Millard-Gubler Syndrome is a rare neurological condition caused by damage to the sixth and seventh cranial nerves, as well as the corticospinal tract in the brainstem. It is characterized by the presence of ipsilatera...Millard-Gubler Syndrome is a rare neurological condition caused by damage to the sixth and seventh cranial nerves, as well as the corticospinal tract in the brainstem. It is characterized by the presence of ipsilateral facial paralysis and contralateral hemiplegia. We report a 55-year-old male patient who presented with sudden onset of left-sided weakness. Imaging revealed a pontine infarct. The patient therefore, was diagnosed with Millard-Gubler Syndrome also known as Ventral Pontine Syndrome based on his symptoms and imaging findings. He was treated with Aspirin and Atorvastatin and was referred to neurology for further consultation and to physiotherapy for his weakness. This case report highlights the importance of prompt recognition and diagnosis of Millard-Gubler Syndrome in patients with pontine infarction. Early identification especially with the use of high-resolution MRI can facilitate appropriate management and treatment, ultimately improving patient outcomes.展开更多
Multifocal pontine glioblastoma exhibiting an exophytic growth pattern in the cerebello-pontine angle(CPA) is rare.We present a case of a 5-year-old girl with consecutive neurological imaging and other clinical findin...Multifocal pontine glioblastoma exhibiting an exophytic growth pattern in the cerebello-pontine angle(CPA) is rare.We present a case of a 5-year-old girl with consecutive neurological imaging and other clinical findings indicating progressive multifocal exophytic pontine glioblastoma.Three lesions were reported,of which two were initially presented,and one was developed 2 months later.One lesion demonstrated a progressing exophytic extension in the cistern of the left side of the CPA.The other two lesions were located and confined within the pons.Initial magnetic resonance imaging and positron emission tomography-computed tomography indicated low-grade glioma or inflammatory disease.However,2 and 3 months later,subsequent magnetic resonance spectroscopy(MRS) displayed elevated choline and depressed N-acetyl aspartate peaks compared with the peaks on the initial MRS,indicating a high-grade glioma.Subtotal resection was performed for the CPA lesion.Histopathologic examination showed discrepant features of different parts of the CPA lesion.The patient received no further chemotherapy or radiotherapy and died 2 months after surgery.The multifocal and exophytic features of this case and the heterogeneous manifestations on neurological images were rare and confusing for both diagnosis and surgical decision-making.Our case report may contribute knowledge and helpful guidance for other medical doctors.展开更多
Progressive motor deficits are relatively common in acute pontine infarction and frequently associated with increased functional disability. However, the factors that affect the progression of clinical motor weakness ...Progressive motor deficits are relatively common in acute pontine infarction and frequently associated with increased functional disability. However, the factors that affect the progression of clinical motor weakness are largely unknown. Previous studies have suggested that pontine infarctions are caused mainly by basilar artery stenosis and penetrating artery disease. Recently, lower pons lesions in patients with acute pontine infarctions have been reported to be related to progressive motor deficits, and ensuing that damage to the corticospinal tracts may be respon- sible for the worsening of neurological symptoms. Here, we review studies on motor weakness progression in pontine infarction and discuss the mechanisms that may underlie the neurologic worsening.展开更多
We analyzed the clinical manifestations and experiences of diagnosing and treating central pontine myelinolysis following living donor liver transplantation. The clinical data of three patients with central pontine my...We analyzed the clinical manifestations and experiences of diagnosing and treating central pontine myelinolysis following living donor liver transplantation. The clinical data of three patients with central pontine myelinolysis following living donor liver transplantation from January 2005 to November 2007 were retrospectively analyzed at the West China Hospital, Sichuan University, China. The three patients developed hyponatremia prior to surgery. Case 1 suffered locked-in syndrome following surgery, and received a large dose of gamma globulin, and subsequently recovered. Case 2 was in a coma for three days, and received hyperbaric chamber treatment. This patient remained in a mild coma for six months following surgery. Case 3 developed consciousness disturbances, gradually went into a coma following surgery, and died due to pulmonary infection. Central pontine myelinolysis is a severe complication in patients following living donor liver transplantation. Large-dose gamma globulin treatment, as well as hyperbaric oxygen, might be effective therapeutic methods.展开更多
