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Neuro Block 6 > Brainstem Pathology: Vascular Syndrome, Lesions, Tumors > Flashcards

Brainstem Pathology: Vascular Syndrome, Lesions, Tumors Flashcards

1
Q

Are there any major syndromes in the superior cerebellar arteries?

A

No

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2
Q

What arteries supply the most lateral part of the medulla

A

PICA

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3
Q

What artery supplied the small portion of rostral medulla and caudal pons

A

AICA

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4
Q

What is the medial zone of the medulla supplied by

A

Anteiror spinal artery

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5
Q

Where do strokes normally happen

A

In the lateral most and medial most regions

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6
Q

What is the lateral zone of medulla supplied by

A
  • Posterior inferior cerebellar artery

- anterior inferior cerebellar artery

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7
Q

Which artery is more likely to be occluded in the lateral zone of the medulla

A

PICA

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8
Q

What gets knocked out with a PICA infarct

A
  • aanteriolateral tract (pain and temp)
  • hypothalamospinal tract (Horners syndrome)
  • spinal trigeminal nucleus (pain/temp to body and face)
  • cochlear and vestibular nuclei
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9
Q

What does an infarct to the AICA knock out

A

Cochlear and vestibular nuclei

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10
Q

Other names for anterior spinal artery infarct

A
  • medial medullary infarct

- djerine syndrome

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11
Q

(ASA) If there is damage to the right pyramid, what kind of motor deficit?

A

Weakness in left side. It is above decussation!

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12
Q

(ASA) Right medial lemniscus damage: sensory deficit?

A

Decreased fine touch contralareal

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13
Q

(ASA) Right hypoglossal nucleus/nerve (XII) damage: motor deficit?

A

Right tongue weakness. Deviation to right side

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14
Q

(ASA) Medial longitudinal fasciculus damage: what happens

A

Nystagmus

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15
Q

Is it possible to have a partial infarct of the ASA?

A

Yes, spares medial lemniscus

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16
Q

What are other names for PICA infarct?

A
  • PICA
  • wallenburg syndrome
  • lateral
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17
Q

What structures can be damaged during PICA infarct?

A
  • right hypothalamospinal projections
  • right anterolateral/spinothalamic tract
  • right spinal trigeminal tract/nucleus
  • right nucleus ambiguus and IX/X nerves
  • right vestibular nuclei
  • right inferior cerebellar peduncle (restiform)
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18
Q

If the right hpothalamospinal projections are damaged during PCIA infarct what will happen

A

Horners syndrome on right face

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19
Q

If the right anterolateral/spinothalamic tract is damaged during a PICA infarct

A

Loss of pinprick sensation from left side of body

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20
Q

If the right spinal trigeminal tract/nucleus is damaged during PICA infarct?

A

Loss of pain/temp sensation from right side of the face

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21
Q

If the right nucleus ambiguus and IX/X is damaged during PICA infarct

A

Right side paralysis of palate, impaired gag reflex, pharynx, larynx

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22
Q

If the right vestibular nuclei is damaged during PICA infarct?

A

Vertigo, nausea/vomitting, left beating nystagmus, imbalance toward right

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23
Q

If the right inferior cerebellar peduncle is damaged during PICA infarct

A

Ataxia of right limbs

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24
Q

What gets spared during a lateral medulla infarct

A

Most medial part of the PICA territory, including the solitary nucleus/tract and dorsal motor nucleus of the vagus

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25
Q

What does the PICA supply in the lateral medulla?

A
  • anterolateral system
  • spinal trigeminal tract
  • restiform body
  • solitary nucleus and tract
  • vestibular nuclei (inferior and spinal)
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26
Q

What is the medial pons territory

A
  • paramedical branches of basilar
  • corticospinal tracts
  • pontine nuclei
  • pontomedullary-cerebellar fibers
  • medial lemniscus
  • abducens VI nerve (not nucleus)
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27
Q

Lateral pons territory

A
  • circumferential branches of basilar
  • middle cerebellar peduncle
  • vestibular nuclei
  • trigmeninal motor nucleus
  • trigeminal main sensory nucleus
  • spinal trigmeninal nucleus and tract
  • anteriolateral (spinothalamic) tract
  • hypothalamus-spinal projections
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28
Q

Medial pontine syndrome (infarct in the medial pons) on left causes what kind of damage to left corticospinal tracts

A

Spastic paralysis/paresis of right extremities

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29
Q

Medial pontine syndrome (infarct in the medial pons) on left causes what kind of damage to left medial lemniscus

