• Investigative Magnetic Resonance Imaging
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• v.18 no.2
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• pp.167-170
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• 2014

The medial longitudinal fasciculus (MLF) is myelinated composite tract, lying near the midline, ventral to periaqueductal grey matter that plays a key role in coordinating eye movements. A lesion of the MLF results in an ipsilateral adduction deficit and a contralateral abducting nystagmus, referred to as an internuclear ophthalmoparesis. The blended tract with adjacent white matter in pons and midbrain is indistinguishable on brain imaging such as CT and MRI. Until now, to the best of our knowledge, MLF is not delineated on in vivo MRI. We present a case showing the whole connecting courses of MLF lesion on MRI in a patient with inflammatory demyelinating disorder.

• Journal of Korean Neurosurgical Society
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• v.47 no.5
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• pp.365-369
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• 2010

Objective : There has been inconsistency about definition of the temporal stem despite of several descriptions demonstrating its microanatomy using fiber dissection and/or diffusion tensor tractography. This study was designed to clarify three dimensional configurations of the temporal stem. Methods : The fronto-temporal regions of several formalin-fixed human cerebral hemispheres were dissected under an operating microscope using the fiber dissection technique. The consecutive coronal cuts of the dissected specimens were made to define the relationships of white matter tracts comprising the temporal stem and the subcortical gray matters (thalamus, caudate nucleus, amygdala) with inferior limiting (circular) sulcus of insula. Results : The inferior limiting sulcus of insula, limen insulae, medial sylvian groove, and caudate nucleus/amygdala were more appropriate anatomical structures than the roof/dorso-lateral wall of the temporal horn and lateral geniculate body which were used to describe previously for delineating the temporal stem. The particular space located inside the line connecting the inferior limiting sulcus of insula, limen insulae, medial sylvian groove/amygdala, and tail of caudate nucleus could be documented. This space included the extreme capsule, uncinate fasciculus, inferior occipito-frontal fasciculus, anterior commissure, ansa peduncularis, and inferior thalamic peduncle including optic radiations, whereas the stria terminalis, cingulum, fimbria, and inferior longitudinal fiber of the temporal lobe were not passing through this space. Also, this continued posteriorly along the caudate nucleus and limiting sulcus of the insula. Conclusion : The temporal stem is white matter fibers passing through a particular space of the temporal lobe located inside the line connecting the inferior limiting sulcus of insula, limen insulae, medial sylvian groove/amygdala, and tail of caudate nucleus. The three dimensional configurations of the temporal stem are expected to give the very useful anatomical and surgical insights in the temporal lobe.

• Animal cells and systems
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• v.6 no.2
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• pp.159-165
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• 2002

Projections from the prefrontal cortex to subdivisions of the dorsal raphe nucleus were investigated in the rat using retrograde and anterograde tracing methods. A retrograde tracer, gold-conjugated horseradish peroxidase (WGA-apo-HRP-gold), was injected into each subdivision of the dorsal raphe including lateral wing, dorsomedial, and ventromedial areas. The majority of retrogradely labeled cells were located in the prelimbic, infralim-bic, and dorsal peduncular areas of the medial prefrontal cortex. A few cells were also identified in the cingulate, various regions of the orbital, and agranular insular cortices. Secondly, an anterograde tracer, Phaseolus vulgaris leucoagglutinin (PHA-L), was injected into the medial prefrontal cortex involving the prelimbic or infralimbic areas. Axonal fibers with varicosities were identified in all subdivisions of the DR including the lateral wing, dorsomedial, and ventromedial areas. Projections were bilateral, with ipsilateral predominance. Axonal fibers were observed at the lateral border of medial longitudinal fasciculus or in the interfascicular region at the midline. The present findings demonstrate that both the midline and lateral wing regions of the dorsal raphe nucleus receive excitatory input from cognitive and emotional centers of the cerebral cortex.

• Journal of Korean Neurosurgical Society
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• v.39 no.6
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• pp.438-442
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• 2006

The sylvian aqueduct syndrome is a global rostral midbrain dysfunction induced by a transtentorial pressure gradient through the aquaeductus. Several months after ventriculoperitoneal shunt, a patient with hydrocephalus began experiencing a constellation of midbrain dysfunction symptoms, including bradykinesia, medial longitudinal fasciculus syndrome, third nerve palsy, and mutism. These were indicative of cerebral aqueduct syndrome. In addition, the patient showed posture-dependent underdrainage or overdrainage. All symptoms were resolved after distal catheter elongation and floating cranioplasty. We present a case of reversible parkinsonism, which developed in a patient with shunted hydrocephalus and aqueductal stenosis, and discuss the diagnosis and treatment of the sylvian aqueduct syndrome. We also review the literature to address problems of drainage and potential treatment modalities.

• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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• v.29 no.3
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• pp.177-185
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• 2016

Objectives : The aim of this study is to report the effect of Korean medicine treatment on bilateral internuclear ophthalmoplegia without abnormal findings on brain magnetic resonance imaging.Methods : The patient was treated by using acupuncture, electroacupuncture treatment and hominis placenta pharmacoacupuncture. The change of eye movement and strabismus were evaluated by comparison the photographs of the extraocular movements of patient. Strabismus also was evaluated by corneal reflex test.Results : Adduction of both eyes were improved after Korean medicine treatment. The amplitude and frequency of nystagmus showed a tendency to decrease in both eyes.Conclusions : Korean medicine treatment should be effective for the idiopathic bilateral internuclear ophthalmoplegia.

