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BRAIN STEM, CEREBELLUM and NEURO-OPTHALMOLOGY Submitted to:- AskTheNeurologist.Com  in 2007
GROSS ANATOMY
LATERAL VIEW
LOCATION OF CRANIAL NERVE NUCLEI WITHIN BRAINSTEM
CRANIAL NERVE 5 Note that although all fibres enter the brainstem at the level of the pons, those concerned with pain and ...
PATHWAYS INVOLVED IN HORIZONTAL GAZE LEFT FRONTAL  EYE FIELD
INTERNUCLEAR OPTHALMOPLEGIA ( INO)
THE FACIAL NERVE
The Long Tracts Note sites of decussation of major tracts : Spinothalamic Cuneate / Gracile Corticospinal
Blood supply of Brainstem and Cerebellum <ul><li>Ant. cerebral </li></ul><ul><li>Internal carotid </li></ul><ul><li>Middle...
Somatotopy of cerebellum posterior <ul><li>Midline lesions: </li></ul><ul><ul><li>nystagmus </li></ul></ul><ul><ul><li>Tit...
Basic Plan of Cerebellar connections DN= Dentate nucleus T = Thalamus RN = Red nucleus Each cerebellar cortex controls ips...
DSCT= dorsal spinocerebellar tract VSCT= ventral spinocerebellar tract VSCT is crossed in the cord but crosses back within...
 
Which of the following patients cannot have MG? <ul><li>Right eye totally paralysed, left eye moves freely but with ptosis...
Anisocoria <ul><li>“  Inequality between the 2 pupils” </li></ul><ul><li>Pupils may be : </li></ul><ul><li>- equal ( to wi...
The 2 neurological causes of anisocoria <ul><li>One pupil too big </li></ul><ul><li>One pupil too small </li></ul>Parasymp...
Anisocoria rules <ul><li>Darkness exaggerates failure of dilation </li></ul><ul><li>Bright light exaggerates failure of co...
 
 
Sphincter pupillae muscle
Left  RAPD  AKA Marcus-Gunn pupil For example a patient with multiple sclerosis who is suffering from acute left sided opt...
Sphincter pupillae muscle
THE END The full lecture can now be accessed at AskTheNeurologist.Com ©
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Neurological Examination Part II:-Clinical Evaluation of the Brainstem and Cerebellum (full lecture on asktheneurologist.com)

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Clinical Evaluation of the Brainstem and Cerebellum

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Transcript of "Neurological Examination Part II:-Clinical Evaluation of the Brainstem and Cerebellum (full lecture on asktheneurologist.com)"

  1. 1. BRAIN STEM, CEREBELLUM and NEURO-OPTHALMOLOGY Submitted to:- AskTheNeurologist.Com in 2007
  2. 2. GROSS ANATOMY
  3. 3. LATERAL VIEW
  4. 4. LOCATION OF CRANIAL NERVE NUCLEI WITHIN BRAINSTEM
  5. 5. CRANIAL NERVE 5 Note that although all fibres enter the brainstem at the level of the pons, those concerned with pain and temperature descend as low as C3
  6. 6. PATHWAYS INVOLVED IN HORIZONTAL GAZE LEFT FRONTAL EYE FIELD
  7. 7. INTERNUCLEAR OPTHALMOPLEGIA ( INO)
  8. 8. THE FACIAL NERVE
  9. 9. The Long Tracts Note sites of decussation of major tracts : Spinothalamic Cuneate / Gracile Corticospinal
  10. 10. Blood supply of Brainstem and Cerebellum <ul><li>Ant. cerebral </li></ul><ul><li>Internal carotid </li></ul><ul><li>Middle cerebral </li></ul><ul><li>Post. communicating </li></ul><ul><li>Sup. cerebellar </li></ul><ul><li>Basilar </li></ul><ul><li>Ant. Inf. cerebellar </li></ul><ul><li>Vertebral </li></ul><ul><li>Ant. Spinal </li></ul><ul><li>Post. Spinal </li></ul><ul><li>Post. Inf. Cerebellar </li></ul><ul><li>Post cerebral </li></ul><ul><li>Mesencephalic </li></ul>
  11. 11. Somatotopy of cerebellum posterior <ul><li>Midline lesions: </li></ul><ul><ul><li>nystagmus </li></ul></ul><ul><ul><li>Titubation </li></ul></ul><ul><ul><li>Trunk / gait ataxia </li></ul></ul><ul><li>Hemispheric lesions: </li></ul><ul><ul><li>nystagmus </li></ul></ul><ul><ul><li>ipsilateral limb signs </li></ul></ul>
  12. 12. Basic Plan of Cerebellar connections DN= Dentate nucleus T = Thalamus RN = Red nucleus Each cerebellar cortex controls ipsilateral side of body Efferents to cortex leave cerebellum via superior cerebellar peduncle Note: red nucleus is present in midbrain and ultimately controls contralateral half of body
  13. 13. DSCT= dorsal spinocerebellar tract VSCT= ventral spinocerebellar tract VSCT is crossed in the cord but crosses back within cerebellum
  14. 15. Which of the following patients cannot have MG? <ul><li>Right eye totally paralysed, left eye moves freely but with ptosis </li></ul><ul><li>Inability of both eyes to move to left with no diplopia </li></ul><ul><li>Bilateral inability to look up with bilateral ptosis </li></ul><ul><li>Left eye deviated down and laterally with ptosis on left and left pupil larger than right </li></ul>
  15. 16. Anisocoria <ul><li>“ Inequality between the 2 pupils” </li></ul><ul><li>Pupils may be : </li></ul><ul><li>- equal ( to within 1mm) </li></ul><ul><li>- unequal due to surgery ( usually irregular) </li></ul><ul><li>- unequal due to neurological disease </li></ul>
  16. 17. The 2 neurological causes of anisocoria <ul><li>One pupil too big </li></ul><ul><li>One pupil too small </li></ul>Parasympathetic---------------------------------------Sympathetic Constricts (Ach) III Dilates (Nad) Symp fibres
  17. 18. Anisocoria rules <ul><li>Darkness exaggerates failure of dilation </li></ul><ul><li>Bright light exaggerates failure of constriction </li></ul><ul><li>If unilateral ptosis is present assume that the eye with the ptosis is sick! </li></ul>
  18. 21. Sphincter pupillae muscle
  19. 22. Left RAPD AKA Marcus-Gunn pupil For example a patient with multiple sclerosis who is suffering from acute left sided optic neuritis
  20. 23. Sphincter pupillae muscle
  21. 24. THE END The full lecture can now be accessed at AskTheNeurologist.Com ©
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