Presentation
Eight of them (12%) presented with intractable nausea and vomiting as the sole initial symptom. [mdedge.com]
This presents in childhood (average age at diagnosis of 10 years) and is preceded by jaundice and hepatosplenomegaly at birth in about half of patients; vertical gaze palsy is present in 80% of patients (32). [neuroophthalmology.ca]
Lateral tegmental hemorrhages present with 1 1/2 syndrome, small reactive pupils, limb ataxia of the cerebellar type, and contralateral hemisensory loss (Caplan and Goodwin, 1982). Diagnosis may be made via MRI or CT scan. [tchain.com]
Type II: This malformation is universally present in children with open neural tube defects (spina bifida aperta or myelomeningocele). [weillcornellbrainandspine.org]
Historical note and terminology Brainstem hemorrhage was first described by Cheyne in 1812 ( Cheyne 1812 ) in a pathological study of patients presenting with lethargy and coma. [medlink.com]
Entire Body System
- Weakness
Abducent ( CN6 ): ipsilateral weakness of abduction (lateral movement) of the eye (lateral rectus). Facial ( CN7 ): ipsilateral facial weakness. Auditory ( CN8 ): ipsilateral deafness.The 6th cranial nerve is the motor nerve in the medial pons. [lifeinthefastlane.com]
This type of weakness may be noticed when climbing stairs, arising from a deep chair, brushing the hair, or lifting an object. Facial weakness results in drooling and in difficulty in whistling. [britannica.com]
Such pressure can result in paralysis, weakness, and loss of sensation. Resources In This Article Drugs Mentioned In This Article MIACALCIN Craniocervical Junction Disorders Craniocervical Junction Disorders [merckmanuals.com]
Abstract Three siblings presented with a progressive neurological disorder beginning in the third decade of life and characterised by palatal myoclonus, nystagmus, bulbar weakness and spastic tetraparesis. [jnnp.bmj.com]
They are usually symptomatic at birth or in the first few weeks of life with hypotonia and muscle weakness, a weak cry and, in 10–30% of cases, with contractures. Motor nerve conduction velocity is generally reduced 36. [mrineonatalbrain.com]
- Pain
Among the symptoms are neck pains, often with a headache that starts at the back of the head. Moving the head usually makes neck pain and headache worse. Coughing or bending forward can trigger the pain. [spine.keckmedicine.org]
Note that although patients in vegetative state have reflex responses to pain, because they are not conscious, they cannot experience either pain or suffering. [dana.org]
Pain Medicine. Kaniecki RG. Basilar-type migraine. Curr Pain Headache Rep. 2009;13(3):217-220. Recommended Reading [migraine.com]
If you have pain, the doctor may suggest various pain medications to help control the pain. You may need to take a non-steroidal anti-inflammatory (NSAID), a medication that works to reduce inflammation as a way to reduce pain. [spineuniverse.com]
Most commonly, people have neck pain and headache, but if the spinal cord or lowest part of the brain (brain stem) is affected, people may have difficulty sensing vibration, pain, and temperature and may have weak muscles, dizziness, and impaired vision [merckmanuals.com]
- Fever
[…] dysfunction (e.g. dysarthria, altered facial sensation, diplopia) cerebellar signs (e.g. ataxia) long tract signs (e.g. spasticity, altered sensation) Generally, patients remain cognitively intact and do not suffer from other signs of inflammation (e.g. fevers [radiopaedia.org]
Epidemiology It is very rare and mostly reported in adults; however, cases affecting children have also been reported. [ 3 ] Very often it follows an illness, and an association with certain infections, including cytomegalovirus, Campylobacter jejuni, typhoid fever [patient.info]
[…] of sleep) CNS depressant medications Sleepwalking disorder Possible hereditary/familial trend Drugs, for example, thioridazine, fluphenazine, perphenazine, desipramine, chloral hydrate, and lithium Fever Sleep deprivation and obstructive sleep apnea [emedicinehealth.com]
Patients with nonbacterial, or aseptic, meningitis also have fever, headache, and other meningeal signs, but they are not so obviously ill. [britannica.com]
S, S, Alcohol Addiction (serotonergic system) S, Pedophilia (hypoactivity) S, Depression S ; Fever; Obesity S, Migraine S 1.2.5.1. [brain-maps.com]
- Fatigue
We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: May 13, 2019 [patientslikeme.com]
Infections of the central nervous system (CNS) Inflammatory disorders of the CNS Sjögren’s syndrome — A chronic autoimmune disease that attacks the body’s moisture producing glands, causing dry eyes and mouth, generalized fatigue, joint pain and sometimes [nationalmssociety.org]