Inoperable brainstem gliomas (BSG) are among the most difficult to treat malignancies. In the intent-to-treat (ITT) population of the BT-11 study for BSG, forty patients (median age 11.2 years old) were enrolled. Anti...Inoperable brainstem gliomas (BSG) are among the most difficult to treat malignancies. In the intent-to-treat (ITT) population of the BT-11 study for BSG, forty patients (median age 11.2 years old) were enrolled. Antineoplastons A10 and AS2-1 (ANP) were administered intravenously daily. The median daily dose of A10 was 8.70 g/kg/day and AS2-1 was 0.32 g/kg/day. Efficacy analyses were conducted in two subgroups: recurrent pediatric diffuse intrinsic pontine glioma (RPDIPG, N?= 17) and non-diffuse intrinsic pontine glioma (NDIPG, N?= 11). This paper reports the results of the study of the efficacy and safety of ANP in patients with NDIPG. The results in the RPDIPG group were reported before;complete response (CR) was 6%, partial response (PR) 23.5%, and stable disease (SD) 17.6%. One year overall survival (OS) was 29.4%, 2 years 11.8%, and 5, 10, and 15 years 6%. In the NDIPG group, there were 36% CR and 27.5% SD. OS at 1, 5, 10, and 15 years was 82%, 73%, 62%, and 50% correspondingly. There was only one serious adverse event (9%) reported in NDIPG represented by hypokalemia, Grade 4. The results suggest that ANP shows efficacy and an acceptable tolerability profile in patients with RPDIPG and NDIPG.展开更多
Integrity of the corticospinal tract is mandatory for good recovery of impaired motor function in patients who have suffered a stroke.A 67-year-old left hemiparetic female showed an infarct in the right pons.Three mon...Integrity of the corticospinal tract is mandatory for good recovery of impaired motor function in patients who have suffered a stroke.A 67-year-old left hemiparetic female showed an infarct in the right pons.Three months after onset,motor function of the affected extremities recovered rapidly to a nearly complete state.Diffusion tensor tractography of both hemispheres showed that the corticospinal tract originated from the primary sensori-motor cortex and descended through the known corticospinal tract pathway.The tract of the affected（right）hemisphere descended through an area within the pontine infarct.The diffusion tensor tractography results suggest that from the onset,the integrity of the corticospinal tract appears to have been spared within the pontine infarct.展开更多
BACKGROUND Hemorrhage lesions may lead to bilateral hypertrophic olivary degeneration(HOD)through interruption of the dentato-rubral-olivary pathway.The pathological features of HOD are unusual neuronal trans-synaptic...BACKGROUND Hemorrhage lesions may lead to bilateral hypertrophic olivary degeneration(HOD)through interruption of the dentato-rubral-olivary pathway.The pathological features of HOD are unusual neuronal trans-synaptic degenerative changes.CASE SUMMARY A 56-year-old female was admitted to our hospital because her lower extremities and left upper ones were unable to move for 3 mo,and the swelling of her right lower extremities became worse 3 days ago.She had a hypertension history.Her characteristic clinical manifestations are palatal myoclonus and nystagmus.The patient’s magnetic resonance imaging(MRI)results showed that she had bilateral HOD after an acute pontine hemorrhage.She was given symptomatic and supportive treatment.The gabapentin,the memantine and the trihexyphenidyl were taken twice a day each.The rehabilitation and psychotherapy were implemented.After 3 months of treatment,her eye symptoms improved.CONCLUSION Bilateral HOD is a rare phenomenon after pontine hemorrhage.The key to diagnosis lies in the clinical manifestations and MRI results.展开更多
Objectives and Importance: Although pontine hemorrhage is very often fatal, the clinical manifestations vary accord-ing to the location and extent of the hematoma. We investigated the prognostic factors of pontine hem...Objectives and Importance: Although pontine hemorrhage is very often fatal, the clinical manifestations vary accord-ing to the location and extent of the hematoma. We investigated the prognostic factors of pontine hemorrhage by assessing clinical manifestation and CT findings in relation to outcome. Materials and Methods: The outcome and clinical features of 19 patients with pontine hemorrhage without surgical intervention were analyzed. The CT features of the hematoma were classified into four types: massive, tegmento-basilar, transverse oval, and small unilateral. The Glasgow Outcome Scale (GOS) was used to assess patient outcome (G, good recovery;MD, moderate disability;SD, severe disability, V, vegetative state, D, death) at discharge. Results: The outcome was MD in 7 cases, SD in 3, and D in 9. Eight of 9 patients with acute hydrocephalus died, whereas only one of 10 patients without hydrocephalus died (p 12, tetraparesis, or respiratory failure (p < 0.01, 0.05, 0.01, respectively). Four of 5 patients with CT evidence of massive hemorrhage died, and another patient became vegetative. The outcome in 6 patients with tegmento-basilar-type hematoma included D in 3, V in 2, and MD in 1, and that in 7 patients with transverse oval hematoma included D in 2, V in 1, SD in 1, and MD in 3. Five (65%) of the 8 patients with transverse oval or small unilateral hematomas were able to walk (MD) with or without assistance, whereas only 2 (18%) of 11 patients with tegmento-basilar-type and massive hematoma were ambulatory at discharge (p < 0.05). Conclu-sion: On the basis of CT classification, the functional prognosis of transverse oval pontine hemorrhage is as favorable as that of the small unilateral type.展开更多
