A clinical characteristic analysis of five cases of rare bilateral cerebral peduncular infarction (BCPI) with the 'Mickey Mouse ears' sign

Objective: To investigate the clinical manifestations, magnetic resonance imaging (MRI) features, and prognosis of patients diagnosed with bilateral cerebral peduncular infarction (BCPI) with the 'Mickey Mouse ears' sign. Methods: This study, retrospectively summarized the clinical features, MRI and magnetic resonance angiography (MRA) manifestations, and prognosis of 5 patients diagnosed with BCPI and with the 'Mickey Mouse ears' sign from our hospital. In the meantime, we also systematically analyzed and summarized the clinical and imaging features, and prognosis in combination with relevant cases from the national and international literature that had been reported. Results: In our study, five cases presented tetraplegia whereas 4 cases presented disturbance of consciousness. In all cases, the 'Mickey Mouse ears' sign was observed in the mid-brain level using a diffusion-weighted imaging (DWI) cross-section. The MRA images showed thrombosis on either the basilar artery (BA), posterior cerebral artery (PCA), or superior cerebellar artery (SCA). All the studied patients received standardized treatment for cerebral infarction. However, three patients died and the remaining two were left in a locked-in syndrome state. Conclusions: BCPI is a very rare stroke disease and its main clinical manifestations are locked-in syndrome and persistent vegetative states. However, the obtained imaging features on the brain-MRI of patients diagnosed with BCPI with the 'Mickey Mouse ears' sign can predict a bad prognosis.