Brainstem Syndromes
Terms
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- Parinaud Syndrome
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Compression of superior colliculus due to pineal gland tumor
*paralysis of upward gaze* - Lateral Medullary (Wallenberg's) Syndrome
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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
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outward deviation of eye
*from imbalance of muscles innervated by CN III and superior oblique (CN IV) and lateral rectus (CN VI) - Diplopia
- double vision
- Ptosis
- Drooping of eyelid
- Mydriasis
- papillary dilation
- Anterior Alternating Hemiplagia (Weber's Syndrome)
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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
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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
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Eye directed inward
- due to unopposed action of medial rectus and inability to abduct eye (damage to CN VI) - Middle Alternating Hemiplegia
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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
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Contraction or relaxation of stapedius muscle in response to damaging sounds
- from superior olivary nucleus - Bell's Palsy
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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)
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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
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LMN damage to CN XII and adjacent corticospinal tract
*ipsilateral paralysis and deviation of tongue
*contralateral hemiparesis - Meniere's Disease
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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 - Miosis
- constriction of iris due to parasympathetic innervation to constrictor muscle
- Presbyopia
- loss of accomodation with age
- Hyperopia
- farsightedness; distant objects focused behind retina.. corrected with a convex lens
- Myopia
- neardisghtedness; distant objects focused infront of restina; corrected with concave lens
- Astigmatism
- Asymmetric curvature of cornea