Intro to Nuclear and Fascicular CNP

What does internuclear mean?

between nuclei

What does supranuclear mean?

anything before the brainstem

What is a fascicle?

moved away from the nucleus but not yet left the brainstem

Where is the nucleus of the 3rd nerve?

midbrain at the level of the superior colliculus

What are the 4 paired sub nuclei of the 3rd nerve?

MR, SR, IR, IO

What does the central caudate nucleus supply?

both levators

What does the Edinger-Westphal supply?

both pupils

What do the SR fibres of the 3rd do?

cross and pass through both sub-nuclei

Where does the fascicle of the 3rd travel?

cross the MLF, traverses the red nucleus

What is the clinical relevance of having only one CCN?

bilateral ptosis

What is the clinical relevance of SRs crossing?

bilateral SR underactions

What is the clinical relevance of having only one Edinger-Westphal nucleus?

both pupils affected

What things mean it must be a nuclear 3rd?

unilateral 3rd and contralateral SR palsy

bilateral 3rd with no ptosis or pupil involvement

What may indicate a nuclear 3rd?

bilateral 3rd including bilateral ptosis

bilateral ptosis

isolated IO or IR palsy

What are common nuclear aetiologies for the 3rd?

ischaemia

haemorrhage

tumour

inflammation

compression

Name some 3rd fascicular syndromes?

Weber syndrome

Benedicts syndrome

Nothnagels syndrome

Claudes syndrome

Where is the lesion in Weber’s syndrome?

cerebral peduncle

What are the symptoms of Weber’s syndrome?

3rd and contralateral hemiparesis of lower face and tongue

Where is the lesion in Benedict’s syndrome?

red nucleus

What are the symptoms of Benedict’s syndrome?

3rd and ipsilateral hemitremour

Where is the lesion in Nothnagel’s syndrome?

cerebellar peduncle

What are the symptoms of Nothnagel’s syndrome?

3rd and ipsilateral cerebellar ataxia

What is cerebella ataxia?

unable to co-ordinate balance and gait

What is Claude’s syndrome?

Benedict’s + Nothnagels

Where is the lesion in Claude’s syndrome?

superior cerebellar peduncle and red nucleus

What are the symptoms of Claude’s syndrome?

3rd and ipsilateral cerebella ataxia and ipsilateral hemitremour

What are some fascicular aetiologies for the 3rd?

ischaemia

haemorrhage

inflammation

compression

trauma

demyelination

Where is the nucleus of the 4th?

midbrain at the level of the inferior colliculus

Why is it so hard to distinguish between nuclear and fascicular 4th?

because the fascicle is so short

Name some aetiologies of 4th nuclear-fascicular syndrome

trauma

ischaemia

tumours vascular malformation

inflammation

demyelination

What is a symptom of 4th nuclear-fascicular syndrome?

contralateral Horners pupil (miosis)

Where is the 6th nucleus?

pons, floor of the 4th ventricle

What is in the 6th nucleus?

motor neurones for ipsilateral 6th

internuclear neurones for contralateral MR subnucleus

What is the 6th fascicle near?

facial nerve fascicle

motor nucleus of V

central tegmental tract

corticospinal tract

What are some signs of a nuclear 6th?

horizontal gaze palsy

ipsilateral conjugate horizontal gaze palsy

ipsilateral horizontal gaze palsy with ipsilateral 7th facial nerve fascicle

Name some nuclear 6th conditions

one and a half syndrome

What is one and a half syndrome?

gaze palsy to one side, limited adduction to the other

Where is the lesion in a one and a half syndrome?

nuclear 6th and MLF

Name some fascicular 6th problems

Raymonds syndrome

millard gubler syndrome

fovilles syndrome

moibus syndrome

Where is the lesion in Raymonds syndrome?

corticospinal tract

What are the symptoms of Raymonds syndrome?

6th and hemiplegia

Where is the lesion in Millard Gubler syndrome?

corticospinal tract and 7th nerve fascicle

What are the symptoms of Millard Gubler syndrome?

hemiplegia and 7th nerve palsy

What are the symptoms of Foibles syndrome?

6th

ipsilateral horizontal conjugate gaze palsy, ipsilateral 5, 7 and 8

Horner’s pupil

What is Moibus syndrome?

type of congenital 6th - chromosomal defect

What are the features of Moibus syndrome?

facial nerve involvement - mask like features

bilateral horizontal gaze palsy

limb, muscular and cardiovascular anomalies, deafness, mental disability

What are some aetiologies of fascicular 6th?

ischaemia

compression

inflammation

demyelination

infection

What are the signs of a CNP being nuclear or fascicular?

non-isolated CNP

other neurological signs

What neurological signs might indicate a nuclear/fascicular CNP?

balance

speech

gait

tremour

posture

pupils

facial

paralysis