• Journal of Korean Neurosurgical Society
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• v.41 no.3
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• pp.190-192
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• 2007

Rarely, downbeat nystagmus can occur due to compression of the lower brainstem by the ectatic vertebral artery and be resolved by microvascular decompression. We present a case of a 67-year-old man with downbeat nystagmus associated with brainstem compression by ectatic vertebral artery. He presented with oscillopsia and vertigo. When he turned his head upward, his symptoms were aggravated and a gait disturbance occurred. Magnetic resonance imaging and computed tomographic angiography demonstrated compression of the medulla oblongata by the left ectatic vertebral artery and other medical causes of downbeat nystagmus were ruled out. Retromastoid craniotomy was performed and after lifting the vertebral artery off the medulla, a trough-shaped indentation in the lower brainstem was identified. The ectatic vertebral artery was repositioned and a Teflon was inserted between the brainstem and the ectatic vertebral artery. Postoperatively, downbeat nystagmus had disappeared.

• The Journal of Pediatrics of Korean Medicine
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• v.12 no.1
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• pp.55-61
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• 1998

Brainstem gliomas remain an important oncologic problem in the pediatric age group. These tumors constitute between 10 and 15% of all intracranial childhood tumors and despite advanced in the diagnosis and treatment of children with brain tumors, brainstem gliomas are still almost invariably rapidly lethal. We have few of clinical records of braintumors and admission case in the oriental medical hospital, classifications of tumor, symptoms and etc, specially in the pediatrics, so we introduce a case of a 7-year-old child with brainstem glioma which is diagnosised by MRI in our hospital.

• Journal of Korean Neurosurgical Society
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• v.54 no.2
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• pp.139-141
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• 2013

Presented here is a 36-year-old male with arterial hypertension who developed brainstem edema and intracranial hemorrhage. Magnetic resonance scan revealed diffuse brainstem hyperintensity in T2-weighted and fluid-attenuated inversion-recovery images, with an increase in apparent diffusion coefficient values. After a reduction in blood pressure, rapid resolution of the brainstem edema was observed on follow-up. The patient's condition was thus interpreted as hypertensive brainstem encephalopathy. While many consider this a vasogenic phenomenon, induced by sudden, severe hypertension, the precise mechanism remains unclear. Prompt recognition and aggressive antihypertensive treatment in such patients are essential to prevent permanent or life-threatening neurologic injury.

• Journal of Korean Neurosurgical Society
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• v.55 no.3
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• pp.152-155
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• 2014

Dural ateriovenous fistula (DAVF) at the craniocervical junction is rare. We report a patient presenting with brainstem dysfunction as an uncommon onset. Brainstem lesion was suggested by magnetic resonance image study. Angiogram revealed a DAVF at a high cervical segment supplied by the meningeal branch of the right vertebral artery, with ascending and descending venous drainage. Complete obliteration of the fistula was achieved via transarterial Onyx embolization. Clinical cure was achieved in the follow-up period; meanwhile, imaging abnormalities of this case disappeared. Accordingly, we hypothesize that a brainstem lesion of this case was caused by craniocervical DAVF, which induced venous hypertension. Thus, venous drainage patterns should be paid attention to because they are important for diagnosis and theraputic strategy.

• Clinical and Experimental Pediatrics
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• v.57 no.12
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• pp.542-545
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• 2014

Bickerstaff's brainstem encephalitis is characterized by ophthalmoplegia, ataxia, and disturbance of consciousness. It is similar to Miller Fisher syndrome, a variant of Guillain-Barre syndrome, in that they share features such as ophthalmoplegia and ataxia. The difference is that patients with Bickerstaff's brainstem encephalitis have impaired consciousness, whereas patients with Miller Fisher syndrome have alert consciousness and areflexia. Here, we report the case of a 3-year-old child who was diagnosed with Bickerstaff's brainstem encephalitis presenting typical clinical features and interesting radiological findings. The patient showed ophthalmoplegia, ataxia, and subsequent stuporous mentality. Brain magnetic resonance imaging revealed high signal intensity in the pons and cerebellum around the 4th ventricle on a T2-weighted image. He was successfully treated with intravenous immunoglobulin. Differentiation of Bickerstaff's brainstem encephalitis and Miller Fisher syndrome is often difficult because they possess many overlapping features. Brain magnetic resonance imaging may be helpful in diagnosing Bickerstaff's brainstem encephalitis, especially when lesions are definitely found.

• Journal of Korean Neurosurgical Society
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• v.29 no.10
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• pp.1357-1359
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• 2000

Isolated brainstem invlovement of neurocysticercosis is rare. We present the clinical and radiological features of a patient with a solitary cysticercus granuloma in the brainstem confirmed by MRI and CSF ELISA test. Good response was obtained from conservative treatment, using praziquantel. We believe that patients from regions where cysticercosis is endemic, who have no systemic disease, who present with nonprogressive symptoms and signs of brainstem involvement, and display a solitary ring-enhancing mass in the brainstem measuring less than 20mm on neuroimaging may be managed conservatively.

