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Sample records for multiple cranial nerve

  1. Tumors Presenting as Multiple Cranial Nerve Palsies

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    Kishore Kumar

    2017-04-01

    Full Text Available Cranial nerve palsy could be one of the presenting features of underlying benign or malignant tumors of the head and neck. The tumor can involve the cranial nerves by local compression, direct infiltration or by paraneoplastic process. Cranial nerve involvement depends on the anatomical course of the cranial nerve and the site of the tumor. Patients may present with single or multiple cranial nerve palsies. Multiple cranial nerve involvement could be sequential or discrete, unilateral or bilateral, painless or painful. The presentation could be acute, subacute or recurrent. Anatomic localization is the first step in the evaluation of these patients. The lesion could be in the brain stem, meninges, base of skull, extracranial or systemic disease itself. We present 3 cases of underlying neoplasms presenting as cranial nerve palsies: a case of glomus tumor presenting as cochlear, glossopharyngeal, vagus and hypoglossal nerve palsies, clivus tumor presenting as abducens nerve palsy, and diffuse large B-cell lymphoma presenting as oculomotor, trochlear, trigeminal and abducens nerve palsies due to paraneoplastic involvement. History and physical examination, imaging, autoantibodies and biopsy if feasible are useful for the diagnosis. Management outcomes depend on the treatment of the underlying tumor.

  2. Multiple Cranial Nerve Palsy Due to Cerebral Venous Thrombosis

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    Esra Eruyar

    2017-04-01

    Full Text Available Cerebral venous thrombosis (CVT is a rare clinical condition between cerebrovasculer diases. The most common findings are headache, seizure and focal neurological deficit. Multiple cranial nerve palsy due to CVT is rarely seen and it is not clear pathology. A pathology that could explain the lack of cranial nerve imaging is carrying suspected diagnosis but the disease is known to provide early diagnosis and treatment. We want to emphasize with this case multipl cranial nerve palsy due to CVT is seen rarely and good response to treatment.

  3. Hemiplegic peripheral neuropathy accompanied with multiple cranial nerve palsy

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    Hirohisa Okuma

    2012-03-01

    Full Text Available A 32-year-old man experienced double vision around January, 2010, followed by weakness of his left upper and lower extremities. Articulation disorders and loss of hearing in his left ear developed, and he was admitted to our hospital on February 14, 2010. Physical examination was normal, and neurological examination showed clear consciousness with no impairment of cognitive function, but with articulation disorders. Olfactory sensation was reduced. Left ptosis and left gaze palsy, complete left facial palsy, perceptive deafness of the left ear, and muscle weakness of the left trapezius muscle were observed. Paresis in the left upper and lower extremities was graded 4/5 through manual muscle testing. Sensory system evaluation revealed complete left-side palsy, including the face. Deep tendon reflexes were slightly diminished equally on both sides; no pathologic reflex was seen. No abnormality of the brain parenchyma, cerebral nerves or cervicothoracolumbar region was found on brain magnetic resonance imaging. On electroencephalogram, alpha waves in the main frequency band of 8 to 9 Hz were recorded, indicating normal findings. Brain single photon emission computed tomography (SPECT scan showed reduced blood flow in the right inner frontal lobe and both occipital lobes. Nerve biopsy (left sural nerve showed reduction of nerve density by 30%, with demyelination. The patient also showed manifestations of multiple cranial nerve disorder, i.e., of the trigeminal nerve, glossopharyngeal nerve, vagus nerve, and hypoglossal nerve. Whole-body examination was negative. Finally, based on ischemic brain SPECT images, spinal fluid findings and nerve biopsy results, peripheral neuropathy accompanied with multiple cranial nerve palsy was diagnosed.

  4. Ramsay Hunt syndrome and zoster laryngitis with multiple cranial nerve involvement.

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    Shinha, Takashi; Krishna, Pasala

    2015-01-01

    Ramsay Hunt syndrome is characterized by varicella zoster virus infection affecting the geniculate ganglion of the facial nerve. It typically presents with vesicles in the external auditory canal associated with auricular pain and peripheral facial nerve paralysis. Although vestibulocochlear nerve is frequently co-involved during the course of Ramsay Hunt syndrome, multiple lower cranial nerve involvement has rarely been described in the literature. In addition, laryngitis due to varicella zoster virus is a diagnostic challenge due to its unfamiliarity among clinicians. We report a case of Ramsay Hunt syndrome with laryngitis involving multiple lower cranial nerves.

  5. Ramsay Hunt syndrome and zoster laryngitis with multiple cranial nerve involvement

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    Takashi Shinha

    2015-01-01

    Full Text Available Ramsay Hunt syndrome is characterized by varicella zoster virus infection affecting the geniculate ganglion of the facial nerve. It typically presents with vesicles in the external auditory canal associated with auricular pain and peripheral facial nerve paralysis. Although vestibulocochlear nerve is frequently co-involved during the course of Ramsay Hunt syndrome, multiple lower cranial nerve involvement has rarely been described in the literature. In addition, laryngitis due to varicella zoster virus is a diagnostic challenge due to its unfamiliarity among clinicians. We report a case of Ramsay Hunt syndrome with laryngitis involving multiple lower cranial nerves.

  6. An Isolated Bee Sting Involving Multiple Cranial Nerves

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    Hassan Motamed

    2013-01-01

    Full Text Available Hymenoptera stings are self-limiting events or due to allergic reactions. Sometimes envenomation with Hymenoptera can cause rare complications such as acute encephalopathy, peripheral neuritis, acute renal failure, nephrotic syndrome, silent myocardial infarction, rhabdomyolysis, conjunctivitis, corneal infiltration, lens subluxation, and optic neuropathy. The mechanism of peripheral nervous system damage is not clearly known. In our studied case after bee sting on face between the eyebrows with little erythema and  cm in size, bilateral blindness developed and gradually improved. Lateral movement of eyes was restricted with no pain. Involvement of cranial nerves including II, V, and VI was found. With conservative therapy after a year significant improvement has been achieved.

  7. Inflammatory myofibroblastic tumor of the orbit with associated enhancement of the meninges and multiple cranial nerves.

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    McKinney, A M; Short, J; Lucato, L; SantaCruz, K; McKinney, Z; Kim, Y

    2006-01-01

    Inflammatory myofibroblastic tumor (IMT), Tolosa-Hunt syndrome (THS), and idiopathic hypertrophic pachymeningitis (IHP) seem to be part of a spectrum of disorders that have diverse locations but similar histologic and imaging findings. We report a case of a 50-year-old man presenting with multiple progressive cranial nerves palsies with leptomeningeal cranial nerve enhancement on MRI (II, V1-V3, and X), orbital and infraorbital masses, prominence within the left cavernous sinus, and diffuse dural enhancement. Biopsies of the orbital lesion and infraorbital nerve revealed IMT. The patient's lesions, symptoms, and dural enhancement quickly improved with steroid administration and nearly resolved over multiple subsequent scans over the next few months. This case illustrates a rare case of pseudotumor mimicking a more aggressive appearance that would usually portend a case of malignancy. There is a potential association of IMT, THS, and IHP, which may have existed in a concomitant fashion in this patient. The case also describes the unique finding of enhancement of the cisternal segments of multiple cranial nerves (simulating leptomeningeal malignant involvement), which may be related to inflammatory perineural edema or ischemic neuropathy.

  8. Acupuncture: a potential modality for the treatment of auricular pruritus in Ramsay Hunt Syndrome with multiple cranial nerve lesions.

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    Liu, Lan Ying; Wang, He Sheng; Sun, Jian Hua

    2015-03-01

    Auricular pruritus coexisted with multiple cranial nerve lesions in Ramsay Hunt syndrome has been rarely reported in the literature especially its treatment. However, auricular pruritus cannot be better improved along with the improvement of multiple cranial nerve lesions. We tried to solve the problem with acupuncture and got experience from it. The following 2 cases of Ramsay Hunt syndrome show a potential modality for the treatment of auricular pruritus with acupuncture.

  9. Hepatocellular carcinoma metastasizing to the skull base involving multiple cranial nerves

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    Soo Ryang Kim; Fumio Kanda; Hiroshi Kobessho; Koji Sugimoto; Toshiyuki Matsuoka; Masatoshi Kudo; Yoshitake Hayashi

    2006-01-01

    We describe a rare case of HCV-related recurrent multiple hepatocellular carcinoma (HCC) metastasizing to the skull base involving multiple cranial nerves in a 50-yearold woman. The patient presented with symptoms of ptosis, fixation of the right eyeball, and left abducens palsy, indicating disturbances of the right oculomotor and trochlear nerves and bilateral abducens nerves. Brain contrast-enhanced computed tomography (CT) revealed an ill-defined mass with abnormal enhancement around the sella turcica. Brain magnetic resonance imaging (MRI)disclosed that the mass involved the clivus, cavernous sinus, and petrous apex. On contrast-enhanced MRI with gadolinium-chelated contrast medium, the mass showed inhomogeneous intermediate enhancement.The diagnosis of metastatic HCC to the skull base was made on the basis of neurological findings and imaging studies including CT and MRI, without histological examinations. Further studies may provide insights into various methods for diagnosing HCC metastasizing to the craniospinal area.

  10. Overview of the Cranial Nerves

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    ... they were damaged. Cranial nerve disorders can affect smell, taste, vision, sensation in the face, facial expression, ... Cranial Nerve Number Name Function Test 1st Olfactory Smell The ability to smell is tested by asking ...

  11. Neuromuscular ultrasound of cranial nerves.

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    Tawfik, Eman A; Walker, Francis O; Cartwright, Michael S

    2015-04-01

    Ultrasound of cranial nerves is a novel subdomain of neuromuscular ultrasound (NMUS) which may provide additional value in the assessment of cranial nerves in different neuromuscular disorders. Whilst NMUS of peripheral nerves has been studied, NMUS of cranial nerves is considered in its initial stage of research, thus, there is a need to summarize the research results achieved to date. Detailed scanning protocols, which assist in mastery of the techniques, are briefly mentioned in the few reference textbooks available in the field. This review article focuses on ultrasound scanning techniques of the 4 accessible cranial nerves: optic, facial, vagus and spinal accessory nerves. The relevant literatures and potential future applications are discussed.

  12. Recurrent malignant otitis externa with multiple cranial nerve involvement: A case report

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    Đerić Dragoslava

    2016-01-01

    Full Text Available Introduction. Necrotizing otitis externa is a rare but conditionally fatal infection of external auditory canal with extension to deep soft tissue and bones, resulting in necrosis and osteomyelitis of the temporal bone and scull base. This condition is also known as malignant otitis due to an aggressive behavior and poor treatment response. Early diagnosis of malignant otitis is a difficult challenge. We present an illustrative case of necrotizing otitis externa and suggest some strategies to avoid diagnostic and treatment pitfalls. Case Outline. A 70-year-old patient presented with signs of malignant otitis externa, complicated by peripheral facial palsy. Adequate diagnostic and treatment procedures were performed with clinical signs of resolution. The recurrence of malignant infection had presented three months after previous infection with multiple cranial nerve neuropathies and signs of jugular vein and lateral sinus thrombosis. An aggressive antibiotic treatment and surgery were carried out, followed by substantial recovery of the patient and complete restoration of cranial nerves’ functions. Conclusion. Necrotizing otitis externa is a serious condition with uncertain prognosis. The suspicion of malignant external otitis should be raised in cases of resistance to topical treatment, especially in patient with predisposing factors. Evidence-based guideline for necrotizing otitis externa still doesn’t exist and treatment protocol should be adjusted to individual presentation of each patient.

  13. Acute necrosis after Gamma Knife surgery in vestibular schwannoma leading to multiple cranial nerve palsies.

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    Kapitza, Sandra; Pangalu, Athina; Horstmann, Gerhard A; van Eck, Albert T; Regli, Luca; Tarnutzer, Alexander A

    2016-08-01

    We discuss a rare acute complication after Gamma Knife therapy (Elekta AB, Stockholm, Sweden) in a single patient. A 52-year-old woman presented with vertigo, facial weakness and hearing loss emerging 48hours following Gamma Knife radiosurgery for a right-sided vestibular schwannoma. Neurological examination 6days after symptom onset showed right-sided facial palsy, spontaneous left-beating nystagmus and pathologic head-impulse testing to the right. Pure-tone audiogram revealed right-sided sensorineural hearing loss. A diagnosis of acute vestibulocochlear and facial neuropathy was made. Brain MRI demonstrated focal contrast sparing within the schwannoma, likely related to acute radiation necrosis. Acute multiple cranial neuropathies of the cerebellopontine angle after Gamma Knife treatment should raise suspicion of acute tissue damage within the schwannoma and should result in urgent MRI. Treatment with steroids may be considered based on accompanying swelling and edema. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. The Cranial Nerve Skywalk: A 3D Tutorial of Cranial Nerves in a Virtual Platform

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    Richardson-Hatcher, April; Hazzard, Matthew; Ramirez-Yanez, German

    2014-01-01

    Visualization of the complex courses of the cranial nerves by students in the health-related professions is challenging through either diagrams in books or plastic models in the gross laboratory. Furthermore, dissection of the cranial nerves in the gross laboratory is an extremely meticulous task. Teaching and learning the cranial nerve pathways…

  15. [Third cranial nerve palsy and Purtscher retinopathy in a child with multiple injuries].

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    Larrañaga-Fragoso, P; del-Barrio, Z; Noval, S; Pastora, N; Royo, A

    2015-07-01

    A 4 year-old girl was referred to our hospital after have suffered a severe accident. The patient was diagnosed with complete third nerve palsy in her right eye and Purtscher retinopathy in her left eye. Purtscher retinopathy is a rare condition. The diagnosis is made on clinical ground and its treatment is not well defined although it is believed that systemic steroids could improve the visual outcome. Traumatic third nerve palsy has a poor spontaneous recovery. The use of botulinum toxin might be useful in children to improve the recovery rate, maintaining binocularity, and avoiding amblyopia in other cases. Copyright © 2013 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

  16. Rhino-oculo Cerebral Mucormycosis with Multiple Cranial Nerve Palsy in Diabetic Patient: Review of Six Cases.

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    Sachdeva, Kavita

    2013-12-01

    AIM of the study is to evaluate etiopathogenesis role played by predisposing conditions (Diabetes, Immunosupression), precipitating factors (trauma/surgery/ketoacidosis) and possible role of occupational hazard is discussed briefly. Clinical presentation and management of patients presenting with rhinoorbitocerebral mucormycosis is discussed. The prospective study of patient undergoing treatment of mucormycosis] without control Setting was done in ENT Deptt. NSCB Medical College, Jabalpur (tertiary referral centre of mid India). Subject were patients presenting with invasive fungal rhino sinusitis presenting with orbital involvement and cranial nerve palsies undergoing treatment. The detailed history, clinical examination including cranial nerve examination, blood test, CTscan and biopsy. Nasal endoscopy, CWL surgery and medical management with 6 month follow up. All six patients were diabetic when evaluated on presentation. Two patients had ketoacidosis. Four had history of surgery in recent past. Blood stained nasal discharge and dysaesthesia of face are early warning signs. They had necrotic lesion in nose and infraorbital area with 2, 3, 4, 5, 6 and 7 cranial nerve involvement. Skin necrosis/Mucosal necrosis, facial palsy and diplopia signify advanced disease. Altered sensorium, panopthalmitis & diabetes complicated with ketoacidosis signify bad prognosis. In present study two patients with advanced disease, altered sensorium and ketoacidosis succumbed within 72 hours in spite of anti fungal medicine. Of the four surviving patients, all responded well to treatment but had residual sixth and seventh nerve palsy. One patient defaulted in diabetes control & had recurrence after 6 months. Early diagnosis, aggressive surgical debridement and proper management of underlying metabolic abnormality along with amphotericin B can avert the bad prognosis of rhinoorbitocerebral mucormycosis.

  17. [First case described of isolated, complete and fluctuating cranial nerve III palsy heralding multiple myeloma].

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    León-Ruiz, Moisés; Benito-León, Julián; Sierra-Hidalgo, Fernando; García-Soldevilla, Miguel Ángel; Izquierdo-Esteban, Laura; Tejeiro-Martínez, José; Cabrera-Valdivia, Francisco; García-Albea Ristol, Esteban

    2015-02-01

    Introduccion. El mieloma multiple es la neoplasia de celulas plasmaticas mas frecuente. Al ser incurable, el tratamiento persigue obtener el mayor tiempo de supervivencia libre de clinica. Constituye una causa extremadamente rara de afectacion de los nervios craneales y es producido habitualmente por un plasmocitoma intracraneal. Presentamos un caso de mieloma multiple, que asociaba un plasmocitoma intracraneal y que comenzo clinicamente con paralisis aislada, completa y fluctuante del III nervio craneal. Caso clinico. Mujer de 63 años que acudio a urgencias por presentar un cuadro clinico oscilante, consistente en diplopia binocular horizontal y, posteriormente, cefalea. La exploracion neurooftalmologica revelo una paralisis completa del III nervio craneal derecho. Se solicito una tomografia axial computarizada craneal urgente, que revelo multiples lesiones osteoliticas diploicas, asociando una de ellas componente de partes blandas en la hendidura esfenoidal derecha. La paciente fue ingresada, y se le diagnostico posteriormente un mieloma multiple IgA-kappa. Tras recibir induccion quimioterapica y ser sometida a un trasplante autologo de progenitores hematopoyeticos, alcanzo la remision completa. Conclusiones. El mieloma multiple es un trastorno raro de los nervios craneales, una causa muy infrecuente de paralisis aislada y completa del III nervio craneal y menos aun fluctuante, y no se ha encontrado ningun caso publicado con este inicio clinico. Tener en cuenta las posibles manifestaciones neurooftalmologicas del mieloma multiple puede contribuir a un diagnostico precoz y a una incidencia positiva sobre el curso de esta enfermedad.

  18. Cranial nerve injury after minor head trauma.

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    Coello, Alejandro Fernández; Canals, Andreu Gabarrós; Gonzalez, Juan Martino; Martín, Juan José Acebes

    2010-09-01

    There are no specific studies about cranial nerve (CN) injury following mild head trauma (Glasgow Coma Scale Score 14-15) in the literature. The aim of this analysis was to document the incidence of CN injury after mild head trauma and to correlate the initial CT findings with the final outcome 1 year after injury. The authors studied 49 consecutive patients affected by minor head trauma and CN lesions between January 2000 and January 2006. Detailed clinical and neurological examinations as well as CT studies using brain and bone windows were performed in all patients. Based on the CT findings the authors distinguished 3 types of traumatic injury: no lesion, skull base fracture, and other CT abnormalities. Patients were followed up for 1 year after head injury. The authors distinguished 3 grades of clinical recovery from CN palsy: no recovery, partial recovery, and complete recovery. Posttraumatic single nerve palsy was observed in 38 patients (77.6%), and multiple nerve injuries were observed in 11 (22.4%). Cranial nerves were affected in 62 cases. The most affected CN was the olfactory nerve (CN I), followed by the facial nerve (CN VII) and the oculomotor nerves (CNs III, IV, and VI). When more than 1 CN was involved, the most frequent association was between CNs VII and VIII. One year after head trauma, a CN deficit was present in 26 (81.2%) of the 32 cases with a skull base fracture, 12 (60%) of 20 cases with other CT abnormalities, and 3 (30%) of 10 cases without CT abnormalities. Trivial head trauma that causes a minor head injury (Glasgow Coma Scale Score 14-15) can result in CN palsies with a similar distribution to moderate or severe head injuries. The CNs associated with the highest incidence of palsy in this study were the olfactory, facial, and oculomotor nerves. The trigeminal and lower CNs were rarely damaged. Oculomotor nerve injury can have a good prognosis, with a greater chance of recovery if no lesion is demonstrated on the initial CT scan.

  19. Disorders of the lower cranial nerves

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    Josef Finsterer

    2015-01-01

    Full Text Available Lesions of the lower cranial nerves (LCN are due to numerous causes, which need to be differentiated to optimize management and outcome. This review aims at summarizing and discussing diseases affecting LCN. Review of publications dealing with disorders of the LCN in humans. Affection of multiple LCN is much more frequent than the affection of a single LCN. LCN may be affected solely or together with more proximal cranial nerves, with central nervous system disease, or with nonneurological disorders. LCN lesions have to be suspected if there are typical symptoms or signs attributable to a LCN. Causes of LCN lesions can be classified as genetic, vascular, traumatic, iatrogenic, infectious, immunologic, metabolic, nutritional, degenerative, or neoplastic. Treatment of LCN lesions depends on the underlying cause. An effective treatment is available in the majority of the cases, but a prerequisite for complete recovery is the prompt and correct diagnosis. LCN lesions need to be considered in case of disturbed speech, swallowing, coughing, deglutition, sensory functions, taste, or autonomic functions, neuralgic pain, dysphagia, head, pharyngeal, or neck pain, cardiac or gastrointestinal compromise, or weakness of the trapezius, sternocleidomastoid, or the tongue muscles. To correctly assess manifestations of LCN lesions, precise knowledge of the anatomy and physiology of the area is required.

  20. Neurosyphilis Involving Cranial Nerves in Brain Stem: 2 Case Reports

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    Jang, Ji Hye [Dept. of Radiology, Kyung Hee University College of Medicine, Seoul (Korea, Republic of); Choi, Woo Suk; Kim, Eui Jong [Dept. of Radiology, Kyung Hee University Hospital, Seoul (Korea, Republic of); Yoon, Sung Sang; Heo, Sung Hyuk [Dept. of Neurology, Kyung Hee University Hospital, Seoul (Korea, Republic of)

    2012-01-15

    Neurosyphilis uncommonly presents with cranial neuropathies in acute syphilitic meningitis and meningovascular neurosyphilis. We now report two cases in which the meningeal form of neurosyphilis involved cranial nerves in the brain stem: the oculomotor and trigeminal nerve.

  1. Cranial nerve development requires co-ordinated Shh and canonical Wnt signaling.

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    Kurosaka, Hiroshi; Trainor, Paul A; Leroux-Berger, Margot; Iulianella, Angelo

    2015-01-01

    Cranial nerves govern sensory and motor information exchange between the brain and tissues of the head and neck. The cranial nerves are derived from two specialized populations of cells, cranial neural crest cells and ectodermal placode cells. Defects in either cell type can result in cranial nerve developmental defects. Although several signaling pathways are known to regulate cranial nerve formation our understanding of how intercellular signaling between neural crest cells and placode cells is coordinated during cranial ganglia morphogenesis is poorly understood. Sonic Hedgehog (Shh) signaling is one key pathway that regulates multiple aspects of craniofacial development, but whether it co-ordinates cranial neural crest cell and placodal cell interactions during cranial ganglia formation remains unclear. In this study we examined a new Patched1 (Ptch1) loss-of-function mouse mutant and characterized the role of Ptch1 in regulating Shh signaling during cranial ganglia development. Ptch1(Wig/ Wig) mutants exhibit elevated Shh signaling in concert with disorganization of the trigeminal and facial nerves. Importantly, we discovered that enhanced Shh signaling suppressed canonical Wnt signaling in the cranial nerve region. This critically affected the survival and migration of cranial neural crest cells and the development of placodal cells as well as the integration between neural crest and placodes. Collectively, our findings highlight a novel and critical role for Shh signaling in cranial nerve development via the cross regulation of canonical Wnt signaling.

  2. Twelfth cranial nerve involvement in Guillian Barre syndrome

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    Subrat Kumar Nanda

    2013-01-01

    Full Text Available Guillian Barre Syndrome (GBS is associated with cranial nerve involvement. Commonest cranial nerves involved were the facial and bulbar (IXth and Xth. Involvement of twelfth cranial nerve is rare in GBS. We present a case of GBS in a thirteen years old boy who developed severe tongue weakness and wasting at two weeks after the onset of GBS. The wasting and weakness of tongue improved at three months of follow up. Brief review of the literature about XIIth cranial nerve involvement in GBS is discussed.

  3. Imaging of muscular denervation secondary to motor cranial nerve dysfunction

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    Connor, S.E.J. [Neuroradiology Department, Kings College Hospital, Denmark Hill, London SE5 9RS (United Kingdom)]. E-mail: sejconnor@tiscali.co.uk; Chaudhary, N. [Neuroradiology Department, Kings College Hospital, Denmark Hill, London SE5 9RS (United Kingdom); Fareedi, S. [Neuroradiology Department, Kings College Hospital, Denmark Hill, London SE5 9RS (United Kingdom); Woo, E.K. [Neuroradiology Department, Kings College Hospital, Denmark Hill, London SE5 9RS (United Kingdom)

    2006-08-15

    The effects of motor cranial nerve dysfunction on the computed tomography (CT) and magnetic resonance imaging (MRI) appearances of head and neck muscles are reviewed. Patterns of denervation changes are described and illustrated for V, VII, X, XI and XII cranial nerves. Recognition of the range of imaging manifestations, including the temporal changes in muscular appearances and associated muscular grafting or compensatory hypertrophy, will avoid misinterpretation as local disease. It will also prompt the radiologist to search for underlying cranial nerve pathology, which may be clinically occult. The relevant cranial nerve motor division anatomy will be described to enable a focussed search for such a structural abnormality.

  4. [Cranial nerves - spectrum of inflammatory and tumorous changes].

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    Nemec, S F; Kasprian, G; Nemec, U; Czerny, C

    2009-07-01

    Inflammatory processes as well as primary and secondary tumorous changes may involve cranial nerves causing neurological deficits. In addition to neurologists, ENT physicians, ophthalmologists and maxillofacial surgeons, radiologists play an important role in the investigation of patients with cranial nerve symptoms. Multidetector computed tomography (MDCT) and particularly magnetic resonance imaging (MRI) allow the depiction of the cranial nerve anatomy and pathological neural changes. This article briefly describes the imaging techniques in MDCT and MRI and is dedicated to the radiological presentation of inflammatory and tumorous cranial nerve pathologies.

  5. Cranial nerve palsy in Wegener's granulomatosis--lessons from clinical cases

    DEFF Research Database (Denmark)

    Nowack, Rainer; Wachtler, Paul; Kunz, Jürgen;

    2009-01-01

    The problem of diagnosing vasculitic neuropathy is discussed based on case reports of two patients with Wegener's granulomatosis. One patient developed de novo 6(th) nerve palsy as an isolated relapse manifestation and the second patient a sequence of multiple cranial nerve palsies. Brain imaging...

  6. Motonuclear changes after cranial nerve injury and regeneration.

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    Fernandez, E; Pallini, R; Lauretti, L; La Marca, F; Scogna, A; Rossi, G F

    1997-09-01

    Little is known about the mechanisms at play in nerve regeneration after nerve injury. Personal studies are reported regarding motonuclear changes after regeneration of injured cranial nerves, in particular of the facial and oculomotor nerves, as well as the influence that the natural molecule acetyl-L-carnitine (ALC) has on post-axotomy cranial nerve motoneuron degeneration after facial and vagus nerve lesions. Adult and newborn animal models were used. Massive motoneuron response after nerve section and reconstruction was observed in the motonuclei of all nerves studied. ALC showed to have significant neuroprotective effects on the degeneration of axotomized motoneurons. Complex quantitative, morphological and somatotopic nuclear changes occurred that sustain new hypotheses regarding the capacities of motoneurons to regenerate and the possibilities of new neuron proliferation. The particularities of such observations are described and discussed.

  7. Bony exostosis of the atlas with resultant cranial nerve palsy

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    Slavotinek, J.P.; Sage, M.R. (Flinders Medical Centre, Bedford Park (Australia). Dept. of Radiology); Brophy, B.P. (Flinders Medical Centre, Bedford Park (Australia). Dept. of Neurosurgery)

    1991-10-01

    A case of tenth and twelfth nerve compression secondary to a bony exostosis of the first cervical vertebra is described. This uncommon phenomenon serves to outline the importance of imaging the course of a cranial nerve when no intracranial abnormality is demonstrable on CT or MRI. The radiologic features of spinal osteochondromas are reviewed. (orig.).

  8. MR of acoustic neuromas; Relationship to cranial nerves

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    Suzuki, Masayuki; Takashima, Tsutomu; Kadoya, Masumi; Takahashi, Shiroh; Miyayama, Shiroh; Taira, Sakae; Kashihara, Kengo; Yamashima, Tetsumori; Itoh, Haruhide (Kanazawa Univ. (Japan). School of Medicine)

    1989-08-01

    In this report, the relationship of acoustic neuromas to the adjacent cranial nerves is discussed. On T{sub 1}-weighted images, the trigeminal nerve was detected in all 13 cases. Mild to marked compression of these nerves by the tumors was observed in eight cases. The extent of compression did not always correspond to the clinical symptoms. In four cases with a maximum tumor diameter of 2 cm or less, the 7th and 8th cranial nerves were identified. There was no facial palsy in these patients. Two patients with a tumor diameter of more than 2 cm also had no facial palsy. All patients, including those with small tumors, complained of hearing loss and/or tinnitus. While MR imaging has some limitations, it is an effective imaging modality for showing the relationship between tumors and nerves. (author).

  9. Tolerance of cranial nerves of the cavernous sinus to radiosurgery

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    Tishler, R.B.; Loeffler, J.S.; Alexander, E. III; Kooy, H.M. (Harvard Medical School, Boston, MA (United States)); Lunsford, L.D.; Duma, C.; Flickinger, J.C. (Univ. of Pittsburgh Medical Center, PA (United States))

    1993-09-20

    Stereotactic radiosurgery is becoming a more accepted treatment option for benign, deep seated intracranial lesions. However, little is known about the effects of large single fractions of radiation on cranial nerves. This study was undertaken to assess the effect of radiosurgery on the cranial nerves of the cavernous sinus. The authors examined the tolerance of cranial nerves (II-VI) following radiosurgery for 62 patients (42/62 with meningiomas) treated for lesions within or near the cavernous sinus. Twenty-nine patients were treated with a modified 6 MV linear accelerator (Joint Center for Radiation Therapy) and 33 were treated with the Gamma Knife (University of Pittsburgh). Three-dimensional treatment plans were retrospectively reviewed and maximum doses were calculated for the cavernous sinus and the optic nerve and chiasm. Median follow-up was 19 months (range 3-49). New cranial neuropathies developed in 12 patients from 3-41 months following radiosurgery. Four of these complications involved injury to the optic system and 8 (3/8 transient) were the result of injury to the sensory or motor nerves of the cavernous sinus. There was no clear relationship between the maximum dose to the cavernous sinus and the development of complications for cranial nerves III-VI over the dose range used (1000-4000 cGy). For the optic apparatus, there was a significantly increased incidence of complications with dose. Four of 17 patients (24%) receiving greater than 800 cGy to any part of the optic apparatus developed visual complications compared with 0/35 who received less than 800 cGy (p = 0.009). Radiosurgery using tumor-controlling doses of up to 4000 cGy appears to be a relatively safe technique in treating lesions within or near the sensory and motor nerves (III-VI) of the cavernous sinus. The dose to the optic apparatus should be limited to under 800 cGy. 21 refs., 4 tabs.

  10. Symptomatic cranial neuralgias in multiple sclerosis: clinical features and treatment.

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    De Santi, Lorenzo; Annunziata, Pasquale

    2012-02-01

    In multiple sclerosis, neuropathic pain is a frequent condition, negatively influencing the overall quality of life. Cranial neuralgias, including trigeminal, glossopharyngeal neuralgias, as well as occipital neuralgia, are typical expression of neuropathic pain. Neuralgias are characterised by paroxysmal painful attacks of electric shock-like sensation, occurring spontaneously or evoked by innocuous stimuli in specific trigger areas. In multiple sclerosis, demyelination in the centrally myelinated part of the cranial nerve roots plays an important role in the origin of neuralgic pain. These painful syndromes arising in multiple sclerosis are therefore considered "symptomatic", in contrast to classic cranial neuralgias, in which no cause other than a neurovascular contact is identified. At this time, the evidence on the management of symptomatic cranial neuralgias in multiple sclerosis is fragmentary and a comprehensive review addressing this topic is still lacking. For that reason, treatment is often based on personal clinical experience as well as on anecdotal reports. The aim of this review is to critically summarise the latest findings regarding the pathogenesis, the diagnosis, the instrumental evaluation and the medical as well as neurosurgical treatment of symptomatic trigeminal, glossopharyngeal and occipital neuralgia in multiple sclerosis, providing useful insights for neurologists and neurosurgeons and a broad range of specialists potentially involved in the treatment of these painful syndromes.

  11. Direct Cranial Nerve Involvement by Gliomas: Case series and review of the literature

    Science.gov (United States)

    Mabray, Marc C.; Glastonbury, Christine M.; Mamlouk, Mark D.; Punch, Gregory E.; Solomon, David A.; Cha, Soonmee

    2017-01-01

    Malignant gliomas are characterized by infiltrative growth of tumor cells, including along white matter tracts. This may result in clinical cranial neuropathy due to direct involvement of a cranial nerve rather than by leptomeningeal spread along cranial nerves. Gliomas directly involving cranial nerves III-XII are rare with only eleven cases reported in the literature prior to 2014, including eight with imaging. We present eight additional cases demonstrating direct infiltration of a cranial nerve by glioma. Asymmetric cisternal nerve expansion as compared to the contralateral nerve was noted with a mean length of involvement of 9.4 mm. Based on our case series, the key imaging feature to recognize direct cranial nerve involvement by a glioma is the detection of an intra-axial mass in the pons or midbrain that is directly associated with expansion, signal abnormality, and/or enhancement of the adjacent cranial nerve(s). PMID:25857757

  12. [Structural anatomy of cranial nerves (V, VII, VIII, IX, X)].

    Science.gov (United States)

    Guclu, B; Meyronet, D; Simon, E; Streichenberger, N; Sindou, M; Mertens, P

    2009-04-01

    This study reports a review of the literature on the structural anatomy of the Vth, VIIth, VIIIth, IXth, and Xth cranial nerves, known to harbor dysfunction syndromes in humans. Because these dysfunctions are hypothesized to be caused by neurovascular conflicts at the root entry/exit zone and the transitional zone between central and peripheral myelinization, this investigation focused on the study and description of this junction. All the cranial nerves, except the optic and olfactory nerves, which are considered to be more a direct expansion of the central nervous system, have a transitional zone between central myelin (coming from oligodendrocytes) and peripheral myelin (produced by Schwann cells). The human studies reported in the literature argue in favor of a dome-shaped transitional zone directed to the periphery. It seems that this junctional region is situated more peripherally in sensory nerves than in motor nerves. The transitional zone is situated very peripherally for the cochlear and vestibular nerves, and on the contrary very close to its exit from the brain stem for the facial nerve.

  13. Exploring vocal recovery after cranial nerve injury in Bengalese finches.

    Science.gov (United States)

    Urbano, Catherine M; Peterson, Jennifer R; Cooper, Brenton G

    2013-02-08

    Songbirds and humans use auditory feedback to acquire and maintain their vocalizations. The Bengalese finch (Lonchura striata domestica) is a songbird species that rapidly modifies its vocal output to adhere to an internal song memory. In this species, the left side of the bipartite vocal organ is specialized for producing louder, higher frequencies (≥2.2kHz) and denervation of the left vocal muscles eliminates these notes. Thus, the return of higher frequency notes after cranial nerve injury can be used as a measure of vocal recovery. Either the left or right side of the syrinx was denervated by resection of the tracheosyringeal portion of the hypoglossal nerve. Histologic analyses of syringeal muscle tissue showed significant muscle atrophy in the denervated side. After left nerve resection, songs were mainly composed of lower frequency syllables, but three out of five birds recovered higher frequency syllables. Right nerve resection minimally affected phonology, but it did change song syntax; syllable sequence became abnormally stereotyped after right nerve resection. Therefore, damage to the neuromuscular control of sound production resulted in reduced motor variability, and Bengalese finches are a potential model for functional vocal recovery following cranial nerve injury.

  14. Brain mass and cranial nerve size in shrews and moles.

    Science.gov (United States)

    Leitch, Duncan B; Sarko, Diana K; Catania, Kenneth C

    2014-09-01

    We investigated the relationship between body size, brain size, and fibers in selected cranial nerves in shrews and moles. Species include tiny masked shrews (S. cinereus) weighing only a few grams and much larger mole species weighing up to 90 grams. It also includes closely related species with very different sensory specializations - such as the star-nosed mole and the common, eastern mole. We found that moles and shrews have tiny optic nerves with fiber counts not correlated with body or brain size. Auditory nerves were similarly small but increased in fiber number with increasing brain and body size. Trigeminal nerve number was by far the largest and also increased with increasing brain and body size. The star-nosed mole was an outlier, with more than twice the number of trigeminal nerve fibers than any other species. Despite this hypertrophied cranial nerve, star-nosed mole brains were not larger than predicted from body size, suggesting that magnification of their somatosensory systems does not result in greater overall CNS size.

  15. A case of bilateral lower cranial nerve palsies after base of skull trauma with complex management issues: case report and review of the literature.

    Science.gov (United States)

    Lehn, Alexander Christoph; Lettieri, Jennie; Grimley, Rohan

    2012-05-01

    Fractures of the skull base can cause lower cranial nerve palsies because of involvement of the nerves as they traverse the skull. A variety of syndromes have been described, often involving multiple nerves. These are most commonly unilateral, and only a handful of cases of bilateral cranial nerve involvement have been reported. We describe a 64-year-old man with occipital condylar fracture complicated by bilateral palsies of IX and X nerves associated with dramatic physiological derangement causing severe management challenges. Apart from debilitating postural hypotension, he developed dysphagia, severe gastrointestinal dysmotility, issues with airway protection as well as airway obstruction, increased oropharyngeal secretions and variable respiratory control. This is the first report of a patient with traumatic bilateral cranial nerve IX and X nerve palsies. This detailed report and the summary of all 6 previous case reports of traumatic bilateral lower cranial nerve palsies illustrate clinical features, treatment strategies, and outcomes of these rare events.

  16. Perineural tumor spread - Interconnection between spinal and cranial nerves.

    Science.gov (United States)

    Kozić, Duško; Njagulj, Vesna; Gaćeša, Jelena Popadić; Semnic, Robert; Prvulović, Nataša

    2012-12-15

    The secondary neoplastic involvement of the cervical plexus in patients with head and neck malignancies is extremely rare. MR examination of the neck revealed the diffuse neoplastic infiltration of the right C2 root, in a 57-year-old patient with several months long pain in the right ear region and a history of the tongue squamous cell carcinoma. Associated perineural tumor spread and consequent distal involvement of great auricular nerve and vagus nerve were evident. Best of our knowledge, this is the first reported involvement of the cervical plexus in patients with head and neck cancers, associated with the clearly documented interconnection between the cervical plexus and cranial nerves via great auricular nerve.

  17. Cranial nerve involvement in Charcot-Marie-Tooth Disease.

    Science.gov (United States)

    Das, Nirav; Kandalaft, Savannah; Wu, Xiao; Malhotra, Ajay

    2017-03-01

    Charcot-Marie-Tooth Disease (CMT) is a rare disorder with less than 200,000 cases reported in the US every year, making diagnosis challenging. MR and CT imaging has become more common in the evaluation of CMT to identify areas of disease involvement. A 27-year-old female from Guatemala with a past history of polio initially presented to the emergency room for necrotizing pneumonia. MRI images demonstrated smoothly enlarged, mildly enhancing trigeminal nerves. CT showed bony widening of the skull base foramina. The patient was noted to have atrophy and weakness of her extremities with decreased sensation, distal more than proximal, and pes cavus. An electromyogram demonstrated absent response in the right median, ulnar, peroneal, and tibial motor studies and bilateral radial and right sural sensory studies. MRI of the spine demonstrated smooth, symmetric enlargement and mild enhancement of the distal spinal nerve roots and cauda equine. CMT is a group of disorders with a wide range of clinical presentations and abnormalities. Cranial nerve involvement is infrequently described in CMT 1A. In our case and prior studies, there does not appear to be a correlation between cranial nerve involvement and symptoms. Trigeminal neuralgia has been described in patients in CMT, but is not common and was not seen in our patient despite abnormal trigeminal nerve findings on imaging. Our patient also demonstrated involvement of the facial nerve without facial muscle weakness. Clinical features are key in distinguishing CMT 1A from other forms of HMSN. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. The Trigeminal (V) and Facial (VII) Cranial Nerves: Head and Face Sensation and Movement

    OpenAIRE

    Sanders, Richard D.

    2010-01-01

    There are close functional and anatomical relationships between cranial nerves V and VII in both their sensory and motor divisions. Sensation on the face is innervated by the trigeminal nerves (V) as are the muscles of mastication, but the muscles of facial expression are innervated mainly by the facial nerve (VII) as is the sensation of taste. This article briefly reviews the anatomy of these cranial nerves, disorders of these nerves that are of particular importance to psychiatry, and some ...

  19. An unusual case of isolated sixth cranial nerve palsy in leprosy.

    Science.gov (United States)

    Vaishampayan, Sanjeev; Borde, Priyanka

    2012-08-15

    Cranial nerve involvement is not common in leprosy. The fifth and seventh cranial nerves are the most commonly affected in leprosy. Herein we present a patient with Hansen disease (BL) with type I reaction who developed isolated involvement of the sixth cranial nerve leading to lateral rectus muscle palsy. He responded to timely anti-reactional therapy and it produced a good response. Careful observation of patients with lepra reaction is needed to avoid damage to important organs.

  20. A Case of Neurosyphilis Presenting with Multiple Cranial Neuropathy

    Directory of Open Access Journals (Sweden)

    Eda Kılıç Çoban

    2016-09-01

    Full Text Available Syphilis is a sexually-transmitted disease caused by the spirochete bacterium Treponema pallidum. Central nervous system involvement can occur in every stage of the disease. It is classified into: acute syphilitic meningitis, meningovascular syphilis, and parenchymatous neurosyphilis. Acute basilar syphilitic meningitis is characterized primarily by the presence of cranial nerve involvement. As cranial nerve enhancement may be seen in a broad range of diseases, it can be the only clinical feature of neurosyphilis.

  1. Ophthalmoplegic and lower cranial nerve variants merge into each other and into classical Guillain-Barre syndrome

    NARCIS (Netherlands)

    ter Bruggen, JP; van der Meche, FGA; de Jager, AEJ; Polman, CH

    We delineated the place of cranial nerve variants within the concept of clinically defined Guillain-Barre syndrome (GBS), In the ophthalmoplegic variant (n = 7) the oculomotor nerves were early involved, In a lower cranial nerve variant (n = 9) the cranial nerves IX, X, and XI were early involved.

  2. Ophthalmoplegic and lower cranial nerve variants merge into each other and into classical Guillain-Barre syndrome

    NARCIS (Netherlands)

    ter Bruggen, JP; van der Meche, FGA; de Jager, AEJ; Polman, CH

    1998-01-01

    We delineated the place of cranial nerve variants within the concept of clinically defined Guillain-Barre syndrome (GBS), In the ophthalmoplegic variant (n = 7) the oculomotor nerves were early involved, In a lower cranial nerve variant (n = 9) the cranial nerves IX, X, and XI were early involved. D

  3. Ophthalmoplegic and lower cranial nerve variants merge into each other and into classical Guillain-Barre syndrome

    NARCIS (Netherlands)

    ter Bruggen, JP; van der Meche, FGA; de Jager, AEJ; Polman, CH

    1998-01-01

    We delineated the place of cranial nerve variants within the concept of clinically defined Guillain-Barre syndrome (GBS), In the ophthalmoplegic variant (n = 7) the oculomotor nerves were early involved, In a lower cranial nerve variant (n = 9) the cranial nerves IX, X, and XI were early involved. D

  4. Stereotactic radiotherapy using Novalis for skull base metastases developing with cranial nerve symptoms.

    Science.gov (United States)

    Mori, Yoshimasa; Hashizume, Chisa; Kobayashi, Tatsuya; Shibamoto, Yuta; Kosaki, Katsura; Nagai, Aiko

    2010-06-01

    Skull base metastases are challenging situations because they often involve critical structures such as cranial nerves. We evaluated the role of stereotactic radiotherapy (SRT) which can give high doses to the tumors sparing normal structures. We treated 11 cases of skull base metastases from other visceral carcinomas. They had neurological symptoms due to cranial nerve involvement including optic nerve (3 patients), oculomotor (3), trigeminal (6), abducens (1), facial (4), acoustic (1), and lower cranial nerves (1). The interval between the onset of cranial nerve symptoms and Novalis SRT was 1 week to 7 months. Eleven tumors of 8-112 ml in volume were treated by Novalis SRT with 30-50 Gy in 10-14 fractions. The tumors were covered by 90-95% isodose. Imaging and clinical follow-up has been obtained in all 11 patients for 5-36 months after SRT. Seven patients among 11 died from primary carcinoma or other visceral metastases 9-36 months after Novalis SRT. All 11 metastatic tumors were locally controlled until the end of the follow-up time or patient death, though retreatment for re-growth was done in 1 patient. In 10 of 11 patients, cranial nerve deficits were improved completely or partially. In some patients, the cranial nerve symptoms were relieved even during the period of fractionated SRT. Novalis SRT is thought to be safe and effective treatment for skull base metastases with involvement of cranial nerves and it may improve cranial nerve symptoms quickly.

  5. Promoting central nervous system regeneration: lessons from cranial nerve I.

    Science.gov (United States)

    Ruitenberg, Marc J; Vukovic, Jana

    2008-01-01

    The olfactory nerve differs from cranial nerves III-XII in that it contains a specialised type of glial cell, called 'olfactory ensheathing cell' (OEC), rather than Schwann cells. In addition, functional neurogenesis persists postnatally in the olfactory system, i.e. the primary olfactory pathway continuously rebuilds itself throughout adult life. The presence of OECs in the olfactory nerve is thought to be critical to this continuous growth process. Because of this intrinsic capacity for self-repair, the mammalian olfactory system has proved as a useful model in neuroregeneration studies. In addition, OECs have been used in transplantation studies to promote pathway regeneration elsewhere in the nervous system. Here, we have reviewed the parameters that allow for repair within the primary olfactory pathway and the role that OECs are thought to play in this process. We conclude that, in addition to intrinsic growth potential, the presence of an aligned substrate to the target structure is a fundamental prerequisite for appropriate restoration of connectivity with the olfactory bulb. Hence, strategies to promote regrowth of injured nerve pathways should incorporate usage of aligned, oriented substrates of OECs or other cellular conduits with additional intervention to boost neuronal cell body responses to injury and/or neutralisation of putative inhibitors.

  6. A case of myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA)-associated hypertrophic pachymeningitis presenting with multiple cranial nerve palsies and diabetes insipidus.

    Science.gov (United States)

    Yasuda, Ken; Sainouchi, Makoto; Goto, Masahiro; Murase, Nagako; Ohtani, Ryo; Nakamura, Michikazu

    2016-05-31

    A 61-year-old woman developed hearing difficulties and became thirsty after experiencing cold symptoms. A neurological examination revealed a loss of odor sensation, facial palsy, dysphasia, and dysarthria. Vocal cord palsy was observed during pharyngoscopy. Brain magnetic resonance imaging (MRI) showed a thickened pituitary stalk and swelling of the pituitary gland, but no high signal intensity regions were seen in the posterior portion of the pituitary gland. Gadolinium-enhanced MRI demonstrated a thickened dura mater over the anterior cranial fossa. A biopsy specimen of the thickened dura mater showed fibrosis, granulomatous inflammation, and necrotic foci. Blood tests detected myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA). The patient's urine osmolarity was low even though she exhibited hypernatremia. We diagnosed her with hypertrophic pachymeningitis associated with MPO-ANCA and diabetes insipidus. The patient received two courses of 5-day high-dose intravenous methylprednisolone (1.0 g/day), and was subsequently administered oral prednisolone, which gradually relieved her symptoms. However, the patient's symptoms recurred despite the high-dose prednisolone treatment. It was difficult to control the patient's symptoms in this case with oral prednisolone monotherapy, but combined treatment with cyclosporine resulted in sustained remission. It is considered that patients with MPO-ANCA-positive hypertrophic pachymeningitis require combination therapy with prednisolone and immunosuppressive agents at an early stage.

  7. A 3-year review of cranial nerve palsies from the University of Port Harcourt Teaching Hospital Eye Clinic, Nigeria

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    Chinyere Nnenne Pedro-Egbe

    2014-01-01

    Conclusion: This is the first study in the literature on ocular cranial nerve palsies in Southern Nigeria. Third and sixth cranial nerve palsies were the most common cases to present to the University of Port Harcourt Teaching Hospital Eye Clinic. There was a statistically significant association to systemic disorders such as hypertension and DM and majority of cases with 6 th cranial nerve palsy.

  8. Cerebrospinal fluid dissemination of anaplastic intraventricular meningioma: report of a case presenting with progressive brainstem dysfunction and multiple cranial nerve palsies.

    Science.gov (United States)

    Fujimaki, Motoki; Takanashi, Masashi; Kobayashi, Manami; Wada, Kei-ichiro; Machida, Yutaka; Kondo, Akihide; Hattori, Nobutaka; Miwa, Hideto

    2016-05-31

    It is extremely rare to see cerebrospinal fluid dissemination of intraventricular meningioma, particularly with the development of acute, progressive brainstem/cerebellar dysfunction with an absence of mass formation in the corresponding anatomical sites. An 81-year-old man was admitted because of double vision, right facial nerve palsy and truncal ataxia. Brain magnetic resonance imaging showed normal findings except for a tumor mass in the left lateral ventricle, which had been noted over 6 months previously. The patient developed hiccups, hyperventilation, and drowsiness, which worsened progressively, and did not respond to corticosteroid or intraventricular immunoglobulin therapy. Cerebrospinal fluid study revealed a mild elevation of protein, and cytology was negative. The patient died and an autopsy was performed. Postmortem investigation disclosed a malignant transformation of benign fibroid meningioma with cerebrospinal fluid dissemination of the malignant cells, diversely involving the surface of brainstem, cerebellum, and spinal cords, secondarily resulting in extensive ischemia in the brain parenchyma by vessel occlusion. If a patient with an intraventricular tumor develops acute, progressive neurological symptoms, the possibility that it is be caused by cerebrospinal fluid dissemination of tumor cells, after malignant transformation, should be considered.

  9. Malignant otitis externa with bilateral cranial nerve involvement: Report of a unique case

    Directory of Open Access Journals (Sweden)

    Somnath Saha

    2013-01-01

    Full Text Available Malignant otitis externa is an inflammatory condition caused by pseudomonas infection usually in the elderly diabetics, or an immunosuppressive condition that presents with diffuse otitis externa along with excruciating pain and granulations tissue in the external auditory meatus. Facial paralysis is common along with occasional involvement of other cranial nerves. Case report describing a patient of malignant otitis externa who presented to a tertiary referral hospital of eastern India. This patient had ipsilateral facial and tenth cranial nerve paralysis along with delayed-onset contralateral sixth and twelfth cranial nerve palsy. The patient was treated initially with intravenous anti-pseudomonal antibody followed by tympanic platectomy, facial nerve decompression and medialisation thyroplasty. The contralateral cranial nerve palsy was managed conservatively with partial recovery of function. Malignant otitis externa, though a common disease, may occasionally present with uncommon or unexplained presentations. The management of these cases should be prompt and aggressive and specifically address each of the debilitating complications.

  10. A Case of Transient, Isolated Cranial Nerve VI Palsy due to Skull Base Osteomyelitis

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    Brijesh Patel

    2014-01-01

    Full Text Available Otitis externa affects both children and adults. It is often treated with topical antibiotics, with good clinical outcomes. When a patient fails to respond to the treatment, otitis externa can progress to malignant otitis externa. The common symptoms of skull bone osteomyelitis include ear ache, facial pain, and cranial nerve palsies. However, an isolated cranial nerve is rare. Herein, we report a case of 54-year-old female who presented with left cranial nerve VI palsy due to skull base osteomyelitis which responded to antibiotic therapy.

  11. Cranial nerves in the Australian lungfish, Neoceratodus forsteri, and in fossil relatives (Osteichthyes: Dipnoi).

    Science.gov (United States)

    Kemp, A

    2017-02-01

    Three systems, two sensory and one protective, are present in the skin of the living Australian lungfish, Neoceratodus forsteri, and in fossil lungfish, and the arrangement and innervation of the sense organs is peculiar to lungfish. Peripheral branches of nerves that innervate the sense organs are slender and unprotected, and form before any skeletal structures appear. When the olfactory capsule develops, it traps some of the anterior branches of cranial nerve V, which emerged from the chondrocranium from the lateral sphenotic foramen. Cranial nerve I innervates the olfactory organ enclosed within the olfactory capsule and cranial nerve II innervates the eye. Cranial nerve V innervates the sense organs of the snout and upper lip, and, in conjunction with nerve IX and X, the sense organs of the posterior and lateral head. Cranial nerve VII is primarily a motor nerve, and a single branch innervates sense organs in the mandible. There are no connections between nerves V and VII, although both emerge from the brain close to each other. The third associated system consists of lymphatic vessels covered by an extracellular matrix of collagen, mineralised as tubules in fossils. Innervation of the sensory organs is separate from the lymphatic system and from the tubule system of fossil lungfish.

  12. Imaging the cranial nerves: Part I: Methodology, infectious and inflammatory, traumatic and congenital lesions

    Energy Technology Data Exchange (ETDEWEB)

    Borges, Alexandra [Instituto Portugues de Oncologia Francisco Gentil- Centro de Lisboa, Department of Radiology, Lisboa Codex (Portugal); Casselman, Jan [A.Z. St. Jan Brugge Hospital, Department of Radiology, Brugge (Belgium); A.Z. St. Augustinus Antwerpen Hospitals, Department of Radiology, Antwerpen (Belgium)

    2007-08-15

    Many disease processes manifest either primarily or secondarily by cranial nerve deficits. Neurologists, ENT surgeons, ophthalmologists and maxillo-facial surgeons are often confronted with patients with symptoms and signs of cranial nerve dysfunction. Seeking the cause of this dysfunction is a common indication for imaging. In recent decades we have witnessed an unprecedented improvement in imaging techniques, allowing direct visualization of increasingly small anatomic structures. The emergence of volumetric CT scanners, higher field MR scanners in clinical practice and higher resolution MR sequences has made a tremendous contribution to the development of cranial nerve imaging. The use of surface coils and parallel imaging allows sub-millimetric visualization of nerve branches and volumetric 3D imaging. Both with CT and MR, multiplanar and curved reconstructions can follow the entire course of a cranial nerve or branch, improving tremendously our diagnostic yield of neural pathology. This review article will focus on the contribution of current imaging techniques in the depiction of normal anatomy and on infectious and inflammatory, traumatic and congenital pathology affecting the cranial nerves. A detailed discussion of individual cranial nerves lesions is beyond the scope of this article. (orig.)

  13. Facial nerve neurinoma presenting as middle cranial fossa and cerebellopontine angle mass : a case report.

    Directory of Open Access Journals (Sweden)

    Devi B

    2000-10-01

    Full Text Available Facial nerve neurinomas are rare. The tumours arising from the geniculate ganglion may grow anteriorly and superiorly and present as a mass in the middle cranial fossa. Only a few cases of facial nerve neurinomas presenting as middle cranial fossa mass have so far been reported. These tumours present with either long standing or intermittent facial palsy along with cerebellopontine angle syndrome.

  14. [Electrophysiological monitoring of cranial motor nerves (V, VII, IX, X, XI, XII)].

    Science.gov (United States)

    Lefaucheur, J-P; Neves, D O; Vial, C

    2009-04-01

    In various neurosurgical operations, there is a risk of cranial nerve lesion that can be avoided or minimized with intraoperative electrophysiological monitoring. Regarding motor function of the cranial nerves, stimulodetection techniques are used, including electrical stimulation of nerve trunks and electromyographic recording of evoked motor responses. These techniques can be used for monitoring the trigeminal nerve (Vth cranial nerve), facial nerve (VIIth), glossopharyngeal nerve (IXth), pneumogastric nerve (Xth), spinal accessory nerve (XIth), and hypoglossal nerve (XIIth), in particular during surgical removal of tumors of the cerebellopontine angle or skull base. When beginning an operation, electrical stimulation is only used to identify the nerve structures. As removal of the tumor progresses, the goal is to verify that a surgical injury to the nerve is avoided by looking for the absence of any change regarding amplitude, morphology, and latency of motor responses. Intraoperative electromyographic monitoring can also be applied during the surgical treatment of primary hemifacial spasm by microvascular decompression. An effective decompression is usually associated with the disappearance of "lateral spread" motor responses to facial nerve branch stimulation. Therefore, the intraoperative disappearance of the lateral spread responses can be considered a predictive factor of good postoperative clinical outcome, even if this assertion remains a matter of debate.

  15. Imaging the cranial nerves: part II: primary and secondary neoplastic conditions and neurovascular conflicts

    Energy Technology Data Exchange (ETDEWEB)

    Borges, Alexandra [Instituto Portugues de Oncologia Francisco Gentil- Centro de Lisboa, Radiology Department, Lisboa Codex (Portugal); Casselman, Jan [A. Z. St Jan Brugge and A. Z. St Augustinus Antwerpen Hospitals, Department of Radiology, Antwerp (Belgium)

    2007-09-15

    There have been unprecedented improvements in cross-sectional imaging in the last decades. The emergence of volumetric CT, higher field MR scanners and higher resolution MR sequences is largely responsible for the increasing diagnostic yield of imaging in patients presenting with cranial nerve deficits. The introduction of parallel MR imaging in combination with small surface coils allows the depiction of submillimetric nerves and nerve branches, and volumetric CT and MR imaging is able to provide high quality multiplanar and curved reconstructions that can follow the often complex course of cranial nerves. Seeking the cause of a cranial nerve deficit is a common indication for imaging, and it is not uncommon that radiologists are the first specialists to see a patient with a cranial neuropathy. To increase the diagnostic yield of imaging, high-resolution studies with smaller fields of view are required. To keep imaging studies within a reasonable time frame, it is mandatory to tailor the study according to neuro-topographic testing. This review article focuses on the contribution of current imaging techniques in the depiction of primary and secondary neoplastic conditions affecting the cranial nerves as well as on neurovascular conflicts, an increasingly recognized cause of cranial neuralgias. (orig.)

  16. New approach to neurorehabilitation: cranial nerve noninvasive neuromodulation (CN-NINM) technology

    Science.gov (United States)

    Danilov, Yuri P.; Tyler, Mitchel E.; Kaczmarek, Kurt A.; Skinner, Kimberley L.

    2014-06-01

    Cranial Nerve NonInvasive NeuroModulation (CN-NINM) is a primary and complementary multi-targeted rehabilitation therapy that appears to initiate the recovery of multiple damaged or suppressed brain functions affected by neurological disorders. It is deployable as a simple, home-based device (portable neuromodulation stimulator, or PoNSTM) and training regimen following initial patient training in an outpatient clinic. It may be easily combined with many existing rehabilitation therapies, and may reduce or eliminate the need for more aggressive invasive procedures or possibly decrease total medication intake. CN-NINM uses sequenced patterns of electrical stimulation on the tongue. Our hypothesis is that CN-NINM induces neuroplasticity by noninvasive stimulation of two major cranial nerves: trigeminal (CN-V), and facial (CN-VII). This stimulation excites a natural flow of neural impulses to the brainstem (pons varolli and medulla), and cerebellum, to effect changes in the function of these targeted brain structures, extending to corresponding nuclei of the brainstem. CN-NINM represents a synthesis of a new noninvasive brain stimulation technique with applications in physical medicine, cognitive, and affective neurosciences. Our new stimulation method appears promising for treatment of a full spectrum of movement disorders, and for both attention and memory dysfunction associated with traumatic brain injury.

  17. MR imaging of the cranial nerves and the intracranial vessels using 3D-SPGR

    Energy Technology Data Exchange (ETDEWEB)

    Hosoya, Takaaki; Sato, Nami; Yamaguchi, Koichi; Sugai, Yukio; Ogushi, Masatoshi; Kubota, Hisashi (Yamagata Univ. (Japan). School of Medicine)

    1992-10-01

    MR angiography (MRA) has developed rapidly, but it is still insufficient to demonstrate the detail of the intracranial vascular anatomy. We found that original images of MRA render more information than MRA images about not only intracranial vessels but also cranial nerves. We have tried to demonstrate cranial nerves and intracranial vessels on 26 patients and evaluated using real time reformation of original images of MRA. MR images were obtained by SPGR (3DFT) after injection of Gd-DTPA. The optic nerve, the oculomotor nerve, the trigeminal nerve, the facial nerve and the vestibulocochlear nerve were visualized clearly on almost patients and detectabilities of these nerves were 100%, 98%, 100%, 94% and 100%, respectively. The abducent nerve was also detectable in 76%. The trochlear nerve, which could not be observed by any modality, was detected at prepontine cistern in 10%. Arteries around brain stem such as the superior cerebellar artery (SCA), the anterior inferior cerebellar artery (AICA), the posterior inferior cerebellar artery (PICA) and the posterior communicating artery (PcomA) were clearly visible, and branching of these arteries and anatomical detail were completely coincide with angiogram on 12 patients. The basal vein of Rosenthal and the petrosal vein were confirmed in 100% and their anastomose were demonstrated obviously. We concluded that this method was extremely useful to observe cranial nerves and intracranial small vessels. (author).

  18. Surgical outcomes of lateral approach for jugular foramen schwannoma: postoperative facial nerve and lower cranial nerve functions.

    Science.gov (United States)

    Cho, Yang-Sun; So, Yoon Kyoung; Park, Kwan; Baek, Chung-Hwan; Jeong, Han-Sin; Hong, Sung Hwa; Chung, Won-Ho

    2009-01-01

    The lateral surgical approach to jugular foramen schwannomas (JFS) may result in complications such as temporary facial nerve palsy (FNP) and hearing loss due to the complicated anatomical location. Ten patients with JFS surgically treated by variable methods of lateral approach were retrospectively reviewed with emphasis on surgical methods, postoperative FNP, and lower cranial nerve status. Gross total removal of the tumors was achieved in eight patients. Facial nerves were rerouted at the first genu (1G) in six patients and at the second genu in four patients. FNP of House-Brackmann (HB) grade III or worse developed immediately postoperatively in six patients regardless of the extent of rerouting. The FNP of HB grade III persisted for more than a year in one patient managed with rerouting at 1G. Among the lower cranial nerves, the vagus nerve was most frequently paralyzed preoperatively and lower cranial nerve palsies were newly developed in two patients. The methods of the surgical approach to JFS can be modified depending on the size and location of tumors to reduce injury of the facial nerve and loss of hearing. Careful manipulation and caution are also required for short facial nerve rerouting as well as for long rerouting to avoid immediately postoperative FNP.

  19. [Visualization of the lower cranial nerves by 3D-FIESTA].

    Science.gov (United States)

    Okumura, Yusuke; Suzuki, Masayuki; Takemura, Akihiro; Tsujii, Hideo; Kawahara, Kazuhiro; Matsuura, Yukihiro; Takada, Tadanori

    2005-02-20

    MR cisternography has been introduced for use in neuroradiology. This method is capable of visualizing tiny structures such as blood vessels and cranial nerves in the cerebrospinal fluid (CSF) space because of its superior contrast resolution. The cranial nerves and small vessels are shown as structures of low intensity surrounded by marked hyperintensity of the CSF. In the present study, we evaluated visualization of the lower cranial nerves (glossopharyngeal, vagus, and accessory) by the three-dimensional fast imaging employing steady-state acquisition (3D-FIESTA) sequence and multiplanar reformation (MPR) technique. The subjects were 8 men and 3 women, ranging in age from 21 to 76 years (average, 54 years). We examined the visualization of a total of 66 nerves in 11 subjects by 3D-FIESTA. The results were classified into four categories ranging from good visualization to non-visualization. In all cases, all glossopharyngeal and vagus nerves were identified to some extent, while accessory nerves were visualized either partially or entirely in only 16 cases. The total visualization rate was about 91%. In conclusion, 3D-FIESTA may be a useful method for visualization of the lower cranial nerves.

  20. Cranial nerve assessment in posterior fossa tumors with fast imaging employing steady-state acquisition (FIESTA).

    Science.gov (United States)

    Mikami, Takeshi; Minamida, Yoshihiro; Yamaki, Toshiaki; Koyanagi, Izumi; Nonaka, Tadashi; Houkin, Kiyohiro

    2005-10-01

    Steady-state free precession is widely used for ultra-fast cardiac or abdominal imaging. The purpose of this work was to assess fast imaging employing steady-state acquisition (FIESTA) and to evaluate its efficacy for depiction of the cranial nerve affected by the tumor. Twenty-three consecutive patients with posterior fossa tumors underwent FIESTA sequence after contrast agent administration, and then displacement of the cranial nerve was evaluated. The 23 patients with posterior fossa tumor consisted of 12 schwannomas, eight meningiomas, and three cases of epidermoid. Except in the cases of epidermoid, intensity of all tumors increased on FIESTA imaging of the contrast enhancement. In the schwannoma cases, visualization of the nerve became poorer as the tumor increased in size. In cases of encapsulated meningioma, all the cranial nerves of the posterior fossa were depicted regardless of location. The ability to depict the nerves was also significantly higher in meningioma patients than in schwannoma patients (PFIESTA sequence offers similar contrast to other heavily T2-weighted sequences, it facilitated a superior assessment of the effect of tumors on cranial nerve anatomy. FIESTA sequence was useful for preoperative simulations of posterior fossa tumors.

  1. Motor palsies of cranial nerves (excluding VII) after vaccination: reports to the US Vaccine Adverse Event Reporting System.

    Science.gov (United States)

    Woo, Emily Jane; Winiecki, Scott K; Ou, Alan C

    2014-01-01

    We reviewed cranial nerve palsies, other than VII, that have been reported to the US Vaccine Adverse Event Reporting System (VAERS). We examined patterns for differences in vaccine types, seriousness, age, and clinical characteristics. We identified 68 reports of cranial nerve palsies, most commonly involving the oculomotor (III), trochlear (IV), and abducens (VI) nerves. Isolated cranial nerve palsies, as well as palsies occurring as part of a broader clinical entity, were reported. Forty reports (59%) were classified as serious, suggesting that a cranial nerve palsy may sometimes be the harbinger of a broader and more ominous clinical entity, such as a stroke or encephalomyelitis. There was no conspicuous clustering of live vs. inactivated vaccines. The patient age range spanned the spectrum from infants to the elderly. Independent data may help to clarify whether, when, and to what extent the rates of cranial nerve palsies following particular vaccines may exceed background levels.

  2. Large Posterior Communicating Artery Aneurysm: Initial Presentation with Reproducible Facial Pain Without Cranial Nerve Deficit

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    Stacie Zelman

    2016-11-01

    Full Text Available Unruptured posterior communicating artery (PCOM aneurysms can be difficult to diagnose and, when large (≥ 7mm, represent a substantial risk to the patient. While most unruptured PCOM aneurysms are asymptomatic, when symptoms do occur, clinical manifestations typically include severe headache (HA, visual acuity loss, and cranial nerve deficit. This case report describes an atypical initial presentation of a large unruptured PCOM aneurysm with symptoms mimicking trigeminal neuralgia, without other associated cranial nerve palsies or neurologic deficits. The patient returned to the emergency department four days later with a HA, trigeminal neuralgia, and a new cranial nerve III palsy. After appropriate imaging, she was found to have a large PCOM aneurysm, which was treated with surgical clipping with significant improvement in patient’s symptoms.

  3. [A case of slowly progressive type 1 diabetes mellitus developing myeloperoxidase-specific anti-neutrophil cytoplasmic antibody-associated vasculitis with hypertrophic pachymeningitis manifesting as multiple cranial nerve palsy].

    Science.gov (United States)

    Kurihara, Yuko; Oku, Kayo; Suzuki, Atsushi; Ohsone, Yasuo; Handa, Michiko; Okano, Yutaka

    2011-01-01

    We report a 63-year-old man with a 35-year history of slowly progressive type 1 diabetes mellitus (SPIDDM), complicated with myeloperoxidase-specific anti-neutrophil cytoplasmic antibody (MPO-ANCA)-associated vasculitis presenting alveolar hemorrhage and pachymeningitis. The patient was first diagnosed as having DM at age of 28 years old and deteriorated secretion of insulin and the typical clinical course led us to the diagnosis of SPIDDM. When he was 58 years old, he suffered from fever, headache, and alveolar hemorrhage. He was diagnosed as having MPO-ANCA associated vasculitis based on a high titer of MPO-ANCA and histological findings of lung biopsy. Treatment with steroid pulse therapy, followed by oral prednisolone and oral cyclophosohamide, resulted in clinical improvement. Five years later, he complained of double vision. A gadolinium-enhanced magnetic resonance imaging (MRI) study of the brain showed normal. Two months later, he developed right cranial nerve V~XII palsy. A second MRI study revealed thickening of the right temporal region and cerebellar dura mater, leading us to the diagnosis of hypertrophic pachymeningitis. He responded well to oral prednisolone (50 mg/day) and intravenous cyclophosohamide (500 mg). This is the first case report of SPIDDM complicated with MPO-ANCA-associated vasculitis, manifesting as alveolar hemorrhage and hypertrophic pachymeningitis.

  4. Isolated sixth cranial nerve aplasia visualized with Fast Imaging Employing Steady-State Acquisition (FIESTA) MRI.

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    Pilyugina, Svetlana A; Fischbein, Nancy J; Liao, Y Joyce; McCulley, Timothy J

    2007-06-01

    An otherwise healthy 12-month-old girl presented for evaluation of reduced abduction of the left eye detected at 6 months of age. The remainder of the examination was unremarkable. A special MRI sequence-fast imaging employing steady-state acquisition (FIESTA)-visualized the right but not the left sixth nerve cisternal segment. This is the first reported use of the MRI FIESTA sequence to diagnose aplasia of the sixth cranial nerve.

  5. Simultaneous involvement of third and sixth cranial nerve in a patient with Lyme disease

    Energy Technology Data Exchange (ETDEWEB)

    Lell, M.; Schmid, A.; Tomandl, B.F. [Division of Neuroradiology, Department of Neurosurgery, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen (Germany); Stemper, B.; Maihoefner, C.; Heckmann, J.G. [Department of Neurosurgery, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen (Germany)

    2003-02-01

    We report a 57-year-old woman with neuroborreliosis presenting with headache, shoulder muscle pain and double vision. MRI demonstrated enhancement of the right third and sixth cranial nerves. A 3D MP-RAGE sequence was used to perform multiplanar reformations to show this more graphically. The patient was free of symptoms 1 month after completion of therapy, when thickening and contrast enhancement of the nerves were less pronounced. (orig.)

  6. Cranial nerves - spectrum of inflammatory and tumorous changes; Hirnnerven - Spektrum entzuendlicher und tumoroeser Veraenderungen

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    Nemec, S.F.; Kasprian, G.; Nemec, U.; Czerny, C. [Universitaetsklinik fuer Radiodiagnostik, Medizinische Universitaet Wien, Klinische Abteilung fuer Neuroradiologie und muskuloskelettale Radiologie, Wien (Austria)

    2009-07-15

    Inflammatory processes as well as primary and secondary tumorous changes may involve cranial nerves causing neurological deficits. In addition to neurologists, ENT physicians, ophthalmologists and maxillofacial surgeons, radiologists play an important role in the investigation of patients with cranial nerve symptoms. Multidetector computed tomography (MDCT) and particularly magnetic resonance imaging (MRI) allow the depiction of the cranial nerve anatomy and pathological neural changes. This article briefly describes the imaging techniques in MDCT and MRI and is dedicated to the radiological presentation of inflammatory and tumorous cranial nerve pathologies. (orig.) [German] Entzuendliche Prozesse sowie primaere und sekundaere tumoroese Veraenderungen koennen Hirnnerven mitbeteiligen und so zu neurologischen Defiziten fuehren. Neben dem Neurologen, HNO-Arzt, Augenarzt und Kiefer-Gesichts-Chirurgen kommt dem Radiologen eine besondere Bedeutung bei der Abklaerung von Patienten mit Hirnnervensymptomatik zu. Die Multidetektorcomputertomographie (MDCT) und insbesondere die Magnetresonanztomographie (MRT) ermoeglichen die Darstellung der Hirnnervenanatomie sowie der nervalen pathologischen Veraenderungen. Der vorliegende Artikel beschreibt kurz gefasst die bildgebenden Techniken von MDCT und MRT und widmet sich der radiologischen Bildgebung entzuendlicher und tumoroeser Hirnnervenveraenderungen. (orig.)

  7. Imaging assessment of isolated lesions affecting cranial nerve III; Avaliacao por imagem das lesoes isoladas do III par craniano

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    Garcia, Marcelo de Mattos [Colegio Brasileiro de Radiologia e Diagnostico por Imagem (CBR), Sao Paulo, SP (Brazil)]. E-mail: cidbh@cidbh.com.br; Martins, Jose Carlos Tadeu [Sociedade Brasileira de Neuroradiologia, Sao Paulo, SP (Brazil)

    2005-05-15

    The aim of this study is to review the anatomy and main pathologic conditions affecting cranial nerve III using imaging studies, particularly magnetic resonance imaging. Imaging methods are essential in the evaluation of patients with suspected lesions of the oculomotor nerve once signs and symptoms are unspecific and a large number of diseases can affect cranial nerve III. A brief review of the literature is also presented. (author)

  8. Nav2 is necessary for cranial nerve development and blood pressure regulation

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    Moechars Dieder

    2010-02-01

    Full Text Available Abstract Background All-trans retinoic acid (atRA is required for nervous system development, including the developing hindbrain region. Neuron navigator 2 (Nav2 was first identified as an atRA-responsive gene in human neuroblastoma cells (retinoic acid-induced in neuroblastoma 1, Rainb1, and is required for atRA-mediated neurite outgrowth. In this paper, we explore the importance of Nav2 in nervous system development and function in vivo. Results Nav2 hypomorphic homozygous mutants show decreased survival starting at birth. Nav2 mutant embryos show an overall reduction in nerve fiber density, as well as specific defects in cranial nerves IX (glossopharyngeal and X (vagus. Nav2 hypomorphic mutant adult mice also display a blunted baroreceptor response compared to wild-type controls. Conclusions Nav2 functions in mammalian nervous system development, and is required for normal cranial nerve development and blood pressure regulation in the adult.

