How to understand/memorize CVA and Brainstem Syndromes!

[soontobePAstudent]

Hi everyone,

I'm not sure if this is the right platform  to post this topic but I have a tough time understanding CVAs and its syndromes. I know it's not about memorizing those symptoms and syndromes but about understanding them which will make it easier to memorize. But my problem is the understanding part hasnt clicked yet and I've been studying for almost two days  and ended up in frustration.

I am kinda understanding the group of symptoms when the ICA, ACA (legs) MCA (face, arms, hands), PCA (vision), are involved. But it gets tricky for me when the brainstem is involved.

I think I know that if there is a brainstem lesion, CN function on the face will be ipsilateral deficit whereas everything distant to the medulla (arms, legs, torso) will be contralateral weakness/sensory loss.

So how come when you have an AICA syndrome: you get

1) ipsilateral cerebellar ataxia, loss of pain and temp sensation, impaired taste, central horners, deafness, peripheral facial palsy, and loss of pain and touch sensation of contralateral limbs? (those symptoms do not make sense to me at all, they are just an accumulation of words without any connection right now)

Same with PICA syndrome: why would you get

2) loss of pain and temp ipsilateral face and contra lateral body, cerebellar ataxia of ipsilateral limbs. , central horner's syndrome, ipsilateral cords etc

Any resources/videos/articles that could be helpful? I've been reading harrison's but they dont go into detail on why we get those symptoms. I dont think I am at that point yet where I know the basic fundamental knowledge on how to tackle those syndromes.

[Hckyplyr]

 This will be the best book for you. The reason why you're not understanding why things are happening is you have to know/understand all the anatomy first, then know all the various nuclei, their locations and at the VERY LEAST, the major tracts. There are multiple CN's that use multiple nuclei, that have different neuron associations. For example. Facial Nerve is (SVE), Uses spinal trigeminal nucleus (GSE, general somatic efferent), superior salivatory nuclei (GVE), Solitary nuclei (GVA, SVA). Then knowing the spinal trigeminal nucleus modality is pain, temp and crude touch, sensory receptors in the skin. It has three different cell bodies, the trigeminal ganglion, spinal trigeminal nucleus (axons cross midline and ascend in the ventral trigeminothalamic tract, and also the VPM thalamus (axons ascend in the posterior limb and of the internal capsule to reach the somatosensory cortox). 

  I'm going to stop because it may just be confusing you more. Its really impossible to understand your questions on a fundamental level, without first knowing the relevant anatomy and tracts. This book I recommend is long, but if you truly have the desire, it will answer all of your questions. Although for PA school, its WAY overkill TBH. I'll sell you mine if you want, I'd be glad for you to take it off my hands.