Pons Lesions

hi and engineers in this video we're going to talk about pontine lesions so let's go ahead and get started hi ninja so in this video we're going to talk about pontine lesions so what we got to do is we're going to go through a bunch of different lesions okay we're going to go over first here ventral pontine syndrome okay also referred to as millard gobler syndrome now with this one what i want us to do is we're going to take here a cross-section of the ponds right and if you guys haven't already go watch our video on the neuroanatomy of the pawns where we go over all the functions all these structures with inside of the pawns what their names are what they do okay if you guys already know that great we're going to go ahead and add on to that so first thing with a ventral pontine syndrome okay or millard gobler syndrome is there's a lesion and it's obviously in the ventral aspect of the pons do you guys remember what this ventral structure of the pons is called it's called the base of the pons or the basilar part of the bonds ponds you guys remember the structures that were involved in it the cortico ponte nuclei the cortico i'm sorry the the pontine nuclei the ponto cerebellar fibers and here your middle cerebellar peduncles which connects your pawns to the cerebellum right one thing we didn't mention in that neuroanatomy video though and we're going to add it in here is you have these little blue dots these blue dots will explain them a little bit more these are your corticospinal and your corticonuclear or cortical bulbar fibers that are coming from the cortex going down your spinal cord or to cranial nuclei in the medulla okay now ventral pontine syndrome is a lesion and look what it's involving it's involving three primary structures what are those structures if you guys remember what is this guy here this is one of your actual cranial nerves he wraps around this nerve and then comes out what is that guy called that's your facial nerve so one of the lesions is actually when this lesion happens it takes out the facial nerve fasciculus okay so these fibers of the facial nerve if that happens then that facial nerve on the left side is going to supply the muscles of facial expression on the left side so this will cause ipsilateral facial nerve palsy now we already covered all the different aspects of the facial nerve in an individual video on that but to give you guys an overview what does the facial nerve do it supplies the muscles of facial expression so if you take out the muscle of facial expression on that side it's going to cause drooping of this one side of the face since the lesion on the left side it'll cause drooping of the left side of the face okay what else does it do it also allows for lacrimation and salivation so there'll be loss of lacrimation and salivation but again it plays a role in salivation and lacrimation and even a little bit of nasal gland secretions too but if you take that out you'll have ipsy lateral in this case left-sided loss of lacrimation and ipsilateral loss of salivation what else it supplies the anterior two-thirds of the tongue but again it's only going to apply supply the left half of that anterior two-thirds so you'll have loss of taste in the left or ipsilateral and here two-thirds of the tongue okay so we're gonna play as a roll with taste and of what part anterior two-thirds of the tongue and again not the biggest most important thing but it also plays a role with pain temperature touch sensations of the external ear and the tympanic membrane so again since it plays a role with touch pain and even some temperature sensation sensations of again the ear but particularly the external ear and the tympanic membrane you'll have loss of touch pain temperature sensations coming from the external ear and what else from the tympanic membrane okay so if there is a lesion involving this facial nerve fasciculus you could have all this ipsilateral same side of the lesion facial nerve palsy so let's write that one down here so again what do we have here we have ipsilateral facial palsy and we already can explain now how that will present all right so now that we covered the facial nerve let's come back up and let's cover the next structure that's damaged okay we covered the facial nerve now you have this blue nerve this blue fasciculus what's that blue fasciculus coming from let's follow it back that's that nucleus that's the abducens nucleus so the abducens nerve the fasciculus of cranial nerve six or the abducens nerve is damaged okay cool let's come down here to the structure here we have an eyeball let's say here is going to be the nasal side of the eye and here is going to be the ear side okay so the towards the temple so medial lateral okay if you guys remember the abducens nerve supplies what muscle the lateral rectus how do you guys remember that lr6 right so if that's the case then let's bring it over here that'll be lateral here right so there'll be a muscle over here now what does the lateral rectus do when he contracts he pulls this eyeball in which direction towards the ear laterally abducts it but if you damage the abducens nerve that's supplying that lateral rectus on the ipsilateral side of the lesion then the eyeball won't be able to move laterally so now the medial rectus who's on the other supply but other side supplied by a completely different nerve right so over here you have the medial rectus he's supplied by the oculomotor nerve he pulls the eyeball inward if the oculomotor nerve is completely intact it's going to pull the eye immediately right we don't have the abducens nerve functioning now to pull the eye laterally so now this this medial rectus is unopposed which way will the eye naturally start to deviate medially okay so if you take out the function of the lateral rectus the eyeball