Neurosurgery notes/Anatomy/Brainstem/Clinical conditions of the brainstem

Clinical conditions of the brainstem

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Parent item
Brainstem
Sub-item
Brainstem syndrome
Bulbar and Pseudobulbar Palsy
Eponym/Name
Site/Localization
Cranial Nerves (CN)
Tracts/Nuclei
Key Signs/Features
Supply
Weber
Medial Midbrain (Cerebral Peduncle)
III
Corticospinal tract
Ipsilateral CN III palsy (ptosis, mydriasis, eye down-and-out); Contralateral hemiplegia (UMN weakness).
P1 Posterior Cerebral Artery (PCA)
Claude
Midbrain Tegmentum (Red Nucleus)
III
Red nucleus, Superior cerebellar peduncle, Brachium conjunctivum
Ipsilateral CN III palsy; Contralateral cerebellar ataxia and tremor.
P1 Posterior Cerebral Artery (PCA)
Benedikt
Midbrain Tegmentum (Red Nucleus, III nucleus)
III
Red nucleus, Substantia nigra, III nucleus
Ipsilateral CN III palsy; Contralateral ataxia and involuntary movements (tremor, choreoathetosis).
P1 Posterior Cerebral Artery (PCA)
Nothnagel
Midbrain Tectum (Tectal Plate)
Unilateral or Bilateral III
Superior cerebellar peduncles
Oculomotor palsy; Ipsilateral cerebellar ataxia.
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Parinaud
Dorsal Midbrain (Tectum/Pretectal Area)
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Paralysis of upward gaze (supranuclear); Light-near dissociation; Retraction nystagmus.
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Raymond
Ventral Caudal Pons
VI
Corticospinal tract
Ipsilateral Abducens (CN VI) palsy; Contralateral hemiparesis/hemiplegia.
Basilar perforators
Millard-Gubler
Caudal Ventral Medial Pons
VI, VII (fascicles)
Corticospinal tract
Ipsilateral Abducens (CN VI) palsy and Facial (CN VII) palsy (LMN); Contralateral hemiparesis/hemiplegia.
Basilar perforators
Foville
Caudal Tegmental Medial Pons (PPRF)
VI nucleus, VII, PPRF
Corticospinal tract, Medial lemniscus, MLF
Ipsilateral gaze palsy (CN VI nucleus/PPRF) and Facial (CN VII) palsy; Contralateral hemiparesis.
Basilar perforators
Raymond-Cestan
Rostral Dorsal Pons
(PPRF and VI nucleus)
Spinothalamic, Medial lemniscus, Corticospinal tract
Ipsilateral gaze palsy; Contralateral loss of all sensory modalities; Ataxia.
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Marie-Foix
Lateral Caudal Pons
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Middle cerebellar peduncle, Corticospinal, Spinothalamic tracts
Ipsilateral cerebellar ataxia; Contralateral hemiparesis and pain/temperature loss.
Anterior Inferior Cerebellar Artery (AICA)
Wallenberg (Lateral Medullary)
Lateral Medulla
Spinal V, IX, X, XI
Lateral spinothalamic tract, Descending sympathetic fibers, Nucleus ambiguus, Vestibular nucleus
Ipsilateral Horner's syndrome, ataxia, dysphagia/dysarthria (CN IX/X/XI), and facial pain/temp loss (CN V); Contralateral body pain/temp loss.
Posterior Inferior Cerebellar Artery (PICA) or Vertebral Artery (VA)
Déjerine (Medial Medullary)
Medial Medulla
XII
Corticospinal (pyramid), Medial lemniscus
Ipsilateral tongue palsy (CN XII); Contralateral hemiparesis (pyramid) and proprioception/vibration loss.
Anterior Spinal Artery (ASA) / VA / Basilar Artery (BA)
Babinski-Nageotte (Hemimedullary)
Hemimedullary Infarct
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Combination of Wallenberg's and Déjerine's syndromes.
Vertebral Artery (VA) (proximal to PICA and spinal artery)
Locked-in syndrome
Bilateral Ventral Pons
Bilateral VI/VII weakness, Lower CN (for aphonia)
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Quadriplegia; Aphonia; Bilateral VI/VII weakness; Intact upgaze and blinking; Preserved consciousness.
Basilar perforators