Despite nighttime behavior, few persons develop excessive daytime sleepiness or fatigue. [emedicinehealth.com]
Stress, tension, or fatigue may cause the brain stem to function less efficiently, resulting in some loss of automatic reflex control of balance. [vestibular.org]
Later consequences include dementia, seizures, irritability, fatigue, headaches, insomnia, loss of concentration, poor memory, and loss of energy. [britannica.com]
- Unconsciousness
Patients with widespread injury to the brain are more likely to have severe neurologic deficits and are at a higher risk of prolonged unconsciousness. [dana.org]
Morris JS, Ohman A, Dolan RJ (1998) Conscious and unconscious emotional learning in the human amygdala. Nature 393: 467–470. View Article Google Scholar 28. Blier P, El Mansari M (2013) Serotonin and beyond: therapeutics for major depression. [journals.plos.org]
Bleeding into the pons causes paresis of all limbs and unconsciousness. Bleeding into the cerebellum produces typical signs of incoordination with headache and stiffness of the neck. [britannica.com]
Respiratoric
- Hoarseness
Voice Dysfunction When Stroke Affects Cerebral Cortex (Brain) Vocal symptoms with cerebral cortex strokes are more often related to articulation disorders (slurred speech, or dysarthria) rather than hoarseness. [voicefoundation.org]
[…] include: headache (especially after sneezing, coughing, or straining) balance problems neck pain dizziness vision problems poor hand coordination numbness and tingling of the hands and feet change in bladder (pee) or bowel (poop) habits trouble swallowing hoarseness [kidshealth.org]
• Nystagmus, diplopia, oscillopsia, vertigo, nausea, vomiting: Vestibular nucleus • Horners syndrome (miosis, ptosis, decreased sweating): Descending sympathetic tract • Dysphagia, hoarseness, paralysis of palate, paralysis of vocal cord, diminished gag [slideshare.net]
- Tachypnea
Nightmares are frightening dreams that occur during REM sleep and are associated with an increase in heart rate (tachycardia), an increase in the rate of breathing (tachypnea), profuse sweating, and arousal. [emedicinehealth.com]
- Respiratory Distress
There have been several descriptions of a fatal infantile form with cardiac and renal involvment, seizures, hypotonia and respiratory distress. [mrineonatalbrain.com]
Gastrointestinal
- Dysphagia
Swallowing assessment and swallow therapy can help you eat and drink more comfortably and may help prevent complications of dysphagia, such as choking and aspiration pneumonia. [verywell.com]
unsteadiness, nasal speech, vomiting, and weakness Sensory loss in the face (involvement of the trigeminal nucleus) Dysphagia and/or dysphonia from lower cranial nerve involvement (commonly IX and X) Long tract signs Ataxia Downbeating nystagmus and [emedicine.medscape.com]
• Nystagmus, diplopia, oscillopsia, vertigo, nausea, vomiting: Vestibular nucleus • Horners syndrome (miosis, ptosis, decreased sweating): Descending sympathetic tract • Dysphagia, hoarseness, paralysis of palate, paralysis of vocal cord, diminished gag [slideshare.net]
A hereditary degenerative disorder has been described in Newfoundland, with manifestations in childhood or early adulthood of impaired downgaze, followed by lower limb spasticity, then ataxia, dysarthria, and dysphagia (35). [neuroophthalmology.ca]
[…] nerve: Mastication (chewing) * Abducens nuclei: Lateral eye movement * Facial nuclei: Facial expression * Cochlear nuclei: Hearing * Vestibular nuclei: Thalamus, Cerebellum, Eye muscle nuclei, Spinal cord Disorders: Central pontine myelinolysis S with Dysphagia [brain-maps.com]
- Failure to Thrive
Certain manifestations suggest specific tumor locations, as follows: Infants and children with failure to thrive – Pontine gliomas Involvement of cranial nerve III or IV – A mesencephalic component Hydrocephalus – Tumors in periaqueductal or fourth ventricle [emedicine.medscape.com]
Cardiovascular
- Vascular Disease
Causes Central nervous system causes of vertigo (central vestibular disorders) include brain stem vascular disease, arteriovenous malformations, acoustic neuromas and tumors of the brain stem and cerebellum, multiple sclerosis, and vertebrobasilar migraine [healthcentral.com]
Vascular disease Diseases of the blood vessels are uncommon in the spinal cord. [britannica.com]
Musculoskeletal
- Muscle Spasm
Myoclonus is a twitching or intermittent spasm of a muscle or group of muscles. Myoclonus is classified into several major types and many subcategories. [aans.org]
