Contralateral Body Research Articles

Prediction model for intraoperative implant volume using the 3D surface imaging system (VECTRA XT 3D) in direct-to-implant breast reconstructions.

In direct-to-implant breast reconstruction, accurate preoperative breast volume estimation is crucial for surgeons to select the appropriate implant volume, considering the cosmetic outcomes during surgery. We proposed the prediction model for intraoperative implant volume based on the preoperative estimated volume of the contralateral breast obtained through a three-dimensional surface imaging system (3DSI) as surgeons usually choose the implant volume on the breast which should be reconstructed considering symmetricity with the contralateral breast. We enrolled 97 patients from our single institution who underwent unilateral mastectomy with immediate breast reconstruction using smooth silicone implants between October 2021 and January 2023. Preoperatively, plastic surgeons measured the volume of the contralateral breast using the VECTRA XT 3D imaging system. Data on implant volume and the types of acellular dermal matrix used during surgery, determined by a single surgeon to ensure symmetry, were also collected. Linear regression analysis was utilized to construct the predictive model. In the multiple linear regression analysis with preoperative contralateral breast volume, age, and body mass index as variables, the coefficient of determination of the model expressed as R squared (R2) was 0.554, and except for age, the other variables were statistically significant. When replaced by mastectomy volume instead of age, R2 increased to 0.723 and all variables were significant. 3DSI can be helpful for preoperative surgical planning and postoperative outcome simulation. With our multiple linear regression model, we can predict the intraoperative implant volume using preoperative contralateral breast volume measured by the 3D scans.

Lateral Medullary Syndrome from brainstem infarction: A case report

Background. Lateral medullary syndrome (LMS) is a rare posterior circulation stroke caused by thrombosis or dissection of the vertebral or posterior inferior cerebellar artery (PICA). It results in neurological deficits such as ipsilateral facial pain and temperature deficits, contralateral body pain and temperature deficits, ipsilateral ataxia, vertigo, nystagmus, slurred speech, dysphagia, and hiccups. Case reports. We report the case of a 50-year-old male with uncontrolled hypertension presented with sudden severe vertigo, ataxia, swallowing difficulties, slurred speech, and sensory deficits. He had right-sided facial pain and left-sided body pain. Conclusions. Neurological examination suggested LMS, confirmed by radiological imaging.

Biomechanical evaluation of various rigid internal fixation modalities for condylar-base-associated multiple mandibular fractures: A finite element analysis.

Condylar-base-associated multiple mandibular fractures are more prevalent than single ones. Direct trauma to mandibular symphysis, body or angle are prone to induce indirect condylar fracture. However, little is known about the effects of various rigid internal fixation modalities in condylar base for relevant multiple mandibular fractures, especially when we are confused in the selection of operative approach. Within the finite element analysis, straight-titanium-plate implanting positions in condylar base contained posterolateral zone (I), anterolateral zone (II), and intermediate zone (III). Von Mises stress (SS) in devices and bone and mandibular displacement (DT) were solved, while maximum values (SSmax and DTmax) were documented. For rigid internal fixation in condylar-base-and-symphysis fractures, I + II modality exhibited least SSmax in screws and cortical bone and least DTmax, I + III modality exhibited least SSmax in plates. For rigid internal fixation in condylar-base-and-contralateral-body fractures, I + III modality exhibited least SSmax in screws and cortical bone, I + II modality exhibited least SSmax in plates and least DTmax. For rigid internal fixation in condylar-base-and-contralateral-angle fractures, I + III modality exhibited least DTmax. The findings suggest that either I + II or I + III modality is a valid guaranty for rigid internal fixation of condylar base fractures concomitant with symphysis, contralateral body or angle fractures.

