Vertical gaze palsy is usually associated with lesions of the rostral midbrain and thalamo-mesencephalic junction. The rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF), the interstitial nucleus of Cajal, and the posterior commissure located in the midbrain are the critical area in supranuclear control of vertical eye movements. We describe a case of vertical one-and-a-half syndrome accompanying contralateral abduction and incomplete depression palsy due to thalamo-mesencephalic infarction. These vertical eye movement abnormalities are presumed to be caused by damage to the ipsilateral riMLF, interstitial nucleus of Cajal, and oculomotor fascicles.
Cerebral Infarction ; Depression ; Eye Movements ; Infarction ; Mesencephalon ; Paralysis ; Tegmentum Mesencephali

In amyotrophic lateral sclerosis(ALS) patients, cervical magnetic resonance imagings are usually performed to rule out surgically treatable cervical cord pro-blems. So the chance to evaluate portions above cervical cord such as brainstem, internal capsule, and cerebral cortex is extremely rare. During evaluation of 34-year-old patient who progressively developed ALS after left brachial plexus injury, we observed bilateral, asymmetric, and high signal intensity lesions at the posterior third quarter of the posterior limb of internal capsule and the lateral third quarter of the cerebral peduncle on proton density image as well as T2 weighted image. The properties of these bilateral lesions suggest that they represent large, degenerated fibers of the corticospinal tract in ALS patient other than normal hyperintense foci in the internal capsule.
Adult ; Brachial Plexus ; Brain Stem ; Cerebral Cortex ; Extremities ; Humans ; Internal Capsule* ; Protons ; Pyramidal Tracts ; Tegmentum Mesencephali

The effects of acidic pH on several voltage-dependent ion channels, such as voltage-dependent K⁺ and Ca²⁺ channels, and hyperpolarization-gated and cyclic nucleotide-activated cation (HCN) channels, were examined using a whole-cell patch clamp technique on mechanically isolated rat mesencephalic trigeminal nucleus neurons. The application of a pH 6.5 solution had no effect on the peak amplitude of voltage-dependent K⁺ currents. A pH 6.0 solution slightly, but significantly inhibited the peak amplitude of voltage-dependent K⁺ currents. The pH 6.0 also shifted both the current-voltage and conductance-voltage relationships to the depolarization range. The application of a pH 6.5 solution scarcely affected the peak amplitude of membrane currents mediated by HCN channels, which were profoundly inhibited by the general HCN channel blocker Cs⁺ (1 mM). However, the pH 6.0 solution slightly, but significantly inhibited the peak amplitude of HCN-mediated currents. Although the pH 6.0 solution showed complex modulation of the current-voltage and conductance-voltage relationships, the midpoint voltages for the activation of HCN channels were not changed by acidic pH. On the other hand, voltage-dependent Ca²⁺ channels were significantly inhibited by an acidic pH. The application of an acidic pH solution significantly shifted the current-voltage and conductance-voltage relationships to the depolarization range. The modulation of several voltage-dependent ion channels by an acidic pH might affect the excitability of mesencephalic trigeminal nucleus neurons, and thus physiological functions mediated by the mesencephalic trigeminal nucleus could be affected in acidic pH conditions.
Acidosis ; Animals ; Hand ; Hydrogen-Ion Concentration* ; Ion Channels* ; Membranes ; Neurons* ; Proprioception ; Rats* ; Tegmentum Mesencephali

A current hypothesis of sleep-wake regulation proposes that the sleep process starts with the activation of sleep-promoting neurons located in the preoptic area of the anterior hypothalamus. This activation leads to the inhibition of wake-promoting neurons located in the posterior hypothalamus, basal forebrain, and mesopontine tegmentum, which, in turn removes inhibition from the sleep-promoting structures(i.e., disinhibition) to initiate the sleep process. Mutual inhibition between these wake- and sleep-promoting neurons results in switching properties that define discrete wakeful and sleep states with sharp transitions between them. Wake-promoting nuclei include the orexinergic lateral hypothalamic/perifornical area, the histaminergic tuberomammillary nucleus, the cholinergic pedunculopontine tegmental nucleus, the noradrenergic locus coeruleus, the 5-hydroxytryptaminergic raphe nuclei, and possibly the dopaminergic ventral tegmental area. The major sleep-promoting nucleus is the GABAergic ventrolateral preoptic nucleus of the hypothalamus. The regulation of sleep is classically viewed as the dual interaction of circadian(SCN-based) and homeostatic processes, and the propensity to be asleep or awake at any given time is a consequence of a sleep debt and its interaction with signals from the SCN circadian clock. To better understand the mechanisms of sleep and wakefulness, the focus of pharmacotherapy is on targeting specific therapies to the particular defect in sleep-wake regulation.
Circadian Clocks ; Circadian Rhythm ; Drug Therapy* ; Hypothalamic Area, Lateral ; Hypothalamus ; Hypothalamus, Anterior ; Hypothalamus, Posterior ; Locus Coeruleus ; Neuroanatomy* ; Neurons ; Pedunculopontine Tegmental Nucleus ; Preoptic Area ; Prosencephalon ; Raphe Nuclei ; Sleep Wake Disorders ; Ventral Tegmental Area ; Wakefulness

