/ Clinical Neuroanatomy
infarct
Posterior spinal a.
stroke
embolus
Anterior spinal a.
ischemia
Brown-Sequard syndrome
aneurysm
ilicit drug
inflammation
toxicity
Tonsillar herniation
pharmaceutical
malformation
tumor
Locked-in syndrome
metastasis
sclerosis
hematoma
hypertension
mutation
Uncal herniation
autoimmunity
infection
prion
Anterior cerebral a.
parasite
Posterior cerebral a.
Middle cerebral a. - superior
blunt trauma
penetrating trauma
degeneration
compression
herniation
demyelination
alien nanobots
SPINAL CORD
Cervical Syringomyelia - C5-C8
DAMAGED
DEFICIT(S) / SIGN(S)
I / C/ B
sensory
A. ventral white commissure
SPINAL CORD
Posterior spinal a. syndrome - cervical
A
DAMAGED
posterior spinal a.
DEFICIT(S) / SIGN(S)
I / C/ B
sensory
A-B. fasciculus gracilis &
cuneatus,
C. Lissauer's tract
D. dorsal horn
SPINAL CORD
Anterior spinal a. syndrome - T9
antererior spinal a.
E F
DAMAGED
DEFICIT
DEFICIT(S)
/ SIGN(S)
I / C/ B
sensory
A. fasciculus gracilis
C. +/- ALS
motor
D. +/- lateral corticospinal fibers
F. ventral horn
SPINAL CORD
Brown-Sequard syndrome (cord hemisection) - C4
A
B
F
C
G
E
H
DAMAGED
DEFICIT(S) / SIGN(S)
I / C/ B
sensory
A-B.fasciculus gracilis & cuneatus,
unconscious proprioception
motor
F. lateral corticospinal fibers + rubrospinal fibers
G. ventral corticospinal fibers
H. ventral horn
I
B
I
MEDULLA OBLONGATA
Medial medullary syndrome (paramedian; Dejerine) - anterior spinal a.
A
paramedian brs.
anterior spinal a.
B
DAMAGED
DEFICIT(S) / SIGN(S)
I / C/ B
sensory
A. medial lemniscus
C. hypoglossal nucleus
motor
B + C. = "alternating hemiplegia
MEDULLA OBLONGATA
Lateral medullary syndrome (Wallenberg) - PICA
B
F
D
G
E
DAMAGED
PICA
A
C
DEFICIT(S) / SIGN(S)
I / C/ B
sensory
A. spinal trigeminal tract & nucleus
B. vestibular nuclei
C. ALS
D. solitary nucleus
loss of taste
motor
E. hypothalamospinal sympathetics
ataxia
G. nucleus ambiguus
MEDULLA OBLONGATA
Tonsillar herniation at foramen magnum (bilateral compression)
normal
herniated
compression
DAMAGED
DEFICIT(S) / SIGN(S)
I / C/ B
other
respiratory and cardioregulatory
centers
CAUDAL PONS
Paramedian pontine syndrome - (Fovilles; Medial Pontine) basilar a. brs.
D
C
E
paramedian brs.
basilar a.
DAMAGED
DEFICIT(S) / SIGN(S)
I / C/ B
sensory
A. medial lemniscus
B. corticospinal tract
motor
facial paralysis
CAUDAL PONS
Basolateral pontine lesion (Millard-Gubler syndrome)
DAMAGED
DEFICIT(S) / SIGN(S)
I / C/ B
motor
B. corticospinal tract
facial paralysis
PONS
Lateral pontine syndrome (Marie-Foix)
F
C
A
G
AICA
basilar - long
circumferential aa.
DAMAGED
DEFICIT(S) / SIGN(S)
I / C/ B
sensory
A . ALS
face analgesia
face anesthesia
motor
E. trigeminal motor nucleus
masticatory paresis/paralysis
F. MCP, SCP
limb ataxias
G. corticospinal fibers
limb paresis/paralysis
autonomic
G. hypothalamospinal sympathetics
Horner's syndrome
PONS
Locked in syndrome "pseudocoma"
basilar artery thrombosis (BAT) - bats under the bridge (like in Austen ,TX)
imagine bilateral
DAMAGED
DEFICIT(S) / SIGN(S)
I / C/ B
motor
corticospinal fibers
quadriplegia
Jean Bauby, a 42-year-old father of two, and editor-in-chief of Elle magazine in Paris, suffered a
massive stroke [1995] which left him paralysed and speechless, but able to move one muscle: his
left eyelid. Yet his mind remained as active and alert as ever. By signalling with his eyelid, he
'dictated' 'The Diving Bell and the Butterfly' (Knopf, New York, 1997), blinking to indicate each
individual letter as an alphabet with letters placed according to the frequency of its use in the
French language was repeatedly read to him. Trapped inside his own body, his dispatches are
poignant and often wryly humorous. Bauby tells us about his life in a hospital overlooking the
English Channel, the flights of fancy that sustain him, the meals he can only eat in his imagination.