Bilateral spontaneous pontine hemorrhage is rare. In addition, bilateral corticospinal tract （CST） involvement in the pons may accompany serious motor sequelae. A 45-year-old right-handed woman was admitted for bila...Bilateral spontaneous pontine hemorrhage is rare. In addition, bilateral corticospinal tract （CST） involvement in the pons may accompany serious motor sequelae. A 45-year-old right-handed woman was admitted for bilateral pontine hemorrhage. The patient presented with moderate quadriparesis at stroke onset and quickly recovered to the point of being able to extend the muscles of all four extremities against resistance, at 2 weeks from onset. At 4 weeks after stroke onset, she was able to perform all fine motor activities, as well as to walk with a normal gait. Diffusion tensor tractography results showed that the CSTs of both hemispheres originated from the primary sensorimotor cortex and descended through the corona radiata, the posterior limb of the internal capsule, midbrain, anterior pons, and the anterior medulla, along the known pathway of the CST. However, at midbrain and pons, the CSTs were compressed posterolaterally. The contralateral primary sensorimotor cortex, centered on the precentral knob, was activated during movement of either hand of the patient, as shown by functional MRI, which indicates the preservation of lateral CST. Findings from this study suggest that diffusion tensor tractography may be helpful in the elucidation of the CST status in patients with pontine hemorrhage.展开更多
To study whether the sympathetic nerves coordinate with the parasympathetic nerves during micturition in the rat. We used antegrade neural tracing with biotinylated dextran amine (BDA) injected into the pontine mictur...To study whether the sympathetic nerves coordinate with the parasympathetic nerves during micturition in the rat. We used antegrade neural tracing with biotinylated dextran amine (BDA) injected into the pontine micturition center (PMC) to label the terminals in the L6-S1 cord. Preganglionic parasympathetic neurons (PPNs) in the L6-S1 segment were labelled by retrograde transport of Fluorogold (FG) from the major pelvic ganglion (MPG).We detected retrograde neurons in L6-S1 using retrograde transport of horseradish peroxidase (HRP) from the intermediolateral cell column (IML) of the L1-L2 segment where sympathetic preganglionic neurons (SPNs) are located. Immunohistochemical methods showed that PPNs were identified to be choline acetyltransferase-immunoreactive (ChAT-IR). HRP-labelled neurons were not ChAT-IR and located dorsal to PPNs. BDA-labelled terminals were located mainly in the bilateral IML of L6-S1, some of which had synaptic contact with the HRP-labelled neurons. In addition, there were some wheat germ agglutinin-horseradish peroxidase (WGA-HRP) labelled terminals in the ipsilateral IML of the L1-L2 segment after WGA-HRP was microinjected into SPN. We conclude that PMC may control the preganglionic neurons of sympathetic nerves through the interneurons located dorsal to PPNs.展开更多
BACKGROUND Central pontine myelinolysis(CPM)usually occurs during rapid correction of serum osmolality,typically with brainstem lesions presenting uniform signals following enhancement on magnetic resonance imaging(MR...BACKGROUND Central pontine myelinolysis(CPM)usually occurs during rapid correction of serum osmolality,typically with brainstem lesions presenting uniform signals following enhancement on magnetic resonance imaging(MRI).We report a case of CPM caused by diabetes,which was characterized by glioma-like imaging features and the patient responded well to corticosteroids.CASE SUMMARY A 49-year-old man with type 2 diabetes was admitted due to numbness and weakness for 6 mo with progressive aggravation for 2 wk.His complete blood count,serum electrolytes,renal and liver function parameters were within the normal range.MRI showed mass lesions in the brainstem,with unusually inhomogeneous signal intensity after contrast-enhanced scans.His symptoms worsened after hypoglycemic therapy.Due to his clinical history and examination results,CPM was considered the most likely diagnosis.Treatment with corticosteroids was administered with a methylprednisolone pulse in the acute phase followed by dose tapering.During the 8-mo follow-up period,his clinical symptoms and imaging features significantly improved.CONCLUSION Diabetes could rarely be accompanied by CPM,and patients who experience this neurological complication could benefit from corticosteroid treatment.Clinicians should recognize the special relationship between diabetes and CPM,and improve awareness of early identification and appropriate treatment.展开更多
