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Radiographics : a Review Publication of... 2019The anatomy of the brainstem is complex. It contains numerous cranial nerve nuclei and is traversed by multiple tracts between the brain and spinal cord. Improved MRI... (Review)
Review
The anatomy of the brainstem is complex. It contains numerous cranial nerve nuclei and is traversed by multiple tracts between the brain and spinal cord. Improved MRI resolution now allows the radiologist to identify a higher level of anatomic detail, but an understanding of functional anatomy is crucial for correct interpretation of disease. Brainstem syndromes are most commonly due to occlusion of the posterior circulation or mass effect from intrinsic space-occupying lesions. These syndromes can have subtle imaging findings that may be missed by a radiologist unfamiliar with the anatomy or typical manifesting features. This article presents the developmental anatomy of the brainstem and discusses associated pathologic syndromes. Congenital and acquired syndromes are described and correlated with anatomic locations at imaging, with diagrams to provide a reference to aid in radiologic interpretation. RSNA, 2019.
Topics: Brain Diseases; Brain Infarction; Craniofacial Abnormalities; Humans; Magnetic Resonance Imaging; Medulla Oblongata; Mesencephalon; Neuroimaging; Pons; Syndrome
PubMed: 31283463
DOI: 10.1148/rg.2019180126 -
Trends in Neurosciences May 2018The parabrachial nucleus (PBN), which is located in the pons and is dissected by one of the major cerebellar output tracks, is known to relay sensory information... (Review)
Review
The parabrachial nucleus (PBN), which is located in the pons and is dissected by one of the major cerebellar output tracks, is known to relay sensory information (visceral malaise, taste, temperature, pain, itch) to forebrain structures including the thalamus, hypothalamus, and extended amygdala. The availability of mouse lines expressing Cre recombinase selectively in subsets of PBN neurons and viruses for Cre-dependent gene expression is beginning to reveal the connectivity and functions of PBN component neurons. This review focuses on PBN neurons expressing calcitonin gene-related peptide (CGRP) that play a major role in regulating appetite and transmitting real or potential threat signals to the extended amygdala. The functions of other specific PBN neuronal populations are also discussed. This review aims to encourage investigation of the numerous unanswered questions that are becoming accessible.
Topics: Animals; Calcitonin Gene-Related Peptide; Humans; Neurons; Parabrachial Nucleus
PubMed: 29703377
DOI: 10.1016/j.tins.2018.03.007 -
Current Neurology and Neuroscience... Sep 2017Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is a recently described treatable, inflammatory, brainstem... (Review)
Review
PURPOSE OF REVIEW
Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is a recently described treatable, inflammatory, brainstem predominant encephalomyelitis. The diagnosis of CLIPPERS is challenging without a specific biomarker, and thus it is important to consider if both the clinical and radiographic features are consistent with the diagnosis, or rather a disease mimicker.
RECENT FINDINGS
Many patients with CLIPPERS-like lesions have been described in the literature with follow-up revealing a range of alternative diagnoses, such as malignancies, vasculitis, and other specific inflammatory diseases. As a result, some have proposed that CLIPPERS might represent a pre-malignancy state or simply an initial clinical syndrome of a variety of possible etiologies. We describe the typical clinical, radiographic, and pathological features of CLIPPERS and emphasize consideration for alternative diagnoses when findings are not classic. A recommended diagnostic evaluation and initial treatment plan is provided.
Topics: Encephalomyelitis; Humans; Inflammation; Lymphocytes; Magnetic Resonance Imaging; Pons; Steroids
PubMed: 28726127
DOI: 10.1007/s11910-017-0773-7 -
Radiologie (Heidelberg, Germany) Aug 2022Brain capillary telangiectasia is usually a small collection of dilated capillary-like vessels. In most cases it is a harmless incidental finding with no clinical... (Review)
Review
Brain capillary telangiectasia is usually a small collection of dilated capillary-like vessels. In most cases it is a harmless incidental finding with no clinical significance. They are most commonly located in the pons. In terms of image morphology, they show brush-like signal extinction in T2*/SWI (susceptibility-weighted imaging) sequences and contrast enhancement in T1-weighted images. Other sequences are usually unremarkable unless they involve unusually large capillary telangiectasias. Angiographically they usually remain silent. Sometimes they are associated with venous abnormalities and/or cavernomas. Their distinctive radiographic features usually allow for a reliable diagnosis. Differential diagnostic considerations, such as differentiation from a tumorous or inflammatory process, are sometimes necessary.
