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Brain Stem Disorder


Presentation

  • Eight of them (12%) presented with intractable nausea and vomiting as the sole initial symptom.[mdedge.com]
  • This presents in childhood (average age at diagnosis of 10 years) and is preceded by jaundice and hepatosplenomegaly at birth in about half of patients; vertical gaze palsy is present in 80% of patients (32).[neuroophthalmology.ca]
  • Lateral tegmental hemorrhages present with 1 1/2 syndrome, small reactive pupils, limb ataxia of the cerebellar type, and contralateral hemisensory loss (Caplan and Goodwin, 1982). Diagnosis may be made via MRI or CT scan.[tchain.com]
  • Abstract Three siblings presented with a progressive neurological disorder beginning in the third decade of life and characterised by palatal myoclonus, nystagmus, bulbar weakness and spastic tetraparesis.[jnnp.bmj.com]
  • Individuals with this malformation present with multiple cranial neuropathies, including SNHL.[ajnr.org]
Tachypnea
  • Nightmares are frightening dreams that occur during REM sleep and are associated with an increase in heart rate (tachycardia), an increase in the rate of breathing (tachypnea), profuse sweating , and arousal.[emedicinehealth.com]
Decreased Bowel Sounds
  • Signs of cholinergic autonomic hypofunction such as dilated unreactive pupils, urinary retention, and decreased bowel sounds are important clues (70).[neuroophthalmology.ca]
Diplopia
  • A 51-year-old woman with MS developed acute vertigo, ataxia, diplopia, dysarthria, and bifacial weakness. She had been in clinical remission for 24 years without immunomodulatory therapy.[neurology.org]
  • There is a clinical continuum between BBE and Fisher's syndrome. [ 1 ] Bickerstaff reported eight patients who, in addition to acute ophthalmoplegia (diplopia) and ataxia, showed drowsiness, extensor plantar responses or hemisensory loss. [ 2 ] Epidemiology[patient.info]
  • Patients typically present subacutely with a wide variety of signs and symptoms dominated by 1 : cranial nerve dysfunction (e.g. dysarthria, altered facial sensation, diplopia) cerebellar signs (e.g. ataxia) long tract signs (e.g. spasticity, altered[radiopaedia.org]
  • Diplopia (“double vision”) is the visual perception of two simultaneous images of the same single object. Ataxia is a lack of muscle coordination when trying to intentionally move the limbs, head, or body.[migraine.com]
  • Myasthenia gravis can also mimic a gaze palsy, though this is usually an asymmetric disease with complaints of diplopia (66). Variability and fatigability are key aspects that point to a neuromuscular junction problem.[neuroophthalmology.ca]
Unilateral Ptosis
  • Patients often have a Horner's syndrome (unilateral ptosis, miosis and facial anhidrosis). There also may be saccadic dysmetria (overshoot), saccadic pulsion (pulling of the eye during vertical saccades toward the side of lesion).[tchain.com]
  • However, a lateral fascicular III lesion affecting the superior recti, inferior oblique and levator may cause a monocular elevator palsy with unilateral ptosis (51).[neuroophthalmology.ca]
Strabismus
  • J Pediatr Ophthalmol Strabismus 1992;29:142-149. 50. Cadera W, Bloom JN, Karlik S, Viirre E. A magnetic resonance imaging study of double elevator palsy. Can J Ophthalmol 1997;32:250-253. 51. Hriso E, Masdeu JC, Miller A.[neuroophthalmology.ca]
Facial Numbness
  • Typical symptoms include eye pain and vision disturbances; speech disorders; facial numbness or pain; incoordination of gait and of the limbs; spasticity, weakness, and increased reflexes; frequency and urgency of bladder emptying; and alteration in sensation[britannica.com]
Vertigo
  • Vertigo is a common early symptom of brainstem strokes.[tchain.com]
  • However, because strokes are much less common than other sources of vertigo such as ear disorders, vertigo is only caused by central nervous system problems (including stroke) about 5% of the time. Migraine is a common cause of vascular vertigo.[dizziness-and-balance.com]
  • A 51-year-old woman with MS developed acute vertigo, ataxia, diplopia, dysarthria, and bifacial weakness. She had been in clinical remission for 24 years without immunomodulatory therapy.[neurology.org]
  • Peripheral vertigo; Central vertigo; Dizziness; Benign positional vertigo; Benign paroxysmal positional vertigo Bhattacharyya N, Gubbels SP, Schwartz SR, et al. Clinical practice guideline: benign paroxysmal positional vertigo (update).[medlineplus.gov]
