Brainstem

Arnold-Chiari Phenomenon:

Congenital anomaly involving herniation of cerebellar tonsils and medulla oblongata through
the foramen magnum into the vertebral canal.

● Effects: Results in blockage of exits in the roof of the fourth ventricle, leading to internal
hydrocephalus.
● Association: Commonly associated with craniovertebral anomalies or various forms of
spina bifida.
● Symptoms: Signs and symptoms include pressure on the cerebellum and medulla
oblongata, as well as involvement of the last four cranial nerves.
● Complications: The blockage of cerebrospinal fluid flow contributes to the development
of internal hydrocephalus.
Medial Medullary Syndrome:

● Cause: Caused by thrombosis of the medullary branch of the vertebral artery.

● Medullary Tegmental Paralysis (Babinski-Nageotte Syndrome):
○ Cause: Results from a lesion at the pontomedullary junction involving both medial and
lateral structures.
○ Combination Syndromes: Combination of features from both medial and lateral
medullary syndromes.
● Pontine Hemorrhage:
○ Cause: Result of hemorrhage from the basilar artery, anterior, inferior, and superior
cerebellar arteries.
○ Symptoms:
■ Facial paralysis on the side of the lesion (facial nerve nucleus involvement and
lower motor neuron palsy).
■ Limb paralysis on the opposite side (damage to corticospinal fibers).
■ Paralysis of conjugate ocular deviation (abducens nerve nucleus and medial
longitudinal fasciculus involvement).
■ Possible pinpoint pupils (sympathetic fibers), bilateral paralysis of face and limb,
and potential poikilothermia.
● Weber Syndrome:

Produced by occlusion of a branch of the posterior cerebral artery supplying the midbrain.

○ Symptoms:
■ Ipsilateral ophthalmoplegia.
■ Contralateral paralysis of the lower part of face, tongue, arm, and leg.
■ Lateral deviation of the eyeball (paralysis of medial rectus muscle).
■ Ptosis (drooping of the upper lid), and dilated fixed pupil to light and
accommodation.
● Benedikt Syndrome:
○ Involvement: Involves brain necrosis affecting the medial lemniscus and red nucleus.
○ Symptoms:
■ Contralateral hemianesthesia.
■ Involuntary movements of the limbs on the opposite side.

● Alternating Hemiplegia:
○ Cause: Occurs when descending corticospinal fibers, cranial nerve nuclei, and nerve fibers
(abducens and facial nerves) are affected due to vascular occlusion.
○ Symptoms:
■ Contralateral hemiplegia.
■ Ipsilateral lower motor neuron paralysis of the cranial nerve.
■ Also known as crossed hemiplegia or alternating hemiplegia.