Topics: Central Nervous System Vascular Malformations; Hemangioma, Cavernous; Humans; Magnetic Resonance Imaging; Pons; Telangiectasis
PubMed: 35792920
DOI: 10.1007/s00117-022-01037-z -
Clinical Nuclear Medicine Aug 2018Sellar and suprasellar paragangliomas are rare. We report the case of a 19-year-old man with sellar paraganglioma with parasellar and posterior pontine extension,...
Sellar and suprasellar paragangliomas are rare. We report the case of a 19-year-old man with sellar paraganglioma with parasellar and posterior pontine extension, requiring multiple transcranial surgeries and radiotherapy. The lesion was avid on Ga DOTANOC PET-CT scan substantiating its neuroendocrine nature.
Topics: Brain Neoplasms; Humans; Male; Organometallic Compounds; Paraganglioma; Pons; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Young Adult
PubMed: 29894338
DOI: 10.1097/RLU.0000000000002157 -
NeuroImage Dec 2022The cerebellum's involvement in cognitive, affective and motor functions is mediated by connections to different regions of the cerebral cortex. A distinctive feature of...
The cerebellum's involvement in cognitive, affective and motor functions is mediated by connections to different regions of the cerebral cortex. A distinctive feature of cortico-cerebellar loops that has been demonstrated in the animal work is a topographic organization that is preserved across its corticopontine, pontocerebellar, and cerebello-thalmo-cortical segments. Here we used tractography derived from diffusion imaging data to characterize the connections between the pons and the individual lobules of the cerebellum and generate a parcellation of the pons and middle cerebellar peduncle based on the pattern of connectivity. We identified a rostral to caudal gradient in the pons, similar to that observed in the animal work, such that rostral regions were preferentially connected to cerebellar lobules involved in non-motor, and caudal regions with motor regions. These findings advance our fundamental understanding of the cerebellum, and the parcellations we generated provide context for future research into the pontocerebellar tract's involvement in health and disease.
Topics: Animals; Pons; Cerebellum; Diffusion Magnetic Resonance Imaging; Cerebral Cortex; Neural Pathways; Brain Mapping; Magnetic Resonance Imaging
PubMed: 36252913
DOI: 10.1016/j.neuroimage.2022.119684 -
Current Opinion in Neurology Jun 2017One of the most discussed topics in migraine pathophysiology is where migraine attacks originate. Although recent evidence suggests central attack generating loci, there... (Review)
Review
PURPOSE OF REVIEW
One of the most discussed topics in migraine pathophysiology is where migraine attacks originate. Although recent evidence suggests central attack generating loci, there is an ongoing debate about the involved centres of the brain and brainstem.
RECENT FINDINGS
Recent neuroimaging studies focussing on the preictal stage of migraine attacks suggest a predominant role of the hypothalamus and its functional connectivity shortly before the beginning of migraine headaches. In interictal migraineurs, changes in resting state functional connectivity of the dorsal pons and the hypothalamus have been found.
SUMMARY
Based on the clinical presentation of the premonitory phase of migraine, the hypothalamus and changes within the dopaminergic system have been discussed as likely candidates for attack generation. Neuroimaging studies however suggested the dorsal pons as attack generator. Taking into account the recent findings of hypothalamic involvement and changing connectivity in the preictal stage, the available evidence suggests that the idea of a single migraine generator within the human brain is probably too simplistic. More likely, spontaneous oscillations of complex networks lead to activity changes in certain subcortical and brainstem areas. This in turn might constitute functional changes of descending pain-modulating pathways, and thus the generation of migraine pain.
