Equilibrium Disorder in Carbamazepine Toxicity

1977 ◽  
Vol 86 (3) ◽  
pp. 318-322 ◽  
Author(s):  
Yoshio Umeda ◽  
Eiji Sakata
Keyword(s):  
Brain Stem ◽  
Optokinetic Nystagmus ◽  
Speech Disorders ◽  
Clinical Findings ◽  
Cerebellar Lesions ◽  
Brain Stem Lesions ◽  
Stem Lesions ◽  
The Brain ◽  
Cerebellar Disorders ◽  
Space Occupying Lesion

Three cases of acute carbamazepine intoxication were evaluated neurotologically and neurologically. Findings included symptoms of equilibrium, gait and speech disorders, drowsiness, gaze nystagmus, depressed optokinetic nystagmus and disturbances of smooth pursuit eye movement. These findings, suggestive of a space-occupying lesion, disappeared after the cessation of the medication. On the basis of the clinical findings it is felt that carbamazepine affects structures within the brain stem and the cerebellum. It is well known that equilibrium disorders caused by anticonvulsant intoxication are due to cerebellar disorders but from our present study it should be noted that they originate not only from cerebellar lesions but also from brain stem lesions.

Blockage of lactation by brain-stem lesions in the cat

1962 ◽  
Vol 202 (3) ◽  
pp. 465-468 ◽  
Author(s):  
Carlos Beyer ◽  
Flavio Mena ◽  
Pablo Pacheco ◽  
Manuel Alcaraz
Keyword(s):  
Brain Stem ◽  
Mammary Glands ◽  
Prolactin Secretion ◽  
Milk Secretion ◽  
Afferent Pathway ◽  
Transient Impairment ◽  
Brain Stem Lesions ◽  
Stem Lesions ◽  
The Brain

The effect of brain-stem lesions on lactation in the cat was studied. Lesions in the rostral mesencephalon or caudal hypothalamus, which involved the dorsal longitudinal fasciculus, caused persistent supression of milk secretion and involution of the mammary glands. This effect seems to be due to interruption of the afferent pathway for prolactin secretion. Control lesions in other parts of the brain caused only a transient impairment of lactation.

Benign Brain Stem Lesions in Pediatric Patients with Neurofibromatosis: Case Reports

Neurosurgery ◽  
1989 ◽  
Vol 25 (6) ◽  
pp. 959-964 ◽  
Author(s):  
Corey Raffel ◽  
Gordon J. McComb ◽  
Sara Bodner ◽  
Floyd E. Gilles
Keyword(s):  
Brain Stem ◽  
Pediatric Patients ◽  
Tumor Imaging ◽  
Case Reports ◽  
Low Grade ◽  
Brain Stem Glioma ◽  
Computed Tomographic ◽  
Brain Stem Lesions ◽  
Stem Lesions ◽  
The Brain

Abstract The symptoms and clinical courses of 4 patients with neurofibromatosis and lesions of the brain stem identifiable on computed tomographic and/or magnetic resonance imaging scans are described. Two patients underwent biopsy and both had low-grade astrocytomas with no evidence of anaplasia. Both received radiation and chemotherapy. The other 2 patients have been monitored without biopsy or treatment. Three patients are alive and clinically stable, having been followed up for an average of 4 years; neuroimaging studies have shown no change in their tumors. The fourth patient died of a supratentorial primitive neuroectodermal tumor. Imaging studies had shown no change in his brain stem lesion, which at autopsy was found to be a focal collection of fibrillary astrocytes. These data suggest that some patients with brain stem lesions and neurofibromatosis may have a prognosis distinctly different from that of the typical patient with a brain stem glioma. We recommend caution against aggressive operative and adjuvant therapy for brain stem lesions in patients with neurofibromatosis, unless progression of the lesion is documented clinically and/or by imaging.

scholarly journals Where and When to Cut? Fluorescein Guidance for Brain Stem and Spinal Cord Tumor Surgery—Technical Note

