Cerebral Mass Displacements. Part II Clinical Findings in Primary and Secondary Brain Stem Lesions

  • Robert Schönmayr
Part of the Acta Neurochirurgica book series (NEUROCHIRURGICA, volume 40)


Damage to the brain stem is manifested clinically in functional disorders which can be assigned either in isolation or in combination with the following categories:
  • — disorders of consciousness

  • — stimulation or deficit manifestations on the part of the cranial nerve nuclei located in the brain stem and the pertinent nerve tracts and connectional systems

  • — stimulation or deficit manifestations on the part of the autonomic centers

  • — losses of functions based on lesions to the ascending and descending tract systems passing through the brain stem.


Brain Stem Severe Head Injury Light Reaction Orbicularis Oculus Lesion Level 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


Part II

  1. 1.
    Agnoli AL, Cristante L, Busse O, Feistner H (1980) Brain herniation by cranial computer tomography: clinical radiological correlations. In: Anatomy-physiology in CT. Kugler Medical Publications, AmstelveenGoogle Scholar
  2. 2.
    Agnoli AL, Laun A, Busse O, Schoch R (1980) Computerized tomography in brain stem haemorrhage. Diagnostic and prognostic aspects. Lecture: IXth Congress of European Society of Neuroradiology, BrusselsGoogle Scholar
  3. 3.
    Amphoux M, Sevin A (1975) Traumatisms cérébraux et focalisations intracraniennes. Agressologie 16, A: 47–53PubMedGoogle Scholar
  4. 4.
    Ansari K (1974) Les hémorrhagies secondaires du tronc cérébral. Arch Suiss de Neurol Neurochir Psychiat 114, fasc 1, 1–28Google Scholar
  5. 5.
    Ansink BJJ (1962) Physiological and clinical investigations into four brain stem reflexes. Neurology (Minneap) 12: 320Google Scholar
  6. 6.
    Arieff AJ, Pyzik SW (1953) The ciliospinal reflex in injuries of the spinal cord in man. Arch Neurol Psychiat (Chic) 70: 621Google Scholar
  7. 7.
    Auer LM et al (1980) Predicting letal outcome after severe head injury—a computer-assisted analysis of neurological symptoms and laboratory values. Acta Neurochir (Wien) 52: 225–238CrossRefGoogle Scholar
  8. 8.
    Auer LM et al (1980) Relevance of CT-scan for the level of ICP in patients with severe head injury. In: Shulman K et al (eds) Intracranial pressure IV. Springer, Berlin Heidelberg New York, pp 45–47CrossRefGoogle Scholar
  9. 9.
    Babić B et al (1979) Prognostic factors in acute head injuries—brain stem contusion during the first week. Acta Neurochir (Wien) 1 [Suppl] 28: 153–157Google Scholar
  10. 10.
    Barge M, Ohanessian J, Baum L, Benabid AL, Chirossel JP (1977) Valeur diagnostique et pronostique des réflexes du tronc cérébral dans les comas post-traumatiques graves. Neurochirurgie 23: 227–238PubMedGoogle Scholar
  11. 11.
    Becker DP et al (1977) The outcome from severe head injury with early diagnosis and intensive management. J Neurosurg 47: 491–502PubMedCrossRefGoogle Scholar
  12. 12.
    Benezech J et al (1979) Apport des potentiels évoqués du tronc cérébral (PET) pour l’étude clinique et le pronostic des comas traumatiques. Corrélations avec les réflexes du tronc cérébral. Neurochirurgie 25 (4): 219–223PubMedGoogle Scholar
  13. 13.
    Berger MS et al (1985) Outcome from severe head injury in children and adolecents. J Neurol 62: 194–199Google Scholar
  14. 14.
    Bogousslavsky J, Meienberg O (1987) Eye-movement disorders in brain stem and cerebellar stroke. Arch Neurol 44 (2): 141–148PubMedCrossRefGoogle Scholar
  15. 15.
    Brendler SJ, Selverstone B (1970) Recovery from decerebration. Brain 93: 381–392PubMedCrossRefGoogle Scholar
  16. 16.
