Brain Stem Flashcards
Medial medullary syndrome (4)
1) tongue deviates toward lesion - cn 12
2) opposite side weakness (med pyramid)
3) oppo vibration loss - med lemniscus
4) pain and temp spared dt spinothalmic lateral
5) upbeat nystagmus - mlf
6) if no tongue deviation - suggests more ant. Spinal infarct
7) cn5 spared dt being high up
Hemiplegia cruciata
Crossed motor hemiparesis
- lower medulla
- hits crossed arm and uncrossed leg
Patho of medial med syndrome
The infarction leads to death of the ipsilateral medullary pyramid, the medial leminiscus, and the hypoglossal nerve fibers that pass through the medulla. The spinothalamic tract is spared because it is located more laterally in the brainstem and is not supplied by the anterior spinal artery, but rather by the vertebral and posterior inferior cerebellar arteries. The trigeminal nucleus is also spared, since most of it is higher up in the pons, and the spinal part of it found in the medulla is lateral to the infarct.
Medial medullary syndrome
Dejerine (dez sure an)
Lateral medullary syndrome symptoms
Same side horners desc sympathetic fibers
Same sided face pain, numbness, no temp) -trigeminal nucleus
Same side orophargeal paralysis (dysphagia, dysarthria) - nucleus ambiguous (11,12)
Oppo hypalgesia - spinothalamic
Vertigo - vestibular nucleas
Hiccups - dl middle medulla
Diplopia - lower pons cn 6
Rostral lateral syndrome vs causal lateral syndrome
Rostral: Facial paralysis, severe dysphagia, hoarseness
- cn7,
Caudal: vertigo,gait ataxia
Triad of wallenberg
Ipsilateral Horner, ipsilateral ataxia, contralateral hypo algesia
Taste center
Nucleus tract of solitarius (rostral and lateral)
Sneezing center
Trigeminal nucleus
Clumsiness
Subolivary area
Wild arm ataxia
Lateral cuneate nucleus
Autonomic dysfunction
Nucleus tract of solitarius
Autonomic (reap, blood pressure)
Nucleus tractus of solitarius - medial caudal
Ondine’s curse
Nucleus ambiguous + reticular
Post stroke facial pain
Descending spinal trigemina
