scholarly journals Bilateral internuclear ophthalmoplegia and clivus fracture following head injury: case report

2002 ◽  
Vol 60 (3A) ◽  
pp. 636-638 ◽  
Author(s):  
Leonardo Bonilha ◽  
Yvens Barbosa Fernandes ◽  
João Paulo de Vasconcelos Mattos ◽  
Wilson Adriano Abraão Borges ◽  
Guilherme Borges
Keyword(s):  
Head Injury ◽  
Brain Stem ◽  
Medial Longitudinal Fasciculus ◽  
Internuclear Ophthalmoplegia ◽  
Patient History ◽  
Rare Association ◽  
Image Investigation ◽  
Post Traumatic ◽  
Clivus Fracture ◽  
Stem Position

Internuclear ophthalmoplegia is a remarkable finding, particularly in patients victims of head injury. The medial longitudinal fasciculus, which is believed to be lesioned in cases of internuclear ophthalmoplegia, has an unique brain stem position and the mechanism involved in brain stem contusions implies a maximal intensity of shearing forces on the skull base. We describe a very rare association of bilateral ophthalmoplegia and clivus fracture following head injury, without further neurological signs. The patient history, his physical examination and the image investigation provide additional evidence to some of the mechanisms of injury proposed to explain post-traumatic internuclear ophthalmoplegia.

Excitatory termination of abducens internuclear neurons on medial rectus motoneurons: relationship to syndrome of internuclear ophthalmoplegia

1978 ◽  
Vol 41 (6) ◽  
pp. 1647-1661 ◽  
Author(s):  
S. M. Highstein ◽  
R. Baker
Keyword(s):  
Brain Stem ◽  
Nerve Stimulation ◽  
Physiological Activity ◽  
Vestibular Nerve ◽  
Medial Rectus ◽  
Medial Longitudinal Fasciculus ◽  
Internuclear Ophthalmoplegia ◽  
Field Potentials ◽  
Abducens Nucleus ◽  
Stimulation Of

1. Field potentials and intracellular records were obtained from the medial rectus subdivision of the IIIrd nucleus in anesthetized cats following electrical stimulation of the abducens nuclei, vestibular nerves, pontomedullary brain stem, and the medial longitudinal fasciculi (MLF). 2. Stimulation of the contralateral abducens nucleus produced unique field potentials in the medial rectus subdivision. They consisted of an early sharp transient volley followed by a slower postsynaptic negativity. 3. Monosynaptic EPSPs were evoked in medial rectus motoneurons following contralateral abducens nucleus stimulation. The EPSP amplitudes were graded when the stimulus intensity was increased from threshold to supramaximal. EPSPs produced by contralateral abducens nucleus stimulation were larger in amplitude than those produced by ipsilateral vestibular nerve stimulation. The current-voltage relationship and reversal potentials for Vi- and abducens-evoked EPSPs were similar and indicated an overlapping location of excitatory synaptic terminals on medial rectus motoneurons. 4. Secondary vestibular axons activated monosynaptically by ipsilateral vestibular nerve stimulation were not recruited by abducens nucleus stimulation. 5. Ipsilateral MLF stimulation produced EPSPs with similar profiles as those observed following abducens nucleus stimulation; however, stimulation of the contralateral MLF at comparable stimulus intensities did not produce any changes in transmembrane potential. 6. When higher intensity stimuli were applied to the contralateral MLF, the synaptic potentials recorded in the medial rectus were occluded by those produced by weaker stimulation applied to the ipsilateral MLF. This suggests that the potentials resulting from stronger contralateral stimulation were due to current spread to the ipsilateral MLF. 7. While recording in the medial rectus subdivision, various sites in the ponto-medullary brain stem were explored with a stimulating electrode. Analysis of evoked field potentials suggested that the ascending internuclear axons were contained only in the MLF ipsilateral to the medial rectus. Acute brain stem lesions confirmed this suggestion. 8. Chronic lesions were placed in the brain stem to isolate the abducens nucleus from either extrinsic fibers of passage or axon collaterals. Acute electrophysiological experiments in these chronic animals corroborated the suggestion that the medial rectus pathway originated from within the abducens nucleus. 9. We conclude that axons from the internuclear neurons of the abducens nucleus exit from the nucleus medially, cross the midline, ascend in the opposite MLF, and terminate monosynaptically on medial rectus motoneurons. 10. we believe that the syndrome of internuclear ophthalmoplegia associated clinically with lesions of the medial longitudinal fasciculus could be due to the absence of ascending physiological activity from internuclear neurons of the abducens nucleus.

