Stroke Syndromes

Question 1

What occurs with lesion to the red nucleus?

Answer 1

• loss of fine tuning of the movements

- > TREMOR AND ATAXIA

Question 2

What occurs with lesion to the Medial Longitudinal Fasciculus?

Answer 2

• Internuclear Ophthalmoplegia

problems with lateral gaze

Question 3

What occurs in Benedikt Syndrome?

Answer 3

• STROKE in the central midbrain

- —red nucleus/ CN3 and Medial leminiscus is affected#

Question 4

What does the medial leminiscus do?

Answer 4

• continuation of the Posterior column (relays info. on proprioception and vibration)

Question 5

What are the symptoms of Bendikt syndrome?

Answer 5

1. Down and Out eye+ Pupil dilation
2. C/L Loss of proprioception and vibration
3. Involuntary movements (TREMOR AND ATAXIA)

Question 6

What occurs in Weber’s Syndrome? What is affected?

Answer 6

• antero-lateral, Midbrain stroke

- —CN3/ corticobulbar/ corticospinal tracts are affected

Question 7

How does Weber’s syndrome present as?

Answer 7

• CN3 Palsy
• C/L hemiparesis
• pseudobulbar palsy

Question 8

How to confirm dx of pseudobulbar palsy?

Answer 8

1. Exaggerated GAG reflex and JAW reflex
2. Spastic tongue
3. Spastic dysarthria
   - —-UMN lesion signs

Question 9

What is affected in Perinaud’s Syndrome?

Answer 9

• posterior aspect of the Midbrain

- SUPERIOR COLLICULUS and the PRETECTAL area

Question 10

What are signs of Perinaud’s Syndrome?

Answer 10

1. Vertical Gaze Palsy

2. Pseudo Argyll Robertson Pupil

Question 11

What is Pseudo Argyll Robertson Pupil ?

Answer 11

• when the pupil does NOT constrict with LIGHT but it constricts with ACCOMMODATION

Question 12

What is said to cause Perinaud’s Syndrome?

Answer 12

• pineal tumor (Pinealoma/ Germinoma)

Question 13

What may occur with progressive pineal tumor growth?

Answer 13

• obstruction of the Cerebral Aqueduct

Question 14

Describe the course of CN7 leaving pons.

Answer 14

• does a “round-about” around CN6 and then leaves

Question 15

What is responsible for PAIN and T* sensation on the face? Where in the brain stem is it located?

Answer 15

• Spinal tract and the Nucleus Trigeminal

- — found in PONS

Question 16

What is PPRF responsible for?

Answer 16

• LATERAL gaze

paramedian pontine reticular formation

Question 17

Name 3 key fts in the PONS, repsonsible to look left or right. Where are they found?

Answer 17

• Abducens N.
• PPRF
• MLF
• —-close to each other in the midline of PONS

Question 18

What is affected in MEDIAL PONTINE $?

Answer 18

• CN 6
• CN 7
• Corticospinal tract
• —-and the lateral gaze structures

Question 19

What is seen with sx in medial pontine $?

Answer 19

• ipsilateral CN 6 PALSY: diplopia and lateral gaze palsy
• ipsilateral facial droop
• c/l hemiparesis
• -ipsilateral? gaze palsy

Question 20

What is affected in the LATERAL pontine syndrome?

Answer 20

• Vestibular Nucleus
• Spinothalamic tract
• Sympathetic tract
• Spinal V nucleus
• CN 7 palsy

Question 21

What signs seen in the Lateral Pontine syndrome?

Answer 21

1. nystagmus, N.V, vertigo
2. c/l pain and T* loss on limbs
3. HORNER’S syndrome (ipsilateral)
4. ipsilateral loss of facial pain/T*
5. ipsilateral FACIAL droop and LOSS of corneal reflex
6. ….deafness (if cochlea nucleus is damaged)

Question 22

Stroke involving which artery is resp. for LATERAL pontine syndrome?

Answer 22

• AICA

Anterior inferior Cerebellar artery

Question 23

What artery supplies the midbrain?

Answer 23

Posterior Cerebral Artery

Question 24

What does the dorsal MOTOR nucleus X and the Nucleus solitarius recieve?

Answer 24

Autonomic sensory info.

Question 25

What CNs are a.w Nucleus ambiguss?

Answer 25

CN 9, 10, 11

Question 26

What dick like structure runs in the centre of the medulla

Answer 26

- Medial Leminiscus

Question 27

Damage to what structure in the medulla results in the Horner's Syndrome?

Answer 27

Hypothalamospinal tract

Question 28

Which nucleus, that was seen in the pons, continues in the medulla?

Answer 28

-vestibular Nucleus

Question 29

What runs in the antero-medial aspect of the medulla? -

Answer 29

Corticospinal tract

Question 30

What occurs with Medial Medullary syndrome? Stroke in what artery results in this?

Answer 30

- stroke of the ANTERIOR SPINAL ARTERY | - ---affects the integrity of the Medial Leminiscus, corticospinal tract and CN 12

Question 31

HOw does the medial medullary syndrome present as?

Answer 31

- c/l hemiparesis - c/l loss of VIBRATION and Proprioception - flaccid paralysis of the TONGUE (deviates to one side)

Question 32

What is affected in the Lateral Medually syndrome?

Answer 32

``` Vestibular nucleus Spinothalamic Tract Sympathetic Tract Spinal V fibres Nucleus Ambiguss ```

Question 33

How would Lateral Medullary syndrome present as?

Answer 33

SAME as Lateral Pontine syndrome!! 1. Nystagmus, N.V, vertigo 2. C.L loss of PAIN and T* on the limbs 3. Ipsilateral loss of PAIN and T* on the FACE 4. Horner's Syndrome 5. d.t involvment of Nucleus Ambiguss, additional sx of HOARSENESS and DYSPHAGIA is seen.

Question 34

What causes the Lateral Medullary syndrome?

Answer 34

- stroke of the Posterior inferior Cerebellar artery

Question 35

What artery is involved in the Medial Pontine syndrome?

Answer 35

- Basilar Artery

Question 36

Name the 4 Midline columns running through the Brainstem.

Answer 36

- Motor nucleus - MLF - Medial leminiscus - Motor pathway

Question 37

Damage to the motor nucleus, results in what?

Answer 37

-ipsilateral MOTOR loss of CNs divisible by 12 | (3,4, 6,12) ----same CNs to run MEDIALLy through out the brainstem

Question 38

What are the side columns that run throughout the brainstem?

Answer 38

- spinothalamic tract - spinocerebellar tract - sensory nucleus (CN5) - Sympathetic tract

Question 39

What occurs with lesion to the Nucleus solitarius?

Answer 39

- Rostral portion of N.Solitarius= LOSS of TASTE in Ipsilateral tongue - Caudal portion of N.Solitarius-increase in HR