Background and purpose: Isolated pontine strokes cause characteristic neurolog ical syndromes and have a good short-term prognosis. The aim of this study was to examine the longterm survival, cumulative recurrence rate and clinical handic ap of patients with isolated pontine infarcts of different aetiology. Methods: O ne hundred consecutive patients with an isolated pontine infarction were identif ied by imaging studies and evaluated prospectively. After extensive study, cases were classified according to the aetiopathogenetic mechanisms: stroke due to ba silar artery branch disease (BABD), small-artery disease (SAD) and large-artery-occlusive disease (LAOD). During a mean follow-up period of 46 months, stroke presentation and initial course, early and long-term mortality, disability and recurrence were evaluated. Results: BABD was the most frequent c ause of isolated pontine ischaemia (43 %), followed by SAD (34%) and LAOD (21 %). Hypertension was the most prominent risk factor, especially among patients with SAD (94.1 %). Neurological impairment on admission was more severe in the LAOD group, followed by BABD. After 1 month patients with LAOD had the highest c umulative mortality (14.3%, p=0.026) and more severe disability (61.1%, p=0.00 1). Fiveyear mortality rate was 20.6%, 14%and 23.8%in the SAD-, BABD-and in LAOD-group respectively (p=0.776). Cumulative 5-year recurrence rate was 2.3 %for BABD, 14.3 %for LAOD, and 29.4 %for SAD (p=0.011). Conclusions: Overall long-term survival of patients with isolated pontine infarcts is good. Initial differences regarding short-term outcome in infarctions of different aetiology resolve with time. Effective secondary prevention among SAD patients may limit s troke recurrence and positively influence long-term prognosis. Background and purpose: Isolated pontine strokes cause characteristic neurological syndromes and have a good short-term prognosis. The aim of this study was to examine the longterm survival, cumulative recurrence rate and clinical handicap of patients with isolated pontine infarcts of different aetiology. Methods: O ne hundred consecutive patients with an isolated pontine infarction were identified by imaging studies and evaluated prospectively. After extensive study, cases were classified according to the aetiopathogenetic mechanisms: stroke due to ba silar artery branch disease (BABD), small-artery disease (SAD) and large-artery-occlusive disease (LAOD). During a mean follow-up period of 46 months, stroke presentation and initial course, early and long-term mortality, disability and recurrence were evaluated. Results: BABD was the most frequent c ofuse of isolated pontine ischaemia (43%), followed by SAD (34%) and LAOD (21%). Hypertension was the most prominent risk factor, espec ially among patients with SAD (94.1%). Neurological impairment on admission was more severe in the LAOD group, followed by BABD. After 1 month patients with LAOD had the highest c umulative mortality (14.3%, p = 0.026) and more severe disability Fiveyear mortality rates were 20.6%, 14% and 23.8% in the SAD-, BABD-and in LAOD-groups respectively (p = 0.776). Cumulative 5-year recurrence rate was 2.3% for BABD, 14.3% for LAOD, and 29.4% for SAD (p = 0.011). Conclusions: Overall long-term survival of patients with isolated pontine infarcts is good. Initial differences regarding short-term outcome in infarctions of different aetiology resolve with time Effective secondary prevention among SAD patients may limit s troke recurrence and ever influence long-term prognosis.