Upper dorsal pontine syndrome (Raymond Cestan syndrome)

What is the upper dorsal pontine syndrome? 

The upper dorsal pontine syndrome is caused by obstruction of the long circumferential branches of the basilar artery and results in:

  • Ipsilateral ataxia and coarse intention tremor (damage to the superior and middle cerebellar peduncles)
  • Ipsilateral paralysis of muscles of mastication and sensory loss in face (damage to sensory and motor nuclei and tracts of V)
  • Contralateral loss of all sensory modalities in the body (damage to medial lemniscus and spinothalamic tract)
  • Contralateral hemiparesis of the face and body (damage to corticospinal tract) may occur with ventral extension of the lesion
  • Horizontal gaze palsy may occur, as in the lower dorsal pontine syndrome

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