STROKE SYNDROMES

DJADJANG SUHANA

Vertebrobasilar arteries syndromes

Midbrain (mesencephalic) disturbances :

1. Weber’s syndrome

- Lesions of ventral portion of midbrain

2. Benedikt’s syndrome

- lesions of tegmentum

3. Parinaud’s syndrome

- Lesions of superior culliculi of the tectum

I. Clinical syndromes of the midbrain

Weber’s syndrome

Clinical manifestations :- Ipsilateral ophthalmoplegia

- results from oculomotor nucleus interruption

- Contralateral hemiparesis

- involvement of corticospinal tract in cerebral peduncle

Benedikt’s syndrome

Clinical 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.

Perinaud’s syndrome

Clinical 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 Pons

1. Raymond’s syndrome

2. Millard-Gubler syndrome

3. Foville’s syndrome

4. Raymond-Cestan syndrome

(Cestan-Chenais syndrome)

5. Pontocerebellar Angle Tumor Syndrome

6. Alternating trigeminal hemiplegia

Raymond’s syndrome

Clinical manifestations :- Alternating abducent hemiplegia

- ipsilateral lateral rectus muscle paresis

- contralateral hemiparesis

Due to infarction of paramedian area of pons involves the

abducens nerve and corticospinal tract

Millard-Gubler syndrome

Clinical manifestations :- Alternating facial hemiplegia

- ipsilateral facial palsy

- contralateral hemiparesis

- sometime the VI - nerve is also involved

(internal strabismus)

- Due to pontine lesion

Foville’s syndrome

Clinical 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 Hemiplegia

Clinical manifestations :- contralateral hemiparesis

- ipsilateral paralysis of jaw muscle

(masseter and temporal muscles paralysis)

- Ipsilateral hypesthesia of facial region

Site of lesion :

- Result from lesion of ventral pons involving :

- corticospinal tract

- fibers of adjacent trigeminal nerve

III. Clinical syndromes of the medulla oblongata

1. Avellis’ syndrome ( X and Bulbar XI )

2. Schmidt’s syndrome ( X and all of XI )

3. Jackson’s syndrome ( X, XI and XII )

4. Tapia’s syndrome ( X and XII )

5. Babinski-Nageotte Bulbar Syndrome

(IX, X, Bulbar portion of XI and Part of V )

6. Wallenberg’s syndrome

7. Cestan-Chenais syndrome

8. Bonnier’s syndrome ( VIII, IX and X )

9. Hypoglossal hemiplegia alternans ( XII )

A. Bulbar and radicular syndomes

III. Clinical syndromes of the medulla oblongata

1. Vernet’s syndrome ( IX, X and XI )

2. Villaret’s syndrome (Collet’s or Sicard’s syndrome)

A. Syndromes caused by peripheral lesions

1.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 sense

Caused by lesion of nucleus ambiguus, tractus solitarius, and adjacent spinothalamicus tract affecting :

- X-nerve, internal branch of the accessory nerve and ascending sensory nerve

2. Schmidt’s 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 paralysis

Site of lesion :Lesion of vagal nuclei and both bulbar and spinal nuclei of accessory

3.Jackson’s 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

4.Tapia’s 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. Wallenberg’s syndrome

Clinical manifestations :- ipsilateral loss of taste on posterior third of tongue

- ipsilateral Horner’s 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

6.Bonnier’s syndrome ( VIII, IX and X )

Clinical manifestations :- ipsilateral loss of taste on posterior third of tongue

- ipsilateral Horner’s 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