Brainstem stroke syndromes
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Brainstem stroke syndromes, also known as crossed brainstem syndromes, refer to a group of syndromes that occur secondary to lesions, most commonly infarcts, of the brainstem.
Although many different brainstem stroke syndromes have been classically described, the majority appear extremely rarely in the literature and are mainly for historical interest only 1. The most common brainstem stroke syndrome seems to be the lateral medullary syndrome (Wallenberg syndrome) 1.
Each brainstem stroke syndrome has a characteristic clinical picture according to the involved area, however, generally, there is ipsilateral cranial nerve palsy and contralateral hemiplegia/hemiparesis and/or hemisensory loss 1-5.
The rule of 4 of the brainstem is a useful and simple clinical tool to aid in the anatomical localization of signs and symptoms in a brainstem stroke 6.
These syndromes are classically caused by ischemic strokes that occur secondary to occlusion of small perforating arteries of the posterior circulation, however many have also been described secondary to hemorrhage, neoplasm, and demyelination 1-5.
Brainstem stroke syndromes are most commonly classified anatomically.
- Brissaud-Sicard syndrome
- facial colliculus syndrome
- Gasperini syndrome
- Gellé syndrome
- Grenet syndrome
- inferior medial pontine syndrome (Foville syndrome)
- lateral pontine syndrome (Marie-Foix syndrome)
- locked-in syndrome
- Millard-Gubler syndrome
- Raymond syndrome
- Raymond-Cestan syndrome
- Avellis syndrome
- Babinski-Nageotte syndrome
- Cestan-Chenais syndrome
- hemimedullary syndrome (Reinhold syndrome)
- Jackson syndrome
- lateral medullary syndrome (Wallenberg syndrome)
- medial medullary syndrome (Dejerine syndrome)
- Opalski syndrome
- Schmidt syndrome
- Spiller syndrome
- Tapia syndrome
- Vernet syndrome (often not caused by a brainstem lesion)
- 1. Marx JJ, Thömke F. Classical crossed brain stem syndromes: myth or reality?. (2009) Journal of neurology. 256 (6): 898-903. doi:10.1007/s00415-009-5037-2 - Pubmed
- 2. Cerebral Small Vessel Disease. Cambridge University Press. ISBN:1107031664. Read it at Google Books - Find it at Amazon
- 3. Ortiz de Mendivil A, Alcalá-Galiano A, Ochoa M et-al. Brainstem stroke: anatomy, clinical and radiological findings. Semin. Ultrasound CT MR. 2013;34 (2): 131-41. doi:10.1053/j.sult.2013.01.004 - Pubmed citation
- 4. Ropper AH, Samuels MA, Klein JP. Adams and Victor's principles of neurology 10th ed. New York: McGraw-Hill Medical Pub. Division; 2014.
- 5. Kumral E, Bayülkem G, Evyapan D. Clinical spectrum of pontine infarction. Clinical-MRI correlations. J. Neurol. 2002;249 (12): 1659-70. doi:10.1007/s00415-002-0879-x - Pubmed citation
- 6. Gates P. The rule of 4 of the brainstem: a simplified method for understanding brainstem anatomy and brainstem vascular syndromes for the non-neurologist. Internal medicine journal. 35 (4): 263-6. doi:10.1111/j.1445-5994.2004.00732.x - Pubmed