Uncal herniation

[username456789]

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As far as I can tell, the spastic paresis can be contra or ipsilat depending on how the crus cerebri are compressed/distorted. In fact, I believe nbme7 had a q where a guy fell and hit his head and had all signs of one with contrlateral hemiparesis. Just looking for confirmation here. I think we actually learned in class that ipsilateral crus distortion with contralateral symptoms was just as common.

 

[eddie13231]

The crus is above the level for the tract to cross over at the pyramid so the lesion would present contralaterlly...is this what you were thinking?

For it to be ipsilateral it would need to be below the level of the medullary pyramid.

 

[username456789]

What I meant was, the typical description in review books is basically "pushing the contralateral crus against something, resulting in ipsilateral body signs (because it decussates)"

But, just from distorting brain architecture on the side with the herniation, you can essentially cause a deficit of the ipsilateral crus (with contralateral signs) instead or in addition to the contralateral crus.

But it is classically described as, say, a left uncal herniation with left sided hemiparesis because the herniation is compressing the right crus against whatever is lateral to it due to the pressure pushing left-to-right.

 

[eddie13231]

What I meant was, the typical description in review books is basically "pushing the contralateral crus against something, resulting in ipsilateral body signs (because it decussates)"

But, just from distorting brain architecture on the side with the herniation, you can essentially cause a deficit of the ipsilateral crus (with contralateral signs) instead or in addition to the contralateral crus.

But it is classically described as, say, a left uncal herniation with left sided hemiparesis because the herniation is compressing the right crus against whatever is lateral to it due to the pressure pushing left-to-right.

Ohh I see what you are saying. Actually I never really thought into it that much. I suppose you could see both ipsi or contra depending on how the herniation in configured. I think that the non-reactive pupil-->blown pupul-->down and out on ipsilateral side is a good rule of thumb though

 

[Krazykyle]

Broski u need to get wit the times. U know this is not something u should be stressed about, it is like 1 question in the big scheme of things, not a big deal dude. Just answer like 90 perent correct and no worries.

 

[Vikingwizardguy]

Broski u need to get wit the times. U know this is not something u should be stressed about, it is like 1 question in the big scheme of things, not a big deal dude. Just answer like 90 perent correct and no worries.

best post of all time

 

[username456789]

Broski u need to get wit the times. U know this is not something u should be stressed about, it is like 1 question in the big scheme of things, not a big deal dude. Just answer like 90 perent correct and no worries.

Gnarly, bro.