Eosinophilic Meningitis due toAngiostrongylus cantonensisin Germany

We report a case of eosinophilic meningitis due to Angiostrongylus cantonensis in a patient who returned from Thailand. The presence of a compatible epidemiologic history and eosinophilia in cerebrospinal fluid (CSF) lead to the diagnosis, which was confirmed by detection of specific antibodies. After treatment with albendazole and corticosteroids he recovered completely.

Poor prognosis despite successful treatment of postanoxic generalized myoclonus.

Generalized myoclonus (GM) after cardiopulmonary resuscitation (CPR) implies a poor prognosis.1 Postanoxic GM is usually classified as one type of convulsive status epilepticus,2 which is also reflected by terms like myoclonic status,3 myoclonic status epilepticus,4 or postanoxic status epilepticus.5 Antiepileptic drugs commonly used in the treatment of status epilepticus such as phenytoin or valproate, however, are ineffective in the majority of these patients.3,4,6 Reports of single patients7 and our own observations6 indicated that propofol may control GM. This prompted us to use propofol as standard treatment of postanoxic GM in 60 consecutive comatose survivors of CPR. ### Level of evi…

Abduction saccades in unilateral internuclear ophthalmoplegia

Horizontal eye movements were investigated in 60 consecutive patients with unilateral internuclear ophthalmoplegia utilizing direct current electrooculography. In nine patients additional conjugated slowing of ipsiversive saccades indicated the diagnosis of a one-and-a-half syndrome. Slowing of abduction saccades was bilateral in two patients and unilateral in 20 (ipsilateral to the MLF lesion in 17 patients and contralateral in three). Slowing of abduction saccades was attributed to impaired inhibition of the tonic resting activity of the antagonistic medial rectus muscle. On the eye contralateral to the lesion 70% of the patients had abduction nystagmus and 66.7% hy permetric abduction sa…

Third nerve palsy as the sole manifestation of midbrain ischemia

Thirty-seven patients with risk factors for the development of cerebrovascular diseases had sudden onset isolated third nerve palsy and abnormal masseter reflex and/or electro-oculographic findings indicating a causative midbrain lesion. Improvement or recovery of the third nerve palsies was accompanied by improvement or recovery of the abnormal electrophysiologic findings pointing to their functional significance. Magnetic resonance imaging (MRI) in 29 of these patients demonstrated corresponding ischemic midbrain lesions in eight, ipsilateral in five patients, bilateral in three. In another three patients with MRI proven midbrain lesions (ipsilateral in two, bilateral in one) electrophysi…

A Pathway in the Brainstem for Roll-Tilt of the Subjective Visual Vertical: Evidence from a Lesion–Behavior Mapping Study

The perceived subjective visual vertical (SVV) is an important sign of a vestibular otolith tone imbalance in the roll plane. Previous studies suggested that unilateral pontomedullary brainstem lesions cause ipsiversive roll-tilt of SVV, whereas pontomesencephalic lesions cause contraversive roll-tilts of SVV. However, previous data were of limited quality and lacked a statistical approach. We therefore tested roll-tilt of the SVV in 79 human patients with acute unilateral brainstem lesions due to stroke by applying modern statistical lesion–behavior mapping analysis. Roll-tilt of the SVV was verified to be a brainstem sign, and for the first time it was confirmed statistically that lesions…

The course of corticofacial projections in the human brainstem.