Physiological effects of dual target DBS in an individual with Parkinson's disease and a sensing-enabled pulse generator

IntroductionDeep brain stimulation (DBS) of the subthalamic nucleus (STN) or globus pallidus (GP) is an established therapy for Parkinson's disease (PD). Novel DBS devices can record local field potential (LFP) physiomarkers from the STN or GP. While beta (13–30 Hz) and gamma (40–90 Hz) STN and GP LFP oscillations correlate with PD motor severity and with therapeutic effects of treatments, STN-GP interactions in electrophysiology in patients with PD are not well characterized. MethodsSimultaneous bilateral STN and GP LFPs were recorded in a patient with PD who received bilateral STN-DBS and GP-DBS. Power spectra in each target and STN-GP coherence were assessed in various ON- and OFF-levodopa and DBS states, both at rest and with voluntary movement. ResultsOFF-levodopa and OFF-DBS, beta peaks were present at bilateral STN and GP, coincident with prominent STN-GP beta coherence. Levodopa and dual-target-DBS (simultaneous STN-DBS and GP-DBS) completely suppressed STN-GP coherence. Finely-tuned gamma (FTG) activity at half the stimulation frequency (62.5 Hz) was seen in the STN during GP-DBS at rest. To assess the effects of movement on FTG activity, we recorded LFPs during instructed movement. We observed FTG activity in bilateral GP and bilateral STN during contralateral body movements while on GP-DBS and ON-levodopa. No FTG was seen with STN-DBS or dual-target-DBS. ConclusionDual-target-DBS and levodopa suppressed STN-GP coherence. FTG throughout the basal ganglia was induced by GP-DBS in the presence of levodopa and movement. This bilateral STN-FTG and GP-FTG corresponded with the least severe bradykinesia state, suggesting a pro-kinetic role for FTG.

Mandibular hypoplasia in hemifacial microsomia: A cross-sectional study

BackgroundHemifacial microsomia (HFM) results from the malformation of facial structures derived from the first and second pharyngeal arches. The ramus of the mandible is the most deformed part of the mandible in HFM, which subsequently affects the linear measurements of the different parts of the mandible. This study evaluated the anatomical differences between the affected and contralateral mandibular ramus and body (MRB) in a select cohort of HFM patients in South Africa. MethodsThis is a serial retrospective study of 20 HFM patients. They were categorised into mild or severe groups by the Pruzansky-Kaban grading and into three age-dependent groups (1–5, 6–12 and 13–19 years old). Linear and angular measurements of the MRB components were recorded from preoperative computed tomography scans to compare severity, age groups, ramus and body index (RBI), and the affected to contralateral (A/C) sides ratio. ResultSignificant differences existed in the linear and angular measurements of the mandible and RBI between affected and contralateral sides, except for the MBL. The mean differences between the mild and severe RBI deformities were insignificant. The A/C ratio was insignificantly smaller in the severe group than in the mild group. Age grouping did not significantly affect the A/C ratio in the mandible ramus and body. ConclusionMandibular asymmetry is more noticeable in HFM patients between 13 and 19 years old. The A/C ratio of the MRB did not worsen with different age groups and severity grading in this study. Hence, clinicians should postpone surgery until HFM patients attain skeletal maturity.

Organization of Somatosensory Cortex in the South American Rodent Paca (Cuniculus paca)

Introduction: The study of non-laboratory species has been part of a broader effort to establish the basic organization of the mammalian neocortex, as these species may provide unique insights relevant to cortical organization, function, and evolution. Methods: In the present study, the organization of three somatosensory cortical areas of the medium-sized (5–11 kg body mass) Amazonian rodent, the paca (Cuniculus paca), was determined using a combination of electrophysiological microelectrode mapping and histochemical techniques (cytochrome oxidase and NADPH diaphorase) in tangential sections. Results: Electrophysiological mapping revealed a somatotopically organized primary somatosensory cortical area (S1) located in the rostral parietal cortex with a characteristic foot-medial/head-lateral contralateral body surface representation similar to that found in other species. S1 was bordered laterally by two regions housing neurons responsive to tactile stimuli, presumably the secondary somatosensory (S2) and parietal ventral (PV) cortical areas that evinced a mirror-reversal representation (relative to S1) of the contralateral body surface. The limits of the putative primary visual (V1) and primary auditory (A1) cortical areas, as well as the complete representation of the contralateral body surface in S1, were determined indirectly by the histochemical stains. Like the barrel field described in small rodents, we identified a modular arrangement located in the face representation of S1. Conclusions: The relative location, somatotopic organization, and pattern of neuropil histochemical reactivity in the three paca somatosensory cortical areas investigated are similar to those described in other mammalian species, providing additional evidence of a common plan of organization for the somatosensory cortex in the rostral parietal cortex of mammals.

