BRAINSTEM SYNDROMES

Level Nuclei

Midbrain III, IV, mesencephalic V

V (principle sensory nucleus)

Pons
V (motor nucleus)
Caudal pons VI, VII

VIII (vestibular nuclei and ventral & dorsal cochlear nuclei)

Ponto-medullary
Superior salivatory nucleus (parasympathetic of VII)
junction
Inferior salivatory nucleus (parasympathetic of IX)

N. of the tract of the V

N. ambiguus (motor for IX, X, XI)
Medulla N. tractus solitarius (GSA for IX, X and SVA for VII, IX, X)
Dorsal motor nucleus of X (parasympathetic for X)
XII

Cervical cord XI (motor for the spinal root-cranial root is from n. ambiguus)
 -
Weber’s syndrome
(superior alternating hemiplegia)

• Due to occlusion of a branch of the posterior

->

cerebral artery that supplies the midbrain

-

↳
 ↓

cortrobulbur
⑧ controspinal
I

damaged
tracts
-

&
↓
damage
• Contralateral hemiparesis (corticospinal tract)

• Central type facial paralysis and genioglossus paralysis

-
on the contralateral side (corticonuclear fibers)
--
-

-
&
-

• Oculomotor nerve damage >

– Paralysis of the muscles innervated by the oculomotor nerve

(eyeball is deviated laterally and downward - horizontal
-
diplopia)
– Ptosis (paralysis of the levator palpebra superioris muscle)
– Dilated pupil and loss of ipsilateral pupillary light reflex and
the accomodation reflex.
 Benedikt’s syndrome

• Due to occlusion of a branch of the posterior

=>

cerebral artery that supplies the midbrain

-
 branches
penetrating
damaged.
name

occulorator
damagech
&
&
• Ipsilateral oculomotor nerve damage
• Contralateral involuntary limb movements due
to the damage to the red nucleus (some authors
suggest that this is due to the damage to
substantia nigra)
• According to the extent of the of the lesion
medial lemniscus may be involved, therefore,
causing the loss of kinesthesis and tactile
E
>

discrimination on the contralateral side

-
-

·
 Middle alternating hemiplegia

•
0
Vascular lesion at the lower half of the pons
->

• Due to occlusion of branches of the basilar

-
artery
- -

-
 section
lower
pans

o
damage.
-
• Damage of the sixth nerve cause paralysis of lateral
-

rectus muscle, and the eye is medially deviated

-

• Involvement of the corticospinal fibers will lead to

-

contralateral hemiparesis
-

• According to the extend of lesion medial lemniscus

-

and -
anteraolateral system may be involved causing
-
contralateral loss of all sensations
-
 Medial medullary syndrome
(inferior alternating hemiplegia)

• Due to the thrombosis of the medullary branch

of the vertebral artery
• Contralateral hemiparesis (corticospinal tract)

• Loss of kinesthesis and tactile discrimination (medial

lemniscus)

• Ipsilateral paralysis of tongue muscles (hypoglossal

nerve)
– Deviation of the tongue to the paralyzed side when
protruded
 Lateral medullary syndrome
(Wallenberg syndrome)

• Due to the thrombosis of posterior inferior

cerebellar artery (PICA) which is a branch of
the vertebral artery
• Contralateral loss of pain and temperature (spinothalamic
tract)
• Analgesia and thermoanesthesia on the ipsilateral side of the
face (nucleus and spinal tract of the trigeminal nerve)
• Dysphagia and dysarthria due to the paralysis of ipsilateral
palatal and larynx muscles (nucleus ambiguus)
• Nausea, vomiting, vertigo and nystagmus (vestibular nuclei)
• Ipsilateral Horner syndrome - myosis, ptosis,enophthalmos,
vasodilatation of skin arterioles (increased temperature) and
loss of sweating - (descending sympathetic fibers)
• Ipsilateral cerebellar signs - gait and limb ataxia - (inferior
cerebellar peduncle)
• Accordingly with the extent of the lesion nucleus of tractus
solitarius and cochlear nuclei could also be affected