Anatomy CN 8 Flashcards

1
Q

What is the auricle (pinna)?

A

outer ear structure a part of the external ear

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2
Q

What is the external auditory canal?

A
  • part of the external ear

- tube connecting auricle to ear drum

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3
Q

What is the ear drum? What 3 things is it composed of?

A
  • Tympanic membrane

- sheet across the external auditory canal composed of epidermis, epithelium and CT fibers (elastic)

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4
Q

What is the middle ear filled with?

A

Small air filled cavity

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5
Q

What are the smallest bones of the body?

A

Auditory ossicles

  1. Malleus
  2. Incus
  3. Stapes
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6
Q

What two things does the malleus (hammer) connect?

A

Hammer connects ear drum to anvil (incus)

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7
Q

What two things does the incus (anvil) connect?

A

Hammer (malleus) to stirrup (stapes)

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8
Q

What two things does the stapes (stirrup) connect?

A

Anvil (incus) to the oval window

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9
Q

What is the oval window?

A

Membrane covered opening into perilymph of cochlea

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10
Q

What is the membrane covered opening into perilymph at the other end of cochlea?

A

Round window

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11
Q

What two muscles (and what are they innervated by) contract to prevent damage to middle ear structures by loud noise?

A
tensor tympani (CN V3)
stapedius (CN 7)
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12
Q

What connects the middle ear chamber to nasopharynx (upper throat)?

A

opening to the auditory tube (eustachian tube)

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13
Q

What does the auditory tube (eustachian tube) do to the middle ear?

A

Equilibrate pressure

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14
Q

What is another name for the inner ear?

A

Labrynth

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15
Q

The bony labyrinth is lined by _____ and contains _____

A

Periosteum and contains parilymph

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16
Q

The semicircular canals of the inner ear contain what type of sensory receptors?
What is their purpose?

A
Crista ampullaris 
For equilibrium (angular)
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17
Q

T/F The semicircular canals lie at right angles to each other in 2 geometric planes

A

False, 3 geometric planes

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18
Q

The vestibule of the inner ear contains what type of sensory receptors?
What are their purpose?

A

Contain macula for equilibrium (linear)

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19
Q

The cochlea of the inner ear contain what type of sensory receptors?

A

Spiral organ of corti for hearing

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20
Q

What are the sacs and tubes inside the bony labyrinth that have the same shape as the inside of the bony labyrinth?
What is it filled with?

A

Membranous labyrinth filled with endolymph

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21
Q

What is the membranous sac in the vestibule that is connected to semicircular canals?

A

Utricle

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22
Q

What is the membranous sac in the vestibule that is connected to the utricle?

A

Saccule

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23
Q

What is the purpose of the cochlear duct in the inner membranous labyrinth?

A

For hearing

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24
Q

CN8 special sensory innervation of what two organs and for what function?

A
  1. vestibular and semicircular canal organs to function in equilibrium
  2. cochlear organ to function in hearing
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25
Q

The vestibular branch of CN 8 travels through what ganglion?

A

Superior and inferior vestibular ganglion

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26
Q

The cochlear branch of CN 8 travels through what ganglion?

A

spiral ganglion

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27
Q

The auditory apparatus the spiral organ of corti do what?

A

Sensory/receptor for hearing

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28
Q

The hair cells of the ear are stereocilia embedded in what matrix?

A

Tectoral membrane which is stationary

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29
Q

The base of hair cells are attached to the basilar membrane which is the floor of what?
Separate what two things?

A

Floor of the cochlear duct separating endolymph (inner tube = membranous labyrinth) from perilymph in cochlea bony labyrinth which ends at the oval and round membranes

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30
Q

T/F Basilar membrane/hair cells move in response to sound

A

True

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31
Q

T/F The auditory apparatus does not have support cells

A

False, it does

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32
Q

What is the spiral core of the cochlear bony labyrinth?

A

Modiolus

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33
Q

The spiral organ of Corti consists of hair cell layer on basilar membrane arranged around modiolus embedded in tectoral membrane the (move/do not move)?

A

Do not move

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34
Q

Pitch is the _____ of sound waves

A

Frequency

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35
Q

amplitude is the ______ of sound waves

A

Loudness

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36
Q

Pitch plus amplitude =

A

Tone

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37
Q

How are sound waves from a vibrating object directed to eardrum?

A

By auricle and external auditory canal

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38
Q

T/F Sound waves cause eardrum to vibrate

A

True

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39
Q

How is the amplified vibration transmitted to the oval window?

A

By the auditory ossicles ear drum -> malleus -> incus -> stapes -> oval window

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40
Q

Pressure waves travel in what two lymphs?

