4.3. Clinical findings with brain stem microinfarcts

Das Horner-Syndrom - Ein Update zur Neuroanatomie, topographischen Differenzialdiagnostik und Ätiologie

Due to the complex neuroanatomy of the sympatho-excitatory pathway, Horner's syndrome represents a clinical sign that may result from a variety of lesions in the central and peripheral nervous system. The purpose of the present communication is to help the reader to localize the site of the lesion and to demonstrate the most common etiologic mechanisms resulting in Horner's syndrome. The functional anatomy of the sympathetic supply to the iris, eyelids, facial sweat glands and blood vessels is reviewed and in particular the structure of the central pathway updated. Moreover, pharmacological testing and tests of sudomotor function are described that may help to guide the decision regarding u…

16. Increasing clinical variety of brainstem infarcts

Trochlear palsies caused by isolated trochlear schwannomas.

To describe clinical features and management of 4 patients suffering from unilateral superior oblique palsies due to MRI-documented trochlear nerve schwannomas.Chart reviews of 4 patients seen at the departments of ophthalmogy and neurology at the University of Mainz.All four patients were male, aged 36 to 72 years at initial presentation. None suffered from neurofibromatosis. The history of double vision prior presentation was 9 months to 13 years, follow-up time was 9 to 156 months. Two patients didn't receive any intervention: one remained stable over the follow-up time of 9 months. In patient #2, fourth nerve palsy was diagnosed 13 years prior to confirmation of a trochlear schwannoma b…

Eye Movement Involvement in Parry-Romberg Syndrome: A Clinicopathologic Case Report

We report the case of a 38-year-old woman who developed a progressive bilateral disease in which the eye motility disorder-diplopia-is the outstanding feature over a period of 12 years. The muscle biopsy of the medial rectus muscle did not show any trace of striated muscle. To the best of our knowledge, this is the first pathological report in an affected extraocular muscle of a patient with Parry-Romberg syndrome (PRS). Previous rare reports of diplopia in PRS have been attributed to enophthalmos, progressive atrophy of the orbit, ocular motor nerve dysfunction, or mechanical restrictions.

Abduction nystagmus in internuclear ophthalmoplegia

Direct current electro-oculography revealed abduction nystagmus with hypermetric abduction saccades in 35 of 64 patients with unilateral and 55 of 66 patients with bilateral internuclear ophthalmoplegia. Slowing of abduction saccades occurred in 27 unilateral cases, mainly ipsilateral to the paretic eye, and in 36 bilateral cases. Abduction nystagmus with hypermetric abduction saccades of normal velocity is explained by an increased phasic innervation adjusted to adduction paresis. Slowed abduction saccades are attributed to impaired inhibition of the medial rectus muscle. Superposition of impaired medial rectus inhibition and increased phasic innervation best explains abduction nystagmus w…

Elektrophysiologie versus Magnetresonanztomographie. Nachweis von Hirnstammläsionen bei Hirnnervenläsionen

Isolierte Hirnnervenlasionen werden gemeinhin auf eine Schadigung des Nerven in seinem peripheren Verlauf nach Austritt aus bzw. vor Eintritt in den Hirnstamm zuruckgefuhrt. Prinzipiell sind isolierte Hirnnervenlasionen nur bei umschriebenen Schadigungen im Tegmentum moglich, da weiter ventral lokalisierte Schadigungen z.B. die Pyramidenbahn involvieren und zu einer kontralateralen Hemiparese (Weber- oder Foville-Syndrom) und eine dorsale Ausdehnung in bestimmten Hohen zu weiteren Symptomen fuhren wurde (bilaterale Ptose und kontralaterale Parese des M. rectus superior bei einer Schadigung des Oculomotoriuskerns bzw. ipsiversive horizontale Blickparese bei einer Lasion des Abducenskerns). I…