STROKE SYNDROMESDJADJANG SUHANA

Vertebrobasilar arteries syndromesMidbrain (mesencephalic) disturbances :Webers syndrome- Lesions of ventral portion of midbrainBenedikts syndrome- lesions of tegmentumParinauds syndrome- Lesions of superior culliculi of the tectum I. Clinical syndromes of the midbrain

Webers syndromeClinical manifestations : Ipsilateral ophthalmoplegia results from oculomotor nucleus interruption Contralateral hemiparesis involvement of corticospinal tract in cerebral peduncle

Benedikts syndromeClinical manifestations : Ipsilateral ophthalmoplegia results from lesion of tegmentum that destroys the oculomotor nerve Contralateral hyperkinesia (tremor, chorea, athetosis) Lesion of tegmentum destroys red nucleus (nucleus of rubra) on one side.

Perinauds syndromeClinical manifestations : Upward gaze paralysis Disorders of the quadrigeminal plate of mid brain (superior culliculi) Etiologies are : compressed by pineal body tumor Lesion of posterior commissure

II. Clinical syndromes of the PonsRaymonds syndromeMillard-Gubler syndromeFovilles syndromeRaymond-Cestan syndrome (Cestan-Chenais syndrome)Pontocerebellar Angle Tumor SyndromeAlternating trigeminal hemiplegia

Raymonds syndromeClinical manifestations : Alternating abducent hemiplegia - ipsilateral lateral rectus muscle paresis - contralateral hemiparesisDue to infarction of paramedian area of pons involves theabducens nerve and corticospinal tract

Millard-Gubler syndromeClinical manifestations : Alternating facial hemiplegia - ipsilateral facial palsy - contralateral hemiparesis - sometime the VI - nerve is also involved (internal strabismus)- Due to pontine lesion

Fovilles syndromeClinical manifestations : contralateral hemiparesis ipsilateral VII-nerve palsy ipsilateral paralysis of lateral conjugate gaze- Due to pontine lesion

Raymond-Cestan syndrome(Cestan-Chenais syndrome)Clinical manifestations : Quadriplegia Anesthesia Nystagmus- Due to atherothrombotic of the branches of basilar artery supplying this region Involvement of pyramidal tract, medial lemniscus and medial longitudinal fasciculus

Alternating Trigeminal HemiplegiaClinical manifestations : contralateral hemiparesis ipsilateral paralysis of jaw muscle (masseter and temporal muscles paralysis)- Ipsilateral hypesthesia of facial regionSite of lesion : Result from lesion of ventral pons involving : corticospinal tract fibers of adjacent trigeminal nerve

III. Clinical syndromes of the medulla oblongataAvellis syndrome ( X and Bulbar XI )Schmidts syndrome ( X and all of XI )Jacksons syndrome ( X, XI and XII )Tapias syndrome ( X and XII )Babinski-Nageotte Bulbar Syndrome (IX, X, Bulbar portion of XI and Part of V )Wallenbergs syndromeCestan-Chenais syndromeBonniers syndrome ( VIII, IX and X )Hypoglossal hemiplegia alternans ( XII )A. Bulbar and radicular syndomes

III. Clinical syndromes of the medulla oblongataVernets syndrome ( IX, X and XI )Villarets syndrome (Collets or Sicards syndrome)A. Syndromes caused by peripheral lesions

Avellis syndrome ( X and Bulbar XI )Clinical manifestations : ipsilateral partalysis of soft palate, pharynx and larynx ( dysarthria, dysphagia, hypesthesia of pharynx and larynx ) Contralateral dissociate hemihypesthesia (spinbothalamic tract) : - loss of pain and temperature senses, - sparing touch and pressure senseCaused by lesion of nucleus ambiguus, tractus solitarius, and adjacent spinothalamicus tract affecting : - X-nerve, internal branch of the accessory nerve and ascending sensory nerve

Schmidts syndrome ( X and all of XI )Clinical manifestations : ipsilateral paralysis of soft palate, pharynx, larynx, and hypesthesia of pharynx and larynx (X and bulbar portion of XI) Ipsilateral sternocleidomastoid and trapezius muscle paralysisSite of lesion :Lesion of vagal nuclei and both bulbar and spinal nuclei of accessory

Jacksons syndrome ( X, XI and XII )Clinical manifestations : ipsilateral paralysis of soft palate, pharynx and larynx (X) ipsilateral paralysis of sternocleidomastoid and trapezius muscle (XI)- Ipsilateral paralysis and atrophy of tongue (XII)Site of lsion :Nuclear lesion of vagus, accessory and hypoglossal

Tapias syndrome ( X and XII )Clinical manifestations : ipsilateral paralysis of pharynx and larynx (X)- Ipsilateral paralysis and atrophy of tongue (XII)Site of lesion :- Nuclear lesion of vagus and hypoglossal

5. Wallenbergs syndromeClinical manifestations : ipsilateral loss of taste on posterior third of tongue ipsilateral Horners syndrome (miosis, ptosis and enophthalmos) Ipsilateral loss of pain and temperature sense of the face ipsilateral asynergia and atxia (tendency to fall to side of lesion)Site of lesion :- Atherothrombosis of Posterior inferior cerebellar artery

Bonniers syndrome ( VIII, IX and X )Clinical manifestations : ipsilateral loss of taste on posterior third of tongue ipsilateral Horners syndrome (miosis, ptosis and enophthalmos) Ipsilateral loss of pain and temperature sense of the face ipsilateral asynergia and atxia (tendency to fall to side of lesion)Site of lesion :- Atherothrombosis of Posterior inferior cerebellar artery