Ears
- Hearing Problem
And hearing problems may necessitate the use of a hearing aid. A Word From Verywell MS can affect any part of the brain, spinal cord, and optic nerves. [verywell.com]
Eyes
- Diplopia
A 51-year-old woman with MS developed acute vertigo, ataxia, diplopia, dysarthria, and bifacial weakness. She had been in clinical remission for 24 years without immunomodulatory therapy. [neurology.org]
There is a clinical continuum between BBE and Fisher's syndrome. [ 1 ] Bickerstaff reported eight patients who, in addition to acute ophthalmoplegia (diplopia) and ataxia, showed drowsiness, extensor plantar responses or hemisensory loss. [ 2 ] Epidemiology [patient.info]
Your doctor or therapist may also recommend corrective lenses or an eye patch to help manage diplopia. And hearing problems may necessitate the use of a hearing aid. [verywell.com]
Patients typically present subacutely with a wide variety of signs and symptoms dominated by 1 : cranial nerve dysfunction (e.g. dysarthria, altered facial sensation, diplopia) cerebellar signs (e.g. ataxia) long tract signs (e.g. spasticity, altered [radiopaedia.org]
• Nystagmus, diplopia, oscillopsia, vertigo, nausea, vomiting: Vestibular nucleus • Horners syndrome (miosis, ptosis, decreased sweating): Descending sympathetic tract • Dysphagia, hoarseness, paralysis of palate, paralysis of vocal cord, diminished gag [slideshare.net]
- Unilateral Ptosis
Patients often have a Horner's syndrome (unilateral ptosis, miosis and facial anhidrosis). There also may be saccadic dysmetria (overshoot), saccadic pulsion (pulling of the eye during vertical saccades toward the side of lesion). [tchain.com]
However, a lateral fascicular III lesion affecting the superior recti, inferior oblique and levator may cause a monocular elevator palsy with unilateral ptosis (51). [neuroophthalmology.ca]
- Strabismus
J Pediatr Ophthalmol Strabismus 1992;29:142-149. 50. Cadera W, Bloom JN, Karlik S, Viirre E. A magnetic resonance imaging study of double elevator palsy. Can J Ophthalmol 1997;32:250-253. 51. Hriso E, Masdeu JC, Miller A. [neuroophthalmology.ca]
Face, Head & Neck
- Facial Numbness
Facial nerve The facial nerve is damaged most commonly by swelling within the facial canal in the temporal bone that results from viral infection. [britannica.com]
Neurologic
- Vertigo
Vertigo is a common early symptom of brainstem strokes. [tchain.com]
Peripheral vertigo; Central vertigo; Dizziness; Benign positional vertigo; Benign paroxysmal positional vertigo Bhattacharyya N, Gubbels SP, Schwartz SR, et al. Clinical practice guideline: benign paroxysmal positional vertigo (update). [medlineplus.gov]
However, because strokes are much less common than other sources of vertigo such as ear disorders, vertigo is only caused by central nervous system problems (including stroke) about 5% of the time. Migraine is a common cause of vascular vertigo. [dizziness-and-balance.com]
The vertigo arising from central lesions tends to be more chronic and debilitating than that resulting from peripheral vestibulopathy. Vertigo of central origin often becomes unremitting and disabling. There may be nausea and vomiting. [healthcentral.com]
A person may have vertigo, dizziness and severe imbalance without the hallmark of most strokes — weakness on one side of the body. The symptoms of vertigo dizziness or imbalance usually occur together; dizziness alone is not a sign of stroke. [strokeassociation.org]
- Nystagmus
In the author's experience, these patients often exhibit rebound nystagmus, which is a variant of gaze-evoked nystagmus. Some of these patients have upbeating nystagmus supine, often confused with BPPV. [dizziness-and-balance.com]
In the author's experience, these patients often exhibit rebound nystagmus, which is a variant of gaze-evoked nystagmus. [tchain.com]
Abstract Three siblings presented with a progressive neurological disorder beginning in the third decade of life and characterised by palatal myoclonus, nystagmus, bulbar weakness and spastic tetraparesis. [jnnp.bmj.com]
Medial inferior pontine syndrome (occlusion of paramedian branch of basilar artery) On side of lesion • Paralysis of conjugate gaze to side of lesion (preservation of convergence): Center for conjugate lateral gaze(PPRF) • Nystagmus: Vestibular nucleus [slideshare.net]
A classic sign is convergence-retraction nystagmus. (see case 51 ) Fragments of the pretectal syndrome are common. [neuroophthalmology.ca]
- Dizziness
