Isolated INO as a presentation of midbrain paramedian area lacunar infarction in patients with diabetes

Zhang, Yun; Wang, Lili; He, Miao

doi:10.1016/j.jocn.2017.08.005

Cited by 5 publications

(7 citation statements)

References 15 publications

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“…Based on these values, it is noticed that the blood vessels of the principal oculomotor nucleus are larger and more convoluted in comparison with the blood vessels of the SC and the magnocellular part of the nucleus ruber, which predisposes the principal oculomotor nucleus to a more frequent vascular occlusion. 17,18 With ageing, no changes in the studied stereological parameters of the blood vessels of the principal oculomotor nucleus and the magnocellular part of the nucleus ruber were observed, 19,16 while the blood vessels of Discussion the SC show a decrease in the length density with age, which means that their tortuosity decreases, which was not seen in other structures at the same transversal level.…”

Section: Resultsmentioning

confidence: 93%

Stereological analysis of the vascular network in superior colliculi

Sladojević¹,

Prerad²,

Mršić³

2020

Scripta Medica

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Background/Aim: Superior colliculi have an important role in the visual system, some motor functions and behaviour. Branches of the posterior cerebral artery and surrounding vessels form a collicular arterial network, which gives rise to several penetrating vessels for superior colliculi. The aim of the study was to determine relative stereological parameters (volume, surface and length density) of the vascular network in superior colliculi and to correlate those parameters with age. Methods: Ten adult brainstems, both male and female, were cut transversally at the middle of superior colliculi in three-millimetre-thick strata. Every stratum was cut in 4 µm thick semiserial sections stained with Mallory method. Images of every fifth section (5, 10, 15, 20) of superior colliculus were taken with "Leica" DM 1000 microscope and "Leica" MC 170HD camera under x 400 magnification and analysed by ImageJ software with A 100 grid. Statistical analysis was performed by the SPSS software with 5 % level of significance using methods of descriptive statistics, Spearman's and Pearson's correlation coefficient. Results: The average volume density of vascular network in superior colliculi was 0.0203 mm 0 , surface density 6.133 mm-1 , and length density 205.357 mm-2. All those parameters decreased with ageing, but statistically significant change was seen only in length density (p = 0.006). Conclusion: Compared to the structures at the same transversal level, the vascular network of superior colliculi has an average density. With ageing, blood vessels become less tortuous.

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Section: Resultsmentioning

confidence: 93%

Stereological analysis of the vascular network in superior colliculi

Sladojević¹,

Prerad²,

Mršić³

2020

Scripta Medica

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“…Hence, vertical gaze palsy with INO can hint clinicians to focus over the pontomesencephalic junction and check for cerebellar involvement. Most of the cases of INO with ataxia are caused by vascular infarct [1,18,20,22]. In our case, he experienced all the symptoms after waking up in the morning.…”

Section: Discussionmentioning

confidence: 50%

“…INO with vertical gaze palsy is rarely seen with lesions in the upper midbrain, and to our best knowledge, there are only 2 cases reported [22]. In cases with lesions at the level of pontomesencephalic junction, vertical palsy is present in 23 % of INO with ataxia and none of the isolated INO patients has vertical gaze palsy [18].…”

Section: Discussionmentioning

confidence: 89%

A rare case of unilateral Cogan’s anterior internuclear ophthalmoplegia, upgaze palsy and ataxia caused by dorsal tegmentum lesion at pontomesencephalic junction

Wai

Lim

et al. 2021

BMC Ophthalmol

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Background Cogan’s anterior internuclear ophthalmoplegia (INO) is characterized by INO with inability to converge and commonly thought to be due to rostral midbrain lesion. A lesion outside midbrain that causes unilateral Cogan’s anterior INO combined with upgaze palsy and ataxia are rarely described. Case presentation A 67-year old male presented with left Cogan’s anterior internuclear ophthalmoplegia (INO), left appendicular ataxia and bilateral upgaze palsy. A Magnetic Resonance Imaging (MRI) and Magnetic Resonance Angiography (MRA) brain showed a left dorsal tegmental infarct at the level of pontomesencephalic junction. Conclusions This case highlights the clinical importance of Cogan’s anterior INO in combination with upgaze palsy and ataxia, and report possible site of lesion in patients with such constellation. Clinicians should consider looking for cerebellar signs in cases of Cogan’s anterior INO, apart from just considering localizing the lesion at the midbrain.

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“…Isolated INO as presentation of focal midbrain infarcts is a very uncommon entity with few reported cases within the literature [2][3][4]. This fact is partially the result of the overlapping vascular supply of the midbrain with other structures, such as the thalamus [5]. The paramedian (PM) area infarction is most frequent, followed by lateral area infarction.…”

Section: Discussionmentioning

confidence: 99%

“…The paramedian (PM) area infarction is most frequent, followed by lateral area infarction. Reported cases of midbrain stroke presenting as INO in the literature were found to have involved the PM region of the midbrain and most cases have been associated with diabetes mellitus [ 5 ] in addition to other medical diseases contributing to chronic arteriopathy [ 3 , 5 ]. This finding is consistent with previous reports of pure midbrain infarction.…”

Section: Discussionmentioning

confidence: 99%

Midbrain Ischemic Strokes Presenting as Isolated Internuclear Opthalmoplegia

Haymes¹,

Jenson²,

Nwachukwu³

et al. 2021

Cureus

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Stroke can present with unique neurologic symptoms, which can be used to help determine the location of the stroke. Internuclear ophthalmoparesis (INO), also known as internuclearophthalmoplegia, is a distinct gaze abnormality with impaired horizontal eye movements with compromised adduction of the affected eye, and abduction nystagmus of the contralateral eye. Infarcts involving the medial longitudinal fasciculus in either the pons or midbrain can result in INO. We present two cases of midbrain ischemic stroke, which presented as isolated INO. The midbrain has a unique and intricate vascular supply including branches from the basilar, superior cerebellar, posterior cerebral, posterior communicating, anterior choroidal, and posterior choroidal arteries, which is reviewed. Infarcts involving the paramedian midbrain, which is supplied by short circumferential arteries and penetrating branches arising from the posterior cerebral artery and superior cerebellar artery, can result in INO.

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Isolated INO as a presentation of midbrain paramedian area lacunar infarction in patients with diabetes

Cited by 5 publications

References 15 publications

Stereological analysis of the vascular network in superior colliculi

Stereological analysis of the vascular network in superior colliculi

A rare case of unilateral Cogan’s anterior internuclear ophthalmoplegia, upgaze palsy and ataxia caused by dorsal tegmentum lesion at pontomesencephalic junction

Midbrain Ischemic Strokes Presenting as Isolated Internuclear Opthalmoplegia

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