Supranuclear Internuclear
Transcript of Supranuclear Internuclear
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CN3Nucleus
CN4Nucleus
CN6NucleusNuclear
Supranuclear
Infranuclear
Internuclear
Fascicular
Subarachnoid
Cavernous sinus
Orbital^^ MLF
Neuromuscular junction
Extraocular muscle
This slide captures one way to think about the motility disorders. If it is unfamiliar, I strongly suggest you review the slide-set entitled ‘Motility disorders: Overview’ before proceeding.
Motility Disorders: Fascicular Syndromes
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CN3Nucleus
CN4Nucleus
CN6NucleusNuclear
Supranuclear
Infranuclear
Internuclear
Fascicular
Subarachnoid
Cavernous sinus
Orbital^^ MLF
Neuromuscular junction
Extraocular muscle
In this slide-set, we’ll take a look at fascicular syndromes
Motility Disorders: Fascicular Syndromes
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Subarachnoid
Cavernous sinus
OrbitalNeuromuscular junction
Extraocular muscle
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Supranuclear
Infranuclear
Internuclear
?
?
?
Fascicular
CN3Nucleus
CN4Nucleus
CN6NucleusNuclear ^^ MLF
As mentioned in the Overview slide-set, the fascicles (along with the cranial-nerve nuclei) are located within the brainstem. Given this, it shouldn’t come as a surprise that, generally speaking, lesions of the nuclei and/or fascicles do not present as isolated EOM abnormalities; ie, the ophthalmoparesis is almost always accompanied by nonocular signs and symptoms of CNS damage.
Motility Disorders: Fascicular Syndromes
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Subarachnoid
Cavernous sinus
OrbitalNeuromuscular junction
Extraocular muscle
4
Supranuclear
Infranuclear
Internuclear
?
?
?
Fascicular
CN3Nucleus
CN4Nucleus
CN6NucleusNuclear ^^ MLF
As mentioned in the Overview slide-set, the fascicles (along with the cranial-nerve nuclei) are located within the brainstem. Given this, it shouldn’t come as a surprise that, generally speaking, lesions of the nuclei and/or fascicles do not present as isolated EOM abnormalities; ie, the ophthalmoparesis is almost always accompanied by nonocular signs and symptoms of CNS damage.
As we will see, the fascicular syndromes are defined by the nonocularCNS signs/symptoms that accompany the ophthalmoparesis
Motility Disorders: Fascicular Syndromes
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CN3 Fascicular Syndromes
Q5
Syndrome
? Contralateral hemiplegia Cerebral peduncle
? Contralateral involuntary movements (often a hand flap)
Red nucleus &substantia nigra
? Contralateral ataxia Cerebellar peduncle
? Ipsilateral ataxia Cerebellar peduncle
Motility Disorders: Fascicular Syndromes
The BCSC Neuro book discusses four CN3 fascicular syndromes.What are their names?
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CN3 Fascicular Syndromes
A6
Syndrome
Weber Contralateral hemiplegia Cerebral peduncle
Benedikt Contralateral involuntary movements (often a hand flap)
Red nucleus &substantia nigra
Claude Contralateral ataxia Cerebellar peduncle
Nothnagel Ipsilateral ataxia Cerebellar peduncle
Motility Disorders: Fascicular Syndromes
The BCSC Neuro book discusses four CN3 fascicular syndromes.What are their names?
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CN3 Fascicular Syndromes
Q7
Syndrome Ipsilateral 3rd plus…
Weber Contralateral hemiplegia Cerebral peduncle
Benedikt Contralateral involuntary movements (often a hand flap)
Red nucleus &substantia nigra
Claude Contralateral ataxia Cerebellar peduncle
Nothnagel Ipsilateral ataxia Cerebellar peduncle
Motility Disorders: Fascicular Syndromes
Each is composed in part by a third nerve palsy. Is the palsy ipsilateral, or contralateral to the side of the lesion?
