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PubMed1984

[Brain stem AEP in toxic comas. Correlation with brain stem reflexes].

24 deep toxic comas with respiratory assistance were studied by brain-stem reflex and BAEP. Laboratory analysis showed several simultaneous toxics (phenobarbital, benzodiazepines, tricyclic antidepressants...). Three groups of patients were defined: Twelve patients with normal BAEP and with relatively preserved brain-stem reflex (oculocephalic and oculovestibular are often disturbed but photomotor is present). Eleven patients with delayed BAEP and with more disturbed brain-stem reflex (photomotor is missing 3 times). In 2 cases (one of which is mentioned above in group B) brain-stem reflex and BAEP disappear and these patients die. Cerebral anoxia is associated here with toxics. Causes of delayed latencies (group B) are discussed (hypothermia, toxics). BAEP seems important in diagnosis and prognosis of toxic coma.

Adult↗
PubMed1978

Auditory brain-stem responses in comatose patients: relationship with brain-stem reflexes and levels of coma.

Auditory brain-stem responses (BSR) were recorded in 20 comatose patients in whom the level of brain-stem dysfunction was defined by clinical assessment of brain-stem reflexes and posture. No BSR abnormalities were found in the 10 cases with cortico-subcortical or diencephalic levels. The other 10 patients showed a clear relationship between alteration of the different components of the BSR and the clinical levels of brain-stem dysfunction caused by the rostro-caudal evolution. Alteration of wave P5 seems related to a midbrain dysfunction, of P3 to a pontine dysfunction and of P1 or P2 to a lower brain-stem dysfunction.

Brain Stem↗
PubMed1983

Evaluation of the brain-stem function by the auditory brain-stem response and the caloric vestibular reaction in comatose patient.

The auditory brain-stem response (ABR) and the caloric vestibular reaction (CVR) were investigated in 100 patients in deep coma to evaluate the brain-stem function of these patients precisely and to predict their prognosis accurately. In the first ABR examination, 54 patients showed normal and 46 abnormal ABRs. Among the latter, five showed partial wave disappearance and 21 exhibited no ABRs. Twenty-six of the 30 patients who recovered (87%) showed normal ABRs and 21 of the 57 who died (37%) also exhibited normal latency at that time. On the other hand, all the patients who showed wave disappearance (the absence of or only wave I response) died. Forty of 86 patients who underwent the CVR test showed some reaction. However, 46 patients showed no CVRs even in the first examination. Twenty-two of 26 patients who recovered exhibited some eye movements, while the remaining four showed no reaction at that time. From these results the following statements can be made. If total or partial (wave I) disappearance of the ABR in comatose patients is observed, one can predict a poor prognosis or death. If no reaction is observed in the CVR, however, one cannot always expect a poor prognosis.

Auditory Perception↗
PubMed1995

MRI of the incisural plane: assessment of normal brain stem position by age and transtentorial brain stem shift in disease.

The standardization on MRI of an anatomic plane passing through the tectum of the midbrain based on fixed landmarks allows assessment of the position of the brain stem during development and in normal adulthood, and comparison with its position in disease states. The level of the tectum relative to this incisural plane changes during normal cranial growth as well as in the presence of masses, frank brain stem herniation correlating with altered consciousness.

Adolescent↗
PubMed1988

Dynamic axial brain stem distortion as a mechanism in the production of brain stem hemorrhages: role of the carotid arteries.

Dynamic axial distortion of the brain stem has long been recognized as occurring in the presence of supratentorial mass lesions. Although brain stem hemorrhages occur under these circumstances, the pathophysiology of these hemorrhages is still a matter of controversy. In the present study, the role of the carotid arteries in tethering the brain stem was evaluated during dynamic axial distortion of the neuraxis of the dog. Brain stem hemorrhages occurred in 32 of 48 dogs in which the carotid arteries were left intact (67%) and in only 9 of 46 animals in which the carotid arteries were sectioned (20%). The difference between the two groups is statistically significant (chi 2 = 19.3; P less than 0.001). In this study, we can eliminate intracranial pressure as the primary cause of the lesions because a single variable is present in one series and absent in the other, whereas intracranial pressure and its duration are kept constant. It is concluded that the tethering effect of the carotid arteries is a significant factor in the production of brain stem hemorrhages in the dog by dynamic axial distortion of the brain stem. A selective review of the literature on production of brain stem lesions is provided to support these findings.

