Part 2 book “Localization in clinical neurology” has contents: Cranial nerves IX and X, the cerebellum, the localization of lesions affecting the hypothalamus and pituitary gland, the anatomic localization of lesions in the thalamus, the localization of lesions affecting the cerebral hemispheres, localization of lesions in the autonomic nervous system,… and other contents.
12 Cranial Nerves IX and X (The Glossopharyngeal and Vagus Nerves) Anatomy of Cranial Nerve IX (Glossopharyngeal Nerve) The glossopharyngeal nerve contains motor, sensory, and parasympathetic fibers The nerve emerges from the posterior lateral sulcus of the medulla oblongata dorsal to the inferior olive in close relation with cranial nerve X (the vagus nerve) and the bulbar fibers of cranial nerve XI (the spinal accessory nerve) (Fig 12-1 ) [11,45] These three nerves then travel together through the jugular foramen Within or distal to this foramen, the glossopharyngeal nerve widens at the superior and the petrous ganglia and then descends on the lateral side of the pharynx, passing between the internal carotid artery and the internal jugular vein The nerve winds around the lower border of the stylopharyngeus muscle (which it supplies) and then penetrates the pharyngeal constrictor muscles to reach the base of the tongue Figure 12-1 Ventral view of medulla and cranial nerves IX, X, and XI exiting together through the jugular foramen Dorsal roots of C1 through C6 in the The motor fibers originate from the rostral nucleus ambiguus and innervate upper cervical spinal cord are also shown (From Daube JR, Reagan TJ, the stylopharyngeus muscle (a pharyngeal elevator) and (with the vagus nerve) Sandok BA Medical Neurosciences: An Approach to Anatomy, Pathology, and the constrictor muscles of the pharynx Physiology by System and Levels 2nd ed Boston, MA: Little, Brown, 1986 By The sensory fibers carried in the glossopharyngeal nerve include taste permission of Mayo Foundation.) afferents, supplying the posterior third of the tongue and the pharynx, and general visceral afferents from the posterior third of the tongue, tonsillary region, posterior palatal arch, soft palate, nasopharynx, and tragus of the ear By way of the tympanic branch of the glossopharyngeal nerve (Jacobson nerve), sensation is supplied to the tympanic membrane, eustachian tube, and the mastoid region Taste afferents and general visceral afferent fibers have their cell bodies in the petrous ganglion and terminate mainly in the nucleus of the solitary tract (the rostral terminating fibers convey taste, and the caudal terminating fibers convey general visceral sensation); exteroceptive afferents have their cell bodies in the superior and petrous ganglia and terminate in the spinal nucleus of the trigeminal nerve The glossopharyngeal nerve also carries chemoreceptive and baroreceptive afferents from the carotid body (chemoreceptors) and carotid sinus (baroreceptors), respectively, by way of the carotid sinus nerve (nerve of Hering) The parasympathetic fibers carried in the glossopharyngeal nerve originate in the inferior salivatory nucleus, located in the periventricular gray matter of the rostral medulla, at the superior pole of the rostral nucleus of cranial nerve X These parasympathetic preganglionic fibers leave the glossopharyngeal nerve at the petrous ganglion and travel by way of the tympanic nerve or Jacobson nerve (coursing in the petrous bone) and the lesser superficial petrosal nerve to reach the otic ganglion (just below the foramen ovale), where they synapse The postganglionic fibers then travel by way of the auriculotemporal branch of the trigeminal nerve, carrying secretory and vasodilatory fibers to the parotid gland Figure: Ventral view of medulla and cranial nerves IX, X, and