Ipsi- vscontralateral
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CN3 Fascicular Syndromes
A8
Syndrome Ipsilateral 3rd plus…
Weber Contralateral hemiplegia Cerebral peduncle
Benedikt Contralateral involuntary movements (often a hand flap)
Red nucleus &substantia nigra
Claude Contralateral ataxia Cerebellar peduncle
Nothnagel Ipsilateral ataxia Cerebellar peduncle
Motility Disorders: Fascicular Syndromes
Each is composed in part by a third nerve palsy. Is the palsy ipsilateral, or contralateral to the side of the lesion?
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CN3 Fascicular Syndromes
Q9
Syndrome Ipsilateral 3rd plus…
Weber Cerebral peduncle
Benedikt Contralateral involuntary movements (often a hand flap)
Red nucleus &substantia nigra
Claude Contralateral ataxia Cerebellar peduncle
Nothnagel Ipsilateral ataxia Cerebellar peduncle
Motility Disorders: Fascicular Syndromes
Each has an associated nonocular finding. What is that finding for…Weber syndrome?
?
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CN3 Fascicular Syndromes
A10
Syndrome Ipsilateral 3rd plus…
Weber Contralateral hemiplegia Cerebral peduncle
Benedikt Contralateral involuntary movements (often a hand flap)
Red nucleus &substantia nigra
Claude Contralateral ataxia Cerebellar peduncle
Nothnagel Ipsilateral ataxia Cerebellar peduncle
Motility Disorders: Fascicular Syndromes
Each has an associated nonocular finding. What is that finding for…Weber syndrome?
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CN3 Fascicular Syndromes
Q11
Syndrome Ipsilateral 3rd plus…
Weber Contralateral hemiplegia Cerebral peduncle
Benedikt Contralateral involuntary movements (often a hand flap)
Red nucleus &substantia nigra
Claude Contralateral ataxia Cerebellar peduncle
Nothnagel Ipsilateral ataxia Cerebellar peduncle
Motility Disorders: Fascicular Syndromes
Each has an associated nonocular finding. What is that finding for…Benedikt syndrome?
?
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CN3 Fascicular Syndromes
A12
Syndrome Ipsilateral 3rd plus…
Weber Contralateral hemiplegia Cerebral peduncle
Benedikt Contralateral involuntary movements (often a hand flap)
Red nucleus &substantia nigra
Claude Contralateral ataxia Cerebellar peduncle
Nothnagel Ipsilateral ataxia Cerebellar peduncle
Motility Disorders: Fascicular Syndromes
Each has an associated nonocular finding. What is that finding for…Benedikt syndrome?
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CN3 Fascicular Syndromes
Q13
Syndrome Ipsilateral 3rd plus…
Weber Contralateral hemiplegia Cerebral peduncle
Benedikt Contralateral involuntary movements (often a hand flap)
Red nucleus &substantia nigra
Claude Contralateral ataxia Cerebellar peduncle
Nothnagel Ipsilateral ataxia Cerebellar peduncle
Motility Disorders: Fascicular Syndromes
Each has an associated nonocular finding. What is that finding for…Claude syndrome?
?
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CN3 Fascicular Syndromes
A14
Syndrome Ipsilateral 3rd plus…
Weber Contralateral hemiplegia Cerebral peduncle
Benedikt Contralateral involuntary movements (often a hand flap)
Red nucleus &substantia nigra
Claude Contralateral ataxia Cerebellar peduncle
Nothnagel Ipsilateral ataxia Cerebellar peduncle
Motility Disorders: Fascicular Syndromes
Each has an associated nonocular finding. What is that finding for…Claude syndrome?
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CN3 Fascicular Syndromes
Q15
Syndrome Ipsilateral 3rd plus…
Weber Contralateral hemiplegia Cerebral peduncle
Benedikt Contralateral involuntary movements (often a hand flap)
Red nucleus &substantia nigra
Claude Contralateral ataxia Cerebellar peduncle
Nothnagel Ipsilateral ataxia Cerebellar peduncle
Motility Disorders: Fascicular Syndromes
Each has an associated nonocular finding. What is that finding for…Nothnagel syndrome?
?