The psychobiology of minor head injury

1991 ◽  
Vol 21 (2) ◽  
pp. 375-384 ◽  
Author(s):  
E. A. Montgomery ◽  
G. W. Fenton ◽  
R. J. McClelland ◽  
G. MacFlynn ◽  
W. H. Rutherford
Keyword(s):  
Head Injury ◽  
Brain Stem ◽  
Power Spectra ◽  
Minor Head Injury ◽  
Conduction Time ◽  
Eeg Power Spectra ◽  
Symptom Check List ◽  
Post Traumatic ◽  
Stem Damage ◽  
The Brain

SYNOPSISTwenty-six consecutive admissions to an accident and emergency unit with minor head injury were examined. This was defined as a head injury warranting brief in-patient overnight stay but with a post-traumatic amnesia of less than 12 hours. Each patient had a neurological examination, a post-traumatic symptom check list completed, EEG power spectra analysis and auditory brain stem-evoked potential recordings, and a four-choice reaction-time measurement. These assessments were repeated six weeks later. Six months after the head injury a symptom check list was completed and four-choice reaction time measured again. Post-traumatic symptoms are persistent in half of all patients at six weeks and six months follow-up. The EEG power spectra showed a significant change in theta power between the first recording and the second one at six weeks, with relative reduction being noted. Approximately half of all the patients had significant delays in brain stem conduction time at day 0. There was a trend towards a decrease in brain stem conduction time at six weeks, though in almost half the brain stem conduction time still remained abnormal at six weeks. Head-injured patients had prolonged choice reaction times at day 0 with serial improvement between then and six months, though the values at six weeks were still significantly longer than healthy controls. It is suggested that these findings reflect both cortical and brain stem damage following minor head injury, the brain stem damage being more persistent. There appear to be three patterns of recovery, half recovering within six weeks, a minority persisting over six months with persisting brain stem dysfunction and less than a third showing an exacerbation of symptoms with no evidence of brain stem dysfunction, the exacerbation being possibly a consequence of psychological and social factors.

Post-traumatic growth after head injury: A long-term follow-up

Brain Injury ◽  
2007 ◽  
Vol 21 (1) ◽  
pp. 31-38 ◽  
Author(s):  
Trevor Powell ◽  
Abigail Ekin-Wood ◽  
Christine Collin
Keyword(s):  
Head Injury ◽  
Post Traumatic Growth ◽  
Long Term Follow Up ◽  
Post Traumatic

Isolated Unilateral Internuclear Ophthalmoplegia Following Head Injury

1996 ◽  
Vol 16 (1) ◽  
pp. 67
Author(s):  
C Strauss ◽  
O Ganslandt ◽  
W J Huk ◽  
J B Jonas
Keyword(s):  
Head Injury ◽  
Internuclear Ophthalmoplegia

Somatosensory and Auditory Brain Stem Conduction after Head Injury: A Comparison with Clinical Features in Prediction of Outcome

Neurosurgery ◽  
1990 ◽  
Vol 26 (2) ◽  
pp. 278-285 ◽  
Author(s):  
Kenneth Lindsay ◽  
Aydin Pasaoglu ◽  
David Hirst ◽  
Gwen Allardyce ◽  
Ian Kennedy ◽  
...  
Keyword(s):  
Head Injury ◽  
Brain Stem ◽  
Evoked Potential ◽  
Predictive Accuracy ◽  
Normal Subjects ◽  
Prediction Of Outcome ◽  
Prognostic Information ◽  
Additional Information ◽  
Auditory Brain Stem ◽  
The Difference

Abstract Evoked potential conduction times in brain stem auditory (BCT) and central somatosensory pathways (CCT) were recorded from 23 normal subjects and 101 patients with severe head injury. Abnormalities in the CCT and the BCT findings correlated with the clinical indices of brain damage (coma score, motor response, pupil response, and spontaneous and reflex eye movements) in the head-injured patients and each correlated with outcome at 6 months from the injury. The CCT in the “best” hemisphere produced the strongest correlation with outcome (P<0.001). The correlation of the CCT with outcome was stronger in the 47 patients examined 2 to 3 days after the injury (P<0.001) compared to the 34 patients examined within 24 hours after the injury (P<0.02). No such difference was noted for the BCT. Serial studies within the first 2 weeks of injury did not show a consistent pattern and repetition of the investigation over this period did not provide any additional information. We used an INDEP-SELECT discriminant analysis program to determine whether information from the evoked potential data could improve prediction of outcome based on clinical data alone. With the addition of the CCT, the predictive accuracy (expressed as the correct classification probability) increased only slightly from 77 to 80%, and the difference was not significant. We conclude that central somatosensory and auditory brain stem conduction times provide useful prognostic information in paralyzed or sedated patients, but when neurological examination is feasible the benefits of evoked potential analysis do not justify the effort involved in data collection.

