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Midbrain Ataxia: An Introduction to the Mesencephalic Locomotor Region and the Pedunculopontine Nucleus

Gasser M. Hathout1,2 and Roongroj Bhidayasiri3,4

1 Department of Radiology, Geffen School of Medicine, University of California–Los Angeles Medical Center, Los Angeles, CA 90095.
2 Department of Radiology, West Los Angeles Veterans Affairs Medical Center, 11301 Wilshire Blvd., Bldg. 500, Los Angeles, CA 90073.
3 Department of Neurology, Geffen School of Medicine, University of California–Los Angeles Medical Center, Los Angeles, CA 90095.
4 Parkinson's Disease Research, Education and Clinical Center (PADRECC), West Los Angeles Veterans Affairs Medical Center, Los Angeles, CA 90073.



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  		Fig. 1A. —66-year-old man with diabetes and hypertension who presented to emergency department with complaints of gait unsteadiness and blurred vision. T2-weighted (A) and diffusion-weighted (B) images show early subacute infarct in left midbrain tegmentum anterior to aqueduct of Sylvius and dorsal to red nucleus.

 


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  		Fig. 1B. —66-year-old man with diabetes and hypertension who presented to emergency department with complaints of gait unsteadiness and blurred vision. T2-weighted (A) and diffusion-weighted (B) images show early subacute infarct in left midbrain tegmentum anterior to aqueduct of Sylvius and dorsal to red nucleus.

 


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  		Fig. 2A. —52-year-old man with diabetes and hypertension who presented to emergency department 2 days after sudden onset of blurred vision and difficulty in walking. T2-weighted (A) and diffusion-weighted (B) images with motion artifact show subacute infarct in left midbrain tegmentum, anterior to aqueduct of Sylvius.

 


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  		Fig. 2B. —52-year-old man with diabetes and hypertension who presented to emergency department 2 days after sudden onset of blurred vision and difficulty in walking. T2-weighted (A) and diffusion-weighted (B) images with motion artifact show subacute infarct in left midbrain tegmentum, anterior to aqueduct of Sylvius.

 


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  		Fig. 3A. —80-year-old man with diabetes and hypertension who presented to emergency department with 1-day history of blurred vision and difficulty in walking. T2-weighted (A) and diffusion-weighted (B) images show small subacute infarct in right dorsal midbrain tegmentum just anterior to aqueduct of Sylvius.

 


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  		Fig. 3B. —80-year-old man with diabetes and hypertension who presented to emergency department with 1-day history of blurred vision and difficulty in walking. T2-weighted (A) and diffusion-weighted (B) images show small subacute infarct in right dorsal midbrain tegmentum just anterior to aqueduct of Sylvius.

 


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  		Fig. 4. —Sagittal T1-weighted MRI of brainstem. Region in black denotes approximate location of mesencephalic locator region and pedunculopontine nucleus.

 

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