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Neurology > Anatomy > Flashcards

Anatomy Flashcards

1
Q

What does the telencephalon form?

A

Cerebral hemispheres

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2
Q

What does the diencephalon form?

A

Thalamus, hypothalamus

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3
Q

What does the mesencephalon form?

A

Midbrain

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4
Q

What does the metencephalon form?

A

Pons, cerebellum

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5
Q

What does the myelencephalon form?

A

Medulla oblongata

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6
Q

What is the brainstem?

A

Midbrain, pons and medulla oblongata

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7
Q

What are the most numerous cells in the CNS?

A

Glial cells

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8
Q

What roles are astrocytes involved in?

A

Support, maintaining the BBB, environmental homeostasis

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9
Q

What do oligodendrocytes produce?

A

Myelin in the CNS (not PNS)

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10
Q

Describe oligodendrocytes

A

Numerous branches that extend to produce internodes of myelin around axons. Round nucleus

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11
Q

What are microglia?

A

Cells of similar lineage to macrophages (haemopoietic origin)- immune monitoring and antigen presentation

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12
Q

What is the appearance of microglia in a resting state?

A

Elongated nucleus and have a number of short spiny cell processes

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13
Q

What is the appearance of microglia in an activated state?

A

Become rounder and take on a similar appearance to macrophages

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14
Q

What can activate microglia?

A

Bacteria infection

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15
Q

What are the 4 major types of glial cells?

A

Astrocytes, oligodendrocytes, microglia, ependymal cells

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16
Q

Describe ependymal cells

A

Ciliated cuboidal/columnar epithelium that lines the ventricles

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17
Q

What is a folium?

A

Equivalent to a gyrus in the cerebral hemispheres

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18
Q

What makes up the grey matter?

A

Huge numbers of neurons, cell processes, synapses and support cells

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19
Q

What makes up the white matter?

A

Medullary centre- axons (most myelinated) and their support cells

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20
Q

Where is the parietal lobe located?

A

Posterior to central sulcus, superior to lateral sulcus, and anterior to a line from parieto-occiptal sulcus to the preoccipital notch

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21
Q

Where is the occipital lobe located?

A

Posterior to a line from the parieto-occipital sulcus to the preoccipital notch

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22
Q

Where is the temporal lobe located?

A

Inferior to the lateral sulcus and posteirorly by a line from the parieto-occipital sulcus and the preoccipital notch

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23
Q

What role does the insular lobe have?

A

Patient’s experience of pain

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24
Q

What are the 3 meningeal layers?

A

Dura mater
Arachnoid space
Pia mater

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25
Q

What is contained within the arachnoid mater?

A

Subarachnoid space containing CSF

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26
Q

Where is the enteric nervous system found?

A

In digestive system from oesophagus to rectum

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27
Q

Where are the neurons of the ENS found?

A

Largely in two plexuses in the walls of the gut (myenteric plexus between outer layers of smooth muscle, submucosal plexus in submucosa)

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28
Q

What is the T4 spinal nerve segment identified by?

A

Male nipple

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29
Q

What is the T10 spinal nerve segment identified by?

A

Umbilicus

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30
Q

What does the C2-4 segment supply?

A

Posterior scalp, neck and shoulder

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31
Q

What does the C5-T1 segment supply?

A

Upper limb

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32
Q

What does the L2-Co1 segment supply?

A

Lower limb, gluteal region and perineum

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33
Q

What are nerve plexuses?

A

Networks of intertwined anterior rami

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34
Q

What makes up the cervical plexus?

A

C1-4 anterior rami

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35
Q

What does the cervical plexus supply?

A

Posterior scalp, neck wall and diaphragm

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36
Q

What makes up the brachial plexus?

A

C5-T1 anterior rami

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37
Q

What does the brachial plexus supply?

A

Upper limb

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38
Q

What does the lumbar plexus supply?

A

Lower limb

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39
Q

What makes up the lumbar plexus?

A

L1-4 anterior rami

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40
Q

What makes up the sacral plexus?

A

L5-S4 anterior rami

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41
Q

What does the sacral plexus supply?

A

Lower limb, gluteal region and perineum

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42
Q

What is the myotome of each spinal nerve?

A

The skeletal muscles supplied with motor innervation by both the anterior and posterior ramus of that spinal nerve

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43
Q

Where does the sympathetic tract exit the spinal cord?

A

T1-L2 spinal nerves

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44
Q

Where do sympathetic fibres synapse in the CNS?

A

Lateral horn of grey matter

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45
Q

What structure does the presynaptic sympathetic axon pass through from the spinal nerve to reach the paravertebral ganglion?

A

Rami communicans

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46
Q

What type of axons come from the anterior horn of the spinal cord?

A

Motor axons

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47
Q

What type of axons come from the posterior horn of the spinal cord?

A

Sensory axons

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48
Q

What is the tapered cone-shape in which the spinal cord terminates?

A

Conus medullaris

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49
Q

What does the conus medullaris continue as?

A

A thin connective tissue cord called the filum terminale

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50
Q

What is the filum terminale anchored to?

A

The dorsum of the coccyx

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51
Q

What is the ribbon of tissue on the lateral aspects of the cord which hold it in the canal?

A

Denticulate ligament

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52
Q

What is the denticulate ligament formed from?

A

Pial and arachnoid tissue

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53
Q

Where does the denticulate ligament attach?

A

To the dura at points along the length of the cord

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54
Q

What is the white matter of the spinal cord conventionally described as being made up of?

A

Posterior, lateral and anterior fasciculi

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55
Q

What is the grey matter of the spinal cord divided into?

A

Left and right posterior and anterior horns

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56
Q

What parts of the grey matter surround the central canal?