XI exiting together through the jugular foramen Dorsal roots of C1 through C6 in the upper cervical spinal cord are also shown (From Daube JR, Reagan TJ, Sandok BA Medical Neurosciences: An Approach to Anatomy, Pathology, and Physiology by System and Levels 2nd ed Boston, MA: Little, Brown, 1986 By permission of Mayo Foundation.) Clinical Evaluation of Cranial Nerve IX Motor Function Stylopharyngeal function is difficult to assess Motor paresis may be negligible with glossopharyngeal nerve lesions, although mild dysphagia may occur and the palatal arch may be somewhat lower at rest on the side of glossopharyngeal injury (However, the palate elevates symmetrically with vocalization.) Sensory Function The integrity of taste sensation may be tested over the posterior third of the tongue and is lost ipsilaterally with nerve lesions Sensation (pain, soft touch) is tested on the soft palate, posterior third of the tongue, tonsillary regions, and pharyngeal wall These areas may be ipsilaterally anesthetic with glossopharyngeal lesions Reflex Function The pharyngeal or gag reflex is tested by stimulating the posterior pharyngeal wall, tonsillar area, or base of the tongue The response is tongue retraction associated with elevation and constriction of the pharyngeal musculature The palatal reflex consists of elevation of the soft palate and ipsilateral deviation of the uvula with stimulation of the soft palate The afferent arcs of these reflexes probably involve the glossopharyngeal nerve, whereas the efferent arcs involve both the glossopharyngeal and vagus nerves Unilateral absence of these reflexes is seen with glossopharyngeal nerve lesions Autonomic Function Salivary secretion (from the parotid gland) may be decreased, absent, or occasionally increased with glossopharyngeal lesions, but these changes are difficult to demonstrate without specialized quantitative studies Localization of Lesions Affecting the Glossopharyngeal Nerve Lesions affecting the glossopharyngeal nerve also usually involve the vagus and therefore syndromes affecting both nerves are much more common than nerve lesions occurring in relative isolation Supranuclear Lesions Supranuclear lesions, if unilateral, do not result in any neurologic deficit because of bilateral corticobulbar input to the nucleus ambiguus However, bilateral corticobulbar lesions (pseudo-bulbar palsy) result in severe dysphagia [23] along with other pseudo-bulbar signs (e.g., pathologic laughter and crying, spastic tongue, explosive spastic dysarthria) With stimulation, the gag reflex may be depressed or markedly exaggerated, resulting in severe retching and even vomiting Nuclear and Intramedullary Lesions These lesions include syringobulbia, demyelinating disease, vascular disease, motor neuron disease, and malignancy Such lesions commonly involve other cranial nerves, especially the vagus, and other brainstem structures (e.g., Wallenberg syndrome) and are therefore localized by “the company they keep.” Extramedullary Lesions Cerebellopontine Angle Syndrome The glossopharyngeal nerve may be injured by lesions, especially acoustic tumors, occurring in the cerebellopontine angle Here there may be glossopharyngeal involvement associated with tinnitus, deafness, and vertigo (cranial nerve VIII), facial sensory abnormalities (cranial nerve V), and occasionally other cranial nerve or cerebellar involvement Jugular Foramen Syndrome (Vernet Syndrome) Lesions at the jugular foramen, especially glomus jugulare tumors and basal skull fractures, injure cranial nerves IX, X, and XI, which travel through this foramen [7,51] Other etiologies include neuroma, metastasis to the skull base, cholesteatoma, meningioma, infection, and giant cell arteritis [19] Vernet syndrome consists of the following: Ipsilateral trapezius and sternocleidomastoid paresis and atrophy (cranial nerve XI) Dysphonia, dysphagia, depressed gag reflex, and palatal droop on the affected side associated with homolateral vocal cord paralysis, loss of taste on the posterior third of the tongue on the involved side, and anesthesia of the ipsilateral posterior third of the tongue, soft palate, uvula, pharynx, and larynx (cranial nerves IX and X) Often dull, unilateral aching pain localized behind the ear Occipital condylar fracture may cause paralysis of cranial nerves IX and X [53] Lehn et al describe a man with occipital condylar fracture complicated by bilateral palsies of IX and X nerves associated with debilitating postural hypotension, dysphagia, severe gastrointestinal dysmotility, issues with airway protection as well as airway obstruction, increased oropharyngeal secretions, and variable respiratory control [33] Lesions within the Retropharyngeal and Retroparotid Space The glossopharyngeal nerve may be injured in the retropharyngeal or retroparotid space by neoplasms (e.g., nasopharyngeal carcinoma, paragangliomas [7,51,55]), abscesses, adenopathy, aneurysms [52], trauma (e.g., birth injury [20]), or surgical procedures (e.g., carotid endarterectomy) Resulting syndromes include the Collet–Sicard syndrome (affecting cranial nerves IX, X, XI, and XII) and Villaret syndrome (affecting cranial nerves IX, X, XI, and XII, the sympathetic chain, and occasionally cranial nerve VII) Villaret syndrome has been described due to a carotid-artery dissection and an associated aneurysm [13] The glossopharyngeal nerve may rarely be damaged in isolation by retropharyngeal or retroparotid space lesions resulting in a “pure” glossopharyngeal syndrome (mild dysphagia, depressed gag reflex, mild palatal droop, loss of taste on the posterior third of the tongue, glossopharyngeal distribution anesthesia) For example, traumatic internal maxillary artery dissection and pseudoaneurysm may present with isolated glossopharyngeal nerve palsy [1] Glossopharyngeal (Vagoglossopharyngeal) Neuralgia Glossopharyngeal neuralgia [9,10,14,17,46,50] refers to a unilateral pain (usually stabbing, sharp, and paroxysmal) located in the field of sensory distribution of the glossopharyngeal or vagus nerves Patients usually describe an abrupt, severe pain in the throat or ear that lasts seconds to minutes and is often triggered by chewing, coughing, talking, yawning, swallowing, and eating certain foods (e.g., highly spiced foods) The pain may occasionally be more persistent and have a dull aching or burning quality Other areas (e.g., larynx, tongue, tonsils, face, jaw) may also be affected According to the International Headache Society (IHS) Classification of Headache Disorders (ICHD-3 beta), the diagnostic criteria for glossopharyngeal neuralgia are as follows [9]: A Paroxysmal attacks of facial pain lasting from a fraction of a second to 2 minutes and fulfilling criteria B and C Neurol 1981;9:194–197 84 Koh MG, Phan TG, Atkinson JL, et al Neuroimaging in deteriorating patients with cerebellar infarcts and mass effect Stroke 2000;31:2062–2067 85 Kors EE, Terwindt GM, Vermeulen FL, et al Delayed cerebral edema and fatal coma after minor head trauma: Role of the CACNA1A calcium channel subunit gene and relationship with familial hemiplegic migraine Ann Neurol 2001;49:753–760 86 Kowalski RG, Buitrago MM, Duckworth J, et al Neuroanatomical predictors of awakening in acutely comatose patients Ann Neurol 2015;77:804– 816 87 Kudo Y, Fukai M, Yamadori A Asterixis due to pontine hemorrhage J Neurol Neurosurg Psychiatry 1985;48:487–489 88 Kwon SU, Lee SH, Kim JS Sudden coma from acute bilateral internal carotid artery territory infarction Neurology 2002;58:1846–1849 89 Lahuerta J, Buxton