Benedict syndrome (BS) is caused by a stroke in the midbrain and usually presents as an ipsilateral oculomotor nerve palsy with contralateral hemi-tremor. Most common symptoms in BS are impaired eye movements affecting only one eye, hemichorea, slow one-sided tremor in the limbs, contralateral ataxia, dilated unresponsive pupils, ptosis, diplopia, hyperactive tendon reflexes, adiadokokinesis, contralateral hyperaesthesia and contralateral hemiparesis [1] [2] [3]. BS manifests with symptoms reminiscent of Weber's syndrome (WS) and Claude's syndrome (CS). BS is more often associated with hemiataxia, i.e. incoordination of movements, while WS more often presents with paralysis symptoms. An identifying symptom for BS in comparison to CS is contralateral hemiparesis, which never occurs in CS. Patients with BS have a rhythmic tremor of the contralateral hand and foot, which intensifies as a consequence of emotional excitement and during voluntary movements. Tremor is always absent during sleep in BS patients [4] [5].

BS is caused by a lesion, i.e. an infarction, hemorrhage or a tumor in the tegmentum of the midbrain and cerebellum. Infarctions of the posterior cerebral artery are suspected to be conducive to BS in most reported cases. Tuberculosis can also cause BS. Disruptions in the third cranial nerve, the red nucleus, the corticospinal tracts, the brachium conjunctivum, and the superior cerebellar peduncle decussation are normally associated with BS manifestations [1].

Motor anomalies in BS patients include a loss in arm swing on the affected side while the patient walks, a permanently semi-flexed arm and uncoordinated walking steps. These steps are characterized by swinging legs and a quick foot drop [4].

Cognitive functions remain unaffected in BS patients [1] [6].

• Pain

  […] and temperature loss Remember: Vocal PATHetic HOG with Vertigo (vocal cord, pain and temp, analgesia, taste, Horner’s, hoarseness, oscillopsia (sensation of things moving back and forth in horizontal plane), gag, vertigo) Avellis syndrome: (tegmentum [prod.wiki.cns.org]

  الصفحة 415 - AD (2000) Cytoarchitectonic and immunohistochemical characterization of a specific pain and temperature relay, the posterior portion of the ventral medial nucleus, in the human thalamus. [books.google.com]

  These are your clinical examination findings: left-sided limb ataxia. left-sided alteration of pain and temperature on the face. left-sided ipsilateral Homer’s syndrome. right-sided alteration of pain and temperature affecting the arm and leg. dysarthria [lessons4medicos.blogspot.com]

  Pain and temperature sensation from the face and body was normal bilaterally. Proprioception and vibratory sense on the right side of the body was normal but was diminished on the left. [lksom.temple.edu]

  SPINOTHALAMIC TRACTS LESIONS RESULT IN CONTRALATERAL LOSS OF PAIN AND TEMPERATURE SENSATION FROM THE TRUNK AND EXTREMITIES. 7. [slideshare.net]

• Weakness

  Unilateral limb weakness, gait ataxia, limb ataxia, nystagmus and dysarthria are the examination findings. Dysphagia due to pharyngeal weakness, nausea, vomiting, and Horner’s syndrome may resulted in the proximal PC territory Infarcts. [explainmedicine.com]

  Scenario 1 You are examining a patient with sudden onset left-sided weakness. [lessons4medicos.blogspot.com]

  CbT. contralateral weakness of lower face (VII), tongue (XII), palate (CNX), uvula and pahrygeal wall pulled towards normal side (X) Acoustic Neuroma - SCHWANNOMA - benign tumour of schwann cells affecting CNVIII - in posterior fossa inside the IAM - [cram.com]

  Levator palpebrae weakness reduces the MRD1 but will not affect the MRD2. [emedicine.medscape.com]

• Falling

  […] consists of irregularities in the rhythm, rate, and amplitude of voluntary movements => voluntary movements become jerky and erratic – cerebellar gait disturbances involve disturbances in stance and gait => see the gait disorders, drop attacks and frequent falls [lifeinthefastlane.com]

  Zelyonaya Kareta (The Green Coach, 2015): Oleg Asadulin's drama focuses on a successful film director whose life suddenly falls apart. Pyat Zvyozd-Novokuznetskaya Thurs. to Wed. at 5:15 p.m. [themoscowtimes.com]

