Brainstem Lesions 1 And 2 - 4/25 Stephens

Question 1

What is characterized by the following:

Destruction of the Hypoglossal nerve
Destruction of the ipsilateral LCST
Partial destruction of the contralateral LCST

Answer 1

Alternating Hypoglossal Hemiplegia and destruction of the contralateral LCST

Question 2

What condition is the following?

Protrusion of the tongue to the right
Loss of proprioception/2pt tactile discrimination on the left (contralaterally)

Answer 2

Alternating Hypoglossal Hemiplegia and destruction of the ipsilateral ML

Question 3

Alternating Abducent Hemiplegia is a result of what?

Answer 3

Destruction of Abducens nerve and internal strabismus

Destruction of ipsilateral LCST

Question 4

Millard-Gubler’s Syndrome is what?

Answer 4

Alternating Abducens Hemiplegia

PLUS CN 7 lesion (Bell’s Palsy)

Question 5

Syndrome of Foville is what?

May also involve what?

What is the reason for this involvement?

Answer 5

A6H + ML
Aka Abducens Hemiplegia + contralateral loss of prop/2pt tactile discrim

Facial nerve, IPSILATERAL nucleus Ambiguus and Hypoglossal nucleus

Destruction of crossed corticobulbar fibers

Question 6

Alternating Trigeminal Hemiplegia has what deficits?

Answer 6

Destruction of CN 5 -> Ipsilateral loss of sensation from half of the face and scalp, paralysis of ipsilateral muscles of mastication

Destruction of LCST -> contralateral spastic Hemiplegia

Question 7

Alternating Trigeminal Hemiplegia with a Dorsal Expansion has what characteristics?

What else may be affected due to uncrossed corticobulbar fibers?

Answer 7

A5H with destruction of ML -> contralateral loss of prop/2pt

CONTRALATERAL CN nuclei:
Abducens
Facial
Hypoglossal
Nucleus Ambiguus

Question 8

Weber’s Syndrome is also known as what?

Answer 8

Alternating Oculomotor Hemiplegia

Question 9

Symptoms involved in A3H?

Answer 9

CN 3 - External strabismus, complete ptosis, pupillary dilation

LCST - contralateral spastic Hemiplegia

SubNigra - Contralateral resting tremor

Uncrossed corticobulbar fibers - Supranuclear facial palsy

Question 10

What is lesion is characterized by dysphagia, dysarthria, hoarseness, paresis of the ipsilateral palatal muscles
AND

Contralateral loss of pain/temp from the body?

Answer 10

Lesion of Nuc Ambiguus and SL

Question 11

Lateral Medullary Syndrome/Wallenberg’s syndrome can be described simply how?

Answer 11

Alternating hemianalgesia with dysphagia

Question 12

What specifically is destroyed in Wallenberg syndrome?

Answer 12

SL - contralateral hemianalgesia
Descending tract of V - loss of pain/temp to the face
CN 9 and 10
Nucleus Ambiguus

Question 13

What vessel when compromised results in lateral medullary syndrome?

Answer 13

PICA

Question 14

Cerebellopontine Angle (CPA) Syndrome can be described simply how?

Answer 14

Alternating Hemianalgesia with DEAFNESS

Question 15

What specifically is destroyed in CPA Syndrome?

Answer 15

CN 8
CN 7
Desc Tract of CN 5
SL

Question 16

Parniaud’s Syndrome is due to a lesion of what?

Answer 16

Pineal body
Superior colliculus
Great vein of Galen

Question 17

What is the principal sign of Parinaud’s Syndrome?

What may these lesions destroy?

Answer 17

Paralysis of upward Gaze

Posterior commissure and therefore consensual light reflex

Question 18

Thalami can Syndrome (Dejerine-Roussy Syndrome) is usually due to what?

Hallmark symptom?

Answer 18

Thrombosis of the posterior choroidal or thalamogeniculate branches of the PCA

Crawling ant sensations

Question 19

Benedikt’s Syndrome is a lesion of what?

Destructions of what structures?

Answer 19

Midbrain Tegmentum

CN 3
ML
Red nucleus, fibers of Sup. cerebellar peduncle -> intention tremors

Question 20

Symptoms of Benedikt’s syndrome?

Answer 20

Oculomotor palsy

Contralateral loss of pain/temp AND prop/2pt

Intention tremors

Question 21

Alternating Hypoglossal Hemiplegia is due to the destruction of what structures?

Symptoms?

Answer 21

Hypoglossal nerve
LCST -> UMN

Atrophy of ipsilateral muscles of the tongue
Contralateral spastic Hemiplegia