The document discusses various cranial nerve lesion syndromes and midbrain/pontine syndromes. It provides details on: - Weber syndrome which involves CN III palsy and contralateral hemiparesis from a midbrain lesion. - Trigeminal neuralgia symptoms and treatment including carbamazepine. Common causes are vascular compression or MS. - Presenting symptoms of cerebellopontine angle tumors such as acoustic neuromas including hearing loss, tinnitus, facial weakness.

1. Lesion syndromes of III
(oculomotor), IV (trochlear),
VI (abducens) cranial nerves

9. Midbrain syndromes: Weber syndrome
• Are involved
-the descending corticospinal and
corticobulbar fibers in the cerebral
peduncle, and
-the fibers of the third nerve that
traverse the peduncle on exiting the
midbrain.
• On the opposite side:
hemiparesis
• On the lesion‘s side: third nerve
palsy (ptosis, inability to move
the eye up, down or medially,
and pupillary dilatation (if fibers
from the Edinger-Westphal
nucleus are involved)

19. Lesion syndromes of II (optic)
cranial nerve

23. OD
OS

24. OS OD

25. OS OD

26. OS OD

27. OS OD

28. OS OD

30. Lesion syndromes of V (trigeminal)
and VII (facial) cranial nerves

32. Trigeminal neuralgia
Pathogenesis of trigeminal
neuralgia
Uncertain
-Traumatic compression of the
trigeminal nerve by vascular
anomalies or neoplastic
(cerebellopontine angle tumor)
-Infection agents
• Human herpes simplex virus
(HSV)
-Demyelinating conditions
• Multiple sclerosis

34. Trigeminal neuralgia symptoms may
include one or more of these patterns
• Episodes of severe, shooting or jabbing pain that may feel like an
electric shock
• Spontaneous attacks of pain or attacks triggered by things such as
touching the face, chewing, speaking or brushing teeth
• Bouts of pain lasting from a few seconds to several minutes
• Episodes of several attacks lasting days, weeks, months or longer —
some people have periods when they experience no pain
• Constant aching, burning feeling that may occur before it evolves into
the spasm-like pain of trigeminal neuralgia
• Pain in areas supplied by the trigeminal nerve, including the cheek, jaw,
teeth, gums, lips, or less often the eye and forehead
• Pain affecting one side of the face at a time, though may rarely affect
both sides of the face
• Pain focused in one spot or spread in a wider pattern
• Attacks that become more frequent and intense over time

35. Treatment
Surgical approach
Charbamazepine

45. Pontine syndromes

52. Possible lesions of cerebellopontine
angle

53. Presenting symptoms of CPA tumors (including
acoustic neuromas) include the following:
• Hearing loss - 95%
• Tinnitus - 80%
• Vertigo/unsteadiness - 50-75%
• Headache - 25%
• Facial hypesthesia (can occur facial weakness) -
35-50%
• Diplopia - 10%

54. • The patient complains about severe shooting
pains in the lower jaw on the right. Pains have
been worrying for three years, occur daily,
paroxysmal by nature, provoked by cold. The
paroxysm lasts from a few seconds to 1
minute. Assuming the dental reason for the
pain, the patient had sanitized all her teeth,
but the seizures have been continuing. There
are no changes of the neurological status out
of attack. What is the most likely diagnosis
and etiology

55. The patient has a weakness of all the facial
muscles on the right. On examination: lowering
of the right angle of the mouth, absense of the
right nasolabial and forehead folds, inability to
close the right eyelids completely, Bell's
symptom. There is lacrimation of his right eye,
loss taste in the front 2/3 of the right half his
tongue, hyperacusia.

56. The patient is evaluated due to weakness in the
left extremities, which appeared for 30 minutes
during blood pressure increasing to 220/110
mm Hg. Art. The neurological examination
shows lower facial weakness on the left ,
weakness in the left extremities, increasing of
the deep tendon reflexes on the left, positive
Babinsky sign on the left.

57. The patient is evaluated for a hearing loss in his
right ear, which began two years ago and have
become progressively worse. Over the past year she
has had an unstable gait. On examination: loss of all
types sensation in the right side of her face; right-
side facial weakness (lower and upper parts);
hearing loss in his right ear, intentional tremor in
the right limbs during performing finger-nose-finger
and heel-knee tests, positive Romberg's test (falls to
the right), deviation to the right while walking.
Name the localization of the lesion

58. The patient has the palsy of all right his facial
muscles, lowered right angle his mouth, absence his
right nasolabial and forehead's folds, right-side
lagophthalmos, double vision during looking into
the right, convergent strabismus on the right.
Muscle power is reduced in his left limbs. His deep
tendon reflexes are +3 on the left and there is left-
side Babinski sign.
Name neurological syndrome and localization of
the lesion

59. • The patient has ptosis, divergent strabismus
and absence pupil reaction to light on the
right, absence any movements in the left
limbs, increasing of deep tendon reflexes and
Babinski sign on the left.
Name neurological syndrome and localization of
the lesion

60. • The patient has the right-side facial palsy:
lowered right angle his mouth, absence his
right nasolabial and forehead's folds, right-
side lagophthalmos. There is decreasing
muscle power in his left limbs, increasing of
deep tendon reflexes on the left and positive
left-side Babinski sign.
Name neurological syndrome and localization of
the lesion