PONS MESEN CLINICAL

Question 1

Caudal Basal Pontine Syndromes

Answer 1

MILLARD-GUBLER SYNDROME-6,7,CST
GELLÉ - 7, 8, CST
BRISSAUD-SICARD SYNDROME- ipsilateral facial hemispasm and contralateral hemiparesis

Question 2

Rostral Basal Pontine Syndrome

Answer 2

Motor Hemiparesis: CST at basis
Ataxic Hemiparesis: corticospinal tract fascicles along with pontocerebellar fascicles
Dysarthria–Clumsy Hand Syndrome: central (supranuclear) facial weakness, severe dysarthria and dysphagia, hand paresis, and clumsiness.
The Locked-in Syndrome
Crying and Laughter:

Question 3

TEGMENTAL PONTINE SYNDROMES

Answer 3

Medial Tegmental Syndrome: cranial nerve VI), the genu of the facial nerve, and the medial lemniscus
1 1/2 syndrome: abducens nucleus and the medial longitudinal fasciculus

Question 4

Dorsolateral Tegmental Pontine Syndrome

Answer 4

dissociated sensory loss (loss of pain and temperature sense with preservation of vibration and position sense) enveloping the entire body, accompanied by truncal and limb ataxia without weakness.

ST, Trigeminal lemniscal, cerebellar

Question 5

Caudal Tegmental Pontine Syndromes

Answer 5

FOVILLE’S SYNDROME (RAYMOND-FOVILLE SYNDROME): (contralateral hemiparesis), the paramedian pontine reticular formation (PPRF), and/or the abducens nucleus (conjugate gaze palsy

MUSICAL HALLUCINOSIS: acoustic striae (including the trapezoid body), superior olivary nucleus, lateral lemniscus. release of auditory memories by disinhibition of reticular pathways from nucleus raphe pontis to sensory centers in the thalamus and cerebral cortex.

Question 6

Mid-Tegmental Pontine Syndrome (Grenet Syndrome)

Answer 6

trigeminal nucleus and trigeminothalamic fibers, superior cerebellar peduncle, and spinothalamic tract, and it extends ventrally to involve corticospinal fibers.

Question 7

Rostral Tegmental Pontine Syndrome (Raymond-Cestan-Chenais Syndrome)

Answer 7

medial lemniscus, medial longitudinal

, spinothalamic tract, and cerebellar fibers.

Question 8

Extreme Lateral Tegmental Pontine Syndrome (Marie-Foix Syndrome)

Answer 8

ipsilateral cerebellar ataxia and contralateral hemiparesis with or without hemisensory loss.

Question 9

Ocular Bobbing and Dipping

Answer 9

ocular bobbing, inverse ocular bobbing, ocular dipping, and inverse ocular dipping

Question 10

characterized by sustained tachypnea that persists despite an elevated arterial PO2 and pH and a low arterial PCO2

pontine lesion of this type disinhibits inhibitory pontine influences on medullary respiratory neurons

Answer 10

Central Neurogenic Hyperventilation

Question 11

Paremedian infarcts of MB:

Lateral infarcts of MB:

Answer 11

nuclear

fascicular

Question 12

Weber, cerebral peduncle

Answer 12

ipsilateral oculomotor nerve paralysis and contralateral upper motor neuron paralysis that includes the lower face

Question 13

Syndrome of Benedikt,

tegmentum, red nucleus

Answer 13

ipsilateral oculomotor nerve paralysis and contralateral tremor

Question 14

low frequency and may have resting, postural, and kinetic components

component of the tremor responds well to treatment with levodopa.

Answer 14

rubral tremors

Question 15

Claude’s Syndrome

Answer 15

medial half of the red nucleus, the adjacent decussating fibers of superior cerebellar peduncle, and oculomotor nerve fascicles.

Question 16

Nothnagel’s Syndrome

Answer 16

oculomotor nerve fascicles and the brachium conjunctivum.

Question 17

Plus-Minus Lid Syndrome

Answer 17

Rostral midbrain involving the nucleus of the posterior commissure and oculomotor fascicles to the ipsilateral levator palpebrae muscle as they emerge from the central caudal subnucleus.

Question 18

Walleyed Syndrome

Answer 18

alleyed bilateral internuclear ophthalmoplegia (WEBINO) syndrome.

lateral deviation of both eyes (exotropic gaze) and the absence of ocular adduction.

Question 19

Vertical One-and-a-Half Syndrome

bilateral impairment of downgaze (the one) and monocular paralysis of elevation (the half)

Answer 19

efferent tracts of the rostral interstitial nucleus of the medial longitudinal fasciculus (RiMLF) bilaterally

and premotor fibers to the contralateral superior rectus subnucleus and the

ipsilateral inferior oblique subnucleus before or after decussation in the posterior commissure.

Question 20

Top of the Basilar Syndrome

Answer 20

Balint’s syndrome (optic ataxia) caused by involvement of the occipital, parietal, and temporal cortices,

vertical gaze abnormalities, lid retraction (Collier’s sign), and convergence disordeR

light-near dissociation and a small reactive or large fixed pupil,

behavioral disturbances (somnolence, memory defects, agitation, hallucination)

Question 21

Peduncular Hallucinosis Syndrome

Answer 21

nonthreatening hallucinations, often formed nonstereotypically, colored, and vivid,

tegmental and cerebral peduncle lesions.

Question 22

akinetic mutism (Cairns syndrome),

Answer 22

Bilateral limited lesions of the mesencephalic reticular formation

absolute mutism and complete immobility except for the eyes, which are kept open and move in all directions

The condition is also known as persistent vegetative state.

Question 23

brain stem caudal to the red nucleus and rostral to the vestibular nuclei

Answer 23

decerebrate rigidity