Eponymous Brainstem strokes

Learning objectives

Introduction

The brainstem is vulnerable to both ischaemic and haemorrhagic strokes. Out come is very variable depending if strokes are unilateral or bilateral. What is important to note is that despite the narrow brainstem the arterial supply is usually from the vertebral or basilar arteries and lesions tend to respect and not cross the midline. It is however possible for a very diseased basilar and especially a top of the basilar syndrome to cause multiple bilateral and asymmetrical strokes. Brainstem stroke is not a term to be used only in its most general sense. Cranial nerves and other signs should help one to localise to midbrain, pons and medulla and MRI will support this and the specificity of the location - ventral or dorsal pons etc. Upper or lower midbrain, medial or lateral medulla. In the 19th century when stroke location and clinical appearance could only be precisely diagnosed by post mortem french neuroanatomists described and named a collection of brainstem strokes and their clinical signs. These are often used in texts. However the eponymous terms are not important if the understand how the anatomy and clinical correlate.