• Journal of Korean Neurosurgical Society
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• v.30 no.sup1
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• pp.20-24
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• 2001

Object : We intended to investigate the relationship between the degree of injury on MRI and the outcome of the patients with diffuse axonal inury. Method : From january, 1995 to march, 1999, 22 patients were supposed to have diffuse axonal injuries by means of their neurologic signs and MRI. We investigated their prognosis according to CT, MRI and initial neurologic findings. Result : 1) The lesions were mainly located at white matter of cerebrum, corpus callosum, brainstem, and basal ganglia. 2) The lesions of white matter were most commonly in the frontal lobe and temporal lobe. 3) The majority of corpus callosal lesions were located in the posterior body and splenium, but anterior corpus callosal lesions combined with posterior lesions were not found. 4) Brainstem lesions, all non-hemorrhagic, were mostly located in the dorsolateral aspect, not be found on CT. 5) The brainstem lesions were found in 10 cases among total 22 cases, and corpus callosal lesions were accompanied with 8 cases of brainstem lesions. 6) The patients with brainstem lesions had worse prognosis. Conclusion : It is important and reasonable to take brain MRI to identify the brainstem lesions in any cases of suspicious diffuse axonal injury, and we should remind that the diffuse axonal injury with stem lesion has worse prognosis.

• Journal of Acupuncture Research
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• v.20 no.6
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• pp.148-159
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• 2003

Objective: This study examines the effects of acupoint combination on NADPH-diaphorase and neuronal nitric oxide synthase(nNOS) in the brainstem of spontaneously hypertensive rats. Methods: The changes of NADPH-d-positive neurons using a histochemical method and the changes of nNOS-positive neurons using an immunohistochemical method were evaluated. The optical densities of NADPH-d-positive neurons and nNOS-positive neurons of the Choksamni(ST36) Umnungchon(SP9) groups were significantly increased in all brainstem areas as compared to the Choksamni and Choksamni Kokchi(LI11) groups and decreased, with the exeption of the nNOS-positive neurons in the superficial gray of superior colliculus, as compared to the normal group. Results: Our results demonstrated that electroacupuncture changes the activity in the NO system in the brainstem of SHR and the acupoint combination is one of the important parameters for this effect.

• Journal of Korean Neurosurgical Society
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• v.57 no.1
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• pp.50-53
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• 2015

Usually fungal infections caused by opportunistic and pathogenic fungi had been an important cause of morbidity and mortality among immunocompromised patients. However clinical data and investigations for immunocompetent pathogenic fungal infections had been rare and neglected into clinical studies. Especially Cryptococcal brainstem abscess cases mimicking brain tumors were also much more rare. So we report this unusual case. This 47-year-old man presented with a history of progressively worsening headache and nausea for 1 month and several days of vomituritions before admission. Neurological and laboratory examinations performed demonstrated no abnormal findings. Previously he was healthy and did not have any significant medical illnesses. A CT and MRI scan revealed enhancing $1.8{\times}1.7{\times}2.0$ cm mass lesion in the left pons having central necrosis and peripheral edema compressing the fourth ventricle. And also positron emission tomogram scan demonstrated a hot uptake of fluoro-deoxy-glucose on the brainstem lesion without any evidences of systemic metastasis. Gross total mass resection was achieved with lateral suboccipital approach with neuronavigation system. Postoperatively he recovered without any neurological deficits. Pathologic report confirmed Cryptococcus neoformans and he was successively treated with antifungal medications. This is a previously unreported rare case of brainstem Cryptococcal abscess mimicking brain tumors in immunocompetent host without having any apparent typical meningeal symptoms and signs with resultant good neurosurgical recovery.

• Journal of Korean Neurosurgical Society
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• v.45 no.3
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• pp.176-178
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• 2009

Traumatic brainstem hemorrhage after blunt head injury is an uncommon event. The most frequent site of hemorrhage is the midline rostral brainstem. The prognosis of these patients is poor because of its critical location. We experienced a case of traumatic brainstem hemorrhage. A 41-year-old male was presented with drowsy mentality and right hemiparesis after blunt head injury. Plain skull radiographs and brain computerized tomography scans revealed a depressed skull fracture, epidural hematoma, and hemorrhagic contusion in the right parieto-occipital region. But, these findings did not explain the right hemiparesis. T2-weighted magnetic resonance (MR) image of the cervical spine demonstrated a focal hyperintense lesion in the left pontomedullary junction. Brain diffusion-weighted and FLAIR MR images showed a focal hyperintensity in the ventral pontomedullary lesion and it was more prominent in the left side. His mentality and weakness were progressively improved with conservative treatment. We should keep in mind the possibility of brainstem hemorrhage if supratentorial lesions or spinal cord lesions that caused neurological deficits in the head injured patients are unexplainable.