One-and-a-half Syndrome and Facial Palsy of Peripheral Type: A Rare Brain-Stem Syndrome

Abstract Thirty-five consecutive adults with Chiari malformation and progressive symptoms underwent surgical treatment at a single institution over a 3-year period. All patients underwent magnetic resonance imaging scan before and after surgery. Images of the craniovertebral junction confirmed tonsillar herniation in all cases and allowed the definition of two anatomically distinct categories of the Chiari malformation in this age group. Twenty of the 35 patients had concomitant syringomyelia and were classified as Type A. The remaining 15 patients had evidence of frank herniation of the brain stem below the foramen magnum without evidence of syringomyelia and were labeled Type B. Type A patients had a predominant central cord symptomatology: Type B patients exhibited signs and symptoms of brain stem or cerebellar compression. The principal surgical procedure consisted of decompression of the foramen magnum, opening of the fourth ventricular outlet, and plugging of the obex. Significant improvement in preoperative symptoms and signs was observed in 9 of the 20 patients (45%) with syringomyelia (Type A), as compared to 13 of the 15 patients (87%) without syringomyelia (Type B). Postoperative reduction in syrinx volume was observed in 11 of the 20 patients with syringomyelia, including all 9 patients with excellent results. Magnetic resonance imaging has allowed a classification of the adult Chiari malformation in adults based on objective anatomic criteria, with clinical and prognostic relevance. The presence of syringomyelia implies a less favorable response to surgical intervention.

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Opalski syndrome and ipsilateral peripheral type facial palsy in lateral medullary infarction: a case report

Nosotchu ◽

10.3995/jstroke.36.287 ◽

2014 ◽

Vol 36 (4) ◽

pp. 287-291

Author(s):

Hiromi Ishikawa ◽

Jiro Kitayama ◽

Yoji Yoshikawa ◽

Asako Nakamura ◽

Hiroshi Nakane ◽

...

Keyword(s):

Case Report ◽

Facial Palsy ◽

Lateral Medullary Infarction ◽

Peripheral Type ◽

Medullary Infarction

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Isolated facial nerve palsy of peripheral type caused by an intrinsic brain stem tumor

Journal of Anesthesia ◽

10.1007/s0054040080365 ◽

1994 ◽

Vol 8 (3) ◽

Author(s):

Kenji Kodama ◽

Takato Morioka ◽

Takrao Machi ◽

Shosuke Takahashi

Keyword(s):

Facial Nerve ◽

Brain Stem ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Brain Stem Tumor ◽

Peripheral Type

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Causes of Facial Nerve Paresis after Translabyrinthine Surgery for Acoustic Neuroma

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949210101004 ◽

1992 ◽

Vol 101 (10) ◽

pp. 821-826 ◽

Cited By ~ 18

Author(s):

Mirko Tos ◽

Jens Thomsen ◽

Mahmoud Youssef ◽

Suat Turgut

Keyword(s):

Facial Nerve ◽

Brain Stem ◽

Acoustic Neuroma ◽

Facial Palsy ◽

Cerebellopontine Angle ◽

Patient Records ◽

Nerve Function ◽

Facial Nerve Function ◽

Common Site ◽

Nerve Paresis

Forty-six consecutive video-recorded translabyrinthine operations at Gentofte Hospital, for tumors of 5 to 25 mm, were investigated for possible damage to the facial nerve from cauterization, suction, stretching, pushing, and other instrumental trauma at the following regions: fundus, internal meatus, porus, cerebellopontine angle, and brain stem. House-Brackmann grading of the postoperative facial nerve function was determined from the patient records for the 1st, 3rd, and 10th days and 3 months and 6 months postoperatively, as well as the final status. Suction on the nerve seems to be the most important factor for perioperative facial nerve damage. The most common site of damage was the porus region. This investigation shows thermic drilling lesions to be very relevant. There was no correlation between the degree and character of damage and the postoperative facial nerve function. In eight patients we cannot explain the postoperative facial palsy.

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