Brainstem Cases Patient 5

Question 1

Patient #5

Overall Dx

Answer 1

Weber’s Syndrome

Left Anteromedial Mesencephalon damage
Damage to the CN III exit point and superior cerebellar peduncle,

Question 2

Hypertension

Answer 2

Lenticulate arteries, thin arteries, aneurysm?

Question 3

Double Vission: diagnally displaced

Normal vision if one eye is covered

Answer 3

LEFT CN III EXIT POINT

Question 4

Left eyelid ptosis and large irregular pupil that was poorly responsive to light

Answer 4

LEFT COMPRESSION ON CN III affects parasympathetic before occulomotor function

Question 5

Left eye slightly abducted and depressed at rest

Left eye voluntary movements to elevate or adduct were compromised

Answer 5

LEFT CN III EXIT POINT affecting superior rectus and inferior oblique

Question 6

OK: no vertigo, headache, or visual loss

Answer 6

.

Question 7

Motor control of right arm and leg decreased

Answer 7

SUPERIOR CEREBELLAR PEDUNCLE controls the LATERAL CORTICOSPINAL TRACT (limb muscles)

Note: the superior cerebellar peduncle controls both the lateral and ventral corticospinal tracts as well as the vestibulospinal, reticulospinal, and rubrospinal tracts, as well as the Corticobulbar tracts (facial and tongue muscles)

Question 8

Voice sounded “drunk” (dysarthria)

Answer 8

SUPERIOR CEREBELLAR PEDUNCLE controls the CORTICOBULBAR TRACT (facial and tongue muscles)

Note: the superior cerebellar peduncle controls both the lateral and ventral corticospinal tracts as well as the vestibulospinal, reticulospinal, and rubrospinal tracts, as well as the Corticobulbar tracts (facial and tongue muscles)

Question 9

OK: Normal strength in all limbs (?) but right limb was ataxic

Answer 9

???

Question 10

Right limb ataxic (finger to nose, rebound, rapid alternating movment)

Answer 10

SUPERIOR CEREBELLAR PEDUNCLE controls the LATERAL CORTICOSPINAL TRACT (limb muscles)

Note: the superior cerebellar peduncle controls both the lateral and ventral corticospinal tracts as well as the vestibulospinal, reticulospinal, and rubrospinal tracts, as well as the Corticobulbar tracts (facial and tongue muscles)

Question 11

Unable to stand (TRUNCAL ATAXIA), falling to the right despite good strength in all limbs

Answer 11

SUPERIOR CEREBELLAR PEDUNCLE controls the VENTRAL CORTICOSPINAL TRACT (axial muscles)

Note: the superior cerebellar peduncle controls both the lateral and ventral corticospinal tracts as well as the vestibulospinal, reticulospinal, and rubrospinal tracts, as well as the Corticobulbar tracts (facial and tongue muscles)

Question 12

Rigth heel to shin test compromised

Answer 12

SUPERIOR CEREBELLAR PEDUNCLE controls the LATERAL CORTICOSPINAL TRACT (limb muscles)

Note: the superior cerebellar peduncle controls both the lateral and ventral corticospinal tracts as well as the vestibulospinal, reticulospinal, and rubrospinal tracts, as well as the Corticobulbar tracts (facial and tongue muscles)

Question 13

Right foot uncoordinated (can’t draw a number in the air)

Answer 13

SUPERIOR CEREBELLAR PEDUNCLE controls the CEREBROCEREBELLUM (skilled movements muscles) via the corticospinal tracts

Note: the superior cerebellar peduncle controls both the lateral and ventral corticospinal tracts as well as the vestibulospinal, reticulospinal, and rubrospinal tracts, as well as the Corticobulbar tracts (facial and tongue muscles)

Question 14

OK: reflexes and sensation

Answer 14

DC-ML intact

Question 15

OK: no aphasia (can understand and produce words)

Answer 15

Broca’s, Wernicke’s, Arcuate fasciculus intact