  Wallenberg syndrome consists of a constellation of signs and symptoms including ipsilateral limb and gait ataxia with a tendency to fall to the ipsilateral side (body lateropulsion) due to involvement of the restiform body and inferior surface of the [neupsykey.com]

• Heart Disease

  الصفحة 1248 - Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: The Scandinavian Simvastatin Survival Study (4S). ‏ الصفحة 1246 - CAPRIE Steering Committee. [books.google.com]

  Other factors that make vascular disease more likely include Family history of vascular or heart diseases Pregnancy Illness or injury Long periods of sitting or standing still Any condition that affects the heart and blood vessels, such as diabetes or [icdlist.com]

  Coronary and other heart disease. Diabetes mellitus. Drug abuse. [ 4, 5 ] Family history of stroke. Giant cell arteritis. [ 6 ] Obesity and physical inactivity. [ 7 ] Previous stroke. Race. [patient.info]

  heart disease, prosthetic heart valves, congenital heart disease, cardiac tumors, and infective and non-bacterial thrombotic (marantic) endocarditis. [neupsykey.com]

• Erythema

  No joint effusion, erythema, or edema was noted. [acphospitalist.org]

• Tinnitus

  […] cerebral peduncle and hemisphere main sensory nucleus and descending tract Impaired muscles of mastication Lateral Inferior Pontine Syndrome Signs Horizontal and vertical nystagmus Facial Paralysis Paralysis conjugate gaze to side of lesion Deafness Tinnitus [quizlet.com]

  Tinnitus (ringing) is a specified complaint. Most people with the Wallenberg syndrome recover better than people who have had a different type of stroke. [braininjury-explanation.com]

  […] inferior cerebellar artery occlusion – exceedingly rare – 4 distinct clinical pictures Classic AICA syndrome – often mistaken for a lateral medullary syndrome; however, certain signs are unusual in lateral medullary syndrome (facial palsy, deafness, tinnitus [lifeinthefastlane.com]

  Scenario 4 You are examining a patient with right-sided deafness, that was preceded by tinnitus. [lessons4medicos.blogspot.com]

  Damage results in tinnitus and unilateral nerve deafness. B. The vestibular nerve of CN VIII. Damage results in vertigo, nystagmus, nausea, vomiting, and unsteadiness of gait. C. The facial nerve (CN VII). [vertigoexercises.us]

• Strabismus

  With the eyelids retracted the right eye had a dilated pupil and a lateral strabismus. On attempted lateral gaze to the left the right eye would not proceed across the midline. [lksom.temple.edu]

  LR; medial strabismus, horizontal diplopia Dorsal Midbrain (Parinaud's Syndrome) Causes; pinealoma or germinoma 1. Superior colliculus and pretectal area. Paralysis of upward & downward gaze, pupillary disturbances & absence of convergence 2. [cram.com]

  Defisit occulomotorius termasuk ptosis, strabismus divergen, dan dilatasi pupil. Red nucleus berkoordinasi dari jaras cerebelar thalamic ke cereberel pedunkel superior (brachium conjunctivum). [docshare.tips]

  • Lesions of the internal genu of the facial nerve cause: -Ipsilateral facial paralysis -Ipsilateral loss of the corneal reflex • Lesions of the abducent nucleus cause: -Lateral rectus paralysis -Medial (convergent) strabismus -Horizontal diplopia 20 [slideshare.net]

• Anisocoria

  The anisocoria remains the same in dim and bright light in simple central anisocoria, also called physiological anisocoria. [emedicine.medscape.com]

• Chemosis

  Orbital portion Orbital signs are usually matters for direct inspection, including conjunctival injection and chemosis, proptosis, and lid swelling. [emedicine.medscape.com]

• Scotoma

  […] frontal lobe with symptoms of ipsilateral optic atrophy, ipsilateral anosmia, and contralateral papilledema Devic’s syndrome – optic neuritis and myelitis Leber’s optic atrophy – caused by mitochondrial DNA mutation and usually causes a centrocecal scotoma [prod.wiki.cns.org]

• Tremor

  “rubral tremor (The blue fibers being the sup. [medicowesome.com]

  Patients with BS have a rhythmic tremor of the contralateral hand and foot, which intensifies as a consequence of emotional excitement and during voluntary movements. Tremor is always absent during sleep in BS patients. [symptoma.com]