Transcranial magnetic stimulation was used to investigate the corticofacial projections in 53 patients with (n = 28) and without (n = 25) central facial paresis due to unifocal ischaemic lesions at different brainstem levels. Lesion topography documented by MRI studies was correlated with the electrophysiological findings. In the majority of patients the corticofacial fibres travel within the ventromedial base of the pons and cross the midline at the level of the facial nucleus. In some individuals, however, we found evidence that corticolingual fibres form an 'aberrant bundle' in a paralemniscal position at the dorsal edge of the pontine base. In other patients the corticofacial fibres loo…

Elektro-Okulographie bei Hirnstammerkrankungen

Zusammenfassung Augenbewegungsstorungen sind haufige und typische Symptomen von Hirnstammerkrankungen. Hier liegt die Bedeutung der Elektrookulographie in erster Linie in der Aufdeckung subklinischer Veranderungen (Abb. 1) und weniger in der Bestatigung klinisch evidenter Storungen. Hierzu eignet sich vor allem die Aufzeichnung von Willkursakkaden, die im Allgemeinen bezuglich Geschwindigkeit und Zielgenauigkeit analysiert werden. Hiermit konnen bei Patienten mit multipler Sklerose oder Bewegungsstorungen (M. Parkinson, progressive supranukleare Parese, Chorea Huntington) eine Reihe recht typischer Befunde erhoben werden, die bei der Diagnose hilfreich sein konnen. Dabei legen neuere Studie…

Acquired monocular elevation paresis. An asymmetric upgaze palsy.

Five patients with acquired monocular elevation paresis were investigated using direct current electrooculography. With recovery, upward saccade velocities significantly increased in both eyes in all patients. The gain of upward-following eye movements significantly increased in the paretic eye of all patients and in the opposite eye of four patients. These findings are interpreted in terms of an asymmetric upgaze palsy which clinically presented as monocular elevation paresis in the more severely affected eye. A brainstem lesion contralateral to monocular elevation paresis was suggested in four patients by contralateral Horner's syndrome and contralateral abduction paresis, each in one pat…

Topodiagnostic implications of hemiataxia: An MRI-based brainstem mapping analysis

The topodiagnostic implications of hemiataxia following lesions of the human brainstem are only incompletely understood. We performed a voxel-based statistical analysis of lesions documented on standardised MRI in 49 prospectively recruited patients with acute hemiataxia due to isolated unilateral brainstem infarction. For statistical analysis individual MRI lesions were normalised and imported in a three-dimensional voxel-based anatomical model of the human brainstem. Statistical analysis revealed hemiataxia to be associated with lesions of three distinct brainstem areas. The strongest correlation referred to ipsilateral rostral and dorsolateral medullary infarcts affecting the inferior ce…

Cranial nerve function in workers exposed to polychlorinated dioxins and furans

OBJECTIVE: To look for possible effects of polychlorinated dioxins and furans (PCDD/F) on cranial nerve function. MATERIAL AND METHODS: Clinical and neurophysiological examinations [visual and brainstem auditory evoked potentials (VEP and BAEP), blink reflex] in 121 PCDD/F exposed workers of one pesticide producing plant. RESULTS: BAEP abnormalities were more frequent in workers with chloracne (6 of 33 workers, 18.2%) than in those without chloracne (7 of 84, 8.3%), but this was not statistically significant (chi2: 2.33). VEP abnormalities were seen in one worker with and two without chloracne. Clinically visual functions were normal except in one worker, who was amaurotic since birth. Blin…

Isolated superior oblique palsies with brainstem lesions

Article abstract Isolated unilateral superior oblique palsies resulting from brainstem lesions occurred in three patients. MRI documented contralateral tegmental lesions of the trochlear nucleus and adjacent intraaxial trochlear nerve. Lacunar infarct was the cause in two patients and a small hemorrhage in a third.

Electrophysiological and MRI findings in 2 patients with Listeria rhombencephalitis.