  9. Sneddon syndrome presenting with unilateral third cranial nerve palsy.

    Science.gov (United States)

    Jiménez-Gallo, David; Albarrán-Planelles, Cristina; Linares-Barrios, Mario; González-Fernández, Julio A; Espinosa-Rosso, Raúl; Báez-Perea, José M

    2014-03-01

    Sneddon syndrome is a rare systemic vasculopathy affecting the skin as livedo racemosa and the central nervous system as stroke. A 31-year-old man with a history of livedo racemosa presented with a partial left third nerve palsy. Skin biopsy showed signs of endotheliitis with obliteration of dermal blood vessels due to intimal proliferation and fibrin thrombi consistent with Sneddon syndrome. The patient was treated with platelet antiaggregant therapy with complete resolution of his third nerve palsy. Clinicians should be aware of Sneddon syndrome because prompt diagnosis and treatment may prevent potential morbidity and mortality.

  10. Sensory-motor axonal polyneuropathy involving cranial nerves: An uncommon manifestation of disulfiram toxicity.

    Science.gov (United States)

    Santos, Telma; Martins Campos, António; Morais, Hugo

    2017-01-01

    Disulfiram (tetraethylthiuram disulfide) has been used for the treatment of alcohol dependence. An axonal sensory-motor polyneuropathy with involvement of cranial pairs due to disulfiram is exceedingly rare. The authors report a unique case of an extremely severe axonal polyneuropathy involving cranial nerves that developed within weeks after a regular dosage of 500mg/day disulfiram. To the authors best knowledge, such a severe and rapidly-progressive course has never been described with disulfiram dosages of only 500mg/day.

  11. Silicon-substrate microelectrode arrays for parallel recording of neural activity in peripheral and cranial nerves.

    Science.gov (United States)

    Kovacs, G T; Storment, C W; Halks-Miller, M; Belczynski, C R; Della Santina, C C; Lewis, E R; Maluf, N I

    1994-06-01

    A new process for the fabrication of regeneration microelectrode arrays for peripheral and cranial nerve applications is presented. This type of array is implanted between the severed ends of nerves, the axons of which regenerate through via holes in the silicon and are thereafter held fixed with respect to the microelectrodes. The process described is designed for compatibility with industry-standard CMOS or BiCMOS processes (it does not involve high-temperature process steps nor heavily-doped etch-stop layers), and provides a thin membrane for the via holes, surrounded by a thick silicon supporting rim. Many basic questions remain regarding the optimum via hole and microelectrode geometries in terms of both biological and electrical performance of the implants, and therefore passive versions were fabricated as tools for addressing these issues in on-going work. Versions of the devices were implanted in the rat peroneal nerve and in the frog auditory nerve. In both cases, regeneration was verified histologically and it was observed that the regenerated nerves had reorganized into microfascicles containing both myelinated and unmyelinated axons and corresponding to the grid pattern of the via holes. These microelectrode arrays were shown to allow the recording of action potential signals in both the peripheral and cranial nerve setting, from several microelectrodes in parallel.

  12. Preservation of cranial nerves during removal of the brain for an enhanced student experience in neuroanatomy classes.

    Science.gov (United States)

    Long, Jennifer; Roberts, David J H; Pickering, James D

    2014-01-01

    Neuroanatomy teaching at the University of Leeds includes the examination of isolated brains by students working in small groups. This requires the prosected brains to exhibit all 12 pairs of cranial nerves. Traditional methods of removing the brain from the skull involve elevating the frontal lobes and cutting each cranial nerve as the brain is reflected posteriorly. This can leave a substantial length of each nerve attached to the skull base rather than to the removed brain. We have found a posterior approach more successful. In this study, five adult heads were disarticulated at the level of the thyroid cartilage and placed, prone, in a head stand. A wedge of bone from the occipital region was removed before the cerebellum and brainstem were elevated to visualize the cranial nerves associated with the medulla oblongata, cerebellopontine angle and mesencephalic-pontine junction prior to cutting them as close to the skull as possible. Five brains were successfully removed from the skull, each having a full complement of cranial nerves of good length attached to them. This approach significantly increases the length and number of cranial nerves remaining attached to the brain, which supports student education. For integration into head and neck dissection courses, careful consideration will be required to ensure the necks are suitably dissected and to decide whether the cranial nerves are best left attached to the skull base or brain.

  13. Cranial nerves of the coelacanth, Latimeria chalumnae [Osteichthyes: Sarcopterygii: Actinistia], and comparisons with other craniata.

    Science.gov (United States)

    Northcutt, R G; Bemis, W E

    1993-01-01

    We reconstructed the cranial nerves of a serially sectioned prenatal coelacanth, Latimeria chalumnae. This allowed us to correct several mistakes in the literature and to make broad phylogenetic comparisons with other craniates. The genera surveyed in our phylogenetic analysis were Eptatretus, Myxine, Petromyzon, Lampetra, Chimaera, Hydrolagus, Squalus, Mustelus, Polypterus, Acipenser, Lepisosteus, Amia, Neoceratodus, Protopterus, Lepidosiren, Latimeria and Ambystoma. Cladistic analysis of our data shows that Latimeria shares with Ambystoma two characters of the cranial nerves. Our chief findings are: 1) Latimeria possesses an external nasal papilla and pedunculated olfactory bulbs but lacks a discrete terminal nerve. In other respects its olfactory system resembles the plesiomorphic pattern for craniates. 2) The optic nerve is plicated, a character found in many but not all gnathostomes. Latimeria retains an interdigitated partial decussation of the optic nerves, a character found in all craniates surveyed. 3) The oculomotor nerve supplies the same extrinsic eye muscles as in lampreys and gnathostomes. As in gnathostomes generally, Latimeria has a ciliary ganglion but its cells are located intracranially in the root of the oculomotor nerve, and their processes reach the eye via oculomotor and profundal rami. 4) The trochlear nerve supplies the superior oblique muscle as in all craniates that have not secondarily reduced the eye and its extrinsic musculature. 5) The profundal ganglion and ramus are entirely separate from the trigeminal system, with no exchange of fibers. This character has an interesting phylogenetic distribution: in hagfishes, lampreys, lungfishes and tetrapods, the profundal and trigeminal ganglia are fused, whereas in other taxa surveyed the ganglia are separate. The principal tissues innervated by the profundal nerve are the membranous walls of the tubes of the rostral organ. 6) As in lampreys and gnathostomes, the trigeminal nerve has

  14. Pontine extension of a tentorial schwannoma without cranial nerve involvement: a case report

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    D'Urso Pietro

    2011-12-01

    Full Text Available Abstract Introduction Intracranial schwannomas unrelated to the cranial nerves are uncommon. We report a new case of tentorial schwannoma unrelated to the cranial nerves, with extension into the pons. A literature review with discussion of the most relevant pathogenetic aspects is also performed. Case presentation A 42-year-old Caucasian man was admitted with right-sided paresthesias and weakness of his upper and lower extremities. The neurological examination revealed right hemiparesis and hemi-hypoesthesia. A brain magnetic resonance imaging scan revealed a cerebellopontine lesion, arising from the left free edge of the tentorium, and extending into his pons. A piecemeal removal was performed through a retrosigmoid approach. The lesion was not found to be associated with any cranial nerves. The histological examination revealed a schwannoma Antoni type A. His postoperative course was uneventful. At one year follow-up, the patient was neurologically intact and the magnetic resonance imaging of his brain performed at that time showed complete removal without signs of recurrence. Conclusion Tentorial schwannomas are rare clinical entities. Knowledge of their clinical, radiological and anatomical characteristics is very important for the correct diagnosis and management.

  15. A guide to the evaluation of fourth cranial nerve palsies.

    Science.gov (United States)

    Lee; Hayman; Beaver; Prager; Kelder; Scasta; Avilla; von Noorden GK; Tang

    1998-12-01

    PURPOSE To devise a cost-effective guide for the evaluation of fourth nerve palsies (FNP). METHODS A review of the pertinent English language literature was performed to devise a guide for the evaluation (including neuroimaging) of FNP. The authors report a retrospective review of imaging studies performed on 206 patients with FNP. RESULTS The literature was used to develop the imaging guide. In the retrospective chart review of 206 patients from two tertiary care centers, 28 patients (13.6%) underwent a computed tomography scan and/or a magnetic resonance scan. Of these patients, five had associated neurological symptoms (non-isolated), one was traumatic, five were congenital, four were vasculopathic, eleven were non-vasculopathic, and two were progressive. Following the recommendations of the imaging guide, the five isolated congenital FNP and the four isolated vasculopathic FNP would not have undergone neuroimaging studies. The total costs of these neuroimaging studies in these nine patients were 19,000 dollars. Four patients in the retrospective review with associated neurological deficits (non-isolated) should have undergone neuroimaging according to the guide, but did not. CONCLUSIONS Although the evaluation of FNP can be difficult, the decision to order neuroimaging can be improved by using an imaging guide. An imaging guide for the evaluation of FNP may allow more appropriate and cost-effective imaging of these patients. Isolated congenital, old traumatic, or vasculopathic FNP do not require neuroimaging studies. Patients with non-isolated FNP should have directed neuroimaging studies based upon the results of clinical examination.

  16. Idiopathic Ninth, Tenth, and Twelfth Cranial Nerve Palsy with Ipsilateral Headache: A Case Report

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    Sun Seung-Ho

    2012-12-01

    Full Text Available Objective: This case report is to report the effect of Korean traditional treatment for idiopathic ninth, tenth, and twelfth cranial nerve palsy with ipsilateral headache. Methods: The medical history and imaging and laboratory test of a 39-year-old man with cranial palsy were tested to identify the cause of disease. A 0.2-mL dosage of Hwangyeonhaedoktang pharmacopuncture was administered at CV23 and CV17, respectively. Acupuncture was applied at P06, Li05, TE05, and G37 on the right side of the body. Zhuapiandutongbang (左偏頭痛方 was administered at 30 minutes to 1 hour after mealtime three times a day. The symptoms were investigated using Visual Analogue Scale (VAS. Results: The results of magnetic resonance imaging (MRI, computed tomography (CT, and laboratory tests were normal. The medical history showed no trauma, other illnesses, family history of diseases, medications, smoking, drinking and so on. All symptoms disappeared at the 10th day of treatment. Conclusion: Korean traditional treatment such as acupuncture, pharmcopuncture, and herbal medicine for the treatment of ninth, tenth, and twelfth cranial nerve palsy of unknown origin is suggested to be effective even though this conclusion is based on a single.

  17. The clinical diagnosis of cranial nerve injuries at operations on the carotid arteries.

    Science.gov (United States)

    Fokin, Al An; Kuklin, A V; Belskaia, G N; Kuznetsova, M Iu; Alekhin, D I; Zotov, S P; Vardugin, I V; Sundukova, Ye I

    2003-01-01

    Operation on the carotid arteries (CA) prevent strokes in patients with occlusions and stenoses of these arteries. We have worked out the measures for preventing perioperative strokes. During interventions on the CA, iatrogenic injuries to the cranial nerves (CN) are paid little attention. 1186 patients underwent 1362 operations. There were 26 lethal outcomes and 38 strokes. 146 (0.7%) cases of CN injuries were documented. Of these, there were 2 (0.1%) injuries to the accessory nerve, 14 (1%) to the glossopharyngeal nerve, 28 (2%) to the hypoglossal nerve, 46 (3.4%) injuries to vagal nerve branches, and 56 (4.2%) to facial nerve branches. In 42 patients, neuropathies acquired the 'permanent' character. We describe the symptomatology of injuries to different CN pairs consequent on carotid operations and the algorithm of their diagnosis. CN injuries deteriorate the results of operations and decrease quality of life of the patients. Early diagnosis and correction of the sequelae of iatrogenic injuries to the CN is a reserve for the refinement of the results of operations on the CA.

  18. Three-dimensional-fast imaging employing steady-state acquisition and T2-weighted fast spin-echo magnetic resonance sequences on visualization of cranial nerves Ⅲ-Ⅻ

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    @@ Because of the small diameter and complex anatomic course of the cranial nerves except for the optic nerve,mgeminal nerve,facial nerve,and cochlear and vestibular nerve,other cranial nerves are difficult to be visualized in magnetic resonance imaging (MRI) scanning with conventional thickness (5-10 mm).

  19. Chronic meningitis with multiple cranial neuropathies: A rare initial presentation of Wegener′s granulomatosis

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    Vikas Gupta

    2013-01-01

    Full Text Available Wegener′s granulomatosis (WG is a systemic necrotizing vasculitis that affects the small blood vessels. It mainly affects the upper and lower respiratory tract and kidneys. Central nervous system (CNS involvement is rare, and has been reported only in about 8% of cases during the course of illness. Initial presentation with neurologic affection, particularly chronic hypertrophic meningitis is very unusual. We report the case of a 34 year old male who presented with chronic hypertrophic meningitis and multiple cranial nerve involvement as the initial manifestation, without respiratory and renal symptoms. This case highlights the difficulties in diagnosing a rare disease with rarer presentation, and at the same time illustrates that Wegener′s granulomatosis should be considered in the differential diagnosis of chronic meningitis.

  20. An inferior alveolar intraneural cyst: a case example and an anatomical explanation to support the articular theory within cranial nerves.

    Science.gov (United States)

    Capek, Stepan; Koutlas, Ioannis G; Strasia, Rhys P; Amrami, Kimberly K; Spinner, Robert J

    2015-06-01

    The authors describe the case of an intraneural ganglion cyst involving a cranial nerve (V3), which was found to have a joint connection in support of an articular origin within the cranial nerves. An inferior alveolar intraneural cyst was incidentally discovered on a plain radiograph prior to edentulation. It was resected from within the mandibular canal with no joint connection perceived at surgery. Histologically, the cyst was confirmed to be an intraneural ganglion cyst. Reinterpretation of the preoperative CT scan showed the cyst arising from the temporomandibular joint. This case is consistent with the articular (synovial) theory of intraneural ganglion cysts. An anatomical explanation and potential joint connection are provided for this case as well as several other cases of intraneural cysts in the literature, and thus unifying cranial nerve involvement with accepted concepts of intraneural ganglion cyst formation and propagation.

  1. Long-Lasting Cranial Nerve III Palsy as a Presenting Feature of Chronic Inflammatory Demyelinating Polyneuropathy

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    Rossella Spataro

    2015-01-01

    Full Text Available We describe a patient with chronic inflammatory demyelinating polyneuropathy (CIDP in which an adduction deficit and ptosis in the left eye presented several years before the polyneuropathy. A 52-year-old man presented with a 14-year history of unremitting diplopia, adduction deficit, and ptosis in the left eye. At the age of 45 a mild bilateral foot drop and impaired sensation in the four limbs appeared, with these symptoms showing a progressive course. The diagnostic workup included EMG/ENG which demonstrated reduced conduction velocity with bilateral and symmetrical sensory and motor involvement. Cerebrospinal fluid studies revealed a cytoalbuminologic dissociation. A prolonged treatment with corticosteroids allowed a significant improvement of the limb weakness. Diplopia and ptosis remained unchanged. This unusual form of CIDP presented as a long-lasting isolated cranial nerve palsy. A diagnostic workup for CIDP should therefore be performed in those patients in which an isolated and unremitting cranial nerve palsy cannot be explained by common causes.

  2. Spontaneous resolution of a Meckel's cave arachnoid cyst causing sixth cranial nerve palsy.

    Science.gov (United States)

    Jacob, Maud; Gujar, Sachin; Trobe, Jonathan; Gandhi, Dheeraj

    2008-09-01

    A 32-year-old pregnant woman developed a progressive right sixth cranial nerve palsy as an isolated finding. Brain MRI disclosed a discrete lobulated lesion centered in the right Meckel's cave with intermediate signal on T1, high signal on T2, and diffusion characteristics similar to those of cerebrospinal fluid on apparent diffusion coefficient mapping. The initial radiologic diagnosis was schwannoma or meningioma. No intervention occurred. Shortly after cesarean delivery, the abduction deficit began to lessen spontaneously. One month later, the abduction deficit had further improved; 7 months later it had completely resolved. Repeat MRI after delivery failed to disclose the lesion, which was now interpreted as consistent with an arachnoid cyst arising within Meckel's cave. Twenty-one similar cases of Meckel's cave arachnoid cyst or meningocele have been reported, 7 found incidentally and 14 causing symptoms, 2 of which produced ipsilateral sixth cranial nerve palsies. All previously reported symptomatic patients were treated surgically. This is the first report of an arachnoid cyst arising from Meckel's cave in pregnancy and having spontaneous resolution.

  3. Visualization of cranial nerves I-XII: value of 3D CISS and T2-weighted FSE sequences

    Energy Technology Data Exchange (ETDEWEB)

    Yousry, I.; Camelio, S.; Wiesmann, M.; Brueckmann, H.; Yousry, T.A. [Department of Neuroradiology, Klinikum Grosshadern, Ludwig-Maximilians University, Marchioninistrasse 15, D-81377 Munich (Germany); Schmid, U.D. [Neurosurgical Unit, Klinik im Park, 8000 Zurich (Switzerland); Horsfield, M.A. [Department of Medical Physics, University of Leicester, Leicester LE1 5WW (United Kingdom)

    2000-07-01

    The aim of this study was to evaluate the sensitivity of the three-dimensional constructive interference of steady state (3D CISS) sequence (slice thickness 0.7 mm) and that of the T2-weighted fast spin echo (T2-weighted FSE) sequence (slice thickness 3 mm) for the visualization of all cranial nerves in their cisternal course. Twenty healthy volunteers were examined using the T2-weighted FSE and the 3D CISS sequences. Three observers evaluated independently the cranial nerves NI-NXII in their cisternal course. The rates for successful visualization of each nerve for 3D CISS (and for T2-weighted FSE in parentheses) were as follows: NI, NII, NV, NVII, NVIII 40 of 40 (40 of 40), NIII 40 of 40 (18 of 40), NIV 19 of 40 (3 of 40), NVI 39 of 40 (5 of 40), NIX, X, XI 40 of 40 (29 of 40), and NXII 40 of 40 (4 of 40). Most of the cranial nerves can be reliably assessed when using the 3D CISS and the T2-weighted FSE sequences. Increasing the spatial resolution when using the 3D CISS sequence increases the reliability of the identification of the cranial nerves NIII-NXII. (orig.)

  4. Carotid and cranial nerve reconstruction after removal of cavernous sinus lesions.

    Science.gov (United States)

    Sekhar, L N; Sen, C N; Lanzino, G; Pomonis, S

    1991-12-01

    During the last 7 years, approximately 170 neoplasms, and 35 vascular lesions involving the cavernous sinus were treated by the first two authors. During the treatment of such lesions, the direct vein graft reconstruction of the internal carotid artery from the petrous to the supraclinoid or infraclinoid ICA was performed in 23 patients. Graft occlusion occurred in 3 patients and in one of these, it was successfully salvaged by placing a long venous graft from the extracranial ICA to the M3 segment of the middle cerebral artery. The latter 3 patients were neurologically normal. One patient with significant atherosclerotic disease suffered the dissection of the distal internal carotid artery with the graft being patent. The suturing technique. This patient eventually died. Two patients with severely compromised collateral circulation suffered minor strokes due to the temporary occlusion of the ICA. This has been avoided in the more recent patients by the adoption of brain protection techniques such as moderate hypothermia, induced hypertension, and barbiturate coma. Low dose heparin therapy during grafting and high dose intravenous steroids prior to the grafting also appear to be beneficial. Direct vein graft reconstruction of the intracavernous carotid artery is a valuable tool during the management of cavernous sinus lesions. The advantages and disadvantages of this technique as well as the pros and cons of other revascularization techniques will be discussed. During microsurgical removal of cavernous sinus lesions, the cranial nerves III-VI were reconstructed by direct resuture or by nerve grafting in 16 patients. In the majority of these patients, recovery of cranial nerve function was observed, which was very encouraging.(ABSTRACT TRUNCATED AT 250 WORDS)

  5. Effective intravenous immunoglobulin therapy for Churg-Strauss syndrome (allergic granulomatous angiitis complicated by neuropathy of the eighth cranial nerve: a case report

    Directory of Open Access Journals (Sweden)

    Ozaki Yoshio

    2012-09-01

    Full Text Available Abstract Introduction We report the case of a patient with Churg-Strauss syndrome with eighth cranial nerve palsy. Vestibulocochlear nerve palsy is extremely rare in Churg-Strauss syndrome. To the best of our knowledge, only one case of complicated neuropathy of the eighth cranial nerve has been described in a previous report presenting an aggregate calculation, but no differentiation between polyarteritis nodosa and Churg-Strauss syndrome was made. High-dose immunoglobulin was administered to our patient, and her neuropathy of the eighth cranial nerve showed improvement. Case presentation At the age of 46, a Japanese woman developed Churg-Strauss syndrome that later became stable with low-dose prednisolone treatment. At the age of 52, she developed sudden difficulty of hearing in her left ear, persistent severe rotary vertigo, and mononeuritis multiplex. At admission, bilateral perceptive deafness of about 80dB and eosinophilia of 4123/μL in peripheral blood were found. A diagnosis of cranial neuropathy of the eighth cranial nerve associated with exacerbated Churg-Strauss syndrome was made. Although high doses of steroid therapy alleviated the inflammatory symptoms and markers, the vertigo and bilateral hearing loss remained. Addition of a high-dose immunoglobulin finally resulted in marked alleviation of the symptoms associated with neuropathy of the eighth cranial nerve. Conclusions A high dose of immunoglobulin therapy shows favorable effects in neuropathy of the eighth cranial nerve, but no reports regarding its efficacy in cranial neuropathy have been published.

  6. Carboxypeptidase A6 in zebrafish development and implications for VIth cranial nerve pathfinding.

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    Peter J Lyons

    Full Text Available Carboxypeptidase A6 (CPA6 is an extracellular protease that cleaves carboxy-terminal hydrophobic amino acids and has been implicated in the defective innervation of the lateral rectus muscle by the VIth cranial nerve in Duane syndrome. In order to investigate the role of CPA6 in development, in particular its potential role in axon guidance, the zebrafish ortholog was identified and cloned. Zebrafish CPA6 was secreted and interacted with the extracellular matrix where it had a neutral pH optimum and specificity for C-terminal hydrophobic amino acids. Transient mRNA expression was found in newly formed somites, pectoral fin buds, the stomodeum and a conspicuous condensation posterior to the eye. Markers showed this tissue was not myogenic in nature. Rather, the CPA6 localization overlapped with a chondrogenic site which subsequently forms the walls of a myodome surrounding the lateral rectus muscle. No other zebrafish CPA gene exhibited a similar expression profile. Morpholino-mediated knockdown of CPA6 combined with retrograde labeling and horizontal eye movement analyses demonstrated that deficiency of CPA6 alone did not affect either VIth nerve development or function in the zebrafish. We suggest that mutations in other genes and/or enhancer elements, together with defective CPA6 expression, may be required for altered VIth nerve pathfinding. If mutations in CPA6 contribute to Duane syndrome, our results also suggest that Duane syndrome can be a chondrogenic rather than a myogenic or neurogenic developmental disorder.

  7. [Aneurysm of the internal carotid artery--a differential diagnosis of paralysis of the caudal cranial nerves].

    Science.gov (United States)

    Koscielny, S; Koch, J; Behrendt, W

    2003-09-01

    Paralysis of the caudal cranial nerves, e. g. the nervus glossopharyngeus, vagus and accessorius, may cause disorders in swallowing and speaking leading to a reduction in the patient's quality of life. Glomus tumors or malignant lesions of the skull base are a frequent cause of such lesions. We report on the case of a 48 year old patient who presented an acute lesion of these cranial nerves in combination with paresis of the nervus hypoglossus as a result of an aneurysm of the internal carotid artery directly underneath the base of the skull. The aneurysm was treated by parent vessel occlusion. The results of this procedure were a shrinkage of the aneurysm and an improvement in the neurological symptoms.

  8. 18F-FDG PET/CT/MRI Fusion Images Showing Cranial and Peripheral Nerve Involvement in Neurolymphomatosis

    Science.gov (United States)

    Trevisan, Ana Carolina; Ribeiro, Fernanda Borges; Itikawa, Emerson Nobuyuki; Alexandre, Leonardo Santos; Pitella, Felipe Arriva; Santos, Antonio Carlos; Simões, Belinda Pinto; Wichert-Ana, Lauro

    2017-01-01

    We report a 56-year-old female patient with non-Hodgkin's diffuse large B cell lymphoma (NHL) who, on magnetic resonance imaging (MRI) with a T1 weighted and gadolinium-enhanced imaging, was found to have thickening and infiltration in 75% of peripheral nerves of the patient and enlargements of cranial nerves, possibly related to lymphomatous infiltration. Subsequent positron emission tomography/computed tomography (PET/CT) using 18F-labeled 2-deoxy-2-fluoro-d-glucose (18F-FDG) showed widespread active involvement of the cervical plexus, bilateral peripheral nerves, right femoral nerve, the parasellar region of the skull, and marked hypermetabolism in the left trigeminal ganglia. This case re-emphasizes that while CT and MRI provide anatomical details, 18F-FDG PET/CT images better delineate the metabolic activity of neurolymphomatosis (NL) in the peripheral and central nervous system.

  9. A pediatric case of pituitary macroadenoma presenting with pituitary apoplexy and cranial nerve involvement: case report

    Science.gov (United States)

    Özçetin, Mustafa; Karacı, Mehmet; Toroslu, Ertuğ; Edebali, Nurullah

    2016-01-01

    Pituitary adenomas usually arise from the anterior lobe of the pituitary gland and are manifested with hormonal disorders or mass effect. Mass effect usually occurs in nonfunctional tumors. Pituitary adenomas may be manifested with visual field defects or rarely in the form of total oculomotor palsy. Visual field defect is most frequently in the form of bitemporal hemianopsia and superior temporal defect. Sudden loss of vision, papilledema and ophthalmoplegia may be observed. Pituitary apoplexy is defined as an acute clinical syndrome characterized with headache, vomiting, loss of vision, ophthalmoplegia and clouding of consciousness. The problem leading to pituitary apoplexy may be decreased blood supply in the adenoma and hemorrhage following this decrease or hemorrhage alone. In this article, we present a patient who presented with fever, vomiting and sudden loss of vision and limited outward gaze in the left eye following trauma and who was found to have pituitary macroadenoma causing compression of the optic chiasma and optic nerve on the left side on cranial and pituitary magnetic resonance imaging.

  10. A pediatric case of pituitary macroadenoma presenting with pituitary apoplexy and cranial nerve involvement: case report.

    Science.gov (United States)

    Özçetin, Mustafa; Karacı, Mehmet; Toroslu, Ertuğ; Edebali, Nurullah

    2016-09-01

    Pituitary adenomas usually arise from the anterior lobe of the pituitary gland and are manifested with hormonal disorders or mass effect. Mass effect usually occurs in nonfunctional tumors. Pituitary adenomas may be manifested with visual field defects or rarely in the form of total oculomotor palsy. Visual field defect is most frequently in the form of bitemporal hemianopsia and superior temporal defect. Sudden loss of vision, papilledema and ophthalmoplegia may be observed. Pituitary apoplexy is defined as an acute clinical syndrome characterized with headache, vomiting, loss of vision, ophthalmoplegia and clouding of consciousness. The problem leading to pituitary apoplexy may be decreased blood supply in the adenoma and hemorrhage following this decrease or hemorrhage alone. In this article, we present a patient who presented with fever, vomiting and sudden loss of vision and limited outward gaze in the left eye following trauma and who was found to have pituitary macroadenoma causing compression of the optic chiasma and optic nerve on the left side on cranial and pituitary magnetic resonance imaging.

  11. Sellar Chordoma Presenting as Pseudo-macroprolactinoma with Unilateral Third Cranial Nerve Palsy

    Institute of Scientific and Technical Information of China (English)

    Hai-feng Wang; Hong-xi Ma; Cheng-yuan Ma; Yi-nan Luo; Peng-fei Ge

    2012-01-01

    We described a 61-year-old female with a sellar chordoma,which presented as pseudo-macroprolactinoma with unilateral third cranial nerve palsy.Physical examination revealed that her right upper lid could not be raised by itself,right eyeball movement limited to the abduction direction,right pupil dilated to 4.5 mm with negative reaction to light,and hemianopsia in bitemporal sides.CT scanning showed a hyperdense lesion at sellar region without bone destruction.Magnetic resonance imaging (MRI) revealed the tumor was 2.3 cm×1.8 cm×2.6 cm,with iso-intensity on T1WI,hyper-intensity on T2WI and heterogeneous enhancement on contrast imaging.Endocrine examination showed her serum prolactin level increased to 1,031.49 mlU/ml.The tumor was sub-totally resected via pterional craniotomy under microscope and was histologically proven to be a chordoma.Postoperatively,she recovered uneventfully but ptosis and hemianopsia remained at the 6th month.

  12. Cranial nerve injuries are associated with specific craniofacial fractures after blunt trauma.

    Science.gov (United States)

    Kampshoff, Jesse L; Cogbill, Thomas H; Mathiason, Michelle A; Kallies, Kara J; Martin, Lynn T

    2010-11-01

    Identification of cranial nerve (CN) injuries after blunt trauma is often delayed due to concomitant life-threatening trauma, altered mental status, and associated bony or soft tissue injuries. We hypothesized that specific craniofacial fracture (FX) patterns are associated with CN injuries, permitting earlier diagnosis. The trauma registry at a single institution was queried for all CN injuries and craniofacial FXs. Associations were determined by Fisher's exact test. Ninety CN injuries were identified in 59 patients. CN injuries were diagnosed on the day of admission in 24 (41%) patients. The most frequently injured CNs were CN VII (22), CN I (16), and CN VI (14). Occipital FXs were associated with CN I injury (P = 0.001). Sphenoid and ethmoid FXs were correlated with CN III trauma (P = 0.019 and 0.04). Temporal bone FXs were associated with CN VII injuries (P = 0.025). Maxillary FXs were associated with CN V injuries (P = 0.041). Complete or partial recovery was documented after 17 per cent and 39 per cent of CN injuries, respectively. Diagnostic delay was documented in 59 per cent of patients. Specific craniofacial FXs were correlated with certain CN injuries. Partial or complete recovery of function occurred after 56 per cent of CN injuries.

  13. Cranial Nerve Dysfunction Associated with Cavernous Dural Arteriovenous Fistulas After Transvenous Embolization with Onyx

    Energy Technology Data Exchange (ETDEWEB)

    Li, Chuanhui; Wang, Yang; Li, Youxiang; Jiang, Chuhan; Wu, Zhongxue; Yang, Xinjian, E-mail: yang-xj@163.net [Capital Medical University, Beijing Neurosurgical Institute and Beijing Tiantan Hospital (China)

    2015-10-15

    PurposeCranial nerve dysfunction (CND) is not uncommon in patients with cavernous dural arteriovenous fistulas (cDAVFs), and may represent an initial manifestation or a complication after endovascular treatment. This study evaluated the outcome of CND associated with cDAVFs after transvenous embolization (TVE) using Onyx.Materials and MethodsForty-one patients with cDAVFs were treated with TVE in our department between April 2009 and October 2013. For each patient, clinical and radiologic records were retrospectively reviewed and evaluated, with an emphasis placed on evaluating the outcomes of the pre-existing cDAVF-induced CND and the TVE-induced CND.ResultsOf the 41 cases, 25 had a history of preoperative CND. Postoperatively, gradual remission to complete recovery (CR) within 8 months was observed in 17 of these cases, transient aggravation in 7, and significant improvement to be better than preoperative function but no CR in 1. All aggravation of CND occurred immediately or within 1 day after TVE and resolved completely within 5 months. Nine patients developed new CND after TVE. New CND occurred during the perioperative period in 8 cases, but all cases resolved completely within 15 days–6 months. Delayed CND was observed in 3 cases with a time lag of 3–25 months after TVE. Two of these completely resolved within 20 days–1 month and the remaining case significantly improved.ConclusionBoth the pre-existing cDAVF-induced CND and the TVE-induced new or aggravated CND completely resolved in almost all cases after embolization with Onyx.

  14. Neurotology findings in patients with diagnosis of vascular loop of cranial nerves VIII in magnetic resonance imaging

    Directory of Open Access Journals (Sweden)

    Grocoske, Francisco Luiz Busato

    Full Text Available Introduction: The vascular compression by redundant vessels under the VIII cranial nerves has been studied since the 80's, and many authors proposed correlations between the compression and the otoneurological findings (vertigo, tinnitus, hypoacusis, audiometry and electrophysiological findings. Objective: Analyze and correlate the different signs and otoneurological symptoms, the audiological findings and its incidence over individuals with Vascular Loop (VL diagnosis of VIII cranial nerves by magnetic resonance imaging (MRI. Method: Retrospective study through the analysis of medical records of 47 patients attended in the otoneurology clinic of Clinical Hospital of UFPR. All the patients have MRI exams with compatible pictures of VL of the VIII cranial nerves. Results: The tinnitus was the most frequent symptom, in 83% of the patients, followed by hypoacusis (60% and vertigo (36%. The audiometry presented alterations in 89%, the brainstem evoked auditory potential in 33% and the vecto-electronystagmography in 17% of the patients. Was not found statistically significant relation between the buzz or hypoacusis, and the presence of VL in MRI. Only 36% of patients had complaints of vertigo, the main symptom described in theory of vascular compression of the VIII pair of nerve. As in the audiometry and in brainstem evoked auditory potential was not found a statistically significant relation between the exam and the presence of the VL in the RMI. Conclusion: The results show independence between the findings of the RMI, clinical picture and audiological results (p>0,05 suggesting that there are no exclusive and direct relation between the diagnosis of vascular loop in the MRI and the clinical picture matching.

  15. Value of Free-Run Electromyographic Monitoring of Extraocular Cranial Nerves during Expanded Endonasal Surgery (EES) of the Skull Base.

    Science.gov (United States)

    Thirumala, Parthasarathy D; Mohanraj, Santhosh Kumar; Habeych, Miguel; Wichman, Kelley; Chang, Yue-Fang; Gardner, Paul; Snyderman, Carl; Crammond, Donald J; Balzer, Jeffrey

    2013-06-01

    Objective To evaluate the value of free-run electromyography (f-EMG) monitoring of extraocular cranial nerves (EOCN) III, IV, and VI during expanded endonasal surgery (EES) of the skull base in reducing iatrogenic cranial nerve (CN) deficits. Design We retrospectively identified 200 patients out of 990 who had at least one EOCN monitored during EES. We further separated patients into groups according to the specific CN monitored. In each CN group, we classified patients who had significant (SG) f-EMG activity as Group I and those who did not as Group II. Results A total of 696 EOCNs were monitored. The number of muscles supplied by EOCNs that had SG f-EMG activity was 88, including CN III = 46, CN IV = 21, and CN VI = 21. There were two deficits involving CN VI in patients who had SG f-EMG activity during surgery. There were 14 deficits observed, including CN III = 3, CN IV = 2, and CN VI = 9 in patients who did not have SG f-EMG activity during surgery. Conclusions f-EMG monitoring of EOCN during EES can be useful in identifying the location of the nerve. It seems to have limited value in predicting postoperative neurological deficits. Future studies to evaluate the EMG of EOCN during EES need to be done with both f-EMG and triggered EMG.

  16. Value of free-run electromyographic monitoring of lower cranial nerves in endoscopic endonasal approach to skull base surgeries.

    Science.gov (United States)

    Thirumala, Parthasarathy D; Mohanraj, Santhosh Kumar; Habeych, Miguel; Wichman, Kelley; Chang, Yue-Fang; Gardner, Paul; Snyderman, Carl; Crammond, Donald J; Balzer, Jeffrey

    2012-08-01

    Objective The main objective of this study was to evaluate the value of free-run electromyography (f-EMG) monitoring of cranial nerves (CNs) VII, IX, X, XI, and XII in skull base surgeries performed using endoscopic endonasal approach (EEA) to reduce iatrogenic CN deficits. Design We retrospectively identified 73 patients out of 990 patients who had EEA in our institution who had at least one CN monitored. In each CN group, we classified patients who had significant (SG) f-EMG activity as group I and those who did not as group II. Results We monitored a total of 342 CNs. A total of 62 nerves had SG f-EMG activity including CN VII = 18, CN IX = 16, CN X = 13, CN XI = 5, and CN XII = 10. No nerve deficit was found in the nerves that had significant activity during procedure. A total of five nerve deficits including (CN IX = 1, CN X = 2, CN XII = 2) were observed in the group that did not display SG f-EMG activity during surgery. Conclusions f-EMG seems highly sensitive to surgical manipulations and in locating CNs. It seems to have limited value in predicting postoperative neurological deficits. Future studies to evaluate the EMG of lower CNs during EEA procedures need to be done with both f-EMG and triggered EMG.

  17. An unusual presentation of adenoid cystic carcinoma of the minor salivary glands with cranial nerve palsy: a case study

    Directory of Open Access Journals (Sweden)

    Morris Pierre A

    2007-08-01

    Full Text Available Abstract Background Adenoid Cystic Carcinoma (ACC is a rare tumor entity and comprises about 1% of all malignant tumor of the oral and maxillofacial region. It is slow growing but a highly invasive cancer with a high recurrence rate. Intracranial ACC is even more infrequent and could be primary or secondary occurring either by direct invasion, hematogenous spread, or perineural spread. We report the first case of the 5th and 6th nerve palsy due to cavernous sinus invasion by adenoid cystic carcinoma. Case presentation A 49-year-old African American female presented to the emergency room complaining of severe right-sided headache, photophobia, dizziness and nausea, with diplopia. The patient had a 14 year history migraine headaches, hypertension, and mild intermittent asthma. Physical examination revealed right lateral rectus muscle palsy with esotropia. There was numbness in all three divisions of the right trigeminal nerve. Motor and sensory examination of extremities was normal. An MRI of the brain/brain stem was obtained which showed a large mass in the clivus extending to involve the nasopharynx, pterygoid plate, sphenoid and right cavernous sinuses. Biopsy showed an ACC tumor with a cribriform pattern of the minor salivary glands. The patient underwent total gross surgical resection and radiation therapy. Conclusion This is a case of ACC of the minor salivary glands with intracranial invasion. The patient had long history of headaches which changed in character during the past year, and symptoms of acute 5th and 6th cranial nerve involvement. Our unique case demonstrates direct invasion of cavernous sinus and could explain the 5th and 6th cranial nerve involvement as histopathology revealed no perineural invasion.

  18. Unilateral blindness with third cranial nerve palsy and abnormal enhancement of extraocular muscles on magnetic resonance imaging of orbit after the ingestion of methanol.

    Science.gov (United States)

    Chung, Tae Nyoung; Kim, Sun Wook; Park, Yoo Seok; Park, Incheol

    2010-05-01

    Methanol is generally known to cause visual impairment and various systemic manifestations. There are a few reported specific findings for methanol intoxication on magnetic resonance imaging (MRI) of the brain. A case is reported of unilateral blindness with third cranial nerve palsy oculus sinister (OS) after the ingestion of methanol. Unilateral damage of the retina and optic nerve were confirmed by fundoscopy, flourescein angiography, visual evoked potential and electroretinogram. The optic nerve and extraocular muscles (superior rectus, medial rectus, inferior rectus and inferior oblique muscle) were enhanced by gadolinium-DTPA on MRI of the orbit. This is the first case report of permanent monocular blindness with confirmed unilateral damage of the retina and optic nerve, combined with third cranial nerve palsy after methanol ingestion.

  19. [Chondroma adjacent to Meckel's cave mimicking a fifth cranial nerve neurinoma. A case report].

    Science.gov (United States)

    Narro-Donate, Jose María; Huete-Allut, Antonio; Velasco-Albendea, Francisco J; Escribano-Mesa, Jose A; Mendez-Román, Paddy; Masegosa-González, Jose

    2016-01-01

    Cranial chondromas are tumours arising from chondrocyte embryonic remnants cells that usually appear in the skull base synchondrosis. In contrast to the rest of the organism, where chondroid tumours are the most common primary bone tumour just behind the haematopoietic lineage ones, they are a rarity at cranial level, with an incidence of less than 1% of intracranial tumours. The case is reported on a 42 year-old male referred to our clinic due to the finding of an extra-axial lesion located close to the Meckel's cave region, with extension to the posterior fossa and brainstem compression after progressive paraparesis of 6 months onset. With the diagnosis of trigeminal schwannoma, a subtotal tumour resection was performed using a combined supra-infratentorial pre-sigmoidal approach. The postoperative histopathology report confirmed the diagnosis of cranial chondroma.

  20. Treatment of Cervical Internal Carotid Artery Spontaneous Dissection with Pseudoaneurysm and Unilateral Lower Cranial Nerves Palsy by Two Silk Flow Diverters

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    Zelenak, Kamil, E-mail: zelenak@unm.sk [University Hospital, Department of Radiology (Slovakia); Zelenakova, Jana [University Hospital, Department of Neurology (Slovakia); DeRiggo, Julius [University Hospital, Department of Neurosurgery (Slovakia); Kurca, Egon; Kantorova, Ema [University Hospital, Department of Neurology (Slovakia); Polacek, Hubert [University Hospital, Department of Radiology (Slovakia)

    2013-08-01

    Internal carotid artery (ICA) lesions in the parapharyngeal space (a dissection and a pseudoaneurysm) may present as isolated lower cranial nerves (IX, X, XI, and XII) palsy (Collet-Sicard syndrome). Some arteriopathies such as fibromuscular dysplasia and tortuosity make a vessel predisposed to dissection. Extreme vessel tortuosity makes the treatment by a stent graft impossible. Two Silk stents were used in a 46 year-old man with left lower cranial nerves (IX-XII) palsy for the treatment of left ICA spontaneous dissection with pseudoaneurysm. A follow-up angiogram 5 months later confirmed pseudoaneurysm thrombosis and patency of the left ICA. The patient recovered completely from the deficits.

  1. Comparison of FSE T2W and 3D FIESTA sequences in the evaluation of posterior fossa cranial nerves with MR cisternography.

    Science.gov (United States)

    Hatipoğlu, Hatice Gül; Durakoğlugil, Tuğba; Ciliz, Deniz; Yüksel, Enis

    2007-06-01

    The aim of this study was to compare 3D fast imaging with steady state acquisition (3D FIESTA) to fast spin echo T2-weighted (FSE T2W) MRI sequences in the imaging of cisternal parts of cranial nerves V-XII. We retrospectively evaluated the temporal MRI sequences of 50 patients (F:M ratio, 27:23; mean age, 44.5 +/- 15.9 years) who were admitted to our hospital with vertigo, tinnitus, and hearing loss. In all, we evaluated 800 nerves. Two radiologists, working independently, divided the imaging findings into 3 groups: 0 (not visualized), 1 (partially visualized), and 2 (completely visualized). The rate of visualization of these cranial nerves with FSE T2W and 3D FIESTA sequences, respectively, (partially and completely visualized) were as follows: nerve V (100% and 100%); nerve VI (43% and 98%); nerve VII (100% and 100%); nerve VIII (100% and 100%); nerve IX-XI complex (67% and 100%); nerve XII (2% and 91%). 3D FIESTA sequences are superior to FSE T2W sequences in the imaging of cisternal parts of the posterior fossa nerves. 3D FIESTA sequences may be used for obtaining high-resolution MR cisternography images.

  2. CT-clinical approach to patients with symptoms related to the V, VII, IX-XII cranial nerves and cervical sympathetics

    Energy Technology Data Exchange (ETDEWEB)

    Kalovidouris, A.; Mancuso, A.A.; Dillon, W.

    1984-06-01

    Forty-three patients who had signs and symptoms possibly related to the extracranial course of cranial nerves V, VII, IX, X-XII, and the cervical sympathetics were examined prospectively using high resolution CT to obtain images of thin sections during rapid drip infusion of contrast material. Anatomic areas in the scan protocols included the posterior fossa, cavernous and paranasal sinuses, skull base, temporal bone, nasopharynx, parotid gland, tongue base, and neck. Nine of the 23 patients with possible fifth nerve deficits had extracranial structural lesions that explained the symptoms; none of these nine, however, had typical trigeminal neuralgia. Of eight patients with peripheral seventh nerve abnormalities, two had positive findings on scans. Of five patients presenting with referred ear pain, three had carcinoma of the upper aerodigestive tract. The authors' experience suggests that patients at high risk for structural lesions responsible for cranial nerve deficits can be selected by clinical criteria. Protocols for each clinical setting are presented.

  3. Tinnitus in vascular conflict of the eighth cranial nerve : a surgical pathophysiological approach to ABR changes

    NARCIS (Netherlands)

    De Ridder, Dirk; Heijneman, Karin; Haarman, Benno; van der Loo, Elsa; Langguth, B; Hajak, G; Kleinjung, T; Cacace, A; Moller, AR

    2007-01-01

    Some forms of tinnitus are associated with a blood vessel being in close contact with the auditory nerve near its entrance into the brainstem. The outcome of operations for tinnitus, moving the blood vessel off the nerve (microvascular decompression operations, MVD) is less successful than microvasc

  4. Outcome on hearing and facial nerve function in microsurgical treatment of small vestibular schwannoma via the middle cranial fossa approach.

    Science.gov (United States)

    Ginzkey, Christian; Scheich, Matthias; Harnisch, Wilma; Bonn, Verena; Ehrmann-Müller, Desiree; Shehata-Dieler, Wafaa; Mlynski, Robert; Hagen, Rudolf

    2013-03-01

    Encouraging results regarding hearing preservation and facial nerve function as well as increasing understanding of the natural behaviour of vestibular schwannomas have led to the recommendation of an early treatment in small VS. The aim of the present study was to evaluate current data on functional outcome of patients with small VS treated by middle cranial fossa (MCF) approach. A retrospective chart study of all cases treated by MCF approach between October 2007 and September 2011 was performed. Records were analyzed regarding demographical data, tumor size, hearing status, vestibular function and facial nerve function. Facial nerve function was classified according to the House-Brackmann scale (HB). Hearing status was classified according to the American Association of Otolaryngology-Head and Neck Surgery (AAO-HNS) and a modified classification of Gardner and Robertson (GR). Eighty-nine patients were included in the study; 41 % of VS was classified as intracanalicular (stage 1) and 59 % as stage 2. From 65 patients with a preoperative hearing status according to AAO-HNS A or B, 74 % still presented with A or B after surgery. Using a modified GR classification, from 70 patients categorized as class I or II prior to surgery, 70 % were still class I or II. Looking to the facial nerve function 1 week after surgery, 82 % of patients presented with HB 1 or 2. Three to twelve months later, 96 % demonstrated HB 1 or 2. A persisting facial palsy was recorded in four patients. Preoperative hearing status was evaluated as a prognostic factor for postoperative hearing, whereas no influence was detected in ABR, vestibular function and tumor length. Early diagnosis of small VS due to high-sensitive MRI requires the management of this tumor entity. Natural behaviour of VS in many cases demonstrates an increase of tumor size over time with deterioration of hearing status. The presented data underline the recommendation of an early surgical treatment in small VS as a valuable

  5. High-resolution MRI of cranial nerves in posterior fossa at 3.0 T

    Institute of Scientific and Technical Information of China (English)

    Zi-Yi Guo; Jing Chen; Qi-Zhou Liang; Hai-Yan Liao; Qiong-Yue Cheng; Shui-Xi Fu; Cai-Xiang Chen; Dan Yu

    2013-01-01

    Objective:To evaluate the influence of high-resolution imaging obtainable with the higher field strength of3.0T on the visualization of the brain nerves in the posterior fossa.Methods:In total,20 nerves were investigated onMRI of12 volunteers each and selected for comparison, respectively, with theFSE sequences with5 mm and2 mm section thicknesses and gradient recalled echo(GRE) sequences acquired with a3.0-T scanner.TheMR images were evaluated by three independent readers who rated image quality according to depiction of anatomic detail and contrast with use of a rating scale.Results:In general, decrease of the slice thickness showed a significant increase in the detection of nerves as well as in the image quality characteristics. ComparingFSE andGRE imaging, the course of brain nerves and brainstem vessels was visualized best with use of the three-dimensional(3D) pulse sequence.Conclusions:The comparison revealed the clear advantage of a thin section.The increased resolution enabled immediate identification of all brainstem nerves.GRE sequence most distinctly and confidently depicted pertinent structures and enables3D reconstruction to illustrate complex relations of the brainstem.

  6. Mitochondrial energy metabolism changes during aging-mouse cranial nerve cells treated with various doses and forms of Fructus schizandrae

    Institute of Scientific and Technical Information of China (English)

    Hongyan Guo; Jinhe Li

    2008-01-01

    BACKGROUND: During the cellular aging process, the number of mitochondria, generation of adenosine triphosphate (ATP), activity of respiratory chain enzyme complex 1 and 4, and oxidation decrease. OBJECTIVE: To observe the effects of aqueous and spirituous extract, as well as polysaccharides from Fructus schizandrae (Magnolia Vine) on energy metabolism and mitochondrial anti-oxidation in cranial nerve cells of a D-gal-induccd aging mouse model.DESIGN, TIME AND SETTING: A randomized, controlled, animal study. The experiment was conducted at the Department of Biochemistry, Qiqihar Medical College between March and July 2006.MATERIALS: Fifty healthy, Kunming mice of both sexes, aged 2 3 months old and weighing 18-22 g, were used for the present study. Fructus schizandrae was purchased from the Medical College of Jiamusi University. Aqueous extracts, spirituous extracts, and polysaccharides from Fructus schizandrae were prepared. D-galactose (D-gal) is a product of the Second Reagent Factory, Shanghai City, China. Mn-superoxide dismutase (Mn-SOD) kit, malonaldehyde (MDA) kit, protein quantification kit, and inorganic phosphorus testing kit were purchased from Jian Cheng Bioeng. Co., China.METHODS: Fifty mice were randomly divided into five groups, with 10 mice in each group: young control, aging model, aqueous Fructus schizandrae extract, spirituous Fructus schizandrae extract, and Fructus schizandrae polysaccharides. Over a course of 30 days, mice in aging model, aqueous Fructus schizandrae extract, spirituous Fructus schizandrae extract, and Fructus schizandrae polysaccharides groups were injected subcutaneously with D-gal (100 mg/kg) into the nape of the neck daily, and administered intragastrically with an equal volume of sterile, warm water (aging model), aqueous Fructus schizandrae extract (2 g/kg), spirituous Fructus schizandrae extract (2 g/kg), or Fructus schizandrae polysaccharides (0.2 g/kg), respectively. Mice in the young control group were injected into

  7. MRI of optic nerve lesion in multiple sclerosis

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    Fujii, Koichi; Uehara, Masako; Ashikaga, Ryuuichirou; Inoue, Masaaki; Yamamoto, Takashi; Hamada, Tatsumi; Ishida, Osamu; Nakao, Yuzou; Miyakoshi, Keizou (Kinki Univ., Osakasayama, Osaka (Japan). School of Medicine)

    1992-12-01

    We evaluated the ability of MRI using short TI inversion recovery (STIR) to detect optic nerve lesions in multiple sclerosis (MS). Eleven patients with MS were studied with MRI at 0.5 T. STIR images revealed high signal lesions in all of 14 nerves in 11 patients with previous and recurrent attack of optic neuritis. In addition, two of seven asymptomatic nerves also showed high intensity on STIR images. The high signal lesions on STIR images seemed to reflect demyelination in the nerves with some attacks and to show occult lesions in the nerves without any attack. STIR method was concluded to be a potentially useful procedure in detection of optic nerve lesions in MS. (author).

  8. Exophytic pilocytic astrocytoma of the brain stem in an adult with encasement of the caudal cranial nerve complex (IX-XII): presurgical anatomical neuroimaging using MRI

    Energy Technology Data Exchange (ETDEWEB)

    Yousry, Indra; Yousry, Tarek A. [Department of Neuroradiology, Klinikum Grosshadern, Ludwig-Maximilians University, Marchioninistr. 15, 81377, Munich (Germany); Muacevic, Alexander; Olteanu-Nerbe, Vlad [Department of Neurosurgery, Klinikum Grosshadern, Ludwig-Maximilians University, Munich (Germany); Naidich, Thomas P. [Department of Radiology, Section of Neuroradiology, Mount Sinai Hospital, New York (United States)

    2004-07-01

    We describe a rare case of adult pilocytic astrocytoma in which exophytic growth from the brain stem presented as a right cerebellopontine angle mass. An initial MRI examination using T2- and T1-weighted images without and with contrast suggested the diagnosis of schwannoma. Subsequent use of 3D CISS (three-dimensional constructive interference in steady state) and T1-weighted contrast-enhanced 3D MP-RAGE (three-dimensional magnetization prepared rapid acquisition gradient echo) sequences led to the diagnosis of an exophytic brain stem tumor, documented the precise relationships of the tumor to cranial nerve VIII, revealed encasement of cranial nerves IX-XII (later confirmed intraoperatively), and provided the proper basis for planning surgical management. (orig.)

  9. Anatomy of the cranial nerves in medieval Persian literature: Esmail Jorjani (AD 1042-1137) and The treasure of the Khwarazm shah.

    Science.gov (United States)

    Shoja, Mohammadali M; Tubbs, R Shane; Ardalan, Mohammad R; Loukas, Marios; Eknoyan, Garabed; Salter, E George; Oakes, W Jerry

    2007-12-01

    Esmail Jorjani was an influential Persian physician and anatomist of the 12th century who did most of his writing after his seventh decade of life. Jorjani's comprehensive textbook of medicine, Zakhirey-e Khwarazmshahi (The Treasure of the Khwarazm Shah) was written in approximately AD 1112 and is considered to be the oldest medical encyclopedia written in Persian. This was an essential textbook for those studying medicine during this time. We describe the life and times of Jorjani and provide a translation and interpretations of his detailed descriptions of the cranial nerves, which were written almost a millennium ago. Medieval Persian and Muslim scholars have contributed to our current knowledge of the cranial nerves. Some of these descriptions, such as the eloquent ones provided by Jorjani, were original and have gone mostly unknown to post-Vesalian European scholars.

  10. Review: oculomotor cranial nerve palsies: symptoms, problems and non-surgical preoperative management of the resultant complex incomitant strabismus and monocular and binocular vision disturbances.

    Science.gov (United States)

    Khawam, Edward; Fahed, Daoud

    2012-01-01

    The purpose of this presentation is first to describe the symptoms and problems encountered in cranial nerve palsies (CNP). The purpose is also to describe the different means of treatment during the observational preoperative period and their positive or negative impact on each of the symptoms and problems. Finally, we will present our way of handling these patients in their preoperative period: practical, inexpensive, and unsophisticated means that keep the patient comfortable and prevent the secondary untoward effects that can take place.

  11. Three-dimensional interactive and stereotactic atlas of head muscles and glands correlated with cranial nerves and surface and sectional neuroanatomy.

    Science.gov (United States)

    Nowinski, Wieslaw L; Chua, Beng Choon; Johnson, Aleksandra; Qian, Guoyu; Poh, Lan Eng; Yi, Su Hnin Wut; Bivi, Aminah; Nowinska, Natalia G

    2013-04-30

    Three-dimensional (3D) relationships between head muscles and cranial nerves innervating them are complicated. Existing sources present these relationships in illustrations, radiologic scans, or autopsy photographs, which are limited for learning and use. Developed electronic atlases are limited in content, quality, functionality, and/or presentation. We create a truly 3D interactive, stereotactic and high quality atlas, which provides spatial relationships among head muscles, glands and cranial nerves, and correlates them to surface and sectional neuroanatomy. The head muscles and glands were created from a 3T scan by contouring them and generating 3D models. They were named and structured according to Terminologia anatomica. The muscles were divided into: extra-ocular, facial, masticatory and other muscles, and glands into mouth and other glands. The muscles, glands (and also head) were placed in a stereotactic coordinate system. This content was integrated with cranial nerves and neuroanatomy created earlier. To explore this complex content, a scalable user interface was designed with 12 modules including central nervous system (cerebrum, cerebellum, brainstem, spinal cord), cranial nerves, muscles, glands, arterial system, venous system, tracts, deep gray nuclei, ventricles, white matter, visual system, head. Anatomy exploration operations include compositing/decompositing, individual/group selection, 3D view-index mapping, 3D labeling, highlighting, distance measuring, 3D brain cutting, and axial/coronal/sagittal triplanar display. To our best knowledge, this is the first truly 3D, stereotactic, interactive, fairly complete atlas of head muscles, and the first attempt to create a 3D stereotactic atlas of glands. Its use ranges from education of students and patients to research to potential clinical applications.

  12. Electrical Stimulation of the Ear, Head, Cranial Nerve, or Cortex for the Treatment of Tinnitus: A Scoping Review

    Directory of Open Access Journals (Sweden)

    Derek J. Hoare

    2016-01-01

    Full Text Available Tinnitus is defined as the perception of sound in the absence of an external source. It is often associated with hearing loss and is thought to result from abnormal neural activity at some point or points in the auditory pathway, which is incorrectly interpreted by the brain as an actual sound. Neurostimulation therapies therefore, which interfere on some level with that abnormal activity, are a logical approach to treatment. For tinnitus, where the pathological neuronal activity might be associated with auditory and other areas of the brain, interventions using electromagnetic, electrical, or acoustic stimuli separately, or paired electrical and acoustic stimuli, have been proposed as treatments. Neurostimulation therapies should modulate neural activity to deliver a permanent reduction in tinnitus percept by driving the neuroplastic changes necessary to interrupt abnormal levels of oscillatory cortical activity and restore typical levels of activity. This change in activity should alter or interrupt the tinnitus percept (reduction or extinction making it less bothersome. Here we review developments in therapies involving electrical stimulation of the ear, head, cranial nerve, or cortex in the treatment of tinnitus which demonstrably, or are hypothesised to, interrupt pathological neuronal activity in the cortex associated with tinnitus.

  13. Multiple, supernumerary retained teeth in the course of cleido-cranial dysplasia. A case report.

    Science.gov (United States)

    Lewandowski, Bogumił; Martula-Gala, Katarzyna; Brodowski, Robert; Zych, Barbara

    2015-01-01

    Cleido-cranial dysplasia, often referred to as Scheuthauer-Marie-Sainton syndrome, is an autosomal dominant disorder of the musculo-skeletal system. Patients with cleido-cranial dysplasia are characterized by short stature, frequent varus or valgus hip, kyphoscoliosis, underdevelopment of the scapulas and the sternum, incorrect number of ribs. The most characteristic feature is unilateral or bilateral, partial or total underdevelopment of clavicles. Mental development is not affected in this syndrome. Malocclusion, occlusal irregularities, multiple supernumerary teeth, impacted teeth, and persistent milk teeth are found in the stomatognathic system. Teeth often have abnormal anatomy. Gothic palate, cleft hard and soft palate are diagnosed. The aim of this paper is to present a case of a 12-year-old boy diagnosed with irregularities in the masticatory system involving an additional number of retained teeth. The boy was referred by an orthodontist for surgical and orthodontic team therapy. The case presented confirms the observations of other authors that only the multi-specialty collaboration of a pediatrician, a geneticist, an orthopedist, an orthodontist, a maxillofacial surgeon, an implant prosthetic surgeon and a physiotherapist can provide proper diagnosis and treatment.

  14. Evaluation of volumetric modulated arc therapy for cranial radiosurgery using multiple noncoplanar arcs

    Energy Technology Data Exchange (ETDEWEB)

    Audet, Chantal; Poffenbarger, Brett A.; Chang, Pauling; Jackson, Paul S.; Lundahl, Robert E.; Ryu, Stephen I.; Ray, Gordon R. [Radiation Oncology Department, Palo Alto Medical Foundation, Palo Alto, California 94301 (United States); Neurosurgery Department, Palo Alto Medical Foundation, Palo Alto, California 94301 (United States); Radiation Oncology Department, Palo Alto Medical Foundation, Palo Alto, California 94301 (United States); Neurosurgery Department, Palo Alto Medical Foundation, Palo Alto, California 94301 (United States); Radiation Oncology Department, Palo Alto Medical Foundation, Palo Alto, California 94301 (United States)

    2011-11-15

    Purpose: To evaluate a commercial volumetric modulated arc therapy (VMAT), using multiple noncoplanar arcs, for linac-based cranial radiosurgery, as well as evaluate the combined accuracy of the VMAT dose calculations and delivery. Methods: Twelve patients with cranial lesions of variable size (0.1-29 cc) and two multiple metastases patients were planned (Eclipse RapidArc AAA algorithm, v8.6.15) using VMAT (1-6 noncoplanar arcs), dynamic conformal arc (DCA, {approx}4 arcs), and IMRT (nine static fields). All plans were evaluated according to a conformity index (CI), healthy brain tissue doses and volumes, and the dose to organs at risk. A 2D dose distribution was measured (Varian Novalis Tx, HD120 MLC, 1000 MU/min, 6 MV beam) for the {approx}4 arc VMAT treatment plans using calibrated film dosimetry. Results: The CI (0-1 best) average for all plans was best for {approx}4 noncoplanar arc VMAT at 0.86 compared with {approx}0.78 for IMRT and a single arc VMAT and 0.68 for DCA. The volumes of healthy brain receiving 50% of the prescribed target coverage dose or more (V{sub 50%}) were lowest for the four arc VMAT [RA(4)] and DCA plans. The average ratio of the V{sub 50%} for the other plans to the RA(4) V{sub 50%} were 1.9 for a single noncoplanar arc VMAT [RA(1nc)], 1.4 for single full coplanar arc VMAT [RA(1f)] and 1.3 for IMRT. The V{sub 50%} improved significantly for single isocenter multiple metastases plan when two noncoplanar VMAT arcs were added to a full single coplanar one. The maximum dose to 5 cc of the outer 1 cm rim of healthy brain which one may want to keep below nonconsequential doses of 300-400 cGy, was 2-3 times greater for IMRT, RA(1nc) and RA(1f) plans compared with the multiple noncoplanar arc DCA and RA(4) techniques. Organs at risk near (0-4 mm) to targets were best spared by (i) single noncoplanar arcs when the targets are lateral to the organ at risk and (ii) by skewed nonvertical planes of IMRT fields when the targets are not lateral to the

  15. Magnetic resonance imaging in optic nerve lesions with multiple sclerosis

    Energy Technology Data Exchange (ETDEWEB)

    Kojima, Shigeyuki; Hirayama, Keizo; Kakisu, Yonetsugu; Adachi, Emiko (Chiba Univ. (Japan). School of Medicine)

    1990-12-01

    Magnetic resonance imaging (MRI) of the optic nerve was performed in 10 patients with multiple sclerosis (MS) using short inversion time inversion recovery (STIR) pulse sequences, and the results were compared with the visual evoked potentials (VEP). The 10 patients had optic neuritis in the chronic or remitting phase together with additional symptoms or signs allowing a diagnosis of clinically definite or probable MS. Sixteen optic nerves were clinically affected and 4 were unaffected. MRI was performed using a 0.5 tesla supeconducting unit, and multiple continuous 5 mm coronal and axial STIR images were obtained. A lesion was judged to be present if a focal or diffuse area of increased signal intensity was detectd in the optic nerve. In VEP, a delay in peak latency or no P 100 component was judged to be abnormal. With regard to the clinically affected optic nerves, MRI revealed a region of increased signal intensity in 14/16 (88%) and the VEP was abnormal in 16/16 (100%). In the clinically unaffected optic nerves, MRI revealed an increased signal intensity in 2/4 (50%). One of these nerves had an abnormal VEP and the other had a VEP latency at the upper limit of normal. The VEP was abnormal in 1/4 (25%). In the clinically affected optic nerves, the degree of loss of visual acuity was not associated with the longitudinal extent of the lesions shown by MRI. The mean length was 17.5 mm in optic nerves with a slight disturbance of visual acuity and 15.0 mm in nerves with severe visual loss. MRI using STIR pulse sequences was found to be almost as sensitive as VEP in detecting both clinically affected and unaffected optic nerve lesions in patients with MS, and was useful in visualizing the location or size of the lesions. (author).

  16. Dysphagia and disrupted cranial nerve development in a mouse model of DiGeorge (22q11 deletion syndrome

    Directory of Open Access Journals (Sweden)

    Beverly A. Karpinski

    2014-02-01

    Full Text Available We assessed feeding-related developmental anomalies in the LgDel mouse model of chromosome 22q11 deletion syndrome (22q11DS, a common developmental disorder that frequently includes perinatal dysphagia – debilitating feeding, swallowing and nutrition difficulties from birth onward – within its phenotypic spectrum. LgDel pups gain significantly less weight during the first postnatal weeks, and have several signs of respiratory infections due to food aspiration. Most 22q11 genes are expressed in anlagen of craniofacial and brainstem regions critical for feeding and swallowing, and diminished expression in LgDel embryos apparently compromises development of these regions. Palate and jaw anomalies indicate divergent oro-facial morphogenesis. Altered expression and patterning of hindbrain transcriptional regulators, especially those related to retinoic acid (RA signaling, prefigures these disruptions. Subsequently, gene expression, axon growth and sensory ganglion formation in the trigeminal (V, glossopharyngeal (IX or vagus (X cranial nerves (CNs that innervate targets essential for feeding, swallowing and digestion are disrupted. Posterior CN IX and X ganglia anomalies primarily reflect diminished dosage of the 22q11DS candidate gene Tbx1. Genetic modification of RA signaling in LgDel embryos rescues the anterior CN V phenotype and returns expression levels or pattern of RA-sensitive genes to those in wild-type embryos. Thus, diminished 22q11 gene dosage, including but not limited to Tbx1, disrupts oro-facial and CN development by modifying RA-modulated anterior-posterior hindbrain differentiation. These disruptions likely contribute to dysphagia in infants and young children with 22q11DS.

  17. Dysphagia and disrupted cranial nerve development in a mouse model of DiGeorge (22q11) deletion syndrome.

    Science.gov (United States)

    Karpinski, Beverly A; Maynard, Thomas M; Fralish, Matthew S; Nuwayhid, Samer; Zohn, Irene E; Moody, Sally A; LaMantia, Anthony-S

    2014-02-01

    We assessed feeding-related developmental anomalies in the LgDel mouse model of chromosome 22q11 deletion syndrome (22q11DS), a common developmental disorder that frequently includes perinatal dysphagia--debilitating feeding, swallowing and nutrition difficulties from birth onward--within its phenotypic spectrum. LgDel pups gain significantly less weight during the first postnatal weeks, and have several signs of respiratory infections due to food aspiration. Most 22q11 genes are expressed in anlagen of craniofacial and brainstem regions critical for feeding and swallowing, and diminished expression in LgDel embryos apparently compromises development of these regions. Palate and jaw anomalies indicate divergent oro-facial morphogenesis. Altered expression and patterning of hindbrain transcriptional regulators, especially those related to retinoic acid (RA) signaling, prefigures these disruptions. Subsequently, gene expression, axon growth and sensory ganglion formation in the trigeminal (V), glossopharyngeal (IX) or vagus (X) cranial nerves (CNs) that innervate targets essential for feeding, swallowing and digestion are disrupted. Posterior CN IX and X ganglia anomalies primarily reflect diminished dosage of the 22q11DS candidate gene Tbx1. Genetic modification of RA signaling in LgDel embryos rescues the anterior CN V phenotype and returns expression levels or pattern of RA-sensitive genes to those in wild-type embryos. Thus, diminished 22q11 gene dosage, including but not limited to Tbx1, disrupts oro-facial and CN development by modifying RA-modulated anterior-posterior hindbrain differentiation. These disruptions likely contribute to dysphagia in infants and young children with 22q11DS.

  18. Currant imaging of the 3rd, 4th and 6th cranial nerves; Nevroradiologisk fremstilling av 3., 4. og 6. hjernenerve

    Energy Technology Data Exchange (ETDEWEB)

    Kerty, Emilia; Bakke, Soeren Jacob

    2001-07-01

    The ocular motor cranial nerves (III, IV, VI) control the eye movements in a near association with the higher cortical areas. Clinically, the most common presentation of abnormal ocular motility is double vision. Identifying the cause of ocular nerve pulsy can be difficult and a large percentage of such cases still remains undiagnosed, even in a new era of neuroradiological techniques. Close co-operation between the clinician and the radiologist is necessary for the selection of the best imaging methods for the specific clinical problem, in order to see the aetiological and topological diagnosis. The article provides a practical review of advances in neuroimaging of the ocular motor nerves. 4 figs., 2 tabs., 15 refs.

  19. A rare case of bilateral malignant otitis externa and osteomyelitis with lower cranial nerve sequelae.

    Science.gov (United States)

    Leahy, Travis William; Sader, Chady

    2011-05-12

    The authors present the case of a 76-year-old male who presented with right-sided recurrent malignant otitis externa (MOE) and skull-base osteomyelitis. His management involved aggressive antimicrobial therapy and multiple hyperbaric oxygen treatments. After resolution of his right-sided infection, the patient returned a short time later with symptoms and findings consistent with new, left-sided MOE with involvement of the left skull-base. With repeat treatment, the patient is now cured of his infection but poses a challenge to the treating team about future management.

  20. Visualization of the 12th Cranial Nerve with MRI: Value of Balanced Fast-Field Echo and 3D-Drive Sequences Among the T2 TSE Post-Contrast T1 Sequences

    OpenAIRE

    2010-01-01

    Background/Objective: Our aim was to optimize the most effective MR imaging sequence for visualization of the 12th cranial nerve (hypoglossal nerve) through its cisternal course."nPatients and Methods: We applied balanced fast-field echo (B-FFE), 3D-T2 weighted Driven Equilibrium RF Reset Pulse (DRIVE), T2 weighted 2D TSE and post-contrast T1 weighted sequences and tried to find out the best sequence for the perfect visualization of the 12th cranial nerve. One-hundred patients without an...

  1. The distribution of nicotinamide adenine dinucleotide phosphate-diaphorase (NADPH-d) in the medulla oblongata, spinal cord, cranial and spinal nerves of frog, Microhyla ornata.

    Science.gov (United States)

    Jadhao, Arun G; Biswas, Saikat P; Bhoyar, Rahul C; Pinelli, Claudia

    2017-04-01

    Nicotinamide adenine dinucleotide phosphate-diaphorase (NADPH-d) enzymatic activity has been reported in few amphibian species. In this study, we report its unusual localization in the medulla oblongata, spinal cord, cranial nerves, spinal nerves, and ganglions of the frog, Microhyla ornata. In the rhombencephalon, at the level of facial and vagus nerves, the NADPH-d labeling was noted in the nucleus of the abducent and facial nerves, dorsal nucleus of the vestibulocochlear nerve, the nucleus of hypoglossus nerve, dorsal and lateral column nucleus, the nucleus of the solitary tract, the dorsal field of spinal grey, the lateral and medial motor fields of spinal grey and radix ventralis and dorsalis (2-10). Many ependymal cells around the lining of the fourth ventricle, both facial and vagus nerves and dorsal root ganglion, were intensely labeled with NADPH-d. Most strikingly the NADPH-d activity was seen in small and large sized motoneurons in both medial and lateral motor neuron columns on the right and left sides of the brain. This is the largest stained group observed from the caudal rhombencephalon up to the level of radix dorsalis 10 in the spinal cord. The neurons were either oval or elongated in shape with long processes and showed significant variation in the nuclear and cellular diameter. A massive NADPH-d activity in the medulla oblongata, spinal cord, and spinal nerves implied an important role of this enzyme in the neuronal signaling as well as in the modulation of motor functions in the peripheral nervous systems of the amphibians.

  2. Cranial nerves palsy as an initial feature of an early onset distal hereditary motor neuropathy--a new distal hereditary motor neuropathy phenotype.

    Science.gov (United States)

    Haberlová, J; Claeys, K G; De Jonghe, P; Seeman, P

    2009-06-01

    Distal hereditary motor neuropathy is a heterogeneous group of disorders characterised by a pure motor axonal neuropathy. It is occasionally associated with additional signs such as facial weakness, vocal cord paralysis, weakness of the diaphragm, and pyramidal signs. Although predominantly the inheritance is autosomal dominant, all types of inheritance have been described. Here we report a Czech family with cranial nerves palsy as an initial feature of a non progressive infantile onset dominant distal hereditary motor neuropathy. This family may represent a new subtype of distal hereditary motor neuropathy.

  3. Microvascular Cranial Nerve Palsy

    Science.gov (United States)

    ... Follow The Academy Professionals: Education Guidelines News Multimedia Public & Patients: Contact Us About the Academy Jobs at the Academy Financial Relationships with Industry Medical Disclaimer Privacy Policy Terms of Service For Advertisers For Media Ophthalmology Job Center © American Academy of ...

  4. Visualization of the 12th Cranial Nerve with MRI: Value of Balanced Fast-Field Echo and 3D-Drive Sequences Among the T2 TSE Post-Contrast T1 Sequences

    Directory of Open Access Journals (Sweden)

    H Aydin

    2010-10-01

    Full Text Available Background/Objective: Our aim was to optimize the most effective MR imaging sequence for visualization of the 12th cranial nerve (hypoglossal nerve through its cisternal course."nPatients and Methods: We applied balanced fast-field echo (B-FFE, 3D-T2 weighted Driven Equilibrium RF Reset Pulse (DRIVE, T2 weighted 2D TSE and post-contrast T1 weighted sequences and tried to find out the best sequence for the perfect visualization of the 12th cranial nerve. One-hundred patients without any hypoglossal nerve paralysis were examined via these sequences. Imaging analysis was graded as follows: certain visualization of nerves (score 2, partially visualized nerves (score 1, non-visualized nerves (score 0."nResults: The hypoglossal nerve was visualized exactly in only eight cases and partially depicted in only six cases with the post-contrast T1 series. In B-FFE sequence; 56% of the nerves were properly seen and 8% of the nerves were partially identified, using T2 weighted DRIVE sequences; 30% of the nerves were clearly visualized, the nerves were partially depicted in 15 patients. Regarding the T2 weighted TSE sequence, 15% of the nerves were certainly depicted and in seven patients the nerves were partially depicted."nConclusion: The most diagnostic sequence for the exact visualization of the cisternal course of hypoglossal nerve is B-FFE revealing a 64% visualization rate for the cisternal parts (112 exactly, 16 partially. T2W DRIVE sequence is shown to be more diagnostic than the T2W TSE for visualization of the cisternal part of the hypoglossal nerve.    