Download the PDF Dizziness, vertigo, disequilibrium Dizziness, vertigo and disequilibrium are common symptoms reported by adults during visits to their doctors. [vestibular.org]
A person may have vertigo, dizziness and severe imbalance without the hallmark of most strokes — weakness on one side of the body. The symptoms of vertigo dizziness or imbalance usually occur together; dizziness alone is not a sign of stroke. [strokeassociation.org]
Vertigo is a sensation of motion or spinning that is often described as dizziness. Vertigo is not the same as being lightheaded. People with vertigo feel as though they are actually spinning or moving, or that the world is spinning around them. [medlineplus.gov]
Definition Deficits in vestibular function typically cause dizziness, loss of balance, and diminished functional independence and reflect a disturbance of the central vestibular pathways in the brain. [healthcentral.com]
Dizziness and problems with balance and coordination Swallowing difficulties Sleep apnea Most children born with type II Chiari malformation have hydrocephalus. [webmd.com]
- Seizure
There was no evidence of intellectual deterioration or seizures. CT scan showed marked brainstem atrophy in two patients and basal ganglia calcification in one. [jnnp.bmj.com]
Seizures are divided into two major categories: generalized seizures (a result of abnormal activity in most or all of the brain) and partial seizures (originating in a specific area of the brain). [britannica.com]
Symptoms can include seizures, strokes, severe developmental delays, inability to walk, talk, see, and digest food combined with a host of other complications. If three or more organ systems are involved, mitochondrial disease should be suspected. [umdf.org]
Gowers noted that loss of consciousness was not an essential feature and that patients frequently presented with seizures ( Gowers 1893 ). In 1900 Oppenheim described the clinical features of pontine hemorrhage in detail ( Oppenheim 1905 ). [medlink.com]
Antiepileptic drugs may be used to control seizures. Occupational therapy, education and supportive services are geared towards helping individuals with Rett cope with daily challenges and maintain a quality of life. [aans.org]
- Dysarthria
A 51-year-old woman with MS developed acute vertigo, ataxia, diplopia, dysarthria, and bifacial weakness. She had been in clinical remission for 24 years without immunomodulatory therapy. [neurology.org]
Voice Dysfunction When Stroke Affects Cerebral Cortex (Brain) Vocal symptoms with cerebral cortex strokes are more often related to articulation disorders (slurred speech, or dysarthria) rather than hoarseness. [voicefoundation.org]
Patients typically present subacutely with a wide variety of signs and symptoms dominated by 1 : cranial nerve dysfunction (e.g. dysarthria, altered facial sensation, diplopia) cerebellar signs (e.g. ataxia) long tract signs (e.g. spasticity, altered [radiopaedia.org]
In addition, people with migraine with brainstem aura get brainstem aura symptoms such as: Dysarthria (slurred speech) Vertigo (feeling of movement/spinning of self or environment) Tinnitus (ringing in ears) Hypacusis (impaired hearing) Diplopia (double [americanmigrainefoundation.org]
It is typified by vertigo, ipsilateral hemiataxia, dysarthria, ptosis and miosis. Most patients with this stroke recover very well and often resume their previous activities (Nelles et al, 1998). [tchain.com]
Workup
See Workup for more detail. [emedicine.medscape.com]
Treatment
There is no treatment. [msdvetmanual.com]
Fink grew up with mood disorders in her family, so she has seen them from every angle and knows the importance of mobilizing the family as a part of any successful treatment. [books.google.com]
While there are treatments (medications and surgical procedures) that improve the motor symptoms, there are no treatments that slow or halt disease progression or prevent dementia in PD patients. [mayo.edu]
Treatment While the underlying cause should be investigated and treated, symptomatic treatment is useful in the vertiginous patient to lessen the abnormal sensation and to alleviate vegetative symptoms such as nausea and vomiting. [healthcentral.com]
Prognosis
The overall prognosis of stroke varies considerably; in general older patients face a worse prognosis for recovery of function. [voicefoundation.org]
Increasing tumor grade is associated with poorer prognosis. Molecular profiling is now an important part of glioma classification. An IDH1 mutation carries a significantly improved prognosis over the IDH1 wildtype, no matter the tumor grade. [emedicine.medscape.com]