Hypertensive brain stem encephalopathy(HBE) is a rare, under diagnosed subtype of hypertensive encephalopathy(HE) which is usually reversible, but with a potentially fatal outcome if hypertension is not managed prompt...Hypertensive brain stem encephalopathy(HBE) is a rare, under diagnosed subtype of hypertensive encephalopathy(HE) which is usually reversible, but with a potentially fatal outcome if hypertension is not managed promptly. To the best of our knowledge, only one case of HE with brain stem hemorrhage has been reported. We report a case of HBE with pontine hemorrhage in a 36-year-old male patient. The patient developed severe arterial hypertension associated with initial computed tomography showing the left basilar part of pons hemorrhage, fluid-attenuated inversion-recovery showing hyperintense signals in the pons and bilateral periventricular, anterior part of bilateral centrum ovale. The characteristic clinical findings were walking difficulty, right leg weakness, and mild headache with nausea which corresponded to the lesions of MR imagings. The lesions improved gradually with improvements in hypertension, which suggested that edema could be the principal cause of the unusual hyperintensity on magnetic resonance images.展开更多
We report on the case of middle-aged right-handed woman with central pontine myelinolysis (CPM) revealed by high resolution structural T2-weighted FLAIR MRI imaging. There was a general flattening of Wechsler Adult In...We report on the case of middle-aged right-handed woman with central pontine myelinolysis (CPM) revealed by high resolution structural T2-weighted FLAIR MRI imaging. There was a general flattening of Wechsler Adult Intelligence Scale—Fourth Edition subtest scores which were 1 standard deviation below expected values. In contrast Wechsler Memory Scale—Fourth Edition visual and auditory memory scores remained within the normal range. Verbal working memory appeared mildly impaired while nonverbal working memory was not. Scores on the Advanced Clinical Solution’s Social Perception battery were all in the normal range as were academic skills measured by the Wide Range Achievement Test—Fourth Edition. Performance was impaired on the Delis-Kaplan Executive Function System’s counterpart of the Trail-Making Test: Part B. Similarly, on the Draw-A-Person Test there was a discrepancy in that our patient’s standard score was 76 compared to her estimated premorbid FSIQ in the average range. She also displayed bilateral motor coordination slowing on the Finger Tapping task collectively suggesting damage to pontine motor tracts. The Minnesota Multiphasic Personality Inventory—Second Edition—Restructured Form profile was consistent with a diagnosis of severe anxiety and depression perhaps due to damage to serotoninergic neural tracts originating within the central pons. Finally, the patient displayed severe sleep disturbances and other signs of reticular activating formation injury. CPM may constitute a unique means of studying reversible subcortical lesions in the central pons in otherwise healthy subjects with benign illness. To our knowledge this is among the first patients with CPM without the usual risk factors for the disorder and who was otherwise healthy. Knowledge of the etiology and neuropsychology of such patients might aid in understanding the interaction of the fronto-ponto-cerebellar tracts in executive functions and motor programming.展开更多
<strong>Background: </strong>Patients with severe hypertensive brainstem hemorrhages have poor prognoses if they only receive conservative medical management. In contrast, aggressive operative intervention...<strong>Background: </strong>Patients with severe hypertensive brainstem hemorrhages have poor prognoses if they only receive conservative medical management. In contrast, aggressive operative interventions may decrease the morbidity and mortality in such patients. These operative treatments include craniotomy for evacuation of the hematoma, stereotactic positioning, and neuronavigational-guided hemorrhage puncture and drainage. Here, we report a novel and relatively simple procedure to achieve satisfactory outcomes in a patient with a brainstem pontine hemorrhage.<strong> Case Presentation:</strong> A 53-year-old man who was diagnosed with brainstem pontine hemorrhage. On hospital day 6, he underwent CT-guided, virtual stereotactic puncture and catheter drainage of this brainstem pontine hemorrhage. Medical treatments were continued after this procedure. On postoperative day 16 (hospital day 22), the patient was discharged from the hospital, awake and able to answer questions appropriately. Muscle strengths were grades V and IV for the left and right extremities, respectively. The patient was continued with active rehabilitation and achieved a Barthel index of 85 points at one month after the percutaneous drainage procedure. <strong>Conclusion:</strong> CT-guided, virtual stereotactic percutaneous transcranial puncture and catheter drainage for brainstem pontine hemorrhages has obvious potential advantages and offers a possible alternative to achieve the best outcomes with minimal operative trauma compared to open microcraniotomy.展开更多
