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
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
<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
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.
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.
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.
