Brainstem Cases Patient 2

Question 1

Patient #2

Overall Dx

Answer 1

Medial Superior Pontine Syndrome
Damage to the RIGHT MID-ROSTRAL PONS rostal the Facial nucleus
PPRF, SUPERIOR CEREBELLAR PEDUNCLE, MEDIAL LEMINISCUS, and somehow the Corticospinal Tract superior to decussation

No damage to surrounding occulomotor nerves and pupilary (CN III, IV, VI), face and tongue (CN V3, IX, X, XII), and left corticospinal tracts

Possible stroke in paramedian branches of the upper portion of the basilar artery.

Question 2

Unable to stand

Answer 2

Indirect corticospinal tracts are responsible for support and stablizing muscles
10% corticospinal tracts are axial and bilateral

Question 3

Both eyes deviated to the LEFT and cannot move to the RIGHT

Answer 3

Damage to RIGHT PPRF in the pons SUPERIOR to the facial nucleus
The PPRF is located anterior and lateral to the medial longitudinal fasciculus (MLF).

It is listed as having not well defined borders, hence we can put it where we want.

Question 4

Lower left face weak with preserved strength in the forehead

Answer 4

Lesion above the upper motor neurons in ROSTRAL PONS on the Right side, rostral to the facial nucleus. Thes upper motor neurons synapse on the facial nucleus and control facial muscles.

Note: This symptom could also be above the pons in in the upper motor neurons, but due to the other symptoms in the case, we have located it in the rostral pons.

Question 5

Left limbs 2/5 strength

Answer 5

corticospinal tract upper motor neuron
WHERE IS THIS ON THE CROSS SECTION? WHERE IS THIS COMPARED TO THE CORTICOFUGAL FIBERS?
Web resources say the corticopinal tract is anterior to the corticofugal fibers in the anterior basal pons
However, if it is in the lateral funiculus that could answer our dilemma. However, is the lateral funiculus only inferior to the pyramidal tracts

Question 6

Babinski

Answer 6

corticospinal tract upper motor neuron
WHERE IS THIS ON THE CROSS SECTION? WHERE IS THIS COMPARED TO THE CORTICOFUGAL FIBERS?
Web resources say the corticopinal tract is anterior to the corticofugal fibers in the anterior basal pons
However, if it is in the lateral funiculus that could answer our dilemma. However, is the lateral funiculus only inferior to the pyramidal tracts

Question 7

Right arm hand-eye coordination compromised

Answer 7

RIGHT SUPERIOR CEREBELLAR PEDUNCLE carrying fibers from the SPINOCEREBELLUM

Question 8

Decreased vibratory sensation on the left side

Answer 8

Slight impingement on RIGHT MEDIAL LEMNISCUS

Note: corticofugal means exiting the cortex

Question 9

OK: Pupils

Answer 9

CN III is intact

Question 10

OK: eyes follow objects when they move to the left

Answer 10

Left conjugate horizontal gaze intact

PPRF on left intact

Question 11

OK: Conjugate eye movement in all diresctions except horizontal right

Answer 11

Extraoccular CN III, IV, VI are intact

Question 12

OK: Right face normal, tongue, jaw, palate

Answer 12

CN V3, IX, X, XII is intact

Question 13

OK: Right upper and lower limb strength with normal reflex

Answer 13

Left corticospinal tracts intact