HISTORY OF THE CLASSICAL BRAIN STEM SYNDROMES

97th DOG Annual Meeting 1999

V290
HISTORY OF THE CLASSICAL BRAIN STEM SYNDROMES

D. Schmidt

Background: Knowledge about the occurrence of pareses of the eye muscles, or gaze-paralyses, in connection with lesions of the long tracts of the brain stem.

Method: The original publications of the authors during the last century and the early years of this one were studied in relation to the neuro-ophthalmological diagnosis and neuroanatomy. It is the goal of this medico-historical investigation to compare the knowledge available at this time when the first descriptions were made with the clinical experience and understanding of today. br>
Results: The following classical brain-stem syndromes are important for an ophthalmologist: Benedikt´s syndrome (1889, hemiparesis with tremor and crossed oculomotor paralysis), Foville´s syndrome (1858, conjugate lateral gaze paralysis, ipsilateral nuclear palsy of the 7th nerve, crossed hemiparesis), the Millard-Gubler´s syndrome (1855/1856, nuclear 7th nerve palsy with crossed hemiplegia), Raymond-Cestan´s syndrome (1895, abducent nerve paralysis with contralateral hemiparesis), Wallenberg´s syndrome (1895, Horner´s syndrome, absent corneal reflex, lateropulsion of saccadic eye movements, nystagmus, ataxia, dysphagia, hoarseness, sensory loss over the facial region etc.) and Weber´s syndrome (1863, ipsilateral oculomotor paralysis with contralateral hemiplegia). The following two syndromes do not belong to the above-mentioned classical examples, because lesions of the long tracts of the brain stem are absent. However, since these two syndromes are accompanied by both ocular and neurological signs which indicate typical lesions of the brain stem, they are also mentioned here: Parinaud´s syndrome (1883, paralysis of conjugate vertical gaze together with additional neuro-ophthalmological signs) and the Koerber-Salus-Elschnig´s syndrome (1903, 1910, 1913, nystagmus retractorius and signs of midbrain disease).

Conclusions: The first descriptions of these syndromes, together with the figures illustrating the neuroanatomical findings in these lesions, are helpful for assessing! the clinical picture. Some named syndromes which are used today in clinical diagnosis (e.g. Parinaud´s syndrome) do not exactly correspond to the first descriptions in the last century.

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