MRCP PACES Brainstem Syndromes Pontine Syndromes
  • Raymond’s syndrome
    • Ipsilateral sixth nerve palsy
    • Contralateral hemiparesis (corticospinal tract which decussates in medulla)
  • Millar-Gubler’s syndrome
    • Ipsilateral abducens nerve palsy
    • Ipsilateral facial nerve palsy with loss of corneal reflex
    • Contralateral hemiparesis
    • ± contralateral loss of vibration / proprioception
  • Lateral pontine syndrome (anterior inferior cerebellar artery)
    • Ipsilateral loss of pain and temperature from face (sensory trigeminal)
    • Loss of ipsilateral corneal reflex (sensory trigeminal)
    • Contralateral loss of pain and temperature from limbs (spinothalamic tract)
    • Ipsilateral lower motor neuron facial weakness (course of nerve)
    • Ipsilateral sensorineural hearing loss (vestibulocochlear nerve)
    • Ipsilateral Horner’s syndrome (descending sympathetic pathway)
  • One-and-a-half syndrome
    • Conjugate horizontal gaze palsy in one direction (involvement of ipsilateral abducens)
    • Internuclear ophthalmoplegia in the other eye
  • Bilateral lesion (locked-in syndrome)
    • Quadriplegia
    • Aphonia
    • Bilateral facial and abducens nerve palsy
    • Spares oculomotor and trochlear nerves (lesion below midbrain)
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