1 Motility Disorders: Fascicular Syndromes Supranuclear
Internuclear
CN3 ^ MLF CN6 CN4 ^ Nuclear Nucleus Nucleus Nucleus
Fascicular This slide captures one way to Subarachnoid think about the motility disorders. If it is unfamiliar, I strongly suggest Cavernous sinus you review the slide-set entitled Infranuclear ‘Motility disorders: Overview’ Orbital before proceeding. Neuromuscular junction Extraocular muscle 2 Motility Disorders: Fascicular Syndromes Supranuclear
Internuclear
CN3 ^ MLF CN6 CN4 ^ Nuclear Nucleus Nucleus Nucleus
Fascicular In this slide-set, we’ll take a Subarachnoid look at fascicular syndromes Cavernous sinus Infranuclear Orbital Neuromuscular junction Extraocular muscle 3 Motility Disorders: Fascicular Syndromes Supranuclear
Internuclear
CN3 ^ MLF CN6 CN4 ^ Nuclear Nucleus Nucleus Nucleus
Fascicular
As mentioned in the?Subarachnoid 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?Cavernous speaking, sinus lesions of the nuclei and/or fascicles do Infranuclearnot present as isolated EOM abnormalities; ie, the ophthalmoparesis is almost always accompanied?Orbital by nonocular signs and symptoms of CNS damage. Neuromuscular junction Extraocular muscle 4 Motility Disorders: Fascicular Syndromes Supranuclear
Internuclear
CN3 ^ MLF CN6 CN4 ^ Nuclear Nucleus Nucleus Nucleus
Fascicular
As mentioned in the?Subarachnoid 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?Cavernous speaking, sinus lesions of the nuclei and/or fascicles do Infranuclearnot present as isolated EOM abnormalities; ie, the ophthalmoparesis is almost always accompanied?Orbital by nonocular signs and symptoms of CNS damage.
As we will see, theNeuromuscular fascicular syndromes junction are defined by the nonocular CNS signs/symptomsExtraocular that accompany muscle the ophthalmoparesis 5 Q Motility Disorders: Fascicular Syndromes CN3 Fascicular Syndromes
Syndrome
? Contralateral hemiplegia Cerebral peduncle Contralateral involuntary Red nucleus & ? movements (often a hand flap) substantia nigra ? Contralateral ataxia Cerebellar peduncle
? Ipsilateral ataxia Cerebellar peduncle
The BCSC Neuro book discusses four CN3 fascicular syndromes. What are their names? 6 A Motility Disorders: Fascicular Syndromes CN3 Fascicular Syndromes
Syndrome
Weber Contralateral hemiplegia Cerebral peduncle Contralateral involuntary Red nucleus & Benedikt movements (often a hand flap) substantia nigra Claude Contralateral ataxia Cerebellar peduncle
Nothnagel Ipsilateral ataxia Cerebellar peduncle
The BCSC Neuro book discusses four CN3 fascicular syndromes. What are their names? 7 Q Motility Disorders: Fascicular Syndromes CN3 Fascicular Syndromes
Ipsi- vs rd Syndrome contralateralIpsilateral 3 plus… Weber Contralateral hemiplegia Cerebral peduncle Contralateral involuntary Red nucleus & Benedikt movements (often a hand flap) substantia nigra Claude Contralateral ataxia Cerebellar peduncle
Nothnagel Ipsilateral ataxia Cerebellar peduncle
Each is composed in part by a third nerve palsy. Is the palsy ipsilateral, or contralateral to the side of the lesion? 8 A Motility Disorders: Fascicular Syndromes CN3 Fascicular Syndromes
Syndrome Ipsilateral 3rd plus…
Weber Contralateral hemiplegia Cerebral peduncle Contralateral involuntary Red nucleus & Benedikt movements (often a hand flap) substantia nigra Claude Contralateral ataxia Cerebellar peduncle
Nothnagel Ipsilateral ataxia Cerebellar peduncle
Each is composed in part by a third nerve palsy. Is the palsy ipsilateral, or contralateral to the side of the lesion? 9 Q Motility Disorders: Fascicular Syndromes CN3 Fascicular Syndromes
Syndrome Ipsilateral 3rd plus…
