A case of intractable hiccup developed by cavernous hemangioma in the medulla oblongata is reported. There have been only five previously reported cases of medullary cavernoma that triggered intractable hiccup. The patient was a 28-year-old man who was presented with intractable hiccup for 15 days. It developed suddenly, then aggravated progressively and did not respond to any types of medication. On magnetic resonance images, a well-demarcated and non-enhancing mass with hemorrhagic changes was noted in the left medulla oblongata. Intraoperative findings showed that the lesion was fully embedded within the brain stem and pathology confirmed the diagnosis of cavernous hemangioma. The hiccup resolved completely after the operation. Based on the presumption that the medullary cavernoma may trigger intractable hiccup by displacing or compression the hiccup arc of the dorsolateral medulla, surgical excision can eliminate the symptoms, even in the case totally buried in brainstem.
Adult ; Brain Stem ; Diagnosis ; Hemangioma, Cavernous* ; Hiccup* ; Humans ; Medulla Oblongata* ; Pathology

Animals ; Basilar Artery ; Brain Ischemia ; pathology ; Brain Stem ; blood supply ; Cats ; Medulla Oblongata ; blood supply

Humans ; Child ; Sleep Apnea Syndromes/complications* ; Medulla Oblongata/pathology* ; Neoplasms/complications*

AIMObservations on medullary ischemia region, the morphology of neurons and changes of respiration and blood pressure were made, in order to give evidences on how medullary ischemia affects respiration and circulation and give some advices on how to protect from it.

METHODSUsing cats as the experimental animals, the different parts of the basilar artery trunk were ligated. The changes in the density of blood vessels, the morphology of neurons in the brainstem, the electromyogram (EMG) of the diaphragm and the blood pressure of the femoral artery were investigated.

RESULTSThe density of blood vessels notably decreased in the medulla after ligating the basilar artery trunk. The ischemic range induced by ligation of the different parts of the basilar artery trunk overlapped, mainly locating in the medulla rostral to the obex. The soma were swelled and the Nissl bodies decreased in some of neurons in the ischemic region of medulla. The duration of inspiration (T1) and expiration (TE) shortened, respiratory frequency (RF) increased, and mean blood pressure (MBP) decreased in the experimental groups (P < 0.05).

CONCLUSIONThere is an obvious overlap of the areas in which blood supplied by different parts of the basilar artery trunk. Medullary ischemia can involve in changes of respiration and blood pressure. The ischemic damage of neurons in the medulla might be the structural basis of the changes in the respiratory and circulatory functions.

Animals ; Basilar Artery ; Blood Pressure ; Brain Ischemia ; physiopathology ; Cats ; Medulla Oblongata ; pathology ; Respiration ; Respiratory System ; blood supply ; physiopathology

Brain Infarction ; diagnostic imaging ; pathology ; Computed Tomography Angiography ; Constriction, Pathologic ; diagnostic imaging ; pathology ; Humans ; Male ; Medulla Oblongata ; diagnostic imaging ; pathology ; Middle Aged ; Vertebral Artery ; diagnostic imaging ; pathology

OBJECTIVETo analyze the clinical characteristics and surgery approach for patients with brainstem cavernous malformation (BSCM).

METHODSThe clinical data of 23 BSCM patients (5 cases at midbrain, 16 cases at pons, and 2 cases at medulla) treated in the Second Affiliated Hospital Zhejiang University School of Medicine from July 2003 to June 2014 were retrospectively reviewed. The medical history, radiological findings, operation records, postoperative course and follow-up results were analyzed.

RESULTSSuboccipital approach, retrosigmoid approach, subtentorial supracerebella approach, Poppen approach, pterional approach, Kawase approach, interhemispheric transcallosal third ventrical approach were applied for the surgery of BSCM patients. Among them, Kawase approach and interhemispheric transcallosal third ventrical approach were firstly reported in treatment of BSCM. Total resection was achieved in 22 cases. Neurological function was improved in 15 cases, unchanged in 7 cases and deteriorated in 1 case. Fifteen cases were followed up for a mean period of 3.5 years and signs of recurrence was found.

