B&B Flashcards
eye turned down & out
- CN3 deficit
- occulomotor
- location: midbrain
eye unable to look down when looking toward nose
- CN4 deficit
- trochlear
- location: midbrain
ipsilateral facial sensory loss
- CN5 deficit
- trigeminal
- location: pons (*don’t use to locate to pons, use for lateral)
ipsilateral eye abduction weakness
- CN6 deficit
- abducens
- location: pons
ipsilateral facial weakness/droop
- CN7 deficit
- facial
- location: pons
ipsilateral deafness
- CN8 deficit
- auditory
- location: pons (*only hearing loss, NOT vestibular)
- vestibular signs medulla OR pons
ipsilateral pharyngeal sensory loss
- CN9 deficit
- glossopharyngeal
- location: medulla
ipsilateral palatal weakness
- CN10 deficit
- vagus
- location: medulla
ipsilateral shoulder weakness
- CN11 deficit
- spinal accessory
- location: medulla
ipsilateral weakness of tongue
- CN12 deficit
- hypoglossal
- location: medulla
contralateral weakness
- motor pathway deficit
- corticospinal tract
contralateral loss of proprioception/vibration
- medial lemniscus deficit
ipsilateral intranuclear ophthalmoplegia
- medial longtudinal fasciculus deficit
ipsilateral CN motor loss (3,4,6,12)
- motor nucleus & nerve deficit
ipsilateral ataxia
- spinocerebellar deficit
contralateral pain/temp sensory loss
- spinothalamic deficit
ipsilateral pain/temp loss in face
- sensory nucleus of V
ipsilateral Horner’s syndrome
- sympathetic pathway
brainstem blood supply
- midbrain: PCA
- pons: basilar (medial), AICA (lateral)
- medulla: ASA (medial), PICA (lateral)
Wallenberg
- lateral medullary infarct (PICA)
- spinothalamic, descending of V, nucleus ambiguus, inferior cerebellar peduncle, descending sympathetic
Hughlings Jackson
- medial medullary syndrome (paramedian perforating a)
- corticospinal, XII n, medial lemniscus
lateral pontine syndrome
- spinothalamic, spinal V, VII, V, middle cerebellar peduncle
- AICA
medial pontine syndrome
- perforator off of basilar
- corticospinal, VI
Weber
- medial midbrain syndrome (PCA)
- corticospinal, III
acoustic neuroma or vestibular schwannoma
- extrinsic to stem
- begins w/ CN signs (vestibular before cochlear & later involvement of V & VII)
- late occurrence of long-tract signs (ataxia: middle cerebellar p & hemiparesis: corticospinal)
Basilar artery occulsion
- bilateral hemiparesis (both corticalspinal tracts)
- bilateral sensory loss (ascending systems)
- variable CN signs
- reticular system (coma if involved, locked in if spared)
time course of disease & etiology
- minutes to hours = vascular disease
- days to weeks = enlarging masses
- months to years = degenerative disease
