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Human Structural Biology: - Localizing & Analyzing Brainstem Lesions By: Dr. Dennis Ivan Bravo
Human Structural Biology: - Localizing & Analyzing Brainstem Lesions By: Dr. Dennis Ivan Bravo
LEARNING OBJECTIVES
You are expected to
1. Localize brainstem lesion based on patient’s signs
and symptoms.
2. Explain signs/symptoms of brainstem lesions
based on neurologic structures affected.
LECTURE OUTLINE
• Review of brainstem structures: The Rule of Four
• Functions and deficits of brainstem structures
• Cases: Localizing brainstem lesion
4 CN in PONS SIGN/SYMPTOM of
DEFICIT
CN 5 Ipsilateral facial sensory
Trigeminal loss
CN 6 Ipsilateral eye abduction
Abducent weakness
CN 7 Ipsilateral facial
Facial weakness
CN 8 Ipsilateral deafness
Auditory
RULE OF FOUR*
RULE OF FOUR
“Pathways and tracts pass through the entire
length of the brainstem and can be likened to
‘meridians of longitude’ whereas the various
cranial nerves can be regarded as ‘parallels of
latitude’.
If you establish where the meridians of
longitude and parallels of latitude intersect,
then you have established the site of the
lesion.
*Gates, P. The rule of 4 of the brainstem: a simplified
method for understanding anatomy and brainstem
vascular syndromes for the non-neurologist. Internal
Medicine Journal 2005: 35: 263-266
REVIEW!!!
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