  5. Ultrastructure of cranial nerves of rats inoculated with rabies virus Ultraestrutura de nervos cranianos de ratos inoculados com o vírus da raiva

    Directory of Open Access Journals (Sweden)

    Guilberto Minguetti

    1997-01-01

    Full Text Available The V and VII cranial nerves of rats inoculated with rabies virus were studied by electron microscopy. The results were compared with the same cranial nerves of rats inoculated with rabies virus but vaccinated against the disease. The findings are those of axonal degeneration and intense demyelination of the nerves of the group of rats not vaccinated. The vaccinated rats showed some ultrastructural irrelevant alterations when compared with the other group. The degree of ultrastructural alterations found in the group of rats not vaccinated suggests that in rabies severe damage of the cranial nerves occurs and that this may be closely related to the clinical picture of the disease (hydrophobia. Furthermore, as far as the authors know, this has not been considered in the classic descriptions of rabies and it is possible that an immunologic process may take part in the demyelination observed in the present study.Os autores estudaram o quinto e o sétimo nervos cranianos de ratos inoculados com o vírus da raiva. Os resultados foram comparados com os mesmos nervos cranianos de ratos inoculados com o vírus da raiva, porém vacinados contra a doença. Os achados no grupo não vacinado foram de degeneração axonal e intensa desmielinização dos nervos examinados. No grupo vacinado foram encontrados apenas discretas alterações da mielina, sem relevância do ponto de vista patológico. As grandes alterações ultraestruturais encontradas no grupo de ratos não vacinados sugerem que na raiva ocorram acentuadas alterações nos nervos cranianos e que tais alterações devem estar intimamente relacionadas ao quadro clínico da doença (hidrofobia. Além disso, é possível que tais alterações estejam associadas a um processo imunológico responsável também por acometimento sistêmico dos nervos periféricos.

  6. One case report of pharyngeal bursa invasive fungal disease with lower cranial nerve involvement as the first manifestation%以后组脑神经受累为首要表现的咽囊侵袭性真菌病1例

    Institute of Scientific and Technical Information of China (English)

    陈静; 袁虎

    2013-01-01

    To increase the identification of pharyngeal bursa invasive fungal disease with lower cranial nerve involvement,reduce the misdiagnosis and improve the awareness of invasive fungal disease.We report the clinical data of a case with lower cranial nerve involvement as the first manifestation and reviewed the related literature.

  7. Detection of third and sixth cranial nerve palsies with a novel method for eye tracking while watching a short film clip.

    Science.gov (United States)

    Samadani, Uzma; Farooq, Sameer; Ritlop, Robert; Warren, Floyd; Reyes, Marleen; Lamm, Elizabeth; Alex, Anastasia; Nehrbass, Elena; Kolecki, Radek; Jureller, Michael; Schneider, Julia; Chen, Agnes; Shi, Chen; Mendhiratta, Neil; Huang, Jason H; Qian, Meng; Kwak, Roy; Mikheev, Artem; Rusinek, Henry; George, Ajax; Fergus, Robert; Kondziolka, Douglas; Huang, Paul P; Smith, R Theodore

    2015-03-01

    Automated eye movement tracking may provide clues to nervous system function at many levels. Spatial calibration of the eye tracking device requires the subject to have relatively intact ocular motility that implies function of cranial nerves (CNs) III (oculomotor), IV (trochlear), and VI (abducent) and their associated nuclei, along with the multiple regions of the brain imparting cognition and volition. The authors have developed a technique for eye tracking that uses temporal rather than spatial calibration, enabling detection of impaired ability to move the pupil relative to normal (neurologically healthy) control volunteers. This work was performed to demonstrate that this technique may detect CN palsies related to brain compression and to provide insight into how the technique may be of value for evaluating neuropathological conditions associated with CN palsy, such as hydrocephalus or acute mass effect. The authors recorded subjects' eye movements by using an Eyelink 1000 eye tracker sampling at 500 Hz over 200 seconds while the subject viewed a music video playing inside an aperture on a computer monitor. The aperture moved in a rectangular pattern over a fixed time period. This technique was used to assess ocular motility in 157 neurologically healthy control subjects and 12 patients with either clinical CN III or VI palsy confirmed by neuro-ophthalmological examination, or surgically treatable pathological conditions potentially impacting these nerves. The authors compared the ratio of vertical to horizontal eye movement (height/width defined as aspect ratio) in normal and test subjects. In 157 normal controls, the aspect ratio (height/width) for the left eye had a mean value ± SD of 1.0117 ± 0.0706. For the right eye, the aspect ratio had a mean of 1.0077 ± 0.0679 in these 157 subjects. There was no difference between sexes or ages. A patient with known CN VI palsy had a significantly increased aspect ratio (1.39), whereas 2 patients with known CN III

  8. 后组颅神经的颅底内镜手术解剖%Endoscopic Anatomy Study of Lower Cranial Nerves

    Institute of Scientific and Technical Information of China (English)

    朱杭军; 王玉海; 叶光明; 张建东; 袁林杰; 马新军

    2013-01-01

    目的:观察迷路后和乙状窦后径路后组颅神经内镜手术的相关解剖结构,为后组颅神经内镜手术提供解剖资料。方法:在8例16侧成人尸头上模拟实施迷路后和乙状窦后径路后组颅神经内镜手术,观察手术径路上各结构对手术的影响以及第9~12颅神经之间的解剖关系;去除顶骨、大脑以及部分小脑组织,暴露颈静脉孔、内耳门及其周围结构,测量颈静脉孔上缘距内耳门下缘垂直距离。结果:8例16侧标本均顺利完成迷路后径路模拟内镜手术;2例4侧在不损伤小脑情况下顺利完成乙状窦后径路模拟手术,小脑为内镜导入的主要障碍。镜下观舌咽和迷走神经之间间距相对较大,迷走神经和副神经发生部相距很近;舌下神经位于上述颅神经前、内、下方,形成5~8束较细神经纤维平行分布。颈静脉孔上缘距内耳门下缘垂直距离为(8.26±1.05)mm。结论:迷路后径路为后组颅神经内镜手术较理想径路,而单纯依靠乙状窦后“锁孔”入路实施内镜手术相当困难;内耳门是手术中可靠的定位标志。%Objective:To provide anatomic data of lower cranial nerves to avoid damnification in the endoscopic surgery.Methods:To perform the postlabyrinthine and postsigmoid endoscopic surgery on 8 fomalin-fixed adult cadaver specimens , the lower cranial nerves was observed by endoscope , and the different approa-ches were compared at the same time .To excise the calvarium and cereburm , the nerves were exposed and ob-served, the distance from internal accoustic pore to glossopharyngeal was measured .Results:All postlabyrin-thine endoscopic surgeries were performed successfully;only 4 postsigmoid endoscopic surgeries were performed as well.The distance from internal accoustic pore to glossopharyngeal was (8.26 ±1.05)mm.Conclusions:The lower cranial nerves endoscopic surgery can be performed successfully by

  9. Formation of a full complement of cranial proprioceptors requires multiple neurotrophins

    NARCIS (Netherlands)

    Fan, GP; Copray, S; Huang, EJ; Jones, K; Yan, Q; Walro, J; Jaenisch, R; Kucera, J

    2000-01-01

    Inactivation of neurotrophin-3 (NT3) completely blocks the development of limb proprioceptive neurons and their end organs, the muscle spindles. We examined whether cranial proprioceptive neurons of the trigeminal mesencephalic nucleus (TMN) require NT3, brain-derived neurotrophic factor (BDNF) or n

  10. Analysis of cranial nerve growthine improving quality of life in cerebral infarction%脑神经生长素治疗脑梗死患者生存质量分析

    Institute of Scientific and Technical Information of China (English)

    吴建农; 刘建新

    2002-01-01

    Background: Cranial nerve growthine (CNG) is a kind of new biochemical drug containing many special neuroactive substances which have a good therapeutic effect in cerebrovascular diseases, and can distinctly improve quality of life for patients with cerebral infarction. The quality of life is an improtant factor for rehabilitation,it is life satisfaction, psychological well being,happiness,adaptation and mental health.

  11. The Multiple Silicone Tube Device, “Tubes within a Tube,” for Multiplication in Nerve Reconstruction

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    Fredrik Johansson

    2014-01-01

    Full Text Available Multiple nerve branches were created during the regeneration procedure after a nerve injury and such multiple branches are suggested to be used to control, for example, prosthesis with many degrees of freedom. Transected rat sciatic nerve stumps were inserted into a nine mm long silicone tube, which contained four, five mm long, smaller tubes, thus leaving a five mm gap for regenerating nerve fibers. Six weeks later, several new nerve structures were formed not only in the four smaller tubes, but also in the spaces in-between. The 7–9 new continuous nerve structures, which were isolated as individual free nerves after removal of the tubes, were delineated by a perineurium and contained both myelinated and unmyelinated nerve fibers as well as blood vessels. Stimulation of the proximal nerve elicited contractions in distal muscles. Thin metal electrodes, inserted initially into the smaller tubes in some experiments, became embedded in the new nerve structures and when stimulated contractions of the distal muscles were observed. The “tubes within a tube” technique, creating multiple new nerves from a single “mother” nerve, can be used to record multiple signals for prosthetic device control or as sources for supply of multiple denervated targets.

  12. Clinical Features and Outcomes of Strabismus Treatment in Third Cranial Nerve Palsy during a 10-Year Period

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    Abbas Bagheri

    2014-01-01

    Conclusion: Surgical management of strabismus in patients with third nerve palsy is difficult and challenging, however the majority of patients achieve ideal results with appropriate and stepwise surgical plans.

  13. Human primitive meninges in and around the mesencephalic flexure and particularly their topographical relation to cranial nerves.

    Science.gov (United States)

    Cho, Kwang Ho; Rodríguez-Vázquez, Jose Francisco; Han, Eui Hyeog; Verdugo-López, Samuel; Murakami, Gen; Cho, Baik Hwan

    2010-09-20

    Development of the meninges in and around the plica ventralis encephali has not been well documented. A distinct mesenchymal structure, the so-called plica ventralis encephali, is sandwiched by the fetal mesencephalic flexure. We histologically examined paraffin-embedded sections from 18 human embryos and fetuses at 6-12 weeks of gestation. In the loose tissues of the plica, the first meninx appeared as a narrow membrane along the oculomotor nerve at 7-8 weeks. Subsequently, the plica ventralis evolved into 3 parts: bilateral lateral mesenchymal condensations and a primitive membranous meninx extending between. Notably, the topographical anatomy of the oculomotor, trochlear and trigeminal nerves did not change: the oculomotor nerve ran along the rostral aspect of the membranous meninx, the trigeminal nerve ran along the caudal side of the lateral mesenchymal condensation, and the trochlear nerve remained embedded in the lateral condensation. Up to 9-10 weeks, the lateral mesenchymal condensations became tongue-like folds; i.e., the primitive form of the tentorium cerebelli, while the membranous meninx became the diaphragma sellae. The falx cerebri seemed to develop from the tongue-like folds. Overall, the final tentorium cerebelli corresponded to the regressed plica ventralis, while the parasellar area originated from the base of the plica and other tissues along the ventral aspects of the basisphenoid and basioccipital.

  14. Magnetic resonance imaging of the extraocular muscles and corresponding cranial nerves in patients with special forms of strabismus

    Institute of Scientific and Technical Information of China (English)

    JIAO Yong-hong; ZHAO Kan-xing; WANG Zhen-chang; QIAN Xue-han; WU Xiao; MAN Feng-yuan; LU Wei; SHE Hai-cheng

    2009-01-01

    Background With the technical advances, magnetic resonance imaging (MRI) is now sensitive enough to detect subtle structural abnormalities of ocular motor nerves arising from the brainstem and orbits of living subjects. This study was designed to delineate the MRI characteristics in patients with special forms of strabismus.Methods A total of 29 patients with special forms of strabismus underwent orbital and intracalvarium MRI. Imaging of the ocular motor nerves in the brainstem was performed in 0.8 mm thickness image planes using the three-dimensional fast imaging employing steady-state acquisition (3D-FIESTA) sequence. Nerves to extraocular muscles (EOMs), EOMs and their associated connective tissues were imaged with T1 weighting in tri-planar scans by dual-phased coils within 2.0 mm thick planes.Results Patients with congenital fibrosis of the extraocular muscles exhibited hypoplasia of the oculomotor (CN3), abducens (CN6), trochlear (CN4) nerves, and the EOMs; hypoplasia of CN6 in the brainstem and an extra branch of the inferior division of CN3 to the lateral rectus were the most common but not the only presentation of Duane's retraction syndrome. Hypoplasia of CN6, facial (CN7) and hypoglossal (CN12) nerves were revealed in patients with M(o)bius syndrome. In a rare case of bilateral synergistic convergence and divergence, an enlarged branch of CN3 to the medial rectus and a questionable branch of CN3 to the inferior rectus bilaterally were found.Conclusion MRI can reveal subtle structures of the ocular motor nerves and their corresponding EOMs. This can provide valuable information regarding pathogenesis in some special forms of strabismus.

  15. Risk factors and prognostic analysis of cranial nerve impairment in 121 patients with tuberculous meningitis%结核性脑膜炎患者颅神经损伤的相关因素及转归

    Institute of Scientific and Technical Information of China (English)

    林仕忠; 张彦亮; 金嘉琳; 陈澍; 翁心华

    2013-01-01

    Objective To investigate the risk factors associated with cranial nerve impairment in patients with tuberculous meningitis.Methods A total of 121 patients with tuberculous meningitis who were admitted to Huashan Hospital from 2000 to 2011 were reviewed retrospectively.Demographic data (gender,age),course of disease,initial results of cerebral spinal fluid (CSF) tests,occurrence of cranial nerve impairment and prognosis of these patients were collected.All the patients were followed up for at least 3 months,and for those with cranial nerve impairment,the minimum follow-up period was 1 year in order to judge the recovery of cranial nerve impairment.Multivariate analysis was performed to study the associated risk factors.Results Out of 121 patients,22 (18.2 %)developed cranial nerve impairment.Nerves involved were abducens nerve,oculomotor nerve,optic nerve and auditory nerve,and impairment of single nerve occurred in 9 (40.9 %),8 (36.4 %),7(31.8%) and 1(4.5%) patient,respectively.Three cases had more than one group of cranial nerves involved,accounting for 13.6% of the 22 patients with cranial nerve impairment.The incidence of conscious disturbance was significantly higher in patients with cranial nerve impairment than those without impairment (77 % vs 45 %,P=0.020).Delay in diagnosis (OR =1.017,95 % CI:1.001-1.033,P=0.040) and occurrence of conscious disturbance (OR =3.242,95 % CI:1.142-9.205,P=0.027) were independent predictive factors of cranial nerve injury.During one-year follow-up,90.9% of patients were fully recovered from cranial nerve impairment,with a median duration of 1 month (range 0.5-6.0 months).Conclusions Cranial nerve impairment is a common complication in patients with tuberculous meningitis.Delay in diagnosis and occurrence of conscious disturbance were independent predictive factors.Most cranial nerve impairment were reversible,and timely diagnosis and treatment are important ways to reduce complications.%目的 了解结

  16. Bilateral abducens nerve and right facial nerve palsy occuring after head trauma

    Directory of Open Access Journals (Sweden)

    ismail Boyraz

    2016-06-01

    Full Text Available Lesions of the nervus abducens, the 6th cranial nerve tend to be rare, usually occur suddenly following head injuries. A 43-year-old male patient presented with a history of fall from a height due to an occupational accident on the date of 11.01.2014. Cranial tomography demonstrated bilateral epidural hematoma. The epidural hematoma was drained during the operation. After the surgery, eye examination showed no vision loss, except limited bilateral lateral gaze. When the patient was unable to walk due to diplopia, he was advised to close one eye. On the right side, there were findings suggesting central facial paralysis. There may be multiple cranial nerve damage following head injury. Therefore, all cranial nerves should be thoroughly examined. [J Contemp Med 2016; 6(2.000: 110-113

  17. Coexisting cranial and multiple spinal meningioma in a child-report of a case.

    Science.gov (United States)

    Shukla, Sujeet Kumar; Trivedi, Adarsh; Sharma, Vivek; Singh, Kulwant

    2011-03-01

    Von Ricklinghausen's disease is commonly associated with simultaneous cranial and spinal meningioma but these are not true meningiomas. Craniospinal meningiomas without Von Ricklinghausen's disease are very rare. We report a 13-year-old girl who presented with two episodes of right focal seizure with secondary generalisation of three year's duration, weakness of both lower limbs for 6 months, and retention of urine of three month's duration. MRI brain showed enhancing lesion in the left fronto-parietal region. MRI spine revealed enhancing intradural extramedullary lesion at D(4-5), D(9-10), and L(1-2). The tumours were excised completely in a single stage, first by craniotomy then by multi level laminectomy. On histology the spinal meningioma had predominant meningothiliomatous. We followed up for 6 months and the patient recovered with power grade 4/5 both lower limb.

  18. Multiple Variations of the Nerves of Gluteal Region and their Clinical Implications

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    Prasad AM

    2016-01-01

    Full Text Available Knowledge of variations of nerves of gluteal region is important for clinicians administering intramuscular injections, for orthopedic surgeons dealing with the hip surgeries and possibly for physiotherapists managing the painful conditions and paralysis of this region. We report multiple variations of the nerves of gluteal region through this article. In the current case, the sciatic nerve was absent. The common peroneal and tibial nerves arose from sacral plexus and reached the gluteal region through greater sciatic foramen above and below piriformis respectively. The common peroneal nerve gave a muscular branch to the gluteus maximus. The inferior gluteal nerve and posterior cutaneous nerve of the thigh arose from a common trunk. The common trunk was formed by three roots. Upper and middle roots arose from sacral plexus and entered gluteal region through greater sciatic foramen respectively above and below piriformis. The lower root arose from the pudendal nerve and joined the common trunk. We discuss the clinical implications of the variations.

  19. Added value of contrast-enhanced CISS imaging in relation to conventional MR images for the evaluation of intracavernous cranial nerve lesions

    Energy Technology Data Exchange (ETDEWEB)

    Yagi, Akiko; Takahashi, Ayako; Morita, Hideo; Amanuma, Makoto; Endo, Keigo [Gunma University School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Gunma (Japan); Sato, Noriko [National Center Hospital of Neurology and Psychiatry, Department of Radiology, Kodaira, Tokyo (Japan); Takeuchi, K. [Takasaki University of Health and Welfare, Department of Health and Welfare, Gunma (Japan)

    2010-12-15

    The normal cranial nerves (CNs) of the cavernous sinus can be clearly demonstrated using contrast-enhanced constructive interference in steady-state (CISS) magnetic resonance imaging (MRI). This study used the method to evaluate pathological CNs III, IV, V{sub 1}, V{sub 2}, and VI in cavernous sinuses affected by inflammatory and neoplastic diseases. MR images from 17 patients with diseases involving the cavernous sinuses and/or causing neuropathy in CNs III-VI were retrospectively evaluated. The patients were divided into inflammatory (n = 11) and neoplastic (n = 6) groups. We defined CNs as abnormal when they exhibited enlargement or enhancement. CNs were evaluated using both contrast-enhanced CISS and T1-weighted MRI. In the inflammatory group, abnormal CNs were identified by contrast-enhanced CISS MRI in 13 of 25 symptomatic CNs (52%) in eight patients, but in only two CNs (8%) in two patients by contrast-enhanced T1-weighted MRI. In the neoplastic group, both sequences of contrast-enhanced CISS and T1-weighted MRI detected abnormalities in the same three of eight symptomatic CNs (37.5%), i.e., the three CNs were all in the same patient with adenoid cystic carcinoma. Contrast-enhanced CISS MRI is useful for detecting CN abnormalities in inflammatory pathological conditions of the cavernous sinuses. (orig.)

  20. The truth is in the water: metastatic prostate cancer presenting as an intermittent facial nerve palsy.

    Science.gov (United States)

    Wooles, N; Gupta, S; Wilkin-Crowe, H; Juratli, A

    2015-04-24

    An elderly man presented to the acute ear, nose and throat (ENT) services with a history of intermittent, self-limiting facial nerve palsy. Full ENT examination was normal, with all cranial nerves and peripheral neurology intact. Multiple imaging modalities suggested an aggressive bony lesion, secondary to locally advanced prostate malignancy with extensive metastatic infiltration. Prostate cancer is known to preferentially metastasise to bone and has been known to cause multiple cranial nerve palsies and ophthalmoplegia. This is the first case described in the literature of metastatic prostate cancer presenting with intermittent facial nerve palsy.

  1. Nerve biopsy findings contribute to diagnosis of multiple mononeuropathy: 78% of findings support clinical diagnosis.

    Science.gov (United States)

    Zhang, Ying-Shuang; Sun, A-Ping; Chen, Lu; Dong, Rong-Fang; Zhong, Yan-Feng; Zhang, Jun

    2015-01-01

    Multiple mononeuropathy is an unusual form of peripheral neuropathy involving two or more nerve trunks. It is a syndrome with many different causes. We reviewed the clinical, electrophysiological and nerve biopsy findings of 14 patients who suffered from multiple mononeuropathy in our clinic between January 2009 and June 2013. Patients were diagnosed with vasculitic neuropathy (n = 6), perineuritis (n = 2), chronic inflammatory demyelinating polyradiculoneuropathy (n = 2) or Lewis-Sumner syndrome (n = 1) on the basis of clinical features, laboratory data, electrophysiological investigations and nerve biopsies. Two patients who were clinically diagnosed with vasculitic neuropathy and one patient who was clinically diagnosed with chronic inflammatory demyelinating polyradiculoneuropathy were not confirmed by nerve biopsy. Nerve biopsies confirmed clinical diagnosis in 78.6% of the patients (11/14). Nerve biopsy pathological diagnosis is crucial to the etiological diagnosis of multiple mononeuropathy.

  2. Nerve biopsy findings contribute to diagnosis of multiple mononeuropathy: 78% of findings support clinical diagnosis

    Directory of Open Access Journals (Sweden)

    Ying-shuang Zhang

    2015-01-01

    Full Text Available Multiple mononeuropathy is an unusual form of peripheral neuropathy involving two or more nerve trunks. It is a syndrome with many different causes. We reviewed the clinical, electrophysiological and nerve biopsy findings of 14 patients who suffered from multiple mononeuropathy in our clinic between January 2009 and June 2013. Patients were diagnosed with vasculitic neuropathy (n = 6, perineuritis (n = 2, chronic inflammatory demyelinating polyradiculoneuropathy (n = 2 or Lewis-Sumner syndrome (n = 1 on the basis of clinical features, laboratory data, electrophysiological investigations and nerve biopsies. Two patients who were clinically diagnosed with vasculitic neuropathy and one patient who was clinically diagnosed with chronic inflammatory demyelinating polyradiculoneuropathy were not confirmed by nerve biopsy. Nerve biopsies confirmed clinical diagnosis in 78.6% of the patients (11/14. Nerve biopsy pathological diagnosis is crucial to the etiological diagnosis of multiple mononeuropathy.

  3. Nerve biopsy ifndings contribute to diagnosis of multiple mononeuropathy:78% of ifndings support clinical diagnosis

    Institute of Scientific and Technical Information of China (English)

    Ying-shuang Zhang; A-ping Sun; Lu Chen; Rong-fang Dong; Yan-feng Zhong; Jun Zhang

    2015-01-01

    Multiple mononeuropathy is an unusual form of peripheral neuropathy involving two or more nerve trunks. It is a syndrome with many different causes. We reviewed the clinical, electrophysi-ological and nerve biopsy ifndings of 14 patients who suffered from multiple mononeuropathy in our clinic between January 2009 and June 2013. Patients were diagnosed with vasculitic neurop-athy (n = 6), perineuritis (n = 2), chronic inlfammatory demyelinating polyradiculoneuropathy (n = 2) or Lewis-Sumner syndrome (n = 1) on the basis of clinical features, laboratory data, elec-trophysiological investigations and nerve biopsies. Two patients who were clinically diagnosed with vasculitic neuropathy and one patient who was clinically diagnosed with chronic inlfamma-tory demyelinating polyradiculoneuropathy were not conifrmed by nerve biopsy. Nerve biopsies conifrmed clinical diagnosis in 78.6% of the patients (11/14). Nerve biopsy pathological diagno-sis is crucial to the etiological diagnosis of multiple mononeuropathy.

  4. Fast imaging employing steady-state acquisition (FIESTA) MRI to investigate cerebrospinal fluid (CSF) within dural reflections of posterior fossa cranial nerves.

    Science.gov (United States)

    Noble, David J; Scoffings, Daniel; Ajithkumar, Thankamma; Williams, Michael V; Jefferies, Sarah J

    2016-11-01

    There is no consensus approach to covering skull base meningeal reflections-and cerebrospinal fluid (CSF) therein-of the posterior fossa cranial nerves (CNs VII-XII) when planning radiotherapy (RT) for medulloblastoma and ependymoma. We sought to determine whether MRI and specifically fast imaging employing steady-state acquisition (FIESTA) sequences can answer this anatomical question and guide RT planning. 96 posterior fossa FIESTA sequences were reviewed. Following exclusions, measurements were made on the following scans for each foramen respectively (left, right); internal acoustic meatus (IAM) (86, 84), jugular foramen (JF) (83, 85) and hypoglossal canal (HC) (42, 45). A protocol describes measurement procedure. Two observers measured distances for five cases and agreement was assessed. One observer measured all the remaining cases. IAM and JF measurement interobserver variability was compared. Mean measurement difference between observers was -0.275 mm (standard deviation 0.557). IAM and JF measurements were normally distributed. Mean IAM distance was 12.2 mm [95% confidence interval (CI) 8.8-15.6]; JF was 7.3 mm (95% CI 4.0-10.6). The HC was difficult to visualize on many images and data followed a bimodal distribution. Dural reflections of posterior fossa CNs are well demonstrated by FIESTA MRI. Measuring CSF extension into these structures is feasible and robust; mean CSF extension into IAM and JF was measured. We plan further work to assess coverage of these structures with photon and proton RT plans. Advances in knowledge: We have described CSF extension beyond the internal table of the skull into the IAM, JF and HC. Oncologists planning RT for patients with medulloblastoma and ependymoma may use these data to guide contouring.

  5. Genomic and cranial phenotype data support multiple modern human dispersals from Africa and a southern route into Asia.

    Science.gov (United States)

    Reyes-Centeno, Hugo; Ghirotto, Silvia; Détroit, Florent; Grimaud-Hervé, Dominique; Barbujani, Guido; Harvati, Katerina

    2014-05-20

    Despite broad consensus on Africa as the main place of origin for anatomically modern humans, their dispersal pattern out of the continent continues to be intensely debated. In extant human populations, the observation of decreasing genetic and phenotypic diversity at increasing distances from sub-Saharan Africa has been interpreted as evidence for a single dispersal, accompanied by a series of founder effects. In such a scenario, modern human genetic and phenotypic variation was primarily generated through successive population bottlenecks and drift during a rapid worldwide expansion out of Africa in the Late Pleistocene. However, recent genetic studies, as well as accumulating archaeological and paleoanthropological evidence, challenge this parsimonious model. They suggest instead a "southern route" dispersal into Asia as early as the late Middle Pleistocene, followed by a separate dispersal into northern Eurasia. Here we test these competing out-of-Africa scenarios by modeling hypothetical geographical migration routes and assessing their correlation with neutral population differentiation, as measured by genetic polymorphisms and cranial shape variables of modern human populations from Africa and Asia. We show that both lines of evidence support a multiple-dispersals model in which Australo-Melanesian populations are relatively isolated descendants of an early dispersal, whereas other Asian populations are descended from, or highly admixed with, members of a subsequent migration event.

  6. [Multiple erythema migrans and facial nerve paralysis: clinical manifestations of early disseminated Lyme borreliosis].

    Science.gov (United States)

    Braun, S A; Baran, A M; Boettcher, C; Kieseier, B C; Reifenberger, J

    2014-04-01

    Lyme borreliosis is a common vector-borne disease in Europe. The infection follows different stages with a broad variability of clinical symptoms and manifestations in different organs. A 49-year-old man presented with flu-like symptoms, facial nerve paralysis and multiple erythematous macular on his trunk and extremities. We diagnosed Lyme disease (stage II) with facial nerve paralysis and multiple erythema migrans. Intravenous ceftriaxone led to complete healing of hissymptoms within 2 weeks.

  7. Nerve biopsy findings contribute to diagnosis of multiple mononeuropathy: 78% of findings support clinical diagnosis

    OpenAIRE

    Ying-shuang Zhang; A-ping Sun; Lu Chen; Rong-fang Dong; Yan-feng Zhong; Jun Zhang

    2015-01-01

    Multiple mononeuropathy is an unusual form of peripheral neuropathy involving two or more nerve trunks. It is a syndrome with many different causes. We reviewed the clinical, electrophysiological and nerve biopsy findings of 14 patients who suffered from multiple mononeuropathy in our clinic between January 2009 and June 2013. Patients were diagnosed with vasculitic neuropathy (n = 6), perineuritis (n = 2), chronic inflammatory demyelinating polyradiculoneuropathy (n = 2) or Lewis-Sumner synd...

  8. A new association – multiple endocrine neoplasia type 1 and malignant peripheral nerve sheath tumor

    OpenAIRE

    Preda, Veronica; Sywak, Mark; Learoyd, Diana

    2014-01-01

    Key Clinical Message We report a patient with multiple endocrine neoplasia type 1 (MEN-1) and an aggressive malignant peripheral nerve sheath tumor (MPNST) arising from a ganglioneuroma of the adrenal gland. Patients with MEN-1 require careful consideration of other tumor associations, including MPNST, as it can portend a poor prognosis. MEN-1 and MPNST have not been reported. We report a patient with multiple endocrine neoplasia type 1 (MEN-1) and an aggressive malignant peripheral nerve she...

  9. Diverse mechanisms for assembly of branchiomeric nerves.

    Science.gov (United States)

    Cox, Jane A; Lamora, Angela; Johnson, Stephen L; Voigt, Mark M

    2011-09-15

    The formation of branchiomeric nerves (cranial nerves V, VII, IX and X) from their sensory, motor and glial components is poorly understood. The current model for cranial nerve formation is based on the Vth nerve, in which sensory afferents are formed first and must enter the hindbrain in order for the motor efferents to exit. Using transgenic zebrafish lines to discriminate between motor neurons, sensory neurons and peripheral glia, we show that this model does not apply to the remaining three branchiomeric nerves. For these nerves, the motor efferents form prior to the sensory afferents, and their pathfinding show no dependence on sensory axons, as ablation of cranial sensory neurons by ngn1 knockdown had no effect. In contrast, the sensory limbs of the IXth and Xth nerves (but not the Vth or VIIth) were misrouted in gli1 mutants, which lack hindbrain bmn, suggesting that the motor efferents are crucial for appropriate sensory axon projection in some branchiomeric nerves. For all four nerves, peripheral glia were the intermediate component added and had a critical role in nerve integrity but not in axon guidance, as foxd3 null mutants lacking peripheral glia exhibited defasciculation of gVII, gIX, and gX axons. The bmn efferents were unaffected in these mutants. These data demonstrate that multiple mechanisms underlie formation of the four branchiomeric nerves. For the Vth, sensory axons initiate nerve formation, for the VIIth the sensory and motor limbs are independent, and for the IXth/Xth the motor axons initiate formation. In all cases the glia are patterned by the initiating set of axons and are needed to maintain axon fasciculation. These results reveal that coordinated interactions between the three neural cell types in branchiomeric nerves differ according to their axial position.

  10. Unusual presentation of multiple nerve entrapment: a case report

    OpenAIRE

    2014-01-01

    Cubital tunnel syndrome is the most common form of ulnar nerve entrapment and the second most common entrapment neuropathy of the upper extremity after carpal tunnel syndrome. However, bilateral compressive ulnar neuropathy is a rare condition. Electro diagnostic studies are a valid and reliable means of confirming the diagnosis.

  11. Femoral versus Multiple Nerve Blocks for Analgesia after Total Knee Arthroplasty

    Science.gov (United States)

    Stav, Anatoli; Reytman, Leonid; Sevi, Roger; Stav, Michael Yohay; Powell, Devorah; Dor, Yanai; Dudkiewicz, Mickey; Bayadse, Fuaz; Sternberg, Ahud; Soudry, Michael

    2017-01-01

    Background The PROSPECT (Procedure-Specific Postoperative Pain Management) Group recommended a single injection femoral nerve block in 2008 as a guideline for analgesia after total knee arthroplasty. Other authors have recommended the addition of sciatic and obturator nerve blocks. The lateral femoral cutaneous nerve is also involved in pain syndrome following total knee arthroplasty. We hypothesized that preoperative blocking of all four nerves would offer superior analgesia to femoral nerve block alone. Methods This is a prospective, randomized, controlled, and observer-blinded clinical study. A total of 107 patients were randomly assigned to one of three groups: a femoral nerve block group, a multiple nerve block group, and a control group. All patients were treated postoperatively using patient-controlled intravenous analgesia with morphine. Pain intensity at rest, during flexion and extension, and morphine consumption were compared between groups over three days. Results A total of 90 patients completed the study protocol. Patients who received multiple nerve blocks experienced superior analgesia and had reduced morphine consumption during the postoperative period compared to the other two groups. Pain intensity during flexion was significantly lower in the “blocks” groups versus the control group. Morphine consumption was significantly higher in the control group. Conclusions Pain relief after total knee arthroplasty immediately after surgery and on the first postoperative day was significantly superior in patients who received multiple blocks preoperatively, with morphine consumption significantly lower during this period. A preoperative femoral nerve block alone produced partial and insufficient analgesia immediately after surgery and on the first postoperative day. (Clinical trial registration number (NIH): NCT01303120) PMID:28178436

  12. Sodium-calcium exchanger and multiple sodium channel isoforms in intra-epidermal nerve terminals

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    Gasser Andreas

    2010-11-01

    Full Text Available Abstract Background Nociception requires transduction and impulse electrogenesis in nerve fibers which innervate the body surface, including the skin. However, the molecular substrates for transduction and action potential initiation in nociceptors are incompletely understood. In this study, we examined the expression and distribution of Na+/Ca2+ exchanger (NCX and voltage-gated sodium channel isoforms in intra-epidermal free nerve terminals. Results Small diameter DRG neurons exhibited robust NCX2, but not NCX1 or NCX3 immunolabeling, and virtually all PGP 9.5-positive intra-epidermal free nerve terminals displayed NCX2 immunoreactivity. Sodium channel NaV1.1 was not detectable in free nerve endings. In contrast, the majority of nerve terminals displayed detectable levels of expression of NaV1.6, NaV1.7, NaV1.8 and NaV1.9. Sodium channel immunoreactivity in the free nerve endings extended from the dermal boundary to the terminal tip. A similar pattern of NCX and sodium channel immunolabeling was observed in DRG neurons in vitro. Conclusions NCX2, as well as NaV1.6, NaV1.7, NaV1.8 and NaV1.9, are present in most intra-epidermal free nerve endings. The presence of NCX2, together with multiple sodium channel isoforms, in free nerve endings may have important functional implications.

  13. Solitary fibrous tumour of the vagus nerve.

    Science.gov (United States)

    Scholsem, Martin; Scholtes, Felix

    2012-04-01

    We describe the complete removal of a foramen magnum solitary fibrous tumour in a 36-year-old woman. It originated on a caudal vagus nerve rootlet, classically described as the 'cranial' accessory nerve root. This ninth case of immunohistologically confirmed cranial or spinal nerve SFT is the first of the vagus nerve.

  14. Radiation-induced cranial neuropathy in patients with nasopharyngeal carcinoma. A follow-up study

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    Rong, X.; Tang, Y.; Lu, K.; Peng, Y. [Sun Yat-sen Memorial Hospital, Guangzhou (China). Dept. of Neurology; Chen, M. [Sun Yat-sen Univ., Guangzhou (China). Dept. of Nasopharyngeal Carcinoma

    2012-03-15

    The purpose of the current study was to investigate the long-term characteristics of radiation-induced cranial nerve injury in nasopharyngeal carcinoma (NPC) patients. We studied cranial nerve palsy (CNP) in 328 NPC patients who received radiotherapy between 1994 and 2006. Follow-up was 93.6% complete as of December 2009. A total of 72 patients with CNP were recruited for analysis (56 men and 16 women). Patients with evidence of residual or recurrent tumor accompanied by CNP were excluded. The characteristics of CNP and the relationship with the radiation fields as well as re-radiotherapy were evaluated. After a mean follow-up of 11.2 years, 72 patients were found to have developed CNP. The latency of palsy ranged from 0.6-16.0 years. For the 67 patients with first course radiation, the glossopharyngeal and vagus nerves were the most vulnerable combination, occurring in 57 patients (85.1%). Patients with facial-cervical field radiation had a significantly longer latency comparing with that of patients with facial-cervical split fields (p = 0.021). In the first 5 years, 49.3% of patients developed CNP, while 40.3% presented CNP in the second 5-year period. In patients with first course radiation, 61 patients had more than one CNP. With regard to the 5 patients with re-radiation, most of them had multiple upper cranial nerve injuries. Radiation therapy of NPC patients may lead to cranial neuropathy. Patients with facial-cervical radiation fields had a longer latency for the manifestation of CNP compared with those patients who were treated with split fields. In patients with re-radiotherapy, the frequency of upper cranial nerve injury increased greatly.

  15. Repair of multiple cervical root avulsion with sural nerve graft.

    Science.gov (United States)

    Hsu, Sanford P C; Shih, Yang-Hsin; Huang, Ming-Chao; Chuang, Tien-Yow; Huang, Wen-Cheng; Wu, Hsiu-Mei; Lin, Pei-Hsin; Lee, Liang-Shong; Cheng, Henrich

    2004-09-01

    To obtain easier access to avulsed roots in the intradural space for patients suffering cervical root avulsion, the authors of this study developed a novel repair method. This involves using nerve grafts to bridge corresponding segments of the spinal cord and the trunk or cord level of the plexus, respectively, in two surgical stages. All eight patients admitted to this study received pre- and post-operative workups of electrophysiological evaluations and muscle power grading through Medical Research Council (MRC) scores. The degrees of impairment were also graded according to a modified version of Dumitru's and Wilbourn's scale (mild = 1; moderate = 2; severe = 3). The preoperative versus post-operative differences in the severity of the injuries and in the grading of the target muscle power were calculated according to the Wilcoxon signed-rank test. The preoperative degree of the severity of the injuries, as measured by electromyography (EMG), was 3.00 +/- 0.00 (mean +/- S.D.). The post-operative result was 2.125 +/- 0.641. Significant change took place after repair (P = 0.0313). Moreover, although little improvement was observed in the triceps, brachioradialis (BR), extensor carpi radialis (ECR), flexor digitorum profundus (FDP) and intrinsic hand muscles, the MRC grading showed significant yet not prominent motor recovery in the deltoid and biceps brachii (both P = 0.0313). We were impressed that the initial significant statistical results of differences in pre- and post-operative severity of the injuries and muscle power grading, demonstrated that regeneration does occur with this repair strategy.

  16. Angioma cavernoso do meato acústico interno envolvendo o complexo VII e VIII nervos cranianos: relato de caso Cavernous hemangioma of the internal auditory canal encasing the VII and VIII cranial nerve complex: case report

    Directory of Open Access Journals (Sweden)

    Roberto Leal Silveira

    2005-03-01

    Full Text Available Relata-se o caso de homem de 21 anos, leucoderma, portador de angioma cavernoso do meato acústico interno direito envolvendo o complexo VII e VIII nervos cranianos tratado cirurgicamente. Apenas 18 casos de angiomas cavernosos dessa localização foram relatados na literatura. São comentados os aspectos clínicos, o diagnóstico diferencial e o tratamento.We report the surgically treated case of a 21-year-old caucasian male harboring a cavernous hemangioma of the right internal auditory canal encasing the seventh and eighth cranial nerves complex. Only 18 cases of cavernous hemangiomas of this location have been previously reported. The clinical features, the differential diagnosis and the treatment are discussed.

  17. Fratura de côndilo occipital associada a fratura de Jefferson e lesão dos nervos cranianos caudais: relato de caso Occipital condyle fracture associated with Jefferson's fracture and injury of lower cranial nerves: case report

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    Asdrubal Falavigna

    2002-12-01

    Full Text Available A fratura de côndilo occipital (FCO é patologia que pode passar despercebida à avaliação médica, não só por sua infrequência (1% como pela variedade de diagnóstico clínico e dificuldade na visualização dessa área ao exame radiológico de rotina. Essa fratura pode vir associada a lesões de nervos cranianos (31%, sendo o hipoglosso o mais comumente envolvido (67%. É rara sua associação com fratura de Jefferson. Relatamos o caso de uma paciente de 58 anos, que desenvolveu FCO, lesão de nervos cranianos caudais e fratura de Jefferson após uma queda. O tratamento preconizado foi tração cervical por seis semanas seguida pelo uso de halo-colete por três meses. Houve consolidação óssea e regressão da lesão nervosa. O objetivo deste relato é alertar para que, uma vez diagnosticada a FCO, está indicada investigação radiológica da transição crânio-cervical pela possibilidade da presença de lesões simultâneas nervosas, de nervos cranianos e ósseas, como por exemplo a fratura de Jefferson. Apesar de suas associações serem raras, devem ter seu diagnóstico conhecido para poder ser manejadas adequadamente.Occipital condyle fracture(OCF is rarely seen and can be missed during medical evaluation due to the variety of clinical presentations and the difficulty to be visualized radiographically. This fracture can be associated with cranial nerves injuries (31%, being the hipoglossal nerve the most frequently involved (67%. We report a 58 years old female patient who presented with OCF, injury of lower cranial nerves and Jefferson's fracture. The patient was treated with cervical traction for six weeks followed by halo immobilization for three months. There was bone consolidation recovery of the nervous injury after this period. This report emphazises the importance of investigating the skull-cervical transition in all patients with cervical trauma. Although Jefferson's fracture is rarely associated with OCF, it should be

  18. Comparison of peripheral nerve stimulator versus ultrasonography guided axillary block using multiple injection technique

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    Alok Kumar

    2014-01-01

    Full Text Available Background: The established methods of nerve location were based on either proper motor response on nerve stimulation (NS or ultrasound guidance. In this prospective, randomised, observer-blinded study, we compared ultrasound guidance with NS for axillary brachial plexus block using 0.5% bupivacaine with the multiple injection techniques. Methods : A total of 120 patients receiving axillary brachial plexus block with 0.5% bupivacaine, using a multiple injection technique, were randomly allocated to receive either NS (group NS, n = 60, or ultrasound guidance (group US, n = 60 for nerve location. A blinded observer recorded the onset of sensory and motor blocks, skin punctures, needle redirections, procedure-related pain and patient satisfaction. Results: The median (range number of skin punctures were 2 (2-4 in group US and 3 (2-5 in group NS (P =0.27. Insufficient block was observed in three patient (5% of group US and four patients (6.67% of group NS (P > =0.35. Patient acceptance was similarly good in the two groups. Conclusion: Multiple injection axillary blocks with ultrasound guidance provided similar success rates and comparable incidence of complications as compared with NS guidance with 20 ml 0.5% bupivacaine.

  19. Comparison of peripheral nerve stimulator versus ultrasonography guided axillary block using multiple injection technique

    Science.gov (United States)

    Kumar, Alok; Sharma, DK; Sibi, Maj. E; Datta, Barun; Gogoi, Biraj

    2014-01-01

    Background: The established methods of nerve location were based on either proper motor response on nerve stimulation (NS) or ultrasound guidance. In this prospective, randomised, observer-blinded study, we compared ultrasound guidance with NS for axillary brachial plexus block using 0.5% bupivacaine with the multiple injection techniques. Methods: A total of 120 patients receiving axillary brachial plexus block with 0.5% bupivacaine, using a multiple injection technique, were randomly allocated to receive either NS (group NS, n = 60), or ultrasound guidance (group US, n = 60) for nerve location. A blinded observer recorded the onset of sensory and motor blocks, skin punctures, needle redirections, procedure-related pain and patient satisfaction. Results: The median (range) number of skin punctures were 2 (2–4) in group US and 3 (2–5) in group NS (P =0.27). Insufficient block was observed in three patient (5%) of group US and four patients (6.67%) of group NS (P > =0.35). Patient acceptance was similarly good in the two groups. Conclusion: Multiple injection axillary blocks with ultrasound guidance provided similar success rates and comparable incidence of complications as compared with NS guidance with 20 ml 0.5% bupivacaine. PMID:25624532

  20. Difficulty in Clinical Evaluation of Radial Nerve Injury due to Multiple Trauma to the Humerus, Wrist, and Hand

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    Balik Mehmet Sabri

    2014-01-01

    Full Text Available Radial nerve damage is frequently encountered in humeral fractures. The radial nerve is primarily damaged when the humerus gets fractured, while secondary damage maybe due to post-traumatic manipulations and surgical exploration. High impact traumatic nerve injury, serious neuropathic pain, lack of response to therapeutic interventions, and indifference to the Tinel test are indications for surgical intervention. Since most humeral fracture-induced low impact radial nerve injuries resolve spontaneously, conservative therapy is preferred. We present a patient with humeral fracture-associated radial nerve injury, accompanied with digital amputation and flexor tendon avulsion on the same arm. These injuries required immediate surgery, thus rendering the clinical evaluation of the radial nerve impossible. We would like to highlight and discuss the inherent difficulties associated with multiple trauma of the upper arm.

  1. Sleeve bridging of the rhesus monkey ulnar nerve with muscular branches of the pronator teres:multiple ampliifcation of axonal regeneration

    Institute of Scientific and Technical Information of China (English)

    Yu-hui Kou; Pei-xun Zhang; Yan-hua Wang; Bo Chen; Na Han; Feng Xue; Hong-bo Zhang; Xiao-feng Yin; Bao-guo Jiang

    2015-01-01

    Multiple-bud regeneration,i.e., multiple amplification, has been shown to exist in peripheral nerve regeneration. Multiple buds grow towards the distal nerve stump during proximal nerve ifber regeneration. Our previous studies have veriifed the limit and validity of multiple ampli-ifcation of peripheral nerve regeneration using small gap sleeve bridging of small donor nerves to repair large receptor nerves in rodents. The present study sought to observe multiple ampli-ifcation of myelinated nerve ifber regeneration in the primate peripheral nerve. Rhesus monkey models of distal ulnar nerve defects were established and repaired using muscular branches of the right forearm pronator teres. Proximal muscular branches of the pronator teres were su-tured into the distal ulnar nerve using the small gap sleeve bridging method. At 6 months after suture, two-ifnger lfexion and mild wrist lfexion were restored in the ulnar-sided injured limbs of rhesus monkey. Neurophysiological examination showed that motor nerve conduction veloc-ity reached 22.63 ± 6.34 m/s on the affected side of rhesus monkey. Osmium tetroxide staining demonstrated that the number of myelinated nerve fibers was 1,657 ± 652 in the branches of pronator teres of donor, and 2,661 ± 843 in the repaired ulnar nerve. The rate of multiple ampliifcation of regenerating myelinated nerve ifbers was 1.61. These data showed that when muscular branches of the pronator teres were used to repair ulnar nerve in primates, effective regeneration was observed in regenerating nerve ifbers, and functions of the injured ulnar nerve were restored to a certain extent. Moreover, multiple ampliifcation was subsequently detected in ulnar nerve axons.

  2. MRI findings in cranial eumycetoma

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    Munawwar Ahmed

    2011-01-01

    Full Text Available Cranial eumycetoma (CE due to direct inoculation of Madurella grisea into the scalp is extremely rare. We describe a case of CE caused by direct inoculation of M. grisea with the characteristic MRI findings of the "dot-in-circle" sign and a conglomeration of multiple, extremely hypointense "dots."

  3. Comparison of plan quality and delivery time between volumetric arc therapy (RapidArc) and Gamma Knife radiosurgery for multiple cranial metastases.

    Science.gov (United States)

    Thomas, Evan M; Popple, Richard A; Wu, Xingen; Clark, Grant M; Markert, James M; Guthrie, Barton L; Yuan, Yu; Dobelbower, Michael C; Spencer, Sharon A; Fiveash, John B

    2014-10-01

    Volumetric modulated arc therapy (VMAT) has been shown to be feasible for radiosurgical treatment of multiple cranial lesions with a single isocenter. To investigate whether equivalent radiosurgical plan quality and reduced delivery time could be achieved in VMAT for patients with multiple intracranial targets previously treated with Gamma Knife (GK) radiosurgery. We identified 28 GK treatments of multiple metastases. These were replanned for multiarc and single-arc, single-isocenter VMAT (RapidArc) in Eclipse. The prescription for all targets was standardized to 18 Gy. Each plan was normalized for 100% prescription dose to 99% to 100% of target volume. Plan quality was analyzed by target conformity (Radiation Therapy Oncology Group and Paddick conformity indices [CIs]), dose falloff (area under the dose-volume histogram curve), as well as the V4.5, V9, V12, and V18 isodose volumes. Other end points included beam-on and treatment time. Compared with GK, multiarc VMAT improved median plan conformity (CIVMAT = 1.14, CIGK = 1.65; P < .001) with no significant difference in median dose falloff (P = .269), 12 Gy isodose volume (P = .500), or low isodose spill (P = .49). Multiarc VMAT plans were associated with markedly reduced treatment time. A predictive model of the 12 Gy isodose volume as a function of tumor number and volume was also developed. For multiple target stereotactic radiosurgery, 4-arc VMAT produced clinically equivalent conformity, dose falloff, 12 Gy isodose volume, and low isodose spill, and reduced treatment time compared with GK. Because of its similar plan quality and increased delivery efficiency, single-isocenter VMAT radiosurgery may constitute an attractive alternative to multi-isocenter radiosurgery for some patients.

  4. Multimodal Navigation in Endoscopic Transsphenoidal Resection of Pituitary Tumors Using Image-Based Vascular and Cranial Nerve Segmentation: A Prospective Validation Study.

    Science.gov (United States)

    Dolati, Parviz; Eichberg, Daniel; Golby, Alexandra; Zamani, Amir; Laws, Edward

    2016-11-01

    Transsphenoidal surgery (TSS) is the most common approach for the treatment of pituitary tumors. However, misdirection, vascular damage, intraoperative cerebrospinal fluid leakage, and optic nerve injuries are all well-known complications, and the risk of adverse events is more likely in less-experienced hands. This prospective study was conducted to validate the accuracy of image-based segmentation coupled with neuronavigation in localizing neurovascular structures during TSS. Twenty-five patients with a pituitary tumor underwent preoperative 3-T magnetic resonance imaging (MRI), and MRI images loaded into the navigation platform were used for segmentation and preoperative planning. After patient registration and subsequent surgical exposure, each segmented neural or vascular element was validated by manual placement of the navigation probe or Doppler probe on or as close as possible to the target. Preoperative segmentation of the internal carotid artery and cavernous sinus matched with the intraoperative endoscopic and micro-Doppler findings in all cases. Excellent correspondence between image-based segmentation and the endoscopic view was also evident at the surface of the tumor and at the tumor-normal gland interfaces. Image guidance assisted the surgeons in localizing the optic nerve and chiasm in 64% of cases. The mean accuracy of the measurements was 1.20 ± 0.21 mm. Image-based preoperative vascular and neural element segmentation, especially with 3-dimensional reconstruction, is highly informative preoperatively and potentially could assist less-experienced neurosurgeons in preventing vascular and neural injury during TSS. In addition, the accuracy found in this study is comparable to previously reported neuronavigation measurements. This preliminary study is encouraging for future prospective intraoperative validation with larger numbers of patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Multiple Sites Ultrasonography of Peripheral Nerves in Differentiating Charcot–Marie–Tooth Type 1A from Chronic Inflammatory Demyelinating Polyradiculoneuropathy

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    Jingwen Niu

    2017-05-01

    Full Text Available IntroductionMultiple sites measurement of cross-sectional areas (CSA by ultrasound was performed to differentiate Charcot–Marie–Tooth type 1A (CMT1A and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP.MethodsNine patients with CMT1A, 28 patients with CIDP, and 14 healthy controls (HC were recruited prospectively. Consecutive ultrasonography scanning was performed from wrist to axilla on median and ulnar nerves. CSAs were measured at 10 predetermined sites of each nerve.ResultsCMT1A had significantly larger CSAs at all sites of median and ulnar nerves (p < 0.01. In CMT1A, CSAs increased gradually and homogeneously from distal to proximal along the nerve, except potential entrapment sites. CIDP displayed three different morphological patterns, including mild enlargement in 15 patients, prominent segmental enlargement in 12, and slight enlargement in 1, among which different treatment responses were observed. All patients with mild nerve enlargement treated with intravenous immunoglobulin were responsive (7/7, while less than half of those with prominent segmental enlargement (3/7 were responsive (p < 0.01.DiscussionConsecutive scan along the nerve and multiple sites measurement by ultrasound could supply more detailed morphological feature of the nerve and help to differentiate CMT1A from CIDP.

  6. MRI of optic nerve and postchiasmal visual pathways and visual evoked potentials in secondary progressive multiple sclerosis

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    Davies, M.B.; Hawkins, C.P. [School of Postgraduate Medicine, Keele Univ. (United Kingdom)]|[Department of Neurology and Neurophysiology, Royal Infirmary, Stoke-on-Trent (United Kingdom); Williams, R. [MRI Unit Cornwall House, Stoke-on-Trent (United Kingdom); Haq, N. [Department of Neurology, North Staffordshire Hospital, Stoke-on-Trent (United Kingdom); Pelosi, L. [Department of Neurology and Neurophysiology, Royal Infirmary, Stoke-on-Trent (United Kingdom)

    1998-12-01

    We studied the relationship between abnormalities shown by MRI and functional disturbances in the visual pathway as assessed by the visual evoked potential (VEP) in 25 patients with established multiple sclerosis (MS); only 4 of whom had a history of acute optic neuritis. Optic nerve MRI was abnormal in 19 (76 %) and is thus useful in detecting subclinical disease. Optic nerve total lesion length and area on the STIR sequence was found to correlate significantly with prolongation of the VEP latency. This may reflect a predominantly demyelinating rather than inflammatory origin for the signal change in the optic nerve. (orig.) With 5 figs., 1 tab., 25 refs.

  7. NI-18MULTIMODAL NAVIGATION IN ENDOSCOPIC TRANS-SPHENOIDAL RESECTION OF PITUITARY TUMORS USING IMAGE-BASED VASCULAR AND CRANIAL NERVE SEGMENTATION: A PROSPECTIVE VALIDATION STUDY

    Science.gov (United States)

    Dolati, Parviz; Raber, Michael; Golby, Alexandra; Laws, Edward

    2014-01-01

    Trans-Sphenoidal surgery (TSS) is a well-known approach for treatment of pituitary tumors. However, in inexperienced hands, the risk of lateral misdirection and vascular damage, intraoperative CSF leakage, and optic nerve injury are all well-known complications of this procedure. This prospective study was conducted to validate the accuracy of image-based segmentation in localization of neurovascular structures during TSS. METHODS: Eight patients with pituitary tumor underwent preoperative 3TMRI, which included thin sectioned 3D space T2, 3D Time of Flight and MPRAGE sequences. Images were reviewed by an expert independent neuroradiologist. Imaging sequences were loaded in BrainLab iPlanNet (6/8) and Stryker (2/8) for segmentation and pre-op planning. After patient registration to the intra-op neuronavigation system and surgical exposure, each segmented neural or vascular element was validated by manual placement of the navigation probe. The pulses of the bilateral ICA were confirmed using micro-Doppler. RESULTS: Pre-operative segmentation of the ICA and cavernous sinus matched with the intra-operative endoscopic and micro-Doppler findings in all cases (Dice-coefficient =1). This information reassured surgeons regarding the lateral extent of bone removal at the sellar floor and the limits of lateral explorations. Perfect correspondence between image-based segmentation and endoscopic view was also found at the surface of the tumor and tumor-normal gland interfaces. This helped in preventing unnecessary removal of the normal pituitary gland. Image-guidance helped surgeon to localize the optic nerve and chiasm in 63% of case and Diaphragma sella in 50% of cases, which helped to determine the limits of upward exploration and decrease the risk of CSF leakage. CONCLUSION: Image-based pre-operative vascular and neural element segmentation especially with 3D reconstruction is highly informative preoperatively and helps young and inexperienced neurosurgeons to prevent

  8. Vestigial-like 3 is a novel Ets1 interacting partner and regulates trigeminal nerve formation and cranial neural crest migration.

    Science.gov (United States)

    Simon, Emilie; Thézé, Nadine; Fédou, Sandrine; Thiébaud, Pierre; Faucheux, Corinne

    2017-09-04

    Drosophila Vestigial is the founding member of a protein family containing a highly conserved domain, called Tondu that mediates their interaction with members of the TEAD family of transcription factors (Scalloped in Drosophila). In Drosophila, the Vestigial/Scalloped complex controls wing development by regulating the expression of target genes through binding to MCAT sequences. In vertebrates, there are four Vestigial-like genes whose functions are still not well understood. Here we describe the regulation and function of vestigial-like 3 (vgll3) during Xenopus early development. A combination of signals including FGF8, Wnt8a, Hoxa2, Hoxb2 and retinoic acid limits vgll3 expression to hindbrain rhombomere 2. We show that vgll3 regulates trigeminal placode and nerve formation and is required for normal neural crest development by affecting their migration and adhesion properties. At the molecular level, vgll3 is a potent activator of pax3, zic1, Wnt and FGF that are important for brain patterning and neural crest cell formation. Vgll3 interacts in the embryo with Tead proteins but unexpectedly with Ets1 with which it is able to stimulate a MCAT driven luciferase reporter gene. Our findings highlight a critical function for vgll3 in vertebrate early development. © 2017. Published by The Company of Biologists Ltd.

  9. Diverse mechanisms for assembly of branchiomeric nerves

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    Cox, Jane A.; LaMora, Angela; Johnson, Stephen L.; Voigt, Mark M.

    2011-01-01

    The formation of branchiomeric nerves (cranial nerves V, VII, IX and X) from their sensory, motor and glial components is poorly understood. The current model for cranial nerve formation is based on the Vth nerve, in which sensory afferents are formed first and must enter the hindbrain in order for the motor efferents to exit. Using transgenic zebrafish lines to discriminate between motor neurons, sensory neurons and peripheral glia, we show that this model does not apply to the remaining thr...

  10. Potenciales Evocados Somatosensitivos (PESS obtenidos por estimulación del nervio Mediano (registros espinal y craneano en caninos Somatosensory Evoked Potentials Obtained by Stimulating the Median Nerve (Spinal Cord and Cranial Recordings in Dogs

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    F.C Pellegrino

    2005-12-01

    latencies of the spinal potencial from the cranial potential. We employed needle electrodes sited between C7-T1 and in the scalp, at the contralateral region respect to the stimulus. At the spinal level a triphasic wave was obtained, its first deflection being positive followed by a larger negative potential and ending up with another small positive deflection. The mean latency to the main negative peak was 4.95 ms +/-0.92 ms. The mean value of CV was 60.79 +/-13.53 m/s. Cranial SSEPs had a "w" shape, their mean latency to the negative peak was 14.62 +/-1.83 ms. The mean value of CCT was 9.67 +/-2.02 ms. In 6 out of the 22 studied dogs, once the regular recording was obtained, the stimulating electrodes were moved distally and a new recording was acquired; this procedure allowed to measure the median nerve conduction velocity between the 1st and the 2nd sites of stimulation, in a restricted segment of the nerve trunk; following this procedure the mean value obtained was 59.83 +/-21.44 m/s, which did not significantly differ from the former calculation. In regards to the sources of these potentials, most probably the spinal one constitute the spatial sum of the electrical activity of the different structures sited in the recording site. The cranial response is brought about by the activation of the thalamo-cortical circuits and the neurons of the parietal cortex situated at the receiving area.

  11. Sensitivity and specificity of vestibular bed-side examination in detecting VIII cranial nerve schwannoma with sensorineural sudden unilateral hearing loss as presenting symptom.

    Science.gov (United States)

    Califano, L; Salafia, F; Melillo, M G; Mazzone, S

    2017-08-01

    The objectives of this study were to identify signs of vestibular nerve suffering through a bedside vestibular examination protocol in case of sudden sensorineural unilateral hearing loss without spontaneous signs of vestibular impairment and to propose a bed-side vestibular examination based protocol for the focused execution of gadolinium-enhanced magnetic resonance imaging (MRI) only if a vestibular schwannoma is suspected. 96 patients, 52 men, 44 women, mean age 57.73 +/- 12.85 years, suffering from sudden sensorineural unilateral hearing loss, which presented neither vertigo nor spontaneous nystagmus, were enrolled. Pure tone audiometry, tympanometry, measurement of acoustic reflexes and Anderson test to detect adaptation, bedside vestibular examination through head shaking test, vibration test, head impulse test, hyperventilation test and detection of nystagmus in supine and lateral decubitus to search for signs of vestibular impairment were performed. Patients with signs of vestibular impairment and pure tone audiometry threshold at high frequencies better than 70 dB nHL were subjected to auditory brainstem responses. Gadolinium enhanced MRI centred on internal acoustic canals was carried out in all patients with sudden sensorineural unilateral hearing loss. Main outcome measures were signs of vestibular impairment at vestibular bedside examination and presence of vestibular schwannoma on MRI. Signs of vestibular impairment were detected in 22/96 cases (22.9%); a vestibular schwannoma was detected by MRI in 5/96 cases (5.2%), always when vestibular impairment was present. In case of sudden sensorineural unilateral hearing loss, vestibular bedside examination seems to be useful to restrict the suspicion of a vestibular schwannoma to cases with signs of vestibular impairment, reducing the number of MRI exams, with considerable economic savings. © Copyright by Società Italiana di Otorinolaringologia e Chirurgia Cervico-Facciale, Rome, Italy.

  12. Unilateral Abducens Nerve Palsy as an Early Feature of Multiple Mononeuropathy Associated with Anti-GQ1b Antibody

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    Ryuta Kinno

    2011-03-01

    Full Text Available Patients with anti-GQ1b antibody syndrome show various combinations of ophthalmoplegia, ataxia, areflexia, or altered sensorium as clinical features. We describe herein a unique case with unilateral abducens nerve palsy as an early feature of multiple mononeuropathy involving dysfunctions of the inferior dental plexus and the ulnar nerve, which was thought to be associated with anti-GQ1b antibody. A 27-year-old man presented with acute-onset diplopia. He subsequently experienced numbness not only in the right lower teeth and gums but also on the ulnar side of the left hand. Neurological examinations revealed dysfunctions of the right abducens nerve, the right inferior dental plexus, and the left ulnar nerve, suggesting multiple mononeuropathy. Serum anti-GQ1b antibody was positive. This is a rare case report of a patient with unilateral abducens nerve palsy as an early feature of multiple mononeuropathy associated with anti-GQ1b antibody. We suggest that anti-GQ1b antibody syndrome should be taken into consideration as a differential diagnosis of acute multiple mononeuropathy if ophthalmoplegia is present unilaterally.

  13. Connections between the facial and trigeminal nerves: Anatomical basis for facial muscle proprioception

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    J.L. Cobo

    2017-06-01

    Full Text Available Proprioception is a quality of sensibility that originates in specialized sensory organs (proprioceptors that inform the central nervous system about static and dynamic conditions of muscles and joints. The facial muscles are innervated by efferent motor nerve fibers and typically lack proprioceptors. However, facial proprioception plays a key role in the regulation and coordination of the facial musculature and diverse reflexes. Thus, facial muscles must be necessarily supplied also for afferent sensory nerve fibers provided by other cranial nerves, especially the trigeminal nerve. Importantly, neuroanatomical studies have demonstrated that facial proprioceptive impulses are conveyed through branches of the trigeminal nerve to the central nervous system. The multiple communications between the facial and the trigeminal nerves are at the basis of these functional characteristics. Here we review the literature regarding the facial (superficial communications between the facial and the trigeminal nerves, update the current knowledge about proprioception in the facial muscles, and hypothesize future research in facial proprioception.

  14. 聚四氟乙烯棉片置入治疗Ⅶ、Ⅷ颅神经微血管压迫症状%Teflon cotton sheet implantation for treatment of microvascular compression symptoms of VII, VIII cranial nerves

    Institute of Scientific and Technical Information of China (English)

    冯兆海; 石鑫; 姜磊; 郝玉军

    2015-01-01

    背景:聚四氟乙烯棉片具有良好的生物学特性和组织相容性,置入颅内不会导致严重排异反应,目前在微血管减压中得到了广泛应用。目的:探讨颅神经Ⅶ、Ⅷ显微血管聚四氟乙烯棉片置入减压治疗面肌痉挛合并眩晕及耳鸣的疗效。方法:纳入10例第Ⅶ、Ⅷ脑神经压迫综合征患者,其中6例面肌痉挛合并耳鸣,2例面肌痉挛合并眩晕,2例面肌痉挛合并耳鸣及眩晕,均采用乙状窦后入路聚四氟乙烯棉片置入减压治疗,其中5例以圈套式置入,另5例以絮状式置入。随访观察棉片置入后的生物相容性及面部抽搐、耳鸣、眩晕改善情况,以及并发症情况。结果与结论:聚四氟乙烯棉片具有良好的生物学特性和组织相容性,置入颅内未导致严重排异反应,未随时间的推移而吸收变形。棉片置入后,10例面部抽搐患者中,7例面部抽搐症状完全消失,3例症状减轻,置入后1周所有患者面部抽搐症状消失;伴有耳鸣症状8例患者中,5例患者自觉耳鸣消失,2例自觉耳鸣减轻2级,1例症状无改善;4例合并眩晕患者中,眩晕症状减轻2例,2例症状无改善。随访6-48个月,面部抽搐症状无复发;6例耳鸣症状消失,1例减轻,1例无改善;3例眩晕症状消失,1例无改善。表明聚四氟乙烯棉片置入减压治疗颅神经Ⅶ、Ⅷ显微血管压迫安全有效。%BACKGROUND:Teflon cotton sheets have good biological characteristics and histocompatibility, and the intracranial implantation of teflon cotton sheets cannot lead to severe rejection, which, at present, has been widely applied in the microvascular decompression. OBJECTIVE:To explore the therapeutic efficacy of the intracranial implantation of teflon cotton sheetsvia VII, VIII cranial nerves in the microvascular decompression treatment of hemifacial spasm combined with vertigo and tinnitus. METHODS:Ten patients

  15. An Osteologic Study of Cranial Opening of Optic Canal in Gujarat Region

    Science.gov (United States)

    Singh, Praveen R

    2016-01-01

    Introduction Optic canal is a bony canal situated in between the roots of lesser wings of sphenoid, lateral to body of sphenoid. It transmits optic nerve and ophthalmic artery, surrounded by meninges. Various authors have studied variations in skull foramina and correlated clinically, as variants in the body structures have been found to be associated with many inherited or acquired diseases. Aim The present study aimed to examine morphologic and morphometric variations in cranial openings of optic canals. Materials and Methods The study was undertaken in total 150 dry adult human skulls. The variations in size, shape, presence or absence and duplication or multiplication if any, in optic canal were observed bilaterally. Unusual features such as recess, fissure and notch were also observed bilaterally. Student’s t-test was applied to compare size of cranial openings of optic canal on both sides. Similarly, morphologic features related with the canal were studied by calculating frequency and proportions of various parameters. Results Optic canal was present in all 150 skulls studied bilaterally. The mean maximum dimension of the canal at cranial opening was 5.03±0.72 mm on right side and 5.02±0.76 mm on left side. The shape of the canal was ovoid at cranial opening in all the skulls studied. Duplication of optic canal was present in one skull on left side. Recess was found in 105(35%) sides of total skulls observed. Fissure was found in 20(6.67%) sides and notch was observed in 30(10%) sides of total skulls. Conclusion The optic canal showed variability in various parameters. Knowledge regarding variations in size, shape and unusual features on cranial opening of optic canal can be helpful to clinicians while approaching optic canal for various invasive procedures such as optic nerve decompression. PMID:28050353

  16. Intraoral presentation of multiple malignant peripheral nerve sheath tumors associated with neurofibromatosis-1

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    Mahija Janardhanan

    2011-01-01

    Full Text Available Neurofibromatosis-1 (NF-1 is a relatively common autosomal dominant disease characterized by multiple cutaneous fibromatoses and café au lait spots. It is associated with the mutation of NF-1 gene, a tumor suppressor gene located on chromosome 17q11.2. Hence, it can be considered as a familial cancer predisposition syndrome in which the affected individuals are at increased risk of developing malignancies. Intraoral neurofibromas associated with NF-1 are quite common, but the occurrence of malignant peripheral nerve sheath tumor (MPNST in the oral cavity is very rare. Oral MPNST can occur either de novo or by malignant transformation of neurofibromas or very rarely can represent a metastatic lesion. Here, we present a case of MPNST involving the maxillary region, in a patient with NF-1. Since MPNST often creates a diagnostic dilemma, histopathologic criteria for the diagnosis of MPNST are also discussed.

  17. Retinal nerve fiber layer thickness in subgroups of multiple sclerosis, measured by optical coherence tomography and scanning laser polarimetry

    NARCIS (Netherlands)

    T.A.M. Siepman (Theodora); M. Wefers Bettink-Remeijer (Marijke); R.Q. Hintzen (Rogier)

    2010-01-01

    textabstractOptical coherence tomography (OCT) and scanning laser polarimetry (GDx ECC) are non-invasive methods used to assess retinal nerve fiber layer (RNFL) thickness, which may be a reliable tool used to monitor axonal loss in multiple sclerosis (MS). The objectives of this study are (1) to com

  18. The multiple life of nerve growth factor: tribute to rita levi-montalcini (1909-2012).

    Science.gov (United States)

    Aloe, Luigi; Chaldakov, George N

    2013-03-01

    At the end of the 19(th) century, it was envisaged by Santiago Ramon y Cajal, but not, proven, that life at the neuronal level requires trophic support. The proof was obtained in the early 1950's by work initiated by Rita Levi-Montalcini (RLM) discovering the nerve growth factor (NGF). Today, NGF and its relatives, collectively designated neurotrophins, are well recognized as mediators of multiple biological phenomena in health and disease, ranging from the neurotrophic through immunotrophic and epitheliotrophic to metabotrophic effects. Consequently, NGF and other neurotrophins are implicated in the pathogenesis of a large spectrum of neuronal and non-neuronal diseases, from Alzheimer's and other neurodegenerative diseases to atherosclerosis and other cardiometabolic diseases. Recent studies demonstrated the therapeutic potentials of NGF in these diseases, including ocular and cutaneous diseases. Furthermore, NGF TrkA receptor antagonists emerged as novel drugs for pain, prostate and breast cancer, melanoma, and urinary bladder syndromes. Altogether, NGF's multiple potential in health and disease is briefly described here.

  19. Charcot-Marie-Tooth syndrome and neurofibromatosis type 1 with multiple neurofibromas of the entire spinal nerve roots.

    Science.gov (United States)

    Onu, David O; Hunn, Andrew W; Peters-Willke, Jens

    2013-07-13

    The coexistence of polyneuropathy which has the definite clinical and electromyographical findings consistent with Charcot-Marie-Tooth (CMT) syndrome and neurofibromatosis type 1 (NF1) has infrequently been reported. We describe a patient with both CMT and NF1, who had multiple neurofibromas involving the entire spinal neural axis. In addition, he had multiple neurofibromas distributed within the ileopsoas and gluteus muscles and subcutaneous tissues. These lesions were detected readily by MRI and the patient underwent successful surgical resection of the largest tumours compressing bilateral C2 nerve roots. To our knowledge, this is the first reported case of CMT syndrome coexisting with NF1 in which multiple neurofibromas involved the entire spinal nerve roots. We discuss the diagnostic and therapeutic challenges, emphasising the role of MRI and electrophysiology in such cases and provide a literature review.

  20. Imaging the trigeminal nerve

    Energy Technology Data Exchange (ETDEWEB)

    Borges, Alexandra [Radiology Department, Instituto Portugues de Oncologia Francisco Gentil, Centro de Lisboa, Rua Prof. Lima Basto, 1093, Lisboa (Portugal)], E-mail: borgalexandra@gmail.com; Casselman, Jan [Department of Radiology, A. Z. St Jan Brugge and A. Z. St Augustinus Antwerpen Hospitals (Belgium)

    2010-05-15

    Of all cranial nerves, the trigeminal nerve is the largest and the most widely distributed in the supra-hyoid neck. It provides sensory input from the face and motor innervation to the muscles of mastication. In order to adequately image the full course of the trigeminal nerve and its main branches a detailed knowledge of neuroanatomy and imaging technique is required. Although the main trunk of the trigeminal nerve is consistently seen on conventional brain studies, high-resolution tailored imaging is mandatory to depict smaller nerve branches and subtle pathologic processes. Increasing developments in imaging technique made possible isotropic sub-milimetric images and curved reconstructions of cranial nerves and their branches and led to an increasing recognition of symptomatic trigeminal neuropathies. Whereas MRI has a higher diagnostic yield in patients with trigeminal neuropathy, CT is still required to demonstrate the bony anatomy of the skull base and is the modality of choice in the context of traumatic injury to the nerve. Imaging of the trigeminal nerve is particularly cumbersome as its long course from the brainstem nuclei to the peripheral branches and its rich anastomotic network impede, in most cases, a topographic approach. Therefore, except in cases of classic trigeminal neuralgia, in which imaging studies can be tailored to the root entry zone, the full course of the trigeminal nerve has to be imaged. This article provides an update in the most recent advances on MR imaging technique and a segmental imaging approach to the most common pathologic processes affecting the trigeminal nerve.

