BACKGROUND

Thirteen-and-a-half syndrome consists of a one-and-a half syndrome with an ipsilateral facial and trigeminal nerve palsy. This is due to lesions that affects the ipsilateral paramedian pontine reticular formation (PPRF) or the ipsilateral abducens nerve nucleus (VI), the contralateral medial longitudinal fasciculus (MLF), the facial nerve (VII), and the trigeminal nerve (V) .

This is a case of Thirteen-and-a-half syndrome and stress the importance of a proper neurologic exam to aid in the localization of lesions in the brain.

This patient was monitored during her admission. She underwent a plain cranial CT scan to confirm the suspected hemorrhage and supportive management was done to relieve her symptoms.

A 14-year-old female patient presented with a one day history of right-sided hemiparesis. There was associated binocular diplopia, dizziness, slurring of speech, dropping of the left lip, and three episodes of spontaneous projectile vomiting. Plain cranial CT scan showed a left-sided pontine hemorrhage, and she was then advised admission. There was exotropia of the right eye on primary gaze with -4 on adduction, abducting nystagmus on the right eye, horizontal gaze palsy on the left eye, no convergence, left facial weakness, and decreased left facial sensation with minimal improvement during her admission. On the 1-year follow up, there was significant improvement with full motility on the right eye and a -1 on abduction on the left eye.

This is a case of a Thirteen-and-a-half syndrome in a young female patient. A complete neuro-ophthalmological exam is paramount as it is both sight-saving and life saving.

No abstract available.
Hemangioma, Cavernous ; Paralysis ; Pontine Tegmentum

One and a half syndrome is an ipsilateral gaze paresis or palsy combined with and internuclear ophthalmoplegia on contralateral gaze. The lesion site is at the paramedian pontine reticular formation and the adjacent MLF. The common causes are unilateral pontine infarction and multiple sclerosis. We experienced a case of one and a half syndrome which has a suspected small pontine infarct.
Infarction ; Multiple Sclerosis ; Ocular Motility Disorders ; Paralysis ; Paresis ; Pontine Tegmentum

BACKGROUND AND OBJECTIVES: The transsynaptic transfer of neurotropic viruses is an effective tool for tracing chains of connected neurons, because replication of virus in the recipient neurons after the transfer amplifies the "tracer signal". The aim of this study is to identify the central neural pathways projecting to the facial nerve using the Bartha strain of the Pseudorabies virus (PRV-Ba )as a transsynaptic tracer. MATERIALS AND METHODS: PRV-Ba was injected into the facial nerve in the stylomastoid foramen of a rat, and was localized in the rat brain with light microscopic immunohistochemistry using primary antibodies against the PRV-Ba. Sequential tracing was carried out on the retrogradely labeled neurons were done. RESULTS: The shapes of upper motor neurons of facial nerve were mostly ovoid or polygonal. The positive immunoreactive cells observed in the brainstem nuclei included raphe obscurus nucleus, facial nucleus, parvocellular reticular nucleus, spinal trigeminal nucleus, ventral parabrachial nucleus, central gray, and dorsal raphe nucleus. Other positive cells stained in the diencephalon were found in periventricular hypothalamic nucleus, dorsal hypothalamic area, orbital gyri, and infralimbic cortex in the frontal lobe. CONCLUSIONS: These results show the central neural pathways of facial nerve using PRV-Ba.
Animals ; Antibodies ; Brain ; Brain Stem ; Diencephalon ; Facial Nerve ; Frontal Lobe ; Herpesvirus 1, Suid ; Immunohistochemistry ; Motor Neurons ; Neural Pathways* ; Neurons ; Orbit ; Raphe Nuclei ; Rats ; Trigeminal Nucleus, Spinal

It is well known that trigeminal nerve injury causes hyperexcitability in trigeminal ganglion neurons, which become sensitized. Long after trigeminal nerve damage, trigeminal spinal subnucleus caudalis and upper cervical spinal cord (C1/C2) nociceptive neurons become hyperactive and are sensitized, resulting in persistent orofacial pain. Communication between neurons and non-neuronal cells is believed to be involved in these mechanisms. In this article, the authors highlight several lines of evidence that neuron-glial cell and neuron macrophage communication have essential roles in persistent orofacial pain mechanisms associated with trigeminal nerve injury and/or orofacial inflammation.
Cell Communication ; Cervical Cord ; Facial Pain ; Inflammation ; Macrophages ; Neurons ; Nociceptors ; Trigeminal Ganglion ; Trigeminal Nerve ; Trigeminal Nerve Injuries ; Trigeminal Nucleus, Spinal

