Cross-sections of the brainstem. A. Rostral midbrain, B. caudal midbrain, C. Pons, D. Rostral medulla, E. Caudal medulla. A= nucleus ambiguus, ML= medial lemniscus, S= nucleus solitarius, SC= Spinothalamic tract, numbers 3-12 refer to cranial nerves. (From Stephen Goldberg’s wondrous book ‘Clinical neuroanatomy made ridiculously simple’)
Signs seen in lateral brainstem syndromes (from Gates, 2005). Note trapezius weakness is rarely seen in lateral medullary lesions.
- Gates P. The rule of 4 of the brainstem: a simplified method for understanding brainstem anatomy and brainstem vascular syndromes for the non-neurologist. Internal Medicine Journal 2005; 35: 263-266 [PMID 15836511]
- Goldberg S. Clinical Neuroanatomy Made Ridiculously Simple. MedMaster Series, 2000 Edition.
- Patten J. Neurological Differential Diagnosis. Springer-Verlag.
- Brainstem Rules of 4 (original rules)
- Helpful Brainstem Figures (original figures)
- The rule of 4 of the brainstem (Rules re-imagined)
- A spider called Willis
- Using the Brainstem 1
- Using the Brainstem 2
- The Magic of the Neuro Exam
- Look Left, Look Right (Internuclear Ophthalmoplegia)
- More Befuddling Pupillary Asymmetry (Horner Syndrome)