CONCLUSIONProper selection of surgical approach is important to assure total resection of the lesions, to protect surrounding normal vital structures and to avoid post-surgical complications.

Humans ; Medulla Oblongata ; pathology ; surgery ; Mesencephalon ; pathology ; surgery ; Neurosurgical Procedures ; methods ; Pons ; pathology ; surgery ; Postoperative Period ; Recurrence ; Retrospective Studies ; Treatment Outcome

OBJECTIVEThere is no report on Bickerstaff's brainstem encephalitis (BBE) patients in China. We here report the first case of BBE in China.

METHODSClinical features, results of electromyography, electroencephalography (EEG), magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) examination were studied to clarify the characteristics of this syndrome.

RESULTSA 44-year-old man presented himself at our inpatient department with somnolence and dizziness as his initial symptoms. He developed multiple cranial nerves paralysis especially internal and external ophthalmoplegia, ataxia and tetraparesis within 1 week. His condition rapidly deteriorated, and he experienced coma. Electromyography showed indications of peripheral nerve dysfunction, electroencephalography revealed loss of basic rhythm, MRI demonstrated high-intensity abnormalities on T(2)-weighted images of medulla oblongata, and CSF albuminocytological dissociation was defined abnormally as high protein. Ten months later, he almost completely recovered.

CONCLUSIONBBE, fisher syndrome (FS) and Guillain-Barré syndrome (GBS) are similar clinically; BBE and FS were proposed to be the variant of GBS.

Adult ; Brain ; pathology ; Coma ; Diagnosis, Differential ; Electroencephalography ; Electromyography ; Encephalitis ; complications ; Guillain-Barre Syndrome ; complications ; Humans ; Magnetic Resonance Imaging ; Male ; Medulla Oblongata ; pathology ; Time Factors

The aim of this study is to study the damage effects of chronic hypoxia on medulla oblongata and to explore whether the damage is associated with oxidative stress and cell apoptosis. Adult male SD rats were randomly divided into two groups: control group and chronic hypoxia group. Medulla oblongata was obtained for the following methods of analyses. Nissl's staining was used to examine the Niss bodies of neurons in medullary respiratory related nuclei, biochemistry methods were utilized to examine oxidant stress damage induced by chronic hypoxia on medulla oblongata through measuring malondialdehyde (MDA) content and superoxide dismutase (SOD) activity, and RT-PCR technique was used to study the influence of apoptosis induced by chronic hypoxia on medulla oblongata through analyzing the levels of Bax mRNA and Bcl-2 mRNA. The results showed the optical densities of Nissl's staining in pre-BötC, NA, NTS, FN, and 12N were significantly decreased in chronic hypoxia group in comparison with that in control group (P < 0.05). In chronic hypoxia group, MDA level was significantly higher than that in the control group (P < 0.05), whereas SOD level had no significant difference between the two groups (P > 0.05). Bax mRNA expression had no obvious change and Bcl-2 mRNA expression significantly decreased in chronic hypoxia group in comparison with that in control group (P < 0.05). The results suggest that chronic hypoxia could bring about serious damage to medullary respiratory centers through aggravating oxidative stress and increasing cell apoptosis.
Animals ; Apoptosis ; Chronic Disease ; Hypoxia ; physiopathology ; Male ; Medulla Oblongata ; metabolism ; pathology ; physiopathology ; Oxidative Stress ; Rats ; Rats, Sprague-Dawley ; Respiratory Center ; metabolism ; pathology ; physiopathology ; Superoxide Dismutase ; metabolism

