Imaging the Brain Stem & Cranial Nerves - UCSD - Center...

Department of Radiology

University of California

San Diego

John R. Hesselink, M.D.

Imaging the Brain Stem

& Cranial Nerves

Brain Stem Nuclei

Netter, CIBA Collection, 1972

Sensory Motor

Brainstem Nuclei

Blue = Sensory

Red = Motor

Dorsal View

Netter, CIBA Collection, 1972

Superior Colliculus

Cranial nerve III

Corticospinal tracts

Substantia nigra

Reticular formation

Red nucleus

Medial lemniscus

Medial longitudinal

fasciculus

3rd nerve nucleus

Superior colliculus

Periaqueductal gray

Midbrain

Ann Hayman, Brain Stem Charts

Dx: Severe lactic acidemia -

Leigh's disease

History: 1 y/o girl with spasticity

& disconjugate gaze

171 -

539 -

History: 48 y/o woman with dysarthria,

diplopia, & right sided weakness

Dx: B-cell lymphoma

pelvis & brain stem

{Page 2}

Dx: Lymphoma

History: 37 y.o. HIV+ male

with a left 3rd nerve palsy

History: 20 y/o male

with a right 3rd nerve palsy

769 - 19066596

Dx: 3rd nerve schwannoma

{Page 2}

AIDS - CMV

Neuropathy

Sarcoidosis

p 37-40

History: A 3rd nerve palsy with dilated pupil

Dx: p-comm aneurysm

{Page 2}

Brain Stem Anatomy

Oculomotor Nerve

Kanski JJ, Clinical Ophthalmology,

Butterworth-Heinemann, 1994.

Carotid artery

Cavernous

sinus

Pituitary

gland 3rd nucleus

Red

nucleus

Clivus

3rd nerve Post. cerebral

artery Basilar artery

Pons

Ophthalmoplegia

Dx: Meningioma - Cavernous sinus

{Page 2}

Reticular formation

Decussation of superior

cerebellar peduncles


Substantia nigra

Medial lemniscus

Medial longitudinal

fasciculus

4th nerve nucleus

Inferior colliculus

Cranial nerve IV

Periaqueductal gray

Inferior Colliculus

Midbrain


Kanski JJ, Clinical Ophthalmology, Butterworth-Heinemann, 1994.

Brain Stem Anatomy

Trochlear Nerve

Internal carotid artery

6th Nerve

Basilar artery

Post. cerebral artery Sup. cerebellar artery

Trochlear nucleus

Cavernous sinus

3rd Nerve

4th Nerve

Post. communicating artery

Dx: MELAS - myopathy, encephalopathy,

lactic acidosis & stroke-like episodes

History: 22 y/o retarded female

with double vision

179 -

History: 63 y/o man with seizures for 8 years

& intermittent diplopia

365 -

Dx: Epidermoid

{Page 2}

Diffusion


Upper Pons

Cranial nerve V


Medial lemniscus

Middle cerebellar

peduncle

5th Nerve Nuclei

Superior cerebellar

peduncle

Medial longitudinal

fasciculus

Trigeminal Nerve

History: 35 y/o man

with bilateral facial pain

363 -

History: 73 y/o woman with weakness

427 -

Dx: Acute pontine infarct

{Page 2}

History: 53 y/o man admitted

with liver failure & hyponatremia

469 -

History: 38 y/o male with

right facial numbness

657 - Telerad

Dx: Schwannoma

{Page 2}

Lung Carcinoma

Metastasis to Meckel's Cave

M 33-4

History: 32 y/o male with diplopia,

right facial pain & numbness

599 –

Dx: Non-Hodgkin’s lymphoma

{Page 2}

Trigeminal Neuralgia

q 126-7

Lower Pons


Cranial nerve VI


Medial lemniscus Cranial nerve VII Cranial nerve VIII Salivatory nuclei

7th nerve nucleus 6th nerve nucleus

Cochlear nucleus

Vestibular nucleus Medial longitudinal

fasciculus Pontine reticular

formation

Brain Stem Anatomy

Abducens Nerve

Kanski JJ, Clinical Ophthalmology,

Butterworth-Heinemann, 1994.