Slowed abduction saccades in bilateral internuclear ophthalmoplegia

Horizontal eye movements were investigated in 65 patients with bilateral internuclear ophthalmoplegia utilizing direct current electro-oculography. Abduction saccades were slowed in 35 patients (53.8%), being hypermetric in 65.7% of them. Slowing of abduction saccades is attributed to impaired inhibition of the tonic resting activity of the antagonistic medial rectus muscle. Experimental data indicate that this slowing results from a lesion of an uncrossed connection between the pontine reticular formation and the oculomotor nucleus. The prevalence of hypermetric abduction saccades increased with increasing severity of adduction paresis on the opposite eye. This confirms the view that media…

Pupil-sparing oculomotor palsy as the only clinical sign of an internal carotid artery occlusion

Rapid improvement from barbiturate coma by phenytoin

Brainstem diseases causing isolated ocular motor nerve palsies

There is a significant number of individual patients with ocular motor nerve palsies as the only clinical sign of MRI- and, less frequently, CT-documented small brainstem lesions with a predominanc...

The so-called one-and-a-half syndrome, type II: a new syndrome?

Objective: The term one-and-a-half syndrome, type II, was recently coined and has been applied to two somewhat different eye movement disorders: the loss of voluntary horizontal eye movements except for adduction in one eye (one patient with two lesions, one in the cerebral hemisphere and the other in the cavernous sinus) and the loss of all voluntary horizontal eye movements with adduction nystagmus in the right eye on attempted gaze to the left and preserved abduction in both eyes with the doll’s head maneuver (one patient with infarction of the midbrain). The justification of the term ‘one-and-a-half syndrome, type II’ is questioned. Design: Retrospective analysis of 9000 consecutive ele…

Vascular Third Nerve Compression—A Possible Cause of Episodic Vertical Diplopia?

We report a 74-year-old man with a 2-year history of episodes of vertical diplopia. In the beginning, there was one episode every 2–3 months, which increased over time to an average of one episode every 2 weeks. These complaints were attributed to an MRI-documented vascular third nerve compression. Treatment with gabapentin (400 mg q.i.d.) was followed by cessation of episodic diplopia.

Isolated superior oblique palsies with electrophysiologically documented brainstem lesions

Over a 13.5-year period, we observed 10 patients with isolated superior oblique palsies in whom electrophysiological abnormalities indicated brainstem lesions. In 7 patients unilateral masseter reflex abnormalities were seen, and were located on the side of the superior oblique palsy in 2 patients and on the opposite side in 5 patients. Two patients had slowed gain of following eye movements to the side contralateral to the superior oblique palsy. Slowed adduction saccades in the eye contralateral to the superior oblique palsy were seen in 1 patient. Clinical improvement was frequently (in 7 of 10 patients) associated with improvement or normalization of electrophysiologic findings. Magneti…

Seventh nerve palsies may be the only clinical sign of small pontine infarctions in diabetic and hypertensive patients

Backgroud: Small brainstem infarctions are increasingly recognized as a cause of isolated ocular motor and vestibular nerve palsies in diabetic and/or hypertensive patients. This raises the question whether there are also isolated 7th nerve palsies due to pontine infarctions in patients with such risk factors for the development of cerebrovascular diseases. Methods: Over an 11-year-period, we retrospectively identified 10 diabetic and/or hypertensive patients with isolated 7th nerve palsies and electrophysiological abnormalities indicating pontine dysfunction. All patients had examinations of masseter and blink reflexes, brainstem auditory evoked potentials, direct current electro-oculograp…

Midbrain vs. pontine medial longitudinal fasciculus lesions: The utilization of masseter and blink reflexes

Masseter (MR) and blink reflexes (BL) were investigated in 51 patients with internuclear ophthalmoplegia (INO) due to multiple sclerosis (28) and lacunar infarction (23). The MR was abnormal in 20 of 23 cases with bilateral INO and in 21 of 28 with unilateral INO. The R1 component of the BL (BL-R1) was abnormal in 7 of 23 patients with bilateral INO and 10 of 28 with unilateral INO. Combined MR and BL-R1 changes occurred in 8 of 28 cases with unilateral INO and 7 of 23 with bilateral INO. The findings provide evidence for a rostral/caudal localization of lesions within the medial longitudinal fasciculus causing INO on the basis of MR and BL-R1 abnormalities. An abnormality limited to MR sug…

The temporal dynamics of postanoxic burst-suppression EEG.

