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Brain Stem Infarction Syndromes

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Posterior Circulation Stroke

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Abstract

Brain stem stroke syndrome includes diverse neurological manifestations. Careful examination and the appropriate use of imaging techniques allow us to understand clinical features and the pathogenic mechanism, which in turn make it possible to treat the patients appropriately. In lateral medullary infarction, clinical manifestations vary according to rostrocaudal and ventrodorsal topography. Rostral-ventral infarcts are associated with severe dysphagia, dysarthria, and contralateral trigeminal sensory involvement, whereas caudal-lateral lesions are characterized by severe gait ataxia, absent dysphagia, and sensory symptoms worse in the lower extremities. Medial medullary infarction occurs mostly in the rostral medulla and presents with unilateral motor, sensory and ocular motor disturbances depending on ventrodorsal topographic involvement. Unilateral paramedian infarction is the most common pattern of pontine infarction. Basal involvement is associated with motor syndromes, while tegmental lesions produce sensory and/or ocular motor symptoms, notably internuclear ophthalmoplegia. Bilateral infarcts often result in devastating locked-in syndrome and are usually associated with significant basilar artery thrombotic occlusion. The most common topographic pattern of midbrain infarction is anteromedial followed by anterolateral; the former is characterized by ocular motor dysfunction, whereas the latter lesions produce various motor syndromes. Basilar top occlusion is mostly embolic and results in peculiar clinical syndromes associated with paramedian midbrain, and diencephalic infarctions, with occasional involvement of the occipital and cerebellar regions. These brainstem infarction syndromes are described here.

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    Jong S. Kim

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    Jong S. Kim

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Kim, J.S. (2021). Brain Stem Infarction Syndromes. In: Kim, J.S. (eds) Posterior Circulation Stroke. Springer, Singapore. https://doi.org/10.1007/978-981-15-6739-1_4

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