Clinical Case: Weber Syndrome, Foville Syndrome, Wallenburg Syndrome

Question 1

Weber syndrome affects the ____ (location in brain)

Answer 1

Weber syndrome affects the ventral midbrain

Question 2

what artery is involved in Weber Syndrome?

Answer 2

there is occlusion of the interpeduncular (paramedian) PCA branches

Question 3

describe the structures seen in the image and what artery is affected

Answer 3

lesion in the interpeduncular (paramedian) PCA branch will affect the ventral midbrain

Question 4

describe the structures damaged and the symptoms seen in Weber syndrome

Answer 4

• corticospinal fibers: contralateral spastic hemiplegia
• corticobulbar fibers: contralateral lower facial paralysis (also hypoglossal)
• substantia nigra: contralateral parkinsonism (bradykinesia)
• exiting CN III: ipsilateral oculomotor deficits and dilated pupil

Question 5

name the artery that supplies the lateral pons

Answer 5

AICA

Question 6

name the structures found in the lateral pons

Answer 6

• facial nucleus: ipisilateral facial paralysis, along with decreased lacrimation, salivation and taste from ant. 2/3 tongue
• vestibular nucleus: vomiting, vertigo, nystagmus
• lateral spinothalamic tract = decreased pain/temp from contralateral body
• spinal trigeminal nucleus = decreased pain/temp from ipsilateral face
• sympathetic fibers = ipsilateral Horner syndrome
• middle/inferior cerebellar peduncles: ataxia, dysmetria

Question 7

describe structures located in the medial pons

Answer 7

• CN VI/PPRF = lateral gaze to side of lesion is affected
• CN VII nucleus = ipsilateral facial droop (upper and lower face)
• DCML = contralateral loss of touch/vibration/proprioception
• corticospinal = contralateral loss of motor

Question 8

what artery is involved in Foville syndrome?

Answer 8

paramedian branches of the basilar artery

Question 9

describe the clinical presentation of Foville syndrome

Answer 9

• abducens nerve affected: inability to abduct ipsilateral eye
• corticospinal tract: UMN lesion signs on contralateral side
• DCML and ALS affected: contralateral body
• facial nerve (or nucleus): complete facial paralysis, unable to close eye
• lateral lemniscus: bilaterally reduced hearing

Question 10

describe the structures affected in Foville syndrome

Answer 10