Ventromedial Medulla

(thrombosis of branch of the anterior spinal artery)

1) pyramid: contralateral hemiparesis

2) Medial Lemniscus: contralateral loss of position and vibratory sense of arm and leg

3) Hypoglossal nerve rootlets: ipsilateral paralysis of tongue

Lateral Medulla

(wallenbergs)

thrombosis of PICA or vertebral a.

1) lateral spinal thalamic tract: Contralateral loss pain/temp/sensation body

2) spinal tract of the nucleus of trigeminal: ipsilateral loss pain/temp/sensation face

3) nucleus ambigueus: dysphagi, dysphonia, ipsilateral loss gag reflex, tachycardia

4)descending central sympathetic: horners syndrome

5) inferior cerebellar peduncle: ipsilateral ataxia of limbs

6) cochlear nuclei: ipsilateral deafness/ tinnitus

7)inferior and medial vestibular nuclei: nystagmus, vertigo, vomitting

8) solitary nucleus: ipsilateral loss of taste

patient is dizzy, cant feel hot water on one side of the face and other side of body, present to the ER with ataxia.

Pontomedullary angle

(rostral medulla close to pons- caused by an acoustic neuroma)

1. vestibulochochlear nerve: ipsilateral deafness, tinnitus, nystagmus, vertigo
   
2. facial nerve: ipsilateral facial paralysis, dry eye, dry mouth, reduced taste, hyperacusis
   
3. inferior cerebellar peduncle: ipsilateral ataxia of limbs
   
4. trigeminal nerve (sometimes): ipsilateral loss sensation face, mout, paralysis of the muscles of mastication, jaw reflex loss, loss corneal reflex
   
5. glossopharyngeal and vagus nerve: ipsilateral paralysis of soft palate, pharynx, dyspnea, dysphagia, tachycardia, hoarseness
   

Facial Colliculus

(neoplasm)

1) Internal Genu of facial nerve: ipsilateral facial paralysis

2) abducens nerve: ipsilatarel internal strabismus and paralysis of lateral gaze

Ventrolateral Pons

(neoplasm, vascular)

1) cortico spinal tract: contralateral hemiparesis

2) facial nerve root: ipsilateral facial nerve signs

3) abducens nerve root: ipsilateral internal strbismus and paralyisis of lateral gaze

Pontine tegmentum

(neoplasm)

1) medial lemniscus: contralateral MVP and cutaneus sensations from body

2) spinothalamic trac: " "

3) trigeminal nerve root: ipsilateral

4) decending sympatheics: horners syndome

5) facial or abducens nuclei

6) spinal tract of trigeminal nerve: ipsilateral loss pain/temp from face

7) vestibular nuclei: nystagmus, vertigo

Anterior Internuclear opthalmaplegia

(multiple sclerosis)

Ventral Pons (locked in syndrome)

thrombosis of the basilar artery

1) corticospinal: quadriplegia

2) cortico bulbar: bilateral facial, laryngal , and lingual paralysis

- they can hear, eyes can move, have alpha rhythym on EKG

Lateral midbrain tegmentum

(neoplasm)

1) medial lemniscus: contralateral loss MVP and cutaneous sensation from the body

2) spinothalamic tract: " "

3) ventral trigeminothalamic tract: contralateral loss pain/temp from face

pure sensory loss lesion here, most common spot to have this is in the thalamus

ventromedial midbrain (occulomotor hemiplegia alternans) (webers)

aneurysm of the posterior communicating artery

1) occulomotor rootlets: ipsilateral nerve signs - ptosis, paralysis of medial and up and down movement of that eye

2) corticospinal tracts: contralateral hemiperisis

3) cortico bulbar : contralateral lower facial weakness

superior colliculus (parinauds)

pinealoma

1. rostra/corticotectal fibers: paralysis of upward gaze

2) pretectal area: loss of pupillary light reflex

3) caudo-lateral corticotectal fibers: paralysis of downward tracking movements  of the eyes