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PubMed1981

Lateralization of brainstem lesions by brainstem auditory evoked potentials.

In eight patients with unilateral pontine and midbrain lesions, brainstem auditory evoked potentials (BAEPs) were studied with ipsilateral (Cz-Ai) and contralateral (Cz-Ac) recordings after monaural stimulation. In all cases, the most prominent abnormality was noted in BAEP generated by stimulating the ear ipsilateral to the lesions. The Cz-Ai and Cz-Ac patterns showed similar abnormalities in five of the patients and dissociated abnormalities in two patients. We conclude that: (1) Lateralization of BAEP is possible in unilateral pontine and midbrain lesions. (2) Monaural stimulation with Cz-Ai and Cz-Ac recordings is essential for lateralization. (3) The BAEP in monaural stimulation is predominantly generated from the auditory structures ipsilateral to the stimulated ear.

Brain Diseases↗
PubMed1991

The spectrum of vertical gaze palsy following unilateral brainstem stroke.

A single unilateral lesion, near the midline, may interrupt the pathways involved in vertical gaze just before and after they decussate, inducing an anatomically unilateral, but functionally bilateral, lesion. We report 11 patients with supranuclear vertical gaze palsies (two with conjugate upgaze palsy, four with combined up- and downgaze palsies, two with monocular elevation palsy, and three with vertical "one-and-a-half" syndrome) due to unilateral midbrain strokes.

Adult↗
PubMed1984

Motor evoked potentials from transcranial stimulation of the motor cortex in humans.

Electrical monitoring of the motor system offers the potential for the detection of injury, the diagnosis of disease, the evaluation of treatment, and the prediction of recovery from damage. Existing evoked potentials monitor one or another sensory modality, but no generally usable motor monitor exists. We have reported a motor evoked potential using direct stimulation of the spinal cord over the motor tracts in cats and in humans. To achieve a less invasive monitor, we used transcranial stimulation over the motor cortex in the cat, thus stimulating the motor cortex. We report here the initial application of this method to humans. A plate electrode over the motor cortex on the scalp and a second electrode on the palate direct a mild current through the motor cortex which will activate the motor pathways. This signal can be recorded over the spinal cord. It can elicit contralateral peripheral nerve and electromyographic signals in the limbs or movements when the appropriate stimulation parameters are used. In clinical use to date, this has been more reliable than the somatosensory evoked potential in predicting motor function in patients where the two tests differed. It offers a number of possibilities for the development of valuable brain and spinal cord monitoring techniques, but requires further animal studies and clinical experience. Studies to date have not demonstrated adverse effects, but evaluation is continuing.

Adult↗
PubMed1987

Periodic alternating gaze: a case without any hemispheric lesion.

A clinicopathological study of a patient with periodic alternating gaze (PAG) is presented. PAG is usually associated with bilateral cerebral hemispheric ischemia. In our case, the anatomical lesion is very limited, restricted to the crus cerebri. The anatomical pathways involved and the mechanism of PAG are discussed.

Brain Stem↗
PubMed1990

Brain stem mechanism in ocular motor function.

The progress of clinical and experimental neuro-ophthalmology during the last two decades was reviewed. The ocular motor system in the brain stem was described firstly based on anatomical, neurophysiological and clinical evidences. Clinical syndromes in cerebrovascular brain stem impairments which present ocular motor dysfunction were analyzed briefly.

Animals↗
PubMed1984

Vertical saccades in brain stem disorders.

Mean peak velocity and accuracy of vertical saccades were measured in 15 patients with disorders in the brain stem and in 12 normal subjects. (1) In the normal group up-directed saccades were faster than down-directed and the velocity of the saccade was not dependent on the age of the subject. Up-saccades were faster whether electro-oculography or photo-electro-oculography were used. (2) In patients with brain stem disorders the velocity of vertical saccades did not significantly differ from the saccadic velocity in the normal group. This is in contrast to what was found in horizontal saccades, where a reduced velocity was characteristic.

Adult↗
PubMed1991

Effect of proprioceptor stimulation on postural stability in patients with peripheral or central vestibular lesion.

Body sway in upright stance at rest and after inducing proprioceptor stimulation, elicited by vibration applied to the calf or neck muscles, was studied in 11 patients with peripheral lesion and in 17 patients with central vestibular lesion. The responses were compared with those of 20 normal subjects. Vibratory stimulus was applied at five different frequencies, ranging from 32 to 150 Hz, and at a constant amplitude of 2.1 mm. Postural stability was measured with a force platform in terms of average deviation of body position (ADBP) analyzed in relation to the individual maximum support distance in the anterio-posterior direction. In patients with peripheral vestibular lesion ADBP was moderately increased, compared to normal subjects, when the calf muscles were exposed to vibration under eyes closed conditions (i.e. no visual information available); stimulation of neck muscles both under eyes open and eyes closed conditions and stimulation of calf muscles with open eyes produced an ADBP of the same magnitude as in controls. In patients with central vestibular lesion, proprioceptor stimulation of calf and neck muscles caused increased ADBP whether with eyes open or closed. The ADBP induced by stimulation of neck muscles was significantly greater in patients with a central lesion than in those with a peripheral vestibular lesion. The results indicate that patients with peripheral lesion differ from those with central vestibular lesion in their reaction to proprioceptor stimulus; and that in patients with central vestibular lesion proprioceptor stimulation of the neck muscles produces disproportionately powerful cervico-collic reflexes.

Brain Stem↗
PubMed1995

Apogeotrophic type of direction-changing positional nystagmus related to slow vertebrobasilar blood flow.

