Multiple Somatotopic Representations of Heat and Mechanical Pain in the Operculo-Insular Cortex: A High-Resolution fMRI Study

Whereas studies of somatotopic representation of touch have been useful to distinguish multiple somatosensory areas within primary (SI) and secondary (SII) somatosensory cortex regions, no such analysis exists for the representation of pain across nociceptive modalities. Here we investigated somatotopy in the operculo-insular cortex with noxious heat and pinprick stimuli in 11 healthy subjects using high-resolution (2 × 2 × 4 mm) 3T functional magnetic resonance imaging (fMRI). Heat stimuli (delivered using a laser) and pinprick stimuli (delivered using a punctate probe) were directed to the dorsum of the right hand and foot in a balanced design. Locations of the peak fMRI responses were c…

Brainstem reflex circuits revisited

Our current understanding of brainstem reflex physiology comes chiefly from the classic anatomical-functional correlation studies that traced the central circuits underlying brainstem reflexes and establishing reflex abnormalities as markers for specific areas of lesion. These studies nevertheless had the disadvantage of deriving from post-mortem findings in only a few patients. We developed a voxel-based model of the human brainstem designed to import and normalize MRIs, select groups of patients with or without a given dysfunction, compare their MRIs statistically, and construct three-plane maps showing the statistical probability of lesion. Using this method, we studied 180 patients with…

Laser guns and hot plates

204 PINPRICK-EVOKED POTENTIALS (PEPS): A NOVEL TOOL TO ASSESS CENTRAL SENSITISATION IN HUMANS

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…

Topodiagnostic significance of hemiataxia: An MRI based mapping analysis

Chapter 4 3D brainstem topodiagnosis – a voxel-based model analyzing MR imaging data

Publisher Summary This chapter presents a new method of statistically based three-dimensional (3D) brainstem mapping to identify brainstem structures responsible for specific clinical and electrophysiological abnormalities. To ensure reliable correlations, a large cohort of patients with magnetic resonance (MR)-documented brainstem infarctions were recruited in two European neurological institutions—namely, the Department of Neurology, Johannes Gutenberg University, Mainz, Germany, and the Department of Neurological Sciences, “La Sapienza” University of Rome, Italy. This method minimizes the risk of highlighting vascular territories rather than the structures specifically responsible for th…

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.

An Artificial Neural Network for 3D Localization of Brainstem Functional Lesions

The human brainstem is a highly complex structure where even small lesions can give rise to a variety of symptoms and signs. Localizing the area of dysfunction within the brainstem is often a difficult task.To make localization easier, we have developed a neural net system, which uses 72 clinical and neurophysiological data inputs and displays it (using 5268 voxels) on a three-dimensional model of the human brainstem. The net was trained by means of a back-propagation algorithm, over a pool of 580 example-cases. Assessed on 200 test-cases, the net correctly localized 83.6% of the target voxels; furthermore the net correctly localized the lesion in 31/37 patients. Because our computer-assist…

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…