Herniation syndromes / ventral and dorsal view of brain stem

Question 1

Herniation syndromes - types

Answer 1

1. Cingulate (subfalcine) herniation under falx cerebri
2. Downward transtentorial (central) herniation
3. Uncal herniation
4. cererbellar tosilar herniation into the foramen magnum

Question 2

cingulate is a part of / AKA

Answer 2

• limbic cortex

- aka subfalcine

Question 3

Cingulate (subfalcine) herniation can cause

Answer 3

compression of anterior cerebral artery

Question 4

Downward transtentorial (central) herniation –> … (mechanism and complication)

Answer 4

caudal displacement of brain stem –> rupture of paramedian basilar artery branches –> duret hemorrhages –> usually fatal

Question 5

Duret haemorrhages are

Answer 5

small lineal areas of bleeding in the midbrain and upper pons of the brainstem.

Question 6

Downward transtentorial (central) herniation - course

Answer 6

usually fatal

Question 7

Uncus =

Answer 7

medial temporal lobe

Question 8

Uncal herniation - manifestations and mechanism

Answer 8

1. compress ipsilateral CN III (blown pupil, down-and-out gaze)
2. compress ispilateral PCA (contralateral homonymous hemianopia with macula sparing)
3. compress contralateral crus cerebri at tha Kernohan notch (ipsilateral paresis, a false localization sign)

Question 9

Herniation syndromes - types

Answer 9

1. Cingulate (subfalcine) herniation under falx cerebri
2. Downward transtentorial (central) herniation
3. Uncal herniation
4. cererbellar tosilar herniation into the foramen magnum

Question 10

crus cerebri

Answer 10

anterior portion of the cerebral peduncle which contains the motor tracts

Question 11

cererbellar tosilar herniation into the foramen magnum - manifestation and mechanism

Answer 11

coma and death result when these herniations compress the brain stem

Question 12

Herniation syndromes - types

Answer 12

1. Cingulate (subfalcine) herniation under falx cerebri
2. Downward transtentorial (central) herniation
3. Uncal herniation
4. cererbellar tosilar herniation into the foramen magnum

Question 13

Herniation syndromes - compresses ACA

Answer 13

Cingulate (subfalcine) herniation under falx cerebri

Question 14

Herniation syndromes - compresses CN III

Answer 14

Uncal herniation

Question 15

uncal hernation can compress

Answer 15

1. compress ipsilateral CN III
2. compress ispilateral PCA
3. contralateral crus cerebri at tha Kernohan notch

Question 16

Herniation syndromes - duret hemmorhages

Answer 16

Downward transtentorial (central) herniation

Question 17

CN nuclei that ilie mediallly at brain stem

Answer 17

III, IV, VI, XII

Question 18

Infundibulum?

Answer 18

alternative names for the pituitary stalk, the connection between the hypothalamus and the posterior pituitary.

Question 19

anterior perforated substance is a

Answer 19

irregularly quadrilateral area in front of the optic tract and behind the olfactory trigone

Question 20

CN IV special characteristic

Answer 20

arises dorsally and immediately decussates

Question 21

nerves that start from the same level - from medial to lateral

Answer 21

VI-VII-VIII

Question 22

pineal gland - is responsible for

Answer 22

melatonin secretion –> circadian rhythms

Question 23

area of superior and inferior culliculi

Answer 23

just below the pineal gland

Question 24

inferior culliculi - function

Answer 24

auditory

Question 25

inferior culliculi - output

Answer 25

thalamus/medial geniculate nucleus

Question 26

superior culliculi - function

Answer 26

conjugate vertical gaze

Question 27

Parinaud syndrome (manifestations, due to)

Answer 27

paralysis of conjugate vertical gaze due to lesion in superior colliculi

Question 28

clinical manifestation of Parunaud syndrome

Answer 28

paralysis of conjugate vertical gaze

Question 29

Parinaud syndrome - due to ... (and examples)

Answer 29

lesion in superior colliculi (examples: stroke, hydrocephalus, pinealoma)

Question 30

Herniation syndromes - types

Answer 30

1. Cingulate (subfalcine) herniation under falx cerebri 2. Downward transtentorial (central) herniation 3. Uncal herniation 4. cererbellar tosilar herniation into the foramen magnum

Question 31

superior vs inferior colliculi according to function

Answer 31

superior colliculi --> conjugate vertical gaze | inferior colliculi --> auditory