Brainstem Clincal Application Flashcards
The somatic motor column (SE) includes the following nuclei:
Midbrain: ______, ______
Pons: ______, _______, ________
Medulla: ________, _________
oculomotor, trochlear nuclei, trigeminal nuclei, facial nuclei, abducens nuclei, nucleus ambiguous, hypoglossal nucleus
A patient presents with contralateral spastic hemiplegia, contralateral loss of vibratory sense and proprioception (Romberg sign), and ipsilateral deviation of the tongue that is soft to the touch. What is the diagnosis?
Dejerine syndrome; inferior alternating hemiplegia
The CST, medial lemniscus, and hypoglossal nucleus/nerve are lesioned, what artery is occluded?
Anterior spinal artery
A patient presents with contralateral hemianalgesia, ipsilateral facial hemianalgesia, contralateral deviation of the uvula and hoarseness, contralateral beating nystagmus, vertigo, nausea, ipsilateral ataxia, and ipsilateral Horner syndrome. What is the diagnosis?
lateral medullary syndrome; Wallenberg syndrome
Another name for lateral medullary syndrome is:
Wallenberg syndrome
In the Medulla, if you have lesion to the ALS, you will also normally have lesion to the _________
hypothalamospinal tract (sympathetics —> Horner Syndrome)
Lateral medullary syndrome/Wallenberg syndrome is most commonly due to occlusion of _______ artery
vertebral
The 6 structures involved in lateral medullary syndrome/Wallenberg syndrome are:
ALS, spinal trigeminal tract/nucleus, nucleus ambiguus, vestibular nuclei, inferior cerebellar peduncle, hypothalamospinal tract
A patient presents with contralateral hemiplegia, dysarthria, and dysphagia. What 2 possible diagnoses could this be, and which part of the brainstem is involved?
pure motor hemiparesis, dysarthria-hemiparesis or dysarthria clumsy hand syndrome (if leg spared)
medial anterior pons
Which 2 structures are damaged in pure motor hemiparesis or dysarthria-hemiparesis?
contralateral corticospinal tract and corticonuclear tract
A patient presents with contralateral spastic hemiplegia, dysarthria, dysphagia, contralateral ataxia, dysmetria, and dysrhythmia.
What is the diagnosis?
ataxic hemiparesis (because pontine nuclei are involved)
pontine nuclei project to the ______ and lesion results in this clinical sign:
cerebellum, contralateral ataxia
The pontocerebellar fibers project to the _______ and lesion results in these clinical signs:
cerebellum, dysmetria & dysrhythmia (difficulty with finger-to-nose and heel-to-shin tests)
A patient presents with contralateral spastic hemiplegia, dysarthria, dysphagia, contralateral ataxia, dysmetria, dysrhythmia, as well as contralateral loss of discriminative touch and ipsilateral gaze palsy. What is the diagnosis and what area of the CNS is involved?
Foville syndrome/middle alternating hemiplegia; medial anterior and middle pons
A patient presents with contralateral spastic hemiplegia, dysarthria, dysphagia (UMN to tongue and palate), contralateral ataxia, dysmetria, dysrhythmia, contralateral loss of discriminative touch, and ipsilateral gaze palsy.
What is the key clinical sign for this syndrome and what area in the CNS is affected?
Wrong way eyes, anterior and middle pons with PPRF included
If the PPRF is lesioned on the right pons, what side will the gaze palsy be on?
right side
If the medial lemniscus is lesioned on the right pons, what clinical sign results?
left-sided loss of discriminative touch
A patient presents with left spastic hemiplegia, dysarthria, dysphagia, left-sided ataxia, dysmetria, dysrhythmia, left-sided loss of discriminative touch, and inability to look to the right in both eyes and nystagmus in left eye when looking to the left.
What is the key clinical sign in this syndrome and what areas of the CNS are affected?