We investigated a topographical distribution of managanese, and immunohistochemical density of tyrosine hydroxylase (TH), and histopathologic findings in globus pallidus and substantia nigra according to manganese dose and time course in the brain of rats which received MnCl2 intravenously. Topographical distribution of manganese was also investigated after injection of FeCl2. The manganese concentrations of brain in control and experimental group were highest in pituitary gland and thalamus, and lowest in the cerebral cortex. The manganese concentration of blood was increased proportionally to the dose administered, and the biological half-life of blood manganese was between 21 and 42 days. The manganese concentrations of brain were increased proportionally to the dose, and increase rate was highest in olfactory bulb, and the biological half-lives of brain manganese ranged from 42 days to 90 or more days; the longest were observed in pituitary gland, medulla oblongata and cerebral cortex. In case of administration of FeCl2, the manganese concentrations of brain were higher than that of control group in dose of 2.5 mg/kg, and decreased proportionally to the administered dose, resulting in lower level compared with control group in high dose of FeCl2 administered. Significantly decreased number of nerve cell and increased gliosis in globus pallidus were observed in experimental group, which were closely correlated with the duration after manganese injection, but no significant change of number of nerve cell expressing TH and gliosis were observed in substantia nigra. Density of immunohistochemical reaction for TH in globus pallidus made little difference between control and experimental group. These results suggest that pathology of manganese intoxication is caused by the loss of nerve cells in globus pallidus, and closely correlated with the duration after manganese exposure.
Animals ; Brain* ; Cerebral Cortex ; Gliosis ; Globus Pallidus ; Half-Life ; Manganese* ; Medulla Oblongata ; Neurons ; Olfactory Bulb ; Pathology ; Pituitary Gland ; Rats* ; Substantia Nigra ; Thalamus ; Tyrosine 3-Monooxygenase

OBJECTIVESTo evaluate the changes of the position of medulla oblongata and cerebellum following posterior fossa decompression (PFD), and to investigate their influences on the prognosis of the syringomyelia in adolescents with Chiari malformation (CM).

METHODSA retrospective review was performed on all CM patients between September 2006 and September 2011. A subset of 46 patients, including 25 male and 21 female patients, was finally enrolled according to the inclusion criteria. The initial age and duration of follow-up averaged 13.9 years (range, 10-17 years) and 13 months (range, 6-52 months), respectively. On mid-sagittal MRI, the following parameters were evaluated pre- and postoperatively (follow-up ≥ 6 months): the longitudinal and transverse position of bulbopontine sulcus, the fourth ventricle vertex, the lower extreme of cerebella tonsil, the cervico-medullary angle, the maximal syrinx/cord(S/C) ratio and the syrinx length. Changes in these parameters were analysed using the paired samples t test, and for these reaching statistical significances, an additional bivariate correlation analysis was performed to investigate their relation with syrinx resolution.

RESULTSAt the latest follow-up, upward shifting of the bulbopontine sulcus was observed in 31 patients(67.4%), with upward shifting of the lower extreme of cerebella tonsil presenting in 35 patients(76.0%). The maximal S/C ratio and the syrinx length were significantly improved postoperatively (t = 7.114 and 7.816, P = 0.000).Significant resolution of the syrinx was demonstrated in 40 patients(86.9%), and more specifically, the average improvement rates of the maximal S/C ratio and the syrinx length were 32% ± 30%and 43% ± 33%, respectively. In addition, the bivariate correlation analysis revealed that syrinx resolution was significantly correlated with the upward shifting of the bulbopontine sulcus (r = 0.332, P = 0.027) and lower extreme of cerebella (r = 0.298, P = 0.044) .

CONCLUSIONThe upward shifting of the bulbopontine sulcus and the lower extreme of cerebella tonsil might be implicated in the mechanisms of postoperative syrinx resolution.

Adolescent ; Arnold-Chiari Malformation ; complications ; surgery ; Child ; Decompression, Surgical ; Female ; Humans ; Male ; Medulla Oblongata ; pathology ; Postoperative Period ; Retrospective Studies ; Syringomyelia ; complications ; surgery ; Treatment Outcome