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Brain stem lessions in sensory symptoms

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Brain stem lessions in sensory symptoms

  1. 1. HOW TOLOCALISEBRAIN STEMLESIONS WITHSENSORYSYMPTOMS????
  2. 2. THE CURIOUS CASE OF A62 YEAR OLD DRIVER… H/o sudden onset ofunsteadiness of gait,tendency to fallto right side C/o loss of sensation in the rt halfof face & left hemitorso,dysphagia. O/e partialptosis,enophthalmos, miosis of righteye.Cerebellar signs present
  3. 3. ANATOMY OF BRAIN STEM
  4. 4. LOCALISATIONOF THE LESIONIS BYOBSERVING THECOMPANY THEYKEEP…
  5. 5. A midbrainlesion: CN III: ptosis, dilatedpupil, eye down andout
  6. 6. A lesion of the pons: CN 6 or 7 (this is a LOWER motor neurone typelesion) : Horizontal gaze palsy : Unilateral facial numbness from CN 5 (results in CROSSED SENSORYLOSS) : Unilateral deafness
  7. 7. A lesion of themedulla: bulbar palsy: Unilateral facial numbness fromCN V Nystagmus : (Descending spinal tract andnucleus) medullo-pontine junction.
  8. 8. MEDIAL LESIONSMedial Lemniscus:contralateral loss of vibration andproprioception in the arm and legMedial longitudinal fasciculus:ipsilateral inter-nuclearophthalmoplegiaMotor cranial nerve nuclei
  9. 9. LATERAL LESIONSSensory pathways.Motor cranial nerve nuclei.Cerebellar peduncles. superior • Ataxic tremor middle • General clumsiness inferior • Motor adaptation impaired.
  10. 10. BACK TO THE CASE… ptosis
  11. 11. Cross section of
  12. 12. WALLENBERGSSYNDROME/ LATERALMEDULLARY SYNDROME
  13. 13. VENTRAL LESIONSDescending corticospinalpathwaysLOW MEDULLARY LESIONSBilaterl or ipsilateralweakness/sensory disturbance.Main pathways decussate at thislevel.
  14. 14. BALACLAVA HELMET DISTRIBUTIONTrigeminal sensoryfibres Back of face-descendmore More forward areasof face- descendshorter distance
  15. 15. MULTIPLE SCLEROSISResemble trigeminal neuralgiaCEREBELLAR INVOLVEMENTUnsteadiness of gaitIntention tremorNystagmus on attemptedlateral gaze
  16. 16. FALSE LOCALISATION SIGNSIncreased ICT – 6th CN palsyThird nerve palsy Tentorial herniation. Posterior communicatingartery aneurysm
  17. 17. Thank you!!!

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