Published online by Cambridge University Press: 10 October 2009
The pattern of cranial nerve abnormalities is the key to distinguishing among these.
Lateral medullary syndrome
Also known as Wallenberg syndrome. The crossed sensory findings, i.e., loss of sensation on one side of the face and the other side of the body, are pathognomonic.
vertigo, nausea, diplopia
ipsilateral headache (descending spinal tract of the fifth cranial nerve, facial or eye pain)
ataxia, hiccups
contralateral body hemianalgesia (pain + temperature)
ipsilateral facial hemianalgesia (pain + temperature)
Horner's syndrome, nystagmus
ipsilateral palate, vocal cord weakness (nucleus ambiguus)
dysphagia
cerebellar findings
motor, tongue function, dorsal column function spared because these structures lie medially in the medulla
due to occlusion of the ipsilateral vertebral artery or its major branch, the posterior inferior cerebellar artery
Millard–Gubler syndrome
Ventrocaudal pons with CN VI and VII involvement
contralateral hemiplegia (pyramidal tract)
ipsilateral lateral rectus paresis (VI)
ipsilateral lower motor neuron (LMN) facial paresis (VII)
Foville syndrome
Dorsal caudal pontine lesion
contralateral body hemiplegia
ipsilateral LMN facial paresis (VII)
inability to move eyes to same side as lesion (parapontine reticular formation, CN VI)
Raymond–Cestan syndrome
Dorsal rostral pons
ataxia with coarse tremor
contralateral hemisensory loss (face + body, all modalities)
+/– contralateral hemiparesis
Marie–Foix syndrome
Lateral pons
ipsilateral cerebellar ataxia
contralateral hemiparesis
+/– contralateral hemisensory loss (pain and temperature) due to spinothalamic tract
Weber syndrome
Ventral midbrain
contralateral hemiplegia (corticospinal and corticobulbar tracts)
ipsilateral oculomotor paresis, dilated pupil
Benedikt syndrome
Midbrain tegmentum (red nucleus, CN III)
ipsilateral oculomotor paresis, dilated pupil
contralateral intention tremor, hemichorea, hemiathetosis
Claude's syndrome
Midbrain tegmentum
ipsilateral oculomotor paresis
contralateral cerebellar ataxia
Parinaud's syndrome
Dorsal midbrain (often with hydrocephalus, tumor)
upgaze paresis
convergence-retraction nystagmus on upgaze
large pupil with light-near dissociation, lid retraction, lid lag
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