brainstem syndromes

Question 1

Anterior Spinal Artery

Answer 1

Medial Medullary Syndrome

MEDIAL LEMNSCUS: Contralateral loss of dorsal column functions (touch, vibration, conscious proprioception) on the opposite trunk.

PYRAMIDS: contralateral spastic paresis of both limbs.

CNXII FIBERS: ipsilateral paralysis of hte muscels on one half of the tongue resulting in tongue deviation to the side of the lesion upon protrusion

Question 2

Anterior Spinal Artery

Answer 2

Medial Medullary Syndrome

MEDIAL LEMNSCUS: Contralateral loss of dorsal column functions (touch, vibration, conscious proprioception) on the opposite trunk.

PYRAMIDS: contralateral spastic paresis of both limbs.

CNXII FIBERS: ipsilateral paralysis of hte muscels on one half of the tongue resulting in tongue deviation to the side of the lesion upon protrusion

Question 3

Posterior Inferior Cerebellar Artery ***

Answer 3

Lateral Medullary Syndrome (Wallenberg Syndrome)

INFERIOR CEREBELLAR PEDUNCLE: Loss of ipsilateral limb coordiation (ataxia)

VESTIBULAR NUCLEI:Nausea, vertigo, and nystagmus (fast compoñ

COCHLEAR NUCLEUS

SPINAL NUCLEUS AND TRACT OF V

SPINOTHALAMIC TRACT

DESCENDING HYPOTHALAMIC FIBERS

SOLITARY NUCLEUS

NUCLEUS AMBIGUUS

Question 4

Posterior Inferior Cerebellar Artery ***

Answer 4

Lateral Medullary Syndrome (Wallenberg Syndrome)

INFERIOR CEREBELLAR PEDUNCLE: Loss of ipsilateral limb coordiation (ataxia)

VESTIBULAR NUCLEI:Nausea, vertigo, and nystagmus (fast component of to the side opposite the side of the lesion).

COCHLEAR NUCLEUS: Ipsilateral sensorineural hearing loss.

SPINAL NUCLEUS AND TRACT OF V: Ipsilateral loss of pain and temperature on the face.

SPINOTHALAMIC TRACT: Contralateral loss of pain and temperature on the limbs and trunk.

DESCENDING HYPOTHALAMIC FIBERS: Ipsilateral Horner syndrome (miosis, ptosis, anhydrosis)

SOLITARY NUCLEUS: Loss of taste on ipsilateral side of tongue

NUCLEUS AMBIGUUS: Affects the lower motor neurons of the CNIX and CNX resulting in loss of gag reflex; difficulty swallowing; horaseness, rough voice (paralysis of vocal fold); dysarthria; and uvula deviated away from the side of hte lesion,

Question 5

Paramedian Branches of the basilar artery

Answer 5

MEDIAL LEMNISCUS PATHWAY: contralateral loss of dorsal column functions on the trunk and limbs (touch, vibration, conscious proprioception).
PYRAMIDS: contralateral spastic paresis of both limbs

CNVI FIBERS Ipsilateral paralysis of the lateral rectus muscle resulting in medial deviation of th eye (interal strabismus

Question 6

Anterior Inferior Cerebellar Artery

Answer 6

Lateral Pontine Syndrome

MIDDLE CEREBELLAR PEDUNCLE: Loss of ipsilatearl limb coordination (ataxia)

VESTIBULAR NUCLEI: Nausea, vertigo, and nystagmus (fast component toward the opposite side of the lesion).

SPINAL NUCLEUS AND TRACT OF V: Ipsilateral loss of pain and temperature on the face

SPINOTHALAMIC TRACT: contralateral loss of pain and temperature on the limbs and trunk.

DESCENDING HYPOTHALAMIC FIBERS: Ipsilateral Horner syndrome on face (miosis, ptosis, anhydrosis)

FACIAL NUCLEUS AND FIBERS: affects the lower motor neurons of the CNVII resulting in ipsilateral facial paralysis, ipsilateral loss of taste on anterior two thirds of tongue, hyperacusis, and loss of lacrimation and salivation (drymouth and dry eye)

Question 7

Superior Cerebellar Artery

Answer 7

Lateral Pontine Syndrome

LOCKED IN SYNDROME

The locked in syndrome is caused by an occlusion of the BASILAR ARTERY producing a large bilateral infarct in the medial and ventral PONS. The infarct involves bilateral lesions of

(a) the corticospinal tract resulting in quadriplegic spasticity
(b) the bilateral cortibulbar fibers producing bilaterla loss of cranial nerve lower mortor neuron nuclei, except for the oculomotor nerve of the midbrain, which is spared.

The lateral sensory functions to the face and body and the arousal system of the pons are not affected. The patient has lsot spinal and most cranial nerve motor functions but is awake and aware of hte surroundings and can communicate by moving the eylids and the eyes.

Question 8

Posterior Cerebellar Artery

Answer 8

Weber Syndrome

OCULOMOTOR NERVE (CNIII) Ipsilateral oculomotor deficits - lateral strabismus; dilated, fixed pupil; severe ptosis.

CORTICOSCPINAL TRACT: contralateral limb spasticity

CORTICOBULBAR TRACT: contralateral lower face muscle weakness.