Burst-suppression EEG (BS-EEG) after cardiopulmonary resuscitation implies a bad prognosis, but little is known of the temporal dynamics of postanoxic BS-EEG. The authors studied 24 consecutive patients who developed BS-EEG within 24 hours after cardiopulmonary resuscitation, and followed 20 of these patients with serial EEGs. Except for one patient, BS-EEG was followed by another EEG pattern within 1 day, mainly areactive alpha EEG (n = 6), isoelectric EEG (n = 5), generalized continuous epileptiform discharges (n = 4), or theta; EEG (n = 3). The coexistence of different EEG patterns in the same recording was seen in 10 patients. Serial recordings disclosed a variety of EEG sequences with …

Blink reflex R2 changes and localisation of lesions in the lower brainstem (Wallenberg's syndrome): an electrophysiological and MRI study

OBJECTIVES—Pathways of late blink reflexes are detected by high resolution MRI. Electronically matched stroke lesions superimposed to an anatomical atlas show the suspected course. METHODS—Fifteen patients with infarction of the lower brainstem, MRI lesions and electrically elicited blink reflexes were examined. The involved structures in patients with R2 and R2c blink reflex changes were identified by biplane high resolution MRI with individual slices matched to an anatomical atlas at 10 different levels using digital postprocessing methods. RESULTS—The blink reflexes were normal in five of 15 patients (33%) and showed loss or delay of R2 and R2c to stimulation ipsilaterally to lesion (R2-…

Assessing Prognosis Following Cardiopulmonary Resuscitation and Therapeutic Hypothermia

SUMMARY Background: The prognosis of patients who are comatose after cardiopulmo nary resuscitation (CPR) is poor but can be improved by mild therapeutic hypothermia. We studied the question whether the known, reliable indicators of a poor prognosis after CPR are also valid for patients treated with CPR and hypothermia. Methods: This review is based on a selective search of the PubMed database for recent articles on the assessment of prognosis in persons who are comatose after CPR and therapeutic hypothermia. Results: On the basis of 21 clinical trials, 4 of which yielded level I evidence, 9 level II evidence, and 8 level III evidence, the following were identified as reliable indicators of…

Evaluation of carpal tunnel syndrome in patients with polyneuropathy

The difference between the median nerve latency to the second lumbrical muscle and the ulnar nerve latency to the second interosseous muscle (L-I DIFF) was tested in a prospective study to discriminate whether prolonged distal motor latency of the median nerve in patients with polyneuropathy (PNP) reflects an additional carpal tunnel syndrome (CTS). We investigated 92 patients (107 hands) with CTS, 30 patients (34 hands) with PNP, 22 patients (27 hands) with CTS and coexisting PNP (PNP+CTS), and 77 controls (87 hands). L-I DIFF was significantly prolonged in both the CTS and PNP+CTS patients as compared to PNP patients and controls. It proved to be the most specific test to differentiate be…

Symmetrical Infarction of the Cervical Spinal Cord Due to Spontaneous Bilateral Vertebral Artery Dissection

To the Editor: Vertebral artery (VA) dissection is a well-known cause of vertebrobasilar ischemia in young people and may be due to preceding chiropractic maneuvers, cystic medial necrosis, mucopolysaccharidosis and reticular fiber diseases, vasculitis,1 2 or a yet-unknown arteriopathy.3 Common findings in VA dissection are unilateral or bilateral neck pain associated with cerebellar and brain stem (usually medullary) infarctions,2 3 which are rarely associated with clinical signs of spinal cord lesions.4 5 6 Recently, 1 patient each was described with bilateral spinal cord infarction7 and Brown-Sequard’s syndrome8 as the sole manifestation of spontaneous unilateral VA dissection. We add an…

A topodiagnostic investigation on body lateropulsion in medullary infarcts.

