nuclear and fascicular

function of the PPRF

control of horizontal eye movements

subnuclei of 3rd nerve

MR, SR, IR, IO, CCN, EWN

what does the central caudal nucleus CCN supply

both levators

what does the edinger westphal nucleus EWN supply

both pupils

what's important about the SR fibres

fibres cross under each other and pass through contralateral SR nuclei e.g. right subnuclei goes to left SR

fasicular

where fibres have left nucleus and travel within brainstem

red nucleus

coordination of movement

what does 1 nuclear lesion of 3rd cause

bilateral ptosis

bilateral SR u/a

3rd CNP with both dialated pupils - direct + consensual response

what features would you get to have a definite nuclear aetiology

unilateral 3rd CNP + contralateral SR palsy

what another feature would you get to have a definite nuclear aetiology

bilateral 3rd with no ptosis or pupil involvement

common nuclear aetiologies

stroke

inflammation

tumour

ischaemia

haemorrhage

brainstem compression

fasicular 3rd ipsilateral with lesion of:

cerebral peduncle

tegmentum

fibres for posture and coordination

weber's syndrome

- aetiology in cerebral peduncle

- get contralateral hemiparesis

3rd NP with ipsilateral lesion in area of red nucleus

ipsilateral hemitremor

benedict's syndrme

3rd nerve with ipsilateral hemitremor due to aetiology in red nucleus region

nothangel's syndrome

lesion in cerebellar peduncles - communicate motor function

- ipsilateral cerebellar ataxia - balance, gait issues

claude's syndrome

benedict and notangen's

superior cerebellar peduncle - posture and coordination

cerebellar peduncle

fibres for posture and coordination

red nucleus

motor control

common fasicular aetiology

ischaemia

haemorrhage

inflammation

compression

trauma

demyelination

4th nuclear-fasicular syndrome

almost impossible to distingusish due to short course of fasicile in midbrain

nuclear-fasicular syndrome

contralateral horner's (constricteD) e.g. right nuclear 4th + left horner's

one and a half syndrome

INO + horizontal gaze palsy

due to 6th and MLF affected

- get gaze palsy on one side, limited adduction to the other side

what OM are affected in a nuclear 6th

saccades

SP

VOR

raymond's syndrome

ipsilateral 6th with lesion in corticospinal tract - hemiplegia + 6th

corticospinal tract function

voluntary movement

millard gubler

6th + 7th nerve affected

millard gubler symptoms

hemiplegia and 7th NP

foxville's syndrome

6th + 5th + 7th + 8th

- numbness of face

- facial

- deafness

- horner's (constricted pupil)

moebius syndrome

congenital 6th NP due to chromosomal defect

moebius syndrome present with

facial nerve involvement - mask-like features

limb, muscular, cardiovascular anomalies

deafness

mental disability

moebius syndrome palsy

bilateral horizontal gaze palsy

6th aetiology

ischaemia

compression

inflammation

demyelination

infection

how to diagnose someone with nuclear/fasicular?

CNP with additional neurological signs

what neurological signs to look out for

balance

speech

gait

tremor

posture

pupils

facial and or limb paralysis