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CN3 Fascicular Syndromes
A16
Syndrome Ipsilateral 3rd plus…
Weber Contralateral hemiplegia Cerebral peduncle
Benedikt Contralateral involuntary movements (often a hand flap)
Red nucleus &substantia nigra
Claude Contralateral ataxia Cerebellar peduncle
Nothnagel Ipsilateral ataxia Cerebellar peduncle
Motility Disorders: Fascicular Syndromes
Each has an associated nonocular finding. What is that finding for…Nothnagel syndrome?
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CN3 Fascicular Syndromes
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Syndrome Ipsilateral 3rd plus…
Weber Contralateral hemiplegia Cerebral peduncle
Benedikt Contralateral involuntary movements (often a hand flap)
Red nucleus &substantia nigra
Claude Contralateral ataxia Cerebellar peduncle
Nothnagel Ipsilateral ataxia Cerebellar peduncle
Motility Disorders: Fascicular Syndromes
I remember that Claude and Nothnagel involve ataxia by noting that, of the four CN3 syndromes, they are the only to have a letter in their nameA is for ataxia!
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CN3 Fascicular Syndromes
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Syndrome Ipsilateral 3rd plus…
Weber Contralateral hemiplegia Cerebral peduncle
Benedikt Contralateral involuntary movements (often a hand flap)
Red nucleus &substantia nigra
Claude Contralateral ataxia Cerebellar peduncle
Nothnagel Ipsilateral ataxia Cerebellar peduncle
Motility Disorders: Fascicular Syndromes
Note that Nothnagel’s is the only fascicular syndrome for which the nonocular findings are ipsilateral
Nonocular CNS findings are contralateral
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CN3 Fascicular Syndromes
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Syndrome Ipsilateral 3rd plus…
Weber Contralateral hemiplegia Cerebral peduncle
Benedikt Contralateral involuntary movements (often a hand flap)
Red nucleus &substantia nigra
Claude Contralateral ataxia Cerebellar peduncle
Nothnagel Ipsilateral ataxia Cerebellar peduncle
Motility Disorders: Fascicular Syndromes
Note that Nothnagel’s is the only fascicular syndrome for which the nonocular findings are ipsilateral
Nonocular CNS findings are contralateral
Nothnagel syndromeis…
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CN3 Fascicular Syndromes
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Syndrome Ipsilateral 3rd plus…
Weber Contralateral hemiplegia Cerebral peduncle
Benedikt Contralateral involuntary movements (often a hand flap)
Red nucleus &substantia nigra
Claude Contralateral ataxia Cerebellar peduncle
Nothnagel Ipsilateral ataxia Cerebellar peduncle
Motility Disorders: Fascicular Syndromes
Note that Nothnagel’s is the only fascicular syndrome for which the nonocular findings are ipsilateral
Nonocular CNS findings are contralateral
Nothnagel syndrome
contralateral!is…
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CN3 Fascicular Syndromes
Q21
Syndrome Ipsilateral 3rd plus… Lesion location
Weber Contralateral hemiplegia
Benedikt Contralateral involuntary movements (often a hand flap)
Claude Contralateral ataxia
Nothnagel Ipsilateral ataxia
Motility Disorders: Fascicular Syndromes
What is the location of the lesion in…Weber syndrome?
?
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CN3 Fascicular Syndromes
A22
Syndrome Ipsilateral 3rd plus… Lesion location
Weber Contralateral hemiplegia Cerebral peduncle
Benedikt Contralateral involuntary movements (often a hand flap)
Claude Contralateral ataxia
Nothnagel Ipsilateral ataxia
Motility Disorders: Fascicular Syndromes
What is the location of the lesion in…Weber syndrome?
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CN3 Fascicular Syndromes
Q23
Syndrome Ipsilateral 3rd plus… Lesion location
Weber Contralateral hemiplegia Cerebral peduncle
Benedikt Contralateral involuntary movements (often a hand flap)
Claude Contralateral ataxia
Nothnagel Ipsilateral ataxia
Motility Disorders: Fascicular Syndromes
What is the location of the lesion in…Benedikt syndrome?
