Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0028738 (nystagmus)
 7,431 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report a case showing supranuclear vertical gaze palsy and convergence nystagmus caused by a unilateral lesion of the rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF). The patient was a 54-year-old female with mitral stenosis and regurgitation and atrial fibrillation, who suddenly developed vertigo and double vision. She was admitted to our hospital because of persisting diplopia 4 days after onset, although vertigo had resolved within 1 hour. On admission she was alert, but presented with supranuclear vertical gaze palsy and convergence nystagmus. Other cranial nerves were intact and motor strength, deep tendon reflexes, sensations were also normal. There were no cerebellar signs. Cranial MRI demonstrated a unilateral ischemic lesion at the left thalamo-mesencephalic junction that involved the unilateral riMLF. Cerebral angiography revealed no abnormalities. Vertical gaze palsy has been reported to be caused by a lesion involving bilateral riMLF or unilateral posterior commissure, and convergence nystagmus usually by a lesion near or within the dorsal mesencephalon. However, recent reports have demonstrated a histopathologic evidence that vertical gaze palsy was caused by unilateral riMLF lesion. The present case confirms clinically that both vertical gaze palsy and convergence nystagmus can be developed by a lesion of unilateral riMLF.
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PMID:[Supranuclear vertical gaze palsy and convergence nystagmus caused by unilateral riMLF lesion]. 181 94

The transoral approach provides a safe exposure to lesions in the midline and the ventral side of the craniovertebral junction. The advantages of the transoral approach are 1) the impinging bony pathology and granulation tissue are accessible only via the ventral route; 2) the head is placed in the extended position, thus decreasing the angulation of the brainstem during the surgery; and 3) surgery is done through the avascular median pharyngeal raphe and clivus. We analyzed the clinical effects of odontoidectomy after treating 38 patients with basilar invagination. The anterior transoral operation to treat irreducible ventral compression in patients with basilar invagination was performed in 38 patients. The patients ages ranged from 34 to 67 years. Fourteen patients had associated Chiari malformation and eight had previously undergone posterior decompressive surgery. The main indication for surgery was significant neurological deterioration. Symptoms and signs included neck pain, myelopathy, lower cranial nerve dysfunction, nystagmus and gait disturbance. Extended exposure was performed in 24 patients. The surgery was beneficial to the majority of patients. There was one death within 10 days of surgery, due to pulmonary embolism. Postoperative complications included two cases of pneumonia, three cases of oronasal fistula with regurgitation and one cerebrospinal fluid leak. In patients with marked ventral compression, the transoral approach provides direct access to the anterior face of the craniovertebral junction and effective means for odontoidectomy.
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PMID:Transoral approach to the craniovertebral junction. 1834 23