B7.028 Brain Stem & Cranial Nerves: From Lesion to Signs and Symptoms

Question 1

symptoms of extra-axial CN III lesion

Answer 1

binocular double vision (skewed)
eyelid drooping
vision blurry

Question 2

signs of extra-axial CN III lesion

Answer 2

eye down and out
ptosis
mydriasis

Question 3

additional symptoms of CN III intra-axial lesions

Answer 3

contralateral body numbness and weakness

Question 4

symptoms of extra-axial CN IV lesion

Answer 4

binocular double vision (vertical or skewed)

Question 5

signs of extra-axial CN IV lesion

Answer 5

head tilt

3 step test

Question 6

when do extra ocular muscle weaknesses manifest the most

Answer 6

when eye is looking in direction of muscle action

Question 7

common cause of CN IV damage

Answer 7

head trauma

Question 8

which eye is affected with and intra-axial CN IV lesion

Answer 8

contralateral eye

CN IV decussates in posterior midbrain

Question 9

symptoms of extra-axial CN VI lesion

Answer 9

binocular double vision (horizontal)

Question 10

signs of extra-axial CN VI lesion

Answer 10

esotropia (cross eyed)

Question 11

symptoms of extra-axial CN V lesion

Answer 11

facial numbness

Question 12

signs of extra-axial CN V lesion

Answer 12

decreased sensation to pain and temperature and fine touch

Question 13

additional symptoms of CN V intra-axial lesions

Answer 13

contralateral body numbness and weakness

Question 14

symptoms of CN VII extra-axial lesions

Answer 14

facial weakness
distorted taste
dry eyes
hyperacusis

Question 15

signs of CN VII extra-axial lesions

Answer 15

upper and lower facial weakness

decreased taste anterior 2/3rd of tongue

Question 16

additional symptoms of CN VII intra-axial lesions

Answer 16

contralateral body numbness and weakness

horizontal double vision (abducens involvement)

Question 17

symptoms of CN VIII extra-axial lesions

Answer 17

decreased hearing

dizziness (vertigo)

Question 18

signs of CN VIII extra-axial lesions

Answer 18

decreased hearing

nystagmus (fast and slow component)

Question 19

what is nystagmus

Answer 19

eyes deviate slowly towards lesion and then correct quickly

Question 20

symptoms of CN IX extra-axial lesions

Answer 20

numbness in back of mouth

difficulty initiating swallowing

Question 21

signs of CN IX extra-axial lesions

Answer 21

decreased sensation of the posterior palate

decreased gag reflex

Question 22

symptoms of CN X extra-axial lesions

Answer 22

difficulty swallowing (nasal regurgitation)
hoarseness

Question 23

signs of CN X extra-axial lesions

Answer 23

decreased palatal elevation (uvula deviated to opposite side)
hoarseness

Question 24

additional symptoms of CN X intra-axial lesions

Answer 24

contralateral body pain and temperature sensation loss

possible Horner syndrome

Question 25

symptoms of CN XI extra-axial lesions

Answer 25

sometimes none | weakness turning head

Question 26

signs of CN XI extra-axial lesions

Answer 26

``` weakness turning head weakness shrugging (maybe) ```

Question 27

how does an affected SCM impact movement

Answer 27

right SCM turns head left | left SCM turns head right

Question 28

symptoms of CN XII extra-axial lesions

Answer 28

tongue weakness

Question 29

signs of CN XII extra-axial lesions

Answer 29

tongue atrophy | tongue deviates toward side of lesion

Question 30

additional symptoms of CN XII intra-axial lesions

Answer 30

contralateral body numbness and weakness | pain and temperature sensation intact

Question 31

difference between medial medullary and lateral medullary lesion effects

Answer 31

medial- contralateral DCML and corticospinal loss | lateral- contralateral ALS loss

Question 32

major blood vessels that supple the brainstem

Answer 32

``` collaterals (rostral > caudal) -posterior cerebral -superior cerebellar -circumferential -anterior inferior cerebellar -vertebral -posterior inferior cerebellar medial (rostral > caudal) -basilar -anterior spinal ```

Question 33

2 classes of brainstem infarcts

Answer 33

dorsolateral infarct | paramedian infarct