Body lateropulsion may occur without signs of vestibular dysfunction and vestibular nucleus involvement. The authors examined 10 such patients with three-dimensional brainstem mapping. Body lateropulsion without limb ataxia reflected an impairment of vestibulospinal postural control caused by a lesion of the descending lateral vestibulospinal tract, whereas body lateropulsion with limb ataxia was probably the consequence of impaired or absent proprioceptive information caused by a lesion of the ascending dorsal spino-cerebellar tract.

Detection of intracranial circulatory arrest in brain death using cranial CT-angiography.

Background and purpose Computed tomographic-angiography (CT-A) is becoming more accepted in detecting intracranial circulatory arrest in brain death (BD). An international consensus about the use and the parameters of this technique is currently not established. We examined intracranial contrast enhancement in CT-A after clinically confirmed BD, compared the results with electroencephalography (EEG) and Transcranial Doppler Ultrasonography (TCD) findings and developed a commonly applicable CT-A protocol. Methods Prospective, monocentric study between April 2008 and October 2011. EEG, TCD and CT-A were performed in 63 patients aged between 18 and 88 years (mean, 55 years) who fulfilled clini…

Spontanes Liquorunterdrucksyndrom

Wir berichten 11 Patienten mit orthostatischem Kopfschmerz bei spontanem Liquorunterdrucksyndrom (SLUDS). Ubelkeit und Abduzensparesen (bei 3 bzw. 2 Patienten) waren die haufigsten zusatzlichen Symptome. Zehn Patienten hatten eine Pleozytose (6 bis 43 Zellen/μl) und/oder Eiweiserhohung (581 bis 1668 mg/l) im Liquor. Die CT und/oder MRT zeigte bei 5 Patienten bifrontal betonte subdurale Hamatome oder Hygrome, die MRT bei allen 4 untersuchten Patienten eine diffuse Gadolinium-Aufnahme der Meningen, bei einem mit Kaudalverlagerung des Hirntammes. Liquorszintigraphisch (9 untersuchte Patienten) war immer ein fruher Tracer-Nachweis in der Blase und eine verminderte oder fehlende Aktivitat uber d…

Mechanisms and predictors of chronic facial pain in lateral medullary infarction

The purpose of this study was to identify clinical predictors and anatomical structures involved in patients with pain after dorsolateral medullary infarction. Eight out of 12 patients (67%) developed poststroke pain within 12 days to 24 months after infarction. The pain occurred in the ipsilateral face (6 patients) and/or the contralateral limbs and trunk (5 patients, 3 of whom also had facial pain). Ipsilateral facial pain was significantly correlated with lower medullary lesions, including those of the spinal trigeminal tract and/or nucleus, as documented by magnetic resonance imaging. The R2 blink reflex component was abnormal only in patients with facial pain. Likewise, pain and temper…

Isolated cranial nerve palsies in multiple sclerosis

During a 10 year period 24 patients with definite multiple sclerosis with isolated cranial nerve palsies were studied (third and fourth nerve: one patient each, sixth nerve: 12 patients, seventh nerve: three patients, eighth nerve: seven patients), in whom cranial nerve palsies were the presenting sign in 14 and the only clinical sign of an exacerbation in 10 patients. MRI was carried out in 20 patients and substantiated corresponding brainstem lesions in seven patients (third nerve: one patient, sixth nerve: four patients, eighth nerve: two patients). Additional abnormal findings of electro-oculography, or masseter reflex, or blink reflex, or combinations of these were found in 20 patients…

Increased risk of sensory neuropathy in workers with chloracne after exposure to 2,3,7,8-polychlorinated dioxins and furans