is going to start kind of deviating medially okay and what do we call this since it's ipsilateral so in other words the lateral rectus of the left eye that's supplied by the left abducens nerve will be damaged this will cause ipsilateral rectus palsy okay so this will cause ipsilateral and we gotta do is twice lateral rectus palsy right so there's going to be again what type of movement the eye will then move in what direction it'll move towards the actual direction of where the ocular the medial rectus is pulling so in other words it won't be it'll have unopposed action of the medial rectus the eye will deviate inwards okay so now we have ipsilateral facial palsy we have this ipsilateral lateral rectus palsy due to damage of the abducens fasciculus what's the last thing okay remember we have this structure here where the pontine nuclei are and what's coming down let's explain here we have up here your cerebral cortex right and here's your upper motor neuron so these are your upper motor neurons these upper motor neurons will descend downwards right these are motor fibers they'll come down as they come down what happens some of these fibers will move around these ponte nuclei all right and when they do that they'll come back together and move down towards the medulla and as they move towards the medulla at the level of the pyramids they cross right and then they'll cross here and move down into the lateral white column and then synapse on the cell bodies of the lower motor neurons in the anterior gray horn and these will go out to your skeletal muscles okay so these are your lower motor neurons now if you guys remember we talked about this in multiple videos but some of these cortical fibers coming from the cortex of these pontine nuclei some will actually synapse on those ponte nuclei and then what some of those will do is they'll send these fibers to the contralateral cerebellum and what do we call these fibers these are your cortico ponto cerebellar fibers because they're fibers going from the cortex to the pontine nuclei to the contralateral cerebellum these blue fibers which we represented as these blue dots in this diagram these ones that are continuing downwards after the ponte nuclei are two types of fibers what types of fibers are these cortico nuclear and cortico spinal okay corticonuclear means that they're going to specific structures like the glossopharyngeal nerve or the vagus nerve or other cranial nerve nuclei that's located within the medulla or the pons okay it'll synapse on those and then stimulate those cranial nerves okay the corticospinal they'll go down into the spinal cord and stimulate these lower motor neurons now whenever there is this lesion ventral pontine syndrome it primarily takes out these corticospinal fibers so let's track this down where's the lesion the lesion we had was on this left side and it was right here it's going to take out let's follow these fibers from the upper motor neuron all the way down to the lower motor knob moving here moving here crossing to the other side it's going to supply the muscles on the contralateral side so those muscles are now going to be paralyzed so that's called contralateral hemiplegia okay let's write that down so that we also will have contralateral hemiplegia all right we covered that right so this is your ventral pontine syndrome how do we remember this triad ipsilateral facial palsy ipsilateral really abducens nerve palsy which will cause uh paresis of the lateral rectus and contralateral hemiplegia that covers the ventral pontine syndrome now let's go into the next one here all right so we covered that now let's move to this next one foval syndrome and actually some of the things that you'll see in foval syndrome we've already covered in the ventral pontine or miller gubler syndrome okay so let's look at this lesion it's still involving the ventral aspect of the pons but it's taking out a piece of this tegmental area too and we'll talk about what that structure is and it's in significance in a second but again we should already know if it's damaging this purple fiber which we already talked about before what is that that's the facial nerve so if that's damaged it's going to cause what thing ipsilateral facial nerve palsy right it's also taking out the fasciculus of the abducens nerve so what's that going to cause ipsilateral what abducens nerve palsy or that lateral rectus palsy right where the eye the lateral rectus of that ipsilateral side won't be able to contract and the eye will deviate medially due to the unopposed activity of the medial rectus and we're taking out some of these corticospinal fibers you see those blue fibers in there we're taking out some of those structures too and remember what did that do that went to the contralateral lower motor neuron eventually right that caused contralateral hemiplegia so three things that we already see here we already saw miller gubler syndrome let's write those down what are they again we have ipsy lateral facial nerve palsy we have ipsy lateral lateral rectus palsy right and that was because of the abducens nerve being damaged and we have contralateral hemiplegia all right the last one here is the only thing that really helps to differentiate these two if you see here this mainly involved the basilar part of the pons but it extends back a little bit into the tegmentum and it involves these pink nuclei structures all right so what we have to talk about here is there's this little pink structure there right that paramedian pontine reticular formation it's got one heck of a name here so what we have here we got the paramedian pontine reticular formation right a lot of times you'll honestly see this in shorthand as what i would rather write it as but pprf right so paramedium pontine reticular formation these are important because