Book contents
- Frontmatter
- Contents
- Preface
- List of abbreviations
- 1 Stroke in the emergency department
- 2 What to do first
- 3 Ischemic stroke
- 4 TPA protocol
- 5 Neurological deterioration in acute ischemic stroke
- 6 Ischemic stroke prevention: why we do the things we do
- 7 Transient ischemic attack (TIA)
- 8 Intracerebral hemorrhage (ICH)
- 9 Subarachnoid hemorrhage (SAH)
- 10 Organization of stroke care
- 11 Rehabilitation
- Appendix 1 Numbers and calculations
- Appendix 2 IV TPA dosing chart
- Appendix 3 Sample admission orders
- Appendix 4 Sample discharge summary
- Appendix 5 Stroke radiology
- Appendix 6 Transcranial Doppler ultrasound (TCD)
- Appendix 7 Heparin protocol
- Appendix 8 Insulin protocol
- Appendix 9 Medical complications
- Appendix 10 Brainstem syndromes
- Appendix 11 Cerebral arterial anatomy
- Appendix 12 Stroke in the young and less common stroke diagnoses
- Appendix 13 Brain death criteria
- Appendix 14 Neurological scales
- Recommended reading
- References
Appendix 10 - Brainstem syndromes
Published online by Cambridge University Press: 10 October 2009
- Frontmatter
- Contents
- Preface
- List of abbreviations
- 1 Stroke in the emergency department
- 2 What to do first
- 3 Ischemic stroke
- 4 TPA protocol
- 5 Neurological deterioration in acute ischemic stroke
- 6 Ischemic stroke prevention: why we do the things we do
- 7 Transient ischemic attack (TIA)
- 8 Intracerebral hemorrhage (ICH)
- 9 Subarachnoid hemorrhage (SAH)
- 10 Organization of stroke care
- 11 Rehabilitation
- Appendix 1 Numbers and calculations
- Appendix 2 IV TPA dosing chart
- Appendix 3 Sample admission orders
- Appendix 4 Sample discharge summary
- Appendix 5 Stroke radiology
- Appendix 6 Transcranial Doppler ultrasound (TCD)
- Appendix 7 Heparin protocol
- Appendix 8 Insulin protocol
- Appendix 9 Medical complications
- Appendix 10 Brainstem syndromes
- Appendix 11 Cerebral arterial anatomy
- Appendix 12 Stroke in the young and less common stroke diagnoses
- Appendix 13 Brain death criteria
- Appendix 14 Neurological scales
- Recommended reading
- References
Summary
The pattern of cranial nerve abnormalities is the key to distinguishing among these.
Lateral medullary syndrome
Also known as Wallenberg syndrome. The crossed sensory findings, i.e., loss of sensation on one side of the face and the other side of the body, are pathognomonic.
vertigo, nausea, diplopia
ipsilateral headache (descending spinal tract of the fifth cranial nerve, facial or eye pain)
ataxia, hiccups
contralateral body hemianalgesia (pain + temperature)
ipsilateral facial hemianalgesia (pain + temperature)
Horner's syndrome, nystagmus
ipsilateral palate, vocal cord weakness (nucleus ambiguus)
dysphagia
cerebellar findings
motor, tongue function, dorsal column function spared because these structures lie medially in the medulla
due to occlusion of the ipsilateral vertebral artery or its major branch, the posterior inferior cerebellar artery
Millard–Gubler syndrome
Ventrocaudal pons with CN VI and VII involvement
contralateral hemiplegia (pyramidal tract)
ipsilateral lateral rectus paresis (VI)
ipsilateral lower motor neuron (LMN) facial paresis (VII)
Foville syndrome
Dorsal caudal pontine lesion
contralateral body hemiplegia
ipsilateral LMN facial paresis (VII)
inability to move eyes to same side as lesion (parapontine reticular formation, CN VI)
Raymond–Cestan syndrome
Dorsal rostral pons
ataxia with coarse tremor
contralateral hemisensory loss (face + body, all modalities)
+/– contralateral hemiparesis
Marie–Foix syndrome
Lateral pons
ipsilateral cerebellar ataxia
contralateral hemiparesis
+/– contralateral hemisensory loss (pain and temperature) due to spinothalamic tract
Weber syndrome
Ventral midbrain
contralateral hemiplegia (corticospinal and corticobulbar tracts)
ipsilateral oculomotor paresis, dilated pupil
Benedikt syndrome
Midbrain tegmentum (red nucleus, CN III)
ipsilateral oculomotor paresis, dilated pupil
contralateral intention tremor, hemichorea, hemiathetosis
Claude's syndrome
Midbrain tegmentum
ipsilateral oculomotor paresis
contralateral cerebellar ataxia
Parinaud's syndrome
Dorsal midbrain (often with hydrocephalus, tumor)
upgaze paresis
convergence-retraction nystagmus on upgaze
large pupil with light-near dissociation, lid retraction, lid lag
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- Acute Stroke CareA Manual from the University of Texas - Houston Stroke Team, pp. 170 - 172Publisher: Cambridge University PressPrint publication year: 2007