Brainstem strokes!

[Hrant Kuchuryan]

Is it safe to think that ALL of the brainstem strokes would result in contralateral tract and ipsilateral CN knock-offs? or are there any exceptions? Also do PICA and AICA strokes ALWAYS result in ipsilateral ataxia, and in the case of the medial midbrain stroke, contralateral parkinsonism?

[Chrissy Durrough Lugge]

Hi Hrant! Of course, in real life, things are rarely ALWAYS or NEVER true. But, in general, brainstem strokes will result in ipsilateral cranial nerve and contralateral long tract signs. Some motor tracts are ipsilateral and would therefore result in impairments ipsilateral to the lesion.

Similarly, PICA and AICA strokes can result in ipsilateral ataxia and medial midbrain strokes can result in contralateral parkinsonism (usually bradykinesia and rigidity more than tremor), but these strokes are usually messy and present with some constellation of the possible clinical presentations.

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