?
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CN3 Fascicular Syndromes
A24
Syndrome Ipsilateral 3rd plus… Lesion location
Weber Contralateral hemiplegia Cerebral peduncle
Benedikt Contralateral involuntary movements (often a hand flap)
Red nucleus &substantia nigra
Claude Contralateral ataxia
Nothnagel Ipsilateral ataxia
Motility Disorders: Fascicular Syndromes
What is the location of the lesion in…Benedikt syndrome?
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CN3 Fascicular Syndromes
25
Syndrome Ipsilateral 3rd plus… Lesion location
Weber Contralateral hemiplegia Cerebral peduncle
Benedikt Contralateral involuntary movements (often a hand flap)
Red nucleus &substantia nigra
Claude Contralateral ataxia
Nothnagel Ipsilateral ataxia
Motility Disorders: Fascicular Syndromes
What is the location of the lesion in…Benedikt syndrome? I remember this by thinking of Benedict Arnold,
the infamous Revolutionary War traitor—ie, he was a ‘Red’
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CN3 Fascicular Syndromes
Q26
Syndrome Ipsilateral 3rd plus… Lesion location
Weber Contralateral hemiplegia Cerebral peduncle
Benedikt Contralateral involuntary movements (often a hand flap)
Red nucleus &substantia nigra
Claude Contralateral ataxia
Nothnagel Ipsilateral ataxia
Motility Disorders: Fascicular Syndromes
What is the location of the lesion in…Claude syndrome?
?
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CN3 Fascicular Syndromes
A27
Syndrome Ipsilateral 3rd plus… Lesion location
Weber Contralateral hemiplegia Cerebral peduncle
Benedikt Contralateral involuntary movements (often a hand flap)
Red nucleus &substantia nigra
Claude Contralateral ataxia Cerebellar peduncle
Nothnagel Ipsilateral ataxia
Motility Disorders: Fascicular Syndromes
What is the location of the lesion in…Claude syndrome?
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CN3 Fascicular Syndromes
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Syndrome Ipsilateral 3rd plus… Lesion location
Weber Contralateral hemiplegia Cerebral peduncle
Benedikt Contralateral involuntary movements (often a hand flap)
Red nucleus &substantia nigra
Claude Contralateral ataxia Cerebellar peduncle
Nothnagel Ipsilateral ataxia
Motility Disorders: Fascicular Syndromes
What is the location of the lesion in…Claude syndrome?
Note: Similar, but not the same!
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CN3 Fascicular Syndromes
Q29
Syndrome Ipsilateral 3rd plus… Lesion location
Weber Contralateral hemiplegia Cerebral peduncle
Benedikt Contralateral involuntary movements (often a hand flap)
Red nucleus &substantia nigra
Claude Contralateral ataxia Cerebellar peduncle
Nothnagel Ipsilateral ataxia
Motility Disorders: Fascicular Syndromes
What is the location of the lesion in…Nothnagel syndrome?
?
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CN3 Fascicular Syndromes
A30
Syndrome Ipsilateral 3rd plus… Lesion location
Weber Contralateral hemiplegia Cerebral peduncle
Benedikt Contralateral involuntary movements (often a hand flap)
Red nucleus &substantia nigra
Claude Contralateral ataxia Cerebellar peduncle
Nothnagel Ipsilateral ataxia Cerebellar peduncle
Motility Disorders: Fascicular Syndromes
What is the location of the lesion in…Nothnagel syndrome?
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CN3 Fascicular Syndromes
31
Syndrome Ipsilateral 3rd plus… Lesion location
Weber Contralateral hemiplegia Cerebral peduncle
Benedikt Contralateral involuntary movements (often a hand flap)
Red nucleus &substantia nigra
Claude Contralateral ataxia Cerebellar peduncle
Nothnagel Ipsilateral ataxia Cerebellar peduncle
Motility Disorders: Fascicular Syndromes
Note: Not just similar--the same!