A

peri and endolymph

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41
Q

Frequency + amplitude = tone result from discriminative movement of spiral organ of corti/basilar membrane and bends what?

A

Bends stero-cilia/kinocilium of hair cells embedded in tectoral membrane which does not vibrate

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42
Q

If the stereo-cilia/kinocilium of hair cells bend laterally -

A

depolarization -> release chemical messenger -> stimulate peripheral process of auditory sensory neuron

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43
Q

If the stereo-cilia/kinocilium of hair cells bend medial -

A

Hyperpolarization -> inhibition

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44
Q

T/F The entire spiral organ of Corti is stimulated by sounds of different pitch

A

False, different areas of spiral organ of Corti are stimulated by sounds of different pitch

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45
Q

What type of neuron in the spiral ganglia (in center, modiolus, of cochlea) of auditory pathway?

A

Bipolar Neuron

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46
Q

The auditory nerve pathway signal travels on what nerve?

A

Cochlear nerve

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47
Q

How does the cochlear nerve enter the skull?

A

Travels through the petrous portion of temporal bone exiting internal auditory meatus

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48
Q

How does the cochlear nerve enter the brain stem and what nuclei does it synapse with?

A

Enters brainstem at junction of pons and medulla and synapses with dorsal/ventral cochlear nuclei in tonotopic manner

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49
Q

The cochlear nuclei ascend to what three things?

A
  1. Bilateral direct connections through superior olivary complex (cross over at trapezoid body)
  2. Contralateral indirect connections to inferior colliculus via the lateral lemniscus
  3. Reticular formation
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50
Q

After the inferior colliculus, the signal travels to what 3 places?

A
  1. Medial geniculate body of thalamus -> auditory cortex (superior medial temporal lobe)
  2. Tectospinal head turning reflex
  3. Reticular formation
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51
Q

The bilateral projection of auditory signals to cortex allows for what?

A

Discrimination of sound differences in each ear

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52
Q

What is linear acceleration? Angular?

A

Linear - change in velocity when traveling in one direction

Angular - change in velocity when rotating

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53
Q

What is the organ of equilibrium?

A

Vestibular apparatus

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54
Q

What is the Macula and what does it do?

A

2 thickened regions in walls of utricle and saccule- sensory receptor for linear acceleration

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55
Q

The hair cells of the macula are what?

A

stereo-cilia (microvilli)

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56
Q

What is the otolithic membrane?

A
  • Extracellular matrix of gelatinous material secreted by supporting cells
  • Has calcium carbonate crystals called otoliths
  • Stereo-cilia and cilia of the hair cells are embedded in the otolithic membrane
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57
Q

How are the macula of the utricle and saccule arranged to each other?

A

Arranged at right angles

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58
Q

Body movement causes the otolithic membrane to move and bend the stereocilia of the hair cells resulting in what two possibilities?

A
  1. membrane depolarization = generate AP in vestibulochoclear nerve
  2. Hyperpolarization = inhibit AP
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59
Q

What is the organ for angular acceleration?

A

Crista ampularis - elevations in lumen of each semicircular canal

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60
Q

The hair cells of the crista ampularis contain what two thigns?

A
  1. Stereocilia

2. Kinocilia

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61
Q

What matrix is the stereocilia of the hair cells of the crista ampularis embedded in?

A

Cupula gelatinous extracellular matrix

62
Q

When the head rotates, the stereocilia of hair cells in crista ampularis will do what two things?

A
  1. Membrane depolarization to generate AP in vestibular nerve on one side
  2. Membrane hyperpolarization to inhibit signaling of vestibular n on the other side
63
Q

What begins equilibrium pathway?

A

Bending stereocilia of hair cell

64
Q

The equilibrium pathway change in pattern travels on what type of neuron through what ganglia?

A

Peripheral axon = bipolar neuron in vestibular ganglia

65
Q

The central axon of the equilibrium pathway forms what?

A

Vestibular branch of vestibulocochlear nerve

66
Q

Equilibrium pathway fibers from these areas go where?
Semicircular canal ->
Utricle maculae ->
Saccule maculae ->

A

Semicircular canal -> superior and medial vestibular nuclei
Utricle maculae -> lateral vestibular nucleus
Saccule maculae -> lateral and inferior vestibular nuclei

67
Q

The vestibular nuclei of the equilibrium pathway project to what 5 areas:

A
  1. Cerebellum flocculonodular lobe
  2. Cervical spinal cord head turning muscles (medial vestibulospinal tract)
  3. Both cervical and lumbar spinal cord extensor m (lateral vestibulospinal tract)
  4. CN 3, 4, 6 nuclei (MLF)
  5. MLF -> bilateral ventro-basal complex of the thalamus -> premotor and other regions of cerebral cortex = postcentral and adjacent associative cortex dealing with head proprioception
68
Q

How does the cerebellum project back to vestibular nuclei in the equilibrium pathway?

