Table 7.

Differential diagnosis of brainstem dysfunction

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