Pontine Syndromes

Question 1

Brissaud-Sicard Syndrome

Answer 1

Vessel: posterior circulation or brainstem glioma

Involvement: CN7 nucleus, corticospinal tract

Deficit:
Ipsilateral
- Facial cramps

Contralateral
- Upper and lower limb hemiparesis

Question 2

Facial Colliculus Syndrome

Answer 2

Cause: neoplasm, MS, viral infection

Involvement: CN6 nucleus, CN7 nucleus, fibres and MLF

Deficit: ipsilateral
- CN7 palsy (LMNL)
- Diplopia
- Horizontal conjugate

Question 3

Gasperini Syndrome

Answer 3

Vessel: pontine branches of basilar artery, long circumferential artery of AICA

Involvement: nucleus of CN5, CN6, CN7, CN8, spinothalamic tract

Deficit:
Ipsilateral
- Facial sensation loss
- Impaired eye abduction
- nystagmus
- vertigo

Contralateral
- Hemisensory impairment

Question 4

Gelle Syndrome

Answer 4

Involvement: CN 7, CN 8, corticospinal tract

Deficit:
Ipsilateral
- Facial palsy
- Hearing loss

Contralateral
- Hemiparesis

Question 5

Grenet Syndrome

Answer 5

Cause: neoplasm

Involvement: CN 5 lemniscus, CN 7 fibres, spinothalamic tract

Deficit:
Ipsilateral
- Altered facial sensation

Contralateral
- Altered upper and lower limb sensation

Question 6

Foville Syndrome
(Inferior medial pontine syndrome)
(lower dorsal pontine syndrome)

Answer 6

Vessel: branches of basilar artery

Involvement: corticospinal tract, medial lemniscus, medial cerebellar peduncle, nucleus of CN 6, CN 7

Deficit:
Ipsilateral
- Ataxia
- Facial palsy
- Lateral gaze paralysis
- Diplopia

Contralateral
- Hemiparesis
- Loss of proprioception and vibration

Question 7

Marie-Foix Syndrome
(Lateral pontine syndrome)

Answer 7

Vessel: perforating branches of basilar artery, AICA

Involvement: nuclei of CN 7, CN 8, corticospinal tract, spinothalamic tract, cerebellar tract

Deficits:
Ipsilateral
- Limb ataxia
- Facial palsy

Contralateral
- Hemiparesis
- Loss of proprioception and vibration
- Hearing loss
- Vertigo
- Nystagmus

Question 8

Locked-in Syndrome

Answer 8

Vessel: middle and proximal segments of basilar artery

Involvement: upper ventral pons, corticospinal tract, corticobulbar tract, CN 6 nucleus

Deficit:
Quadriplegia
Bilateral facial palsy
Horizontal eye palsy (can move eyes vertically, blink)
Has intact consciousness

Question 9

Raymond Syndrome

Answer 9

Vessel: branches of basilar artery

Involvement: CN 6 fibres, corticospinal ttact, corticofacial fibres

Deficit:
Ipsilateral
- Lateral gaze palsy

Contralateral
- Facial palsy
- Hemiparesis

Question 10

Raymond-Cestan Syndrome
(Upper dorsal pontine syndrome)

Answer 10

Vessel: circumferential branches of basilar artery

Involvement: MLF, medial lemiscus, spinothalamic tract, CN 5 fibres and nuclei, superior and middle cerebellar peduncles

Deficit:
Ipsilateral
- Ataxia
- Coarse intentional tremors
- Facial sensory loss
- Mastication weakness

Contralateral
- Loss of all sensory modalities

Question 11

Millard-Gubler Syndrome
(Ventral pontine syndrome)

Answer 11

Vessel: branches of basilar artery

Involvement: CN 6, CN 7 and corticospinal tract

Deficit:
Ipsilateral
- Lateral rectus palsy
- Diplopia
- Facial palsy

Contralateral
- Hemiparesis of upper and lower limbs