Syndrome of Dejerine's Fourth Reich.

Dejerine's (1914) precise description of the human corticobulbar tracts is now doubted and forgotten for want of clinical significance. He described them as five bundles of aberrant pyramidal fibres which separate out as leashes from the corticospinal fibres at different levels and each had its territory of bulbar nuclei (like the Reich which is the territory of the German empire of which there were only three). Five cases are described who presented with uppermotor neurone lesion of the 7th, 10th and 12th cranial nerves without evidence of involveement of the pyramidal fibres to the limbs. It is postulated that this is caused by a lesion of the 4th Reich described by Dejerine.