Cerebellar and brainstem syndromes- terms

Question 1

Medial cerebellar syndrome

Answer 1

Dysfunction of medial cerebellum or its connections

Ataxia of gait or torso, dysarthrai, nystagmus, nausea

Question 2

Lateral cerebellar syndrome

Answer 2

Dysfunction of lateral cerebellum or its connections

Ataxia, dysmetria, intention tremor of ipsilateral limbs, dysarthria, vertigo, nystagmus, nausea

Question 3

Accessory neuropathy

Answer 3

LMN abnormalities of ipsilateral sternocleinomastoid and trapezius muscles

Question 4

Hypoglossal neuropathy

Answer 4

Deviation of protruded tongue toward weak side, dysarthria due to inability to enunciate lingual sounds (la)

Question 5

Vagus neuropathy

Answer 5

Dysarthria of pharyngeal consonants (ka, ha), dysphonia, dysphagia, nasal regurgitation, ipsilateral weakness of palate elevation, diminished ipsilateral efferent limb of pharyngeal reflex

Question 6

Glossopharyngeal neuropathy

Answer 6

Ipsilateral afferent limb dysfunction of gag reflex, LMN abnormalities of stylopharyngeus muscle
Rare to see parasympathetic, viscerosensory, taste abnormalities due to redundancy between two glossopharyngeal nerves

Question 7

Vestibulocochlear neuropathy

Answer 7

Conductive or sensorineural hearing loss, vertigo, nausea, nystagmus

Question 8

Conductive hearing loss

Answer 8

Unilateral dysfunction of external or middle ear

Sound louder in ipsilateral ear with Webers and louder on mastoid for Rhinnes

Question 9

Sensorineural hearing loss

Answer 9

Unilateral dysfunction of inner ear, vistibulocochlaer nerve, cochlear nuclei
Sound louder in contralateral ear for Webers and louder near ear than mastoid for Rhinne’s

Question 10

Facial neuropathy

Answer 10

Ipsilateral hyperacusis (stapedius), abnormal taste (solitary nucleus)
Ipsilateral LMN abnormalities of upper and lower face
Ipsilateral decreased lacrimation and salivation (parasympathetics to glands)

Question 11

Trigeminal neuropathy

Answer 11

Somatosensory abnormalities of face, hyperacusis (tensor tympani)
LMN abnormalities of muscles of mastication

Question 12

Abducens neuropathy

Answer 12

Horizontal diplopia due to weakness of lateral rectus, worse with gaze in the direction of the weak muscle
Abnormal eye is unable to abudct

Question 13

Trochlear neuropathy

Answer 13

Ipsilateral weakness of eye depression when adducted and intorsion when abducted
Patients flex neck anteriorly and contralaterally to improve diplopia

Question 14

Oculomotor neuropathy

Answer 14

Ipsilateral ptosis (levator palpebrae), weakness of eye elevation and adduction
Aniscoria worse in light (parasympathetics to iris constrictor)

Question 15

Horner’s syndrome

Answer 15

Ipsilateral ptosis (superior tarsal muscle)
Aniscoria worse in dark (iris dilator)
Anhidrosis

Question 16

Medial medullary syndrome

Answer 16

Position, vibration, fine touch abnormalities in contralateral body (medial lemniscus)
Pain, temp, gross touch abnormalities in contralateral face (trigeminothalamic)
LMN abnormalities fo the ipsilateral tongue (hypoglossal nucleus)
UMN abnormalities of contralateral body (pyramid)

Question 17

Lateral medullary syndrome

Answer 17

Diminished pain, temp, gross touch for ipsilateral face (spinal trigeminal nucleus)
Diminished pain, temp, cross touch for contralateral body (spinothalamic)
Diminished ipsilateral taste (solitary nucleus)
Vergtigo, nausea, nystagmus (vestibular nuclei)
Ipsilateral sensorineural hearing loss (cochlear nuclei)
Diminished ipsilateral afferent limb function of the pharyngeal reflex (spinal trigeminal nucleus)
Diminished ipsilateral palate elevation, dysarthria, dysphagia, dysphonia, diminished ipsilateral efferent limb of gag reflex (ambiguus nucleus)
Ipsilateral limb ataxia (inferior cerebellar peduncle)
Ipsilateral Horner’s syndrome
Usually caused by posterior inferior cerebellar artery dysfunction

Question 18

Medial pontine syndrome

Answer 18

Position, vibration, fine touch abnormalities of contralateral body (medial lemniscus)
Somatosensory abnormalities of contralateral face (trigeminothalamic tract)

UMN abnormalities of contralateral body (corticospinal)
Limb ataxia (corticopontine)
Ipsilateral eye abduction weakness (abducens nucleus)
Ipsilateral horizontal gaze paresis (pontine horizontal gaze center)
Ipsilateral opthalmoparesis (medial longitudinal fasciculus)
Weakness of ipsilateral face (facial nucleus)
Contralateral lower facial weakness (corticobulbar tract)

Question 19

Lateral potine syndrome

Answer 19

Pain, temperature, gross touch abnormalities of contralateral body (spinothalamic tract)
Somatosensory abnormalities of ipsilateral face and ipsilateral afferent limb dusyfunction of corneal reflex (trigeminal nuc)
Ipsilateral hyperacusis (facial or trigeminal nucleus)
Ipsilateral hearing loss, vergigo, nausea, nystagmus (vestibular or cochlear nuclei)

ipsilateral upper and lower facial weakness and efferent limb dysfunction of norneal reflex (facial nucleus)
LMN abnormalities of ipsilateral muscles of mastication (trigeminal nucleus)
Ipsilateral limb ataxia (pontocerebellar)

Ipsilateral Horner’s syndrome

Question 20

Locked in syndrome

Answer 20

Loss of most voluntary motor functions (corticospinal, corticobulbar)
may have control of eyelid elevation

Bilateral lesion of basis pontis that spares tegmentum

Question 21

Medial midbrain syndrome

Answer 21

UMN abnormalities of contralateral arm, leg, lower face (corticospinal, corticobulbar)
Ptosis, dysconjugacy (oculomotor nucleus)
Contralateral trochlear neuropathy (trochlar nucleus)
Contralateral limb ataxia (corticopontine)

Dysfunction of ipsilateral efferent limb of pupillary light reflex (EW nucleus)

Question 22

Lateral midbrain syndrome

Answer 22

Somatosensory abnormalities of contralateral face, arm, leg (trigeminothalamic, spinothalamic, medial lemniscus)

UMN abnormalities of contralatreral leg, arm, face (corticospinal, corticobulbar)
Contralateral limb ataxia (corticopontine)

Horner’s syndrome

Question 23

Retinopathy/ optic neuropathy

Answer 23

Monocular visual loss

Afferent pupillary defect

Question 24

Bitemporal hemianopsia

Answer 24

Lesion of medial optic chiasm

Medial optic chiasm= dysfunction of decussating axons from nasal retina of both eyes

Question 25

Olfactory neuropathy

Answer 25

Ipsilateral hyposmia or anosmia