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The basal ganglia is an important part of the brain which program impulses from cerebral cortex and initiates motor activities through cerebellum and corticospinal tracts. Parkinsonism is a disorder in which there is decrease in the dopaminergic neurons in the striatum which results in motor impairment.
The components of the basal ganglia are:
Corpus Striatum- Caudate+Lentiform nucleus.
Lentiform nucleus- Putamen+Globus pallidus.
Striatum - Caudate nucleus+Putamen.
Also known as Wallenberg syndrome.
Vertebral artery is the most commonly involved artery (V4 segment) or Posterior Inferior cerebellar artery(PICA)
Right sided lateral medullary lesion
- Loss of pain and temperature in right side of face and left side of body.
- Ipsilateral palatal palsy and loss of gag reflex due to involvement of IXth and Xth cranial nerves.
- Ipsilateral ataxia nad horners syndrome(because sympathetic chain runs along this course)
- Loss of taste sensation on ipsilateral part of tongue.
- No hemiplegia/Hemiparesis.
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Ipsilateral 3rd Nerve palsy with contralateral hemiplegia
- Due to superior cerebellar peduncle injury.
- Ipsilateral 3rd nerve palsy with Contralateral cerebellar ataxia
- Due to involvement of red nucleus
- Ipsilateral 3rd nerve palsy with contralateral chorea,tremors, athetosis.
- Combination of features of benedicts and Nothnagel’s syndromes.
- 3rd N palsy with contralateral tremor and ataxia, no hemiparesis.
- Dorsal Midbrain sydrome
- Paralysis of upgaze
- Pseudo Argyll Robertson’s pupils:Light near dissociation
- Skew deviation
- Lid retraction(Colliers sign)
- Setting sun sign:Downward ocular deviation
- Seen in pinealomas,Obstructive hydrocephalus
Raymond Cestan Syndrome
- Upper dorsal pontine syndrome
- Ipsilateral ataxia,tremor,INO,contalateral hemiparesis
Millard Gubler Syndrome
- Ventral paramedian pontine lesion involving 6th and 7th fascicles and the pyramidal tract
- Lateral rectus palsy
- Lower pontine tegmental lesion involving PPRF,6th N,7th N,pyramidal tract.
- Lateral gaze palsy present
Locked In syndrome
- Bilateral pontine infarction/bleed
- Quardiplegia, consiousness preserved
- Only vertical eye movements present.
Festinant gait – Parkinsonism
Reeling/ Ataxic gait – Cerebellar vermis involvement.
Stamping/Tabetic gait – Sensory ataxia.
Steppage/ Equine gait – Foot drop.
Waddling gait/ Trendelenberg gait – Gluteal muscle weakness.
Toppling gait – Vestibular neuronitis, Brainstem strokes.
Apraxic gait, paratonia(Gegenhalten), Bruns ataxia – Frontal lobe involvement.
Circumductive gait – Hemiplegia.
Astasia- Abasia - Hysterical.