Midbrain syndromes pdf file

Although many different brainstem stroke syndromes have been classically described, the majority appear extremely rarely in the literature and are mainly for historical. A number of nerve tracts run through the midbrain that connect the cerebrum with the cerebellum and other hindbrain structures. Midbrain syndromes axial section at the level of the midbrain, depicted schematically on the left, with a corresponding mr image on the right. Each is irrigated by a system made up of four large vessels.

The midbrain is located in between the forebrain and hindbrain. A 36yearold woman visited a neurology department with a 7day history of throbbing headache and blurred vision in both eyes. Lateral midbrain syndrome superior cerebella artery sca ipsilateral ataxia of limb, nystagmus, nausea, vertigo horners syndrome contralateral sensory loss of arm, leg and face. Dorsal midbrain parinaud syndrome american academy of. This is an unusual case of dorsal midbrain syndrome because, first, it usually results from extrinsic compressive lesions such as thalamic and pineal gland tumours or untreated hydrocephalus, resulting in dilation of the aqueduct sylvia. The following text describes the various clinical signs to recognize this condition and the possible measures one can take to treat it. The midbrain serves important functions in motor movement, particularly movements of the eye, and in auditory and visual processing. Our study, therefore, provides individual values of midbrain diameters in pd, atypical parkinsonian syndromes including msap and psp, and healthy controls from routine mr imaging and clearly shows that the simple measurement of the midsagittal mesencephalic anteroposterior diameter on routine mr imaging may differentiate psp from typical pd on. All presented with limited upward voluntary gaze and convergence nystagmus with attempted upward voluntary gaze.

Parinauds syndrome dorsal midbrain syndrome with bilateral superior oblique palsy. Discussion will contain basic neuroanatomy of the brainstem from a clinicians perspective details. The pons also contains the locus ceruleus, a noradrenergic nucleus with diffuse projections throughout the cerebral hemispheres 7, and serotonergic nuclei the pontine raphe nuclei providing modulatory input into the reticular formation 6, 8. Ipsilateral 3rd nerve palsy with contralateral cerebellar ataxia. Parinauds syndrome an overview sciencedirect topics. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Most acute dizziness, however, is not dangerous, but some types are highly dangerous. Sometimes, the concavity of the lateral margin of the midbrain tegmentum is referred to as the morning glory sign and has high specificity but rather. Parinaud syndrome consists of supranuclear vertical gaze palsy secondary to lesions damaging the vertical gaze centre in the posterior commissure of the dorsal midbrain. Acute dizziness is a frequent index symptom in the emergency department as well as in the rural practice office. The first page of the pdf of this article appears above.

Midbraindiencephalic junction midpons basilar pons upper medulla pyramidal decussation uncrossed fibers anterior corticospinal tract cerebral crus lower midbrain nucleus of facial nerve co nuclear fibers hypoglossal nerve lower medulla cl cord segment lateral corticospinal tract. Medial midbrain syndrome penetrating branch of basilar artery webers syndrome. Because the lesions in the anterior part of the tegmentum were in the upper midbrain in the first patient and in the lower midbrain in the second, it is suggested that the pupillary components of the oculomotor nerve are located in the upper midbrain. Unilateral midbrain infarct presenting as dorsal midbrain. Radiological findings in brainstem infarction syndromes. The 4 medial structures and the associated deficit are. At the level of the pons, four cranial nerves emerge including. If you have not installed and configured the adobe acrobat reader on your system. A rare case of isolated left medial midbrain stroke. Jul 04, 2019 a thorough workup of the causes of this syndrome through neuroimaging such as mri brain is essential before proceeding to any management plan. Parinaud syndrome is an upward gaze palsy that can also be seen in any patient as a result of pressure on the upward gaze eye center in the region of the suprapineal recess and quadrigeminal plate due to hydrocephalus or a pineal region mass lesion. Compression of the tectal plate causes parinaud syndrome. Sylvian aqueduct syndrome and global rostral midbrain. The mlf are a group of fiber tracts located in the paramedian area of the midbrain and pons.

Introduction the diagnosis of parkinson disease in the early. Caudal to cranial they are the medulla oblongata, pons, and midbrain. To our knowledge, our patient is only the second posttraumatic benedikts syndrome case ever reported in the international literature. Pdf current research has indicated an apparent pandemic of fear of the neural sciences, termed neurophobia, among medical students. Brainstem vascular syndromes edorium journal of neurology. Midbrain syndromes idara eshiet c midbrain syndromes.

