Management of Stroke, with right pontine infarction

Priyanga*

Senior Staff Nurse, Kauvery Hospital, Salem, Tamil Nadu

*Correspondence

Abstract

This case report described the recent successful management of a patient diagnosed with recent stroke associated with right-side Pontine Infarction, Left sided Hemiplegia and hypo responsiveness, Detailed clinical assessment, Radiological evaluation, electrolytes correction, nursing care, rehabilitation and nutritional Support resulted in gradual clinical improvement.

Key words: Pontine Infarction; Hemiplegia

Introduction

Stroke is a neurological emergency caused by interruption of blood supply to the brain, resulting in neurological deficits. Pontine infarction affects the brainstem and can cause motor weakness, swallowing difficulty and altered consciousness. Earlier diagnosis, prompt medical management and comprehensive nursing care are essential for recovery.

Case Presentation

The patient is a known case of left side hemiplegia since 22/3/2026, with right pontine infarction. He was on regular treatment and rehabilitation. During The present illness, he developed decreased responsiveness associated with vomiting and loose stools for one week. Due to worsening symptoms the  patient was admitted for further evaluation and management.

Relevant Clinical Findings:

  • Decreased response since 1 Week
  • Vomiting × 3 days
  • Loose stool x 3 Days
  • Reduced oral intake
  • Reduced motor activities on the left side

Relevant Investigation and Results

Fig(1): MRI findings

  • Subacute to chronic infarcts in the Right hemi pons and right middle cerebellar peduncle. No evidence of hemorrhagic transformations
  • Mild cerebral atrophy with chronic small vessel ischemic changes
  • Chronic lacunar hemorrhages in bilateral ganglio capsular regions and left Corona Radiata
  • Micro bleeds in the bilateral cerebellar hemispheres
  • No evidence of large vessel occlusion in brain and neck.

Laboratory findings

Lab Tests28.04.202629.04.202630.04.202601.05.2026
Serum Sodium98121128130
Serum Potassium3.45.03.93.4

Diagnosis

  • Recent cerebrovascular Accident
  • Right-sided Pontine Infarction
  • Left Side Hemiplegia
  • Hyponatremia

Management

  • On Admission, Serum Sodium level was found to be 98 mEq/L . Appropriate treatment was initiated for correction of severe hyponatremia, as pe physician’s order [NACL 3% 10ml /Hr On flow]
  • Serum Potassium level was 3.4 and Potassium correction was given as prescribed by the doctor [KCL 1 amp in 500 ml NS]
  • Syrup KCL 15 ml TDS followed IV correction
  • Supportive treatment and close monitoring of vitals and electrolytes were maintained

Nursing Management

On admission, the patient had a Ryle’s Tube in situ and was bedridden due to left hemiplegia and right pontine infarction. Comprehensive nursing care was provided throughout the hospital stay.

  • Vital signs, neurological status, and pupillary reaction were monitored regularly.
  • Airway patency was maintained, and aspiration precautions were followed during feeding.
  • Ryle’s tube feeding was administered as prescribed, and feeding tolerance was closely monitored.
  • Strict intake and output chart were maintained.
  • The patient was repositioned every 2 hours to prevent pressure injuries. Pressure area care, back care, and skin integrity assessment were performed regularly.
  • Passive and active range-of-motion exercises were carried out as tolerated.
  • Affected limbs were supported with pillows, and proper body alignment was maintained.
  • Oral hygiene was provided regularly.
  • Swallowing ability was assessed periodically.

With continuous nursing care, medical management, and rehabilitation, the patient showed gradual improvement. Feeding through Ryle’s tube gradually transitioned to oral intake after improvement in swallowing ability. The patient tolerated oral feeds well without aspiration.

Mobility status improved gradually with physiotherapy and nursing assistance. The patient progressed from bed-bound status to sitting, standing with support, and subsequently ambulation with the assistance of a Walker.

The patient showed improvement in overall functional status, nutritional intake, mobility, and neurological response.

Discharge

At the time of discharge, the patient was hemodynamically stable, tolerating oral feeds, and able to ambulate with the assistance of Walker. The patient and family were educated regarding medication compliance, physiotherapy, nutritional care, skin care, and follow-up

Discussion, medical aspects

Pontine infarction is a serious neurological condition that may result in hemiplegia, swallowing difficulty, and altered consciousness. Severe hyponatremia may worsen neurological symptoms. Early diagnosis and timely correction of electrolyte imbalance contributed significantly to clinical improvement, functional independence and quality of life.

Conclusion

This case highlights the importance of multidisciplinary management, early neurological assessment, electrolyte correction, comprehensive nursing care, and rehabilitation in improving outcomes in stroke patients with pontine infarction.w

Outcome

The patient showed gradual clinical improvement during the hospital stay Electrolyte imbalance was corrected, and the level of consciousness improved. Swallowing ability improved gradually, Ryles Tube feeding was transitioned to oral feeding, and the patient’s oral intake was good, Mobility improved from bedridden status to assisted ambulation.

References

  1. American Stroke Association, guideline for the management of acute ischemic Store.
  2. National Institute of Neurological Disorder and Stroke, Stroke Information and rehabilitation.
  3. Brunner and Siddarth’s textbook of medical – surgical nursing . Hinkle JL , Cheever KH., 15th edition, Philadelphia : Wolters Kluwer ,2022.

Nightingale Journals

Kauvery Hospital
Find Doctor
Book Appointment