A

Dorsal and ventral commisures

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57
Q

What is found at spinal segments T1 to L2 which contains the preganglionic sympathetic neurons?

A

A smaller lateral horn

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58
Q

What is the arterial supply of the spinal cord?

A

Three major longitudinal arteries
Segmental arteries
Radicular arteries

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59
Q

What are the three major longitudinal arteries that supply the spinal cord?

A

One anterior and two posterior that originate from the vertebral arteries. Run along length of the cord

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60
Q

What are the segmental arteries derived from?

A

Vertebral, intercostal and lumbar arteries

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61
Q

Where do the radicular arteries travel?

A

The dorsal and ventral roots

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62
Q

Describe the venous drainage of the spinal cord

A

Follows a similar pattern to the supply, with both longitudinal and segmental veins

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63
Q

What is the epidural space?

A

The space between the dura and bone in the spinal canal

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64
Q

What does the epidural space contain?

A

Adipose tissue and the anterior and posterior epidural venus plexuses

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65
Q

What does the dorsal pathway control?

A

Fine touch and conscious proprioception (particularly from the upper limb)

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66
Q

Where do the fibres in the dorsal pathway cross?

A

Medulla

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67
Q

What does the STT control?

A

Pain, temperature, deep pressure

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68
Q

What does the corticospinal tract form on the anterior surface of the medulla?

A

Visible ridges referred to as pyramids- hence pyramidal tract

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69
Q

What can a CVA of the internal capsule result in?

A

A lack of descending control of the corticospinal tract which results in spastic paralysis with hyperflexion of the upper limbs- referred to as decorticate posturing

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70
Q

What is a general rule regarding fibres originating from the pons and medulla?

A

Fibres from pons facilitate extensor movements and inhibit flexor movements, while those from medulla to the opposite

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71
Q

Where is the cerebellum located?

A

Posterior and inferior cerebral hemispheres

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72
Q

What is the cerebellum attached to the brainstem by?

A

3 stalks termed peduncles:

Superior, middle and inferior cerebellar peduncle

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73
Q

What are the 3 layers of the cerebellar cortex?

A 
Molecular layer (outer)
Purkinje cell layer (middle)
Granular layer (inner)
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74
Q

What type of neuron projects to the cerebellum?

A

Afferent

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75
Q

Where do the important afferents to the cerebellum mainly arrive from?

A 
Spinal cord (somatic proprioceptors and pressure receptors)
Cerebral cortex (via pons)
Vestibular apparatus (via vestibular nuclei)
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76
Q

Where do the afferent neurones mainly project to in the cerebellum?

A

Granule cell layer

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77
Q

What is the only output from the cerebellum?

A

Via the axons of Purkinje cells which mainly synapse on neurons of deep cerebellar nuclei- contribute to motor tract function of brainstem/cord

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78
Q

Where do most efferent axons of the deep cerebellar nuclei cross and synapse?

A

Midline and synapse in the thalamus- fibres than sent to the motor cortex

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79
Q

Cerebellar hemispheres influence what side of the body?

A

Ipsilateral

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80
Q

What can a unilayeral hemispheric lesion result in?

A

Disturbance of coordination in limbs. Can result in intention tremor and unsteady gait in the absence of weakness or sensory loss

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81
Q

What does bilateral cerebellar dysfunction result in?

A

Slowed, slurred speech, bilateral incoordination of arms and a staggering, wide based gait (cerebellar ataxia)

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82
Q

What does acute alcohol exposure cause in the cerebellum?

A

Bilateral cerebellar hemisphere dysfunction and presents with cerebellar ataxia

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83
Q

What will a midline cerebellar lesion cause?

A

Disturbance of postural control, but preserved limb coordination

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84
Q

What are the functions of the basal ganglia?

A

Facilitate purposeful movement
Inhibit unwanted movements
Role in posture and muscle tone

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85
Q

What are the components of the basal ganglia?

A 
Striatum
Corpus striatum
Lenticular nucleus
Subthalamic nucleus
Substantia nigra
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86
Q

What makes up the lenticular nucleus?

A

Putamen

Globus pallidus

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87
Q

What makes up the corpus striatum?

A

Caudate nucleus
Putamen
Globus pallidus

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88
Q

What makes up the striatum?

A

Caudate nucleus, putamen

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89
Q

What is the pathology of Parkinson’s?

A

Degeneration of dopaminergic neurons of the substantia nigra

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90
Q

How do the basal ganglia work with the motor cortex to enhance normal movement?

A

There is a direct pathway between them which enhances outflow of the thalamus, thusly enhancing the desired movement

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91
Q

What issues the command to move?

A

Pyramidal neurones (under voluntary control)

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92
Q

How do the basal ganglia work with the motor cortex to suppress unwanted movement?

A

An indirect pathway inhibits the outflow of thalamus

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93
Q

What side of the body do unilateral lesions of the basal ganglia affect?

A

Contralateral

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94
Q

What do lesions of the basal ganglia cause?

A

Changes in muscle tone

Dyskinesias: Tremor, chorea, myoclonus

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95
Q

What is the pathology of Huntington’s?

A

Progressive degeneration of the basal ganglia and cerebral cortex

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96
Q

What do the extrinsic back muscles do?

A

Move the upper limb

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97
Q

What are the main extrinsic back muscles?

A

Trapezius
Lattimus dorsi
Levator scapulae
Rhomboids (major and minor)

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98
Q

What do the intrinsic back muscles do?

A

Maintain back posture and move the spine

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99
Q

What are the main intrinsic back muscles?

A 
Erector spinae (superficial)
Transversospinalis (deep)
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100
Q

What makes up erector spinae?

A

3 vertically arranged muscle groups located just lateral to the spine

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101
Q

What do all the erector spinae muscle fibres attach inferiorly by?

