OBJECTIVES: Clinically, it has been found that some patients with epilepsy are accompanied by cerebellar atrophy that is inconsistent with symptoms, but the pattern of cerebellar atrophy after epilepsy and the role of cerebellar atrophy in the mechanism of epilepsy have not been elucidated. This study aims to explore the specific pattern of cerebellar atrophy after epilepsy via analyzing magnetic resonance images in patients with postepileptic cerebellar atrophy. METHODS: A total of 41 patients with epilepsy, who received the treatment in Xiangya Hospital of Central South University from January 2017 to January 2022 and underwent cranial MRI examination, were selected as the case group. The results of cranial MRI examination of all patients showed cerebellar atrophy. In the same period, 41 cases of physical examination were selected as the control group. General clinical data and cranial MRI results of the 2 groups were collected. The maximum area and signal of dentate nucleus, the maximum width of the brachium pontis, the maximum anterior-posterior diameter of the pontine, and the maximum transverse area of the fourth ventricle were compared between the 2 groups. The indexes with difference were further subjected to logistic regression analysis to clarify the characteristic imaging changes in patients with cerebellar atrophy after epilepsy. RESULTS: Compared with the control group, the maximum width of the brachium pontis and the maximum anterior-posterior diameter of the pontine were decreased significantly, the maximum transverse area of the fourth ventricle was increased significantly in the case group (all P<0.05). The difference in distribution of the low, equal, and high signal in dentate nucleus between the 2 groups was statistically significant (χ²=43.114, P<0.001), and the difference in the maximum area of dentate nucleus between the 2 groups was not significant (P>0.05). The maximum width of the brachium pontis [odds ratio (OR)=3.327, 95% CI 1.454 to 7.615, P=0.004] and the maximum transverse area of the fourth ventricle (OR=0.987, 95% CI 0.979 to 0.995, P=0.002) were independent factors that distinguished cerebellar atrophy after epilepsy from the normal control, while the anterior-posterior diameter of pontine (OR=1.456, 95% CI 0.906 to 2.339, P>0.05) was not an independent factor that distinguished them. CONCLUSIONS In MRI imaging, cerebellar atrophy after epilepsy is manifested as significant atrophy of the brachium pontis, significant enlargement of the fourth ventricle, and increased dentate nucleus signaling while insignificant dentate nucleus atrophy. This particular pattern may be associated with seizures and exacerbated pathological processes.
Humans ; Magnetic Resonance Imaging ; Pons ; Epilepsy/diagnostic imaging* ; Atrophy/pathology* ; Cerebellum/pathology*

Brainstem glimas are common intracranial tumors in young age and have dismal prognosis despite the advance in diagnostic and treatment modalities. The purpose of this study is to classify the brainstem gliomas by growth patterns and to correlate the growth patterns with histological findings. With these results,we have studied further to verify the prognostic factors in brainstem gliomas. Sixty four patients with brainstem gliomas were treated between May, 1989 and March, 1997. For the location of brainstem gliomas, 41 cases were in pons, 13 cases in medulla, 8 cases in midbrain, and 2 disseminated cases. Operations were performed in 44 cases of these lesions which were focally enhanced type or had exophytic growth patterns. Histological diagnoses were low grade gliomas in 22 cases and high grade gliomas in 21 cases. Among them, radiotherapy was performed in 39 patients with diffuse or disseminated type. Among operated pateints, seven were treated with Gamma Knife radiosurgery for focal residual lesion. Diffuse types were more common in pons. Exophytic or focal types were common in medulla and midbrain. High grade glioma was more common in diffuse type and low grade glioma was common in exophytic or focal type. We concluded that the favorable prognostic factors are long duration of symptoms(>2mos), exophytic type, low grade glioma, and radiotherapy treatment.
Brain Stem* ; Classification* ; Diagnosis ; Glioma* ; Humans ; Mesencephalon ; Pathology ; Pons ; Prognosis* ; Radiosurgery ; Radiotherapy

