BRAINSTEM NATASHA HAMEED PGY 3 NEUROLOGY RESIDENT 8152017

BRAINSTEM NATASHA HAMEED PGY 3 NEUROLOGY RESIDENT 8/15/2017

CONTENT: • GROSS ANATOMY • BLOOD SUPPLY • CROSS SECTIONS & COMMON BRAINSTEM STROKE SYNDROMES • RULE OF 4’S FOR LOCALIZATION/LATERALIZATION

ANATOMY • Https: //www. youtube. com/watch? v=Mkj 78 h 8 w 4 a 8

BLOOD SUPPLY

SC A AICA

Vertebral artery

CROSS SECTIONS

MIDBRAIN:

MIDBRAIN STROKE Weber syndrome: Involves: 1. Occulomotor nerve fascicles 2. Cerebral penducle Symptoms: • Ipsilateral Occulomotor nerve palsy • Contralateral hemiparesis

MIDBRAIN STROKE Benedikt’s syndrome: Involves: 1. CN 3 nerve fascicles 2. Red nucleus Symptoms: • Ipsilateral Oculomotor nerve palsy • Contralateral hemi ataxia (Ataxia, tremor)

MIDBRAIN SYNDROME Parinaud syndrome: Involves: 1. Superior colliculus 2. Pretectal nucleus Symptoms: • Vertical gaze palsy • Pseudo argyl robertson pupil

PONS:

PONTINE STROKES Medial pontine stroke: Involved: 1. Facial nucleus 2. Abducents nucleus 3. Corticospinal/corticobulba r tracts Symtpms: 1. Ipsilatral facial weakness 2. Ipsilateral CN 6 palsy 3. Contralateral hemiparesis, Dysarthria

Lateral pontine stroke: PONTINE STROKES AICA Involved: 1. Vestibular nuclei 2. Cochlear nuclei 3. Spinal trigeminal nucleus 4. Facial nerve 5. Spinothalamic tract 6. Sympathetic tract 7. Middle cerebellar peduncle Symptoms: 1. n/v, nystagmus, vertigo 2. Ipsilateral Hearing loss 3. Ipsilateral loss of facial sensations 4. Ipsilateral facial weakness 5. Contralateral hemi sensory loss 6. Ipsilateral horners syndrome

MEDULLA:

MEDULLARY STROKE Medial medullary stroke: Involved: 1. Corticospinal tracts 2. Medial lemiscus 3. Hypoglossal nucleus Symptoms: • Contralateral hemiparesis • Contralateral loss of vibration/proprioception • Ipsilateral tongue weakness with deviation towards affected side

MEDULLARY STROKES: Lateral medullary sydrome: Involved: 1. Vestibular nuclei 2. Spinal trigeminal nucleus 3. Spinothalamic tract 4. Sympathetic tract 5. Inferior cerebellar peduncle 6. Nucleus ambiguus: horseness/dysphagia WALLENBURG SYBDROME

RULE OF 4’S

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