Brainstem and Cranial Nerves: Longitudinal Pathways of the Brainstem

This chapter reviews pathways that are not at a single level of the brainstem but rather involve multiple areas with supratentorial input. The chapter highlights autonomic pathways, the reticular formation and chemically defined groups, and coordination of eye movements. Sympathetic fibers travel from the hypothalamus to the intermediolateral column in the spinal cord through the lateral brainstem. Patients with a unilateral lesion of the lateral brainstem may have ipsilateral Horner syndrome. The ventrolateral medulla, also a sympathetic region of the brainstem, projects to the spinal cord and is involved in the innervation of blood vessels in the limbs.

External auditory canal osteoma: a case report

<p>External auditory canal (EAC) osteomas are rare, solitary benign unilateral lesion. Small lesions are incidentally diagnosed and larger lesions produce symptoms of pain, ear discharge and defective hearing. Diagnosis is made based on a combination of clinical history and examination, radiographic imaging, and histopathology. They are usually confused with exostosis which are multiple, bilateral, smooth-bordered, broad-based lesions without deep extension. We present a case of 21-year-old male patient who came to our outpatient department, with complaints of left ear blocking sensation for past 6 months. On evaluation, it was diagnosed as left EAC osteoma and the same was excised via post-auricular approach. This case is being presented for its rarity</p>

Isolated Complete Tongue Paralysis as a Manifestation of Focal Cortical Infarction

Although isolated contralateral tongue deviation following unilateral cortical infarction was occasionally reported, the unilateral lesion usually produces no significant deficit of tongue motility considering bilateral supranuclear innervation of the hypoglossal nerve. We observed a patient with obvious tongue paralysis, including intrinsic muscles, caused by ischemic stroke involving the motor area of the tongue in the primary motor cortex.

TUBERCULOUS MEDIUM OTITIS: CLINICAL EXAMPLE

The article describes a rare localization of extrapulmonary tuberculosis in the form of a unilateral lesion of the middle ear in a 47-year-old woman without immunodeficiency, but having a history of pulmonary tuberculosis with residual changes. Sluggish middle purulent otitis media in the patient for 1.5 years was regarded as nonspecific, and only surgical intervention with histological examination of the surgical material made it possible to establish a tuberculous etiology of the process

Congenital Lacrimal Sac Fistula: A Case Report and Literature Review

Introduction: Congenital lacrimal sac fistula is a rare anomaly of the lacrimal system in which, an epithelium-lined lacrimal tract is connected to the skin through a fistula. In most cases, it usually presents as an asymptomatic unilateral lesion located inferolateral to the medial canthus. Several studies reported that congenital lacrimal sac fistulas may be associated with systemic anomalies like Down syndrome, renal agenesis, etc. However, in this case, we aimed to report a patient with isolated bilateral congenital lacrimal sac fistula and its surgical management. Case presentation: A previously healthy 17 years old female presented with the complaint of intermittent watery discharge from her left eye since a few months ago. Physical examination revealed a small orifice in the skin at about 4 mm from the medial canthus on the medial side in both eyes without any signs of inflammation. Probing and irrigation in the left eye disclosed communication with the puncta and nose. Surgical repair was carried out through fistulectomy which successfully controlled the patient’s lacrimation. Conclusions: Recent advances in surgical techniques have shown better rates of success in relieving the patient’s lacrimation through fistulectomy than the simple excision methods. Our experience with the case presented here demonstrates that this lacrimal system anomaly can be treated successfully by surgical intervention.

Prediction of Independent Gait in Acute Stroke Patients with Hemiplegia Using the Ability for Basic Movement Scale II Score

Introduction: Since independent gait is an important factor for home discharge, early prediction of independent gait after stroke is essential. The revised version of the Ability for Basic Movement Scale II (ABMS II) has been developed and validated for assessment of basic movements poststroke. Objective: The purpose of this study was to investigate the predictive value of the ABMS II score for independent gait in acute stroke patients with hemiplegia. Methods: We included 67 patients with first stroke and a unilateral lesion who were admitted to the stroke care unit. We evaluated the gait on the 14th and 90th days from admission. Results: The ABMS II score was significantly higher in patients with independent gait on both the 14th and 90th days from admission. On receiver operating characteristic curve analysis, a minimum score of 26 points was predictive of independent gait on the 14th day from admission. Similarly, a score of 15 points was predictive of independent gait on the 90th day from admission. Conclusions: The ABMS II score is a useful predictor of independent gait in acute stroke patients with hemiplegia.