Background:　Wallerian　degeneration　(WD)　of　bilateral　middle　cerebellar　peduncles　(MCPs)　can　occur　following　pontine　infarction,　but　its　characteristics　have　not　yet　been　clarified　because　of　the　low　incidence.　Thus,　the　present　study　discussed　the　clinical　and　radiological　features　to　improve　the　awareness　of　this　disease.　Methods:　Clinical　and　radiological　information　from　consecutive　individuals　diagnosed　with　WD　of　bilateral　MCPs　following　pontine　infarction　in　three　hospitals　over　the　past　4　years　between　October　2012　and　October　2016　were　retrospectively　investigated　and　compared　with　a　control　group　(patients　with　pontine　infarction　had　no　secondary　WD).　Results:　This　study　involved　30　patients　with　WD　of　MCPs,　with　a　detection　rate　of　only　4.9%.　The　primary　infarctions　(chi(2)　=　24.791,　P　=　0.001,　vs.　control　group)　were　located　in　the　paramedian　pons　in　21　cases　(70.0%),　and　ventrolateral　pons　in　nine　cases　(30.0%).　WD　of　the　MCPs　was　detected　8-24　weeks　after　pons　infarction　using　conventional　magnetic　resonance　imaging　(MRI);　all　secondary　WDs　were　asymptomatic　and　detected　incidentally.　All　WD　lesions　exhibited　bilateral,　symmetrical,　and　boundary　blurring　on　MRI.　The　signal　features　were　hypointense　on　T1-weighted　imaging,　hyperintense　on　T2-weighted　imaging　and　fluid-attenuated　inversion　recovery,　and　slightly　hyperintense　or　isointense　on　diffusion-weighted　imaging　and　apparent　diffusion　coefficient　maps.　Secondary　brainstem　atrophy　was　found　in　six　(20.0%)　cases.　A　Modified　Rankin　Scale　score　0-2　was　found　in　10　(33.3%)　cases　and　score　＞2　in　20　(66.7%)　cases　at　90　days　after　discharge,　and　the　short-term　prognosis　was　worse　than　that　in　control　group　(chi(2)　=　12.814,　P　=　0.001).　Conclusions:　Despite　the　rarity　of　bilateral　and　symmetrical　lesions　of　MCPs,　secondary　WD　should　be　highly　suspected　if　these　lesions　occur　within　6　months　after　pontine　infarction,　particularly　paramedian　pons.　Conventional　MRI　appears　to　be　a　relatively　sensitive　method　for　detecting　WD　of　MCPs,　which　might　affect　the　short-term　prognosis.