Brainstem Syndromes

What are the four rules of four?

1. There are 4 midline structures that begin with the letter M
2. There are 4 lateral structures that begin with the letter S
3. There are 4 cranial nerves below the pons, 4 in the pons, and 4 above the pons
4. There are 4 midline cranial nerve motor nucl

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What are the four medial structures that start with M?

Motor tract (corticospinal tract), medial lemniscus, medial longitudinal fasciculus, four CN motor nuclei

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What are the four lateral structures that start with S?

Spinothalamic tract, spinocerebellar tract, sensory nucleus of CN V, sympathetic pathway

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What are the four medial motor CN nuclei?

3, 4, 6 and 12

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What does the spinothalamic tract do? If it's damaged, is the contra or ipsilateral side of the body affected?

Carries information about pain and temperature from the body. Contralateral.

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What does the spinocerebellar tract do? If it's damaged, is the contra or ipsilateral side of the body affected?

Subconscious proprioception (connects spinal cord and cerebellum). Loss of this tract causes ipsilateral ataxia

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What does the corticospinal tract do? If it's damaged, is the contra or ipsilateral side of the body affected?

Carries motor signals. Contralateral

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What does the dorsal column medial lemniscus pathway do? If the medial lemniscus is damaged, is the contra or ipsilateral side of the body affected?

Carries fine touch, conscious proprioception, vibration. Contralateral

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What does the medial longitudinal fasciculus do?

Co-ordinates eye movements

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What structures are affected in lateral medullary syndrome?

1) the four S structures; spinothalamic tract, spinocerebellar, sensory nucleus of CN V, sympathetic pathway to ipsilateral eye
2) CN IX (glossopharyngeal)
and X (vagus)
3) vestibular nucleus

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Which artery is usually affected in lateral medullary syndrome?

PICA (posterior inferior cerebellar artery). "Never pick a (PICA) horse (hoarseness) that can't eat (dysphagia)”

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What structures are affected in medial medullary syndrome?

1) Medial M structures: motor (corticospinal) tract, medial lemniscus, medial longitudinal fasciculus
2) CN XII nucleus

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Which artery is usually affected in medial medullary syndrome?

anterior spinal artery or vertebral artery

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What structures are affected in lateral pontine syndrome?

1) the four S structures; spinothalamic tract, spinocerebellar, sensory nucleus of CN V, sympathetic pathway to ipsilateral eye
2) CN VII (facial)
3) vestibular nucleus

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Which artery is usually affected in lateral pontine syndrome?

Anterior inferior cerebellar artery. ("Facial droop means AICA is pooped“)

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What structures are affected in medial pontine syndrome?

1) Medial M structures: motor (corticospinal) tract, medial lemniscus, medial longitudinal fasciculus
2) CN VI (abducens)

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Which artery is usually affected in medial pontine syndrome?

Paramedian branches of basilar artery

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What structures are affected in lateral midbrain syndrome?

1) Oculomotor nerve -> ipsilateral eye down & out with dilation and unresponsive pupil
2) Red nucleus -> ataxia of contralateral body
3) Dentatorubrothalamic tract -> tremor

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Which artery is usually affected in lateral midbrain syndrome?

Penetrating branches of posterior cerebral artery

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What structures are affected in medial midbrain syndrome?

1) Oculomotor nerve -> ipsilateral eye down and out with dilation & unresponsive pupil
2) Corticobulbar tract -> weakness of contralateral face
3) Corticospinal tract -> weakness of the contralateral arm and leg

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Which artery is usually affected in medial midbrain syndrome?

Posterior cerebral artery

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Brainstem Syndromes

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