Topics: Brain; Brain Stem; Humans; Hypothalamus; Migraine Disorders; Nerve Net; Neuroimaging; Pons
PubMed: 28240611
DOI: 10.1097/WCO.0000000000000441 -
Child's Nervous System : ChNS :... Oct 2023Diffuse intrinsic pontine glioma (DIPG) is a primary brainstem tumor of childhood that carries a dismal prognosis, with median survival of less than 1 year. Because of... (Review)
Review
Diffuse intrinsic pontine glioma (DIPG) is a primary brainstem tumor of childhood that carries a dismal prognosis, with median survival of less than 1 year. Because of the brain stem location and pattern of growth within the pons, Dr. Harvey Cushing, the father of modern neurosurgery, urged surgical abandonment. Such a dismal prognosis remained unchanged for decades, coupled with a lack of understanding of tumor biology and an unchanging therapeutic panorama. Beyond palliative external beam radiation therapy, no therapeutic approach has been widely accepted. In the last one to two decades, however, increased tissue availability, an improving understanding of biology, genetics, and epigenetics have led to the development of novel therapeutic targets. In parallel with this biological revolution, new methods intended to enhance drug delivery into the brain stem are contributing to a surge of exciting experimental therapeutic strategies.
Topics: Humans; Glioma; Brain Stem Neoplasms; Pons; Prognosis; Neurosurgical Procedures
PubMed: 37382660
DOI: 10.1007/s00381-023-06037-5 -
JAMA Neurology Jul 2015
Topics: Aged, 80 and over; Facial Paralysis; Humans; Male; Ophthalmoplegia; Pons
PubMed: 25962103
DOI: 10.1001/jamaneurol.2015.0255 -
European Radiology Jul 2023To conduct brainstem MRI shape analysis across neurodegenerative parkinsonisms and control subjects (CS), along with its association with clinical and cerebrospinal...
OBJECTIVES
To conduct brainstem MRI shape analysis across neurodegenerative parkinsonisms and control subjects (CS), along with its association with clinical and cerebrospinal fluid (CSF) correlates.
METHODOLOGY
We collected demographic and clinical variables, performed planimetric and shape MRI analyses, and determined CSF neurofilament-light chain (NfL) levels in 84 participants: 11 CS, 12 with Parkinson's disease (PD), 26 with multiple system atrophy (MSA), 21 with progressive supranuclear palsy (PSP), and 14 with corticobasal degeneration (CBD).
RESULTS
MSA featured the most extensive and significant brainstem shape narrowing (that is, atrophy), mostly in the pons. CBD presented local atrophy in several small areas in the pons and midbrain compared to PD and CS. PSP presented local atrophy in small areas in the posterior and upper midbrain as well as the rostral pons compared to MSA. Our findings of planimetric MRI measurements and CSF NfL levels replicated those from previous literature. Brainstem shape atrophy correlated with worse motor state in all parkinsonisms and with higher NfL levels in MSA, PSP, and PD.
CONCLUSION
Atypical parkinsonisms present different brainstem shape patterns which correlate with clinical severity and neuronal degeneration. In MSA, shape analysis could be further explored as a potential diagnostic biomarker. By contrast, shape analysis appears to have a rather limited discriminant value in PSP.
KEY POINTS
• Atypical parkinsonisms present different brainstem shape patterns. • Shape patterns correlate with clinical severity and neuronal degeneration. • In MSA, shape analysis could be further explored as a potential diagnostic biomarker.
Topics: Humans; Pilot Projects; Retrospective Studies; Parkinsonian Disorders; Mesencephalon; Parkinson Disease; Pons; Magnetic Resonance Imaging; Multiple System Atrophy; Atrophy; Biomarkers; Diagnosis, Differential
PubMed: 36773046
DOI: 10.1007/s00330-023-09435-0