localization of disease in the brainstem

Question 1

cranial nerve involvement means _______ disease

Answer 1

brainstem

Question 2

long tract involvement of corticospinal tract and medial lemniscus

Answer 2

medial disease

Question 3

involvement of spinothalamic and descending CN V

Answer 3

lateral disease

Question 4

midbrain cranial nerves

Answer 4

3 and 4

Question 5

pons cranial nerves

Answer 5

5, 6, 7, and 8

Question 6

medulla cranial nerves

Answer 6

9, 10, 11, and 12

Question 7

Brainstem syndromes are crossed:

cranial nerve is _____ side of the lesion

long tract is _______ side of the lesion

Answer 7

cranial nerve is ipsilateral side of the lesion

long tract is contralateral side of the lesion

Question 8

blood supply to the brainstem [3]

Answer 8

1. paramedian
2. short circumferential
3. long circumeferential

Question 9

brainstem infarct affect one side? or both side?

Answer 9

one side

Question 10

Medial cranial nerves involved in medial syndromes derived from somatic motor column
XII –
VI-
III –

Answer 10

XII – medulla
VI- pons
III – midbrain

Question 11

Lateral cranial nerves involved in lateral syndromes sensory and branchial arch muscles
IX, X, XI =
VII, VIII, V =
V =

Answer 11

• X, X, XI -medulla
• VII, VIII, V – pons
• V = motor, main sensory

Question 12

Lateral brainstem syndromes:

Contralateral loss of pain and temperature in body: ___________

Ipsilateral loss of pain and temperature in face: _________

Laterally exiting cranial nerves to branchial arch muscles:
Medulla-
Lower pons-
Upper pons-

Is there weakness in the body?

Answer 12

-Contralateral loss of pain and temperature in body: Spinothalamic tract

Ipsilateral loss of pain and temperature in face: Descending nucleus of V

Laterally exiting cranial nerves to branchial arch muscles:
Medulla- nucleus ambiguus
Lower pons- facial
Upper pons- trigeminal (main sensory, motor)

NO WEAKNESS OF THE BODY

Question 13

Medial brainstem syndromes

Contralateral hemipareis:

Ipsilateral involvement of somatic motor nerves exiting medially
Medulla =
Pons =
Midbrain =

Contralateral loss of position and vibratory sense :

Answer 13

Medial brainstem syndromes

Contralateral hemipareis: Corticospinal tract

Ipsilateral involvement of somatic motor nerves exiting medially
Medulla = XII
Pons = VI
Midbrain = III

Contralateral loss of position and vibratory sense : Medial lemniscus (medulla, lower pons)

Question 14

Wallenberg

Answer 14

lateral medullary infarct

Question 15

Wallenberg symptoms:

1. spinothalamic tract
2. descending tract of Vth nerve
3. nucleus ambiguus
4. inferior cerebellar peduncle
5. descending sympathetics

Answer 15

1. spinothalamic tract: Contralateral loss of pain and temperature in the body
2. descending tract of the 5th nerve: Ipsilateral loss of pain and temperature in the face
3. nucleus ambiguus: Hoarseness, deviated uvula
4. inferior cerebellar peduncle: Ipsilateral ataxia
5. descending sympathetic: Ipsilateral Horner’s

Question 16

Hughlings Jackson:

1. Corticospinal tract
2. XIIth nerve
3. medial lemniscus

Answer 16

1. corticospinal tract: Contralateral hemiparesis
2. 12th nerve: Ipsilateral tongue paralysis
3. medial lemniscus: Contralateral loss of position and vibratory sense in the body

Question 17

what is the problem of the trigeminothalamic tract?

Answer 17

fibers probably run more than once place, or on both sides or they do not form a discrete tract

Question 18

Lateral pontine syndrome

1. spinothalamic tract
2. Spinal V
3. VII
4. Motor V
5. middle cerebellar penduncle

Answer 18

Lateral pontine syndrome

1. spinothalamic tract: Contralateral loss of pain and temperature in the body
2. Spinal V: Ipsilateral loss of pain and temperature in the face
3. VII: Ipsilateral paralysis of face, LMN type
4. Motor V: Ipsilateral loss of all facial sensation and paralysis of muscles of mastication
5. middle cerebellar peduncle: Ipsilateral ataxia

Question 19

Medial pontine syndrome:

1. Corticospinal tract
2. VIth nerve

Answer 19

medial pontine syndrome

1. corticospinal tract: Contralateral hemiparesis
2. 6th nerve: Ipsilateral paralysis of abduction of the eye

Question 20

weber

Answer 20

medial midbrain syndrome

Question 21

Medial midbrain syndrome (Weber)

1. Corticospinal tract
2. palsy?

Answer 21

Medial midbrain syndrome (Weber)

1. corticospinal tract Contralateral hemiparesis
2. Ipsilateral third nerve palsy: pupillary enlargement, ptosis, oculomotor palsy

Question 22

Acoustic neuroma or vestibular schwannoma

what are the beginnings with the cranial nerve signs?

Answer 22

1. vestibular before cochlear

2. V and VII involvement

Question 23

Acoustic neuroma or vestibular schwannoma

what are the late occurrence symptoms ?

Answer 23

long tract signs:

1. ataxia–> middle cerebellar peduncle
2. Hemiparesis–> corticospinal tract

Question 24

Acoustic neuroma or vestibular schwannoma

small will lead to compression of

Answer 24

cranial nerve 8

Question 25

Acoustic neuroma or vestibular schwannoma

large brainstem compression leads to

Answer 25

compression of cranial nerve 5, 6, 7, and 8

Question 26

where does a tumor arising from the acoustic nerve situated?

Answer 26

cerebellopontine angle

Question 27

Adams and Kubick

Answer 27

basilary arter occlusion

Question 28

basilary artery occlusion leads to

Answer 28

1. bilateral hemiparesis of both corticospinal tracts

2. bilateral sensory loss from ascending systems

Question 29

time course of vascular disease

Answer 29

minutes to hours

Question 30

time course of enlarging masses and tumors

Answer 30

days to weeks

Question 31

time course of degenerative diseases

Answer 31

months to years

Question 32

pseudobulbar palsy

Answer 32

bilateral lesions of corticobulbar tracts…. ALS, MS bilateral strokes