Does Chronic Brainstem Injury Alter Neurological Response to the Environment?
Friday, November 1, 2013
4:00 PM-5:30 PM
Fraser Cummins Henderson Sr., MD, Director of the Metropolitan Neurosurgery Group, LLC in Chevy Chase, MD, will discuss how the brainstem is the aggregate of central pathways of perception and response to most environmental stimuli. Chronic injury and deformation of the brainstem may result in headache and neurological deficits, which can encompass poor sleep architecture, sleep apnea and poor CO2 regulation (Howard,1994), changes in regulation of blood pressure, dysautonomia and orthostatic intolerance, problems with speech, swallowing and digestion, changes in hearing, balance and vision, scoliosis, sensory motor dissociation and clumsiness, and bowel and bladder problems (Milhorat,1999; Menezes, 2001; Henderson 1994,2005,2005,2010). Wired into every part of the cortex, the brainstem is responsible for arousal, concentration and modulation of sensation and pain. Chronic microtrauma to the brainstem occurs in congenital and degenerative conditions of the skull base (Goel, 2012). Acute brainstem injury has been demonstrated in whiplash injury. Furthermore, the overlying cerebellum has been implicated in altered behavioral response to environmental stimuli. Cerebellar hypoplasia appears to result in mental retardation, loss of interest in the environment, apathy, developmental delay, episodic hyperpnoea, involuntary facial movements, delayed speech and language development (Mercuri, 1979). Injury to ascending pathways from the cerebellum are thought to compromise cerebellar function, and thereby the projections to the brain (Goel, 2002). Neuro-imaging and autopsy studies show decreased size of the cerebellum and loss of Purkinje cells in 10/10 autopsies in children with autism (Courchesne, 1988). Hypoplasia or dysfunction in the neocerebellar vermis lobules VI and VII, neocerebellar hemispheres, the semi-lunar, gracile, biventate, and tonsilar lobules affect projections to regions of the brain that are suggested to be dysfunctional in autism (Courchesne, E. Neuroanatomic Imaging. Suppl 781-790, 2001). This presentation, therefore, seeks to demonstrate how acute and chronic deformative injury to the brainstem can change behavioral accommodation to altered perception and neurological function. The subjects were referred by pediatricians, neurologists and geneticists. All study groups were IRB approved. Evaluation and or surgical treatment utilized published standards of practice (Kim, 2004), and the clinical results of three groups of patients are presented. For more info, please visit www.biomed.drexel.edu