A

A common tendon to the sacrum & the iliac crest

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102
Q

What do individual erector spinae muscle fibres attach superiorly to?

A

Via a tendon either:
a rib (between angle and tubercle)
a transverse process of a vertebra
a spinous process of a vertebra

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103
Q

Where is transversospinalis located?

A

Within the deep grooves between the transverse and spinous processes

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104
Q

Where do the inidividual muscle fibres of transversospinalis attach between?

A

A vertebra and the skull
A vertebra and a rib
One vertebra and another
A vertebra and the sacrum

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105
Q

What is extension of the spine a function of?

A

The intrinsic back muscles

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106
Q

What is spine flexion a function of?

A

Psoas major and rectus abdominus

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107
Q

What are the functions of the spine?

A

Support weight of the head and trunk in upright posture
Protect spinal cord (and nerves)
Allow movements

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108
Q

What are the pain signals of facet joints and IV discs transmitted via?

A

Posterior rami

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109
Q

What do the facet joints join?

A

Articular processes of 2 adjacent vertebrae

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110
Q

Where along the spine will you not find IV discs?

A

Between C1-2 and fused sacrum and coccyx

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111
Q

What ligaments run along the spine?

A 
Ligamentum flavum
Posterior longitudinal ligament
Anterior longitudinal ligament 
Supraspinous ligament
Interspinous ligament
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112
Q

What does the ligamentum flavum connect?

A

Adjacent laminae posterior to spinal cord

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113
Q

Where do the anterior and posterior longitudinal ligaments attach?

A

To the anterior and posterior aspects of all vertebral bodies and intervertebral discs respectively

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114
Q

What do the anterior and posterior longitudinal ligaments prevent?

A

Over extension and over flexion of the spine respectively

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115
Q

What does the supraspinous ligament connect?

A

Tips of spinous processes

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116
Q

What does the interspinous ligament connect?

A

Superior and inferior surfaces of adjacent spinous processes

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117
Q

What do all cervical vertebrae have in the transverse process?

A

A foramen for vertebral arteries

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118
Q

What does C1 have instead of a body or spinous process?

A

An anterior and posterior arch

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119
Q

Where are the atlanto-occipital joints between?

A

The occipital condyles and the superior articular facets of the atlas

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5
Perfectly
120
Q

What type of joints are the atlanto-axial joints?

A

Synovial (3)

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121
Q

Where are the atlanto-axial joints located?

A

2 between the inferior articular facets of atlas and superior articular facets of axis
1 between anterior arch of atlas and odontoid process of axis

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122
Q

What are the main movements of the atlanto-axial joints?

A

Rotations

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123
Q

What foraminae are present in the sacrum instead of intervertebral foraminae?

A

Anterior and posterior sacral foraminae

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124
Q

Where is local anaesthetic injected in caudal anaesthesia to anaesthetise the sacral spinal nerve roots of the cauda equina?

A

Sacral hiatus

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125
Q

Where is the spinal cord located?

A

From C1-L2. Continuous with medulla oblongata at foramen magnum

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126
Q

What is located in the L1 dermatome?

A

Groin

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127
Q

What is located in the L2 dermatome?

A

Anterior thigh

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128
Q

What is located in the L3 dermatome?

A

Anterior knee

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129
Q

What is located in the L4 dermatome?

A

Medial malleolus

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130
Q

What is located in the L5 dermatome?

A

Dorsum of foot

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131
Q

What is located in the S1 dermatome?

A

Heel

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132
Q

What is located in the S2 dermatome?

A

Posterior knee

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133
Q

What is located in the S3 dermatome?

A

Buttock

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134
Q

What is located in the S4 dermatome?

A

Perineum

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135
Q

What is located in the S5 dermatome?

A

Perianal skin

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136
Q

What happens when a dermatome is tested for sensory function (T10 example)?

A

Stimulation in anterior aspect of right T10 dermatome
AP generated by receptors in segment
AP continues along axons to anterior ramus
Then to T10 spinal nerve
Then to T10 posterior root
Then to T10 posterior rootlets
Then to posterior horn of spinal cord

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137
Q

What are the spinal nerve root levels of the femoral nerve?

A

L2,3,4

138
Q

What supplies the neck and scalp skin posteriorly?

A

Posterior rami of spinal nerves C2-8

139
Q

What supplies the skin of the neck anterolaterally?

A

Named sensory branches of the cervical plexus (anterior rami of C1-4 spinal nerves)

140
Q

Describe lesser occipital nerve

A

Spinal nerve C2

Skin posterior to external ear

141
Q

Describe great auricular nerve

A

Spinal nerve C2,3

Skin over the angle of the mandible & some of the external ear

142
Q

Describe transverse cervical

A

Spinal nerve C2,3

Skin over anterior neck

143
Q

Describe the supraclavicular nerves

A

Spinal nerve C3,4

Skin over the clavicle and shoulder tip

144
Q

What supplies the upper anterolateral trunk wall?

A

Intercostal nerves (anterior rami of spinal nerves T2-11)

145
Q

What supplies the lower anterolateral trunk wall?

A

Iliohyogastric & the iliolingual nerves (formed from bifurcation of anterior ramus of L1 spinal nerve)

146
Q

What supplies the T12 dermatome of the trunk?

A

The subcostal nerve (anterior ramus of T12 spinal nerve)

147
Q

What are the posterior parts of the back dermatomes supplied by?

A

Posterior rami

148
Q

Describe the axillary nerve

A

C5,6

Badge patch

149
Q

Describe the supraclavicular nerves

A

C3,4

Anterior arm, shoulder

150
Q

Describe the radial nerve

A

C5,6,7,8,T1
Lateral arm
Posterior hand

151
Q

Describe the cutaneous branch of the musculocutaneous nerve

A

C5,6,7

Inferolateral arm

152
Q

Describe the ulnar nerve

A

C7,8,T1

Medial hand

153
Q

Describe the median nerve

A

C5,6,7,8,T1

Lateral hand

154
Q

What supplies the anatomical snuff box?

