1、神经解剖学神经解剖学脑干损伤脑干损伤lesions of the brain stem 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):Dorsal pons syndrome affects nerve VI or VII or their respective nuclei,with or without involvement of the
2、 medial lemniscus,spinothalamic tract,or lateral lemniscus.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).Larger lesions can result in bilateral defects.The syndrome is
3、called alternating abducens(VI),facial(V),or trigeminal hemiplegia(V).This area is supplied by perforators and branches of circumferential arteries.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 o
4、n the same side as the lesion,but the body paralysis is on the opposite side.The syndrome is called alternating abducens(VI),facial(V),or trigeminal hemiplegia(V).At a more rostral level,nerve V and its nuclei may no longer be functioning.(Involvement of the sympathetic pathways may lead to Honers s
5、yndrome.Larger lesions can result in bilateral defects.lesions of the brain stemAt a more rostral level,nerve V and its nuclei may no longer be functioning.Dorsal pons syndrome affects nerve VI or VII or their respective nuclei,with or without involvement of the medial lemniscus,spinothalamic tract,
6、or lateral lemniscus.An example is provided in Clinical Illustration 7-1.Peduncular syndrome,also called alternating oculomotor hemiplegia and Webers syndrome in the basal midbrain,involves nerve III and portions of the cerebral peduncle(Fig 7-14).lesions of the brain stemIf the lesion is large,it m
7、ay include the medial lemniscus.The syndrome is called alternating abducens(VI),facial(V),or trigeminal hemiplegia(V).The lateral gaze center is often involved(see Fig 8-7).Medial(basal)medullary syndrome usually in-volves the pyramid,part or all of the medial lemniscus,and nerve XII.If it is unilat
8、eral,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 an
9、terior 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,sp
10、inal 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 Clinica
11、l Illustration 7-1.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.inferior cerebellar peduncle,vestibular nuclei,fibers or nuclei of nerve IX or X,spinal nucleus and tract of V,s
12、pinothalamic tract,and sympathetic pathways.The area involved is supplied by the anterior spinal artery or by medial branches of the vertebral artery.lesions of the brain stemAt a more rostral level,nerve V and its nuclei may no longer be functioning.Basal pontine syndromes can involve both the cort
13、icospinal 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).Medial(basal)medullary syndrome usually in-volves the pyramid,part or all of the medial lemniscus,and nerve XII.An example is provided in Clinical Illustration 7-1.lesions
14、 of the brain stemThe syndrome is called alternating abducens(VI),facial(V),or trigeminal hemiplegia(V).The vascular supply comes from the perforators,or pontine branches,of the anterior inferior cerebellar artery.At a more rostral level,nerve V and its nuclei may no longer be functioning.Lateral me
15、dullary,or Wallenbergs,syndrome involves some(or all)of the following structures in the open medulla on the dorsolateral side(see Fig 7-12):At a more rostral level,nerve V and its nuclei may no longer be functioning.An example is provided in Clinical Illustration 7-1.)The affected area is supplied b
16、y branches of the vertebral artery or,most commonly,the posterior inferior cerebellar artery.(Involvement of the sympathetic pathways may lead to Honers syndrome.Lateral medullary,or Wallenbergs,syndrome involves some(or all)of the following structures in the open medulla on the dorsolateral side(se
17、e Fig 7-12):If the lesion is large,it may include the medial lemniscus.There is a nerve III palsy on the side of the lesion and a contralateral hemiparesis(because the lesion is above the pyramidal decussation).Basal pontine syndromes can involve both the corticospinal tract and a cranial nerve(VI,V
18、II,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
19、,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
20、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 hemiplegia and Webers syndrome in the basal midbrain,involves nerve III and portions of the cerebral pe
21、duncle(Fig 7-14).There is a nerve III palsy on the side of the lesion and a contralateral hemiparesis(because the lesion is above the pyramidal decussation).The arterial supply is by the posterior perforators and branches of the posterior cerebral artery.Benedikts syndrome,situated in the tegmentum
22、of the midbrain,may damage the medial lemniscus,the red nucleus,and nerve III and its nucleus and associated tracts(see Fig 714).This area is supplied by perforators and branches of circumferential arteries.Dorsal pons syndrome affects nerve VI or VII or their respective nuclei,with or without invol
23、vement of the medial lemniscus,spinothalamic tract,or lateral lemniscus.The area involved is supplied by the anterior spinal artery or by medial branches of the vertebral artery.There is a nerve III palsy on the side of the lesion and a contralateral hemiparesis(because the lesion is above the pyram
24、idal decussation).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):Dorsal pons syndrome affects nerve VI or VII or their respective nuclei,with or without involvement of the medial lemniscus,spinotha
25、lamic tract,or lateral lemniscus.There is a nerve III palsy on the side of the lesion and a contralateral hemiparesis(because the lesion is above the pyramidal decussation).If it is unilateral,it is also known as alternating hypoglossal hemiplegia(Fig 7-12);the term refers to the finding that the cr
26、anial nerve weakness is on the same side as the lesion,but the body paralysis is on the opposite side.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 par
27、alysis is on the opposite side.An example is provided in Clinical Illustration 7-1.At a more rostral level,nerve V and its nuclei may no longer be functioning.Peduncular syndrome,also called alternating oculomotor hemiplegia and Webers syndrome in the basal midbrain,involves nerve III and portions o
