The Neuroanatomy of a Stroke: Stroke Syndromes and Location Identification

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► THIS VIDEO will help medical students preparing for the USMLE master the complex topic of stroke localization within the brainstem, focusing on high-yield information that’s essential for both your exams and clinical practice. 🧠 We will guide you through the anatomy and function of the three main sections of the brainstem—midbrain, pons, and medulla—and explain how different stroke syndromes manifest depending on the location of the pathology. With this knowledge, you'll be better equipped to understand and interpret the neurological deficits caused by strokes in these critical areas.

We begin by exploring the midbrain, where you’ll learn about the structures housed there, including cranial nerves III and IV, and the cerebral peduncles. You'll understand how a stroke in this area can affect vertical eye movement, motor strength, and sensory pathways. We’ll explain important stroke syndromes, like medial midbrain strokes, which lead to cranial nerve III palsy and contralateral motor weakness, and lateral midbrain strokes, which involve sensory loss and hemisensory deficits. You'll learn how to connect these clinical findings to their underlying anatomical structures, a crucial skill for localizing brainstem lesions during your USMLE.

Next, we’ll dive into the pons, discussing its vital role in controlling horizontal eye movements, facial sensation, and motor control through the corticospinal tract. You’ll learn about the major stroke syndromes affecting the pons, including medial pontine strokes, which lead to contralateral hemiparesis, and lateral pontine strokes, which involve cranial nerve V deficits, resulting in sensory loss on one side of the face. We also cover the significance of the medial longitudinal fasciculus (MLF) and how lesions in this structure cause internuclear ophthalmoplegia (INO), a classic finding in pontine strokes. Understanding these syndromes will prepare you to answer high-yield USMLE questions related to crossed findings, which are characteristic of brainstem strokes.

Finally, we explore the medulla, home to cranial nerves IX, X, XI, and XII, and discuss how strokes in this region can affect autonomic functions, such as heart rate, blood pressure, and swallowing. You’ll learn how medullary strokes present with a combination of motor and sensory losses, such as contralateral motor weakness and ipsilateral cranial nerve deficits, due to the decussation of the corticospinal tract. We'll review key syndromes, like lateral medullary (Wallenberg) syndrome, characterized by dysphagia, vertigo, and loss of pain and temperature sensation. Knowing how to localize strokes in the medulla is essential for recognizing life-threatening conditions in clinical settings and is frequently tested on the USMLE.

► CHAPTERS
00:00 Brainstem Stroke Localization
00:22 Midbrain Stroke Syndromes
03:25 Pontine Stroke Syndromes
06:33 Medullary Stroke Syndromes
09:09 Cross-sectional Stroke Syndromes

► THE PROF:
Roy Strowd is the Assistant Dean of Undergraduate Medical Education at the Wake Forest Baptist Medical Center, where he co-directs the Neurofibromatosis and Tuberous Sclerosis Clinics. He is a researcher for the Adult Brain Tumor Consortium (ABTC) and Alliance for Clinical Trials in Neuro-Oncology.

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