A

Cutaneous branches of the radial nerve

155
Q

What happens when a named nerve is tested for sensory function (femoral nerve function)?

A

Stimulation in area innervated by femoral nerve
AP generated by receptors in that area (L2 dermatome)
AP continues along axons weaving through lumbar plexus
AP continues to L2 anterior rami
AP continues to L2 spinal nerve
AP continues to L2 posterior root
AP continues to L2 posterior rootlets
AP continues into posterior horn of spinal cord

156
Q

What do the cervical plexus motor axons supply?

A

Neck postural and strap muscles

Diaphragm

157
Q

What do the brachial plexus motor axons supply?

A

Muscles of the upper limb

Extrinsic back muscles

158
Q

What do the T2-L3 motor axons supply?

A

Postural back muscles
Intercostal muscles
Anterolateral abdominal wall muscles

159
Q

Through what nerves are the anterolateral abdominal wall muscles supplied?

A

Thoracoabdominal, subcostal, iliohypogastric and iliolingual nerves

160
Q

What do the lumbosacral plexus motor axons supply?

A

Lower limb muscles

Perineal skeletal muscles

161
Q

What innervates the muscles of facial expression?

A

CNVII

162
Q

What innervates the muscles of mastication?

A

CNV3

163
Q

What innervates the muscles of the tongue?

A

CNXII

164
Q

What innervates the muscles of the soft palate?

A

CNX/pharyngeal plexus

165
Q

What innervates neck postural muscles?

A

Posterior rami of cervical spinal nerves

166
Q

What innervates the strap muscles?

A

Cervical plexus

167
Q

What innervates the diaphragm?

A

Phrenic nerve (C3,4,5)

168
Q

What innervates sternocleidomastoid & trapezius?

A

CNXI

169
Q

What innervates the muscles of the pharynx?

A

CNX

170
Q

What innervates the intrinsic muscles of the larynx ?

A

CNX

171
Q

What inervates the intercostal muscles?

A

Intercostal nerves

172
Q

What innervates the anterolateral abdominal wall muscles?

A

Thoracoabdominal nerves

173
Q

What innervates erector spinae and transversospinalis groups?

A

Posterior rami of spinal nerves

174
Q

What innervates deltoid and teres minor?

A

Axillary nerve

175
Q

What innervates the anterior compartment of the arm?

A

Musculocutaneous nerve: C5,6,7

Biceps brachii
Brachialis
Coracobrachialis

176
Q

What innervates the anterior compartment of the forearm and hand muscles?

A

Median nerve: (C5), C6,7,8,T1
Muscles of the anterior compartment of forearm:
The pronator muscles (Teres & Quadratus)
Flexor carpi radialis
Palmaris longus
Flexor digitorum superficialis
Lateral half of flexor digitorum profundus
Flexor pollicis longus
Muscles of the hand:
Thenar muscles
Lumbricals 1&2

177
Q

What dos the radial nerve innervate in the upper limb (motor)?

A

Muscle of the posterior compartment of arm: Triceps brachii
Muscles of the posterior compartment of forearm: Brachioradialis
Supinator
ALL the extensors of the carpus & digits
Abductor pollicis longus

178
Q

What does the ulnar nerve innervate in the upper limb(motor)?

A

Muscles of the anterior compartment of forearm:
Flexor carpi ulnaris
Medial half of flexor pollicis longus
Adductor pollicis
Muscles of the hand:
Hypothenar muscles, Lumbricals 3&4
& ALL the interossei (dorsal & palmar)

179
Q

What does the femoral nerve innervate in the lower limb (motor)?

A

Quadriceps femoris, sartorius and pectineus

180
Q

What does the sciatic nerve innervate in the lower limb (motor)?

A 
Tibial part: L4-S3 
muscles of the posterior compartment of leg:
true hamstrings -
semimembranosus
semitendinosus
long head of biceps femoris
muscles of the posterior compartment of leg:
gastrocnemius
soleus
plantaris
popliteus
tibialis posterior
flexors of the digits (digitorum & hallucis longus)
muscles of the sole of the foot:
ALL intrinsic muscles of the sole of the foot
common fibular part: L4-S2
short head of biceps femoris
181
Q

What does the obturator nerve (L2-4) innervate in the lower limb (motor)?

A 
All of the medial compartment of thigh
All adductors (Brevis/longus/magnus) and gracilis
182
Q

What does the common fibular nerve innervate in the lower limb (Motor)

A

Superficial fibular branch:
muscles of the lateral compartment of leg:
fibularis longus & brevis

Deep fibular branch: 
muscles of the anterior compartment of leg:
fibularis longus & brevis
muscles of the dorsum of the foot:
extensor digitorum brevis (EDB)
extensor hallucis brevis (EHB)
183
Q

What is tested in shoulder joint movement?

A

Abduction: C5 deltoid
Adduction: C7 Pectoralis major and latissumus dorsi

184
Q

What is tested in elbow joint movement?

A

Flexion: C5,6 Biceps brachii
Extension: C7,8 triceps brachii
Pronation: C6 pronator teres and quadratus
Supination: C8 supinator

185
Q

What is tested in wrist joint movement?

A

Flexion: C6,7 (flexors of carpus)
Extension: C7,8 (extensors of carpus)

186
Q

What is tested in finger joint movement?

A

Flexion: C8 (flexors of digits)
Extenson: C7 (extensors of digits)
Abduction: T1 (palmar interossei)
Adduction: T1 (dorsal interossei)

187
Q

What is tested in hip joint movement?