2017 ◽  
Vol 15 (3) ◽  
pp. 325-331 ◽  
Author(s):  
Eric Suero Molina ◽  
Walter Stummer
Keyword(s):  
Spinal Cord ◽  
Brain Stem ◽  
Surrounding Tissue ◽  
Surgical Removal ◽  
Anesthesia Induction ◽  
Clinical Value ◽  
Thoracic Spinal Cord ◽  
Brain Stem Lesions ◽  
Stem Lesions ◽  
The Brain

Abstract BACKGROUND Spinal cord and brain stem lesions require a judicious approach with an optimized trajectory due to a clustering of functions on their surfaces. Intraoperative mapping helps locate function. To confidently locate such lesions, neuronavigation alone lacks the desired accuracy and is of limited use in the spinal cord. OBJECTIVE To evaluate the clinical value of fluoresceins for initial delineation of such critically located lesions. METHODS We evaluated fluorescein guidance in the surgical resection of lesions with blood-brain barrier disruption demonstrating contrast enhancement in magnet resonance imaging in the spinal cord and in the brain stem in 3 different patients. Two patients harbored a diffuse cervical and thoracic spinal cord lesion, respectively. Another patient suffered metastatic lesions in the brain stem and at the floor of the fourth ventricle. Low-dose fluorescein (4 mg/kg body weight) was applied after anesthesia induction and visualized using the Zeiss Pentero 900 Yellow560 filter (Carl Zeiss, Oberkochen, Germany). RESULTS Fluorescein was helpful for locating lesions and for defining the best possible trajectory. During resection, however, we found unspecific propagation of fluorescein within the brain stem up to 6 mm within 3 h after application. As these lesions were otherwise distinguishable from surrounding tissue, monitoring resection was not an issue. CONCLUSION Fluorescein guidance is a feasible tool for defining surgical entry zones when aiming for surgical removal of spinal cord and brain stem lesions. Unselective fluorescein extravasation cautions against using such methodology for monitoring completeness of resection. Providing the right timing, a window of pseudoselectivity could increase fluoresceins’ clinical value in these cases.

Stereotactic Management of Cystic Gliomas of the Brain Stem

Neurosurgery ◽  
1989 ◽  
Vol 24 (3) ◽  
pp. 373-378 ◽  
Author(s):  
Terry W. Hood ◽  
Paul E. McKeever
Keyword(s):  
Brain Stem ◽  
External Radiation ◽  
Stereotactic Technique ◽  
Progressive Neurological Deficit ◽  
Permanent Morbidity ◽  
Brain Stem Lesions ◽  
External Radiation Therapy ◽  
Stem Lesions ◽  
Multimodality Approach ◽  
The Brain

Abstract Although cystic gliomas of the brain stem can be readily aspirated using a stereotactic technique, they will frequently recur, resulting in progressive neurological deficit. Since standard neurosurgical approaches to cystic gliomas of the cerebral hemispheres and cerebellum are difficult to apply to brain stem lesions, modification of these techniques are necessary to provide cyst control with minimal morbidity and mortality. This report, based upon 12 procedures performed on 10 patients with gliomas of the mesencephalon, pons, and medulla, details an approach using aspiration, stereotactically placed cyst catheters, and/or intracavitary irradiation with colloidal chromium phosphorus-32 in addition to external radiation therapy and chemotherapy. Cyst control without mortality or permanent morbidity was obtained in all patients using this multimodality approach.

Surgical Resection of Intrinsic Brain Stem Lesions: An Overview

Neurosurgery ◽  
1990 ◽  
Vol 27 (5) ◽  
pp. 789-798 ◽  
Author(s):  
Dan S. Heffez ◽  
James S. Zinreich ◽  
Donlin M. Long
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Brain Stem ◽  
Magnetic Resonance Imaging Scan ◽  
Resonance Imaging ◽  
Aggressive Approach ◽  
Brain Stem Lesions ◽  
Stem Lesions ◽  
Mass Lesions ◽  
The Brain

Abstract A major limitation to the effective treatment of intrinsic mass lesions of the brain stem has been the inability to clearly define the pathological anatomy radiographically. The improved soft tissue resolution offered by magnetic resonance imaging, as compared with axial computed tomography, now makes it possible not only to accurately distinguish anatomical relationships, but also to predict the pathological nature of the lesion. Accordingly, we have been encouraged to pursue a more aggressive approach to intrinsic lesions of the brain stem that appear well circumscribed on magnetic resonance imaging scan. The object of this paper is to report the successfuly treatment of four intrinsic lesions of the brain stem and to present an overview of the relevant published experience.