Weber ? Cerebral peduncle Contralateral involuntary Red nucleus & Benedikt movements (often a hand flap) substantia nigra Claude Contralateral ataxia Cerebellar peduncle
Nothnagel Ipsilateral ataxia Cerebellar peduncle
Each has an associated nonocular finding. What is that finding for… Weber syndrome? 10 A Motility Disorders: Fascicular Syndromes CN3 Fascicular Syndromes
Syndrome Ipsilateral 3rd plus…
Weber Contralateral hemiplegia Cerebral peduncle Contralateral involuntary Red nucleus & Benedikt movements (often a hand flap) substantia nigra Claude Contralateral ataxia Cerebellar peduncle
Nothnagel Ipsilateral ataxia Cerebellar peduncle
Each has an associated nonocular finding. What is that finding for… Weber syndrome? 11 Q Motility Disorders: Fascicular Syndromes CN3 Fascicular Syndromes
Syndrome Ipsilateral 3rd plus…
Weber Contralateral hemiplegia Cerebral peduncle Contralateral involuntary Red nucleus & Benedikt movements (often? a hand flap) substantia nigra Claude Contralateral ataxia Cerebellar peduncle
Nothnagel Ipsilateral ataxia Cerebellar peduncle
Each has an associated nonocular finding. What is that finding for… Benedikt syndrome? 12 A Motility Disorders: Fascicular Syndromes CN3 Fascicular Syndromes
Syndrome Ipsilateral 3rd plus…
Weber Contralateral hemiplegia Cerebral peduncle Contralateral involuntary Red nucleus & Benedikt movements (often a hand flap) substantia nigra Claude Contralateral ataxia Cerebellar peduncle
Nothnagel Ipsilateral ataxia Cerebellar peduncle
Each has an associated nonocular finding. What is that finding for… Benedikt syndrome? 13 Q Motility Disorders: Fascicular Syndromes CN3 Fascicular Syndromes
Syndrome Ipsilateral 3rd plus…
Weber Contralateral hemiplegia Cerebral peduncle Contralateral involuntary Red nucleus & Benedikt movements (often a hand flap) substantia nigra Claude Contralateral? ataxia Cerebellar peduncle
Nothnagel Ipsilateral ataxia Cerebellar peduncle
Each has an associated nonocular finding. What is that finding for… Claude syndrome? 14 A Motility Disorders: Fascicular Syndromes CN3 Fascicular Syndromes
Syndrome Ipsilateral 3rd plus…
Weber Contralateral hemiplegia Cerebral peduncle Contralateral involuntary Red nucleus & Benedikt movements (often a hand flap) substantia nigra Claude Contralateral ataxia Cerebellar peduncle
Nothnagel Ipsilateral ataxia Cerebellar peduncle
Each has an associated nonocular finding. What is that finding for… Claude syndrome? 15 Q Motility Disorders: Fascicular Syndromes CN3 Fascicular Syndromes
Syndrome Ipsilateral 3rd plus…
Weber Contralateral hemiplegia Cerebral peduncle Contralateral involuntary Red nucleus & Benedikt movements (often a hand flap) substantia nigra Claude Contralateral ataxia Cerebellar peduncle
Nothnagel Ipsilateral? ataxia Cerebellar peduncle
Each has an associated nonocular finding. What is that finding for… Nothnagel syndrome? 16 A Motility Disorders: Fascicular Syndromes CN3 Fascicular Syndromes
Syndrome Ipsilateral 3rd plus…
Weber Contralateral hemiplegia Cerebral peduncle Contralateral involuntary Red nucleus & Benedikt movements (often a hand flap) substantia nigra Claude Contralateral ataxia Cerebellar peduncle
Nothnagel Ipsilateral ataxia Cerebellar peduncle
Each has an associated nonocular finding. What is that finding for… Nothnagel syndrome? 17 Motility Disorders: Fascicular Syndromes
CN3 Fascicular Syndromes
Syndrome Ipsilateral 3rd plus…
Weber Contralateral hemiplegia Cerebral peduncle Contralateral involuntary Red nucleus & Benedikt movements (often a hand flap) substantia nigra Claude Contralateral ataxia Cerebellar peduncle Nothnagel Ipsilateral ataxia Cerebellar peduncle 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 name A is for ataxia! 18 Motility Disorders: Fascicular Syndromes
