Diseases of the nervous system : a text-book of neurology and psychiatry . o the right and the eyes look to the right, the patient looks to theside of the lesion. In a there are multiple isolated lesions. Four large foci in the anteriorportion destroy the pontine pyramidal fibers with a resulting crossed contralateral hemi-plegia of the extremities, the face, and the tongue. Another focus occupies the posteriorinternal portion of the tegmentum and destroys the internuclear oculogyric fibers ofthe posterior longitudinal bundle which directly unites the nuclei of the sixth and thirdnerves and vi
Diseases of the nervous system : a text-book of neurology and psychiatry . o the right and the eyes look to the right, the patient looks to theside of the lesion. In a there are multiple isolated lesions. Four large foci in the anteriorportion destroy the pontine pyramidal fibers with a resulting crossed contralateral hemi-plegia of the extremities, the face, and the tongue. Another focus occupies the posteriorinternal portion of the tegmentum and destroys the internuclear oculogyric fibers ofthe posterior longitudinal bundle which directly unites the nuclei of the sixth and thirdnerves and vice versa. There results a paralysis of the eyeballs by which they cannotturn sideways toward the right—right oculorotary paralysis—by reason of the predom-inance of the antagonists the patient looks to the left. The patient looks away from thelesion toward the paralyzed members. The cortical oculorotary fibers and the pes lem-niscus are intact. For details of structure and abbreviations, see chapter on MidbrainLesions. (Dejerine.) DISEASES OF THE OCULOMOTOR NERVES m. Fig. 89.—Pontine syndrome, with eye palsies of central origin and sjTingomyelic dis-sociation. There is here a crossed hemianesthesia with alternating paralysis of theVI and VII cranial nerves, anesthesia of the V nerve due to hemorrhage in the lateraland lower portion of the pontine tegmentum of the left side. The right-hand figureshows the hemianesthesia, dissociated as in syringomyelia (hemianalgesia and hemi-thermanesthesia due to lesion of the crossed sensory pathways of the lateral portion ofthe reticular formation. There is preservation of the tactile and postural sensibilitiesand of the stereognostic sense, because of the incomplete extension of the lesion to themedian lemniscus (Rm). The left-hand figure shows (1) atrophic paralysis of the VIInerve with reaction of degeneration, lagophthalmia, drooping of the lips, loss of facialmimicry, paralysis of the entire left facial (VII) indicated (Fig. a); (
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