Brainstem Cases Patient 3

Question 1

Patient #3

Overall Dx

Answer 1

Parinaud’s with Pineal Tumor
Damage to the Rostral Mesencephalon

Damage to the dorsal part of the superior colliculus: pretectal nuclei, posterior commissure, vertical gaze center aka rostral interstitial nucleus in the MLF

No damage to CN nerves or descending tracts

Question 4

Inability to look up with voluntary movement

Answer 4

Rostral Interstitial Nucleus aka Vertical Gaze Center
Posterior Commisure

Where is the rostral interstitial nucleus on the brainstem?

Note: the vertical gaze center is in the MLF and is an integration site of CN III and CN IV

Question 5

When attempting to look up, upper eyelids moved up, but iris did not follow

Answer 5

Levator palpebrae intact innervated by CN III is intact

Question 6

Repetitive jerking eyemovements (Vertical nystagmus?)

Answer 6

Convergent upward (vertical nystagmus)
Caused by what? Where on the cross section?

Question 7

OK: Reflex upward gaze

Answer 7

VestibuloOculular Reflex is intact and unaffected by the voluntary verticle gaze center.
The VOR works through the vestibular complex which is in the medulla

Question 8

Pupils dilated with no light respone

Answer 8

DAMAGE TO PRETECTAL, POSTERIOR COMMISURE, and/or EDINGER-WESTPHAL NUCLEUS
Do we want to pick one?
CN II sensory goes to Pretectal to Edinger-Westphal pathway along the CN III

Question 9

OK: pupils constrict with accomodation

Answer 9

Accomodation intact
Motor function of the ciliary bodies intact
Parasympathetics are intact.

Question 10

OK: no double vision

Answer 10

What nucleus?

Question 11

OK: strength, coordination, reflexes, and sensation

Answer 11

Normal pons and medulla

Question 12

OK: speech and cranial nerves intact

Answer 12

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