Vascular Syndromes

Question 1

Lateral medullary syndrome

Answer 1

PICA syndrome
Wallenburg syndrome
Lesion/blockage of PICA
Contralateral loss of pain and thermal sense on body–damage to anterolateral system fiber
Ipsilateral loss of pain and thermal sense on face–damage to spinal trigeminal tract and nucleus
Dysphagia, soft palate paralysis, hoarseness, diminished gag reflex–damage to nucleus ambiguus

Question 2

Medial medullary syndrome

Answer 2

Inferior alternating hemiplegia
Lesion/blockage of ASA
Contralateral hemiplegia of arm & leg–damage to pyramid
Contralateral loss of proprioception, vibratory sense, and discriminative touch–damage to medial lemniscus
Deviation of tongue to ipsilateral side–damage to XII

**Localized by CN XII symptoms

Question 3

Medial pontine syndrome

Answer 3

Middle alternating hemiplegia
Contralateral hemiplegia of arm and leg due to damage of blood supply (paramedian branches of basilar artery) to corticospinal fibers in the basilar pons
Contralateral loss or decrease of position and vibratory sense and discriminative touch due to damage to blood supply of medial lemniscus

**Localized by CN VI symptoms

Question 4

Lateral pontine syndrome

Answer 4

Occlusion/lesion of basilar artery
Ipsilateral paralysis of facial muscles due to damage of blood supply to facial motor nucleus
Ipsilateral paralysis of masticatory muscles due to damage to blood supply at trigeminal motor nucleus
Ipsilateral loss of pain and thermal sense from face due to damage of blood supply to spinal trigeminal tract and nucleus
Contralateral loss of pain and thermal sense from the body due to damage to blood supply to anterolateral system

Question 5

Medial midbrain syndrome

Answer 5

Weber syndrome
Occlusion/lesion of PCA
Superior alternating hemiplegia
CN III+cerebral peduncle affected
Contralateral hemiplegia of arm and leg due to damage of blood supply to corticospinal fibers in cerebral peduncle
Ipsilateral lateral strabismus, fixed and dilated pupil

Localizing feature: CN III symptoms