Exacerbation of Mirror Movement Disorder: A Complex Case of Childhood-onset Mirror Movements Aggravated by Essential Tremors, and Parkinson's Disease

Background Mirror movement (MM), also known as bimanual synkinesis, is characterized by simultaneous involuntary movements of homologous muscles accompanying voluntary movements of contralateral body regions. MM can be observed in various neurological conditions, including cerebral palsy, corticobasal syndrome, Parkinson's disease, certain types of symptomatic epilepsies, Creutzfeldt-Jakob's disease, Huntington's disease, and others. Case Description A 52-year-old female with a history of epileptic seizures, essential tremors and mild MM was presented to a neurology clinic for seizure management. She had a long-standing history of seizures since childhood. Initial neurological examination revealed mild MM disorder. During the follow up visits, patient’s mirror movements were exacerbated months before she was diagnosed with Parkinson’s disease. Multiple antiepileptic drug regiments along with Carbidopa-levodopa were used and dose adjustments were done during follow up visits to help stabilize the patient’s symptoms. Conclusion In conclusion, this case highlights the progressive nature of mirror movement disorder (MMD) and its association with other neurological conditions, such as epilepsy, essential tremors, and Parkinson's disease. The primary aim of this study was to showcase that individuals with early childhood onset of MMD may experience a deterioration of their condition as they acquire additional neurological disorders, such as essential tremors or Parkinson's disease. Moreover, this study seeks to elucidate how the exacerbation of mirror movement symptoms in such cases can serve as an early indicator of the onset of Parkinson's disease. Medication adjustments played a crucial role in managing the patient's symptoms, emphasizing the importance of individualized treatment plans and close monitoring.

Ophthalmic artery reversal predicts contralateral body weakness symptoms better than carotid Doppler velocity-preliminary results.

The measurement of blood velocity in the carotid artery has been the most popular noninvasive method of identifying and classifying carotid stenosis for half a century. Carotid stenosis is an indicator of elevated risk of stroke; anatomic revascularization reduces the chance of stroke by more than half. Controversy persists on how patients with severe carotid stenosis should be selected for anatomic revascularization. Patients with a connected circle of Willis (coW) might not benefit from anatomic revascularization; patients with two segments missing in the coW are most likely to benefit from revascularization. Based on this analysis of data from carotid duplex examinations and transcranial Doppler examinations including ophthalmic artery (OA) direction in 28 patients, a refined carotid examination protocol is proposed. This refinement includes Doppler measurement of OA flow direction and documentation of internal carotid artery (ICA) bruit in addition to the adoption of an ICA peak systolic velocity (PSV) criterion exceeding 350 cm/s for identification of the patient most likely to benefit from carotid stenosis treatment. Sensitivity and specificity of OA direction or carotid bruit are 84.6%±5.4%, 71.4%±2.1% and for PSV >350 cm/s are 84.6%±5.4%, 59.5%±2.3% for predicting contralateral body weakness. The proposed examination can be performed with the same duplex scanner and scan head currently used for carotid examinations with little additional time.

"Uncrossed Central Facial Paralysis" Caused by Pontine Infarction: A Case Report.

We report a patient with extraordinary pontine infarction-induced contralateral central facial palsy and weakened limb strength. This is a 66-year-old man with left arm movement difficulty for 10 days and worsening over the last 1 day. His left nasolabial fold flattening and left arm strength and sensory were decreased. He could not complete the finger-nose test well with his right hand. Magnetic resonance and magnetic resonance angiography tests confirmed his right pontine acute infarction but without large vessel stenosis or occlusion. "Uncrossed paralysis" patients may present with contralateral face and body weakness with pontine infarcts, if the infarct occurs above the level of the facial nucleus head, and may be simmilar with the higher level pontine lesions or cerebrum semisphere infarction, which need particular attention during clinical practice.

