Background <p>Wallerian degeneration (WD) is a secondary neuropathological process following cerebral infarction, characterized by axonal degeneration that exacerbates motor and swallowing dysfunction. Involvement of the bilateral brachium pontis is extremely rare, and no specific treatments are currently available.</p> Case presentation <p>A 60-year-old Chinese female got acute pontine infarction (day 0) manifesting as left limb weakness. Nineteen days later (day 19), she developed sudden-onset dysarthria, dysphagia, and bilateral lower limb weakness. Brain MRI (day 19) showed high signal on diffusion-weighted imaging (DWI), slightly high signal on T2-weighted imaging (T2WI), slightly low signal on T1-weighted imaging (T1WI), and low signal on apparent diffusion coefficient (ADC) maps in the bilateral brachium pontis—consistent with early WD. The patient received acupuncture treatment (once daily for 5 consecutive days, day 20d to day 24) targeting neural functional recovery. Objective assessments (Barthel Index, Modified Rankin Scale, muscle strength grading, and Water Swallowing Test) were performed at baseline, post-treatment, and 6-month follow-up. Post-treatment, the patient’s dysarthria, dysphagia, and lower limb weakness resolved (muscle strength improved from Grade IV to Grade IV + , Barthel Index increased from 75 to 95). Sustained recovery was confirmed at 6-month follow-up with no symptom recurrence.</p> Conclusions <p>This case suggests that acupuncture may be a promising complementary therapy for alleviating neurological symptoms associated with early WD of the brachium pontis. However, due to the limitations of a single case report, further controlled studies are needed to validate its efficacy.</p>