Objective - The existence of a peripheral neuropathy after exposure to polychlorinated dioxins (PCDD) is still discussed, as studies concerning dioxin effects on the peripheral nervous system are rare and contradictory. Material and methods - Clinical and neurophysiological examinations (motor conduction velocity of the peroneal nerve, sensory conduction velocities of the sural and ulnar nerves) were made in 156 dioxin exposed workers (42 with, 114 without cloracne) from one pesticide producing plant. Because of known risk factors for peripheral neuropathy, 7 workers with and 28 without cloracne were excluded from further analysis. Results - Workers with chloracne had a significantly higher…

Pontine lesions mimicking acute peripheral vestibulopathy

OBJECTIVES Clinical signs of acute peripheral vestibulopathy (APV) were repeatedly reported with pontine lesions. The clinical relevance of such a mechanism is not known, as most studies were biased by patients with additional clinical signs of brainstem dysfunction. METHODS Masseter reflex (MassR), blink reflex (BlinkR), brainstem auditory evoked potentials (BAEPs), and DC electro-oculography (EOG) were tested in 232 consecutive patients with clinical signs of unilateral APV. RESULTS Forty five of the 232 patients (19.4%) had at least one electrophysiological abnormality suggesting pontine dysfunction mainly due to possible vertebrobasilar ischaemia (22 patients) and multiple sclerosis (ei…

17. Masseter reflex abnormalities with meso-diencephalic lesions

different papers and some eponyms used to characterize a certain neurological state differ from the original description. Except for Wallenberg‘s syndrome, classical brainstem syndromes are rarely seen in clinical practice. Lacunar brainstem syndromes are the consequence of infarcts, which involve long tracts and spare intra-axial cranial nerve segments. This group includes pure motor or pure sensory stroke, dysarthriaclumsy hand syndrome, or ataxic hemiparesis. Such infarcts may also cause body lateropulsion with or without limb ataxia, internuclear ophthalmoplgia, skew-torsion sign, or ocular tilt reaction. Small deep infarcts, which solely affect certain nuclei, may be followed by horizo…

Medullary infarcts may cause ipsilateral masseter reflex abnormalities.

There is a suprasegmental influence on the masseter reflex (MassR) in animals, which is mediated via the fifth nerve spinal nucleus (5SpN). Corresponding data in humans are lacking. Out of 268 prospectively recruited patients with clinical signs of acute brainstem infarctions, we identified 38 with magnetic resonance imaging (MRI)-documented unilateral infarcts caudal to the levels of the fifth nerve motor and main sensory nuclei. All had biplanar T2- and echo planar diffusion-weighted MRI and MassR testing. Five patients (13%) had ipsilateral MassR abnormalities. In all, the infarcts involved the region of the 5SpN. Patients with medullary infarcts involving the region of the 5SpN may thus…

MRI and neurophysiology in vestibular paroxysmia: contradiction and correlation

Background Vestibular paroxysmia (VP) is defined as neurovascular compression (NVC) syndrome of the eighth cranial nerve (N.VIII). The aim was to assess the sensitivity and specificity of MRI and the significance of audiovestibular testing in the diagnosis of VP. Methods 20 VP patients and, for control, 20 subjects with trigeminal neuralgia (TN) were included and underwent MRI (constructive interference in steady-state, time-of-flight MR angiography) for detection of a NVC between N.VIII and vessels. All VP patients received detailed audiovestibular testing. Results A NVC of N.VIII could be detected in all VP patients rendering a sensitivity of 100% and a specificity of 65% for the diagnosi…

Successful treatment of HSV encephalitis during pregnancy.

A propos d'une femme presentant une grossesse de 23 semaines. Description des signes cliniques et electroencephalographiques. Les effets de l'aciclovir sur l'encephalite et sur l'evolution de la grossesse sont etudies

Somatotopic organization of the corticospinal tract in the human brainstem: a MRI-based mapping analysis.

