blood flow from superior saggital sinus to internal carotid veinsuperior saggital sinus→ superior anastomotic vein(Trolard vein)→ Sylvian vein→ cavernous sinus→ inferior petrosal sinus→ internal carotid vein neurologyneurosurgery HirotoShishido
When facial nucleus is affected at the level of lower-pons, what nucleus is likely to be affected too?abducens nucleus(CN Ⅵ) neurologyneurosurgery HirotoShishido
trigeminal nucleus
homunculusonion-skin pattern
upper portion of nucleus→ innervate A region
lower portion of nucleus→ C region
trigeminal nucleimesencephalic nucleus→ reflex proprioception of the periodontium and of the muscles of mastication in the jaw
chief sensory nucleus(mid pons)→ sensation and light touch of the face as well as conscious proprioception of the jaw
spinal trigeminal nucleus(mid pons-C2)→ information about deep/crude touch, pain, and temperature from the ipsilateral face neurologyneurosurgery HirotoShishido
internal capsule
homunculusanterior→frontopontine, eye movement
genu→corticonuclear,corticospinal
posterior→arm,trunk,leg,optic and auditory radiation neurologyneurosurgery HirotoShishido
6 types of brain herniation
characteristicssupratentorial
①cingulate(subfalcine) herniation
anterior cerebral aretery is compressed
②central herniation
Duret hemorrhage(rupture of paramedian basilar artery branches)
③uncal herniation
ipsilateral CN Ⅲ compression, contralateral crus cerebri compression against Kernohan notch
④transcalvarial(external herniation, 経頭蓋冠ヘルニア)
infratentorial
⑤upward herniation
almost same as transtentrial herniation
⑥cerebellar tonsillar herniation
coma and death(brain stem compression) neurologyneurosurgery HirotoShishido
decorticate and decerebrate posturingDecorticate (flexor) posturing—lesion above red nucleus, presents with flexion of upper extremities and extension of lower extremities
Decerebrate (extensor) posturing—lesion at or below red nucleus(eg. midbrain tegmentum, pons), presents with extension of upper and lower extremities neurologyneurosurgeryUWorld HirotoShishido
which structure is targeted at by high-frequency deep brain stimulation(DBS) for medically intractable symptoms of Parkinson disease?globus pallidus internus or subthalamic nucleus
