Medicine Marrow Pg No 697-702 (Neurology)
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Questions and Answers

Which structure is associated with the abducens nerve?

  • Abducens Nucleus (correct)
  • Medial Vestibular Nucleus
  • Cochlear Nucleus
  • Facial Nucleus

    • The Lateral Pons receives its blood supply mainly from the Anterior Inferior Cerebellar Artery (AICA).

    True

    What clinical feature is associated with Millard-Gubler Syndrome?

    1/L LMN Facial Nerve Palsy

    The _____ nucleus is involved in the control of balance and spatial orientation in the pons.

    <p>Lateral Vestibular</p> Signup and view all the answers

    Match the syndromes with their corresponding features:

    <p>Millard-Gubler Syndrome = 1/L LMN Facial Nerve Palsy Raymond Syndrome = 1/L Sixth Nerve Palsy + C/L Hemiplegia Ventral Lesion = 1/L LMN Basal Pons Lesion = Sixth Nerve Palsy</p> Signup and view all the answers

    What is a characteristic feature of brachial diplegia?

    <p>Weakness of both arms</p> Signup and view all the answers

    Avellis syndrome is characterized by weakness in both arms.

    <p>False</p> Signup and view all the answers

    What is the primary site of lesion in cruciate paralysis?

    <p>Rostral portion of pyramidal decussation</p> Signup and view all the answers

    In Jackson syndrome, the primary clinical feature is I/L LMN ______ CN Palsy.

    <p>XII</p> Signup and view all the answers

    Match the syndromes with their characteristics:

    <p>Avellis Syndrome = I/L LMN X CN palsy, C/L pain and temperature loss Jackson Syndrome = I/L LMN XII CN Palsy</p> Signup and view all the answers

    Which clinical feature is associated with Foville Syndrome in a dorsal brainstem stroke?

    <p>1/L LMN Facial Nerve palsy</p> Signup and view all the answers

    Dizziness is one of the 5 D's associated with posterior stroke presentations.

    <p>True</p> Signup and view all the answers

    What is a key clinical feature of Locked-in Syndrome?

    <p>Quadriplegia</p> Signup and view all the answers

    A patient experiencing 1/L Ataxia due to a Lateral Pons stroke likely has __________ syndrome.

    <p>Marie-Foix</p> Signup and view all the answers

    Match the type of brainstem stroke with its associated features:

    <p>Locked-in Syndrome = Bilateral extensive Pontine infarction Top of Basilar Occlusion = Absent visual/occulomotor functions Dorsal Stroke = Foville Syndrome Posterior Stroke = 5 D's: Dizziness, Dysarthria, Dysphagia, Diplopia, Dystaxia</p> Signup and view all the answers

    What is the primary goal of thrombolysis in stroke management?

    <p>To achieve recanalisation/reperfusion</p> Signup and view all the answers

    Immediate management includes administering a CT scan if the onset of stroke is known.

    <p>True</p> Signup and view all the answers

    What medication is used for thrombolysis within 4.5 hours of symptom onset?

    <p>Alteplase or Tenecteplase</p> Signup and view all the answers

    When BP is greater than / mmHg, it must be corrected before thrombolysis.

    <p>185/110</p> Signup and view all the answers

    Match the contraindications to thrombolysis with their descriptions:

    <p>Age &gt;80 years = Increased risk of hemorrhage due to age CT hypodensity &gt;1/3rd = Indicates significant ischemic damage Intra axial neoplasm = Presence of brain tumor Aortic dissection = Risk of blood vessel compromise</p> Signup and view all the answers

    Which medication is primarily used for anticoagulation in patients with valvular atrial fibrillation?

    <p>Warfarin</p> Signup and view all the answers

    Dual antiplatelet therapy is indicated indefinitely for all patients with minor strokes or TIA.

    <p>False</p> Signup and view all the answers

    What is the minimum percentage of carotid artery blockage required in symptomatic patients to consider carotid endarterectomy?

