Authors: Flaherty, Alice W.; Rost, Natalia S.
Title: Massachusetts General Hospital Handbook of Neurology, The, 2nd Edition
Copyright 2007 Lippincott Williams & Wilkins
> Table of Contents > Adult Neurology > Brainstem Anatomy
Brainstem Anatomy
A. See also
Figure 6, Cranial nerve nuclei, p. 34.
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Figure 3. The ventral surface of the brainstem. (From Duus P. Topical Diagnosis in Neurology. New York: Thieme, 1983:101, with permission.) |
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B. Slice anatomy
For easier comparison with MRIs, the five images in Figure 4 are in radiologic convention, as if looking up from the feet, upside down and backwards from neuropathologic convention. In order, they show the upper medulla, lower pons, midpons, upper pons, and midbrain.
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Figure 4. Brainstem cross-sections drawn in radiologic convention. (From Schwamm L. In Batjer HH, ed. Cerebrovascular Disease. Philadelphia: Lippincott, 1996, with permission.) Continued on next page. |
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Table 3. CSF findings by disease. |
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| Condition | OP(cm H2O) | Color | Cells/mm3 | Protein (mg%) | Glucose (CSF serum) | Miscellaneous | | Normal adult | 6-20 | Clear | 0 PMN,0 RBC, <5 mono | 15-45 | 0.5 | Lymph/PMN ratio = 100/0 | | Normal child | 6-20 | Clear | <5 WBCs | 5-40 | ~0.5 | | | Normal term | 8-10 | Clear | <8 WBCs | 90 | ~0.5 | Lymph/PMN = 40/60 | | Normal preemie | | Clear | <9 WBCs | 115 | ~0.5 | Lymph/PMN = 40/60 | | Acute bacterial meningitis | ~Up | Turbid | >100 WBCs, mostly PMNs | 100-1,000 | <0.2 | Do rapid antigen tests | | Viral meningoen-cephalitis | nl | Clear | 10-350 WBCs, mostly monos | 40-100 | nl | PMNs early | | Toxopla-smosis | ~Up | Clear | nl or up | Usually high | ~Up | CSF often nl | | Tuberculous meningitis | ~Up | Pearly, clumps | 50-500 lymphs and monos | 60-700 | 0.2-0.4 | Do AFB culture and stain | | Fungal meningitis | ~Up | Pearly monos (PMNs early) | 30-300 | 100-700 | <0.3 | Do India ink prep for crypto | | HSV encephalitis | ~Up | Pink | High monos and RBCs | High (nl early) | ~Down | WBCs nl in 3%; PCR for antigen | | Parameningeal infection | Up if block | Clear | 0-800 WBCs | High | nl | E.g., epidural abscess | | Neurosyphilis | nl | Clear | 0-300 | High (nl late) | nl | Oligoclonal band, antitreponema Ab | | Leptome-ningeal metastasis | ~Up | ~Clear | 0-500 | nl or up | ~Down | Cytology shows tumor in 50% | | Multiple sclerosis | nl | Clear | 5-50 monos | nl-800 | nl | Oligoclonal bands | | Guillain-Barr syndrome | nl | Clear | nl to 100 monos | 50-1,000 | nl | Protein nl early | | Bloody tap (traumatic) | nl | Pink yellow | RBC/WBC ratio like blood | Slightly up | nl | Less blood in following tubes | | Subarachnoid hemorrhage | Up | Pink yellow | RBC/WBC < blood (nl early) | 50-800 | nl | RBCs last 2 wks; xantho longer | | Pseudotumor cerebri | 25-50 | Clear | nl | nl | nl | Do large-volume therapeutic tap | |