A

Flexion: L2,3 (psoas major)
Extension: L5,S1 (gluteus maximum and hamstrings)

188
Q

What is tested in knee joint movement?

A

Flexion: L5,S1 (hamstrings)
Extension: L3,4 (quadriceps)

189
Q

What is tested in ankle joint movement?

A

Dorsiflexion: L4,5 (tibialis anterior)
Plantar flexion: S1,2 (gastrocnemius/soleus)
Inversion: L4 (tibialis anterior and posterior)
Eversion: L5,S1 (fibularis longus and brevis)

190
Q

What happens when a spinal nerve myotome is tested for motor function (L3 spinal cord segment)?

A

APs generated by voluntary intention in primary somatosensory cortext
Conducted via UMN axons of corticospinal tract
Continues along axons to anterior horn L3 spinal cord
UMN synapse with L3 LMN stimulating AP
AP continues along axons to L3 spinal nerve
Then to either L3 posterior or anterior ramus
APS via L3 anterior rami often weave through the lumbar plexus via named nerve
Then reach NMJ of supplied muscle

191
Q

What happens in the spinal cord reflex of the knee jerk?

A

Briskly tap the patellar tendon (ligament) with a tendon hammer
The tap applies stretch to the quadriceps muscle fibres via the quadriceps tendon
The quadriceps muscle spindles (stretch receptors) initiate APs in the anterior rami axons within the femoral nerve
These sensory APs are conducted to the dorsal horn of, predominantly, spinal cord segment L4
The axons then pass into the anterior horn to synapse upon the LMNs that supply quadriceps
The APs conducted via the LMN axons in the femoral nerve reach the quadriceps neuromuscular junctions
The muscle contracts to bring about extension of the knee joint

192
Q

What are descending tracts important in regarding muscle contractions?

A

Modulating reflex contractions

193
Q

What can loss of descending controls, such as with a UMN lesion e.g. CVA, result in?

A

Increased stretch reflexes and spasticity

194
Q

What reflexes are tested?

A 
Biceps Brachii- C5(6)
Triceps Brachii- C7
Brachioradialis- C6
Knee Jerk- L4
Ankle Jerk- S1
195
Q

Where do cranial nerves exit the brain?

A

Anteriorly except CN IV

196
Q

What are the sensory cranial nerves?

A

1,2,8

197
Q

What are the motor cranial nerves?

A

3,4,6,11,12

198
Q

What cranial nerves are mixed motor and sensory?

A

5,7,9,10

199
Q

What will motor components of cranial nerves be associated with?

A

Motor nuclei

200
Q

Where will the soma of sensory nerve cells be found?

A

In ganglia outside of the CNS (analogous to the DRGs for the spinal nerves)

201
Q

What is the only sensory modality that does not synapse in the thalamus prior to reaching the cortex?

A

CN 1

202
Q

Where are the nuclei for CN 3,4,6 found near?

A

Midline of the brainstem

203
Q

Where is the nucleus of the oculomotor nerve located?

A

Superior colliculus of the midbrain

204
Q

What type of nerve fibres are contained within CNIII?

A

Somatic motor + p.symp

205
Q

Where is the nucleus of the trochlear nerve located?

A

Inferior colliculus of the midbrain

206
Q

What type of nerve fibres are contained within CNIV?

A

Somatic motor

207
Q

Where is the nucleus of the abducens nerve located?

A

In the pons at the floor of the 4th ventricle

208
Q

What type of nerve fibres are contained within CNVI?

A

Somatic motor

209
Q

What type of nerve fibres are contained within CNXII?

A

Somatic motor

210
Q

Where is the nucleus of the hypoglossal nerve located?

A

Medulla

211
Q

Where does the spinal accessory nerve arise from?

A

Cervical spinal cord

212
Q

What are the functions of CNV5?

A

Somatosensation of face:discriminative touch, vibration, pain, temperature
Proprioception of chewing
Motor control- muscles of mastication, tensor tympani, mylohyoid, ant. belly of digastric, tensor veli palatini

213
Q

Where is the trigeminal nerve sensory nucleus located?

A

From midbrain down to upper 2 segments of spinal cord- 3 parts, separated by function

214
Q

What is the function of the mesencephalic nucleus of CNV?

A

Proprioception info from chewing muscles

215
Q

What is the function of the pontine trigeminal nucleus of CNV?

A

Principle nucleus- discriminative touch, vibration

216
Q

What is the function of the spinal nucleus of CNV?

A

Pain, temperature

217
Q

What is unusual about the mesencephalic nucleus?

A

It is the only site in the CNS where the cell bodies of primary afferent neurons live inside the CNS

218
Q

Where is the motor nucleus of CNV located?

A

Pons

219
Q

What are the functions of CNVII?

A

Motor (muscles of mastication, stapedius)
Parasymp. innervation to pterygopalatine and submandibular ganglia
Taste (anterior 2/3 of tongue via c. tympani).

220
Q

What are the functions of CNIX?

A

Tactile sense, pain and temperature from the posterior tongue, pharyngotympanic tube and upper pharynx.
Taste (posterior 1/3 of the tongue).
Parasympathetic fibres to the otic ganglion (parotid gland).
Motor (one muscle: stylopharyngeus)

221
Q

What are the functions of CNX?

A

Tactile sense, pain and temperature from the pharynx, larynx, trachea, oesophagus and thoracic and abdominal viscera.
Taste (epiglottis)
Parasympathetic innervation to ganglia serving thoracic and abdominal viscera.
Motor (striated muscle of the pharynx and larynx) (cranial accessory contributes to this function).

222
Q

Where is the facial nerve nucleus located?

A

Caudal pons (3 parts)

223
Q

What are the 3 parts of the facial nerve nucleus?

