Section 8 - Brainstem

Question 1

What is a vestibular schwannoma?

Answer 1

Tumor of vestibular portion of CN VIII and lesion at cerebellopontine angle.

Question 2

A lesion of anterior spinal artery in the medulla will damage:

Answer 2

Medial lemniscus, CN XII, pyramid (corticospinal)

Question 3

A lesion of PICA in medulla will damage:

Answer 3

ALS, spinal trigeminal tract/nucleus

Question 4

What is an early sign of compression of the lateral medullary reticular area?

Answer 4

Central apnea (the area is responsible for heart rate and respiratory control - you better get that shit under control, and fast)

Question 5

Hey Reuben

Answer 5

Study harder.

Question 6

What is Medial Medullary Syndrome = Inferior Alternating Hemiplegia = Dejerine Syndrome?

Answer 6

• Contralateral hemiparesis (corticospinal)
• Contralateral hemianesthesia (medial lemniscus)
• Ipsilateral deviation of tongue when protruded (XII)

Question 7

Inferior alternating hemiplegia can result from:

Answer 7

Lesion or occlusion of one of the medial medullary penetrating br. of Anterior Spinal artery

Question 8

Occlusion of anterior spinal artery can result in ________

Answer 8

Bilateral deficits similar to the inferior alternating hemiplegia

Question 9

What is Lateral Medullary Syndrome = PICA Syndrome = Wallenburg Syndrome? (vascular insufficiency of PICA)

Answer 9

• Contralateral loss of pain/temp (spinothalamic tracts)
• Ipsilateral loss of pain/temp from face (spinal trigeminal tract/nuc)
• Ipsilateral vertigo/nystagmus (vestibular nuc)
• Ataxia (inferior cerebellar peduncle)
• Loss of taste ipsilateral half of tongue (solitary tract/nuc)
• Hoarseness, dysphagia, etc. (nucleus ambiguus or roots)
• Horner’s syndrome (hypothalamospinal fibers)

Question 10

A posterior spinal artery lesion (rare) in the medulla causes:

Answer 10

• Ipsilateral proprioception/vibration/fine touch loss (dorsal columns/nuclei)
• Ipsilateral pain/temp loss (spinal trigeminal)

Question 11

Characteristics of fetal alcohol syndrome:

Answer 11

Craniofacial dysmorphology, short palpebral fissure, flat midface, abnormal premaxillary zone, growth retardation, decreased cranial size, impaired fine motor skills (cerebellar loss), impaired coordination/behavior/cognition; bad gait due to cerebellar issues

Question 12

The nucleus ceruleus is _______ during sleep and ________ when suddenly woken.

Answer 12

Low; high (norepinephrine)

Question 13

What is Foville syndrome?

Answer 13

Occlusion of paramedial br. of basilar a. - ipsilateral abducens n. paralysis, contralateral hemiparesis, variable contralateral sensory loss (ML)

Question 14

If Foville lesion extends posteriorly to pontine tegmentum, _______

Answer 14

Ipsilateral horizontal gaze paralysis (damaged pontine reticular formation)

Question 15

What is Gubler or Millard-Gubler Syndrome?

Answer 15

Ischemic lesion involving root of facial n. with corticospinal fibers –> contralateral hemiparesis and ipsilateral paralysis of facial muscles

Question 16

What is syndrome of midpontine base?

Answer 16

Occlusion of paramedial/short circumferential brs.

• Damage to corticospinal
• Sensory and motor trigeminal
• Fibers of middle cerebellar peduncle (ataxia)

Question 17

What is middle alternating hemiplegia?

Answer 17

Ipsilateral CN VI and contralateral motor (corticospinal)

Question 18

What is superior alternating hemiplegia?

Answer 18

Ipsilateral CN III and contralateral motor (corticospinal)

Question 19

PCA and basilar aa. occlusion can lead to…

Answer 19

Weber’s Syndrome (a superior alternating hemiplegia)

Question 20

What is Claude’s syndrome?

Answer 20

PCA and basilar aa. occlusion can lead to CN III palsy, red nucleus damage, superior cerebellar peduncle signs (light reflex, contralateral ataxia)

ipsilateral oculomotor nerve palsy
contralateral hemiparesis
contralateral ataxia
contralateral hemiplegia of the lower face, tongue, and shoulder (corticobulbar/nuclear business)

Question 21

Lesion of the midbrain reticular formation will lead to…

Answer 21

Hypersomnia (slow respirating, indicative of sleep state)

Question 22

Benedikt’s Syndrome is…

Answer 22

PCA and basilar aa. occlusion, where damaged structures are CN III, crus cerebri, red nucleus, substantia nigra, SCP signs (contralateral hemiplegia, contralateral ataxia, tremors, involuntary movements)

Question 23

What is Parinaud’s Syndrome?

Answer 23

Vertical gaze palsy typically from pineal tumor pushing down on dorsal midbrain, creating problems with vertical gaze

Question 24

What is “Top of the Basilar” Syndrome?

Answer 24

Infarction of thalamic somatosensory portion (ventral posterior thalamus)

• Proprioception, pain, temp, touch impaired CONTRALATERAL body
• Pain can be spontaneous, intractable to analgesics
• Emotional liability, spontaneous laughing/crying (this last one by itself is just a general symptom of medical school)