  • The vertigo arising from central lesions tends to be more chronic and debilitating than that resulting from peripheral vestibulopathy. Vertigo of central origin often becomes unremitting and disabling. There may be nausea and vomiting.[healthcentral.com]
Dizziness
  • Dizziness, vertigo, disequilibrium Dizziness, vertigo and disequilibrium are common symptoms reported by adults during visits to their doctors.[vestibular.org]
  • A person may have vertigo, dizziness and severe imbalance without the hallmark of most strokes – weakness on one side of the body. The symptoms of vertigo dizziness or imbalance usually occur together; dizziness alone is not a sign of stroke.[strokeassociation.org]
  • Vertigo is a sensation of motion or spinning that is often described as dizziness. Vertigo is not the same as being lightheaded . People with vertigo feel as though they are actually spinning or moving, or that the world is spinning around them.[medlineplus.gov]
  • Definition Deficits in vestibular function typically cause dizziness, loss of balance, and diminished functional independence and reflect a disturbance of the central vestibular pathways in the brain.[healthcentral.com]
  • Dizziness and problems with balance and coordination Swallowing difficulties Sleep apnea Most children born with type II Chiari malformation have hydrocephalus.[webmd.com]
Nystagmus
  • In the author's experience, these patients often exhibit rebound nystagmus , which is a variant of gaze-evoked nystagmus . Some of these patients have upbeating nystagmus supine, often confused with BPPV.[dizziness-and-balance.com]
  • In the author's experience, these patients often exhibit rebound nystagmus, which is a variant of gaze-evoked nystagmus .[tchain.com]
  • Abstract Three siblings presented with a progressive neurological disorder beginning in the third decade of life and characterised by palatal myoclonus, nystagmus, bulbar weakness and spastic tetraparesis.[jnnp.bmj.com]
  • A classic sign is convergence-retraction nystagmus . (see case 51 ) Fragments of the pretectal syndrome are common.[neuroophthalmology.ca]
  • Medial inferior pontine syndrome (occlusion of paramedian branch of basilar artery) On side of lesion • Paralysis of conjugate gaze to side of lesion (preservation of convergence): Center for conjugate lateral gaze(PPRF) • Nystagmus: Vestibular nucleus[slideshare.net]
Dysarthria
  • A 51-year-old woman with MS developed acute vertigo, ataxia, diplopia, dysarthria, and bifacial weakness. She had been in clinical remission for 24 years without immunomodulatory therapy.[neurology.org]
  • Voice Dysfunction When Stroke Affects Cerebral Cortex (Brain) Vocal symptoms with cerebral cortex strokes are more often related to articulation disorders (slurred speech, or dysarthria) rather than hoarseness.[voicefoundation.org]
  • It is typified by vertigo, ipsilateral hemiataxia, dysarthria, ptosis and miosis. Most patients with this stroke recover very well and often resume their previous activities (Nelles et al, 1998).[tchain.com]
  • Patients typically present subacutely with a wide variety of signs and symptoms dominated by 1 : cranial nerve dysfunction (e.g. dysarthria, altered facial sensation, diplopia) cerebellar signs (e.g. ataxia) long tract signs (e.g. spasticity, altered[radiopaedia.org]
  • Dysarthria refers to difficulty controlling the speech-producing muscles (mouth, tongue, larynx, etc) resulting in slurring, mumbling, and general difficulty in producing sounds and words.[migraine.com]
Cranial Nerve Involvement
  • Clinically, in localizing strokes to the brainstem one looks for the "cardinal" feature of an ipsilateral peripheral cranial nerve involvement, and a contralateral weakness or sensory deficit. Cerebellar signs, if present, should be ipsilateral.[tchain.com]
  • Contra pain and temp Vascular - Pica or vertebral Symptoms of brainstem stroke Clinically, in localizing strokes to the brainstem one looks for the "cardinal" feature of an ipsilateral peripheral cranial nerve involvement, and a contralateral weakness[dizziness-and-balance.com]
  • nerve involvement (commonly IX and X) Long tract signs Ataxia Downbeating nystagmus and oculomyoclonus (medullary involvement) See Clinical Presentation for more detail.[emedicine.medscape.com]

