Test 3 clinicals

Question 1

Tumor of 4th Ventricle Impinging facial colliculus

Answer 1

1) Result:
-damage to abducens nucleus
-ipsilateral weakness of lateral rectus
=internal strabismus (ipsilateral)
weakness of facial muscles

Question 2

Nucleus Ceruleus

Answer 2

1) located in the lateral floor of 4th ventricle at level of midpontine
2) Contains Pigment
- aka nucleus pigmentosus
3) Larges location of noradrenaline/norepinephrine containing cells in CNS
4) Axons project to:
- cerebral cortex
- most of diencephalon
- limbic system
- brainstem
- spinal cord
5) Low stress situation
- aka sleep
- activity level low
6) High stress situation
- aka threatening situation
- high activity
- norepinephrine release
7) Intermediate stress
- normal activity; non sleep
- intermediate activity
8) low levels of nucleus correlates to vegetative activities

Question 3

Paramedian Branches of basilar artery

Answer 3

1) caudal pontine levels
2) includes
- exiting fibers of abducens nerve
- corticospinal fibers
- portions of ML

Question 4

Occlusion of Paramedical Branches at caudal pontine levels results in:

Answer 4

1) Foville Syndrome
2) Ipsilateral abducens nerve paralysis
- contralateral hemiparesis
- variable loss of proprioception, position, and vibratory sensory reflecting damage to Medial Lemniscus
2) If lesion extends into pontine tegmenjtum
- ipsilateral horizontal gaze paralysis->damage to medial portions of pontine reticular formation
3) If damage shifted laterally to involve corticospinal fibers & root of facial nerve=MILLARD-Gubler syndrome
- contralateral hemiparesis
- ipsilateral paralysis of facial muscles

Question 5

Occlusion of Midpontine levels of paramedical and short circumferential branches result in the

Answer 5

Syndrome of Midpontine base

Main Structtures damages and deficits are:

1) Corticospinal fibers
- contral lateral hemiparesis
2) Sensory and Motor Trigeminal roots
- ipsilateral loss of pain & temp
- thermal sense in face
- paralysis of masticatory muscles
3) Ataxias
- Middle cerebellar peduncle

Question 6

Lesion within pontine tegmentum

Answer 6

1) Caudal pontine tegmentum
- damage abducens and facial nuclei
- paralysis of ipsilateral lateral rectus and facial musculature
- damage to ALS
- contralateral loss of pain and thermal sense of body
2) Rostral Pontine tegmentum
- ALS + trigeminal motor nucleus and/or sensory and motor roots of the trigeminal nerve