28、f the cerebral peduncle(Fig 7-14).The syndrome is called alternating abducens(VI),facial(V),or trigeminal hemiplegia(V).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 gaz
29、e center is often involved(see Fig 8-7).Peduncular syndrome,also called alternating oculomotor hemiplegia and Webers syndrome in the basal midbrain,involves nerve III and portions of the cerebral peduncle(Fig 7-14).An example is provided in Clinical Illustration 7-1.lesions of the brain stemAt a mor
30、e rostral level,nerve V and its nuclei may no longer be functioning.Peduncular syndrome,also called alternating oculomotor hemiplegia and Webers syndrome in the basal midbrain,involves nerve III and portions of the cerebral peduncle(Fig 7-14).If the lesion is large,it may include the medial lemniscu
31、s.The area involved is supplied by the anterior spinal artery or by medial branches of the vertebral artery.Medial(basal)medullary syndrome usually in-volves the pyramid,part or all of the medial lemniscus,and nerve XII.Larger lesions can result in bilateral defects.Dorsal pons syndrome affects nerv
32、e VI or VII or their respective nuclei,with or without involvement of the medial lemniscus,spinothalamic tract,or lateral lemniscus.The vascular supply comes from the perforators,or pontine branches,of the anterior inferior cerebellar artery.If the lesion is large,it may include the medial lemniscus
33、.lesions of the brain stemMedial(basal)medullary syndrome usually in-volves the pyramid,part or all of the medial lemniscus,and nerve XII.)The affected area is supplied by branches of the vertebral artery or,most commonly,the posterior inferior cerebellar artery.Lateral medullary,or Wallenbergs,synd
34、rome involves some(or all)of the following structures in the open medulla on the dorsolateral side(see Fig 7-12):The lateral gaze center is often involved(see Fig 8-7).Peduncular syndrome,also called alternating oculomotor hemiplegia and Webers syndrome in the basal midbrain,involves nerve III and p
35、ortions of the cerebral peduncle(Fig 7-14).Peduncular syndrome,also called alternating oculomotor hemiplegia and Webers syndrome in the basal midbrain,involves nerve III and portions of the cerebral peduncle(Fig 7-14).The lateral gaze center is often involved(see Fig 8-7).(Involvement of the sympath
36、etic pathways may lead to Honers syndrome.This area is supplied by perforators and branches of circumferential arteries.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 area involv
37、ed is supplied by the anterior spinal artery or by medial branches of the vertebral artery.At a more rostral level,nerve V and its nuclei may no longer be functioning.At a more rostral level,nerve V and its nuclei may no longer be functioning.At a more rostral level,nerve V and its nuclei may no lon
38、ger be functioning.If the lesion is large,it may include the medial lemniscus.The area involved is supplied by the anterior spinal artery or by medial branches of the vertebral artery.Dorsal pons syndrome affects nerve VI or VII or their respective nuclei,with or without involvement of the medial le
39、mniscus,spinothalamic tract,or lateral lemniscus.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 h
40、emiplegia(V).The area involved is supplied by the anterior spinal artery or by medial branches of the vertebral artery.If the lesion is large,it may include the medial lemniscus.(Involvement of the sympathetic pathways may lead to Honers syndrome.(Involvement of the sympathetic pathways may lead to
41、Honers syndrome.Peduncular syndrome,also called alternating oculomotor hemiplegia and Webers syndrome in the basal midbrain,involves nerve III and portions of the cerebral peduncle(Fig 7-14).There is a nerve III palsy on the side of the lesion and a contralateral hemiparesis(because the lesion is ab
42、ove the pyramidal decussation).Peduncular syndrome,also called alternating oculomotor hemiplegia and Webers syndrome in the basal midbrain,involves nerve III and portions of the cerebral peduncle(Fig 7-14).The affected area is supplied by various perforators(pontine branches)of the circumferential a
43、rteries.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 arterial supply is by the posterior perforators and branches of the posterior cerebral artery.The lateral gaze center is of
44、ten involved(see Fig 8-7).Larger lesions can result in bilateral defects.At a more rostral level,nerve V and its nuclei may no longer be functioning.Dorsal pons syndrome affects nerve VI or VII or their respective nuclei,with or without involvement of the medial lemniscus,spinothalamic tract,or late
45、ral lemniscus.lesions of the brain stemLarger lesions can result in bilateral defects.At a more rostral level,nerve V and its nuclei may no longer be functioning.An example is provided in Clinical Illustration 7-1.At a more rostral level,nerve V and its nuclei may no longer be functioning.Basal pont
46、ine 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).At a more rostral level,nerve V and its nuclei may no longer be functioning.Dorsal pons syndrome affects nerve VI or VII or their re
47、spective nuclei,with or without involvement of the medial lemniscus,spinothalamic tract,or lateral lemniscus.The affected area is supplied by various perforators(pontine branches)of the circumferential arteries.At a more rostral level,nerve V and its nuclei may no longer be functioning.At a more ros
48、tral level,nerve V and its nuclei may no longer be functioning.The syndrome is called alternating abducens(VI),facial(V),or trigeminal hemiplegia(V).lesions of the brain stemAn example is provided in Clinical Illustration 7-1.At a more rostral level,nerve V and its nuclei may no longer be functionin
49、g.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):Peduncular syndrome,also called alternating oculomotor hemiplegia and Webers syndrome in the basal midbrain,involves nerve III and portions of the c
50、erebral peduncle(Fig 7-14).The affected area is supplied by various perforators(pontine branches)of the circumferential arteries.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 ar