    Bricolo A (1976) Prolonged post-traumatic coma. In: Vinken PJ, Bruyn GW (eds) Handbook of clinical neurology. North Holland Publishing Comp, Amsterdam, Oxford, vol 24, p 699Google Scholar
  17. 17.
    Bricolo A, Gentilomo A, Rosadini G, Rossi GF (1968) Long-lasting post-traumatic unconsciousness. Acta Neurol Scand 44: 512–532CrossRefGoogle Scholar
  18. 18.
    Bricolo A, Battistini N, Bergamini L et al (1975) A proposal for the clinical classification of acute coma due to organic cerebral lesions. J Neurosurg Sci 19: 113PubMedGoogle Scholar
  19. 19.
    Bricolo A, Dolce G (1975) Evoluzioni cliniche del coma post-traumatico grave. Min Neurochir 13: 61Google Scholar
  20. 20.
    Bruce DA, Schut L, Bruno LA, Wood JH, Sutton LN (1978) Outcome following severe head injuries in children. J Neurosurg 48: 679–688PubMedCrossRefGoogle Scholar
  21. 21.
    Bryan R, Weisberg L (1982) Prolonged survival with good functional recovery in 3 patients with computer tomographic evidence of brain stem haemorrhage. Comput Radiol 6 (1): 43–48PubMedCrossRefGoogle Scholar
  22. 22.
    Buonaguidi R, Rossi B, Sartucci F, Ravelli V (1979) Blink reflexes in severe traumatic coma. J Neurol Neurosurg Psychiat 42: 470–474PubMedCrossRefGoogle Scholar
  23. 23.
    Burns J et al (1980) Recovery following brain stem haemorrhage. Ann Neurol 7 (2): 183–184PubMedCrossRefGoogle Scholar
  24. 24.
    Busse O, Agnoli A, Schoch P, Laun A (1981) Primary brain stem haematomas of vascular aethiology: clinical and CT-correlations. 12th World Congress of Neurology, Kyoto, JapanGoogle Scholar
  25. 25.
    Byuke O (1980) Facial reflex examination. A clinical and neurophysiological study on acustic tumours and brain displacement at the tentorial notch. Acta Neurol Scand [Suppl] 62 (76): 1–127Google Scholar
  26. 26.
    Carlsson C, Essen C von, Lörfren J (1968) Factors affecting the clinical course of patients with severe head injuries. Part 1: Influence of biological factors. Part 2: Significance of post-traumatic coma. J Neurosurg 29: 242PubMedCrossRefGoogle Scholar
  27. 27.
    Clay SA, Ramseyer JC (1977) The orbicularis oculi reflex: pathologic studies in childhood. Neurology 27: 892–895PubMedGoogle Scholar
  28. 28.
    Cooper PR et al (1979) Traumatically induced brain stem haemorrhage and the computerized tomographic scan: clinical, pathological and experimental observations. Neurosurg 4 (2): 115–124CrossRefGoogle Scholar
  29. 29.
    Le Coz P et al (1986) Aspects cliniques et evolutifs des haematomas circonscrits du tronc cérébral. Apport du scanner X. Rev Neurol (Paris) 142 (1): 52–60Google Scholar
  30. 30.
    Crompton MR (1966) Prolonged coma after head injury. The Lancet 938-940Google Scholar
  31. 31.
    Dengler R, Struppler A (1981) Beurteilung der Lokalisation und Ausdehnung von Hirnstammaffektionen mit Hilfe des Orbicularis-oculi-Reflexes. EEG EMG 12 (1): 50–55PubMedGoogle Scholar
  32. 32.
    Denny-Brown D (1962) The midbrain and motor integration. Proc Roy Soc Med 55: 527PubMedGoogle Scholar
  33. 33.
    Fisher CM (1969) The neurological examination of the comatouse patient. Acta Neurol Scand [Suppl] 36: 45Google Scholar
  34. 34.
    Fisher MA, Shahani BT (1979) Assessing segmental excitability after acute rostral lesions: II. The blink reflex. Neurology (Minneap) 29 (1): 45–50Google Scholar
  35. 35.
    Gennarelli TA et al (1982) Influence of the type of intracranial lesion on outcome from severe head injury. J Neurosurg 56: 26–32PubMedCrossRefGoogle Scholar
  36. 36.
    Gerstenbrand F (1967) Das traumatische appallische Syndrom. Springer, Wien New YorkGoogle Scholar
  37. 37.
    Gerstenbrand F, Lücking CH (1970) Die akuten traumatischen Hirnstammschäden. Arch Psychiatr Nervenkr 213: 264–281PubMedCrossRefGoogle Scholar