A

fastigial nucleus

69
Q
Basal nucleus (ganglia) components:
Caudate function?
A

Functions primarily in emotional/cognitive

70
Q
Basal nucleus (ganglia) components:
Striatum (neostriatum)
A

caudate + putamen

71
Q

What is the ventral striatum? What does it contain? What is its function?

A
  • Area of striatum where caudate joins putamen
  • Contains nucleus accumbens
  • Function primarily limbic
72
Q
Basal nucleus (ganglia) components:
Globus pallidus (GP) (internus/externus)
A
Internus = medial GP
Externus = lateral GP
73
Q

WHat two things make up the lentiform?

A

putamen + globus pallidus

74
Q
Basal nucleus (ganglia) components:
What do you find in the substantia nigra?
A
  1. Compacta (dopamine)

2. Reticularis

75
Q

What is the overall function of the basal ganglia?

Describe behavior and motor aspects.

A

Psychomotor:
Behavior - goal directed behavior, social behavior, emotions
Motor - decision making (initiation), judgment (force), prioritizing (multi-join movement and sequencing), emotional response, learning, eye movements, spatial attention

76
Q

T/F The BG acts by increasing excitatory input to the motor cortex

A

False, it acts by reducing excitatory input to the motor cortex (inhibitory)

77
Q

T/F most afferent input to BG is excitatory

A

True

78
Q

Where does the BG receive afferent input from (3 places)?

A
  1. Cerebral cortex (glutamate - excitatory)
  2. Pedunculopontine nucleus (PPN) (glutamate & AcH - excitatory)
  3. Raphe nucleus (serotonin - inhibitory)
79
Q

What NT sends efferent output from BG?

A

GABA - inhibitory

80
Q

What three places do efferent output from BG go to?

A
  1. Thalamus - VA and VL = motor & MD = limbic to decrease activity precentral gyrus
  2. . Pedunculopontine nucleus (PPN; part of reticular formation) to increase activity of axial, postural muscles
  3. Tectum to decrease activity of stepping pattern generators (walking); affect reflex eye movements
81
Q

Non motor BG loops:

Goal directed behavior loop (pathway and role)

A
  1. Prefrontal cortex -> caudate -> GPi -> decrease activity VA thalamus
  2. Decision making, goal directed behavior, planning, choose action, learning
82
Q

Non motor BG loops:

Social behavior loop (pathway and role)

A
  1. Prefrontal cortex -> head/caudate nucleus + Substantia nigra reticularis -> Mediodorsal thalamus
  2. Recognize social cues, regulate self control, evaluates what information is relevant and irrelevant
83
Q
Non motor BG loops:
Emotion loop (pathway and role)
A
  1. Prefrontal cortex -> striatum -> Mediodorsal thalamus

2. Link emotions to cognitive and motor systems, reward seeking, outcome predictions (emotions to facial expressions)

84
Q
Motor BG loops:
Oculomotor loop (pathway and role)
A
  1. Frontal and supplementary eye fields -> caudate nucleus -> Substanta nigra reticularis -> decrease activity VA thalamus allow for reflexive prosaccades
  2. Spatial attention, initiate fast eye movements toward an object = prosaccades
85
Q

Motor loop Basal ganglia (pathway and role)

A
  1. Motor and premotor cortex -> affect level of GAB inhibitory activity of GPi
  2. Muscle contraction, muscle force, multi-joint movements, muscle sequencing
86
Q

The motor loop of the BG sends output to what 3 locations?

A
  1. motor cortex = voluntary movement
  2. PPN = posture muscle control
  3. Midbrain tectum (superior colliculus) = eye movements and step generator = walking
87
Q

General role hyperdirect no go pathway of BG motor pathway:

A

Uses subthalamic nucleus which stimulates GPi

88
Q

Describe the hyperdirect no go pathway from cortex (BG motor pathway)

A

Cortex -> subthalamic nucleus -> GPi activity increases -> resulting in:

  1. inhibition of motor thalamus = precentral gyrus
  2. inhibit PPN = increase activity reticulospinal tract/postural and girdle muscles (inhibit and inhibitor = disinhibition)
  3. Inhibit midbrain locomotor/step pattern generator
89
Q

General role of go pathway of BG motor pathway:

A

Direct pathway decreases activity of GPi

90
Q

Describe the go pathway from cortex (BG motor pathway)

A

Cortex -> putamen -> decreases activity of GPi (stimulate an inhibition of GPi so activity GPi decreases) resulting in:

