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

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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 the clinical deficit. It allows proper visualization of functional–anatomical correlations in humans. It may also account for the variance of data within the considered population, and it provides a measure of the extent to which the results represent the general population. The model, however, does not ignore completely the vascular supply to the brainstem and areas generally favored by brainstem infarction. Another drawback of the method is that the spatial resolution (2 mm) cannot match the anatomical details of pathological studies.