Cerebellopontine angle (CPA) medulloblastomas (MB) are rare lesions with few cases previously described in the literature. We report one more case of CPA MB. The patient was a (36)-year-old female with a mass developi...Cerebellopontine angle (CPA) medulloblastomas (MB) are rare lesions with few cases previously described in the literature. We report one more case of CPA MB. The patient was a (36)-year-old female with a mass developing in the CPA. The preoperative radiological diagnosis was (hemangioblastoma) in the case. The patient was operated in Tripoli university hospital September 2020 neurosurgical department. Operated through a (retrosigmoid) approach. The intraoperative findings revealed an extra-axial tumor and the histological diagnosis was classic type of MB in the case. We review the literature and discuss pathological, radiological features and clinical follow up of CPA MB, underlining the necessity to consider MB in the differential diagnosis of CPA lesions.展开更多
文摘Millard-Gubler Syndrome is a rare neurological condition caused by damage to the sixth and seventh cranial nerves, as well as the corticospinal tract in the brainstem. It is characterized by the presence of ipsilateral facial paralysis and contralateral hemiplegia. We report a 55-year-old male patient who presented with sudden onset of left-sided weakness. Imaging revealed a pontine infarct. The patient therefore, was diagnosed with Millard-Gubler Syndrome also known as Ventral Pontine Syndrome based on his symptoms and imaging findings. He was treated with Aspirin and Atorvastatin and was referred to neurology for further consultation and to physiotherapy for his weakness. This case report highlights the importance of prompt recognition and diagnosis of Millard-Gubler Syndrome in patients with pontine infarction. Early identification especially with the use of high-resolution MRI can facilitate appropriate management and treatment, ultimately improving patient outcomes.
文摘Multifocal pontine glioblastoma exhibiting an exophytic growth pattern in the cerebello-pontine angle(CPA) is rare.We present a case of a 5-year-old girl with consecutive neurological imaging and other clinical findings indicating progressive multifocal exophytic pontine glioblastoma.Three lesions were reported,of which two were initially presented,and one was developed 2 months later.One lesion demonstrated a progressing exophytic extension in the cistern of the left side of the CPA.The other two lesions were located and confined within the pons.Initial magnetic resonance imaging and positron emission tomography-computed tomography indicated low-grade glioma or inflammatory disease.However,2 and 3 months later,subsequent magnetic resonance spectroscopy(MRS) displayed elevated choline and depressed N-acetyl aspartate peaks compared with the peaks on the initial MRS,indicating a high-grade glioma.Subtotal resection was performed for the CPA lesion.Histopathologic examination showed discrepant features of different parts of the CPA lesion.The patient received no further chemotherapy or radiotherapy and died 2 months after surgery.The multifocal and exophytic features of this case and the heterogeneous manifestations on neurological images were rare and confusing for both diagnosis and surgical decision-making.Our case report may contribute knowledge and helpful guidance for other medical doctors.
文摘Progressive motor deficits are relatively common in acute pontine infarction and frequently associated with increased functional disability. However, the factors that affect the progression of clinical motor weakness are largely unknown. Previous studies have suggested that pontine infarctions are caused mainly by basilar artery stenosis and penetrating artery disease. Recently, lower pons lesions in patients with acute pontine infarctions have been reported to be related to progressive motor deficits, and ensuing that damage to the corticospinal tracts may be respon- sible for the worsening of neurological symptoms. Here, we review studies on motor weakness progression in pontine infarction and discuss the mechanisms that may underlie the neurologic worsening.
文摘We analyzed the clinical manifestations and experiences of diagnosing and treating central pontine myelinolysis following living donor liver transplantation. The clinical data of three patients with central pontine myelinolysis following living donor liver transplantation from January 2005 to November 2007 were retrospectively analyzed at the West China Hospital, Sichuan University, China. The three patients developed hyponatremia prior to surgery. Case 1 suffered locked-in syndrome following surgery, and received a large dose of gamma globulin, and subsequently recovered. Case 2 was in a coma for three days, and received hyperbaric chamber treatment. This patient remained in a mild coma for six months following surgery. Case 3 developed consciousness disturbances, gradually went into a coma following surgery, and died due to pulmonary infection. Central pontine myelinolysis is a severe complication in patients following living donor liver transplantation. Large-dose gamma globulin treatment, as well as hyperbaric oxygen, might be effective therapeutic methods.
