrome promptly, as early localisation guides imaging strategy, monitoring, and management.

Discussion

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Cite This Study

Bakar et al. (2026) conducted a case report in Pontine Warning Syndrome (n=1). Dual antiplatelet therapy (aspirin and clopidogrel) was evaluated on Clinical recovery. Treatment with dual antiplatelet therapy led to a complete recovery in a 102-year-old woman presenting with pontine warning syndrome and recurrent fluctuating neurological deficits.

synapsesocial.com/papers/6a59c6b8a58755010b471c20 https://doi.org/10.7759/cureus.112701

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Pontine Warning Syndrome in a 102-Year-Old Independent Woman: A Rare Cause of Recurrent Fluctuating Neurological Deficits

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Pontine Warning Syndrome in a 102-Year-Old Independent Woman: A Rare Cause of Recurrent Fluctuating Neurological Deficits

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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