P, Lipton S, et al The location and function of respiratory fibres in the second cervical spinal cord segment: Respiratory dysfunction syndrome after cervical cordotomy J Neurol Neurosurg Psychiatry 1992;55:1142–1145 90 Larmande P, Dongmo L, Limodin J, et al Periodic alternating gaze: A case without any hemispheric lesion Neurosurgery 1987;20:481–483 91 Larmande P, Henin D, Jan M, et al Periodic alternating gaze: Electrooculographic and anatomical observation of a new case Neurosurgery 1982;10:263–265 92 Larmande P, Limodin J, Dongmo L, et al Periodic alternating gaze Neurosurgery 1987;20:666–667 93 Larmande P, Limodin J, Henin D, et al Ocular bobbing: Abnormal eye movement or eye movement’s abnormality? Ophthalmologica 1983;187:161– 165 94 Laureys S, Celesia GG, Cohadon F, et al Unresponsive wakefulness syndrome: A new name for the vegetative state or apallic syndrome BMC Med 2010;8:68 95 Laureys S, Schiff ND Coma and consciousness: Paradigms (re)framed by neuroimaging Neuroimage 2012;61(2):478–491 96 Lawn ND, Wijdicks EF Fatal Guillain-Barre syndrome Neurology 1999;52:635–638 97 Lee YC, Phan TG, Jolley DJ, et al Accuracy of clinical signs, SEP, and EEG in predicting outcome of hypoxic coma: A meta-analysis Neurology 2010;74:572–580 98 Lennox G Reverse ocular bobbing due to combined phenothiazine and benzodiazepine poisoning J Neurol Neurosurg Psychiatry 1993;56:1136–1137 99 Levin BE, Margolis G Acute failure of automatic respirations secondary to a unilateral brainstem infarct Ann Neurol 1977;1:583–586 100 Linn FH, Wijdicks EF Causes and management of thunderclap headache: A comprehensive review Neurologist 2002;8:279–289 101 Llinas RR, Ribary U, Jeanmonod D, et al Thalamocortical dysrhythmia: A neurological and neuropsychiatric syndrome characterized by magnetoencephalography Proc Natl Acad Sci U S A 1999;96:15222–15227 102 Luda E Ocular dipping Arch Neurol 1982;39:67 103 Mandel S, Arenas A, Scasta D Spinal automatism in cerebral death N Engl J Med 1982;307:501 104 Maramattom BV, Zaldivar RA, Glynn SM, et al Acute intermittent porphyria presenting as a diffuse encephalopathy Ann Neurol 2005;57:581–584 105 Marshman LA, Polkey CE, Penney CC Unilateral fixed dilation of the pupil as a false-localizing sign with intracranial hemorrhage: Case report and literature review Neurosurgery 2001;49:1251–1255; discussion 1255–1256 106 Massey EW, Goodman JC, Stewart C, et al Unilateral asterixis: Motor integrative dysfunction in focal vascular disease Neurology 1979;29:1180– 1182 107 Massucci EF Periodic alternating ping-gong gaze Ann Ophthalmol 1981;13:1123 108 Matsuda W, Matsumura A, Komatsu Y, et al Awakenings from persistent vegetative state: Report of three cases with parkinsonism and brain stem lesions on MRI J Neurol Neurosurg Psychiatry 2003;74:1571–1573 109 Mega MS, Cohenour RC Akinetic mutism: Disconnection of frontalsubcortical circuits Neuropsychiatry Neuropsychol Behav Neurol 1997;10:254– 259 110 Mehler MF The clinical spectrum of ocular bobbing and ocular dipping J Neurol Neurosurg Psychiatry 1988;51:725–727 111 Meienberg O, Mumenthaler M, Karbowski K Quadriparesis and nuclear oculomotor palsy with total bilateral ptosis mimicking coma: A mesencephalic “locked-in syndrome”? Arch Neurol 1979;36:708–710 112 Meletti S, Slonkova J, Mareckova I, et al Claustrum damage and refractory status epilepticus following febrile illness Neurology 2015;85:1224– 1232 113 Minagar A, David NJ Bilateral infarction in the territory of the anterior cerebral arteries Neurology 1999;52:886–888 114 Mochizuki H, Masaki T, Miyakawa T, et al Benign type of central pontine myelinolysis in alcoholism–clinical, neuroradiological and electrophysiological findings J Neurol 2003;250:1077–1083 115 Monti MM, Vanhaudenhuyse A, Coleman MR, et al Willful