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46 Cards in this Set

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What 2 arteries wrap around CN3
Posterior cerebral and superior cerebellar
What is the most common artery for berry aneurysm
PCOM
What is dysartheria
It is a common speech disorder, problems with speaking and it is due to loss of muscles that we use in speech, speech is often stammered and stuttered, however they have no problem understanding speech. CAUSE OF THIS IS DEGENERATIVE NEUROLOGICAL DISORDERS LIKE BULBAR PALSY OR AMYOTROPIC LATERAL SCLEROSIS (ALS)
What does vertebrobasillar arterial system supply
It supplies everything in the posterior brain like brain stem and cerebellum
Vertebrobasillar system consists of what vessels
Vertebral a, single basilar a. at the pontomedullary junction, and paired PCA (posterior cerebral aa. At pontomesencephalic junction, and PCOM to anterior circulation
What are the 3 cerebellar arteries
Superior cerebellar, AICA and PICA
What is the vascular territory SCA
Arises from the top of the basilar artery at the level of rostral pons and supplies the superior cerebellum and bit of rostral laterodorsal pons
What is the vascular territory AICA
Arises form basilar at level of caudal pons and supplies the lateral caudal pons and a small portion of the cerebellum
What is the vascular territory PICA
Arises from vertebral artery and it supplies the lateral medulla and inferior cerebellum
What is the blood supply to the midbrain
PCA and penetrating branches of the basilar
What is the blood supply to the pons
Basilar artery
What is the blood supply to the medulla
Medial basilar
What is the blood supply to the lateral
Vertebral and PICA
What structures make up the brain stem
Midbrain, pons, medulla
What is an embolism
Cardiac origin
Thrombosis
In situ occurs at the site of a preexisting atherosclerotic stenosis
Lacunar disease
Small vessel occlusion in the setting of hypertension
If we say brain stem is going down
It is usually a warning sign for the vertebrobasillar ischemia
What are some of the common signs of vertebrobasillar ischemia
Dizziness (vestibular),
CN3 or 4 lesion
Midbrain
CN 5,6,7,8, lesion
PONS
CN 9,10,12 lesion `
Medulla
Where would all of these lesion be localized
In the brain stem
What else is lesioned in the brain stem
CN and long tracts, and lesion in the brainstem to any of long tracts will have a contralateral body deficit i.e. corticospinal, spinothalamic, medial lemniscus
What are the exceptions to the contralateral problems due to lesion in brainstem
1)
2)
Cerebellar peduncles which cause ipsi motor ataxia (discoordinated movements)
3)
Damage to the cranial nerves will result in ipsi head sensory or motor defects
So another name for lesions of the brainstem is
Alternating because we see both contralateral and ipsilateral problems
What If we have upper midbrain damage, esp. of the lesion is above the red nucleus
Impaired consciousness, flexion +, so patient is going to have flexor (decorticate) posturing, also there is CN3 palsy, and unilateral and bilateral pupil dilation and ataxia. THE REASON WE DON’T WALK AROUNF FLEXED IS THAT THE RUBROSPINAL TRACT HAS A STRONG NEGATIVE INHIBITION FROM THE CORTEX, BUT WHEN THERE IS A LESION, THAT INHIBITION IS GONE AND THE PATIENT IS FLEXED. This has good prognosis
What if we have upper pontine damage
Impaired consciousness, patient shows decerebrate or extensor posturing since the lesion is below RED NUCLEUS, here we have abducens palsy or horizontal gaze palsy, (IF THE LESION IS ON THE RIGHT, CAN TURN THE EYES TO THE RIGHT AND HAVE A LEFT GAZE PREFERENCE), WE HAVE BILATERAL SMALL BUT REACTIVE PUPILS, prognosis here is bad
WHAT NYSTAGMUS IS NOT SEEN IN AN UNCOSNCIOUS PATIENT
CALORIC NYSTAGMUS, BECAUSE THERE IS NO SACCADE
What if there is a lesion in the medulla
Bad prognosis, respiratory arrest, vertigo, ataxia, nausea, vomiting, autonomic instability and hiccups
What are some of the most common brainstem lesions
Lateral medullary syndrome, medial pontine base, and midbrain
What Is lateral medullary syndrome
It is a lesion in the lateral medulla mainly due to vertebral artery, main structure that is involved is inferior cerebellar peduncle (ipsi ataxia), vestibular nuclei (vertigo, nausea, nystagmus), CN5 (ipsi facial loss of pain and temp), nucleus ambiguus (hoarseness, dysphagia), nucleus solitarius (ipsi ↓taste), descending sympathetic fibers (Horner’s syndrome), spinothalamic tract (contra body ↓ pain and temp). The disorder is also called Wallenberg syndrome, lateral tegmentum is involved, not too much motor involvement prognosis is good.