This story was depicted in the film "The Diving Bell & the Butterfly" in 1997.
NOTE: patient has normal awake consciousness with all cognitive abilities and can feel, but has
most to nearly all voluntary muscles paralysed; usually some eyelid control remains (dont know
why)
CEREBELLUM
Distal PICA - spino- and vestibulocerebellum
DAMAGED
DEFICIT(S) / SIGN(S)
I / C/ B
motor
posterior spinocerebellum,
vestibulocerebellum (nodulus)
CAUDAL MIDBRAIN
Caudal Paramedian Midbrain Syndrome
DAMAGED
DEFICIT(S) / SIGN(S)
I / C/ B
motor
A trochlear nuc. or fibers; MLF
ataxia
minor hemiplegia
CAUDAL MIDBRAIN
Caudal Paramedian Midbrain Syndrome
A
B
DAMAGED
DEFICIT(S) / SIGN(S)
I / C/ B
motor
A trochlear nuc. or fibers; MLF
ataxia
ROSTRAL MIDBRAIN
Paramedian midbrain syndrome (Claude's syndrome)
B
A
DAMAGED
DEFICIT(S) / SIGN(S)
I / C/ B
motor
A. oculomotor nuc. or fibers; MLF
B. Edinger-Westphal
ataxias
and
C. superior cerebellar peduncle
decussation
or
D. red nucleus, rubrospinal
decussation
ROSTRAL MIDBRAIN
Cerebral peduncle syndrome (Webers; midbrain base syndrome)
D
A
B
C
DAMAGED
DEFICIT(S) / SIGN(S)
I / C/ B
motor
A. oculomotor fibers
B. CST
C. CNT
D. substantia nigra
parkinsonism
ROSTRAL MIDBRAIN
Medial midbrain syndrome (Benedikt's syndrome) = Claude's + Weber's
DAMAGED
DEFICIT(S) / SIGN(S)
I / C/ B
motor
oculomotor nuc. or fibers
CST, CNT
hemiplegia
ROSTRAL MIDBRAIN
Midbrain tegmentum lesion (Nothnagels syndrome)
DAMAGED
DEFICIT(S) / SIGN(S)
I / C/ B
motor
oculomotor nuc. or fibers
ROSTRAL MIDBRAIN
Dorsal midbrain syndrome (Parinaud's) - e.g., pineal tumor
compression
A
B
DAMAGED
DEFICIT(S) / SIGN(S)
I / C/ B
motor
A. pretectal nucs. & post.
commissure
B. superior colliculus
MIDBRAIN
Uncal herniation (thru tentorial notch) - supratentorial space-filling masses
uncus
DAMAGED
DEFICIT(S) / SIGN(S)
I / C/ B
motor
CN III compression
I/ B
C/ B
I/ B
CEREBRAL CORTEX
Anterior cerebral a. occlusion
C
B A
D
B
A
E
DAMAGED
DEFICIT(S) / SIGN(S)
I / C/ B
sensory
A. posterior paracentral lobule and
superiormost postcentral gyrus
motor
B. anterior paracentral lobule and
superiormost precentral gyrus
C. micturition center
B*
D. olfactory tract
anosmia
E. corpus callosum
dissconnection syndromes
other
CEREBRAL CORTEX
Posterior cerebral a. occlusion
A
B
C
D
E
F
+/-
+/-
A
A
A
B
C
C
DAMAGED
DEFICIT(S) / SIGN(S)
I / C/ B
sensory
A. medial occipital cortex; +/- pole
I/C
B. thalamus
thalamic syndromes
I/C
C. hippocampal region
memory
NOTE: basilar emboli tend to lodge at its apex; vision is most acute and dbilitating effect
CEREBRAL CORTEX
Middle cerebral a. - superior division occlusion
D
A
C
A
C
D
B
E
DAMAGED
DEFICIT(S) / SIGN(S)
I / C/ B
sensory
A. central & lower postcentral gyrus
B. insula + operculum
loss of taste
C. angular gyrus
writing
reading aloud
B?
motor
D. central & lower precentral gyrus
CEREBRAL CORTEX
Middle cerebral a. - inferior division occlusion
+/A
B
DAMAGED
DEFICIT(S) / SIGN(S)
I / C/ B
sensory
A. Wernicke's area (dominant side)
upper quadrantanopia
B*
ipsi- eye
+ contraeye =
homony
mous
*NOTE not strictly applicable here, but fluent speech requires both side laryngeal muscles, so
in some sense it becomes bilateral
CEREBRAL CORTEX
Middle cerebral a. - occlusion at its origin
B
A
B
DAMAGED
sensory
DEFICIT(S) / SIGN(S)
I / C/ B
motor
B. lenticular nucleus
(masked by paralysis)