modulation of brain activity in disorders of consciousness N Engl J Med 2010;362:579– 589 116 Morgan BW, Ford MD, Follmer R Ethylene glycol ingestion resulting in brainstem and midbrain dysfunction J Toxicol Clin Toxicol 2000;38:445–451 117 Moruzzi G, Magoun HW Brainstem reticular formation and activation of the EEG Electroeucephalogr Clin Neurophysiol 1949;1:455 118 Munschauer FE, Mador MJ, Ahuja A, et al Selective paralysis of voluntary but not limbically influenced automatic respiration Arch Neurol 1991;48:1190–1192 119 Nagaratnam N, McNeil C, Gilhotra JS Akinetic mutism and mixed transcortical aphasia following left thalamo-mesencephalic infarction J Neurol Sci 1999;163:70–73 120 Nakagawa TA, Ashwal S, Mathur M, et al Guidelines for the determination of brain death in infants and children: An update of the 1987 task force recommendations-executive summary Ann Neurol 2012;71:573–585 121 Niedermeyer E Akinesia and the frontal lobe Clin EEG Neurosci 2008;39:39–42 122 Nighoghossian N, Trouillas P, Vial C, et al Unilateral upper limb asterixis related to primary motor cortex infarction Stroke 1995;26:326–328 123 Noda S, Ide K, Umezaki H, et al Repetitive divergence Ann Neurol 1987;21:109–110 124 Noda S, Ito H, Umezaki H, et al Hip flexion-abduction to elicit asterixis in unresponsive patients Ann Neurol 1985;18:96–97 125 North JB, Jennett S Abnormal breathing patterns associated with acute brain damage Arch Neurol 1974;31:338 126 Norton L, Hutchison RM, Young GB, et al Disruptions of functional connectivity in the default mode network of comatose patients Neurology 2012;78:175–181 127 Ongerboer de Visser BW Corneal reflex latency in lesions of the lower postcentral region Neurology 1981;31:701–707 128 Osenbach RK, Blumenkopf B, McComb B, et al Ocular bobbing with ruptured giant distal posterior inferior cerebellar artery aneurysm Surg Neurol 1986;25:149–152 129 Otto A, Zerr I, Lantsch M, et al Akinetic mutism as a classification criterion for the diagnosis of Creutzfeldt-Jakob disease J Neurol Neurosurg Psychiatry 1998;64:524–528 130 Parvizi J, Damasio AR Neuroanatomical correlates of brainstem coma Brain 2003;126:1524–1536 131 Patel VM, Jankovic J Myoclonus In: Apel H, ed Current Neurology Vol Chicago: Year Book; 1988:109–156 132 Perren F, Clarke S, Bogousslavsky J The syndrome of combined polar and paramedian thalamic infarction Arch Neurol 2005;62:1212–1216 133 Pessin MS, Adelman LS, Prager RJ, et al “Wrong-way eyes” in supratentorial hemorrhage Ann Neurol 1981;9:79–81 134 Peterson DI, Peterson GW Unilateral asterixis due to ipsilateral lesions in the pons and medulla Ann Neurol 1987;22:661–663 135 Petit-Pedrol M, Armangue T, Peng X, et al Encephalitis with refractory seizures, status epilepticus, and antibodies to the GABAA receptor: A case series, characterization of the antigen, and analysis of the effects of antibodies Lancet Neurol 2014;13(3):276–286 136 Pevehouse BC, Bloom WH, McKissock W Ophthalmoplegic aspects of diagnosis and localization of subdural hematoma Neurology 1960;10:1037 137 Phan TG, Koh M, Vierkant RA, et al Hydrocephalus is a determinant of early mortality in putaminal hemorrhage Stroke 2000;31:2157–2162 138 Plum F, Posner JB The Diagnosis of Stupor and Coma 3rd ed Philadelphia, PA: Davis; 1980 139 Plum F Cerebral lymphoma and central hyperventilation Arch Neurol 1990;47:10–11 140 Pulst SM, Lombroso CT External ophthalmoplegia, alpha and spindle coma in imipramine overdose: case report and review of the literature Ann Neurol 1983;14:587–590 141 Qureshi AI, Geocadin RG, Suarez JI, et al Long-term outcome after medical reversal of transtentorial herniation in patients with supratentorial mass lesions Crit Care Med 2000;28:1556–1564 142 Rabinstein AA, Atkinson JL, Wijdicks EF Emergency craniotomy in