Cerebellar and brainstem syndromes- terms Flashcards
Medial cerebellar syndrome
Dysfunction of medial cerebellum or its connections
Ataxia of gait or torso, dysarthrai, nystagmus, nausea
Lateral cerebellar syndrome
Dysfunction of lateral cerebellum or its connections
Ataxia, dysmetria, intention tremor of ipsilateral limbs, dysarthria, vertigo, nystagmus, nausea
Accessory neuropathy
LMN abnormalities of ipsilateral sternocleinomastoid and trapezius muscles
Hypoglossal neuropathy
Deviation of protruded tongue toward weak side, dysarthria due to inability to enunciate lingual sounds (la)
Vagus neuropathy
Dysarthria of pharyngeal consonants (ka, ha), dysphonia, dysphagia, nasal regurgitation, ipsilateral weakness of palate elevation, diminished ipsilateral efferent limb of pharyngeal reflex
Glossopharyngeal neuropathy
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
Vestibulocochlear neuropathy
Conductive or sensorineural hearing loss, vertigo, nausea, nystagmus
Conductive hearing loss
Unilateral dysfunction of external or middle ear
Sound louder in ipsilateral ear with Webers and louder on mastoid for Rhinnes
Sensorineural hearing loss
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
Facial neuropathy
Ipsilateral hyperacusis (stapedius), abnormal taste (solitary nucleus)
Ipsilateral LMN abnormalities of upper and lower face
Ipsilateral decreased lacrimation and salivation (parasympathetics to glands)
Trigeminal neuropathy
Somatosensory abnormalities of face, hyperacusis (tensor tympani)
LMN abnormalities of muscles of mastication
Abducens neuropathy
Horizontal diplopia due to weakness of lateral rectus, worse with gaze in the direction of the weak muscle
Abnormal eye is unable to abudct
Trochlear neuropathy
Ipsilateral weakness of eye depression when adducted and intorsion when abducted
Patients flex neck anteriorly and contralaterally to improve diplopia
Oculomotor neuropathy
Ipsilateral ptosis (levator palpebrae), weakness of eye elevation and adduction Aniscoria worse in light (parasympathetics to iris constrictor)
Horner’s syndrome
Ipsilateral ptosis (superior tarsal muscle)
Aniscoria worse in dark (iris dilator)
Anhidrosis
Medial medullary syndrome
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)
Lateral medullary syndrome
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
Medial pontine syndrome
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)
Lateral potine syndrome
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
Locked in syndrome
Loss of most voluntary motor functions (corticospinal, corticobulbar)
may have control of eyelid elevation
Bilateral lesion of basis pontis that spares tegmentum
Medial midbrain syndrome
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)
Lateral midbrain syndrome
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
Retinopathy/ optic neuropathy
Monocular visual loss
Afferent pupillary defect
Bitemporal hemianopsia
Lesion of medial optic chiasm
Medial optic chiasm= dysfunction of decussating axons from nasal retina of both eyes
