localization of disease in the brainstem Flashcards
exam 1
cranial nerve involvement means _______ disease
brainstem
long tract involvement of corticospinal tract and medial lemniscus
medial disease
involvement of spinothalamic and descending CN V
lateral disease
midbrain cranial nerves
3 and 4
pons cranial nerves
5, 6, 7, and 8
medulla cranial nerves
9, 10, 11, and 12
Brainstem syndromes are crossed:
cranial nerve is _____ side of the lesion
long tract is _______ side of the lesion
cranial nerve is ipsilateral side of the lesion
long tract is contralateral side of the lesion
blood supply to the brainstem [3]
- paramedian
- short circumferential
- long circumeferential
brainstem infarct affect one side? or both side?
one side
Medial cranial nerves involved in medial syndromes derived from somatic motor column
XII –
VI-
III –
XII – medulla
VI- pons
III – midbrain
Lateral cranial nerves involved in lateral syndromes sensory and branchial arch muscles
IX, X, XI =
VII, VIII, V =
V =
- X, X, XI -medulla
- VII, VIII, V – pons
- V = motor, main sensory
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?
-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
Medial brainstem syndromes
Contralateral hemipareis:
Ipsilateral involvement of somatic motor nerves exiting medially
Medulla =
Pons =
Midbrain =
Contralateral loss of position and vibratory sense :
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)
Wallenberg
lateral medullary infarct
Wallenberg symptoms:
- spinothalamic tract
- descending tract of Vth nerve
- nucleus ambiguus
- inferior cerebellar peduncle
- descending sympathetics
- spinothalamic tract: Contralateral loss of pain and temperature in the body
- descending tract of the 5th nerve: Ipsilateral loss of pain and temperature in the face
- nucleus ambiguus: Hoarseness, deviated uvula
- inferior cerebellar peduncle: Ipsilateral ataxia
- descending sympathetic: Ipsilateral Horner’s
Hughlings Jackson:
- Corticospinal tract
- XIIth nerve
- medial lemniscus
- corticospinal tract: Contralateral hemiparesis
- 12th nerve: Ipsilateral tongue paralysis
- medial lemniscus: Contralateral loss of position and vibratory sense in the body
what is the problem of the trigeminothalamic tract?
fibers probably run more than once place, or on both sides or they do not form a discrete tract
Lateral pontine syndrome
- spinothalamic tract
- Spinal V
- VII
- Motor V
- middle cerebellar penduncle
Lateral pontine syndrome
- spinothalamic tract: Contralateral loss of pain and temperature in the body
- Spinal V: Ipsilateral loss of pain and temperature in the face
- VII: Ipsilateral paralysis of face, LMN type
- Motor V: Ipsilateral loss of all facial sensation and paralysis of muscles of mastication
- middle cerebellar peduncle: Ipsilateral ataxia
Medial pontine syndrome:
- Corticospinal tract
- VIth nerve
medial pontine syndrome
- corticospinal tract: Contralateral hemiparesis
- 6th nerve: Ipsilateral paralysis of abduction of the eye
weber
medial midbrain syndrome
Medial midbrain syndrome (Weber)
- Corticospinal tract
- palsy?
Medial midbrain syndrome (Weber)
- corticospinal tract Contralateral hemiparesis
- Ipsilateral third nerve palsy: pupillary enlargement, ptosis, oculomotor palsy
Acoustic neuroma or vestibular schwannoma
what are the beginnings with the cranial nerve signs?
- vestibular before cochlear
2. V and VII involvement
Acoustic neuroma or vestibular schwannoma
what are the late occurrence symptoms ?
long tract signs:
- ataxia–> middle cerebellar peduncle
- Hemiparesis–> corticospinal tract
Acoustic neuroma or vestibular schwannoma
small will lead to compression of
cranial nerve 8
Acoustic neuroma or vestibular schwannoma
large brainstem compression leads to
compression of cranial nerve 5, 6, 7, and 8
where does a tumor arising from the acoustic nerve situated?
cerebellopontine angle
Adams and Kubick
basilary arter occlusion
basilary artery occlusion leads to
- bilateral hemiparesis of both corticospinal tracts
2. bilateral sensory loss from ascending systems
time course of vascular disease
minutes to hours
time course of enlarging masses and tumors
days to weeks
time course of degenerative diseases
months to years
pseudobulbar palsy
bilateral lesions of corticobulbar tracts…. ALS, MS bilateral strokes
