9/16 Clinical Brainstem - DiCicco-Bloom Flashcards Preview

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Flashcards in 9/16 Clinical Brainstem - DiCicco-Bloom Deck (11):
1

multiple cranial nerves affected without any long tracts affected

prob out in the csf → extra-medullary lesion!

  • meningitis
  • fungus
  • cancer

2

mediolateral organization of brainstem

medial

  • corticospinal
  • medial lemniscus
  • motor CN (III, IV, VI; VII; IX-XII)

lateral

  • spinothalamic (anterolateral)
  • spinocerebellar
  • sensory CN (V, VIII)
  • descending sympathetics (Horner's)

3

long tracts and crossed syndromes

long tracts (CST, STT, DCMLS) are crossed from medulla up to midbrain (except most rostrally, where they converge and cross)

 

crossed syndromes

  • CN facial dysfx and cerebellar problems ipsilateral
  • long tract body signs (sensory/motor) contralateral

4

general regions served in medulla by

  • ant spinal a
  • vertebral a
  • PICA

anterior spinal a → medial structures

vertebral a → ventral lateral

PICA → dorsal lateral

5

lateral medullary syndrome

Wallenberg

usually involves PICA

 

lesion → symptom

1. spinal V tract and nucleus → ipsilateral loss of P/T on face

2. vestibular nuclei → nystagmus, vertigo, nausea, ataxia

3. inf cerebellar peduncle → ipsilat ataxia, nystagmus

4. nucleus ambiguus & fascicles of vagus n → dysphagia, hoarseness, deviation of uvula to contralat side

5. descending autonomics → ipsilat Horner's syndrome

6. spinothalamic tract (anterolat system) → contralat loss of P/T on body

6

medial medullary syndrome

Déjérine

usually related to vertebral a

 

lesion → symptom

1. hypoglossal nucleus & nerve fascicles → ipsilateral paralysis & fasciculations of tongue

2. pyramid/CST → contralat hemiparesis/hemiplegia

3. medial lemniscus → contralat loss of touch, vibration, position sense on body

7

lateral pontine syndrome

AICA infarct

  • sx vary depending on rostral-caudal level

 

lesion → symptom

1. middle cerebellar peduncle → ipsilateral ataxia, nystagmus

2. vestibular nuclei/nerve → vertigo, nystagmus, ataxia

3. auditory nerve → ipsilat deafness, tinnitus

4. spinal tract of V → ipsilateral loss of P/T on face

5. STT (anterolat system) → contralat loss of P/T on body

6. facial nucleus/nerve → ipsilat facial weakness, dysarthria

7. motor nucleus of V → jaw weakness, dysarthria

8. descending autonomics → ipsilat Horner's syndrome

 

8

medial pontine syndrome

lesion → symptom

1. CST/corticobulbar tract → contralat hemiparesis (body/face); dysarthria

2. pontine nuclei & pontocerebellar fibers → ataxia (usually contralat)

3. facial nerve fascicles → ipsilat facial weakness, dysarthria

4. PPRF; abducens nucleus/nerve → ipsilat horizontal gaze palsy, diplopia

5. medial lemniscus → contralat loss of touch, vibration, position sense

6. MLF → internuclear ophthalmoplegia (connection between III and VI interrupted)

9

relationship of STT and DCMLS in rostral midbrain

in region of superior colliculus, the two ascending sensory pathways become much closer to one another

(previously ascending in posteromedial portion and anterolateral portion of SC)

here, possible for one lesion to knock out fx to all sensory modalities

10

midbrain syndrome

midbrain base (Weber's syndrome)

usually involves posterior cerebral a

 

lesion → symptom

1. CST/corticobulbar tract → contralateral hemiparesis (body/face), dysarthria

2. oculomotor nerve & fascicles → ipsilat CN III palsy ("down and out")

11

midbrain syndrome

Benedikt

Weber + Claude = Benedikt syndrome

 

lesion → symptom

1. CST/corticobulbar tract → contralateral hemiparesis (body/face/tongue), dysarthria

2. oculomotor nerve & fascicles → ipsilat CN III palsy ("down and out")

3. red nucleus → contralat tremor and ataxia

4. medial lemniscus → contralat loss of position, vibration, discriminative touch

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