A

Facial motor nucleus
Sup. salivatory (ps)
Solitary nucleus (taste)

224
Q

Where is the glossopharyngeal nerve nucleus located?

A

Upper medulla (4 components)

225
Q

What are the 4 components of the glossopharyngeal nerve nucleus?

A 
Solitary nucleus (taste)
Commissural (visceral)
Inferior salivatory (ps)
Nucleus ambiguous (stylopharyngeus muscle)
226
Q

Where is the vagus nerve nucleus located?

A

Upper medulla (4 components)

227
Q

What are the 4 components of the vagus nerve nucleus?

A

Solitary nucleus (taste)
Commissural (visceral)
Dorsal motor nucleus (ps)
Nucleus Ambiguus (motor)

228
Q

What nucleus is shared by CN VII, IX and X?

A

Solitary nucleus (taste and visceral sensory information)

229
Q

What nucleus is shared by CN VII, IX?

A

Inf. and Sup. Salivatory nuclei (parasympathetic efferents to ganglia of salivary glands and pterygopalatine ganglion)

230
Q

What nucleus is shared by CN IX and X (and cranial part of XI?

A

Nucleus ambiguus (motor efferents to muscles of pharynx and larynx)

231
Q

What shape do the solitary and commissural nucleus form?

A

V shape

232
Q

What is the corticobulbar tract?

A

Part of the pyramidal tract that is motor to cranial nerves

233
Q

Where does the input to CN’s containing parasymp efferents (VII, IX, X) mainly come from?

A

Hypothalamus whose efferents reach the preganglionic autonomic neurons both directly and via synapses in the reticular formation

234
Q

What is the reticular formation?

A

A network of loosely aggregated cells with cell bodies, axons and dendrites intermingling in the central core of the brainstem.

235
Q

What are the functions of the reticular formation?

A

Integrate cranial nerve reflexes
Participate in conduction and modulation of pain.
Influence voluntary movement
Regulate autonomic activity.
Integrate some basic functions, like respiration and sleep
Activate the cerebral cortex: major component of the Ascending Reticular Activating System

236
Q

Where do CN VI, VII, VIII exit?

A

At the pontomedullary junction

237
Q

What is the extracranial part of CNI?

A

Within olfactory mucosa in nasal cavity

238
Q

What is the cranial foramina of CNI?

A

Cribriform plate of ethmoid bone-anterior cranial fossa

239
Q

What is the intracranial part of CNI?

A

Olfactory nerves synapse in olfactory bulb

Then pass though the olfactory tract to cortical areas

240
Q

What is the extracranial part of CNII?

A

Neurons of retina travel posteriorly via optic nerve from posterior hemisphere of eye through orbit

241
Q

What is the cranial foramina of CNII?

A

Optic canal in middle cranial fossa

242
Q

What is the intracranial part of CNII?

A

Travels around pituitary stalk to optic chiasm to form optic tract. Connects with diencephalon

243
Q

How is CNI tested?

A

Ask patient to smell familiar smell while covering contralateral nostril

244
Q

How is CNII tested?

A 
Acuity (Snellen)
Colour (Ishihara plates-colour blindness)
Fields (quadrants)
Reflexes (corneal, pupillary light)
Fundoscopy
245
Q

What is the extracranial part of CNIII?

A

Passed through SOF into orbit (parasymps synapse in ciliary ganglion)

246
Q

What is the cranial foramina of CNIII?

A

SOF

247
Q

What is the intracranial part of CNIII?

A

Connects at midbrain

Travels towards orbit in lateral wall of cavernous sinus

248
Q

What is the extracranial part of CNIV?

A

Passed through SOF into orbit

249
Q

What is the cranial foramina of CNIV?

A

SOF

250
Q

What is the intracranial part of CNIV?

A

Connects with midbrain. Travels towards orbit in lateral wall of the cavernous sinus

251
Q

What is the extracranial part of CNVI?

A

Passed through SOF into orbit

252
Q

What is the cranial foramina of CNVI?

A

SOF

253
Q

What is the intracranial part of CNVI?

A

Connects at pontomedullary junction. Travels towards orbit within cavernous sinus

254
Q

What is the extracranial part of CNVIII?

A

Axons from cochlear and vestibular apparatus

255
Q

What is the cranial foramina of CNVIII?

A

IAM in posterior cranial fossa

256
Q

What is the intracranial part of CNVIII?

A

Travels posteromedially from the IAM to the pontomedullary junction.

257
Q

What is the extracranial part of CNXI?

A

Axons supply sternocleidomastoid (SCM) on deep surface, then continue across the posterior triangle to supply trapezius and (SCM)

258
Q

What is the cranial foramina of CNXI?

A

Jugular foramen In posterior cranial fossa

259
Q

What is the intracranial part of CNXI?

A

Connects with cervical spinal cord. Ascends through foramen magnum then travels towards jugular foramen

260
Q

How is CNXI tested?

A

Ask patients to shrug shoulders

Ask them to turn head to flex neck and turn towards opposite side

261
Q

Where do the cutaneous nerves of the cervical plexus pass deep to?

A

Midpoint of the posterior border of SCM, but not trapezius

262
Q

What is the extracranial part of CNXII?

A

Desends lateral to carotid sheath
At level of hyoid turns anteriorly towards lateral aspect of tongue
Supplies most muscles of tongue

263
Q

What is the cranial foramina of CNXII?

A

Hypoglossal canal (pcf)

264
Q

What is the intracranial part of CNXII?

A

Connects via many rootlets lateral to the pyramids of medulla oblongata. Passes anteriorly to hypoglossal canal

265
Q

What does CN XII innervate?

A

All -glossus muscles except palatoglossus (genio/stylo/hyoglossus and intrinsic tongue muscles)

266
Q

How is CNXII tested?