CN3 Fascicular Syndromes
Syndrome Ipsilateral 3rd plus…
Weber Contralateral hemiplegia Cerebral peduncle Contralateral involuntary Red nucleus & Benedikt Nonocular CNS findings are contralateral movements (often a hand flap) substantia nigra
Claude Contralateral ataxia Cerebellar peduncle Note that Nothnagel’s is the only Nothnagel Ipsilateral ataxia fascicularCerebellar syndrome peduncle for which the nonocular findings are ipsilateral 19 Motility Disorders: Fascicular Syndromes
CN3 Fascicular Syndromes
Syndrome Ipsilateral 3rd plus…
Weber Contralateral hemiplegia Cerebral peduncle Contralateral involuntary Red nucleus & Benedikt Nonocular CNS findings are contralateral movements (often a hand flap) substantia nigra
Claude Contralateral ataxia Cerebellar peduncle Note that Nothnagel’s is the only Nothnagel Ipsilateral ataxia fascicularCerebellar syndrome peduncle for which the nonocular findings are ipsilateral
hnagel syndrome Not is… 20 Motility Disorders: Fascicular Syndromes
CN3 Fascicular Syndromes
Syndrome Ipsilateral 3rd plus…
Weber Contralateral hemiplegia Cerebral peduncle Contralateral involuntary Red nucleus & Benedikt Nonocular CNS findings are contralateral movements (often a hand flap) substantia nigra
Claude Contralateral ataxia Cerebellar peduncle Note that Nothnagel’s is the only Nothnagel Ipsilateral ataxia fascicularCerebellar syndrome peduncle for which the nonocular findings are ipsilateral
hnagel syndrome is… Not contralateral! 21 Q Motility Disorders: Fascicular Syndromes CN3 Fascicular Syndromes
Syndrome Ipsilateral 3rd plus… Lesion location
Weber Contralateral hemiplegia ? Contralateral involuntary Benedikt movements (often a hand flap) Claude Contralateral ataxia
Nothnagel Ipsilateral ataxia
What is the location of the lesion in… Weber syndrome? 22 A Motility Disorders: Fascicular Syndromes CN3 Fascicular Syndromes
Syndrome Ipsilateral 3rd plus… Lesion location
Weber Contralateral hemiplegia Cerebral peduncle Contralateral involuntary Benedikt movements (often a hand flap) Claude Contralateral ataxia
Nothnagel Ipsilateral ataxia
What is the location of the lesion in… Weber syndrome? 23 Q Motility Disorders: Fascicular Syndromes CN3 Fascicular Syndromes
Syndrome Ipsilateral 3rd plus… Lesion location
Weber Contralateral hemiplegia Cerebral peduncle Contralateral involuntary Benedikt movements (often a hand flap) ? Claude Contralateral ataxia
Nothnagel Ipsilateral ataxia
What is the location of the lesion in… Benedikt syndrome? 24 A Motility Disorders: Fascicular Syndromes CN3 Fascicular Syndromes
Syndrome Ipsilateral 3rd plus… Lesion location
Weber Contralateral hemiplegia Cerebral peduncle Contralateral involuntary Red nucleus & Benedikt movements (often a hand flap) substantia nigra Claude Contralateral ataxia
Nothnagel Ipsilateral ataxia
What is the location of the lesion in… Benedikt syndrome? 25 Motility Disorders: Fascicular Syndromes
CN3 Fascicular Syndromes
Syndrome Ipsilateral 3rd plus… Lesion location
Weber Contralateral hemiplegia Cerebral peduncle Contralateral involuntary Red nucleus & Benedikt movements (often a hand flap) substantia nigra Claude Contralateral ataxia
Nothnagel Ipsilateral ataxia
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’ 26 Q Motility Disorders: Fascicular Syndromes CN3 Fascicular Syndromes
Syndrome Ipsilateral 3rd plus… Lesion location
Weber Contralateral hemiplegia Cerebral peduncle Contralateral involuntary Red nucleus & Benedikt movements (often a hand flap) substantia nigra Claude Contralateral ataxia ?
