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PubMed1979

Serial computerized tomographic scanning and the prognosis of severe head injury.

Serial (two or three) computerized tomographic (CT) scans were performed on a series of 58 patients with severe head injury. The protocol called for scans to be done upon admission and on Days 3 and 7 after injury. New lesions (i.e., lesions not visualized on the initial CT scans but appearing on subsequent scans) were a frequent finding, occurring in over half of all patients. For the purposes of this study a new lesion was classified as edema involving two or more lobes, extra-axial hematoma, parenchymal hemorrhage, or infarction. Significant correlation was found between good outcome and the absence of new lesions and between bad outcome and the development of new lesions (p less than 0.001). Several patients did well in spite of the development of new lesions, but these patients were unique in that most had small, unilateral parenchymal hematomas located at or near the frontal or temporal poles. In most cases, patients who did poorly in spite of not developing new lesions had severe injuried visualized on their initial scans (massive intracerebral hematoma, hemorrhage of the corpus callosum) or succumbed to medical complications. The pertinent literature is reviewed, and other CT findings associated with a poor prognosis are noted. The authors suggest that serial CT scanning may be used to make prognostic assessments in severely head-injured patients and may be of value in increasing the confidence in and accuracy of assessments made on clinical grounds alone. (Neurosurgery, 5: 566--569, 1979).

Brain Edema↗
PubMed1993

Blink reflex in patients with an ischaemic lesion of the brain-stem verified by MRI.

The electrically elicited blink reflex was investigated in 25 patients with ischaemic lesions of the pons or the medulla oblongata. Only patients with a lesion on MRI appropriate to the clinical syndrome were included. Twenty patients had an infarction of the pons, bilateral in 5. Additional 5 patients had an infarction of the dorsolateral medulla oblongata. Patients with hemispheric lesions were excluded. Four of the 5 patients with Wallenberg's syndrome showed delayed R2 components to stimulation ipsilateral to the lesion. Additional loss of the ipsilateral R1 component was observed in 1 patient. Fifteen of the 20 patients with pontine infarctions had pathological blink reflexes. All 6 patients with a unilateral pons lesion and an abnormality of R1 had this abnormality on the side contralateral to the lesion. In 3 cases with bilateral pontine infarction R1 was abnormal on one side or on either side. Of 11 patients with a normal R1, 6 had isolated abnormalities of R2 without consistent correlation to the side of the lesion. We conclude that abnormalities of the blink reflex are of minor localizing value in pontine infarction. This may be explained by the fact that a pontine infarction affects either the reflex arch itself or descending pathways that have a modulating influence on the reflex arch. Infarctions of the medulla oblongata, however, have characteristic abnormalities that have already been described.

Adult↗
PubMed1980

[Morphologic verification in computer tomography of the brain].

A comparison of computer-aided tomograms of the brain with the results of morphological examinations of the latter in 51 autopsy cases was carried out. The causes of the death were brain infarctions, hemorrhages, and tumours. It was found that roentgenological diagnosis of cerebral infarctions entailed no difficulties, if the examinations were performed within 24 hours after the disease onset and the focus size was over 1 to 2 cm. There were some difficulties in diagnosing small foci in the brain stem and in the cortex of brain hemispheres as well as infarctions with hemorrhages irrespectively of their size and location. The diagnoses of cerebral hemorrhages were rather precise in the early stages of hemorrhagic strokes, but extremely difficult later, in a definite stage of the hemorrhagic focus organization when computer-aided tomography revealed densities characteristic for unaffected brain. A high diagnostic efficiency of the computer-aided tomography was noted in brain tumours. Certain difficulties sometimes arose in determining the character of the tumour in cases of multiple of small-size foci. The morphological verification of the results of the computer-aided brain tomography is of a decisive importance for developing roentgenomorphological criteria for diagnosing CNS pathologies with the aid of this method, and contributes to further improvement of the latter.

Brain↗
PubMed2000

Effects of cerebrovascular autoregulation and CO2 reactivity in experimental localized brainstem infarction.