• Journal of Yeungnam Medical Science
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• v.8 no.1
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• pp.220-230
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• 1991

Internuclear ophthalmoplegia is a conjugated gaze disorder characterized by impaired adduction on the side of a lesion involving the medial longitudinal fasciculus with dissociated nystagmus of the other abducting eye. Six patients with INO(who had clinical cerebrovascular diseases) underwent MR imaging and the results were as follows : 1. The MLF lesions were identified by MR imaging in 5 cases 2. The ratio of unilateral INO to bilateral INO was 5:1 3. The nature of lesions was infarction in 4 cases and hemorrhage in 1 case 4. The sites of MLF lesion were in the midbrain in 4 cases and in the pons in 1 case 5. All 5 cases of INO identified by MR imaging had other lesion sites in addition to MLF lesion.

• The Journal of Internal Korean Medicine
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• v.33 no.4
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• pp.599-608
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• 2012

Objectives : To report three cases of eye movement impairment: internuclear ophthalmoplegia (INO) due to pontine infarction, traumatic abducens nerve palsy, and abducens nerve involvement in Miller-Fisher syndrome. Cases Summary : There were three cases. First, a 64-year-old woman, who was given a diagnosis of INO due to pontine infarction, had left gaze palsy of her right eye while the convergence was intact. Second, a 34-year-old man had abduction impairment of his right eye after a traffic accident. Third, a 66-year-old man, who was diagnosed with Miller-Fisher syndrome, had left gaze palsy of his left eye. Their symptoms improved substantially and their anxieties were relieved after treatment with herbal medicine and acupuncture. Conclusions : There has been no certain cure for eye movement impairment yet. In this report, we present three successful cases of patients with eye movement impairment and show that Korean medical treatment could be a solution for this incurable disease.

• Investigative Magnetic Resonance Imaging
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• v.21 no.4
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• pp.223-232
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• 2017

Purpose: To report the use of multiband accelerated echo-planar imaging (EPI) for resting-state functional MRI (rs-fMRI) to achieve rapid high temporal resolution at 3T compared to conventional EPI. Materials and Methods: rs-fMRI data were acquired from 20 healthy right-handed volunteers by using three methods: conventional single-band gradient-echo EPI acquisition (Data 1), multiband gradient-echo EPI acquisition with 240 volumes (Data 2) and 480 volumes (Data 3). Temporal signal-to-noise ratio (tSNR) maps were obtained by dividing the mean of the time course of each voxel by its temporal standard deviation. The resting-state sensorimotor network (SMN) and default mode network (DMN) were estimated using independent component analysis (ICA) and a seed-based method. One-way analysis of variance (ANOVA) was performed between the tSNR map, SMN, and DMN from the three data sets for between-group analysis. P < 0.05 with a family-wise error (FWE) correction for multiple comparisons was considered statistically significant. Results: One-way ANOVA and post-hoc two-sample t-tests showed that the tSNR was higher in Data 1 than Data 2 and 3 in white matter structures such as the striatum and medial and superior longitudinal fasciculus. One-way ANOVA revealed no differences in SMN or DMN across the three data sets. Conclusion: Within the adapted metrics estimated under specific imaging conditions employed in this study, multiband accelerated EPI, which substantially reduced scan times, provides the same quality image of functional connectivity as rs-fMRI by using conventional EPI at 3T. Under employed imaging conditions, this technique shows strong potential for clinical acceptance and translation of rs-fMRI protocols with potential advantages in spatial and/or temporal resolution. However, further study is warranted to evaluate whether the current findings can be generalized in diverse settings.

• The Journal of Internal Korean Medicine
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• v.40 no.2
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• pp.254-261
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• 2019

Internuclear Ophthalmoplegia (INO) is characterized by lesion side eye's adduction limitation in lateral horizontal gaze and nystagmus in the abducting eye due to lesions in the Medial Longitudinal Fasciculus (MLF). Brainstem infarction is one of the causes of INO, but related issues have seldom been reported in the Korean medical literature. The present case was a pontine infarction patient with INO who complained of diplopia and eye movement disorder. The patient was treated with Korean medicine treatment, including herbal medicine, acupuncture, cupping, and moxibustion for 30 days. Her changes in clinical symptoms were measured with a Numeric Rating Scale (NRS) and a length of External Ocular Movement (EOM), in which the patient's right eyeball moved to the left from the midline in the left gaze. After treatment, her clinical symptoms were improved. Diplopia decreased from NRS 10 to NRS 2, and eye movement disorder was improved such that EOM increased from 1mm to 5 mm. Therefore, integrative Korean medicine treatment may be effective in the treatment of INO patients caused by pontine infarction.

• Investigative Magnetic Resonance Imaging
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• v.16 no.2
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• pp.115-123
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• 2012

Purpose : To evaluate white matter abnormalities on diffusion tensor imaging (DTI) in patients with mild Alzheimer disease (AD) and mild cognitive impairment (MCI), using tract-based spatial statistics (TBSS) and voxel-based morphometry (VBM). Materials and Methods: DTI was performed in 21 patients with mild AD, in 13 with MCI and in 16 old healthy subjects. A fractional anisotropy (FA) map was generated for each participant and processed for voxel-based comparisons among the three groups using TBSS. For comparison, DTI data was processed using the VBM method, also. Results: TBSS showed that FA was significantly lower in the AD than in the old healthy group in the bilateral anterior and right posterior corona radiata, the posterior thalamic radiation, the right superior longitudinal fasciculus, the body of the corpus callosum, and the right precuneus gyrus. VBM identified additional areas of reduced FA, including both uncinates, the left parahippocampal white matter, and the right cingulum. There were no significant differences in FA between the AD and MCI groups, or between the MCI and old healthy groups. Conclusion: TBSS showed multifocal abnormalities in white matter integrity in patients with AD compared with old healthy group. VBM could detect more white matter lesions than TBSS, but with increased artifacts.