    <p>50%</p> Signup and view all the answers

    In the case of a high-risk cardiac patient, _______ stenting is considered if there is no risk of procedural myocardial infarction.

    <p>carotid</p> Signup and view all the answers

    Match the treatment with its appropriate indication:

    <p>Aspirin = Most cases of stroke management Dual antiplatelet therapy = Minor stroke or TIA Carotid endarterectomy = &gt;50% blockage in symptomatic patients Cholesterol management = Target LDL levels</p> Signup and view all the answers

    What is the primary purpose of a plain CT scan in stroke management?

    <p>To rule out bleeding</p> Signup and view all the answers

    A FLAIR MRI sequence can show lesions as white if presented within 4-6 days of stroke onset.

    <p>False</p> Signup and view all the answers

    What does a PWI-DWI mismatch indicate in stroke assessment?

    <p>Potential for treatment options.</p> Signup and view all the answers

    The normal perfusion rate is _____ ml/100 g/min.

    <p>22</p> Signup and view all the answers

    Match the MRI types with their functions:

    <p>DWI = Identify hyperintense lesions FLAIR = Show areas of inflammation PWI = Analyze blood perfusion ADC = Measure apparent diffusion coefficient</p> Signup and view all the answers

    Which imaging technique is specifically used to identify stroke in cases with unknown onset time?

    <p>Diffusion Weighted MRI</p> Signup and view all the answers

    A lesion identified in DW MRI should always be black in the DWI sequence.

    <p>False</p> Signup and view all the answers

    What is the threshold for classifying an area as the penumbra region in perfusion imaging?

    <p>10-22 ml/100 g/min.</p> Signup and view all the answers

    Study Notes

    Pontine Syndromes Anatomy

    • The pons is a part of the brainstem.
    • Key structures within the pons include the cochlear nucleus, vestibular nuclei, abducens nucleus, facial nucleus, trigeminal nerve nucleus, pontine reticular formation, lateral lemniscus, superior olivary nucleus, medial lemniscus, and raphe nuclei.
    • The pons is supplied by the basilar artery and the anterior inferior cerebellar artery.

    Pontine Syndromes

    • Several syndromes are associated with lesions in the pons, such as Millard-Gubler Syndrome, Raymond Syndrome, and Cruciate Paralysis.
    • Millard-Gubler Syndrome involves a unilateral lower motor neuron facial nerve palsy.
    • Raymond Syndrome is characterized by a unilateral sixth nerve palsy and contralateral hemiplegia.
    • Cruciate Paralysis involves a lesion in the rostral portion of the pyramidal decussation, resulting in weakness in both arms and sparing of the legs.

    Avellis Syndrome vs Jackson Syndrome

    • Avellis Syndrome involves a lesion affecting the tegmentum of the medulla, the vagus nerve, and the spinothalamic tract.
    • Clinical features of Avellis Syndrome include unilateral lower motor neuron vagus nerve palsy and contralateral loss of pain and temperature sensation in the body.
    • Jackson Syndrome involves a lesion affecting the hypoglossal nucleus.
    • The clinical feature of Jackson Syndrome is a unilateral lower motor neuron hypoglossal nerve palsy.

    Brainstem Stroke

    • Various clinical features can be associated with different types of brainstem stroke depending on the location of the lesion.
    • Lesions in the dorsal tegmentum can cause Foville Syndrome, FGH Syndrome, conjugate gaze palsy, and contralateral hemiplegia.
    • Lateral pontine lesions can cause Marie-Foix Syndrome, ASH Syndrome, contralateral hemiplegia, and contralateral pain and temperature loss.

    Locked-in Syndrome

    • Locked-in Syndrome occurs due to bilateral extensive pontine infarction.
    • Clinical features include an alert state, quadriplegia, and preserved vertical eye movements.

    Top of Basilar Occlusion

    • Features of a top of basilar occlusion include absent visual and oculomotor function, bilateral medial temporal lobe lesion, behavioural changes, fluctuating alertness, amnesia, and visual hallucinations.

