E-Pearl of the Week: Gates' Rule of 4 of the Brainstem

November 28, 2011

Share:

Interested in submitting an e-Pearl? Click here!

Brought to you by the Resident and Fellow Section of Neurology®.

November 28, 2011

Gates' Rule of 4 of the Brainstem: A Simple Method to Demystify the Brainstem

According to Gates' rule of 4, there are 4 structures in the midline of the brainstem beginning with M: motor pathway or cortical spinal tract, motor cranial nerves (3, 4, 6 and 12), medial lemniscus, and medial longitudinal fasciculus. There are 4 lateral structures beginning with "S" including the spinocerebellar pathways, sympathetic pathway, spinothalamic pathways and sensory nucleus of trigeminal nerve. There are 4 cranial nerves above the pons (1-4), 4 in the pons (5-8), and 4 in the medulla. Knowledge of the rule of 4 makes the teaching and diagnosis of brainstem syndromes less challenging.

References

  1. Gates P. The rule of 4 of the brainstem: a simplified method for understanding brainstem anatomy and brainstem vascular syndromes for the non-neurologist. Intern Med J. 2005; 35: 263-266.

Submitted by: Tissa Wijeratne

Disclosures: Dr. Wijeratne has nothing to disclose.

For more clinical pearls and other articles of interest to neurology trainees, visit www.neurology.organd click on the link to the Resident and Fellow Pages. Click here to visit the E-Pearl of the Week Archive.

Click here to listen to this week's Neurology® Podcast.