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Degenerative Diseases of the Nervous System
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
James A. Mastrianni, Elizabeth A. Harris
Cranial CT scan may show enlargement of the third ventricle and interpeduncular cistern due to atrophy of the midbrain; however, MRI is more sensitive imaging for brainstem pathology. CT is performed to exclude structural lesions, hydrocephalus, and multi-infarct states, which may produce clinical findings similar to PSP.
Test Paper 7
Published in Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike, Get Through, 2017
Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike
The third nerves exit the brain stem medial to the cerebral peduncles, and course forward and laterally in the interpeduncular cistern between the posterior cerebral arteries–posterior communicating arteries (PcomA) above and superior cerebellar arteries below. The pupillary fibres are located dorsomedially and peripherally at this segment.
The Problems
Published in John Greene, Ian Bone, Understanding Neurology a problem-orientated approach, 2007
The oculomotor (III) nerve is the major nerve supplying eye movement, controlling the superior, inferior and medial recti, and the inferior oblique (106, 107). It also innervates levator palpebrae superioris (which elevates the eyelid) and carries the parasympathetic nerve supply to the pupil. On leaving the midbrain anteriorly, the nerve passes through the interpeduncular cistern in close relation to the posterior communicating artery and runs through the cavernous sinus. From here it enters the orbit through the superior orbital fissure.
Cranial Polyneuropathy Secondary to Remote Iophendylate Myelography
Published in Neuro-Ophthalmology, 2022
Eleven months earlier she had fallen and hit the back of her head. Three months later, she developed intermittent binocular, oblique double vision and eventually was found to have a left hypertropia of 9 prism dioptres (PD), increasing to 14 PD on right gaze. The hypertropia worsened on head tilt towards the left shoulder and disappeared on head tilt towards the right shoulder. There was 7–10 degrees of left excyclotorsion. A diagnosis of traumatic left trochlear nerve paresis was made, and magnetic resonance imaging (MRI) of the brain and orbits was obtained. The MRI was interpreted by a radiologist as follows: On the sagittal T1-weighted images multiple small foci of increased signal intensity are identified along the anterior aspect of the midbrain as well as the borders of the suprasellar cistern. These also are seen on the optic chiasm and pituitary stalk. These findings are more significant on the left side. A slightly larger focus is identified on the left side between the fifth nerve and the seventh/eighth nerve complex, close to the internal auditory canal. Some of these foci are seen accumulating in the interpeduncular cistern. None of the foci enhance after administration of contrast. Impression: Fat droplets consistent with a ruptured dermoid cyst.
Delayed ischaemia due to vasospasm after fenestration of a large arachnoid cyst
Published in British Journal of Neurosurgery, 2019
Jochem K. H. Spoor, Hugo P. Aben, Bachtiar Burhani, Geert-Jan Rutten
An 18-year-old female presented to our hospital after a mild head trauma. She had fallen off her scooter, after which an epileptic seizure was reported by a nurse, who coincidentally was present at the scene. The patient was unconscious for ten minutes and suffered from posttraumatic amnesia. Neurological examination showed no deficits. The patient had a history of migraine-like headaches. According to her parents, she had always had some difficulties with memory and learning in school. Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) showed a large left-hemispheric arachnoid cyst, which caused significant compression on the brain (Figure 1). There were no signs of subarachnoid haemorrhage or other posttraumatic injuries. Given the large size and the mass effect of the cyst, and the fact that it was a probable cause of the seizure, it was decided to perform surgery. Three days later an endoscopic fenestration of the cyst was performed via a navigated temporal burrhole. The fluid of the cyst appeared slightly clouded. During the procedure we continuously irrigated with Ringer’s fluid. The interpeduncular cistern was opened using micro-scissors and coagulation. There were no complications during surgery.
MRI evaluation of progressive supranuclear palsy: differentiation from Parkinson’s disease and multiple system atrophy
Published in Neurological Research, 2019
Cenk Eraslan, Ahmet Acarer, Serkan Guneyli, Esra Akyuz, Elcin Aydin, Zafer Colakoglu, Omer Kitis, Mehmet Cem Calli
To measure cerebral peduncle angle, Step 1 included reformatting the 3D axial T1-weighted images along the anterior commissure–posterior commissure line. Step 2 was to precisely identify the axial plane, selected as a level below the mammillary bodies, for measuring the cerebral peduncle angle. This was done to ensure that the imaging plane used to measure the cerebral peduncle angle would remain constant amongst the study population. Step 3 included measurement of the cerebral peduncle angle. We defined the cerebral peduncle angle as the angle measured between the medial aspects of the cerebral peduncles with the posterior midline point of the interpeduncular cistern representing the vertex of the angle. Step 4 was the evaluation of the cerebral peduncle angle in the study population (Figure 1(d)).