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Brainstem Strokes
Brainstem Strokes
Brainstem:
Midbrain
Pons
Medulla oblongata
The brainstem at the cranocervical junction continues with the spinal cord.
Motor fibres enter via the cerebral peduncles (brain sections mickey mouse ears cerebral peduncles at level of midbrain)
Note: bleeds don’t respect vascular territories but if there is an infarct it will be a small area & can
have a good prognosis unless it’s the basilar artery then we are in trouble.
You are not dead until your brainstem is dead seat of life. Even if your heart is beating.
Blood supply:
Vertebro- basilar system
Lateral aspect of:
Medulla PICA
Pons AICA
Midbrain SCA (superior cerebellar artery)
Medical aspect supplied by circumferential
Major structures Oh oh oh to touch and feel very good Midbrain:
found in brainstem: Lateral aspect Medial aspect of virgins after hours III
1. Cranial nerve of brainstem brainstem Olfactory (S) IV
Spinothalamic - Motor
nuclei Sympathetic nuclei all Optic (S)
2. Spinothalamic Sensory motor nuclei Oculomotor (M) Pons
tract cranial n lie medially Trochlear (M) V
nuclei
3. Corticospinal Trigeminal (B) VI
corticospinal
tract
tract Abducent (M) VII
4. Sympathetic Facial (B)
fibres Vestibulocochlear (S) Pontomedullary junction VIII
5. Lemnisci Glossopharyngeal (B)
Vagus (B) Medulla:
Accessory (M) IX
X
Hyoglossus (M)
XII
Some say marry money, but my
brother says big boobs matter most
CN IX/XX CN IX/X:
if you are having only abducent Hoarse
nerve issues this is a false localising voice
sign. (this could just be due to raised Dysarthria
ICP) Dysphagia
You have to have abducent nerve Ipsilateral
issue+ contralateral weakness for it to CN IXX/X
be a stroke in the brainstem. Paralysis
Difficult to Vertical diplopia
WE DO NOT EXPCECT STROKES TO localize (skew deviation)
CROSS VASCULAR BOUNDRIES!!
(unless it’s the basilar artery) CN VIII/ Vertigo, n/v
peduncle
Locked in syndrome:
Here the lesion is crossing both the
corticospinal tracts so person gets
quadriplegia.
It will also involve the bulbar
muscles locked in syndrome
Hyponatraemia corrected too
quickly
2ndary to:
Central pontine myelinolysis
Glioma
Tuberculoma
Notes made by the aid of Neurology Handbook- University of Pretoria & Professor Kakaza lecture slides