Using the previously reported method of experimental localized brainstem infarct in dogs, we designed this study to elucidate sequential changes of regional cerebral blood flow (rCBF) in three separate regions of the central nervous system: the cerebral cortex, thalamus, and midbrain. The data obtained were referred to in subsequent investigations of cerebrovascular autoregulation and vasomotor reactivity to CO2. Localized brainstem infarct was produced by permanently occluding the perforators of the posterior cerebral arteries between the bilateral origins of the posterior communicating arteries. The hydrogen clearance method was applied to measure rCBF. Cerebrovascular autoregulation and CO2 reactivity were assessed in three regions 1, 3, and 5 h after vascular occlusion, respectively. Vascular occlusion resulted in a decrease of rCBF that was 65% in the midbrain and close to 30%-40% in the thalamus. However, no significant change was seen in the cerebral cortex even 5 h after vascular occlusion. Induced hypertension impaired autoregulation in the thalamus, while it was preserved in the cerebral cortex. Induced hypotension did not alter autoregulation in any of the three regions. A marked loss of CO2 reactivity was observed in the ischemic brainstem, although it was well preserved in the cerebral cortex. The results suggest that noradrenergic fibers originating from the cervical sympathetic ganglia play a main role in the cerebrovascular autoregulation in the cerebral cortex, while noradrenergic fibers possibly originating from the autonomic centers in the brainstem are responsible in the thalamus; that the noradrenergic neuron probably is not involved in the maintenance of cerebral blood flow during hypotension; and that the effect of CO2 is mediated by its direct effect on the arteriolar wall in the central nervous system.

Animals↗
PubMed1990

[Brainstem infarcts presented medial longitudinal fasciculus (MLF) syndrome and cerebellar ataxia--report of three cases].

Vascular disorders of the brainstem manifest characteristic neurologic symptoms according to their localization. The medial longitudinal fasciculus (MLF) lies in the paramedian portion of the upper brainstem tegmentum, and the lesion in this fasciculus shows specific abnormality of the eye movement pattern which is known as the MLF syndrome. Although the MLF syndrome was reported frequently to be accompanied by varieties of other neurologic deficits according to the lesion extending into the adjacent structures in the brainstem, the combination of MLF syndrome and cerebellar ataxia has attracted less attention of neurologists. Recently we experienced three cases of cerebellar ataxia arisen simultaneously with MLF syndrome. Magnetic resonance imaging (MRI) tomography or X-ray computed tomography visualized lacunar lesion(s) in the upper brainstem tegmentum in all of three cases. It was obvious that the lesion included the MLF and caused the MLF syndrome in these cases. It was speculated that ventro-caudal extension of the lesion involved the decussation of the superior cerebellar peduncle, and was responsible for the association of cerebellar ataxia with MLF syndrome. According to the recent discussion about the feeding arteries in the brainstem, we decided that the damage of the paramedian branches diverging from the basilar tip resulted in the lacunar lesion(s). The development of diagnostic procedures especially MRI enables the diagnosis of the vascular disorders in the brainstem with considerable accuracy.

Aged↗
PubMed1988

[The influence and outcome of acute infantile intracranial hematoma with hypoxemia].

Unusually broad areas of cerebral infarction were demonstrated by CT scan in three head injured infants with acute intracranial hematoma. They revealed very characteristic CT findings including contralateral hemispheric ischemic zone. Case 1 is a 5-month-old boy who had hit his head 4 days before. On admission he was semicomatose and his respiration had suffered from generalized seizures with arterial PO2 value of 43 mmHg. CT scan revealed right subdural hematoma, and bihemispheric ischemic low density was also demonstrable. Hematoma clot weighing 10 grams was removed through emergency craniotomy, followed by external decompression. There was a marked atrophic change in the right cerebral hemisphere and contralateral frontal base during the following few months, but the basal ganglionic region, brainstem and cerebellum were hardly affected. The patient developed comparatively well mentally for the next one and a half years. Case 2 was a 2-year-old boy who had a previous history of moderate head trauma 8 hours before admission. After a lucid interval, sudden epileptic attacks hospitalized him in a condition of cardiopulmonary arrest. CT scan revealed severe epidural hematoma on the patient's right cerebrum. Emergency craniotomy was performed and hematoma 95 g in weight was removed followed by decompression. Postoperative CT showed broad ipsilateral ischemic edema including the contralateral cerebral hemisphere and brainstem. One and a half years later, the patient shows decorticated posture with ataxic respiration and negative light reflexes. Case 3 was an 8-month-old boy who had fallen down and hit his head on the floor. Status epilepticus had attacked him, causing him to be admitted in a dyspneic state.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed2002

Focal pathological startle following pontine infarction.

