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Brainstem vascular lesions (Medulla (Posterior inferior cerebellar artery/…
Brainstem vascular lesions
Medulla
Anterior spinal Syndrome
medial
Medial lemniscus/DC pathway
contralateral loss of tactile, vibration, propioceptive sensation
XII nerve
spastic paresis/
weakness
of tongue w/ deviation to lesion side
CST
contralateral spastic paresis
Posterior inferior cerebellar artery/ PICA: Wallenberg's sd
- lateral
SpTh
contralateral anesthesia - limbs and trunk
DHF
ipsilateral
Horner's
sd
CN X
- localizes section
ipsilateral palate, pharynx, larynx weakness
spinal nucleus and r of V
ipsilateral facial anesthesia
Vestibular nuclei
nystagmus away from lesion, vomiting, vertigo, +/- auditory problems
inferior cerebellar peduncle
ipsilateral ataxia
Pons
Paramedian branches of Basilar artery
- medial
CST, ML
:Fibers of VI
medial strabismus
AICA -
Lateral
SpTh, DHF, Spinal nucleus and tract of V, vestibular nuclei
Nucleus and fibers of the VII
ipsilateral Bell's Palsy
Cochlear nucleus/VIII fibers
ipsilateral sensorineural hearing loss
distinguish from a
Pontocerebellar angle sd
CN affected outside the brainstem
acoustic schwannoma (slow growing tumor)
starts with dizziness, nausea, vomiting, progressive ipsilateral loss of hearing
compression of the VII nerve fibers- ipsilateral bells palsy
V nerve compression:
ONLY INVOLVES CNs, ABSENCE OF LONG TRACTS SIGNS= OUTSIDE OF THE BS
Midbrain
Branches of PCA
-Weber's Syndrome - medial midbrain
CST
CN III fibers
ipsilateral external strabismus, pstosis, mydriasis
corticobulbar tract
contralateral spastic hemiparesis of lower face
Dorsal Midbrain - Parinaud Sd
Pineal gland tumor - compression
:warning: superior colliculi or pretectal region
paralysis of upward conjugated gaze
posterior commissure a/o pretectal
slightly supressed lpupilary ight reflex
cerebral aqueduct
noncommunicating hydrocephalus