1 1/2 syndrome; medial anterior and middle pons with MLF and PPRF included
The 6 structures of the medial mid pons to be concerned about if there is a lesion are:
corticospinal tract, corticonuclear tract, pontine nuclei & pontocerebellar fibers, medial lemniscus, MLF, PPRF
Are UE or LE more affected with a medial lesion of the mid pons?
UE (especially hand)
A localizing sign for the pons is _______.
While the localizing sign for the medulla is _________.
facial hemiplegia (facial nuc. and nerve), dysphagia (nucleus ambiguus)
A patient presents with contralateral hemianalgesia, ipsilateral facial hemianalgesia, ipsilateral facial hemiplegia, and ipsilateral horner syndrome.
What is the diagnosis and what area of the CNS is this in?
Gubler syndrome, caudal pons
In __________ syndrome, the following clinical signs are noted:
left UE and LE loss of pain sensation, right-sided loss of pain to the face, right-sided facial droop that affects the lower face, vertigo, left-beating nystagmus, right-sided ataxia, dysmetria and dysrhythmia, as well as right-sided ptosis and myosis.
AICA syndrome
The key clinical signs of ________ are vertigo, left-beating nystagmus, ipsilateral ataxia, and ipsilateral horner syndrome
AICA syndrome
The cause of ataxia, dysmetria, and dysrhythmia in AICA syndrome is damage to the _____ in the _________.
MPC (middle cerebellar peduncle), caudal pons
A patient presents with loss of pin prick sensation to the left side body, right facial hemianesthesia, deviation of jaw to the right, right ataxia with dysmetria and dysrhythmia, right-sided ptosis and myosis, and some loss of discriminative touch to the LE.
What portion of the CNS is lesioned?
lateral posterior quadrant of mid pons
damage to the ________ in the mid pons results in:
possible loss of discriminative touch sensation of mostly LE and some UE
Lesion to the hypothalamospinal tract results in:
Horner syndrome
bilateral lesion to pontine basis results in this diagnosis:
Locked-in syndrome
a patient presents with tetraplegia, inability to speak and swallow, and impaired horizontal eye movement. What is the diagnosis?
Locked-in syndrome
The _______ (structure) is unaffected in Locked-in Syndrome, which means the patient is awake and alert
reticular formation
Only vertical eye movements and blinking are possible in _________, while the patient is tetraplegic and unable to speak
Locked-in syndrome
________ is typically caused by a basilar artery infarct or thrombosis
Locked-in syndrome
The _______ part of the reticular formation is spared in Locked-in syndrome
midbrain
Bauby blinking to dictate The Diving Bell and the Butterfly book. He was only blinking because he had:
Locked-in syndrome
If vertical gaze is unaffected, the lesion cannot be in the ______
midbrain reticular formation
The _______ is the most posterior/dorsal portion of the midbrain
Tectum
The substantia nigra is found in the ________
midbrain
The distinguishing feature of __________ (diagnosis) is right oculomotor palsy with ipsilateral loss of accommodation and pupillary light reflex
Weber syndrome
A patient presents with dryness in the right eye, hypersensitivity to noise in right ear, and loss of taste to anterior tongue. The right eyelid also droops.
There is no myosis.
Bell’s palsy
A __________ describes weakness of only lower facial muscles without ptosis or dryness of the eye, and potentially loss of taste sensation to anterior 2/3 of tongue.
central seven
A patient presents with right oculomotor palsy, right-sided loss of accommodation and pupillary light reflex, cerebellar outflow tremor, left-sided ataxia and dysmetria.
What is the diagnosis and what area in the CNS is the lesion in?
Claude syndrome, middle midbrain
Cerebellar outflow tremor results from damage to the _________ in the _______
red nucleus, medial midbrain
________ is associated with ipsilateral deafness
AICA syndrome
ipsilateral deafness is also a clinical sign of ________ because the labyrinthine artery supplies the cochlear nuclei in the pons
AICA syndrome