patients worsening due to expanded cerebral hematoma: To what purpose? Neurology 2002;58:1367–1372 143 Rabinstein AA, Tisch SH, McClelland RL, et al Cause is the main predictor of outcome in patients with pontine hemorrhage Cerebrovasc Dis 2004;17:66–71 144 Rabinstein AA, Wijdicks EF Warning signs of imminent respiratory failure in neurological patients Semin Neurol 2003;23:97–104 145 Ragazzoni A, Grippo A, Tozzi F, et al Event-related potentials in patients with total locked-in state due to fulminant Guillain-Barre syndrome Int J Psychophysiol 2000;37:99–109 146 Rapenne T, Moreau D, Lenfant F, et al Could heart rate variability analysis become an early predictor of imminent brain death? A pilot study Anesth Analg 2000;91:329–336 147 Reich JB, Sierra J, Camp W, et al Magnetic resonance imaging measurements and clinical changes accompanying transtentorial and foramen magnum brain herniation Ann Neurol 1993;33:159–170 148 Reinfeld H, Louis S Unilateral asterixis Clinical significance of the sign N Y State J Med 1983;83:206–208 149 Reynard M, Wertenbaker C, Behrens M, et al “Ping-pong gaze” amplified Neurology 1979;29:757–758 150 Ringel RA, Riggs JE, Brick JF Reversible coma with prolonged absence of pupillary and brainstem reflexes: An unusual response to a hypoxic-ischemic event in MS Neurology 1988;38:1275–1278 151 Rivera-Lara L, Henninger N Delayed sudden coma due to artery of percheron infarction Arch Neurol 2011;68:386–387 152 Ropper AH, Cole D, Louis DN Clinicopathologic correlation in a case of pupillary dilation from cerebral hemorrhage Arch Neurol 1991;48:1166–1169 153 Ropper AH A preliminary MRI study of the geometry of brain displacement and level of consciousness with acute intracranial masses Neurology 1989;39:622–627 154 Ropper AH Atypical ocular bobbing Ann Neurol 1987;7:285 155 Ropper AH Lateral displacement of the brain and level of consciousness in patients with an acute hemispheral mass N Engl J Med 1986;314:953–958 156 Ropper AH Ocular dipping in anoxic coma Arch Neurol 1981;38:297– 299 157 Ropper AH Syndrome of transtentorial herniation: Is vertical displacement necessary? J Neurol Neurosurg Psychiatry 1993;56:932–935 158 Ropper AH The opposite pupil in herniation Neurology 1990;40:1707– 1709 159 Ropper AH Unusual spontaneous movements in brain-dead patients Neurology 1984;34:1089–1092 160 Rosa A, Moudi M, Mizon JP Typical and atypical ocular bobbing: Pathology through five case reports Neuro-Ophthalmol 1987;7:285 161 Rosenberg ML Spontaneous vertical eye movements in coma Ann Neurol 1986;20:635–637 162 Rosenberg ML The eyes in hysterical states of unconsciousness J Clin Neuroophthalmol 1982;2:259–260 163 Ross ED, Stewart RM Akinetic mutism from hypothalamic damage: Successful treatment with dopamine agonists Neurology 1981;31:1435–1439 164 Rossi A, Biancheri R, Bruno C, et al Leigh Syndrome with COX deficiency and SURF1 gene mutations: MR imaging findings AJNR Am J Neuroradiol 2003;24:1188–1191 165 Rubin DI, So EL Reversible akinetic mutism possibly induced by baclofen Pharmacotherapy 1999;19:468–470 166 Rudick R, Satran R, Eskin TA Ocular bobbing in encephalitis J Neurol Neurosurg Psychiatry 1981;44:441–443 167 Safran AB, Berney J Synchronism of reverse ocular bobbing and blinking Am J Ophthalmol 1983;95:401–402 168 Sakas DE, Bullock MR, Teasdale GM One-year outcome following craniotomy for traumatic hematoma in patients with fixed dilated pupils J Neurosurg 1995;82:961–965 169 Sanchez-Villasenor F, Devinsky O, Hainline B, et al Psychogenic basilar migraine: Report of four cases Neurology 1995;45:1291–1294 170 Sander HW, Golden M, Danon MJ Quadriplegic areflexic ICU illness: Selective thick filament loss and normal nerve histology Muscle Nerve 2002;26:499–505 171 Saposnik G, Basile VS, Young GB Movements