Glossary of Brainstem Syndromes

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Created by alstoner

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Parinaud Syndrome
Compression of superior colliculus due to pineal gland tumor

*paralysis of upward gaze*

Lateral Medullary (Wallenberg's) Syndrome
Blockage of PICA - affects dorsal-lateral region of medulla

*contralateral loss of P&T from body (AL system)
*Ipsilateral loss of P&T from face (spinal trigeminal nucleus)
*Vertigo and nystagmus (vestibular nuclei)
*Loss of taste from ipsilateral half of tongue (nucleus solitarius)
*Horaseness and dysphagia (nucleus ambiguus.. CN IX, X)

Divergent strabismus
outward deviation of eye

*from imbalance of muscles innervated by CN III and superior oblique (CN IV) and lateral rectus (CN VI)

double vision
Drooping of eyelid
papillary dilation
Anterior Alternating Hemiplagia (Weber's Syndrome)
Lesion affects CN III and adjacent corticospinal fibers

*ipsilateral ophthalmoplegia (paralysis of eye)
*contralateral hemiparesis (descending fibers cross at pyramidal decussation)

*Paralysis of contralateral lower face and tonge...IF corticolbulbar fibers are also affected

Claude's Syndrome
Lesion that affects CN III and extends dorsally to include red nucleus (think motor control)

*Ipsilateral ophthalmoplegia (CN III)
*Contralateral hemiparesis (descending corticospinal tract)
*Contralateral paralysis of lower face and tongue (corticobulbar tract)
*Contralateral ataxia (rubrospinal tract)

Convergent strabismus
Eye directed inward

- due to unopposed action of medial rectus and inability to abduct eye (damage to CN VI)

Middle Alternating Hemiplegia
Lesion to CN IV and corticospinal tract

*Ipsilateral ophthalmoplegia (IV)
*contralateral hemiparesis (corticospinal tract)

If the corticobulbar fibers are involved - deficits would be contralateral to the side of the lesion
... at this level of the brainstem, those deficits would most likely be restricted to the tongue and trapezius.. as corticobulbar fibers to CN VII would already ahve terminated in the more dorsally located facial motor nucleus

Stapedius Reflex
Contraction or relaxation of stapedius muscle in response to damaging sounds

- from superior olivary nucleus

Bell's Palsy
Injury to LMN in motor nucleus of VII or damage to VII itself (herpes zoster in ear canal)

*Flaccid paralysis and atrophy of ipislateral upper and lower facial musculature
*Pain around ear
*Loss of corneal reflex
*Hyperacusis on affected side
*Loss of taste from anterior 2/3rds of tongue
*loss of input to platysma (difficulty shaving)
*Can't hold lips together, can't whistle
*Food stuck in cheek because no buccinator activation

Central facial paralysis (central seven paralysis)
Unilateral damage to motor cortex or descending corticobulbar fibers in the internal capsule and rostral brainstem

*Paralysis (no atrophy!) of contralateral lower face muscles
*NO functional deficits in upper face musculature

Inferior Alternating Hemiplegia
LMN damage to CN XII and adjacent corticospinal tract

*ipsilateral paralysis and deviation of tongue
*contralateral hemiparesis

Meniere's Disease
Abnormal endolymph volume = distention of membranous labyrinth

- vertigo, nystagmus, nausea, tinnitus (ringing of ears), unstable posture and gait

Swelling reduced with diuretic, low salt diet, shunt to drain excess fluid

constriction of iris due to parasympathetic innervation to constrictor muscle
loss of accomodation with age
farsightedness; distant objects focused behind retina.. corrected with a convex lens
neardisghtedness; distant objects focused infront of restina; corrected with concave lens
Asymmetric curvature of cornea

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