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Old 02-11-2012
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Neuro How to memorize Brainstem Syndromes!

Hi guys,
can u advice me how to remember lateral, medial medullary, pontine, midbrian syndromes? how to easily diagnose them on the test very quickly? are those really important?
any tips?

thanks in advance
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Old 02-12-2012
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Now, this is an interesting topic! Thanks!

When I was answering anatomy in Kaplan qbook (I don't know if it is just "recall bias"), I remember that these syndromes were frequently tested. Hence, in my opinion, they are important.

Like you, I am still looking for a way to make the brainstem syndromes stick by sheer memorization. So far, I haven't found the ultimate technique yet.

I have a crude way of answering the questions though. I only basically generalize. I am able to narrow the choices in the mcqs using this rough guideline:

Levelize: Recognizing they are brainstem lesions

If in a problem, there's just too many deficits! I know by "gut-feel" that it IS a brainstem syndrome. But to be specific I try to identify if there are:

1. Ipsilateral CN --> ipsilateral "face" deficit
2. Contralateral long-tract sign--> contralateral "trunk" deficit

Localize: Which part of the brainstem?

I scan the problem for a specific CN involved:

CN III, IV affected -> midbrain
CN V, VI, VII, VIII affected -> pons
CN IX, X, XI affected -> medulla

Lateralize: Medial or lateral?

This is the only part that I memorize. The following key symptoms clinch my best guess of identifying the syndrome:

Medial vs Lateral Medullary Syndrome
Medial Med. has hypoglossal nerve lesion (tongue deviation)

Medial vs Lateral Pontine Syndrome
Medial Pon. has abducens nerve lesion (internal strabismus)

Pontocerebellar Angle Syndrome
If the lesions specifically involve: CN V, VII, VIII

Dorsal vs. Medial Midbrain
Dorsal Midbain has sup coll./pretectal area deficit (paralysis of upward gaze)


IN A NUTSHELL

It is a quick 3-step process:

a. Cross-over (face/trunk) deficit means brainstem.
b. CN deficit points to midbrain/pons/medulla.
c. Laterality is best guessed using the 3 key symptoms mentioned above
(tongue deviation, internal strabismus, paralysis of upward gaze).


I don't really memorize the whole set of symptoms. Somehow, I feel that the question-makers can always add or subtract a deficit. It's always a constellation of symptoms.

(I did try to memorize the whole sets of symptoms per syndrome but I always forget... Can't make it stick more than a day... )

When I do my second reading, watch the neuro anatomy videos, and scan HY neuroanatomy, I'll get back on this thread and share my "polished" insights.

But for the meantime... I only have this. I hope this somehow helps.

Last edited by d_wiqed; 02-12-2012 at 09:43 AM.
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Old 02-12-2012
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ha ha that's a great overview/Diff.Dx kind of think. I really appreciate your effort in putting that down on this thread. thnks
cramming the whole set of symptoms is waste of time and energy i feel. better cross question them and remember imp points. great job
i will put down if i found any other alternative method
take care
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Old 02-12-2012
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Quote:
Originally Posted by doctordexter View Post
Hi guys,
can u advice me how to remember lateral, medial medullary, pontine, midbrian syndromes? how to easily diagnose them on the test very quickly? are those really important?
any tips?

thanks in advance
Well,its confusing all in all.but u can think and exclude in this manner other options..
First try to differentiate whether it is a symptom or a group of symptoms(i mean just limb weaknes,reflex loss etc or dysphagia and hoarseness and loss of gag reflex)..well now u can do is that differntiate it between a lesion of a bunch of cranial nerves or in brain cortex..when u can differentiate this u can come down to two broad division :1.artereries in total 2.communicating arteries.now cranial nerve injuries are associated with intercommunicating arteries and well the only exception is anterior spinal artery...now as u narrow it down just think this way:as u move from spinal to brain u get spinal arteries to intercommunicating arteries..as as we all know from brainstem to cortx we have structures in order of medulla and pons..and in case of anterior communicating the pons is affected as the topmost structure in this circulation...now u can see the symptoms..specially the cranial nerves lesion are so typical...u know which CN cums out of pons..u just go for pons..and regarding medulla..remember the rule:medial lies motor...u get the cranial nerve lesions and motor 12th nerve is the medial and medial medulla supplied by ASA..u just have to remember this fact only.its over for communicating arteries..as far as the main arteries is corcerned its far more easy...the most confusing part is this ...just a hang of blood supply to brain and homunculus(generally head and lower limbs are asked!!) will give u an idea which part is injured in brain communicating artery supply blockage.....it all boils down to elimination in MCQ..hope it helps
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thanks avash.nrs your way is working.keep it up
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Old 07-20-2012
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Also for lateralization, any contralateral corticospinal tract involvement, it means it's medial syndrome, whether it's medullary, pontine, or midbrain.
any contralateral loss of pain and temp over the body, it is either pons or medullary lateral syndrome.
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