• MRI may provide further detail and aid prognosis. • Surgery is reserved for select cases in which specific expertise is available. [medlink.com]
Prognosis is generally quite good with full or near full recovery expected at 6 months. Diagnosis is generally via MRI. [tchain.com]
Treatment and prognosis Patients typically respond rapidly to the administration of glucocorticosteroids but have a tendency to relapse if immunosuppression is ceased. As such long-term immunosuppression is recommended 1. [radiopaedia.org]
Etiology
Furthermore, the concept of secondary mania casts doubt on any unitary or single-agent hypothesis of the etiology of mania and supports the notion of a continuum of psychopathologic syndromes. [jamanetwork.com]
Etiology These syndromes are classically caused by ischemic strokes that occur secondary to occlusion of small perforating arteries of the posterior circulation, however many have also been described secondary to hemorrhage, neoplasm, and demyelination [radiopaedia.org]
MRI is frequently needed to make a specific diagnosis and to separate vascular etiologies from tumor and other structural injuries. The pattern of sensory disturbance may be helpful. [tchain.com]
Rocca, M.D., is working to clarify the etiology of Parkinson's disease and to identify means to prevent it in independent but related studies based on different sampling and measurement strategies. [mayo.edu]
Epidemiology
Basilar-type migraine: clinical, epidemiologic, and genetic features. Neurology. 2006;66(6):880-886. Ying G, Fan W, Li N, et al. Clinical characteristics of basilar-type migraine in the neurological clinic of a university hospital. Pain Medicine. [migraine.com]
Epidemiology and Genetics of Parkinson's Disease Walter A. [mayo.edu]
There is a clinical continuum between BBE and Fisher's syndrome. [ 1 ] Bickerstaff reported eight patients who, in addition to acute ophthalmoplegia (diplopia) and ataxia, showed drowsiness, extensor plantar responses or hemisensory loss. [ 2 ] Epidemiology [patient.info]
[…] allow trainees to eventually return to their country of origin and to facilitate translation of these rapidly emerging experimental technologies into novel therapeutic applications and into creative collaborative partnerships in the areas of genetic epidemiology [einstein.yu.edu]
Basilar-type migraine: Clinical, epidemiologic, and genetic features. Neurology 2006;66: 880-886. Klapper J, Mathew N, Nett R. Triptans in the treatment of basilar migraine and migraine with prolonged aura. Headache. 2001;41:981-984. [americanmigrainefoundation.org]
Pathophysiology
This finding has implications for pathophysiologic models of panic disorder, and provides structural evidence for the role of the brainstem in neurocircuitry models of panic disorder. [nyuscholars.nyu.edu]
This finding has implications for pathophysiologic models of panic disorder, and provides structural evidence for the role of the brainstem in neurocircuitry models of panic disorder. a Functional Neuroimaging Laboratory, Department of Psychiatry, Weill [journals.lww.com]
Anatomic location determines the pathophysiological manifestation of the tumor. With tectal lesions, hydrocephalus may occur as a result of fourth ventricular compression. [emedicine.medscape.com]
With the breadth of possible pathophysiologic mechanisms, ANSD can manifest with a wide variety and degree of symptoms and findings, 8 but these various phenotypes may exhibit indistinguishable audiometric and electrophysiologic results (ie, the presence [ajnr.org]
The brainstem is the site of primary neurotransmitter innervation to both the fronto-limbic system and the HPA, and is hence a site of primary interest in understanding the pathophysiology of MDD. [journals.plos.org]
Prevention
Prevention of MS brainstem problems relies on the same disease-modifying treatments (DMTs) used to prevent MS progression. [verywell.com]
Of the preventive medications, topiramate, verapamil and lamotrigine are most commonly used. [americanmigrainefoundation.org]
Peever hopes that his research will pave the way for neuroprotective therapies that would prevent against the development of such neurodegenerative disorders. [medicalnewstoday.com]
These studies will contribute greatly to understanding the causes and possible prevention of PD by exploring novel hypotheses and by using innovative methods. [mayo.edu]
Exercises can also strengthen your muscles to help prevent falls. To prevent worsening of symptoms during an episode of vertigo, try the following: Keep still. Sit or lie down when symptoms occur. Gradually resume activity. [medlineplus.gov]