Stroke Syndromes Flashcards
What occurs with lesion to the red nucleus?
- loss of fine tuning of the movements
- > TREMOR AND ATAXIA
What occurs with lesion to the Medial Longitudinal Fasciculus?
- Internuclear Ophthalmoplegia
problems with lateral gaze
What occurs in Benedikt Syndrome?
- STROKE in the central midbrain
- —red nucleus/ CN3 and Medial leminiscus is affected#
What does the medial leminiscus do?
- continuation of the Posterior column (relays info. on proprioception and vibration)
What are the symptoms of Bendikt syndrome?
- Down and Out eye+ Pupil dilation
- C/L Loss of proprioception and vibration
- Involuntary movements (TREMOR AND ATAXIA)
What occurs in Weber’s Syndrome? What is affected?
- antero-lateral, Midbrain stroke
- —CN3/ corticobulbar/ corticospinal tracts are affected
How does Weber’s syndrome present as?
- CN3 Palsy
- C/L hemiparesis
- pseudobulbar palsy
How to confirm dx of pseudobulbar palsy?
- Exaggerated GAG reflex and JAW reflex
- Spastic tongue
- Spastic dysarthria
- —-UMN lesion signs
What is affected in Perinaud’s Syndrome?
- posterior aspect of the Midbrain
- SUPERIOR COLLICULUS and the PRETECTAL area
What are signs of Perinaud’s Syndrome?
- Vertical Gaze Palsy
2. Pseudo Argyll Robertson Pupil
What is Pseudo Argyll Robertson Pupil ?
- when the pupil does NOT constrict with LIGHT but it constricts with ACCOMMODATION
What is said to cause Perinaud’s Syndrome?
- pineal tumor (Pinealoma/ Germinoma)
What may occur with progressive pineal tumor growth?
- obstruction of the Cerebral Aqueduct
Describe the course of CN7 leaving pons.
- does a “round-about” around CN6 and then leaves
What is responsible for PAIN and T* sensation on the face? Where in the brain stem is it located?
- Spinal tract and the Nucleus Trigeminal
- — found in PONS
What is PPRF responsible for?
- LATERAL gaze
paramedian pontine reticular formation
Name 3 key fts in the PONS, repsonsible to look left or right. Where are they found?
- Abducens N.
- PPRF
- MLF
- —-close to each other in the midline of PONS
What is affected in MEDIAL PONTINE $?
- CN 6
- CN 7
- Corticospinal tract
- —-and the lateral gaze structures
What is seen with sx in medial pontine $?
- ipsilateral CN 6 PALSY: diplopia and lateral gaze palsy
- ipsilateral facial droop
- c/l hemiparesis
- -ipsilateral? gaze palsy
What is affected in the LATERAL pontine syndrome?
- Vestibular Nucleus
- Spinothalamic tract
- Sympathetic tract
- Spinal V nucleus
- CN 7 palsy
What signs seen in the Lateral Pontine syndrome?
- nystagmus, N.V, vertigo
- c/l pain and T* loss on limbs
- HORNER’S syndrome (ipsilateral)
- ipsilateral loss of facial pain/T*
- ipsilateral FACIAL droop and LOSS of corneal reflex
- ….deafness (if cochlea nucleus is damaged)
Stroke involving which artery is resp. for LATERAL pontine syndrome?
- AICA
Anterior inferior Cerebellar artery
What artery supplies the midbrain?
Posterior Cerebral Artery
What does the dorsal MOTOR nucleus X and the Nucleus solitarius recieve?
Autonomic sensory info.
What CNs are a.w Nucleus ambiguss?
CN 9, 10, 11
What dick like structure runs in the centre of the medulla
- Medial Leminiscus
Damage to what structure in the medulla results in the Horner’s Syndrome?
Hypothalamospinal tract
Which nucleus, that was seen in the pons, continues in the medulla?
-vestibular Nucleus
What runs in the antero-medial aspect of the medulla? -
Corticospinal tract
What occurs with Medial Medullary syndrome? Stroke in what artery results in this?
- stroke of the ANTERIOR SPINAL ARTERY
- —affects the integrity of the Medial Leminiscus, corticospinal tract and CN 12
HOw does the medial medullary syndrome present as?
- c/l hemiparesis
- c/l loss of VIBRATION and Proprioception
- flaccid paralysis of the TONGUE (deviates to one side)
What is affected in the Lateral Medually syndrome?
Vestibular nucleus Spinothalamic Tract Sympathetic Tract Spinal V fibres Nucleus Ambiguss
How would Lateral Medullary syndrome present as?
SAME as Lateral Pontine syndrome!!
- Nystagmus, N.V, vertigo
- C.L loss of PAIN and T* on the limbs
- Ipsilateral loss of PAIN and T* on the FACE
- Horner’s Syndrome
- d.t involvment of Nucleus Ambiguss, additional sx of HOARSENESS and DYSPHAGIA is seen.
What causes the Lateral Medullary syndrome?
- stroke of the Posterior inferior Cerebellar artery
What artery is involved in the Medial Pontine syndrome?
- Basilar Artery
Name the 4 Midline columns running through the Brainstem.
- Motor nucleus
- MLF
- Medial leminiscus
- Motor pathway
Damage to the motor nucleus, results in what?
-ipsilateral MOTOR loss of CNs divisible by 12
(3,4, 6,12) —-same CNs to run MEDIALLy through out the brainstem
What are the side columns that run throughout the brainstem?
- spinothalamic tract
- spinocerebellar tract
- sensory nucleus (CN5)
- Sympathetic tract
What occurs with lesion to the Nucleus solitarius?
- Rostral portion of N.Solitarius= LOSS of TASTE in Ipsilateral tongue
- Caudal portion of N.Solitarius-increase in HR