What if there is a lesion in the middle pontine base
Caused by lacunar disease, mainly due to ↑ chronic BP, also called Ataxic Hemiparesis and the ataxia is same side as the weakness. There is a ↑# of motor tracks that run through here. The lesion happens because there is circumferential brr. from the basilar artery is not lesioned.
1-
Corticospinal tracts – UMN, contralateral leg arm weakness
2-
Corticobulbar tracts- UMN, contralateral face weakness, these people have central 7, with dysartheria. Assuming that the lesion is on the right, these people have facial weakness on the left side since it is UMN it is going to be left lower ¼, and they will be able to close their eye on the left but not tight
3-
Abducens nerve- ipsi paralysis of lateral rectus, this happens because the cell bodies are in the tegmentum
4-
Pontine nuclei and pontocerebellar tracts- contralateral ataxia which is on the same side of the weakness. This happens because the pontine nuclei send their fibers (w/c cross the midline) to medial cerebellar peduncle and they MCP sends it to the cortex and at this point they are called MOSSY FIBERS
What is the cause of midbrain lesions
It could be due to infarcts in the PCA and vessels from the top of the basilar A, it is also called top of the Basilar syndrome, could be due to an embolus 1- if the lesion occurs in the Occulomotor nerve, it will → to Moritz Benedikt syndrome (which shares some of the characteristics with the Weber syndrome, like eye down and out, drooping eye lid, dilated, non-responsive pupil, and contralateral tremor.
What are some of the common signs of vertebrobasillar ischemia
Dizziness (vestibular),
Diplopia and dyscongugate (supra on infra nuclear eye pathway)
Blurred vision or other eye (eye movement pathway)
Incoordination/ataxia (cerebellum)
Dysartheria or dysphagia (corticobulbar)
Numbness (somtaosensory)
Hemi or quadra paresis (corticospinal)
SOMNOLENCE (PONTOMESENCEPHALIC RETICULAR FORMATION OF BILATERAL THALAMI), these patients are in a coma and they cant keep the patient awake
What are the exceptions to the contralateral problems due to lesion in brainstem
1) Descending sympathetic hypothalamic fibers, lesions always result in Horner’s which is ipsi to the side of the lesion in the brain stem (Ptosis, Anhidrosis, miosis)
2) Cerebellar peduncles which cause ipsi motor ataxia (discoordinated movements)
3) Damage to the cranial nerves will result in ipsi head sensory or motor defects
What Is lateral medullary syndrome
It is a lesion in the lateral medulla mainly due to vertebral artery, main structure that is involved is inferior cerebellar peduncle (ipsi ataxia), vestibular nuclei (vertigo, nausea, nystagmus), CN5 (ipsi facial loss of pain and temp), nucleus ambiguus (hoarseness, dysphagia), nucleus solitarius (ipsi ↓taste), descending sympathetic fibers (Horner’s syndrome), spinothalamic tract (contra body ↓ pain and temp). The disorder is also called Wallenberg syndrome, lateral tegmentum is involved, not too much motor involvement prognosis is good
What if there is a lesion in the middle pontine base
Caused by lacunar disease, mainly due to ↑ chronic BP, also called Ataxic Hemiparesis and the ataxia is same side as the weakness. There is a ↑# of motor tracks that run through here. The lesion happens because there is circumferential brr. from the basilar artery is not lesioned.
Deficits:
1- Corticospinal tracts – UMN, contralateral leg arm weakness
2- Corticobulbar tracts- UMN, contralateral face weakness, these people have central 7, with dysartheria. Assuming that the lesion is on the right, these people have facial weakness on the left side since it is UMN it is going to be left lower ¼, and they will be able to close their eye on the left but not tight
3- Abducens nerve- ipsi paralysis of lateral rectus, this happens because the cell bodies are in the tegmentum
4- Pontine nuclei and pontocerebellar tracts- contralateral ataxia which is on the same side of the weakness. This happens because the pontine nuclei send their fibers (w/c cross the midline) to medial cerebellar peduncle and they MCP sends it to the cortex and at this point they are called MOSSY FIBERS
What is the cause of midbrain lesions
It could be due to infarcts in the PCA and vessels from the top of the basilar A, it is also called top of the Basilar syndrome, could be due to an embolus 1- if the lesion occurs in the Occulomotor nerve, it will → to Moritz Benedikt syndrome (which shares some of the characteristics with the Weber syndrome, like eye down and out, drooping eye lid, dilated, non-responsive pupil, and contralateral tremor.
2- Weber’s syndrome- this is caused by a lesion in the mid brain and basically we take out of the cerebral peduncle (PTO) we have eyeball down and out, drooping of eye lid, dilated non-responsive pupil, and contralateral UMN paralysis (because PTO is knocked out)
3- occulomotor palsy- this lesion is infranuclear, and we get the same symptoms as before, eye lid down and out, drooping of the eyelid, dilated non responsive pupil