Brainstem Syndromes

Question 1

Lateral Medullary Syndrome

Answer 1

• @ medulla
• aka syndrome of PICA or Wallenberg
• alternating hemianalgesia: c/l hemianalgesia & i/l loss of p/T from face
• possible nystagmus, asynegia or hypotonia
• dest of solitary nucleus, nucleus ambiguus, CN XII and X

Question 2

CPA Syndrome

Answer 2

• @ medulla
• defness and vestibular disturbances
• bell’s palsy
• alternating hemianalgesia
• i/l cerebellar ataxia, intention tremor, dysmetria, and dysdiadochokinesia

Question 3

Benedikt’s Syndrome

Answer 3

• @ midbrain
• lesion of midbrain tegmentum
• ext stabismus, pupillar dilation, complete ptosis
• c/l loss of prop/ 2pt tact (body)
• i/l occulomotor palsy
• c/l motor dysfxn like tremor, ataxia, or choreiform movements

Question 4

Parinaud Syndrome

Answer 4

• lesion of sup colliculus
• paralysis of upward gaze
• cause: pineal tumor or varix of great v of galen
• post commisure destruction possible = loss of consensual light reflex

Question 5

Lesion of the Nucelus Ambiguus and the Spinal Lemniscus

Answer 5

• @ medulla
• dysphagia, dysarthria, hoarseness, paresis of i/l palate -
• c/l loss of p/T (body) - SL
• c/l prop/2pt tact hemianesthesia (body) - ML
• i/l anesthesia of palate and pharynx
• loss of tase from 1/2 tongue and pharynx (gag reflex)