Section 8 - Brainstem Flashcards
What is a vestibular schwannoma?
Tumor of vestibular portion of CN VIII and lesion at cerebellopontine angle.
A lesion of anterior spinal artery in the medulla will damage:
Medial lemniscus, CN XII, pyramid (corticospinal)
A lesion of PICA in medulla will damage:
ALS, spinal trigeminal tract/nucleus
What is an early sign of compression of the lateral medullary reticular area?
Central apnea (the area is responsible for heart rate and respiratory control - you better get that shit under control, and fast)
Hey Reuben
Study harder.
What is Medial Medullary Syndrome = Inferior Alternating Hemiplegia = Dejerine Syndrome?
- Contralateral hemiparesis (corticospinal)
- Contralateral hemianesthesia (medial lemniscus)
- Ipsilateral deviation of tongue when protruded (XII)
Inferior alternating hemiplegia can result from:
Lesion or occlusion of one of the medial medullary penetrating br. of Anterior Spinal artery
Occlusion of anterior spinal artery can result in ________
Bilateral deficits similar to the inferior alternating hemiplegia
What is Lateral Medullary Syndrome = PICA Syndrome = Wallenburg Syndrome? (vascular insufficiency of PICA)
- 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)
A posterior spinal artery lesion (rare) in the medulla causes:
- Ipsilateral proprioception/vibration/fine touch loss (dorsal columns/nuclei)
- Ipsilateral pain/temp loss (spinal trigeminal)
Characteristics of fetal alcohol syndrome:
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
The nucleus ceruleus is _______ during sleep and ________ when suddenly woken.
Low; high (norepinephrine)
What is Foville syndrome?
Occlusion of paramedial br. of basilar a. - ipsilateral abducens n. paralysis, contralateral hemiparesis, variable contralateral sensory loss (ML)
If Foville lesion extends posteriorly to pontine tegmentum, _______
Ipsilateral horizontal gaze paralysis (damaged pontine reticular formation)
What is Gubler or Millard-Gubler Syndrome?
Ischemic lesion involving root of facial n. with corticospinal fibers –> contralateral hemiparesis and ipsilateral paralysis of facial muscles
What is syndrome of midpontine base?
Occlusion of paramedial/short circumferential brs.
- Damage to corticospinal
- Sensory and motor trigeminal
- Fibers of middle cerebellar peduncle (ataxia)
What is middle alternating hemiplegia?
Ipsilateral CN VI and contralateral motor (corticospinal)
What is superior alternating hemiplegia?
Ipsilateral CN III and contralateral motor (corticospinal)
PCA and basilar aa. occlusion can lead to…
Weber’s Syndrome (a superior alternating hemiplegia)
What is Claude’s syndrome?
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)
Lesion of the midbrain reticular formation will lead to…
Hypersomnia (slow respirating, indicative of sleep state)
Benedikt’s Syndrome is…
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)
What is Parinaud’s Syndrome?
Vertical gaze palsy typically from pineal tumor pushing down on dorsal midbrain, creating problems with vertical gaze
What is “Top of the Basilar” Syndrome?
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)