Clinical Applications & Brainstem Lesions Flashcards
What are the midbrain vascular territories?
- Paramedian branches at top of Basilar Artery
- Proximal Posterior Cerebral Artery
- Superior Cerebellar Artery
What are the rostral pons vascular territories?
- Basilar Artery (Paramedian branches, Circumferential branches)
- Superior Cerebellar Arteries (supply superior cerebellar peduncles)
What are the caudal pons vascular territories?
- Basilar artery (paramedian branches & circumferential branches)
- Anterior inferior cerebellar artery
What are the medulla vascular territories?
- Vertebral arteries & anterior spinal artery (paramedian branches)
- Posterior inferior cerebellar arteries
What vasculature is implicated in the medial medullary syndrome?
Paramedian branches of vertebral and anterior spinal arteries
What are the symptoms of the medial medullar syndrome?
- Contralateral arm & leg weakness
- Contralateral position & vibration sense impaired
- ipsilateral tongue weakness
What vasculature is implicated in lateral medullary syndrome?
Posterior inferior cerebellar artery (and/or vertebral artery)
What are the symptoms of lateral medullary syndrome?
- Ipsilateral ataxia, vertigo, nystagmus & nausea
- Ipsilateral facial pain & temp sense impaired
- Contralateral body pain & temp sense impaired
- Ipsilateral Horner’s syndrome
- Hoarseness, dysphagia
- Ipsilateral decreased taste
What vasculature is implicated in medial pontine basis infarcts?
Paramedian branches of Basilar Artery
What are the symptoms of medial pontine basis infarcts?
- Contralateral weakness of face arm & leg
- Dysarthria
- Contralateral (or ipsilateral ataxia)
- Ipsilateral face weakness
- Ipsilateral horizontal gaze palsy
- internuclear ophthalmoplegia (INO)
- Contralateral body position & vibration sense impaired
What vasculature is implicated in lateral caudal pons (AICA syndrome)?
Anterior inferior cerebellar artery & labyrinthine artery
What are the symptoms of lateral caudal pons infarcts?
- Ipsilateral ataxia
- Vertigo, nystagmus
- Ipsilateral fascial pain & temp sense impaired
- Contralateral body pain & temp sense impaired
- Ipsilateral Horner’s Syndrome
- Ipsilateral hearing loss
What are the symptoms of superior cerebellar artery syndrome?
Ipsilateral ataxia
Damage were causes locked in syndrome?
Bilateral ventral pons (Basilar artery)
What are symptoms of locked in syndrome?
absent motor function bilaterally
What is intact in locked-in syndrome?
- cognition
- Sensation
- vertical eye movement
What are the symptoms of midbrain basis?
- Ipsilateral third-nerve palsy
- Contralateral hemiparesis
What are the symptoms of midbrain tegmentum?
- Ipsilateral third- nerve palsy
- Contralateral ataxia
What are the symptoms of midbrain basis & tegmentum?
- ipsilateral third nerve palsy
- contralateral hemiparesis
- contralateral ataxia, tremor, involuntary movements
Within medial medullary syndrome what structures are damaged to cause:
- Contralateral arm & leg weakness
- Contralateral position & vibration sense impaired
- ipsilateral tongue weakness
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- Corticospinal tract (Contralateral arm & leg weakness)
- Medial lemniscus (Contralateral position & vibration sense impaired)
- Hypoglossal nucleus & fascicles (ipsilateral tongue weakness)
Within lateral medullary syndrome what structures are damaged to cause:
- Ipsilateral vertigo, nystagmus
- Ipsilateral ataxia, nausea, vertigo, nystagmus
- Ipsilateral facial pain & temp sense impaired
- Contralateral body pain & temp sense impaired
- Ipsilateral Horner’s syndrome
- Hoarseness, dysphagia
- Ipsilateral decreased taste
- Vestibular nuclei (vertigo, nystagmus)
- Inferior cerebellar peduncle (Ipsilateral ataxia, vertigo, nystagmus & nausea)
- Spinal trigeminal nucleus & tract (Ipsilateral facial pain & temp sense impaired)
- Anterolateral pathway (Contralateral body pain & temp sense impaired)
- Descending sympathetic fibers (Ipsilateral Horner’s syndrome)
- Nucleus ambiguous (Hoarseness, dysphagia)
- Solitary nucleus (Ipsilateral decreased taste)
Within medial pontine basis infarcts what structures are damaged to cause:
- Contralateral weakness of face, arm & leg
- Contralateral (or ipsilateral ataxia)
- Ipsilateral face weakness
- Ipsilateral horizontal gaze palsy
- internuclear ophthalmoplegia (INO)
- Contralateral body position & vibration sense impaired
- corticospinal & corticobulbar tracts (Contralateral weakness of face arm & leg)
- pontine nuclei (Contralateral ataxia))
- Fascial nucleus & faciculus (Ipsilateral face weakness)
- Abducens Nucleus (Ipsilateral horizontal gaze palsy)
- Medial Longitudinal Fascicles (internuclear ophthalmoplegia (INO))
- Medial leminscus (Contralateral body position & vibration sense impaired)
Within lateral caudal pons what structures are damage to cause:
- Ipsilateral ataxia
- Vertigo, nystagmus
- Ipsilateral fascial pain & temp sense impaired
- Contralateral body pain & temp sense impaired
- Ipsilateral Horner’s Syndrome
- Ipsilateral hearing loss
- Middle cerebellar peduncle (Ipsilateral ataxia)
- Vestibular nuclei (Vertigo, nystagmus)
- Spinal trigeminal nucleus & tract (Ipsilateral fascial pain & temp sense impaired)
- Anterolateral system (Contralateral body pain & temp sense impaired)
- Descending sympathetic fibers (Ipsilateral Horner’s Syndrome)
- Labyrinthe artery also supplies labyrinth (Ipsilateral hearing loss)
Within Midbrain Basis what structures are damage to cause:
- Ipsilateral third nerve palsy
- Contralateral hemiparesis
- Oculomotor fibers leaving oculomotor nucleus (ipsilateral third nerve palsy)
- Corticospinal tract (contralateral hemiparesis)
Within Midbrain tegmentum what structures are damaged to cause:
- ipsilateral third nerve palsy
- Contralateral ataxia
- Oculomotor fibers leaving oculomotor nucleus (ipsilateral third nerve palsy)
- Red nucleus (Contralateral ataxia)
Within midbrain basis & tegmentum what structures are damaged to cause:
- Ipsilateral third nerve palsy
- Contralateral hemiparesis
- Contralateral ataxia, tremor, involuntary movements
- Oculomotor fibers leaving oculomotor nucleus (ipsilateral third nerve palsy)
- Corticospinal tract (contralateral hemiparesis)
- Substantia nigra (contralateral ataxia, tremor, involuntary movements)