We examined the incidence of slow blood flow (SBF) in the vertebrobasilar system by magnetic resonance imaging (MRI) in 35 patients showing direction-changing positional nystagmus (DCPN). The subjects consisted of 20 patients with apogeotrophic type (group A) and 15 with geotrophic type (group B) of DCPN. Fifty-seven age-matched subjects without vestibular symptoms were examined as a control group (group C). SBF was detected in 11 (55%), 3 (20%) and 6 (11%) patients in groups A, B and C, respectively. Lacunae of the brainstem were found in 7 (35%) patients in group A and 1 (7%) in group B. The higher incidence of SBF in group A suggested a possible relationship between SBF and apogeotrophic type of DCPN. Apogeotrophic type of DCPN associated with SBF was considered to be caused by ischemia in the posterior circulation, though it was unclear whether the vestibular labyrinth or the hindbrain was mainly involved.

Adult↗
PubMed2004

Deep brain stimulation of the nucleus ventralis intermedius for Holmes (rubral) tremor and associated dystonia caused by upper brainstem lesions. Report of two cases.

Holmes tremor is caused by structural lesions in the perirubral area of the midbrain. Patients often present with associated symptoms such as dystonia and paresis, which are usually refractory to medical therapy. Here, the authors describe two patients in whom both tremor and associated dystonia improved markedly following unilateral stimulation of the thalamic nucleus ventralis intermedius.

Ataxia↗
PubMed1992

[Rehabilitation of patients with brain stem damage].

We describe seven patients with serious brain stem damage who were admitted to Sunnaas Rehabilitation Hospital over a period of two years (1989-91). Our patients had quadriplegia and anarthria with some or completely preserved cognitive function. They experienced varying degrees of restitution, but all remained severely impaired. Important areas for rehabilitation include communication, alimentation, mobility, emotional reactions, medical complications and daily living arrangements. Severely impaired patients can enhance their quality of life by use of technical devices. Minimal motor function is necessary to control a switch, but preserved cognitive function is essential.

Adult↗
PubMed2004

[Dissecting vertebral aneurysm with subarachnoid hemorrhage after ischemic onset on the same day: a case report].

We report a case of a dissecting vertebral aneurysm with subarachnoid hemorrhage (SAH) after ischemic onset on the same day. A 48-year-old man had abrupt vertigo and nausea. CT & MRI on admission showed no abnormality, but he complained of left hemiparesis after admission. Twelve hours after the ischemic onset he suddenly complained of severe headache and his consciousness deteriorated. The follow-up CT showed diffuse SAH. Cerebral angiography showed occlusion of the right vertebral artery at the origin of the posterior inferior cerebellar artery (PICA) and segmental stenosis of the left vertebral artery at the portion distal to the vertebral PICA junction. We treated the patient conservatively. Four days later, he suddenly fell into a coma, but CT showed no bleeding. Because of this we suspected brain stem ischemia due to deterioration of vertebral dissection. The patient died 8 hours after the ischemic reattack. We report difficulty of treatment of a dissecting vertebral aneurysm with simultaneous ischemia and subarachnoid hemorrhage.

Brain Stem↗
PubMed1991

[A mechanism of cheiro-oral syndrome due to brainstem lesions, a case of a dissecting aneurysm of the basilar artery].

A 42-year-old woman developed an abrupt onset of severe headache, nausea, vomiting, unstable gait and numbness around the right side of her mouth and in her right hand. Neurological examination revealed bilateral pyramidal tract signs and hypesthesia of her right palmar tip and the right side of her mouth. However, pain and temperature sensibility was preserved. Cerebrospinal fluid was clear and colorless. CT scan showed an enhancing mass in the prepontine cistern compressing the pontine base. Vertebral angiography revealed irregular narrowing of bilateral vertebral arteries (string sign) proximal to a fusiform aneurysm on the entire length of the basilar artery. MRI showed double lumina in the wall of the aneurysm. The medial lemniscus conducts the discriminatory tactile and the deep sensory impulses from the extremities. The ventral ascending tract of the trigeminal nerve conducts the discriminatory tactile sensory impulses from the face. These two tracts lie close together in the pontine tegmentum, which is also a watershed area of the paramedian branches and circumferential branches of the basilar artery. We suggest that in this case the dissecting aneurysm caused ischemia of these two tracts in the left pontine tegmentum, presenting right cheiro-oral syndrome.

Adult↗
PubMed1988

[The value of auditory evoked brain stem potentials in the diagnosis of circulatory disorders in the area of vertebrobasilar circulation].

The acoustically-evoked brain-stem potential in patients with vertebrobasilar insufficiency has enjoyed a varied diagnostic evaluation in the literature. Our own examinations reveal an advantage in subdividing AEBP changes into normal and marginal, slight and pronounced, within a group of patients with blood supply disorders in the vertebrobasilar region. AEBP permits inferences to be made on the extent of the damage. However, one should be chary of referring AEBP change of vascular origin to any particular section on the basis of these deductions alone. Only the comprehensive consideration of clinical symptoms, AEBP findings, and neuroradiological examination leads to a valid opinion on extent and location.

Adult↗
PubMed1987

[Multimodality evoked potentials and brain death. Prerequisites, findings and problems].

According to the recommendations of the medical board of the FRG the clinical diagnosis of cerebral death in adults requires an observation period of 12 hours. Evoked cerebral potentials have been accepted as a technical method of confirmation of clinical signs. In 32 patients with the signs of apneic brain-stem areflexia acoustic evoked brain-stem potentials and median-evoked somatosensory potentials were recorded. In supratentorial lesions evoked potentials are adequate to confirm complete cessation of brain function. In three cases of primary brain-stem disease evoked potentials were abolished, however, unequivocal EEG activity was preserved. The registration of evoked potentials is sufficient to confirm the brain death syndrome in primary supratentorial lesions, in infratentorial disease, however, demonstration of isoelectric EEG is necessary.

Adult↗