案例精講錄音review524brain stemcarnial nerve

BrainCarnialBrainMedullary:medialmedullarysyndrome, lmedullarysyndromeMid-pontine:Medialmid-pontinesyndrome, lmid-potinesyndromeCranialnerve:CNI-三叉三叉（parinaudsyndrome） IsitabrainWhatleveldoesthelesionIsitconsisitentwithsomebrainstemCarnialnerve&theircorrespondingSomeimportantFasciculigracilis&SomeotherimportantCardiac&respiratorySubstantianigra,nucleusLinkingfiberstootherCarnialnerveAlternateOthernon-specificInstabilityofvital

→共濟(jì)失調(diào)CertaincranialnerveCertainalternatesymptoms&SomeparticularEg.Impairedvitalsign-2為OnthesideofTonguedeviatestolesionside:ipsila twelfthnerveOnthesideoppositetotheSpastichemiparesisandlossofpositionandvibrationonbody,sparingfaceOnthesideofPain,numbness,impairedsensationoverhalftheface:descendingtractandnucleusVnerveHornersyndrome:descendingsympatheticDysphagia,hoarseness,paraphysisofpalate,paralysisofvocalcord,diminishgagreflex:issuingfibersIXandXnervesNumbnessofipsilalarm,trunkorleg:cuneateandgravcilenucleiOnthesideoppositetotheImpairedpainandthermalsenseoverhalfthebody:spinothalamictracknausea,vomiting:vestibularNystagmus,nausea,vomiting:vestibular 覺交 交 OnthesideofAtaxiaoflimbsandgait(moreprominentinbila OnthesideoppositetotheParalysisofface,armandleg:corticobulbarandcorticospinalLossofpositionandvibrationonthebody:mediallemniscusOnthesideofParalysisofmusclesofmastication:motorfibersornucleusofVnerveImpairedsensationoversideofface:sensoryfiberornucleusofVnerveOnthesideoppositetotheImpairedpainandthermalsenseonlimbsandtrunk:spinothalamictractvomiting,vertigo,nystagmus,vestibular交 動眼N1動眼N1）downandoutDilatedEyepointingdownandout(laterstrabismus) lspastichemiparesisoflowerhalfoffaceandupperlimbTheoculomotornerveCompleteipsila loculomotorparalysis.Ptosis(paralysisofthelevatorpalpebramuscle)andfixationanddilationofthe lpupil(completein ophthalmoplegia)alsooccur

ThedentatothelamicCausecontrala lcerebellardystaxiawithintentiontremorThemedialCausecontrala llossoftactilesensationfromthetrunkandextremities（parinaudsyndrome）

椎脊髓前ExamineCNClinicalapproach&neuroanatomicVisualfield:CNOcularmovement:CNIII,IV,modationreflex:CNAssociatedPupillarymodationreflex:CNAssociated除外展NRR視視N中腦頂蓋前區(qū)→動眼N→瞳孔括約MarcusGunnAfferentpupillarydefect(eg.duetoopticnervedamageorretinaldetachement) lpupillaryconstrictionwhenlightshoneinaffectedArgyllrobertson Pupilsconstrictwithmodationbutisnotreactivetolight.Associatedwith3rd HornerPtosis,anhidrosis,Adie’sTonicPupilsaredilatedandnotreactivetoFailureofadductiononthesideoflesionandnystagmusoftheabductingAssociatedwithwernickeN核(展N,通過MLF協(xié)調(diào)動眼N)MLF

OneandahalfImpairmentofconjugatehorizontalgaze ltothelesionAninternuclearophthalmoplegia ltolesionV1,V1,V2V3感覺+咀嚼(特殊內(nèi)臟CNVV1V1過框上裂(同時(shí)過IIIIIIVVI) Somaticmotor-facialmusculature-Visceralmotor-lacrimalandsalivary(submandibularandsublingual)glands;mucosalglandsofnoseandpalatesVisceralsensory-tasteinanterior2/3oftheSomaticsensory-smallamountofskinaroundtheexternalerac CochlearDestructivelesionscausehearingloss(sensorineuraldeafness)Irrigativelesionscancausetinnitus(earAnacousticneuroma(schwannoma)isaschwanncelltumorofthecochlearnervethatcausesdeafnessConductionCausedbyinterruptionofthepassageofsoundwavesthroughtheexternalormiddleear.Itmaybecausedbyobstruction(eg.wax),otosclerosis,orotitismediaAbnormalrinneWebertestlocalizestoaffected同側(cè)骨傳導(dǎo)Nervedeafness(sensorineural,orperceptive,Causedbydiseaseofthecochlea,cochlearnerve(acousticneuroma),orcentralauditoryPresbycusisthatresultsfromdegenerativediseaseoftheorganofCorti.Congenitalrubellainfectionduringthe8thweekofpregnancy.NormalrinneWebertestlocalizestounaffectedVestibularItregulatescompensatoryeyeItprojectsitsefferentfiverstothehaircellsfromthebrainstemLesionsresultindisequillibrium,vetigoand 支配胸鎖乳突肌支配胸鎖乳突肌(對側(cè)轉(zhuǎn)頭)、斜方肌(伸舌患側(cè)閉眼：眼輪匝肌-面運(yùn)動(closeCNVIIopenCNSomatic:CNIII,IV,Superior lVisceral:pupillarysphincter, 視覺CNTaste VII(chorda觸覺 V(lingalnerve);后1/3CNCNI-CNII-CNIII,IV,VI-moveCNIIIconstrictpupils,CNV-chewsandfeelsfrontofCNVII-movetheface,salivates,cries,tastes,receivessmallamountofsensationaroundtheexternalearCNVIII-hears,CNIX-swallows,salivates,tastes,monitorscarotidbodyandsinus,smallamountsensationaroundexternalearCNX-swallows,liftsp