Abstract: Objective: To investigate the clinical and imaging characteristics of acute pontine brachium infarction. Methods: The clinical and imaging data of 20 patients with acute pontine brachium infarction admitted at our hospital from August 2014 to September 2017 were analyzed retrospectively. All patients underwent the first brain CT examination within 48 h and the first MRI examination within 3 d. 8 cases had MRA examination data. Results: All the patients were acute onset; all were with vertigo, with ataxia gait in 16 cases, with nausea and vomiting in 13 cases, tinnitus, with hearing loss in 7 cases, with horizontal nystagmus in 5 cases, unilateral ocular motility disorders in 3 cases, facial paralysis in 3 cases, Horner syndrome in 3 cases, and limb paralysis in 1 case. The first CT was negative in 13 cases and follow-up CT showed the low density of the pontine brachium. Cranial MRI showed the pontine brachium with low signal in T1WI, high signal in T2WI, FLAIR and DWI, low signal in ADC. Unilateral involved in 16 cases and bilateral involved in 10 cases. The acute infarctions of other areas of posterior circulation were showed clearly on MRI. Conclusion: The clinical manifestations of acute pontine infarction are complex and diverse, and most of them are characterized by the damage manifestations of vestibular nerve and cerebellum. Imaging examination, especially timely MRI examination is helpful for diagnosis and differential diagnosis.