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3-D Model of The Oculomotor Fascicular Arrangement Within The Midbrain Using Brain MRI
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Jeong Ho Park, Du Shin Jeong, Sun Ah Park, Tae Kyeong Lee, Ki Bum Sung
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J Korean Bal Soc. 2008;7(1):22-32.
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- Background and Purpose: The oculomotor nerve fascicles arise along its entire length and sweep ventrally to exit the midbrain at the medial edge of the crus cerebri. A rostro-caudal topography among the fascicular fibers is relatively well established. There are, however, some controversies whether medio-lateral topography also exists.
Methods: We retrospectively reviewed the clinical records and MRI of the 8 patients showing isolated oculomotor nerve palsy due to midbrain infarction. Brain MRI was performed using a 1.5-T magnet with 2mm thickness and 0.1 mm slice interval. The anterior-posterior axis(X) was defined as the midline crossing the center of the cerebral aqueduct and the medio-lateral axis(Y) as the line crossing the same point. For rostro-caudal measurement, the intercommissural line was used as base line of the Z axis. The location of the lesions was defined by measuring actual distance of the margins of the lesions in millimeter from each axis; anterior, right, and caudal direction was defined as positive values in X, Y and Z coordinates, respectively.
Results: The mean values and range of the X, Y and Z are as follows: X=7.56±4.34, 1≤X≤15; Y=3.43±1.37, 0≤Y≤6; Z=6.51±3.91, 0≤Z≤12.5.
Conclusions: The distribution of all the MRI lesions was 0≤|Y|≤6 (mm), 0≤|Z|≤12.5 (mm) in mediolateral and rostrocaudal direction respectively, which is almost the same as the previously reported divergent range of the oculomotor fascicles in midbrain tegmentum. We suggest that our method of three dimensional measurements of the MRI lesion in midbrain tegmentum could be a useful tool for the study of oculomotor fascicular arrangement.
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A Case of Bilateral Vestibulopathy Caused by Varicella-Zoster Meningitis
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Young Hun Yun, Jeong Ho Park, Tae Kyeong Lee, Ki Bum Sung
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J Korean Bal Soc. 2007;6(2):230-233.
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- Among various etiologies of bilateral vestibulopathy, meningitis has rarely been reported and no case by varicellazoster meningitis. We experienced a case of bilateral vestibulopathy and aseptic meningitis developed in a 22-year old woman who was previously affected by chicken pox. She had oscillopsia and unsteadiness of gait when the typical skin lesion of chicken pox was improving. Neurootologic examination, bithermal caloric irrigation, and rotary chair test showed the result compatible with complete bilateral vestibulopathy. With mild headache and nausea, her CSF finding revealed aseptic meningitis and the serum antibody for varicella-zoster virus (VZV) was elevated. On the contrary of previous report that associated with bilateral vestibulopathy tend to poorly improved, this patient showed a favorable outcome with recovery of symptoms and caloric test.
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Lateralizing Value of Romberg Test and Modified Romberg Test in Acute Unilateral Vestibular Neuritis
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Won Hee Chung, Jeong Ho Park, Tae Kyeong Lee, Ki Bum Sung
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J Korean Bal Soc. 2007;6(1):41-49.
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- Background and objectives: Romberg test has been regarded as simple and efficient bedside modality to evaluate the vestibulospinal reflex in patients with balance disorders. we compared the direction of fall and that of yaw head rotation during Romberg test to evaluate its lateralizing value in acute unilateral vestibular neuritis.
Materials and methods: Forty three patients (n=43) with acute unilateral vestibular neuritis were included. We did Romberg test in three different head positions: with a head looking straight ahead (Romberg test1), turned to the right by about 90 degrees (Romberg test2) and turned to the left by about 90 degrees (Romberg test3) in yaw. Affected side of the vestibular neuritis was decided by the direction of nystagmus and the side of canal paresis. We compared the falling direction in each Romberg test, direction of nystagmus and canal paresis.
Results: During Romberg test, 19 out of 43 fell to the lesion side (44%) and during modified Romberg test, 18 out of 43 fell to the lesion side (42%). On modified Romberg test, fallings to the side of affected labyrinth showed 14/18(78%) in the Romberg test 2 and 15/18 (83%) in the Romberg test 3. The direction of falling in each maneuvers correlated statistically to the side of the affected labyrinth (p<0.05). Direction of nystagmus and the side of the canal paresis also showed correlation to the direction of falling in modified Romberg test.
Conclusion: Romberg and Modified Romberg tests are helpful to decide the affected side in vestibular neuritis to some extents.
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Biphasic Head-Shaking Nystagmus in a Patient with Anterior Inferior Cerebellar Artery Infarction
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Won Hee Chung, Jeong Ho Park, Tae Kyeong Lee, Ki Bum Sung
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J Korean Bal Soc. 2006;5(2):317-319.
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- Head-shaking test is a sensitive screening tool for a detection of peripheral and central vestibular system disease. Biphasic head-shaking nystagmus (b-HSN) is a rather uncommon phenomenon which was a combination of the paretic nystagmus and recovery nystagmus. We report characteristics of b-HSN in a patient with anterior inferior cerebellar artery infarction, whose only complaint was recurrent vertigo.