A

Ask patient to stick tongue straight out
If both CNXII’s are functioning normally the tongue tip remains in the midline on protrusion
If unilateral CNXII pathology tongue points towards side of injury

267
Q

Which division of CNV is sensory and motor?

A

V3-mandibular

268
Q

What is the extracranial part of CNV?

A

Sensory axons from all 3 divisions course, from superficial and deep structures, posteriorly, towards their foramen

269
Q

What is the cranial foramina of CNV?

A

V1-SOF
V2-Foramen rotundum
V3-Foramen ovale

270
Q

What is the intracranial part of CNV?

A

Inferior to edge of tentorium cerebelli between posterior and middle cranial fossa. Connects with pons

271
Q

What does CNV1 supply?

A
  • The upper eyelid
  • The cornea (corneal reflex)
  • All the conjunctiva
  • Skin of the root/bridge/tip of the nose
272
Q

What does CNV2 supply?

A
  • The skin of the lower eyelid
  • The skin over the maxilla
  • The skin of the ala of the nose
  • The skin/mucosa of the upper lip
273
Q

What does CNV3 supply (superficial sensory)?

A
  • Skin over the mandible and temporomandibular joint

apart from the angle of the mandible – supplied by C2,3 spinal nerves

274
Q

What is the deep sensory territory of CNV1?

A

Bones & soft tissues of the orbit (except the orbital floor & lower eyelid)
Upper anterior nasal cavity
Paranasal sinuses (except the maxillary sinus)
Anterior & posterior cranial fossae

275
Q

What is the deep sensory territory of CNV2?

A

Lower posterior nasal cavity
Maxilla & maxillary sinus
Floor of the nasal cavity/palate
Maxillary teeth & associated soft tissues (gingivae & mucosae)

276
Q

What is the deep sensory territory of CNV3?

A 
Middle cranial fossa
Mandible
Anterior 2/3rds of the tongue
Floor of the mouth
Buccal mucosa
Mandibular teeth & associated soft tissues
277
Q

What does CNV3 supply (motor)?

A 
Masseter
Temporalis
Medial pterygoid
Lateral pterygoid 
Tensor veli palatine
Tensor tympani
278
Q

How is the sensory component of CNV tested?

A

Ask patient to close eyes
Brush skin in each dermatome with cotton wool
Ask patient to tell you when they feel skin being touched
Compare 2 sides

279
Q

How is the motor component of CNV tested?

A

Palpate strength of contraction of masseter and temporalis by asking patient to clench teeth
Ask patient to open their jaw against resistance

280
Q

What is the extracranial part of CNVII?

A

Most somatic motor axons pass into the parotid gland then into 1 of the 5 branches that supply the muscles of facial expression

281
Q

What is the cranial foramen of CNVII?

A

Temporal bone- IAM (in), stylomastoid foramen (out)

282
Q

What is the intracranial part of CNVII?

A

Directly into IAM in the pcf. Connects anterolateral to pontomedullary junction

283
Q

What does the chorda tympani do?

A

Taste buds of anterior 2/3 tongue

Parasymp supply to submandibular/lingual glands

284
Q

What supplies stapedius?

A

CNVII

285
Q

What are the muscles of facial expression?

A

Frontalis, orbicularis oculi, elevators of lips, orbicularis oris

286
Q

How can the motor function of CNVII be tested?

A

Raise eyebrows
Close eyes tightly
Smile
Puff out cheeks and hold air

287
Q

What types of nerve make up CNIX?

A

Special sensory (Taste), Sensory, Motor, Visceral afferent and Parasympathetic

288
Q

What is the intracranial part of CNIX?

A

Directly towards jugular foramen in pcf. Connects with lateral aspect of superior medulla oblongata

289
Q

What is the extracranial part of CNIX?

A

Descends towards pharynx and mouth to stylopharyngeus, parotid gland, pharyngeal mucosa, carotid body and sinus, posterior 1/3 of tongue

290
Q

What is the cranial foramen of CNIX?

A

Jugular foramen

291
Q

What does CNIX provide the general sensory supply of?

A

The posterior 1/3rd of the tongue
The mucosa of most of the nasopharynx and oropharynx
The mucosa of some of the laryngopharynx (some overlap with CN X territory)
The palatine tonsil
The eustachian tube
The middle ear cavity

292
Q

What does CNIX provide the special sensory supply of?

A

Vallate papillae of posterior 1/3 tongue

293
Q

What does CNIX provide the visceral afferent supply of?

A

Carotid sinus baroreceptors and carotid body chemoreceptors

294
Q

What does CNIX provide the somatic motor supply of?

A

Stylopharyngeus

295
Q

What does CNIX provide the parasym supply of?

A

Parotid gland

296
Q

What nerve axons form the afferent limb of the gag reflex?

A

CNIX

297
Q

What is the cranial foramen of CNX?

A

Jugular foramen

298
Q

What is the intracranial part of CNX?

A

Directly towards jugular foramen in pcf. Connects with lateral aspect of medulla oblongata, immediately inferior to CNIX

299
Q

What is the extracranial part of CNX?

A

Axons supply lots of structures between palate and midgut

300
Q

What types of nerve are involved in CNX?

A

Sensory, Motor, Visceral afferent and Parasympathetic

301
Q

Where does CNX travel within the neck?

A

Within the carotid sheath, posterior to and between the common carotid artery and IJV

302
Q

Where do the recurrent laryngeal nerves curve under?

A

Left: arch of aorta
Right: right subclavian artery

303
Q

What branches of CNX exist in the abdomen?

A 
Both CNs X pass onto stomach surface
Celiac and superior mesenteric ganglia
Splenic branches 
Pancreatic branches
Foregut branches 
Midgut branches
Renal branches
304
Q

Where do the very last ps axons of CNX pass to?

