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Old 10-04-2012
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Neuro Brainstem Dorsum and Cross section Lesion!

Pt has acute onset of left sided CN III palsy, right sided hemiparesis. PE shows that tongue deviates to the left and uvula to the right. the diagrams of the lesion is shown below:

Brainstem Dorsum and Cross section Lesion!-brainstem-cross.png
click image to enlarge

Brainstem Dorsum and Cross section Lesion!-brainstem-dorsum.png
click image to enlarge

based on given data

1. What addition physical finding can be seen in patient:

a) contraletral cellebelar dystaxia
b) ipsilateral loss of deep sensation
c) paralysis of gaze to side of lesion
d) weakness of contralateral lower part of face
e) nothing additional can be seen

2. Which artery is involved in this case:

a) Paramedian Branches of basilar artery
b) AICA
c) Paramedian Midbrain arteries
d) Paramedian branches of PCA
e) PComm

P.s. i hate this stuff
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Embarrassed thanks for the question---beka-cts

i think the pt. has lesions in lt. pontomedullary jn.(above figure) and lt. midbrain(lower diagram).....unable to diagnose the syndrome the pt. got..
but, i'll go with
1).d)c/l weakness in lower part of face
2) e) post.communicating
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Old 10-04-2012
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i/l CN 3, rt hemiparesis>> medial mid brain >> PCA

i/l CN 10 >> lateral medulla>> PICA

i/l CN 12 >> medial medulla >> Anterior spinal artery




1) not sure

2) would go with PCA
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Old 10-05-2012
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Default My asnwer 1) D 2)D

In relation of the symptons, signs and the first picture , this case is a Weber Synd (medial midbrain) wich affects oculomotover nerve roots -->ipsilateral eye paralysis,,, but abduction must be intact (cause in the second image shows the lowest line pointing CN VI wich isn`t affected)

Also is afeccted corticospinal tract --> contralateral spastic hemiparesis--> so the patient must have --> weakness in lower part of face (1) D

the signs of the tonge, uvula (VII, X) -->corticonuclear fiber affected

One of the causes of weber`s synd could be a tumor or an oclussion PCA (2) D



P.S. What ipsilateral loss of "deep sensation" means?????
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Old 10-05-2012
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Haha.. Always I study this carefully and later it goes to my un-retrieve part of sub conscious mind.

My guess is-
1. C. Paralysis of gaze to side of lesion
2. D. Paramedian branch of PCA
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Will go with D and D.

(Had to exhaust all my dying brain cells for this. Help me, Dear God.)
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Old 10-05-2012
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Correct Answer

great job guys.

Correct answers are :
D) weakness of contralateral lower part of face
and
D) Paramedian branches of PCA

It's weber syndrome.
midbrain infarction resulting from occlusion of the paramedian branches of posterioir cerebral artery:
- Corticospinal tract lesion -> contralateral spastic paralysis
- Corticobulbar tract lesion -> UMN lesion of cranial nerves, In this case nerves VII( contralateral weakness of lower face), X ( uvula deviates contralateral to lesion) & XII ( tongue deviates ipsilateral to lesion).
- Oculomotor nerve palsy -> ipsilateral ptosis,pupillary dilatation and lateral strabismus.

The structures identified here are as follows:

Brainstem Dorsum and Cross section Lesion!-brainstem-sections.png
click image to enlarge


Quote:
P.S. What ipsilateral loss of "deep sensation" means?????
Deep sensation( proprioceptive one) -> due to dorsal column of medial lemniscus lesion.

for more information check:
HY Neuro anatomy Page: 112.

P.S. Tomorrow will discuss Med. oblongata anatomy. Day after tomorrow Pons.
I can't memorize these stuff, i'll repeat them before exam everyday
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Thank you Beka-CTS. Shall be looking forward to more neuroanat!
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Embarrassed

Quote:
Originally Posted by beka-CTS View Post
great job guys.

Correct answers are :
D) weakness of contralateral lower part of face
and
D) Paramedian branches of PCA

It's weber syndrome.
midbrain infarction resulting from occlusion of the paramedian branches of posterioir cerebral artery:
- Corticospinal tract lesion -> contralateral spastic paralysis
- Corticobulbar tract lesion -> UMN lesion of cranial nerves, In this case nerves VII( contralateral weakness of lower face), X ( uvula deviates contralateral to lesion) & XII ( tongue deviates ipsilateral to lesion).
- Oculomotor nerve palsy -> ipsilateral ptosis,pupillary dilatation and lateral strabismus.

The structures identified here are as follows:

Attachment 2857
click image to enlarge


Deep sensation( proprioceptive one) -> due to dorsal column of medial lemniscus lesion.

for more information check:
HY Neuro anatomy Page: 112.

P.S. Tomorrow will discuss Med. oblongata anatomy. Day after tomorrow Pons.
I can't memorize these stuff, i'll repeat them before exam everyday
thanks for the explanation beka-cts..,
i have a doubt...i'm poor at anat so correct me.....
i learnt only paramedian branches for basilar a...,so do they also presnt for PCA too?...by seeing the paramedian branches of pca option---i thought they won't even exist and went for post. communicating a.
correct me dude...thank again for the question
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Quote:
Originally Posted by venky2600 View Post
thanks for the explanation beka-cts..,
i have a doubt...i'm poor at anat so correct me.....
i learnt only paramedian branches for basilar a...,so do they also presnt for PCA too?...by seeing the paramedian branches of pca option---i thought they won't even exist and went for post. communicating a.
correct me dude...thank again for the question
Paramedian branches of basilar artery are feeding medial part of pons.
Syndrome associated with it : medial pontine syndrome
Paramedian branches of posterior CA are feeding medial part of Midbrain.
Syndrome associated with it: Weber's.

Yes they do exist and are derived form very proximal part of PCA

you are welcome dude
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thanks for quick reply and new point too....
i never know they exist till now
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thank u sooooooo much..
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Default

Quote:
Originally Posted by beka-CTS View Post
Pt has acute onset of left sided CN III palsy, right sided hemiparesis. PE shows that tongue deviates to the left and uvula to the right. the diagrams of the lesion is shown below:

Attachment 2856
click image to enlarge

Attachment 2855
click image to enlarge

based on given data

1. What addition physical finding can be seen in patient:

a) contraletral cellebelar dystaxia
b) ipsilateral loss of deep sensation
c) paralysis of gaze to side of lesion
d) weakness of contralateral lower part of face
e) nothing additional can be seen

2. Which artery is involved in this case:

a) Paramedian Branches of basilar artery
b) AICA
c) Paramedian Midbrain arteries
d) Paramedian branches of PCA
e) PComm

P.s. i hate this stuff

from my point of view "d" and "e" is the answer
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Quote:
Originally Posted by KINGSTONSWAGGER View Post
from my point of view "d" and "e" is the answer
And in point of view of neuroscience D and D are corrects answers
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Old 10-06-2012
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Nice questions beka-CTS waiting for another one; maybe that way my memory will incorporate all this neuro stuff
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