B&B

Question 1

eye turned down & out

Answer 1

• CN3 deficit
• occulomotor
• location: midbrain

Question 2

eye unable to look down when looking toward nose

Answer 2

• CN4 deficit
• trochlear
• location: midbrain

Question 3

ipsilateral facial sensory loss

Answer 3

• CN5 deficit
• trigeminal
• location: pons (*don’t use to locate to pons, use for lateral)

Question 4

ipsilateral eye abduction weakness

Answer 4

• CN6 deficit
• abducens
• location: pons

Question 5

ipsilateral facial weakness/droop

Answer 5

• CN7 deficit
• facial
• location: pons

Question 6

ipsilateral deafness

Answer 6

• CN8 deficit
• auditory
• location: pons (*only hearing loss, NOT vestibular)
• vestibular signs medulla OR pons

Question 7

ipsilateral pharyngeal sensory loss

Answer 7

• CN9 deficit
• glossopharyngeal
• location: medulla

Question 8

ipsilateral palatal weakness

Answer 8

• CN10 deficit
• vagus
• location: medulla

Question 9

ipsilateral shoulder weakness

Answer 9

• CN11 deficit
• spinal accessory
• location: medulla

Question 10

ipsilateral weakness of tongue

Answer 10

• CN12 deficit
• hypoglossal
• location: medulla

Question 11

contralateral weakness

Answer 11

• motor pathway deficit

- corticospinal tract

Question 12

contralateral loss of proprioception/vibration

Answer 12

• medial lemniscus deficit

Question 13

ipsilateral intranuclear ophthalmoplegia

Answer 13

• medial longtudinal fasciculus deficit

Question 14

ipsilateral CN motor loss (3,4,6,12)

Answer 14

• motor nucleus & nerve deficit

Question 15

ipsilateral ataxia

Answer 15

• spinocerebellar deficit

Question 16

contralateral pain/temp sensory loss

Answer 16

• spinothalamic deficit

Question 17

ipsilateral pain/temp loss in face

Answer 17

• sensory nucleus of V

Question 18

ipsilateral Horner’s syndrome

Answer 18

• sympathetic pathway

Question 19

brainstem blood supply

Answer 19

• midbrain: PCA
• pons: basilar (medial), AICA (lateral)
• medulla: ASA (medial), PICA (lateral)

Question 20

Wallenberg

Answer 20

• lateral medullary infarct (PICA)

- spinothalamic, descending of V, nucleus ambiguus, inferior cerebellar peduncle, descending sympathetic

Question 21

Hughlings Jackson

Answer 21

• medial medullary syndrome (paramedian perforating a)

- corticospinal, XII n, medial lemniscus

Question 22

lateral pontine syndrome

Answer 22

• spinothalamic, spinal V, VII, V, middle cerebellar peduncle
• AICA

Question 23

medial pontine syndrome

Answer 23

• perforator off of basilar

- corticospinal, VI

Question 24

Weber

Answer 24

• medial midbrain syndrome (PCA)

- corticospinal, III

Question 25

acoustic neuroma or vestibular schwannoma

Answer 25

• 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)

Question 26

Basilar artery occulsion

Answer 26

• bilateral hemiparesis (both corticalspinal tracts)
• bilateral sensory loss (ascending systems)
• variable CN signs
• reticular system (coma if involved, locked in if spared)

Question 27

time course of disease & etiology

Answer 27

• minutes to hours = vascular disease
• days to weeks = enlarging masses
• months to years = degenerative disease