The Massachusetts General Hospital Handbook of Neurology

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.

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.

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.

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

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