Localisation of Brainstem lesions : Rule of Four
 
 Ugh got destroyed by another brainstem lesion question on Qbank? Having hard time with neurology?  then you are at right place..   a simplified method for answering the question ‘Where is the lesion?’      Below I have summarized RULE OF 4.    In the rule of 4 there are 4 rules:   There are 4 structures in the ‘midline‘ beginning with M  There are 4 structures to the ‘side‘ (lateral) beginning with S  There are 4 cranial nerves below the pons, 4 in the pons and 4 above the pons.  The 4 motor nuclei that are in the mid line are those that divide equally into 12 except for 1 and 2, that is 3, 4, 6 and 12 (5, 7, 9 and 11 are in the lateral brainstem).       The 4  Medial  structures and the associated deficits are:   M otor pathway (or corticospinal tract): CL weakness of the arm and leg    M edial Lemniscus: CL loss of vibration and proprioception in the arm and leg    M LF: IPSI inter-nuclear ophthalmoplegia (failure  of adduction of the IPSI eye +nystagmus...
 
 