Comparison of subthalamic unilateral and bilateral theta burst deep brain stimulation in Parkinson's disease.

High-frequency, conventional deep brain stimulation (DBS) of the subthalamic nucleus (STN) in Parkinson's disease (PD) is usually applied bilaterally under the assumption of additive effects due to interhemispheric crosstalk. Theta burst stimulation (TBS-DBS) represents a new patterned stimulation mode with 5 Hz interburst and 200 Hz intraburst frequency, whose stimulation effects in a bilateral mode compared to unilateral are unknown. This single-center study evaluated acute motor effects of the most affected, contralateral body side in 17 PD patients with unilateral subthalamic TBS-DBS and 11 PD patients with bilateral TBS-DBS. Compared to therapy absence, both unilateral and bilateral TBS-DBS significantly improved (p < 0.05) lateralized Movement Disorder Society-Unified Parkinson's Disease Rating Scale part III (MDS-UPDRS III) scores. Bilateral TBS-DBS revealed only slight, but not significant additional effects in comparison to unilateral TBS-DBS on total lateralized motor scores, but on the subitem lower limb rigidity. These results indicate that bilateral TBS-DBS has limited additive beneficial effects compared to unilateral TBS-DBS in the short term.

Clinical profile and sensory pattern in lateral medullary syndrome

Background: Lateral Medullary syndrome is an acute ischemic stroke syndrome characterised by occlusion of the vertebral artery/posterior inferior cerebellar artery. The study aimed to describe the sensory pattern and clinical profile of patients admitted with lateral medullary syndrome. Methods: This cross-sectional descriptive study was done in the neurology department at Thanjavur Government Medical College, Tamil Nadu. Twenty patients with acute stroke clinically suspected of lateral medullary syndrome were taken into this study for one year. Magnetic Resonance Imaging (MRI) of the brain with an MR Angiogram was done to confirm clinical suspicion of Lateral medullary syndrome. They were examined in detail for clinical profile and sensory pattern, and relevant investigations were done. Results: Among the 20 LMS patients, 85% were males, and the mean age of occurrence was 53.2 years. All of them had acute infarcts in the lateral medulla. Hypertension, diabetes mellitus and dyslipidemia were the most common systemic risk factors. The most common sensory pattern observed was classical, with loss of sensation in the ipsilateral face and contralateral body in 45% of patients. The most common clinical presentation was walking instability, bulbar symptoms, and a longer hospital stay. The second most common pattern was only sensory impairment in the ipsilateral face, seen in 30%. Their clinical presentation was unsteadiness while walking, with no bulbar symptoms, shorter hospital stays, and better recovery. Conclusions: LMS is an acute stroke syndrome common in males, often after 50 years, with hypertension, diabetes, and dyslipidemia as systemic risk factors.

Multiple cranial palsy in pasein with cerebral cavernoma malformations on the brain stem

Facial palsy is a condition that is often encountered in neurological practice. The weakness of closing the eyes can be found in cases of central facial paralysis. Facial palsy is characterized by acute, unilateral, partial, or complete facial paralysis. Cerebral cavernous malformation is one rare form of lesion, accounting for about 5 to 13% of blood vessel anomalies in the central nervous system. Brain stem cavernomas are rare and less than 20% intracerebral cavernomas. Most patients with cerebral cavernoma of the brain stem have symptoms of acute neurological deficits. The inferior cerebellar pedunkel, vestibular nucleus, trigeminal nucleus of the spine, and ambiguous nucleus are usually affected. Clinical signs include vestibulocerebellar symptoms such as vertigo, falling to the side of lesions, diplopia, multidirectional nystagmus, ipsilateral Horner syndrome, hiccups, contralateral body weakness, pain and sensation of temperature, motion, dysphonia, dysphagia, dysarthria, and decreased gag reflex (Sciacca et al., 2019). A 26-year-old man with a right eye cannot close, the right face cannot be moved since 4 months, the right side face feels thick from the right cheek to the right chin. The patient has no previous history of stroke. In the examination obtained hipestesi NV2 and NV3 right, facial palsy peripheral right.