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CN3 Fascicular Syndromes
32
Syndrome Ipsilateral 3rd plus… Lesion location
Weber Contralateral hemiplegia Cerebral peduncle
Benedikt Contralateral involuntary movements (often a hand flap)
Red nucleus &substantia nigra
Claude Contralateral ataxia Cerebellar peduncle
Nothnagel Ipsilateral ataxia Cerebellar peduncle
Motility Disorders: Fascicular Syndromes
I remember this because it just makes sense to me that ataxia will be due to a cerebellar lesion
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Q33
Motility Disorders: Fascicular Syndromes
CN6 Fascicular Syndromes
The BCSC Neuro book discusses two CN6 fascicular syndromes.What are their names?
Syndrome Ipsilateral 6th plus…
? Ipsilateral CN7 and contralateral hemiplegia
?Ipsilateral CN7 & facial hypoesthesia, and
loss of taste to anterior tongue, andcontralateral hemiplegia
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A34
Motility Disorders: Fascicular Syndromes
CN6 Fascicular Syndromes
Syndrome Ipsilateral 6th plus…
Millard-Gubler Ipsilateral CN7 and contralateral hemiplegia
FovilleIpsilateral CN7 & facial hypoesthesia, and
loss of taste to anterior tongue, andcontralateral hemiplegia
The BCSC Neuro book discusses two CN6 fascicular syndromes.What are their names?
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Syndrome Ipsilateral 6th plus…
Millard-Gubler Ipsilateral CN7 and contralateral hemiplegia
FovilleIpsilateral CN7 & facial hypoesthesia, and
loss of taste to anterior tongue, andcontralateral hemiplegia
Q35
Motility Disorders: Fascicular Syndromes
CN6 Fascicular SyndromesIpsi- vscontralateral
Each is composed in part by a sixth nerve palsy. Is the palsy ipsilateral, or contralateral to the side of the lesion?
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A36
Motility Disorders: Fascicular Syndromes
CN6 Fascicular Syndromes
Syndrome Ipsilateral 6th plus…
Millard-Gubler Ipsilateral CN7 and contralateral hemiplegia
FovilleIpsilateral CN7 & facial hypoesthesia, and
loss of taste to anterior tongue, andcontralateral hemiplegia
Each is composed in part by a sixth nerve palsy. Is the palsy ipsilateral, or contralateral to the side of the lesion?
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Q37
Motility Disorders: Fascicular Syndromes
Syndrome Ipsilateral 6th plus…
Millard-Gubler Ipsilateral CN7 and contralateral hemiplegia
FovilleIpsilateral CN7 & facial hypoesthesia, and
loss of taste to anterior tongue, andcontralateral hemiplegia
CN6 Fascicular Syndromes
Each has an associated nonocular finding(s). What is that finding for…Millard-Gubler syndrome?
?
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A38
Motility Disorders: Fascicular Syndromes
Syndrome Ipsilateral 6th plus…
Millard-Gubler Ipsilateral CN7 and contralateral hemiplegia
FovilleIpsilateral CN7 & facial hypoesthesia, and
loss of taste to anterior tongue, andcontralateral hemiplegia
CN6 Fascicular Syndromes
Each has an associated nonocular finding(s). What is that finding for…Millard-Gubler syndrome?
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Q39
Motility Disorders: Fascicular Syndromes
Syndrome Ipsilateral 6th plus…
Millard-Gubler Ipsilateral CN7 and contralateral hemiplegia
FovilleIpsilateral CN7 & facial hypoesthesia, and
loss of taste to anterior tongue, andcontralateral hemiplegia
CN6 Fascicular Syndromes
Each has an associated nonocular finding(s). What is that finding for…Foville syndrome?
?
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A40
Motility Disorders: Fascicular Syndromes
Syndrome Ipsilateral 6th plus…
Millard-Gubler Ipsilateral CN7 and contralateral hemiplegia
FovilleIpsilateral CN7 and contralateral hemiplegia
and facial hypoesthesia andloss of taste to anterior tongue
CN6 Fascicular Syndromes
Each has an associated nonocular finding(s). What is that finding for…Foville syndrome?