they play a role with what's called your corrective cycads we're going to make it kind of we're going to break it down really simply but what happens is for example let's say you turn your head to the right when you turn your head to the right naturally through your vestibular ocular reflex your eyes will beat to the left okay so when you turn your head to the right your eyes will be to the left what happens is that your paramedian pontine reticular formation or your front and your frontal eye fields okay kind of conjugated together will send information to these cranial nerve nuclei six four and three really via that medial longitudinal fasciculus and tell them to then move in the direction that you're moving your head so again you'll turn your head to the right your eyes will quick beat to the left your paramedium pontine reticular formation will help them to go in the direction that you're turning your head right after so it goes boom and then boom so what happens here is if you damp so what does the paramedium pontine reticular formation do and the simplest way really is it kind of just tells this six nerve nucleus okay go ahead and go ahead and work go ahead and send your signals so what this guy will do is this six nerve what does he do he goes out to your lateral rectus on that same side so he'll go to this lateral rectus here on the left this is your left eye so your right eye tells the lateral rectus to contract okay which will pull your eye laterally it'll help to move it in this direction then if that's stimulated here we'll put a little stimulatory symbol there if that's stimulated then what's going to happen he'll send that signal there and he'll also move over to the contralateral side right so he'll move over here and stimulate that third nerve via the medial longitudinal fasciculus same thing if we were to do it here on the right side it would go to this lateral rectus and it would go over here to the contralateral third nerve and stimulate that let's just focus on this left side here if this abducens nerve is stimulated he'll stimulate the left lateral rectus move over through this contralateral or in this case the right medial longitudinal fasciculus to the right third nerve nucleus this right third nerve nucleus will then go to your right medial rectus and what is the medial rectus going to do it's going to cause adduction or medial rotation moving the eyeball in this direction you see how they're both going the same direction there so if you have a lesion here you damage what we said here that paramedian pontine particular formation you don't have any stimulation to this abducens nerve now now if that's the case there's no stimulation to this left lateral rectus he is going to be inhibited so whenever you're trying to turn your gaze or move your eyes in that direction in this case towards the left it won't be able to do that so you won't be able to move towards that move your gaze towards the left side for this situation here right so this abducens nerve is inhibited then again from the abducens nerve contralateral right through the right medial longitudinal fasciculus he's going to stimulate that third nerve nucleus but because you damage that paramedian pontine reticular formation you don't have a positor positive signal to this less positive signals is going to lead to less stimulation to this right third nerve nucleus if this right third nerve nucleus is inhibited he is not going to stimulate your medial rectus to contract on the right side so now the medial rectus on the right side won't move the eye medially or towards the left this will be inhibited so your gaze will be inhibited on the same side as the lesion as occurs so we call this an ipsilateral gaze palsy does that make sense so again your damage that the lesion that you have is going to cause the gaze towards the same side of that lesion to be inhibited so again what do we call this an ipsilateral gaze palsy all right sweet deal so that covers foveal syndrome all right so now we've got to go into the next one ventromedial pontine syndrome or raymond syndrome okay so again this lesion it's going to be pretty simple because we've already talked about these this is a very simple one thankfully again look where the lesion is it's involving primarily the ventral part of the pons and it's taking out only two structures in this situation here it's taking out this purple nerve what was that purple nerve again that was the facial nerve right so the facial fasciculus so there's going to be an ipsy lateral facial nerve palsy pretty simple what else are we taking out again we're primarily focusing on those blue fibers that are going down that's going to take out your corticospinal fibers okay so the ipsilateral corticospinal fat well the corticospinal fibers that are coming down that'll go to the contralateral side those will also be damaged so you'll have contralateral hemiplegia so again what do we have here ipsilateral facial nerve palsy and again since these fibers from the corticospinal tract will cross over contralateral hemiplegia so that's pretty simple right so we can write these down so again what do we have here ipsy lateral facial nerve palsy and what else do we have we have contralateral hemiplegia okay i just want to take a quick second here because we haven't had a chance to discuss it just yet but we can do it now a little bit about the blood supply the reason why i want to cover this really quickly is because sometimes these will come up on exams okay and it's also important to know if you guys remember we did a video on the circle of willis and we're just going to kind of briefly only go through a couple of those vessels if you guys remember coming up on the sides here of the spinal cord through those transverse foramina within the cervical vertebra you had your vertebral