Bartha strain of pseudorabies virus[PRV-Ba] was utilized as a tracer to identify the neuronal axis of rat tongue muscles ; intrinsic muscles and extrinsic muscles, styloglossus, genioglossus, and hyoglossus muscle. After injection of 10 microliter of PRV-Ba into tongue muscles and 48-96 hours survivals, rats were perfused with 4% paraformaldehyde lysine periodate and brains were removed. PRV-Ba were localized in neural circuits by immunohistochemistry employing rabbit anti PRV-Ba as a primary antibody and ABC method. Injection of PRV-Ba into the tongue muscles resulted in uptake and retrograde transport of PRV-Ba in the rat brain. The result showed a circuit specific connection of many nerve cell groups along the time sequence : PRV-Ba immunoreactive cells appeared in hypoglossal nucleus and motor trigeminal nucleus ipsilaterally as seen with conventional tracers. Raphe nucleus, prepositus hypoglossal nucleus, spinal trigeminal nucleus, Al, A5 and facial nucleus of rhombencephalon showed immunoreactivity bilaterally. There were positive neurons in parabrachial nucleus, locus ceruleus, mesencephalic trigeminal nucleus, periaqueductal gray and A7 of mesencephalon and paraventricular nucleus, suprachiasmatic nucleus, organum vasculosum of lamina terminalis of diencephalon. Also positive reactions were showed in amygdala, insular cortex, frontal cortex and subfornical organ in telencephalon. Early immunoreactivity was appeared in hypoglossal nucleus and motor trigeminal nucleus, and there were positive neurons in the nuclei of the medulla oblongate, midbrain, pons, hypothalamus, cerebellum and medial preoptic area at middle stage. Subsequently the viral antigens were found in forebrain cell groups, paraventricular nuclei, suprachiasmatic nucleus, lateral hypothalamic area and primary motor cortex in frontal lobe bilaterally at 80-90hrs postinjection. These data demonstrate that the PRV-Ba can across synapses in the central nervous system with projection specific pattern, and this virus defines many elements of the neural network governing tongue. Therefore PRV-Ba are proved as a excellent neurotracer in the tract-tracing researches.
Amygdala ; Animals ; Antigens, Viral ; Axis, Cervical Vertebra ; Brain ; Central Nervous System ; Cerebellum ; Diencephalon ; Frontal Lobe ; Hypothalamic Area, Lateral ; Hypothalamus ; Immunohistochemistry ; Locus Coeruleus ; Lysine ; Mesencephalon ; Motor Cortex ; Muscles ; Neural Pathways* ; Neurons ; Paraventricular Hypothalamic Nucleus ; Periaqueductal Gray ; Pons ; Preoptic Area ; Prosencephalon ; Pseudorabies ; Raphe Nuclei ; Rats* ; Rhombencephalon ; Subfornical Organ ; Suprachiasmatic Nucleus ; Synapses ; Telencephalon ; Tongue* ; Trigeminal Nuclei ; Trigeminal Nucleus, Spinal

A 49-year-old male presented with horizontal binocular diplopia without facial pain or skin lesion. Limitation of medial gaze in the left eye was revealed on neurological examination, which is accompanied by peripheral facial nerve palsy ipsilaterally. The diagnosis had been made based on the diffusion restriction lesion of left pontine tegmentum. We may denominate a “seven-and-a-half syndrome” and clinician should maintain a high level of awareness of the various syndromes associated with pontine lesions.
Diagnosis ; Diffusion ; Diplopia ; Facial Nerve ; Facial Pain ; Facial Paralysis ; Humans ; Male ; Middle Aged ; Neurologic Examination ; Ocular Motility Disorders ; Paralysis ; Pontine Tegmentum ; Skin ; Telescopes