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41
Motility Disorders: Fascicular Syndromes
Syndrome Ipsilateral 6th plus…
Millard-Gubler Ipsilateral CN7 and contralateral hemiplegia
FovilleIpsilateral CN7 and contralateral hemiplegia
and facial hypoesthesia andloss of taste to anterior tongue
CN6 Fascicular Syndromes
Each has an associated nonocular finding(s). What is that finding for…Foville syndrome?
Note that both include an ipsilateral 7th along with contralateral hemiplegia…
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42
Motility Disorders: Fascicular Syndromes
Syndrome Ipsilateral 6th plus…
Millard-Gubler Ipsilateral CN7 and contralateral hemiplegia
FovilleIpsilateral CN7 and contralateral hemiplegia
and facial hypoesthesia andloss of taste to anterior tongue
CN6 Fascicular Syndromes
Each has an associated nonocular finding(s). What is that finding for…Foville syndrome?
…but Foville includes a number of other findings
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Q43
Motility Disorders: Fascicular Syndromes
Syndrome Ipsilateral 6th plus… Lesion location
Millard-Gubler Ipsilateral CN7 and contralateral hemiplegia
FovilleIpsilateral CN7 and contralateral hemiplegia
and facial hypoesthesia andloss of taste to anterior tongue
CN6 Fascicular Syndromes
What is the location of the lesion in…Millard-Gubler syndrome?
?
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A44
Motility Disorders: Fascicular Syndromes
Syndrome Ipsilateral 6th plus… Lesion location
Millard-Gubler Ipsilateral CN7 and contralateral hemiplegia Ventral pons
FovilleIpsilateral CN7 and contralateral hemiplegia
and facial hypoesthesia andloss of taste to anterior tongue
CN6 Fascicular Syndromes
What is the location of the lesion in…Millard-Gubler syndrome?
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Q45
Motility Disorders: Fascicular Syndromes
Syndrome Ipsilateral 6th plus… Lesion location
Millard-Gubler Ipsilateral CN7 and contralateral hemiplegia Ventral pons
FovilleIpsilateral CN7 and contralateral hemiplegia
and facial hypoesthesia andloss of taste to anterior tongue
CN6 Fascicular Syndromes
What is the location of the lesion in…Foville syndrome?
?
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A46
Motility Disorders: Fascicular Syndromes
Syndrome Ipsilateral 6th plus… Lesion location
Millard-Gubler Ipsilateral CN7 and contralateral hemiplegia Ventral pons
FovilleIpsilateral CN7 and contralateral hemiplegia
and facial hypoesthesia andloss of taste to anterior tongue
Tractus solitarius
CN6 Fascicular Syndromes
What is the location of the lesion in…Foville syndrome?
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47
Motility Disorders: Fascicular Syndromes
Syndrome Ipsilateral 6th plus… Lesion location
Millard-Gubler Ipsilateral CN7 and contralateral hemiplegia Ventral pons
FovilleIpsilateral CN7 and contralateral hemiplegia
and facial hypoesthesia andloss of taste to anterior tongue
Tractus solitarius
CN6 Fascicular Syndromes
CN3 Fascicular Syndromes
Syndrome Ipsilateral 3rd plus… Lesion location
Weber Contralateral hemiplegia Cerebral peduncle
Benedikt Contralateral involuntary movements (often a hand flap)
Red nucleus &substantia nigra
Claude Contralateral ataxia Cerebellar peduncle
Nothnagel Ipsilateral ataxia Cerebellar peduncle
(No question--summary/review slide)
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48
CN3Nucleus
CN4Nucleus
CN6NucleusNuclear
Supranuclear
Infranuclear
Internuclear
Fascicular
Subarachnoid
Cavernous sinus
Orbital^^ MLF
Neuromuscular junction
Extraocular muscle
Finally, we will discuss Gradenigo syndrome. Gradenigo’s is not, repeat not, a fascicular syndrome (because the nerve fascicle is not involved).
