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The clinical syndrome and etiological mechanism of infarction involving the nucleus prepositus hypoglossi

 Hyun-Ji Cho  ;  Hye-Yeon Choi  ;  Young Dae Kim  ;  Sang Won Seo  ;  Ji Hoe Heo 
 CEREBROVASCULAR DISEASES, Vol.26(2) : 178-183, 2008 
Journal Title
Issue Date
Aged ; Aged, 80 and over ; Aortic Diseases/complications ; Aortic Diseases/pathology ; Ataxia/etiology ; Ataxia/pathology ; Atherosclerosis/complications ; Atherosclerosis/pathology ; Atrial Fibrillation/complications ; Atrial Fibrillation/pathology ; Cerebral Infarction/complications ; Cerebral Infarction/etiology* ; Cerebral Infarction/pathology ; Deglutition Disorders/etiology ; Deglutition Disorders/pathology ; Diffusion Magnetic Resonance Imaging ; Facial Paralysis/etiology ; Facial Paralysis/pathology ; Female ; Humans ; Male ; Medulla Oblongata/pathology* ; Middle Aged ; Nausea/etiology ; Nausea/pathology ; Nystagmus, Pathologic/etiology ; Nystagmus, Pathologic/pathology ; Ophthalmoplegia/etiology ; Ophthalmoplegia/pathology ; Pons/pathology* ; Risk Factors ; Syndrome ; Vertebrobasilar Insufficiency/complications ; Vertebrobasilar Insufficiency/pathology ; Vertigo/etiology ; Vertigo/pathology ; Vomiting/etiology ; Vomiting/pathology
Brain infarction, diffusion-weighted imaging ; Nucleus prepositus hypoglossi.
BACKGROUND: The human nucleus prepositus hypoglossi (NPH), which is known to be a neural integrator of horizontal eye movement, may also serve vestibular function. The present study investigated the clinical spectrum and etiological mechanism of isolated, small infarctions involving the NPH area demonstrated on MRI. METHODS: The subjects of this study were 18 consecutive patients with a small infarction involving the NPH that was demonstrated by diffusion-weighted MRI. We assessed their clinical features according to the level involved (pons or medulla oblongata) and determined etiological mechanisms that may cause infarction in this region. RESULTS: Vertigo and nausea/vomiting were the presenting symptoms in all patients. Sixteen patients showed truncal ataxia (contralateral falls in 11 patients and bilateral falls in 3). Gaze-evoked nystagmus was observed in 13 patients. In addition to those NPH-related symptoms, ipsi- lateral peripheral facial palsy and horizontal gaze palsies, including internuclear ophthalmoplegia and horizontal conjugate gaze palsy, were commonly associated with pontine lesions, and dysphagia was common in medullary lesions. Ten out of 18 patents showed significant stenosis (>or=50%) of the relevant vertebral artery. Two patients had aortic atheroma >4 mm, and 1 patient had atrial fibrillation. CONCLUSIONS: Clinical features of vertigo, contralateral falls and gaze-evoked nystagmus are suggestive of an NPH lesion. Accompanying signs of ipsilateral facial palsy of the peripheral type and/or horizontal gaze palsies are highly specific for a pontine NPH lesion. Large-artery atherosclerosis was the most common causative mechanism of infarctions involving the NPH area
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1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Young Dae(김영대) ORCID logo https://orcid.org/0000-0001-5750-2616
Heo, Ji Hoe(허지회) ORCID logo https://orcid.org/0000-0001-9898-3321
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