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Neurosciences > Brainstem Lesions > Flashcards

Brainstem Lesions Flashcards

1
Q

What is weber syndrome?

A

It is a form of stroke characterized by the presence of an ipsilateral oculomotor nerve palsy and contralateral hemiparesis or hemiplegia.

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2
Q

What artery is occluded in weber syndrome?

A

Posterior cerebral artery

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3
Q

What happens in weber syndrome?

A

Necrosis of occulomotor nerve and crus cerebri due to occlusion of artery.

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4
Q

What happens to the eyeball in weber syndrome?

A

Eyeball is deviated laterally because of the paralysis of medial rectus muscle.

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5
Q

What happens to the eyelid in weber syndrome?

A

Upper eyelid droops (ptosis)

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6
Q

What happens to pupil in weber syndrome?

A

Pupil is dilated and fixed to light and accomodation

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7
Q

Define weber syndrome in a nutshell?

A

Ipsilateral opthalmoplegia + Contralateral hemiplegia + paralysis of face and tongue

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8
Q

What is benedikt syndrome?

A

A form of stroke in which red nucleus and medial lemniscus undergo necrosis due to occlusion of posterior cerebral artery

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9
Q

What are the symptoms in benedikt syndrome?

A

Contralateral hemianesthesia

Involuntary movements of the limbs contralaterally

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10
Q

What kind of head trauma is likely to cause damage to midbrain?

A

Sudden lateral movement of head, that causes movement of different parts of the brain at different velocities that can stretch or bend the midbrain OR the cerebral peduncles might imping against sharp edges of the tentorium cerebelli.

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11
Q

A patient has an intracranial tumor, what signs or symptoms would you look to localize the tumor to the region of the medulla oblongata?

A

Involvement of the CN IX, X, XI and XII.

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12
Q

What will be the symptoms if CN IX is damaged?

A

No gag reflex

Loss of taste sensation on the posterior 1/3 of the tongue.

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13
Q

What will be the symptoms if CN X is damaged?

A

Impairment of pharyngeal sensibility
Difficulty in swallowing
Nasal Regurgitation of fluids with asymmetry of movement of the soft palate
Hoarseness of voice with paralysis of laryngeal muscles

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14
Q

What will be the symptoms if CN XI is damaged?

A

The symptoms of damaged CN XI cranial part are not distinguished because it runs with the vagus.

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15
Q

What will be the symptoms if CN XII is damaged?

A

Wasting, fasciculations, and paralysis of half of the tongue.

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16
Q

What is Arnold-Chiari malformation?

A

A congenital anomaly in which there is a herniation of the tonsils of cerebellum and the medulla oblongata through the foramen magnum into the vertebral canal.

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17
Q

What are the signs and symptoms of Arnold-Chiari malformation?

A

Headache, neck stiffness and all the problems with the last four cranial nerves nuclei

18
Q

What is internal hydrocephalus?

A

Internal hydrocephalus is characterized by a progressive accumulation of cerebrospinal fluid in the ventricles.

19
Q

How does internal hydrocephalus occurs in Arnold-Chiari malformation?

A

The herniation of the medulla and cerebellum through the foramen magnum can cause blockage of the exits in the roof of the fourth ventricle to the CSF, causing accumulation of CSF.

20
Q

What is the condition that is associated with Arnold-Chiari malformation?

A

Spina bifida (myelocele) or other craniovertebral abnormalities.

21
Q

What is enophthalmos?

A

Enophthalmos is the posterior displacement of the eyeball within the orbit.

22
Q

What are the causes of enophthalmos?

A
  1. Changes in the volume of the orbit (bone) relative to its contents (the eyeball and orbital fat)
  2. Loss of function of the orbitalis muscle
23
Q

What is myosis?

A

Excessive constriction of the pupil of the eye

24
Q

What is Horner Syndrome?

A

A syndrome with three conditions
Ptosis
Enophthalmos
Myosis

25
Q

What artery is involved in Lateral Medullary Syndrome of Wallenberg (LMSOW)?

A

Posterior Inferior Cerebellar Artery (a branch of vertebral artery)

26
Q

What areas are damaged in Lateral Medullary Syndrome of Wallenberg (LMSOW)?

