Cross-sections of the brainstem. A. Rostral midbrain, B. caudal midbrain, C. Pons, D. Rostral medulla, E. Caudal medulla. A= nucleus ambiguus, ML= medial lemniscus, S= nucleus solitarius, SC= Spinothalamic tract, numbers 3-12 refer to cranial nerves. (From Stephen Goldberg's wondrous book 'Clinical neuroanatomy made ridiculously simple')
The signs seen in medial brainstem syndromes (from Gates, 2005).
The signs seen in lateral brainstem syndromes (from Gates, 2005). Note trapezius weakness is rarely seen in lateral medullary lesions.
References
- Gates, P. The rule of 4 of the brainstem: a simplified method for understanding brainstem anatomy and brainstem vascular syndromes for the non-neurologist. Internal Medicine Journal 2005; 35: 263-266 [pubmed]
- Goldberg, S. Clinical Neuroanatomy Made Ridiculously Simple. MedMaster Series, 2000 Edition. [betterworldbooks]
‘Life in the Fast Lane’ links
- The ultimate Brainstem Rule diagram
- Brainstem Rules of 4
- Helpful Brainstem Figures
- Using the Brainstem 1
- Using the Brainstem 2
PDF 
About Chris Nickson