A

The splenic flexure of the colon

305
Q

How is CNX tested?

A

Patient says ‘ah’ (palate muscles)
Uvula goes to functioning side if unilateral pathology

Patient swallows water (pharyngeal muscles)
Larynx movement, splutter may suggest abnormality

Listen to speech (laryngeal muscles)
Hoarseness may indicate abnormality

306
Q

What are the 5 layers of the scalp?

A 
Skin
Connective tissue
Aponeurosis
Loose connective tissue 
Pericranium
307
Q

Where are the named arteries of the scalp located?

A

Layer 2- connective tissue

308
Q

What do the scalp arteries form just deep to the skin?

A

An anastomotic network

309
Q

Where does the middle meningeal artery course over?

A

The deep aspect of the pterion

310
Q

What are the layers of the meninges?

A

Dura mater- tough/fibrous. Sensory from CNV, enclodes dural venous sinuses
Arachnoid mater- arachnoid granulations (reabsorb CSF)
Subarachnoid space
Pia mater- adherent to brain and vessels entering or leaving brain

311
Q

What is the diaphragm sellae?

A

A tough sheet of dura mater forming a roof over the pituitary fossa

312
Q

What is the tentorium cerebelli?

A

Tough sheet of dura mater tenting over cerebellum
Attaches to ridges of petrous temporal bones
Central gap to permit the brainstem to pass through

313
Q

What is the falx cerebri?

A

Midline structure made of dura mater
Attaches to deep aspect of skull: crista galli of ethmoid bone anteriorly
internal aspect of sagittal suture
internal occipital protruberane of occipital bone posteriorly
Separates hemispheres

314
Q

What is the venous drainage of the brain?

A

Facial vein
Ophthalmic veins
Cavernous sinuses
Cerebral veins
Drain into superior and inferior sagittal sinuses
They drain into the sigmoid sinuses which drains into the IJV

315
Q

What is the arterial supply to the brain?

A

Vertebral arteries

Internal and external carotids

316
Q

What contains arterial branches supplying the brainstem and cerebellum?

A

Circle of Willis

317
Q

Where is the circle of Willis located?

A

Inferior to midbrain, closely related to pituitary stalk and optic chiasm, within the subarachnoid space

318
Q

Where is CSF reabsorbed?

A

Dural venous sinuses via arachnoid granulations

319
Q

Where can the subarachnoid space be accessed?

A

Via LP at L3/4 or L4/5 IV disc levels

320
Q

Where does the subarachnoid space end?

A

At the level of the S2 part of the sacrum

321
Q

What causes hydrocephalus?

A

Excessive production, obstruction to flow or inadequate reabsorption leads to an increased CSF volume

322
Q

What may cause an extradural haemorrhage?

A

Ruptured MMA- trauma to pterion

323
Q

What may cause a subdural haemorrhage?

A

Torn cerebral veins- falls in elderly

324
Q

What may cause a subarachnoid haemorrhage?

A

Ruptured circle of Willis (berry) aneurysm

Congenital aneurysm

325
Q

In epidural anaesthesia and an LP, where does the catheter/needle pass through?

A 
Both through:
supra-, then interspinous ligaments
Ligamental flavum
Epidural space (fat and veins)
Needle continues on to:
Through dura and arachnoid mater to obtain CSF
326
Q

What can result in an epidural haematoma compressing spinal cord and cauda equine?

A

Damage to the extradural venous plexus

327
Q

Where is the needle for an LP most safely inserted?

A

Where the SA space surrounds the cauda equine, not spinal cord
Where the vertebrae are not fused

328
Q

When should a LP not be performed?

A

In cases of raised ICP

329
Q

Describe the fibres superior to the cochlear nuclei

A

Some are crossed and some are not, therefore input above this level is essentially bilateral

330
Q

What are the superior olivary nucleus and nucleus of lateral lemniscus important in?

A

Sound localisation and as relays for stapedial and tensor tympany reflexes

331
Q

What type of organisation is present in the auditory cortex?

A

Tonotopic- low frequency at anterolateral part, high frequency at posteromedial part

332
Q

What happens if Broca’s area is damaged?

A

Patient’s have difficulty in producing language, often using few words and only saying the most important words in a sentence. Don’t usually have difficulty comprehending language. Known as Broca’s, motor or expressive aphasia

333
Q

What happens if Wernicke’s area is damaged?

A

Patient’s have difficulty comprehending language. These patients can manifest defects ranging from words out of order to meaningless words.
Known as Wernicke’s, sensory or receptive aphasia

334
Q

What does maintenance of equilibrium use information from?

A

Vision, proprioception, vestibular apparatus

335
Q

What areas of the brain receive vestibular input?

A

Posterior insula, region of parietal lobe just posterior to the postcentral gyrus and midway between apex of brain and lateral fissure

336
Q

What do the superior colliculi provide output to?

A

Nuclei of CNIII, IV and VI, and motor nucleus of VII, and spinal cord

337
Q

Where does the lower visual field project to?

A

The gyrus superior to the calcarine sulcus

338
Q

Where does the upper visual field project to?

A

The gyrus inferior to the calcarine sulcus

339
Q

Where does the macula project to?

A

The posterior pole of the visual cortex and occupies a much greater proportion of the cortex relative to the size of the visual field it covers

340
Q

What roles do the visual cortex and frontal eye fields have in eye movement?

A

Visual cortex- provides for movements in response to visual stimuli, such as tracking moving objects
Frontal eye fields- control movements of command, as in movements that are independent of moving visual stimuli

341
Q

What does the accommodation reflex require input to?

A

Oculomotor and Edinger-Westphal nucleus from the visual cortex

Neurology (27 decks)

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