Nothnagel Ipsilateral ataxia
What is the location of the lesion in… Claude syndrome? 27 A Motility Disorders: Fascicular Syndromes CN3 Fascicular Syndromes
Syndrome Ipsilateral 3rd plus… Lesion location
Weber Contralateral hemiplegia Cerebral peduncle Contralateral involuntary Red nucleus & Benedikt movements (often a hand flap) substantia nigra Claude Contralateral ataxia Cerebellar peduncle
Nothnagel Ipsilateral ataxia
What is the location of the lesion in… Claude syndrome? 28 Motility Disorders: Fascicular Syndromes
CN3 Fascicular Syndromes
Syndrome Ipsilateral 3rd plus… Lesion location
Weber Contralateral hemiplegia Cerebral peduncle Contralateral involuntary Red nucleus & Benedikt Note: Similar, but not the same! movements (often a hand flap) substantia nigra
Claude Contralateral ataxia Cerebellar peduncle
Nothnagel Ipsilateral ataxia
What is the location of the lesion in… Claude syndrome? 29 Q Motility Disorders: Fascicular Syndromes CN3 Fascicular Syndromes
Syndrome Ipsilateral 3rd plus… Lesion location
Weber Contralateral hemiplegia Cerebral peduncle Contralateral involuntary Red nucleus & Benedikt movements (often a hand flap) substantia nigra Claude Contralateral ataxia Cerebellar peduncle
Nothnagel Ipsilateral ataxia ?
What is the location of the lesion in… Nothnagel syndrome? 30 A Motility Disorders: Fascicular Syndromes CN3 Fascicular Syndromes
Syndrome Ipsilateral 3rd plus… Lesion location
Weber Contralateral hemiplegia Cerebral peduncle Contralateral involuntary Red nucleus & Benedikt movements (often a hand flap) substantia nigra Claude Contralateral ataxia Cerebellar peduncle
Nothnagel Ipsilateral ataxia Cerebellar peduncle
What is the location of the lesion in… Nothnagel syndrome? 31 Motility Disorders: Fascicular Syndromes
CN3 Fascicular Syndromes
Syndrome Ipsilateral 3rd plus… Lesion location
Weber Contralateral hemiplegia Cerebral peduncle Contralateral involuntary Red nucleus & Benedikt movements (often a hand flap) substantia nigra
Claude Contralateral ataxia Cerebellar peduncle Note: Not just similar--the same! Nothnagel Ipsilateral ataxia Cerebellar peduncle 32 Motility Disorders: Fascicular Syndromes
CN3 Fascicular Syndromes
Syndrome Ipsilateral 3rd plus… Lesion location
Weber Contralateral hemiplegia Cerebral peduncle Contralateral involuntary Red nucleus & Benedikt movements (often a hand flap) substantia nigra
Claude Contralateral ataxia Cerebellar peduncle
Nothnagel Ipsilateral ataxia Cerebellar peduncle
I remember this because it just makes sense to me that ataxia will be due to a cerebellar lesion 33 Q Motility Disorders: Fascicular Syndromes CN6 Fascicular Syndromes
Syndrome Ipsilateral 6th plus… Ipsilateral CN7 and ? contralateral hemiplegia Ipsilateral CN7 & facial hypoesthesia, and ? loss of taste to anterior tongue, and contralateral hemiplegia The BCSC Neuro book discusses two CN6 fascicular syndromes. What are their names? 34 A Motility Disorders: Fascicular Syndromes CN6 Fascicular Syndromes
Syndrome Ipsilateral 6th plus… Ipsilateral CN7 and Millard-Gubler contralateral hemiplegia Ipsilateral CN7 & facial hypoesthesia, and Foville loss of taste to anterior tongue, and contralateral hemiplegia The BCSC Neuro book discusses two CN6 fascicular syndromes. What are their names? 35 Q Motility Disorders: Fascicular Syndromes CN6 Fascicular Syndromes
