Friday, March 17, 2017

Brainstem syndromes-Midbrain!

Here we shall review three syndromes in the Midbrain occuring majorly due to a vascular event.
Weber's Syndrome:
Lesion Location: Midbrain base
Structures involved :CN III fibers; cerebral peduncle
Features: Ipsilateral CN III palsy; contralateral hemiparesis

(The image showing the involved 3 nerve and the crus! The lesion is anterior—in the cerebral peduncle—in  Weber’s syndrome, causing hemiparesis.)

Claude's Syndrome:
Lesion location :Midbrain tegmentum
Structures involved: CN III fibers; red nucleus; SCP
Clinical features: Ipsilateral CN III palsy; contralateral ataxia and tremor (“rubral tremor”)

(The sky blue line depicts the sup. Cerebellar peduncle! Lesion is more posterior—in the tegmentum—in Claude’s syndrome, causing hemiataxia.)

Benedikt's Syndrome:
Lesion location: Midbrain tegmentum
Structures involved: CN III fibers; red nucleus; CST (corticospinal tract)SCP(superior cerebellar peduncle)
Clinical features:
•Ipsilateral CN III palsy; contralateral hemiparesis with ataxia, hyperkinesia and tremor “rubral tremor

(The blue fibers being the sup. Cerebellar peduncle. In Benedikt’s syndrome, the lesion is more extensive, involving both the tegmentum and the peduncle, causing hemiparesis with tremor and ataxia of the involved limbs)

These three midbrain syndromes are variations on a theme.
Benedikt’s is essentially  Weber’s + Claude’s.

Because the fascicles of cranial nerve (CN) III are scattered in their course through the midbrain, the third nerve palsy in any of these syndromes may be partial.

Last on the list....
 Nothnagel's Syndrome mainly due to neoplasms ...affecting the Midbrain tectum involving Ipsilateral or bilateral CN 3 causes Oculomotor palsies; ataxia.

We finish Alll the midbrain syndromes !!!!!😎

Hope it helps!


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