Amyotrofik Lateral Sklerozlu Bireylerin Beyin Sapı Morfometrisinin Anatomik ve Radyolojik Olarak Değerlendirilmesi

Abstract

Background: The aim of this study was to define the significant new insights and reveal the morphometric and volumetric changes in brainstem of ALS patients. Material and Methods: We analyzed the clinical records of 50 (males, n = 30; females, n = 20) ALS patients who were admitted to the Department of Neurology between January 2012 and September 2022. Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised was used to quantify the patients. Onset complaints were in the upper extremity (n = 37), lower extremity (n= 19), bulbar involving (n = 15), dizziness (n= 3), unilateral paresthesia, and arm pain (n= 4). Results: The means of the brainstem morphology were estimated as following: the diameters of cerebrum anteroposterior (154.53mm), superior inferior (132.83mm), transverse (133.25mm), pons anteroposterior (14.6mm), vertical (22.84mm), mesencephalon anteroposterior (10.33mm), vertical (14.55mm), the distance between the interpedincular fissure and aquaduct (11.78mm), the distance between cerebral peduncles and aqueduct (13.13mm), the distance between pons, mesencephalon, medulla and the fourth ventricular floor (21.57mm), the anteroposterior diameters of medulla at pontomedullary junction (11.69mm) and at medulla spinal junction (8.35mm), the volume of medulla oblongata (2035.76mm3). After these measurements, the following ratios were calculated as: the ratio between pons, mesencephalon, medulla and the fourth ventricular floor and anteroposterior diameter of medulla at pontomedullary junction (1.87), the ratio between pons, mesencephalon, medulla and the fourth ventricular floor and anteroposterior diameter of medulla at medullaspinal junction (2.65), the ratio between pons, mesencephalon, medulla and the fourth ventricular floor and the distance between the interpedincular fissure and aquaduct (1.86), the ratio between pons, mesencephalon, medulla and the fourth ventricular floor and cerebral peduncles and aqueduct (1.66), the ratio between anteroposterior distances of mesencephalon and pons (0.71) and the vertical diameters between mesencephalon and pons (0.639). Some values showed significant difference in terms of age and gender, whereas all parameters were found higher in males than in females (p<0.05). Conclusions: According to literature analysis, this paper is the first study that determined the linear brain stem measurements and ratios of ALS patients. Therefore, we believe that the data presented in this paper underline the clinical importance and detailed knowledge about ALS diagnosis.