Animals↗
PubMed1983

Computed tomography of the brain stem with intrathecal metrizamide. Part I: the normal brain stem.

In summary, the anatomic details of the brain stem are exquisitely demonstrated with metrizamide CT. The obex is the zone of transition from the closed medulla, which has a conical pear-shaped appearance to the quadriconcave open medulla. The pyramids and inferior olivary nuclei characterize the anterior surface of the open medulla, whereas the median sulcus and the cranial nerve nuclei constitute the floor of the fourth ventricle at the same level. The mushroomlike appearance of the pontomedullary junction is easily reproducible with the restiform bodies forming the posteriorly diverging biped. The seventh and eighth nerves are usually seen at this level or on the adjacent higher section of the low pons. The brachia pontis are well delineated in almost their entire length at the level of the low pons as they bound the fourth ventricle laterally. The trigeminal nerves are seen at the level of the midpons, which is a few millimeters lower than the isthmus. The latter constitutes the junction of the pons with the mesencephalon. The colliculi divide the midbrain into two levels of axial cross section: the inferior collicular level, which may or may not show the trochlear nerve, and the superior collicular level, which features anteriorly the suprasellar cistern and its contents. Air is an inadequate contrast agent for CT for the demonstration of the surface features of the brain stem because of partial filling of the cisterns and meniscus formation that precludes a detailed outline. Metrizamide, however, with careful technique, fills the fourth ventricle and subarachnoid space both infra- and supratentorially. High-resolution scanning using primary reconstruction, and thin tomographic sections of no more than 5 mm are a necessity for metrizamide CT. Consecutive scans should not be spaced more than 5 mm apart if all the features of the brain stem are to be evaluated. The demonstration of the various grooves and protuberances on the surface of the brain stem provides a unique opportunity for evaluating focal atrophy and focal swelling henceforth impossible to visualize consistently.

Brain Stem↗
PubMed1989

Brain-stem auditory evoked potential abnormalities with unilateral brain-stem lesions demonstrated by magnetic resonance imaging.

We correlated the brain-stem auditory evoked potential (BAEP) abnormalities in 24 patients with discrete unilateral brain-stem lesions demonstrated by magnetic resonance imaging. In 18 patients who had BAEP abnormalities either confined to or more severe on stimulation of one ear, the lesion on magnetic resonance imaging was in the brain stem ipsilateral to the corresponding ear. Mesencephalic lesions produced amplitude abnormalities of the IV/V complex while pontine lesions resulted in abnormalities of earlier components (wave II and/or III). Prolongation of the I-III interpeak latency tended to occur with pontine lesions and of the III-V interpeak latency with mesencephalic lesions. Unilateral brain-stem lesions, particularly at the mesencephalic level, often produced BAEP abnormalities on both ipsilateral and contralateral monaural stimulation.

Adult↗
PubMed1985

Synthesis of arachidonoyl coenzyme A and docosahexaenoyl coenzyme A in synaptic plasma membranes of cerebrum and microsomes of cerebrum, cerebellum, and brain stem of rat brain.