arteries right then what happens is your vertebral arteries will eventually come together and whenever they come together they make the basal artery right the basal artery will then move its way upwards and eventually once it gets kind of towards the top of the midbrain it'll give off a branch here right and if you guys so again what do we have here i'm just going to annotate them vertebral arteries then here you're going to have the basilar artery and then here at the top at the level of the midbrain really you're going to have the posterior cerebral arteries well we've got to worry about the vessels primarily for the pons because again you guys know that there is a couple other structures here you have your superior cerebellar arteries right and then we have another one here if you guys really want to remember you have your pica so your posterior and fair cerebellar arteries then you have your anterior inferior cerebellar arteries right so again you have your pica and ica well if we look here the primary vessels that are supplying the ponds is mainly the basilar arter because the basilar artery gives off these little pontine perforating arteries off the basilar artery but also the anterior inferior cerebellar artery also gives a little bit of supply to the pons as well so easy way to remember it is to look at a cross section here really okay now the cross section here if we have here the pons right and here's going to be the dorsal aspect here right so here's our dorsal aspect and here's our ventral aspect here from all the way from the ventral aspect more towards the medial aspect of this pons from this portion here all the way to this portion here so ventral to dorsal more medial this whole thing is primarily supplied by the basilar artery but particularly a branch called the paramedian branches of basilar artery okay so if there is usually an occlusion of these vessels it's going to cause damage to this portion of the pons now if we go to this other one here here's this brown marker here you have some other vessels here so you see right here this brown portion this is also little branches coming off of the basilar artery but you know what these branches are called these are called your short circumferential i'm just going to put circum branches of your basilar artery okay and the last one here is actually kind of a combo believe it or not this is we're going to kind of shorten this one down here but this outer lateral portion so pretty much the lateral portion of the pons is supplied by two vessels this was the short circumferential branches of the bacillar artery the green one gives off small what's called long circumferential so again long circumferential we're just going to do that branches of the basilar artery and guess what else is supplying this portion here branches of the anterior inferior cerebellar artery so again what vessels primarily supplying the pons the basilar artery okay but what supplies more of that lateral portion of the pons is the anterior inferior cerebellar artery branches okay so again it's important to remember this blood supply because this commonly comes up as questions on certain exams okay so now that we've covered this one let's move on to the next pontine lesion all right so now let's go ahead and talk about lateral pontine syndrome or marie syndrome right so it's a kind of an interesting name there but again easier way to remember it's act it's actually causing lesions more to the lateral aspect of the pons so you have your medial and again here you have more lateral aspect okay so this lateral pontine syndrome is going to involve pretty much two structures and again one of them we've already covered see where the lesion is look what it's involving here it's involving this kind of ascending tract and we'll talk about what that is but it's also involving those blue dots and again were those blue dots representing corticospinal cortical nuclear fibers okay so it's going to inhibit what it's going to inhibit those corticospinal fibers that are coming down crossing at the medulla and going down to the contralateral lower motor neuron leading to contralateral hemiplegia so again what will be one of the presentations that we already know we don't have to go into great detail about one of the lesions here is contralateral hemiplegia okay so if we look here we have contralateral hemiplegia all right sweet so that covers that aspect that's an easy one now we have to cover another thing here uh you see how this is damaging this kind of red structure here what is that red structure there you know what that's called it's called the spinal liminiscus now the spinal meniscus if you guys remember we already talked about this in multiple videos might as well do it again though right this is carrying pain temperature so what is it carrying it's carrying pain it's carrying temperature it's carrying crude touch and even a little bit of pressure sensations and again it's coming through two tracks right if we were to say particularly the pain and temperature pathway that's getting carried through what's called the lateral spinal thalamic tract the crude touch and pressure is primarily being carried through the ventral spinothalamic tract but both of these eventually fuse together and become the spinal meniscus so these guys will come here into your dorsal gray horn synapse on these uh these neurons here within the dorsal dorsal horn cross over and again if it's pain temperature sensations it'll go to the lateral white column and ascent if it's crude touch and pressure sensations those fibers will go to the ventral white column and ascend but eventually they will fuse together along with other fibers like the uh spine the spinotecto fibers and spinal mesencephalics there's a bunch of different fibers spinal reticular fibers bunch of