Brainstem Lesions

Front 1

Anterior spinal artery Syndrome

Back 1

- medial medullary syndrome
1. CsT; contralateral spastic hemiparesis
2. ML; contralateral loss of tactile, vibration
3. CNXIIn. Ipsilateral flaccid hemiparalysis of tongue

Front 2

PICA syndrome or
Lateral Medullary Syndrome

Back 2

- dissociated sensory loss
1. vestibular n.; i.e nystagmus, n/v & vertigo
2. Inferior cerebellar peduncle. Ipsilateral cerebellar signs (e.g dystaxia, dysmetria, dysdiadochokinesia)
3. NA. ipislateral...
4. IX nerve roots
5. Vagal Nerve roots
6. SptT contralateral
7. Sp V n & T. Ipsilateral (facial hemianesthesia)
8. Descending sympathetic tract. Ipsilateral horners

Front 3

Medial Inferior Pontine Syndrome

Back 3

- occlusion of paramediam branches of the basilar a.
1. CsT contralateral
2. ML contalateral
3. CNVI roots. ipsilateral

Front 4

Lateral Inferior Pontine Syndrome

Back 4

AICA
1. VIIn and intraaxial nerve fibres; ipsilateral
2. Cochlear n & intraaxial fibres
3. vestibular nuclei and intraaxial nerve fibres
4. Spinal trigeminal nucleus & tract. ipsilateral
5. Middle & inferior cerebellar peduncles. ipsilateral limb & gait dystaxia
6. SpT
7. Descending Sympathetics

Front 5

MLF Syndrome aka
Internuclear Opthalmoplegia

Back 5

fibres from contralateral CNVI that project via MLF to the ipsilateral CNIII (medial rectus nuclei)
CAUSES;
- MR palsy on attempted lateral conjugate gaze & nystagmus in the abducting eye
- convergence remains intact
- often seen in MS

Front 6

Facial Colliculus Syndronme

Back 6

Causes; pontine glioma or vascular
- the internal genu of CNVII & nucleus of CN VI
1. facial nerve ipsilateral facial paralysis
2. LR; medial strabismus, horizontal diplopia

Front 7

Dorsal Midbrain (Parinaud's Syndrome)

Back 7

Causes; pinealoma or germinoma
1. Superior colliculus and pretectal area. Paralysis of upward & downward gaze, pupillary disturbances & absence of convergence
2. Cerebral Aqueduct. compressioon causing non-communicating hydrocephalus

Front 8

Paramedian midbrain (benedikt) syndrome

Back 8

1. CNIII roots
2. dentatothalamic fibres. contralateral cerebellar dystaxia with intention tremor
3. ML

Front 9

Medial Midbrain (weber) Syndrome

Back 9

1. CNIII roots
2. CsT
3. CbT. contralateral weakness of lower face (VII), tongue (XII), palate (CNX), uvula and pahrygeal wall pulled towards normal side (X)

Front 10

Acoustic Neuroma
- SCHWANNOMA

Back 10

- benign tumour of schwann cells affecting CNVIII
- in posterior fossa inside the IAM
- can often compress VII
- can impinge on the pons affecting SpV tract
- more often in females
A. Cochlear n
B. vestibular N.
C. VII
D. Spinal trigeminal tract
E. Neurofibromatosis type 2

Front 11

Jugular Foramen Syndrome

Back 11

IX, X, Xi

Front 12

Locked In Syndrome

Back 12

lesion in base of pons due to
- infarction, trauma, tumor, demyelination
1. CsT & CbT bilaterally
2. CNII & IV are not injured

Front 13

Central Pontine Myelinolysis

Back 13

lesion @ base of pons affects CsT & CbT
- CAUSES 75% are alcoholism or rapid correction of hyponatremia
- may become locked in syndrome

Front 14

Top of the Basilar Syndrome

Back 14

embolic occlusion of rostral basilar a.
- optic ataxia
- psychic paralysis of fixation of gaze
- ectopic pupils
- somnolence
- cortical blindness

Front 15

Subclavian Steal Syndrome

Back 15

thrombosis of left subclavian aa. proximal to vertebral a. blood shunted retrograde down the left verterbral a & into the left subclavian
- clinical signs transient weakness & claudication of left arm on exercise & vertebrobasilar insufficiency (i.e vertigo & dizziness)

Front 16

Cerebellopontine angle

Back 16

junction between medulla, pons & cerebellum (CNVII & VIII)
- 5 common brain tumours
- SAME (mneumonic)
- schwannoma (75%)
- arachnoid cyst (1%)
- meningioma (10%)
- Ependymoma (1%)
- EPidermoid (5%)

Front 17

Coma

Back 17

BRF

Front 18

Cerebellar signs

Back 18

cerebellar peduncles

Front 19

Nystagmus, vertigo, nausea

Back 19

Vestibular Nuclei
- fast phase towards lesion side

Front 20

Speech

Back 20

NA (X)

Front 21

Vomit

Back 21

BRF vomit centre
Area posterima

Front 22

Motor Loss

Back 22

Corticospinal tract

Front 23

Sensory Loss

Back 23

Trigeminal nuclei
Spinothalamic tract

- specific to brainstem injury
- loss sensation on one side of face and opposite side of the body CARDINAL SIGNATURE

Front 24

Cortical Innervations

Back 24

Corticobulbar Tract
- most are bilateral
EXCEPT VII (Upper face is lower face isnt) and XII (contralateral)