Effectiveness of Pilates Training on Body Composition and Isokinetic Muscular Strength in Adolescent Baseball Players.

Body composition and muscular strength are important for baseball skills and successful performance. Conditioning training programs have the potential to enhance athletic performance via physiological changes. In this single-group interventional study, we investigated the effect of 8 weeks of Pilates training (PT) on contralateral and regional body composition, and isokinetic muscular strength in knee and trunk flexion/extension in adolescent baseball players. In our results, PT increased both right- and left-sided lean mass in the trunk. Following PT, work per repetition and average power showed significant increases in the flexion and extension of the left knee only. PT significantly decreased the peak torque of the trunk flexor and increased the average power of the trunk extensor. In addition, the ratio of the trunk flexion/extension strength of peak torque showed a decreasing trend, whereas that of work and average power did not change significantly following PT. In conclusion, PT evenly improved lean mass on both the right and left sides of the body. Knee and trunk strength increased after PT. Our findings suggest that PT may be a useful strategy for enhancing athletic performance in regard to the muscular strength of adolescent baseball players.

Clinico-Radiological Profile of Patients With Lateral Medullary Syndrome: A Five Years Observation From a Single-Centered Tertiary Hospital in Nepal.

Objective: We aim to correlate the prevalence of symptoms of the lateral medullary syndrome (LMS) based on radiological classification.Methods: A five-year record of 41 patients diagnosed with LMS and admitted to a tertiary care center in Nepal was reviewed. We used chi-square tests to compare symptoms between rostral and caudal groups and different horizontal subtypes.Results: The subtype prevalence in the horizontal classification of LMS was large (31.7%), lateral (22%), dorsal (19.5%), typical (14.6%), and ventral (12.2%). The most common symptoms in the typical subtype of the horizontal classification were: pain/temperature loss in the contralateral body (7.3%) and dysphagia (7.3%); in the ventral subtype, swaying on the Romberg test (12.2%), dysarthria (9.8%) and dizziness (9.8%); in the dorsal subtype, headache (12.2%) and vomiting (12.2%). Whereas headache (22.2%) and lateropulsion on standing (14.6%), swaying on the Romberg test (14.6%), nausea/vomiting (14.6%) were common in the large subtype, and nausea/vomiting (19.5%) and headache (17.1%) in the lateral subtypes. Whereas, in rostrocaudal classification, the rostral subtype (61%) was more common than the caudal subtype (31%). There was no significant variation in symptoms based on the rostrocaudal classification of LMS.Conclusion: The common clinical manifestations are different for different radiological subtypes of LMS. Further comprehensive studies are essential to understand the prevalence of symptoms in different radiological subtypes and the clinical-radiologic correlation in LMS.

Distinct representation of ipsilateral hand movements in sensorimotor areas

There is ample evidence that the contralateral sensorimotor areas play an important role in movement generation, with the primary motor cortex and the primary somatosensory cortex showing a detailed spatial organization of the representation of contralateral body parts. Interestingly, there are also indications for a role of the motor cortex in controlling the ipsilateral side of the body. However, the precise function of ipsilateral sensorimotor cortex in unilateral movement control is still unclear. Here, we show hand movement representation in the ipsilateral sensorimotor hand area, in which hand gestures can be distinguished from each other and from contralateral hand gestures. High‐field functional magnetic resonance imaging (fMRI) data acquired during the execution of six left‐ and six right‐hand gestures by healthy volunteers showed ipsilateral activation mainly in the anterior section of precentral gyrus and the posterior section of the postcentral gyrus. Despite the lower activation in ipsilateral areas closer to the central sulcus, activity patterns for the 12 hand gestures could be mutually distinguished in these areas. The existence of a unique representation of ipsilateral hand movements in the human sensorimotor cortex favours the notion of transcallosal integrative processes that support optimal coordination of hand movements.

