Alternating Hemiplegias

Question 1

Alternating Hypoglossal Hemiplegia + dest of c/l CST

Answer 1

• @ medulla
• i/l paralysis and atrophy of mm of tongue
• CST destruction = c/l spastic hemiplegia + some degree of i/l spastic paralysis
• “A12H” + migration to opposite pyramid

Question 2

Alternating Hypoglossal Hemiplegia + destruction of i/l Medial Lemniscus

Answer 2

• @ medulla
• i/l paralysis and atrophy of mm of tongue
• CST destruction = c/l spastic hemiplegia
• c/l loss of prop/2pt tact/vib from body
• “A12H” + ML

Question 3

Alternating Abducens Hemiplegia

Answer 3

• @ pons
• i/l paralysis of lateral gaze &/or int strabismus
• CST destruction = c/l spastic hemiplegia
• classic “A6H”

Question 4

Millard-Gubler’s Syndrome

Answer 4

• @ pons
• i/l paralysis of lateral gaze &/or int strabismus
• CST destruction = c/l spastic hemiplegia
• Bell’s Palsy: i/l facial palsy, loss of taste sensations from ant 2/3 tongue, decreased lacrimation, and hyperacusis
• “A6H” + 7

Question 5

Syndrome of Foville

Answer 5

• @ pons
• i/l paralysis of lateral gaze &/or int strabismus
• CST destruction = c/l spastic hemiplegia
• ML destruction = c/l loss of prop/2pt descrim/vib
• possible CN VII involvement
• dysphagia, hoarseness, and weakness of tongue from nuc ambinguus & hypoglossal nuc destruction

Question 6

Alternating Trigeminal Hemiplegia

Answer 6

• @ pons
• i/l loss of all sensation of 1/2 face and scalp
• paralysis of i/l mm of mastication
• dest of CST = c/l spastic hemiplegia
• “A5H”

Question 7

Alternating Trigeminal Hemiplegia w/ Dorsal Expansion

Answer 7

• @midbrain
• s/s of alt trigem hemiplegia
• ML dest = c/l loss of prop/2pt descrim from body
• uncrossed CBT fibers = c/l abducens, hypoglossal, and nucleus ambiguus destruction + SNP7

Question 8

Alternating Oculomotor Hemiplegia

Answer 8

• aka Weber’s Syndrome
• ext strab, pupillary dilation, complete ptosis
• substantia nigra dest = resting tremor
• c/l spastic hemiplegia
• uncrossed CBT fibers = c/l brainstem motor nuclear palseys + SNP7

Question 9

Alternating Hypoglossal Hemiplegia

Answer 9

• @ medulla
• i/l paralysis and atrophy of mm of tongue
• CST destruction = c/l spastic hemiplegia
• classic “A12H”