“alt and Pepper” in the Eye and Face: A Prelude to Braintem Ichemia

Purpoe To report the “alt and pepper”(P) eye pain a a herald ymptom of pontine ichemia. Deign Obervational cae erie. Method We reviewed clinical and neuroimaging finding of four patient who preented initially with the enation of P in the eye and then developed paramedian pontine infarct confirmed by neuroimaging. Reult All of the patient developed other neurologic ymptom or ign, either in aociation with the enation of P in the eye, from hour to day later. Magnetic reonance imaging (MRI) howed paramedian pontine infarct in all of the patient and angiography howed bailar artery occluive dieae in three of them. Concluion Impending pontine ichemia i an important differential diagnoi in patient with acute ocular pain. Prompt neurovacular evaluation and treatment may avoid devatating braintem infarct that caue death or long-term diability, particularly in patient with bailar artery occluive dieae.