• Adriana B Conforto, Maria da Graça M Martin, Jovana G M Ciríaco, Claudia C Leite, Cynthia R Campos, Fabio I Yamamoto, Paulo Puglia, Gabriel Gattás, and Milberto Scaff.
• Department of Neurology, Hospital das Clínicas, São Paulo University, São Paulo, Brazil. abconf@yahoo.com
• Am. J. Ophthalmol. 2007 Aug 1; 144 (2): 322-5.

PurposeTo report the "salt and pepper"(SP) eye pain as a herald symptom of pontine ischemia.DesignObservational case series.MethodsWe 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.ResultsAll 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.ConclusionImpending 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.

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