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Table 7 Differential diagnosis of brainstem dysfunction

From: Brainstem dysfunction in critically ill patients

Brainstem dysfunction

Differential diagnosis

Oculomotor anomalies (III, IV, VI cranial nerves nuclei)

Cranial nerve palsy

Myopathy involving oculomotor muscles

Neuromuscular disorders: myasthenia, Lambert-Eaton syndrome and botulism

Pupillary size anomalies

Anisocoria: compressive lesion of the III cranial nerve such as herniation/intracranial hypertension and posterior communicative artery aneurysm

Mydriasis: third nerve lesion

Claude Bernard-Horner’s syndrome (ptosis, myosis, enophtalmia, anhidrosis)

Pancoast tumor

Carotid or aortic dissection

Facial sensory anomalies (V cranial nerve nucleus)

Contralateral brain injury

Cranial nerve palsy (V)

Facial motor anomalies (VII cranial nerve nucleus)

Contralateral brain injury

Cranial nerve palsy (VII)

Myopathy with facial paralysis

Neuro-muscular disorders: myasthenia, Lambert-Eaton syndrome and botulism

Posture and movement anomalies

Uni- or bilateral basal ganglia lesions

Motor and/or sensory deficit

Contralateral brain injury

Critical illness neuromyopathy

Guillain-Barre syndrome

Motor deficit

Myopathy

Neuro-muscular disorders: myasthenia, Lambert-Eaton syndrome and botulism

Autonomic (sympathetic and parasympathetic) dyfunctions

Spine injury

Guillain-Barre syndrome

Respiratory control anomalies

Cervical spine injury (C3–C5)

Phrenic nerve palsy

Diaphragmatic injury

Critical illness neuromyopathy

Neuromuscular disorders: myasthenia, Lambert-Eaton syndrome and botulism