That part of the brainstem developing from the middle of the three primary cerebral vesicles of the embryo. At the level of the medulla, four cranial nerves emerge including the glossopharyngeal, vagus, accessory, and hypoglossal nerves. To date, reports in the literature concerning claudes syndrome associated. Webers syndrome, also known as superior alternating hemiplegia, is a form of stroke characterized by the presence of an ipsilateral oculomotor nerve palsy and contralateral hemiparesis or hemiplegia. Specifically, compression or ischemic damage of the mesencephalic tectum, including the superior colliculus adjacent oculomotor origin of cranial nerve iii and edingerwestphal nuclei, causing dysfunction to the motor function of the eye. Any information contained in this pdf file is automatically generated from digital material submitted to epos by third parties in the form of scientific presentations. View notes midbrain syndromes from physiology 1001 at windsor som. Dai1, mohammad wasay2 gaziantep university, gaziantep1, turkey, aga khan university hospital2, karachi abstract wernekink commissure involves the decussation of superior cerebellar peduncle scp in midbrain. Mar 16, 2018 the mesencephalon or midbrain is the portion of the brainstem that connects the hindbrain and the forebrain. Most rostral in the brainstem are structures often collectively referred to as the diencephalon.

Links to pubmed are also available for selected references. Midbrain tegmental lesions affecting or sparing the. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. Brainstem stroke syndromes radiology reference article. Measurement of the midbrain diameter on routine magnetic. Early dorsal midbrain syndrome mimicking an adies tonic pupil.

Full text full text is available as a scanned copy of the original print version. A rare case of isolated left medial midbrain stroke 93 a b figure 1. It is located within the brainstem and between the two other. Figure 1 shows a crosssection of the brainstem, in this case at the level of the medulla, but the concept of 4 lateral and 4 medial structures also applies to the pons, only the 4 medial structures relate to midbrain vascular syndromes. Dec 16, 20 the midbrain is penetrated by the cerebral aqueduct of sylvius and surrounded by cisterns that contain csf.

Study 69 midbrain syndromes flashcards from ashley a. Discussion will contain basic neuroanatomy of the brainstem from a clinicians perspective details of the blood supply of the brainstem various syndromes caused by stroke involving the brainstem vessels rule of four a very simple way to remember various brainstem lesions. Get a printable copy pdf file of the complete article 588k, or click on a page image below to browse page by page. The usual causes of parinauds syndrome are pineal neoplasms, stroke and multiple sclerosis. Mesencephalic and associated posterior circulation infarcts. Vanderbilt university medical center stroke symposium 20 41 basilar artery occlusion complete basilar syndrome impairment of consciousness bilateral sensory and motor dysfunction cerebellar signs cranial nerve signs indicative of site top of basilar occlusion lateral midbrain. The reason of compression of tectal plate usually sporadic.

The midbrain is the narrowest part of the brainstem and contains the tectum, or roof, one of the three longitudinal divisions of the brainstem. However, given their diverse functions, midbrain pathology often leads to distinct clinical syndromes. Sylvian aqueduct syndrome and global rostral midbrain dysfunction associated with shunt malfunction giuseppe cinalli m. On axial views, the selective atrophy of the midbrain tegmentum with relative preservation of the tectum and cerebral peduncles produces the mickey mouse sign see fig. Piyush ranjan sahoo slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising.

Particular syndromes associated with midbrain pathology include the weber, claude, benedikt, nothnagel, and parinaud syndromes. Lateral pontine syndrome, parinauds syndrome, webers syndrome. Approximate regions involved in medial and lateral midbrain stroke syndromes are shown. A 45 year old woman who had abdominal surgery 2 weeks before suddenly remarked to her husband that she was seeing double. The brainstem is made up of all the unpaired structures that connect the cerebrum with the spinal cord. The main eponymous brainstem infarction syndromes were named prior to the advent of cross sectional imaging, and are classified as either medial or lateral, within the midbrain, pons and medulla. We did not find a significant correlation between alteration in the superior profile of the midbrain and reduction in the ap diameter p. In the united states, 795,000 people experience strokes annually one stroke every 40 seconds.