Motility Disorders: Fascicular SyndromesGradenigo^
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49
CN3Nucleus
CN4Nucleus
CN6NucleusNuclear
Supranuclear
Infranuclear
Internuclear
Fascicular
Subarachnoid
Cavernous sinus
Orbital^^ MLF
Neuromuscular junction
Extraocular muscle
Finally, we will discuss Gradenigo syndrome. Gradenigo’s is not, repeat not, a fascicular syndrome (because the nerve fascicle is not involved). Rather, it involves the subarachnoidcourse of the nerve. (We’re discussing Gradenigo’s in this slide-set only because it doesn’t fit well in any other.)
Motility Disorders: Fascicular SyndromesGradenigo^
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Q50
Syndrome ?
Gradenigo
Gradenigo Syndrome
Motility Disorders: Fascicular SyndromesGradenigo^
Which oculo-motor nerve is involved in Gradenigo syndrome?
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A51
Syndrome Ipsilateral 6th plus…
Gradenigo
Gradenigo Syndrome
Motility Disorders: Fascicular SyndromesGradenigo^
Which oculo-motor nerve is involved in Gradenigo syndrome?
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Q52
Syndrome Ipsilateral 6th plus…
Gradenigo
Gradenigo Syndrome
Motility Disorders: Fascicular SyndromesGradenigo^
Gradenigo syndrome involves a sixth nerve palsy. Is the palsy ipsilateral, or contralateral to the side of the lesion?
Ipsi- vscontralateral
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A53
Syndrome Ipsilateral 6th plus…
Gradenigo
Gradenigo Syndrome
Motility Disorders: Fascicular SyndromesGradenigo^
Gradenigo syndrome involves a sixth nerve palsy. Is the palsy ipsilateral, or contralateral to the side of the lesion?
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Q54
Syndrome Ipsilateral 6th plus…
Gradenigo ?
Gradenigo Syndrome
Motility Disorders: Fascicular SyndromesGradenigo^
Gradenigo syndrome has an associated nonocular finding. What is it?
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A55
Syndrome Ipsilateral 6th plus…
Gradenigo Ipsilateral facial pain
Gradenigo Syndrome
Motility Disorders: Fascicular SyndromesGradenigo^
Gradenigo syndrome has an associated nonocular finding. What is it?
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Q56
Syndrome Ipsilateral 6th plus… Lesion location
Gradenigo Ipsilateral facial pain ?
Gradenigo Syndrome
Motility Disorders: Fascicular SyndromesGradenigo^
Where is the lesion located?
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A57
Syndrome Ipsilateral 6th plus… Lesion location
Gradenigo Ipsilateral facial pain Petrous bone
Gradenigo Syndrome
Motility Disorders: Fascicular SyndromesGradenigo^
Where is the lesion located?
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Q58
Syndrome Ipsilateral 6th plus… Lesion location
Gradenigo Ipsilateral facial pain Petrous bone
Gradenigo Syndrome
Motility Disorders: Fascicular SyndromesGradenigo^
What is the fundamental pathogenesis in Gradenigo’s?
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A59
Syndrome Ipsilateral 6th plus… Lesion location
Gradenigo Ipsilateral facial pain Petrous bone
Gradenigo Syndrome
Motility Disorders: Fascicular SyndromesGradenigo^
What is the fundamental pathogenesis in Gradenigo’s?Chronic inflammation in the mastoid air cells of the petrous portion of the temporal bone knocks out CN6 and the first two divisions of CN5
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Q60
Syndrome Ipsilateral 6th plus… Lesion location
Gradenigo Ipsilateral facial pain Petrous bone
Gradenigo Syndrome
Motility Disorders: Fascicular SyndromesGradenigo^
What is the fundamental pathogenesis in Gradenigo’s?Chronic inflammation in the mastoid air cells of the petrous portion of the temporal bone knocks out CN6 and the first two divisions of CN5
By what noneponymous name is Gradenigo’s syndrome also known?Petrous apex syndrome
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A61
Syndrome Ipsilateral 6th plus… Lesion location
Gradenigo Ipsilateral facial pain Petrous bone
Gradenigo Syndrome
Motility Disorders: Fascicular SyndromesGradenigo^
What is the fundamental pathogenesis in Gradenigo’s?Chronic inflammation in the mastoid air cells of the petrous portion of the temporal bone knocks out CN6 and the first two divisions of CN5
By what noneponymous name is Gradenigo’s syndrome also known?Petrous apex syndrome
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Q62
Syndrome Ipsilateral 6th plus… Lesion location
Gradenigo Ipsilateral facial pain Petrous bone
Gradenigo Syndrome
Motility Disorders: Fascicular SyndromesGradenigo^
What is the fundamental pathogenesis in Gradenigo’s?Chronic inflammation in the mastoid air cells of the petrous portion of the temporal bone knocks out CN6 and the first two divisions of CN5
Which population is especially at risk?
