"Salt and pepper" in the eye and face: a prelude to brainstem ischemia.
OBJECTIVE
To report the "salt and pepper"(SP) eye pain as a herald symptom of pontine ischemia.


METHODS
Observational case series.


METHODS
We reviewed clinical and neuroimaging findings of four patients who presented initially with the sensation of SP in the eyes and then developed paramedian pontine infarcts confirmed by neuroimaging.


RESULTS
All of the patients developed other neurologic symptoms or signs, either in association with the sensation of SP in the eyes, from hours to days later. Magnetic resonance imaging (MRI) showed paramedian pontine infarcts in all of the patients and angiography showed basilar artery occlusive disease in three of them.


CONCLUSIONS
Impending pontine ischemia is an important differential diagnosis in patients with acute ocular pain. Prompt neurovascular evaluation and treatment may avoid devastating brainstem infarcts that cause death or long-term disability, particularly in patients with basilar artery occlusive disease.
Department of Neurology, Hospital das Clínicas, São Paulo University, São Paulo, Brazil. abconf@yahoo.com
Adriana B
AB
Conforto
Maria da Graça M
Mda G
Martin
Jovana G M
JG
Ciríaco
Claudia C
CC
Leite
Cynthia R
CR
Campos
Fabio I
FI
Yamamoto
Paulo
P
Puglia
Gabriel
G
Gattás
Milberto
M
Scaff
D000328:Adult; D015901:Angiography, Digital Subtraction; D001157:Arterial Occlusive Diseases / Q000175:diagnosis*; D001488:Basilar Artery / Q000473:pathology*; D002545:Brain Ischemia / Q000175:diagnosis*; D020526:Brain Stem Infarctions / Q000175:diagnosis; D002533:Cerebral Angiography; D003937:Diagnosis, Differential; D005128:Eye Diseases / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis*; D010147:Pain Measurement; D011149:Pons / Q000098:blood supply*; D011379:Prognosis; D012720:Severity of Illness Index