文摘Inoperable brainstem gliomas (BSG) are among the most difficult to treat malignancies. In the intent-to-treat (ITT) population of the BT-11 study for BSG, forty patients (median age 11.2 years old) were enrolled. Antineoplastons A10 and AS2-1 (ANP) were administered intravenously daily. The median daily dose of A10 was 8.70 g/kg/day and AS2-1 was 0.32 g/kg/day. Efficacy analyses were conducted in two subgroups: recurrent pediatric diffuse intrinsic pontine glioma (RPDIPG, N?= 17) and non-diffuse intrinsic pontine glioma (NDIPG, N?= 11). This paper reports the results of the study of the efficacy and safety of ANP in patients with NDIPG. The results in the RPDIPG group were reported before;complete response (CR) was 6%, partial response (PR) 23.5%, and stable disease (SD) 17.6%. One year overall survival (OS) was 29.4%, 2 years 11.8%, and 5, 10, and 15 years 6%. In the NDIPG group, there were 36% CR and 27.5% SD. OS at 1, 5, 10, and 15 years was 82%, 73%, 62%, and 50% correspondingly. There was only one serious adverse event (9%) reported in NDIPG represented by hypokalemia, Grade 4. The results suggest that ANP shows efficacy and an acceptable tolerability profile in patients with RPDIPG and NDIPG.
基金the National Research Foundation of Korea Grant Funded by the Korean Government, No. KRF-2008-314-E00173
文摘Integrity of the corticospinal tract is mandatory for good recovery of impaired motor function in patients who have suffered a stroke.A 67-year-old left hemiparetic female showed an infarct in the right pons.Three months after onset,motor function of the affected extremities recovered rapidly to a nearly complete state.Diffusion tensor tractography of both hemispheres showed that the corticospinal tract originated from the primary sensori-motor cortex and descended through the known corticospinal tract pathway.The tract of the affected（right）hemisphere descended through an area within the pontine infarct.The diffusion tensor tractography results suggest that from the onset,the integrity of the corticospinal tract appears to have been spared within the pontine infarct.
基金Scientific Research Project of Sichuan Hospital Management and Development Research Center,No.SCYG2019-25Key Technology Plan of Yaan City,No.21KJH0006.
文摘BACKGROUND Hemorrhage lesions may lead to bilateral hypertrophic olivary degeneration(HOD)through interruption of the dentato-rubral-olivary pathway.The pathological features of HOD are unusual neuronal trans-synaptic degenerative changes.CASE SUMMARY A 56-year-old female was admitted to our hospital because her lower extremities and left upper ones were unable to move for 3 mo,and the swelling of her right lower extremities became worse 3 days ago.She had a hypertension history.Her characteristic clinical manifestations are palatal myoclonus and nystagmus.The patient’s magnetic resonance imaging(MRI)results showed that she had bilateral HOD after an acute pontine hemorrhage.She was given symptomatic and supportive treatment.The gabapentin,the memantine and the trihexyphenidyl were taken twice a day each.The rehabilitation and psychotherapy were implemented.After 3 months of treatment,her eye symptoms improved.CONCLUSION Bilateral HOD is a rare phenomenon after pontine hemorrhage.The key to diagnosis lies in the clinical manifestations and MRI results.
文摘Objectives and Importance: Although pontine hemorrhage is very often fatal, the clinical manifestations vary accord-ing to the location and extent of the hematoma. We investigated the prognostic factors of pontine hemorrhage by assessing clinical manifestation and CT findings in relation to outcome. Materials and Methods: The outcome and clinical features of 19 patients with pontine hemorrhage without surgical intervention were analyzed. The CT features of the hematoma were classified into four types: massive, tegmento-basilar, transverse oval, and small unilateral. The Glasgow Outcome Scale (GOS) was used to assess patient outcome (G, good recovery;MD, moderate disability;SD, severe disability, V, vegetative state, D, death) at discharge. Results: The outcome was MD in 7 cases, SD in 3, and D in 9. Eight of 9 patients with acute hydrocephalus died, whereas only one of 10 patients without hydrocephalus died (p 12, tetraparesis, or respiratory failure (p < 0.01, 0.05, 0.01, respectively). Four of 5 patients with CT evidence of massive hemorrhage died, and another patient became vegetative. The outcome in 6 patients with tegmento-basilar-type hematoma included D in 3, V in 2, and MD in 1, and that in 7 patients with transverse oval hematoma included D in 2, V in 1, SD in 1, and MD in 3. Five (65%) of the 8 patients with transverse oval or small unilateral hematomas were able to walk (MD) with or without assistance, whereas only 2 (18%) of 11 patients with tegmento-basilar-type and massive hematoma were ambulatory at discharge (p < 0.05). Conclu-sion: On the basis of CT classification, the functional prognosis of transverse oval pontine hemorrhage is as favorable as that of the small unilateral type.
