Midbrain and pontine syndromes

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Midbrain Syndromes

Weber’s syndrome

Ipsilateral 3rd Nerve palsy with contralateral hemiplegia

Nothnagels Syndrome

  1. Due to superior cerebellar peduncle injury.
  2. Ipsilateral 3rd nerve palsy with Contralateral cerebellar ataxia

Benedicts Syndrome

  1. Due to involvement of red nucleus
  2. Ipsilateral 3rd nerve palsy with contralateral chorea,tremors, athetosis.

Claudes Syndrome

  1. Combination of features of benedicts and Nothnagel’s syndromes.
  2. 3rd N palsy with contralateral tremor and ataxia, no hemiparesis.

Perinaud’s syndrome

  1. Dorsal Midbrain sydrome
  2. Paralysis of upgaze
  3. Pseudo Argyll Robertson’s pupils:Light near dissociation
  4. Skew deviation
  5. Lid retraction(Colliers sign)
  6. Setting sun sign:Downward ocular deviation
  7. Seen in pinealomas,Obstructive hydrocephalus

Pontine Syndromes

Raymond Cestan Syndrome

  1. Upper dorsal pontine syndrome
  2. Ipsilateral ataxia,tremor,INO,contalateral hemiparesis

Millard Gubler Syndrome

  1. Ventral paramedian pontine lesion involving 6th and 7th fascicles and the pyramidal tract
  2. Lateral rectus palsy

Fovilles syndrome

  1. Lower pontine tegmental lesion involving PPRF,6th N,7th N,pyramidal tract.
  2. Lateral gaze palsy present

Locked In syndrome

  1. Bilateral pontine infarction/bleed
  2. Quardiplegia, consiousness preserved
  3. Only vertical eye movements present.

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