Brainstem and Cranial Nerves: Midbrain

The midbrain (or mesencephalon) is the uppermost segment of the brainstem. This chapter reviews the important structures in the midbrain, including cranial nerves III and IV. The midbrain extends from the level of the trochlear nucleus to an imaginary line between the mammillary bodies and the posterior commissure. Important structures at this level include the cerebral peduncles, superior and inferior colliculi, red nucleus, substantia nigra, decussation of the middle cerebellar peduncle, and cranial nerves III and IV.

Mammillary body atrophy and other MRI correlates of school-age outcome following neonatal hypoxic-ischemic encephalopathy

The mammillary bodies (MB) and hippocampi are important for memory function and are often affected following neonatal hypoxic ischemic encephalopathy (HIE). The aim of this study was to assess neurodevelopmental outcome in 10-year-old children with HIE with and without therapeutic hypothermia. Additional aims were to assess the associations between MB atrophy, brain volumes (including the hippocampi), white matter microstructure and neurodevelopmental outcome at school-age. Ten-year-old children with HIE were included, who were treated with therapeutic hypothermia (n = 22) or would have qualified but were born before this became standard of care (n = 28). Children completed a neuropsychological and motor assessment and MRI. Mammillary bodies were scored as normal or atrophic at 10 years. Brain volumes were segmented on childhood MRI and DTI scans were analysed using tract-based spatial statistics. Children with HIE suffered from neurocognitive and memory problems at school-age, irrespective of hypothermia. Hippocampal volumes and MB atrophy were associated with total and performance IQ, processing speed and episodic memory in both groups. Normal MB and larger hippocampi were positively associated with global fractional anisotropy. In conclusion, injury to the MB and hippocampi was associated with neurocognition and memory at school-age in HIE and might be an early biomarker for neurocognitive and memory problems.

Machiafava-Bigmami and Wernicke’s Encephalopathy: Association of two rare conditions

Introduction: Both Machiafava-Bigmami disease (MBD) and Wernicke’s encephalopathy (WE) result from hypovitaminosis mainly associated with chronic alcoholism. The former affects the corpus callosum while the latter affects mostly the mammillary bodies. There are two main clinical subtypes for MBD in Heinrich’s classification. In type A the entire corpus callosum is affected and is characterized by acute or subacute lowering of consciousness and pyramidal deficits. A poor outcome is expected even with initial, prompt therapy. Methods: Case study with medical record review. Case report: Female patient, 53 years old, with subacute monoparesis in the right lower limb, progressing to generalized paresis, altered mental status and communication impairment. She reported smoking and chronic alcohol addiction for 30 years. She was emaciated, dehydrated, drowsy, sometimes agitated; she had eye opening to speech, dysarthric, bradypsychic, hypoactive pupils, bilateral evoked horizontal nystagmus, proximal paresis with dystonic posture. Impaired coordination and gait, with no other positive findings. Head-CT showed hypodensity in the corpus callosum, more pronounced in the splenium. Head- MRI indicated signs of abnormal impregnation in the mammillary bodies, cerebellar atrophy in the anterior vermis, diffuse cytotoxic lesion in the corpus callosum compatible with toxic demyelination. Conclusion: Although rare, such conditions must be recognized and treated promptly in order to delay progress and improve prognosis.

Morphological Characterization of the Developing Greater Cane Rat (Thryonomys swinderianus) Brain