  1. Strength-Duration Time Constant in Peripheral Nerve: No Abnormality in Multiple Sclerosis

    Directory of Open Access Journals (Sweden)

    Gençer Genç

    2012-01-01

    Full Text Available Objectives. To investigate the properties of the strength-duration time constant (SDTC in multiple sclerosis (MS patients. Methods. The SDTC and rheobase in 16 MS patients and 19 healthy controls were obtained following stimulation of the right median nerve at the wrist. Results. SDTC and rheobase values were 408.3±60.0 μs and 4.0±1.8 mA in MS patients, versus 408.0±62.4 μs and 3.8±2.1 mA in controls. The differences were not significant in SDTC or rheobase values between the patients and controls (=0.988 for SDTC and =0.722 for rheobase. Conclusion. Our study showed no abnormality in relapsing remitting MS patients in terms of SDTC, which gives some indirect information about peripheral Na+ channel function. This may indicate that alterations in the Na+ channel pattern in central nervous system (CNS couldnot be shown in the peripheral nervous system (PNS in the MS patients by SDTC. The opinion that MS can be a kind of channelopathy might be proven by performing other axonal excitability tests or SDTC in progressive forms of MS.

  2. Microstructural abnormalities in the trigeminal nerves of patients with trigeminal neuralgia revealed by multiple diffusion metrics

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Yaou [Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053 (China); Beijing Key laboratory of MRI and Brain Informatics, Beijing (China); Li, Jiping [Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053 (China); Butzkueven, Helmut [Department of Medicine, University of Melbourne, Parkville 3010 (Australia); Duan, Yunyun; Zhang, Mo [Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053 (China); Shu, Ni [State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100875 (China); Li, Yongjie [Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053 (China); Zhang, Yuqing, E-mail: yuqzhang@sohu.com [Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053 (China); Li, Kuncheng, E-mail: kunchengli55@gmail.com [Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053 (China)

    2013-05-15

    Objective: To investigate microstructural tissue changes of trigeminal nerve (TGN) in patients with unilateral trigeminal neuralgia (TN) by multiple diffusion metrics, and correlate the diffusion indexes with the clinical variables. Methods: 16 patients with TN and 6 healthy controls (HC) were recruited into our study. All participants were imaged with a 3.0 T system with three-dimension time-of-flight (TOF) magnetic resonance angiography and fluid attenuated inversion recovery (FLAIR) DTI-sequence. We placed regions of interest over the root entry zone of the TGN and measured fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD). The mean values of FA, MD, AD and RD were compared between the affected and unaffected sides in the same patient, and to HC values. The correlation between the side-to-side diffusion metric difference and clinical variables (disease duration and visual analogy scale, VAS) was further explored. Results: Compared with the unaffected side and HC, the affected side showed significantly decreased FA and increased RD; however, no significant changes of AD were found. A trend toward significantly increased MD was identified on the affected side comparing with the unaffected side. We also found the significant correlation between the FA reduction and VAS of pain (r = −0.55, p = 0.03). Conclusion: DTI can quantitatively assess the microstructural abnormalities of the affected TGN in patients with TN. Our results suggest demyelination without significant axonal injury is the essential pathological basis of the affected TGN by multiple diffusion metrics. The correlation between FA reduction and VAS suggests FA as a potential objective MRI biomarker to correlate with clinical severity.

  3. Use of Corneal Confocal Microscopy to Detect Corneal Nerve Loss and Increased Dendritic Cells in Patients With Multiple Sclerosis.

    Science.gov (United States)

    Bitirgen, Gulfidan; Akpinar, Zehra; Malik, Rayaz A; Ozkagnici, Ahmet

    2017-07-01

    Multiple sclerosis (MS) is characterized by demyelination, axonal degeneration, and inflammation. Corneal confocal microscopy has been used to identify axonal degeneration in several peripheral neuropathies. To assess corneal subbasal nerve plexus morphologic features, corneal dendritic cell (DC) density, and peripapillary retinal nerve fiber layer (RNFL) thickness in patients with MS. This single-center, cross-sectional comparative study was conducted at a tertiary referral university hospital between May 27, 2016, and January 30, 2017. Fifty-seven consecutive patients with relapsing-remitting MS and 30 healthy, age-matched control participants were enrolled in the study. Corneal subbasal nerve plexus measures and DC density were quantified in images acquired with the laser scanning in vivo corneal confocal microscope, and peripapillary RNFL thickness was measured with spectral-domain optical coherence tomography. Corneal nerve fiber density, nerve branch density, nerve fiber length, DC density, peripapillary RNFL thickness, and association with the severity of neurologic disability as assessed by the Kurtzke Expanded Disability Status Scale (score range, 0-10; higher scores indicate greater disability) and Multiple Sclerosis Severity Score (score range, 0.01-9.99; higher scores indicate greater severity). Of the 57 participants with MS, 42 (74%) were female and the mean (SD) age was 35.4 (8.9) years; of the 30 healthy controls, 19 (63%) were female and the mean (SD) age was 34.8 (10.2) years. Corneal nerve fiber density (mean [SE] difference, -6.78 [2.14] fibers/mm2; 95% CI, -11.04 to -2.52; P = .002), nerve branch density (mean [SE] difference, -17.94 [5.45] branches/mm2; 95% CI, -28.77 to -7.10; P = .001), nerve fiber length (mean [SE] difference, -3.03 [0.89] mm/mm2; 95% CI, -4.81 to -1.25; P = .001), and the mean peripapillary RNFL thickness (mean [SE] difference, -17.06 [3.14] μm; 95% CI, -23.29 to -10.82; P < .001) were reduced in patients with MS compared

  4. Ganglioneuromas involving the hypoglossal nerve and the vagus nerve in a child: Surgical difficulties.

    Science.gov (United States)

    Bakshi, Jaimanti; Mohammed, Abdul Wadood; Lele, Saudamini; Nada, Ritambra

    2016-02-01

    Ganglioneuromas are benign tumors that arise from the Schwann cells of the autonomic nervous system. They are usually seen in the posterior mediastinum and the paraspinal retroperitoneum in relation to the sympathetic chain. In the head and neck, they are usually related to the cervical sympathetic ganglia or to the ganglion nodosum of the vagus nerve or the hypoglossal nerve. We describe what we believe is the first reported case of multiple ganglioneuromas of the parapharyngeal space in which two separate cranial nerves were involved. The patient was a 10-year-old girl who presented with a 2-year history of a painless and slowly progressive swelling on the left side of her neck and a 1-year history hoarseness. She had no history of relevant trauma or surgery. Intraoperatively, we found two tumors in the left parapharyngeal space-one that had arisen from the hypoglossal nerve and the other from the vagus nerve. Both ganglioneuromas were surgically removed, but the affected nerves had to be sacrificed. Postoperatively, the patient exhibited hypoglossal nerve and vocal fold palsy, but she was asymptomatic. In addition to the case description, we discuss the difficulties we faced during surgical excision.

  5. Varicella-zoster virus reactivation from multiple ganglia: a case report

    Directory of Open Access Journals (Sweden)

    Hashemilar Mazyar

    2009-09-01

    Full Text Available Abstract Introduction Simultaneous involvements of multiple cranial nerve ganglia (geniculate ganglion and peripheral ganglia of cranial nerves VIII, IX and X by varicella-zoster virus and its subsequent activation may result in the characteristic eruptions of herpes zoster cephalicus. Coexistence of facial palsy and involvement of upper cervical dermatomes by varicella-zoster virus is quite rare. Case presentation Here, we report a 71-year-old Iranian man with involvement of multiple sensory ganglia (geniculate ganglion and upper dorsal root ganglia by varicella-zoster virus. He presented with right-sided facial weakness along with vesicular eruptions on the right side of his neck, and second and third cervical dermatomes. Conclusion The present case is an example of herpes zoster cephalicus with cervical nerve involvement. Although resembling Ramsay Hunt syndrome with presence of facial nerve paralysis and accompanying vesicles, involvement of cervical dermatomes is not a feature of the classic Ramsay Hunt syndrome.

  6. Multiple dental anomalies accompany unilateral disturbances in abducens and facial nerves: A case report

    Directory of Open Access Journals (Sweden)

    Elham Talatahari

    2016-01-01

    Full Text Available This article describes the oral rehabilitation of an 8-year-old girl with extensively affected primary and permanent dentition. This report is unique in which distinct dental anomalies including enamel hypoplasia, irregular dentin formation, taurodontism, hpodontia and dens in dente accompany unilateral disturbance of abducens and facial nerves which control the lateral eye movement, and facial expression, respectively.   Keywords: enamel hypoplasia; irregular dentin formation; taurodontism; hypodontia; dens in dente; abducens and facial nerves;

  7. Analysis of macular and nerve fiber layer thickness in multiple sclerosis patients according to severity level and optic neuritis episodes.

    Science.gov (United States)

    Soler García, A; Padilla Parrado, F; Figueroa-Ortiz, L C; González Gómez, A; García-Ben, A; García-Ben, E; García-Campos, J M

    2016-01-01

    Quantitative assessment of macular and nerve fibre layer thickness in multiple sclerosis patients with regard to expanded disability status scale (EDSS) and presence or absence of previous optic neuritis episodes. We recruited 62 patients with multiple sclerosis (53 relapsing-remitting and 9 secondary progressive) and 12 disease-free controls. All patients underwent an ophthalmological examination, including quantitative analysis of the nerve fibre layer and macular thickness using optical coherence tomography. Patients were classified according to EDSS as A (lower than 1.5), B (between 1.5 and 3.5), and C (above 3.5). Mean nerve fibre layer thickness in control, A, B, and C groups was 103.35±12.62, 99.04±14.35, 93.59±15.41, and 87.36±18.75μm respectively, with statistically significant differences (P<.05). In patients with no history of optic neuritis, history of episodes in the last 3 to 6 months, or history longer than 6 months, mean nerve fibre layer thickness was 99.25±13.71, 93.92±13.30 and 80.07±15.91μm respectively; differences were significant (P<.05). Mean macular thickness in control, A, B, and C groups was 220.01±12.07, 217.78±20.02, 217.68±20.77, and 219.04±24.26μm respectively. Differences were not statistically significant. The mean retinal nerve fibre layer thickness in multiple sclerosis patients is related to the EDSS level. Patients with previous optic neuritis episodes have a thinner retinal nerve fibre layer than patients with no history of these episodes. Mean macular thickness is not correlated to EDSS level. Copyright © 2014 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. The Forgotten Cranial Nereve - clinical importance of olfaction

    DEFF Research Database (Denmark)

    Fjældstad, Alexander; Clausen, Christian H; Kjærgaard, Thomas;

    2014-01-01

    Hyposmia is often undiagnosed despite the known negative effect on taste, appetite and life quality. However, a new focus on the first cranial nerve has emerged as a consequence of a discovered connection between neurodegenerative disorders and hyposmia. In Parkinson's disease and Alzheimer's dis...

  9. Vincristine-Induced Cranial Neuropathy

    Directory of Open Access Journals (Sweden)

    Ahmad TALEBIAN*

    2014-01-01

    Full Text Available How to Cite This Article: Talebian A, Goudarzi RM, Mohammadzadeh M , Mirzadeh AS. Vincristine-Induced Cranial Neuropathy. Iran J Child Neurol. 2014 Winter; 8(1:66-68. AbstractVincristine (VCR is a vinca alkaloid that is used for treatment of many malignancies.The vinca alkaloids are neurotoxic, usually causing a peripheral neuropathy, but cranial neuropathies are rare as side effects. Described here is the case of a 2.5-year-old boy, a known case of Wilms’ tumor, treated by vincristine (0/067 mg/kg/day and dactinomycin (0/045 mg/kg/day after surgery. Three weeks after treatment, he presented with bilateral ptosis.Neurological examination revealed bilateral ptosis with normal pupillary reflex and eye movement. He received 3.015 mg cumulative dose of vincristine before development of ptosis.Treatment with pyridoxine (150 mg/m2 p.o. BID and pyridostigmine (3 mg/kg p.o. BID started as neuroprotective agents, and after 7 days the problem disappeared.The treatment continued for 6 weeks and there were no signs of ptosis or a recurrence in follow up 2 months later. References:Toopchizade V, Hosseini M, et al. Electrophysiological signs of neuropathy caused by vincristine. Medical Journal of Tabriz University of Medical Sciences. 2010 Autumn;31(3; 19-25.Gursel E.S. Vincristine-Induced Unilateral Ptosis in a Child. Pediatr Neurol 2009; 41:461-463.Ngamphaiboon N, Sweeney R, Wetzler M, Wang ES. Pyridoxine treatment of vincristine-induced cranial polyneuropathy in an adult patient with acute lymphocytic leukemia: Case report and review of the literature. Leuk Res. 2010 Aug;34(8:e194-6.Lash SC, Williams CP, Marsh CS, Crithchley C, Hodgkins PR, Mackie EJ. Acute Sixth-Nerve Palsy After Vincristine Therapy. Journal of AAPOS 2004 Feb;8(1: 67-8.Bay A, Yilmaz C, Yilmaz N, Oner AF. Vincristine induced cranial polyneuropathy. Indian J Pediatr. 2006 Jun;73(6:531-3.Tuxen M K, Hansen SW. Complication of treatment, Neurotoxicity secondary to antineoplastic

  10. Facial nerve palsy due to birth trauma

    Science.gov (United States)

    Seventh cranial nerve palsy due to birth trauma; Facial palsy - birth trauma; Facial palsy - neonate; Facial palsy - infant ... this condition. Some factors that can cause birth trauma (injury) include: Large baby size (may be seen ...

  11. Findings of Optical Coherence Tomography of Retinal Nerve Fiber Layer in Two Common Types of Multiple Sclerosis.

    Science.gov (United States)

    Yousefipour, Gholamali; Hashemzahi, Zabihollah; Yasemi, Masood; Jahani, Pegah

    2016-06-01

    Multiple sclerosis (MS) is the most prevalent disease caused by the inflammatory demyelinating process that causes progressive nervous system degeneration over the time. Optical Coherence Tomography (OCT) is a non-invasive optical imaging technology, which can measure the thickness of retinal nerve fiber layer as well as the diameter of the macula. The purpose of the study is evaluation OCT findings in two common types of multiple sclerosis. For doing the cross-sectional study, 63 patients with two prevalent types of multiple sclerosis (35 patients with Relapse Remitting Multiple Sclerosis (RRMS) and 28 patients with Secondary Progressive Multiple Sclerosis (SPMS) were evaluated for 6 months. Exclusion criteria of the study were a history of optic neuritis, suffering from diabetes mellitus, hypertension, ocular disease, and the presence of other neurologic degenerative diseases. Then, the thickness of retinal nerve fiber layer (RNFL), as well as thickness and volume of the macula, were measured in the patients using OCT technology. The disability rate of patients was evaluated according to Expanded Disability Status Scale (EDSS). Finally, data was analyzed by means of SPSS software. Overall, 35 patients with RRMS (with mean age of 32.37+10.01, average disease period of 3.81+3.42 and mean EDSS of 1.84+0.45) and 28 patients with SPMS (with mean age of 39.21+9.33, average disease period of 11.32+5.87 and mean EDSS of 5.12+1.46) were assessed and compared in terms of retinal nerve fiber layer and size and thickness of macula. In all of these sections, the thicknesses were smaller in SPMS patients than patients with RRMS. But, there was a significant difference in total thickness (81.82µm versus 96.03µm with P=0.04) and thickness of temporal sector (54.5 µm versus 69.34 µm with P=0.04) of retinal nerve fiber layer and macular size at the superior sector of external ring (1.48 mm³ versus 1.58 mm³ with P=0.03), and nasal sector of external ring surrounding macula (1

  12. Findings of Optical Coherence Tomography of Retinal Nerve Fiber Layer in Two Common Types of Multiple Sclerosis

    Directory of Open Access Journals (Sweden)

    Gholamali Yousefipour

    2016-06-01

    Full Text Available Multiple sclerosis (MS is the most prevalent disease caused by the inflammatory demyelinating process that causes progressive nervous system degeneration over the time. Optical Coherence Tomography (OCT is a non-invasive optical imaging technology, which can measure the thickness of retinal nerve fiber layer as well as the diameter of the macula. The purpose of the study is evaluation OCT findings in two common types of multiple sclerosis. For doing the cross-sectional study, 63 patients with two prevalent types of multiple sclerosis (35 patients with Relapse Remitting Multiple Sclerosis (RRMS and 28 patients with Secondary Progressive Multiple Sclerosis (SPMS were evaluated for 6 months. Exclusion criteria of the study were a history of optic neuritis, suffering from diabetes mellitus, hypertension, ocular disease, and the presence of other neurologic degenerative diseases. Then, the thickness of retinal nerve fiber layer (RNFL, as well as thickness and volume of the macula, were measured in the patients using OCT technology. The disability rate of patients was evaluated according to Expanded Disability Status Scale (EDSS. Finally, data was analyzed by means of SPSS software. Overall, 35 patients with RRMS (with mean age of 32.37+10.01, average disease period of 3.81+3.42 and mean EDSS of 1.84+0.45 and 28 patients with SPMS (with mean age of 39.21+9.33, average disease period of 11.32+5.87 and mean EDSS of 5.12+1.46 were assessed and compared in terms of retinal nerve fiber layer and size and thickness of macula. In all of these sections, the thicknesses were smaller in SPMS patients than patients with RRMS. But, there was a significant difference in total thickness (81.82µm versus 96.03µm with P=0.04 and thickness of temporal sector (54.5 µm versus 69.34 µm with P=0.04 of retinal nerve fiber layer and macular size at the superior sector of external ring (1.48 mm³ versus 1.58 mm³ with P=0.03, and nasal sector of external ring surrounding

  13. From recurrent peripheral facial palsy to multiple sclerosis.

    Science.gov (United States)

    Ivanković, Mira; Demarin, Vida

    2011-09-01

    Peripheral facial palsy is a clinical entity, which may be presented as the first symptom of multiple sclerosis (MS). Although MS is mostly a multifocal chronic inflammation of the central nervous system, peripheral nervous system can also be involved. Isolated cranial nerve palsies are rare and occur in 1.6% of MS patients. In this report, a case is presented of a 35-year-old woman who developed isolated seventh nerve palsy that was misdiagnosed as Bell's palsy. Despite recurrent peripheral facial palsy, positive cerebrospinal fluid finding and magnetic resonance imaging, the diagnosis of MS could only be confirmed when the patient developed other neurologic symptoms and when the criteria for dissemination in space were satisfied. In clinical presentation, the patient had only cranial nerve involvement, with complete recovery.

  14. Differential proteomics reveals multiple components in retrogradely transported axoplasm after nerve injury.

    Science.gov (United States)

    Perlson, Eran; Medzihradszky, Katalin F; Darula, Zsuzsanna; Munno, David W; Syed, Naweed I; Burlingame, Alma L; Fainzilber, Mike

    2004-05-01

    Information on axonal damage is conveyed to neuronal cell bodies by a number of signaling modalities, including the post-translational modification of axoplasmic proteins. Retrograde transport of a subset of such proteins is thought to induce or enhance a regenerative response in the cell body. Here we report the use of a differential 2D-PAGE approach to identify injury-correlated retrogradely transported proteins in nerves of the mollusk Lymnaea. A comprehensive series of gels at different pI ranges allowed resolution of approximately 4000 spots by silver staining, and 172 of these were found to differ between lesioned versus control nerves. Mass spectrometric sequencing of 134 differential spots allowed their assignment to over 40 different proteins, some belonging to a vesicular ensemble blocked by the lesion and others comprising an up-regulated ensemble highly enriched in calpain cleavage products of an intermediate filament termed RGP51 (retrograde protein of 51 kDa). Inhibition of RGP51 expression by RNA interference inhibits regenerative outgrowth of adult Lymnaea neurons in culture. These results implicate regulated proteolysis in the formation of retrograde injury signaling complexes after nerve lesion and suggest that this signaling modality utilizes a wide range of protein components.

  15. Neonatal cranial sonography: A concise review for clinicians

    Directory of Open Access Journals (Sweden)

    Pankaj Gupta

    2016-01-01

    Full Text Available Cranial sonography continues to hold an important place in neonatal care. Attributes favorable to sonography that make it almost indispensable for routine care of the newborn includes easy access, low cost, portability, lack of ionizing radiations and exemption from sedation or anaesthesia. Cranial sonography has highest impact in neonates suspected to have meningitis and its complications; perinatal ischemia particularly periventricular leukomalacia (PVL; hydrocephalus resulting from multitude of causes and hemorrhage. Not withstanding this, cranial sonography has yielded results for a repertoire of indications. Approach to cranial sonography involves knowledge of the normal developmental anatomy of brain parenchyma for correct interpretation. Correct technique, taking advantage of multiple sonographic windows and variable frequencies of the ultrasound probes allows a detailed and comprehensive examination of brain parenchyma. In this review, we discuss the technique, normal and variant anatomy as well as disease entities of neonatal cranial sonography.

  16. Comparative research on the techniques for screening patients with primary or post-traumatic cranial nerve disorders%原发性及创伤后脑神经病变磁共振检查序列的对比研究

    Institute of Scientific and Technical Information of China (English)

    苏家威; 俞顺; 罗敏; 包强

    2015-01-01

    确诊。结论在应用Philips 1.5T磁共振仪进行脑干区脑神经检查中,联合应用3d-Tof、3d-BffE序列扫描所获脑神经脑池段的成像效果、观察毗邻血管走行及有无血管压迫的效果均显著优于单选序列,因此在检查时间允许的条件下应推荐行两种序列联合扫描能取得良好的诊断效果,更好地指导临床诊治。%Objective To investigate the use of three-dimensional time of flight spoiled gradient echo (3d-Tof) sequence and three-dimensional balance fast field echo (3d-BffE) sequence for the imaging of the cranial nerves in brain stem and the adjacent vessels by Philips 1.5T mri scanner and to optimize the techniques for screening patients with primary and post-traumatic cranial nerve disorders.Method 3d-Tof sequence and 3d-BffE sequence wereused to visualize the brain stem region in 50 patients who were found to have no intracranial mass lesions or intracranial inflammation. The imaging appearance of the cranial nerves and the adjacent vessels with solely 3d-Tof sequence, solely 3d-BffE sequence, and both sequences were evaluated by two attending physicians experienced in mri diagnosis using a double-blind method. The emphasis was put on the observation of the relation between theⅢ、Ⅴ、Ⅶ andⅧcranial nerves and their adjacent vessels, the follow-up conducted with the clinical treatment, and the evaluation of the accuracy of the above three diagnostic methods.Result The score results given by both physicians were as follows: There was a significant superiority in the qualities of images of nerves and vessels with both sequences, compared with 3d-BffE sequence or 3d-Tof sequence alone. There was a significant superiority in the qualities of images of nerves with 3d-BffE sequence alone or with both sequences, compared with 3d-Tof sequence (P0.05). There was also a significant superiority in the quality of images of vessels with 3d-Tof sequence alone and with both sequences, compared with 3d-BffE sequence (P0

  17. Cerebellopontine angle facial schwannoma relapsing towards middle cranial fossa

    Directory of Open Access Journals (Sweden)

    Takafumi Nishizaki

    2011-05-01

    Full Text Available Facial nerve schwannomas involving posterior and middle fossas are quite rare. Here, we report an unusual case of cerebellopontine angle facial schwannoma that involved the middle cranial fossa, two years after the first operation. A 53-year-old woman presented with a 3-year history of a progressive left side hearing loss and 6-month history of a left facial spasm and palsy. Magnetic resonance imaging (MRI revealed 4.5 cm diameter of left cerebellopontine angle and small middle fossa tumor. The tumor was subtotally removed via a suboccipital retrosigmoid approach. The tumor relapsed towards middle cranial fossa within a two-year period. By subtemporal approach with zygomatic arch osteotomy, the tumor was subtotally removed except that in the petrous bone involving the facial nerve. In both surgical procedures, intraoperative monitoring identified the facial nerve, resulting in preserved facial function. The tumor in the present case arose from broad segment of facial nerve encompassing cerebellopontine angle, meatus, geniculate/labyrinthine and possibly great petrosal nerve, in view of variable symptoms. Preservation of anatomic continuity of the facial nerve should be attempted, and the staged operation via retrosigmoid and middle fossa approaches using intraoperative facial monitoring, may result in preservation of the facial nerve.

  18. Evc works in chondrocytes and osteoblasts to regulate multiple aspects of growth plate development in the appendicular skeleton and cranial base.

    Science.gov (United States)

    Pacheco, María; Valencia, María; Caparrós-Martín, José A; Mulero, Francisca; Goodship, Judith A; Ruiz-Perez, Victor L

    2012-01-01

    Ellis-van Creveld syndrome protein homolog (Evc) was previously shown to mediate expression of Indian hedgehog (Ihh) downstream targets in chondrocytes. Consequently disruption of the Ihh/Pthrp axis was demonstrated in Evc(-/-) mice, but the full extent of Evc involvement in endochondral development was not totally characterized. Herein we have examined further the Evc(-/-) growth plate in a homogeneous genetic background and show that Evc promotes chondrocyte proliferation, chondrocyte hypertrophy and the differentiation of osteoblasts in the perichondrium, hence implicating Evc in both Pthrp-dependent and Pthrp-independent Ihh functions. We also demonstrate that Evc, which localizes to osteoblast primary cilia, mediates Hedgehog (Hh) signaling in the osteoblast lineage. In spite of this, bone collar development is mildly affected in Evc(-/-) mutants. The onset of perichondrial osteoblastogenesis is delayed at the initial stages of endochondral ossification in Evc(-/-) mice, and in later stages, the leading edge of expression of osteoblast markers and Wnt/β-catenin signaling components is located closer to the primary spongiosa in the Evc(-/-) perichondrium owing to impaired osteoblast differentiation. Additionally we have used Ptch1-LacZ reporter mice to learn about the different types of Hh-responsive cells that are present in the perichondrium of normal and Evc(-/-) mice. Evc mediates Hh target gene expression in inner perichondrial cells, but it is dispensable in the external layers of the perichondrium. Finally, we report cranial base defects in Evc(-/-) mice and reveal that Evc is essential for intrasphenoidal synchondrosis development.

  19. Inferior alveolar nerve injury with laryngeal mask airway: a case report.

    LENUS (Irish Health Repository)

    Hanumanthaiah, Deepak

    2011-01-01

    The incidence of damage to the individual cranial nerves and their branches associated with laryngeal mask airway use is low; there have been case reports of damage to the lingual nerve, hypoglossal nerve and recurrent laryngeal nerve. To the best of our knowledge we present the first reported case of inferior alveolar nerve injury associated with laryngeal mask airway use.

  20. Investigation of multiple optical and biometric properties of optic nerve head (Conference Presentation)

    Science.gov (United States)

    Hong, Young-Joo; Chan, Aaron C.; Kasaragod, Deepa K.; Makita, Shuichi; Miura, Masahiro; Yasuno, Yoshiaki

    2017-02-01

    Glaucoma is a group of eye diseases which results in optic nerve damage and vision loss. Optical coherence tomography (OCT) has been widely used to investigate geometric risk factor of glaucoma. However, material properties of ONH are also important to understand intra-ocular pressure related stress. We developed Jones-matrix based multifunctional posterior eye OCT (JM-OCT), which uses 1-μm band swept-source with a 100-kHz A-line rate. It provides three different optical properties, attenuation coefficient (AC), local birefringence (LB), and optical coherence angiography (OCA). We investigated the utility those properties for the investigation of normal ONH cases. 3 mm x 3 mm area around ONH was scanned for each eye, and biometric parameters were measured in hospital. Statistical analyses were performed with the mean values of above parameters at the regions of prelamina, lamina cribrosa, peripapillary sclera, and peripapillary nerve fiber layer, and biometric parameters of age, axial eye length, refractive error, and intraocular pressure. In qualitative observation, the lamina cribrosa generally shows more hyper signals in AC, LB, and OCA than prelamina. In t-test, AC, LB, and OCA showed significant difference (p eye length is positively correlated with LB and AC in lamina cribrosa. And these LB and AC are also negatively correlated with the refractive error. Age was found to be negatively correlated with OCA in lamina cribrosa.

  1. Clinical applied value of brain stem auditory evoked potential in facial neuritis patients combined the damage of other cranial nerves%伴其他颅神经症状的面神经炎患者治疗前后的脑干听觉诱发电位研究

    Institute of Scientific and Technical Information of China (English)

    王金风; 王民

    2012-01-01

    Objective: To explore the clinical applied value of brain stem auditoryk evoed potential (BAEP)in facial neuritis patients combined with damage of other cranial nerves. Methods: Fifty facial neuritis patients combined with damage of other cranial nerves were selected to get BAEP information) the results before and after treatment were analyzed. Results;The inter-peak latencies (IPL) of Ⅰ -- Ⅲ, Ⅲ - V . Ⅰ - V were significantly shorten(P<0. 01)after treatment of the. More than one IPL shortened IPL took up 84%. 74% cases had prolonged potential latencies (PL) of Wave I , Ⅲ and V with more than one shortened or disappeared waveform. In 69 % cases with amplitude of wave V increased and ratio of V/ I more than 0. 5 or ILD of bilateral Wave V was less than 0. 3 ms, IPL of Ⅲ - V shorter than that of Ⅰ - Ⅲ. Conclusion:Facial neuritis involves not only medial surface nerves of foramen stylomastoi-deum but also brainstem and/or other cranial nerves . BAEP can objectively reflect the function of audi-tory system and brain stem, and can be used to follow-up with patients with facial neuritis.%目的:观察伴其他颅神经症状的面神经炎患者治疗前后的脑干听觉诱发电位(BAEP)表现.方法:选择50例面神经炎伴其他颅神经症状的患者进行BAEP检测,并进行治疗前后对比.结果:与治疗前相比,治疗后Ⅱ-Ⅲ、Ⅲ-Ⅴ、Ⅰ-Ⅴ波IPL明显缩短(P<0.01),其中有一个以上的IPL缩短者42例占84%;Ⅰ、Ⅲ、Ⅴ波PL有一个以上缩短或治疗前BAEP波形消失而于治疗后出现者37例占74%;Ⅴ波波幅增高并且Ⅴ/Ⅰ IPL比大于0.5或双侧Ⅴ波侧间潜伏期差(IDL)小于0.3 ms,Ⅲ-Ⅴ波IPL小于Ⅰ-Ⅲ波IPL的35例占70%.结论:面神经炎不仅累及茎乳孔内面神经,还可累及脑干和其他颅神经.BAEP可以客观地反映面神经炎患者听觉系统和脑干功能,因此可以用于对该类患者进行疗效观察.

  2. Detailed Anatomy of the Cranial Cervical Ganglion in the Dromedary Camel (Camelus dromedarius).

    Science.gov (United States)

    Nourinezhad, Jamal; Mazaheri, Yazdan; Biglari, Zahra

    2015-08-01

    The detailed morphology and topography of the cranial cervical ganglion (CCG) with its surrounding structures were studied in 10 sides of five heads of adult one-humped camel to determine its general arrangement as well as its differences and similarities to other animals. The following detailed descriptions were obtained: (1) the bilateral CCG was constantly present caudal to cranial base at the rostroventral border of the occipital condyle over the caudolateral part of nasopharynx; (2) the CCG was always in close relations medially with the longus capitis muscle, rostrolaterally with the internal carotid artery, and caudally with the vagus nerve; and (3) the branches of the CCG were the internal carotid and external carotid nerves, jugular nerve, cervical interganglionic branch, laryngopharyngeal branch, carotid sinus branch and communicating branches to the vagus, and first spinal nerves. In conclusion, there was no variation regarding topography of dromedary CCG among the specimens, in spite of typical variations in number, and mainly in origin of nerve branches ramifying from the CCG. In comparative anatomy aspect, the close constant relations, and presence of major nerves (internal/external carotid and jugular nerves) of dromedary CCG exhibited a typical reported animal's pattern. However, the shape, structures lateral to the CCG, the origin and course pattern of external carotid and jugular nerves, the number of the major nerves branches, the communicating branches of the CCG to the spinal and cranial nerves, and the separation of most rostral parts of vagosympathetic trunk of dromedary were different from those of most reported animals.

  3. Entrainment and the cranial rhythmic impulse.

    Science.gov (United States)

    McPartland, J M; Mein, E A

    1997-01-01

    Entrainment is the integration or harmonization of oscillators. All organisms pulsate with myriad electrical and mechanical rhythms. Many of these rhythms emanate from synchronized pulsating cells (eg, pacemaker cells, cortical neurons). The cranial rhythmic impulse is an oscillation recognized by many bodywork practitioners, but the functional origin of this impulse remains uncertain. We propose that the cranial rhythmic impulse is the palpable perception of entrainment, a harmonic frequency that incorporates the rhythms of multiple biological oscillators. It is derived primarily from signals between the sympathetic and parasympathetic nervous systems. Entrainment also arises between organisms. The harmonizing of coupled oscillators into a single, dominant frequency is called frequency-selective entrainment. We propose that this phenomenon is the modus operandi of practitioners who use the cranial rhythmic impulse in craniosacral treatment. Dominant entrainment is enhanced by "centering," a technique practiced by many healers, for example, practitioners of Chinese, Tibetan, and Ayurvedic medicine. We explore the connections between centering, the cranial rhythmic impulse, and craniosacral treatment.

  4. 双侧正中神经、尺神经多节段运动神经传导各参数正常值的建立%Establishment of normative value of multiple segments motor nerve conduction velocity of bilateral median nerve and ulnar nerve

    Institute of Scientific and Technical Information of China (English)

    张朔; 郑菊阳

    2009-01-01

    目的:建立双侧正中神经、尺神经多节段运动神经传导速度(MCV)、潜伏期(LAT)和波幅(AMP)的正常值.方法:200例健康志愿者,男100例,女100例,分别按年龄分成5组,正中神经记录点在拇短展肌,刺激点分别为掌点、腕点、肘点、腋点、Erb点;尺神经记录点在小指展肌,刺激点分别为腕点、肘下点、肘上点、腋点、Erb点,记录各段MCV、LAT、AMP值.结果:正中神经、尺神经多节段MCV、LAT、AMP与性别、侧别无相关性;年龄与正中神经各段MCV、LAT、AMP及尺神经AMP有关.结论:双侧正中神经、尺神经多节段运动神经传导的准确检测对临床疾病诊断有重要价值.%Objective: To establish normative value of multiple segments motor nerve conduction of bilateral median nerve and ulnar nerve, including motor nerve conduction velocity (MCV)、latency (LAT)and amplitude (AMP). Method: Two hundred normal volunteers were divided into 5 groups according to different ages. Median nerve was examined at multiple points: palm, wrist, elbow, axilla and Erb's. Ulnar nerve was examined at multiple points: wrist, below elbow, above elbow, axilla and Erb's. The values of segmental MCV, LAT and AMP were recorded. Result: Gender and sidedness had no effect on MCV, LAT and AMP of median nerve and ulnar nerve. However, age had significant effects on MCV, LAT and AMP of median nerve and AMP of ulnar nerve. Conclusion: The examination of multiple segments motor nerve conduction of bilateral median nerve and ulnar nerve possess important value in diagnosis.

  5. In vitro classical conditioning of abducens nerve discharge in turtles.

    Science.gov (United States)

    Keifer, J; Armstrong, K E; Houk, J C

    1995-07-01

    In vitro classical conditioning of abducens nerve activity was performed using an isolated turtle brainstem-cerebellum preparation by direct stimulation of the cranial nerves. Using a delayed training procedure, the in vitro preparation was presented with paired stimuli consisting of a 1 sec train stimulus applied to the auditory nerve (CS), which immediately preceded a single shock US applied to the trigeminal nerve. Conditioned and unconditioned responses were recorded in the ipsilateral abducens nerve. Acquisition exhibited a positive slope of conditioned responding in 60% of the preparations. Application of unpaired stimuli consisting of CS-alone, alternate CS and US, or backward conditioning failed to result in conditioning, or resulted in extinction of CRs. Latencies of CR onset were timed such that they occurred midway through the CS. Activity-dependent uptake of the dye sulforhodamine was used to examine the spatial distribution of neurons labeled during conditioning. These data showed label in the cerebellum and red nucleus during conditioning whereas these regions failed to label during unconditioned responses. Furthermore, the principal abducens nucleus labeled heavily during conditioning. These findings suggest the feasibility of examining classical conditioning in a vertebrate in vitro brainstem-cerebellum preparation. It is postulated that the abducens nerve CR represents a behavioral correlate of a blink-related eye movement. Multiple sites of conditioning are hypothesized, including the cerebellorubral circuitry and brainstem pathways that activate the principal abducens nucleus.

  6. Evaluation of changes in retinal nerve fiber layer thickness and visual functions in cases of optic neuritis and multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Rohit Saxena

    2013-01-01

    Full Text Available Context: Retinal nerve fiber layer (RNFL thinning has been demonstrated in cases of optic neuritis (ON and multiple sclerosis (MS in Caucasian eyes, but no definite RNFL loss pattern or association with visual functions is known in Indian eyes. Aim : To evaluate RNFL thickness in cases of ON and MS, and to correlate it with visual function changes in Indian patients. Settings and Design: Cross-sectional case-control study at a tertiary level institution . Materials and Methods: Cases consisted of patients of (i typical ON without a recent episode (n = 30:39 ON eyes and 21 fellow eyes, (ii MS without ON (n = 15;30 eyes while the controls were age-matched (n = 15; 30 eyes. RNFL thickness was measured using the Stratus 3 °CT. The visual functions tested included the best-corrected visual acuity (BCVA, contrast sensitivity, stereopsis, visual evoked responses, and visual fields. Statistical analysis used: Intergroup analysis was done using ANOVA and Pearson′s correlation coefficient used for associations. Results: RNFL thickness was reduced significantly in the ON and MS patients compared to the controls (P-0.001. Maximum loss is in the temporal quadrant. Lower visual function scores are associated with reduced average overall RNFL thickness. In ON group, RNFL thinning is associated with severe visual field defects while contrast sensitivity has strongest correlation with RNFL in the MS group. Conclusions:RNFL thickness is reduced in ON and MS cases in a pattern similar to Caucasians and is associated with the magnitude of impairment of other visual parameters. Contrast sensitivity and stereoacuity are useful tests to identify subclinical optic nerve involvement in multiple sclerosis.

  7. Common Peroneal Nerve Palsy with Multiple-Ligament Knee Injury and Distal Avulsion of the Biceps Femoris Tendon

    Directory of Open Access Journals (Sweden)

    Takeshi Oshima

    2015-01-01

    Full Text Available A multiple-ligament knee injury that includes posterolateral corner (PLC disruption often causes palsy of the common peroneal nerve (CPN, which occurs in 44% of cases with PLC injury and biceps femoris tendon rupture or avulsion of the fibular head. Approximately half of these cases do not show functional recovery. This case report aims to present a criteria-based approach to the operation and postoperative management of CPN palsy that resulted from a multiple-ligament knee injury in a 22-year-old man that occurred during judo. We performed a two-staged surgery. The first stage was to repair the injuries to the PLC and biceps femoris. The second stage involved anterior cruciate ligament reconstruction. The outcomes were excellent, with a stable knee, excellent range of motion, and improvement in the palsy. The patient was able to return to judo competition 27 weeks after the injury. To the best of our knowledge, this is the first case report describing a return to sports following CPN palsy with multiple-ligament knee injury.

  8. Concomitant cranial and ocular combat injuries during Operation Iraqi Freedom.

    Science.gov (United States)

    Cho, Raymond I; Bakken, Hans E; Reynolds, Mark E; Schlifka, Brett A; Powers, David B

    2009-09-01

    Concomitant cranial and ocular injuries were frequently seen in combat casualties during Operation Iraqi Freedom. The incidence of these injuries is reported along with an interventional case series. A retrospective review was conducted of all surgical patients treated by U.S. Army neurosurgeons and ophthalmologists in Iraq from December 2005 to April 2006. Out of 104 patients with cranial trauma and 158 patients with ocular trauma, 34 had both cranial and ocular injuries (32.7 and 21.5% of patients with cranial and ocular injuries, respectively). Neurosurgical procedures included exploratory craniotomy, decompressive craniectomy, and frontal sinus surgery. Ophthalmologic surgical procedures included globe exploration, open globe repair, primary enucleation, orbital fracture repair, lateral canthotomy and cantholysis, and repair of lid and periocular lacerations. Patients with cranial trauma had a higher incidence of orbital fracture, orbital compartment syndrome, and multiple ocular injuries compared with patients without cranial trauma (odds ratio 6.4, 3.9, and 3.3, respectively). A strong association exists between cranial and ocular trauma in combat casualties treated during Operation Iraqi Freedom. Combat health support personnel should maintain a high level of suspicion for one of these injuries when the other is present. Co-locating neurosurgeons and ophthalmologists in support of combat operations facilitates the optimal treatment of patients with these combined injuries.

  9. Trigeminal neuralgia and facial nerve paralysis

    Energy Technology Data Exchange (ETDEWEB)

    Borges, Alexandra [IPOFG, Department of Radiology, Lisbon (Portugal)

    2005-03-01

    The trigeminal nerve is the largest of the cranial nerves. It provides sensory input from the face and motor innervation to the muscles of mastication. The facial nerve is the cranial nerve with the longest extracranial course, and its main functions include motor innervation to the muscles of facial expression, sensory control of lacrimation and salivation, control of the stapedial reflex and to carry taste sensation from the anterior two-thirds of the tongue. In order to be able adequately to image and follow the course of these cranial nerves and their main branches, a detailed knowledge of neuroanatomy is required. As we are dealing with very small anatomic structures, high resolution dedicated imaging studies are required to pick up normal and pathologic nerves. Whereas CT is best suited to demonstrate bony neurovascular foramina and canals, MRI is preferred to directly visualize the nerve. It is also the single technique able to detect pathologic processes afflicting the nerve without causing considerable expansion such as is usually the case in certain inflammatory/infectious conditions, perineural spread of malignancies and in very small intrinsic tumours. Because a long course from the brainstem nuclei to the peripheral branches is seen, it is useful to subdivide the nerve in several segments and then tailor the imaging modality and the imaging study to that specific segment. This is particularly true in cases where topographic diagnosis can be used to locate a lesion in the course of these nerves. (orig.)

  10. The in vivo phosphorylation sites in multiple isoforms of amphiphysin I from rat brain nerve terminals

    DEFF Research Database (Denmark)

    Craft, George E; Graham, Mark E; Bache, Nicolai;

    2008-01-01

    -proline-directed kinases, Ser-626, -250, -252, and -539, contained low amounts of 32P and were not depolarization-responsive. At least one alternatively spliced amphI isoform was identified in synaptosomes as being constitutively phosphorylated because it did not incorporate 32P during the 1-h labeling period. Multiple......, incorporating 16 and 23% of the 32P. The multiple phosphopeptides containing Ser-268, Ser-276, Ser-272, and Ser-285 had 27% of the 32P. Evidence for a role for at least one proline-directed protein kinase and one non-proline-directed kinase was obtained. Four phosphosites predicted for non...

  11. [Babies with cranial deformity].

    Science.gov (United States)

    Feijen, Michelle M W; Claessens, Edith A W M Habets; Dovens, Anke J Leenders; Vles, Johannes S; van der Hulst, Rene R W J

    2009-01-01

    Plagiocephaly was diagnosed in a baby aged 4 months and brachycephaly in a baby aged 5 months. Positional or deformational plagio- or brachycephaly is characterized by changes in shape and symmetry of the cranial vault. Treatment options are conservative and may include physiotherapy and helmet therapy. During the last two decades the incidence of positional plagiocephaly has increased in the Netherlands. This increase is due to the recommendation that babies be laid on their backs in order to reduce the risk of sudden infant death syndrome. We suggest the following: in cases of positional preference of the infant, referral to a physiotherapist is indicated. In cases of unacceptable deformity of the cranium at the age 5 months, moulding helmet therapy is a possible treatment option.

  12. Vincristine induced cranial polyneuropathy.

    Science.gov (United States)

    Bay, Ali; Yilmaz, Cahide; Yilmaz, Nebi; Oner, Ahmet Faik

    2006-06-01

    We describe a 5-year-old girl showed recovery of vincristine induced cranial polyneuropathy with pyridoxine and pyridostigmine treatment. A 5-year-old girl was diagnosed preB cell Acute Lymphoblastic Leukemia (ALL). She received chemotherapy according to the previously described modified St. Jude total therapy studies XIII. Five days after the fourth dose of vincristine, she presented with bilateral ptosis. Neurological examination revealed bilateral ptosis, and complete external opthalmoplegia with normal pupillary and corneal reflexes. She received 3.8 mg cumulative dose of vincristin before development of ptosis. A neuroprotective and neuroregenerative treatment attempt with pyridoxine and pyridostigmine was initiated. The bilateral ptosis markedly improved after 7 days of pyridoxine and pyridostigmine treatment and completely resolved after two weeks. The both agents were given for 3 weeks and were well tolerated without any side effects. During the follow up period we did not observe residue or recurrence of the ptosis.

  13. A Rare Neurological Involvement in Sjogrens Syndrome: Abducens Nerve Palsy

    Directory of Open Access Journals (Sweden)

    Yunus Ugan

    2016-05-01

    Full Text Available Sjogren%u2019s syndrome (SS is an autoimmune disorder characterized by lymphocytic infiltration of exocrine organs. Although neurological involvement occurs in approximately one quarter of patients, involvement of cranial nerves is a relatively rare occurrence. Here a rare case of cranial neuropathy related to SS is reported.

  14. Aspects of the History of the Nerves: Bell's Theory, the Bell-Magendie Law and Controversy, and Two Forgotten Works by P.W. Lund and D.F. Eschricth

    DEFF Research Database (Denmark)

    Jørgensen, C. Barker

    2003-01-01

    History of nerves, Bell's Idea, Bell-Magendie law, Bell-Magendie controversy, Charles Bell, Francois Magendie, P.W. Lund, D.F. Eschricht, Herbert Mayo, Johannes Müller, Claude Bernard, spinal nerve roots, cranial nerves, recurrent sensitivity...

  15. Abnormal Nerve Conduction Study Findings Indicating the Existence of Peripheral Neuropathy in Multiple Sclerosis and Neuromyelitis Optica

    Directory of Open Access Journals (Sweden)

    Yoko Warabi

    2013-01-01

    Full Text Available Objective. Chronic inflammatory demyelinating polyneuropathy (CIDP has been reported in patients with multiple sclerosis (MS. However, there have been limited reports of peripheral neuropathy as a complication of neuromyelitis optica (NMO. In this paper, we showed the characteristics and differences between peripheral neuropathy as a complication of MS and NMO. Method. We analyzed a series of 58 MS and 28 NMO patients and evaluated nerve conduction studies (NCS in 21 MS and 5 NMO patients. Results. Six of the 58 MS and 3 of the 28 NMO patients revealed abnormal NCS findings. Three (5.2% of the 58 MS patients fulfilled the criteria for CIDP. One (3.6% of the 28 NMO patients showed peripheral neuropathy at the same time of NMO relapse, although CIDP was not seen in NMO. The other 5 (3 MS and 2 NMO patients were complicated with neuropathy caused by concomitant diabetes mellitus and Sjögren’s syndrome. Conclusion. Frequency of abnormal NCS findings might exhibit no significant difference between MS and NMO, although the cause and pathophysiology of peripheral neuropathy were different in MS and in NMO. There might be a group of NMO who were affected simultaneously in the central and peripheral nervous tissues.

  16. Correlation of optic neuritis and retinal nerve fibre thickness using optical coherence tomography in a cohort of multiple sclerosis patients

    Directory of Open Access Journals (Sweden)

    Izanne Roos

    2016-03-01

    Full Text Available Background: Optical coherence tomography (OCT is a fast, non-invasive imaging technology that produces 3D, high-resolution images of the retina. Direct visualisation of the retina allows a unique opportunity to study the effects of multiple sclerosis (MS-associated neurodegeneration on retinal ganglion cells as well as effects of retrobulbar demyelination on axonal and retinal architecture through measurement of retinal nerve fibre layer (RNFL thickness and total macular volume (TMV. These findings are clinically important as axonal loss is irreversible and correlates with disability.Aim: To determine the role and usefulness of OCT in a local cohort of MS patients.Setting: Neurology Clinic, Inkosi Albert Luthuli Central Hospital, KwaZulu-Natal, South Africa.Methods: Nineteen patients with MS currently being treated with interferon β-1b underwent OCT examination of both eyes. RNFL thickness and macular volume were measured and correlated with clinical disease characteristics, history of optic neuritis and level of disability.Results: Mean RNFL thickness was 77.3 μm with no significant difference in mean RNFL in eyes with a history of optic neuritis (ON and those without (p = 0.4. Eyes with a history of ON did, however, have significantly thinner RNFL compared with the contralateral eye (p = 0.04. Despite a strong correlation between TMV and RNFL (p = 0.001, a subset of patients with normal RNFL had TMV that was less than 1% of what was expected. There was no correlation between RNFL and disability scores.Conclusion: OCT enables a direct axonal ‘optical biopsy’, for monitoring disease progression and treatment response in MS. RNFL thinning occurs independently of a history of optic neuritis and may represent a chronic optic neuropathy in patients with MS.Keywords: Multiple sclerosis; optical coherence tomography

  17. An unusual cause of trochlear nerve palsy and brainstem compression

    Directory of Open Access Journals (Sweden)

    Jasmit Singh

    2016-01-01

    Full Text Available Schwannoma originates from the Schwann cells at the Obersteiner-Redlich zone, which marks the junction of central and peripheral myelin of the cranial nerves. Most frequently affected are the vestibular, trigeminal, and facial nerves followed by the lower cranial nerves. Trochlear schwannoma in the absence of neurofibromatosis is a rare entity. The purpose of this report is to serve as a reminder to consider trochlear nerve schwannoma in the list of differential diagnosis of such tumors as the outcome is far better than the intraaxial tumor in that location.

  18. Spinal accessory nerve schwannomas masquerading as a fourth ventricular lesion

    Directory of Open Access Journals (Sweden)

    Shyam Sundar Krishnan

    2015-01-01

    Full Text Available Schwannomas are benign lesions that arise from the nerve sheath of cranial nerves. The most common schwannomas arise from the 8 th cranial nerve (the vestibulo-cochlear nerve followed by trigeminal and facial nerves and then from glossopharyngeal, vagus, and spinal accessory nerves. Schwannomas involving the oculomotor, trochlear, abducens and hypoglossal nerves are very rare. We report a very unusual spinal accessory nerve schwannoma which occupied the fourth ventricle and extended inferiorly to the upper cervical canal. The radiological features have been detailed. The diagnostic dilemma was due to its midline posterior location mimicking a fourth ventricular lesion like medulloblastoma and ependymoma. Total excision is the ideal treatment for these tumors. A brief review of literature with tabulations of the variants has been listed.

  19. Cranial Autonomic Symptoms in Migraine

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2009-11-01

    Full Text Available Cranial autonomic symptoms (CAS in patients with migraine and cluster headaches (CH were characterized and compared in a prospective study of consecutive patients attending a headache clinic at Taipei Veterans General Hospital, Taiwan.

  20. The computed cranial focal point

    NARCIS (Netherlands)

    Jong, G.A. de; Maal, T.J.J.; Delye, H.

    2015-01-01

    INTRODUCTION: Stereophotogrammetry is a radiation-free method for monitoring skull development after craniosynostosis repair. Lack of clear fixed reference points complicate longitudinal comparison of 3D photographs. Therefore we developed the 'computed cranial focal point' (CCFP). METHODS: The CCFP

  1. Lumbar Plexus and Sciatic Nerve Blocks for Fixation of Proximal Femoral Fractures in patients with Multiple Co-Morbidities

    Directory of Open Access Journals (Sweden)

    T.V.S Gopal

    2014-06-01

    Full Text Available Anaesthesia management for proximal femoral fractures of high risk patients with debilitating systemic co-morbidities is a challenging task. It is generally done under the effect of regional anaesthesia or general anaesthesia (GA, with systemic analgesics for alleviation of pain after surgery. A combination of lumbar plexus and sciatic nerve blocks can provide anaesthesia and analgesia to the entire lower extremity including the hip. Analgesic potency of lumbar plexus and sciatic nerve blocks is similar to epidural analgesia for hip surgery without the undesirable side effects. We describe here two cases of proximal femoral fractures which were done under combined lumbar plexus and sciatic nerve block.

  2. Heterogeneous pattern of retinal nerve fiber layer in multiple sclerosis. High resolution optical coherence tomography: potential and limitations.

    Directory of Open Access Journals (Sweden)

    Nermin Serbecic

    Full Text Available BACKGROUND: Recently the reduction of the retinal nerve fibre layer (RNFL was suggested to be associated with diffuse axonal damage in the whole CNS of multiple sclerosis (MS patients. However, several points are still under discussion. (1 Is high resolution optical coherence tomography (OCT required to detect the partly very subtle RNFL changes seen in MS patients? (2 Can a reduction of RNFL be detected in all MS patients, even in early disease courses and in all MS subtypes? (3 Does an optic neuritis (ON or focal lesions along the visual pathways, which are both very common in MS, limit the predication of diffuse axonal degeneration in the whole CNS? The purpose of our study was to determine the baseline characteristics of clinical definite relapsing-remitting (RRMS and secondary progressive (SPMS MS patients with high resolution OCT technique. METHODOLOGY: Forty-two RRMS and 17 SPMS patients with and without history of uni- or bilateral ON, and 59 age- and sex-matched healthy controls were analysed prospectively with the high resolution spectral-domain OCT device (SD-OCT using the Spectralis 3.5mm circle scan protocol with locked reference images and eye tracking mode. Furthermore we performed tests for visual and contrast acuity and sensitivity (ETDRS, Sloan and Pelli-Robson-charts, for color vision (Lanthony D-15, the Humphrey visual field and visual evoked potential testing (VEP. PRINCIPAL FINDINGS: All 4 groups (RRMS and SPMS with or without ON showed significantly reduced RNFL globally, or at least in one of the peripapillary sectors compared to age-/sex-matched healthy controls. In patients with previous ON additional RNFL reduction was found. However, in many RRMS patients the RNFL was found within normal range. We found no correlation between RNFL reduction and disease duration (range 9-540 months. CONCLUSIONS: RNFL baseline characteristics of RRMS and SPMS are heterogeneous (range from normal to markedly reduced levels.

  3. Cyberknife radiosurgery for cranial plasma cell tumor.

    Science.gov (United States)

    Alafaci, Cetty; Grasso, Giovanni; Conti, Alfredo; Caffo, Mariella; Salpietro, Francesco Maria; Tomasello, Francesco

    2014-01-01

    Cranial and intracranial involvement by myelomatous disease is relatively uncommon. Furthermore, systemic manifestations of multiple myeloma are present in the majority of these cases at the time of symptom onset. The authors report the case of a patient with serial appearance of multiple intracranial plasma cell tumor localizations as the first manifestations of a multiple myeloma. The patient was treated with CyberKnife radiosurgery for a lesion localized at the clivus and sella turcica with complete local control. With such a technique, based on high-dose conformality, the tumor was centered with an ablative dose of radiation and, at the same time, with a low dose spreading to the surrounding critical structures. The radiosensitivity of plasma cell tumors renders this treatment modality particularly advantageous for their localized manifestation. A technical description of this case is provided. To our knowledge, this is the first case of successful Cyberknife radiosurgery of multifocal intracranial plasmacytoma.

  4. Peripheral nerve involvement in Bell's palsy

    Directory of Open Access Journals (Sweden)

    J. A. Bueri

    1984-12-01

    Full Text Available A group of patients with Bell's palsy were studied in order to disclose the presence of subclinical peripheral nerve involvement. 20 patients, 8 male and 12 female, with recent Bell's palsy as their unique disease were examined, in all cases other causes of polyneuropathy were ruled out. Patients were investigated with CSF examination, facial nerve latencies in the affected and in the sound sides, and maximal motor nerve conduction velocities, as well as motor terminal latencies from the right median and peroneal nerves. CSF laboratory examination was normal in all cases. Facial nerve latencies were abnormal in all patients in the affected side, and they differed significantly from those of control group in the clinically sound side. Half of the patients showed abnormal values in the maximal motor nerve conduction velocities and motor terminal latencies of the right median and peroneal nerves. These results agree with previous reports which have pointed out that other cranial nerves may be affected in Bell's palsy. However, we have found a higher frequency of peripheral nerve involvement in this entity. These findings, support the hypothesis that in some patients Bell's palsy is the component of a more widespread disease, affecting other cranial and peripheral nerves.

  5. Cranial electrotherapy stimulation and fibromyalgia.

    Science.gov (United States)

    Gilula, Marshall F

    2007-07-01

    Cranial electrotherapy stimulation (CES) is a well-documented neuroelectrical modality that has been proven effective in some good studies of fibromyalgia (FM) patients. CES is no panacea but, for some FM patients, the modality can be valuable. This article discusses aspects of both CES and FM and how they relate to the individual with the condition. FM frequently has many comorbidities such as anxiety, depression, insomnia and a great variety of different rheumatologic and neurological symptoms that often resemble multiple sclerosis, dysautonomias, chronic fatigue syndrome and others. However, despite long-standing criteria from the American College of Rheumatology for FM, some physicians believe there is probably no single homogeneous condition that can be labeled as FM. Whether it is a disease, a syndrome or something else, sufferers feel like they are living one disaster after another. Active self-involvement in care usually enhances the therapeutic results of various treatments and also improves the patient's sense of being in control of the condition. D-ribose supplementation may prove to significantly enhance energy, sleep, mental clarity, pain control and well-being in FM patients. A form of evoked potential biofeedback, the EPFX, is a powerful stress reduction technique which assesses the chief stressors and risk factors for illness that can impede the FM patient's built-in healing abilities. Future healthcare will likely expand the diagnostic criteria of FM and/or illuminate a group of related conditions and the ways in which the conditions relate to each other. Future medicine for FM and related conditions may increasingly involve multimodality treatment that features CES as one significant part of the therapeutic regimen. Future medicine may also include CES as an invaluable, cost-effective add-on to many facets of clinical pharmacology and medical therapeutics.

  6. Neurotization of oculomotor, trochlear and abducent nerves in skull base surgery

    Institute of Scientific and Technical Information of China (English)

    李世亭; 潘庆刚; 刘宁涛; 刘忠; 沈峰

    2003-01-01

    Objective To anatomically reconstruct the oculomotor nerve, trochlear nerve, and abducent nerve by skull base surgery. Methods Seventeen cranial nerves (three oculomotor nerves, eight trochlear nerves and six abducent nerves) were injured and anatomically reconstructed in thirteen skull base operations during a period from 1994 to 2000. Repair techniques included end-to-end neurosuture or fibrin glue adhesion, graft neurosuture or fibrin glue adhesion. The relationships between repair techniques and functional recovery and the related factors were analyzed.Results Functional recovery began from 3 to 8 months after surgery. During a follow-up period of 4 months to 6 years, complete recovery of function was observed in 6 trochlear nerves (75%) and 4 abducent nerves (67%), while partial functional recovery was observed in the other cranial nerves including 2 trochlear nerves, 2 abducent nerves, and 3 oculomotor nerves.Conclusions Complete or partial functional recovery could be expected after anatomical neurotization of an injured oculomotor, trochlear or abducent nerve. Our study demonstrated that, in terms of functional recovery, trochlear and abducent nerves are more responsive than oculomotor nerves, and that end-to-end reconstruction is more efficient than graft reconstruction. These results encourage us to perform reconstruction for a separated cranial nerve as often as possible during skull base surgery.

  7. Madurella mycetoma--a rare case with cranial extension.

    Science.gov (United States)

    Maheshwari, Shradha; Figueiredo, Antonio; Narurkar, Swati; Goel, Atul

    2010-01-01

    Madurella species of fungus causes chronic subcutaneous infection of lower extremities; the infection is commonly labeled as Madura foot. We report a case of Madurella infection involving the cranial cavity. Such an involvement by Madurella fungal infection is not recorded in the literature. A 31-year-old non-immunocompromised male patient presented with complaints of left hemifacial pain for 1 year and diplopia on looking toward left side for a period of 2 weeks. On examination, he had ipsilateral sixth nerve paresis. Investigations revealed a large paranasal sinus lesion that extended in the cavernous sinus. The lesion was partially resected. Histologic examination revealed that the lesion was a fungus Madurella mycetomi. A rare cranial extension of Madurella fungal infection is reported. Copyright (c) 2010 Elsevier Inc. All rights reserved.

  8. Preoperative surgical planning and simulation of complex cranial base tumors in virtual reality

    Institute of Scientific and Technical Information of China (English)

    YI Zhi-qiang; LI Liang; MO Da-peng; ZHANG Jia-yong; ZHANG Yang; BAO Sheng-de

    2008-01-01

    @@ The extremely complex anatomic relationships among bone,tumor,blood vessels and cranial nerves remains a big challenge for cranial base tumor surgery.Therefore.a good understanding of the patient specific anatomy and a preoperative planning are helpful and crocial for the neurosurgeons.Three dimensional (3-D) visualization of various imaging techniques have been widely explored to enhance the comprehension of volumetric data for surgical planning.1 We used the Destroscope Virtual Reality (VR) System (Singapore,Volume Interaction Pte Ltd,software:RadioDexterTM 1.0) to optimize preoperative plan in the complex cranial base tumors.This system uses patient-specific,coregistered,fused radiology data sets that may be viewed stereoscopically and can be manipulated in a virtual reality environment.This article describes our experience with the Destroscope VR system in preoperative surgical planning and simulation for 5 patients with complex cranial base tumors and evaluates the clinical usefulness of this system.

  9. Variations of the accessory nerve: anatomical study including previously undocumented findings-expanding our misunderstanding of this nerve.

    Science.gov (United States)

    Tubbs, R Shane; Ajayi, Olaide O; Fries, Fabian N; Spinner, Robert J; Oskouian, Rod J

    2017-02-01

    The anatomy of the accessory nerve has been well described but continued new clinical and anatomical findings exemplify our lack of a full understanding of the course of this nerve. Therefore, this study aimed to expand on our knowledge of the course of the 11th cranial nerve via anatomical dissections. Fifty-six cadavers (112 sides) underwent dissection of the accessory nerve from its cranial and spinal origins to its emergence into the posterior cervical triangle. Immunohistochemistry was performed when appropriate. Our findings included two cases (1.8%) where the nerve was duplicated, one intracranially and one extracranially. One accessory nerve (0.9%) was found to enter its own dural compartment within the jugular foramen. The majority of sides (80%) were found to have a cranial root of the accessory nerve. Thirty-one sides (28%) had connections to cervical dorsal roots medially and three sides (2.7%) laterally. Medial connections were most common with the C1 nerve. Medial components of these dorsal root connections were all sensory in nature. However, lateral components were motor on two sides (1.8%). Nerves traveled anterior to the internal jugular vein on 88% of sides. One (0.9%) left side nerve joined an interneural anastomosis between the dorsal rootlets. Macroganglia were found on the spinal part of the intracranial nerve on 13% of sides. The lesser occipital nerve arose directly from the accessory nerve on two sides (1.8%) and communicated with the accessory nerve on 5.4% of sides. One side (0.9%) was found to communicate with the facial nerve with both nerves innervating the sternocleidomastoid muscle. Additional anatomical knowledge of the variants of the accessory nerve may benefit patient care when this nerve is pathologically involved.

  10. Visualization of the Peripheral Branches of the Mandibular Division of the Trigeminal Nerve on 3D Double-Echo Steady-State with Water Excitation Sequence

    National Research Council Canada - National Science Library

    Fujii, H; Fujita, A; Yang, A; Kanazawa, H; Buch, K; Sakai, O; Sugimoto, H

    2015-01-01

    Although visualization of the extracranial branches of the cranial nerves has improved with advances in MR imaging, only limited studies have assessed the detection of extracranial branches of the mandibular nerve (V3...

  11. Reconstruction of Multiple Facial Nerve Branches Using Skeletal Muscle-Derived Multipotent Stem Cell Sheet-Pellet Transplantation.

    Directory of Open Access Journals (Sweden)

    Kosuke Saito

    Full Text Available Head and neck cancer is often diagnosed at advanced stages, and surgical resection with wide margins is generally indicated, despite this treatment being associated with poor postoperative quality of life (QOL. We have previously reported on the therapeutic effects of skeletal muscle-derived multipotent stem cells (Sk-MSCs, which exert reconstitution capacity for muscle-nerve-blood vessel units. Recently, we further developed a 3D patch-transplantation system using Sk-MSC sheet-pellets. The aim of this study is the application of the 3D Sk-MSC transplantation system to the reconstitution of facial complex nerve-vascular networks after severe damage. Mouse experiments were performed for histological analysis and rats were used for functional examinations. The Sk-MSC sheet-pellets were prepared from GFP-Tg mice and SD rats, and were transplanted into the facial resection model (ST. Culture medium was transplanted as a control (NT. In the mouse experiment, facial-nerve-palsy (FNP scoring was performed weekly during the recovery period, and immunohistochemistry was used for the evaluation of histological recovery after 8 weeks. In rats, contractility of facial muscles was measured via electrical stimulation of facial nerves root, as the marker of total functional recovery at 8 weeks after transplantation. The ST-group showed significantly higher FNP (about three fold scores when compared to the NT-group after 2-8 weeks. Similarly, significant functional recovery of whisker movement muscles was confirmed in the ST-group at 8 weeks after transplantation. In addition, engrafted GFP+ cells formed complex branches of nerve-vascular networks, with differentiation into Schwann cells and perineurial/endoneurial cells, as well as vascular endothelial and smooth muscle cells. Thus, Sk-MSC sheet-pellet transplantation is potentially useful for functional reconstitution therapy of large defects in facial nerve-vascular networks.

  12. Bilateral Facial Nerve Palsy in Acute B Cell Lymphoblastic Leukemia: A Case Report and Review of the Literature.

    Science.gov (United States)

    Sen, Shiraj; Gupta, Arjun; Friedman, Paul; Naina, Harris V

    2016-06-01

    Acute lymphoblastic leukemia (ALL) is a haematological malignancy that can involve the central nervous system (CNS). Less than 10 % of patients with ALL have CNS involvement at presentation. The cranial nerve most commonly affected is cranial nerve VII although bilateral involvement is rare. Management and outcomes of these patients are not well understood. Moreover bilateral Bells palsy as a presenting symptom of ALL is extremely uncommon. We report a very unusual presentation of ALL with bilateral facial nerve palsy, and discuss the management strategies and outcomes for patients with ALL that present with cranial nerve palsies.

  13. [Dynamics of lagophthalmos depending on facial nerve repair and its intraoperative monitoring in neurosurgical patients].

    Science.gov (United States)

    Tabachnikova, T V; Serova, N K; Shimansky, V N

    2014-01-01

    Over 200 patients with acoustic neuromas and over 100 patients with posterior cranial fossa meningiomas are annually operated on at the N.N. Burdenko Neurosurgical Institute. Intraoperative monitoring of the facial nerve function is used in most patients with tumors of the posterior cranial fossa to identify the facial nerve in the surgical wound. If the anatomical integrity of the facial nerve in the cranial cavity cannot be retained, facial nerve repair is performed to restore the facial muscle function. Intraoperative electrical stimulation of the facial nerve has a great prognostic significance to evaluate the dynamics of lagophthalmos in the late postoperative period and to select the proper method for lagophthalmos correction. When the facial nerve was reinnervated by the descending branch or trunk of the hypoglossal nerve, sufficient eyelid closure was observed only in 3 patients out of 17.

  14. Invasive cranial mycosis our experiences

    Directory of Open Access Journals (Sweden)

    Tapas Kumbhkar

    2013-01-01

    Full Text Available Fungi can cause serious cranial infections in immunocompromised and diabetic patients. Common pathogens mainly include Aspergillus and Mucor. These organisms cause tissue invasion and destruction of adjacent structures (e.g. orbit, ethmoid, sphenoid, maxillary & cavernous sinuses. Mortality and morbidity rate is high despite combined surgical, antifungal and antidiabetic treatment. We present our experience of six cases with such infection.

  15. Effects of multiple intravitreal anti-VEGF injections on retinal nerve fiber layer and intraocular pressure: a comparative clinical study

    Institute of Scientific and Technical Information of China (English)

    Franck; Amouyal; Danièle; Denis; Frédéric; Matonti

    2014-01-01

    Dear Sir,Ifound the article by Sobac1etal[1]very interesting.The authors concluded that repeated intravitreal injection(IVI)of ranibizumab or bevacizumab didn’t seem have adverse effects on retinal nerve fiber layer(RNFL)thickness in wet age-related macular degeneration(AMD)patients.

  16. Nerve biopsy

    Science.gov (United States)

    Biopsy - nerve ... A nerve biopsy is most often done on a nerve in the ankle, forearm, or along a rib. The health care ... feel a prick and a mild sting. The biopsy site may be sore for a few days ...

  17. The controversy of cranial bone motion.

    Science.gov (United States)

    Rogers, J S; Witt, P L

    1997-08-01

    Cranial bone motion continues to stimulate controversy. This controversy affects the general acceptance of some intervention methods used by physical therapists, namely, cranial osteopathic and craniosacral therapy techniques. Core to these intervention techniques is the belief that cranial bone mobility provides a compliant system where somatic dysfunction can occur and therapeutic techniques can be applied. Diversity of opinion over the truth of this concept characterizes differing viewpoints on the anatomy and physiology of the cranial complex. Literature on cranial bone motion was reviewed for the purpose of better understanding this topic. Published research overall was scant and inconclusive. Animal and human studies demonstrate a potential for small magnitude motion. Physical therapists should carefully scrutinize the literature presented as evidence for cranial bone motion. Further research is needed to resolve this controversy. Outcomes research, however, is needed to validate cranial bone mobilization as an effective treatment.

  18. Epidemiological approach to emergent cranial surgery of cranial traumas

    Directory of Open Access Journals (Sweden)

    Hülagü Kaptan

    2008-03-01

    Full Text Available

    Objective: In this study, we aim to define the emergent cranial surgery of cranial trauma cases in terms of the reason of occurance, diagnosis, prognostic factors and results. Methods: 153 cases hospitalized in our clinic during a four year period were statistically analysed in accordance with trauma etiology, age, gender, application GCS (Glascow Coma Score mortality rate, location and established patology.

    Results: 76% (116 of the 153 cases were male. The most frequent etiological reasons were, in descending order, traffic accident 52% (n = 80, fall 34% (n = 53, direct trauma to the head 14(n =20. 45% (n = 69 were diagnosed epidural haematomas, 26% (n = 40 were diagnosed depression fractures and 3% (n = 5 were diagnosed intracerebral haematomas. A meaningful statistical difference was found in the comparison of the diagnosis regarding gender (p=0,012 age group (p=0,0282 and GCS (p=0,0001.

    Conclusions: In order to prevent cranial traumas, studies aimed at minimizing traffic accidents should be undertaken. The most essential action after the accident has occured is triage, and this is of great importance in order to establish communication among the health institutions.

  19. The effect of the field strength on standardized MRI of the brain to demonstrate cranial nerves and vessels: a comparison of 1.5 and 3.0 Tesla; Auswirkung der Feldstaerke bei der standardisierten Kernspintomographie des Gehirns am Beispiel der Darstellung von Hirnnerven und Gefaessen in den basalen Zisternen: Vergleich zwischen 1,5 und 3,0 Tesla

    Energy Technology Data Exchange (ETDEWEB)

    Roettgen, R.; Haltaufderheide, K.; Schroeder, R.J.; Lorenz, M.; Herzog, H.; Neumann, F.; Lehmkuhl, L.; Winter, L.; Felix, R.; Bruhn, H. [Klinik fuer Strahlenheilkunde, Campus Virchow-Klinikum, Charite Univ. Berlin (Germany)

    2005-04-01

    Purpose: Comparison of MR images acquired as routine examinations at a field strength of 3.0 T and 1.5 T to determine whether and to which degree the image quality improves at the higher field strength of 3.0 T. Materials and Methods: Routine MR images of 200 patients were examined retrospectively, with 100 images obtained at 1.5 T and 100 obtained at 3.0 T. The examinations were performed with a quadrature head coil and focused on the basal cisterns because of the abundance of small distinct structures in this region. We selected the T2-weighted 2D-FSE sequence in transverse direction for comparison. At both field strengths, the same section thickness of 5 mm and a matrix of 512 x 388 (FOV: 220 mm) were used. The quality of the images was evaluated with regard to depicting the cranial nerves N. III, V-X, the AICA and PICA. For comparison, image quality was rated with a score from 1 (well defined) to 5 (not depicted). Results: A score of 1 was obtained in 46% of the anatomic structures examined at 3.0 T and in only 9.2% at 1.5 T. A score of 2 was given in 27.6% of the anatomic structures at 3.0 T vs. 23.5% at 1.5 T, a score of 3 in 17.2% vs. 28.1%, a score of 4 in 8.6% vs. 28.7%, and a score of 5 in 0.4% vs. 10.3%, respectively. The Mann-Whitney U test showed significance at p<0.001 for the comparison of images at 1.5 and 3.0 Tesla. Conclusion: Routine magnetic resonance imaging using the same quadrature coil technique and similar acquisition times at 3.0 T and 1.5 T shows an improvement for T2-weighted images at the higher field strength. (orig.)

  20. Magnetic resonance imaging of optic nerve

    Directory of Open Access Journals (Sweden)

    Foram Gala

    2015-01-01

    Full Text Available Optic nerves are the second pair of cranial nerves and are unique as they represent an extension of the central nervous system. Apart from clinical and ophthalmoscopic evaluation, imaging, especially magnetic resonance imaging (MRI, plays an important role in the complete evaluation of optic nerve and the entire visual pathway. In this pictorial essay, the authors describe segmental anatomy of the optic nerve and review the imaging findings of various conditions affecting the optic nerves. MRI allows excellent depiction of the intricate anatomy of optic nerves due to its excellent soft tissue contrast without exposure to ionizing radiation, better delineation of the entire visual pathway, and accurate evaluation of associated intracranial pathologies.

