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Results for “Brain Stem Infarctions”

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PubMed1979

Upward transtentorial herniation: seven cases and a literature review.

Seven cases of upward transtentorial herniation occurred. In each patient, coma with reactive, miotic pupils, asymmetrical or absent caloric responses, and decerebrate posture indicated brain-stem compression. In this setting, the development of unequal, then midposition, fixed pupils signaled midbrain failure from upward herniation. Vertebral angiography showed upward displacement of the superior cerebellar arteries. Results of autopsy confirmed the existence of grooving of the vermis by the tentorial margins and, in one case, of anterior displacement and distortion of the midbrain. In five of 45 reported cases of upward herniation, the conditions were diagnosed antemortem. Instances of cerebellar hematoma and tumor predominated. In at least seven patients, performance of ventriculography may have precipitated herniation. Clinical details were provided in only nine patients and did not separate upward herniation from brain-stem compression. Cerebellar ischemic infarct found in one of our patients is a rarely reported cause of upward herniation.

Adult↗
PubMed1979

Short latency somatosensory evoked potentials in patients with neurological lesions.

Short latency somatosensory potentials following median nerve stimulation were recorded in patients grouped according to anatomic location of neurological lesion. Patients with cerebral lesions causing severe sensory deficit lacked a major positive wave of cortical origin that in normal subjects peaked at a mean latency of 20.5 ms. Patients with severe cervical spinal cord disease lacked all of the normal somatosensory response except for the earliest component attributed to peripheral nerve activity. Patients with brain-stem lesions showed delayed latencies of later waves and prolonged interwave latencies. However, auditory evoked potentials measured in the group with brain-stem lesions were more helpful in localization. Analysis of short latency somatosensory potentials can discriminate between peripheral nerve, spinal cord, brain-stem, and cerebral lesions. Further experience and refinement of technique of measurement should increase the value of this procedure.

Adolescent↗
PubMed1988

MR of childhood tuberculous meningitis.

MR imaging was performed on 27 children with stage II-III tuberculous meningitis for the specific purpose of examining the brainstem, as well as comparison with other CT features of the disease. In addition to defining the ischemic disturbances of basal ganglia and diencephalon more clearly, MR also demonstrates the frequent occurrence of parenchymal signal abnormalities in the brainstem and adjacent temporal lobes, which are invisible or uncertain on CT. Although the presence of brainstem abnormalities on MR correlated well with clinical findings of brainstem dysfunction, clinical staging on admission remains the best prognostic indicator in advanced TBM. We also review the MR features of basal exudation, hydrocephalus and tuberculoma.

Basal Ganglia↗
PubMed1994

Raymond's syndrome following petrosal sinus sampling.

Inferior petrosal sinus sampling (IPSS) is used to evaluate the pituitary-dependency of Cushing's disease, and to predict the laterality of a microadenoma prior to transsphenoidal operation. A serious complication occurred in a 14-year-old boy: he suffered brain stem ischaemia with abducens nerve palsy and hemiparesis (Raymond's syndrome). The case prompted us to reconsider the indication for this investigation.

Abducens Nerve↗
PubMed1982

Auditory brain stem and middle latency responses in a patient with cortical deafness.

Auditory brain stem (ABR) and middle latency responses (MLR) were recorded in a patient with bilateral temporal lobe lesions. Audiological and higher cortical functions were assessed using conventional behavioral methods. Roentgenological findings were presented for localizing the lesions. Initially the patient showed no behavioral response to sound. Subsequently the patient reported inconsistent awareness of environmental sounds and pure tone sensitivity was impaired to a severe degree. Higher cortical function was essentially intact and the patient was not aphasic. ABR and acoustic reflex findings were consistent with normal functioning of the auditory periphery and brain stem pathways. MLR component Pa was absent bilaterally. These findings suggest that MLR component is bilaterally generated in the temporal lobes. Auditory cortex appears to play a role in auditory sensitivity in humans.

Adult↗
PubMed1980

Studies on asterognosis and amyotrophy of the hand in brainstem syndromes. Relation to the symptomatology of tumours at the spinocranial junction.

Fifteen patients with symptoms of an ischaemic lesion in the vertebrobasilar territory were investigated with respect to the presence of asterognosis and amyotrophy of the hand muscles. Stereognostic disturbances were noted in 4 patients with a medullary lesion and in two patients with brainstem syndromes of less defined level. The findings in these cases suggested a lesion of the medial lemniscus. Amyotrophy of the hand muscles was not seen in these patients. The absence of association of astereognosis and amyotrophy of the hand muscles in syndromes due to lower brainstem lesions supports the view that these symptoms, when occurring conjointly in foramen magnum tumours, originate from two different lesions and are caused by different mechanisms.

Agnosia↗
PubMed1992

Distribution of amyloid in the brainstem of patients with Alzheimer disease.

A4 protein (beta-protein, beta-amyloid) deposits were identified with silver stains in postmortem brainstem sections from 13 patients with Alzheimer disease (AD), 6 patients with mixed Alzheimer disease and Parkinson disease (AD-PD), 5 disease controls, and 2 elderly controls. A rostro-caudal gradient of A4 was found in patients with AD and AD-PD, such that A4 was most prevalent in the midbrain and least prevalent in the medulla. The brainstem of the controls contained little or no A4. The midbrain tectum and tegmentum contained the greatest densities of A4, but the red nucleus and substantia nigra pars reticulata were largely spared. This distribution of A4 suggests that A4 deposition is a function of synaptic connectivity rather than passive diffusion from vascular sources.