基金supported by National Research Foundation of Korea Grant funded by the Korean Government,No.KRF-2008-314-E00173
文摘Bilateral spontaneous pontine hemorrhage is rare. In addition, bilateral corticospinal tract （CST） involvement in the pons may accompany serious motor sequelae. A 45-year-old right-handed woman was admitted for bilateral pontine hemorrhage. The patient presented with moderate quadriparesis at stroke onset and quickly recovered to the point of being able to extend the muscles of all four extremities against resistance, at 2 weeks from onset. At 4 weeks after stroke onset, she was able to perform all fine motor activities, as well as to walk with a normal gait. Diffusion tensor tractography results showed that the CSTs of both hemispheres originated from the primary sensorimotor cortex and descended through the corona radiata, the posterior limb of the internal capsule, midbrain, anterior pons, and the anterior medulla, along the known pathway of the CST. However, at midbrain and pons, the CSTs were compressed posterolaterally. The contralateral primary sensorimotor cortex, centered on the precentral knob, was activated during movement of either hand of the patient, as shown by functional MRI, which indicates the preservation of lateral CST. Findings from this study suggest that diffusion tensor tractography may be helpful in the elucidation of the CST status in patients with pontine hemorrhage.
基金This project was supported by a grant fromthe Ministry ofSicience and Technology of China (No .2003CB515300) .
文摘To study whether the sympathetic nerves coordinate with the parasympathetic nerves during micturition in the rat. We used antegrade neural tracing with biotinylated dextran amine (BDA) injected into the pontine micturition center (PMC) to label the terminals in the L6-S1 cord. Preganglionic parasympathetic neurons (PPNs) in the L6-S1 segment were labelled by retrograde transport of Fluorogold (FG) from the major pelvic ganglion (MPG).We detected retrograde neurons in L6-S1 using retrograde transport of horseradish peroxidase (HRP) from the intermediolateral cell column (IML) of the L1-L2 segment where sympathetic preganglionic neurons (SPNs) are located. Immunohistochemical methods showed that PPNs were identified to be choline acetyltransferase-immunoreactive (ChAT-IR). HRP-labelled neurons were not ChAT-IR and located dorsal to PPNs. BDA-labelled terminals were located mainly in the bilateral IML of L6-S1, some of which had synaptic contact with the HRP-labelled neurons. In addition, there were some wheat germ agglutinin-horseradish peroxidase (WGA-HRP) labelled terminals in the ipsilateral IML of the L1-L2 segment after WGA-HRP was microinjected into SPN. We conclude that PMC may control the preganglionic neurons of sympathetic nerves through the interneurons located dorsal to PPNs.
文摘BACKGROUND Central pontine myelinolysis(CPM)usually occurs during rapid correction of serum osmolality,typically with brainstem lesions presenting uniform signals following enhancement on magnetic resonance imaging(MRI).We report a case of CPM caused by diabetes,which was characterized by glioma-like imaging features and the patient responded well to corticosteroids.CASE SUMMARY A 49-year-old man with type 2 diabetes was admitted due to numbness and weakness for 6 mo with progressive aggravation for 2 wk.His complete blood count,serum electrolytes,renal and liver function parameters were within the normal range.MRI showed mass lesions in the brainstem,with unusually inhomogeneous signal intensity after contrast-enhanced scans.His symptoms worsened after hypoglycemic therapy.Due to his clinical history and examination results,CPM was considered the most likely diagnosis.Treatment with corticosteroids was administered with a methylprednisolone pulse in the acute phase followed by dose tapering.During the 8-mo follow-up period,his clinical symptoms and imaging features significantly improved.CONCLUSION Diabetes could rarely be accompanied by CPM,and patients who experience this neurological complication could benefit from corticosteroid treatment.Clinicians should recognize the special relationship between diabetes and CPM,and improve awareness of early identification and appropriate treatment.
