A Case of Bilateral Upgaze Palsy associated with Unilateral Midbrain Hemorrhage in Moyamoya Disease

PURPOSE: To report a case of bilateral upgaze palsy associated with unilateral midbrain hemorrhage in moyamoya disease. METHODS: A 29-year-old woman presented with a sudden decrease of consciousness and was diagnosed with a spontaneous brain hemorrhage in the right side of the midbrain, right basal ganglion, and third ventricle. The mentality was improved after external ventricular drainage of hemorrhage, but bilateral upgaze difficulty remained. We performed neuro-ophthalmic and radiologic evaluation of the cause of bilateral upgaze difficulty. RESULTS: She showed a upgaze limitation of -2 grade in the right eye and -3 grade in the left eye, but normal movements in other versions and ductions. There were normal responses in pupillary light reflex, forced duction and convergence tests, but no ocular elevation in the vertical vestibulo-ocular reflex. The Bell's phenomenon was absent. She was diagnosed with moyamoya disease through brain MRI and cerebral angiography, and we found a hemorrhage in the right area of the midbrain. This hemorrhagic area was consistent with the right rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF). We think that the bilateral upgaze palsy was caused by damage to the riMLF in the affected side and to projections through the posterior commissure.

THE INDIRECT PATHWAY OF THE SOMATIC AFFERENT ELEMENTS FROM TRIGEMINAL NERVE TO NUCLEUS TRACTUS SOLITARII——A LIGHT AND ELECTRON MICROSCOPIC HRP TRANSGANGLIONIC AND RETROGRADE TRACING STUDY / 解剖学报

The indirect pathway of the somatic afferent elements from trigeminal nerve (TGN) to nucleus tractus solitarii (NTS) was studied with the light and electron microscopic HRP transganglionic and retrograde tracing. After HRP was injected into NTS at the level of obex, the retrogradely labeled cells were mainly found in the interstitial nucleus buried in the spinal tract of TGN along caudal subnucleus. The interstitial nucleus was also the terminating area of the primary afferent fibers of lingual and inferior orbital nerves. Under electron microscope, it was found that the primary afferent terminals of lingual and inferior orbital nerves formed synapses on the dendrites of neurons in the interstitial nucleus. Moreover, in cellular architecture, the interstitial nucleus and the superficial laminae of the caudal nucleus of TGN were similar and continuous with each other. Hence, the pathway from the TGN to NTS via the interstitial nucleus is consisted of two neurons and the sensations transmitted through this pathway may be considered to be somatic. It is presumed that this pathway composed of two neurons might modulate the visceral afferent function in NTS when certain points in the skin area innervated by TGN were acupunctured.

PROJECTION OF THE CALBINDIN D-28K NEURONS RECEIVING VISCERAL NOCICEPTIVE INFORMATION FROM INTERSTITIAL NUCLEUS OF THE SPINAL TRIGEMINAL TRACT TO NUCLEUS OF THE SOLITARY TRACT IN THE RAT / 解剖学报

Objective To investigate the calbindin D\|28K (CB) neurons that receive the visceral nociceptive information in the interstitial nucleus of the spinal trigeminal tract (INV) directly project to the nucleus of the solitary tract (NTS). Methods Triple\|labeled methods of fluorogold (FG) retrograde tracing combined with Fos and CB proteins immunofluorescence histochemistry after formalin stimulating upper alimentary tract. Results Most of FG\|retrograde labeled neurons distributed in the paratrigeminal nucleus (PaV) and the dorsal paramarginal nucleus (PaMd) of INV ipsilateral to the FG injection. About 71^2% of FG\|retrograde labeled neurons contained CB and 31^5% of FG/CB double\|labeled neurons exhibited positive Fos\|immunoreaction in INV.Conclusion The results suggested that a part of neurons containing CB in INV receive the visceral nociceptive information and directly project to NTS. CB neurons might play an important role in transmitting visceral nociceptive information from INV to NTS. [