Adult↗
PubMed1998

Bilateral internal ophthalmoplegia as a feature of oculomotor fascicular syndrome disclosed by magnetic resonance imaging.

PURPOSE: To describe the magnetic resonance imaging features of bilateral internal ophthalmoplegia as an oculomotor fascicular syndrome. METHODS: A 55-year-old man was initially examined with bilateral photophobia. Neuro-ophthalmologic examinations disclosed preganglionic bilateral internal ophthalmoplegia. Magnetic resonance imaging of the brainstem was performed. RESULT: Magnetic resonance imaging disclosed high-intensity areas on T2-weighted images along medial portions of the bilateral oculomotor fascicles in the mesencephalon. CONCLUSION: These findings suggest that mesencephalic lesions may selectively cause bilateral internal ophthalmoplegia as a partial oculomotor fascicular syndrome.

Brain Stem↗
PubMed1992

[Embolism in the brain stem as a consequence of cervical spine dislocation complicated by thrombosis of the vertebral artery].

A case is reported of a 52-year-old man who sustained a cervical spine dislocation in a road traffic accident, which was complicated by an initially asymptomatic vertebral arterial thrombosis. Embolism from this thrombosis into the vertebrobasilar territory during the surgical manoeuvers to reduce the dislocation was the cause of a fatal postanaesthetic coma. Such unexpected but life-threatening neurological consequences may be found with trauma of the cervical spine of various intensities. The diagnosis may be made by angiography. However, the usefulness of atraumatic investigations, such as the cervical doppler, and the indications for angiography need to be assessed.

Brain Stem↗
PubMed2003

Motor evoked potentials following transcranial magnetic stimulation after middle cerebral artery and/or basilar artery occlusions in rats.

To clarify the significance of motor evoked potentials following transcranial magnetic stimulation (MMEPs) in acute stage of cerebral ischemia, MMEPs were recorded in rats with the right middle cerebral artery (MCA) and/or the basilar (BA) artery occlusions. MMEPs from bilateral forelimb muscle and regional cerebral blood flow (rCBF) of the pons were recorded simultaneously. After MCA occlusion, the amplitudes of MMEPs from left forelimb were increased up to approximately 184-221% of the pre-ischemic value for 60 min, though the latencies were unchanged. On the other hand, in the rats of BA occlusion and both BA and MCA occlusion groups, MMEPs amplitudes were decreased to 8-25% of the pre-ischemic value for 60 min. Pontine rCBF was decreased to 28-44% in both groups. As a mechanism of the facilitation of MMEPs after MCA occlusion, the affection of the inhibitory mechanism between the cerebral cortex and the generator of MMEPs by MCA occlusion is speculated.

Animals↗
PubMed1989

[Isolated abducens paralysis--a retrospective study of 165 patients].

In this retrospective study the case reports of 165 patients suffering from an abducens nerve palsy as the main presenting symptom were evaluated. The sixth nerve palsy was more frequent on the left (52%) than on the right hand side (38%), in 10% there was bilateral involvement. In 49 cases a vascular origin was suspected (29.7%), with diabetes mellitus as the most important risk factor (n = 35). Abducens palsies in inflammatory diseases (n = 32, 19.4%) were seen most often in multiple sclerosis (n = 11), viral meningoencephalitis (n = 5) and accompanying systemic viral infections (n = 5). Postvaccinal paresis was seldom (n = 1). Tumours (n = 18, 10.9%) causing sixth nerve paresis were metastases to the brain (n = 7), meningiomas (n = 3) and glioblastomas (n = 2). Nasopharyngeal carcinomas lead in 4 cases to an involvement of the abducens. Aneurysms causing sixth nerve palsy (n = 7, 4.2%) most frequent being located at the intracavernous region of the internal carotid artery (n = 4). In traumatic abducens paresis (n = 5, 3.1%) pathological findings of neuroradiological examinations are rare. In 48 patients (29.1%) diagnosis remained unclear, especially in young adults between the 20th and 40th year of age. Prognosis of abducens paresis is good in lesions of vascular and unknown origin; in these cases non-steroidal antiphlogistics are of benefit.

Abducens Nerve↗
PubMed1982

Pure word deafness. Analysis of a case with bilateral lesions and a defect at the prephonemic level.

We have demonstrated that the deficit in speech perception in our patient with pure word deafness is secondary to a prephonemic temporal auditory acuity disorder. We delineated the nature of the auditory processing deficit in our patient with bilateral lesions and then demonstrated the presence of a predicted deficit in phonemic discrimination. This pattern is comparable to previous cases with bilateral lesions and distinct from other cases with unilateral lesions. Review of previous reports suggests that there are two distinct types of pure word deafness: type 1, in which the deficit is prephonemic and related to a temporal auditory acuity disorder, and type 2, a form that is independent of a temporal auditory acuity disorder, and has a deficit in linguistic discrimination that does not adhere to a prephonemic pattern (Denes and Semenza, 1975; Saffran et al., 1976). The former has been associated with bilateral temporal lobe lesions (Naeser, 1974; Chocholle et al., 1975), the latter with left unilateral lesions (Denes and Semenza, 1975; Saffran et al., 1976). The first form is an apperceptive disorder, whereas the second represents a higher disorder in phonemic discrimination and may be considered a fragment of Wernicke's aphasia.

Agnosia↗