  38. 38.
    Gerstenbrand F (1970) Klinik und Therapie der akuten traumatischen Hirnstammschäden. Z ges Neurologie Psychiat 197: 105Google Scholar
  39. 39.
    Greenberg RP et al (1977) Evaluation of brain function in severe human trauma with multimodality evoked potentials. Part 1: Evoked brain injury potentials, methods and analysis. Part 2: Localisation of brain dysfunction and correlation with post traumatic neurological conditions. J Neurosurg 47 (2) 150–177PubMedCrossRefGoogle Scholar
  40. 40.
    Greenberg RP et al (1979) Clinical findings associated with brain stem dysfunction: an electrophysiological study in severe human head trauma. In: Popp AJ et al (eds) Neural trauma. Raven Press, New York, pp 229–236Google Scholar
  41. 41.
    Greenberg RP et al (1981) Noninvasive localization of brain stem lesions in the cat with multimodality evoked potentials: correlation with human head-injury data. J Neurosurg 54 (6): 740–750PubMedCrossRefGoogle Scholar
  42. 42.
    Herrmann D, Kunze K, Agnoli A (1982) Orbicularis Oculi-Reflexe in der Differentialdiagnose der Hirnstammsyndrome. In: Struppler A (Hrsg) Elektrophysiologische Diagnostik in der Neurologic G Thieme, Stuttgart New York, pp 246–247Google Scholar
  43. 43.
    Jellinger K (1968) Zur Neuropathologie des Komas und postkomatöser Encephalopathien. Wien Klin Wschr 80: 505–517PubMedGoogle Scholar
  44. 44.
    Jellinger K, Gerstenbrand E, Pateisky K (1963) Die protrahierte Form der posttraumatischen Encephalopathie. Nervenarzt 34: 145–159PubMedGoogle Scholar
  45. 45.
    Jellinger K, Seitelberger F (1970) Protracted post-traumatic encephalopathy. J Neurol Sci 10: 51–94PubMedCrossRefGoogle Scholar
  46. 46.
    Jennett B, Teasdale G et al (1977) Severe head injuries in three countries. J Neurol Neurosurg Psychiat 40: 291–298PubMedCrossRefGoogle Scholar
  47. 47.
    Jennett B, Teasdale G (1977) Aspects of coma after severe head injury. Lancet 23: 878–881CrossRefGoogle Scholar
  48. 48.
    Jennett B et al (1979) Prognosis of patients with severe head injury. Neurosurg 4: 283–289CrossRefGoogle Scholar
  49. 49.
    Jouvet M, Dechaume J (1967) Sémiologie des troubles de la conscience. Essay de classification. Rev Lyon Med 9: 961–968Google Scholar
  50. 50.
    Jouvet M (1969) Coma and other disorders of consciousness. In: Vinken PJ, Bruyn GW (eds) Handbook of clinical neurology, vol 3. North Holland, Amsterdam, pp 62–79Google Scholar
  51. 51.
    Kimura J (1970) Alterations of the orbicularis oculi reflex by pontine lesions. Arch Neurol (Chic) 22: 156–161CrossRefGoogle Scholar
  52. 52.
    Kimura J (1971) Electrodiagnostic study of brain stem. Stroke 2: 576–586PubMedCrossRefGoogle Scholar
  53. 53.
    Kimura J (1973) The blink reflex as a test for brain stem and higher central nervous system function. In: Desmedt JE (ed) New developments in electromyography and clinical neurophysiology, vol 3. Karger, Basel, pp 682–691Google Scholar
  54. 54.
    Kistler JP, Hochberg FH et al (1975) Computerized axial tomography: Clinico-pathologic correlation. Neurology 25: 201–209PubMedGoogle Scholar
  55. 55.
    Klug N (1982) Brain stem auditory evoked potentials in syndromes of decerebration, bulbar syndromes and in central death. J Neurol 227: 219–228PubMedCrossRefGoogle Scholar
  56. 56.
    Klug N, Csécsei G, Rap Z (1982) Evoked potentials and blink reflex in clinical and experimental traumatic brain stem lesions. Excerpta MedicaGoogle Scholar
  57. 57.
    Klug N (1983) Funktionsuntersuchungen des Hirnstammes im akuten Mittelhirnsyndrom unter Berücksichtigung vegetativer Größen während der Dezerebration. Habil-Schrift, GiessenGoogle Scholar