Brainstem stroke syndromes, also known as crossed brainstem syndromes, refer to a group of syndromes that occur secondary to lesions, most commonly infarcts, of the brainstem. Midbrain syndromes case 1 a 45 year old woman who had abdominal surgery 2. Measurement of the midbrain diameter on routine magnetic resonance imaging. Claudes syndrome associated with supranuclear horizontal. There are many functions of the midbrain, including body temperature regulation, motor control i. Her husband noticed that her left eyelid was drooping. The tegmentum of the midbrain extends from the base of the tectum to, but does not include, the substantia nigra. Thus a medial brainstem syndrome will consist of the 4 ms and the relevant motor cranial nerve, and a lateral brainstem syndrome will consist of the 4 ss and either the 911th cranial nerve if in the medulla, or the 5th, 7th and 8th cranial nerve if in the pons. Alien limb syndrome, cortical sensory deficits, focal frontal or temporoparietal atrophy hallucinations or delusions unrelated to dopaminergic therapy. Ipsilateral 3rd nerve palsy with contralateral hemiplegia.

Midbrain atrophy in parkinsons, alzheimers and multiple. These syndromes are classically caused by ischemic strokes that occur secondary to occlusion of small perforating arteries of the posterior circulation, however many have also been described secondary to hemorrhage, neoplasm, and demyelination 15. It needs to be differentiated from other clinical conditions such as pineal cyst, niemannpick disease, wilsons disease, and hydrocephalus. The cause of diplopia, oscillopsia, and anomalous head posture in this patient was a combination of dorsal midbrain syndrome and bilateral superior oblique palsy. They control horizontal eye movements by interconnecting oculomotor and abducens nuclei in. Benedikt syndrome, also called benedikts syndrome or paramedian midbrain syndrome, is a rare type of posterior circulation stroke of the brain, with a range of neurological symptoms affecting the midbrain, cerebellum and other related structures. Parinauds syndrome results from injury, either direct or compressive, to the dorsal midbrain. Occasionally lateral brainstem syndromes are seen in unilateral vertebral occlusion. Mr imaging of the superior profile of the midbrain. Benedikts syndrome is a rare condition, usually due to a midbrain vascular occlusion. Midbrain syndromes 1 midbrain syndromes idara eshiet c. Midbrain syndromes at pacific university studyblue. Midbrain, region of the developing vertebrate brain that is composed of the tectum and tegmentum.

Brainstem stroke syndromes there are many brainstem stroke syndromes some of the clinical features seen are. These structures are the epithalamus, the thalamus, the hypothalamus, and the subthalamus. Brainstem syndromes are most commonly due to occlusion of the posterior circulation or mass effect from intrinsic spaceoccupying lesions. These branches are also called mesencephalic artery and are paramedian arteries 3. Pt, and some features may become unavailable intermittently. In turn, the crus cerebri is composed primarily of descending fibers. The midbrain is a critical area for the control of combined eye and head gaze movements, containing nuclei such as the rostral interstitial nucleus of the medial longitudinal fasciculus rimlf, which serves as the verticaltorsional saccade generator and the interstitial nucleus of cajal inc, which is regarded as the verticaltorsional neuronal integrator for the eye and head. Original contribution measurement of the midbrain diameter on. Brainstem stroke syndromes are most commonly classified anatomically. The 3rd and 4th cranial nerves are the motor nerves in the midbrain. Midbrain syndromes case 1 a 45 year old woman who had abdominal surgery 2 weeks before. Pdfs are designed to be printed out and read, but if you prefer to read them online, you may find it easier if you increase the view size to 125%.

Brain herniation types, symptoms and radiology see online here brain herniation is a potentially fatal condition that may present as a rise in intracranial pressure. The midbrain represents the uppermost portion of the brainstem, containing numerous important nuclei and white matter tracts, most of which are involved in motor control, as well as the auditory and visual pathways. The brain can shift across such structures as the falx cerebri, the tentorium cerebelli, and even through the foramen magnum the hole in the base of the skull through. Quantitative analysis of vertical eye movements documented characteristic abnormalities of saccades with relative preservation of reflex eye. The anterolateral portion of the midbrain on either side is formed by the basis pedunculi, which consists of the substantia nigra and the crus cerebri. Human nervous system human nervous system brainstem. It is caused by midbrain infarction as a result of occlusion of the paramedian branches of the posterior cerebral artery or of basilar bifurcation perforating arteries. Midbrain syndromes of benedikt, claude, and nothnagel setting the record straight. Brain herniation is a potentially deadly side effect of very high pressure within the skull that occurs when a part of the brain is squeezed across structures within the skull. A brainstem stroke syndrome falls under the broader category of stroke syndromes, or specific symptoms caused by vascular injury to an area of brain for example, the lacunar syndromes.

