Brainstem
Brainstem
CHAPTER OBJECTIVES
To review the anatomy of the brainstem
To develop a three-dimensional picture of the interior of the brainstem
To know the positions of several of the cranial nerve nuclei, the olivary nuclear complex, and the paths
A fifty-eight-year-old woman is referred to a neurologist because of recent onset of difficulty with walking. The neurologist notes that she stands and walks with her left arm flexed at the elbow and the left leg extended (left hemiparesis). While walking, she has difficulty flexing the left hip and knee and dorsiflexing the ankle; the forward motion is possible by swinging the left leg outward at the hip to avoid dragging the foot on the ground. Her left arm remains motionless.
Neurologic examination shows no signs of facial paralysis, but tongue weakness is evident. On protrusion, the tongue deviates toward the right side (right hypoglossal nerve palsy). Cutaneous sensations are found to be normal, but muscle joint sense, tactile discrimination, and vibratory sense on the left side of the body are impaired.
Based on the neurologic findings, a diagnosis of right-sided medial medullary syndrome is made. The medial part
SKULL ANATOMY
SKULL ANATOMY
Head injuries from blunt trauma and penetrating missiles are associated with a high mortality and disabling morbidity. Because of the close relationship that exists between the skull and the underlying brain and cranial nerves, as well as their common involvement in many diseases, a brief review of the anatomy of the skull will first be considered.