Rhinocerebral mucormycosis is a very rare, but mostly fatal fungal infection, usually found in diabetic or other immunocompromised hosts. It has a characteristic pattern of spread, invasion of vessel walls with subsequent local thrombotic infarction or direct invasion. But we found two cases contrast to these typical patterns of spread. Our cases initially originated in the nasal cavity and progressed to the cavernous sinus in usual manner, but after then, extended along the trigeminal nerve into the pons. MRI demonstrated the perineural spread, which was confirmed by pathology.
Cavernous Sinus ; Immunocompromised Host ; Infarction ; Magnetic Resonance Imaging ; Mucormycosis* ; Nasal Cavity ; Pathology ; Pons* ; Trigeminal Nerve

Rhinocerebral mucormycosis is a very rare, but mostly fatal fungal infection, usually found in diabetic or other immunocompromised hosts. It has a characteristic pattern of spread, invasion of vessel walls with subsequent local thrombotic infarction or direct invasion. But we found two cases contrast to these typical patterns of spread. Our cases initially originated in the nasal cavity and progressed to the cavernous sinus in usual manner, but after then, extended along the trigeminal nerve into the pons. MRI demonstrated the perineural spread, which was confirmed by pathology.
Cavernous Sinus ; Immunocompromised Host ; Infarction ; Magnetic Resonance Imaging ; Mucormycosis* ; Nasal Cavity ; Pathology ; Pons* ; Trigeminal Nerve

Cri-du-Chat syndrome, also called the 5p-syndrome, is a rare genetic abnormality, and only few cases have been reported on its brain MRI findings. We describe the magnetic resonance imaging findings of a 1-year-old girl with Cri-du-Chat syndrome who showed brain stem hypoplasia, particularly in the pons, with normal cerebellum and diffuse hypoplasia of the cerebral hemispheres. We suggest that Cri-du-Chat syndrome chould be suspected in children with brain stem hypoplasia, particularly for those with high-pitched cries.
Brain Stem/*pathology ; Cri-du-Chat Syndrome/*complications/diagnosis ; Diagnosis, Differential ; Female ; Humans ; Infant ; Magnetic Resonance Imaging/*methods ; Pons/pathology

Micturition is a complex process involving the bladder, spinal cord, and the brain. Highly sophisticated central neural program controls bladder function by utilizing multiple brain regions, including pons and suprapontine structures. Periaqueductal grey, insula, anterior cingulate cortex, and medial prefrontal cortex are components of suprapontine micturition centers. Under pathologic conditions such as epilepsy, urinary dysfunction is a frequent symptom and it seems to be associated with increased suprapontine cortical activity. Interestingly, micturition can also trigger seizures known as reflex epilepsy. During voiding behavior, frontotemporal cortical activation has been reported and it may induce reflex seizures. As current researches are only limited to present clinical cases, more rigorous investigations are needed to elucidate biological mechanisms of micturition to advance our knowledge on the process of micturition in physiology and pathology.
Brain ; Epilepsy* ; Epilepsy, Reflex ; Gyrus Cinguli ; Pathology ; Physiology ; Pons ; Prefrontal Cortex ; Reflex ; Seizures ; Spinal Cord ; Urinary Bladder ; Urination*

BACKGROUNDThere are few studies for evaluating plaque characteristics of nonstenotic basilar arteries (BA). Our aim was to determine entire BA plaques with a three-dimensional volumetric isotropic turbo spin-echo acquisition (VISTA) and investigate the differences between the patients with and without isolated pontine infarction (IPI).

METHODSTwenty-four consecutive symptomatic patients with nonstenotic BA on time of flight magnetic resonance angiography (TOF MRA) were enrolled from China-Japan Friendship Hospital between January 2014 and December 2014. BA was classified as "normal" or "irregular" based on TOF MRA, and "normal wall", "slight wall-thickening", and "plaque" based on three-dimensional VISTA images. Outcomes from MRA and VISTA were compared. Patients were categorized as IPI and non-IPI groups based on the diffusion-weighted imaging. Clinical and plaque characteristics were compared between the two groups.