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A63
Syndrome Ipsilateral 6th plus… Lesion location
Gradenigo Ipsilateral facial pain Petrous bone
Gradenigo Syndrome
Motility Disorders: Fascicular SyndromesGradenigo^
What is the fundamental pathogenesis in Gradenigo’s?Chronic inflammation in the mastoid air cells of the petrous portion of the temporal bone knocks out CN6 and the first two divisions of CN5
Which population is especially at risk?Children
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Q64
Syndrome Ipsilateral 6th plus… Lesion location
Gradenigo Ipsilateral facial pain Petrous bone
Gradenigo Syndrome
Motility Disorders: Fascicular SyndromesGradenigo^
What is the fundamental pathogenesis in Gradenigo’s?Chronic inflammation in the mastoid air cells of the petrous portion of the temporal bone knocks out CN6 and the first two divisions of CN5
Which population is especially at risk?Children
Which group of children is especially at risk?
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Q/A65
Syndrome Ipsilateral 6th plus… Lesion location
Gradenigo Ipsilateral facial pain Petrous bone
Gradenigo Syndrome
Motility Disorders: Fascicular SyndromesGradenigo^
What is the fundamental pathogenesis in Gradenigo’s?Chronic inflammation in the mastoid air cells of the petrous portion of the temporal bone knocks out CN6 and the first two divisions of CN5
Which population is especially at risk?Children
Which group of children is especially at risk?Those who suffer chronic and recurrent bouts of otitis mediatwo words
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A66
Syndrome Ipsilateral 6th plus… Lesion location
Gradenigo Ipsilateral facial pain Petrous bone
Gradenigo Syndrome
Motility Disorders: Fascicular SyndromesGradenigo^
What is the fundamental pathogenesis in Gradenigo’s?Chronic inflammation in the mastoid air cells of the petrous portion of the temporal bone knocks out CN6 and the first two divisions of CN5
Which population is especially at risk?Children
Which group of children is especially at risk?Those who suffer chronic and recurrent bouts of otitis media
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Q67
Syndrome Ipsilateral 6th plus… Lesion location
Gradenigo Ipsilateral facial pain Petrous bone
Gradenigo Syndrome
Motility Disorders: Fascicular SyndromesGradenigo^
What is the fundamental pathogenesis in Gradenigo’s?Chronic inflammation in the mastoid air cells of the petrous portion of the temporal bone knocks out CN6 and the first two divisions of CN5
Which population is especially at risk?Children
Which group of children is especially at risk?Those who suffer chronic and recurrent bouts of otitis media
In addition to pain, what other ipsilateral ‘face finding’ is often found in Gradenigo’s syndrome?Hemifacial palsy
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A68
Syndrome Ipsilateral 6th plus… Lesion location
Gradenigo Ipsilateral facial pain Petrous bone
Gradenigo Syndrome
Motility Disorders: Fascicular SyndromesGradenigo^
What is the fundamental pathogenesis in Gradenigo’s?Chronic inflammation in the mastoid air cells of the petrous portion of the temporal bone knocks out CN6 and the first two divisions of CN5
Which population is especially at risk?Children
Which group of children is especially at risk?Those who suffer chronic and recurrent bouts of otitis media
In addition to pain, what other ipsilateral ‘face finding’ is often found in Gradenigo’s syndrome?Hemifacial palsy