文摘Hypertensive brain stem encephalopathy(HBE) is a rare, under diagnosed subtype of hypertensive encephalopathy(HE) which is usually reversible, but with a potentially fatal outcome if hypertension is not managed promptly. To the best of our knowledge, only one case of HE with brain stem hemorrhage has been reported. We report a case of HBE with pontine hemorrhage in a 36-year-old male patient. The patient developed severe arterial hypertension associated with initial computed tomography showing the left basilar part of pons hemorrhage, fluid-attenuated inversion-recovery showing hyperintense signals in the pons and bilateral periventricular, anterior part of bilateral centrum ovale. The characteristic clinical findings were walking difficulty, right leg weakness, and mild headache with nausea which corresponded to the lesions of MR imagings. The lesions improved gradually with improvements in hypertension, which suggested that edema could be the principal cause of the unusual hyperintensity on magnetic resonance images.
文摘We report on the case of middle-aged right-handed woman with central pontine myelinolysis (CPM) revealed by high resolution structural T2-weighted FLAIR MRI imaging. There was a general flattening of Wechsler Adult Intelligence Scale—Fourth Edition subtest scores which were 1 standard deviation below expected values. In contrast Wechsler Memory Scale—Fourth Edition visual and auditory memory scores remained within the normal range. Verbal working memory appeared mildly impaired while nonverbal working memory was not. Scores on the Advanced Clinical Solution’s Social Perception battery were all in the normal range as were academic skills measured by the Wide Range Achievement Test—Fourth Edition. Performance was impaired on the Delis-Kaplan Executive Function System’s counterpart of the Trail-Making Test: Part B. Similarly, on the Draw-A-Person Test there was a discrepancy in that our patient’s standard score was 76 compared to her estimated premorbid FSIQ in the average range. She also displayed bilateral motor coordination slowing on the Finger Tapping task collectively suggesting damage to pontine motor tracts. The Minnesota Multiphasic Personality Inventory—Second Edition—Restructured Form profile was consistent with a diagnosis of severe anxiety and depression perhaps due to damage to serotoninergic neural tracts originating within the central pons. Finally, the patient displayed severe sleep disturbances and other signs of reticular activating formation injury. CPM may constitute a unique means of studying reversible subcortical lesions in the central pons in otherwise healthy subjects with benign illness. To our knowledge this is among the first patients with CPM without the usual risk factors for the disorder and who was otherwise healthy. Knowledge of the etiology and neuropsychology of such patients might aid in understanding the interaction of the fronto-ponto-cerebellar tracts in executive functions and motor programming.
文摘<strong>Background: </strong>Patients with severe hypertensive brainstem hemorrhages have poor prognoses if they only receive conservative medical management. In contrast, aggressive operative interventions may decrease the morbidity and mortality in such patients. These operative treatments include craniotomy for evacuation of the hematoma, stereotactic positioning, and neuronavigational-guided hemorrhage puncture and drainage. Here, we report a novel and relatively simple procedure to achieve satisfactory outcomes in a patient with a brainstem pontine hemorrhage.<strong> Case Presentation:</strong> A 53-year-old man who was diagnosed with brainstem pontine hemorrhage. On hospital day 6, he underwent CT-guided, virtual stereotactic puncture and catheter drainage of this brainstem pontine hemorrhage. Medical treatments were continued after this procedure. On postoperative day 16 (hospital day 22), the patient was discharged from the hospital, awake and able to answer questions appropriately. Muscle strengths were grades V and IV for the left and right extremities, respectively. The patient was continued with active rehabilitation and achieved a Barthel index of 85 points at one month after the percutaneous drainage procedure. <strong>Conclusion:</strong> CT-guided, virtual stereotactic percutaneous transcranial puncture and catheter drainage for brainstem pontine hemorrhages has obvious potential advantages and offers a possible alternative to achieve the best outcomes with minimal operative trauma compared to open microcraniotomy.
文摘Cerebellopontine angle (CPA) medulloblastomas (MB) are rare lesions with few cases previously described in the literature. We report one more case of CPA MB. The patient was a (36)-year-old female with a mass developing in the CPA. The preoperative radiological diagnosis was (hemangioblastoma) in the case. The patient was operated in Tripoli university hospital September 2020 neurosurgical department. Operated through a (retrosigmoid) approach. The intraoperative findings revealed an extra-axial tumor and the histological diagnosis was classic type of MB in the case. We review the literature and discuss pathological, radiological features and clinical follow up of CPA MB, underlining the necessity to consider MB in the differential diagnosis of CPA lesions.
