Brainstem syndromes

Question 1

webers syndrome (anterior midbrain)

Answer 1

ipsilateral CN3 palsy

contralateral hemiplegia

Question 2

Claudes syndrome

Answer 2

ipsilateral CN3

contralateral cerebellar ataxia

Question 3

Nothnagels syndrome

not high enough for cerebellar peduncles to cross

Answer 3

ipsi CN3

ipsi ataxia

Question 4

Benedikts syndrome

both- combined webers and claudes

Answer 4

contralateral weak and clumsy limbs

contralateral tremor

Question 5

Parinaud’s syndrome (dorsal midbrain)

Answer 5

upwards gaze paralysis

conversion- retraction nystagmus

Question 6

cause of parinauds

Answer 6

pineal gland germinoma

tectal plate glioma

Question 7

intranuclear ophthalmoplegia

common in MS

Answer 7

lesions the side of eye will not adduct

Question 8

one and a half syndrome

Answer 8

total lateral gaze palsy one one side

INO on the other

Question 9

cushings triad

Answer 9

intracranial hypertension
arterial hypertension
reflex bradycardia

Question 10

hakim triad- normal pressure hydrocephalus

- wet, wacky and wobbly

Answer 10

dementia
gait apraxia
incontinence

Question 11

argyle-robertson pupil- classic in tertiary syphillis

Answer 11

accommodates but does not react

Question 12

holmes-adie myotonic pupil

often in young women

Answer 12

tonically dilated pupil
reacts more to accomodation
depressed reflexes

Question 13

physiological anisocoria

Answer 13

normal people have one pupil bigger than the other

Question 14

marcus- gunn pupil + relative afferent pupillary defect (after optic neuritis)

Answer 14

partial optic nerve injury
brisk movements will cause paradoxical eye dilation in light because the stronger factor will be loss of light in the other eye

Question 15

Devics disease

Answer 15

nueromyelitis optica
optic and cervical cord demyelination
mimics MS

Question 16

raymonds syndrome (base of pons)

Answer 16

ipsilateral CN6

contralateral hemiplegia

Question 17

locked in syndrome (basilar artery thrombosis)

Answer 17

bilateral Raymonds

both CN 6 palsy and both hemiplegia

Question 18

lateral pontine syndrome (Marie-Foix)

Answer 18

• Ipsilateral cerebellar ataxia due to involvement of cerebellar tracts
• Contralateral hemiparesis due to corticospinal tract involvement
• Variable contralateral hemihypesthesia for pain and temperature due to spinothalamic tract involvement
• CN 7 and 8

Question 19

dejerines- medial medullary syndrome

Answer 19

ipsy CN 12

contralateral paralysis + vibration+ proprioception

Question 20

wallenburg- lateral medullary syndrome

Answer 20

PICA syndrome

CN 9 , 10, 11

Question 21

hemimedullary syndrome of Reinhold

Answer 21

medial + lateral medullary syndrome

including CN 12

Question 22

brown squared syndrome

Answer 22

spinal cord hemisection
ipsi weakness/dorsal column
contra pain

Question 23

medical 3rd nerve palsy

Answer 23

vascular, diabetic affects vasa nervosum

pupil sparing

Question 24

surgical 3rd nerve palsy

Answer 24

compressive, raised ICP

non pupil sparing

Question 25

Fovilles syndrome

Answer 25

ipsi horizontal gaze palsy facial palsy contralateral hemi

Question 26

avellis syndrome

Answer 26

partial lateral medullary | vestibular nuclei + cerebellar connections spared

Question 27

millard- gubler syndrome

Answer 27

CN 6 + 7 with contralateral hemi

Question 28

top of basilar syndrome- thalamic perforators

Answer 28

strange behaviour drowsiness dream like state eye abnormalities

Question 29

artery or percheron infarct

Answer 29

paramedian thalamic syndrome due to vessel variant

Question 30

anterior cingulotomy

Answer 30

pain asymbolia - feels pain but doesn't care

Question 31

foster kennedy

Answer 31

olfactory groove lesion anosmia ipsilateral optic atrophy contralateral papilloedema

Question 32

dominant side parietal lobe lesion (left)

Answer 32

astereogeneis - can't identify things by touch

Question 33

non dominant parietal lobe lesion (right)

Answer 33

anosognosia - lack of knowledge of disease (unaware they are blind)

Question 34

both side parietal lesion

Answer 34

contralateral inferior quadrantanopia | contralateral neglect

Question 35

dominant (left) temporal lobe lesion

Answer 35

dyslexia agraphia acalculia wernickes

Question 36

non dominant (right) temporal lobe(fusiform) lesion

Answer 36

prosopagnosia- can't recognise faces

Question 37

occipital lobe lesion

Answer 37

homonymous hemianopia | central vision usually spared due to dual blood supply

Question 38

what can asterogenesis be associated with

Answer 38

cortical neglect = loss of contralateral spatial awareness | - patient denies existence of one side of body and visual field

Question 39

where is the lesion for cortical neglect most likely

Answer 39

right superior parietal

Question 40

why can damage to parietal lobe also cause apraxia

Answer 40

connection with premotor cortex