Neurology Quiz: Brainstem Syndromes

Medial Medullary Syndrome

• Location: Middle region of the medulla oblongata
• Cause: Vertebral artery damage
• Symptoms:
  • Contralateral hemiparesis (difficulty or inability to move) due to corticospinal/pyramidal tract damage
  • Contralateral loss of tactile discrimination, vibration, fine touch, proprioception etc. due to dorsal column medial lemniscus damage
  • Ipsilateral paralysis of tongue and tongue deviation to the paralyzed side due to hypoglossal nerve damage

Weber Syndrome

• Location: Front region of the midbrain
• Cause: Posterior cerebral artery (branch of Basilar artery) damage
• Symptoms:
  • Ipsilateral ophthalmoplegia, eyeball deviated towards the right due to medial rectus muscle paralysis, ptosis (drooping eyelid) due to levator palpebrae superioris muscle paralysis due to oculomotor nerve damage
  • Light accommodation reflex gone due to Edinger-Westphal nucleus damage

Benedict Syndrome

• Location: Middle region of the midbrain
• Cause: Posterior cerebral artery (branch of Basilar artery) damage
• Symptoms:
  • Contralateral hemianesthesia (loss of sensation) due to medial lemniscus damage
  • Contralateral involuntary limb movements due to red nucleus damage

Cerebellar Disease

• Location: Cerebellum
• Cause: Damage to any area of the cerebellum
• Symptoms:
  • Hypotonia (decreased muscle tone)
  • Change in posture and gait
  • Ataxia (disturbance of voluntary movement)
  • Dysdiadochokinesia (inability to perform rapidly alternating movements)
  • Disturbances of reflexes
  • Nystagmus (involuntary rapid eye movements)
  • Dysarthria (difficulty speaking)

Types of Cerebellar Syndromes

• Vermis Syndrome: Symptoms mainly seen in the trunk and head
• Cerebellar Hemisphere Syndrome: Symptoms mainly seen in the limbs and phonation (articulating speech)

Aphasia

• Types:
  • Expressive Aphasia (Broca's Aphasia): Damage to Broca’s motor speech area, loss of ability to speak
  • Receptive Aphasia (Wernicke’s Aphasia): Damage to Wernicke’s sensory speech area, loss of ability to understand speech
  • Global Aphasia: Both expressive and receptive aphasia together, both Wernicke and Broca areas damaged

Schizophrenic

• Symptoms:
  • Disordered thinking
  • Emotional withdrawal
  • Blunted affect (lack of emotional expression)
  • Paranoid delusions
  • Auditory hallucinations

Kluver-Bucy Syndrome

• Location: Amygdaloid complex
• Cause: Destruction of the amygdaloid complex
• Symptoms:
  • Decreased anger
  • Decreased fear
  • Decreased restlessness
  • Increased appetite
  • Increased sexual activity

Basal Nuclei Disorders

• Types:
  • Hyperkinetic (Excessive abnormal movements):
    • Chorea (involuntary jerky movements)
    • Athetosis (slow, writhing movements)
    • Ballismus (violent, flinging movements)
    • Parkinsonism (tremors, rigidity, slow movements)
  • Hypokinetic (Lack or slowness of movements):
    • Parkinsonism (tremors, rigidity, slow movements)

Headaches:

• Meningeal Headache: Damage to the dura mater causing referred pain along the trigeminal nerve
• Cerebral Tumor Headache: Stretching of the dura matter
• Migraine Headache: Multiple reasons causing dilation and constrictions of cerebral arteries
• Alcoholic Headache: Toxic effect on the meninges
• Diseases of Teeth, Eye or Sinus Headache: Referred pain by the trigeminal nerve

Hydrocephalus

• Location: Skull
• Cause: Increased CSF volume and pressure in the skull due to overproduction, reduced drainage, or blockage
• Types:
  • Communicating Hydrocephalus: No obstruction present, CSF circulates freely through the ventricles and subarachnoid space
  • Non-communicating Hydrocephalus: Obstruction present which prevents circulation between ventricles and the subarachnoid space

Lumbar Puncture

• Location: Between L4-L5 vertebrae
• Structures Pierced:
  • Skin
  • Superficial fascia
  • Deep fascia
  • Vertebral ligaments
  • Dura matter
  • Subdural space
  • Arachnoid matter

Cerebral Artery Syndrome

• Cause: Damage to the named areas, which causes infarction (death) of the corresponding brain tissue
• Anterior Cerebral Artery:
  • Lobe: Paracentral Lobe
  • Symptom: Contralateral hemiparesis (difficulty or inability to move) and hemisensory loss (loss of sensation) of the leg and foot
• Middle Cerebral Artery:
  • Lobe: Precentral, postcentral, and frontal lobe
  • Symptom: Contralateral hemiparesis and hemisensory loss of the arms and face
• Posterior Cerebral Artery:
  • Lobe: Occipital Lobe
  • Symptom: Contralateral homonymous hemianopia (loss of half of the visual field in both eyes on the same side)
• Internal Carotid Artery:
  • Lobe: Anterior part of the cerebrum
  • Symptom: Symptoms of middle cerebral artery and anterior cerebral artery
• Vertebrobasilar Artery:
  • Lobe: Brainstem and occipital lobe
  • Symptom: Medial and Lateral Medullary syndromes, Benedict and Weber syndromes

Extracranial Hemorrhage

• Types:
  • Epidural Hemorrhage
  • Subdural Hemorrhage
  • Subarachnoid Hemorrhage
  • Cerebral Hemorrhage

Epidural Hemorrhage

• Location: Between periosteal and meningeal layer of the dura matter
• Vessel: Anterior branch of middle meningeal artery
• Cause: Blunt trauma
• Symptoms: Lucid interval (temporary recovery of consciousness followed by loss of consciousness), progressively increasing intervals of unconsciousness

Subdural Hemorrhage

• Location: Between dura matter and arachnoid matter
• Vessel: Cerebral/bridging vein
• Cause: Elderly people moving their head suddenly
• Symptoms: Varies

Subarachnoid Hemorrhage

• Location: Between arachnoid matter and pia matter
• Vessel: Circle of Willis
• Cause: Hypertension
• Symptoms: Severe and sudden headache

Cerebral Hemorrhage

• Location: Within the cerebrum
• Vessel: Capillaries of the cerebrum
• Cause: Hypertension
• Symptoms: Depends on the location of the hemorrhage

Test your knowledge on medial medullary, Weber, and Benedict syndromes in this quiz. Explore the causes, symptoms, and affected regions of the brainstem for each syndrome. Perfect for students and professionals in the field of neuroscience and neurology.