A 
Inferior cerebellar peduncle
Spinal Tract and Nucleus of CN V
Lateral Spinothalamic Tract
Ascending Spinothalamic Tract
Nucleus Ambiguus
Vestibular nucleus
Descending Sympathetic fibers
27
Q

What are the symptoms if nucleus ambiguus is damaged in Lateral Medullary Syndrome of Wallenberg (LMSOW)?

A

Dysphagia (difficulty in swallowing) and Dysarthria (slow or slurred speech)

28
Q

What are the symptoms if spinal tract and nucleus of CN V is damaged in Lateral Medullary Syndrome of Wallenberg (LMSOW)?

A

Analgesia and thermoanesthesia on the same side of the face.

29
Q

What is the cause of vertigo, nausea, vomitting, nystagmus in Lateral Medullary Syndrome of Wallenberg (LMSOW)?

A

Damage to vestibulat nuclei

30
Q

What are the signs if descending sympathetic fibers are damaged in Lateral Medullary Syndrome of Wallenberg (LMSOW)?

A

It will result in Horner Syndrome. The symptoms are ptosis, enophthalmos, and myosis.

31
Q

What are the symptoms if inferior cerebellar peduncle is damaged in Lateral Medullary Syndrome of Wallenberg (LMSOW)?

A

Cerebellar signs like gait and limb ataxia

32
Q

What happens if the spinal lemniscus is damaged in Lateral Medullary Syndrome of Wallenberg (LMSOW)?

A

Contralateral loss of sensation of pain and temperature

33
Q

What artery is involved in the Medial Medullary Syndrome?

A

Vertebral artery

34
Q

What structures are affected in Medial Medullary Syndrome?

A

Pyramids
Hypoglossal nucleus
Medial Lemniscus

35
Q

What are the signs of Medial Medullary Syndrome?

A

Contralateral hemiparesis
Contralateral impaired sensations of position and movement and tactile discrimination
Ipsilateral paralysis of tongue muscles with deviation to the paralyzed side when the tongue is protruded.

36
Q

What is an astrocytoma?

A

It is a type of brain tumor that involves astrocytes.

37
Q

What will be the signs and symptoms if a patient comes to you with astrocytoma of the pons?

A

Ipsilateral CN paralysis (CN 5, 6, 7 and 8)

Contralateral Hemiparesis

38
Q

A 10-year-old girl is taken to a physician because
her mother has noticed that the right half of her
face was weak and does not appear to react to emotional
changes. Her mouth is pulled over slightly
to the left, especially when she is tired. On questioning,
the patient admits that food tends to stick
inside her right cheek and that the right side of her
face “felt funny.” The mother had first noticed the
facial changes 3 months previously, and the condition
has progressively worsened. On examination,
definite weakness of the facial muscles on the right
side is noted; the facial muscles on the left side are
normal. Skin sensation on stimulation of the face is
normal. On testing of the ocular movements, slight
weakness of the lateral rectus muscle is evident on
the right side. Examination of the movements of
the arm and leg shows slight weakness on the left
side. WHAT IS YOUR DIAGNOSIS?

A

She has astrocytoma of the pons.
The right unilateral facial weakness, together with weakness of the right lateral rectus muscle of the eye, was due to involvement of the right facial and abducens nuclei by the tumor.
The absence of paresthesia of the face
indicated that the principal sensory nucleus of
the trigeminal nerve was intact on both sides.
The weakness in the movements of the left arm and left
leg was due to the involvement of the corticospinal
fibers in the pons.

39
Q

What are the arteries that supply pons?

A

Basilar artery
Anterior cerebellar artery
Inferior cerebellar artery
Superior cerebellar artery

40
Q

What are the symptoms of unilateral hemorrhage of pons?

A

Facial paralysis on the side of the lesion (CN VII nucleus)
Paralysis of the limbs contralaterally (Corticospinal fibers)
Paralysis of conjugate ocular deviation (MLF + CN VI nucleus)

41
Q

What are the symptoms of bilateral hemorrhage of pons?

A

Pupils may be pinpoint
Facial muscles paralyzed on both sides
Bilateral paralysis of the limbs
The patient may become poikilothermic because severe damge to pons has cut off the body from heat-regulating centers in the hypothalamus.

Neurosciences (13 decks)

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