  1. Imaging the olfactory tract (Cranial Nerve no.1)

    Energy Technology Data Exchange (ETDEWEB)

    Duprez, Thierry P. [Department of Radiology and Medical Imaging, Universite catholique de Louvain, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200-Brussels (Belgium)], E-mail: Thierry.Duprez@uclouvain.be; Rombaux, Philippe [Department of Otorhinolaryngology, Universite catholique de Louvain, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200-Brussels (Belgium)], E-mail: Philippe.Rombaux@uclouvain.be

    2010-05-15

    This review paper browses pros and cons of the different radiological modalities for imaging the olfactory tract and highlights the potential benefits and limitation of more recent advances in MR and CT technology. A systematic pictorial overview of pathological conditions affecting olfactory sense is given. Techniques for collecting quantitative data on olfactory bulb volume and on olfactory sulcus depth are described. At last, insights into functional imaging of olfactory sense are shown.

  2. Cranial Nerve Disorders in Children: MR Imaging Findings

    National Research Council Canada - National Science Library

    Hwang, Jae-Yeon; Yoon, Hye-Kyung; Lee, Jeong Hyun; Yoon, Hee Mang; Jung, Ah Young; Cho, Young Ah; Lee, Jin Seong; Yoon, Chong Hyun

    2016-01-01

    ...) imaging techniques that provide higher spatial resolution and fast imaging techniques including three-dimensional MR images with or without the use of gadolinium contrast agent, radiologists can more...

  3. Posttraumatic Cranial Cystic Fibrous Dysplasia

    Directory of Open Access Journals (Sweden)

    Arata Tomiyama

    2011-01-01

    Full Text Available A 14-year-old was girl admitted to our hospital with a subcutaneous mass of the occipital head. The mass had grown for 6 years, after she had sustained a head injury at the age of 6, and was located directly under a previous wound. Skull X-ray Photograph (xp, computed tomography (CT, and magnetic resonance imaging (MRI showed a bony defect and cystic changes in the skull corresponding to a subcutaneous mass. Bone scintigraphy revealed partial accumulation. The patient underwent total removal of the skull mass, and the diagnosis from the pathological findings of the cyst wall was fibrous dysplasia (FD. The radiographic findings for cystic cranial FD can be various. Progressive skull disease has been reported to be associated with head trauma, but the relationship between cranial FD and head trauma has not been previously reported. Previous studies have suggested that c-fos gene expression is a key mechanism in injury-induced FD.

  4. Cranial kinesis in palaeognathous birds.

    Science.gov (United States)

    Gussekloo, Sander W S; Bout, Ron G

    2005-09-01

    Cranial kinesis in birds is induced by muscles located caudal on the cranium. These forces are transferred onto the moveable parts of the skull via the Pterygoid-Palatinum Complex (PPC). This bony structure therefore plays an essential role in cranial kinesis. In palaeognathous birds the morphology of the PPC is remarkably different from that of neognathous birds and is thought to be related to the specific type of cranial kinesis in palaeognaths known as central rhynchokinesis. We determined whether clear bending zones as found in neognaths are present in the upper bill of paleognaths, and measured bending forces opposing elevation of the upper bill. A static force model was used to calculate the opening forces that can be produced by some of the palaeognathous species. We found that no clear bending zones are present in the upper bill, and bending is expected to occur over the whole length of the upper bill. Muscle forces are more than sufficient to overcome bending forces and to elevate the upper bill. The resistance against bending by the bony elements alone is very low, which might indicate that bending of bony elements can occur during food handling when muscles are not used to stabilise the upper bill. Model calculations suggest that the large processi basipterygoidei play a role in stabilizing the skull elements, when birds have to resist external opening forces on the upper bill as might occur during tearing leafs from plants. We conclude that the specific morphology of the palaeognathous upper bill and PPC are not designed for active cranial kinesis, but are adapted to resist external forces that might cause unwanted elevation of the upper bill during feeding.

  5. Cranial computed tomography in pediatrics

    Energy Technology Data Exchange (ETDEWEB)

    Boltshauser, E. (Zuerich Univ. (Switzerland). Kinderklinik)

    1984-01-01

    This paper deals mainly with methodical aspects (such as sedation, intravenous and intrathecal application of contrast media) and with common difficulties in interpretation of computed tomography images. The indications for cranial CT are discussed in respect to probable therapeutic consequences and expected diagnostic yield. In the view of the author CT is, as a rule, not required in assessing chronic headache, generalised epileptic convulsions, non-specific mental retardation and cerebral palsy.

  6. Cranial imaging in child abuse

    Energy Technology Data Exchange (ETDEWEB)

    Demaerel, P.; Wilms, G. [Department of Radiology, University Hospitals, Leuven (Belgium); Casteels, I. [Department of Ophthalmology, University Hospitals, Leuven (Belgium)

    2002-04-01

    Serious head injury in children less than 2 years old is often the result of child abuse. The role of the different neuroimaging modalities in child abuse is reviewed. Skull X-ray and cranial CT are mandatory. Repeat or serial imaging may be necessary and brain MR imaging may contribute to the diagnostic work-up, particularly in the absence of characteristic CT findings. The radiologist plays an important role in accurately identifying non-accidental cranial trauma. The clinical presentation can be non-specific or misleading. The possibility should be considered of a combined mechanism, i.e., an underlying condition with superimposed trauma. In this context, the radiologist is in the front line to suggest the possibility of child abuse. It is therefore important to know the spectrum of, sometimes subtle, imaging findings one may encounter. Opthalmological examination is of the greatest importance and is discussed here, because the combination of retinal hemorrhages and subdural hematoma is very suggestive of non-accidental cranial trauma. (orig.)

  7. Using an end-to-side interposed sural nerve graft for facial nerve reinforcement after vestibular schwannoma resection. Technical note.

    Science.gov (United States)

    Samii, Madjid; Koerbel, Andrei; Safavi-Abbasi, Sam; Di Rocco, Federico; Samii, Amir; Gharabaghi, Alireza

    2006-12-01

    Increasing rates of facial and cochlear nerve preservation after vestibular schwannoma surgery have been achieved in the last 30 years. However, the management of a partially or completely damaged facial nerve remains an important issue. In such a case, several immediate or delayed repair techniques have been used. On the basis of recent studies of successful end-to-side neurorrhaphy, the authors applied this technique in a patient with an anatomically preserved but partially injured facial nerve during vestibular schwannoma surgery. The authors interposed a sural nerve graft to reinforce the facial nerve whose partial anatomical continuity had been preserved. On follow-up examinations 18 months after surgery, satisfactory cosmetic results for facial nerve function were observed. The end-to-side interposed nerve graft appears to be a reasonable alternative in cases of partial facial nerve injury, and might be a future therapeutic option for other cranial nerve injuries.

  8. Perineurial malignant peripheral nerve sheath tumor in the setting of multiple soft tissue perineuriomas: A rare presentation of an uncommon tumor

    Directory of Open Access Journals (Sweden)

    Bharat Rekhi

    2013-01-01

    Full Text Available Perineurioma is an uncommon soft tissue tumor with characteristic histological and immunohistochemical features. Herein, this tumor is presented within a rare clinical setting, in a 45-year-old gentleman, with multiple soft tissue swellings and a previous history of surgical excision of a thigh mass. Four years back, he developed multiple soft tissue tumor swellings for which he lately underwent multiple wide excisions, elsewhere that were reported as multiple dermatofibrosarcoma protuberans (DFSPs. Histopathological review of the thigh and axillary tumor showed a perineurioma (EMA+, S100-P-ve, CD34-ve, low MIB1, whereas the recurrent leg mass disclosed a high-grade perineurial malignant peripheral nerve sheath tumor (MPNST (EMA+, CD56+, S100-P-, high MIB1, CD34-ve, p53+ve. Within four months of post-excision, he developed additional swellings, and died of respiratory insufficiency. This case forms the first documented case of perineurial MPNST with multiple, metachronous soft tissue perineuriomas. Available literature review of perineurial MPNSTs and diagnostic implications are discussed herewith

  9. Severe cranial neuropathies caused by falls from heights in children.

    Science.gov (United States)

    Zahavi, A; Luckman, J; Yassur, I; Michowiz, S; Goldenberg-Cohen, N

    2016-04-01

    Falls from heights are the most common traumatic event associated with emergency department visits in children. This study investigated the incidence and clinical course of cranial neuropathies caused by falls from heights in children. The computerized records of a tertiary pediatric medical center were searched for all patients admitted to the emergency department in 2004-2014 with a head injury caused by falling from a height. Those with cranial neuropathies involving optic and eye-motility disturbances were identified, and their clinical, imaging, and outcome data were evaluated. Of the estimated 61,968 patients who presented to the emergency department during the study period because of a fall, 18,758 (30.3 %) had head trauma. Only 12 (seven boys, five girls, average age 6.7 years) had a visual disturbance. Eight were diagnosed with traumatic optic neuropathy, one after a 6-month delay, including two with accompanying cranial nerve (CN) III injuries. Five patients had anisocoria or an abnormal pupillary response to light at presentation, one patient had CN VI paralysis and temporary vision loss, and one patient had an isolated CN III injury diagnosed on follow-up. Visual improvement varied among the patients. Cranial neuropathies due to falls from heights are rare in children and are associated with high visual morbidity. Vision or ocular motility impairment, especially monocular vision loss, may be missed during acute intake to the emergency department, and a high index of suspicion is needed. Assessment of the pupillary response to light is essential.

  10. Centella asiatica accelerates nerve regeneration upon oral administration and contains multiple active fractions increasing neurite elongation in-vitro.

    Science.gov (United States)

    Soumyanath, Amala; Zhong, Yong-Ping; Gold, Sandra A; Yu, Xiaolin; Koop, Dennis R; Bourdette, Dennis; Gold, Bruce G

    2005-09-01

    Axonal regeneration is important for functional recovery following nerve damage. Centella asiatica Urban herb, also known as Hydrocotyle asiatica L., has been used in Ayurvedic medicine for centuries as a nerve tonic. Here, we show that Centella asiatica ethanolic extract (100 microg mL-1) elicits a marked increase in neurite outgrowth in human SH-SY5Y cells in the presence of nerve growth factor (NGF). However, a water extract of Centella was ineffective at 100 microg mL-1. Sub-fractions of Centella ethanolic extract, obtained through silica-gel chromatography, were tested (100 microg mL-1) for neurite elongation in the presence of NGF. Greatest activity was found with a non-polar fraction (GKF4). Relatively polar fractions (GKF10 to GKF13) also showed activity, albeit less than GKF4. Thus, Centella contains more than one active component. Asiatic acid (AA), a triterpenoid compound found in Centella ethanolic extract and GKF4, showed marked activity at 1 microM (microg mL-1). AA was not present in GKF10 to GKF13, further indicating that other active components must be present. Neurite elongation by AA was completely blocked by the extracellular-signal-regulated kinase (ERK) pathway inhibitor PD 098059 (10 microM). Male Sprague-Dawley rats given Centella ethanolic extract in their drinking water (300-330 mg kg-1 daily) demonstrated more rapid functional recovery and increased axonal regeneration (larger calibre axons and greater numbers of myelinated axons) compared with controls, indicating that the axons grew at a faster rate. Taken together, our findings indicate that components in Centella ethanolic extract may be useful for accelerating repair of damaged neurons.

  11. Bilateral traumatic paralysis of abducent nerves and clivus fracture: Case Report

    Directory of Open Access Journals (Sweden)

    Calderon-Miranda Willen Guillermo

    2014-12-01

    Full Text Available Clivus fractures are a rare pathology, frecuently associated tohigh power trauma. Such injuries may be associated with vascular and cranial nerves lesions. The abducens nerve is particularly vulnerable to traumatic injuries due to its long intracranial course, since their real origin until the lateral rectus muscle. The unilateral abducens nerve palsy of 1- 2-7% occurs in patients with cranial trauma, bilateral paralysis is rare. We report a patient who presented bilateral abducens nerve palsy associated with a clivus fracture

  12. Cranial kinesis in the amphibia: a review.

    Science.gov (United States)

    Iordanskiĭ, N N

    2000-01-01

    All extant orders of amphibians are characterized by kinetic skulls. Main type of intracranial movability in amphibians is pleurokinetism, that is supplemented in different amphibian groups by various types of rhyncho- and prokinetism. The most primitive pattern of cranial kinesis is revealed in the stegocrotaphic gymnophions. More paedomorphic species retain general cranial flexibility that is characteristic of larval skull. That is unfavourable for evolution of well-regulated (adult) cranial kinesis and related feeding adaptations. Kinetism is also reduced in the species with heavily ossified skulls. Adaptive role and evolution of cranial kinesis in amphibians are discussed.

  13. Effect of Da-Cheng-Qi Decoction on the Repair of the Injured Enteric Nerve-Interstitial Cells of Cajal-Smooth Muscle Cells Network in Multiple Organ Dysfunction Syndrome

    Science.gov (United States)

    Liu, Mu-Cang; Xie, Ming-Zheng; Ma, Bin; Qi, Qing-Hui

    2014-01-01

    Wistar rats were randomly divided into control group, multiple organ dysfunction syndrome (MODS) group, and Da-Cheng-Qi decoction (DCQD) group. The network of enteric nerves-interstitial cells of Cajal- (ICC-) smooth muscle cells (SMC) in small intestine was observed using confocal laser scanning microscopy and transmission electron microscopy. The results showed that the numbers of cholinergic/nitriergic nerves, and the deep muscular plexus of ICC (ICC-DMP) and connexin43 (Cx43) in small intestine with MODS were significantly decreased. The network integrity of enteric nerves-ICC-SMC was disrupted. The ultrastructures of ICC-DMP, enteric nerves, and SMC were severely damaged. After treatment with DCQD, the damages were repaired and the network integrity of enteric nerves ICC-SMC was significantly recovered. In conclusion, the pathogenesis of gastrointestinal motility dysfunction in MODS in part may be due to the damages to enteric nerves-ICC-SMC network and gap junctions. The therapeutic mechanism of DCQD in part may be that it could repair the damages and maintain the integrity of enteric nerves ICC-SMC network. PMID:25477993

  14. Cranial birth trauma; Kraniales Geburtstrauma

    Energy Technology Data Exchange (ETDEWEB)

    Papanagiotou, P.; Roth, C.; Politi, M.; Zimmer, A.; Reith, W. [Universitaetsklinikum des Saarlandes, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Homburg/Saar (Germany); Rohrer, T. [Universitaetsklinikum des Saarlandes, Klinik fuer Allgemeine Paediatrie und Neonatologie, Homburg/Saar (Germany)

    2009-10-15

    Injuries to an infant that result during the birth process are categorized as birth trauma. Cranial injuries due to mechanical forces such as compression or traction include caput succedaneum, cephalhematoma, subgaleal hematoma and intracranial hemorrhaging. Hypoxic ischemic encephalopathy is the consequence of systemic asphyxia occurring during birth. (orig.) [German] Als Geburtstrauma werden die Verletzungen des Saeuglings bezeichnet, die waehrend der Geburt stattfinden. Zu den Verletzungen, die am Schaedel auftreten koennen und hauptsaechlich durch mechanische Kraefte wie Kompression oder Traktion verursacht werden, gehoeren das Caput succedaneum, das Zephalhaematom, das subgaleale Haematom und die intrakranielle Blutung. Die hypoxisch-ischaemische Enzephalopathie ist die Folge einer systemischen Asphyxie waehrend der Geburt. (orig.)

  15. How strong is the relationship between glaucoma, the retinal nerve fibre layer, and neurodegenerative diseases such as Alzheimer's disease and multiple sclerosis?

    Science.gov (United States)

    Jones-Odeh, E; Hammond, C J

    2015-10-01

    Glaucoma is a neurodegenerative disorder with established relationships with ocular structures such as the retinal nerve fibre layer (RNFL) and the ganglion cell layer (GCL). Ocular imaging techniques such as optical coherence tomography (OCT) allow for quantitative measurement of these structures. OCT has been used in the monitoring of glaucoma, as well as investigating other neurodegenerative conditions such as Alzheimer's disease (AD) and multiple sclerosis (MS). In this review, we highlight the association between these disorders and ocular structures (RNFL and GCL), examining their usefulness as biomarkers of neurodegeneration. The average RNFL thickness loss in patients with AD is 11 μm, and 7 μm in MS patients. Most of the studies investigating these changes are cross-sectional. Further longitudinal studies are required to assess sensitivity and specificity of these potential ocular biomarkers to neurodegenerative disease progression.

  16. Vincristine-Induced Cranial Neuropathy

    Directory of Open Access Journals (Sweden)

    Ahmad TALEBIAN*

    2013-12-01

    Full Text Available How to Cite This Article: Talebian A, Goudarzi RM, Mohammadzadeh M , Mirzadeh AS. Vincristine-Induced Cranial Neuropathy. Iran J Child Neurol. 2014 Winter; 8(1:66-68. Abstract Vincristine (VCR is a vinca alkaloid that is used for treatment of many malignancies. The vinca alkaloids are neurotoxic, usually causing a peripheral neuropathy, but cranial neuropathies are rare as side effects. Described here is the case of a 2.5-year-old boy, a known case of Wilms’ tumor, treated by vincristine (0/067 mg/kg/day and dactinomycin (0/045 mg/kg/day after surgery. Three weeks after treatment, he presented with bilateral ptosis. Neurological examination revealed bilateral ptosis with normal pupillary reflex and eye movement. He received 3.015 mg cumulative dose of vincristine before development of ptosis. Treatment with pyridoxine (150 mg/m2 p.o. BID and pyridostigmine (3 mg/kg p.o. BID started as neuroprotective agents, and after 7 days the problem disappeared. The treatment continued for 6 weeks and there were no signs of ptosis or a recurrence in follow up 2 months later.

  17. Primary meningeal melanocytoma of the anterior cranial fossa: a case report and review of the literature

    OpenAIRE

    2012-01-01

    Abstract Background Primary meningeal melanocytoma is a rare neurological disorder. Although it may occur at the base of the brain, it is extremely rare at the anterior cranial fossa. Case presentation A 27-year-old man presented with headache and diplopia at our department. Fundoscopy showed left optic nerve atrophy and right papilledema consistent with Foster-Kennedy syndrome. Neurological exams were otherwise normal. A left frontal irregular space-occupying lesion was seen on magnetic reso...

  18. Cranial osteology in Momotidae (Aves: Coraciiformes).

    Science.gov (United States)

    Pascotto, Márcia C; Donatelli, Reginaldo J

    2003-10-01

    Momotidae (motmots) is found throughout Latin America between Mexico and northern Argentina. Given the absence of detailed studies of cranial osteology of Momotidae in the literature, this article presents a comprehensive description of the variation of the cranial osteology in all nine species of Momotidae and compares the results with published studies of other families of Coraciiformes and families in other orders. In addition, the cranial structures described are related to ecological and behavioral aspects of Momotidae. The cranial osteology of Baryphthengus ruficapillus is described in detail and compared with other species of Momotidae. The results indicate the presence in Momotidae of modified cranial structures, among which the most conspicuous are the frontal, lacrimal, squamosal, orbital, and laterosphenoid regions, as well as the palatine, upper jaw, pterygoid, and mandible.

  19. [Complex diagnosis of congenital cranial dysostosis in children].

    Science.gov (United States)

    Iakubov, R K; Azimov, M I

    2002-01-01

    Ten patients (aged 3-15 years) with congenital cranial dysostosis were examined by a pediatrician, geneticist, gastroenterologist, neuropathologist, ophthalmologist, endocrinologist, and orthopaedist. In addition to the clinical signs characteristic of hereditary multiple developmental defects, the study revealed changes in the jaws and temporomandibular joint and local factors promoting the progress of deformations of the jaws. Manifest and inapparent pathological changes and dysfunctions in gastrointestinal organs were paralleled by dysfunctions of the central and autonomic nervous systems, risk of maxillofacial and general deformations, and signs of congenital disorders in calcium, lactic acid, and pyridoxine metabolism. The results necessitate analyses of the blood and urine and development of new methods for the diagnosis of congenital cranial dysostosis and improvement of methods for the correction of this condition.

  20. A Case of Skull Base Osteomyelitis with Multiple Cerebral Infarction

    Directory of Open Access Journals (Sweden)

    Haruka Miyabe

    2016-01-01

    Full Text Available Skull base osteomyelitis is classically documented as an extension of malignant otitis externa. Initial presentation commonly includes aural symptoms and cranial nerve dysfunctions. Here we present a case that emerged with multiple infarctions in the right cerebrum. A male in his 70s with diabetes mellitus and chronic renal failure presented with left hemiparesis. Imaging studies showed that blood flow in the carotid artery remained at the day of onset but was totally occluded 7 days later. However, collateral blood supply prevented severe infarction. These findings suggest that artery-to-artery embolization from the petrous and/or cavernous portion of the carotid artery caused the multiple infarctions observed on initial presentation. Osteomyelitis of the central skull base was diagnosed on the basis of the following findings taken together: laboratory results showing high levels of inflammation, presence of Pseudomonas aeruginosa in the otorrhea and blood culture, multiple cranial nerve palsies that appeared later, the bony erosion observed on CT, and the mass lesion on MRI. Osteomyelitis was treated successfully by long-term antibiotic therapy; however, the patient experienced cefepime-induced neurotoxicity during therapy. The potential involvement of the internal carotid artery in this rare and life-threatening disease is of particular interest in this case.

  1. Morphometric analysis of the fascicular organisation of the optic nerve

    Directory of Open Access Journals (Sweden)

    Radunović Miroslav

    2015-01-01

    Full Text Available Background/Aim. The optic nerve is anatomically observed in four segments: intrabulbar, orbital, canalicular, and cranial. According to the literature, the surface of the transversal cut of the nerve is different through it. The aim of this study was to evaluate the fascicular organisation of the optic nerve, throughout its three segments from the eye. Methods. Five pairs of optic nerves, obtained from the autopsies were examined. Using Heidenhain's (azan staining, the cuts were prepared for microscopy. Morphometric analysis was performed using the stereological methods for morphometric cytology - the Weible’s testing system M42. The following measures were established: the surface of the transverse cut of the nerve, the entire surface of fasciculi, the entire surface of connective tissue and blood vessels, the number of fasciculi, the surface of a single fasciculus. Results. The surface of the transverse cut of the nerve was found to grow from the orbital to the cranial segment, as well as the entire surface of fasciculi. While their number is significantly lower in the cranial segment, the number of fasciculi varied slightly between the orbital and the canalicular segment. The surface of a single fasciculus grows from the bulb to the chiasma. There is probable a cause to believe that this may be due to fusion of the “small” fasciculi in the orbitocranial direction. Conclusion. There are significant differences among the examined parameters of the different parts of the optic nerve.

  2. [Scalp neuralgia and headache elicited by cranial superficial anatomical causes: supraorbital neuralgia, occipital neuralgia, and post-craniotomy headache].

    Science.gov (United States)

    Shimizu, Satoru

    2014-01-01

    Most scalp neuralgias are supraorbital or occipital. Although they have been considered idiopathic, recent studies revealed that some were attributable to mechanical irritation with the peripheral nerve of the scalp by superficial anatomical cranial structures. Supraorbital neuralgia involves entrapment of the supraorbital nerve by the facial muscle, and occipital neuralgia involves entrapment of occipital nerves, mainly the greater occipital nerve, by the semispinalis capitis muscle. Contact between the occipital artery and the greater occipital nerve in the scalp may also be causative. Decompression surgery to address these neuralgias has been reported. As headache after craniotomy is the result of iatrogenic injury to the peripheral nerve of the scalp, post-craniotomy headache should be considered as a differential diagnosis.

  3. Isolated abducens nerve palsy with hyperhomocysteinemia: Association and outcomes

    Directory of Open Access Journals (Sweden)

    Virender Sachdeva

    2013-01-01

    Full Text Available Ischemic abducens nerve palsy usually presents as isolated cranial nerve palsy in the middle aged and elderly patients with known risk factors such as diabetes mellitus, hypertension, dyslipidemia, carotid artery disease, etc., In this report, we describe four patients with isolated abducens nerve palsy who presented with an acute onset diplopia whose detailed history and examination were suggestive of an ischemic etiology. Detailed systemic and laboratory evaluation revealed hyperhomocysteinemia as the only potential risk factor. To the best of our knowledge this is the first report of association of hyperhomocysteinemia and isolated abducens nerve palsy.

  4. Surgical treatment of cranial neuralgias.

    Science.gov (United States)

    Franzini, Angelo; Ferroli, Paolo; Messina, Giuseppe; Broggi, Giovanni

    2010-01-01

    The most common types of cranial neuralgias amenable to surgical therapeutic options are trigeminal neuralgia and glossopharyngeal neuralgia, the former having an approximate incidence of 5/100000 cases per year and the latter of 0.05/100000 cases per year. Surgical therapy of these pathological conditions encompasses several strategies, going from ablative procedures to neurovascular decompression, to radiosurgery. The choice of the most appropriate surgical option (which must be taken into account when all conservative treatments have proven to be unsuccessful) has to take into account many factors, the most important ones being neuroradiological evidence of a neurovascular conflict, severity of symptoms, the age and clinical history of the patient, and the patient's overall medical condition. In this chapter we report our experience with the treatment of trigeminal and glossopharyngeal neuralgia, describing the surgical procedures performed and reviewing the most recent aspects on this subject in the past literature.

  5. IQGAP1: A microtubule-microfilament scaffolding protein with multiple roles in nerve cell development and synaptic plasticity.

    Science.gov (United States)

    Jausoro, Ignacio; Mestres, Iván; Remedi, Mónica; Sanchez, Mónica; Cáceres, Alfredo

    2012-11-01

    In this article, we review our current understanding of the biology of IQ domain-containing GTPase-Activating Protein 1, IQGAP1, a scaffolding protein with multiple binding partners, which is widely expressed among different cell types, including neurons, and capable of linking Rho-GTPase signaling with cytosleletal elements and environmental cues. Interestingly, a series of recent studies suggest that IQGAP family members have an important role in neuronal development, synaptic plasticity and nervous system disorders involving alterations in spine density.

  6. Imaging the ocular motor nerves

    Energy Technology Data Exchange (ETDEWEB)

    Ferreira, Teresa [Department of Radiology, Leiden University Medical Center (Netherlands)], E-mail: T.A.Ferreira@lumc.nl; Verbist, Berit [Department of Radiology, Leiden University Medical Center (Netherlands)], E-mail: B.M.Verbist@lumc.nl; Buchem, Mark van [Department of Radiology, Leiden University Medical Center (Netherlands)], E-mail: M.A.van_Buchem@lumc.nl; Osch, Thijs van [C.J. Gorter for High-Field MRI, Department of Radiology, Leiden University Medical Center (Netherlands)], E-mail: M.J.P.van_Osch@lumc.nl; Webb, Andrew [C.J. Gorter for High-Field MRI, Department of Radiology, Leiden University Medical Center (Netherlands)], E-mail: A.Webb@lumc.nl

    2010-05-15

    The ocular motor nerves (OMNs) comprise the oculomotor, trochlear and the abducens nerves. According to their course, they are divided into four or five anatomic segments: intra-axial, cisternal, cavernous and intra-orbital and, for the abducens nerve, an additional interdural segment. Magnetic resonance imaging is the imaging method of choice in the evaluation of the normal and pathologic ocular motor nerves. CT still plays a limited but important role in the evaluation of the intraosseous portions at the skull base and bony foramina. We describe for each segment of these cranial nerves, the normal anatomy, the most appropriate image sequences and planes, their imaging appearance and pathologic conditions. Magnetic resonance imaging with high magnetic fields is a developing and promising technique. We describe our initial experience with a Phillips 7.0 T MRI scanner in the evaluation of the brainstem segments of the OMNs. As imaging becomes more refined, an understanding of the detailed anatomy is increasingly necessary, as the demand on radiology to diagnose smaller lesions also increases.

  7. Imaging the ocular motor nerves.

    Science.gov (United States)

    Ferreira, Teresa; Verbist, Berit; van Buchem, Mark; van Osch, Thijs; Webb, Andrew

    2010-05-01

    The ocular motor nerves (OMNs) comprise the oculomotor, trochlear and the abducens nerves. According to their course, they are divided into four or five anatomic segments: intra-axial, cisternal, cavernous and intra-orbital and, for the abducens nerve, an additional interdural segment. Magnetic resonance imaging is the imaging method of choice in the evaluation of the normal and pathologic ocular motor nerves. CT still plays a limited but important role in the evaluation of the intraosseous portions at the skull base and bony foramina. We describe for each segment of these cranial nerves, the normal anatomy, the most appropriate image sequences and planes, their imaging appearance and pathologic conditions. Magnetic resonance imaging with high magnetic fields is a developing and promising technique. We describe our initial experience with a Phillips 7.0T MRI scanner in the evaluation of the brainstem segments of the OMNs. As imaging becomes more refined, an understanding of the detailed anatomy is increasingly necessary, as the demand on radiology to diagnose smaller lesions also increases.

  8. Congenital third nerve palsy with synergistic depression on attempted adduction and trigemino-oculomotor synkinesis: Underpinnings of a spectral dysinnervation disorder

    Directory of Open Access Journals (Sweden)

    Pramod Kumar Pandey

    2016-01-01

    Full Text Available The authors describe a case of congenital partial pupil-sparing third cranial nerve palsy with absent adduction, synergistic depression of globe and widening of palpebral fissure on attempted adduction and synergistic elevation and adduction on mouth opening and sideways thrusting of jaw. The case illustrates trigemino-oculomotor synkinesis associated with congenital third nerve palsy. The possible mechanism of miswiring involving the medial longitudinal fasciculus and trigeminal nuclei is discussed. At least some cases of congenital third cranial nerve palsy may fall in the realm of congenital cranial dysinnervation disorders (CCDDs sharing a much wider spectrum of presentation.

  9. Congenital third nerve palsy with synergistic depression on attempted adduction and trigemino-oculomotor synkinesis: Underpinnings of a spectral dysinnervation disorder.

    Science.gov (United States)

    Pandey, Pramod Kumar; Bhambhwani, Vishaal; Ranjith, P C; Kadav, Mandar; Aparnaa, C

    2016-05-01

    The authors describe a case of congenital partial pupil-sparing third cranial nerve palsy with absent adduction, synergistic depression of globe and widening of palpebral fissure on attempted adduction and synergistic elevation and adduction on mouth opening and sideways thrusting of jaw. The case illustrates trigemino-oculomotor synkinesis associated with congenital third nerve palsy. The possible mechanism of miswiring involving the medial longitudinal fasciculus and trigeminal nuclei is discussed. At least some cases of congenital third cranial nerve palsy may fall in the realm of congenital cranial dysinnervation disorders (CCDDs) sharing a much wider spectrum of presentation.

  10. Cranial Autonomic Symptoms in Pediatric Migraine

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2013-09-01

    Full Text Available Investigators at the University of California, San Francisco, examined the frequency of cranial autonomic symptoms in all pediatric and adolescent patients with migraine seen in 4 different clinical settings during July 2010 to June 2012.

  11. Intra cranial complications of tuberculous otitis media

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    M Prakash

    2015-01-01

    Full Text Available Tuberculosis is one of the most common infections in the world. It is seen that tuberculous otitis media (TOM is almost secondary to pulmonary tuberculosis. In this review we have tried to deal with all the aspects of the intra cranial complications of TOM such as tuberculoma, otitic hydrocephalus, brain abscess and tuberculous meningitis. The aspects covered in this review are the pathology, clinical features, and investigations of the intra cranial manifestations.

  12. Cranial trepanation in The Egyptian.

    Science.gov (United States)

    Collado-Vázquez, S; Carrillo, J M

    2014-09-01

    Medicine and literature have been linked from ancient times; proof of this shown by the many doctors who have made contributions to literature and the many writers who have described medical activities and illnesses in their works. An example is The Egyptian, the book by Mika Waltari that provides a masterly narration of the protagonist's medical activity and describes the trepanation technique. The present work begins with the analysis of trepanations since prehistory and illustrates the practice of the trepanation in The Egyptian. The book mentions trepanation frequently and illustrates how to practice it and which instruments are required to perform it. Trepanation is one of the oldest surgical interventions carried out as treatment for cranial trauma and neurological diseases, but it also had the magical and religious purpose of expelling the evil spirits which caused the mental illness, epilepsy, or migraine symptoms. Trepanation is a surgical practice that has been carried out since prehistory to treat post-traumatic epilepsy, migraine, and psychiatric illness. The Egyptian is a book that illustrates the trepan, the trepanation technique, and the required set of instruments in full detail. Copyright © 2010 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

  13. [Computed tomography and cranial paleoanthropology].

    Science.gov (United States)

    Cabanis, Emmanuel Alain; Badawi-Fayad, Jackie; Iba-Zizen, Marie-Thérèse; Istoc, Adrian; de Lumley, Henry; de Lumley, Marie-Antoinette; Coppens, Yves

    2007-06-01

    Since its invention in 1972, computed tomography (C.T.) has significantly evolved. With the advent of multi-slice detectors (500 times more sensitive than conventional radiography) and high-powered computer programs, medical applications have also improved. CT is now contributing to paleoanthropological research. Its non-destructive nature is the biggest advantage for studying fossil skulls. The second advantage is the possibility of image analysis, storage, and transmission. Potential disadvantages include the possible loss of files and the need to keep up with rapid technological advances. Our experience since the late 1970s, and a recent PhD thesis, led us to describe routine applications of this method. The main contributions of CT to cranial paleoanthropology are five-fold: --Numerical anatomy with rapid acquisition and high spatial resolution (helicoidal and multidetector CT) offering digital storage and stereolithography (3D printing). --Numerical biometry (2D and 3D) can be used to create "normograms" such as the 3D craniofacial reference model used in maxillofacial surgery. --Numerical analysis offers thorough characterization of the specimen and its state of conservation and/or restoration. --From "surrealism" to virtual imaging, anatomical structures can be reconstructed, providing access to hidden or dangerous zones. --The time dimension (4D imaging) confers movement and the possibility for endoscopic simulation and internal navigation (see Iconography). New technical developments will focus on data processing and networking. It remains our duty to deal respectfully with human fossils.

  14. Cranial kinesis in gekkonid lizards

    Science.gov (United States)

    Herrel; De Vree F; Delheusy; Gans

    1999-12-01

    Cranial kinesis was studied in two species of gekkonid lizard, Gekko gecko and Phelsuma madagascariensis, using cineradiography and electromyography. The skull of these geckoes showed the three types of kinesis described by Versluys at the beginning of this century: streptostyly, mesokinesis and metakinesis. In accordance with the later model of Frazzetta, the skull of these animals can be modelled by a quadratic crank system: when the mouth opens during feeding, the quadrate rotates forward, the palato-maxillary unit is lifted and the occipital unit swings forward. During jaw closing, the inverse movements are observed; during crushing, the system is retracted beyond its resting position. The data gathered here indicate that the coupled kinesis (streptostyly + mesokinesis) is most prominently present during the capture and crushing cycles of feeding and is largely absent during late intraoral transport, swallowing, drinking and breathing. The electromyographic data indicate a consistent pattern of muscular activation, with the jaw opener and pterygoid protractor always active during the fast opening phase, and the jaw closers active during closing and crushing. Our data generally support the model of Frazzetta. Although the data gathered here do not allow speculation on the functional significance of the kinesis, they clearly provide some key elements required for a further investigation of the functional and adaptive basis of the system.

  15. Osteopathia striata with cranial sclerosis

    Energy Technology Data Exchange (ETDEWEB)

    Gay, B.B. [Emory Univ., Atlanta, GA (United States). Dept. of Radiology; Elsas, L.J. [Emory Univ., Atlanta, GA (United States). Dept. of Pediatrics; Wyly, J.B. [Emory Univ., Atlanta, GA (United States). Dept. of Radiology; Pasquali, M. [Emory Univ., Atlanta, GA (United States). Dept. of Pediatrics

    1994-03-01

    Osteopathia striata with cranial sclerosis (OS-CS) is a specific bone dysplasia manifested by hypertelorism, flat nasal bridge, frontal bossing, large head, hypoplastic maxilla, palate anomalies, chronic otitis media, hearing deficits, nasal obstruction, and neurological changes of deafness, facial palsy, ophthalmoplegia, and mental retardation. We will review the clinical and radiologic findings in a new patient from birth to 20 years; this is believed to be the thirty-fifth patient reported. OS-CS is 2.5 times more common in females and occurs as an autosomal dominant condition or a sporadic dominant mutation with patients presenting for evaluation from the newborn period to the fifth decade. Skeletal abnormalities are distinctive including sclerosis of the skull base and calvarium, linear striated densities in the long bones and pelvis, and poor development of the mastoid and sinus air cells. Radionuclide bone scans with SPECT indicated in our patient increased bone turnover which was supported by biochemical findings of increased pyridinoline excretion. The major complications are due to constriction of essential foramina at the skull base. The condition is not life-threatening but can produce disability. (orig.)

  16. Vincristine-induced cranial neuropathy.

    Science.gov (United States)

    Talebian, Ahmad; Goudarzi, Razieh Moazam; Mohammadzadeh, Mahdi; Mirzadeh, Azadeh Sadat

    2014-01-01

    Vincristine (VCR) is a vinca alkaloid that is used for treatment of many malignancies. The vinca alkaloids are neurotoxic, usually causing a peripheral neuropathy, but cranial neuropathies are rare as side effects. Described here is the case of a 2.5-year-old boy, a known case of Wilms' tumor, treated by vincristine (0.067 mg/kg/day) and dactinomycin (0.045 mg/kg/day) after surgery. Three weeks after treatment, he presented with bilateral ptosis. Neurological examination revealed bilateral ptosis with normal pupillary reflex and eye movement. He received 3.015 mg cumulative dose of vincristine before development of ptosis. Treatment with pyridoxine (150 mg/m2 p.o. BID) and pyridostigmine (3 mg/kg p.o. BID) was started as neuroprotective agents, and after 7 days the problem disappeared. The treatment continued for 6 weeks and there were no signs of ptosis or a recurrence in follow up 2 months later.

  17. An association of multiple endocrine neoplasia 2B, a RET mutation; constipation; and low substance P-nerve fiber density in colonic circular muscle.

    Science.gov (United States)

    King, Sebastian K; Southwell, Bridget R; Hutson, John M

    2006-02-01

    Multiple endocrine neoplasia (MEN) 2B is a rare hereditary syndrome that results from an activating mutation of the RET proto-oncogene. The RET gene is involved in the development of the enteric nervous system. Patients with MEN 2B have enlarged enteric ganglia and may be affected by gastrointestinal dysmotility. A deficiency of the neurotransmitter substance P (SP) has been identified in both pediatric and adult patients with chronic constipation. Three patients, in whom constipation was the presenting symptom and MEN 2B had been provisionally diagnosed, underwent genetic analysis. Seromuscular colonic biopsies were taken for immunofluorescence imaging in all 3 patients. A retrospective review of the patient notes was undertaken. All 3 patients had constipation refractory to conservative treatment. Genetic analyses in the 3 patients confirmed an identical RET mutation (Met918Thr). Immunofluorescence imaging in all 3 patients identified grossly enlarged myenteric plexus ganglia but surprisingly a low density of SP-labeled nerve fibers in the colonic circular muscle. Nitric oxide synthase and vasoactive intestinal peptide labeling were not reduced. The results show an association between MEN 2B and its most common RET mutation, colonic dysmotility, and low density of SP in the colonic circular muscle. Larger numbers of patients need to be studied to investigate whether low SP is primarily associated with the constipation or RET mutation and if it is a common feature of MEN 2B.

  18. Intense inflammation and nerve damage in early multiple sclerosis subsides at older age: a reflection by cerebrospinal fluid biomarkers.

    Directory of Open Access Journals (Sweden)

    Mohsen Khademi

    Full Text Available Inflammatory mediators have crucial roles in leukocyte recruitment and subsequent central nervous system (CNS neuroinflammation. The extent of neuronal injury and axonal loss are associated with the degree of CNS inflammation and determine physical disability in multiple sclerosis (MS. The aim of this study was to explore possible associations between a panel of selected cerebrospinal fluid biomarkers and robust clinical and demographic parameters in a large cohort of patients with MS and controls (n = 1066 using data-driven multivariate analysis. Levels of matrix metalloproteinase 9 (MMP9, chemokine (C-X-C motif ligand 13 (CXCL13, osteopontin (OPN and neurofilament-light chain (NFL were measured by ELISA in 548 subjects comprising different MS subtypes (relapsing-remitting, secondary progressive and primary progressive, clinically isolated syndrome and persons with other neurological diseases with or without signs of inflammation/infection. Principal component analyses and orthogonal partial least squares methods were used for unsupervised and supervised interrogation of the data. Models were validated using data from a further 518 subjects in which one or more of the four selected markers were measured. There was a significant association between increased patient age and lower levels of CXCL13, MMP9 and NFL. CXCL13 levels correlated well with MMP9 in the younger age groups, but less so in older patients, and after approximately 54 years of age the levels of CXCL13 and MMP9 were consistently low. CXCL13 and MMP9 levels also correlated well with both NFL and OPN in younger patients. We demonstrate a strong effect of age on both inflammatory and neurodegenerative biomarkers in a large cohort of MS patients. The findings support an early use of adequate immunomodulatory disease modifying drugs, especially in younger patients, and may provide a biological explanation for the relative inefficacy of such treatments in older patients at later

  19. Intense inflammation and nerve damage in early multiple sclerosis subsides at older age: a reflection by cerebrospinal fluid biomarkers.

    Science.gov (United States)

    Khademi, Mohsen; Dring, Ann M; Gilthorpe, Jonathan D; Wuolikainen, Anna; Al Nimer, Faiez; Harris, Robert A; Andersson, Magnus; Brundin, Lou; Piehl, Fredrik; Olsson, Tomas; Svenningsson, Anders

    2013-01-01

    Inflammatory mediators have crucial roles in leukocyte recruitment and subsequent central nervous system (CNS) neuroinflammation. The extent of neuronal injury and axonal loss are associated with the degree of CNS inflammation and determine physical disability in multiple sclerosis (MS). The aim of this study was to explore possible associations between a panel of selected cerebrospinal fluid biomarkers and robust clinical and demographic parameters in a large cohort of patients with MS and controls (n = 1066) using data-driven multivariate analysis. Levels of matrix metalloproteinase 9 (MMP9), chemokine (C-X-C motif) ligand 13 (CXCL13), osteopontin (OPN) and neurofilament-light chain (NFL) were measured by ELISA in 548 subjects comprising different MS subtypes (relapsing-remitting, secondary progressive and primary progressive), clinically isolated syndrome and persons with other neurological diseases with or without signs of inflammation/infection. Principal component analyses and orthogonal partial least squares methods were used for unsupervised and supervised interrogation of the data. Models were validated using data from a further 518 subjects in which one or more of the four selected markers were measured. There was a significant association between increased patient age and lower levels of CXCL13, MMP9 and NFL. CXCL13 levels correlated well with MMP9 in the younger age groups, but less so in older patients, and after approximately 54 years of age the levels of CXCL13 and MMP9 were consistently low. CXCL13 and MMP9 levels also correlated well with both NFL and OPN in younger patients. We demonstrate a strong effect of age on both inflammatory and neurodegenerative biomarkers in a large cohort of MS patients. The findings support an early use of adequate immunomodulatory disease modifying drugs, especially in younger patients, and may provide a biological explanation for the relative inefficacy of such treatments in older patients at later disease stages.

  20. [Neuroanatomy of the optic, trigeminal, facial, glossopharyngeal, vagus, accessory and hypoglossal nerves (author's transl)].

    Science.gov (United States)

    Lang, J

    1981-01-01

    1. The intracranial and intraorbital course of the optic nerve is described concisely, the intracanicular one in full details. Apart from the wide and small sections of the optic canal, its axis opposite to the cranial planes, the coating of the canal and the adjacency to the paranasal sinuses and arteries are exactly described. 2. At the trigeminal nerve the trigeminal ganglion, its roots and also the mandibular nerve have great importance in the practical medicine considering thermo-coagulation or surgery of the trigeminal nerve. This segments and also the adjacency of the fifth nerve to the internal carotid artery and subarachinoid brain vessels are exactly, the nuclei areas and central tracts are briefly explained. 3. The nuclei of the facial nerve the intracerebral and intracisternal course and its development, the facial canal and its narrow passes are described. Also the position of the internal acoustic pore in the skull, the dimensions of the internal acoustic meatus and the relations between nerves and vessels are explained. In addition to the geniculate ganglion and the chorda tympani the communications of the facial nerve inside the temporal bone, the tympanic intumescentia (ganglion) and the nervus intermedius, also the petrosal nerves are included in the description. The sheaths of the segments of the seventh cranial nerve and also the fasciculation are exactly, the somatotopic organization is briefly described. 4. The extracranial course of the glossopharyngeal nerve is briefly, its intracranial sections are included exactly in the investigation. 5. The nuclei of the vagus nerve and the intra- und extracranial course are described. 6. The accessory nerve, its nucleus and the intra- and extracranial course are concisely explained. 7. The hypoglossal nerve, its nucleus, the emergence of the fibres and also the relations of nerves and vessels in the posterior cranial fossa are described. The hypoglossal canal and also the extracranial course are

  1. [Electrical nerve stimulation for plexus and nerve blocks].

    Science.gov (United States)

    Birnbaum, J; Klotz, E; Bogusch, G; Volk, T

    2007-11-01

    Despite the increasing use of ultrasound, electrical nerve stimulation is commonly used as the standard for both plexus and peripheral nerve blocks. Several recent randomized trials have contributed to a better understanding of physiological and clinical correlations. Traditionally used currents and impulse widths are better defined in relation to the distance between needle tip and nerves. Commercially available devices enable transcutaneous nerve stimulation and provide new opportunities for the detection of puncture sites and for training. The electrically ideal position of the needle usually is defined by motor responses which can not be interpreted without profound anatomical knowledge. For instance, interscalene blocks can be successful even after motor responses of deltoid or pectoral muscles. Infraclavicular blocks should be aimed at stimulation of the posterior fascicle (extension). In contrast to multiple single nerve blocks, axillary single-shot blocks more commonly result in incomplete anaesthesia. Blockade of the femoral nerve can be performed without any nerve stimulation if the fascia iliaca block is used. Independently of the various approaches to the sciatic nerve, inversion and plantar flexion are the best options for single-shot blocks. Further clinical trials are needed to define the advantages of stimulating catheters in continuous nerve blocks.

  2. Facial Nerve Schwannoma of Parotid Gland: Difficulties in Diagnosis and Management

    Directory of Open Access Journals (Sweden)

    Murat Damar

    2016-01-01

    Full Text Available Facial nerve schwannomas (FNS are encapsulated benign tumors arising from Schwann cells of seventh cranial nerve. Most of the facial nerve schwannomas are localized in intratemporal region; only 9% of cases involve a portion of the extratemporal segment. Preoperative diagnosis is often unclear; diagnosis is often made intraoperatively. Management of intraparotid FNS is troublesome because of the facial nerve paralysis. In this report we presented a case of intraparotid schwannoma in a 55-year-old male patient complaining of a painless mass without peripheral facial nerve palsy in left parotid gland. Clinical features, preoperative and intraoperative diagnosis, and difficulties during management are discussed with the review of the literature.

  3. Acute sixth nerve palsy in a young man, beware of the 'red herring'.

    LENUS (Irish Health Repository)

    O'Neill, E C

    2012-02-01

    BACKGROUND: Cranial nerve palsies has several etiologies including vascular insufficiency, neoplasm, trauma and inflammation. Isolated sixth nerve palsy is an extremely rare presenting feature of leukemia. AIM: We describe an unusual ocular presentation of a bilateral progressive sixth nerve palsy in a young male with a preceding head injury. CONCLUSION: Acquired sixth nerve palsies in young adults may be due to trauma but in the absence of a definitive history other systemic processes must be outruled. We describe a case of bilateral sixth nerve palsy in a patient with ALL with no obvious CNS involvement. Potential etiological mechanisms are discussed.

  4. [The superior laryngeal nerve and the superior laryngeal artery].

    Science.gov (United States)

    Lang, J; Nachbaur, S; Fischer, K; Vogel, E

    1987-01-01

    Length, diameter and anastomoses of the nervus vagus and its ganglion inferius were measured 44 halved heads. On the average, 8.65 fiber bundles of the vagus nerve leave the retro-olivary area. In the area of the jugular foramen is the near superior ganglion of the 10th cranial nerve. In this area were found 1.48 (mean value) anastomoses with the 9th cranial nerve. 11.34 mm below the margo terminalis sigmoidea branches off the ramus internus of the accessory nerve which has a length of 9.75 mm. Further anastomoses with the 10th cranial nerve were found. The inferior ganglion of the 10th nerve had a length of 25.47 mm and a diameter of 3.46 mm. Five mm below the ganglion the 10th nerve had a width of 2.9 and a thickness of 1.5 mm. The mean length of the superior sympathetic ganglion was 26.6 mm, its width 7.2 and its thickness 3.4 mm. In nearly all specimens anastomoses of the superior sympathetic ganglion with the ansa cervicalis profunda and the inferior ganglion of the 10th cranial nerve were found. The superior laryngeal nerve branches off about 36 mm below the margo terminalis sigmoidea. The width of this nerve was 1.9 mm, its thickness 0.8 mm on the right and 1.0 mm on the left side. The division in the internal and external rami was found about 21 mm below its origin. Between the n. vagus and thyreohyoid membrane the ramus internus had a length of 64 mm, the length of external ramus between the vagal nerve and the inferior pharyngeal constrictor muscle was 89 mm. Its mean length below the thyreopharyngeal part was 10.7 mm, 8.6 branchlets to the cricothyroid muscle were counted. The superior laryngeal artery had its origin in 80% of cases in the superior thyroideal artery, in 6.8% this vessel was a branch of the external carotid artery. Its average outer diameter was 1.23 mm on the right side and 1.39 mm on the left. The length of this vessel between its origin and the thyreohyoid membrane was 34 mm. In 7% on the right side and in 13% on the left, the superior

  5. Anatomical and Clinical Aspects of the Hypoglossal Nerve: Literature Review

    OpenAIRE

    Rivera Cardona, Guillermo; Pontificia Universidad Javeriana

    2014-01-01

    Hypoglossal nerve or twelfth cranial nerve supplies the tongue´s muscles, it has its real origin general somatic efferent in the hypoglossal motor nucleus; it is localized in the brain stem and its apparent origin in preolivary sulcus. It passes through anterior condyle foramen, after passes through neck and tongue. Along the hypoglossal nerve pathway by trigonum caroticum, trigonum submandibulare and trigonum submentale, it receives branches of the cervical plexus for the infra-hyoid muscles...

  6. Posterior cranial base natural growth and development: A systematic review.

    Science.gov (United States)

    Currie, Kris; Sawchuk, Dena; Saltaji, Humam; Oh, Heesoo; Flores-Mir, Carlos; Lagravere, Manuel

    2017-07-24

    To provide a synthesis of the published studies evaluating the natural growth and development of the human posterior cranial base (S-Ba). The search was performed on MEDLINE, Embase, PubMed, and all EBM Reviews electronic databases. In addition, reference lists of the included studies were hand-searched. Articles were included if they analyzed posterior cranial-base growth in humans specifically. Study selection, data extraction, and risk of bias assessment were completed in duplicate. A meta-analysis was not justified. Finally, 23 published studies were selected: 5 cross-sectional and 18 cohort studies. Articles were published between 1955 and 2015, and all were published in English. The sample sizes varied between 20 and 397 individuals and consisted of craniofacial measurements from either living or deceased human skulls. Validity of the measurements was not determined in any of the studies, while six papers reported some form of reliability assessment. All the articles included multiple time points within the same population or data from multiple age groups. Growth of S-Ba was generally agreed to be from spheno-occipital synchondrosis growth. Basion displaced downward and backward and sella turcica moved downward and backward during craniofacial growth. Timing of cessation of S-Ba growth was not conclusive due to limited identified evidence. Current evidence suggests that S-Ba is not totally stable, as its dimensions change throughout craniofacial growth and a minor dimensional change is observed even in late adulthood.

  7. Pediatric neuroradiology: Cerebral and cranial diseases

    Energy Technology Data Exchange (ETDEWEB)

    Diebler, C.; Dulac, O.

    1987-01-01

    In this book, a neuroradiologist and a neuropediatrician have combined forces to provide the widest possible knowledge in investigating cranial and cerebral disorders in infancy and childhood. Based on more than 20,000 pediatric CT examinations, with a follow-up time often exceeding ten years, the book aims to bridge interdisciplinary gaps and help radiologists, pediatricians and neurosurgeons solve the various problems of pediatric neuroradiology that frequently confront them. For each disease, the etiology, clinical manifestation, pathological lesions and radiological presentations are discussed, supported by extensive illustrations. Malformative, vascular, traumatic, tumoral, infectious and metabolic diseases are reviewed. Miscellaneous conditions presenting particular symptoms or syndromes are also studied, such as hydrocephalus and neurological complications of leukemia. Contents: Cerebral and cranial malformations; neurocutaneous syndromes; inherited metabolic diseases; infectious diseases - vascular disorders; intracranial tumors; cranial trauma - miscellaneous and subject index.

  8. Cranial osteopathy: its fate seems clear

    Directory of Open Access Journals (Sweden)

    Hartman Steve E

    2006-06-01

    Full Text Available Abstract Background According to the original model of cranial osteopathy, intrinsic rhythmic movements of the human brain cause rhythmic fluctuations of cerebrospinal fluid and specific relational changes among dural membranes, cranial bones, and the sacrum. Practitioners believe they can palpably modify parameters of this mechanism to a patient's health advantage. Discussion This treatment regime lacks a biologically plausible mechanism, shows no diagnostic reliability, and offers little hope that any direct clinical effect will ever be shown. In spite of almost uniformly negative research findings, "cranial" methods remain popular with many practitioners and patients. Summary Until outcome studies show that these techniques produce a direct and positive clinical effect, they should be dropped from all academic curricula; insurance companies should stop paying for them; and patients should invest their time, money, and health elsewhere.

  9. Mosaicism in osteopathia striata with cranial sclerosis.

    Science.gov (United States)

    Joseph, Dennis J; Ichikawa, Shoji; Econs, Michael J

    2010-04-01

    Osteopathia striata with cranial sclerosis is an X-linked dominant condition caused by mutations in the WTX gene, resulting in linear striations in long bones in combination with cranial sclerosis. This condition is usually lethal in males. OBJECTIVE/PATIENT: Our aim was to determine the underlying genetic cause in a 37-yr-old male with this condition. DNA sequencing of peripheral blood and hair was performed to identify mutations in WTX. Quantitative PCR was performed to determine gene copy number variation. DNA sequenced from peripheral blood revealed the presence of two alleles at the 1108th position of the WTX gene. Subsequent DNA sequencing of hair follicles and quantitative PCR confirmed the presence of mosaicism. A novel mutation (c.1108G>T) found in our patient results in a truncated protein (E370X). Our patient represents the first confirmed case of mosaicism in osteopathia striata with cranial sclerosis.

  10. Cranial symmetry in baleen whales (Cetacea, Mysticeti) and the occurrence of cranial asymmetry throughout cetacean evolution

    Science.gov (United States)

    Fahlke, Julia M.; Hampe, Oliver

    2015-10-01

    Odontoceti and Mysticeti (toothed and baleen whales) originated from Eocene archaeocetes that had evolved from terrestrial artiodactyls. Cranial asymmetry is known in odontocetes that can hear ultrasound (>20,000 Hz) and has been linked to the split function of the nasal passage in breathing and vocalization. Recent results indicate that archaeocetes also had asymmetric crania. Their asymmetry has been linked to directional hearing in water, although hearing frequencies are still under debate. Mysticetes capable of low-frequency and infrasonic hearing (<20 Hz) are assumed to have symmetric crania. This study aims to resolve whether mysticete crania are indeed symmetric and whether mysticete cranial symmetry is plesiomorphic or secondary. Cranial shape was analyzed applying geometric morphometrics to three-dimensional (3D) cranial models of fossil and modern mysticetes, Eocene archaeocetes, modern artiodactyls, and modern odontocetes. Statistical tests include analysis of variance, principal components analysis, and discriminant function analysis. Results suggest that symmetric shape difference reflects general trends in cetacean evolution. Asymmetry includes significant fluctuating and directional asymmetry, the latter being very small. Mysticete crania are as symmetric as those of terrestrial artiodactyls and archaeocetes, without significant differences within Mysticeti. Odontocete crania are more asymmetric. These results indicate that (1) all mysticetes have symmetric crania, (2) archaeocete cranial asymmetry is not conspicuous in most of the skull but may yet be conspicuous in the rostrum, (3) directional cranial asymmetry is an odontocete specialization, and (4) directional cranial asymmetry is more likely related to echolocation than hearing.

  11. Glossopharyngeal neuralgia secondary to vascular compression in a patient with multiple sclerosis: a case report

    Directory of Open Access Journals (Sweden)

    Gaitour Emil

    2012-07-01

    Full Text Available Abstract Introduction Glossopharyngeal neuralgia is an uncommon, painful syndrome, characterized by paroxysms of pain in the sensory distribution of the 9th cranial nerve. Idiopathic glossopharyngeal neuralgia may be due to compression of the glossopharyngeal nerve by adjacent vessels, while secondary glossopharyngeal neuralgia is associated with identifiable lesions affecting the glossopharyngeal nerve at different levels of its neuroanatomic pathway. Glossopharyngeal neuralgia is rare in the general population, but is more common in patients with multiple sclerosis. Case presentation A 56-year-old Caucasian woman with multiple sclerosis and migraine presented to our facility with intermittent lancinating pain to the right of her throat, tongue, and the floor of her mouth that had been occurring for the past year. The pain was intense, sharp, and stabbing, which lasted two to six seconds with radiation to the right ear. Initially, the attacks were infrequent, however, they had become more intense and frequent over time. Our patient reported weight loss, headache, painful swallowing, and the inability to maintain sleep due to painful attacks. A neurological examination revealed a right-handed woman with trigger points in the back of the tongue and throat on the right side. She also had dysphagia, hoarseness, and pain in the distribution of the right glossopharyngeal nerve. Mild right hemiparesis, hyperreflexia, dysmetria, and an ataxic gait were present. A magnetic resonance imaging scan of the brain was consistent with multiple sclerosis and magnetic resonance angiography demonstrated a loop of the posterior inferior cerebellar artery compressing the right glossopharyngeal nerve. She responded satisfactorily to carbamazepine. Microvascular decompression and Gamma Knife® radiosurgery were discussed in case of failure of the medical treatment; however, she declined these options. Conclusions Glossopharyngeal neuralgia in multiple sclerosis may

  12. Isovaleric acidaemia: cranial CT and MRI findings

    Energy Technology Data Exchange (ETDEWEB)

    Sogut, Ayhan; Acun, Ceyda; Tomsac, Nazan; Demirel, Fatma [Department of Paediatrics, Karaelmas University, Zonguldak (Turkey); Aydin, Kubilay [Department of Radiology, Istanbul Medical School, Istanbul University, Camlikyolu, B. mehmetpasa sokak yavuz apt. No:10/10, Etiler, Istanbul (Turkey); Aktuglu, Cigdem [Department of Paediatrics, Cerrahpasa Medical School, Istanbul University, Istanbul (Turkey)

    2004-02-01

    Isovaleric acidaemia is an inborn error of leucine metabolism due to deficiency of isovaleryl-CoA dehydrogenase, which results in accumulation of isovaleric acid in body fluids. There are acute and chronic-intermittent forms of the disease. We present the cranial CT and MRI findings of a 19-month-old girl with the chronic-intermittent form of isovaleric acidaemia. She presented with severe metabolic acidosis, hyperglycaemia, glycosuria, ketonuria and acute encephalopathy. Cranial CT revealed bilateral hypodensity of the globi pallidi. MRI showed signal changes in the globi pallidi and corticospinal tracts of the mesencephalon, which were hypointense on T1-weighted and hyperintense on T2-weighted images. (orig.)

  13. Posterior communicating artery aneurysm in a 20 year old boy presenting as non-isolated third nerve palsy

    Directory of Open Access Journals (Sweden)

    H C Obiudu

    2009-01-01

    Result: A clinical diagnosis of left third and fourth cranial nerve palsies from intracranial space-occupying lesion was made. Computed tomography and computed tomography angiography confirmed left posterior communicating artery aneurysm. Conclusion: Any degree of pupillary involvement in third nerve palsy, whether isolated or not should warrant neuroimaging in view of the high mortality risk from intracranial aneurysms.

  14. A CLINICAL STUDY ON EXTRA CRANIAL COMPLICATIONS OF CHRONIC SUPPURATIVE OTITIS MEDIA

    Directory of Open Access Journals (Sweden)

    Devi Prasad

    2015-06-01

    Full Text Available OBJECTIVES : The Objective is to study the risk of extra - cranial complications in cases of CSOM and to study the common extra - cranial complications of CSOM with respect to age , sex and socio - economic status . METHODS: The present study comprises of 60 patients with extra - cranial complications secondary to Chronic Suppurative Otitis media who attended to the Dept . o f E. N. T S rivenkateswara G overnment General Hospital, T irupathi . An analysis was made regarding the demographic profile , clinical features , surgical techniques , operative findings , and the outcome of the study . RESULTS : In this study of 60 cases , the most common ext racranial complication of CSOM is Postauralabscess . These extra cranial complications are associated with 15% of intracranial complications of which Meningitis is most common . The complications are more commonly seen in the younger population in second to third decades of life with Male predominance . The duration of ear discharge is not associated with the increasing number of complications . Cholesteatoma is commonly responsible for the development of Extracranial complications of CSOM . Pseudomonas aerugino sa is the commonest organism found in the complications . Canal wall down surgery is the main mode of treatment in this category of patients . The Facial canal dehiscence is associated with a poor outcome in the cases of Facial nerve paralysis . CONCLUSION: The extra - cranial complications of CSOM pose a great challenge to the Developing countries despite its declining incidence . It is in this situation that early diagnosis and prompt surgical intervention are most important for the decreased morbidity and mor tality of patients .

  15. Isolated trochlear nerve schwannoma presenting with diplopia: A case report and literature review

    Directory of Open Access Journals (Sweden)

    Mohammad Samadian

    2015-06-01

    Conclusion: Trochlear nerve schwannoma is a rare type of schwannoma and in almost all of the cases is diagnosed intraoperatively. There are three types of trochlear nerve schwannoma according to the classification proposed for trigeminal schwannoma: cisternal type—confined to the precavernous segment of the trochlear nerve; cistocavernous type—invading the cavernous sinus and the retroclival and retropetrosal cistern; cavernous type—located in the middle cranial fossa on the cavernous or paracavernous segment of the fourth cranial nerves, with or without cavernous sinus invasion. The cisternal type was the most common type encountered in previous studies. The clinical signs and symptoms of trochlear nerve schwannoma are similar to the trigeminal schwannoma and should be considered in the differential diagnosis of trigeminal schwannoma.

  16. Transcutaneous vagus and trigeminal nerve stimulation for neuropsychiatric disorders: a systematic review

    Directory of Open Access Journals (Sweden)

    Pedro Shiozawa

    2014-07-01

    Full Text Available We reviewed trigeminal nerve stimulation (TNS and transcutaneous vagus nerve stimulation (tVNS. All techniques have shown preliminary promising results, although the results are mixed. Method: We performed a systematic review of the Medline and Embase databases, with no constraint to dates, through June 2013. The keywords were [(1 trigeminal nerve stimulation OR (2 cranial nerve OR (3 trigemin* OR (4 transcutaneous VNS OR (5 transcutaneous cranial nerve stimulation] and (6 mental disorders. Results: We included four preclinical and clinical five studies on TNS. All clinical data were based on open-label studies with small samples, which diminished the external validity of the results, thus reflecting the modest impact of TNS in current clinical practice. Of the tVNS clinical trials, three assessed physiological features in healthy volunteers, and one examined patients with epilepsy. Conclusion: TNS and tVNS improve treatment of particular neuropsychiatric disorders such as depression.

  17. 21 CFR 882.4325 - Cranial drill handpiece (brace).

    Science.gov (United States)

    2010-04-01

    ... (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4325 Cranial drill handpiece (brace). (a) Identification. A cranial drill handpiece (brace) is a hand holder, which is...

  18. Cranial kinesis in geckoes: functional implications.

    Science.gov (United States)

    Herrel, A; Aerts, P; De Vree, F

    2000-05-01

    Although it is generally assumed that cranial kinesis is a plesiomorphic characteristic in squamates, experimental data tend to contradict this hypothesis. In particular, coupled kinesis (i.e. streptostyly and mesokinesis) presumably arose independently in only a limited number of highly specialised groups. In this study, we investigated cranial kinesis in one of the most specialised of these groups: geckoes. On the basis of cineradiographic and electromyographic data, the fast opening and the slow closing/power stroke phases were modelled to elucidate possible functions of the observed kinesis. The results of these analyses show that the retraction of the muzzle unit during crushing is a self-reinforcing system that increases bite force and reduces the joint forces; the active protraction of the kinetic system during jaw opening, in contrast, enhances opening speed through the coupling of the intracranial units. It can be argued that cranial kinesis in geckoes is probably not an adaptive trait as such but, instead, a consequence of the 'Bauplan' of the cranial system in these animals. Presumably as a result of constructional constraints on the size of the jaw musculature and eyes, the supratemporal and postorbital bars were lost, which resulted in enormous mobility in the skull. To counteract the potential negative factors associated with this (decrease in bite force, skull damage), the kinetic system may have become coupled, and thus functional.

  19. 21 CFR 882.4360 - Electric cranial drill motor.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Electric cranial drill motor. 882.4360 Section 882...) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4360 Electric cranial drill motor. (a) Identification. An electric cranial drill motor is an electrically operated power source...

  20. 38 CFR 4.124 - Neuralgia, cranial or peripheral.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Neuralgia, cranial or....124 Neuralgia, cranial or peripheral. Neuralgia, cranial or peripheral, characterized usually by a... code number and rating. Tic douloureux, or trifacial neuralgia, may be rated up to complete...

  1. 38 CFR 4.123 - Neuritis, cranial or peripheral.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Neuritis, cranial or peripheral. 4.123 Section 4.123 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS....123 Neuritis, cranial or peripheral. Neuritis, cranial or peripheral, characterized by loss...

  2. Dural neurogenic inflammation induced by neuropathic pain is specific to cranial region.

    Science.gov (United States)

    Filipović, B; Matak, I; Lacković, Z

    2014-05-01

    Up to now, dural neurogenic inflammation (DNI) has been studied primarily as a part of migraine pain pathophysiology. A recent study from our laboratory demonstrated the occurrence of DNI in response to peripheral trigeminal nerve injury. In this report, we characterize the occurrence of DNI after different peripheral nerve injuries in and outside of the trigeminal region. We have used the infraorbital nerve constriction injury model (IoNC) as a model of trigeminal neuropathic pain. Greater occipital nerve constriction injury (GoNC), partial transection of the sciatic nerve (ScNT) and sciatic nerve constriction injury (SCI) were employed to characterize the occurrence of DNI in response to nerve injury outside of the trigeminal region. DNI was measured as colorimetric absorbance of Evans blue plasma protein complexes. In addition, cellular inflammatory response in dural tissue was histologically examined in IoNC and SCI models. In comparison to the strong DNI evoked by IoNC, a smaller but significant DNI has been observed following the GoNC. However, DNI has not been observed either in cranial or in lumbar dura following ScNT and SCI. Histological evidence has demonstrated a dural proinflammatory cell infiltration in the IoNC model, which is in contrast to the SCI model. Inflammatory cell types (lymphocytes, plasma cells, and monocytes) have indicated the presence of sterile cellular inflammatory response in the IoNC model. To our knowledge, this is the first observation that the DNI evoked by peripheral neuropathic pain is specific to the trigeminal area and the adjacent occipital area. DNI after peripheral nerve injury consists of both plasma protein extravasation and proinflammatory cell infiltration.

  3. Pediatric cerebral sinovenous thrombosis following cranial surgery.

    Science.gov (United States)

    Petrov, Dmitriy; Uohara, Michael Y; Ichord, Rebecca; Ali, Zarina; Jastrzab, Laura; Lang, Shih-Shan; Billinghurst, Lori

    2017-03-01

    Pediatric cerebral sinovenous thrombosis (CSVT) is an important, though less common subtype of pediatric stroke. It has been linked to several risk factors, including cranial procedures, with few studies highlighting this relationship. The aim of this study was to characterize the diagnosis and treatment of CSVT after cranial surgery. An institutional pediatric stroke research database was used to identify all CSVT cases diagnosed within 30 days of cranial surgery from November 2004 to December 2014. Thirteen subjects were retrospectively analyzed for clinical presentation, surgical details, radiographic characteristics, laboratory study results, treatment, and outcome. Diagnostic testing and treatment adhered to a consensus-based institutional stroke protocol. Cranial vault reconstruction, subdural empyema evacuation, and tumor resection were each observed in three subjects. Eleven (85%) subjects had sinus exposure during surgery, and eight (73%) developed thrombus in a sinus within or adjacent to the operative field. Two (15%) had documented iatrogenic sinus injury. On post-operative testing, ten (77%) subjects had prothrombotic abnormalities. Seven (54%) were treated with anti-coagulation therapy (ACT) starting on a median of post-operative day (POD) 3 (IQR 1-3) for a median of 2.9 months (IQR 2.4-5.4). Median time to imaging evidence of partial or complete recanalization was 2.4 months (IQR 0.7-5.1). No symptomatic hemorrhagic complications were encountered. Pediatric CSVT may be encountered after cranial surgery, and decisions related to anti-coagulation are challenging. The risk of CSVT should be considered in pre-surgical planning and post-operative evaluation of cases with known risk factors. In our study, judicious use of ACT was safe in the post-operative period.

  4. Ulnar nerve dysfunction

    Science.gov (United States)

    Neuropathy - ulnar nerve; Ulnar nerve palsy; Mononeuropathy; Cubital tunnel syndrome ... neuropathy occurs when there is damage to the ulnar nerve. This ... syndrome may result. When damage destroys the nerve covering ( ...

  5. Cutaneous nerve entrapment syndrome

    Institute of Scientific and Technical Information of China (English)

    DongFuhui

    2004-01-01

    The cutaneous nerve entrapment syndrome is named that, the cutaneous nerve's functional disorder caused by some chronic entrapment, moreover appears a series of nerve's feeling obstacle,vegetative nerve function obstacle, nutrition obstacle, even motor function obstacle in various degree.

  6. Nerve biopsy (image)

    Science.gov (United States)

    Nerve biopsy is the removal of a small piece of nerve for examination. Through a small incision, a sample ... is removed and examined under a microscope. Nerve biopsy may be performed to identify nerve degeneration, identify ...

  7. Vagus Nerve Stimulation

    Science.gov (United States)

    Vagus nerve stimulation Overview By Mayo Clinic Staff Vagus nerve stimulation is a procedure that involves implantation of a device that stimulates the vagus nerve with electrical impulses. There's one vagus nerve on ...

  8. 多组神经移位治疗臂丛C5~C7根性撕脱伤重建肩外展及屈肘功能%Multiple nerve transfer to rebuilt the shoulder abduction and elbow flexion after the avulsion of C5-C7 nerve roots

    Institute of Scientific and Technical Information of China (English)

    聂铭博; 鲍远; 张滋洋; 康皓

    2016-01-01

    Objective To observe the curative effect of the multiple nerve transfer to cure the disabili⁃ty of shoulder abduction and elbow flexion after the avulsion of C5⁃C7 nerve roots. Methods Sixteen cases of the avulsion of C5⁃C7 nerve roots were subjected to multiple nerve transfer to rebuilt the shoulder abduction and elbow flexion during April 2012 to April 2014. We transferred the accessory nerve to suprascapular nerve, the anconeus longus branch of radial nerve to the axillary nerve and ulnar nerve partial fascicle to the musculo⁃cutaneous nerve (Oberlin transfer), respectively. The curative effect was estimated by the DASH questionnaire. Results Fourteen out of 16 patients had been successfully followed up. The mean period of follow⁃up was 25 months (ranging from 24⁃28 months). The range of shoulder abduction was 75°⁃90° and the average recovery time was 14.0 months (ranging from 9.0⁃18.0 months). The range of elbow flexion was 100°⁃160° and the aver⁃age recovery time was 5.8 months (ranging from 4.0⁃7.5 months). The mean value of DASH score was 14.6 (rang⁃ing from 8.0⁃16.0). Conclusion The multiple nerve transfer can successfully rebuilt the shoulder abduction and elbow flexion after the avulsion of C5⁃C7 nerve roots and the ulnar nerve partial fascicle to the musculocuta⁃neous nerve will do no harm to the function of intrinsic muscles in hand.%目的观察联合应用多组神经移位治疗臂丛上、中干根性撕脱伤重建肩外展及屈肘功能的临床效果。方法我科于2012年4月至2014年4月收治臂丛上、中干根性撕脱伤患者16例,采用副神经斜方肌肌支移位修复肩胛上神经、桡神经肱三头肌长头支移位修复腋神经肌支及尺神经部分束支移位肌皮神经(Oberlin术式),联合修复臂丛上、中干根性撕脱伤,以恢复肩外展及屈肘功能。术后随访采用臂肩手功能障碍(the disabilities of the arm, shoulder and hand, DASH)

  9. Delayed presentation of traumatic facial nerve (CN VII) paralysis.

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    Napoli, Anthony M; Panagos, Peter

    2005-11-01

    Facial nerve paralysis (Cranial Nerve VII, CN VII) can be a disfiguring disorder with profound impact upon the patient. The etiology of facial nerve paralysis may be congenital, iatrogenic, or result from neoplasm, infection, trauma, or toxic exposure. In the emergency department, the most common cause of unilateral facial paralysis is Bell's palsy, also known as idiopathic facial paralysis (IFP). We report a case of delayed presentation of unilateral facial nerve paralysis 3 days after sustaining a traumatic head injury. Re-evaluation and imaging of this patient revealed a full facial paralysis and temporal bone fracture extending into the facial canal. Because cranial nerve injuries occur in approximately 5-10% of head-injured patients, a good history and physical examination is important to differentiate IFP from another etiology. Newer generation high-resolution computed tomography (CT) scans are commonly demonstrating these fractures. An understanding of this complication, appropriate patient follow-up, and early involvement of the Otolaryngologist is important in management of these patients. The mechanism as well as the timing of facial nerve paralysis will determine the proper evaluation, consultation, and management for the patient. Patients with total or immediate paralysis as well as those with poorly prognostic audiogram results are good candidates for surgical repair.

