Pontine Hemorrhage Simulating Acute Coronary Syndrome

Intracerebral hemorrhage in the pons can, on rare occasions, present with acute coronary syndrome-like symptoms via neurogenic cardiac findings, such as electrocardiographic changes and increased cardiac biomarkers. The challenge in this condition is that the treatment for acute coronary syndrome can potentially exacerbate the neurological outcome in hemorrhagic stroke. Neurogenic stress-induced cardiomyopathy in pontine hemorrhage is a result of autonomic dysfunction and excess catecholamine, which cause reversible myocardial dysfunction in the absence of obstructive coronary artery disease. The key to this condition is the proper differentiation between true myocardial ischemia and neurogenic cardiac injury to avoid the risks of antithrombotic therapy and invasive cardiac procedures. This review aims to highlight the neurocardiac mechanisms, challenges, and implications of pontine hemorrhage presenting with acute coronary syndrome-like symptoms.