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Case Report
- Ponto-medullary Junction Infarction Presenting as Ipsilateral Abducens Nerve Palsy and Contralateral Hemiparesis without Facial Involvement
- Ji Hun Lim, Young Seo Kim, Hak Seung Lee
- Res Vestib Sci. 2019;18(4):118-121. Published online December 15, 2019
- DOI: https://doi.org/10.21790/rvs.2019.18.4.118
- 8,316 View
- 88 Download
- 2 Crossref
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Abstract
PDF - Raymond syndrome is a pontine syndrome consisting of ipsilateral abducens nerve palsy, contralateral facial paralysis, and contralateral hemiparesis. However, subsequent clinical observations argued on the presentation of facial involvement. The only differentiating point between the facial including called classic type and the facial sparing Raymond syndrome is the location of the lesion. The classic type involves abducens nerve, corticofacial, and corticospinal tracts; while in the facial sparing type, corticofacial tracts, and peripheral facial nerves are spared. We experienced a 78-year-old man presented with sudden onset dizziness, binocular horizontal diplopia, and right-sided motor weakness. Neurological examination showed he had left abducens nerve palsy and right hemiparesis without facial involvement. Brain magnetic resonance imaging showed acute ischemic infarction in the left ponto-medullary junction. Regardless of the presence or absence of facial palsy, the combination of abducence nerve palsy and contralateral hemiparesis should direct the clinician’s attention towards the medial ventral caudal ponto-medullary junction.
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Citations
Citations to this article as recorded by
Review
- Anatomy and Physiology of the Autonomic Nervous System
- Byung Rim Park
- Res Vestib Sci. 2017;16(4):101-107. Published online December 15, 2017
- DOI: https://doi.org/10.21790/rvs.2017.16.4.101
- 15,332 View
- 939 Download
- 5 Crossref
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Abstract
PDF
- The autonomic nervous system (ANS) integrates the function of the internal organs for the homeostasis against various external environmental changes. The efferent components of the ANS are regulated by sensory signals arising from the viscera as well as non-visceral organs. The central neural networks that integrate these sensory signals and modify visceral motor output are complex, and synaptic reflexes formed in the brainstem and spinal cord integrate behavioral responses and visceral responses through the central neural networks. A detailed understanding of the neural network presented above may explain the role of the vestibular system on the homeostasis more extensively.
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Citations
Citations to this article as recorded by- Sound stimulation using the individual's heart rate to improve the stability and homeostasis of the autonomic nervous system
Daechang Kim, Nahyeon Kim, Younju Lee, Sungmin Kim, Jiyean Kwon
Physiological Reports.2023;[Epub] CrossRef - A Study on Resonance Sound Stimulation Using an Individual's Heart Rate to Improve the Stability and Homeostasis of the Autonomic Nervous System
kim daechang, Seungbong Lee, Jaehoon Jeong, Sung Min Kim
SSRN Electronic Journal .2022;[Epub] CrossRef - Effect of Acupuncture at the Field of the Auricular Branch of the Vagus Nerve on Autonomic Nervous System Change
Sunjoo An, Dongho Keum
Journal of Korean Medicine Rehabilitation.2021; 31(2): 81. CrossRef - A Study on the Gamification of Television Broadcasting
Shin-kyu Kang
Korean Journal of Journalism & Communication Studi.2019; 63(3): 145. CrossRef - A Clinical Study on the Relationship between Pattern and Ryodoraku Test Identifications for Patients with Functional Dyspepsia
Whee-hyoung Ko, Na-yeon Ha, Seok-jae Ko, Jae-woo Park, Jin-sung Kim
The Journal of Internal Korean Medicine.2019; 40(3): 369. CrossRef
- Sound stimulation using the individual's heart rate to improve the stability and homeostasis of the autonomic nervous system
Case Reports
- Lateral Medullary Infarction with Ipsilesional Gaze-Evoked and Head-Shaking Nystagmus
- Taesuk Kyung, Minbum Kim
- Res Vestib Sci. 2014;13(4):114-116.