A

Loss of two point discrimination and vibration from right body

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30
Q

Medial pontine syndrome (infarct in the medial pons) on left causes what kind of damage to left abducens nerve (not nucleus)

A

Left VI palsy, medial strabismus, diplopia

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31
Q

Medial pontine syndrome (infarct in the medial pons) on left causes what kind of damage to left pontine nuclei

A

Potential motor coordination impairment masked by weakness

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32
Q

Medial pontine syndrome (infarct in the medial pons) on left causes what kind of damage to left pont-cerebellar fibers

A

Motor coordination impairment masked by weakness

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33
Q

What is Foville’s syndrome

A

A type of medial pontine syndrome that causes damage to corticospinal tracts, CN 6 nucleus/nerve, genu of CN 7 nerve and leaves the medial lemniscus intact

Full face paralysis

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34
Q

Occlusion of long circumferential arteries coursing along the borderline of the medial and lateral territories and sparing of the medial lemniscus

A

Foville syndrome

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35
Q

What would happen in lateral pons syndrome (AICA infarct) to the right anterolateral (spinothalamic) tract?

A

Loss of pain and temp on left of body

36
Q

What would happen in lateral pons syndrome (AICA infarct) to the right spinal trigeminal nucleus and tract

A

Right face analgesia

37
Q

What would happen in lateral pons syndrome (AICA infarct) to the right hypothalamo-spinal projections

A

Horners syndrome on the right face

38
Q

What would happen in lateral pons syndrome (AICA infarct) to the right facial nucleus/nerve (VII)

A

Right upper and lower face flaccid paralysis/paresis

39
Q

What would happen in lateral pons syndrome (AICA infarct) to the corneal blink refelx?

A

Neither eye blinks to cornea touch in the right eye

40
Q

What would happen in lateral pons syndrome (AICA infarct) to the right vestibular nuclei (caudally)

A

Vertigo, nausea/vomitting, left beating nystagmus, imbalance toward right

41
Q

What would happen in lateral pons syndrome (AICA infarct) to the right inferior and middle cerebellar peduncles

A

Ataxia, similar signs as for right lateral cerebellar lesions

42
Q

If rostral pons has a lateral infarct what will it affect

A

Right anteiror/ventral trigeminothalamic tract, loss of somatosensation from left face

43
Q

If mid level pons has lateral infarct

A
  • right trigeminal main sensory nucleus (VO): loss of fine touch on the right face
  • Right trigeminal motor nucleus (V): right paresis/paralysis of mastication muscles
44
Q

Ventral midbrain blood supply

A

Medial branches of PCA

45
Q

Blood supply of the lateral midbrain

A

Quadrigeminal artery (off PCA)

46
Q

Dorsal blood supply of midbrain

A

Branches from SCA

47
Q

What are some common midbrain infarct zones

A
  • Weber
  • Claude’s
  • Benedikt’s
48
Q

What is affected in Weber’s syndrome

A
  • left III nerve

- left crus cerebri (cerebral peduncle)

49
Q

What deficits are caused in Weber’s syndrome from the left CNIII

A

Ipsilateral CNIII palsy, ptosis, failure of direct/consensual pupillary constriction in left eye.

50
Q

What deficits would be caused by the left crus cerebri (cerebeal peduncles) in Weber’s syndrome

A

Right hemi-paralysis/paresis of extremities and UMN for CN 4-12. Level down.

Easy to identify

51
Q

What structures are affected in CLaude’s syndrome (midbrain blood infarct)

A

Left CNIII nerve

Left Red Nucleus

52
Q

What does a deficit in left CN III nerve cause in Claude’s syndrome

A

Ipsilateral CN III palsy, ptosis, failure of direct/consensual pupillary constriction in left eye

53
Q

What deficits come from Left red nucleus in Claude’s syndrome (midbrain infarct)

A

Possibly ataxia for right limbs; as if damage to right lateral cerebellar cortex, which projects to or through left red nucleus, on to left thalamus and left motor neocortex, controlling right limbs

54
Q

Creates a flap that flutters inside the lumen and can occlude blood

A

Vertebral artery dissection

55
Q

Narrowing due to atherosclerosis can lead to brainstem ischemia if systemic blood pressure falls

A

Vertebral or basilar artery stenosis

56
Q

Clot can not only occlude an individual branch, but also can transiently block several major branches on the way up to the bifurcation of PCA which leads to transient brainstem signs

A

Vertebral or basilar artery thrombosis

57
Q

Top-of-basilar syndrome, visual disturbances and other supratentorial problems

A

Occlusion of the basilar artery at bifurcation of PCA

58
Q

Basilar pons is especially prone to hypertension-related ______ which can lead to locked-in syndrome

A

Hemorrhage

59
Q

What is normal in locked in syndrome (bilateral damage to basilar pons)?