  Benedikt syndrome - hemiplegia with clonic spasm or tremor and oculomotor paralysis on the opposite side. Medical Eponyms © Farlex 2012 [medical-dictionary.thefreedictionary.com]

  Lesi di red nucleus menghasilkan deficit dalam berkoordinasi kontralateral (ataxia), dysmetria, dysdiadokokinesis, rubral tremor ( resting tremor kasar yang meningkat apabila bergerak), dan pseudoparkinson tremor. [docshare.tips]

  He described three similar cases involving oculomotor palsy, contralateral hemiparesis, and contralateral tremors. [pubmed.ncbi.nlm.nih.gov]

• Stroke

  Benedict syndrome (BS), also termed paramedian midbrain syndrome, is a rare stroke manifestation involving a lesion of the tegmentum of the midbrain. [symptoma.com]

  Epidemiology A relatively uncommon form of stroke. [patient.info]

  Causes of brainstem stroke -- the basics Strokes may be ischemic (lack of blood flow), or hemorrhagic (leakage of blood into the brain). Risk factors for stroke are considered here. Ischemic strokes are caused by blockage of blood vessels. [dizziness-and-balance.com]

  References Related articles: Stroke and intracranial haemorrhage Promoted articles (advertising) [radiopaedia.org]

• Nystagmus

  i.e nystagmus, n/v & vertigo 2. Inferior cerebellar peduncle. Ipsilateral cerebellar signs (e.g dystaxia, dysmetria, dysdiadochokinesia) 3. NA. ipislateral... 4. IX nerve roots 5. Vagal Nerve roots 6. SptT contralateral 7. Sp V n & T. [cram.com]

  […] or intra-axial midline brainstem lesions) – other more bizzare forms of nystagmus can also be seen eg. periodic alternating nystagmus, pendular nystagmus, divergent nystagmus, pure torsional nystagmus on vertical gaze (* see the nystagmus guidemap for [lifeinthefastlane.com]

  In the author's experience, these patients often exhibit rebound nystagmus, which is a variant of gaze-evoked nystagmus. Some of these patients have upbeating nystagmus supine, often confused with BPPV. [dizziness-and-balance.com]

  Gaze Palsey Paramedian Midbrain Syndrome: Similar to Weber Syndrome except hemiparesis instead of hemiplegia Midbrain: (Ipsalateral) CN III Palsey (Contralateral) Ataxia and vertical gaze palsey Midbrain: Paralysis of Upgaze, Convergance Retraction Nystagmus [quizlet.com]

  Brain stem lesions are also found in Wallenberg's syndrome (1895, Horner's syndrome, absent corneal reflex, lateropulsion of saccadic eye movements, nystagmus, ataxia, dysphagia, hoarseness, sensory loss over the facial region, contralateral dissociated [ncbi.nlm.nih.gov]

• Hemianesthesia

  Jackson Syndrome Cranial Nerves Paralysis of soft palate, vocal cord, contralateral hemianesthesia and ipsilateral tongue paralysis Lateral Tegmentum of Medulla Wallenberg Syndrome Cranial Nerves Spinal Tract V, IX, X, XI Wallenberg Syndrome Tracts Lateral [quizlet.com]

  Ipsilateral (facial hemianesthesia) 8. Descending sympathetic tract. Ipsilateral horners Medial Inferior Pontine Syndrome - occlusion of paramediam branches of the basilar a. 1. CsT contralateral 2. ML contalateral 3. [cram.com]

  Benedikt syndrome is similar to Weber syndrome, but the necrosis involves the medial lemniscus and red nucleus, producing contralateral hemianesthesia and involuntary movements of the limbs of the opposite side. [healthy--mind.blogspot.com]

  […] cord, pain and temp, analgesia, taste, Horner’s, hoarseness, oscillopsia (sensation of things moving back and forth in horizontal plane), gag, vertigo) Avellis syndrome: (tegmentum of the medulla) paralysis of soft palate and vocal cord + contralateral hemianesthesia [prod.wiki.cns.org]

  SPINAL TRIGEMINAL NUCLEUS AND TRACT • LESIONS RESULT IN IPSILATERAL LOSS OF PAIN AND TEMPERATURE SENSATION FROM THE FACE FACIAL HEMIANESTHESIA). 8. DESCENDING SYMPATHETIC TRACT. [slideshare.net]

