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Brain StemBrain Stem
Anterior ViewAnterior View Posterior ViewPosterior View
Adducent7 & 8th
12
9,10,115
3
4
Facial colliculus
Striae Medullare
Medulla OblongataMedulla Oblongata Nuclei in the medulla are Nuclei in the medulla are
associated w/ autonomic associated w/ autonomic control, cranial nerves, and control, cranial nerves, and motor/sensory relay.motor/sensory relay.
Autonomic nuclei:Autonomic nuclei: Cardiovascular centersCardiovascular centers
Cardioinhibitory/cardioacceleratory Cardioinhibitory/cardioacceleratory centers alter the rate and force of centers alter the rate and force of cardiac contractionscardiac contractions
Vasomotor center alters the tone Vasomotor center alters the tone of vascular smooth muscleof vascular smooth muscle
Respiratory rhythmicity centersRespiratory rhythmicity centers Receive input from the ponsReceive input from the pons
Additional CentersAdditional Centers Emesis, deglutition, coughing, Emesis, deglutition, coughing,
hiccupping, and sneezinghiccupping, and sneezing
Medullary syndromesMedullary syndromes
MedialMedial Lateral medullary syndromesLateral medullary syndromes
Medial Medullary SyndromeMedial Medullary Syndrome
Cranial NervesCranial Nerves Tongue Paralysis -Tongue Paralysis -
Hypoglossal NerveHypoglossal Nerve Motor PathwaysMotor Pathways
Contralateral Spastic Contralateral Spastic Paralysis -- Pyramids Paralysis -- Pyramids
Sensory PathwaysSensory Pathways Contralateral loss Contralateral loss
Fine Touch and Fine Touch and Proprioception -- Proprioception -- Medial LemniscusMedial Lemniscus
Alternating Alternating hemiplegiahemiplegia
HypoglossalHypoglossalPalsyPalsy
Lower Motor Lower Motor NeuronNeuron
SyndromeSyndrome
HypoglossalHypoglossalPalsyPalsy
Lower Motor Lower Motor NeuronNeuron
SyndromeSyndrome Deviation of Tongue to affected sideDeviation of Tongue to affected side
Atrophy of Tongue MusclesAtrophy of Tongue Muscles
Lateral medullary syndromeLateral medullary syndrome(Wallenberg's syndrome)(Wallenberg's syndrome)
This is the commonest of the brain This is the commonest of the brain stem strokes. Involvement of the stem strokes. Involvement of the spinothalamic tract results in spinothalamic tract results in contralateral loss of pain and contralateral loss of pain and temperature sensation below the temperature sensation below the neck. neck.
Involvement of the descending Involvement of the descending nucleus and tract of V results in loss nucleus and tract of V results in loss of pain and temperature sensation of pain and temperature sensation on the face ipsilateral to the lesion.on the face ipsilateral to the lesion.
Lateral medullary syndromeLateral medullary syndrome
Involvement of descending autonomic Involvement of descending autonomic fibers results in an ipsilateral Horner's fibers results in an ipsilateral Horner's syndrome (ptosis, meiosis, and syndrome (ptosis, meiosis, and anhidrosis). Involvement of the nucleus anhidrosis). Involvement of the nucleus ambiguus causes palatal weakness and ambiguus causes palatal weakness and dysphagia.dysphagia.
Involvement of the inferior cerebellar Involvement of the inferior cerebellar peduncle (restiform body) causes peduncle (restiform body) causes ipsilateral ataxia. ipsilateral ataxia.
Alternating hemianaesthesiaAlternating hemianaesthesia
Pontine syndromesPontine syndromesMedial pontine SyndromeMedial pontine Syndrome
Structures AssociatedStructures Associated CSTCST Medial lemniscusMedial lemniscus 6th nerve fibers6th nerve fibers 77thth nerve fibres nerve fibres
SignSign Contralateral spastic Contralateral spastic
hemiparesis of the bodyhemiparesis of the body Contralateral loss of Contralateral loss of
position and vibration of position and vibration of the bodythe body
Medial strabismusMedial strabismus Raymond's SyndromeRaymond's Syndrome
Alternating abducent Alternating abducent hemiplegiahemiplegia
Miller-gubler syndromeMiller-gubler syndrome Alternating Facial Alternating Facial
hemiplegia.hemiplegia.
Lateral pontine syndromeLateral pontine syndrome
StructureStructure ICPICP Spinal 5Spinal 5 Spinothalamic Spinothalamic Fibers of 7Fibers of 7 Fibers of 8Fibers of 8
SignSign Ipsilateral limb ataxiaIpsilateral limb ataxia Ipsilateral pain and Ipsilateral pain and
temp loss - Facetemp loss - Face Contralateral pain and Contralateral pain and
temp-Bodytemp-Body Horner’s syndrome Horner’s syndrome
(Ipsilateral)(Ipsilateral) Hearing lossHearing loss Ipsilateral facial Ipsilateral facial
paralysisparalysis
Ventromedial Superior Midbrain Ventromedial Superior Midbrain SyndromeSyndrome
(Weber’s Syndrome)(Weber’s Syndrome) ContralateralContralateral
paralysis of face, arm and legparalysis of face, arm and leg IpsilateralIpsilateral
III palsy (fascicular)III palsy (fascicular) ArteryArtery
paramedian perforators of terminal basilar, paramedian perforators of terminal basilar, oror
peduncular perforating branches of peduncular perforating branches of posterior cerebral arteryposterior cerebral artery
Paracentral (Tegmental) Superior Paracentral (Tegmental) Superior Midbrain SyndromesMidbrain Syndromes
(Claude’s and Benedikt’s (Claude’s and Benedikt’s syndromes)syndromes)
ContralateralContralateral ataxia with tremor (red nucleus) ± ataxia with tremor (red nucleus) ±
hemichorea hemichorea (subthalamic nucleus)(subthalamic nucleus)
IpsilateralIpsilateral III fascicular palsyIII fascicular palsy
ArteryArtery paramedian perforators of terminal basilar, paramedian perforators of terminal basilar,
or or interpeduncular branches of Posterior interpeduncular branches of Posterior
Cerebral ArteryCerebral Artery
Dorsal Superior Midbrain Dorsal Superior Midbrain SyndromeSyndrome
(Parinaud’s, of Sylvian (Parinaud’s, of Sylvian Aqueduct)Aqueduct)
Paralysis of upgaze ± convergenceParalysis of upgaze ± convergence Light/near dissociationLight/near dissociation Eyelid retractionEyelid retraction Convergence/retraction nystagmusConvergence/retraction nystagmus ArteryArtery - posterior choroidal/quadrigeminal- posterior choroidal/quadrigeminal (Note - usually (Note - usually notnot vascular) vascular)
““Top of the Basilar” SyndromeTop of the Basilar” Syndrome
Usually due to embolic occlusionUsually due to embolic occlusion Posterior Cerebral Artery cortical territory Posterior Cerebral Artery cortical territory
infarction (unilateral or bilateral)infarction (unilateral or bilateral) hemianopia/cortical blindnesshemianopia/cortical blindness amnesiaamnesia
Basilar/Posterior Cerebral Artery Basilar/Posterior Cerebral Artery thalamic/midbrain territory infarctionthalamic/midbrain territory infarction impairment of ocular movements (e.g. skew impairment of ocular movements (e.g. skew
deviation, vertical gaze palsies)deviation, vertical gaze palsies) pupillary abnormalities (various)pupillary abnormalities (various)