in brain death: A systematic review Can J Neurol Sci 2009;36:154–160 172 Scott TF, Lang D, Girgis RM, et al Prolonged akinetic mutism due to multiple sclerosis J Neuropsychiatry Clin Neurosci 1995;7:90–92 173 Selhorst JB, Hoyt WF, Feinsod M, et al Midbrain corectopia Arch Neurol 1976;33:193–195 174 Selwa LM, Geyer J, Nikakhtar N, et al Nonepileptic seizure outcome varies by type of spell and duration of illness [In Process Citation] Epilepsia 2000;41:1330–1334 175 Senelick RC “Ping-pong” gaze Periodic alternating gaze deviation Neurology 1976;26:532–535 176 Shaner DM, Orr RD, Drought T, et al Really, most SINCERELY dead: Policy and procedure in the diagnosis of death by neurologic criteria Neurology 2004;62:1683–1686 177 Silva S, de Pasquale F, Vuillaume C, et al Disruption of posteromedial large-scale neural communication predicts recovery from coma Neurology 2015;85(23):2036–2044 178 Simon RP, Aminoff MJ Electrographic status epilepticus in fatal anoxic coma Ann Neurol 1986;20:351–355 179 Simon RP Forced downward ocular deviation Occurrence during oculovestibular testing in sedative drug-induced coma Arch Neurol 1978;35:456–458 180 Simon RP Pathophysiology of respiratory dysfunction In: Asbury AK, McKhann GM, McDonald WI, eds Diseases of the Nervous System Clinical Neurobiology 2nd ed Philadelphia, PA: Saunders; 1992:537–549 181 St Louis EK, Wijdicks EF, Li H, et al Predictors of poor outcome in patients with a spontaneous cerebellar hematoma Can J Neurol Sci 2000;27:32– 36 182 Stark SR, Masucci EF, Kurtzke JF Ocular dipping Neurology 1984;34:391–393 183 Stell R, Davis S, Carroll WM Unilateral asterixis due to a lesion of the ventrolateral thalamus J Neurol Neurosurg Psychiatry 1994;57:878–880 184 Stewart JD, Kirkham TH, Mathieson G Periodic alternating gaze Neurology 1979;29:222–224 185 Susac JO, Hoyt WF, Daroff RB, et al Clinical spectrum of ocular bobbing J Neurol Neurosurg Psychiatry 1970;33:771–775 186 Tang-Wai DF, Wijdicks EF Pituitary apoplexy presenting as postoperative stupor Neurology 2002;58:500–501 187 Teasdale G, Jennett B Assessment of coma and impaired consciousness A practical scale Lancet 1974;2:81–84 188 Thompson HJ, Pinto-Martin J, Bullock MR Neurogenic fever after traumatic brain injury: An epidemiological study J Neurol Neurosurg Psychiatry 2003;74:614–619 189 Tijssen CC, Ter Bruggen JP Locked-in syndrome associated with ocular bobbing Acta Neurol Scand 1986;73:444–446 190 Tijssen CC Contralateral conjugate eye deviation in acute supratentorial lesions Stroke 1994;25:1516–1519 191 Titer EM, Laureno R Inverse/reverse ocular bobbing Ann Neurol 1988;23:103–104 192 Titulaer MJ, McCracken L, Gabilondo I, et al Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: An observational cohort study Lancet Neurol 2013;12:157–165 193 Toshniwal P, Yadava R, Goldbarg H Presentation of pinealoblastoma with ocular dipping and deafness J Clin Neuroophthalmol 1986;6:128–136 194 Tranmer BI, Tucker WS, Bilbao JM Sleep apnea following percutaneous cervical cordotomy Can J Neurol Sci 1987;14:262–267 195 Tzovara A, Simonin A, Oddo M, et al Neural detection of complex sound sequences in the absence of consciousness Brain 2015;138:1160–1166 196 Uldry PA, Kuntzer T, Bogousslavsky J, et al Early symptoms and outcome of Listeria monocytogenes rhombencephalitis: 14 adult cases J Neurol 1993;240:235–242 197 Ure J, Faccio E, Videla H, et al Akinetic mutism: A report of three cases Acta Neurol Scand 1998;98:439–444 198 van Weerden TW, van Woerkom TC Ocular dipping Neurology 1985;35:135 199 Ventura F, Rocca G, Gentile R, et al Sudden death in Leigh syndrome: An autopsy case Am J Forensic Med Pathol 2012;33:259–261 200 Voss HU, Uluc AM, Dyke JP, et al Possible axonal regrowth in late recovery from the minimally conscious state