Monday, 4-25-Brainstem Lesions (Stephens) Flashcards
A lesion of the hypoglossal nucleus results in:
Protruded tongue deviates toward the side of the affected nucleus
The level of a brainstem lesion may be determined by identifying the coordinates of the __ affected CN and/or nuclei.
Highest (most superior)
A lesion of __ leads to contralateral loss of pain and temp on opposite 1/2 of the body
SL
A lesion of __ leads to loss of proprioception, 2-pt tactile discrimination, and vibratory sensation on the opposite 1/2 of the body
ML
A lesion of __ leads to loss of pain and temp sensation on opposite side of face
TL
A lesion of __ leads to contralateral spastic hemiplegia
Corticospinal tracts
What structures yield only ipsilateral deficits?
Cranial nerves
Desc tract of V
Posterior columns in lower medulla
A lesion of __ leads to loss pain/temp sensations from the same side of the face
Desc tract of V
Which structures lead to predominantly contralateral deficits?
LL
Brachium of inferior colliculus
A lesion of the LL and/or brachium of inferior colliculus leads to:
Bilateral dimunition of hearing which is most predominant in the contralateral ear
A lesion in these cranial nerves leads to ipsilateral CN deficits and contralateral loss of pain and temp sensations from the body:
V, VII, IX, X, and XI
These CNs exit the brainstem in close association with the SL. As a result, a lesion in any one of these regions may involve 1 of these nerves as well as the SL
Which 4 CNs exit the brainstem adjacent to the CST and lead to alternating hemiplegia with lesions?
Alternating HYPOGLOSSAL hemiplegia
Alternating ABDUCENS hemiplegia
Alternating TRIGEMINAL hemiplegia
Alternating OCULOMOTOR hemiplegia
XII, VI, V, III
You are doing a neurological exam on a patient and find that the tongue protrudes to the right and there is +4/4 muscle reflexes on the left, hypertonicity on the left, and well as paralysis on the left side of the body. What is the diagnosis?
Alternating hypoglossal hemiplegia
Destruction of XII on the right results in ipsilateral paralysis of muscles of tongue and atrophy of ipsilateral muscles of the tongue
Destruction of CST at this level results in contralateral spastic hemiplegia
A pt presents with a protrusion of the tongue to the left, hyperreflexia/hypertonicity/paralysis of the right UE and LE as well as hyperreflexia/hypertonicity/paresis of the left LE (not UE). What is the diagnosis?
Alternating hypoglossal hemiplegia and destruction of contralateral CST (A12H + CST)
Destruction of CN XII=ipsilateral paralysis and atrophy of tongue muscles
Destruction of ipsilateral CST=contralalteral spastic hemiplegia
Partial destruction of contralateral CST=some degree of ipsilateral spastic paralysis
A pt presents with protrusion of the tongue to the right as well as a loss of proprioception, 2-pt tactile discrimination, and vibratory sensations on the left side of the body. What is the diagnosis?
Alternating hypoglossal hemiplegia and destruction of ipsilateral ML (A12H + ML)
Destruction of ipsilateral XII and CST
Destruction of ipsilateral ML=contralateral loss of proprioception, 2-pt tactile discrimination, and vibratory sensations from the body
A pt presents with internal strabismus of the right eye as well as hyperreflexia/hypertonia/paralysis of both the left UE and LE. What is the diagnosis?
Alternating abducent hemiplegia (A6H)
Destruction of VI=ipsilateral paralysis of lateral gaze and/or internal strabismus
Destruction of CST at this level results in contralateral spastic hemiplegia
A patient presents to you with an internal strabimus of the right eye as well as a facial palsy of the right side. He also displays hyperreflexia/hypertonia/paralysis of the left side of the body. What is the diagnosis?
Millard-Gubler’s syndrome (A6H + 7)
Includes signs of alternating abducens hemiplegia plus a VII lesion
Destruction of VII=ipsilateral facial palsy, loss of taste from ant 2/3 of tongue, decreased lacrimation, and hyperacusis
__ includes the signs of an alternating abducens hemiplegia plus additional signs due to the dorsal extension of the lesion
Syndrome of Foville
1) destruction of ML=contralateral loss of prop/2pt/tactile discrimination, and vibratory sensations from body
2) destruction of MLF=internuclear ophthalmoplegia
3) VII palsy
4) Destruction of CROSSED corticobulbar fibers=denervation of ipsilateral NUCLEUS AMBIGUUS and HYPOGLOSSAL nucleus
In syndrome of Foville, destruction of the crossed corticobulbar fibers results in denervation of the:
Ipsilateral: Nucleus ambiguus and hypoglossal nucleus
A pt presents with a loss of sensation from the right half of the face and scalp as well as paralysis of the muscles of mastication on the right side. He also displays hyperreflexia/hypertonia/paralysis of the left UE and LE. What is the diagnosis?
Alternating trigeminal hemiplegia (A5H)
Destruction of V=ipsilateral loss of all sensations from half of the face and scalp, and paralysis of ipsilateral muscles of mastication
Destruction of CST=contralateral spastic hemiplegia
A pt presents with a loss of sensation from the left side of the face and scalp as well as paralysis of the left facial muscles of mastication. In addition, there is loss of proprioception/2pt tactile discrimination from the body and limbs on the right side, as well as a supranuclear facial palsy on the right side of the face and protrusion of the tongue to the right. What is the diagnosis?
Alternating V hemiplegia with a dorsal expansion (A5H + ML)
Signs of A5H plus deficits associated with involvement of more dorsally located structures
Destruction of ML=contralateral loss of proprioception and 2-pt tactile discrimination from body and limbs
Destruction of UNCROSSED corticobulbar fibers=denervation of the contralateral CN nuclei: abducens nucleus, 1/2 of facial nucleus (supranuclear facial palsy), hypoglossal and nucleus ambiguus
A pt presents with external strabisumus, pupillary dilation and complete ptosis of the right eye. He also has spastic hemiplegia of the left side of the body. You notice that he has a resting tremor of his left hand when attempting to sign his name. What is the diagnosis?
Webers syndrome (Alternating Oculomotor Hemiplegia) or A3H
Destruction of III=ext strabismus, pupillary dilation, complete ptosis
Destruction of CST=contralateral spastic hemiplegia
Destruction of substantia nigra=contralalteral resting tremor
Destruction of UNCROSSED corticobulbar tract=contralateral brainstem motor nuclear palsies, including supranuclear facial palsy
A pt presents with dysphagia and paresis of the right palatal muscles as well as a loss of pain and temperature sensation on the left side of the body. What is the diagnosis?
Lesion of the nucleus ambiguus and the SL
- destruction of nucleus ambiguus=dysphagia,dysarthria,hoarseness, and paresis of ipsilateral palatal muscles
- destruction of SL=contralateral loss of pain and temp sensations from the body
- lesions may extend medially to include the ML and solitary nucleus
A pt presents with loss of pain/temp sensation of the right side of the face as well as a loss of pain and temp sensation of the left side of the body. The pt also does not have a gag reflex, has dysphonia, and swallowing is difficult. What is the diagnosis?
Lateral medullary syndrome (Wallenberg’s syndrome or Syndrome of the PICA)
- Destroyed SL=contralateral hemianalgesia
- Destroyed desc tract of V=ipsilateral loss of pain and temp from face
- Alternating hemianalgesia
- Destroyed glossopharyngeal and vagus nerves
- Destroyed nucleus ambiguus
- Destroyed solitary nucleus
- Destroyed spinocerebellar tracts
- Irritation of vestibular nuclei=nystagmus
