title: Topodiagnostic investigations on the sympathoexcitatory brain stem pathway using a new method of three dimensional brain stem mapping.
abstract: OBJECTIVE
  To study the incompletely understood sympathoexcitatory pathway through the human brain stem, using a new method of three dimensional brain stem mapping on the basis of digitally postprocessed magnetic resonance imaging (MRI).
  
  
  METHODS
  258 consecutive patients presenting with acute signs of brain stem ischaemia underwent biplane T2 and EPI diffusion weighted MRI, with slice orientation parallel and perpendicular to a transversal slice selection of the stereotactic anatomical atlas of Schaltenbrand and Wahren, 1977. The individual slices were digitally normalised and projected onto the appropriate slices of the anatomical atlas. For correlation analysis lesions were imported into a three dimensional model of the human brain stem.
  
  
  RESULTS
  31 of the 258 patients had Horner's syndrome caused by acute brain stem ischaemia. Only four of the patients with Horner's syndrome had pontine infarctions, 12 had pontomedullary lesions, and 15 had medullary lesions. Correlation analysis showed significantly affected voxels in the dorsolateral medulla but not in the pons. A statistical comparison with infarct topology in patients with medullary lesions but without Horner's syndrome indicated that involvement of the medial and ventral part of affected voxels located in the ventrolateral medullary tegmentum was specific for Horner's syndrome.
  
  
  CONCLUSIONS
  Based on this first in vivo topodiagnostic study, the central sympathoexcitatory pathway probably descends through the dorsal pons before converging on specific generators in the ventrolateral medullary tegmentum at a level below the IX and X nerve exits.
authors.affiliation: Department of Neurology, University of Mainz, Mainz, Germany. marx@neurologie.klinik.uni-mainz.de
authors.forename: J J
authors.initials: JJ
authors.lastname: Marx
authors.forename: G D
authors.initials: GD
authors.lastname: Iannetti
authors.forename: A
authors.initials: A
authors.lastname: Mika-Gruettner
authors.forename: F
authors.initials: F
authors.lastname: Thoemke
authors.forename: S
authors.initials: S
authors.lastname: Fitzek
authors.forename: G
authors.initials: G
authors.lastname: Vucurevic
authors.forename: P P
authors.initials: PP
authors.lastname: Urban
authors.forename: P
authors.initials: P
authors.lastname: Stoeter
authors.forename: G
authors.initials: G
authors.lastname: Cruccu
authors.forename: H C
authors.initials: HC
authors.lastname: Hopf
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001927:Brain Diseases / Q000175:diagnosis* / Q000503:physiopathology*; D001931:Brain Mapping / Q000379:methods*; D001933:Brain Stem / Q000503:physiopathology*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D009434:Neural Pathways / Q000503:physiopathology*; D013564:Sympathetic Nervous System / Q000503:physiopathology*