PMID- 18031943
OWN - NLM
STAT- MEDLINE
DCOM- 20080709
LR  - 20080326
IS  - 0306-9877 (Print)
IS  - 0306-9877 (Linking)
VI  - 70
IP  - 5
DP  - 2008
TI  - Neuroanatomical basis of Sandifer's syndrome: a new vagal reflex?
PG  - 957-61
AB  - Sandifer's syndrome is a gastrointestinal disorder with neurological features. It 
      is characterized by reflex torticollis following deglutition in patients with 
      gastroesophageal reflux and/or hiatal hernia. The authors believe that 
      neurological manifestations of the syndrome are the consequence of vagal reflex 
      with the reflex center in nucleus tractus solitarii (NTS). Three models for the 
      neuroanatomical basis of the hypothetic reflex arc are presented. In the first 
      one the hypothetic reflex arc is based on the classic hypothesis of two 
      components nervus accessorius (n.XI) - radix cranialis (RC) and radix spinalis 
      (RS) The nervous impulses are transmitted by nervus vagus (n.X) general visceral 
      afferent (GVA) fibers to NTS situated in medulla oblongata, then by interneuronal 
      connections on nucleus ambiguus (NA) and nucleus dorsalis nervi vagi (NDX). 
      Special visceral efferent fibers (SVE) impulses from NA are in part transferred 
      to n.XI ramus externus (RE) (carrying the majority of general somatic efferent 
      (GSE) fibers) via hypothetic anastomoses in the region of foramen jugulare. This 
      leads to contraction of trapezius and sternocleidomastoideus muscles, and the 
      occurrence of intermittent torticollis. In the second suggested neuroanatomical 
      model the hypothetic reflex arc is organized in the absence of n.XI RC, the 
      efferent part of the reflex arc continues as NA, which is motor nucleus of nervus 
      glossopharyngeus (n.IX) and n.X in this case while distal roots of n.XI that 
      appear at the level of the olivary nucleus lower edge represent n.X roots. In the 
      third presented model the hypothetic reflex arc includes no jugular transfer and 
      could be realized via interneuronal connections directly from NTS to the spinal 
      motoneurons within nucleus radicis spinalis nervi accessorii (NRS n.XI) or from 
      NA to NRS n.XI. The afferent segment of the postulated reflex arc in all three 
      models is mediated via n.X. We conclude that Sandifer's syndrome is a clinical 
      manifestation of another vagal reflex that could be termed a "vagocervical" or 
      "esophagocervical" reflex, based on the neuroanatomical hypotheses elaborated in 
      this paper.
FAU - Cerimagic, Denis
AU  - Cerimagic D
AD  - Department of Neurology, Dubrovnik General Hospital, Roka Misetica bb, HR-20000 
      Dubrovnik, Croatia. deniscerimgic@yahoo.com
FAU - Ivkic, Goran
AU  - Ivkic G
FAU - Bilic, Ervina
AU  - Bilic E
LA  - eng
PT  - Journal Article
DEP - 20071126
PL  - United States
TA  - Med Hypotheses
JT  - Medical hypotheses
JID - 7505668
SB  - IM
MH  - Brain/*pathology
MH  - Humans
MH  - Models, Biological
MH  - Models, Neurological
MH  - Models, Theoretical
MH  - Motor Neurons/pathology
MH  - Neurons/metabolism
MH  - *Reflex
MH  - Respiratory System Abnormalities/etiology/*pathology
MH  - Syndrome
MH  - Vagus Nerve/*pathology
EDAT- 2007/11/23 09:00
MHDA- 2008/07/10 09:00
CRDT- 2007/11/23 09:00
PHST- 2007/08/26 00:00 [received]
PHST- 2007/09/07 00:00 [accepted]
PHST- 2007/11/23 09:00 [pubmed]
PHST- 2008/07/10 09:00 [medline]
PHST- 2007/11/23 09:00 [entrez]
AID - S0306-9877(07)00584-1 [pii]
AID - 10.1016/j.mehy.2007.09.011 [doi]
PST - ppublish
SO  - Med Hypotheses. 2008;70(5):957-61. doi: 10.1016/j.mehy.2007.09.011. Epub 2007 Nov 
      26.