STROKE SYNDROMES

DJADJANG SUHANA

Vertebrobasilar arteries syndromes

I. Clinical syndromes of the midbrain
Midbrain (mesencephalic) disturbances :
1. Webers syndrome
- Lesions of ventral portion of midbrain
2. Benedikts syndrome
- lesions of tegmentum
3. Parinauds syndrome
- Lesions of superior culliculi of the tectum

Webers syndrome
Clinical manifestations :
- Ipsilateral ophthalmoplegia
- results from oculomotor nucleus interruption
- Contralateral hemiparesis
- involvement of corticospinal tract in cerebral peduncle

Benedikts syndrome
Clinical manifestations :
- Ipsilateral ophthalmoplegia
- results from lesion of tegmentum that destroys
the oculomotor nerve
- Contralateral hyperkinesia (tremor, chorea, athetosis)
- Lesion of tegmentum destroys red nucleus
(nucleus of rubra) on one side.

Perinauds syndrome
Clinical manifestations :
- Upward gaze paralysis
- Disorders of the quadrigeminal plate of mid brain
(superior culliculi)
- Etiologies are :
- compressed by pineal body tumor
- Lesion of posterior commissure

II. Clinical syndromes of the Pons

1. Raymonds syndrome
2. Millard-Gubler syndrome
3. Fovilles syndrome
4. Raymond-Cestan syndrome
(Cestan-Chenais syndrome)
5. Pontocerebellar Angle Tumor Syndrome
6. Alternating trigeminal hemiplegia

Raymonds syndrome
Clinical manifestations :
- Alternating abducent hemiplegia
- ipsilateral lateral rectus muscle paresis
- contralateral hemiparesis
Due to infarction of paramedian area of pons involves the
abducens nerve and corticospinal tract

Millard-Gubler syndrome
Clinical manifestations :
- Alternating facial hemiplegia
- ipsilateral facial palsy
- contralateral hemiparesis
- sometime the VI - nerve is also involved
(internal strabismus)
- Due to pontine lesion

Fovilles syndrome
Clinical manifestations :
- contralateral hemiparesis
- ipsilateral VII-nerve palsy
- ipsilateral paralysis of lateral conjugate gaze
- Due to pontine lesion

Raymond-Cestan syndrome
(Cestan-Chenais syndrome)
Clinical manifestations :
- Quadriplegia
- Anesthesia
- Nystagmus
- Due to atherothrombotic of the branches of basilar artery
supplying this region
- Involvement of pyramidal tract, medial lemniscus and
medial longitudinal fasciculus

Alternating Trigeminal Hemiplegia

Clinical manifestations :
- contralateral hemiparesis
- ipsilateral paralysis of jaw muscle
(masseter and temporal muscles paralysis)
- Ipsilateral hypesthesia of facial region
Site of lesion :
- Result from lesion of ventral pons involving :
- corticospinal tract
- fibers of adjacent trigeminal nerve

III. Clinical syndromes of the medulla oblongata

A. Bulbar and radicular syndomes
1. Avellis syndrome ( X and Bulbar XI )
2. Schmidts syndrome ( X and all of XI )
3. Jacksons syndrome ( X, XI and XII )
4. Tapias syndrome ( X and XII )
5. Babinski-Nageotte Bulbar Syndrome
(IX, X, Bulbar portion of XI and Part of V )
6. Wallenbergs syndrome
7. Cestan-Chenais syndrome
8. Bonniers syndrome ( VIII, IX and X )
9. Hypoglossal hemiplegia alternans ( XII )

III. Clinical syndromes of the medulla oblongata

A. Syndromes caused by peripheral lesions
1. Vernets syndrome ( IX, X and XI )
2. Villarets syndrome (Collets or Sicards syndrome)

1.Avellis syndrome ( X and Bulbar XI )

Clinical manifestations :
- ipsilateral partalysis of soft palate, pharynx and larynx
( dysarthria, dysphagia, hypesthesia of pharynx and larynx )
- Contralateral dissociate hemihypesthesia (spinbothalamic
tract) :
- loss of pain and temperature senses,
- sparing touch and pressure sense
Caused by lesion of nucleus ambiguus, tractus solitarius,
and adjacent spinothalamicus tract affecting :
- X-nerve, internal branch of the accessory nerve and
ascending sensory nerve

2. Schmidts syndrome ( X and all of XI )

Clinical manifestations :
- ipsilateral paralysis of soft palate, pharynx, larynx,
and hypesthesia of pharynx and larynx (X and
bulbar portion of XI)
- Ipsilateral sternocleidomastoid and trapezius
muscle paralysis
Site of lesion :
Lesion of vagal nuclei and both bulbar and
spinal nuclei of accessory

3.Jacksons syndrome ( X, XI and XII )

Clinical manifestations :
- ipsilateral paralysis of soft palate, pharynx and larynx (X)
- ipsilateral paralysis of sternocleidomastoid and
trapezius muscle (XI)
- Ipsilateral paralysis and atrophy of tongue (XII)

Site of lsion :
Nuclear lesion of vagus, accessory and hypoglossal

4.Tapias syndrome ( X and XII )

Clinical manifestations :
- ipsilateral paralysis of pharynx and larynx (X)
- Ipsilateral paralysis and atrophy of tongue (XII)

Site of lesion :
- Nuclear lesion of vagus and hypoglossal

5. Wallenbergs syndrome
Clinical manifestations :
- ipsilateral loss of taste on posterior third of tongue
- ipsilateral Horners syndrome (miosis, ptosis and
enophthalmos)
- Ipsilateral loss of pain and temperature sense of the face
- ipsilateral asynergia and ataxia (tendency to fall to
side of lesion)
Site of lesion :
- Atherothrombosis of Posterior inferior cerebellar artery

6.Bonniers syndrome ( VIII, IX and X )

Clinical manifestations :
- ipsilateral loss of taste on posterior third of tongue
- ipsilateral Horners syndrome (miosis, ptosis and
enophthalmos)
- Ipsilateral loss of pain and temperature sense of the face
- ipsilateral asynergia and atxia (tendency to fall to
side of lesion)
Site of lesion :
- Atherothrombosis of Posterior inferior cerebellar artery