Workup

Treatment

  • There is no treatment.[msdvetmanual.com]
  • Fink grew up with mood disorders in her family, so she has seen them from every angle and knows the importance of mobilizing the family as a part of any successful treatment.[books.google.com]
  • In addition, the center continues to expand and pioneer treatments directed at other abnormalities in and around the brainstem.[neurosurgery.pitt.edu]
  • Our cohort was drawn from the imaging sub-study of the International Study to Predict Optimized Treatment for Depression (iSPOT-D) [15] .[journals.plos.org]

Prognosis

  • Prognosis is generally quite good with full or near full recovery expected at 6 months. Diagnosis is generally via MRI.[tchain.com]
  • Prognosis of the pretectal syndrome varies with cause. Some resolution can be expected over several weeks as thalamic hemorrhages resolve. Shunting in hydrocephalus has variable effect (36). 5.[neuroophthalmology.ca]
  • The overall prognosis of stroke varies considerably; in general older patients face a worse prognosis for recovery of function.[voicefoundation.org]
  • . • MRI may provide further detail and aid prognosis. • Surgery is reserved for select cases in which specific expertise is available.[medlink.com]
  • In this article arrow-down Epidemiology arrow-down Presentation arrow-down Differential diagnosis arrow-down Investigations arrow-down Associated diseases arrow-down Management arrow-down Prognosis This disease is notifiable in the UK, see NOIDs article[patient.info]

Etiology

  • Furthermore, the concept of secondary mania casts doubt on any unitary or single-agent hypothesis of the etiology of mania and supports the notion of a continuum of psychopathologic syndromes.[jamanetwork.com]
  • MRI is frequently needed to make a specific diagnosis and to separate vascular etiologies from tumor and other structural injuries. The pattern of sensory disturbance may be helpful.[tchain.com]
  • Etiology Several different vascular territories exist within the thalamus, giving rise to distinct families of thalamic stroke presentations (7, 8).[neuroophthalmology.ca]
  • Although the exact mechanisms underlying these associations are not entirely known, alterations in the normal interactions between the developing inner ears, cochlear nerves, and rhombencephalon during early fetal life likely play major roles in the etiology[ajnr.org]

Epidemiology

  • McFarland Plural Publishing , 15.08.2008 - 550 Seiten 0 Rezensionen Featuring contributions from a stellar team of expert contributors in the areas of audiology, psychology, anatomy, neuroscience, imaging science, and epidemiology, this book addresses[books.google.com]
  • Epidemiology and Genetics of Parkinson's Disease Walter A.[mayo.edu]
  • Epidemiology The incidence of BBE is higher in Japan compared to Western nations.[practicalneurology.com]
  • In this article arrow-down Epidemiology arrow-down Presentation arrow-down Differential diagnosis arrow-down Investigations arrow-down Associated diseases arrow-down Management arrow-down Prognosis This disease is notifiable in the UK, see NOIDs article[patient.info]
  • Basilar-type migraine: Clinical, epidemiologic, and genetic features. Neurology 2006;66: 880-886. Klapper J, Mathew N, Nett R. Triptans in the treatment of basilar migraine and migraine with prolonged aura. Headache. 2001;41:981-984.[americanmigrainefoundation.org]
Sex distribution
Age distribution

Pathophysiology

  • This finding has implications for pathophysiologic models of panic disorder, and provides structural evidence for the role of the brainstem in neurocircuitry models of panic disorder.[nyuscholars.nyu.edu]
  • This finding has implications for pathophysiologic models of panic disorder , and provides structural evidence for the role of the brainstem in neurocircuitry models of panic disorder . a Functional Neuroimaging Laboratory, Department of Psychiatry, Weill[journals.lww.com]
  • Common seropositivity between these two conditions highlights their pathophysiological and clinical similarities.[practicalneurology.com]
  • With the breadth of possible pathophysiologic mechanisms, ANSD can manifest with a wide variety and degree of symptoms and findings, 8 but these various phenotypes may exhibit indistinguishable audiometric and electrophysiologic results (ie, the presence[ajnr.org]
  • The brainstem is the site of primary neurotransmitter innervation to both the fronto-limbic system and the HPA, and is hence a site of primary interest in understanding the pathophysiology of MDD.[journals.plos.org]

Prevention

  • Of the preventive medications, topiramate, verapamil and lamotrigine are most commonly used.[americanmigrainefoundation.org]
  • These studies will contribute greatly to understanding the causes and possible prevention of PD by exploring novel hypotheses and by using innovative methods.[mayo.edu]
  • Exercises can also strengthen your muscles to help prevent falls . To prevent worsening of symptoms during an episode of vertigo , try the following: Keep still. Sit or lie down when symptoms occur. Gradually resume activity.[medlineplus.gov]
  • Insulation is important for the prevention of short-circuits. Through its special construction, myelin accelerates the propagation of impulses along nerve fibers. Myelin is an essential part of the white matter.[vumc.com]
  • Such a therapy would likely not cure the patient of RBD, since the brain cells that cause that disorder would have already been damaged, but it could prevent the disease from spreading to the rest of the brain, Peever said.[livescience.com]

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