THE ROAD TO 250

DRUGS
BUG
COMPLICATIONS
 OTHER POINTS TO REMEMBER
Selective Media- Thayer Martin agar contains antibiotics that allow the
selective growth of Neisseria by inhibiting the growth of other sensitive
organisms.
Increased susceptibility to recurrent Neisseria infections with C5-C9 (MAC)
deficiencies.
Fitz-HughCurtis syndrome- Infection of the liver capsule and violin string
adhesions of peritoneum to liver.
QUESTION
CONCEPT
VASCULAR SYNDROMES OF THE
BRAIN
 BRAINSTEM
Rule of 4s
There are 4 structures in the Midline beginning with M.
There are 4 structures to the Side beginning with S.
There are 4 cranial nerves in the medulla, 4 in the pons and 4 above the pons (2
in the midbrain).
The 4 Motor nuclei that are in the Midline are those that divide equally into 12 (3,
4, 6 and 12)
The 4 Sensory nuclei 5, 7, 9 and 11 are in the lateral (SIDE) brainstem).
 THE 4 MEDIAL STRUCTURES AND
DEFECTS
The Motor pathway (corticospinal tract): contralateral weakness of the arm
and leg.
The Medial Lemniscus: contralateral loss of vibration and proprioception in
the arm and leg.
The Medial longitudinal fasciculus: ipsilateral internuclear ophthalmoplegia
(failure of adduction of the ipsilateral eye towards the nose and nystagmus
in the opposite eye as it looks laterally).
The Motor nucleus and nerve: ipsilateral loss of the cranial nerve that is
affected (3, 4, 6 or 12).
 THE 4 LATERAL (SIDE) STRUCTURES
AND DEFECTS
The Spinocerebellar pathways: ipsilateral ataxia of the arm and leg.
The Spinothalamic pathway: contralateral alteration of pain and
temperature affecting the arm, leg and rarely the trunk.
The Sensory nucleus of the 5th: ipsilateral alteration of pain and temperature
on the face in the distribution of the 5th cranial nerve (this nucleus is a long
vertical structure that extends in the lateral aspect of the pons down into the
medulla).
The Sympathetic pathway: ipsilateral Horner's syndrome, that is partial ptosis
and a small pupil (miosis).
CN III Oculomotor: impaired adduction, supraduction and infraduction of the
ipsilateral eye with or without a dilated pupil. The eye is turned out and slightly
down.

CN IV Trochlear: eye unable to look down when the eye is looking in towards
the nose.
CN V Trigeminal: ipsilateral alteration of pain, temperature and light touch on
the face back as far as the anterior two-thirds of the scalp and sparing the
angle of the jaw.

CN VI Abducent: ipsilateral weakness of abduction (lateral movement) of the

eye.

CN VII Facial: ipsilateral facial weakness.

CN VIII Auditory: ipsilateral deafness.

 LATERAL PONTINE SYNDROME

The Spinocerebellar pathways: ipsilateral ataxia of the arm and leg.

The Spinothalamic pathway: contralateral alteration of pain and temperature affecting the arm, leg and
rarely the trunk.
The Sensory nucleus of the 5th: ipsilateral alteration of pain and temperature on the face in the distribution
of the 5th cranial nerve (this nucleus is a long vertical structure that extends in the lateral aspect of the pons
down into the medulla).
The Sympathetic pathway: ipsilateral Horner's syndrome, that is partial ptosis and a small pupil (miosis).
CN V Trigeminal: ipsilateral alteration of pain, temperature and light touch on
the face back as far as the anterior two-thirds of the scalp and sparing the
angle of the jaw.

CN VII Facial: ipsilateral facial weakness.

CN VIII Auditory: ipsilateral deafness.

CN IX Glossopharyngeal: ipsilateral loss of pharyngeal sensation.

CN X Vagus: ipsilateral palatal weakness.

CN XI Spinal accessory: ipsilateral weakness of the trapezius and

sternocleidomastoid muscles.

CN XII Hypoglossal: ipsilateral weakness of the tongue

 MEDIAL MEDULLARY SYNDROME

The Motor pathway (corticospinal tract): contralateral weakness of the arm and leg.

The Medial Lemniscus: contralateral loss of vibration and proprioception in the arm and leg.

The Motor nucleus and nerve: ipsilateral loss of the cranial nerve 12.
CN XII Hypoglossal: ipsilateral weakness of the tongue
 LATERAL MEDULLARY SYNDROME

The Spinocerebellar pathways: ipsilateral ataxia of the arm and leg.

The Spinothalamic pathway: contralateral alteration of pain and temperature affecting the arm, leg and
rarely the trunk.
The Sensory nucleus of the 5th: ipsilateral alteration of pain and temperature on the face in the distribution
of the 5th cranial nerve (this nucleus is a long vertical structure that extends in the lateral aspect of the pons
down into the medulla).
The Sympathetic pathway: ipsilateral Horner's syndrome, that is partial ptosis and a small pupil (miosis).
CN IX Glossopharyngeal: ipsilateral loss of pharyngeal sensation.

CN X Vagus: ipsilateral palatal weakness.

CN XI Spinal accessory: ipsilateral weakness of the trapezius and

sternocleidomastoid muscles.
 QUESTIONS
A 65 year old women was brought to the ED by her husband after she
complained about numbness and drooping of her face. A neurological
exam showed loss of pain and temperature sensation on the right face and
the left body. A lesion causing these symptoms would be located in:
A. right postcentral gyrus
B. medial part of the medulla on the right
C. lateral part of the medulla on the right
D. right trigeminothalamic tract
E. lateral part of the pons on the right
 QUESTION
A 65 year old women was brought to the ED by her husband after she
complained about numbness and drooping on her face. A neurological
exam showed loss of pain and temperature sensation on the RIGHT face and
the LEFT body. A lesion causing these symptoms would be located in:
A. right postcentral gyrus
B. medial part of the medulla on the right
C. lateral part of the medulla on the right
D. right trigeminothalamic tract
E. lateral part of the pons on the right