[Brainstem infarcts presented medial longitudinal fasciculus (MLF) syndrome and cerebellar ataxia--report of three cases].
Vascular disorders of the brainstem manifest characteristic neurologic symptoms according to their localization. The medial longitudinal fasciculus (MLF) lies in the paramedian portion of the upper brainstem tegmentum, and the lesion in this fasciculus shows specific abnormality of the eye movement pattern which is known as the MLF syndrome. Although the MLF syndrome was reported frequently to be accompanied by varieties of other neurologic deficits according to the lesion extending into the adjacent structures in the brainstem, the combination of MLF syndrome and cerebellar ataxia has attracted less attention of neurologists. Recently we experienced three cases of cerebellar ataxia arisen simultaneously with MLF syndrome. Magnetic resonance imaging (MRI) tomography or X-ray computed tomography visualized lacunar lesion(s) in the upper brainstem tegmentum in all of three cases. It was obvious that the lesion included the MLF and caused the MLF syndrome in these cases. It was speculated that ventro-caudal extension of the lesion involved the decussation of the superior cerebellar peduncle, and was responsible for the association of cerebellar ataxia with MLF syndrome. According to the recent discussion about the feeding arteries in the brainstem, we decided that the damage of the paramedian branches diverging from the basilar tip resulted in the lacunar lesion(s). The development of diagnostic procedures especially MRI enables the diagnosis of the vascular disorders in the brainstem with considerable accuracy.
Department of Neurology, School of Medicine, Kanazawa University.
S
S
Sakakibara
S
S
Sakato
T
T
Shima
Y
Y
Ide
M
M
Takamori
D000368:Aged; D001933:Brain Stem / Q000098:blood supply*; D002524:Cerebellar Ataxia / Q000209:etiology*; D002544:Cerebral Infarction / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015835:Ocular Motility Disorders / Q000209:etiology*; D013577:Syndrome