Voiding and MRI analysis of the brain.

Observations of surgery, angiography and postmortem studies have indicated that the frontal lobe is a higher center important in the control of micturition. CT and MRI have made it possible to extend these early observations, and we report here the results of imaging in patients with hemispheric and brain-stem strokes. In a series of stroke patients urinary dysfunction was found in 68% with frontal lesions 20% with parietal, 14% with temporal and none with occipital lobe lesions. With lesions in the frontal lobe, it appears that medial aspects are particularly important in the prefrontal lobe, cingulate gyrus, paracentral lobule and the orbital area in micturition control. Frontal lobe disease may cause disorders of storage as well as voiding, as shown by urodynamics: detrusor hyperreflexia, detrusor areflexia, uninhibited sphincter relaxation and unrelaxing sphincter on voiding were found. We have also had the opportunity to make observations about the role of the basal ganglia and pons in micturition control in humans.