Synthesis of arachidonoyl CoA and docosahexaenoyl CoA in homogenates and microsomes from cerebrum, cerebellum, and brain stem and in synaptic plasma membranes from cerebrum of control rats and rats undergoing bicuculline-induced status epilepticus were studied. Arachidonoyl CoA synthesis was 3-5 times higher than docosahexaenoyl CoA in homogenates and microsomes. The synaptic plasma membranes showed only 1.5- to 2.5-fold higher activity. The presence of Triton X-100 (0.1%) in the incubation medium did not alter the activity of arachidonoyl CoA synthesis but did increase the synthesis of docosahexaenoyl CoA in homogenates, microsomes, and especially in synaptic plasma membranes. The synthesis of these polyenoic fatty acyl CoAs were 4-6 times higher in microsomes than in homogenates. Synaptic plasma membranes exhibited about the same amount of activity as homogenates in the synthesis of docosahexaenoyl CoA, but only half the activity of the latter in arachidonoyl CoA synthesis. The synthesis of arachidonyl CoA and docosahexaenoyl CoA in cerebral homogenates and microsomes was higher than that of cerebellum and brain stem. The apparent Km values for labeled arachidonic acid (17 microM) and docosahexaenoic acid (12 microM) in synaptic plasma membranes were lower than the values for microsomes isolated from different brain regions. The Vmax values were also 4-10 times lower. Microsomes from different regions did not differ in their apparent Km values, but did show variations in apparent Vmax values. Cerebellar microsomes showed lower Vmax values than the other two regions. The presence of Triton X-100 caused a significant decrease in the apparent Km values with little change in the Vmax values. Bicuculline-induced seizures did not alter the kinetic properties of arachidonoyl CoA and docosahexaenoyl CoA synthesis, except there was a significant decrease in the apparent Km and Vmax values for cerebellar microsomal docosahexaenoyl CoA synthesis. In conclusion, there were marked differences in the activation of polyenoic fatty acids in different parts of the brain and in subcellular fractions. Although bicuculline-induced convulsions accumulate free polyenoic fatty acids in the brain, no changes were detected when the fatty activation was assayed with exogenous cofactors, except in cerebellum.

Acyl Coenzyme A↗
PubMed1980

Compositional changes in soluble proteins of cerebral mantle, cerebellum, and brain stem of rat brain during development: a two-dimensional gel electrophoretic analysis.

Soluble proteins from the cerebral mantle, cerebellum, and brain stem of rat brains were analyzed at various developmental stages by a two-dimensional gel electrophoresis technique. The electrophoretic technique resolved the soluble proteins into 100--150 polypeptide spots on two-dimensional gels and gave reproducible and highly resolved profiles of them. Although most of major polypeptides were commonly found in all the three brain regions, some polypeptides were shown to be unique to a specific brain region. Each brain region was different in the electrophoretic profile of soluble proteins at every developmental stage examined, although there was considerable similarity in the profiles of each of the three brain regions in fetal animals (16--17 days), indicating that soluble proteins undergo different compositional changes in each of the three brain regions during postnatal development. In addition, the number of polypeptide spots on the electrophoretic profile increased remarkably during postnatal development in all of the three brain regions, suggesting that soluble proteins become more heterogeneous during postnatal development in each of the three brain regions.

Animals↗
PubMed1983

The dielectric properties of the cerebellum, cerebrum and brain stem of mouse brain at radiowave and microwave frequencies.

The relative permittivity and conductivity of the cerebellum, cerebrum and brain stem of mouse brain were measured at a temperature of 37 degrees C over a frequency range of 72 MHz to over 5 GHz using time-domain spectroscopy. An analysis of the data suggests that the water exists in various forms of binding with an average relaxation frequency less than free water.

Animals↗
PubMed2004

Topodiagnostic investigations on the sympathoexcitatory brain stem pathway using a new method of three dimensional brain stem mapping.

OBJECTIVES: To study the incompletely understood sympathoexcitatory pathway through the human brain stem, using a new method of three dimensional brain stem mapping on the basis of digitally postprocessed magnetic resonance imaging (MRI). METHODS: 258 consecutive patients presenting with acute signs of brain stem ischaemia underwent biplane T2 and EPI diffusion weighted MRI, with slice orientation parallel and perpendicular to a transversal slice selection of the stereotactic anatomical atlas of Schaltenbrand and Wahren, 1977. The individual slices were digitally normalised and projected onto the appropriate slices of the anatomical atlas. For correlation analysis lesions were imported into a three dimensional model of the human brain stem. RESULTS: 31 of the 258 patients had Horner's syndrome caused by acute brain stem ischaemia. Only four of the patients with Horner's syndrome had pontine infarctions, 12 had pontomedullary lesions, and 15 had medullary lesions. Correlation analysis showed significantly affected voxels in the dorsolateral medulla but not in the pons. A statistical comparison with infarct topology in patients with medullary lesions but without Horner's syndrome indicated that involvement of the medial and ventral part of affected voxels located in the ventrolateral medullary tegmentum was specific for Horner's syndrome. CONCLUSIONS: Based on this first in vivo topodiagnostic study, the central sympathoexcitatory pathway probably descends through the dorsal pons before converging on specific generators in the ventrolateral medullary tegmentum at a level below the IX and X nerve exits.