The nerves innervating the sublingual gland of the rat was investigated using PRV (pseudorabies virus) as a neural tracer. The neural tracer was injected into left sublingual gland of the rat. In the central nervous system, PRV immunoreactive neurons were labeled bilaterally and tended to be more densely labeled in the left side. PRV immunoreactive neuronal cell bodies and fibers were observed in insular cortex, paraventricular nucleus, deep mesencephalic nucleus, spinal trigeminal tract, lateral paragigantocellular nucleus, parvicellular reticular nucleus, raphe obscurus, gigantocellular reticular nucleus and gigantocellular reticular nucleus, alpha. The more densely labeled PRV immunoreactive neurons were found in the deep mesencephalic nucleus, spinal trigeminal tract and lateral paragigantocellular nucleus. These results may provide a neuroanatomical data on the nerves innervating the sublingual gland in the rat brain.
Animals ; Brain* ; Central Nervous System ; Herpesvirus 1, Suid* ; Neurons ; Paraventricular Hypothalamic Nucleus ; Pseudorabies* ; Raphe Nuclei ; Rats* ; Sublingual Gland* ; Trigeminal Nucleus, Spinal

Metronidazole is a widely used antibiotic for the treatment of anaerobic bacterial infections. Metronidazole-induced encephalopathy (MIEP) is a rare but potentially reversible disease. The mechanism of MIEP remains unclear, and differences in the neurotoxic effects of oral versus intravenous (IV) metronidazole administration have not yet been determined. We report the case of a Crohn's disease (CD) patient who experienced encephalopathy immediately after a single IV dose of metronidazole following long-term exposure to the oral form of the drug. The 64-year-old man with intractable CD experienced a sudden change in mental status, aphasia, and muscle weakness after IV administration of metronidazole. He had previously taken metronidazole orally for 13 years and received intermittent IV metronidazole treatments for CD exacerbation. Brain magnetic resonance imaging (MRI) showed high-intensity signals in the bilateral medial thalamus and the midbrain and pontine tegmentum on fluid-attenuated inversion recovery images. After discontinuation of metronidazole, the high-intensity brain MRI signals resolved and the patient's mental status dramatically improved; however, the patient exhibited mild cognitive dysfunction 2 months after the onset of encephalopathy.
Aphasia ; Bacterial Infections ; Brain ; Brain Diseases* ; Brain Diseases, Metabolic ; Crohn Disease* ; Drug-Related Side Effects and Adverse Reactions ; Humans ; Magnetic Resonance Imaging ; Mesencephalon ; Metronidazole ; Middle Aged ; Muscle Weakness ; Pontine Tegmentum ; Thalamus

Central pontine myelinolysis (CPM) and extrapontine myelinolysis (EPM) is a rare syndrome that is clinically characterized by quadriparesis, pseudobulbar palsy, and disturbance of consciousness. It commonly occurs in patients with rapid correction of hyponatremia and chronic alcoholism. We report a case of CPM and EPM in a 55-year-old male patient with maintenance hemodialysis. He had type 2 diabetes mellitus for more than 20 years and underwent hemodialysis for the past 7 months. He was admitted for left periorbital cellulitis and uremic symptoms. On the 34th hospital day, he had nausea, vomiting, decreased consciousness, dysarthria and quadriparesis. Laboratory data were revealed as follows:glucose, 117 mg/dL; sodium, 137.1 mEq/L; and serum osmolality, 277 mosm/L. Magnetic resonance imaging (MRI) of the brain revealed increased signal intensity in the pons, upper medulla, cerebellar peduncle and cerebral peduncle in T2 weighted images. This case was considered as primary CPM and EPM occurring in a patient with maintenance hemodialysis. With general supportive care, the patient has been recovered gradually and is being followed up on an outpatient basis.
Alcoholism ; Brain ; Cellulitis ; Consciousness ; Diabetes Mellitus, Type 2 ; Dysarthria ; Humans ; Hyponatremia ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Myelinolysis, Central Pontine* ; Nausea ; Osmolar Concentration ; Outpatients ; Pons ; Pseudobulbar Palsy ; Quadriplegia ; Renal Dialysis* ; Sodium ; Tegmentum Mesencephali ; Vomiting