Lidocaine-induced unilateral internuclear ophthalmoplegia: effects on convergence and conjugate eye movements

1989 ◽  
Vol 62 (1) ◽  
pp. 82-95 ◽  
Author(s):  
P. D. Gamlin ◽  
J. W. Gnadt ◽  
L. E. Mays
Keyword(s):  
Eye Movements ◽  
Smooth Pursuit ◽  
Open Loop ◽  
Medial Longitudinal Fasciculus ◽  
Slow Phase ◽  
Internuclear Ophthalmoplegia ◽  
Unaffected Side ◽  
Affected Side ◽  
Position Signal ◽  
Slow Drift

1. To characterize the vergence signal carried by the medial longitudinal fasciculus (MLF), it was subjected to reversible blockade by small injections of 10% lidocaine hydrochloride. The effects of these blockades on both conjugate and vergence eye movements were studied. 2. With this procedure, experimentally induced internuclear ophthalmoplegia (INO) and its effects on conjugate eye movements could be studied acutely, without possible contamination from long-term oculomotor adaptation. In the eye contralateral to the MLF blockade, saccadic and horizontal smooth-pursuit eye movements were normal. Horizontal abducting nystagmus, often seen in patients with INO, was not observed in this eye. 3. As previously reported for INO, profound oculomotor deficits were seen in the eye ipsilateral to the MLF blockade. During maximal blockade, adducting saccades and horizontal smooth-pursuit movements in this eye did not cross the midline. Adducting saccades were reduced in amplitude and peak velocity and showed significantly increased durations. Abducting saccades, which were slightly hypometric, displayed a marked postsaccadic centripetal drift. 4. The eye ipsilateral to the blockade displayed a pronounced, upward, slow drift, whereas the eye contralateral to the blockade showed virtually no drift. Furthermore, although vertical saccades to visual targets remained essentially conjugate, the size of the resetting quick phases in each eye was related to the amplitude of the slow phase movement in that eye. Thus the eye on the affected side displayed large quick phases, whereas the eye on the unaffected side showed only slight movements. On occasion, unilateral downbeating nystagmus was seen. This strongly suggests that the vertical saccade generators for the two eyes can act independently. 5. The effect of MLF blockade on the vergence gain of the eye on the affected side was investigated. As a measure of open-loop vergence gain, the relationship of accommodative convergence to accommodation (AC/A) was measured before, during, and after reversible lidocaine block of the MLF. After taking conjugate deficits into account, the net vergence signal to the eye ipsilateral to the injection was found to increase significantly during the reversible blockade. 6. The most parsimonious explanation for this increased vergence signal is suggested by the accompanying single-unit study. This study showed that abducens internuclear neurons, whose axons course in the MLF, provide medial rectus motoneurons with an appropriate horizontal conjugate eye position signal but an inappropriate vergence signal. Ordinarily, this incorrect vergence signal is overcome by another, more potent, v

Auditory Brain Stem Responses in the Prognosis of Late Postconcussional Symptoms and Neuropsychological Dysfunction after Minor Head Injury

Neurosurgery ◽  
1986 ◽  
Vol 19 (4) ◽  
pp. 532-534 ◽  
Author(s):  
Rudolf Schoenhuber ◽  
Massimo Gentilini
Keyword(s):  
Head Injury ◽  
Brain Stem ◽  
Neuropsychological Tests ◽  
Statistical Difference ◽  
Minor Head Injury ◽  
Mental Function ◽  
Postconcussion Syndrome ◽  
Neuropsychological Dysfunction ◽  
Auditory Brain Stem Responses ◽  
Auditory Brain Stem

Abstract Thirty patients suffering from minor head injury were examined with auditory brain stem responses (ABR), neuropsy-chological tests for assessment of higher nervous functions, and a questionnaire on postconcussional symptoms. Comparison of the 6 patients with altered ABR with the other 24 showed no statistical difference in either the number of long-lasting postconcussional symptoms or the scores on neuropsychological tests. Subclinical brain stem involvement as shown by ABR does not seem to correlate with impaired mental function or symptoms of the postconcussion syndrome. This greatly limits the use of ABR in forensic medicine.

scholarly journals Decompressive craniotomy: prognostic factors and complications in 89 patients

2008 ◽  
Vol 66 (2b) ◽  
pp. 369-373 ◽  
Author(s):  
Rodrigo Moreira Faleiro ◽  
Luiz Carlos Mendes Faleiro ◽  
Elisa Caetano ◽  
Isabella Gomide ◽  
Cristina Pita ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Head Injury ◽  
Severe Head Injury ◽  
Traffic Accidents ◽  
Acute Subdural Hematoma ◽  
Brain Swelling ◽  
Decompressive Craniotomy ◽  
Independent Test ◽  
Post Traumatic ◽  
Subdural Effusions

Decompressive craniotomy (DC) is applied to treat post-traumatic intracranial hypertension (ICH). The purpose of this study is to identify prognostic factors and complications of unilateral DC. Eighty-nine patients submited to unilateral DC were retrospectively analyzed over a period of 30 months. Qui square independent test and Fisher test were used to identify prognostic factors. The majority of patients were male (87%). Traffic accidents had occurred in 47% of the cases. 64% of the patients had suffered severe head injury, while pupillary abnormalities were already present in 34%. Brain swelling plus acute subdural hematoma were the most common tomographic findings (64%). Complications occurred in 34.8% of the patients: subdural effusions in 10 (11.2%), hydrocephalus in 7 (7.9%) and infection in 14 (15.7%). The admittance Glasgow coma scale was a statistically significant predictor of outcome ( p=0.0309).

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