Stephens Brainstem Lesions

Question 1

Internuclear ophthalmoplegia

Answer 1

MLF lesion
Can’t adduct ipsilateral eye
Nystagmus of contralateral eye on abduction

Question 2

Corticobulbar fibers

Decussate where?

Answer 2

Motor nerves to cranial nerve motor nuclei

Lower pons (between CN5 and CN6)

Question 3

Supranuclear facial palsy

Answer 3

CBT lesion above decussation in lower pons

Question 4

Uvula deviation

Answer 4

Contralateral to nucleus ambiguus affected

Question 5

Tongue protrusion

Answer 5

Ipsilateral hypoglossal nucleus affected

Question 6

Loss of corneal reflex

Answer 6

Ipsilateral motor nucleus of VII

Question 7

Diminished jaw-jerk reflex

Answer 7

Ipsilateral motor nucleus of V

Question 8

Pupillary dilation and bad accommodation

Answer 8

Edinger-Westphal nucleus

Question 9

Loss of lacrimation from lacrimal gland

Answer 9

Superior salivatory nucleus

Question 10

Loss of salivation from parotid gland

Answer 10

Inferior salivatory nucleus

Question 11

External strabismus + complete ptosis

Answer 11

Oculomotor palsy

Question 12

Loss of prop/2-pt from half of face

Answer 12

Ipsilateral sensory nucleus of V

Question 13

Loss of p/t from half of face

Answer 13

Ipsilateral decending nucleus/tract of V

Question 14

Nystagmus

Answer 14

Vestibular n. (CN 8) issue

Question 15

Deficit patterns of central lesions

Answer 15

Hemianalgesia, hemianesthesia
Spastic paralysis
Bilateral deficits
Supranuclear facial palsy
Systemic disorders/diseases
Visual field pattern blindness

Question 16

Important parts of spinal cord

Answer 16

LSTT (Contralateral P/T)
Fasciculus gracilis/cuneatus (Prop/2-pt)
LCST (UMNs)
Anterior commissure (P/T)

Question 17

Important parts of brainstem

Answer 17

Cranial nerves
SL (Contralateral body P/T)
ML (Contralateral body prop/2-pt)
TL (Contralateral face P/T)
LL (Contralateral hearing deficits)
CST (Contralateral body UMNs)
CBT (Ipsilateral facial motor neurons)

Question 18

Cranial nerves that exit anteriorly near CST

Answer 18

Hypoglossal
Abducens
Trigeminal
Oculomotor

Question 19

Cranial nerves that exit near SL

Answer 19

Trigeminal
Facial
Glossopharyngeal
Vagus
Spinal Accessory

Question 20

Lesions of V, VII, IX, X, or XI

Answer 20

Can include contralateral P/T loss from body

Question 21

Lesions of III, V, VI, XII

Answer 21

Can include contralateral spastic hemiplegia of body

Question 22

List all A12H combos (w/ names)

Level?

Answer 22

A12H
A12H + contralateral CST (midline extension)
A12H + ML (dorsal extension)

Medulla at olive

Question 23

List all A6H combos (w/ names)

Level?

Answer 23

A6H
Millard-Gubler (A6H + 7) (lateral extension)
Syndrome of Foville (A6H + ML) (dorsal extension)

Pons at facial colliculus

Question 24

List all A5H combos (w/ names)

Level?

Answer 24

A5H
A5H + ML + uncrossed CBT (dorsal extension)

Pons at trigeminal n

Question 25

List all A3H combos (w/ names) Level?

Answer 25

Weber's Syndrome (A3H + uncrossed CBT + SN) Diencephalon/midbrain at white commissure

Question 26

Dysphagia, dysarthria, dysphonia Contralateral loss of P/T to body (Maybe ML symptoms) Level?

Answer 26

Lesion of Nucleus Ambiguus and SL Medulla at olive

Question 27

Loss of P/T from face Contralateral loss of P/T from body IX, X, spinocerebellar, vestibular symptoms Level?

Answer 27

Wallenberg's Syndrome (Alternating Hemianalgesia) Medulla at olive

Question 28

Deafness, vestibular disturbances Bell's palsy Alternating Hemianalgesia Cerebellar problems Level? Cause?

Answer 28

Cerebellopontine Angle (CPA) Syndrome Medulla at olive Cause = acoustic neuroma

Question 29

Oculomotor palsy Contralateral loss of prop/2-pt of body Contralateral motor dysfunction (tremor, ataxia) Level? Importance of this one?

Answer 29

Benedikt's Syndrome (Midbrain tegmentum - red nucleus) Diencephalon/Midbrain at posterior commissure WHERE LEMNISCAL SYSTEMS ARE ADJACENT

Question 30

Paralysis of upward gaze Loss of consensual light reflex Cause?

Answer 30

Parinaud's Syndrome Pineal tumor impinges on superior colliculus (upward gaze) and posterior commissure (consensual light reflex)

Question 31

Contralateral hemianesthesia (P/T and prop/2-pt)

Answer 31

Unilateral lesion of VPM/VPL nuclei (thalamus)

Question 32

Diffuse spontaneous pain without stimulus Extreme mood swings Contralateral tingling/crawling ant feeling, hemiparesis, homonymous hemianopia, or auditory deficits Cause?

Answer 32

Thalamic syndrome Thrombosis of posterior choroidal or deep PCA branches