Pons Lesions ( Return to Lesions Front Page ) 1) VASCULAR LESIONS - MEDIAL SUPERIOR PONTINE SYNDROME A Sample Case: A 60 year old man was suddenly stricken with paralysis of his right arm and leg. The patient presented to the emergency department with an acute history of slurred speech, vertigo and diplopia as major complaints. Pontine Symptoms Comatose, locked in syndrome with preservation of upward gaze, Pinpoint pupils Pyrexias and autonomic dysfunction LMN or UMN VIIth which is ipsilateral. Clinical manifestations of medial medullary syndrome (A) Body representation of the clinical manifestations of left medial medullary syndrome. b Pons (rostral): Raymond-Cestan syndrome: a) superior cerebellar peduncle (cerebellar ataxia with a coarse "rubral" tremor); b) medial lemniscus and. Diminished sensation over the side of the face due to the lesion of sensory fibers or the nucleus of the trigeminal nerve. Medial Medullary (Dejerine) Syndrome Contralateral hemiparesis (pyramidal tract) Contralateral loss of light touch, vibration, proprioception (medial lemniscus) Ipsilateral tongue weakness (hypoglossal fibers) Question A 56 year old with refractory HTN presents with diplopia and left facial droop. CN VIII CN VII. Superior, inferior, and middle cerebellar peduncles generally are distinguished ( Fig. William DeMyer, in Stroke in Children and Young Adults (Second Edition), 2009. Medial Pontine Syndrome Last Updated on Wed, 11 May 2022 | Anatomy Medial pontine syndrome results from occlusion of paramedian branches of the basilar artery (Figure IV-5-16). A lateral pontine syndrome is a lesion which is similar to the lateral medullary syndrome, but because it occurs in the pons, it also involves the cranial nerve nuclei of the pons. The middle cerebellar peduncle, or the brachium pontis, is located laterally. Median-Paramedian Arteries of the Medulla and the Medial Medullary Syndromes of Dejerine, Babinski-Nageotte, and Opalski. The lateral pontine syndrome occurs due to occlusion of perforating branches of the basilar and anterior inferior cerebellar (AICA) arteries 1,2 . Cause Human brainstem blood supply description. medial medullary syndrome ipsilateral to lesion (paralysis to atrophy of half the tongue with deviation to the paralyzed side when tongue is protuded) , CN XII , hypoglossal or nucleus medial medullary syndrome impaired tactile and proprioceptive sense medial medullary syndrome contralateral to lesion; corticospinal tract lateral medullary syndrome Pontine strokes can be classified as either ischemic or hemorrhagic. Medial Sedullary Syndrome (Dejerine Syndrome) Texas Stroke Institute 1600 Coit Road Suite 104 Plano, TX 75075 Telephone: (972) 566-5411 Fax: (972) 519-8337 He was helped to his feet but his left arm and leg felt stiff. Diplopia, Lateral gaze palsy if VIth nerve affected References c inferior cerebellar penduncle pontine reticular formation. He also mentioned the appearance of weakness and numbness in his left leg. In addition, he complained of seeing "double". Clinical findings are the following: . 38 Because of low survival rate and poor prognosis, few people with brain-stem stroke enter rehabilitation, and most accounts of motor deficits and rehabilitation following stroke concern people with cortical stroke rather than brain-stem stroke. Contents 1 Symptoms 2 Causes 3 Treatment 4 References 5 External links Symptoms Damage to the following areas produces symptoms (from medial to lateral): Causes Lateral superior pontine syndrome or syndrome of the superior cerebellar artery: Ipsilaterally: ataxia of limbs and gait . In the classic unilateral medial medullary syndrome of Dejerine, in the caudalmost medulla, the VspAs give off paramedian arteries for the pyramidal tracts, but more rostrally, the VAs give off . This infarction involves the following 1-3: Paralysis of muscles of mastication resulting from the lesson to the Motor fibers or nucleus of the trigeminal nerve. Medial superior pontine syndrome (paramedian branches of upper basilar artery) Common Symptoms Contralateral weakness Clumsiness On side of lesion Cerebellar ataxia (probably): Superior and/or middle cerebellar peduncle Internuclear ophthalmoplegia: Medial longitudinal fasciculus Myoclonic syndrome, of palate, pharynx, vocal cords . Depending upon the size of