- 2,577 View
- 76 Download
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Abstract
PDF
- For differential diagnosis between vestibular neuritis and lateral medullary infarction with similar clinical features, bedside examination of nystagmus is important. We report a 45-year-old male who presented with acute vertigo for two days. He showed spontaneous right-beating nystagmus. However, left-beating nystagmus was evoked during bilateral horizontal gaze and by horizontal head oscillation. Brain MRI revealed an acute infarction in the left lateral medulla.
- A Case of Posterior Inferior Cerebellar Artery Infarction Presenting with Sudden Hearing Loss and Vertigo
- Sang Hyo Lee, Go Woon Kim, Bum Ki Cho, Chang Woo Kim
- Res Vestib Sci. 2013;12(4):136-139.
- 2,645 View
- 77 Download
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Abstract
PDF
- Sudden hearing loss and vertigo are the typical presentation of anterior inferior cerebellar artery infarction, but may rarely occur in posterior inferior cerebellar artery (PICA) infarction. Here we describe a 65-year-old man who presented with sudden hearing loss in his left ear and severe vertigo. The diffusion-weighted magnetic resonance imaging revealed acute infarction in the territory of PICA and cerebral angiography showed non-visualization of left vertebral artery. Sudden hearing loss and vertigo may be a presentation of PICA infarction.
- Isolated Body Lateropulsion as a Presenting Symptom of Lateral Medullary Infarction
- Jae Hwan Choi, Min Gyu Park, Kyung Pil Park, Kwang Dong Choi
- Res Vestib Sci. 2013;12(1):31-34.
- 2,054 View
- 30 Download
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Abstract
PDF
- Body lateropulsion is a common manifestation of lateral medullary infarction (LMI), and usually associated with vertigo, limb ataxia, sensory disturbance, and Horner’s syndrome. However, isolated body lateropulsion as a presenting symptom of LMI is rare, and the responsible lesion for lateropulsion remains uncertain. We report a 71-year-old woman who showed isolated body lateropulsion as a presenting symptom of LMI. Ipsilateral body lateropulsion in our patient may be ascribed to the involvement of the ascending dorsal spinocerebellar tract rather than the descending lateral vestibulospinal tract, which runs more ventromedially.
- A Case of Lateral Medullary Syndrome with Ipsilesional Nystagmus due to Intramedullary Hemorrhage
- Ki Bum Sung, Ji Yun Park, Sun Ah Park, Tae Kyeong Lee
- Res Vestib Sci. 2009;8(1):52-55.
- 2,099 View
- 28 Download
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Abstract
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- We report a rare case of primary dorsal medullary hemorrhage showing lateral medullary syndrome with ipsilesional nystagmus. A 41-year woman, presented with the first degree horizontal vestibular nystagmus and ocular tilt reaction to the left in lateral medullary hemorrhagic lesion. Primary medullary hemorrhage is rare and details of the abnormal eye movement in the lesion have never been described well. While most of the reported vestibular nystagmus in the lateral medullary infarction was contralesional., the nystagmus in this case was ipsilesional. This ipsilesional beating of the nystagmus might be explained that either destruction of the rostral part of vestibular nuclei or irritative effect of blood to vestibular nuclei is responsible. In addition, ocular tilt reaction (OTR) can be more important in deciding the side of the lesion in medullary hemorrhage. Key Words: Lateral medullary syndrome; Medulla oblongata, Hemorrhage; Nystagmus, Pathologic
Original Article
- Role of Central Vestibular Pathway on Control of Blood Pressure During Acute Hypotension in Rats
- Yuan Zhe Jin, Guang Shi Jin, Min Sun Kim, Byung Rim Park
- J Korean Bal Soc. 2005;4(2):189-200.
