Brainstem Vascular Lesions

Question 1

Medial Medullary syndrome/ Dejerine’s syndrome

blood supply, areas affected, s+s

Answer 1

stroke: paramedian branches of vertebral and anterior spinal arteries
areas: hypoglossal nucleus/nerve, corticospinal, corticobulbar tract, medial lemniscus

s+s: ipsilateral deviation of the tongue, fasiculations and atrophy of tongue, dysarthria, contralateral spastic hemiparesis, contralateral loss of fine touch and proprioception

Question 2

Lateral medullary syndrome/ Wallenberg’s syndrome

Answer 2

stroke: branches of the vertebral or PICA

areas: CN IX, X, nucleus ambiguus.
Cochlear and vestibular nuclei.
solitary nucleus
STT
spinal nucleus and tract of V
descending sympathetic fibers
ICP

s+s: vertigo, nystagmus, ipsilateral loss of hearing
ipsilateral Horner’s
hoarsness, dysphagia, decreased gag reflex
ipsilateral loss of pain and temp from face
ipsilateral ataxia
ipsilateral loss of taste
contralateral loss of pain and temp from body

Question 3

Medial pontine syndrome/ middle alternating hemiplegia

in basal pons

Answer 3

stroke: paramedian branches of the basilar artery
areas: abducens nerve, corticospinal and corticobulbar tracts, pontine nuclei and transverse pontine fibers

s+s: ipsilateral medial strabismus, contralateral spastic paralysis, contralateral ataxia

Question 4

Medial pontine syndrome/ middle alternating hemiplegia

in basal pons + tegmentum

Answer 4

stroke: paramedian branches of the basilar artery
areas: abducens nuclei/n, corticospinal and corticobulbar tracts, pontine nuclei and transverse pontine fibers, facial colliculus, MLF

s+s: ipsilateral medial strabismus, contralateral spastic paralysis, contralateral ataxia, contralateral loss of pain and temp from body, ipsilateral facial weakness, ipsilateral horizontal gaze paralysis, internuclear ophthalmoplegia

Question 5

Lateral Caudal Pontine Syndrome

Answer 5

stroke: AICA, or circumferential branches of the basilar artery
areas: STT, descending sympathetic fibers, spinal nucleus and tract of V, facial motor nucleus, facial n, superior vestibular nucleus, MCP

s+s: contralateral loss of pain and temp from body, Horner’s, ipsilateral loss of pain and temp from face, ipsilateral facial weakness, dry eye, loss of taste in anterior 2/3 of tongue, ipsilateral ataxia, vertigo, nystagmus, ipsilateral hearing loss

Question 6

Lateral Mid-Rostral pontine syndrome

Answer 6

stroke: circumferential branches of basilar artery
areas: mesenchepalic nucleus and tract of V, motor nucleus of V, chief sensory nucleus of V, sympathetic fibers, STT, trigeminal n.

s+s= ipsilateral loss of jaw jerk reflex, weakness in muscles of mastication, ipsilateral jaw deviation, loss of blink reflex, ipsilateral facial hemianesthesia, Horner’s, contralateral loss of pain and temp from body

Question 7

Basal Midbrain Syndrome/ Weber’s syndrome

superior alternating hemiplegia

Answer 7

stroke: paramedian branches of basilar artery and PCA
areas: corticobulbar, corticospinal tracts, oculomotor nerve (parasympathetics and somatic motor)

s+s= contralateral drooping of mouth, contralateral spasticity in body, 3rd nerve palsy with opthlamogplegia, ipsilateral ptosis (levator palpebrae superioris), mydriasis, ipsilateral loss of accommodation, loss of pupillary light reflex

Question 8

Tegmentum and Basal Midbrain syndrome/ Benedikt’s syndrome

Answer 8

stroke: lateral and paramedian branches of basilar artery and PCA
areas: red nucleus, superior cerebellar peduncle, corticobulbar, corticospinal, corticopontine tracts, substantia nigra, medial lemniscus

s+s: contralateral spastic hemiparesis, contralateral lower face weakness, drooping of mouth. Contralateral ataxia, intention tremor, dysmetria (bc red nucleus and SCP), contralateral loss of fine touch and proprioception from body, 3rd nerve palsy with ophthalmoplegia, lateral strabismus, mydriasis, loss of pupillary light reflex