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[A 67-year-old man with progressive disturbance of gait].

We report a 67-year-old man with progressive disturbance of gait. He was well until the spring of 1993 (62 years of the age), when he noted an onset of unsteady gait. He also noted that he started to have a difficulty in playing tennis, in which he became unable to hit the ball with his racket. He also noted parkinsonian features such as bradykinesia and loss of hand dexterity. He was treated with levodopa, which did not improve his symptoms. His MRI revealed marked atrophy of the cerebellum and the pons. The criss-cross high signal lesion was seen in the center of the pons. The third ventricl…

An Unusual Case of Metronidazole-induced Encephalopathy in a Patient with Hereditary Hemorrhagic Telangiectasia.

Metronidazole-induced encephalopathy (MIE) is a rare toxic encephalopathy. We describe a reversible MIE case in a patient with hereditary hemorrhagic telangiectasia (HHT), treated with metronidazole for brain abscess, who developed dizziness, weakness, dysarthria, and severe dysmetria. His Magnetic Resonance Imaging (MRI) brain revealed bilateral, symmetric lesions in bilateral symmetrical regions of increased intensity in the medullary olives, cerebellar dentate nuclei, and the dorsal pons, all characteristic of MIE. Upon metronidazole discontinuation, the patient experienced significant symp…

Isolated contralateral sudden sensorineural hearing loss: an unusual manifestation of pontine infarct.

Unilateral, acute onset sensorineural hearing loss ("sudden sensorineural hearing loss" [SSNHL]) as an isolated event without other associated neurological deficits usually results from a lesion of the cochlea. Lesions in the ascending central auditory pathways cranial to the cochlear nucleus seldom result in unilateral hearing loss due to decussation of the central auditory pathways at multiple levels. We describe a patient with a tiny acute infarct in the right pons resulting in isolated acute onset left-sided SSHNL, without any other associated acute neurological deficits.

Neurocutaneous melanosis in children with giant congenital melanocytic nevi.

Twenty-four children with giant congenital melanocytic nevi underwent brain MRI at 1.5 T scanner. Melanin deposits in the brain were found in seven children (29.2%) located in temporal lobes, thalamus, cerebellum, and pons. One patient showed leptomeningeal involvement. Six patients were asymptomatic, and one had epilepsy. As opposed to previous reports, localization of skin nevi on anterior part of trunk was correlated to central nervous system involvement. In all patients with brain involvement skin nevi showed picture of compound nevus with neurofibromatic component.

Neuro-Behçet's disease with dizziness.

A 30-year-old man had complete-type Behçet's disease since he was 23 years old. Disease signs and symptoms were well controlled. After experiencing no symptoms for some years, however, he experienced dizziness, headache, fever, dysarthria, right facial nerve palsy, and right tinnitus. He showed spontaneous horizontal-rotatory nystagmus directed toward the right side, and upbeat nystagmus. T2-weighted and fluid-attenuated inversion recovery MRI showed slight hyperintense signals in the medulla oblongata, pons, and left midbrain. Neurological involvement in Behçet's disease was diagnosed.

Cytotoxic edema in neuro-Behcet's disease ?

We report a case of a 52-year-old woman with Behcet's disease who presented with dysarthria and right-sided hemiparesis. T2-weighted and diffusion-weighted images (DWI) showed a hyperintense lesion in the left pons with a relatively decreased apparent diffusion coefficient (ADC). Imaging showed almost complete resolution of the lesion after treatment with prednisolone. The atypical DWI and ADC findings in this case may reflect cytotoxic edema due to excitotoxic brain injury. This case thus illustrates the radiological diversity of neuro-Behcet's lesions.

Acute brain injury in hypoglycaemia-induced hemiplegia.

BACKGROUND: The development of hemiplegia as a result of hypoglycaemia was first described in 1928. However, the mechanism remains unclear. CASE REPORT: We report a case of a 58-year-old male with diabetes, who developed left hemiplegia during a severe hypoglycaemic event. Results Diffusion-weighted magnetic resonance imaging detected an increased signal intensity in the pons, indicating that the patient's hemiplegia resulted from acute brain injury. CONCLUSIONS: This report provides evidence that acute brain injury may be a cause of the neurological deficit.

