4. Medial medullary syndrome (anterior
spinal artery syndrome). Affected structures
and resultant deficits include:
• corticospinal tract
medullary pyramid Lesions result in
contralateral spastic hemiparesis.
• medial lemniscus.
Lesions result in
contralateral loss of tactile and
vibration sensation from the trunk
and extremities.
• hypoglossal nucleus or intraaxial root fibers [cranial nerve (CN)
XII].
Lesions result in ipsilateral flaccid hemiparalysis of
the tongue
When protruded
the tongue points to the side of the lesion (i.e.,
the weak side).
7. Lateral medullary syndrome or posterior
inferior cerebellar artery (PICA) syndrome
characterized by
dissociated sensory loss
Affected structures -- resultant deficits include:
1. vestibular nuclei
Lesions result in
nystagmus, nausea, vomiting, and vertigo.
2. inferior cerebellar peduncle Lesions
result in ipsilateral cerebellar signs
e.g., dystaxia, dysmetria (past
pointing), dysdiadochokinesia].
8. 3. nucleus ambiguus of CN IX, CN X, and CN XI.
Lesions result in
· ipsilateral laryngeal, pharyngeal, and
palatal hemiparalysis
· i.e., loss of the gag reflex (efferent limb)
dysphagia
dysphonia (hoarseness)].
4. glossopharyngeal nerve roots.
■ Lesions result in
loss of the gag reflex (afferent limb).
5. Vagal nerve roots
Lesions result in
• same deficits as seen in lesions
involving the nucleus ambiguus
•
9. 6. SPINOTHALAMIC TRACTS
LESIONS RESULT IN
CONTRALATERAL LOSS OF PAIN AND
TEMPERATURE SENSATION
FROM THE TRUNK AND EXTREMITIES.
7. SPINAL TRIGEMINAL NUCLEUS AND TRACT
• LESIONS RESULT IN
IPSILATERAL LOSS OF PAIN AND TEMPERATURE
SENSATION FROM THE FACE
FACIAL HEMIANESTHESIA).
8. DESCENDING SYMPATHETIC TRACT. LESIONS RESULT IN
IPSILATERAL HORNER'S SYNDROME
■ I.E., PTOSIS, MIOSIS
• HEMIANHIDROSIS
APPARENT ENOPHTHALMOS
13. Medial inferior pontine syndrome
• results from thrombosis of the para median branches
of the basilar artery. Affected structures--
• Corticospinal tract
Lesions result in
contralateral spastic hemiparesis.
• Medial lemniscus
Lesions result in
contralateral loss of tactile sensation from the trunk
extremities.
• Abducent nerve roots
Lesions result in
ipsilateral lateral rectus paralysis.
14. Lateral inferior pontine syndrome
• anterior inferior cerebellar artery (AICA) syndrome
Affected structures and resultant deficits include--
• facial nucleus and intraaxial nerve fibers
Lesions result in:
· Ipsilateral facial nerve paralysis
· Ipsilateral loss of taste from the ant. 2/3 of tongue
· Ipsilateral loss of lacrimation and reduced
· salivation
· Loss of corneal and stapedial reflexes
(efferent limbs).
17. • Cochlear nuclei and intraaxial nerve fibers
Lesions result in unilateral central deafness.
• Vestibular nuclei and intraaxial nerve fibers
Lesions result in
nystagmus, nausea, vomiting and vertigo.
• Spinal trigeminal nucleus and tract
Lesions result in
ipsilateral loss of pain and temperature sensation from the face (facial
hemianesthesia).
• Middle and inferior cerebellar peduncles
Lesions result in
ipsilateral limb and gait dystaxia.
• Splnothalamic tracts (spinal lemniscus).
Lesions result in
contralateral loss of pain and temperature sensation from the trunk
and extremities.
• Descending sympathetic tract
Lesions result in ipsilateral Homer's syndrome.
18. Medial longitudinal fasciculus (MLF) syndrome
• internuclear ophthalmoplegia)
interrupts fibers from the contralateral
• abducent nucleus
that projects through the MLF to the ipsilateral
medial rectus
• subnucleus of CN III
causes-
-medial rectus palsy on attempted lateral conjugate
gaze and
-nystagmus in the abducting eye.
-Convergence remains intact.
• This syndrome is often seen in patients with
multiple sclerosis.
21. Facial colliculus syndrome
usually results from a pontine glioma
or
a vascular accident
• internal genu of CN VII
• nucleus of CN VI underlie the facial colliculus.
• Lesions of the internal genu of the facial nerve cause:
-Ipsilateral facial paralysis
-Ipsilateral loss of the corneal reflex
• Lesions of the abducent nucleus cause:
-Lateral rectus paralysis
-Medial (convergent) strabismus
-Horizontal diplopia
23. Dorsal midbrain (Parinaud's)
syndrome
often the result of a
• pinealoma or germinoma of the pineal region.
Affected structures and resultant deficits include:-
• superior colliculus and pretectal area
Lesions cause
-paralysis of upward and downward gaze
-pupillary disturbances(Pseudo-Argyll Robertson pupils)
-absence of convergence(Convergence-
Retraction nystagmus on Attempts at upward gaze)
• cerebral aqueduct
-Compression causes noncommunicating hydrocephalus.
24. Paramedian midbrain (Benedikt)
syndrome
• oculomotor nerve roots (intraaxial fibers).
Lesions cause
-complete ipsilateral oculomotor paralysis
-Eye abduction and depression
• caused by
intact lateral rectus (CN VI) and superior oblique (CN IV) muscles Ptosis
-paralysis of the levator palpebra muscle) and
-fixation and dilation of the ipsilateral pupil
-complete internal ophthalmoplegia) also occur.
• dentatothalamic fibers
Lesions cause
-contralateral cerebellar dystaxia with intention tremor.
• medial lemniscus
Lesions result in
-contralateral loss of tactile sensation from the trunk and extremities.
25. Medial midbrain (Weber) syndrome
Affected structures and resultant deficits include:
• Oculomotor nerve roots (intraaxial fibers).
Lesions cause-
-complete ipsilateral oculomotor paralysis
-Eye abduction and depression
caused by intact lateral rectus (CN VI) and superior
oblique (CN IV) muscles.
-Ptosis and fixation
-dilation of the ipsilateral pupil also occur.
• corticospinal tracts
Lesions result in
contralateral spastic hemiparesis.
26. Contd…
• corticobulbar fibers
Lesions cause
-contralateral weakness of
· lower face (CN VII)
· tongue (CN XII)
· palate (CN X)
upper face division of the facial nucleus receives
bilateral corticobulbar input, uvula and
• pharyngeal wall pulled toward the normal side (CN
• X), protruded tongue points to the weak side.
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