Ipsi- vs th Syndrome contralateralIpsilateral 6 plus… Ipsilateral CN7 and Millard-Gubler contralateral hemiplegia Ipsilateral CN7 & facial hypoesthesia, and Foville loss of taste to anterior tongue, and contralateral hemiplegia Each is composed in part by a sixth nerve palsy. Is the palsy ipsilateral, or contralateral to the side of the lesion? 36 A Motility Disorders: Fascicular Syndromes CN6 Fascicular Syndromes
Syndrome Ipsilateral 6th plus… Ipsilateral CN7 and Millard-Gubler contralateral hemiplegia Ipsilateral CN7 & facial hypoesthesia, and Foville loss of taste to anterior tongue, and contralateral hemiplegia Each is composed in part by a sixth nerve palsy. Is the palsy ipsilateral, or contralateral to the side of the lesion? 37 Q Motility Disorders: Fascicular Syndromes CN6 Fascicular Syndromes
Syndrome Ipsilateral 6th plus… Ipsilateral CN7 and Millard-Gubler ? contralateral hemiplegia Ipsilateral CN7 & facial hypoesthesia, and Foville loss of taste to anterior tongue, and contralateral hemiplegia Each has an associated nonocular finding(s). What is that finding for… Millard-Gubler syndrome? 38 A Motility Disorders: Fascicular Syndromes CN6 Fascicular Syndromes
Syndrome Ipsilateral 6th plus… Ipsilateral CN7 and Millard-Gubler contralateral hemiplegia Ipsilateral CN7 & facial hypoesthesia, and Foville loss of taste to anterior tongue, and contralateral hemiplegia Each has an associated nonocular finding(s). What is that finding for… Millard-Gubler syndrome? 39 Q Motility Disorders: Fascicular Syndromes CN6 Fascicular Syndromes
Syndrome Ipsilateral 6th plus… Ipsilateral CN7 and Millard-Gubler contralateral hemiplegia Ipsilateral CN7 & facial hypoesthesia, and Foville loss of taste to anterior? tongue, and contralateral hemiplegia Each has an associated nonocular finding(s). What is that finding for… Foville syndrome? 40 A Motility Disorders: Fascicular Syndromes CN6 Fascicular Syndromes
Syndrome Ipsilateral 6th plus… Ipsilateral CN7 and Millard-Gubler contralateral hemiplegia Ipsilateral CN7 and contralateral hemiplegia Foville and facial hypoesthesia and loss of taste to anterior tongue Each has an associated nonocular finding(s). What is that finding for… Foville syndrome? 41 Motility Disorders: Fascicular Syndromes
CN6 Fascicular Syndromes
Syndrome Ipsilateral 6th plus… Ipsilateral CN7 and Millard-Gubler Note that both include an contralateral hemiplegia ipsilateral 7th along with Ipsilateral CN7 and contralateral hemiplegia contralateral hemiplegia… Foville and facial hypoesthesia and loss of taste to anterior tongue Each has an associated nonocular finding(s). What is that finding for… Foville syndrome? 42 Motility Disorders: Fascicular Syndromes
CN6 Fascicular Syndromes
Syndrome Ipsilateral 6th plus… Ipsilateral CN7 and Millard-Gubler contralateral hemiplegia Ipsilateral CN7 and contralateral hemiplegia Foville and facial hypoesthesia and …but Foville includes a loss of taste to anterior tongue number of other findings Each has an associated nonocular finding(s). What is that finding for… Foville syndrome? 43 Q Motility Disorders: Fascicular Syndromes CN6 Fascicular Syndromes