Petroclinoid

ligament

VI Nerve Clivus

Pyramidal tract

Cavernous

sinus

Carotid artery

Pituitary

gland

Basilar

artery Medial

lemniscus

4th

Ventricle

Vestibular

nucleus

Dx: Brain stem plaques

History: 26 y/o man with bilateral

6th nerve palsies

V-3, 8

Dx: Multiple hemorrhagic

contusions - MLF

Trauma - MVA

Dx: NF 2 with CN schwannomas

Cranial nerves

{Page 2}

History: 46 y/o man

with 6th nerve palsy

following trauma

322 -

Dx: Meningioma

{Page 2}

History: 39 woman with SLE

on chronic immunosuppression

with steroids & methotrexate

701 –

{Page 2}

Dx: TB meningitis

History: 35-year-old male

with diplopia on right

lateral gaze

Dx: Intracavernous aneurysm

{Page 2}

Cavernous Sinus

A B C

Rootman J, et al., Orbital Surgery, Lippincott-Raven, 1995.

Posterior Middle Anterior

III

IV

VI

V1

V2

III

VI

V1

V2

IV IV

III

V1

VI

V2

Rootman J, et al., Orbital Surgery, Lippincott-Raven, 1995.

Cavernous Sinus

History: 9 y.o. girl

with multiple bilateral

cranial nerve palsies

Dx: Pituitary macroadenoma

History: 50 y/o woman

with headaches & visual changes

History: 59 y/o man presented in diabetic ketoacidosis

with swollen right eye, unresponsive to antibiotics.

Now blind in right eye & unable to open eye.

717 -

{Page 2}

Dx: Rhinocerebral mucormycosis

& cavernous sinus thrombosis

{Page 3}

8 days later

History: 71 y/o woman with left facial swelling

& increased tearing for 6 months

600 -

{Page 2}

Dx: Lymphoma - responded

to prednisone

{Page 3}

History: 65 y/o female presented with

trigeminal neuralgia & facial numbness

618 -

Dx: SCCA maxillary sinus

{Page 2}

Normal Cranial Nerves

{CISS-3D}

202 -

191 -

History: 58 y/o man with a right

7th nerve palsy & hearing loss

{Page 2}

Dx: 7th nerve schwannoma

{Page 3}

History: 56 y/o female

with left hemifacial spasm

574 -

Dx: Tortuous VB arteries

{Page 2}

Dx: Bell’s palsy – Herpes zoster

History: 81 y/o woman with chronic lymphocytic

leukemia and a right 7th nerve palsy

711 -

History: 47 y/o male with headache,

dizziness & bilateral hearing loss

676 -

Dx: Superficial siderosis –

chronic cocaine abuse but

none recently

{Page 2}

History: 47 y.o. female with unilateral

sensorineural hearing loss

55 -

Dx: Acoustic neurinoma

{Page 2}

Dx: Viral labyrinthitis –

on steroids for 8 days

History: 55 y/o woman with

acute hearing loss in the

right ear 10 day ago

619 -

History: 26 y/o man with nystagmus

750 - 24144875

Dx: MS

{Page 2}

Dx: Brain stem hemorrhage

History: 42 man with a right

7th nerve palsy & vertigo

778 - 11849809


Upper Medulla


Olivary nucleus

Medial lemniscus

Cranial nerve IX

Cranial nerve X

Nucleus ambiguous

Inferior cerebellar

peduncle

Solitary nucleus

Dorsal motor

nucleus (X) 12th nerve nucleus

Cranial nerve XII

Normal Cranial Nerves

{CISS-3D}

Medial Lemniscal Decussation

Medulla


Cranial nerve XII

Medial lemniscal

decussation

Medullary reticular

formation

Spinotrigeminal nucleus

12th nerve nucleus

Cuneate nuclei

and fasciculus

Gracile nucleus

and fasciculus


Pyramidal Decussation

Medulla


Pyramidal decussation

11th nerve nucleus

Lateral corticospinal

tract

Cranial nerve XI

Spinotrigeminal nucleus

Cuneate nuclei

and fasciculus

Gracile nucleus

and fasciculus


History: 40 y.o. female

with decreased left upper

gaze and multiple lower

cranial nerve palsies

Dx: En plaque meningioma

History: 60 y/o man with polycystic

kidney disease, tinnitus, hoarseness

& paretic right vocal cord

409 -

{Page 2}

Dx: Glomus jugulare

Tinnitus & hoarseness

{Page 3}

607 -

History: 51 y/o male with

paralysis of the right vocal cord

Dx: Arachnoid cyst

{Page 2}

Sarcoid

History: 34 y/o male with lump in neck

787 - 24158057

Dx: 11th nerve schwannoma

{Page 2}

CMV Cranial

Neuropathy

Imaging the Brain Stem & Cranial Nerves - UCSD - Center...

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