brain stem anterior view anterior view posterior view adducent 7 & 8 th 12 9,10,11 5 3 4 facial...

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Brain Stem Brain Stem Anterior View Anterior View Posterior View Posterior View Adducent 7 & 8 th 12 9,10,11 5 3 4 Facial collicul Striae Medullare

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  • Slide 1
  • Brain Stem Anterior View Anterior View Posterior View Adducent 7 & 8 th 12 9,10,11 5 3 4 Facial colliculus Striae Medullare
  • Slide 2
  • Medulla Oblongata Nuclei in the medulla are associated w/ autonomic control, cranial nerves, and motor/sensory relay. Nuclei in the medulla are associated w/ autonomic control, cranial nerves, and motor/sensory relay. Autonomic nuclei: Autonomic nuclei: Cardiovascular centers Cardiovascular centers Cardioinhibitory/cardioacceler atory centers alter the rate and force of cardiac contractions Cardioinhibitory/cardioacceler atory centers alter the rate and force of cardiac contractions Vasomotor center alters the tone of vascular smooth muscle Vasomotor center alters the tone of vascular smooth muscle Respiratory rhythmicity centers Respiratory rhythmicity centers Receive input from the pons Receive input from the pons Additional Centers Additional Centers Emesis, deglutition, coughing, hiccupping, and sneezing Emesis, deglutition, coughing, hiccupping, and sneezing
  • Slide 3
  • Medulla.
  • Slide 4
  • Medulla Sagittal Section And Cranial Nuclei
  • Slide 5
  • Cranial Nuclei
  • Slide 6
  • Section of Medulla
  • Slide 7
  • Section of Medulla At the level of Pyramid
  • Slide 8
  • Medullary syndromes Medial Medial Lateral medullary syndromes Lateral medullary syndromes
  • Slide 9
  • Medial Medullary Syndrome Cranial Nerves Cranial Nerves Tongue Paralysis - Hypoglossal Nerve Tongue Paralysis - Hypoglossal Nerve Motor Pathways Motor Pathways Contralateral Spastic Paralysis -- Pyramids Contralateral Spastic Paralysis -- Pyramids Sensory Pathways Sensory Pathways Contralateral loss Fine Touch and Proprioception -- Medial Lemniscus Contralateral loss Fine Touch and Proprioception -- Medial Lemniscus Alternating hemiplegia
  • Slide 10
  • HypoglossalPalsy Lower Motor NeuronSyndromeHypoglossalPalsy NeuronSyndrome Deviation of Tongue to affected side Atrophy of Tongue Muscles
  • Slide 11
  • Lateral medullary syndrome (Wallenberg's syndrome) This is the commonest of the brain stem strokes. Involvement of the spinothalamic tract results in contralateral loss of pain and temperature sensation below the neck. This is the commonest of the brain stem strokes. Involvement of the spinothalamic tract results in contralateral loss of pain and temperature sensation below the neck. Involvement of the descending nucleus and tract of V results in loss of pain and temperature sensation on the face ipsilateral to the lesion. Involvement of the descending nucleus and tract of V results in loss of pain and temperature sensation on the face ipsilateral to the lesion.
  • Slide 12
  • Lateral medullary syndrome Involvement of descending autonomic fibers results in an ipsilateral Horner's syndrome (ptosis, meiosis, and anhidrosis). Involvement of the nucleus ambiguus causes palatal weakness and dysphagia. Involvement of descending autonomic fibers results in an ipsilateral Horner's syndrome (ptosis, meiosis, and anhidrosis). Involvement of the nucleus ambiguus causes palatal weakness and dysphagia. Involvement of the inferior cerebellar peduncle (restiform body) causes ipsilateral ataxia. Involvement of the inferior cerebellar peduncle (restiform body) causes ipsilateral ataxia. Alternating hemianaesthesia Alternating hemianaesthesia
  • Slide 13
  • Brain stem Anterior view
  • Slide 14
  • Brain stem Posterior view
  • Slide 15
  • Section of Pons at the level of Facial colliculus
  • Slide 16
  • Section of pons at the level of trigeminal nuclei
  • Slide 17
  • Vestibular component of VIII Nerve
  • Slide 18
  • Cochlear component of VIII Nerve
  • Slide 19
  • Pontine syndromes Medial pontine Syndrome Structures Associated Structures Associated CST CST Medial lemniscus Medial lemniscus 6th nerve fibers 6th nerve fibers 7 th nerve fibres 7 th nerve fibres Sign Contralateral spastic hemiparesis of the body Contralateral loss of position and vibration of the body Medial strabismus Raymond's Syndrome Alternating abducent hemiplegia Miller-gubler syndrome Alternating Facial hemiplegia.
  • Slide 20
  • Lateral pontine syndrome Structure Structure ICP ICP Spinal 5 Spinal 5 Spinothalamic Spinothalamic Fibers of 7 Fibers of 7 Fibers of 8 Fibers of 8 Sign Ipsilateral limb ataxia Ipsilateral pain and temp loss - Face Contralateral pain and temp-Body Horners syndrome (Ipsilateral) Hearing loss Ipsilateral facial paralysis
  • Slide 21
  • Section of Mid Brain at Inferior colliculus
  • Slide 22
  • Section of Mid Brain at superior colliculus
  • Slide 23
  • At Superior colliculus
  • Slide 24
  • Ventromedial Superior Midbrain Syndrome (Webers Syndrome) Contralateral Contralateral paralysis of face, arm and leg paralysis of face, arm and leg Ipsilateral Ipsilateral III palsy (fascicular) III palsy (fascicular) Artery Artery paramedian perforators of terminal basilar, or paramedian perforators of terminal basilar, or peduncular perforating branches of posterior cerebral artery peduncular perforating branches of posterior cerebral artery
  • Slide 25
  • Paracentral (Tegmental) Superior Midbrain Syndromes (Claudes and Benedikts syndromes) Contralateral Contralateral ataxia with tremor (red nucleus) hemichorea (subthalamic nucleus) ataxia with tremor (red nucleus) hemichorea (subthalamic nucleus) Ipsilateral Ipsilateral III fascicular palsy III fascicular palsy Artery Artery paramedian perforators of terminal basilar, or paramedian perforators of terminal basilar, or interpeduncular branches of Posterior Cerebral Artery interpeduncular branches of Posterior Cerebral Artery
  • Slide 26
  • Dorsal Superior Midbrain Syndrome (Parinauds, of Sylvian Aqueduct) Paralysis of upgaze convergence Paralysis of upgaze convergence Light/near dissociation Light/near dissociation Eyelid retraction Eyelid retraction Convergence/retraction nystagmus Convergence/retraction nystagmus Artery - posterior choroidal/quadrigeminal Artery - posterior choroidal/quadrigeminal (Note - usually not vascular) (Note - usually not vascular)
  • Slide 27
  • Top of the Basilar Syndrome Usually due to embolic occlusion Usually due to embolic occlusion Posterior Cerebral Artery cortical territory infarction (unilateral or bilateral) Posterior Cerebral Artery cortical territory infarction (unilateral or bilateral) hemianopia/cortical blindness hemianopia/cortical blindness amnesia amnesia Basilar/Posterior Cerebral Artery thalamic/midbrain territory infarction Basilar/Posterior Cerebral Artery thalamic/midbrain territory infarction impairment of ocular movements (e.g. skew deviation, vertical gaze palsies) impairment of ocular movements (e.g. skew deviation, vertical gaze palsies) pupillary abnormalities (various) pupillary abnormalities (various)