Brain stem

Question 1

What 8 regions of the medulla are affected in a PICA occlusion (Lateral medullary syndrome aka Wallenberg)

Answer 1

Dorsal & lateral

1. Vestibular nuclei - nystagmus, vertigo, nausea, ataxia
2. Inferior cerebellar peduncle - ipsilateral ataxia
3. Spinal trigeminal nucleus & tract
   - loss of pain and temp from ipsilateral face
4. Nucleus ambiguus
   - dysphagia, hoarseness, uvula deviation towards contralateral side, loss of gag reflex
5. descending sympathetics - ipsilateral Horner
6. spinothalamic - loss of pain and temp from contralateral body

7- cochlear nuclei - ipsilateral hearing loss

8. Nucleus solitarius - Taste loss (posterior 1/3 and epiglottis), also mucosal surfaces

Question 2

What are the 8 regions affected by an AICA infarct

Answer 2

Lateral pontine syndrome

1. Middle cerebellar peduncle- ipsilateral ataxia, nystagmus
2. Vestibular nuclei/nerve - vertigo, nystagmus, ataxia
3. Cochlear nuc/auditory nerve - hearing loss, tinnitus
4. Spinal tract of V - loss of pain and temp from ipsilateral face
5. Spinothalamic tract - loss of pain and temp from contralateral body
6. Facial nucleus/nerve - ipsilateral facial weakness, dysarthria (slurred speech)
7. Motor of V - jaw weakness
8. Descending autonomics - ipsilateral horners

Question 3

what 6 things are affected in basilar artery paramedian branches occlusion at the level of the pons

Answer 3

1. CST/corticobulbar - contralateral hemiparesis of body and face, dysarthria
2. Pontine nuclei/ pontocerebellar fibers - contralalteral
3. Facial nerve fascicles - ipsilateral facial weakness, dysarthria
4. PPRF, abducens nuc/nerve - ipsilateral horizontal gaze palsy, diplopia. (right PPRF, can’t look to right)
5. Medial lemniscus (DCLMS) - contralateral loss of touch, vibration, position sense
6. MLF - ispilateral internuclear opthalmoplegia (INO)- convergence is preserved, impairment of adduction.

Question 4

Weber symptoms (2) (posterior cerebral artery)

Benedikt symptoms (4)

Answer 4

1. “the only two things you need to do while surfing on the web”

• CST/corticobulbar: contralateral hemiparesis - body and face
• oculomotor nerve and fascicles: ipsilateral 3rd nerve palsy - down and out

2. • claude (red nucleus)

• CST/corticobulbar: contralateral hemiparesis - body and face
• oculomotor nerve and fascicles: ipsilateral 3rd nerve palsy - down and out
• red nucleus - contralateral tremor and ataxia
• ML - contralateral loss of position, vibration and two point discrimination.