Cerebellum co-help disorder, lesions but not in the cerebellum? So the positioning diagnosis is clear.

Today, we're going to learn about a patient with a bi-sided comorbidities and peripheral muscle palsy, but the lesions are not in the cerebellumpatient male, 68 years old, was admitted to hospital for "re-vision, walking unstable 8h"Before the self-complaining 8h no obvious trigger sudden vision blurring, visual ghost, walking unstable, need the help of othersThe limbs are clumsy and speechlessThe limbs are normaland and have no limb numbnessNo spats, no water coughing, swallowing difficultieshad a history of hypertension for more than 10 years, oral benzoic acid chlorephe (5 mg/day), did not monitor blood pressureThe history of smoking has been more than 50 years, with an average of 20 cigarettes/daycheck: clear-minded, speech less fluent, cognitive normalDouble pupil seamounts and other large equal circles, sensitive to light reflectionWhen staring to the right, the left eye is blocked, and the right eye is accompanied by a rotating eye shock when the right eye is outstretchedThe texture is not clear, the remaining cranial nerve is negativeThe two-sided limb pain tactile symmetry exists, deep feel normalLimb muscle strength 5, muscle tension is moderateWide-base gait, two-sided finger-nosis test, rotation test, and knee-tib test positivePhysiological reflexes exist, pathological reflexes are not emitted, and neckises are soft admitted to the hospital with no abnormal signs of CT patients have two core clinical manifestations: two-sided comorbidities and out-of-the-eye muscle paralysis Location Diagnostics: the patient was characterized by two-sided torso and limb-like co-harm and sound disorder No deep sensory disorder, no frontal lobe damage other manifestations, no dizziness and accompanied by nausea, vomiting and other autonomic nerve symptoms Therefore, it conforms to the bilateral cerebellum Patients to the right when staring in the left eye internal barrier, right eye outreach with rotary eye shock, spoke seamount reflection is normal, positioned in the left front intercore ophthalmeosis - inner vertical beam damage qualitative diagnosis: patients elderly male, acute onset, sudden symptoms, the emergence of double-sided cerebellum disorder and left pre-nuclear interstitastic palsy There have been risk factors for high blood pressure and smoking There were no high-density signs of ct in the hospital, considering ischemic stroke-brain infarction possible the second day of admission to improve the cranial brain MRI show: (cross-section) in the brain see a little lower signal T1WI, T2WI and other signals, DWI high signal, (crown bit) FLAIR high signal MRA show: the base artery walks The arteries in the right brain and the latter arteries in the brain on both sides of the brain see multiple segmented stenosis Diagnosed with cerebral infarction, aspirin antiplatelet, atoflavatin to stabilize plaques, Ida la pedire sepsis and other treatments After 10d, the patient's eye shock disappeared, can assist walking, still re-vision and left eye inthe collection disorder The syllable synopsis suggests that the lesions are located at the lower end of the middle brain, near the brain bridge common centre-brain infarctions are central cerebral infarction, Parinaud, Benedict, Claude Weber syndrome, and this type of cerebral infarction is very rare - Wernekekink conjoined syndrome I, the concept of Wernekink-linked syndrome Wernekink connected The nerve fibers emitted by the cerebellum toothed nucleus pass through the upper part of the cerebellum, and in front of the middle brain guide water pipe the lower part of the central part of the brain crosses to the opposite red core, which is called Wernekink conjoined Mid-brain hypothalamus (lower part of the middle brain) 1 Cortical spinal cord beam 2 Inner thoracic 3 Inner vertical beam 20 Wernekek conjoined 21 black matter 22.Lower hills 23 carriage nerve core 27 nipple body 28.Beam 45 Central Small Leaf 47.