Trigeminal neurinomas are relatively rare tumors that arise from the sheath of Schwann and constitute 2.9% of intracranial neurinomas and 0.26% of all brain tumors. The most cases are confined to the middle fossa and arising from the Gasserian ganglion. In slight fewer cases the tumor occupy the cerebellopontine angle. In minority it is an hourglass form both situations. By reason of their rarity, the complex clinical problems which may present and the difficult technical aspects involved in their removal, neurinomas of the Gasserian ganglion are of extreme interest. We are reporting a case of trigeminal neurinoma which was arised from the right Gasserian ganglion and located in both situations of middle and posterior cranial fossas. A 37 year-old female was admitted to our department with characteristic symptoms and signs involving many cranial nerves, cerebellum and cerebral peduncle. We chose temporal craniotomy and approached to and exposed the mass by extradural and intradural techniques. Complete removal of the tumor occupying the middle and posterior cranial fossas are accomplished satisfactorily.
Adult ; Brain Neoplasms ; Cerebellopontine Angle ; Cerebellum ; Cranial Fossa, Posterior ; Cranial Nerves ; Craniotomy ; Female ; Humans ; Neurilemmoma* ; Tegmentum Mesencephali ; Trigeminal Ganglion

A young woman developed a hemilateral tonic spasm associated with multiple sclerosis. Her symptoms included brief recurrent episodes of abnormal, often painful, posturing of one or more extremities without alteration of consciousness. An area of demyelination in the contralateral cerebral peduncle was observed on a magnetic resonance imaging. The tonic attacks abated with carbamazepine therapy. The pathophysiology may involve ephaptic transmission between demyelinated fibers in acute plaques within the corticospinal tract secondary to axonal irritation by lymphokines. (J Korean Neurol Assoc 19(2):167~169, 2001)
Axons ; Carbamazepine ; Consciousness ; Demyelinating Diseases ; Extremities ; Female ; Humans ; Lymphokines ; Magnetic Resonance Imaging ; Multiple Sclerosis* ; Pyramidal Tracts ; Spasm* ; Tegmentum Mesencephali

A young woman developed a hemilateral tonic spasm associated with multiple sclerosis. Her symptoms included brief recurrent episodes of abnormal, often painful, posturing of one or more extremities without alteration of consciousness. An area of demyelination in the contralateral cerebral peduncle was observed on a magnetic resonance imaging. The tonic attacks abated with carbamazepine therapy. The pathophysiology may involve ephaptic transmission between demyelinated fibers in acute plaques within the corticospinal tract secondary to axonal irritation by lymphokines. (J Korean Neurol Assoc 19(2):167~169, 2001)
Axons ; Carbamazepine ; Consciousness ; Demyelinating Diseases ; Extremities ; Female ; Humans ; Lymphokines ; Magnetic Resonance Imaging ; Multiple Sclerosis* ; Pyramidal Tracts ; Spasm* ; Tegmentum Mesencephali