- 2,094 View
- 4 Download
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Abstract
PDF
- Background
and Objectives: Central role of the vestibular system on control of blood pressure and interrelationships between the vestibular nucleus and solitary nucleus during acute hypotension were investigated in bilateral labyrinthectomized (BLX) or sinoaortic denervated (SAD) rats. Changes of electrical activity in the medial vestibular nucleus (MVN), solitary tract nucleus (STN), and rostral ventrolateral medullary nucleus (RVLM) were investigated in rats in while acute hypotension was induced by sodium nitroprusside (SNP).
Results
Evoked potential in MVN neuron caused by electrical stimulation of the peripheral vestibular system was composed of 3 waves with latencies of 0.48±0.10 ms, 1.04±0.09 ms and 1.98±0.19 ms. Electrical stimulation to MVN or RVLM increased blood pressure. MVN at the induction of acute hypotension showed excitation in 61% of type I neurons and inhibition in 68% of type II neurons. In STN, acute hypotension produced excitation in 62.1% of neurons recorded in intact abyrinthine animals, inhibition in 72.3% of neurons recorded in BL animals, and excitation in 60% of recorded neurons in SAD animals. In RVLM, acute hypotension produced excitation in 66.7% of neurons recorded in intact labyrinthine animals and inhibition in 64.9% of neurons recorded in BL animals. In spatial distribution of STN neurons responded to acute hypotension, excitatory responses were mainly recorded in rostral and ventral portion, and inhibitory responses were mainly recorded in caudal and lateral portion. In RVLM, excitatory responses were mainly recorded in rostral and dorsomedial portion, and inhibitory responses were mainly recorded in caudal and ventrolateral portion.
Conclusion
These results suggest that afferent signals from the peripheral vestibular receptors are transmitted to STN through the vestibular nuclei and assist to the baroreceptors for controlling blood pressure following acute hypotension.
Review
- Central Positional Nystagmus from Focal Brain Lesion
- Ja Won Koo, Kwang Dong Choi, So Young Moon, Seong Ho Park, Ji Soo Kim
- J Korean Bal Soc. 2004;3(1):129-135.
- 2,115 View
- 11 Download
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Abstract
PDF
- Department of Otolaryngology, Head and Neck Surgery1, and Neurology2, Seoul National University Bundang Hospital,
Seoul National University College of Medicine, Seongnam, Korea
Background and Objectives : Central positional nystagmus is induced by positional changes from brainstem or
cerebellar lesions. Differentiation central from peripheral positional nystagmus is important in clinical practice. To
delineate characteristics of the positional nystagmus observed in central lesions, we analyzed the parameters of
positional nystagmus from focal brain lesions.
Materials and Methods : Ten patients with central positional nystagmus were recruited from the dizziness clinic
of Seoul National University Bundang Hospital. All the patients had focal brainstem or cerebellar lesions documented
by magnetic resonance imaging. The nystagmus was observed with and without fixation by using Frenzel glasses or
Video Goggles. The nystagmus was videotaped or recorded with video-oculography. Provoking positional maneuvers,
direction, latency, duration, phase reversal, and fatigue phenomenon of the nystagmus were analyzed.
Results
: Of the 10 patients, seven had infarctions in the lateral medulla or inferior cerebellum while two experienced cerebellar hemorrhage and remaining one showed a compression of the ventrolateral medulla by cavernous malformation of the vertebral artery. The directions of the positional nystagmus were variable depending on the lesions and provoking maneuvers. Most patients exhibited direction-changing nystagmus without latency, direction-reversal and fatigue phenomenon. However, some of the patients also showed patterns of nystagmus characteristic of peripheral positional nystagmus. In two of the four patients with infarction in the territory of medial posterior inferior cerebellar artery, the positional nystagmus was the only abnormal findings.
Conclusions
: Central positional nystagmus may share many characteristics with peripheral type of positional nystagmus. In individual cases, the patterns of nystagmus should be interpreted with caution in differentiating central from peripheral positional nystagmus. Considering the isolated positional nystagmus in some patients with caudal cerebellar lesions, systematic positional maneuvers should be applied to all the patients with vertigo Key Words : Positional nystagmus, Medulla, Cerebellum
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