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Old 04-25-2012
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Neuro cerebellar hemorrhage and conjugate eye gaze

Quote:
Educational Objective:
The sudden onset of vertigo, vomiting and occipital headache in a hypertensive patient is strongly suggestive of cerebellar hemorrhage. Other manifestations are 6th nerve paralysis, conjugate deviation,facial weakness, blepharospasm and coma.
this excerpt from uworld. i wonder how cerebellar hemorrhage causes conjugate eye deviation and facial weakness. any1? or do i need to cram it down...

this is exact q...
Quote:
A 69-year-old man presents to the emergency department with a severe occipital headache, nausea and
vomiting for several hours. His medical history is significant for poorly controlled essential hypertension for
the last 7 years. The neurologic examination shows ataxia, right-sided facial weakness and deviation of the
eyes to the left side.
His CT scan is consistent with a hemorrhagic stroke. Which of the following is the most
likely diagnosis?
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Old 04-25-2012
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cerebellar artery m/c pica also supplies pons...so any hemorrhagic event may lead to pontine syndrome...millard gublar or fovallie sx. soo...6th and 7th nerves are involved in these syndrome....
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Old 04-25-2012
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Originally Posted by avirag View Post
cerebellar artery m/c pica also supplies pons...so any hemorrhagic event may lead to pontine syndrome...millard gublar or fovallie sx. soo...6th and 7th nerves are involved in these syndrome....
thanks. but then what is the cause of conjugate eye movement to left in above q ??? i may be sounding stupid but i really want to know...
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Old 04-25-2012
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due to medial longitudinal fasciculas palsy.....i.e lateral ractus in one eye and median ractus in other...coz of fibers connecting 6th and 3rd nerve supplyn median ractus i.e mlf....
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Old 07-27-2012
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Originally Posted by avirag View Post
due to medial longitudinal fasciculas palsy.....i.e lateral ractus in one eye and median ractus in other...coz of fibers connecting 6th and 3rd nerve supplyn median ractus i.e mlf....

isn't the MLF found in the midbrain?

and this case is lateral pontine syndrome, so shouldn't we think of PPRF instead?
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Old 01-21-2013
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Gaze Palsy and facial weakness are due to pontine compression and herald deterioration of the casedt expanding hematoma.


Source:
Localization in Clinical Neurology
By Paul W. Brazis, Joseph C. Masdeu, Josť Biller
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