11.03.2017 Views

DR Medhat MRCP

You also want an ePaper? Increase the reach of your titles

YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.

Medial pontine syndrome<br />

- e.g occlusion of pontine (paramedian) branchs of basilar artery.<br />

• Features :<br />

Pontine<br />

Effect of lesion<br />

structure<br />

A. Tracts Motor ( ) tract Contralateral spastic hemiparesis (UMNL)<br />

Sensory (medial<br />

lemniscus = Gracil +<br />

cuneate tracts)<br />

Contralateral loss of proprioceptions<br />

(deep sensations) & fine touch.<br />

B. Cranial<br />

nerves<br />

Abducence (VI)<br />

Ipsilateral lateral rectus paralysis →<br />

diplopia & inability to look outwards<br />

سؤال مهم Lateral medullary syndrome<br />

(=Wallenberg`s syndrome)<br />

- Occurs following occlusion of the posterior inferior cerebellar artery (branch of<br />

vertebral artery) resulting in sensory and sympathetic disturbances<br />

Lateral<br />

Effect of lesion<br />

medullary<br />

structure<br />

A. Tracts Motor (pyramidal)tract ± Contralateral spastic paraparesis<br />

Sensory (lateral Contralateral loss of pain & temp.<br />

spinothalamic tract)<br />

Descending<br />

Ipsilateral Horner syndrome.<br />

sympathetic fibers<br />

B. Cranial Spinal trigeminal Ipsilateral loss of pain & temp from face<br />

nerves sensory nucleus (V)<br />

Vestibular nuclei (VIII) Vomiting , vertigo , nystagmus<br />

Nucleus ambiguous (Cr<br />

9 &Cr 10)<br />

Ipsilateral bulbar palsy (LMNL)<br />

- Dysphagia<br />

- Dysarthria<br />

- Dysphonia ,hoarseness of voice<br />

- Nasal regurge<br />

- Loss of palatal/pharengeal reflex<br />

C. Inferior<br />

cerebellar<br />

peduncle<br />

Ipsilateral cerebellar signs :<br />

- Ataxia<br />

- Nystagmus<br />

- Dysdiadokokinesis.<br />

65

Hooray! Your file is uploaded and ready to be published.

Saved successfully!

Ooh no, something went wrong!