Brainstem

• Brainalem lesions can arise from

  • Vascular Syndromes - Arterial occlusion and arterial haemorrhage
  • Posterior Fossa Tumours (more common in children)
  • Multiple Sclerosis
  • Metabolic Brainstem Dysfunction
• Localisation for Vascular BSL (occlusive)

  Defined, focal area of damage in an identifiable vascular territory
• Localisation for Tumour

  Defined, focal area of damage NOT in an identifiable vascular territory
• Onset for Vascular BSL

  Sudden or abrupt onset, maximal close to onset
• Onset for Tumour

  Insidious, gradual onset (not always)
• Progression for Vascular BSL

  Maximal close to onset (don't progress unless secondary complications or a 2nd Vascular event)
• Progression for Tumour

  Gradually progressive (worsening of each symptom or increasing number of symptoms as pathology grows)
• Onset and progression not always accurate, many symptoms related to BSL by their nature appear suddenly to the patient
• Acoustic Neuroma


  Earliest symptoms are slowly progressive auditory, often unrecognized loss of hearing develops, sometimes proceeded by tinnitus
• Acoustic Neuroma


  Earliest consistent sign may be loss of corneal reflex or facial nerve palsy (hemifacial spasm), facial nerve symptoms often late
• Acoustic Neuroma

  Vertigo is often late, vestibular system can compensate for a time, unsteadiness on feet is an earlier symptom
• Acoustic Neuroma

  Brainstem and cerebellar symptoms when mass is large, suboccipital headache
• Brainstem lesion characteristics

  • Nuclear cranial nerve deficits, weakness or sensory deficit
  • Cranial nerve deficits are ipsilateral to lesion, limb weakness or sensory deficits are contralateral
  • Cerebellar deficits (limb ataxia) are commonly seen, almost always ipsilateral to lesion
  • Dizziness (vertigo) is common
• Symptoms of brainstem lesions (5D’s And 3C’s)

  • Diplopia
  • Dizziness
  • Dysarthria
  • Dysphagia
  • Drop Attacks
  • Ataxia
  • Numbness
  • Nausea
  • Nystagmus