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Brainstem syndromes 

Brainstem syndromes
Brainstem syndromes

David Bates

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date: 25 February 2021

The classic presentation of brainstem syndromes, including the long tracts and deficits of cranial nerve nuclei, commonly causes crossed cranial nerve and motor or sensory long tract deficits; the cranial nerve lesions are ipsilateral to the lesion and the long tract signs are contralateral. It is important to assess the extracranial vascular supply to the posterior circulation, especially to listen for bruits over the subclavian vessels and to record the pulse and blood pressure in both upper limbs, remembering that the vertebral arteries arise from the subclavian vessels. Apart from the cranial nerve and long tract deficits, there may be ataxia, vertigo, the presence of an internuclear ophthalmoplegia and unreactive pupils, the symptoms of diplopia and oscillopsia, and the finding of nystagmus or ocular paresis.

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