  10. Langerhans Cell Histiocytosis of the Cranial Base: Is Low-Dose Radiotherapy Effective?

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    Andreas Meyer

    2012-01-01

    Full Text Available Introduction. Langerhans cell histiocytosis (LCH is a rare disease of unknown etiology with different clinical features. A standardised treatment has not been established so far. Case Report. We report a case of a 28-year-old patient who initially presented with hypesthesia of the fifth cranial nerve and pain of the left ear. Diagnosis showed a tumour localised in the cranial base with a maximum diameter of 4.1 cm. The diagnosis of LCH was confirmed histologically by biopsy. Diagnostic workup verified the cranial lesion as the sole manifestation of LCH. A total dose of 9 Gy (single dose 1.8 Gy was delivered. The symptoms dissolved completely within 6 months after radiation; repeated CT and MRI scans revealed a reduction in size of the lesion and a remineralisation of the bone. After a followup of 13 years the patient remains free of symptoms without relapse or any side effects from therapy. Discussion. Due to the indolent course of the disease with a high rate of spontaneous remissions the choice of treatment strongly depends on the individual clinical situation. In the presented case low-dose radiotherapy was sufficient to obtain long-term local control in a region with critical structures and tissues.

  11. Parotid lymphangioma associated with facial nerve paralysis.

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    Imaizumi, Mitsuyoshi; Tani, Akiko; Ogawa, Hiroshi; Omori, Koichi

    2014-10-01

    Parotid lymphangioma is a relatively rare disease that is usually detected in infancy or early childhood, and which has typical features. Clinical reports of facial nerve paralysis caused by lymphangioma, however, are very rare. Usually, facial nerve paralysis in a child suggests malignancy. Here we report a very rare case of parotid lymphangioma associated with facial nerve paralysis. A 7-year-old boy was admitted to hospital with a rapidly enlarging mass in the left parotid region. Left peripheral-type facial nerve paralysis was also noted. Computed tomography and magnetic resonance imaging also revealed multiple cystic lesions. Open biopsy was undertaken in order to investigate the cause of the facial nerve paralysis. The histopathological findings of the excised tumor were consistent with lymphangioma. Prednisone (40 mg/day) was given in a tapering dose schedule. Facial nerve paralysis was completely cured 1 month after treatment. There has been no recurrent facial nerve paralysis for eight years.

  12. Cranial neuralgias: from physiopathology to pharmacological treatment.

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    De Simone, Roberto; Ranieri, Angelo; Bilo, Leonilda; Fiorillo, Chiara; Bonavita, Vincenzo

    2008-05-01

    Cranial neuralgias are paroxysmal painful disorders of the head characterised by some shared features such as unilaterality of symptoms, transience and recurrence of attacks, superficial and "shock-like" quality of pain and the presence of triggering factors. Although rare, these disorders must be promptly recognised as they harbour a relatively high risk for underlying compressive or inflammatory disease. Nevertheless, misdiagnosis is frequent. Trigeminal and glossopharyngeal neuralgias are sustained in most cases by a neurovascular conflict in the posterior fossa resulting in a hyperexcitability state of the trigeminal circuitry. If the aetiology of trigeminal neuralgia (TN) and other typical neuralgias must be brought back to the peripheral injury, their pathogenesis could involve central allodynic mechanisms, which, in patients with inter-critical pain, also engage the nociceptive neurons at the thalamic-cortical level. Currently available medical treatments for TN and other cranial neuralgias are reviewed.

  13. Cranial Imaging Findings of Hypertension in Pregnancy

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    Yusuf Tamam

    2005-01-01

    Full Text Available The aim of this study was to find out the cranial imaging findings of complicated hypertensive disorders of pregnancy. Forty two patients with preeclampsia, eclampsia and HELLP syndrome were admitted to the study at Obstetrics Division of Dicle University from January 2001 to December 2004. Computed Tomography was made to the forty two patients. The Computed Tomograpy findings of 20 (47.62% patients were normal whereas computed Tomograpy findings of 22 (52.28% patients were pathological. Eight patients (19% had intracranial hemorrhage, 5 (11.9 % patients had infarct, 9 (21.42% patients had specific lesions. A wide imaging spectrum from ischemic area to intracranial hemorrhages can be detected in hypertensive disorders of pregnancy. Thus it is essential to make cranial imaging in patients with symptoms and neurological deficit.

  14. Sciatic Nerve Intercommunications: New Finding.

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    Tubbs, R Shane; Collin, Peter G; D'Antoni, Anthony V; Loukas, Marios; Oskouian, Rod J; Spinner, Robert J

    2017-02-01

    Communicating branches between the tibial and common fibular divisions of the sciatic nerve have not been previously described. The aim of our study was to examine such neural connections. Twenty unembalmed adult cadavers underwent dissection of the sciatic nerve. Observations were made for interneural communications between the tibial and common fibular divisions of this nerve. When present, these were measured and classified. The majority of sides (75%) had neural communications between the parts of the sciatic nerve in the gluteal/posterior thigh regions before the normal bifurcation of the nerve just above the knee. These connections were always within 20 cm of the greater sciatic notch. Most connections were represented by Testut intercommunicating branches types A (14 sides), F (8 sides), and D (2 sides). Most sides were found to have 1 location for sciatic nerve intercommunications. However, 4 sides (13%) had multiple locations (up to 3) for these intercommunications. The mean length of the communications was 4.1 cm, and the mean diameter was 2.4 mm. No statistically significant difference was found between sides or sexes. To our knowledge, neural interconnections between the divisions of the sciatic nerve in the posterior thigh have not been described in the extant literature. Such data might help explain unusual neurologic examinations and alert the surgeon as to the potential for encountering such connections at operation. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Children's cranial lesions from Neolithic.

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    Shbat, A; Smrcka, V

    2009-01-01

    In skeletal material from the neolithic settlement at Makotrasy, county Kladno, were analysed two children's craniums (identification numbers Ao 8218 and Ao 4184) with pathological cases. Case 1 (Object 127, Ao 8218) is the individual about 4 to 5 years old. There is oval aperture with the diameter 25 x 20 mm in the area of anthropometrical point bregma, with vertical, multiple knurled edges. Bevelled and rounded segment in the left frontal part of the aperture with diameter 10 mm is imitating healing process. We suggest this case is the trephination with the marks of the healing process in the period of 1 to 2 weeks after the surgery took over. Case 2 (Pit 25, Ao 4184) is child with age determined about 4 years old. Cranium was found buried separately. There is oval defect located at os occipitale and os parietale sin and goes through sutura lambdoidea. Caudal part of defect is missing. The edge of the defect is sharp and inward bevelled with exposed diploe. Traces of any vital reaction were not identified. Diameter is around 50 mm. Perimortal trephination leading to death, or postmortal taking of the trephinational amulet must be considered. There were several pathological lesions on the same skull. Defect of oval shape sized 8 x 12 mm is located at the os parietale dex. Defect interferes mostly with lamina externa and less with lamina interna. Exposed diploe is without any vital reaction.

  16. Transverse sinus air after cranial trauma

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    Cihangiroglu, Mutlu E-mail: mmutlucihan@hotmail.com; Ozdemir, Huseyin; Kalender, Omer; Ozveren, Faik; Kabaalioglu, Adnan

    2003-11-01

    Air in vascular compartments has been rarely reported. We report a case in whom air within transverse sinus and sinus confluence through ruptured superior sagittal sinus (SSS) due to fractures of parietal and frontal bones was disclosed by computed tomography (CT). Although air in transverse sinus has been reported rarely this could be the first case with air in transverse sinus through the SSS after cranial trauma.

  17. Role of cranial imaging in epileptic status

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    Nair, Pradeep P.; Kalita, Jayantee [Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014 (India); Misra, Usha K. [Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014 (India)], E-mail: drukmisra@rediffmail.com

    2009-06-15

    Introduction: There is paucity of studies evaluating the role of cranial imaging in the management of status epilepticus (SE); therefore this study evaluates the role of imaging in predicting the outcome of SE. Methods: Consecutive patients with SE were prospectively evaluated. Clinical evaluation, blood counts, serum chemistry and cerebrospinal fluid (CSF) were carried out. Cranial CT scan was performed on a spiral CT and MRI on a 1.5 T scanner. Patients were treated with IV sodium valproate, phenytoin and benzodiazepines as per fixed protocol. Outcome was defined as seizure control at 1 h and mortality. Various clinical and radiological parameters were correlated. Results: There were 99 patients with SE whose mean age was 35 (1-78) years, 40 females and 17 were below 12 years of age. Fifty six patients had central nervous system (CNS) infections, 15 strokes, 13 metabolic encephalopathy, 5 drug default and in the remaining 10 patients various acute symptomatic causes were present. Cranial imaging was abnormal in 59% patients. CT was abnormal in 21 (47.7%) out of 44 patients whereas MRI was abnormal in 26 (63.4%) out of 41 patients. Both MRI and CT were carried out in 14 patients and 12 revealed abnormalities; 2 had abnormality only on MRI. Imaging revealed cortical lesions in 10, subcortical in 19 and both cortical as well as subcortical in 30 patients. One hour seizure control was achieved in 60, seizures recurred within 24 h in 38 and 27 patients died during hospital stay. Seizure type, duration of SE, seizure control at 1 h and mortality did not correlate with radiological abnormalities. Conclusion: Cranial imaging reveals structural abnormality in 59% patients with SE and was not related to SE control and mortality.

  18. Cranial Osteology of Meiglyptini (Aves: Piciformes: Picidae

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    Reginaldo José Donatelli

    2012-01-01

    Full Text Available The Meiglyptini comprise eight species grouped into three genera: Meiglyptes and Mulleripicus, with three species each, and Hemicircus, with two species. The aim of the present study was to describe the cranial osteology of six species and three genera of Meiglyptini and to compare them to each other, as well as with other species of woodpeckers and other bird groups. The cranial osteology varied among the investigated species, but the most markedly distinct characteristics were: (1 a frontal overhang is only observed in the middle portion of the frontale of H. concretus; (2 the Proc. zygomaticus and suprameaticus are thick and long in species of the genus Mulleripicus, but short in other species; (3 the Pes pterygoidei is relatively larger in species of the genus Mulleripicus, while it is narrow, thin and relatively smaller in species of the genus Meiglyptes and indistinct in H. concretus; (4 the bony projection of the ectethmoidale is relatively short and thin in species of Mulleripicus and more developed in H. concretus. It appears that the greatest structural complexity of the cranial osteology is associated with the birds’ diet, with the frugivorous H. concretus being markedly different from the insectivorous species.

  19. CRANIAL OSTEOLOGY OF CYCLARHIS GUJANENSIS (AVES: VIREONIDAE

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    DIEGO MATIUSSI PREVIATTO

    2015-01-01

    Full Text Available The small passerine Cyclaris gujanensis can tear into small pieces large or heavy-bodied preys that could not be swallowed whole such as frogs, snakes, bats and birds. However there are few studies on the cranial anatomy of this species. Thus, we focused on the description of the cranial osteology to contribute to the anatomical knowledge of this species and to make some assumptions about functional anatomy. The fossa temporalis is shallow but broad and the fossa of os palatinum is deepened. The os quadratum processes are long and thick. The os pterygoideum is enlarged and the upper jaw is strongly inclined ventrally (140° with reference to the skull. The rostral extremity of rhamphotheca is hooked with ventral concavity to fit the mandible (pincer form. The mandible fossae are deepened and broad and its bulky medial process probably provides mandible stability and strong support to the muscles attached on it. All these peculiar characteristics probably indicate a considerable force in the C. gujanensis jaws and partially explain its distinctive feeding habit compared with the other Vireonidae. Nevertheless, new studies with functional approaches to analysis the forces of the muscle fibers and the cranial kinesis are needed to prove the hypotheses mentioned above.

  20. Cranial osteology of meiglyptini (aves: piciformes: picidae).

    Science.gov (United States)

    Donatelli, Reginaldo José

    2012-01-01

    THE MEIGLYPTINI COMPRISE EIGHT SPECIES GROUPED INTO THREE GENERA: Meiglyptes and Mulleripicus, with three species each, and Hemicircus, with two species. The aim of the present study was to describe the cranial osteology of six species and three genera of Meiglyptini and to compare them to each other, as well as with other species of woodpeckers and other bird groups. The cranial osteology varied among the investigated species, but the most markedly distinct characteristics were: (1) a frontal overhang is only observed in the middle portion of the frontale of H. concretus; (2) the Proc. zygomaticus and suprameaticus are thick and long in species of the genus Mulleripicus, but short in other species; (3) the Pes pterygoidei is relatively larger in species of the genus Mulleripicus, while it is narrow, thin and relatively smaller in species of the genus Meiglyptes and indistinct in H. concretus; (4) the bony projection of the ectethmoidale is relatively short and thin in species of Mulleripicus and more developed in H. concretus. It appears that the greatest structural complexity of the cranial osteology is associated with the birds' diet, with the frugivorous H. concretus being markedly different from the insectivorous species.

  1. Cranial fasciitis of childhood: a case report.

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    Kumon, Y; Sakaki, S; Sakoh, M; Nakano, K; Fukui, K; Kurihara, K

    1992-07-01

    Cranial fasciitis of childhood is very rare, only 17 cases having been reported in the literature. We report an additional case of this rare disease. The patient was a 5-year-old boy who complained of left exophthalmos and double vision. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a large epidural mass in the left frontal region that had invaded into the underlying anterior skull base. The tumor showed homogeneous, low density with nonhomogeneous contrast enhancement on the CT scans, and low intensity on the T1-weighted and high intensity on the T2-weighted MRI images. A whitish-pink, elastic, hard tumor was revealed in the epidural space in the left anterior cranial fossa, which was totally excised with curettage of the affected anterior skull base. The origin of the tumor was suspected to be the fibrous connective tissue of the sphenofrontal suture. The histological diagnosis was that of cranial fasciitis. There was no evidence of recurrence 1 year postoperatively.

  2. Studing cranial vault modifications in ancient Mesoamerica.

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    Tiesler, Vera

    2012-01-01

    The artificial modification of infant cranial vaults through massages or by means of constriction and compression devices constitutes a readily visible, permanent body modification that has been employed cross-culturally to express identity, ethnicity, beauty, status and gender. For those ancient societies that staged head shaping, these cultural correlates may be ascertained by examining cranial shapes together with other data sets from the archaeological record. Studies of skulls modified for cultural reasons also provide important clues for understanding principles in neural growth and physiopathological variation in cranial expansion. This paper focuses on head shaping techniques in Mesoamerica, where the practice was deeply rooted and widespread before the European conquest. It provides a comprehensive review of the Mesoamericanistic research on shaping techniques, implements and taxonomies. An up-dated, interdisciplinary examination of the physiological implications and the cultural meanings of artificially produced head shapes in different times and culture areas within Mesoamerica leads to a discussion of the scope, caveats, and future directions involved in this kind of research in the region and beyond.

  3. Cranial involvement in sickle cell disease

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    Alkan, Ozlem, E-mail: yalinozlem@hotmail.com [Department of Radiology, Faculty of Medicine, Baskent University, Ankara (Turkey); Kizilkilic, Ebru, E-mail: ebru90@yahoo.com [Department of Hematology, Faculty of Medicine, Baskent University, Ankara (Turkey); Kizilkilic, Osman, E-mail: ebos90@hotmail.com [Department of Radiology, Faculty of Medicine, Baskent University, Ankara (Turkey); Yildirim, Tulin, E-mail: ytulin@hotmail.com [Department of Radiology, Faculty of Medicine, Baskent University, Ankara (Turkey); Karaca, Sibel, E-mail: sibelkaraca@hotmail.com [Department of Neurology, Faculty of Medicine, Baskent University, Ankara (Turkey); Yeral, Mahmut, E-mail: mahmutyeral@hotmail.com [Department of Hematology, Faculty of Medicine, Baskent University, Ankara (Turkey); Kasar, Mutlu, E-mail: mutlukasar@hotmail.com [Department of Hematology, Faculty of Medicine, Baskent University, Ankara (Turkey); Ozdogu, Hakan, E-mail: hakanozdogu@hotmail.com [Department of Hematology, Faculty of Medicine, Baskent University, Ankara (Turkey)

    2010-11-15

    Purpose: To evaluate cranial findings in patients with neurologically symptomatic sickle cell disease (SCD). Materials and methods: We studied 50 consecutive patients with SCD and neurologic symptoms. All patients underwent brain MR examinations: all 50 underwent classic MR imaging; 42, diffusion-weighted MR imaging; 10, MR angiography; four, MR venography; and three patients, digital subtraction angiography. Results: Of the 50 SCD patients, 19 (38%) had normal MR findings, and 31 (62%) showed abnormalities on brain MR images. Of the 50 patients, 16 (32%) had ischemic lesions; two (4%), subarachnoid hemorrhage; one (2%), moya-moya pattern; one (2%), posterior reversible encephalopathy; one (2%), dural venous sinus thrombosis; 12 (24%), low marrow signal intensity and thickness of the diploic space; 12 (24%), cerebral atrophy; and two (4%), osteomyelitis. Twenty-seven patients (54%) presented with headache, which was the most common clinical finding. Conclusions: The cranial involvement is one of the most devastating complications of SCD. Early and accurate diagnosis is important in the management of cranial complications of SCD.

  4. Convergence in reflex pathways from multiple cutaneous nerves innervating the foot depends upon the number of rhythmically active limbs during locomotion.

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    Nakajima, Tsuyoshi; Mezzarane, Rinaldo A; Hundza, Sandra R; Komiyama, Tomoyoshi; Zehr, E Paul

    2014-01-01

    Neural output from the locomotor system for each arm and leg influences the spinal motoneuronal pools directly and indirectly through interneuronal (IN) reflex networks. While well documented in other species, less is known about the functions and features of convergence in common IN reflex system from cutaneous afferents innervating different foot regions during remote arm and leg movement in humans. The purpose of the present study was to use spatial facilitation to examine possible convergence in common reflex pathways during rhythmic locomotor limb movements. Cutaneous reflexes were evoked in ipsilateral tibialis anterior muscle by stimulating (in random order) the sural nerve (SUR), the distal tibial nerve (TIB), and combined simultaneous stimulation of both nerves (TIB&SUR). Reflexes were evoked while participants performed rhythmic stepping and arm swinging movement with both arms and the leg contralateral to stimulation (ARM&LEG), with just arm movement (ARM) and with just contralateral leg movement (LEG). Stimulation intensities were just below threshold for evoking early latency (reflexes. For each stimulus condition, rectified EMG signals were averaged while participants held static contractions in the stationary (stimulated) leg. During ARM&LEG movement, amplitudes of cutaneous reflexes evoked by combined TIB&SUR stimulation were significantly larger than simple mathematical summation of the amplitudes evoked by SUR or TIB alone. Interestingly, this extra facilitation seen during combined nerve stimulation was significantly reduced when performing ARM or LEG compared to ARM&LEG. We conclude that locomotor rhythmic limb movement induces excitation of common IN reflex pathways from cutaneous afferents innervating different foot regions. Importantly, activity in this pathway is most facilitated during ARM&LEG movement. These results suggest that transmission in IN reflex pathways is weighted according to the number of limbs directly engaged in human

  5. Convergence in reflex pathways from multiple cutaneous nerves innervating the foot depends upon the number of rhythmically active limbs during locomotion.

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    Tsuyoshi Nakajima

    Full Text Available Neural output from the locomotor system for each arm and leg influences the spinal motoneuronal pools directly and indirectly through interneuronal (IN reflex networks. While well documented in other species, less is known about the functions and features of convergence in common IN reflex system from cutaneous afferents innervating different foot regions during remote arm and leg movement in humans. The purpose of the present study was to use spatial facilitation to examine possible convergence in common reflex pathways during rhythmic locomotor limb movements. Cutaneous reflexes were evoked in ipsilateral tibialis anterior muscle by stimulating (in random order the sural nerve (SUR, the distal tibial nerve (TIB, and combined simultaneous stimulation of both nerves (TIB&SUR. Reflexes were evoked while participants performed rhythmic stepping and arm swinging movement with both arms and the leg contralateral to stimulation (ARM&LEG, with just arm movement (ARM and with just contralateral leg movement (LEG. Stimulation intensities were just below threshold for evoking early latency (<80 ms to peak reflexes. For each stimulus condition, rectified EMG signals were averaged while participants held static contractions in the stationary (stimulated leg. During ARM&LEG movement, amplitudes of cutaneous reflexes evoked by combined TIB&SUR stimulation were significantly larger than simple mathematical summation of the amplitudes evoked by SUR or TIB alone. Interestingly, this extra facilitation seen during combined nerve stimulation was significantly reduced when performing ARM or LEG compared to ARM&LEG. We conclude that locomotor rhythmic limb movement induces excitation of common IN reflex pathways from cutaneous afferents innervating different foot regions. Importantly, activity in this pathway is most facilitated during ARM&LEG movement. These results suggest that transmission in IN reflex pathways is weighted according to the number of limbs

  6. Optic nerve decompression for orbitofrontal fibrous dysplasia.

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    Abe, Takumi; Sato, Kaneshige; Otsuka, Takaharu; Kawamura, Noriyoshi; Shimazu, Motohiko; Izumiyama, Hitoshi; Matsumoto, Kiyoshi

    2002-08-01

    Orbitofrontal fibrous dysplasia often involves the bony orbit and the optic canal. Although fibrous dysplasia reportedly produces compression of the optic nerve leading to visual distrubances, optic nerve decompression in patients without clinical signs of optic neuropathy is still controversial. We describe two patients with orbitofrontal fibrous dysplasia without signs of visual disturbance and one patient with McCune-Albright syndrome and progressive visual impairment. Optic nerve decompression was performed prophylactically for two patients and therapeutically for one patient through the transcranial extradural route. Dystopias and craniofacial deformities induced by fibrous dysplasia also were corrected. The micropressure suction-irrigation system was especially effective for decreasing heat transfer and thereby preventing thermal injury of the optic nerve. The orbitofrontal area was reconstructed from cranial bone, iliac bone, and ribs. Postoperative follow-up revealed no disturbances in visual function and no evidence of cerebrospinal fluid leakage. These findings suggest that optic nerve decompression may be effective in preventing visual disturbances with minimal risk of other neurological sequelae. Subsequent orbital reconstruction yielded satisfactory cosmetic results.

  7. Endocrine tumors associated with the vagus nerve.

    Science.gov (United States)

    Varoquaux, Arthur; Kebebew, Electron; Sebag, Fréderic; Wolf, Katherine; Henry, Jean-François; Pacak, Karel; Taïeb, David

    2016-09-01

    The vagus nerve (cranial nerve X) is the main nerve of the parasympathetic division of the autonomic nervous system. Vagal paragangliomas (VPGLs) are a prime example of an endocrine tumor associated with the vagus nerve. This rare, neural crest tumor constitutes the second most common site of hereditary head and neck paragangliomas (HNPGLs), most often in relation to mutations in the succinate dehydrogenase complex subunit D (SDHD) gene. The treatment paradigm for VPGL has progressively shifted from surgery to abstention or therapeutic radiation with curative-like outcomes. Parathyroid tissue and parathyroid adenoma can also be found in close association with the vagus nerve in intra or paravagal situations. Vagal parathyroid adenoma can be identified with preoperative imaging or suspected intraoperatively by experienced surgeons. Vagal parathyroid adenomas located in the neck or superior mediastinum can be removed via initial cervicotomy, while those located in the aortopulmonary window require a thoracic approach. This review particularly emphasizes the embryology, molecular genetics, and modern imaging of these tumors.

  8. [Malignant lymphoma in a perineural spreading along trigeminal nerve, which developed as trigeminal neuralgia].

    Science.gov (United States)

    Mano, Tomoo; Matsuo, Koji; Kobayashi, Yosuke; Kobayashi, Yasushi; Ozawa, Hiroaki; Arakawa, Toshinao

    2014-01-01

    A rare cause of trigeminal neuralgia is malignant lymphoma which spread along the trigeminal nerve. We report a 79-year-old male presented with 4-month history of neuralgic pain in right cheek. He was diagnosed as classical trigeminal neuralgia. It had improved through medication of carbamazepine. Four months later, the dull pain unlike neuralgia complicated on the right cheeks, it was ineffective with the medication. Furthermore, diplopia and facial palsy as the other cranial nerve symptoms appeared. Gadolinium-enhanced magnetic resonance imaging (MRI) revealed contrast-enhanced mass lesion extend both external pterygoid muscle and brainstem through the swelling trigeminal nerve. The patient was pathological diagnosed of diffuse large B cell lymphoma by biopsy. Malignant lymphoma should be considered in the different diagnosis of cases with a minimal single cranial nerve symptom.

  9. Hand function after nerve repair.

    Science.gov (United States)

    Lundborg, G; Rosén, B

    2007-02-01

    Treatment of injuries to major nerve trunks in the hand and upper extremity remains a major and challenging reconstructive problem. Such injuries may cause long-lasting disabilities in terms of lost fine sensory and motor functions. Nowadays there is no surgical repair technique that can ensure recovery of tactile discrimination in the hand of an adult patient following nerve repair while very young individuals usually regain a complete recovery of functional sensibility. Post-traumatic nerve regeneration is a complex biological process where the outcome depends on multiple biological and environmental factors such as survival of nerve cells, axonal regeneration rate, extent of axonal misdirection, type of injury, type of nerve, level of the lesion, age of the patient and compliance to training. A major problem is the cortical functional reorganization of hand representation which occurs as a result of axonal misdirection. Although protective sensibility usually occurs following nerve repair, tactile discriminative functions seldom recover--a direct result of cortical remapping. Sensory re-education programmes are routinely applied to facilitate understanding of the new sensory patterns provided by the hand. New trends in hand rehabilitation focus on modulation of central nervous processes rather than peripheral factors. Principles are being evolved to maintain the cortical hand representation by using the brain capacity for visuo-tactile and audio-tactile interaction for the initial phase following nerve injury and repair (phase 1). After the start of the re-innervation of the hand (phase 2), selective de-afferentation, such as cutaneous anaesthesia of the forearm of the injured hand, allows expansion of the nerve-injured cortical hand representation, thereby enhancing the effects of sensory relearning. Recent data support the view that training protocols specifically addressing the relearning process substantially increase the possibilities for improved

  10. Chronic cranial window with access port for repeated cellular manipulations, drug application, and electrophysiology

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    Christopher Joel Roome

    2014-11-01

    Full Text Available Chronic cranial windows have been instrumental in advancing optical studies in vivo, permitting long-term, high-resolution imaging in various brain regions. However, once a window is attached it is difficult to regain access to the brain under the window for cellular manipulations. Here we describe a simple device that combines long term in vivo optical imaging with direct brain access via glass or quartz pipettes and metal, glass, or quartz electrodes for cellular manipulations like dye or drug injections and electrophysiological stimulations or recordings while keeping the craniotomy sterile. Our device comprises a regular cranial window glass coverslip with a drilled access hole later sealed with biocompatible silicone. This chronic cranial window with access port is cheap, easy to manufacture, can be mounted just as the regular chronic cranial window, and is self-sealing after retraction of the pipette or electrode. We demonstrate that multiple injections can be performed through the silicone port by repetitively bolus loading calcium sensitive dye into mouse barrel cortex and recording spontaneous cellular activity over a period of weeks. As an example to the extent of its utility for electrophysiological recording, we describe how simple removal of the silicone seal can permit patch pipette access for whole-cell patch clamp recordings in vivo. During these chronic experiments we do not observe any infections under the window or impairment of animal health.

  11. Circumscribed changes in the cranial vault in extracerebral accumulations of fluid in the middle cranial fossa

    Energy Technology Data Exchange (ETDEWEB)

    Trittmacher, S.; Purmann, H.; Hunsdiek, F.; Schmid, A.; Traupe, H.

    1988-11-01

    On the basis of 26 cases with extracerebral fluid accumulation in the middle cranial fossa the bony changes occurring in this connection are described and discussed in respect of their aetiology. If there are bony accompanying reactions, two entities can be observed on principle: One group shows thinning and protrusion of the temporal squama, raising of the lesser wing of the sphenoid bone and protrusion of the greater wing of the sphenoid bone. The second group is associated with thickening of the temporal squama and of the lesser and greater wing of the sphenoid bone without showing any change in volume of the middle cranial fossa. (orig./GDG).

  12. 伴有全身多发性损伤的颅颌面骨折同期与延期手术的疗效比较%A comparative study of the clinical effects of simultaneous and delayed surgery for the treatment of cranial and maxillofacial fractures with multiple systemic injuries

    Institute of Scientific and Technical Information of China (English)

    谭锡涛; 池宇峰; 王维; 王佩

    2016-01-01

    目的:探讨颅颌面部骨折伴有全身其他部位多发性损伤的患者采用同期或延期手术治疗的临床效果差异。方法85例颅颌面部骨折伴有全身其他部位多发性损伤的患者,根据患者本人、家属意愿及实际情况,将患者按照颅颌面部骨折与全身其他部位是否同期治疗分为2组,同期组48例行同期手术治疗;延期组37例行延期手术治疗。比较2组伴有颅脑损伤患者的神经功能缺损程度、术后咬合、张口度、住院时间及术后并发症的差异。结果根据神经外科评分标准,2组术后3个月的格拉斯哥预后评分(Glasgow outcome scale,GOS)分布差异无统计学意义(Z=⁃1.545,P=0.122);术后同期组患者的咬合优良率(93.75%)高于延期组患者(75.68%)(c2=5.630,P=0.018);术后同期组患者的张口度(34.5±3.6)mm高于延期组(28.9±3.3)mm (c2=7.370,P<0.001);同期组住院时间(28.5±5.2)d,短于延期组(40.1±5.7)d(c2=9.778,P<0.001);术后同期组手术并发症发生率为8.33%,低于延期组24.32%(c2=4.124,P=0.042)。结论在患者创伤严重程度适宜的情况下,对于颅颌面部骨折伴多发性损伤患者可以采取多科室联合手术治疗,可缩短住院时间、有利于患者颌面部外观及功能恢复。%Objective To investigate the clinical effect of simultaneous and delayed surgery with cranial and maxil⁃lofacial fractures with multiple systemic injuries. Methods From January 2013 to January 2015, 85 cases of patients with multiple systematic injuries and maxillofacial fractures were treated in our hospital. Fractures of the maxillofacial parts and other parts of body were divided into 2 groups, 37 cases of delayed surgery, 48 of simultaneous surgery. The degree of neurologic impairment, occlusion, mouth opening, the time in hospital, postoperative complication rate were compared between two groups. Results There

  13. Nerve Biopsy In The Diagnosis Of Leporsy

    Directory of Open Access Journals (Sweden)

    Hazra B

    1997-01-01

    Full Text Available Skin and nerve biopsies were done in 33 cases of different clinical types of leprosy selected from Dermatology OPD of Medical College and Hospitals, Calcutta during 1994-95. Histopathological results were compared with emphasis on the role of nerve biopsies in detection of patients with multibacillary leprosy. The evident possibility of having patients with multibacillary leprosy in peripheral leprosy with multiple drugs. It is found that skin and nerve biopsy are equally informative in borderline and lepromatour leprosy and is the only means to diagnose polyneuritic leprosy. Nerve biopsy appears to be more informative in the diagnosis of all clinical types of leprosy.

  14. Postpartum pituitary apoplexy with isolated oculomotor nerve palsy: A rare medical emergency

    Directory of Open Access Journals (Sweden)

    Sujeet Raina

    2015-01-01

    Full Text Available Pituitary apoplexy is a clinical syndrome characterized by sudden onset headache, visual deficits, ophthalmoplegia, altered mental status, and hormonal dysfunction due to an expanding mass within the sella turcica resulting from hemorrhage or infarction of pituitary gland. We report a case of pituitary apoplexy that developed in postpartum period following postpartum hemorrhage and presented with isolated third cranial nerve palsy.

  15. Multiple Reflex Pathways Contribute to Bladder Activation by Intraurethral Stimulation in Persons With Spinal Cord Injury.

    Science.gov (United States)

    McGee, Meredith J; Swan, Brandon D; Danziger, Zachary C; Amundsen, Cindy L; Grill, Warren M

    2017-08-08

    To measure the urodynamic effects of electrical co-stimulation of 2 individual sites in the proximal and distal urethra in persons with spinal cord injury (SCI). This work was motivated by preclinical findings that selective co-stimulation of the cranial urethral sensory nerve and the dorsal genital nerve, which innervate the proximal and distal portions of the urethra, respectively, increased reflex bladder activation and voiding efficiency. Electrical co-stimulation of urethral afferents was conducted in persons with chronic SCI during urodynamics. The effects of different frequencies of intraurethral stimulation at multiple urethral locations on bladder pressure and pelvic floor electromyographic activity were measured. Electromyographic activity indicated that multiple reflex pathways were recruited through stimulation that contributed to bladder activation. The size of reflex bladder contractions evoked by stimulation was dependent on stimulation location or reflex activated and stimulation frequency. Pudendal nerve afferents are a promising target to restore lost bladder control, as stimulation with different frequencies may be used to treat urinary incontinence and increase continent volumes or to generate stimulation-evoked bladder contractions for on-demand voiding. This work identified that co-stimulation of multiple afferent reflex pathways can enhance activation of spinal circuits and may enable improved bladder emptying in SCI when stimulation of a single pathway is not sufficient. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Cranial radiation exposure during cerebral catheter angiography.

    Science.gov (United States)

    Chohan, Muhammad Omar; Sandoval, Daniel; Buchan, Andrew; Murray-Krezan, Cristina; Taylor, Christopher L

    2014-10-01

    Radiation exposure to patients and personnel remains a major concern in the practice of interventional radiology, with minimal literature available on exposure to the forehead and cranium. In this study, we measured cranial radiation exposure to the patient, operating interventional neuroradiologist, and circulating nurse during neuroangiographic procedures. We also report the effectiveness of wearing a 0.5 mm lead equivalent cap as protection against radiation scatter. 24 consecutive adult interventional neuroradiology procedures (six interventional, 18 diagnostic) were prospectively studied for cranial radiation exposures in the patient and personnel. Data were collected using electronic detectors and thermoluminescent dosimeters. Mean fluoroscopy time for diagnostic and interventional procedures was 8.48 (SD 2.79) min and 26.80 (SD 6.57) min, respectively. Mean radiation exposure to the operator's head was 0.08 mSv, as measured on the outside of the 0.5 mm lead equivalent protective headgear. This amounts to around 150 mSv/year, far exceeding the current deterministic threshold for the lens of the eye (ie, 20 mSv/year) in high volume centers performing up to five procedures a day. When compared with doses measured on the inside of the protective skullcap, there was a statistically significant reduction in the amount of radiation received by the operator's skull. Our study suggests that a modern neurointerventional suite is safe when equipped with proper protective shields and personal gear. However, cranial exposure is not completely eliminated with existing protective devices and the addition of a protective skullcap eliminates this exposure to both the operator and support staff. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  17. The role of cranial kinesis in birds.

    Science.gov (United States)

    Bout, R G; Zweers, G A

    2001-12-01

    In birds, the ability to move the upper beak relative to the braincase has been the subject of many functional morphological investigations, but in many instances the adaptive significance of cranial kinesis remains unclear. Alternatively, cranial kinesis may be considered a consequence of the general design of the skull, rather than an adaptive trait as such. The present study reviews some results related to the mechanism and functional significance of cranial kinesis in birds. Quantitative three-dimensional X-ray has shown that in skulls morphologically as divers as paleognaths and neognaths the mechanism for elevation of the upper beak is very similar. One of the mechanisms proposed for avian jaw movement is a mechanical coupling of the upper and the lower jaw movement by the postorbital ligament. Such a mechanical coupling would necessitate upper beak elevation. However, independent control of upper and lower jaw has been shown to occur during beak movements in birds. Moreover, kinematic modeling and force measurements suggests that the maximum extensibility of collagen, in combination with the short distance of the insertion of the postorbital ligament to the quadrato-mandibular articulation do not constitute a block to lower jaw depression. The lower jaw ligaments serve to limit the maximal extension of the mandibula. It is suggested here that cranial kinesis in avian feeding may have evolved as a consequence of an increase in eye size. This increase in size led to a reduction of bony bars in the lateral aspect of the skull enabling the transfer of quadrate movement to the upper jaw. The selective forces favoring the development of a kinetic upper beak in birds may be subtle and act in different ecological contexts. Simultaneous movement of the upper and lower jaw not only increases the velocity of beak movements, but with elevated upper beak also less force is required to open the lower jaw. However, the penalty of increased mobility of elements in a

  18. Cranial computed tomographic abnormalities in leptomeningeal metastasis

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Y.Y.; Glass, J.P.; Geoffray, A.; Wallace, S.

    1984-11-01

    Sixty-four (57.6%) of 111 cancer patients with cerebrospinal fluid cytology positive for malignant cells had cranial computed tomographic (CT) scans within 2 weeks before or after a lumbar puncture. Twenty-two (34.3%) of the 64 had abnormal CT findings indicative of leptomeningeal metastasis. Thirteen (59.6%) of these 22 patients had associated parenchymal metastases. Recognition of leptomeningeal disease may alter the management of patients with parenchymal metastases. Communicating hydrocephalus in cancer patients should be considered to be related to leptomeningeal metastasis until proven otherwise.

  19. Cranial juvenile psammomatoid ossifying fibroma: case report.

    Science.gov (United States)

    Barrena López, Cristina; Bollar Zabala, Alicia; Úrculo Bareño, Enrique

    2016-03-01

    Juvenile psammomatoid ossifying fibroma (JPOF) is a fibroosseous tumor that arises in the craniofacial bones in young people. This lesion usually originates in the jaw, orbit, and ethmoid complex but can also be associated with the skull base and calvaria. Diagnosis must be made based on observing typical radiological and histopathological features. Although JPOF is a rare pathological entity, neurosurgeons must consider this odontogenic lesion in the differential diagnosis of skull masses given the lesion's aggressive behavior and locally invasive growth. Treatment must be gross-total resection. In the following article, the authors present a case of cranial JPOF and discuss various aspects of this entity.

  20. Cranial symmetry in baleen whales (Cetacea, Mysticeti) and the occurrence of cranial asymmetry throughout cetacean evolution.

    Science.gov (United States)

    Fahlke, Julia M; Hampe, Oliver

    2015-10-01

    Odontoceti and Mysticeti (toothed and baleen whales) originated from Eocene archaeocetes that had evolved from terrestrial artiodactyls. Cranial asymmetry is known in odontocetes that can hear ultrasound (>20,000 Hz) and has been linked to the split function of the nasal passage in breathing and vocalization. Recent results indicate that archaeocetes also had asymmetric crania. Their asymmetry has been linked to directional hearing in water, although hearing frequencies are still under debate. Mysticetes capable of low-frequency and infrasonic hearing (evolution. Asymmetry includes significant fluctuating and directional asymmetry, the latter being very small. Mysticete crania are as symmetric as those of terrestrial artiodactyls and archaeocetes, without significant differences within Mysticeti. Odontocete crania are more asymmetric. These results indicate that (1) all mysticetes have symmetric crania, (2) archaeocete cranial asymmetry is not conspicuous in most of the skull but may yet be conspicuous in the rostrum, (3) directional cranial asymmetry is an odontocete specialization, and (4) directional cranial asymmetry is more likely related to echolocation than hearing.

  1. Horseradish peroxidase dye tracing and embryonic statoacoustic ganglion cell transplantation in the rat auditory nerve trunk.

    Science.gov (United States)

    Palmgren, Björn; Jin, Zhe; Jiao, Yu; Kostyszyn, Beata; Olivius, Petri

    2011-03-04

    At present severe damage to hair cells and sensory neurons in the inner ear results in non-treatable auditory disorders. Cell implantation is a potential treatment for various neurological disorders and has already been used in clinical practice. In the inner ear, delivery of therapeutic substances including neurotrophic factors and stem cells provide strategies that in the future may ameliorate or restore hearing impairment. In order to describe a surgical auditory nerve trunk approach, in the present paper we injected the neuronal tracer horseradish peroxidase (HRP) into the central part of the nerve by an intra cranial approach. We further evaluated the applicability of the present approach by implanting statoacoustic ganglion (SAG) cells into the same location of the auditory nerve in normal hearing rats or animals deafened by application of β-bungarotoxin to the round window niche. The HRP results illustrate labeling in the cochlear nucleus in the brain stem as well as peripherally in the spiral ganglion neurons in the cochlea. The transplanted SAGs were observed within the auditory nerve trunk but no more peripheral than the CNS-PNS transitional zone. Interestingly, the auditory nerve injection did not impair auditory function, as evidenced by the auditory brainstem response. The present findings illustrate that an auditory nerve trunk approach may well access the entire auditory nerve and does not compromise auditory function. We suggest that such an approach might compose a suitable route for cell transplantation into this sensory cranial nerve. Copyright © 2011 Elsevier B.V. All rights reserved.

  2. Lateral angle and cranial base sexual dimorphism

    DEFF Research Database (Denmark)

    Duquesnel Mana, Mathilde; Adalian, Pascal; Lynnerup, Niels

    2016-01-01

    SUMMARY: Previous studies have yielded very different results in sex estimation based on measurements of the lateral angle (LA) of the temporal bone. The purpose of this study was to, first, investigate if the bad results obtained by the LA method could be due to the methodology and then, second......, to examine sexual dimorphism in the relationship between the lateral angle and cranial base shape. The lateral angle method was tested using a forensic sample of 102 CT scans of the head with known sex. We measured the angle using two methods: measurements directly on the CT slide, the method usually applied...... the direct measurements. The mean angle was greater in females (48.2° ± 7.2°) than in males (45.38° ±8.06°) but the difference was not significant (t-test, p = 0.063). A statistically significant difference in cranial base shape existed between the two sexes, but the results also demonstrated a major overlap...

  3. STUDY OF EXTRA CRANIAL COMPLICATIONS OF CHRONIC SUPPURATIVE OTITIS MEDIA

    Directory of Open Access Journals (Sweden)

    Sanal Mohan

    2016-10-01

    socio-economic group which amounted to thirty nine cases. Nine cases belonged to middle class and six cases belonged to high socio-economic group. Based on extra cranial complications, twenty one cases presented with acute mastoiditis features, nineteen cases presented with discharging sinuses. Eight cases presented with features of petrositis, four cases presented with features of labyrinthitis, and two cases presented with facial nerve palsy. CONCLUSION In this study it was noted that usually the poor who suffer, may be because of financial constraints, lack of health care facilities or general neglect on the patient’s part. Maintaining proper hygiene and early treatment can reduce the number of complications in such cases.

  4. Therapeutic results in sixth nerve palsy

    Directory of Open Access Journals (Sweden)

    Pruna Violeta-Ioana

    2015-03-01

    Full Text Available Authors aim to assess through a retrospective study the efficiency of different therapeutic methods used in VIth nerve palsy. 60 patients with VIth nerve palsy, admitted and treated in Oftapro Clinic, were divided into two groups: a group with partial dysfunction (paresis of sixth nerve and a group with the complete abolition of neuromuscular function (VIth nerve palsy. Initial examination included assessment of neuromuscular function, binocular vision and existence of medial rectus muscle contracture (ipsi- and contralateral and contralateral lateral rectus inhibitory palsy. Neuromuscular dysfunction was graded from - 8 (paralysis to 0 (normal abduction. Therapeutic modalities ranged from conservative treatment (occlusion, prism correction, botulinum toxin chemodenervation and surgical treatment: medial rectus recession + lateral rectus resection, in cases of paresis, and transposition procedures (Hummelscheim and full tendon transfer in cases of sixth nerve palsy. Functional therapeutic success was defined as absence of diplopia in primary position, with or without prism correction, and surgical success was considered obtaining orthoptic alignment in primary position or a small residual deviation (under 10 PD. 51 patients had unilateral dysfunction, and 9 patients had bilateral VI-th nerve dysfunction. 8 patients had associated fourth or seventh cranial nerves palsy. The most common etiology was traumatic, followed by tumor and vascular causes. There were 18 cases of spontaneous remission, partial or complete (4-8 months after the onset, and 6 cases enhanced by botulinum toxin chemodenervation. 17 paretic eyes underwent surgery, showing a very good outcome, with restoration of binocular single vision. The procedure of choice was recession of medial rectus muscle, combined with resection of lateral rectus muscle. All patients with sixth nerve palsy underwent surgery, except one old female patient, who refused surgery. Hummelscheim procedure was

  5. Idiopathic hypertrophic cranial pachymeningitis: Three biopsy-proven cases including one case with abdominal pseudotumor and review of the literature

    Directory of Open Access Journals (Sweden)

    K M Hassan

    2011-01-01

    Full Text Available Hypertrophic pachymeningitis (HP is a rare disorder of diverse etiology. It presents with headaches, cranial neuropathies and ataxia occurring alone or in combination. Dural biopsy is essential to exclude secondary causes of pachymeningitis. There is paucity of data on biopsied cases of HP. We report three biopsy-proven cases of idiopathic hypertrophic cranial pachymeningitis. All our patients had headaches and multiple cranial neuropathies; ataxia was seen in one patient. One patient had recurrent anterior and posterior cranial neuropathies, while one each had recurrent anterior and posterior cranial neuropathies. Two patients had profound irreversible mono-ocular visual loss. All of them showed prominent pachymeningeal thickening on imaging. Infarcts were seen in one patient, which have rarely been documented. All patients showed biopsy evidence of meningeal thickening and nonspecific chronic inflammation of the dura. The disease may have a remitting and relapsing course, and usually responds to steroids. Clinical improvement was excellent in two patients and modest in one on steroid therapy. All our patients required azathioprine during the course of therapy. Early institution and long-term maintenance of steroid therapy prevents neurologic sequelae. Occurrence of abdominal inflammatory pseudotumor in a patient of HP possibly as part of multifocal fibrosclerosis has not been described earlier.

  6. Cranial muscles in amphibians: development, novelties and the role of cranial neural crest cells.

    Science.gov (United States)

    Schmidt, Jennifer; Piekarski, Nadine; Olsson, Lennart

    2013-01-01

    Our research on the evolution of the vertebrate head focuses on understanding the developmental origins of morphological novelties. Using a broad comparative approach in amphibians, and comparisons with the well-studied quail-chicken system, we investigate how evolutionarily conserved or variable different aspects of head development are. Here we review research on the often overlooked development of cranial muscles, and on its dependence on cranial cartilage development. In general, cranial muscle cell migration and the spatiotemporal pattern of cranial muscle formation appears to be very conserved among the few species of vertebrates that have been studied. However, fate-mapping of somites in the Mexican axolotl revealed differences in the specific formation of hypobranchial muscles (tongue muscles) in comparison to the chicken. The proper development of cranial muscles has been shown to be strongly dependent on the mostly neural crest-derived cartilage elements in the larval head of amphibians. For example, a morpholino-based knock-down of the transcription factor FoxN3 in Xenopus laevis has drastic indirect effects on cranial muscle patterning, although the direct function of the gene is mostly connected to neural crest development. Furthermore, extirpation of single migratory streams of cranial neural crest cells in combination with fate-mapping in a frog shows that individual cranial muscles and their neural crest-derived connective tissue attachments originate from the same visceral arch, even when the muscles attach to skeletal components that are derived from a different arch. The same pattern has also been found in the chicken embryo, the only other species that has been thoroughly investigated, and thus might be a conserved pattern in vertebrates that reflects the fundamental nature of a mechanism that keeps the segmental order of the head in place despite drastic changes in adult anatomy. There is a need for detailed comparative fate-mapping of pre

  7. 21 CFR 882.4370 - Pneumatic cranial drill motor.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Pneumatic cranial drill motor. 882.4370 Section 882.4370 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... drill motor. (a) Identification. A pneumatic cranial drill motor is a pneumatically operated...

  8. 21 CFR 882.5800 - Cranial electrotherapy stimulator.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cranial electrotherapy stimulator. 882.5800 Section 882.5800 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... electrotherapy stimulator. (a) Identification. A cranial electrotherapy stimulator is a device that...

  9. Osteopathia Striata With Cranial Sclerosis Owing to WTX Gene Defect

    NARCIS (Netherlands)

    Perdu, Bram; de Freitas, Fenna; Frints, Suzanne G. M.; Schouten, Meyke; Schrander-Stumpel, Connie; Barbosa, Mafalda; Pinto-Basto, Jorge; Reis-Lima, Margarida; de Vernejoul, Marie-Christine; Becker, Kristin; Freckmann, Marie-Louise; Keymolen, Kathlijn; Haan, Eric; Savarirayan, Ravi; Koenig, Rainer; Zabel, Bernhard; Vanhoenacker, Filip M.; Van Hul, Wim

    2010-01-01

    Osteopathia striata with cranial sclerosis (OSCS) is an X-linked dominant condition marked by linear striations mainly affecting the metaphyseal region of the long bones and pelvis in combination with cranial sclerosis. Recently, the disease-causing gene was identified as the WTX gene (FAM123B), an

  10. The contribution of subsistence to global human cranial variation.

    Science.gov (United States)

    Noback, Marlijn L; Harvati, Katerina

    2015-03-01

    Diet-related cranial variation in modern humans is well documented on a regional scale, with ample examples of cranial changes related to the agricultural transition. However, the influence of subsistence strategy on global cranial variation is less clear, having been confirmed only for the mandible, and dietary effects beyond agriculture are often neglected. Here we identify global patterns of subsistence-related human cranial shape variation. We analysed a worldwide sample of 15 populations (n = 255) with known subsistence strategies using 3-D landmark datasets designed to capture the shape of different units of the cranium. Results show significant correlations between global cranial shape and diet, especially for temporalis muscle shape and general cranial shape. Importantly, the differences between populations with either a plant- or an animal-based diet are more pronounced than those between agriculturalists and hunter-gatherers, suggesting that the influence of diet as driver of cranial variation is not limited to Holocene transitions to agricultural subsistence. Dental arch shape did not correlate with subsistence pattern, possibly indicating the high plasticity of this region of the face in relation to age, disease and individual use of the dentition. Our results highlight the importance of subsistence strategy as one of the factors underlying the evolution of human geographic cranial variation.

  11. Cranial joint histology in the mallard duck (Anas platyrhynchos): new insights on avian cranial kinesis.

    Science.gov (United States)

    Bailleul, Alida M; Witmer, Lawrence M; Holliday, Casey M

    2017-03-01

    The evolution of avian cranial kinesis is a phenomenon in part responsible for the remarkable diversity of avian feeding adaptations observable today. Although osteological, developmental and behavioral features of the feeding system are frequently studied, comparatively little is known about cranial joint skeletal tissue composition and morphology from a microscopic perspective. These data are key to understanding the developmental, biomechanical and evolutionary underpinnings of kinesis. Therefore, here we investigated joint microstructure in juvenile and adult mallard ducks (Anas platyrhynchos; Anseriformes). Ducks belong to a diverse clade of galloanseriform birds, have derived adaptations for herbivory and kinesis, and are model organisms in developmental biology. Thus, new insights into their cranial functional morphology will refine our understanding of avian cranial evolution. A total of five specimens (two ducklings and three adults) were histologically sampled, and two additional specimens (a duckling and an adult) were subjected to micro-computed tomographic scanning. Five intracranial joints were sampled: the jaw joint (quadrate-articular); otic joint (quadrate-squamosal); palatobasal joint (parasphenoid-pterygoid); the mandibular symphysis (dentary-dentary); and the craniofacial hinge (a complex flexion zone involving four different pairs of skeletal elements). In both the ducklings and adults, the jaw, otic and palatobasal joints are all synovial, with a synovial cavity and articular cartilage on each surface (i.e. bichondral joints) ensheathed in a fibrous capsule. The craniofacial hinge begins as an ensemble of patent sutures in the duckling, but in the adult it becomes more complex: laterally it is synovial; whereas medially, it is synostosed by a bridge of chondroid bone. We hypothesize that it is chondroid bone that provides some of the flexible properties of this joint. The heavily innervated mandibular symphysis is already fused in the

  12. Trigeminal nerve involvement in T-cell acute lymphoblastic leukemia: value of MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Karadag, Demet; Karaguelle, Ayse Tuba; Erden, Ilhan; Erden, Ayse E-mail: erden@ada.net.tr

    2002-10-01

    A 30-year-old male with T-cell acute lymphoblastic leukemia presented with facial numbness. Neurological examination revealed paresthesia of the left trigeminal nerve. Cerebrospinal fluid (CSF) cytology showed no atypical cells. Gadolinium-enhanced magnetic resonance (MR) imaging demonstrated enlargement and enhancement of intracranial portions of the left trigeminal nerve. The abnormal MR imaging findings almost completely resolved after the chemotherapy. Gadolinium-enhanced MR imaging is not only a useful procedure for the early diagnosis of cranial nerve invasion by leukemia but it might be helpful to follow the changes after the treatment.

  13. Quantitative computed tomography and cranial burr holes: a model to evaluate the quality of cranial reconstruction in humans.

    Science.gov (United States)

    Worm, Paulo Valdeci; Ferreira, Nelson Pires; Ferreira, Marcelo Paglioli; Kraemer, Jorge Luiz; Lenhardt, Rene; Alves, Ronnie Peterson Marcondes; Wunderlich, Ricardo Castilho; Collares, Marcus Vinicius Martins

    2012-05-01

    Current methods to evaluate the biologic development of bone grafts in human beings do not quantify results accurately. Cranial burr holes are standardized critical bone defects, and the differences between bone powder and bone grafts have been determined in numerous experimental studies. This study evaluated quantitative computed tomography (QCT) as a method to objectively measure cranial bone density after cranial reconstruction with autografts. In each of 8 patients, 2 of 4 surgical burr holes were reconstructed with autogenous wet bone powder collected during skull trephination, and the other 2 holes, with a circular cortical bone fragment removed from the inner table of the cranial bone flap. After 12 months, the reconstructed areas and a sample of normal bone were studied using three-dimensional QCT; bone density was measured in Hounsfield units (HU). Mean (SD) bone density was 1535.89 (141) HU for normal bone (P < 0.0001), 964 (176) HU for bone fragments, and 453 (241) HU for bone powder (P < 0.001). As expected, the density of the bone fragment graft was consistently greater than that of bone powder. Results confirm the accuracy and reproducibility of QCT, already demonstrated for bone in other locations, and suggest that it is an adequate tool to evaluate cranial reconstructions. The combination of QCT and cranial burr holes is an excellent model to accurately measure the quality of new bone in cranial reconstructions and also seems to be an appropriate choice of experimental model to clinically test any cranial bone or bone substitute reconstruction.

  14. Application and histology-driven refinement of active contour models to functional region and nerve delineation: towards a digital brainstem atlas

    Science.gov (United States)

    Patel, Nirmal; Sultana, Sharmin; Rashid, Tanweer; Krusienski, Dean; Audette, Michel A.

    2015-03-01

    This paper presents a methodology for the digital formatting of a printed atlas of the brainstem and the delineation of cranial nerves from this digital atlas. It also describes on-going work on the 3D resampling and refinement of the 2D functional regions and nerve contours. In MRI-based anatomical modeling for neurosurgery planning and simulation, the complexity of the functional anatomy entails a digital atlas approach, rather than less descriptive voxel or surface-based approaches. However, there is an insufficiency of descriptive digital atlases, in particular of the brainstem. Our approach proceeds from a series of numbered, contour-based sketches coinciding with slices of the brainstem featuring both closed and open contours. The closed contours coincide with functionally relevant regions, whereby our objective is to fill in each corresponding label, which is analogous to painting numbered regions in a paint-by-numbers kit. Any open contour typically coincides with a cranial nerve. This 2D phase is needed in order to produce densely labeled regions that can be stacked to produce 3D regions, as well as identifying the embedded paths and outer attachment points of cranial nerves. Cranial nerves are modeled using an explicit contour based technique called 1-Simplex. The relevance of cranial nerves modeling of this project is two-fold: i) this atlas will fill a void left by the brain segmentation communities, as no suitable digital atlas of the brainstem exists, and ii) this atlas is necessary to make explicit the attachment points of major nerves (except I and II) having a cranial origin. Keywords: digital atlas, contour models, surface models

  15. An unusual orbito-cranial foreign body

    Directory of Open Access Journals (Sweden)

    Misra Madhumati

    1992-01-01

    Full Text Available The rarity of orbito-cranial gun shot injury in both war and civilian practice has been reported. In a large series of 351 missile head injuries in the Vietnam war, orbital penetration was noted in 0.6% cases only. Review of literature shows that orbital injury was ipsilateral to the cerebral injury in most reported cases. We have previously reported a rare case of left parieto-occipital lobe injury due to gun shot wound of the contralateral (right orbit. The case reported here sustained a bullet injury to the left frontal bone but the missile was located below the contralateral (right optic canal. The rarity of the case prompted this report.

  16. External QX-314 inhibits evoked cranial primary afferent synaptic transmission independent of TRPV1.

    Science.gov (United States)

    Hofmann, Mackenzie E; Largent-Milnes, Tally M; Fawley, Jessica A; Andresen, Michael C

    2014-12-01

    The cell-impermeant lidocaine derivative QX-314 blocks sodium channels via intracellular mechanisms. In somatosensory nociceptive neurons, open transient receptor potential vanilloid type 1 (TRPV1) receptors provide a transmembrane passageway for QX-314 to produce long-lasting analgesia. Many cranial primary afferents express TRPV1 at synapses on neurons in the nucleus of the solitary tract and caudal trigeminal nucleus (Vc). Here, we investigated whether QX-314 interrupts neurotransmission from primary afferents in rat brain-stem slices. Shocks to the solitary tract (ST) activated highly synchronous evoked excitatory postsynaptic currents (ST-EPSCs). Application of 300 μM QX-314 increased the ST-EPSC latency from TRPV1+ ST afferents, but, surprisingly, it had similar actions at TRPV1- ST afferents. Continued exposure to QX-314 blocked evoked ST-EPSCs at both afferent types. Neither the time to onset of latency changes nor the time to ST-EPSC failure differed between responses for TRPV1+ and TRPV1- inputs. Likewise, the TRPV1 antagonist capsazepine failed to prevent the actions of QX-314. Whereas QX-314 blocked ST-evoked release, the frequency and amplitude of spontaneous EPSCs remained unaltered. In neurons exposed to QX-314, intracellular current injection evoked action potentials suggesting a presynaptic site of action. QX-314 acted similarly at Vc neurons to increase latency and block EPSCs evoked from trigeminal tract afferents. Our results demonstrate that QX-314 blocked nerve conduction in cranial primary afferents without interrupting the glutamate release mechanism or generation of postsynaptic action potentials. The TRPV1 independence suggests that QX-314 either acted extracellularly or more likely entered these axons through an undetermined pathway common to all cranial primary afferents.

  17. Benign anatomical mistakes: the correct anatomical term for the recurrent laryngeal nerve.

    Science.gov (United States)

    Mirilas, Petros; Skandalakis, John E

    2002-01-01

    The term recurrent laryngeal nerve has been adopted by Nomina Anatomica (1989) and Terminologia Anatomica (1998) to describe this vagus branch from its origin, its turn dorsally around the subclavian artery and the aortic arch, and its cranial pathway until it reaches its terminal organs in the neck. However, there is still much confusion, and either the terms inferior and recurrent laryngeal nerve are used interchangeably or inferior laryngeal nerve is considered the terminal branch of the recurrent laryngeal nerve. We hereby feel that it is necessary to reassess the term and we propose the term inferior laryngeal nerve for the entire nerve under consideration, from its origin from the vagus nerve to its destinations, including tracheal, esophageal, and pharyngeal branches. If the term superior laryngeal nerve is a given, standard and accepted term in the anatomical terminology, then logically the term inferior laryngeal nerve should also be accepted, as opposed to it. Of course the upward travel of the inferior laryngeal nerve is "recurrent". When nonrecurrence is encountered together with an arteria lusoria, a retroesophageal right subclavian artery or a right aortic arch, we consider that the term nonrecurrent inferior laryngeal nerve should be used to describe the deviation from the normal.

  18. Potassium titanyl phosphate laser welding following complete nerve transection.

    Science.gov (United States)

    Bhatt, Neel K; Mejias, Christopher; Kallogjeri, Dorina; Gale, Derrick C; Park, Andrea M; Paniello, Randal C

    2017-07-01

    Cranial nerve transection during head and neck surgery is conventionally repaired by microsuture reanastomosis. Laser nerve welding (LNW), using CO2 laser to spot-weld the epineurium of transected nerve endings, has been shown in animal models to be a novel alternative to microsuture repair. This method avoids needle/suture material and minimizes instrumentation of the nerve. We hypothesized that potassium titanyl phosphate (KTP) laser would be superior to CO2 laser in repairing transected nerves. Using a rat posterior tibial nerve injury model, we compared CO2 laser, KTP laser, and microsuture reanastomosis. Animal study. Animals underwent unilateral posterior tibial nerve transection. The injury was repaired by microsuture repair (n = 15), CO2 laser repair (n = 15), or KTP laser repair (n = 15). Weekly walking tracks were performed to measure functional recovery. Nerve segments were harvested for axon counting. At 6 weeks, the KTP LNW had the best functional recovery (92.4 ± 8.6%) compared to microsuture repair (84.5 ± 10.2%, difference 7.9%, 95% confidence interval [CI]: 0.84%-14.96%). CO2 laser repair had a functional recovery of 86.8 ± 11.2%. KTP LNW had better axon recovery compared to transection/repair (difference 530.7 axons, 95% CI: 329.9-731.5). Operative time for the microsuture repair was 18.2 ± 6.8 minutes, compared to 5.8 ± 3.7 minutes for the LNW groups (difference 12.4 minutes, 95% CI: 8.6-16.2 minutes). KTP, CO2 , and microsuture repair all showed good functional recovery following complete transection of the posterior tibial nerve. Following complete nerve transection during head and neck surgery, KTP LNW may be a novel alternative to microsuture repair. NA Laryngoscope, 127:1525-1530, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  19. Anthropogenic environments exert variable selection on cranial capacity in mammals.

    Science.gov (United States)

    Snell-Rood, Emilie C; Wick, Naomi

    2013-10-22

    It is thought that behaviourally flexible species will be able to cope with novel and rapidly changing environments associated with human activity. However, it is unclear whether such environments are selecting for increases in behavioural plasticity, and whether some species show more pronounced evolutionary changes in plasticity. To test whether anthropogenic environments are selecting for increased behavioural plasticity within species, we measured variation in relative cranial capacity over time and space in 10 species of mammals. We predicted that urban populations would show greater cranial capacity than rural populations and that cranial capacity would increase over time in urban populations. Based on relevant theory, we also predicted that species capable of rapid population growth would show more pronounced evolutionary responses. We found that urban populations of two small mammal species had significantly greater cranial capacity than rural populations. In addition, species with higher fecundity showed more pronounced differentiation between urban and rural populations. Contrary to expectations, we found no increases in cranial capacity over time in urban populations-indeed, two species tended to have a decrease in cranial capacity over time in urban populations. Furthermore, rural populations of all insectivorous species measured showed significant increases in relative cranial capacity over time. Our results provide partial support for the hypothesis that urban environments select for increased behavioural plasticity, although this selection may be most pronounced early during the urban colonization process. Furthermore, these data also suggest that behavioural plasticity may be simultaneously favoured in rural environments, which are also changing because of human activity.

  20. Primary meningeal melanocytoma of the anterior cranial fossa: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Lin Bowen

    2012-07-01

    Full Text Available Abstract Background Primary meningeal melanocytoma is a rare neurological disorder. Although it may occur at the base of the brain, it is extremely rare at the anterior cranial fossa. Case presentation A 27-year-old man presented with headache and diplopia at our department. Fundoscopy showed left optic nerve atrophy and right papilledema consistent with Foster-Kennedy syndrome. Neurological exams were otherwise normal. A left frontal irregular space-occupying lesion was seen on magnetic resonance imaging (MRI, and enhancement was shown on contrast-enhanced computed tomography (CT scan. CT angiography (CTA revealed vascular compression around the lesion. Prior to surgery, meningioma was diagnosed and gross tumor removal was performed. On postoperative pathohistological exam, the tumor proved to be a meningeal melanocytoma, WHO grade I. No skin melanoma was found. After surgery, the patient received radiation therapy. No tumor was seen on follow-up MR images six months after surgery. The patient was well after two and a half years, and there was no tumor recurrence on the follow-up CT. Conclusions This case of primary meningeal melanocytoma located at the anterior cranial fossa is very rare. Although primary meningeal melanocytoma is benign, it may behave aggressively. Complete surgical resection is curative for most cases. Radiation therapy is important to prevent relapse of the tumor, especially in cases of incomplete surgical resection.

  1. Clinical features of multiple myeloma invasion of the central nervous system in Chinese patients

    Institute of Scientific and Technical Information of China (English)

    QU Xiao-yan; FU Wei-jun; XI Hao; ZHOU Fan; WEI Wei; HOU Jian

    2010-01-01

    Background Although neurologic manifestations often complicate the course of patients with multiple myeloma, direct central nervous system invasion is rare. This study explored the neurologic symptoms, signs, clinical features, therapy and prognosis of Chinese patients with central nervous system myeloma invasion.Methods The diagnosis, therapy and prognosis were analyzed retrospectively in 11 Chinese multiple myeloma patients with central nervous system infiltration from a total of 625 patients who have been treated at Changzheng Hospital (Shanghai, China) between January 1993 and May 2009. Survival curve was constructed with the use of Kaplan-Meier estimates.Results There were 11 patients with central nervous system involvement from 625 multiple myeloma patients. The occurrence rate was 1.8%. Ten of the 11 patients had other extramedullary diseases. Symptoms included cerebral symptoms, cranial nerve palsies, and spinal cord or spinal nerve roots symptoms.Cerebrospinal fluid was abnormal in 7 patients, usually exhibiting pleocytosis and elevated protein content, plus positive cytologic findings. Specific magnetic resonance imaging findings suggestive of central nervous system invasion were found in 9 patients. After a median follow-up of 19 months, 3 patients were alive. The median overall survival for all patients was 23 months, while the median overall survival for patients after central nervous system invasion was merely 6 months.Conclusions It is exceedingly rare for there to be central nervous system infiltration in multiple myeloma patients. When it occurs, the prognosis is extremely poor despite the use of aggressive local and systemic treatment including stem cell transplantation.

  2. Clinical features of multiple myeloma invasion of the central nervous system in Chinese patients.

    Science.gov (United States)

    Qu, Xiao-yan; Fu, Wei-jun; Xi, Hao; Zhou, Fan; Wei, Wei; Hou, Jian

    2010-06-01

    Although neurologic manifestations often complicate the course of patients with multiple myeloma, direct central nervous system invasion is rare. This study explored the neurologic symptoms, signs, clinical features, therapy and prognosis of Chinese patients with central nervous system myeloma invasion. The diagnosis, therapy and prognosis were analyzed retrospectively in 11 Chinese multiple myeloma patients with central nervous system infiltration from a total of 625 patients who have been treated at Changzheng Hospital (Shanghai, China) between January 1993 and May 2009. Survival curve was constructed with the use of Kaplan-Meier estimates. There were 11 patients with central nervous system involvement from 625 multiple myeloma patients. The occurrence rate was 1.8%. Ten of the 11 patients had other extramedullary diseases. Symptoms included cerebral symptoms, cranial nerve palsies, and spinal cord or spinal nerve roots symptoms. Cerebrospinal fluid was abnormal in 7 patients, usually exhibiting pleocytosis and elevated protein content, plus positive cytologic findings. Specific magnetic resonance imaging findings suggestive of central nervous system invasion were found in 9 patients. After a median follow-up of 19 months, 3 patients were alive. The median overall survival for all patients was 23 months, while the median overall survival for patients after central nervous system invasion was merely 6 months. It is exceedingly rare for there to be central nervous system infiltration in multiple myeloma patients. When it occurs, the prognosis is extremely poor despite the use of aggressive local and systemic treatment including stem cell transplantation.

  3. Botulinum toxin physiology in focal hand and cranial dystonia.

    Science.gov (United States)

    Karp, Barbara Illowsky

    2012-11-20

    The safety and efficacy of botulinum toxin for the treatment of focal hand and cranial dystonias are well-established. Studies of these adult-onset focal dystonias reveal both shared features, such as the dystonic phenotype of muscle hyperactivity and overflow muscle contraction and divergent features, such as task specificity in focal hand dystonia which is not a common feature of cranial dystonia. The physiologic effects of botulinum toxin in these 2 disorders also show both similarities and differences. This paper compares and contrasts the physiology of focal hand and cranial dystonias and of botulinum toxin in the management of these disorders.

  4. Botulinum Toxin Physiology in Focal Hand and Cranial Dystonia

    Directory of Open Access Journals (Sweden)

    Barbara Illowsky Karp

    2012-11-01

    Full Text Available The safety and efficacy of botulinum toxin for the treatment of focal hand and cranial dystonias are well-established. Studies of these adult-onset focal dystonias reveal both shared features, such as the dystonic phenotype of muscle hyperactivity and overflow muscle contraction and divergent features, such as task specificity in focal hand dystonia which is not a common feature of cranial dystonia. The physiologic effects of botulinum toxin in these 2 disorders also show both similarities and differences. This paper compares and contrasts the physiology of focal hand and cranial dystonias and of botulinum toxin in the management of these disorders.

  5. Radial plus musculocutaneous nerve stimulation for axillary block is inferior to triple nerve stimulation with 2% mepivacaine.

    Science.gov (United States)

    Rodríguez, Jaime; Taboada, Manuel; Oliveira, Juan; Ulloa, Beatriz; Bascuas, Begoña; Alvarez, Julián

    2008-06-01

    To compare the extent of sensory and motor block with two different nerve stimulation techniques in axillary blocks. Prospective, randomized, investigator-blinded study. Ambulatory surgery unit of a university hospital. 60 ASA physical status I, II, and III patients undergoing surgery at or below the elbow. Patients receiving axillary block were randomized into two nerve stimulation groups with either radial plus musculocutaneous or triple nerve stimulation (radial, median, and musculocutaneous nerves). Thirty milliliters of plain 2% mepivacaine was given to all patients either in a single or fractionated dosing for radial or for radial and median nerves, according to group assignment. Five milliliters of plain 1% mepivacaine for the musculocutaneous nerve was given to all patients. Blocks were assessed at 10, 20, and 30 minutes. Rates of supplementation given as a result of insufficient surgical anesthesia were also noted. Statistically significantly higher rates of anesthesia at the cutaneous distributions of median and medial cutaneous of the arm nerves with multiple nerve stimulation at 30 minutes were found as compared with radial plus musculocutaneous nerve stimulation. The rate of supplementation was lower with multiple nerve stimulation. Radial plus musculocutaneous nerve stimulation showed lower efficacy of axillary block than did triple nerve stimulation when using 2% mepivacaine.

  6. Dermatosis neglecta in a case of multiple fractures, shoulder dislocation and radial nerve palsy in a 35-year-old man: a case report

    Directory of Open Access Journals (Sweden)

    Qadir Syed

    2008-11-01

    Full Text Available Abstract Introduction Dermatosis neglecta is an often misdiagnosed and under-diagnosed condition. In dermatosis neglecta, a progressive accumulation of sebum, sweat, keratin and other dirt and debris, occurs due to inadequate local hygiene resulting in a localized hyperpigmented patch or a verrucous plaque. Vigorous rubbing with alcohol-soaked gauze or soap and water results in a complete resolution of the lesion. This is the first case of dermatosis neglecta reported in a patient with multiple traumatic injuries. Case presentation We report a case of a 35-year-old male Caucasian of Pakistani origin, with multiple fractures, neurological deficit and immobility sustained in a fall, leading to the development of dermatosis neglecta of the left hand. Conclusion Early and prompt clinical recognition of this condition eliminates the need for aggressive diagnostic and therapeutic procedures.

  7. Recurrent laryngeal nerve pathology in spasmodic dysphonia.

    Science.gov (United States)

    Bocchino, J V; Tucker, H M

    1978-08-01

    Since it was first described in 1871, spasmodic (spastic) dysphonia has been considered a disease of psychogenic origin. Unsupported theories of possible organic etiology have appeared sporadically in the literature. In 1976 sectioning of the recurrent laryngeal nerve for patients with this disease was reported with resultant improvement in voice production. This was attempted because the spasmodic dysphonic has, in effect, already compensated vocal cords bilaterally. It was reasoned, therefore, that if one of these was paralyzed the patient would immediately be converted to a state approximating that of well-compensated unilateral vocal cord paralysis which situation, as is well known, usually carries with it a fairly good voice. A controlled study to evaluate the efficacy of this surgical approach has been undertaken at the Cleveland Clinic during the past year. In an attempt to elucidate the possible organic etiology of spasmodic dysphonia, a section of nerve was removed in every case and examined by both light and electron microscopy. Special stains for myelin were also used on the light microscopy specimens. Demyelinization has been found in most of the cases examined by electron microscopy. Possible correlation between this disease entity and other cranial nerve syndromes of unknown etiology is noted. Such conditions as trigeminal neuralgia, glossopharyngeal neuralgia, belpharospasm, hemifacial spasm, and even possibly Bell's palsy may exhibit a similar etiology.

  8. Cranial ontogeny in Stegoceras validum (Dinosauria: Pachycephalosauria: a quantitative model of pachycephalosaur dome growth and variation.