To investigate the incompletely understood somatotopical organization of the corticospinal tract in the human brainstem, we performed a voxel-based statistical analysis of standardized magnetic resonance scans of 41 prospectively recruited patients with pyramidal tract dysfunction caused by acute brainstem infarction. Motor hemiparesis was rated clinically and by the investigation of motor evoked potentials to arms and legs. Infarction affected the pons in 85% of cases. We found the greatest level of significance of affected brainstem areas between the pontomesencephalic junction and the mid pons. Lesion location was significantly more dorsal in patients with hemiparesis affecting more prox…

The risk of abducens palsy after diagnostic lumbar puncture.

Abducens palsy occasionally has been observed after diagnostic lumbar puncture (DLP).1-3 Its risk is not exactly known. We are aware of only one report, which mentions not a single case among 1,341 DLPs when using 22-gauge needles.4 At our clinic, an average of 800 inpatients a year undergo DLP. We usually use 22-gauge needles, and occasionally (in less than 5%), 20-gauge needles. Over a 14.5-year period, we saw two patients with abducens palsy—one unilateral, one bilateral—after DLP. This translates to a risk of less than 1 out of 5,800 DLPs. ### Patient 1. A 61-year-old man with type 2 diabetes noticed progressive weakness of the legs. Neurologic examination revealed proximal paraparesis,…

Ipsilateral facial weakness in upper medullary infarction-supranuclear or infranuclear origin?

We describe two patients with upper medullary infarctions showing ipsilateral facial weakness and relative sparing of the upper facial muscles. Electrophysiological follow-up using transcranial magnetic stimulation of the motor cortex in combination with stimulation of the peripheral facial nerve disclosed a supranuclear (corticofacial) tract lesion in one patient and a partial nuclear/infranuclear intra-axial facial nerve lesion in another.

Aktueller Stand der Hirntoddiagnostik in Deutschland

□ Der Hirntod kann grundsatzlich nur dann diagnostiziert werden, wenn eine schwere akute Hirnschadigung vorliegt und andere Storungen sicher auszuschliesen sind. Primare Hirnschadigungen betreffen das Gehirn direkt (zum Beispiel intrakranielle Blutungen, Raumforderungen, schweres Schadel-Hirn-Trauma), sekundare Hirnschadigungen indirekt (zum Beispiel Hypoxie nach kardiopulmonaler Reanimation). Supratentorielle Hirnschadigungen betreffen das Groshirn, infratentorielle Hirnschadigungen den Hirnstamm und/oder das Kleinhirn. □ Koma, Hirnstammareflexie und Ausfall der Spontanatmung sind die obligaten klinischen Hirntodzeichen. Wenn diese Zeichen im Verlauf unverandert fortbestehen, ist der irrev…

Internuclear ophthalmoplegia of abduction: clinical and electrophysiological data on the existence of an abduction paresis of prenuclear origin.

Three patients showed unilateral and five bilateral abduction paresis. Five had associated adduction nystagmus of the contralateral eye. Electrophysiological testing of masseter and blink reflexes indicated an ipsilateral rostral pontine or mesencephalic lesion, and excluded a lesion of the infranuclear portion of the abducens nerve. Abduction paresis was attributed to impaired inhibition of the tonic resting activity of the antagonistic medial rectus muscle. The prenuclear origin of the disorder is based on morphological and neurophysiological evidence of an ipsilateral inhibitory connection between the paramedian pontine reticular formation and the oculomotor nucleus running close to but …

Cerebrovascular Brainstem Diseases with Isolated Cranial Nerve Palsies

There is a significant number of individual patients with cranial nerve palsies as the sole manifestation of MRI- and, less frequently, CT-documented small brainstem infarctions or hemorrhages. The 3rd and 6th nerves are most commonly involved and, less frequently, the 4th, 5th, 7th, and 8th nerves. An intra-axial basis for such lesions may be underestimated if the diagnosis is based solely on MRI. The electrophysiologic abnormalities indicating brainstem lesions may be independent of MRI-documented morphological lesions. This paper reviews the literature on cerebrovascular brainstem diseases manifesting as isolated cranial nerve palsies. It supports the concept that small pontine and mesen…