A 36-year-old male developed an acute right-sided weakness due to left-sided pontine infarction. Two months later, he first noticed sudden right elbow flexion in response to a loud unexpected noise. Detailed electrophysiological assessment was performed. A large, short-latency (median 39 msec), synchronous electromyographic discharge occurred in the right biceps brachii electrodes following a 50-msec, 120-dB 1-kHz tone burst, with habituation only with very short (30-second) interstimulus intervals. Less synchronous activity at longer latencies was present both in a number of right-sided arm muscles at rest and on the clinically unaffected side during a tonic voluntary contraction. We discuss possible underlying mechanisms and our reasons for considering this a focally enhanced startle response. Our report broadens the range of expression of acquired startle disorders.

Adult↗
PubMed1990

MR imaging of wallerian degeneration in the human brain stem after ictus.

Magnetic resonance (MR) imaging of wallerian degeneration in the brain stem was studied in 30 hemiplegic patients within 12 months of ictus. As early as 25 days after the ictus, decreased signal intensities on proton-density(PD)-weighted images were observed in the brain stem ipsilaterally. This hypointensity gradually approached an isointense stage during 70-80 days after the ictus, abnormal intensities were not detected in any pulse sequence. We termed this phenomenon "Fogging effect of wallerian degeneration". In later stages, at least 81 days after the ictus, increased signal intensities on T2-weighted images, with or without decreased signal intensities on T1-weighted images, were observed in the brain stem, ipsilaterally. Finally, at least six months after the ictus, mild shrinkage of the ipsilateral brain stem was newly detected on the T1-weighted images. MR imaging has proven to be a sensitive diagnostic modality for evaluating wallerian degeneration in the brain stem.

Brain Stem↗
PubMed1989

Lesions of the brain stem: assessment by magnetic resonance imaging.

Ninety-six magnetic resonance imaging (MRI) studies demonstrating solitary brain stem lesions were reviewed in order to establish distinguishing features between tumours and other lesions. Histological confirmation of the radiological diagnoses was obtained in 33% of patients. The morphology of the lesion rather than its signal characteristics was the most useful feature in differential diagnosis, except after haemorrhage. However, areas of abnormal T2 recovery time were significantly more extensive than areas of abnormal T1 recovery time in tumours at presentation. In other lesions and in tumours following radiotherapy induced regression, the extent of abnormal T1 and T2 signal was the same. Possible reasons for this observation are discussed. The accuracy of computed tomography (CT) and MRI were similar for lesions causing brain stem expansion but for small lesions MRI was more sensitive and provided better topographical information.

Adolescent↗
PubMed1989

Cranial computed tomography and magnetic resonance tomography in cerebrovascular occlusive disease.

CT is the method of choice for acute diagnosis of cerebral infarction. Attention is to be paid to the alterations of the absorption values with time during the infarction course. In particular, the "fogging effect" should be considered in the second and third week when the infarct may not be demonstrable in the simple CT owing to isodensity and lack of signs of space occupation. The xenon CT enables cerebral blood flow to be measured with calculation of regional cerebral blood flow in ml/100 g brain tissue/min. The simple clinical implementation and the good anatomical correlation are advantageous. MR offers a further non-invasive possibility of diagnosing cerebrovascular diseases. MR is especially efficient in detecting small lacunar infarcts in the medullary bed and in the brain stem. The application of gadolinium-DTPA has in particular differential diagnostic significance. In MR angiography, it is to be expected that the large vessels of the neck and brain can be imaged in the future without administration of contrast media.

Arterial Occlusive Diseases↗
PubMed1986

Primary brain stem haemorrhages: clinico-radiological considerations on five cases observed.

Five patients with primary brain stem haemorrhage are reported, of whom four survived. One died from complications involving other organs. The diagnosis was made by computerized tomography which also allowed the temporal evolution of the lesion to be followed. The importance of haemorrhagic lesions in brain stem vascular pathology with regard to ischaemic lesions is re-evaluated.

Aged↗