Alpha-pattern coma in primary brainstem hemorrhage; clinical, electrophysiologic, and cerebral blood flow studies.

A patient with a brainstem hemorrhage and alpha-pattern coma is reported. Brainstem auditory and somatosensory evoked responses were severely abnormal, suggesting bilateral lesions of the pons, which was confirmed by magnetic resonance imaging. Regional cerebral blood flow, studied using IMP-SPECT, showed no remarkable regional radioactive accumulation or deficit in either the cerebral cortex or the subcortical regions. Based on these findings, we speculate that the alpha-pattern coma may be observed when the functions of brain structures rostral to the pontomesencephalic junction are preserve…

[Acute meningoencephalitis in children caused by herpes simplex virus type I].

In 14 observations of acute meningoencephalitis in children mainly under 3 years of the age, data pointing to an etiological role of herpes simplex type I virus, were obtained on laboratory examination. Six children died, and in the rest 8 children who survived gross residua were observed. The morphological picture showed extensive colliquation necroses in the parietal, temporal, and less frequently, in occipital lobes and the Varolian pons. In 4 cases out of 6 intranuclear inclusions were detected. The incidence of herpetic encephalitis was 16%.

Androgen concentration in motor neurons of cranial nerves and spinal cord.

After injection of [3H]dihydrotestosterone, a major testosterone metabolite, radioactivity is concentrated in nuclei of certain cells in the midbrain, pons, medulla oblongata, cerebellum, and spinal cord. While there is some overlap between androgen and estrogen target neuron distribution, certain motor neurons appear to be selectively labeled by androgen; in contrast, estrogen localization prevails in sensory neurons. These results may help to explain why male sexual behavior in some rodents is not fully activated with dihydrotestosterone alone but in addition requires estradiol, a testostero…

FDG PET/CT Aiding in Early Diagnosis of Central Pontine Myelinolysis.

We report a 70-year-old man with central pontine myelinolysis who presented in the emergency department with recent onset altered sensorium and tremors (Glasgow Coma Scale score, 13). Laboratory findings revealed hyponatremia and hypokalemia. MRI brain was unremarkable. Subsequently, patient was referred for FDG PET/CT to rule out malignancy or paraneoplastic syndrome. FDG PET revealed focal radiotracer uptake in the pons without any underlying CT abnormality consistent with central pontine myelinolysis, thus aiding in early diagnosis where conventional imaging modality was unremarkable.

Rampant spread of infection in an afebrile immune-competent patient presenting with young-onset ischaemic stroke.

A 27-year-old healthy woman developed spontaneous right-sided orbital cellulitis, followed by left hemiparesis and cranial nerve palsies. MRI revealed underlying basal exudates and vasculitic infarction involving the pons and cerebellar peduncles, following which a cerebrospinal fluid examination confirmed acute bacterial meningitis. Although the patient remained afebrile, imaging revealed asymptomatic septic foci in bilateral lungs, empyema and pyelonephritis. Blood culture grew drug-resistant Klebsiella pneumoniae The case highlights the absence of fever in an immune-competent patient presen…

An unusual case of basilar artery aneurysm presenting with spastic quadriparesis.

Unruptured aneurysm usually presents with headache and neuro-ophthalmic features; when it ruptures, it presents with subarachnoid haemorrhag … th sixth cranial nerve palsy, which implicate involvement of corticospinal pathways at the level of pons.

Reversible brainstem dysfunction from spinal arterio-venous fistula.

A 45-year-old man presented with subacute onset of ataxia, diplopia, urinary retention and paraparesis. MR scan of brain showed abnormal T2 hyperintense signal within the cervical cord, medulla and lower pons and vascular appearances suggesting an arterio-venous fistula. The fistula was surgically explored and successfully disconnected with good clinical outcome. Brainstem or cervical dural arterio-venous fistulae more typically present as a myelopathy; only a handful of cases have presented with brainstem dysfunction. This is a rare but reversible cause of subacute brainstem dysfunction.