  58. 58.
    Klug N, Csécsei G (1985) Evoked potentials and brain stem reflexes. Neurosurg Rev 8(1): 83–84CrossRefGoogle Scholar
  59. 59.
    Klug N, Csécsei G (1985) Brain stem acoustic evoked potentials in the acute midbrain syndrome and in central death. In: Morocuti C, Rizzo PA (eds) Evoked potentials—neurophysiological and clinical aspects. Elsevier, Amsterdam New York Oxford, pp 203–210Google Scholar
  60. 60.
    Klug N (1986) Neurophysiological results (brain stem reflexes and evoked potentials) in primary and secondary brain stem disorders. In: Samii M (ed) Surgery in and around the brain stem and 3rd ventricle. Springer, Berlin Heidelberg New York London Paris Tokyo, pp 147–152CrossRefGoogle Scholar
  61. 61.
    Laun A, Agnoli AL (1980) Brain stem haemorrhages. In: Pia HW, Langmaid L, Zierski J (eds) Spontaneous intracerebral haematomas—advances in diagnosis and treatment. Springer, Berlin Heidelberg New York, pp 196–201Google Scholar
  62. 62.
    Laun A, Agnoli AL, Schönmayr R, Villagrasa J (1983) Morphological and CT-findings in traumatic brain stem haemorrhages—a contribution of pathophysiology of primary and secondary lesions. In: Villani R (ed) Advances in neuro-traumatology. JCS 612, Excerpta Medica, Amsterdam Oxford PrincetonGoogle Scholar
  63. 63.
    Lyon LW, Kimura J, McCormick WF (1972) Orbicularis oculi reflex in coma: clinical, electrophysiological and pathological correlations. J Neurol Neurosurg Psychiat 35: 582–588PubMedCrossRefGoogle Scholar
  64. 64.
    McNealy DE, Plum F (1962) Brain stem dysfunction with supratentorial mass lesions. Arch Neurol (Chic) 7: 10–32CrossRefGoogle Scholar
  65. 65.
    Ongerboer De Visser BW, Goor C (1976) Jaw reflexes and masseter myograms in mesencephalic and pontine lesions. J Neurol Neurosurg Psychiat 39: 90–92PubMedCrossRefGoogle Scholar
  66. 66.
    Ongerboer De Visser BW, Kuypers HG (1978) Late blink reflex changes in lateral medullary lesions. An electrophysiological and neuro-anatomical study of Wallenberg’s syndrome. Brain 101 (2): 285–294PubMedCrossRefGoogle Scholar
  67. 67.
    Ottaviani F et al (1986) Auditory brain stem and middle latency auditory responses in the prognosis of severely head-injured patients. Electroencephalogr Clin Neurophysiol 65 (3): 196–202PubMedCrossRefGoogle Scholar
  68. 68.
    Overgaard J, Petersen K, Christensen S et al (1973) Prognosis after head injury based on early clinical examination. Lancet 11: 631CrossRefGoogle Scholar
  69. 69.
    Pagni CA (1973) The prognosis of head injured patients in a state of coma with decerebrate posture. J Neurosurg Sci 17: 289–295Google Scholar
  70. 70.
    Pazzaglia P, Frank G, Frank F et al (1975) Clinical course and prognosis of acute post-traumatic coma. J Neurol Neurosurg Psychiat 38: 149–154PubMedCrossRefGoogle Scholar
  71. 71.
    Perez-Dominguez E (1974) Les réflexes du tronc cérébral. Leur valeur dans l’étude des comas. Thèse, Université du MontpellierGoogle Scholar
  72. 72.
    Pia HW (1956) Die Einwirkung der Hirndrucksteigerung auf den Hirnstamm, ihre Klinik und Behandlung. Münch med Wschr 98: 1609–1612PubMedGoogle Scholar
  73. 73.
    Pia HW (1957) Die Schädigungen des Hirnstammes bei den raumfordernden Prozessen des Gehirns. Acta Neurochir (Wien) [Suppl] 4, Springer, WienGoogle Scholar
  74. 74.
    Rappaport M et al (1981) Evoked potentials and head injury. 2. Clinical applications. Clin Electroencephalogr 12 (4): 167–176PubMedGoogle Scholar
  75. 75.
    Reeves AG, Posner JB (1969) The ciliospinal response in man. Neurology (Minneap) 19: 1145–1152Google Scholar
  76. 76.