the infarct, it can also involve the facial nerve . This nucleus provides efferent fibers that innervate the facial muscles, the posterior belly of digastric muscle, the stapedius and stylohyoid muscles. Medial superior pontine syndrome: occurs secondary to compressing tumor to the upper and medial portion of the pons or stoke affecting paramedian branches of the upper basilar artery. Although medial pontine syndrome has many similarities to medial medullary syndrome, because it is located higher up the brainstem in the pons, it affects a different set of cranial nuclei. A case of medial inferior pontine syndrome or Foville's syndrome is described. At a minimum, this lesion affects the exiting fibers of the abducens nerve and the corticospinal tract. The red lines represent weakness of the contralateral. The pontine tegmentum is supplied by the lateral group of the arteries, the superior cerebellar artery and anterior inferior cerebellar artery, which create a capillary network on the lateral aspect of the . pyramidal tract pontine tracts locked-in syndrome. 11.13 ). pyramidal tract pontine tracts locked-in syndrome. History and etymology The syndrome was first described by Pierre Marie (1853-1940), Charles Foix (1882-1927), and Thophile Alajouanine (1890-1980), French neurologists, in 1922 3. 1) VASCULAR LESIONS - MEDIAL PONTINE SYNDROME (MIDDLE ALTERNATING HEMIPLEGIA) A Sample Case: A 48 year old man suffered a sudden weakness of his left arm and leg which caused him to fall while shaving. pyramidal tract pontine tracts medial lemniscus c inferior cerebellar penduncle pontine reticular formation. Coma is especially common following bilateral lesions that involve the medial pontine tegmentum. 15171819 However, reports of sufficient numbers of patients are rare, and a clinical-radiological . Foville syndrome (inferior medial pontine syndrome) is due to an infarct of the pons involving the corticospinal tract, medial lemniscus, medial longitudinal fasciculus, paramedian reticular formation, and nuclei of the abducens and facial nerves ( Figs 13, 14 ). CN VIII CN VII. There have been sporadic reports of pontine base infarction producing clinical syndromes of pure motor hemiparesis (PMH), 123456 sensorimotor stroke (SMS), 6 ataxic hemiparesis (AH), 678910111213141516 and dysarthria-clumsy hand (DA-CH) syndrome. Middle cerebral peduncle is supplied by branches of the superior cerebellar and anterior inferior cerebellar arteries. An ischemic stroke occurs when an artery in the brain becomes blocked by a blood clot, while a hemorrhagic stroke occurs when an artery in the brain bursts. The superior peduncle contains a compact, sickle-shaped fiber bundle, the brachium conjunctivum, which consists of fibers from all the ipsilateral cerebellar nuclei. Citation, DOI & article data Inferior medial pontine syndrome, also known as Foville syndrome , is one of the brainstem stroke syndromes occurring when there is infarction of the medial inferior aspect of the pons due to occlusion of the paramedian branches of the basilar artery 1-3. The physical This site needs JavaScript to work properly. Terminal or segmental occlusion of the anteromedial long arteries can present with horizontal gaze palsy (Fig 4) or one-and-a-half syndrome. pyramidal tract pontine tracts medial lemniscus Medial midpontine syndrome (paramedian midbasilar artery branch) Ipsilateral ataxia; Contralateral face/arm/leg paralysis and decreased proprioception; Medial superior pontine syndrome (paramedian upper basilar artery branches) Ipsilateral ataxia, INO, myoclonus of pharynx/vocal cords/face; Contralateral face/arm/leg paralysis and decreased . With the involvement of the PPRF, this presents as a conjugate gaze palsy, meaning the inability to move the eyes towards the affected side; this becomes important here since conjugate gaze palsy can localize to more than one area in the neuroaxis. A pontine stroke refers to a stroke within the pons, the largest component of the brain stem. The nucleus of facial nerve is a motor nucleus located in the lower pontine tegmentum,ventromedial to the spinal nucleus and spinal tract of the trigeminal nerve. b Pons (rostral): Raymond-Cestan syndrome: a) superior cerebellar peduncle (cerebellar ataxia with a coarse "rubral" tremor); b) medial lemniscus and.