脑干损伤说课材料.pptVIP

脑干损伤;;;;Medial (basal) medullary syndrome usually in-volves the pyramid, part or all of the medial lemniscus, and nerve XII. If it is unilateral, it is also known as alternating hypoglossal hemiplegia (Fig 7-12); the term refers to the finding that the cranial nerve weakness is on the same side as the lesion, but the body paralysis is on the opposite side. Larger lesions can result in bilateral defects. The area involved is supplied by the anterior spinal artery or by medial branches of the vertebral artery.;Lateral medullary, or Wallenbergs, syndrome involves some (or all) of the following structures in the open medulla on the dorsolateral side (see Fig 7-12): inferior cerebellar peduncle, vestibular nuclei, fibers or nuclei of nerve IX or X, spinal nucleus and tract of V, spinothalamic tract, and sympathetic pathways. (Involvement of the sympathetic pathways may lead to Honers syndrome.) The affected area is supplied by branches of the vertebral artery or, most commonly, the posterior inferior cerebellar artery. An example is provided in Clinical Illustration 7-1.;Basal pontine syndromes can involve both the corticospinal tract and a cranial nerve (VI, VII, or V) in the affected region, depending on the extent and level of the lesion (Fig 7-13). The syndrome is called alternating abducens (VI), facial (V), or trigeminal hemiplegia (V). If the lesion is large, it may include the medial lemniscus. The vascular supply comes from the perforators, or pontine branches, of the anterior inferior cerebellar artery.;Dorsal pons syndrome affects nerve VI or VII or their respective nuclei, with or without involvement of the medial lemniscus, spinothalamic tract, or lateral lemniscus. The lateral gaze center is often involved (see Fig 8-7). At a more rostral level, nerve V and its nuclei may no longer be functioning. The affected area is supplied by various perforators (pontine branches) of the circumferential arteries. ;Peduncular syndrome, also called alternating oculomotor