• Fixed Pupils

  […] gaze and cerebellar ataxia Nothnagel syndrome Causes Parinaud Syndrome Cranial Nerves Involved Parinaud Syndrome Tracts Involved Supranuclear mechanism for forward upward gaze and periaquaductal gray matter Paralysis of upward gaze and accommodation, fixed [quizlet.com]

  […] corticospinal tract, brachium conjunctivum Oculomotor palsy, Vascular, contralateral tuberculoma, cerebellar ataxia, tumor corticospinal signs Superior Unilateral or cerebellar bilateral III peduncles Paralysis of upward gaze and accommodation, Pinealoma, fixed [docshare.tips]

  In more than 95% of aneurysmal palsies, the pupil reacts sluggishly to light or is fixed and dilated, but, in 73%, of ischemic palsies, the pupil is spared. [emedicine.medscape.com]

  Ocular palsies, paralysis of gaze, cerebellar ataxia Tumor Parinaud Dorsal Midbrain Paralysis of upward gaze and accommodation, fixed pupils, retraction nystagmus Pinealoma, hydrocephalus Wernekinck Decussation of superior cerebellar peduncle. [dizziness-and-balance.com]

Diagnosis of BS relies on a confirming the patient's stroke risk factors, on clinical investigations and on brain imaging studies. In selected cases with a possible connection to a tuberculosis infection, an analysis of cerebrospinal fluid is also necessary [1].

A patient history featuring a smoking habit, pronounced hypertension, prolonged untreated diabetes, hypercholesterolemia and a familial predisposition for stroke-related disorders are crucial parameters for the diagnosis [7][8].

Clinical examination should focus on obvious BS symptoms like ptosis, eye deviations, pupillary anomalies, contralateral hemiparesis, lack of voluntary motor coordination and tremors. Eye deviations occur because of an injury to the oculomotor nerve and force the eyes outward or downward [1].

Magnetic resonance imaging (MRI) and computer tomography (CT) scans are the final step in the workup since these methods provide the best chance to exclude other ailments with similar symptoms, e.g. cavernous sinus thrombosis. Both methods can detect disruptions in the above-mentioned midbrain areas [1] [9].

Deep brain stimulation may provide a valuable treatment option for the BS associated intention tremor [10].

[…] were more likely to receive treatment than the poor ... that prevented equal access to HIV/AIDs treatment ... [liquisearch.com]

[…] in long-term outcomes for both of these treatments. [patient.info]

/ Management Owing to the varied etiology of this syndrome, treatment is dependent on the underlying pathology. [statpearls.com]

“Deep brain stimulation as an effective treatment option for post-midbrain infarction-related tremor as it presents with Benedikt syndrome”. Journal of Neurosurgery. 109 (4): 635–639. doi : 10.3171/JNS/2008/109/10/0635. PMID 18826349. [checkrare.com]

Sections Continuing Education Activity Introduction Etiology Epidemiology Pathophysiology History and Physical Evaluation Treatment / Management Differential Diagnosis Prognosis Complications Deterrence and Patient Education Pearls and Other Issues Enhancing [pubmed.ncbi.nlm.nih.gov]

Causes and prognosis in 4,278 cases of paralysis of the oculomotor, trochlear, and abducens cranial nerves. Am J Ophthalmol. 1992 ; 113(5) : 489 –496. [aao.org]

Underlying structures involved are thought to be the superior cerebellar peduncle and tectum of the midbrain.[22][21] Prognosis Prognosis varies widely according to the underlying etiology. [statpearls.com]

Prognosis This will depend on the extent of disease; however: Acute basilar artery occlusion has a very high mortality rate. Vertebrobasilar stroke usually leaves significant neurological deficits. [patient.info]

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]

Underlying structures involved are thought to be the superior cerebellar peduncle and tectum of the midbrain.[22][21] Prognosis Prognosis varies widely according to the underlying etiology. [statpearls.com]

In this article, we reported a case of Benedikt syndrome with an etiologic cause of cardioembolic stroke, who was diagnosed by the neurological examination and neuroradiological findings. [ingentaconnect.com]

From Jump to: navigation, search Contents 1 Etiology 2 Epidemiology 3 Pathology 4 Clinical-manifestations 5 Management 6 More General Terms 7 References Etiology ischemic stoke hemorrhagic stroke brain tumor tuberculosis Epidemiology rare Pathology stroke [anvita.info]