A

Full awareness and cognitive/emotional function, normal sleep-wake cycles, vital functions intact, sensory functions intact

60
Q

What can cause locked in syndrome

A

Bilateral lesion of the BASILAR pons such as a bilateral hemorrhage or infarct, MS lesions, cnretal pontine myelinolysis

61
Q

Degeneration of myelin causes by rapid over correction for dehydration by large amounts of water, inducing hyponatremia, low Na+

A

Central pontine myelinolysis

62
Q

What gets covered in the pons when there is locked in syndrome

A

Most/all of BASILAR pons.

  • corticospinal tract
  • corticonuclear projections

Usually only CNIII function is spared!

63
Q

What are the major deficits from locked in syndrome

A

Cranial motor paralysis and quadriplegia, patient can response to questions with vertical eye movements (up or down for yes/no) if CN 3 is spared. Usually permanent damage

64
Q

Examples of cerebellopontine angle tumors

A
  • meningioma
  • cerebellar astrocytoma
  • acoustic neuroma
  • metastatic and other origins
65
Q

Compression of dorsal midbrain

A

Parinaud’s syndrome

66
Q

Bilateral compression of midbrain tectum, the dorsal region containing the superior colliculi

A

Parinaud’s syndrome

67
Q

What is there disruption to in parinaud’s syndrome

A

To the pretectal nuclei,, CN 3 nucleus, causing loss of the light reflex and disruption of vergence and accommodation

68
Q

What are some causes of parinaud’s syndrome

A
  • pineal tumor
  • hydrocephalus
  • ischemic damage
  • MS lesion
69
Q

Vulnerable zone for simultaneously losing one or multiple cranial nerves, if there is an infection, embolism, tear in sinus wall allowing direct contact between venous blood and nerves

A

Cavernous sinus

70
Q

What is the difference between cavernous sinus syndrome and orbital apex syndrome

A

Cavernous sinus just involves the CN that run through the sinus, orbital apex syndrome involves cranial nerves contained within the cavernous sinus and also the optic nerve as well

71
Q

What nerves run through the cavernous sinus

A 
III (oculomotor)
IV (trochlear)
VI (abducens)
V1 (ophthalmic)
V2 (maxillary)
72
Q

Uncalled herniation into midbrain

A

Compression of CN III, blockade of pupillary light reflex

73
Q

Left temporal lobe her acting across left tentorial notch

A
  • compresses left cerebral peduncle and left CN 3
  • right hemiplegia and cranial nerve motor deficits (UMN probs)
  • CN 3 palsy, drooped eyelid, blown pupil
74
Q

Right temporal lobe herniated across right notch

A
  • pushes midbrain against contralteral clivus

- left cerebral peduncle compresses, but right CN3 compressed

75
Q

A general longitudinal regional, not a nucleus or tract that contains many functionally different nuclei and tracts that includes respiratory centers and baroreceptors reflex circuit

A

Reticular formation

76
Q

Respiratory centers of spinal cord

A

Contains groups of LMNs controlling diaphragm and intercostal muscles

77
Q

Which has more regions for respiratory control, pons or medulla?

A

Medulla. Damage to pons does not cause much resp problems

78
Q

Repeated cycles of increased and decreases volume of each breath due to bilateral damage in medulla or pons

A

Cheyne-stokes pattern

79
Q

If blood pressure is too high

A

Sensory info goes in on glossopharyngeal and out on vagus (parasympathetic)

To carotid SINUS

80
Q

If blood pressure is too low?

A

In on glosspharyngeal and out via anterolateral medulla and sympathetic action

81
Q

Unilateral lesions on brainstem

A

Usually do not significantly affect function, but bilateral can abolish function

82
Q

What is the vomiting (emetic) center in the brain?

A

Area postrema

83
Q

What can area postrema sense

A

Chemicals in CSF from 4th ventricle and in blood (no BBB here)

84
Q

After the area postrema sense chemicals from the CSF and 4th ventricle. What does it do

A

Activates medulla reticular formation neuron, generate motor functions that generate vomitting: vagus, nucleus ambiguus, resp muscles

85
Q

How can CN X act similarly to area postrema

A

Sensing emetics in the gut

86
Q

Are nausea and vomitting always together?

A

No, can have vomitting without nausea

Neuro Block 6 (8 decks)

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