Developmental mode along the altricial-precocial spectrum is well known to be influenced by brain development and maturation. The greater cane rat (GCR) is an indigenous precocial African rodent with uncommon phenotypes and life traits. This study was therefore designed to characterize and describe distinctive external developmental features in the prenatal GCR brain across the entire gestational length using the emergence and differentiation of external features of the brain vesicles. Four gross morphometric brain parameters (weight, length, width, and height) were evaluated and expressed as mean ± SEM. Relationship between all brain morphometrics and gestation length were analyzed using one-way ANOVA and linear regression. Developmental milestones in the prenatal GCR were then compared with closely related precocial mammals. The earliest time point with gross observable features in the prenatal GCR brain was at gestation day (GD) 60. The period with the most remarkable gross developmental features was noted between GD80 and GD100. Some of these gross features include differentiation of the cerebellar plate into vermis and lateral lobes, emergence of the piriform lobes, mammillary bodies, colliculi bodies, cerebral peduncles, and primordial pons. By GD130, most gross topographic neural features were already established. Cerebellar lobation and patterning at GD130 were the last recognizable gross developmental features noticed in the prenatal GCR brain. This coincided with the time of first eye opening in the GCR fetus. The developmental pattern observed in the prenatal GCR brain is similar to those noted in precocial rodent like the guinea pig. However, the onset of these milestones was delayed, and their duration was relatively shorter in the GCR. This study provides a frame of baseline reference of morphological brain features in the GCR embryos and fetuses that will be useful for fetal age estimation, for home grown neurodevelopmental and eco-toxicological studies, as this rodent is being proposed as a research model.

Cellular taxonomy and spatial organization of the ventral posterior hypothalamus reveals neuroanatomical parcellation of the mammillary bodies

ABSTRACTThe ventral posterior hypothalamus (VPH) is an anatomically complex brain region implicated in arousal, reproduction, energy balance and memory processing. However, neuronal cell type diversity within the VPH is poorly understood, an impediment to deconstructing the roles of distinct VPH circuits in physiology and behavior. To address this question, we employed a droplet-based single cell RNA sequencing (scRNA-seq) approach to systematically classify molecularly distinct cell types in the mouse VPH. Analysis of >16,000 single cells revealed 20 neuronal and 18 non-neuronal cell populations, defined by suites of discriminatory markers. We validated differentially expressed genes in a selection of neuronal populations through fluorescence in situ hybridization (FISH). Focusing on the mammillary bodies (MB), we discovered transcriptionally-distinct clusters that exhibit a surprising degree of segregation within neuroanatomical subdivisions of the MB, while genetically-defined MB cell types project topographically to the anterior thalamus. This single cell transcriptomic atlas of cell types in the VPH provides a detailed resource for interrogating the circuit-level mechanisms underlying the diverse functions of VPH circuits in health and disease.

Deep brain stimulation modulates hypothalamic-brainstem fibers in cluster headache: case report

Hypothalamic deep brain stimulation (DBS) has been used for more than a decade to treat cluster headache (CH) but its mechanisms remain poorly understood. The authors have successfully treated a patient with CH using hypothalamic DBS and found that the contact used for chronic stimulation was located in a white matter region posterior to the mammillary bodies. Fiber tracts crossing that region were the medial forebrain bundle and those interconnecting the hypothalamus and brainstem, including the dorsal longitudinal fasciculus. Because the stimulation of axons is an important mechanism of DBS, some of its clinical effects in CH may be related to the stimulation of fibers interconnecting the hypothalamus and brainstem.

Feasibility of iliosacral screw placement in patients with upper sacral dysplasia

Background Exact knowledge of the sacral anatomy is crucial for the percutaneous insertion of iliosacral screws. However, dysplastic anatomical patterns are common. In addition to a preoperative computed tomography (CT) analysis, conventional radiographic measures may help to identify upper sacral dysplasia and to avoid damage to surrounding structures. Aiming to further increase safety in percutaneous iliosacral screw placement in the presence of sacral dysmorphism, this study examined the prevalence of previously established radiographic signs and, in addition, defined the “critical SI angle” as a new radiographic criterion. Methods Pelvic CT scans of 98 consecutive trauma patients were analysed. Next to assessment of established signs indicating upper sacral dysplasia, the critical sacroiliac (SI) angle was defined in standardized pelvic outlet views. Results The critical SI angle significantly correlates with the presence of mammillary bodies and an intraarticular vacuum phenomenon. With a cut-off value of − 14.2°, the critical SI angle detects the feasibility of a safe iliosacral screw insertion in pelvic outlet views with a sensitivity of 85.9% and a specificity of 85.7%. Conclusions The critical SI angle can support the decision-making when planning iliosacral screw fixation. The clinical value of the established signs of upper sacral dysplasia remains uncertain.