Aged↗
PubMed1984

Brain-stem involvement in multiple sclerosis: a comparison between brain-stem auditory evoked potentials and the acoustic stapedius reflex.

Brain-stem auditory evoked potentials (BAEPs) and the acoustic stapedius reflex (ASR) were recorded in 68 patients with definite, probable and possible multiple sclerosis (using the definitions of McAlpine). The high incidence of abnormal results, 68% and 60%, respectively, pointed to the diagnostic value of these two measures in detecting brain-stem dysfunction. Combination of the methods increased the diagnostic yield to 85%. Since in part the same brain-stem generator sites underlie BAEPs and the ASR, it was considered that a study of their correlation might serve to increase the reliability and validity of these techniques. There was 71% agreement overall between results from the two measures. Furthermore, 72% of the joint BAEP and ASR abnormalities corresponded in detection of the brain-stem lesion site. It was concluded that the combined approach may supply powerful, complementary information on brain-stem dysfunction, which may aid in establishing the diagnosis of multiple sclerosis.

Brain Stem↗
PubMed1988

Effects of a hyperbaric environment on human brain stem function with specific reference to auditory brain stem responses.

Hyperbaric chamber dives at 31 ATA with helium-oxygen were performed at the Japan Marine Science and Technology Center in 1987. During simulated underwater experiments, auditory brain stem responses were recorded in 4 professional divers for assessment of brain stem function. All divers had no clinical symptoms at 150 m below sea level, and their ABRs also showed no significant changes. During the 150-250 m depth saturation dives, all divers complained of various symptoms such as euphoria, ataxia, joint pain, tremor and dyspnea, while, I-III and I-V interpeak latencies on their ABRs increased with a tendency of recovery. Furthermore, the changes of both interpeak latency were independent of each other. These results indicate that transient dysfunction clinically or subclinically occurred at the processes between 150-300 m below sea level. Moreover, independent changes of I-III and I-V interpeak latencies in this study may mean that the pathways reached to the generation sites of wave III and V were different.

Adult↗
PubMed1981

Brain-stem auditory-evoked potentials recorded directly from human brain-stem and thalamus.

Brain-stem auditory-evoked potentials were recorded in neurosurgical patients from surface electrodes applied to the VIIIth nerve, medulla, pons, midbrain and cortex; from depth electrodes in the thalamus; and from a movable electrode in the IVth, IIIrd, and lateral ventricles. The potentials recordable over the scalp within 10 ms after click stimulation are characterized by a slow positive wave (peaking at 5 to 6 ms) and a negative wave (8 to 10 ms) with 7 small positive wavelets superimposed upon them. The sources of these components have been identified by observing their increased amplitude in depth recordings, and by tracing the potentials from their intracranial maxima to the scalp. Wave I is generated within the most distal portion of the VIII nerve; Wave V in the midbrain (inferior colliculus); and Wave VI the medial geniculate body. Both low positive and negative components have their origins in the inferior colliculus. Intracranially-recorded brain-stem auditory-evoked potential showed very rapid changes in amplitude within the brain-stem but only slight changes in the more rostral regions, although their amplitude gradients varied in the different components. They also demonstrated minor but systematic shifts in latency with distance from the potential sources, reflecting a significant overlap of separate potentials. This effect must be taken into account in the interpretation of a 'concurrent' intracranial potential as the source of a far-field surface-recorded potential.

Auditory Pathways↗