Sections Continuing Education Activity Introduction Etiology Epidemiology Pathophysiology History and Physical Evaluation Treatment / Management Differential Diagnosis Prognosis Complications Deterrence and Patient Education Pearls and Other Issues Enhancing [pubmed.ncbi.nlm.nih.gov]

Due to the extremely low frequency of reported cases, there remain no epidemiological studies outlying the frequency of this condition. [statpearls.com]

Epidemiology A relatively uncommon form of stroke. [patient.info]

[…] signification worked out study than one exclusively devoted to a of imaging and magnetic resonance imaging, which limited number of scientific papers. will perhaps allow us to detect ischemic edema in the After a brief clinical and pathophysiological [books.google.com]

Medicine, Biology Cerebellum 2022 The internist Hermann Nothnagel (1841-1905) took a special interest in the cerebellum and demonstrated the involvement of the vermis in the pathophysiology of motor ataxia, culminating in the Cerebellar Classic highlighted [semanticscholar.org]

Sections Continuing Education Activity Introduction Etiology Epidemiology Pathophysiology History and Physical Evaluation Treatment / Management Differential Diagnosis Prognosis Complications Deterrence and Patient Education Pearls and Other Issues Enhancing [pubmed.ncbi.nlm.nih.gov]

This is probably because the pathophysiology of the third cranial nerve lesion involves leakage of blood from the aneurysm dome into the nerve across its outer margin. [emedicine.medscape.com]

الصفحة 1607 - Centers for Disease Control and Prevention: 1994 Revised Classification System for Human Immunodeficiency Virus Infection in Children Less Than 13 Years of Age, MMWR, 43, 1-19, No. ‏ [books.google.com]

Lowering of insulin levels Restoration of fertility Treatment of hirsutism or acne Restoration of regular menstruation, and prevention of endometrial hyperplasia and endometrial cancer In each of these ... the major reasons for this is the lack of large [liquisearch.com]

Even with vertebral artery occlusion, collaterals (circle of Willis) may prevent ischaemia. [patient.info]

In this article, the authors present in depth the clinical correlates of midbrain and thalamic ischemic lesions, while also summarizing the advances in treatment and prevention of ischemic lesions involving the different vascular territories of the thalamus [medlink.com]

Doctors should advise their patients to engage with healthy lifestyles to prevent cerebrovascular accidents.[18] Pearls and Other Issues Damage from any etiology to the red nucleus, oculomotor fascicles, cerebral peduncle, and substantia nigra causes [statpearls.com]

1. Ruchalski K, Hathout GM. A Medley of Midbrain Maladies: A Brief Review of Midbrain Anatomy and Syndromology for Radiologists. Radiol Res Pract. 2012;258524.
2. Khan AO. Pupil-sparing complete third nerve palsy from cryptogenic midbrain stroke in an otherwise healthy young adult with patent foramen ovale. 2012; 19(2): 237–239.
3. Cormier PJ, Long ER, Russell EJ. MR imaging of posterior fossa infarctions: vascular territories and clinical correlates. Radiographics. 1992; 12(6):1079-1096.
4. Fujieda T, Yamauchi T, Takahasi S, Moroji T. Letter: Effect of levodopa on tremor in Benedikt's syndrome. Br Med J. 1974; 1(5905):456-457.
5. Afifi AK, Bergman RA. Functional Neuroanatomy: Text and Atlas. New York, NY: McGraw-Hill Companies, Health Professions Division; 1998.
6. Hebb ALO, Brandman D, Shankar JAI, Hebb AO. Visualizing Recovery of Cognitive Function in Stroke. Journal of Behavioral and Brain Science. 2013; 3: 641-652.
7. Spence JD. Intensive risk factor control in stroke prevention. F1000Prime Rep. 2013; 5:42.
8. Nicol MB, Thrift AG. Knowledge of Risk Factors and Warning Signs of Stroke. Vasc Health Risk Manag. 2005; 1(2): 137–147.
9. Nouh A, Remke J, Ruland S. Ischemic Posterior Circulation Stroke: A Review of Anatomy, Clinical Presentations, Diagnosis, and Current Management. Front Neurol. 2014; 5:30.
10. Bandt SK, Anderson D, Biller J. Deep brain stimulation as an effective treatment option for post-midbrain infarction-related tremor as it presents with Benedikt syndrome. J Neurosurg. 2008; 109(4):635-639.