Medullary Syndromes

Question 1

Lateral Medullary Syndrome

occlusion of:

structures damaged:

Answer 1

Lateral Medullary Syndrome (wallenbergs)

•Often caused by occlusion of PICA

•Structures damaged:

–Ascending spinal trigeminal system and STT, descending sympathetic fibers, nuclei for CN VIII, IX, X, and XI

•Related symptoms

–Impaired pain and temperature sensibility over ipsilateral face and contralateral body;

• ipsilateral Horner’s syndrome (meiosis - Constriction of the pupil of the eye), ptosis (drooping eye-lid), anhydrosis (is the inability to sweat normally)
• dysequilibrium and impaired control of eye movements,
• dysphonia (difficulty in speaking due to a physical disorder of the mouth, tongue, throat, or vocal cords.),
• dysphagia (diffuculty swallowing)
• dysarthria ( slurred or slow speech)
• vertigo and nausea because of vestibular problems

Question 2

Medial Medullary Syndrome

occlusion of:

structures damaged:

Symptoms

Answer 2

Medial Medullary Syndrome

• Also called alternating hypoglossal hemiplegia
• Often caused by occlusion of the proximal anterior spinal artery
• Structures damaged

–Medial lemniscus (think DCML) , medullary pyramid (think CST - UMN), nucleus for CN XII

•Related symptoms

–Loss of discriminative touch and kinesthesia (DCML)

• Spastic hemiparesis of contralateral body,
• LMN weakness, and atrophy of ipsilateral tongue (Think CN XII- hypoglossal)

Question 3

Infarcts of the Pons

Pons nourished by:

Answer 3

• Pons nourished by branches of the basilar artery
• Syndromes

–Medial (paramedian) inferior pontine syndrome

–Lateral superior pontine syndrome

–Complete basilar syndrome

–Locked-in syndrome

• Infarct confined to the ventral pons spares ascending somatosensory pathways and ascending reticular activating system (ARAS)
• Structures damaged include bilateral corticobulbar and corticospinal tracts
• Person fully conscious, but locked-in with near total paralysis

•Inexpressible – only vertical eye movements remain

Question 4

Weber’s Syndrome

AKA:

Infarction of:

Structured damaged:

Symptoms

Answer 4

Webers

• Also called superior alternating hemiplegia
• Often caused by infarction of branches of the PCA (paramedian penetrating branches of PCA)

•Structures damaged

–Descending tracts in cerebral peduncle (think CST), nucleus for CN III (think medial rectus)

•Related symptoms

–Spastic hemiparesis of contralateral body and lower half of face,

• ipsilateral oculomotor palsy
• lateral strabismus (eye goes laterally because the medial rectus (CNII) does not work).
• ptosis (drooping eye lid)
• diplopia (double Vision)

Question 5

–Locked-in syndrome

Answer 5

–Locked-in syndrome

• Infarct confined to the ventral pons spares ascending somatosensory pathways and ascending reticular activating system (ARAS)
• Structures damaged include bilateral corticobulbar and corticospinal tracts
• Person fully conscious, but locked-in with near total paralysis
• Inexpressible – only vertical eye movements remain

Question 6

Progressive Bulbar Palsy

Answer 6

Progressive Bulbar Palsy

Degenerative motor system disease of corticobulbar tract

UMN and LMN signs dominated by weakness of orofacial mm

Symptoms:

Dysarthria, impaired chewing and swallowing, atrophy and fasciculations of tongue

• may present w/ pathological laughing and crying

Question 7

Pseudobulbar Palsy

Answer 7

PSEUDOBULBAR PALSY

• Also called spastic bulbar paralysis
• Often caused by bilateral lesions of internal capsule affecting corticobulbar tracts
• Pathological laughing and crying along with bilateral bulbar signs