Syndrome Ipsilateral 6th plus… Lesion location Ipsilateral CN7 and Millard-Gubler ? contralateral hemiplegia Ipsilateral CN7 and contralateral hemiplegia Foville and facial hypoesthesia and loss of taste to anterior tongue What is the location of the lesion in… Millard-Gubler syndrome? 44 A Motility Disorders: Fascicular Syndromes CN6 Fascicular Syndromes
Syndrome Ipsilateral 6th plus… Lesion location Ipsilateral CN7 and Millard-Gubler Ventral pons contralateral hemiplegia Ipsilateral CN7 and contralateral hemiplegia Foville and facial hypoesthesia and loss of taste to anterior tongue What is the location of the lesion in… Millard-Gubler syndrome? 45 Q Motility Disorders: Fascicular Syndromes CN6 Fascicular Syndromes
Syndrome Ipsilateral 6th plus… Lesion location Ipsilateral CN7 and Millard-Gubler Ventral pons contralateral hemiplegia Ipsilateral CN7 and contralateral hemiplegia Foville and facial hypoesthesia and ? loss of taste to anterior tongue What is the location of the lesion in… Foville syndrome? 46 A Motility Disorders: Fascicular Syndromes CN6 Fascicular Syndromes
Syndrome Ipsilateral 6th plus… Lesion location Ipsilateral CN7 and Millard-Gubler Ventral pons contralateral hemiplegia Ipsilateral CN7 and contralateral hemiplegia Foville and facial hypoesthesia and Tractus solitarius loss of taste to anterior tongue What is the location of the lesion in… Foville syndrome? 47 Motility Disorders: Fascicular Syndromes
CN6 Fascicular Syndromes
Syndrome Ipsilateral 6th plus… Lesion location Ipsilateral CN7 and Millard-Gubler Ventral pons contralateral hemiplegia Ipsilateral CN7 and contralateral hemiplegia Foville and facial hypoesthesia and Tractus solitarius loss of taste to anterior tongue
CN3 Fascicular Syndromes
Syndrome Ipsilateral 3rd plus… Lesion location
Weber Contralateral hemiplegia Cerebral peduncle Contralateral involuntary Red nucleus & Benedikt movements (often a hand flap) substantia nigra Claude Contralateral ataxia Cerebellar peduncle
Nothnagel Ipsilateral ataxia Cerebellar peduncle (No question--summary/review slide) 48 Motility Disorders: Fascicular Syndromes ^ Supranuclear Gradenigo
Internuclear
CN3 ^ MLF CN6 CN4 ^ Nuclear Nucleus Nucleus Nucleus
Fascicular Finally, we will discuss Gradenigo syndrome. Subarachnoid Gradenigo’s is not, repeat not, a fascicular syndrome Cavernous sinus Infranuclear (because the nerve fascicle is Orbital not involved). Neuromuscular junction Extraocular muscle 49 Motility Disorders: Fascicular Syndromes ^ Supranuclear Gradenigo
Internuclear
CN3 ^ MLF CN6 CN4 ^ Nuclear Nucleus Nucleus Nucleus
Fascicular Finally, we will discuss Gradenigo syndrome. Subarachnoid Gradenigo’s is not, repeat not, a fascicular syndrome Cavernous sinus Infranuclear (because the nerve fascicle is Orbital not involved). Rather, it involves the subarachnoid Neuromuscular junction course of the nerve. (We’re discussing Gradenigo’s in this Extraocular muscle slide-set only because it doesn’t fit well in any other.) 50 Motility Disorders: Fascicular Syndromes ^ Q Gradenigo
Gradenigo Syndrome
Syndrome ?