Discussion will contain basic neuro anatomy of the brainstem from a clinicians perspective details. Blockage of csf flow may play a role in enlargement of the cerebal aqueduct and atrophy of the midbrain in alzheimers parkinsons and multiple sclerosis, as well as as signs of nystagmus and diplopia. There is resultant third nerve palsyparesis and contra lateral hemiplegia. View notes midbrain syndromes 1 from physiology 1001 at windsor som. Isolated medial longitudinal fasciculus mlf syndrome due to infarction limited only to the midbrain is a rare occurrence. Nov 15, 2019 the midbrain and hindbrain together compose the brainstem. Posted by admin on june 19, 2011 leave a comment 1 go to comments.

Dorsal midbrain lesions have characteristic eye signs involving vertical gaze, vergence and the pupil light reflex. Oculocerebrocutaneous syndrome occs, also known as delleman syndrome, is a rare multiple congenital anomalymental retardation syndrome characterised by the triad of eye, brain, and skin malformations, sometimes associated with other features such as craniofacial clefts, skull or rib defects, and urogenital anomalies. The possible reason of compression may due to idiopathic brainstem hemorrhage, which may extend from the pontomesencephalic intersection up to the cerebral peduncles and that involves the rostral midbrain 1,2,3,4. It balances right brain and left brain, so optimum function of brain can be achieved. Midbrain syndrome definition of midbrain syndrome by the.

Vascular anatomy and syndromes of the midbrain and hindbrain. Anteroposterior diameters of the suprapontine midbrain, the pons, and the collicular plate were measured in 50 patients with various parkinsonian syndromes parkinson disease pd n 20, progressive supranuclear palsy psp n 16, and multiplesystem atrophy of striatonigral type n 14 and 12 agematched healthy control subjects by means of axial t2weighted magnetic resonance. In the first, pupillary reaction was affected and in the second this reaction was spared. Ipsilateral 3rd nerve palsy with contralateral chorea,tremors, athetosis. Midbrain tegmental lesions affecting or sparing the pupillary. She had early dorsal midbrain syndrome mimicking an adies tonic pupil, and cholinergic supersensitivity was demonstrated using topical 0. P ersonal v iewpoint c linical t the rule of 4 of the.

Clinical presentation ipsilateral cn iii palsy 14 crossed hemiataxia 14 crossed chore. Webers syndrome is a fascicular syndrome of the oculomotor nerve, commonly caused by the occlusion of the blood vessels that supply the midbrain and results in necrosis of midbrain tissue, involving oculomotor nerve fascicle and the cerebral peduncles. We report clinical and oculographic findings in seven patients with the dorsal midbrain syndrome parinauds syndrome. Notable midbrain nuclei include the superior and inferior colliculus nuclei, red nucleus, substantia nigra, oculomotor nuclear complex, and trochlear nucleus. The brainstem connects the spinal cord with the cerebrum.

The rule of 4 is a simplified method to localize brainstem vascular syndromes specific to a vascular territory. Midbrain syndrome definition of midbrain syndrome by. If you continue browsing the site, you agree to the use of cookies on this website. A major function of the midbrain is to aid in movement as well as visual and auditory processing. It is underneath the cerebral cortex, just above the brain stem, and is located toward the center of the brain. The midbrain regulates movement and aids in the processing of auditory and visual information.

Information on how to subscribe to neurology and neurology. It contains numerous cranial nerve nuclei and is traversed by multiple tracts between the brain and spinal cord. In an adult, the mesencephalon is characterized by the unique conformation of its roof plate, the lamina of the mesencephalic tectum, composed of the bilaterally paired superior and inferior colliculi, and by the massive paired prominence of the crus cerebri at its ventral surface. This case of parinauds syndrome may be an unusual form of limbic encephalitis with underlying neoplasm. Claudes syndrome associated with supranuclear horizontal gaze palsy caused by dorsomedial midbrain infarction chinshih fong abstractclaudes syndrome caused by dorsal midbrain lesion is characterized by ipsilateral third nerve palsy and contralateral ataxia. Bilateral mesencephalic involvement was found only in 1 patient figure 2. First, isolated midbrain infarcts 9 patients were usually small and limited to the upper and middle lower part of the mesencephalon without other rostral or caudal involvement. Dorsal midbrain parinaud syndrome the academy will be performing website maintenance thursday, april 16 from 5 6 p. Benedikt syndrome, or paramedian midbrain syndrome, is a midbrain stroke syndrome that involves the fascicles of the oculomotor nerve and the red nucleus. The oculomotor and trochlear cranial nerves are located in the midbrain. These syndromes can have subtle imaging findings that may be missed by a radiologist unfamiliar with the anatomy or typical manifesting features.