Large Cerebellar Infarction
Because of its unique position abutting the brainstem, infarction of the cerebellum can lead to a compression of the fourth ventricle with resulting hydrocephalus, direct compressive brainstem injury, and downward…
Malignant Middle Cerebral Artery Infarction
“Malignant” infarction refers to a large hemispheric ischemic stroke characterized by severe cerebral edema; such infarction can lead to midline shift with resultant compression of contralateral hemispheric structures and downward…
Acute Ischemic Stroke
When a patient presents with acute focal neurologic deficits consistent with ischemic stroke, the immediate goal is to determine whether the patient is eligible for reperfusion therapies with intravenous thrombolysis…
Transient Ischemic Attack
A transient ischemic attack (TIA) represents focal brain ischemia that reverses before leaving a permanent neurologic deficit. Most TIAs present suddenly and last for minutes, though on occasion symptoms can…
Transient Loss of Consciousness
Dysfunction of either the brainstem or both cerebral hemispheres is necessary for loss of consciousness (LOC) to occur. Syncope, caused by global hypoperfusion of the brain due to a drop…
Bladder Dysfunction
Urinary continence requires coordination of both the somatic and autonomic nervous systems, and also involves elements of volitional control and assessments of social appropriateness. Urinary storage is primarily mediated involuntarily…
Difficulty Walking
Gait disorders can result from dysfunction of motor coordination systems, pyramidal or extrapyramidal motor pathways, or impairments in proprioceptive sensation. In addition, there are a number of nonneurologic causes of…
Multiple Cranial Neuropathies
Aside from the olfactory cranial nerve (CN I) and the optic nerve (CN II), the remaining cranial nerves (CN III–XII) have nuclei in the brainstem. These then have axons extending…
Hyperreflexia and Hyporeflexia
The muscle stretch, or “deep tendon,” reflex is the product of a segmental reflex arc involving specific spinal cord or brainstem regions; this makes testing reflexes useful for anatomic localization….
