Brain stem strokes

Clinical features of different types of brain stem stroke

 Neurology  stroke

thalamic strokemidbrain strokepontine strokemedial medullary strokelateral medullary stroke
cranial nervesVertical gaze ophthalmoplegia, loss of pupillary reflexes, loss of convergenceIpsilateral III/IV nerve palsy. Ipsilateral Horner's. Ptosis, supranuclear gaze palsy, internuclear ophthalmoplegiaLoss of conjugate gaze to side of lesion, Horner's (lateral superior pontine), internuclear ophthalmoplegia (medial superior pontine), Vth nerve palsy (lateral mid pontine)Ipsilateral XIIth nerve palsyIpsilateral Horner's, left facial pain and sensory loss, nystagmus, oscillopsia, dysphagia, ipsilateral vocal chord paralysis
sensory findingsContralateral pain, dysaethsesia, loss of position sense sometimesContralateral sensory lossVariable or contralateral sensory lossContralateral loss of touch, vibration and position senseIpsilateral sensory loss, contralateral loss of pain and temperature
pyramidal featuresContralateral hemiparesisContralateral hemiparesisContralateral hemiparesis (medial syndromes)Contralateral hemiparesis
ataxiaContralateral ataxiacontralateral ataxiaIpsilateral ataxiaIpsilateral ataxia
other featuresConfusion, memory impairment, language disturbanceWeber's Ipsilateral IIIrd, contralateral hemiplegia. Claude's ipsilateral IIIrd, contralateral ataxia. Benedikt's = Weber's plus Claude's.Dizziness, vertigo, vomiting, tinnitusVertigo, vomiting
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Cerebral lobe signs | Loss of consciousness | Cranial nerves (V, VII, VIII) | Motor defects | Cranial nerves (ocular and smell) | Stroke classification |