Contralateral Projection of Anterior Cingulate Cortex Contributes to Mirror-Image Pain.

Long-term limb nerve injury often leads to mirror-image pain (MIP), an abnormal pain sensation in the limb contralateral to the injury. Although it is clear that MIP is mediated in part by central nociception processing, the underlying mechanisms remain poorly understood. The anterior cingulate cortex (ACC) is a key brain region that receives relayed peripheral nociceptive information from the contralateral limb. In this study, we induced MIP in male mice, in which a unilateral chronic constrictive injury of the sciatic nerve (CCI) induced a decreased nociceptive threshold in both hind limbs and an increased number of c-Fos-expressing neurons in the ACC both contralateral and ipsilateral to the injured limb. Using viral-mediated projection mapping, we observed that a portion of ACC neurons formed monosynaptic connections with contralateral ACC neurons. Furthermore, the number of cross-callosal projection ACC neurons that exhibited c-Fos signal was increased in MIP-expressing mice, suggesting enhanced transmission between ACC neurons of the two hemispheres. Moreover, selective inhibition of the cross-callosal projection ACC neurons contralateral to the injured limb normalized the nociceptive sensation of the uninjured limb without affecting the increased nociceptive sensation of the injured limb in CCI mice. In contrast, inhibition of the non-cross-callosal projection ACC neurons contralateral to the injury normalized the nociceptive sensation of the injured limb without affecting the MIP exhibited in the uninjured limb. These results reveal a circuit mechanism, namely, the cross-callosal projection of ACC between two hemispheres, that contributes to MIP and possibly other forms of contralateral migration of pain sensation.SIGNIFICANCE STATEMENT Mirror-image pain (MIP) refers to the increased pain sensitivity of the contralateral body part in patients with chronic pain. This pathology requires central processing, yet the mechanisms are less known. Here, we demonstrate that the cross-callosal projection neurons in the anterior cingulate cortex (ACC) contralateral to the injury contribute to MIP exhibited in the uninjured limb, but do not affect nociceptive sensation of the injured limb. In contrast, the non-cross-callosal projection neurons in the ACC contralateral to the injury contribute to nociceptive sensation of the injured limb, but do not affect MIP exhibited in the uninjured limb. Our study depicts a novel cross-callosal projection of ACC that contributes to MIP, providing a central mechanism for MIP in chronic pain state.

A novel virtual reality approach for functional lateralization in healthy adults

Functional lateralization relates to a natural asymmetry in the dominance right or left body side, and is a fundamental principle of the brain. The hemispheres of the brain control the contralateral body side, and show subtle, yet striking, anatomical asymmetries and functional lateralization. Innovative technologies, including Virtual Reality (VR), are entering the areas of experimental research, modeling and simulation related to the study of lateralization, with new perspectives of different applications in modern medical practice. Researchers/clinicians note that there are fewer VR studies with healthy participants, and which are important in evaluating/interpreting clinical outcomes, and testing the usefulness, limitations, and sensitivity of VR. The presented influence of the domination of upper/lower limbs on the performance of VR exercises was studied in healthy right-handed adults. Virtual testing sessions were performed independently with both/ dominant/ non-dominant hands, and the similar VR sessions were conduced on a Wii Balance Board (WBB) with the choice of body side, at different levels of the difficulty. The obtained results are consistent with other studies which show that cognitive-motor training in VR with the WBB platform is a very sensitive and promising tool for recognizing/assessing functional asymmetries of the right-left body side not only in disturbed lateralization, but also in the test training of healthy subjects.

Loading comparison of two structures in the moving tube of a non-invasive prosthesis.

