Major Pathways of the brainstem and their relationship to lesions

Question 1

Brain lesions make up ___-___% of strokes

Answer 1

5-15%

Question 2

What are the general characteristics of a brainstem lesion? What affected CNs do these symptoms come from?

Answer 2

dysphagia and dysarthria (CN IX, X, and XII)
diploplia (CN III, IV, VI)
dysmetria (CN VIII)

Question 3

definition: inability to judge distance that also includes balance and limb coordination

Answer 3

dysmetria

Question 4

(true/false) receptive and expressive language deficits are often seen with brainstem lesions.

Answer 4

FALSE

Question 5

With decorticate rigidity, the LEs are in ___ and the UEs are in ____.

Answer 5

EXT, FLX

Question 6

With decorticate rigidity, the lesion is most likely at the _____ even though it is still functioning.

Answer 6

red nucleus (midbrain)

Question 7

With decerebrate rigidity, the LEs are in ___ and the UEs are in ____.

Answer 7

EXT, EXT

Question 8

Decerebrate rigidity is caused when a lesion travels below the ____.

Answer 8

red nucleus

Question 9

Which is worse… decerebrate rigidity or decorticate rigidity?

Answer 9

decerebrate rigidity

Question 10

(true/false) a patient can switch between decerebrate and decorticate postures.

Answer 10

TRUE

Question 11

definition: lesion is in the base of the pons
- patient is tetraplegic but can still move and communicate with their eyes (ocular nerves are intact and patient does have cognition.

Answer 11

locked-in syndrome

Question 12

What tract is affected when a patient has locked-in syndrome?

Answer 12

corticospinal tract

Question 13

Lateral Medullary (Wallenberg) syndrome has lesions in the ___ and ___ arteries.

Answer 13

Vertebral and PICA arteries

Question 14

(true/false) Motor and proprioception are not intact when lateral medullary (Wallenberg) Syndrome is present.

Answer 14

False, they are intact

Question 15

What are the symptoms of lateral medullary (Wallenberg) syndrome? What causes these symptoms?

Answer 15

• contralateral loss of pain and temperature (spinothalamic tract)
• ipsilateral loss of pain and temperature in the face (CN V)
• dysphagia and dysarthria (CN IX , X, and XII)
• vestibular issues
• ataxia (inferior cerebellar peduncle)
• horner’s syndrome

Question 16

Medial Medullary syndrome has lesions in the ___ and ___ arteries.

Answer 16

anterior spinal and vertebral arteries.

Question 17

What are the symptoms of medial medullary syndrome? What causes these symptoms?

Answer 17

• contralateral hemiparesis (corticospinal tract)
• contralateral impairment of proprioception and vibration (medial lemniscus)
• ipsilateral motor problems of the tongue muscles (CN XII)

Question 18

Definition: disruption of the ANS pathway

Answer 18

horner’s syndrome

Question 19

What are the symptoms of Horner’s Syndrome?

Answer 19

• ptosis
• constricted pupils