    Rosenblum WI, Greenberg RP et al (1981) Midbrain lesions: frequent and significant prognostic feature in closed head injury. Neurosurg 9: 613–620CrossRefGoogle Scholar
  77. 77.
    Rossi GF (1965) Some aspects of the functional organisation of the brain stem: neurophysiological and neurosurgical observations. Copenhagen, IIIrd Int Congr Neurol Surg. Excerpta Medica, pp 117-122Google Scholar
  78. 78.
    Sancesario G et al (1984) Prognostic evaluation of brain stem haematomas: the role of CT scan and brain stem auditory evoked potentials. Acta Neurol Scand 70 (6): 396–406PubMedCrossRefGoogle Scholar
  79. 79.
    Schoenhuber R et al (1983) Neurophysiological assessment in progressive supranuclear palsy (letter). Ital J Neurol Sci 4 (3): 363PubMedCrossRefGoogle Scholar
  80. 80.
    Schönmayr R (1973) Übersicht über die klinisch wichtigen Fremdreflexe des Menschen. Diss TU MünchenGoogle Scholar
  81. 81.
    Schönmayr R, Laun A, Agnoli AL, Busse O (19821) Spontaneous brain stem lesions. CT-findings and clinical data in respect to morbidity. Advances in Neurosurgery, vol 10. Springer, Berlin Heidelberg New York, pp 47–49Google Scholar
  82. 82.
    Snyder BD et al (1981) Neurologic prognosis after cardiopulmonary arrest: IV. Brain stem reflexes. Neurology (NY) 31 (9): 1092–1097Google Scholar
  83. 83.
    Stewart WA, Litten SP, Sheehe PR (1973) A prognostic model for brain stem injury. Surg Neurol 1: 303–310PubMedGoogle Scholar
  84. 84.
    Struppler A, Dobbelstein H (1963) Elektromyographische Untersuchungen des Glabellareflexes bei verschiedenen neurologischen Störungen. Nervenarzt 34: 347PubMedGoogle Scholar
  85. 85.
    Tanaka Y, Kaga K (1980) Application of brain stem response in brain-injured children. Brain Dev 2 (1): 45–56PubMedGoogle Scholar
  86. 86.
    Tandon PN, Bhatia R, Banerji AK (1973) Vestibulo-ocular reflex and brain stem lesions. A clinico-pathological study. Neurology (India) 193-199Google Scholar
  87. 87.
    Teasdale G, Jennett B (1974) Assessment of coma and impaired consciousness. A practical scale. Lancet 2: 81–83PubMedCrossRefGoogle Scholar
  88. 88.
    Turazzi S, Alexandre A, Bricolo (1975) Incidence and significance of clinical signs of brain stem traumatic lesions. J Neurosurg Sciences 19: 215–222Google Scholar
  89. 89.
    Uziel A et al (1982) Clinical applications of brain stem auditory evoked potentials in comatose patients. Adv Neurol 32: 195–202PubMedGoogle Scholar
  90. 90.
    Vapalahti M, Troupp H (1971) Prognosis for patients with severe brain injuries. Br Med J: 404-406Google Scholar
  91. 91.
    Verier A et al (1984) Evaluation clinique et pronostique d’un coma post-traumatique selon le nineau de souffrance du tronc cerebral. Sem Hop Paris, 60 (14): 1014–1019PubMedGoogle Scholar
  92. 92.
    Walshe FMR (1957) States of consciousness in neurology. Acta Med Belg 141-145Google Scholar
  93. 93.
    Werf AJM van der (1979) Brain stem injuries. European association of neurosurgical societies. Neurosurgical CourseGoogle Scholar
  94. 94.
    Zee DS (1986) Brain stem and cerebellar deficits in eye movement control. Trans Ophtalmol Soc UK 105 (Pt 5): 599–605Google Scholar
  95. 95.
    Zuccarello M et al (1983) Importance of auditory brain stem responses in the CT diagnosis of traumatic brain stem lesions. AJNR 4 (3): 481–483PubMedGoogle Scholar
  96. 96.
    Zuccarello M et al (1983) Traumatic primary brain stem haemorrhage. A clinical and experimental study. Acta Neurochir (Wien) 67 (1-2): 103–113CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Wien 1987

Authors and Affiliations

  • Robert Schönmayr
    • 1
  1. 1.Department of NeurosurgeryUniversity of GiessenFederal Republic of Germany

Personalised recommendations