Key Words : Nystagmus, Anterior inferior cerebellar artery infarction
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A Case of Carotid Cavernous Fistula Presenting with “Delayed Red-Eyed Shunts”
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Ki Bum Sung, Won Hee Chung, Jeong Ho Park, Dae Ho Kim
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J Korean Bal Soc. 2006;5(2):307-310.
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- Presenting symptoms of carotid cavernous fistulas (CCF) may vary according to the draining vessels. Prominent external orbito-ocular signs such as red eye, proptosis, ocular bruit occur, when the shunt drains anteriorly (“red-eyed shunts”), whereas an isolated ocular motor nerve palsy and headache can be the only presenting symptoms when it drains posteriorly (“white-eyed shunts”). Turning the eyes red from white eyed-shunt weeks to months (“delayed red-eyed shunts”) suggest the direction of fistula drainage shifted anteriorly; it has rarely been reported. We report a patient with delayed red-eyed shunts whose red eye resolved after chemical embolization of draining vessels.
Key Words : Carotid cavernous sinus fistula, Ocular motor nerve palsy
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Partial Oculomotor Nerve Palsy due to Different Fascicular Involvements in Recurrent Midbrain Infarctions
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Jeong Ho Park, Won Hee Chung, Tae Kyeong Lee, Ki Bum Sung
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J Korean Bal Soc. 2006;5(2):292-295.
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- We experienced a patient with partial oculomotor palsy who had initially manifested pupillary mydriasis and inferior rectus palsy which were attributed to an ipsilateral fascicular lesion in midbrain. She developed ipsilateral ptosis and monocular elevation palsy due to a new lesion on MRI one month later. This case could be the first neuroimaging evidence which support the hypothesis that fascicles of the oculomotor nerve for inferior oblique, superior rectus, and levator palphebrae muscle fibers are located more laterally and caudally than fascicles for pupil and inferior rectus muscle within midbrain tegmentum.
Key Words : Oculomotor nerve, Infarction, Midbrain
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A Rostro-Caudal Arrangement of the Oculomotor Fascicles Based on MR Findings of Midbrain Infarctions in Two Cases
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Jeong Ho Park, Won Hee Chung, Tae Kyeong Lee, Ki Bum Sung
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J Korean Bal Soc. 2006;5(2):281-284.
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- A rostro-caudal topography of the oculomotor nerve fascicles is relatively well known in animal but not in human. We experienced two cases of midbrain infarctions presenting with isolated oculomotor nerve palsies. The MRI of the patient who had monocular elevation palsy with ptosis revealed a lesion in the middle to lower midbrain, whereas that of the other who had monocular depression and adduction palsy with pupillary mydriasis showed a discrete lesion in the upper to middle midbrain. We present the rostro-caudal arrangement of the oculomotor fascicles within midbrain based on MRI findings.
Key Words : Oculomotor nerve palsies, Magnetic resonance imaging
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A Case of Isolated Unilateral Abducens Nerve Palsy Caused by Clival Metastasis from Rectal Cancer
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Won Hee Chung, Jeong Ho Park, Sun Ah Park, Ki Bum Sung
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J Korean Bal Soc. 2006;5(1):78-80.
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- A wide variety of abnormalities, both primary to the nerve itself and secondarily involving the nerve, can cause isolated abducens nerve palsy. Skull base lesions are also regarded as possible causes of isolated abducens nerve palsy but clival metastasis from systemic malignancy has rarely been reported. We report a case of isolated abducens nerve palsy caused by clival metastasis from rectal cancer.
Key Words : Abducens nerve palsy, Metastasis, Skull base, Rectal neoplasm
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A Case of Tolosa-Hunt Syndrome with Serial MRI Findings
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Jeong Ho Park, Won Hee Chung, Dae Ho Kim, Ki Bum Sung
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J Korean Bal Soc. 2006;5(1):74-77.
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- To diagnosis Tolosa-Hunt syndrome (TSH) used to be difficult because some other diseases like tumors, sarcoids, vasculitises or other inflammatory masses simulate the clinical manifestations, including steroid responsiveness and radiologic findings. According to the international classification of headache disorders 2nd edition, the diagnosis of THS requires demonstration of granuloma by MRI or biopsy. We performed MRI 4 times during 6 months in a patient who seemed to have THS. Initial MRI was normal but the second MRI showed granuloma which decreased gradually in size with steroid treatment.
Key Words : Tolosa-Hunt syndrome, Magnetic resonance imaging, Granuloma
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Isolated Abducens Nerve Palsy Caused by De Novo Pontine Cavernous Angioma
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Jeong Ho Park, Won Hee Chung, Sun Ah Park, Ki Bum Sung
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J Korean Bal Soc. 2006;5(1):70-73.
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- Cavernous angiomas are considered to be congenital in origin. Patients under age of 14 years usually does not require imaging because they are likely to have a benign abducens nerve palsy, unless they develop additional signs or symptoms of neurologic disease during observation. Here we report a case of an isolated abducens nerve palsy caused by overt hemorrhage from de novo formation of cavernous angioma in the pons. Cavernous angiomas of the brain stem should be considered as a possible cause of isolated abducens nerve palsy in young adult and MRI, including gradient-echo sequences should be performed.
Key Words : Cavernous angioma, Abducens nerve palsy
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