Brain stem syndromes
Keywords:
brain stem syndromes, etiology, pathogenesis, clinical presentationAbstract
Brain stem syndromes have been described by different authors at different times. Their etiology is most often vascular, in the area of the posterior circulation, but can be also inflammatory, neoplastic or demyelinating. The medulla oblongata, pons and mesencephalon, nuclei of cranial nerves homolaterally and tracts of white cerebral matter contralaterally are affected, depending on the localization of the lesion. Clinically, they occur as alternating and non-alternating syndromes. Alternating syndromes are a combination of homolateral symptoms from damage to cranial nerve nuclei (CN) and contralateral symptoms from damage to motor and sensory pathways. Due to variations in the blood supply and in the affected structures, there are differences in the clinical course of the syndromes. This creates certain contradictions in the clinical descriptions of different authors.
The differential diagnosis is with cerebral hemorrhages, transient ischemic attacks, demyelinating diseases, brain tumors, status epilepticus, toxic, infectious, and metabolic encephalitis, central pontine demyelination, basilar migraine, tumors in the pontocerebellar angle, brain herniation with stem compression, and electrolyte imbalance.
Mesencephalon syndromes mainly include three overlapping syndromes – superior alternating hemiplegia (Weber syndrome), paramedian mesencephalic syndrome (Benedict syndrome), and Claude syndrome. Less common are Nothnagel's and Wernekink's commissure syndromes, as well as the non-alternating Parinaud and Hertwig-Magendie syndromes.
The pons syndromes are mainly medial pontine syndrome (medial alternating hemiplegia, inferior medial pontine or Foville syndrome) and lateral pontine syndrome (Marie-Foix syndrome).
Other pons syndromes are Brissaud-Sicard, Gasperini, Gelle, Millard-Gubler, Raymond, Raymond-Cestan, Grenet, colliculus facialis syndrome, and locked-in syndrome.
Medullary syndromes include Dejerine, Wallenberg, Avellis, Babinski-Nageotte, Cestan-Chenais, Reinhold, Jackson, Schmidt, Tapia, Vernet, Opalski, and Spiller syndromes. Beck syndrome classically presents with spinal symptoms, but the lesion may extend proximally and affect the medial half of the medulla oblongata, with alternating symptoms.
In conclusion, brain stem syndromes are rare and variable, but their recognition is important for topical diagnosis in neurological practice.
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