The treatment of adolescent patients with distal femoral cancer has always been a concern. The limb-salvage, regarded as a mainstream treatment, had been developed in recent years, but its application in children still remains challenging. This is because it can lead to potential limb-length discrepancy from the continued normal growth of the contralateral lower body. The extendable prosthesis could solve this problem. The principle is that it can artificially control the length of the prosthesis, making it consistent with the length of the side of the lower limbs. However, this prosthesis has some complications. The extendable prosthesis is classified into invasive and minimally invasive, which extends the prosthesis with each operation. We designed a new non-invasive prosthesis that can be extended in the body. Based on the non-invasive and extendable characteristics, we need to verify the supporting performance of this prosthesis. We carried out a mechanical testing method and finite element analysis simulation. The support performance and non-invasively extension of this prosthesis were verified.

Imaging Parameters of the Ipsilateral Medial Geniculate Body May Predict Prognosis of Patients with Idiopathic Unilateral Sudden Sensorineural Hearing Loss on the Basis of Diffusion Spectrum Imaging.

Idiopathic sudden sensorineural hearing loss is an acute unexplained onset of hearing loss. We examined the central auditory pathway abnormalities in patients with unilateral idiopathic sudden sensorineural hearing loss using diffusion spectrum imaging and the relationships between hearing recovery and diffusion spectrum imaging parameters. Forty-eight patients with unilateral idiopathic sudden sensorineural hearing loss with a duration of ≤2 weeks (range, 8.9 ± 4.3 days) and 20 healthy subjects underwent diffusion spectrum imaging tractography. Hearing levels were evaluated using a pure-tone average at initial presentation and 3-month follow-up. Clinical characteristics and MR imaging findings were assessed. Compared with healthy control subjects, the generalized fractional anisotropy values of patients decreased significantly in the bilateral posterior limbs of the internal capsule, with no differences between the ipsilateral and contralateral sides. The quantitative anisotropy values decreased in the Brodmann area 41, contralateral medial geniculate body, bilateral lateral lemniscus, anterior limb of internal capsule, middle temporal gyrus, and anterior corona radiata. Furthermore, at 3-month follow-up, 14 patients had <15 dB of hearing gain. Receiver operating characteristic curve analysis demonstrated that generalized fractional anisotropy in the ipsilateral medial geniculate body was related to prognosis (sensitivity = 64.7%; specificity = 85.7%; area under the curve = 0.796, 95% CI, 0.661-0.931; P < .01). Diffusion spectrum imaging can detect abnormalities of white matter microstructure along the central auditory pathway in patients with unilateral idiopathic sudden sensorineural hearing loss. The generalized fractional anisotropy value of the ipsilateral medial geniculate body may help to predict recovery outcomes.

Pseudothalamic pattern of sensory loss in lateral medullary syndrome- A clinicoanatomic correlation

Context: Lateral medullary infarction is typically associated with loss of pain and temperature over ipsilateral face and contralateral body. However, sensory loss in contralateral face and body has been described in lateral medullary syndrome- the pseudothalamic pattern or type IV sensory loss of Stopford classification. Aims: This article aims at identifying lateral medullary syndromes associated with sensory impairment over contralateral face and body, and reviewing the neuroanatomical substrate leading to the same. Settings and Design: This was a prospective study conducted at Department of Neurology, at a tertiary level teaching hospital, Kerala, India, over a period of 5 years, among patients with acute ischemic stroke. Methods and Material: We studied all patients with acute ischemic stroke, who were admitted to our department, over a five-year period. Patients presenting with lateral medullary syndrome, with a pseudothalamic pattern of sensory loss were shortlisted and were assessed by investigators independently. All patients underwent MRI brain, which was assessed by investigators 1 and 2, independently. The demographic profile, risk factors, clinical features, neuroimaging findings and outcomes were analysed. Results: A total of 1492 patients with acute ischemic strokes were identified, of which 6 with lateral medullary syndrome with a pseudothalamic pattern of sensory loss were included in the study. Of the 6 patients, two had central post stroke pain, which was refractory to treatment. Conclusions: The type IV sensory loss of Stopford classification or the pseudothalamic pattern of sensory loss is a less described pattern in lateral medullary syndrome. The central post stroke pain (CPSP) which may develop in these patients is difficult to treat. Keywords: Pseudothalamic pattern, Stopford classification, Lateral medullary syndrome, Central post.