neurological examination part ii:-clinical evaluation of the brainstem and cerebellum (full lecture...

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Clinical Evaluation of the Brainstem and Cerebellum

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  • BRAIN STEM, CEREBELLUM and NEURO-OPTHALMOLOGY Submitted to:- AskTheNeurologist.Com in 2007
  • GROSS ANATOMY
  • LATERAL VIEW
  • LOCATION OF CRANIAL NERVE NUCLEI WITHIN BRAINSTEM
  • CRANIAL NERVE 5 Note that although all fibres enter the brainstem at the level of the pons, those concerned with pain and temperature descend as low as C3
  • PATHWAYS INVOLVED IN HORIZONTAL GAZE LEFT FRONTAL EYE FIELD
  • INTERNUCLEAR OPTHALMOPLEGIA ( INO)
  • THE FACIAL NERVE
  • The Long Tracts Note sites of decussation of major tracts : Spinothalamic Cuneate / Gracile Corticospinal
  • Blood supply of Brainstem and Cerebellum
    • Ant. cerebral
    • Internal carotid
    • Middle cerebral
    • Post. communicating
    • Sup. cerebellar
    • Basilar
    • Ant. Inf. cerebellar
    • Vertebral
    • Ant. Spinal
    • Post. Spinal
    • Post. Inf. Cerebellar
    • Post cerebral
    • Mesencephalic
  • Somatotopy of cerebellum posterior
    • Midline lesions:
      • nystagmus
      • Titubation
      • Trunk / gait ataxia
    • Hemispheric lesions:
      • nystagmus
      • ipsilateral limb signs
  • Basic Plan of Cerebellar connections DN= Dentate nucleus T = Thalamus RN = Red nucleus Each cerebellar cortex controls ipsilateral side of body Efferents to cortex leave cerebellum via superior cerebellar peduncle Note: red nucleus is present in midbrain and ultimately controls contralateral half of body
  • DSCT= dorsal spinocerebellar tract VSCT= ventral spinocerebellar tract VSCT is crossed in the cord but crosses back within cerebellum
  • Which of the following patients cannot have MG?
    • Right eye totally paralysed, left eye moves freely but with ptosis
    • Inability of both eyes to move to left with no diplopia
    • Bilateral inability to look up with bilateral ptosis
    • Left eye deviated down and laterally with ptosis on left and left pupil larger than right
  • Anisocoria
    • Inequality between the 2 pupils
    • Pupils may be :
    • - equal ( to within 1mm)
    • - unequal due to surgery ( usually irregular)
    • - unequal due to neurological disease
  • The 2 neurological causes of anisocoria
    • One pupil too big
    • One pupil too small
    Parasympathetic---------------------------------------Sympathetic Constricts (Ach) III Dilates (Nad) Symp fibres
  • Anisocoria rules
    • Darkness exaggerates failure of dilation
    • Bright light exaggerates failure of constriction
    • If unilateral ptosis is present assume that the eye with the ptosis is sick!
  • Sphincter pupillae muscle
  • Left RAPD AKA Marcus-Gunn pupil For example a patient with multiple sclerosis who is suffering from acute left sided optic neuritis
  • Sphincter pupillae muscle
  • THE END The full lecture can now be accessed at AskTheNeurologist.Com

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