PURPOSE: Ganglioglioma is a rare primary brain tumor usually found in the temporal lobe. The purpose of thisstudy is to describe the characteristic MR findings of temporal lobe ganglioglioma. MATERILA AND METHODS: Over aseven-year period, ten patients with cerebral ganglioglioma were evaluated at our institution. Seven cases oftemporal lobe ganglioma were found ; six of these involved men, and one, a woman ; their mean age was 29.6 years.In three patients, Gd-DTPA-enhanced T1 weighted images were also obtained. We retrospectively analysed the MRIfindings with respect to location, size, cortical involvement, margin, cystic change, degree of enhancement, MRsignal intensity, calcification and peritumoral change. RESULTS: In five cases, tumors were located within thetemporal lobe. In one, a tumor extended from the temporal lobe to the thalamus, and in one from the temporal lobeto the thalamus and cerebral peduncle. All temporal gangliogliomas measured 1.6-3.8cm in their greatestdiameter(mean diameter, 2.7cm). In all cases, the cortices were involved with the maintenance of gyriform. Thetumor margin was ill defined in five cases and well defined in two. Tumors showed multiple small cystic changes infour cases, a large cyst in two, and a solid nodule in one. In three cases in which contrast media wasadministered, no lesions were enhanced. On T1-weighted images, iso-signal intensities were seen in five cases andhigh signal intensities in two. On T2-weighted images, the corresponding figures were five and two. On MRI, tumorcalcification and calvarial erosion were each detected in two cases. CONCLUSION: In patients with temporal lobeepilepsy in whom cortical solid or cystic and poorly enhanced lesions were seen on brain MRI, and in whomaccociated findings such as calcification and or adjacent bony erosion were noted, ganglioglioma must beconsidered.
Brain ; Brain Neoplasms ; Contrast Media ; Female ; Ganglioglioma* ; Humans ; Magnetic Resonance Imaging* ; Male ; Retrospective Studies ; Tegmentum Mesencephali ; Temporal Lobe* ; Thalamus

BACKGROUND AND PURPOSE: This study aimed to determine whether there are clinicoelectrical differences between anterior lateral temporal lobe epilepsy (ALTLE) and posterior lateral temporal lobe epilepsy (PLTLE), taking medial temporal lobe epilepsy (MTLE) as a reference. METHODS: We analyzed the historical information, ictal semiologies, and ictal EEGs of temporal lobe epilepsy patients with a documented favorable surgical outcome (Engel class I or II) at follow-up after more than one year. LTLE was defined when a discrete lesion on MRI or an ictal onset zone in invasive study was located outside the collateral sulcus. LTLE was further divided into ALTLE and PLTLE by reference to the line across the cerebral peduncle. Total 107 seizures of 13 ALTLE, 8 PLTLE and 21 MTLE patients were reviewed. RESULTS: Initial hypomotor symptom was frequently observed in PLTLE (P<0.001). Oroalimentary automatism (OAA) was not observed initially in PLTLE. Generalized tonic-clonic seizures occurred significantly earlier in PLTLE than in ALTLE or MTLE (P< 0.001). Ictal scalp EEG was not helpful in differentiating between ALTLE and PLTLE. CONCLUSIONS: Frequent hypomotor onset, the absence of initial oroalimentary automatism, and early generalization are characteristic findings of PLTLE, although they are insufficient to differentiate it from ALTLE or MTLE.
Automatism ; Electroencephalography ; Epilepsy, Temporal Lobe* ; Follow-Up Studies ; Generalization (Psychology) ; Humans ; Magnetic Resonance Imaging ; Scalp ; Seizures ; Tegmentum Mesencephali ; Temporal Lobe*

PURPOSE: Dendritic cells are antigen presenting cells(APC) that express class II major histocompatibility complex gene products on their surface. Recently, it was proved that dendritic cells activate antitumor immunity for intracranial germ cell tumor. The aim of the present study is to investigate the age-related changes of MHC class II-immunoreactive dendritic cells in the rat brain. METHODS: Male rats(Sprague-Dawley) were sacrificed at 1 month, 12 months and 24 months after birth. Brains were removed and sliced in rat brain matrix. Brain slices were cryosectioned coronally at interaural 5.70-6.70 mm. Brain tissue sections were immunohistochemically reacted with monoclonal MHC class II antibody. RESULTS: MHC class II-immunoreactive dendritic cells were observed in choroid plexuses and white matter(corpus callosum, cerebral peduncle and external capsule). The number of MHC class II-immunoreactive dendritic cells was slightly increased with age. As age increases, shapes of MHC class II-immunoreactive dendritic cells became more complex and aggregated together. CONCLUSION: As age increases, MHC class II-immunoreactive dendritic cells in choroid plexuses and white matter of the brain became not only more complex in shape, but also increased in number to improve immunity.
Aging ; Animals ; Brain* ; Choroid Plexus ; Dendritic Cells* ; Humans ; Major Histocompatibility Complex ; Male ; Neoplasms, Germ Cell and Embryonal ; Parturition ; Rats* ; Tegmentum Mesencephali