those but the main ones is lateral spinothalamic and the ventral spinal phthalate tract and again these pain pathway will come all the way up and eventually it'll synapse at the thalamus and then go to your cerebral cortex so again eventually it'll come here to your thalamus but again this is called your spinal lemniscus so if we have a lesion here in this case let's just for example just pretend i know it's here on the left but pretend the lesion is over here on the right side just for this diagram's sake here the lesion we have damaged here follow this pain temperature crew touch and pressure pathway back down goes here goes here and goes to the contralateral side so if the lesion is on the right side the pain temperature crew touch and pressure sensations are going to be lost on the contralateral side okay so again you'll have what other kind of symptom or clinical manifestation here you'll have contralateral loss of pain temperature crude touch and what else pressure sensations right there's actually one more structure that we have to cover here and if you guys remember what is this structure here all right so the last thing i want to mention here again for these lesions is we already talked about how it can involve a little bit of these corticospinal fibers okay another one that it can involve is again this spinal meniscus and another aspect of this lesion if we were to extend it out a little bit more too is it can take out a teensy bit of the middle cerebellar peduncles so again what else could we have damaged here we could also have some damage to the middle cerebellar peduncles now again what is the middle cerebellar peduncles connecting they're connecting the pons to the cerebellum so if this lesion is occurring here on this left middle cerebellar peduncle in this situation on this diagram it's going to cause the connection to the left cerebellum to be affected right so this is going to lead to what is the responsibility of this cerebellum it's important for coordination for posture for muscle tone for even helping with equilibrium so if you take out if you damage this structure going to the left cerebellum what's it going to cause it's going to cause ataxia right and that is going to be on the same side since it's the left middle cerebellar peduncle it's going to be going to the left cerebellum so the left cerebellum is going to be affected here and this is going to cause ipsilateral ataxia so again what is another presentation for these this is ipsilateral ataxia okay and if we want to be really specific cerebellar ataxia okay so again that covers these main the main presentation of lateral pontine syndrome it is important to remember though that sometimes this lesion can even extend more dorsally so if in certain textbooks you read that this lesion goes a little bit more dorsally what else could it potentially involve it could involve the spinal nucleus of the trigeminal system and it could also take out the cochlear nuclei so that could lead to deafness and it could also cause laws of loss of pain temperature and even a little bit of proprioceptive information from the face so again if this does extend farther back it can involve more of these dorsal structures but the main ones that i have within the book that we read and we'll have down the description box involves these three things all right so the last one that i want to talk about here is locked in syndrome now this one is a terrible condition it honestly is very very depressing and sad to talk about but it is important that we understand it so locked in syndrome is basically a bilateral pontine lesion okay primarily affecting the ventral aspect but it can actually affect the six nerve nucleus as well so big thing that i want you to remember for this one okay is going back to this so if it involves this structure here okay where pretty much all your corticospinal and those corticonuclear fibers are coming down through what's that going to cause okay if you guys remember let's go back to this diagram here here's going to be our upper motor neurons these guys are going to come down they're going to kind of disperse throughout the pontine some of them will move down into the eventually will go into the medulla at the level of the pyramids and do what eventually they will cross move into the lateral white column same thing disperse come together cross at the pyramids of the medulla lateral white column and synapse on these lower motor neurons that will go to your muscles okay so these are your lower motor neurons and these are your upper motor neurons the other thing that can happen is as some of these fibers are going down some of these can stimulate certain cranial nerve as they're going downwards maybe in this case the glossopharyngeal nerve maybe the vagus nerve right so if you guys really want to we can even put here the eighth nerve and the ninth nerve i'm sorry ninth and tenth nerve so again glossopharyngeal nerve is the ninth nerve and the vagus nerve is the tenth nerve but if they're stimulating these structures then what happens is the the vagus and the glossopharyngeal nerve will go to their specific structures as well now here's what i want you to remember the lesion was on what side in this case it's on both sides so we're going to damage this here and damage this here if you see this it doesn't matter if we follow anything from this point down is damaged on both sides so what happens is is if you follow this guy down these corticospinal fibers all the way down here you're losing the contralateral side okay and if you damage these you're losing this contralateral side so this means you have bilateral loss of muscle control or bilateral paralysis from that point down but guess what these lower motor neurons are going to the upper extremities and the lower extremities again so this