Brainstem Lesions

Question 1

lesion of genu of internal capsule

Answer 1

Contralateral supra nuclear palsy

Question 2

lesion of posterior limb internal capsule

Answer 2

contralateral hemiplegia and hemianesthesia (body_

Question 3

Alternating hypoglossal hemiplegia

Answer 3

ipsilateral paralysis of tongue (deviates to side of lesion)

contralateral spastic hemiplegia

Question 4

alternating hypoglossal hemiplegia + destruction of contralateral corticospinal tract

Answer 4

ipsilateral paralysis of tongue

ipsilateral and contralateral spastic hemiplegia

Question 5

alternating hypoglossal hemiplegia + ipsilateral ML

Answer 5

deviating tongue to side of lesion
contralateral spastic hemiplegia
contralateral loss of 2pt/proprio

Question 6

alternating abducent hemiplegia

Answer 6

ipsilateral internal strabismus

contralateral spastic hemiplegia

Question 7

Millard -Gubler’s syndrome

Answer 7

ipsilateral internal strabismus
contralateral spastic hemiplegia
ipsilateral bells palsy (loss of taste ant 2/3, decreased lacrimation, hyperacusis)

Question 8

syndrome of Foville

Answer 8

A6H + DORSAL EXTENSION
Ipsilateral internal strabismus
contralateral spastic hemiplegia
Contralateral loss of 2pt/prop (ipsilateral ML)
internuclear ophthamoplegia (MLF)
Bells palsy
destruction of CROSSED CBT 
- tongue deviation to side of lesion (XII)
- uvula deviates away from lesion (X)

Question 9

alternating trigeminal hemiplegia

Answer 9

ipsilateral loss of sensation of face and mastication muscles
contralateral spastic hemiplegia

Question 10

alternating trigeminal hemiplegia + dorsal extension

Answer 10

ipsilateral loss of sensation of face and mastication muscles
contralateral spastic hemiplegia
destruction of uncrossed CBT
- contralateral internal strabismus
- contralateral supranuclear palsy
- tongue deviates away from lesion 
- uvula deviates towards lesion

Question 11

Weber’s syndrome

Answer 11

A3H
ipsilateral external strabismus, pup dilation, complete ptosis
contralateral spastic hemiplegia
substantia nigra involvement = contralateral resting tremor
uncrossed CBT = contralateral supra nuclear palsy + X and XII

Question 12

lateral medullary syndrome

Answer 12

Wallenberg's syndrome, syndrome of PICA
involvement of:
- SL
- descending tract of V 
(ALTERNATING HEMIANALGESIA)
- IX, X involvement 
- Solitary nucleus= ipsilateral loss of visceral sensation and reflex from palate and pharynx 
-spinocerebellar tracts = asynergia or hypotonia 
- vestibular nuclei = nystagmus

Question 13

Cerebellopontine angle syndrome (CPA)

Answer 13

common with acoustic neurinoma 
destruction of VIII
bells palsy 
alternating hemianalgesia 
cerebellar peduncles = ipsilateral cerebellar ataxia, intention tremor, dysdiadochokinesia

Question 14

benedikt’s syndrome

Answer 14

Lesion of midbrain tegmentum, red nucleus, superior cerebellar peduncle
contralateral motor dysfunction (ataxia, choreiform movements, tremor)
III = external strabismus, pup dilation, complete ptosis
ML = contralateral loss of 2pt/prop
red nucleus = intention tremor

Question 15

Parinaud’s syndrome

Answer 15

lesion of superior colliculus
paralysis of upward gaze
caused by pineal tumor or varix of great vein of Galen

Question 16

Thalamic syndrome Dejerine-Roussy syndrome

Answer 16

due to thrombosis of posterior choroidal or thalamogeniculate branches of PCA
spontaneous pain with stimulus
extreme mood swings
Contralateral hemihypalgesia (crawling ant sensation)
neglect, can’t recognize parts of body as own