J Clin Invest 2006;116:2005– 2011 201 Wakabayashi K, Fukushima T, Koide R, et al Juvenile-onset generalized neuroaxonal dystrophy (Hallervorden-Spatz disease) with diffuse neurofibrillary and lewy body pathology Acta Neuropathol (Berl) 2000;99:331–336 202 Wali GM “Fou fire prodromique” heralding a brainstem stroke J Neurol Neurosurg Psychiatry 1993;56:209–210 203 Watkins HC, Ellis CJ Ping Pong gaze in reversible coma due to overdose of monoamine oxidase inhibitor J Neurol Neurosurg Psychiatry 1989;52:539 204 Weijer C, Bruni T, Gofton T, et al Ethical considerations in functional magnetic resonance imaging research in acutely comatose patients Brain 2016;139(Pt 1):292–299 205 Wijdicks EF, Atkinson JL, Okazaki H Isolated medulla oblongata function after severe traumatic brain injury J Neurol Neurosurg Psychiatry 2001;70:127–129 206 Wijdicks EF, Bamlet WR, Maramattom BV, et al Validation of a new coma scale: The FOUR score Ann Neurol 2005;58:585–593 207 Wijdicks EF, Campeau NG, Miller GM MR imaging in comatose survivors of cardiac resuscitation AJNR Am J Neuroradiol 2001;22:1561–1565 208 Wijdicks EF, Giannini C Wrong side dilated pupil Neurology 2014;82:187 209 Wijdicks EF, Manno EM, Holets SR Ventilator self-cycling may falsely suggest patient effort during brain death determination Neurology 2005;65:774 210 Wijdicks EF, Miller GM Transient locked-in syndrome after uncal herniation Neurology 1999;52:1296–1297 211 Wijdicks EF, Parisi JE, Sharbrough FW Prognostic value of myoclonus status in comatose survivors of cardiac arrest Ann Neurol 1994;35:239–243 212 Wijdicks EF, Rabinstein AA, Manno EM, et al Pronouncing brain death: Contemporary practice and safety of the apnea test Neurology 2008;71:1240– 1244 213 Wijdicks EF, Varelas PN, Gronseth GS, et al Evidence-based guideline update: Determining brain death in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology Neurology 2010;74:1911–1918 214 Wijdicks EF The case against confirmatory tests for determining brain death in adults Neurology 2010;75:77–83 215 Yanaka K, Meguro K, Fujita K, et al Immediate surgery reduces mortality in deeply comatose patients with spontaneous cerebellar hemorrhage Neurol Med Chir (Tokyo) 2000;40:295–299 216 Yasaki E, Saito Y, Nakano K, et al Characteristics of breathing abnormality in Leigh and its overlap syndromes Neuropediatrics 2001;32:299– 306 217 Young G, Ropper A, Bolton C Coma and Impaired Consciousness: A Clinical Perspective New York, NY: McGraw Hill; 1998 218 Zahuranec DB, Morgenstern LB, Sanchez BN, et al Do-not-resuscitate orders and predictive models after intracerebral hemorrhage Neurology 2010;75:626–633 219 Zegers Beyl D, Flament-Durand J, Borenstein S, et al Ocular bobbing and myoclonus in central pontine myelinolysis J Neurol Neurosurg Psychiatry 1983;46:564–565 220 Zhong C, Jin L, Fei G MR Imaging of nonalcoholic Wernicke encephalopathy: a follow-up study AJNR Am J Neuroradiol 2005;26:2301– 2305 Glossary Glossary term Glossary term Text of definition ... pharynx, or beneath the angle of the lower jaw and/or in the ear Sharp, stabbing, and severe Precipitated by swallowing, chewing, talking, coughing, and/or yawning C Attack are stereotyped in the individual patient D There is no clinically evident neurologic deficit... laryngeal abductor paralysis, cerebellar ataxia, and pure motor neuropathy Neurology 20 01;56:14 12 1414 Benarroch EE, McKeon A Recurrent syncope as a manifestation of a dopamine–secreting glomus vagale tumor Neurology 20 11;76:1 021 –1 022 Bickerstaff ER, Howell JS... Chiari type I malformation presenting as glossopharyngeal neuralgia: case report Neurosurgery 20 01;48 :22 6– 22 8 30 Kim YJ, Paeing SH, Bae JS Diabetic vagal mononeuropathy manifesting with isolated dysphagia Neurology Asia 20 15 ;20 :187–189