will go to the upper extremities and to the lower extremities so if you damage both bilateral corticospinal tracts going to the upper extremities and lower extremities what is that going to cause quadriplegia okay so you're going to lose you're going to have paralysis of the entire body okay bilateral side so bilateral upper extremity lower extremity trunk everything is going to be taken out and that's going to present with quadriplegia so this will present with quadraplegia okay the next thing and here's what's again really sad so they're quadriplegic so they don't have any function of the upper extremity lower extremities and you also are taking out the ninth and the tenth nerve you know the ninth and the tenth and they're actually important because they go to a bunch of different structures around your larynx and and basically help with speech production okay so if you take out the ninth and the tenth nerve all right because these corticonuclear fibers are also damaged not just the corticospinal but the corticone nuclear fibers are also damaged guess what that's gonna cause loss of speech because again the ninth and the tenth nerve also play a role in speech production okay so they play a role in speech production and if you damage these because your corticonuclear fibers are taken out what's gonna happen if you lose your speech production it's called aphonia so they can't speak so not only are they quadriplegic but they also have a phonia it's terrible okay so we have quadriplegia we have aphonia the next things you have to remember here is it also takes out that abducens nerve nucleus so you see here we have the abducens nerve okay it takes out the abducens nucleus so if you guys remember what does the abducens nucleus do where the heck is that blue marker oh i have it so here's the abducens nucleus here the abducens nucleus if you guys remember we'll obviously go and go to the lateral rectus on the same side right so lateral rectus here on the right side lateral rectus here on the left side but also we'll supply the contralateral third and fourth nerve via the medial longitudinal fasciculus if you damage both of these now look what happens i'm going to damage these abducens nuclei i can't move the lateral rectus on either side so lateral rectus on both sides are damaged so i can't move my eyes i can't abduct them okay i also damage primarily the third nerve nucleus as well if i lose the activity of the oculomotor nerve what does the oculomotor nerve go to a ton of different muscles okay but the main one that i want to focus on here is the medial rectus if you inhibit this now the medial rectus of both eyes won't be able to contract so now your eyes won't be able to move medially so you lose the horizontal movement there's a horizontal gaze palsy and again moving left to right that's a terrible thing right and on top of that you now have no connection between the six nerve nucleus to all these guys via this medial longitudinal fasciculus so technically the medial longitudinal fasciculus is null at this point you know what they call it whenever you have damage to the medial longitudinal fasciculus what that leads to it leads to internuclear abdominoplasia but guess what both abducens nuclei are damaged so this is bilateral internuclear ophthalmoplegia with horizontal gaze palsy okay so let's write that down so again they have bilateral enter i'm going to put inter nuclear abdominoplasia with horizontal gaze palsy and believe it or not the vertical gaze center or the vertical movements are actually somewhat intact just because of their position within the pawns okay so again the vertical gaze is actually somewhat intact but their horizontal gaze is lost so they have quadriplegia aponia bilateral internucleophthalmoplasia with horizontal gaze palsy the only thing that actually they do have is this doesn't take out the reticular formation okay so if you guys remember what does the reticular formation do a simple diagram here here's your reticular formation right it extends pretty much the entire aspect of the brain stem if you have any stimulus whatever the stimulus is whether it be touch stimulus whether it be a visual stimulus whether it be an auditory stimulus all of those things go to your reticular formation he sifts through that and then sends that information to your cerebral cortex to alert you to arouse you to let you know of all of these sensations this is actually intact it's it's fine and someone was locked in syndrome so in other words they can hear you if you open up their eyes they can see you they can feel all the sensations and they're aware of everything and conscious but they can't move they can't talk okay so it's a terrible condition so again one of the things to remember here is that the reticular formation is intact so they are conscious all right nizhner so in this video we covered the pontine lesions i hope all of them made sense i hope you guys did enjoy it if you guys did hit that like button comment down in the comment section and please subscribe i know that you guys always ask me the references that i use for some of these videos i'm going to put down the references down in the description box that we use for these lesions guys if you guys did like this video please hit that like button comment down in the comment section subscribe seriously subscribe also down in the description box we'll have links to our facebook our instagram our patreon account if you guys want to go ahead and join that we would truly appreciate it and guys we love to hear from you we love all the messages all the kind words and again as always ninja nerds until next time [Music] so you

Channel: Ninja Nerd

Views: 45,062

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Id: vZhNwdKRzcQ

Length: 40min 42sec (2442 seconds)

Published: Sat Sep 12 2020