    Directory of Open Access Journals (Sweden)

    Ryan K Schott

    Full Text Available Historically, studies of pachycephalosaurs have recognized plesiomorphically flat-headed taxa and apomorphically domed taxa. More recently, it has been suggested that the expression of the frontoparietal dome is ontogenetic and derived from a flat-headed juvenile morphology. However, strong evidence to support this hypothesis has been lacking. Here we test this hypothesis in a large, stratigraphically constrained sample of specimens assigned to Stegoceras validum, the best known pachycephalosaur, using multiple independent lines of evidence including conserved morphology of ornamentation, landmark-based allometric analyses of frontoparietal shape, and cranial bone histology. New specimens show that the diagnostic ornamentation of the parietosquamosal bar is conserved throughout the size range of the sample, which links flat-headed specimens to domed S. validum. High-resolution CT scans of three frontoparietals reveal that vascularity decreases with size and document a pattern that is consistent with previously proposed histological changes during growth. Furthermore, aspects of dome shape and size are strongly correlated and indicative of ontogenetic growth. These results are complementary and strongly support the hypothesis that the sample represents a growth series of a single taxon. Cranial dome growth is positively allometric, proceeds from a flat-headed to a domed state, and confirms the synonymy of Ornatotholus browni as a juvenile Stegoceras. This dataset serves as the first detailed model of growth and variation in a pachycephalosaur. Flat-headed juveniles possess three characters (externally open cranial sutures, tuberculate dorsal surface texture, and open supratemporal fenestrae that are reduced or eliminated during ontogeny. These characters also occur in putative flat-headed taxa, suggesting that they may also represent juveniles of domed taxa. However, open cranial sutures and supratemporal fenestrae are plesiomorphic within

  9. Androgen action during male sex differentiation includes suppression of cranial suspensory ligament development

    NARCIS (Netherlands)

    J.M.A. Emmen (Judith); A. McLuskey; J.A. Grootegoed (Anton); A.O. Brinkmann (Albert)

    1998-01-01

    textabstractThe cranial suspensory ligament is located on the border of the cranial (mesonephric) mesentery in adult female mammals, which runs between the cranial pole of the internal genitalia and the dorsal abdominal wall. Absence of the cranial suspensory ligament i

  10. Use of an infrared camera to improve the outcome of facial nerve monitoring.

    Science.gov (United States)

    Murphy, Emily K

    2008-03-01

    Intraoperative cranial nerve neuromonitoring (IONM) has significantly reduced morbidity historically associated with skull-base procedures. It provides the surgeon with immediate feedback to preserve both anatomic and physiologic function of monitored nerves. However, when the surgeon cauterizes tissue near the nerve, the monitoring equipment is saturated by the cautery signal, eliminating IONM information at a critical time. The use of an infrared camera under the drapes to observe the face for movement due to nerve stimulation is an invaluable adjunct to traditional IONM. Monitoring may also be improved by contralateral electrode placement to help identify artifact from nerve stimulation, using the microscope's video output to compare the surgeon's hand movements to recorded activity, and learning basic anatomy of the inner ear and skull base in order to know when heightened attention is important.

  11. "Moya-moya' disease caused by cranial trauma.

    Science.gov (United States)

    Fernandez-Alvarez, E; Pineda, M; Royo, C; Manzanares, R

    1979-01-01

    A case of "moya-moya" disease of a 12-year-old boy is reported. The clinical history started at 3 years 2 months after cranial trauma. The patient developed mental retardation, hemiparesis and seizures.

  12. Prevalence of and risk factors for cranial ultrasound abnormalities in ...

    African Journals Online (AJOL)

    in cerebral blood flow, or platelet and coagulation disorders, form the ... To assess how many very low birth weight (VLBW) infants had cranial ultrasound screening at ..... who were outborn, and there are many factors that could explain the.

  13. Clinical and cranial computed tomography scan findings in adults ...

    African Journals Online (AJOL)

    cerebral haemorrhage followed by brain oedema and raised Intra-cranial pressure (ICP). Intra-cerebral ... This was a descriptive, cross sectional study conduct- ed in Mulago .... This could partly be explained by the mechanism of impact in ...

  14. Accounting for cranial vault growth in experimental design.

    Science.gov (United States)

    Power, Stephanie M; Matic, Damir B; Holdsworth, David W

    2014-05-01

    Earlier studies have not accounted for continued growth when using the rat calvarial defect model to evaluate bone healing in vivo. The purpose of this study was: 1) to calculate rat cranial vault growth over time; and 2) to determine the effects of accounting for growth on defect healing. Bilateral parietal defects were created in 10 adult Wistar rats. Serial microscopic computerized tomography scans were performed. Bone mineral content (BMC) measured according to standard technique and repeated accounting for cranial growth over time was compared with the use of parametric and nonparametric tests. Cranial vault growth continued through 22 weeks of age, increasing 7.5% in width and 9.1% in length, and calvarial defects expanded proportionately. BMC was greater within defects accounting for growth 2-12 weeks postoperatively (P accounting for cranial growth given advances in serial imaging techniques. Crown Copyright © 2014. Published by Mosby, Inc. All rights reserved.

  15. Functional electrical stimulation improves brain perfusion in cranial trauma patients

    National Research Council Canada - National Science Library

    Amorim, Bárbara Juarez; Santos, Allan de Oliveira; Oberg, Telma Dagmar; Romanato, Juliana; Anjos, Dalton A; Lima, Mariana da Cunha Lopes de; Ramos, Celso Darío; Honorato, Donizete Cesar; Camargo, Edwaldo Eduardo; Etchebehere, Elba Cristina de Sá Camargo

    2011-01-01

    ...: cranial trauma and major vascular insults. All SPECT images were analyzed using SPM. RESULTS: There was a significant statistical difference between the two groups related to patient's ages and extent of hypoperfusion in the SPECT...

  16. Updates on the diagnosis and treatment of intracranial nerve malignant peripheral nerve sheath tumors

    Directory of Open Access Journals (Sweden)

    L'Heureux-Lebeau B

    2013-04-01

    Full Text Available Bénédicte L'Heureux-Lebeau,1 Issam Saliba2 1University of Montreal, 2Department of Otolaryngology Head and Neck Surgery, Montreal University Hospital Center (CHUM, University of Montreal, Montreal, Quebec, Canada Background: Malignant peripheral nerve sheath tumors (MPNSTs are rare entities and MPNSTs of intracranial nerves are even more sporadic. MPNSTs present diagnosis and treatment challenges since there are no defined diagnosis criteria and no established therapeutic strategies. Methods: We reviewed literature for MPNST-related articles. We found 45 relevant studies in which 60 cases were described. Results: We identified 60 cases of intracranial nerve MPNSTs. The age ranged from 3 to 75 years old. Male to female ratio was 1.5:1. The most involved cranial nerves (CNs were CN VIII (60%, CN V (27%, and CN VII (10%. Most of the MPNSTs reported (47% arose sporadically, 40% arose from a schwannoma, 8% arose from a neurofibroma, and 6% arose from an unspecified nerve tumor. Twenty patients had a history of radiation exposure, four patients had neurofibromatosis type 1 (NF1, four patients had neurofibromatosis type 2 (NF2, and NF2 was suspected in two other patients. Twenty-two patients were treated with radiotherapy and presented a higher survival rate. Seventy-two percent of patients died of their disease while 28% of patients survived. One-year survival rate was 33%. Forty-five percent of tumors recurred and 19% of patients had metastases. Conclusion: MPNSTs involving CNs are very rare. Diagnosis is made in regards to the histological and pathological findings. Imaging may help orient the diagnosis. A preexisting knowledge of the clinical situation is more likely to lead to a correct diagnosis. The mainstay of treatment is radical surgical resection with adjuvant radiotherapy. Since these tumors are associated with a poor prognosis, a close follow-up is mandatory. Keywords: malignant peripheral nerve sheath tumor, MPNST, neurofibroma

  17. Nerve conduction velocity

    Science.gov (United States)

    ... to measure the speed of the nerve signals. Electromyography (recording from needles placed into the muscles) is ... Often, the nerve conduction test is followed by electromyography (EMG). In this test, needles are placed into ...

  18. Common peroneal nerve dysfunction

    Science.gov (United States)

    ... toe-out movements Tests of nerve activity include: Electromyography (EMG, a test of electrical activity in muscles) Nerve ... Peroneal neuropathy. In: Preston DC, Shapiro BE, eds. Electromyography and Neuromuscular Disorders . 3rd ed. Philadelphia, PA: Elsevier; ...

  19. Sciatic nerve regeneration in rats by a promising electrospun collagen/poly(ε-caprolactone nerve conduit with tailored degradation rate

    Directory of Open Access Journals (Sweden)

    Jiang Xinquan

    2011-07-01

    Full Text Available Abstract Background To cope with the limitations faced by autograft acquisitions particularly for multiple nerve injuries, artificial nerve conduit has been introduced by researchers as a substitute for autologous nerve graft for the easy specification and availability for mass production. In order to best mimic the structures and components of autologous nerve, great efforts have been made to improve the designation of nerve conduits either from materials or fabrication techniques. Electrospinning is an easy and versatile technique that has recently been used to fabricate fibrous tissue-engineered scaffolds which have great similarity to the extracellular matrix on fiber structure. Results In this study we fabricated a collagen/poly(ε-caprolactone (collagen/PCL fibrous scaffold by electrospinning and explored its application as nerve guide substrate or conduit in vitro and in vivo. Material characterizations showed this electrospun composite material which was made of submicron fibers possessed good hydrophilicity and flexibility. In vitro study indicated electrospun collagen/PCL fibrous meshes promoted Schwann cell adhesion, elongation and proliferation. In vivo test showed electrospun collagen/PCL porous nerve conduits successfully supported nerve regeneration through an 8 mm sciatic nerve gap in adult rats, achieving similar electrophysiological and muscle reinnervation results as autografts. Although regenerated nerve fibers were still in a pre-mature stage 4 months postoperatively, the implanted collagen/PCL nerve conduits facilitated more axons regenerating through the conduit lumen and gradually degraded which well matched the nerve regeneration rate. Conclusions All the results demonstrated this collagen/PCL nerve conduit with tailored degradation rate fabricated by electrospinning could be an efficient alternative to autograft for peripheral nerve regeneration research. Due to its advantage of high surface area for cell attachment, it

  20. Cranial suture morphology and its relationship to diet in Cebus.

    Science.gov (United States)

    Byron, Craig D

    2009-12-01

    Cranial sutures are complex morphological structures. Four Cebus species (C. albifrons, C. apella, C. capucinus, C. olivaceus) are used here to test the hypothesis that sagittal suture complexity is enhanced in animals that eat materially challenging foods. These primates are ideal for such comparative studies because they are closely related and some are known to exhibit differences in the material properties of the foods they ingest and masticate. Specifically, Cebus apella is notable among members of this genus for ingesting food items of high toughness as well as consistently demonstrating a relatively robust cranial morphology. Consistent with previous studies, C. apella demonstrates significantly more robust mandibular and temporal fossa morphology. Also, C. apella possesses sagittal sutures that are more complex than congenerics. These data are used to support the hypothesis that cranial suture complexity is increased in response to consuming diets with more obdurate material properties. One interpretation of this hypothesis is that, compared to non-apelloids, total strain in the apelloid cranial suture connective tissue environment is elevated due to increased jaw muscle activity by increases in either force magnitudes or the number of chewing events. It is argued that greater masticatory function enhances the growth and modeling of cranial suture interdigitation. These data show that cranial suture complexity is one more hard tissue feature from the skull that might be used to inform hypotheses of dietary functional morphology.

  1. Differential gene expression profiling and biological process analysis in proximal nerve segments after sciatic nerve transection.

    Science.gov (United States)

    Li, Shiying; Liu, Qianqian; Wang, Yongjun; Gu, Yun; Liu, Dong; Wang, Chunming; Ding, Guohui; Chen, Jianping; Liu, Jie; Gu, Xiaosong

    2013-01-01

    After traumatic injury, peripheral nerves can spontaneously regenerate through highly sophisticated and dynamic processes that are regulated by multiple cellular elements and molecular factors. Despite evidence of morphological changes and of expression changes of a few regulatory genes, global knowledge of gene expression changes and related biological processes during peripheral nerve injury and regeneration is still lacking. Here we aimed to profile global mRNA expression changes in proximal nerve segments of adult rats after sciatic nerve transection. According to DNA microarray analysis, the huge number of genes was differentially expressed at different time points (0.5 h-14 d) post nerve transection, exhibiting multiple distinct temporal expression patterns. The expression changes of several genes were further validated by quantitative real-time RT-PCR analysis. The gene ontology enrichment analysis was performed to decipher the biological processes involving the differentially expressed genes. Collectively, our results highlighted the dynamic change of the important biological processes and the time-dependent expression of key regulatory genes after peripheral nerve injury. Interestingly, we, for the first time, reported the presence of olfactory receptors in sciatic nerves. Hopefully, this study may provide a useful platform for deeply studying peripheral nerve injury and regeneration from a molecular-level perspective.

  2. The Physics of Nerves

    CERN Document Server

    Heimburg, Thomas

    2010-01-01

    The accepted model for nerve pulse propagation in biological membranes seems insufficient. It is restricted to dissipative electrical phenomena and considers nerve pulses exclusively as a microscopic phenomenon. A simple thermodynamic model that is based on the macroscopic properties of membranes allows explaining more features of nerve pulse propagation including the phenomenon of anesthesia that has so far remained unexplained.

  3. A large dumbbell glossopharyngeal schwannoma involving the vagus nerve: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Zhao Hongyu

    2008-10-01

    Full Text Available Abstract Introduction Schwannoma arising from the glossopharyngeal nerve is a rare intracranial tumor. Fewer than 40 cases have been reported. Accurate pre-operative diagnosis and optimal treatment are still difficult. Case presentation We present one case of schwannoma originating from the ninth cranial nerve with palsies of the trigeminal nerve, facial-acoustic nerve complex, and vagus nerve in addition to ninth nerve dysfunction. Magnetic resonance imaging showed tumors located in the cerebellopontine angle with extracranial extension via the jugular foramen, with evident enhancement on post-contrast scan. Surgical management single-staged with the help of gamma knife radiosurgery achieved total removal. Conclusion Glossopharyngeal schwannoma is devoid of clinical symptoms and neurological signs. High resolution magnetic resonance imaging may play a key role as an accurate diagnostic tool. A favorable option of approach and appropriate planning of surgical strategy should be the goal of operation for this benign tumor.

  4. Maxillary nerve compression in cynomolgus monkey Macaca fascicularis: altered somatic sensation and peripheral nerve firing

    Directory of Open Access Journals (Sweden)

    Guo Ning

    2012-12-01

    Full Text Available Abstract Background Trigeminal nerve is a major source of the sensory input of the face, and trigeminal neuropathology models have been reported in rodents with injury to branches of the maxillary or mandibular division of the trigeminal nerve. Non-human primates are neuroanatomically more closely related to human than rodents; however, nerve injury studies in non-human primates are limited. Results We describe here a nerve injury model of maxillary nerve compression (MNC in the cynomolgus macaque monkey, Macaca fascicularis, and the initial characterization of the consequences of damage to this trigeminal nerve branch. The nerve injury from the compression appeared to be mild, as we did not observe overt changes in home-cage behavior in the monkeys. When mechanical stimulation was applied to the facial area, monkeys with MNC displayed increased mechanical sensitivity, as the avoidance response scores were lower than those from the control animals. Such a change in mechanical sensitivity appeared to be somewhat bilateral, as the contralateral side also showed increased mechanical sensitivity, although the change on the ipsilateral side was more robust. Multiple-unit recording of the maxillary nerve showed a general pattern of increasing responsiveness to escalating force in mechanical stimulation on the contralateral side. Ipsilateral side of the maxillary nerve showed a lack of responsiveness to escalating force in mechanical stimulation, possibly reflecting a maximum stimulation threshold effect from sensitized nerve due to MNC injury. Conclusions These results suggest that MNC may produce increased sensitivity of the ipsilateral maxillary nerve, and that this model may serve as a non-human primate model to evaluate the effect of injury to trigeminal nerve branches.

  5. Comparative Diagnostic Accuracy of Ganglion Cell-Inner Plexiform and Retinal Nerve Fiber Layer Thickness Measures by Cirrus and Spectralis Optical Coherence Tomography in Relapsing-Remitting Multiple Sclerosis

    Directory of Open Access Journals (Sweden)

    Julio J. González-López

    2014-01-01

    Full Text Available Objective. To estimate sensitivity and specificity of several optical coherence tomography (OCT measurements for detecting retinal thickness changes in patients with relapsing-remitting multiple sclerosis (RRMS, such as macular ganglion cell-inner plexiform layer (GCIPL thickness measured with Cirrus (OCT and peripapillary retinal nerve fiber layer (pRNFL thickness measured with Cirrus and Spectralis OCT. Methods. Seventy patients (140 eyes with RRMS and seventy matched healthy subjects underwent pRNFL and GCIPL thickness analysis using Cirrus OCT and pRNFL using Spectralis OCT. A prospective, cross-sectional evaluation of sensitivities and specificities was performed using latent class analysis due to the absence of a gold standard. Results. GCIPL measures had higher sensitivity and specificity than temporal pRNFL measures obtained with both OCT devices. Average GCIPL thickness was significantly more sensitive than temporal pRNFL by Cirrus (96.34% versus 58.41% and minimum GCIPL thickness was significantly more sensitive than temporal pRNFL by Spectralis (96.41% versus 69.69%. Generalised estimating equation analysis revealed that age (P=0.030, optic neuritis antecedent (P=0.001, and disease duration (P=0.002 were significantly associated with abnormal results in average GCIPL thickness. Conclusion. Average and minimum GCIPL measurements had significantly better sensitivity to detect retinal thickness changes in RRMS than temporal pRNFL thickness measured by Cirrus and Spectralis OCT, respectively.

  6. High resolution CT on multiple plane reconstruction of lesion of 5th lumbar nerve at the same slice%第5腰神经病变 HRCT 重建同层显示的初步探讨

    Institute of Scientific and Technical Information of China (English)

    彭建鸿; 王磊; 黄自立; 肖越勇; 林井副

    2014-01-01

    目的:探讨第5腰神经(L5)病变高分辨率CT(high-resolution computed tomography, HRCT)重建同层显示的可行性,为该神经病变的临床诊断提供依据。方法筛选20例(40侧)正常及30例(41侧)病变者的L5神经。使用美国GE公司Light Speed 16层和PHILIPS iCT 256层螺旋CT扫描,然后传至工作站( GE,ADW4.1及Philips Brilliance 3.0)进行多平面重建,观察L5神经正常解剖及病变基本表现。结果正常L5神经在斜冠状面上呈双侧对称的弧形条索状,整体形态呈“八字形”,由硬膜囊穿出至椎管外腰大肌缘20例(100%);16例(80%)显示至骶髂关节上段。斜冠状内旋切面上20例(100%)显示起点至骶髂关节平面处;6例(30%)至骶丛神经或坐骨神经上段。显示L5神经病变处走行方向及张力状态改变16例(24侧),模糊15例(18侧),受压及萎缩12例(18侧),局部增粗3例(5侧),扭曲变形1例(1侧)。其中导致神经病变L5~S1椎间盘侧方突出伴骨质增生10例(15侧),L5横突肥大5例(8侧),L5峡部裂8例(10侧),L5压缩骨折3例(4侧),腰骶段恶性肿瘤4例(4侧)。结论 HRCT重建同层显示技术能够清晰显示L5神经解剖及相关疾病,对该神经疾病可提供有价值的诊断信息。%Objective To explore the feasibility of CT on multiple plane reconstruction of the lesion 5th lumber nerve at the same slice, providing the basis for the clinical diagnosis of L 5 neuropathy.Methods 30 patients with of L5 neuropathy and 20 normal adults were scanned by GE Light Speed 16 and PHILIPS iCT 256-slice CT, reconstructed with their own workstations ( GE, ADW4.1 and Philips Brilliance 3.0) to observe the normal anatomy and basic disease of L 5 nerve.Results 20 cases (40 sides)of normal L5 nerve were symmetrically displayed from starting point to margin of psoas major and 15 cases (75%) to upper sacroiliac

  7. Optic nerve oxygenation

    DEFF Research Database (Denmark)

    Stefánsson, Einar; Pedersen, Daniella Bach; Jensen, Peter Koch

    2005-01-01

    at similar levels of perfusion pressure. The levels of perfusion pressure that lead to optic nerve hypoxia in the laboratory correspond remarkably well to the levels that increase the risk of glaucomatous optic nerve atrophy in human glaucoma patients. The risk for progressive optic nerve atrophy in human...... glaucoma patients is six times higher at a perfusion pressure of 30 mmHg, which corresponds to a level where the optic nerve is hypoxic in experimental animals, as compared to perfusion pressure levels above 50 mmHg where the optic nerve is normoxic. Medical intervention can affect optic nerve oxygen......-oxygenase inhibitor, indomethacin, which indicates that prostaglandin metabolism plays a role. Laboratory studies suggest that carbonic anhydrase inhibitors might be useful for medical treatment of optic nerve and retinal ischemia, potentially in diseases such as glaucoma and diabetic retinopathy. However, clinical...

  8. Optic nerve oxygenation

    DEFF Research Database (Denmark)

    Stefánsson, Einar; Pedersen, Daniella Bach; Jensen, Peter Koch;

    2005-01-01

    at similar levels of perfusion pressure. The levels of perfusion pressure that lead to optic nerve hypoxia in the laboratory correspond remarkably well to the levels that increase the risk of glaucomatous optic nerve atrophy in human glaucoma patients. The risk for progressive optic nerve atrophy in human...... glaucoma patients is six times higher at a perfusion pressure of 30 mmHg, which corresponds to a level where the optic nerve is hypoxic in experimental animals, as compared to perfusion pressure levels above 50 mmHg where the optic nerve is normoxic. Medical intervention can affect optic nerve oxygen......-oxygenase inhibitor, indomethacin, which indicates that prostaglandin metabolism plays a role. Laboratory studies suggest that carbonic anhydrase inhibitors might be useful for medical treatment of optic nerve and retinal ischemia, potentially in diseases such as glaucoma and diabetic retinopathy. However, clinical...

  9. An overview of the third, fourth and sixth cranial nerve palsies

    African Journals Online (AJOL)

    produce a symptom complex that involves .... Treatment of CN III lesions[2,4] ... of the blood pressure, glucose metabolism, and the presence of other medical risk ... Prisms may be tried, but because of the incomitant and torsional nature of this.

  10. Motor responses of muscles supplied by cranial nerves to subthalamic nucleus deep brain stimuli.

    Science.gov (United States)

    Costa, João; Valls-Solé, Josep; Valldeoriola, Francesc; Rumià, Jordi; Tolosa, Eduardo

    2007-01-01

    The distribution of human corticobulbar motor excitatory and inhibitory output is not fully understood. In particular, it is unclear whether the pattern of innervation is the same for upper and lower facial muscles, and what is the motor cortical area giving rise to such innervation. We used electrodes implanted in the subthalamic nucleus (STN) in patients with Parkinson's disease to activate motor tracts at a subcortical level. We examined the excitatory and inhibitory effects of unilateral single STN deep brain stimulation (sSTN-DBS) in 14 patients by taking recordings from facial, cervical and upper limb muscles on both sides. We measured the latency and amplitude of the motor-evoked potentials (MEPs), and the latency and duration of the silent periods, and compared ipsilateral with contralateral responses and responses obtained in different muscles. Unilateral sSTN-DBS induced strictly contralateral MEPs in the trapezius, deltoid, biceps and thenar muscles. The same stimulus always induced bilateral MEPs in the orbicularis oculi, orbicularis oris, masseter and sternocleidomastoid at a mean latency in the range 6.0-9.1 ms. MEP latencies in the orbicularis oculi and orbicularis oris were significantly longer than in the masseter and sternocleidomastoid (P motor nuclei descend together at the level of the STN. These findings are relevant in the discussion of the innervation of upper and lower facial muscles in humans and in the interpretation of previous results obtained with transcranial cortical stimulation.

  11. EMBRYOLOGICAL ORIGIN FOR AUTISM: DEVELOPMENTAL ANOMALIES OF THE CRANIAL NERVE MOTOR NUCLEI. (R824758)

    Science.gov (United States)

    The perspectives, information and conclusions conveyed in research project abstracts, progress reports, final reports, journal abstracts and journal publications convey the viewpoints of the principal investigator and may not represent the views and policies of ORD and EPA. Concl...

  12. Optical stimulation of the facial nerve: a surgical tool?

    Science.gov (United States)

    Richter, Claus-Peter; Teudt, Ingo Ulrik; Nevel, Adam E.; Izzo, Agnella D.; Walsh, Joseph T., Jr.

    2008-02-01

    One sequela of skull base surgery is the iatrogenic damage to cranial nerves. Devices that stimulate nerves with electric current can assist in the nerve identification. Contemporary devices have two main limitations: (1) the physical contact of the stimulating electrode and (2) the spread of the current through the tissue. In contrast to electrical stimulation, pulsed infrared optical radiation can be used to safely and selectively stimulate neural tissue. Stimulation and screening of the nerve is possible without making physical contact. The gerbil facial nerve was irradiated with 250-μs-long pulses of 2.12 μm radiation delivered via a 600-μm-diameter optical fiber at a repetition rate of 2 Hz. Muscle action potentials were recorded with intradermal electrodes. Nerve samples were examined for possible tissue damage. Eight facial nerves were stimulated with radiant exposures between 0.71-1.77 J/cm2, resulting in compound muscle action potentials (CmAPs) that were simultaneously measured at the m. orbicularis oculi, m. levator nasolabialis, and m. orbicularis oris. Resulting CmAP amplitudes were 0.3-0.4 mV, 0.15-1.4 mV and 0.3-2.3 mV, respectively, depending on the radial location of the optical fiber and the radiant exposure. Individual nerve branches were also stimulated, resulting in CmAP amplitudes between 0.2 and 1.6 mV. Histology revealed tissue damage at radiant exposures of 2.2 J/cm2, but no apparent damage at radiant exposures of 2.0 J/cm2.

  13. Schwannoma of the 6th nerve: case report and review of the literature

    Institute of Scientific and Technical Information of China (English)

    Xin Li; Jingjun Li; Jing Li; Zhen Wu

    2015-01-01

    Introduction: Schwannomas of the 6th nerve are extremely rare.Only 22 cases of intracranial schwannomas of the 6th cranial nerve pathologically confirmed have been reported.Case Presentation: Here, we report a case of a 14-year-old girl who presented with isolated progressive 6th nerve palsy.A cisternal type of schwannomawas found from neuro-imaging.Subtotal removal of the tumor was performed by a routine left subtemporal craniotomy with an petrosectomy.The attachment to the 6th nerve was found.After surgery, the patient's 6th nerve palsy remained.Histological images revealed a cellular schwannoma.Then the classification, clinical presentation, diagnosis, operation, stereotactic radiosurgery are reviewed.Conclusions: The location and the attachment to the 6th nerve is the key for diagnosis.Most cases are treated surgically.It looks like it is not easy to completely remove for CA type because of invasion of the cavernous sinus or firm adherence to the nerves.The 6th nerve function seldom completely recovered postoperatively.The direction of further research is to improve the diagnosis and therapy to have better nerve recovery.

  14. Nerve transection repair using laser-activated chitosan in a rat model.

    Science.gov (United States)

    Bhatt, Neel K; Khan, Taleef R; Mejias, Christopher; Paniello, Randal C

    2017-08-01

    Cranial nerve transection during head and neck surgery is conventionally repaired with microsuture. Previous studies have demonstrated recovery with laser nerve welding (LNW), a novel alternative to microsuture. LNW has been reported to have poorer tensile strength, however. Laser-activated chitosan, an adhesive biopolymer, may promote nerve recovery while enhancing the tensile strength of the repair. Using a rat posterior tibial nerve injury model, we compared four different methods of nerve repair in this pilot study. Animal study. Animals underwent unilateral posterior tibial nerve transection. The injury was repaired by potassium titanyl phosphate (KTP) laser alone (n = 20), KTP + chitosan (n = 12), microsuture + chitosan (n = 12), and chitosan alone (n = 14). Weekly walking tracks were conducted to measure functional recovery (FR). Tensile strength (TS) was measured at 6 weeks. At 6 weeks, KTP laser alone had the best recovery (FR = 93.4% ± 8.3%). Microsuture + chitosan, KTP + chitosan, and chitosan alone all showed good FR (87.4% ± 13.5%, 84.6% ± 13.0%, and 84.1% ± 10.0%, respectively). One-way analysis of variance was performed (F(3,56) = 2.6, P = .061). A TS threshold of 3.8 N was selected as a control mean recovery. Three groups-KTP alone, KTP + chitosan, and microsuture + chitosan-were found to meet threshold 60% (95% confidence interval [CI]: 23.1%-88.3%), 75% (95% CI: 46.8%-91.1%), and 100% (95% CI: 75.8%-100.0%), respectively. In the posterior tibial nerve model, all repair methods promoted nerve recovery. Laser-activated chitosan as a biopolymer anchor provided good TS and appears to be a novel alternative to microsuture. This repair method may have surgical utility following cranial nerve injury during head and neck surgery. NA Laryngoscope, 127:E253-E257, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  15. Systemic and non-systemic vasculitis affecting the peripheral nerves.

    Science.gov (United States)

    Finsterer, J

    2009-06-01

    Vasculitis affecting the peripheral nerves predominantly manifests as subacute, progressive, asymmetric sensorimotor polyneuropathy or mononeuritis multiplex, and more rarely as painful mononeuropathy, pure sensory neuropathy, neuropathy of the cranial nerves, plexopathy, or as autonomic neuropathy. Vasculitic neuropathy may occur isolated or non-isolated (systemic) together with involvement of other organs. Systemic vasculitis with involvement of the peripheral nerves is further subdivided into primary (Takayasu syndrome, giant cell arteritis, classical panarteritis nodosa, thrombangitis obliterans, Kawasaki disease, Churg-Strauss syndrome, Wegener granulomatosis, cryoglobulinemic vasculitis, Behcet disease, microscopic polyangitis, Schoenlein Henoch purpura) or secondary systemic vasculitis (autoimmune connective tissue diseases, vasculitis from infection, sarcoidosis, malignancy, drugs, radiation, or diabetes). In addition to routine laboratory investigations and nerve conduction studies, nerve biopsy is essential for diagnosing the condition and to delineate it from differentials, although its sensitivity is only approximately 60%. Therapy of non-viral vasculitic neuropathy is based on corticosteroids and cyclophosphamide alone or in combination. Additional options include azathioprine, methotrexate, mycophenolate mofetil, or rituximab. In single cases immunoglobulins, immunoadsorbtion, or plasma exchange have been successfully applied. In case of virus-associated vasculitis interferon-alpha plus lamivudine or ribaverin may be beneficial.

  16. Stimulation of the human auditory nerve with optical radiation

    Science.gov (United States)

    Fishman, Andrew; Winkler, Piotr; Mierzwinski, Jozef; Beuth, Wojciech; Izzo Matic, Agnella; Siedlecki, Zygmunt; Teudt, Ingo; Maier, Hannes; Richter, Claus-Peter

    2009-02-01

    A novel, spatially selective method to stimulate cranial nerves has been proposed: contact free stimulation with optical radiation. The radiation source is an infrared pulsed laser. The Case Report is the first report ever that shows that optical stimulation of the auditory nerve is possible in the human. The ethical approach to conduct any measurements or tests in humans requires efficacy and safety studies in animals, which have been conducted in gerbils. This report represents the first step in a translational research project to initiate a paradigm shift in neural interfaces. A patient was selected who required surgical removal of a large meningioma angiomatum WHO I by a planned transcochlear approach. Prior to cochlear ablation by drilling and subsequent tumor resection, the cochlear nerve was stimulated with a pulsed infrared laser at low radiation energies. Stimulation with optical radiation evoked compound action potentials from the human auditory nerve. Stimulation of the auditory nerve with infrared laser pulses is possible in the human inner ear. The finding is an important step for translating results from animal experiments to human and furthers the development of a novel interface that uses optical radiation to stimulate neurons. Additional measurements are required to optimize the stimulation parameters.

  17. Nerve abscess in primary neuritic leprosy.

    Science.gov (United States)

    Rai, Dheeraj; Malhotra, Hardeep Singh; Garg, Ravindra Kumar; Goel, Madhu Mati; Malhotra, Kiran Preet; Kumar, Vijay; Singh, Arun Kumar; Jain, Amita; Kohli, Neera; Singh, Shailesh Kumar

    2013-06-01

    Nerve abscess is an infrequently reported complication of leprosy. We describe a patient with a pure neuritic type of leprosy with multiple nerve abscesses, who presented with tingling and numbness in the medial aspect of his right forearm and hand. Subsequently he developed pain, redness and swelling over the medial side of his right elbow and the flexor aspect of his right wrist. High-resolution ultrasound showed diffuse thickening of the right ulnar nerve with hypoechoic texture housing a cystic lesion with internal debris suggesting an abscess, at the cubital tunnel. Histopathological examination of the pus and tissue obtained from the abscess revealed presence of granulomas with lepra bacilli. The patient responded to surgery and multidrug therapy. In conclusion, the nerve abscess as the first manifestation of leprosy is uncommon and a high index of suspicion is required to make a correct diagnosis.

  18. Nerve excitability in the rat forelimb

    DEFF Research Database (Denmark)

    Arnold, Ria; Moldovan, Mihai; Rosberg, Mette Romer;

    2017-01-01

    Background Nerve excitability testing by threshold-tracking is the only available method to study axonal ion channel function and membrane potential in the clinical setting. The measures are, however, indirect and the interpretation of neuropathic changes remains challenging. The same multiple...... measures of axonal excitability were adapted to further explore the pathophysiological changes in rodent disease models under pharmacologic and genetic manipulations. These studies are typically limited to the investigation of the “long nerves” such as the tail or the tibial nerves. New method We introduce...... a novel setup to explore the ulnar nerve excitability in rodents. We provide normative ulnar data in 11 adult female Long Evans rats under anaesthesia by comparison with tibial and caudal nerves. Additionally, these measures were repeated weekly on 3 occasions to determine the repeatability of these tests...

  19. Calvarial reconstruction using high-density porous polyethylene cranial hemispheres

    Directory of Open Access Journals (Sweden)

    Nitin J Mokal

    2011-01-01

    Full Text Available Aims: Cranial vault reconstruction can be performed with a variety of autologous or alloplastic materials. We describe our experience using high-density porous polyethylene (HDPE cranial hemisphere for cosmetic and functional restoration of skull defects. The porous nature of the implant allows soft tissue ingrowth, which decreases the incidence of infection. Hence, it can be used in proximity to paranasal sinuses and where previous alloplastic cranioplasties have failed due to implant infection. Materials and Methods: We used the HDPE implant in seven patients over a three-year period for reconstruction of moderate to large cranial defects. Two patients had composite defects, which required additional soft tissue in the form of free flap and tissue expansion. Results: In our series, decompressive craniectomy following trauma was the commonest aetiology and all defects were located in the fronto-parieto-temporal region. The defect size was 10 cm on average in the largest diameter. All patients had good post-operative cranial contour and we encountered no infections, implant exposure or implant migration. Conclusions: Our results indicate that the biocompatibility and flexibility of the HDPE cranial hemisphere implant make it an excellent alternative to existing methods of calvarial reconstruction.

  20. An osteological and histological investigation of cranial joints in geckos.

    Science.gov (United States)

    Payne, Samantha L; Holliday, Casey M; Vickaryous, Matthew K

    2011-03-01

    Cranial kinesis is a widespread feature of gekkotan lizards. Previous studies of kinesis in lizards often described the relevant, mobile joints as synovial, thus characterized by the presence of a synovial cavity lined with articular cartilage. To date however, detailed investigations of cranial joint histology are lacking. We examined eight cranial joints (quadrate-articular, quadrate-pterygoid, quadrate-otooccipital, quadrate-squamosal, epipterygoid-prootic, epipterygoid-pterygoid, basisphenoid-pterygoid, and frontal-parietal) in five gekkotan species (Oedura lesueuerii, Eublepharis macularius, Hemitheconyx caudicinctus, Tarentola annularis, and Chondrodactylous bibronii) using microcomputed tomography and serial histology. Particular focus was given to the relationship between the bony and soft-tissue components of the joint. Our results demonstrate that only three of these joints are synovial: the quadrate-articular, epipterygoid-pterygoid, and basisphenoid-pterygoid joints. The frontal-parietal and quadrate-pterygoid joints are syndesmosis (fibrous), the epipterygoid-prootic and quadrate-otooccipital joints are synchondroses (cartilaginous without a synovial cavity) and the quadrate-squamosal joint was not present. Based on previous descriptions, we determine that the structure of some cranial joints is variable among lizard taxa. We caution that osteology does not necessarily predict cranial joint histology. Although the functional implications of these findings remain to be explored we note that the development of synovial joints appears to be associated with a neural crest origin for the elements involved.

  1. Ets-1 confers cranial features on neural crest delamination.

    Directory of Open Access Journals (Sweden)

    Eric Théveneau

    Full Text Available Neural crest cells (NCC have the particularity to invade the environment where they differentiate after separation from the neuroepithelium. This process, called delamination, is strikingly different between cranial and trunk NCCs. If signalings controlling slow trunk delamination start being deciphered, mechanisms leading to massive and rapid cranial outflow are poorly documented. Here, we show that the chick cranial NCCs delamination is the result of two events: a substantial cell mobilization and an epithelium to mesenchyme transition (EMT. We demonstrate that ets-1, a transcription factor specifically expressed in cranial NCCs, is responsible for the former event by recruiting massively cranial premigratory NCCs independently of the S-phase of the cell cycle and by leading the gathered cells to straddle the basal lamina. However, it does not promote the EMT process alone but can cooperate with snail-2 (previously called slug to this event. Altogether, these data lead us to propose that ets-1 plays a pivotal role in conferring specific cephalic characteristics on NCC delamination.

  2. Risk factors for dislocation of the ulnar nerve after simple decompression for cubital tunnel syndrome.

    Science.gov (United States)

    Murata, K; Omokawa, S; Shimizu, T; Nakanishi, Y; Kawamura, K; Yajima, H; Tanaka, Y

    2014-01-01

    Anterior dislocation of the ulnar nerve is occasionally encountered after simple decompression of the nerve for treatment of cubital tunnel syndrome. The purpose of this study was to determine whether the incidence of dislocation of the nerve following simple decompression of the nerve is correlated with the patient's preoperative characteristics and/or elbow morphology. We studied 51 patients with cubital tunnel syndrome who underwent surgery at our institution. Intraoperatively, we simulated dislocation of the nerve after simple decompression by flexing the elbow after releasing the nerve in each patient. Univariate and multiple logistic regression analysis showed that young age and a small ulnar nerve groove angle are positively correlated with dislocation of the nerve. Our results suggest that patients who are young and/or have a sharply angled ulnar nerve groove identified radiographically have a high probability of experiencing anterior dislocation of the ulnar nerve after simple decompression.

  3. Total Facial Nerve Decompression for Severe Traumatic Facial Nerve Paralysis: A Review of 10 Cases

    Directory of Open Access Journals (Sweden)

    Sertac Yetiser

    2012-01-01

    Full Text Available Management of traumatic facial nerve disorders is challenging. Facial nerve decompression is indicated if 90–95% loss of function is seen at the very early period on ENoG or if there is axonal degeneration on EMG lately with no sign of recovery. Middle cranial or translabyrinthine approach is selected depending on hearing. The aim of this study is to present retrospective review of 10 patients with sudden onset complete facial paralysis after trauma who underwent total facial nerve decompression. Operation time after injury is ranging between 16 and105 days. Excitation threshold, supramaximal stimulation, and amplitude on the paralytic side were worse than at least %85 of the healthy side. Six of 11 patients had HBG-II, one patient had HBG-I, 3 patients had HBG-III, and one patient had HBG-IV recovery. Stretch, compression injuries with disruption of the endoneurial tubules undetectable at the time of surgery and lack of timely decompression may be associated with suboptimal results in our series.

  4. Anatomical Variations of Carotid Artery and Optic Nerve in Sphenoid Sinus Using Computerized Tomographic Imaging

    Directory of Open Access Journals (Sweden)

    Nikakhlagh

    2014-12-01

    Full Text Available Background Sphenoid sinus is surrounded by many vital vascular and nervous structures. In more than 20% of patients with chronic sinusitis, involvement of sphenoid sinus has been observed. Besides, sphenoid sinus is an appropriate route to access anterior and middle cranial fossa in surgery. Therefore, it is important to have an adequate knowledge about the contents of sphenoid sinus and its proximity for nasal endoscopy, sinus surgeries and neurosurgeries. Objectives The aim of this study was to study sphenoid sinus proximity with carotid artery and the optic nerve using computerized tomographic imaging. Materials and Methods In this prospective study, computerized tomographic images of sphenoid sinus of patients referred to Imam Khomeini and Apadana hospitals were studied. The images were studied regarding any bulging, as well as not having a bone covering in sphenoid sinus regarding internal carotid artery and optic nerve. Furthermore, unilateralness or bilateralness of their relationships was studied. Results Among 468 coronal and axial CT scan images of sphenoid sinus, 365 (78% showed post-sellar pneumatization and 103 (22% pre-sellar pneumatization. Regarding existence of internal septa, 346 (74% cases showed multiple septation, and the remaining images were reported to have a single septum. According to the reports of CT scan images, the existence of bulging as a result of internal carotid artery and uncovered artery were 4.22% and 5.8% in the right sinus, 4.9% and 5.4% in the left sinus, and 4.34% and 4.6% in both sinuses, respectively. According to the reports of CT scan images, existence of bulging as a result of optic nerve and uncovered nerve were 5.7% and 4.3% in the right sinus, 6% and 5.4% in the left sinus, and 12% and 3.2% in both sinuses, respectively. Conclusions Due to variability of sphenoid sinus pneumatization and the separator blade of the two sinus cavities, careful attention is required during sinus surgery to avoid

  5. Side-To-Side Nerve Bridges Support Donor Axon Regeneration Into Chronically Denervated Nerves and Are Associated With Characteristic Changes in Schwann Cell Phenotype.

    Science.gov (United States)

    Hendry, J Michael; Alvarez-Veronesi, M Cecilia; Snyder-Warwick, Alison; Gordon, Tessa; Borschel, Gregory H

    2015-11-01

    Chronic denervation resulting from long nerve regeneration times and distances contributes greatly to suboptimal outcomes following nerve injuries. Recent studies showed that multiple nerve grafts inserted between an intact donor nerve and a denervated distal recipient nerve stump (termed "side-to-side nerve bridges") enhanced regeneration after delayed nerve repair. To examine the cellular aspects of axon growth across these bridges to explore the "protective" mechanism of donor axons on chronically denervated Schwann cells. In Sprague Dawley rats, 3 side-to-side nerve bridges were placed over a 10-mm distance between an intact donor tibial (TIB) nerve and a recipient denervated common peroneal (CP) distal nerve stump. Green fluorescent protein-expressing TIB axons grew across the bridges and were counted in cross section after 4 weeks. Immunofluorescent axons and Schwann cells were imaged over a 4-month period. Denervated Schwann cells dedifferentiated to a proliferative, nonmyelinating phenotype within the bridges and the recipient denervated CP nerve stump. As donor TIB axons grew across the 3 side-to-side nerve bridges and into the denervated CP nerve, the Schwann cells redifferentiated to the myelinating phenotype. Bridge placement led to an increased mass of hind limb anterior compartment muscles after 4 months of denervation compared with muscles whose CP nerve was not "protected" by bridges. This study describes patterns of donor axon regeneration and myelination in the denervated recipient nerve stump and supports a mechanism where these donor axons sustain a proregenerative state to prevent deterioration in the face of chronic denervation.

  6. Nerve conduction and excitability studies in peripheral nerve disorders

    DEFF Research Database (Denmark)

    Krarup, Christian; Moldovan, Mihai

    2009-01-01

    PURPOSE OF REVIEW: The review is aimed at providing information about the role of nerve excitability studies in peripheral nerve disorders. It has been known for many years that the insight into peripheral nerve pathophysiology provided by conventional nerve conduction studies is limited. Nerve...

  7. Effectiveness of C5 or C6-Cz assembly in predicting immediate post operative facial nerve deficit.

    Science.gov (United States)

    Verst, Silvia Mazzali; Sucena, Andrea Caivano; Maldaun, Marcos Vinicius Calfat; Aguiar, Paulo Henrique Pires

    2013-10-01

    Intraoperative neurophysiology monitoring (IOM) is a valuable tool in cerebellopontine angle (CPA) surgeries posing risk to the cranial nerves. Transcranial electrical stimulation (TES) for cranial nerves has been performed in the last 7 years, for obtaining the facial nerve motor evoked potential (MEP), using either C3/C4-Cz or C3-C4 (or inverse) stimulating points, which have been correlated with facial nerve functional outcome. Intraoperative surgical and electrophysiological findings were documented prospectively. Patient files were reviewed for clinical data. We studied 23 patients undergoing CPA tumor resection using C5 or C6-Cz montage for TES, and were able to determine the correlation between facial nerve functional outcome and the amplitude drop of facial MEP above 50 %. Patients were evaluated for immediate facial nerve outcome and 6 months after the surgery. Follow-up was performed by structured telephone interviews with local physicians. The sensibility of the studied parameters was 92.8 % for amplitude drop of facial nerve MEP, with positive predictive value of 81.2 %. The absence of changes during IOM has shown a negative predictive value of 100 %. In this series, the used montage was effective in predicting new facial deficit.

  8. Transient facial nerve paralysis (Bell's palsy) following administration of hepatitis B recombinant vaccine: a case report.

    Science.gov (United States)

    Paul, R; Stassen, L F A

    2014-01-01

    Bell's palsy is the sudden onset of unilateral transient paralysis of facial muscles resulting from dysfunction of the seventh cranial nerve. Presented here is a 26-year-old female patient with right lower motor neurone facial palsy following hepatitis B vaccination. Readers' attention is drawn to an uncommon cause of Bell's palsy, as a possible rare complication of hepatitis B vaccination, and steps taken to manage such a presentation.

  9. Cranial ultrasound and chronological changes in molybdenum cofactor deficiency

    Energy Technology Data Exchange (ETDEWEB)

    Serrano, Mercedes; Dias, Anna P.; Perez-Duenas, Belen; Campistol, Jaume; Garcia-Cazorla, Angels [Hospital Sant Joan de Deu, Department of Pediatric Neurology, Paseo de Sant Joan de Deu, Barcelona (Spain); Lizarraga, Isabel [Hospital Sant Joan de Deu, Department of Neonatology, Barcelona (Spain); Reiss, Jochen [University of Goettingen, Institute for Human Genetics, Goettingen (Germany); Vilaseca, Maria A.; Artuch, Rafael [Hospital Sant Joan de Deu, Clinical Biochemistry Department, Barcelona (Spain)

    2007-10-15

    Molybdenum cofactor is essential for the function of three human enzymes: sulphite oxidase, xanthine dehydrogenase, and aldehyde oxidase. Molybdenum cofactor deficiency is a rare autosomal recessively inherited disease. Disturbed development and damage to the brain may occur as a result of accumulation of toxic levels of sulphite. The CT and MRI findings include severe early brain abnormalities and have been widely reported, but the cranial US imaging findings have seldom been reported. We report a chronological series of cranial US images obtained from an affected infant that show the rapid development of cerebral atrophy, calcifications and white matter cysts. Our report supports the utility of cranial US, a noninvasive bed-side technique, in the detection and follow-up of these rapidly changing lesions. (orig.)

  10. 3D Printed, Customized Cranial Implant for Surgical Planning

    Science.gov (United States)

    Bogu, Venkata Phanindra; Ravi Kumar, Yennam; Asit Kumar, Khanra

    2016-06-01

    The main objective of the present work is to model cranial implant and printed in FDM machine (printer model used: mojo). Actually this is peculiar case and the skull has been damaged in frontal, parietal and temporal regions and a small portion of frontal region damaged away from saggital plane, complexity is to fill this frontal region with proper curvature. The Patient CT-data (Number of slices was 381 and thickness of each slice is 0.488 mm) was processed in mimics14.1 software, mimics file was sent to 3-matic software and calculated thickness of skull at different sections where cranial implant is needed then corrected the edges of cranial implant to overcome CSF (cerebrospinal fluid) leakage and proper fitting. Finally the implant average thickness is decided as 2.5 mm and printed in FDM machine with ABS plastic.

  11. Signaling mechanisms implicated in cranial sutures pathophysiology: Craniosynostosis

    Directory of Open Access Journals (Sweden)

    Maria A. Katsianou

    2016-12-01

    Full Text Available Normal extension and skull expansion is a synchronized process that prevails along the osteogenic intersections of the cranial sutures. Cranial sutures operate as bone growth sites allowing swift bone generation at the edges of the bone fronts while they remain patent. Premature fusion of one or more cranial sutures can trigger craniosynostosis, a birth defect characterized by dramatic manifestations in appearance and functional impairment. Up until today, surgical correction is the only restorative measure for craniosynostosis associated with considerable mortality. Clinical studies have identified several genes implicated in the pathogenesis of craniosynostosis syndromes with useful insights into the underlying molecular signaling events that determine suture fate. In this review, we exploit the intracellular signal transduction pathways implicated in suture pathobiology, in an attempt to identify key signaling molecules for therapeutic targeting.

  12. Preoperative anemia increases postoperative morbidity in elective cranial neurosurgery

    Science.gov (United States)

    Bydon, Mohamad; Abt, Nicholas B.; Macki, Mohamed; Brem, Henry; Huang, Judy; Bydon, Ali; Tamargo, Rafael J.

    2014-01-01

    Background: Preoperative anemia may affect postoperative mortality and morbidity following elective cranial operations. Methods: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was used to identify elective cranial neurosurgical cases (2006-2012). Morbidity was defined as wound infection, systemic infection, cardiac, respiratory, renal, neurologic, and thromboembolic events, and unplanned returns to the operating room. For 30-day postoperative mortality and morbidity, adjusted odds ratios (ORs) were estimated with multivariable logistic regression. Results: Of 8015 patients who underwent elective cranial neurosurgery, 1710 patients (21.4%) were anemic. Anemic patients had an increased 30-day mortality of 4.1% versus 1.3% in non-anemic patients (P neurosurgery was independently associated with an increased risk of 30-day postoperative mortality and morbidity when compared to non-anemic patients. A hematocrit level below 33% (Hgb 11 g/dl) was associated with a significant increase in postoperative morbidity. PMID:25422784

  13. Functional electrical stimulation improves brain perfusion in cranial trauma patients

    Directory of Open Access Journals (Sweden)

    Bárbara Juarez Amorim

    2011-08-01

    Full Text Available OBJECTIVE: Demonstrate brain perfusion changes due to neuronal activation after functional electrical stimulation (FES. METHOD: It was studied 14 patients with hemiplegia who were submitted to a program with FES during fourteen weeks. Brain perfusion SPECT was performed before and after FES therapy. These patients were further separated into 2 groups according to the hemiplegia cause: cranial trauma and major vascular insults. All SPECT images were analyzed using SPM. RESULTS: There was a significant statistical difference between the two groups related to patient's ages and extent of hypoperfusion in the SPECT. Patients with cranial trauma had a reduction in the hypoperfused area and patients with major vascular insult had an increase in the hypoperfused area after FES therapy. CONCLUSION: FES therapy can result in brain perfusion improvement in patients with brain lesions due to cranial trauma but probably not in patients with major vascular insults with large infarct area.

  14. Unusual Clinical Presentation of Ethylene Glycol Poisoning: Unilateral Facial Nerve Paralysis

    Directory of Open Access Journals (Sweden)

    Eray Eroglu

    2013-01-01

    Full Text Available Ethylene glycol (EG may be consumed accidentally or intentionally, usually in the form of antifreeze products or as an ethanol substitute. EG is metabolized to toxic metabolites. These metabolites cause metabolic acidosis with increased anion gap, renal failure, oxaluria, damage to the central nervous system and cranial nerves, and cardiovascular instability. Early initiation of treatment can reduce the mortality and morbidity but different clinical presentations can cause delayed diagnosis and poor prognosis. Herein, we report a case with the atypical presentation of facial paralysis, hematuria, and kidney failure due to EG poisoning which progressed to end stage renal failure and permanent right peripheral facial nerve palsy.

  15. Unusual clinical presentation of ethylene glycol poisoning: unilateral facial nerve paralysis.

    Science.gov (United States)

    Eroglu, Eray; Kocyigit, Ismail; Bahcebasi, Sami; Unal, Aydin; Sipahioglu, Murat Hayri; Kocyigit, Merva; Tokgoz, Bulent; Oymak, Oktay

    2013-01-01

    Ethylene glycol (EG) may be consumed accidentally or intentionally, usually in the form of antifreeze products or as an ethanol substitute. EG is metabolized to toxic metabolites. These metabolites cause metabolic acidosis with increased anion gap, renal failure, oxaluria, damage to the central nervous system and cranial nerves, and cardiovascular instability. Early initiation of treatment can reduce the mortality and morbidity but different clinical presentations can cause delayed diagnosis and poor prognosis. Herein, we report a case with the atypical presentation of facial paralysis, hematuria, and kidney failure due to EG poisoning which progressed to end stage renal failure and permanent right peripheral facial nerve palsy.

  16. [Schwannoma of the hypoglossal nerve presenting as a syndrome of Collet-Sicard].

    Science.gov (United States)

    Garcia-Escrivà, A; Pampliega Pérez, A; Martín-Estefania, C; Botella, C

    2005-01-01

    Collet-Sicard is a rare syndrome that consists of the palsy of all the lower four cranial nerves. We describe this entity in relation with a schwannoma of the hypoglossal nerve. A 45 year-old-patient was admitted to the hospital referring hoarseness and difficulty in swallowing for two weeks. On neurological examination, the patient exhibited palsy of the ninth, tenth, eleventh and twelfth nerves. This is a syndrome of Collet-Sicard. The cranial MRI revealed a small intracranial and extracranial tumor adjacent to the hypoglossal foramen. The tumor involved the jugular foramen and was moderately enhanced with gadolinium The patient underwent surgical removal. The pathologic examination of the surgical specimen confirmed the diagnosis of a schwannoma of the hypoglossal nerve. We have carried out a research of the Collet-Sicard syndrome and of its aetiology. Although schwannoma the hypoglossal nerve is a rare disorder we consider that this entity should be included in the differential diagnosis of the Collet-Sicard syndrome.

  17. Unilateral Recurrent Laryngeal and Hypoglossal Nerve Paralysis Following Rhinoplasty: A Case Report and review of Articles

    Directory of Open Access Journals (Sweden)

    Mehdi Bakhshaee

    2014-01-01

    Full Text Available Introduction: Injury to cranial nerves IX, X, and XII is a known complication of laryngoscopy and intubation. Here we present a patient with concurrent hypoglossal and recurrent laryngeal nerve paralysis after rhinoplasty. Case Report: The patient was a 27-year-old woman who was candidate for rhinoplastic surgery. The next morning after the operation, the patient complained of dysphonia and a sore throat .7 days after the operation she was still complaining of dysphonia. She underwent a direct laryngoscopy, and right TVC paralysis was observed. Right hypoglossal nerve paralysis was also detected during physical cranial nerve function tests. Hypoglossal and recurrent laryngeal nerve function was completely recovered after 5 and 7 months, respectively, and no complication was remained. Conclusion: Accurate and atraumatic intubation and extubation, true positioning of the head and neck, delicate and gentle packing of the oropharynx, and maintenance of mean blood pressure at a safe level are appropriate methods to prevent this complication during anesthesia and surgical procedures.

  18. Large Extremity Peripheral Nerve Repair

    Science.gov (United States)

    2016-12-01

    Photochemical bond- ing required clear access 5 mm proximal and dis- tal to coaptation sites. As a result, the maximum achievable nerve gap before...rodents for nerve gap reconstruction. Induction and maintenance anesthesia was achieved using isoflurane (Baxter Healthcare Corp., Deerfield, Ill...injury, nerve gap , nerve wrap, PTB, photosealing, Rose Bengal, amnion, nerve conduit, crosslinking, allograft, photochemistry. 3. Accomplishments

  19. Development of a Human Cranial Bone Surrogate for Impact Studies.

    Science.gov (United States)

    Roberts, Jack C; Merkle, Andrew C; Carneal, Catherine M; Voo, Liming M; Johannes, Matthew S; Paulson, Jeff M; Tankard, Sara; Uy, O Manny

    2013-01-01

    In order to replicate the fracture behavior of the intact human skull under impact it becomes necessary to develop a material having the mechanical properties of cranial bone. The most important properties to replicate in a surrogate human skull were found to be the fracture toughness and tensile strength of the cranial tables as well as the bending strength of the three-layer (inner table-diplöe-outer table) architecture of the human skull. The materials selected to represent the surrogate cranial tables consisted of two different epoxy resins systems with random milled glass fiber to enhance the strength and stiffness and the materials to represent the surrogate diplöe consisted of three low density foams. Forty-one three-point bending fracture toughness tests were performed on nine material combinations. The materials that best represented the fracture toughness of cranial tables were then selected and formed into tensile samples and tested. These materials were then used with the two surrogate diplöe foam materials to create the three-layer surrogate cranial bone samples for three-point bending tests. Drop tower tests were performed on flat samples created from these materials and the fracture patterns were very similar to the linear fractures in pendulum impacts of intact human skulls, previously reported in the literature. The surrogate cranial tables had the quasi-static fracture toughness and tensile strength of 2.5 MPa√ m and 53 ± 4.9 MPa, respectively, while the same properties of human compact bone were 3.1 ± 1.8 MPa√ m and 68 ± 18 MPa, respectively. The cranial surrogate had a quasi-static bending strength of 68 ± 5.7 MPa, while that of cranial bone was 82 ± 26 MPa. This material/design is currently being used to construct spherical shell samples for drop tower and ballistic tests.

  20. An annotated history of craniofacial surgery and intentional cranial deformation.

    Science.gov (United States)

    Goodrich, J T; Tutino, M

    2001-01-01

    The history of craniofacial surgery and the use of intentional cranial deformation is a long and varied one. Researching some of the earliest medical writings and reviews of early terracotta and stone figures from throughout the world clearly revealed that these two forms of treatment were widely extant. Intentional cranial deformation was used for a number of reasons including beautification, tribal identification, and social stature. The development of craniofacial surgery is a more modern practice and its historical evolution is reviewed in the context of techniques and the personalities involved.

  1. Autopsy case of acute multiple sclerosis with multifocal low density areas in the cerebral white matter on CT scans

    Energy Technology Data Exchange (ETDEWEB)

    Kamikura, Isao; Mizutani, Tomohiko; Sakamaki, Shuji; Takasu, Toshiaki; Kawamura, Toshiaki

    1988-01-01

    A 34-year-old woman presented with urination difficulty and consciousness disturbance, followed by persistent neurologic findings, such as semicomatose mental status and bilateral optic neuritis, and monophasic clinical course. Cranial CT showed multifocal low density areas in cerebral white matter. The patient was clinically diagnosed as having acute disseminated encephalomyelitis. She died of sepsis four months later. Autopsy revealed multifocal large demyelinating lesions confined to the cerebral white matter, shown as low density areas on CT scans, and demyelinating plaques scattered in the optic nerves and chiasm, and cerebral peduncle. The final diagnosis was acute multiple sclerosis. The CT appearance of multifocal low density areas was most likely due to demyelinating lesions causing edema and tissue necrosis. (Namekawa, K.).

  2. Suprascapular nerve palsy.

    Science.gov (United States)

    Moskowitz, E; Rashkoff, E S

    1989-11-01

    Isolated traumatic suprascapular nerve palsy without associated fracture is a rare occurrence. Localized segmental muscle atrophy limited to the supraspinatus and infraspinatus muscles associated with weakness in initiating abduction and in external rotation of the shoulder should suggest the diagnosis. Electromyography will confirm the diagnosis by excluding nerve root and brachial plexus involvement with denervation potentials limited to the supraspinatus and infraspinatus muscles.

  3. Imaging the hypoglossal nerve

    Energy Technology Data Exchange (ETDEWEB)

    Alves, Pedro [Department of Radiology, Centro Hospitalar de Lisboa Central-Hospital de Sao Jose, Rua Jose Antonio Serrano, 1150-199 Lisboa Codex (Portugal)], E-mail: tojais.pedro@gmail.com

    2010-05-15

    The hypoglossal nerve is a pure motor nerve. It provides motor control to the intrinsic and extrinsic tongue muscles thus being essential for normal tongue movement and coordination. In order to design a useful imaging approach and a working differential diagnosis in cases of hypoglossal nerve damage one has to have a good knowledge of the normal anatomy of the nerve trunk and its main branches. A successful imaging evaluation to hypoglossal diseases always requires high resolution studies due to the small size of the structures being studied. MRI is the preferred modality to directly visualize the nerve, while CT is superior in displaying the bony anatomy of the neurovascular foramina of the skull base. Also, while CT is only able to detect nerve pathology by indirect signs, such as bony expansion of the hypoglossal canal, MRI is able to visualize directly the causative pathological process as in the case of small tumors, or infectious/inflammatory processes affecting the nerve. The easiest way to approach the study of the hypoglossal nerve is to divide it in its main segments: intra-axial, cisternal, skull base and extracranial segment, tailoring the imaging technique to each anatomical area while bearing in mind the main disease entities affecting each segment.

  4. Zuigelingen met een scheef hoofd [Babies with cranial deformity

    NARCIS (Netherlands)

    Feijen, M.M.; Claessens, E.A.; Dovens, A.J.; Vles, J.S.; van der Hulst, R.R.

    2009-01-01

    Plagiocephaly was diagnosed in a baby aged 4 months and brachycephaly in a baby aged 5 months. Positional or deformational plagio- or brachycephaly is characterized by changes in shape and symmetry of the cranial vault. Treatment options are conservative and may include physiotherapy and helmet

  5. Morphometric analysis of the cranial base in Asians.

    Science.gov (United States)

    Chang, Hong-Po; Liu, Pao-Hsin; Tseng, Yu-Chuan; Yang, Yi-Hsin; Pan, Chin-Yun; Chou, Szu-Ting

    2014-01-01

    This study tested the hypothesis that developmental heterogeneity in cranial base morphology increases the prevalence of Class III malocclusion and mandibular prognathism in Asians. Thin-plate spline (TPS) graphical analysis of lateral cephalometric radiographs of the cranial base and the upper midface configuration were compared between a European-American group (24 females and 31 males) and four Asian ethnic groups (100 Chinese, 100 Japanese, 100 Korean and 100 Taiwanese; 50 females and 50 males per group) of young adults with clinically acceptable occlusion and facial profiles. Procrustes analysis was performed to identify statistically significant differences in each configuration of landmarks (P expansion in the anterior portion of the cranial base and upper midface region. The most posterior cranial base region also showed horizontal compression between the basion and Bolton point, with forward displacement of the articulare. Facial flatness and anterior displacement of the temporomandibular joint, resulting from a relative retrusion of the nasomaxillary complex and a relative forward position of the mandible were also noted. These features that tend to cause a prognathic mandible and/or retruded midface indicate a morphologic predisposition of Asian populations for Class III malocclusion.

  6. Cranial electrotherapy stimulation for treatment of anxiety, depression, and insomnia.

    Science.gov (United States)

    Kirsch, Daniel L; Nichols, Francine

    2013-03-01

    Cranial electrotherapy stimulation is a prescriptive medical device that delivers a mild form of electrical stimulation to the brain for the treatment of anxiety, depression, and insomnia. It is supported by more than 40 years of research demonstrating its effectiveness in several mechanistic studies and greater than 100 clinical studies. Adverse effects are rare (electrotherapy stimulation may also be used as an adjunctive therapy.

  7. Cranial Radiation Therapy and Damage to Hippocampal Neurogenesis

    Science.gov (United States)

    Monje, Michelle

    2008-01-01

    Cranial radiation therapy is associated with a progressive decline in cognitive function, prominently memory function. Impairment of hippocampal neurogenesis is thought to be an important mechanism underlying this cognitive decline. Recent work has elucidated the mechanisms of radiation-induced failure of neurogenesis. Potential therapeutic…

  8. Teaching Parents How to Prevent Acquired Cranial Asymmetry in Infants.

    Science.gov (United States)

    Lennartsson, Freda; Nordin, Per; Wennergren, Göran

    2016-01-01

    Acquired cranial asymmetry is prevalent in infants today. This is largely attributed to the supine sleep position recommended for infant safety. The condition can become permanent, so prevention and early detection are important. A prevention project was initiated where guidelines for Swedish child health nurses were developed, tested in a pilot study, revised, and then incorporated into a short cranial asymmetry prevention program for nurses. The program included detailed information on what to teach parents of newborns. An intervention study was initiated where one group of nurses was taught according to the program and the other group followed the standard recommendations. The aim of this survey was to compare intervention and control group parents' responses regarding the cranial asymmetry prevention information that they had received from their nurses during their infant's first four months. Participants included 272 parents (180 intervention group, 92 control group) at 26 child health centers. A checklist was distributed to parents in conjunction with infants' four month health checkup. A significantly higher percentage of intervention group parents were aware of regular recommendations - alternate direction of the infant's head when putting the child to bed (82%: 64%, p=0.001), which pillow to use (92%: 80%, p=0.01), and when to remove the pillow (48%: 31%, p=0.006) - and five newly introduced recommendations compared to controls. Results indicate that educating child health nurses on prevention of cranial asymmetry works to increase parental awareness of what to do and how to do it safely.

  9. Damage Effects of Rat Thymus After Cranial Irradiation

    Institute of Scientific and Technical Information of China (English)

    YU; Ying-qi; WANG; Xiao; SUI; Li; KONG; Fu-quan; MA; Nan-ru

    2012-01-01

    <正>To study the damage effects of the thymus and investigate the interaction of hypothalamic- pituitary-adrenal axis (HPA axis) in neuroimmunological signaling pathway, the rat model of cranial irradiated by carbon ions was establish. By means of enzyme-linked immunoassay (Elisa), one day of post-irradiation with carbon ions, for the group of control, irradiated or drug (Longxuejie) treated,

  10. Postnatal cranial ultrasonographic findings in feto-fetal transfusion syndrome.

    NARCIS (Netherlands)

    Breysem, L.; Naulaers, G.; Deprest, J.; Schoubroeck, D.V.; Daniels, H.; Lammens, M.M.Y.; Smet, M.H.

    2002-01-01

    Our objective was a retrospective evaluation of cranial US in survivors of twin pregnancy with feto-fetal transfusion syndrome (FFTS), with knowledge of prenatal treatment and neonatal/postnatal clinical data. In 18 pregnancies with FFTS (January 1996 to May 2000), pregnancy management and outcome,

  11. Automatic Detection of Wild-type Mouse Cranial Sutures

    DEFF Research Database (Denmark)

    Ólafsdóttir, Hildur; Darvann, Tron Andre; Hermann, Nuno V.;

    , automatic detection of the cranial sutures becomes important. We have previously built a craniofacial, wild-type mouse atlas from a set of 10 Micro CT scans using a B-spline-based nonrigid registration method by Rueckert et al. Subsequently, all volumes were registered nonrigidly to the atlas. Using...

  12. Association of fetal cranial shape with shoulder dystocia

    NARCIS (Netherlands)

    Belfort, M. A.; White, G. L.; Vermeulen, F. M.

    2012-01-01

    Objective To evaluate whether fetal cranial shape is related to shoulder dystocia. Methods We compared shoulder dystocia cases (n = 18) with controls (normal vaginal deliveries, n = 18) in a retrospective matched- pairs observational study. Subjects were matched for known maternal and fetal risk fac

  13. Is phenytoin contraindicated in patients receiving cranial irradiation?

    Energy Technology Data Exchange (ETDEWEB)

    Borg, M.F. [Royal Adelaide Hospital, SA (Australia); Probert, J.C. [Auckland Hospital, Auckland (New Zealand). Dept. of Radiation Oncology; Zwi, L.J. [Auckland Univ. (New Zealand). Dept. of Medicine and Surgery

    1995-02-01

    Three recent publications have reported the development of erythema multiforme and Stevens-Johnson syndrome in patients receiving cranial irradiation and sodium phenytoin. Some authors have recommended that patients receiving whole brain radiation therapy and who have had seizures should not be prescribed phenytoin but an alternative anticonvulsant. This article reviews the current literature pertaining to the development of this potentially lethal complication in patients receiving whole brain radiation and phenytoin, with reference to the single recorded case of Stevens-Johnson syndrome in a patient receiving cranial irradiation and phenytoin in Auckland, New Zealand. While the clinical picture in the 16 patients reported in the literature and the current case report differed from the classical form of erythema multiforme, a similar pattern of presentation and outcome appeared in all patients reviewed, suggesting that the combination of phenytoin, cranial irradiation and the gradual reduction of concomitant steroids seem to lead to the development of erythema multiforme and/or Stevens-Johnson syndrome. The data presented, although sparse, suggest that phenytoin should not be prescribed in patients receiving cranial irradiation. 21 refs., 2 tabs., 3 figs.

  14. Zuigelingen met een scheef hoofd [Babies with cranial deformity

    NARCIS (Netherlands)

    Feijen, M.M.; Claessens, E.A.; Dovens, A.J.; Vles, J.S.; van der Hulst, R.R.

    2009-01-01

    Plagiocephaly was diagnosed in a baby aged 4 months and brachycephaly in a baby aged 5 months. Positional or deformational plagio- or brachycephaly is characterized by changes in shape and symmetry of the cranial vault. Treatment options are conservative and may include physiotherapy and helmet ther

  15. A reassessment of human cranial plasticity: Boas revisited.

    Science.gov (United States)

    Sparks, Corey S; Jantz, Richard L

    2002-11-12

    In 1912, Franz Boas published a study demonstrating the plastic nature of the human body in response to changes in the environment. The results of this study have been cited for the past 90 years as evidence of cranial plasticity. These findings, however, have never been critiqued thoroughly for their statistical and biological validity. This study presents a reassessment of Boas' data within a modern statistical and quantitative genetic framework. The data used here consist of head and face measurements on over 8,000 individuals of various European ethnic groups. By using pedigree information contained in Boas' data, narrow sense heritabilities are estimated by the method of maximum likelihood. In addition, a series of t tests and regression analyses are performed to determine the statistical validity of Boas' original findings on differentiation between American and European-born children and the prolonged effect of the environment on cranial form. Results indicate the relatively high genetic component of the head and face diameters despite the environmental differences during development. Results point to very small and insignificant differences between European- and American-born offspring, and no effect of exposure to the American environment on the cranial index in children. These results contradict Boas' original findings and demonstrate that they may no longer be used to support arguments of plasticity in cranial morphology.

  16. Association of fetal cranial shape with shoulder dystocia

    NARCIS (Netherlands)

    Belfort, M. A.; White, G. L.; Vermeulen, F. M.

    2012-01-01

    Objective To evaluate whether fetal cranial shape is related to shoulder dystocia. Methods We compared shoulder dystocia cases (n = 18) with controls (normal vaginal deliveries, n = 18) in a retrospective matched- pairs observational study. Subjects were matched for known maternal and fetal risk fac

  17. Spontaneous defects between the mastoid and posterior cranial fossa.

    Science.gov (United States)

    Rereddy, Shruthi K; Mattox, Douglas E

    2016-01-01

    Conclusions Spontaneous defects between the mastoid and the posterior cranial fossa are exceedingly rare. Patients with these lesions may have a lower BMI compared to those with middle cranial fossa encephaloceles, but are otherwise demographically similar. This study recommends repair via a transtemporal approach to allow for examination of the entire posterior face of the temporal bone. Objective To describe cases of spontaneous posterior cranial fossa defects. Methods This study reviewed all cases of spontaneous posterior fossa defects presenting to a tertiary referral center over the last decade and described clinical presentation, imaging, operative findings, and outcomes. We also compared these lesions to those previously reported in the literature as well as the more common spontaneous encephaloceles of the middle cranial fossa. Results This study identified five cases with a mean age of 61.4 years, female-to-male ratio of 4:1, and a mean BMI of 31. Three cases presented with spontaneous pneumocephalus, one with CSF otorrhea, and one as an incidental imaging finding. Four defects were found medial to the sigmoid sinus and one was in the lateral retrosigmoid air cells.

  18. State of the art cranial ultrasound imaging in neonates

    NARCIS (Netherlands)

    Ecury-Goossen, Ginette M; Camfferman, Fleur A; Leijser, Lara M; Govaert, Paul; Dudink, Jeroen

    2015-01-01

    Cranial ultrasound (CUS) is a reputable tool for brain imaging in critically ill neonates. It is safe, relatively cheap and easy to use, even when a patient is unstable. In addition it is radiation-free and allows serial imaging. CUS possibilities have steadily expanded. However, in many neonatal in

  19. Cranial trauma and the assessment of posttraumatic survival time.

    Science.gov (United States)

    Steyn, M; De Boer, H H; Van der Merwe, A E

    2014-11-01

    Assessment of trauma on skeletal remains can be very difficult, especially when it comes to the estimation of posttraumatic survival time in partially healed lesions. The ability to reliably estimate the time an individual has survived after sustaining an injury is especially important in cases of child abuse and torture, but can also aid in determining the association between an injury and eventual death. Here a case from South Africa is reported, where the skeletal remains of an unknown individual were found with cranial and scapular fractures. These fractures all presented with macroscopic features indicative of healing. Using recently published data on the timing of fractures by De Boer et al., the two sets of cranial trauma and the scapular fracture were assessed by means of radiology, histology and microCT scanning. This was primarily done in order to obtain more information on the events surrounding the death of this individual, but also to assess the usability of the published methods on cranial fractures. It was found that the initial trauma was most likely sustained at least two weeks before death, whilst a neurosurgical procedure was performed at least one week before death. It seems that cranial fractures, especially if stable, may show some different healing features than postcranial fractures. The individual has since been identified, but unfortunately as is often the case in South Africa, limited information is available and the medical records could not be found. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  20. Myological variability in a decoupled skeletal system: batoid cranial anatomy.

