Brainstem stroke syndromes
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Brainstem stroke syndromes

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Brainstem stroke syndromes Brainstem stroke syndromes Presentation Transcript

  • BRAINSTEM STROKE SYNDROMES Dr. Piyush Ranjan Sahoo
  • LESIONS OF THE MEDULLA • Medial medullary syndrome • Lateral medullary syndrome
  • Medial Medullary Syndrome
  • Medial medullary syndrome (anterior spinal artery syndrome). Affected structures and resultant deficits include: • corticospinal tract medullary pyramid Lesions result in contralateral spastic hemiparesis. • medial lemniscus. Lesions result in contralateral loss of tactile and vibration sensation from the trunk and extremities. • hypoglossal nucleus or intraaxial root fibers [cranial nerve (CN) XII]. Lesions result in ipsilateral flaccid hemiparalysis of the tongue When protruded the tongue points to the side of the lesion (i.e., the weak side).
  • New Colleagues
  • Lateral Medullary syndrome
  • Lateral medullary syndrome or posterior inferior cerebellar artery (PICA) syndrome characterized by dissociated sensory loss Affected structures -- resultant deficits include: 1. vestibular nuclei Lesions result in nystagmus, nausea, vomiting, and vertigo. 2. inferior cerebellar peduncle Lesions result in ipsilateral cerebellar signs e.g., dystaxia, dysmetria (past pointing), dysdiadochokinesia].
  • 3. nucleus ambiguus of CN IX, CN X, and CN XI. Lesions result in · ipsilateral laryngeal, pharyngeal, and palatal hemiparalysis · i.e., loss of the gag reflex (efferent limb) dysphagia dysphonia (hoarseness)]. 4. glossopharyngeal nerve roots. ■ Lesions result in loss of the gag reflex (afferent limb). 5. Vagal nerve roots Lesions result in • same deficits as seen in lesions involving the nucleus ambiguus •
  • 6. SPINOTHALAMIC TRACTS LESIONS RESULT IN CONTRALATERAL LOSS OF PAIN AND TEMPERATURE SENSATION FROM THE TRUNK AND EXTREMITIES. 7. SPINAL TRIGEMINAL NUCLEUS AND TRACT • LESIONS RESULT IN IPSILATERAL LOSS OF PAIN AND TEMPERATURE SENSATION FROM THE FACE FACIAL HEMIANESTHESIA). 8. DESCENDING SYMPATHETIC TRACT. LESIONS RESULT IN IPSILATERAL HORNER'S SYNDROME ■ I.E., PTOSIS, MIOSIS • HEMIANHIDROSIS APPARENT ENOPHTHALMOS
  • Pontine Syndromes
  • Time Spent ProjectsWorkedOn
  • Medial inferior pontine syndrome • results from thrombosis of the para median branches of the basilar artery. Affected structures-- • Corticospinal tract Lesions result in contralateral spastic hemiparesis. • Medial lemniscus Lesions result in contralateral loss of tactile sensation from the trunk extremities. • Abducent nerve roots Lesions result in ipsilateral lateral rectus paralysis.
  • Lateral inferior pontine syndrome • anterior inferior cerebellar artery (AICA) syndrome Affected structures and resultant deficits include-- • facial nucleus and intraaxial nerve fibers Lesions result in: · Ipsilateral facial nerve paralysis · Ipsilateral loss of taste from the ant. 2/3 of tongue · Ipsilateral loss of lacrimation and reduced · salivation · Loss of corneal and stapedial reflexes (efferent limbs).
  • Discussion • Best practices • Take-aways
  • • Cochlear nuclei and intraaxial nerve fibers Lesions result in unilateral central deafness. • Vestibular nuclei and intraaxial nerve fibers Lesions result in nystagmus, nausea, vomiting and vertigo. • Spinal trigeminal nucleus and tract Lesions result in ipsilateral loss of pain and temperature sensation from the face (facial hemianesthesia). • Middle and inferior cerebellar peduncles Lesions result in ipsilateral limb and gait dystaxia. • Splnothalamic tracts (spinal lemniscus). Lesions result in contralateral loss of pain and temperature sensation from the trunk and extremities. • Descending sympathetic tract Lesions result in ipsilateral Homer's syndrome.
  • Medial longitudinal fasciculus (MLF) syndrome • internuclear ophthalmoplegia) interrupts fibers from the contralateral • abducent nucleus that projects through the MLF to the ipsilateral medial rectus • subnucleus of CN III causes- -medial rectus palsy on attempted lateral conjugate gaze and -nystagmus in the abducting eye. -Convergence remains intact. • This syndrome is often seen in patients with multiple sclerosis.
  • INTERNUCLEAR OPHTHALMOPLEGIA RESULTS FROM LESIONS IN THE MEDIAL LONGITUDINAL FASCICULUS CONNECTING THE IPSILATERAL CN VI AND THE CONTRALATERAL CN III NUCLEI
  • APPENDIX
  • Facial colliculus syndrome usually results from a pontine glioma or a vascular accident • internal genu of CN VII • nucleus of CN VI underlie the facial colliculus. • Lesions of the internal genu of the facial nerve cause: -Ipsilateral facial paralysis -Ipsilateral loss of the corneal reflex • Lesions of the abducent nucleus cause: -Lateral rectus paralysis -Medial (convergent) strabismus -Horizontal diplopia
  • LESIONS OF THE MIDBRAIN Dr. Piyush Ranjan Sahoo
  • Dorsal midbrain (Parinaud's) syndrome often the result of a • pinealoma or germinoma of the pineal region. Affected structures and resultant deficits include:- • superior colliculus and pretectal area Lesions cause -paralysis of upward and downward gaze -pupillary disturbances(Pseudo-Argyll Robertson pupils) -absence of convergence(Convergence- Retraction nystagmus on Attempts at upward gaze) • cerebral aqueduct -Compression causes noncommunicating hydrocephalus.
  • Paramedian midbrain (Benedikt) syndrome • oculomotor nerve roots (intraaxial fibers). Lesions cause -complete ipsilateral oculomotor paralysis -Eye abduction and depression • caused by intact lateral rectus (CN VI) and superior oblique (CN IV) muscles Ptosis -paralysis of the levator palpebra muscle) and -fixation and dilation of the ipsilateral pupil -complete internal ophthalmoplegia) also occur. • dentatothalamic fibers Lesions cause -contralateral cerebellar dystaxia with intention tremor. • medial lemniscus Lesions result in -contralateral loss of tactile sensation from the trunk and extremities.
  • Medial midbrain (Weber) syndrome Affected structures and resultant deficits include: • Oculomotor nerve roots (intraaxial fibers). Lesions cause- -complete ipsilateral oculomotor paralysis -Eye abduction and depression caused by intact lateral rectus (CN VI) and superior oblique (CN IV) muscles. -Ptosis and fixation -dilation of the ipsilateral pupil also occur. • corticospinal tracts Lesions result in contralateral spastic hemiparesis.
  • Contd… • corticobulbar fibers Lesions cause -contralateral weakness of · lower face (CN VII) · tongue (CN XII) · palate (CN X) upper face division of the facial nucleus receives bilateral corticobulbar input, uvula and • pharyngeal wall pulled toward the normal side (CN • X), protruded tongue points to the weak side.