A study of safe entry zones via the floor of the fourth ventricle for brain-stem lesions

1993 ◽  
Vol 78 (6) ◽  
pp. 987-993 ◽  
Author(s):  
Kazuhiko Kyoshima ◽  
Shigeaki Kobayashi ◽  
Hirohiko Gibo ◽  
Takayuki Kuroyanagi
Keyword(s):  
Facial Nerve ◽  
Brain Stem ◽  
Fourth Ventricle ◽  
Medial Lemniscus ◽  
Content Type ◽  
Brain Stem Lesions ◽  
Stem Lesions ◽  
Hazardous Procedure ◽  
The Brain ◽  
Fine Print

✓ Direct surgery for intra-axial lesions of the brain stem is considered a hazardous procedure, and morbidity of varying degrees cannot be avoided even with partial removal or biopsy. The main causes of morbidity relate to direct damage during removal of the lesion, selection of an entry route into the brain stem, and the direction of brain stem retraction. The authors examined the possibility of making a medullary incision and retracting the brain stem, taking into account the symptomatology and surgical anatomy, and found two safe entry zones into the brain stem through a suboccipital approach via the floor of the fourth ventricle. These safe entry zones are areas where important neural structures are less prominent. One is the “suprafacial triangle,” which is bordered medially by the medial longitudinal fascicle, caudally by the facial nerve (which runs in the brainstem parenchyma), and laterally by the cerebellar peduncle. The second is the “infrafacial triangle,” which is bordered medially by the medial longitudinal fascicle, caudally by the striae medullares, and laterally by the facial nerve. In order to minimize the retraction-related damage to important brain-stem structures, the brain stem should be retracted either laterally or rostrally in the suprafacial triangle approach and only laterally in the infrafacial triangle approach. Three localized intra-axial brain-stem lesions were treated surgically via the safe entry zones using the suprafacial approach in two and the infrafacial approach in one. The cases are described and the approaches delineated. Both approaches are indicated for focal intra-axial lesions located unilaterally and dorsal to the medial lemniscus in the lower midbrain to the pons. Magnetic resonance imaging is useful in selecting these approaches, and intraoperative ultrasonography is helpful to confirm the exact location of a lesion before a medullary incision is made. These approaches can also be used as routes for aspiration of brain-stem hemorrhage as well as for tumor biopsy.

scholarly journals THE BRAIN-STEM LESIONS IN PARKINSONISM

1953 ◽  
Vol 16 (4) ◽  
pp. 213-226 ◽  
Author(s):  
J. G. Greenfield ◽  
F. D. Bosanquet
Keyword(s):  
Brain Stem ◽  
Brain Stem Lesions ◽  
Stem Lesions ◽  
The Brain

Traumatic Decerebracy with Preserved Consciousness and Voluntary Movement

Neurosurgery ◽  
1985 ◽  
Vol 16 (1) ◽  
pp. 71-74
Author(s):  
Jogi Pattisapu ◽  
Robert R. Smith ◽  
Jose Bebin ◽  
James H. Wood
Keyword(s):  
Brain Stem ◽  
Craniocerebral Trauma ◽  
Physiological Mechanism ◽  
Clinical Findings ◽  
Cerebral Lesions ◽  
Decerebrate Rigidity ◽  
Anatomical Basis ◽  
Brain Stem Lesions ◽  
Stem Lesions ◽  
Unilateral Brain

Abstract Decerebrate rigidity is a frequent occurrence in cases of craniocerebral trauma. It is almost always accompanied by coma and usually denotes a poor prognosis. Primary focal brain stem lesions due to trauma are uncommon and may be accompanied by other diffuse cerebral lesions. This report reviews the anatomical basis and clinical findings of a unilateral brain stem lesion in a patient with traumatic decerebracy and preserved consciousness. The anatomical pathways and possible physiological mechanism are discussed, and a few comments on the prognosis of such lesions are given. (Neurosurgery 16:71–74, 1984)

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