Gradenigo Which oculo-motor nerve is involved in Gradenigo syndrome? 51 Motility Disorders: Fascicular Syndromes ^ A Gradenigo
Gradenigo Syndrome
Syndrome Ipsilateral 6th plus…
Gradenigo Which oculo-motor nerve is involved in Gradenigo syndrome? 52 Motility Disorders: Fascicular Syndromes ^ Q Gradenigo
Gradenigo Syndrome
Ipsi- vs th Syndrome contralateralIpsilateral 6 plus… Gradenigo Gradenigo syndrome involves a sixth nerve palsy. Is the palsy ipsilateral, or contralateral to the side of the lesion? 53 Motility Disorders: Fascicular Syndromes ^ A Gradenigo
Gradenigo Syndrome
Syndrome Ipsilateral 6th plus…
Gradenigo Gradenigo syndrome involves a sixth nerve palsy. Is the palsy ipsilateral, or contralateral to the side of the lesion? 54 Motility Disorders: Fascicular Syndromes ^ Q Gradenigo
Gradenigo Syndrome
Syndrome Ipsilateral 6th plus…
Gradenigo ? Gradenigo syndrome has an associated nonocular finding. What is it? 55 Motility Disorders: Fascicular Syndromes ^ A Gradenigo
Gradenigo Syndrome
Syndrome Ipsilateral 6th plus…
Gradenigo Ipsilateral facial pain Gradenigo syndrome has an associated nonocular finding. What is it? 56 Motility Disorders: Fascicular Syndromes ^ Q Gradenigo
Gradenigo Syndrome
Syndrome Ipsilateral 6th plus… Lesion location
Gradenigo Ipsilateral facial pain ? Where is the lesion located? 57 Motility Disorders: Fascicular Syndromes ^ A Gradenigo
Gradenigo Syndrome
Syndrome Ipsilateral 6th plus… Lesion location
Gradenigo Ipsilateral facial pain Petrous bone Where is the lesion located? 58 Motility Disorders: Fascicular Syndromes ^ Q Gradenigo
Gradenigo Syndrome
Syndrome Ipsilateral 6th plus… Lesion location
Gradenigo Ipsilateral facial pain Petrous bone What is the fundamental pathogenesis in Gradenigo’s? 59 Motility Disorders: Fascicular Syndromes ^ A Gradenigo
Gradenigo Syndrome
Syndrome Ipsilateral 6th plus… Lesion location
Gradenigo Ipsilateral facial pain Petrous bone 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 60 Motility Disorders: Fascicular Syndromes ^ Q Gradenigo
Gradenigo Syndrome
Syndrome Ipsilateral 6th plus… Lesion location
Gradenigo Ipsilateral facial pain Petrous bone 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 61 Motility Disorders: Fascicular Syndromes ^ A Gradenigo
Gradenigo Syndrome
Syndrome Ipsilateral 6th plus… Lesion location
Gradenigo Ipsilateral facial pain Petrous bone 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 62 Motility Disorders: Fascicular Syndromes ^ Q Gradenigo
Gradenigo Syndrome
Syndrome Ipsilateral 6th plus… Lesion location
Gradenigo Ipsilateral facial pain Petrous bone 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? 63 Motility Disorders: Fascicular Syndromes ^ A Gradenigo
Gradenigo Syndrome
Syndrome Ipsilateral 6th plus… Lesion location
Gradenigo Ipsilateral facial pain Petrous bone 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 64 Motility Disorders: Fascicular Syndromes ^ Q Gradenigo
Gradenigo Syndrome
Syndrome Ipsilateral 6th plus… Lesion location
Gradenigo Ipsilateral facial pain Petrous bone 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? 65 Motility Disorders: Fascicular Syndromes ^ Q/A Gradenigo
Gradenigo Syndrome
Syndrome Ipsilateral 6th plus… Lesion location
Gradenigo Ipsilateral facial pain Petrous bone 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 otitistwo media words 66 Motility Disorders: Fascicular Syndromes ^ A Gradenigo
Gradenigo Syndrome
Syndrome Ipsilateral 6th plus… Lesion location
Gradenigo Ipsilateral facial pain Petrous bone 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 67 Motility Disorders: Fascicular Syndromes ^ Q Gradenigo
Gradenigo Syndrome
Syndrome Ipsilateral 6th plus… Lesion location
Gradenigo Ipsilateral facial pain Petrous bone 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 68 Motility Disorders: Fascicular Syndromes ^ A Gradenigo
Gradenigo Syndrome
Syndrome Ipsilateral 6th plus… Lesion location
Gradenigo Ipsilateral facial pain Petrous bone 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