    Presentation of Posterior Stroke

    • Commonly seen features of a posterior stroke include dizziness, dysarthria, dysphagia, diplopia, and dystaxia.

    Goals of Stroke Management

    • The main goals of stroke management include recanalisation/reperfusion, prevention of secondary brain damage, and optimisation of collateral blood flow.

    Causes of Secondary Brain Damage

    • Several factors can contribute to secondary brain damage after a stroke, including increased intracranial pressure, cerebral edema, herniation, hemorrhagic transformation, and SIADH.

    Immediate Management of Stroke

    • Immediate management of stroke includes supportive care, management of hypo/hyperglycemia, ECG and troponin monitoring, and blood pressure correction.
    • A CT scan is typically used to rule out bleeding in patients presenting within 6 hours of stroke onset.

    Scenarios, Updates, and Investigations in Stroke Management

    • If the stroke is suspected to be a TIA, a diffusion-weighted MRI is required to rule out stroke.
    • If the patient presents within 4.5 hours of stroke onset and a CT scan has ruled out bleeding, thrombolysis with alteplase or tenecteplase can be administered.

    Contraindications to Thrombolysis

    • Contraindications to thrombolysis include age >80 years, blood pressure >185/110 mmHg despite medication, CT hypodensity >1/3rd, intracranial neoplasm, aortic dissection, and infective endocarditis.

    Use of Heparin

    • Heparin is used after 24 hours of stroke onset.

    Repeat Imaging

    • Repeat imaging after 24 hours of stroke onset is recommended.

    Anticoagulation

    • Anticoagulation is indicated for cardioembolic stroke.
    • Warfarin is used for patients with valvular atrial fibrillation, mitral stenosis, or prosthetic valve.

    Antiplatelet

    • Aspirin is the most common antiplatelet medication used after stroke.
    • Dual antiplatelet therapy with aspirin and ticagrelor is temporarily used for patients with corresponding cardiac disease, minor stroke, or TIA, and intracranial atherosclerotic disease greater than 50%.

    Carotid Endarterectomy

    • Carotid endarterectomy is indicated for patients with a greater than 50% blockage in a symptomatic patient or greater than 60% blockage in an asymptomatic patient.

    Carotid Stenting

    • Carotid stenting is an alternative to carotid endarterectomy for patients with high-risk cardiac disease.

    Cholesterol Management

    • Low-density lipoprotein (LDL) cholesterol management is essential in stroke prevention.

    CT Protocol for Stroke

    • A plain CT is used to rule out bleeding.
    • A CT angiography is used to visualize the blood vessels in the brain.

    MRI Protocol for Wake-Up Stroke

    • Diffusion-weighted MRI (DWI) is used to identify hyperintense lesions, which are suggestive of stroke.
    • T2-FLAIR MRI is used to identify lesions and their signal intensity, which can indicate the age of the stroke.
    • A DWI-FLAIR mismatch indicates the presence of a penumbra region, which could be salvageable with treatment.
    • Perfusion imaging with PWI and DWI is used to assess penumbra and determine treatment options.

    Key Findings in MRI Images

    • DWI: Provides information about the diffusion of water molecules, which can be altered in stroke.

    • FLAIR: Identifies hyperintense lesions indicating possible inflammation or stroke.

    • PWI: Shows areas of blood perfusion in the brain.

    • ADC: Measures the apparent diffusion coefficient in FLAIR MRI images, which can help distinguish between different tissue types.

    • Penumbra: A region of the brain that has reduced blood flow but is not yet irreversibly damaged.

    • PWI-DWI mismatch: Indicates a region of penumbra that may be salvageable with treatment.

    Important Note

    • The information provided is for educational purposes only and should not be used for self-diagnosis or treatment.
    • A qualified medical professional should interpret any MRI findings and advise on appropriate treatment.

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    Description

    Test your knowledge on the anatomy of the pons and the various syndromes associated with lesions in this brain structure. This quiz covers key nuclei, vascular supply, and the specific syndromes such as Millard-Gubler and Raymond. Dive deep into the intricate workings of the pons and its clinical implications.

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