Wernekek conjure syndrome first reported by Lhermitte in 1958, Wernekek link damage after the clinical appearance of two-sided cerebellum dysfunction, accompanied by or not accompanied by eye muscle paralysis and other eye signs contrasted the patient's cranial brain MRI and anatomical diagram clearly for the clinical manifestations of Wernekink conjugation and its surrounding structure II, Wernekink conjugation syndrome cerebellum co-syllability disorder the outgoing fibers from the cerebellum passing through the upper leg of the cerebellum, crossing in the Wernekink conjoined, to the lateral red core projection to the hypothalamus (tooth-red nuclear-brain bundle) Passed from the thalamus to the cerebral cortex and the pre-motor area (courcecortical bundle) Impulses from the cerebral cortex pass through the brain bridge nucleus to the cerebellum cortex (cortical-brain bridge-cerebellum bundle), forming a loop Cerebellum co-symlocation can be divided into the following three cases: (1) from the spinal cord of the incoming sexual impulse, through the spinal cord cerebellum forearm, spinal cerebellum, wedge cerebellum bundle into the conjoined cerebellum cortex, this transmission pathway damage can appear the same side cerebellum cosyin disorder, such as enberg Wall syndrome, cerebellum infarction (2) by the cerebellum tooth-like nucleus of the outgoing fibers and after the Wernekink conjoined cross-project edges to the opposite red core, through the thoracia to the cerebral cortex, so after Wernekek ek conjoined the appearance of side-brain co-syllation disorders, such as syndrome Claude, hypocephalus (common disorder mild paraplegia syndrome) (3) Wernekink has a double-sided cerebellum disorder the front alt-core intercore palsy the inner column is an important contact path for the eye level and the same movement, the upper and upper middle brain cover the eye nerve sub-core, down to the upper end of the neck, close to the middle line, connecting the inner straight muscle core of the moving eye nerve on one side and the lateral nervous core, but also connected with the side of the brain bridge's side vision center, so as to achieve the horizontal movement of the eye, and the visual and auditory center under the optics because the patient infarction layer in the lower part of the middle brain next to the central region, the direction of the water pipe abdominal, which is located between the motor eye nerve core and the brain bridge side view center, the lesions and Wernekink joint adjacent to the inner column, so that the exocardial internuclear palsy can appear Clinical manifestations of re-vision and eye movement disorder, check the body for two-eye lesions to the side gaze, the affected side eye ball can not be internal, the side eye exorcism accompanied by eye shock, spokesre reflection normal The of the eye nerve paralysis if the lesions and the upper hill level of the middle brain, the hypothermia subcore is damaged, and the insufficiency of the motor eye nerve paralysis can occur The out-of-the-way fibers from the cerebellum toothed nucleus pass through the upper foot of the cerebellum, cross the Wernekink conjoined to the opposite red core, and the red nucleus emits the fiber sending down through the central cover to the olive core relay on the same side The lower olive nucleus then emits outgoing fibers through the lower part of the cerebellum to the opposite cerebellum cortex, which then projects onto the toothed nucleus, forming a complete Guillain-Mollaret triangle The Wernekink bond is located in the Ring Road of the Guillain-Mollaret Triangle, where it can develop myoclonus after being affected The brain mesh structure is affected
, blood supply arterial the lower part of the brain (lower part of the middle brain) 1 Cortical spinal cord beam 2 Inner clot3 Inner vertical beam 20.Wernekek conjoined 21 Black 22 Underhills 23 Carriage nerve core 27 nipple body 28 beam 45 Cerebellum hilltop 47 Central small leaf Wernekek-linked blood supply artery for the middle brain foot nest artery The foot nest pierces the last 5mm section of the base artery, the upper artery in the two sides of the cerebellum starting 7mm segment, and the p1 section of the post-artery of the two-sided brain summary Wernekink conjoined syndrome is a rare type of mid-brain infarction syndrome Its lesions are located in the middle of the middle part of the middle part of the middle of the brain in front of the central brain-guided water pipe, the typical clinical manifestations of a double-sided cerebellum co-encephalopathy, accompanied or not accompanied by extra-ocular palaeontial paralysis, palate myoclonus and drowsiness Cerebellum cohort lesions are not only located in the cerebellum, after the tooth-like nuclear relay of the outgoing fibers can also be shown as cerebellum co-free disorder Through case analysis, it plays a role in familiarizing the anatomy of the nervous system, understanding the distribution of terrier lesions and the artery of blood supply author: Shen Yaoyao Zhang Wenjun Source: of the Medical Neurology Channel