0000000000293328
AUTHOR
Annette Mika-grüttner
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…
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…
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…
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,…