Brainstem Vascular Lesions

medial blood supply of the midbrain

posterior cerebral artery

medial blood supply of the pons

Basilar artery and paramedian branches

lateral blood supply of the pons

anterior inferior cerebellar artery

medial blood supply of the medulla

posterior inferior cerebellar artery

lateral blood supply of the medulla

anterior spinal artery

midbrain syndrome affecting PICA

Weber syndrome (without RN involvement) or Benedikt syndrome (with RN involvement)

Weber syndrome presentation

CN III palsy

diplopia

dilation of ipsilateral pupil (if pre-para fibers from EW nucleus are affected

hemiparesis of contra Limbs with UMN signs

hemiparesis of contra lower mm. of facial expression

Benedikt syndrome presentation

CN III palsy

diplopia

dilation of ipsilateral pupil (if pre-para fibers from EW nucleus are affected

hemiparesis of contra Limbs with UMN signs

hemiparesis of contra lower mm. of facial expression

contralateral intention tremor and atazia

pontine syndrome affecting Basilar a. and paramedian branches

inferior medial pontine syndrome / foville syndrome

pontine syndrome affecting AICA

lateral pontine syndrome / AICA syndrome

Foville syndrome presentation

hemiparesis of contralateral limbs with UMN signs

ipsilateral facial palsy

contralateral touch and proprioception diminished

paresis of ipsilateral lateral rectus with internal strabismus

diplopia

lateral pontine syndrome presentation

paralysis of all ipsilateral mm of facial expression

diminished pain and temp sensation on ipsilateral face (CNV)

diminished pain and temp sensation on contra body (STT)

cerebellar ataxia, vertigo, nausea, nystagmus

Pontine syndrome affecting entire basilar artery

locked in syndrome

locked in syndrome presentation

bilateral sensory and motor signs with occasional CN V-VIII dysfunction

quadriplegia and bilateral corticobulbar signs

consciousness is preserved

medullary syndrome affecting anterior spinal a.

dejerine syndrome/ medial medullary syndrome

medullary syndrome affecting PICA

Wallenberg syndrome/ lateral medullary syndrome

4 structures at midline

motor pathways

motor nuclei

medial lemniscus

medial longitudinal fasciculus

4 lateral structures

spinothalamic tract, sensory nucleus (CN V), sympathetics, spinocerebellar tracts