    Science.gov (United States)

    Kolmann, Matthew A; Huber, Daniel R; Dean, Mason N; Grubbs, R Dean

    2014-08-01

    Chondrichthyans (sharks, batoids, and chimaeras) have simple feeding mechanisms owing to their relatively few cranial skeletal elements. However, the indirect association of the jaws to the cranium (euhyostylic jaw suspension) has resulted in myriad cranial muscle rearrangements of both the hyoid and mandibular elements. We examined the cranial musculature of an abbreviated phylogenetic representation of batoid fishes, including skates, guitarfishes and with a particular focus on stingrays. We identified homologous muscle groups across these taxa and describe changes in gross morphology across developmental and functional muscle groups, with the goal of exploring how decoupling of the jaws from the skull has effected muscular arrangement. In particular, we focus on the cranial anatomy of durophagous and nondurophagous batoids, as the former display marked differences in morphology compared to the latter. Durophagous stingrays are characterized by hypertrophied jaw adductors, reliance on pennate versus fusiform muscle fiber architecture, tendinous rather than aponeurotic muscle insertions, and an overall reduction in mandibular kinesis. Nondurophagous stingrays have muscles that rely on aponeurotic insertions onto the skeletal structure, and display musculoskeletal specialization for jaw protrusion and independent lower jaw kinesis, relative to durophagous stingrays. We find that among extant chondrichthyans, considerable variation exists in the hyoid and mandibular muscles, slightly less so in hypaxial muscles, whereas branchial muscles are overwhelmingly conserved. As chondrichthyans occupy a position sister to all other living gnathostomes, our understanding of the structure and function of early vertebrate feeding systems rests heavily on understanding chondrichthyan cranial anatomy. Our findings highlight the incredible variation in muscular complexity across chondrichthyans in general and batoids in particular.

  1. Cranial suture biology of the Aleutian Island inhabitants.

    Science.gov (United States)

    Cray, James; Mooney, Mark P; Siegel, Michael I

    2011-04-01

    Research on cranial suture biology suggests there is biological and taxonomic information to be garnered from the heritable pattern of suture synostosis. Suture synostosis along with brain growth patterns, diet, and biomechanical forces influence phenotypic variability in cranial vault morphology. This study was designed to determine the pattern of ectocranial suture synostosis in skeletal populations from the Aleutian Islands. We address the hypothesis that ectocranial suture synostosis pattern will differ according to cranial vault shape. Ales Hrdlicka identified two phenotypes in remains excavated from the Aleutian Island. The Paleo-Aleutians, exhibiting a dolichocranic phenotype with little prognathism linked to artifacts distinguished from later inhabitants, Aleutians, who exhibited a brachycranic phenotype with a greater amount of prognathism. A total of 212 crania representing Paleo-Aleuts and Aleutian as defined by Hrdlicka were investigated for suture synostosis pattern following standard methodologies. Comparisons were performed using Guttmann analyses. Results revealed similar suture fusion patterns for the Paleo-Aleut and Aleutian, a strong anterior to posterior pattern of suture fusion for the lateral-anterior suture sites, and a pattern of early termination at the sagittal suture sites for the vault. These patterns were found to differ from that reported in the literature. Because these two populations with distinct cranial shapes exhibit similar patterns of suture synostosis it appears pattern is independent of cranial shape in these populations of Homo sapiens. These findings suggest that suture fusion patterns may be population dependent and that a standardized methodology, using suture fusion to determine age-at-death, may not be applicable to all populations.

  2. Morphology of Donor and Recipient Nerves Utilised in Nerve Transfers to Restore Upper Limb Function in Cervical Spinal Cord Injury

    Directory of Open Access Journals (Sweden)

    Aurora Messina

    2016-09-01

    Full Text Available Loss of hand function after cervical spinal cord injury (SCI impacts heavily on independence. Multiple nerve transfer surgery has been applied successfully after cervical SCI to restore critical arm and hand functions, and the outcome depends on nerve integrity. Nerve integrity is assessed indirectly using muscle strength testing and intramuscular electromyography, but these measures cannot show the manifestation that SCI has on the peripheral nerves. We directly assessed the morphology of nerves biopsied at the time of surgery, from three patients within 18 months post injury. Our objective was to document their morphologic features. Donor nerves included teres minor, posterior axillary, brachialis, extensor carpi radialis brevis and supinator. Recipient nerves included triceps, posterior interosseus (PIN and anterior interosseus nerves (AIN. They were fixed in glutaraldehyde, processed and embedded in Araldite Epon for light microscopy. Eighty percent of nerves showed abnormalities. Most common were myelin thickening and folding, demyelination, inflammation and a reduction of large myelinated axon density. Others were a thickened perineurium, oedematous endoneurium and Renaut bodies. Significantly, very thinly myelinated axons and groups of unmyelinated axons were observed indicating regenerative efforts. Abnormalities exist in both donor and recipient nerves and they differ in appearance and aetiology. The abnormalities observed may be preventable or reversible.

  3. Biological and artificial nerve conduit for repairing peripheral nerve defect

    Institute of Scientific and Technical Information of China (English)

    Xuetao Xie; Changqing Zhang

    2006-01-01

    OBJECTIVE: Recently, with the development of biological and artificial materials, the experimental and clinical studies on application of this new material-type nerve conduit for treatment of peripheral nerve defect have become the hotspot topics for professorial physicians.DATA SOURCES: Using the terms "nerve conduits, peripheral nerve, nerve regeneration and nerve transplantation" in English, we searched Pubmed database, which was published during January 2000 to June 2006, for the literatures related to repairing peripheral nerve defect with various materials. At the same time, we also searched Chinese Technical Scientific Periodical Database at the same time period by inputting" peripheral nerve defect, nerve repair, nerve regeneration and nerve graft" in Chinese.STUDY SELECTION: The materials were firstly selected, and literatures about study on various materials for repairing peripheral nerve defect and their full texts were also searched. Inclusive criteria: nerve conduits related animal experiments and clinical studies. Exclusive criteria: review or repetitive studies.DATA EXTRACTION: Seventy-nine relevant literatures were collected and 30 of them met inclusive criteria and were cited.DATA SYNTHESTS: Peripheral nerve defect, a commonly seen problem in clinic, is difficult to be solved. Autogenous nerve grafting is still the gold standard for repairing peripheral nerve defect, but because of its application limitation and possible complications, people studied nerve conduits to repair nerve defect. Nerve conduits consist of biological and artificial materials.CONCLUSION: There have been numerous reports about animal experimental and clinical studies of various nerve conduits, but nerve conduit, which is more ideal than autogenous nerve grafting, needs further clinical observation and investigation.

  4. Ventricular Pneumocephalus with Meningitis after Lumbar Nerve Root Block

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    Shin Ahn

    2013-01-01

    Full Text Available Lumbar nerve root block is a common modality used in the management of radiculopathy. Its complications are rare and usually minor. Despite its low morbidity, significant acute events can occur. Pneumocephalus is an accumulation of air in the intracranial space. It indicates a violation of the dura or the presence of infection. The object of this report is to describe the case of a patient with intraventricular pneumocephalus and bacterial meningitis after lumbar nerve root block. A 70-year-old female was brought into emergency department with severe headache and vomiting which developed during her sleep. She had received lumbar nerve block for her radiculopathy one day before her presentation. Cranial computed tomography scan revealed a few hypodense lesions in her left lateral ventricle frontal horn and basal cistern indicating ventricular pneumocephalus. Five hours later, she developed sudden hearing loss. Cerebrospinal fluid analysis showed bacterial meningitis, and she was treated with high dose steroid and antibiotics. However, her impaired hearing as a sequela from meningitis was persistent, and she is still in follow-up. Intracranial complications of lumbar nerve root block including meningitis and pneumocephalus can occur and should be considered as high-risk conditions that require prompt intervention.

  5. Temporal Stability of Dysmorphic, Fusiform Aneurysms of the Intra-cranial Internal Carotid Artery

    Science.gov (United States)

    Boussel, Loic; Rayz, Vitaliy; Martin, Alastair; Lawton, Michael; Higashida, Randall; Smith, Wade S.; Young, William L.; Saloner, David

    2011-01-01

    Purpose Estimation of the stability of dysmorphic fusiform aneurysms of the intra-cranial internal carotid artery requires precise monitoring of their volumes. In this report we apply a method using MRI and 3D post-processing to study the evolution of these aneurysms on a prospective cohort of patients not immediately suitable for surgery or endovascular treatment. Materials and Methods Ten patients with fusiform aneurysms of the intra-cranial internal carotid artery underwent serial MRI studies. Five patients were studied at two time points and the remainder at multiple time points (mean delay between studies: 12.6 +/− 3.8 months). For each patient, studies from all time points were co-registered. Volumes of each vessel component were calculated. Results Mean aneurysm volume was 833 +/− 878 mm3. Mean annual rate of volume progression was 1.37 +/− 2.09 % per year. All the aneurysms were thrombus-free. Conclusion This study indicates that, given the relatively low rate of progression of these dysplastic fusiform aneurysms and the complexity of their shape, 3D quantitative volumetric methods can be helpful in monitoring whether any growth has occurred. PMID:21419648

  6. Successful treatment of cranial metastases of extrapulmonary small cell carcinoma with chemotherapy alone.

    Science.gov (United States)

    Orhan, B; Yalçin, S; Evrensel, T; Yerci, O; Manavoğlu, O

    1998-04-01

    Extrapulmonary small cell carcinoma (EPSCC) is a distinct clinical and pathological entity other than small cell carcinoma of the lung. We present a case with EPSCC, with neurologic impairment due to brain metastases at initial diagnosis, which showed a complete response to combination chemotherapy. A 55-year-old male patient was first admitted with a mass of 6 x 6 cm in diameter in the right cervical region. The diagnosis of small cell carcinoma was entertained with immunohistopathologic and light microscopic findings. During the period of investigation the tumor showed rapid progression and the patient had neurologic dysfunction with right hemiparesia, and papilla oedema in fundoscopy. Cranial CT showed supratentorial multiple cranial metastases and peritumoral oedema. Since the patient refused radiotherapy, combination chemotherapy was started (Etoposide 100 mg/sq m i.v., days 1,3,5 and cisplatin 80 mg/sq m i.v., day 1). A fast response to the chemotherapy was observed with rapid disappearance of the cervical mass. Following six cycles of the chemotherapy the patient recovered fully and all the lesions disappeared with CT.

  7. Experimental Comparison of Cranial Particulate Bone Graft, rhBMP-2, and Split Cranial Bone Graft for Inlay Cranioplasty.

    Science.gov (United States)

    Hassanein, Aladdin H; Couto, Rafael A; Kurek, Kyle C; Rogers, Gary F; Mulliken, John B; Greene, Arin K

    2013-05-01

    Background :  Particulate bone graft and recombinant human bone morphogenetic protein-2 (rhBMP-2) are options for inlay cranioplasty in children who have not developed a diploic space. The purpose of this study was to determine whether particulate bone graft or rhBMP-2 has superior efficacy for inlay cranioplasty and to compare these substances to split cranial bone. Methods :  A 17 mm × 17 mm critical-sized defect was made in the parietal bones of 22 rabbits and managed in four ways: Group I (no implant; n=5), Group II (particulate bone graft; n=5), Group III (rhBMP-2; n=7), and Group IV (split cranial bone graft; n=5). Animals underwent microcomputed tomography and histologic analysis 16 weeks after cranioplasty. Results :  Defects without an implant (Group I) demonstrated inferior ossification (41.4%; interquartile range [IQR], 28.9% to 42.5%) compared to those treated with particulate bone graft (Group II: 99.5%; IQR, 97.8% to 100%), rhBMP-2 (Group III: 99.6%; IQR, 99.5% to 100%), or split cranial bone (Group IV: 100%) (P inlay calvarial defect areas equally, although the thickness of bone healed with rhBMP-2 is inferior. Clinically, particulate bone graft or split cranial bone graft may be superior to rhBMP-2 for inlay cranioplasty.

  8. Constitutively active Notch1 converts cranial neural crest-derived frontonasal mesenchyme to perivascular cells in vivo

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    Sophie R. Miller

    2017-03-01

    Full Text Available Perivascular/mural cells originate from either the mesoderm or the cranial neural crest. Regardless of their origin, Notch signalling is necessary for their formation. Furthermore, in both chicken and mouse, constitutive Notch1 activation (via expression of the Notch1 intracellular domain is sufficient in vivo to convert trunk mesoderm-derived somite cells to perivascular cells, at the expense of skeletal muscle. In experiments originally designed to investigate the effect of premature Notch1 activation on the development of neural crest-derived olfactory ensheathing glial cells (OECs, we used in ovo electroporation to insert a tetracycline-inducible NotchΔE construct (encoding a constitutively active mutant of mouse Notch1 into the genome of chicken cranial neural crest cell precursors, and activated NotchΔE expression by doxycycline injection at embryonic day 4. NotchΔE-targeted cells formed perivascular cells within the frontonasal mesenchyme, and expressed a perivascular marker on the olfactory nerve. Hence, constitutively activating Notch1 is sufficient in vivo to drive not only somite cells, but also neural crest-derived frontonasal mesenchyme and perhaps developing OECs, to a perivascular cell fate. These results also highlight the plasticity of neural crest-derived mesenchyme and glia.

  9. Cranial Anatomy and Palaeoneurology of the Archosaur Riojasuchus tenuisceps from the Los Colorados Formation, La Rioja, Argentina

    Science.gov (United States)

    von Baczko, Maria Belen; Desojo, Julia Brenda

    2016-01-01

    Riojasuchus tenuisceps Bonaparte 1967 is currently known from four specimens, including two complete skulls, collected in the late 1960s from the upper levels of the Los Colorados Formation (Late Triassic), La Rioja, Argentina. Computed tomography (CT) scans of the skulls of the holotype and a referred specimen of Riojasuchus tenuisceps and the repreparation of the latter allows recognition of new features for a detailed analysis of its cranial anatomy and its comparison with a wide variety of other archosauriform taxa. The diagnosis of Riojasuchus tenuisceps is emended and two autapomorphies are identified on the skull: (1) a deep antorbital fossa with its anterior and ventral edges almost coinciding with the same edges of the maxilla itself and (2) a suborbital fenestra equal in size to the palatine-pterygoid fenestra. Also, the first digital 3D reconstruction of the encephalon of Riojasuchus tenuisceps was carried out to study its neuroanatomy, showing a shape and cranial nerve disposition consistent to that of other pseudosuchians. PMID:26849433

  10. Cranial Anatomy and Palaeoneurology of the Archosaur Riojasuchus tenuisceps from the Los Colorados Formation, La Rioja, Argentina.

    Science.gov (United States)

    von Baczko, Maria Belen; Desojo, Julia Brenda

    2016-01-01

    Riojasuchus tenuisceps Bonaparte 1967 is currently known from four specimens, including two complete skulls, collected in the late 1960s from the upper levels of the Los Colorados Formation (Late Triassic), La Rioja, Argentina. Computed tomography (CT) scans of the skulls of the holotype and a referred specimen of Riojasuchus tenuisceps and the repreparation of the latter allows recognition of new features for a detailed analysis of its cranial anatomy and its comparison with a wide variety of other archosauriform taxa. The diagnosis of Riojasuchus tenuisceps is emended and two autapomorphies are identified on the skull: (1) a deep antorbital fossa with its anterior and ventral edges almost coinciding with the same edges of the maxilla itself and (2) a suborbital fenestra equal in size to the palatine-pterygoid fenestra. Also, the first digital 3D reconstruction of the encephalon of Riojasuchus tenuisceps was carried out to study its neuroanatomy, showing a shape and cranial nerve disposition consistent to that of other pseudosuchians.

  11. Cranial Anatomy and Palaeoneurology of the Archosaur Riojasuchus tenuisceps from the Los Colorados Formation, La Rioja, Argentina.

    Directory of Open Access Journals (Sweden)

    Maria Belen von Baczko

    Full Text Available Riojasuchus tenuisceps Bonaparte 1967 is currently known from four specimens, including two complete skulls, collected in the late 1960s from the upper levels of the Los Colorados Formation (Late Triassic, La Rioja, Argentina. Computed tomography (CT scans of the skulls of the holotype and a referred specimen of Riojasuchus tenuisceps and the repreparation of the latter allows recognition of new features for a detailed analysis of its cranial anatomy and its comparison with a wide variety of other archosauriform taxa. The diagnosis of Riojasuchus tenuisceps is emended and two autapomorphies are identified on the skull: (1 a deep antorbital fossa with its anterior and ventral edges almost coinciding with the same edges of the maxilla itself and (2 a suborbital fenestra equal in size to the palatine-pterygoid fenestra. Also, the first digital 3D reconstruction of the encephalon of Riojasuchus tenuisceps was carried out to study its neuroanatomy, showing a shape and cranial nerve disposition consistent to that of other pseudosuchians.

  12. Genetic Studies of Strabismus, Congenital Cranial Dysinnervation Disorders (CCDDs), and Their Associated Anomalies

    Science.gov (United States)

    2017-02-16

    Congenital Fibrosis of Extraocular Muscles; Duane Retraction Syndrome; Duane Radial Ray Syndrome; Mobius Syndrome; Brown Syndrome; Marcus Gunn Syndrome; Strabismus Congenital; Horizontal Gaze Palsy; Horizontal Gaze Palsy With Progressive Scoliosis; Facial Palsy; Facial Paresis, Hereditary, Congenital; Third Nerve Palsy; Fourth Nerve Palsy; Sixth Nerve Palsy; Synkinesis; Ocular Motility Disorders; Levator-Medial Rectus Synkinesis; Athabaskan Brainstem Dysgenesis; Tongue Paralysis; Ninth Nerve Disorder; Fifth Nerve Palsy; Seventh Nerve Palsy; Eleventh Nerve Disorder; Twelfth Nerve Disorder; Vagus Nerve Paralysis; Moebius Sequence

  13. Acute GI bleeding by multiple jejunal gastrointestinal autonomic nerve tumour associated with neurofibromatosis type I Urgencia quirúrgica por sangrado intestinal debido a tumor intestinal de nervios autónomos asociados a neurofibromatosis tipo I

    Directory of Open Access Journals (Sweden)

    M. Keese

    2007-10-01

    Full Text Available We describe a surgical emergency due to GI-bleeding caused by gastrointestinal autonomic nerve tumours (GANT's in a patient with von Recklinghausen's disease. A 72 year old female patient with von Recklinghausen's disease was admitted with maelena. Endoscopy showed no active bleeding in the stomach and the colon. Therefore an angio-CT-scan was performed which revealed masses of the proximal jejunum as source of bleeding. Laparotomy was indicated and a 20 cm segment of jejunum which carried multiple extraluminal tumours was resected. The source of the bleeding was a 2 cm tumour which had eroded the mucosal surface. Immunohistologically, evidence of neuronal differentiation could be shown in the spindle-formed cells with positive staining for C-Kit (CD 117, CD 34, and a locally positive staining for synaptophysine and S100. This case report illustrates the association between neurofibromatosis and stromal tumours and should alert surgeons and gastroenterologist about gastrointestinal manifestations in patients with von Recklinghausen's disease.Se describe una urgencia quirúrgica por sangrado intestinal debido a tumor gastrointestinal de nervios autónomos (GANT asociado a enfermedad de von Recklinghausen. Una mujer de 72 años con neurofibromatosis fue ingresada con signos de melena. La endoscopia digestiva alta y baja fue negativa. Se indicó TAC con contraste que advirtió tumores yeyunales como causa del sangrado. Se realizó laparotomía y resección de un segmento de 20 cm de yeyuno que incluía varios tumores. La causa del sangrado activo fue lesión en mucosa intestinal por erosión tumoral. El análisis por inmunohistoquímica de la pieza mostró diferenciación neuronal, con células fusiformes con tinción positiva para el C-Kit (CD 117, CD 34. Esta nota clínica pone de manifiesto la asociación entre la neurofibromatosis y los tumores estromales y debe alertar a gastroenterólogos y cirujanos sobre las posibles manifestaciones

  14. Changes in nerve microcirculation following peripheral nerve compression

    Institute of Scientific and Technical Information of China (English)

    Yueming Gao; Changshui Weng; Xinglin Wang

    2013-01-01

    Following peripheral nerve compression, peripheral nerve microcirculation plays important roles in regulating the nerve microenvironment and neurotrophic substances, supplying blood and oxygen and maintaining neural conduction and axonal transport. This paper has retrospectively analyzed the articles published in the past 10 years that addressed the relationship between peripheral nerve compression and changes in intraneural microcirculation. In addition, we describe changes in different peripheral nerves, with the aim of providing help for further studies in peripheral nerve microcirculation and understanding its protective mechanism, and exploring new clinical methods for treating peripheral nerve compression from the perspective of neural microcirculation.

  15. Stem cells and related factors involved in facial nerve function regeneration

    Directory of Open Access Journals (Sweden)

    Kamil H. Nelke

    2015-09-01

    Full Text Available The facial nerve (VII is one of the most important cranial nerves for head and neck surgeons. Its function is closely related to facial expressions that are individual for every person. After its injury or palsy, its functions can be either impaired or absent. Because of the presence of motor, sensory and parasympathetic fibers, the biology of its repair and function restoration depends on many factors. In order to achieve good outcome, many different therapies can be performed in order to restore as much of the nerve function as possible. When rehabilitation and physiotherapy are not sufficient, additional surgical procedures and therapies are taken into serious consideration. The final outcome of many of them is discussable, depending on nerve damage etiology. Stem cells in facial nerve repair are used, but long-term outcomes and results are still not fully known. In order to understand this therapeutic approach, clinicians and surgeons should understand the immunobiology of nerve repair and regeneration. In this review, potential stem cell usage in facial nerve regeneration procedures is discussed.

  16. Intratemporal facial nerve neuromas and their mimics: CT and MR findings

    Energy Technology Data Exchange (ETDEWEB)

    Han, Moon Hee; Chang, Kee Hyun; Lee, Kyung Hwan; Cha, Sang Hoon; Kim, Chong Sun [Seoul National University College of Medicine, Seoul (Korea, Republic of); Kim, Sang Joon [Chungang Gil General Hospital, Seoul (Korea, Republic of)

    1992-05-15

    CT and MR findings of nine cases with intra temporal facial nerve neuromas were described and compared with CT findings of 3 cases with facial nerve palsy and facial nerve canal erosion which may mimic facial nerve neuroma. The tympanic segment of the facial nerve was involved in 8 cases, mastoid segment in 7 cases and labyrinthine segment in 5 cases. The lesions were easily diagnosed with high resolution CT with bone algorithms by showing the expansion of bony structures along the course of the facial nerves. In 4 cases with large vertical segment tumors, extensive destruction of mastoid air cells and external auditory canals posed difficulty in making a diagnosis. Two out of 5 cases with labyrinthine segment involvement were presented as middle cranial fossa masses. MRI with enhancement was performed in 4 cases and was useful in characterizing the lesion as a tumor with its superior sensitivity to enhancement. Three cases of facial neuroma-mimicking lesion including post-inflammatory peri neural thickening, peri neural extension from parotid adenoid cystic carcinoma, and congenita; cholesteatoma showed irregular erosion or mild expansion of the facial nerve canal which may be helpful for differential diagnosis from neuromas.

  17. Alpha-synuclein pathology and axonal degeneration of the peripheral motor nerves innervating pharyngeal muscles in Parkinson disease.

    Science.gov (United States)

    Mu, Liancai; Sobotka, Stanislaw; Chen, Jingming; Su, Hungxi; Sanders, Ira; Adler, Charles H; Shill, Holly A; Caviness, John N; Samanta, Johan E; Beach, Thomas G

    2013-02-01

    Parkinson disease (PD) is a neurodegenerative disease primarily characterized by cardinal motor manifestations and CNS pathology. Current drug therapies can often stabilize these cardinal motor symptoms, and attention has shifted to the other motor and nonmotor symptoms of PD that are resistant to drug therapy. Dysphagia in PD is perhaps the most important drug-resistant symptom because it leads to aspiration and pneumonia, the leading cause of death. Here, we present direct evidence for degeneration of the pharyngeal motor nerves in PD. We examined the cervical vagal nerve (cranial nerve X), pharyngeal branch of nerve X, and pharyngeal plexus innervating the pharyngeal muscles in 14 postmortem specimens, that is, from 10 patients with PD and 4 age-matched control subjects. Synucleinopathy in the pharyngeal nerves was detected using an immunohistochemical method for phosphorylated α-synuclein. Alpha-synuclein aggregates were revealed in nerve X and the pharyngeal branch of nerve X, and immunoreactive intramuscular nerve twigs and axon terminals within the neuromuscular junctions were identified in all of the PD patients but in none of the controls. These findings indicate that the motor nervous system of the pharynx is involved in the pathologic process of PD. Notably, PD patients who have had dysphagia had a higher density of α-synuclein aggregates in the pharyngeal nerves than those without dysphagia. These findings indicate that motor involvement of the pharynx in PD is one of the factors leading to oropharyngeal dysphagia commonly seen in PD patients.

  18. Damaged axillary nerve (image)

    Science.gov (United States)

    Conditions associated with axillary nerve dysfunction include fracture of the humerus (upper arm bone), pressure from casts or splints, and improper use of crutches. Other causes include systemic disorders that cause neuritis (inflammation of ...

  19. Diabetes and nerve damage

    Science.gov (United States)

    Diabetic neuropathy; Diabetes - neuropathy; Diabetes - peripheral neuropathy ... In people with diabetes, the body's nerves can be damaged by decreased blood flow and a high blood sugar level. This condition is ...

  20. Sacral nerve stimulation.

    Science.gov (United States)

    Matzel, K E; Stadelmaier, U; Besendörfer, M

    2004-01-01

    The current concept of recruiting residual function of an inadequate pelvic organ by electrostimulation involves stimulation of the sacral spinal nerves at the level of the sacral canal. The rationale for applying SNS to fecal incontinence was based on clinical observations of its effect on bowel habits and anorectal continence function in urologic patients (increased anorectal angulation and anal canal closure pressure) and on anatomic considerations: dissection demonstrated a dual peripheral nerve supply of the striated pelvic floor muscles that govern these functions. Because the sacral spinal nerve site is the most distal common location of this dual nerve supply, stimulating here can elicit both functions. Since the first application of SNS in fecal incontinence in 1994, this technique has been improved, the patient selection process modified, and the spectrum of indications expanded. At present SNS has been applied in more than 1300 patients with fecal incontinence limited.

  1. Diabetic Nerve Problems

    Science.gov (United States)

    ... at the wrong times. This damage is called diabetic neuropathy. Over half of people with diabetes get ... you change positions quickly Your doctor will diagnose diabetic neuropathy with a physical exam and nerve tests. ...

  2. Axillary nerve dysfunction

    Science.gov (United States)

    ... is the nerve that helps control the deltoid muscles of the shoulder and the skin around it. A problem with ... can cause difficulty moving your arm. The deltoid muscle of the shoulder may show signs of muscle atrophy . Tests that ...

  3. Degenerative Nerve Diseases

    Science.gov (United States)

    Degenerative nerve diseases affect many of your body's activities, such as balance, movement, talking, breathing, and heart function. Many of these diseases are genetic. Sometimes the cause is a medical ...

  4. Optic nerve oxygen tension

    DEFF Research Database (Denmark)

    la Cour, M; Kiilgaard, Jens Folke; Eysteinsson, T

    2000-01-01

    To investigate the influence of acute changes in intraocular pressure on the oxygen tension in the vicinity of the optic nerve head under control conditions and after intravenous administration of 500 mg of the carbonic anhydrase inhibitor dorzolamide....

  5. Conjoined lumbosacral nerve roots

    Directory of Open Access Journals (Sweden)

    Atila Yılmaz

    2012-03-01

    Full Text Available Lumbosacral nerve root anomalies are a rare group ofcongenital anatomical anomalies. Various types of anomaliesof the lumbosacral nerve roots have been documentedin the available international literature. Ttheseanomalies may consist of a bifid, conjoined structure, ofa transverse course or of a characteristic anastomizedappearance. Firstly described as an incidental findingduring autopsies or surgical procedures performed forlumbar disk herniations and often asymptomatic, lumbosacralnerve root anomalies have been more frequentlydescribed in the last years due to the advances made inradiological diagnosis.

  6. Cranial electrotherapy stimulation for the treatment of depression.

    Science.gov (United States)

    Gunther, Mary; Phillips, Kenneth D

    2010-11-01

    More prevalent in women than men, clinical depression affects approximately 15 million American adults in a given year. Psychopharmaceutical therapy accompanied by psychotherapy and wellness interventions (e.g., nutrition, exercise, counseling) is effective in 80% of diagnosed cases. A lesser known adjunctive therapy is that of cranial electrotherapy stimulation (CES). The major hypothesis for the use of CES in depression is that it may reset the brain to pre-stress homeostasis levels. It is conjectured that the pulsed electrical currents emitted by cranial electrical stimulators affect changes in the limbic system, the reticular activating system, and/or the hypothalamus that result in neurotransmitter secretion and downstream hormone production. While evidence is good for applied research, basic research about the mechanisms of action for CES remains in its infancy. A review of the literature provides an overview of current research findings and implications for clinical mental health practice.

  7. Distraction Osteogenesis Update: Introduction of Multidirectional Cranial Distraction Osteogenesis.

    Science.gov (United States)

    Gomi, Akira; Sunaga, Ataru; Kamochi, Hideaki; Oguma, Hirofumi; Sugawara, Yasushi

    2016-05-01

    In this review, we discuss in detail our current procedure for treating craniosynostosis using multidirectional cranial distraction osteogenesis (MCDO). The MCDO method allows all phenotypes of skull deformity to be reshaped by distraction osteogenesis, except in patients who are 5 months of age or younger and patients with posterior cranial vault problems. We report the results of clinical data of 36 children with craniosynostosis who underwent MCDO between 2005 and 2014 in our institute. This method has the following benefits, such as a high flexibility of reshaping, shorter treatment period and less invasive secondary intervention. We also discuss the other distraction osteogenesis techniques that are used to treat craniosynostosis and compare them with MCDO. The preferred procedure for correction of craniosynostosis may depend on the patient's age, the extent of deformity, and the extent of correction achievable by surgery. We can arrange the combinations of various methods according to the advantage and disadvantage of each technique.

  8. Tracking modern human population history from linguistic and cranial phenotype.

    Science.gov (United States)

    Reyes-Centeno, Hugo; Harvati, Katerina; Jäger, Gerhard

    2016-11-11

    Languages and genes arguably follow parallel evolutionary trajectories, descending from a common source and subsequently differentiating. However, although common ancestry is established within language families, it remains controversial whether language preserves a deep historical signal. To address this question, we evaluate the association between linguistic and geographic distances across 265 language families, as well as between linguistic, geographic, and cranial distances among eleven populations from Africa, Asia, and Australia. We take advantage of differential population history signals reflected by human cranial anatomy, where temporal bone shape reliably tracks deep population history and neutral genetic changes, while facial shape is more strongly associated with recent environmental effects. We show that linguistic distances are strongly geographically patterned, even within widely dispersed groups. However, they are correlated predominantly with facial, rather than temporal bone, morphology, suggesting that variation in vocabulary likely tracks relatively recent events and possibly population contact.

  9. Clinical characteristics and diagnostic imaging of cranial osteoblastoma.

    Science.gov (United States)

    Pelargos, Panayiotis E; Nagasawa, Daniel T; Ung, Nolan; Chung, Lawrance K; Thill, Kimberly; Tenn, Stephen; Gopen, Quinton; Yang, Isaac

    2015-03-01

    Benign osteoblastoma is a rare, vascular, osteoid-forming bone tumor that occurs even less frequently in the cranial bones. Benign osteoblastoma of the cranium affects women slightly more often than men and typically presents in the first three decades of life. Although clinical presentation can vary depending on location, cranial osteoblastoma usually presents as a painful, non-mobile, subcutaneous mass or swelling. On CT scan, it generally presents as a well-demarcated, mixed lytic and sclerotic lesion, with enlarged diploe, thinning outer and/or inner tables, and varying degrees of calcification. It is hypo to isointense on T1-weighted MRI and has variable presentation on T2-weighted MRI. Gross total resection is the definitive treatment, while subtotal resection is utilized when it is necessary to preserve critical adjacent neurovascular structures.

  10. [Minor cranial injury: clinical, audiovestibular and medico-legal aspects].

    Science.gov (United States)

    Tripodi, D; D'Ambrosio, L; Palladino, V; Paduano, F

    1989-02-28

    Minor cranial trauma is a common pathology upon which there is no general agreement. This is why the verification and quantification of the damages should not depend on the analysis of subjective data and objective elements which are not quantifiable. By careful clinical and instrumental examination of 42 patients, the authors come to the conclusion that ENG and ABR can often provide objective and documentable data of clinical and forensic relevance.

  11. Cranial magnetic resonance imaging in chronic demyelinating polyneuropathy.

    OpenAIRE

    Hawke, S H; Hallinan, J M; McLeod, J G

    1990-01-01

    Twenty one patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and five patients with chronic demyelinating polyneuropathy associated with benign monoclonal paraproteinaemia none of whom had signs or symptoms of central nervous system disease, had cranial magnetic resonance imaging (MRI) on a 1.5 Tesla unit. Areas of increased white matter signal intensity were seen in one of 10 patients aged less than 50 years and in five of 16 patients aged more than 50 years. In ...

  12. Germline mosaicism in osteopathia striata with cranial sclerosis--recurrence in siblings.

    Science.gov (United States)

    O'Byrne, James J; Phelan, Ethna; Steenackers, Ellen; van Hul, Wim; Reardon, William

    2016-04-01

    We report recurrence of osteopathia striata with cranial sclerosis (OSCS) in two full siblings conceived by unaffected parents. Molecular confirmation of OSCS in both siblings was achieved by identification of a novel heterozygous mutation in the WTX gene. Neither parent had clinical features of OSCS nor was the pathogenic mutation demonstrable in DNA extracted from both peripheral blood leucocytes and buccal cells. This case demonstrates germline mosaicism in OSCS and represents the third report of mosaicism affecting the germline in families with OSCS. Previous reports were of parental gonadosomal mosaicism, with one showing recurrence in multiple children. Our observation adds to a body of evidence that suggests that germline mosaicism in OSCS may occur more frequently than believed previously and may have implications for counselling families with OSCS.

  13. Leader Cells Define Directionality of Trunk, but Not Cranial, Neural Crest Cell Migration

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    Jo Richardson

    2016-05-01

    Full Text Available Collective cell migration is fundamental for life and a hallmark of cancer. Neural crest (NC cells migrate collectively, but the mechanisms governing this process remain controversial. Previous analyses in Xenopus indicate that cranial NC (CNC cells are a homogeneous population relying on cell-cell interactions for directional migration, while chick embryo analyses suggest a heterogeneous population with leader cells instructing directionality. Our data in chick and zebrafish embryos show that CNC cells do not require leader cells for migration and all cells present similar migratory capacities. In contrast, laser ablation of trunk NC (TNC cells shows that leader cells direct movement and cell-cell contacts are required for migration. Moreover, leader and follower identities are acquired before the initiation of migration and remain fixed thereafter. Thus, two distinct mechanisms establish the directionality of CNC cells and TNC cells. This implies the existence of multiple molecular mechanisms for collective cell migration.

  14. Nerve autografts and tissue-engineered materials for the repair of peripheral nerve injuries: a 5-year bibliometric analysis

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    Yuan Gao

    2015-01-01

    Full Text Available With advances in biomedical methods, tissue-engineered materials have developed rapidly as an alternative to nerve autografts for the repair of peripheral nerve injuries. However, the materials selected for use in the repair of peripheral nerve injuries, in particular multiple injuries and large-gap defects, must be chosen carefully. Various methods and materials for protecting the healthy tissue and repairing peripheral nerve injuries have been described, and each method or material has advantages and disadvantages. Recently, a large amount of research has been focused on tissue-engineered materials for the repair of peripheral nerve injuries. Using the keywords "pe-ripheral nerve injury", "autotransplant", "nerve graft", and "biomaterial", we retrieved publications using tissue-engineered materials for the repair of peripheral nerve injuries appearing in the Web of Science from 2010 to 2014. The country with the most total publications was the USA. The institutions that were the most productive in this field include Hannover Medical School (Germany, Washington University (USA, and Nantong University (China. The total number of publications using tissue-engineered materials for the repair of peripheral nerve injuries grad-ually increased over time, as did the number of Chinese publications, suggesting that China has made many scientific contributions to this field of research.

  15. Cranial skeletogenesis and osteology of the redeye tetra Moenkhausia sanctaefilomenae.

    Science.gov (United States)

    Walter, B E

    2013-01-01

    The skeletogenesis and osteology of the syncranium of the redeye tetra Moenkhausia sanctaefilomenae is described. Skeletal development is rapid, with many elements of the chondrocranium and splanchnocranium well formed prior to the onset of ossification. The chondrocranium develops from an initial set of cartilaginous precursors, and continued elaboration proceeds from a series of processes which expand and converge to form the floor of the cranial vault, the otic capsule, the supraorbital bridge and the ethmoid region. Prodigious growth is observed for a number of splanchnocranial elements, including the Meckel's cartilage and the ceratohyal cartilage. Ossification occurs in overlapping phases with initial ossification of the jaws and neurocranial floor followed by the splanchnocranium, the supraorbital bridges and the ethmoid and cranial vault. Teeth are observed primarily on the premaxilla and dentary, while a single tooth is present on the maxilla. Particular cartilages, which had originally formed in the early larva, appear to degenerate and have no ossified representative in the adult syncranium. The cranial development for M. sanctaefilomenae is compared to those of other characiforms.

  16. Brief communication: Artificial cranial modification in Kow Swamp and Cohuna.

    Science.gov (United States)

    Durband, Arthur C

    2014-09-01

    The crania from Kow Swamp and Cohuna have been important for a number of debates in Australian paleoanthropology. These crania typically have long, flat foreheads that many workers have cited as evidence of genetic continuity with archaic Indonesian populations, particularly the Ngandong sample. Other scientists have alleged that at least some of the crania from Kow Swamp and the Cohuna skull have been altered through artificial modification, and that the flat foreheads possessed by these individuals are not phylogenetically informative. In this study, several Kow Swamp crania and Cohuna are compared to known modified and unmodified comparative samples. Canonical variates analyses and Mahalanobis distances are generated, and random expectation statistics are used to calculate statistical significance for these tests. The results of this study agree with prior work indicating that a portion of this sample shows evidence for artificial modification of the cranial vault. Many Kow Swamp crania and Cohuna display shape similarities with a population of known modified individuals from New Britain. Kow Swamp 1, 5, and Cohuna show the strongest evidence for modification, but other individuals from this sample also show evidence of culturally manipulated changes in cranial shape. This project provides added support for the argument that at least some Pleistocene Australian groups were practicing artificial cranial modification, and suggests that caution should be used when including these individuals in phylogenetic studies.

  17. Heterochrony and developmental modularity of cranial osteogenesis in lipotyphlan mammals

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    Koyabu Daisuke

    2011-11-01

    Full Text Available Abstract Background Here we provide the most comprehensive study to date on the cranial ossification sequence in Lipotyphla, the group which includes shrews, moles and hedgehogs. This unique group, which encapsulates diverse ecological modes, such as terrestrial, subterranean, and aquatic lifestyles, is used to examine the evolutionary lability of cranial osteogenesis and to investigate the modularity of development. Results An acceleration of developmental timing of the vomeronasal complex has occurred in the common ancestor of moles. However, ossification of the nasal bone has shifted late in the more terrestrial shrew mole. Among the lipotyphlans, sequence heterochrony shows no significant association with modules derived from developmental origins (that is, neural crest cells vs. mesoderm derived parts or with those derived from ossification modes (that is, dermal vs. endochondral ossification. Conclusions The drastic acceleration of vomeronasal development in moles is most likely coupled with the increased importance of the rostrum for digging and its use as a specialized tactile surface, both fossorial adaptations. The late development of the nasal in shrew moles, a condition also displayed by hedgehogs and shrews, is suggested to be the result of an ecological reversal to terrestrial lifestyle and reduced functional importance of the rostrum. As an overall pattern in lipotyphlans, our results reject the hypothesis that ossification sequence heterochrony occurs in modular fashion when considering the developmental patterns of the skull. We suggest that shifts in the cranial ossification sequence are not evolutionarily constrained by developmental origins or mode of ossification.

  18. Hypertrophic cranial pachymeningitis in a patient with aplastic anemia.

    Science.gov (United States)

    Asano, T; Hayashida, M; Ogawa, K; Adachi, K; Teramoto, A; Yamamoto, M

    1998-12-01

    We report on a 13-year old girl with severe aplastic anemia and hypertrophic cranial pachymeningitis. She was admitted to our hospital with severe headache and vomiting. A computerized tomographic (CT) scan of the brain on the third day of symptoms showed a hyperdense area in the tentorial region. Magnetic resonance imaging (MRI) showed iso-intensity in the same tentorial region in T1- and T2-weighted images, and gadolinium enhancement of this region suggested a thickened dura mater. Initially, a diagnosis of subdural or subarachnoid hemorrhage was made. Since her platelet count was low (3000/microl) making the patient a poor-risk candidate for surgery, and the area was limited to the dura mater, conservative therapy, including glycerol administration and platelet transfusion, was carried out. Despite clinical improvement 10 days after admission without specific therapy, the iso-intense region on the left side of the tentorial region remained unchanged on MRI. On the other hand, the iso-intense area on the right side of the tentorial region became hyperdense on T1-weighted MRI images and was also enhanced by gadolinium. Cerebrospinal fluid findings were normal except for slightly elevated protein at 62 mg/dl. A diagnosis of hypertrophic cranial pachymeningitis of the tentorial dura mater with hemorrhage on the right side was made. Although hypertrophic cranial pachymeningitis is a rare disease, it must be considered in the differential diagnosis of severe headache in a case of aplastic anemia.

  19. Cranial and mandibular morphometry in Leontopithecus Lesson, 1840 (Callitrichidae, primates).

    Science.gov (United States)

    Burity, C H; Mandarim-De-Lacerda, C A; Pissinatti, A

    1999-01-01

    In this paper, we report on a craniometric analysis comparing the species of lion tamarins, Leontopithecus Lesson, 1840. Seventeen cranial and mandibular measures were taken on skulls of 59 adult crania: 20 L. rosalia (14 females and 6 males); 13 L. chrysomelas (6 females and 7 males); 23 L. chrysopygus (8 females and 15 males), and 3 L. caissara (1 female and 2 males). All specimens were from the Rio de Janeiro Primate Center (CPRJ-FEEMA, Brazil), except the specimens of L. caissara. Statistical treatment involved a one-way analysis of variance (the Bonferroni test) and discriminant analysis, comparing cranium and mandibles separately to determine variables which best distinguished groups and to group the specimens, using size corrected methods. The Mahalanobis distance was computed from the centroids of each group. Seven measures distinguished females of L. chrysopygus with L. rosalia, six to L. rosalia with L. chrysomelas, and L. chrysopygus with L. chrysomelas. In males, the numbers of measures statistically different were 5, 4, and 3 of the pairwise comparisons above mentioned. Cranial base length and orbital breadth were the only measures that were significantly different in all three dyads, considering both sexes. For the cranium, function 1 of the Discriminant Analysis accounted for 52.4% of the variance and function 2 accounted for 40.3%. Both functions exhibited a significant value for Wilks' lambda (PLeontopithecus. Despite of sample size, L. caissara shows morphological distances to L. chrysopygus in cranial analysis. However, other investigations are necessary to confirm this.

  20. Phylogeny, diet, and cranial integration in australodelphian marsupials.

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    Anjali Goswami

    Full Text Available Studies of morphological integration provide valuable information on the correlated evolution of traits and its relationship to long-term patterns of morphological evolution. Thus far, studies of morphological integration in mammals have focused on placentals and have demonstrated that similarity in integration is broadly correlated with phylogenetic distance and dietary similarity. Detailed studies have also demonstrated a significant correlation between developmental relationships among structures and adult morphological integration. However, these studies have not yet been applied to marsupial taxa, which differ greatly from placentals in reproductive strategy and cranial development and could provide the diversity necessary to assess the relationships among phylogeny, ecology, development, and cranial integration. This study presents analyses of morphological integration in 20 species of australodelphian marsupials, and shows that phylogeny is significantly correlated with similarity of morphological integration in most clades. Size-related correlations have a significant affect on results, particularly in Peramelia, which shows a striking decrease in similarity of integration among species when size is removed. Diet is not significantly correlated with similarity of integration in any marsupial clade. These results show that marsupials differ markedly from placental mammals in the relationships of cranial integration, phylogeny, and diet, which may be related to the accelerated development of the masticatory apparatus in marsupials.

  1. Surgical pitfalls with custom-made porous hydroxyapatite cranial implants

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    Bruno Zanotti

    2015-03-01

    Full Text Available Aim: Cranioplasty implants are used primarily in cases of surgical cranial decompression following pathological elevations of intracranial pressure. Available bone substitutes include porous hydroxyapatite (HA and polymethylmethacrylate. Whichever material is used, however, prosthetic cranial implants are susceptible to intra- and postsurgical complications and even failure. The aim of this study was to investigate such occurrences in HA cranioplasty implants, seeking not only to determine the likely causes (whether correlated or not with the device itself but also, where possible, to suggest countermeasures. Methods: We analyzed information regarding failures or complications reported in postmarketing surveillance and clinical studies of patients treated worldwide with custom-made HA cranial implants (Custom Bone Service Fin-Ceramica Faenza, Italy in the period 1997-2013. Results: The two most common complications were implant fractures (84 cases, 2.9% of the total fitted and infections (51 cases, 1.77%. Conclusion: Although cranioplasties are superficial and not difficult types of surgery, and use of custom-made implants are often considered the "easy" option from a surgical perspective, these procedures are nonetheless plagued by potential pitfalls. If performed well they yield more than satisfactory results from the points of view of both the patient and surgeon, but lack of appropriate care can open the door to numerous potential sources of failure, which can compromise-even irreparably-the ability to heal.

  2. The cisternal segment of the abducens nerve in man: three-dimensional MR imaging

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    Alkan, Alpay E-mail: aalkan@inonu.edu.tr; Sigirci, Ahmet; Ozveren, M. Faik; Kutlu, Ramazan; Altinok, Tayfun; Onal, Cagatay; Sarac, Kaya

    2004-09-01

    Purpose: The goal of this study was to identify the abducens nerve in its cisternal segment by using three-dimensional turbo spin echo T2-weighted image (3DT2-TSE). The abducens nerve may arise from the medullopontine sulcus by one singular or two separated rootlets. Material and methods: We studied 285 patients (150 males, 135 females, age range: 9-72 years, mean age: 33.3{+-}14.4) referred to MR imaging of the inner ear, internal auditory canal and brainstem. All 3D T2-TSE studies were performed with a 1.5 T MR system. Imaging parameters used for 3DT2-TSE sequence were TR:4000, TE:150, and 0.70 mm slice thickness. A field of view of 160 mm and 256x256 matrix were used. The double rootlets of the abducens nerve and contralateral abducens nerves and their relationships with anatomical structures were searched in the subarachnoid space. Results: We identified 540 of 570 abducens nerves (94.7%) in its complete cisternal course with certainty. Seventy-two cases (25.2%) in the present study had double rootlets of the abducens nerve. In 59 of these cases (34 on the right side and 25 on the left) presented with unilateral double rootlets of the abducens. Thirteen cases presented with bilateral double rootlets of the abducens (4.5%). Conclusion: An abducens nerve arising by two separate rootlets is not a rare variation. The detection of this anatomical variation by preoperative MR imaging is important to avoid partial damage of the nerve during surgical procedures. The 3DT2-TSE as a noninvasive technique makes it possible to obtain extremely high-quality images of microstructures as cranial nerves and surrounding vessels in the cerebellopontine cistern. Therefore, preoperative MR imaging should be performed to detect anatomical variations of abducens nerve and to reduce the chance of operative injuries.

  3. Anatomical study of sciatic nerve and common peroneal nerve compression

    Institute of Scientific and Technical Information of China (English)

    Mingzhao Jia; Qing Xia; Jinmin Sun; Qiang Zhou; Weidong Wang

    2008-01-01

    BACKGROUND: Many diseases of the common peroneal nerve are a result of sciatic nerve injury. The present study addresses whether anatomical positioning of the sciatic nerve is responsible for these injuries. OBJECTIVE: To analyze anatomical causes of sciatic nerve and common peroneal nerve injury by studying the relationship between the sciatic nerve and piriformis. DESIGN, TIME AND SETTING: Observe and measure repeatedly. The experiment was conducted in the Department of Anatomy, Tianjin Medical College between January and June 2005. MATERIALS: Fifty-two adult cadavers 33 males and 19 females, with a total of 104 hemispheres, and fixed with formaldehyde, were provided by Tianjin Medical College and Tianjin Medical University. METHODS: A posterior cut was made from the lumbosacral region to the upper leg, fully exposing the piriformis and path of the sciatic nerve. MAIN OUTCOME MEASURES: (1) Anatomical characteristics of the tibial nerve and common peroneal nerve. (2) According to different areas where the sciatic nerve crosses the piriformis, the study was divided into two types--normal and abnormal. Normal is considered to be when the sciatic nerve passes through the infrapiriform foramen. Remaining pathways are considered to be abnormal. (3) Observe the relationship between the suprapiriform foramen, infrapiriform foramen, as well as the superior and inferior space of piriformis. RESULTS: (1) The nerve tract inside the common peroneal nerve is smaller and thinner, with less connective tissue than the tibial nerve. When pathological changes or variations of the piriformis, or over-abduction of the hip joint, occur, injury to the common peroneal nerve often arises due to blockage and compression. (2) A total of 76 hemispheres (73.08%) were normal, 28 were abnormal (26.92%). The piriformis can be injured, and the sciatic nerve can become compressed, when the hip joint undergoes intorsion, extorsion, or abduction. (3) The structures between the infrapiriform and

  4. [Anatomic study on intercostal nerve transfer to suprascapular nerve].

    Science.gov (United States)

    Chu, Bin; Hu, Shaonan; Chen, Liang; Song, Jie

    2012-09-01

    To investigate the feasibility of the 3rd-6th intercostal nerve transfer to the suprascapular nerve for reconstruction of shoulder abduction. Fifteen thoracic walls (30 sides) were collected from cadavers. The 3rd-6th intercostal nerve length which can be dissected between the midaxillary line and midclavicular the transfer distance between the midaxillary line and midpoint of the clavicular bone (prepared point for neurotization) measured. In 30 sides of specimens, the 3rd and 4th intercostal nerves could be obtained between the midaxillary and midclavicular line, the available length of which was significantly greater than the transfer distance (P intercostal nerve and 16 sides of 6th intercostal nerve were covered by the costal cartilage before reaching the midclavicular line. The available length of the 5th intercostal nerve was similar to the transfer distance (P > 0.01), while the available the 6th intercostal nerve was significantly less than transfer distance (P intercostal nerve length and length (2 cm) of suprascapular nerve was significantly greater than the transfer distance (P intercostal nerve transfer to the suprascapular nerve for reconstruction of shoulder abduction. And 6th intercostal nerve, longer dissociated length may be required for direct coaptation or using a graft for nerve repair.

  5. Neurodevelopment. Parasympathetic neurons originate from nerve-associated peripheral glial progenitors.

    Science.gov (United States)

    Dyachuk, Vyacheslav; Furlan, Alessandro; Shahidi, Maryam Khatibi; Giovenco, Marcela; Kaukua, Nina; Konstantinidou, Chrysoula; Pachnis, Vassilis; Memic, Fatima; Marklund, Ulrika; Müller, Thomas; Birchmeier, Carmen; Fried, Kaj; Ernfors, Patrik; Adameyko, Igor

    2014-07-04

    The peripheral autonomic nervous system reaches far throughout the body and includes neurons of diverse functions, such as sympathetic and parasympathetic. We show that the parasympathetic system in mice--including trunk ganglia and the cranial ciliary, pterygopalatine, lingual, submandibular, and otic ganglia--arise from glial cells in nerves, not neural crest cells. The parasympathetic fate is induced in nerve-associated Schwann cell precursors at distal peripheral sites. We used multicolor Cre-reporter lineage tracing to show that most of these neurons arise from bi-potent progenitors that generate both glia and neurons. This nerve origin places cellular elements for generating parasympathetic neurons in diverse tissues and organs, which may enable wiring of the developing parasympathetic nervous system.

  6. Optimization and Implementation of Long Nerve Allografts

    Science.gov (United States)

    2014-10-01

    nerve tissue requires a graft to restore continuity and promote nerve regeneration and recovery of function. Presently, there is no acceptable nerve ...for nerve regeneration and meaningful recovering of nerve function that, in several cases was better than autografting. Other decellularized allografts... nerve graft, allograft, nerve regeneration , rehabilitation 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT 18. NUMBER OF PAGES 19a. NAME

  7. Normal and pathological findings for the facial nerve on magnetic resonance imaging

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    Al-Noury, K., E-mail: Kalnoury@kau.edu.sa [Department of Otolaryngology, King Abdulaziz University, Jeddah (Saudi Arabia); Lotfy, A. [Radiology Department, King Abdulaziz University Hospital and International Medical Centre, Jeddah (Saudi Arabia)

    2011-08-15

    Aim: To demonstrate the enhanced radiological anatomy and common pathological conditions of the facial nerve by using magnetic resonance imaging (MRI). Materials and methods: A retrospective review of the MRI findings of the facial nerve of 146 patients who visited a tertiary academic referral center was conducted. Results: The radiological anatomy of the facial nerve was well illustrated using MRI, as were most of the common pathological conditions of the facial nerve. Conclusions: Enhancement of the facial nerve in MRI should be correlated with the clinical data. Normal individuals can show enhancement of the tympanic or vertical segments of the facial nerve. Enhancement of the labyrinthine portion of the nerve is almost diagnostic of Bell's palsy. No specific enhancement patterns were observed for tumours or for infections of the middle or external ear. A larger population study is required for the accurate assessment of facial nerve enhancement in multiple sclerosis patients.

  8. Regeneration of Optic Nerve

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    Kwok-Fai So

    2011-05-01

    Full Text Available The optic nerve is part of the central nervous system (CNS and has a structure similar to other CNS tracts. The axons that form the optic nerve originate in the ganglion cell layer of the retina and extend through the optic tract. As a tissue, the optic nerve has the same organization as the white matter of the brain in regard to its glia. There are three types of glial cells: Oligodendrocytes, astrocytes, and microglia. Little structural and functional regeneration of the CNS takes place spontaneously following injury in adult mammals. In contrast, the ability of the mammalian peripheral nervous system (PNS to regenerate axons after injury is well documented. A number of factors are involved in the lack of CNS regeneration, including: (i the response of neuronal cell bodies against the damage; (ii myelin-mediated inhibition by oligodendrocytes; (iii glial scarring, by astrocytes; (iv macrophage infiltration; and (v insufficient trophic factor support. The fundamental difference in the regenerative capacity between CNS and PNS neuronal cell bodies has been the subject of intensive research. In the CNS the target normally conveys a retrograde trophic signal to the cell body. CNS neurons die because of trophic deprivation. Damage to the optic nerve disconnects the neuronal cell body from its target-derived trophic peptides, leading to the death of retinal ganglion cells. Furthermore, the axontomized neurons become less responsive to the peptide trophic signals they do receive. On the other hand, adult PNS neurons are intrinsically responsive to neurotrophic factors and do not lose trophic responsiveness after axotomy. In this talk different strategies to promote optic-nerve regeneration in adult mammals are reviewed. Much work is still needed to resolve many issues. This is a very important area of neuroregeneration and neuroprotection, as currently there is no cure after traumatic optic nerve injury or retinal disease such as glaucoma, which

  9. A surgical case of frontal lobe epilepsy due to focal cortical dysplasia accompanied by olfactory nerve enlargement: case report.

    Science.gov (United States)

    Minami, Noriaki; Uda, Takehiro; Matsumoto, Takahiro; Nagai, Taiki; Uchida, Tatsuya; Kamei, Takamasa; Morino, Michiharu

    2014-01-01

    A 45-year-old man came to our clinic due to refractory general tonic seizure and an attack of unintended yelling. Magnetic resonance imaging (MRI) demonstrated mild cortical hyperintensity on fluid attenuated inversion recovery (FLAIR) image in the left basal frontal area. Enlargement of the left olfactory nerve was also detected below the affected gyrus. Subtotal resection of the MRI-visible epileptogenic lesion was performed without any neurological deficit. The final pathological diagnosis was focal cortical dysplasia (FCD) type IIa. Seizures and yelling attacks subsided after surgery. Extracerebral abnormalities, including cranial nerve enlargement, are common in patients with hemimegalencephaly. However, such abnormalities are rare with FCD.

  10. Construction of a three-dimensional bionic nerve conduit containing two neurotrophic factors with separate delivery systems for the repair of sciatic nerve defects

    Institute of Scientific and Technical Information of China (English)

    Zhiyue Li; Qun Zhao; Ran Bi; Yong Zhuang; Siyin Feng

    2011-01-01

    Previous studies of nerve conduits have investigated numerous properties, such as conduit luminal structure and neurotrophic factor incorporation, for the regeneration of nerve defects. The present study used a poly(lactic-co-glycolic acid) (PLGA) copolymer to construct a three-dimensional (3D) bionic nerve conduit, with two channels and multiple microtubule lumens, and incorporating two neurotrophic factors, each with their own delivery system, as a novel environment for peripheral nerve regeneration. The efficacy of this conduit in repairing a 1.5 cm sciatic nerve defect was compared with PLGA-alone and PLGA-microfilament conduits, and autologous nerve transplantation. Results showed that compared with the other groups, the 3D bionic nerve conduit had the fastest nerve conduction velocity, largest electromyogram amplitude, and shortest electromyogram latency. In addition, the nerve fiber density, myelin sheath thickness and axon diameter were significantly increased, and the recovery rate of the triceps surae muscle wet weight was lowest. These findings suggest that 3D bionic nerve conduits can provide a suitable microenvironment for peripheral nerve regeneration to efficiently repair sciatic nerve defects.

  11. Preactivation of the quadriceps muscle could limit cranial tibial translation in a cranial cruciate ligament deficient canine stifle.

    Science.gov (United States)

    Ramirez, Juan M; Lefebvre, Michael; Böhme, Beatrice; Laurent, Cédric; Balligand, Marc

    2015-02-01

    Cranial cruciate ligament (CrCL) deficiency is the leading cause of lameness of the canine stifle. Application of tension in the quadriceps muscle could trigger cranial tibial translation in case of CrCL rupture. We replaced the quadriceps muscle and the gastrocnemius muscle by load cells and turn-buckles. First, eight canine limbs were placed in a servo-hydraulic testing machine, which applied 50% of body weight (BW). In a second phase, the CrCL was transected, and the limbs were tested in a similar manner. In a third phase, a quadriceps pretension of 15% BW was applied and limbs were again tested in a similar manner. Cranial tibial translation was significantly decreased in CrCL deficient stifles (p quadriceps pretension was applied. These findings indicate that quadriceps pretension could play a role in the stability of a CrCL deficient stifle and should then be considered in rehabilitation programs and conservative treatment of CrCL rupture in dogs.

  12. EVALUATION OF OPTIC AND VESTIBULOCOCHLEAR NERVE INVOLVEMENT IN TYPE 2 DIABETES MELLITUS PATIENTS BY USING EVOKED POTENTIAL

    Directory of Open Access Journals (Sweden)

    Arrthy S, Vinodha R, Saravanan S

    2015-09-01

    Full Text Available Background and Objectives: Cranial neuropathy is one of the common late complications of Diabetes Mellitus(DM, including distal symmetric sensory polyneuropathy and peripheral neuropathy(PN. Though many studies support the involvement of Cranial nerves III, VI and VII in diabetic patients, little was known about the involvement of II & VIII nerve. The goal of this study was to evaluate the involvement of optic nerve and vestibulocochlear nerve using Visual Evoked potential (VEP and Brainstem Auditary Evoked Potential (BAEP. Methods: Forty patients with 8 to 12 years duration of type 2 DM in 40 to 60 years age group (Group1 were selected from diabetic outpatient department in Thanjavur medical college hospital and compared with control group (Group 2 who were normal subjects and was age and sex matched. Physical examination and laboratory investigations including fasting glucose, renal functions were done in addition to VEP & BAEP for all groups. P100 latency using VEP and bilateral inter-peak latency IPL I-III, IPL III-V & IPL I-V using BAEP was evaluated and and analyzed for the study group and control group. Result: VEP P100 latency and BAEP bilateral inter-peak latency IPL I-III, IPL III-V & IPL I-V were prolonged in the study group compared to control group. Conclusion: This study concluded the involvement of optic and vestibulocochlear nerve in type 2 DM as the latency was prolonged.

  13. Repair of sciatic nerve defects using tissue engineered nerves*

    Institute of Scientific and Technical Information of China (English)

    Caishun Zhang; Gang Lv

    2013-01-01

    In this study, we constructed tissue-engineered nerves with acel ular nerve al ografts in Sprague-Dawley rats, which were prepared using chemical detergents-enzymatic digestion and mechanical methods, in combination with bone marrow mesenchymal stem cel s of Wistar rats cultured in vitro, to repair 15 mm sciatic bone defects in Wistar rats. At postoperative 12 weeks, electrophysiological detection results showed that the conduction velocity of regenerated nerve after repair with tis-sue-engineered nerves was similar to that after autologous nerve grafting, and was higher than that after repair with acel ular nerve al ografts. Immunohistochemical staining revealed that motor endplates with acetylcholinesterase-positive nerve fibers were orderly arranged in the middle and superior parts of the gastrocnemius muscle;regenerated nerve tracts and sprouted branches were connected with motor endplates, as shown by acetylcholinesterase histochemistry combined with silver staining. The wet weight ratio of the tibialis anterior muscle at the affected contralateral hind limb was similar to the sciatic nerve after repair with autologous nerve grafts, and higher than that after repair with acel ular nerve al ografts. The hind limb motor function at the affected side was significantly improved, indicating that acel ular nerve al ografts combined with bone marrow me-senchymal stem cel bridging could promote functional recovery of rats with sciatic nerve defects.

  14. Dog sciatic nerve gap repaired by artificial tissue nerve graft

    Institute of Scientific and Technical Information of China (English)

    GU Xiaosong; ZHANG Peiyun; WANG Xiaodong; DING Fei; PENG Luping; CHENG Hongbing

    2003-01-01

    The feasibility of repairing dog sciatic nerve damage by using a biodegradable artificial tissue nerve graft enriched with neuroregenerating factors is investigated. The artificial nerve graft was implanted to a 30 mm gap of the sciatic nerve damage in 7 dogs. The dogs with the same nerve damage that were repaired by interposition of the autologous nerve or were given no treatment served as control group 1 or 2, respectively. The observations include gross and morphological observations, immune reaction, electrophysiological examination, fluorescence tracing of the neuron formation and the number of the neurons at the experimental sites, etc. Results showed that 6 months after the implantation of the graft, the regenerated nerve repaired the damage of the sciatic nerve without occurrence of rejection and obvious inflammatory reaction in all 7 dogs, and the function of the sciatic nerve recovered with the nerve conduction velocity of (23.91±11.35)m/s. The regenerated neurons and the forming of axon could be observed under an electron microscope. This proves that artificial tissue nerve graft transplantation can bridge the damaged nerve ends and promote the nerve regeneration.

  15. Acellular Nerve Allografts in Peripheral Nerve Regeneration: A Comparative Study

    Science.gov (United States)

    Moore, Amy M.; MacEwan, Matthew; Santosa, Katherine B.; Chenard, Kristofer E.; Ray, Wilson Z.; Hunter, Daniel A.; Mackinnon, Susan E.; Johnson, Philip J.

    2011-01-01

    Background Processed nerve allografts offer a promising alternative to nerve autografts in the surgical management of peripheral nerve injuries where short deficits exist. Methods Three established models of acellular nerve allograft (cold-preserved, detergent-processed, and AxoGen® -processed nerve allografts) were compared to nerve isografts and silicone nerve guidance conduits in a 14 mm rat sciatic nerve defect. Results All acellular nerve grafts were superior to silicone nerve conduits in support of nerve regeneration. Detergent-processed allografts were similar to isografts at 6 weeks post-operatively, while AxoGen®-processed and cold-preserved allografts supported significantly fewer regenerating nerve fibers. Measurement of muscle force confirmed that detergent-processed allografts promoted isograft-equivalent levels of motor recovery 16 weeks post-operatively. All acellular allografts promoted greater amounts of motor recovery compared to silicone conduits. Conclusions These findings provide evidence that differential processing for removal of cellular constituents in preparing acellular nerve allografts affects recovery in vivo. PMID:21660979

  16. Ocular and periocular injuries associated with an isolated orbital fracture depending on a blunt cranial trauma: anatomical and surgical aspects.

    Science.gov (United States)

    Karabekir, H Selim; Gocmen-Mas, Nuket; Emel, Erhan; Karacayli, Umit; Koymen, Ramazan; Atar, Elmas Kagnici; Ozkan, Nezih

    2012-10-01

    The anatomical location of fractures following blunt cranio-orbital trauma is important for neurosurgeons and maxillofacial surgeons. In this study, 588 cranio-orbital fractures following blunt trauma were evaluated retrospectively with regard to the anatomical site and surgical treatment. Orbital cranial nerve injuries and the outcomes of the medical and/or surgical treatment are described. Distribution of the zygomatic complex and orbital fractures were as follows: zygomatic complex fractures (n:304), isolated orbital fractures (n:58), complex comminuted fractures (n:226). In 58 cases, 69 orbit fractures were found (11 bilateral and 47 unilateral fractures). The lateral wall was the most frequent fracture (n:63). The least frequent fracture was the roof of the orbit (n:11). The accompanying lesions were as follows: 89.65% of cases were associated with periorbital haematoma (n:52), 13.79% of cases with retrobulbar haemorrhage (n:8), 96.55% cases with periorbital soft tissue oedema (n:56), 53.45% cases with pneumocephalus (n:31), 8.62% cases with intra-parenchymal contusion (n:5), 6.89% cases with enophthalmia (n:4), 5.17% of cases with rhinorrhoea (n: 3), 5.17% cases with optic bulb injury and adnexial trauma (n:3), 32.76% cases with intra-orbital emphysema (n:19), and 20.69% with vision dysfunctions (n:12), of whom 2 had no optic nerve injury. Copyright © 2011 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  17. Toxicity of Gamma Knife Radiosurgery in the Treatment of Intracranial Tumors in Patients With Collagen Vascular Diseases or Multiple Sclerosis

    Energy Technology Data Exchange (ETDEWEB)

    Lowell, Dot [Department of Radiation Oncology, School of Medicine, Wake Forest University, Winston-Salem, NC (United States); Tatter, Stephen B. [Department of Neurosurgery, School of Medicine, Wake Forest University, Winston-Salem, NC (United States); Bourland, J. Daniel; Guzman, Allan F. de; Ekstrand, Kenneth E. [Department of Radiation Oncology, School of Medicine, Wake Forest University, Winston-Salem, NC (United States); Ellis, Thomas L. [Department of Neurosurgery, School of Medicine, Wake Forest University, Winston-Salem, NC (United States); Lovato, James F. [Division of Public Health Sciences, School of Medicine, Wake Forest University, Winston-Salem, NC (United States); McMullen, Kevin P.; Munley, Michael T.; Shaw, Edward G.; Urbanic, James J. [Department of Radiation Oncology, School of Medicine, Wake Forest University, Winston-Salem, NC (United States); Chan, Michael D., E-mail: mchan@wfubmc.edu [Department of Radiation Oncology, School of Medicine, Wake Forest University, Winston-Salem, NC (United States)

    2011-11-15

    Purpose: To assess toxicity in patients with either a collagen vascular disease (CVD) or multiple sclerosis (MS) treated with intracranial radiosurgery. Methods and Materials: Between January 2004 and April 2009, 6 patients with MS and 14 patients with a CVD were treated with Gamma Knife radiosurgery (GKRS) for intracranial tumors. Treated lesions included 15 total brain metastases in 7 patients, 11 benign brain tumors, 1 low grade glioma, and 1 cavernous malformation. Toxicities were graded by the Radiation Therapy Oncology Group Acute/Late Radiation Morbidity Scoring Criteria. 'Rare toxicities' were characterized as those reported in the scientific literature at an incidence of <5%. Results: Median follow-up time was 16 months. Median dose to the tumor margin was 13.0 Gy (range, 12-21 Gy). Median size of tumor was 5.0 cm{sup 3} (range, 0.14-7.8 cm{sup 3}). Of the 14 patients with CVD, none experienced a Grade 3 or 4 toxicity or a toxicity characterized as rare. Of the 6 patients with MS, 3 experienced rare toxicities, and two of these were Grade 3 toxicities. Rare complications included a patient experiencing both communicating hydrocephalus and facial nerve palsy, as well as 2 additional patients with motor cranial nerve palsy. High-grade toxicities included the patient with an acoustic neuroma requiring ventriculoperitoneal shunt placement for obstructive hydrocephalus, and 1 patient with a facial nerve schwannoma who experienced permanent facial nerve palsy. Interval between radiosurgery and high-grade toxicities ranged from 1 week to 4 months. Conclusions: Our series suggests that patients with MS who receive GKRS may be at increased risk of rare and high-grade treatment-related toxicity. Given the time course of toxicity, treatment-related edema or demyelination represent potential mechanisms.

  18. Removal of vestibular schwannoma and facial nerve preservation using small suboccipital retrosigmoid craniotomy

    Institute of Scientific and Technical Information of China (English)

    CHEN Ling; CHEN Li-hua; LING Feng; LIU Yun-sheng; Madjid Samii; Amir Samii

    2010-01-01

    Background Vestibular schwannoma, the commonest form of intracranial schwannoma, arises from the Schwann cells investing the vestibular nerve. At present, the surgery for vestibular schwannoma remains one of the most complicated operations demanding for surgical skills in neurosurgery. And the trend of minimal invasion should also be the major influence on the management of patients with vestibular schwannomas. We summarized the microsurgical removal experience in a recent series of vestibular schwannomas and presented the operative technique and cranial nerve preservation in order to improve the rates of total tumor removal and facial nerve preservation.Methods A retrospective analysis was performed in 145 patients over a 7-year period who suffered from vestibular schwannomas that had been microsurgicaily removed by suboccipital retrosigmoid transmeatus approach with small craniotomy. CT thinner scans revealed the tumor size in the internal auditory meatus and the relationship of the posterior wall of the internal acoustic meatus to the bone labyrinths preoperatively. Brain stem evoked potential was monitored intraoperatively. The posterior wall of the internal acoustic meatus was designedly drilled off. Patient records and operative reports, including data from the electrophysiological monitoring, follow-up audiometric examinations, and neuroradiological findings were analyzed.Results Total tumor resection was achieved in 140 cases (96.6%) and subtotal resection in 5 cases. The anatomical integrity of the facial nerve was preserved in 91.0% (132/145) of the cases. Intracranial end-to-end anastomosis of the facial nerve was performed in 7 cases. Functional preservation of the facial nerve was achieved in 115 patients (Grade Ⅰ and Grade Ⅱ, 79.3%). No patient died in this series. Preservation of nerves and vessels were as important as tumor removal dudng the operation. CT thinner scan could show the relationship between the posterior wall of the internal

  19. Ultrasonographic nerve enlargement of the median and ulnar nerves and the cervical nerve roots in patients with demyelinating Charcot-Marie-Tooth disease: distinction from patients with chronic inflammatory demyelinating polyneuropathy.

    Science.gov (United States)

    Sugimoto, Takamichi; Ochi, Kazuhide; Hosomi, Naohisa; Takahashi, Tetsuya; Ueno, Hiroki; Nakamura, Takeshi; Nagano, Yoshito; Maruyama, Hirofumi; Kohriyama, Tatsuo; Matsumoto, Masayasu

    2013-10-01

    Demyelinating Charcot-Marie-Tooth disease (CMT) and chronic inflammatory demyelinating polyneuropathy (CIDP) are both demyelinating polyneuropathies. The differences in nerve enlargement degree and pattern at multiple evaluation sites/levels are not well known. We investigated the differences in nerve enlargement degree and the distribution pattern of nerve enlargement in patients with demyelinating CMT and CIDP, and verified the appropriate combination of sites/levels to differentiate between these diseases. Ten patients (aged 23-84 years, three females) with demyelinating CMT and 16 patients (aged 30-85 years, five females) with CIDP were evaluated in this study. The nerve sizes were measured at 24 predetermined sites/levels from the median and ulnar nerves and the cervical nerve roots (CNR) using ultrasonography. The evaluation sites/levels were classified into three regions: distal, intermediate and cervical. The number of sites/levels that exhibited nerve enlargement (enlargement site number, ESN) in each region was determined from the 24 sites/levels and from the selected eight screening sites/levels, respectively. The cross-sectional areas of the peripheral nerves were markedly larger at all evaluation sites in patients with demyelinating CMT than in patients with CIDP (p demyelinating CMT and CIDP were 0.90 and 0.94, respectively, with the cut-off value set at four. Nerve ultrasonography is useful to detect nerve enlargement and can clarify morphological differences in nerves between patients with demyelinating CMT and CIDP.

  20. [Peripheral facial nerve palsy].

    Science.gov (United States)

    Pons, Y; Ukkola-Pons, E; Ballivet de Régloix, S; Champagne, C; Raynal, M; Lepage, P; Kossowski, M

    2013-06-01

    Facial palsy can be defined as a decrease in function of the facial nerve, the primary motor nerve of the facial muscles. When the facial palsy is peripheral, it affects both the superior and inferior areas of the face as opposed to central palsies, which affect only the inferior portion. The main cause of peripheral facial palsies is Bell's palsy, which remains a diagnosis of exclusion. The prognosis is good in most cases. In cases with significant cosmetic sequelae, a variety of surgical procedures are available (such as hypoglossal-facial anastomosis, temporalis myoplasty and Tenzel external canthopexy) to rehabilitate facial aesthetics and function.