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A comprehensive guide for identifying and managing brainstem lesions, which are injuries to the midbrain, pons, or medulla. This podcast outlines a systematic approach, starting with an ABCDE assessment to stabilize unstable patients through interventions like intubation and managing intracranial pressure. For stable patients, the text details a focused history and physical examination, explaining how symptoms vary based on lesion location and which cranial nerves or pathways are affected, such as changes in vision or limb weakness. Furthermore, in this podcast we systematically describes several specific brainstem syndromes including Weber, Millard-Gubler, and Locked-in syndromes, as well as Lateral and Medial Medullary syndromes, based on distinct combinations of physical exam findings. Finally, the podcast also addresses broader causes like meningeal processes, such as leptomeningeal carcinomatosis and subarachnoid hemorrhage, which can affect multiple brainstem areas simultaneously.