Vertebrobasilar infarcts in patients with dolichoectatic basilar artery.

We reported 18 patients who had stroke in the posterior circulation with dolichoectatic basilar artery. TIAs preceded posterior circulation infarct in 5 patients. Strokes involved medulla oblongata (3), pons (4), cerebellum (4), mesencephalon (4), thalamus or occipital lobe (3). Dolichoectatic basilar artery also produced hydrocephalus in one patient. The mechanism of stroke may be due to penetrating artery occlusion, basilar artery thrombosis or an embolism from the abnormal basilar artery. Short-term prognosis was poor seeing that 4 patients died within 12 days of stroke.

Network biomarkers of Alzheimer's disease risk derived from joint volume and texture covariance patterns in mouse models.

Alzheimer's disease (AD) lacks effective cures and is typically detected after substantial pathological changes have occurred, making interv … w these factors converge on specific brain regions - with genotype influencing the caudate putamen, pons, cingulate cortex, and cerebellum; sex affecting the amygdala and piriform cortex; and immune status impacting association cortices and cerebellar nuclei. Importantly, our integrated approach revealed factor interactions that would remain undetected …

Endoscopic pre-subtemporal keyhole approach: Anatomical feasibility and clinical applications [SevEN-016].

INTRODUCTION: Endoscopic endonasal approaches (EEAs) are routinely used to resect skull base lesion. However, they are laterally restricted … within the anterior tentorial incisural space, petroclival region, and ventrolateral surface of the pons. The approach was subsequently applied in ten patients: eight with meningiomas, one with an epidermoid cyst, and one with a cavernous malformation. Gross total resection was achieved in four cases, near total resection in two cases, and subtotal res …

Improved Beam-hardening Reduction in CT - Impact on Image Quality and Diagnostic Certainty in Emergency Imaging of the Brain.

RATIONALE AND OBJECTIVES: To assess the impact of an optimized beam-hardening artifact reduction algorithm on image quality and diagnostic certainty in emergency unenhanced brain CT. MATERIALS AND METHODS: Retrospective study of consecutive patients referred for unenhanced brain CT to rule out traumatic brain injuries in 2023. Images were reconstructed using both (A) a standard and (B) an optimized iterative beam-hardening correction algorithm (iBHC). CT attenuation, image noise and SNR were measured in the cortex of supratentorial and infratentorial regions and in the pons. Posterior Fossa A…

An Investigation of Corticospinal Tract Microstructural Integrity in ARSACS Using a Profilometry MRI Analysis: Results From the PROSPAX Study.

BACKGROUND: Spasticity represents a core clinical feature of Autosomal Recessive Spastic Ataxia of Charlevoix-Saguenay (ARSACS) patients. No … fined pattern of more pronounced microstructural integrity loss occurring right below and above the pons, a structure that was also confirmed to be thickened in these patients (p < 0.001). A bilateral negative correlation emerged between the microstructural integrity of the CST and clinical indices of spasticity expressed via SPRS (p = 0.02 for both CS …

Мозговая сигнатура склероза: предсказуемые повреждения, последовательные синдромы.

Интеграция клинических результатов с нейрорадиологическими изменениями является важнейшим навыком неврологии, особенно для диагностики. Множественные повреждения склероза (MS) в стержне мозга редко являются асимптомами, что приводит к уникальным и часто локализованным клиническим синдромам. Повреждения MS имеют характерное перуанальное распределение, которое в стебле мозга припечатано последовательной топографией проникающих в вены вен. ЦЕЛЬ: Настоящий обзор обеспечивает комплексный подход к анатомическим моделям поражения MS в стержне мозга (мидбрайн, пруны и мелула). Он коррелирует конкретны

Совпадение в аннотации оригинала
BACKGROUND: Integrating clinical findings with neuroradiological changes is a crucial skill in neurology, particularly for diagnosis. Multip … des an integrative perspective on the anatomical patterns of MS lesions in the brainstem (midbrain, pons, and medulla). It correlates specific clinical syndromes with radiological appearances, aiding in both diagnosis and functional localisation. METHODS: We searched the available literature using keywords related to the three brainstem sections (midb …