RESULTSA total of 1024 image slices including 311 (30.37%) plaque slices, 427 (41.70%) slight wall-thickening slices, and 286 (27.93%) normal wall slices for the entire BA from 23 patients were finally included for analysis. VISTA images detected plaques in all the 9 (100%) irregular MRA patients and 7 of 14 (50%) normal MRA patients. IPI was found in 11 (47.83%) patients. Compared to non-IPI group, the IPI group had a higher percentage of plaque slices (P = 0.001) and lower percentage of normal wall slices (P = 0.014) than non-IPI group.

CONCLUSIONSThree-dimensional VISTA images enable detection of BA plaques not visualized by MRA. BA plaques could be found in both the IPI and non-IPI group. However, IPI group showed plaques more extensively in BA than the non-IPI group.

Adult ; Aged ; Basilar Artery ; pathology ; Female ; Humans ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Plaque, Atherosclerotic ; pathology ; Pons ; 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

AIMTo investigate the change of latency and interpeak latency of each component of BAEP (brainstem auditory evoked potential, BAEP) and its correlation with PV/PFV (pontine volume/posterior fossa volume, PV/PFV) ratio in OPCA (olivopontocerebellar atrophy, OPCA).

METHODSWe used Keypoint EMG/EP to determine waves I PL (peak latency, PL), III PL, V PL and I - III IPL (interpeak latency, IPL), III - V IPL, I - V IPL and used 1.5TMR 3D volume rendering software to determine PV (pontine volume, PV), CV(cerebellar volume, CV) and PFV (posterior fossa volume,PFV). Then calculated PV/PFV ratio, CV/PFV ratio and PV/ CV ratio in OPCA group and control group.

RESULTSCompared with control group, in OPCA group wave IIII PL, I - III IPL were significantly elongated (P < 0.05), III - V IPL was significantly shorten (P < 0.05), PV/PFV ratio was significantly decreased (P < 0.01); there was a positive correlation between III-V IPL and PV/PFV ratio (r = 0.83, P < 0.01).

CONCLUSIONIn patients with OPCA, III PL, I - III IPL of BAEP were elongated and III - V IPL of BAEP was shorten. III - V IPL became shorter when the volume of pontine decreased.

Adult ; Case-Control Studies ; Evoked Potentials, Auditory, Brain Stem ; physiology ; Female ; Humans ; Male ; Middle Aged ; Olivopontocerebellar Atrophies ; pathology ; physiopathology ; Pons ; pathology

PURPOSE: To describe the magnetic resonance (MR) imaging findings of hypertrophic olivary degeneration (HOD). MATERIALS AND METHODS: MR images of seven patients with HOD were retrospectively reviewed. Two were women and five were men, and they were aged between 48 and 65 (mean 58) years. Imaging examinations were performed with a 1.5-T unit, and the findings were used to evaluate the size and signal intensity of olivary lesions. The time interval from hemorrhagic ictus to MR imaging was between two and 30 months. Follow-up examinations were performed in two patients. RESULTS: All four patients with hemorrhages involving the central tegmental tract in the pons or midbrain showed ipsilateral HOD. Among these four, bilateral HOD was seen in one patient with hemorrhage involving the bilateral central tegmental tract, and in another with tegmental hemorrhage extending to the ipsilateral superior cerebellar peduncle. One patient with cerebellar hemorrhage involving the dentate nucleus had contralateral HOD. Two patients with multiple hemorrhages involving both the pons and cerebellum showed bilateral HOD. Axial MR images showed mild enlargement of the involved olivary nucleus, with high signal intensity on both proton density and T2 weighted images. There was no apparent enhancement on postcontrast T1-weighted images. CONCLUSION: MR imaging can clearly distinguish secondary olivary degeneration from underlying pathology involving the central tegmental tract in the pons or midbrain and cerebellum. These olivary abnormalities should not, however, be mistaken for primary medullary lesions.
Cerebellar Nuclei ; Cerebellum ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Magnetic Resonance Imaging* ; Male ; Mesencephalon ; Olivary Nucleus ; Pathology ; Pons ; Protons ; Retrospective Studies