  1. Disinhibition motor thalamus/cortex to increase precentral gyrus activity
  2. Disinhibition PPN to inhibit reticulospona/postural and girdle muscle activity
  3. Disinhibition midbrain locomotor/step pattern generator
91
Q

Basic role of no go pathway in BG motor pathway

A

Indirect pathway works by inhibiting GPe which normally inhibits GPi = disinhibition to increase activity of GPi

92
Q

Describe the no go pathway from cortex (BG motor pathway)

A

Cortex -> putamen -> decrease activity of GPe which was an inhibitor of GPi so GPi activity goes up & GPe disinhibits STN which will stimulate GPi (increase activity) resulting in:

  1. Inhibit motor thalamus/cortex
  2. Inhibit PPN = increase reticuluospinal/postural and girdle muscle activity
  3. Inhibit midbrain locomotor/step pattern generator
93
Q

Substantia nigra modulates neostriatum to modulate what structure?

A

GPi

94
Q

Substantia nigra reticularis:
Input =
Output =

A
Input = GABA inhibitory from neostriatum
Output = GABA inhibitory to:
1. substantia nigra compacta 
2. Midbrain tectum (superior colliculus)
3. Motor thalamus (VA, VL)
95
Q

Substantia nigra compacta:
Input =
Output =

A
Input = GABA inhibitory from substantia nigra reticularis 
Output = dopamine stimulation (D1 receptor) and inhibition (D2 receptor) of neostriatum
96
Q

Substantia nigra reticularis pathway from cortex->

A

Cortex -> stimulate putamen -> inhbit SN reticularis resulting in:

  1. Disinhibition thalamus -> increase motor cortex activity
  2. Disinhibition tectum -> increase eye movement step generator
  3. Disinhibition SN compacta
97
Q

Substantia Nigra compacta putamen D1 receptor ->

A

Stimulates go pathway resulting in:

  1. Disinhibition on thalamus -> increase motor cortex activity limbs
  2. Disinhibition PPN -> decrease reticulo and vestibulospinal tract activity to decrease activity of postural muscles
98
Q

Substantia Nigra compacta putamen D2 receptor ->

A

Inhibit no go pathway resulting in:

  1. Disinhibition on thalamus -> increase motor cortex activity limbs
  2. Disinhibition PPN -> decrease reticulo and vestibulospinal tract activity to decrease activity of postural muscles
99
Q

When substantia nigra compacta putamen D1 and D2 receptors is results in =

A

Stimulates voluntary movement

Inhibits postural muscles

100
Q

Describe disease states:

Parkinson’s Disease (hypokinetic)

A
  1. Due to loss of dopamine from sunstantia nigra pars compacta
  2. Go pathway no longer stimulated = decrease thalamic motor activity
  3. No go pathway no longer inhibited = decrease thalamic motor activity
101
Q

Describe disease states:

Huntington’s Disease (hyperkinetic)

A
  1. Due to loss of GABA from neostriatum

2. No go pathway no longer inhibits thalamus = increase thalamic motor activity

102
Q

What are the functions of the cerebellum?

A
  1. Modulation of somatomotor signaling
  2. Balance
  3. Tone
103
Q
Cerebellum anatomy:
Vermis - 
Cortex - 
White matter below cortex - 
Nuclei -
A

Vermis - jois 2 hemis
Cortex - gray matter
White matter below cortex - afferent and efferent axons
Nuclei - gray mater located in white matter

104
Q

Anterior lobe (paleocerebellum) receives what signals and what are its functions?

A
  1. Receives spinal cord afferents (spinocerebellum)

2. Functions in controlling axial muscle tone and degree of flexion and extension

105
Q

Posterior lobe (neocerebellum) receives what signals and what are its functions?

A
  1. Is linked input and output to the cerebral cortex (cerebrocerebellum)
  2. Functions in planning, organization, and coordination fo motor activity
106
Q

Flocculonodular lobe receives what signals and what are its functions?

A
  1. Receives input from the vestibular system (vestibulocerebellum)
  2. Control of eyes and head position
107
Q

Lateral anterior/posterior lobe signals?

A

Efferent fine motor to limbs

108
Q

Vermal/paravermal (medial ant/post lobe) signals?

A

efferent axial muscles for head turning, posture, and tone

109
Q

Fastigial nucleus -

A

relay efferent signals to vestibular nuc and reticular formation

110
Q

Dentate nucleus -

A

relay efferent signals to cortex via superior colliculus

111
Q

interposed nucleus:
globose nucleus -
emboliform nucleus -

A

globose nucleus - efferent to red nucleus

emboliform nucleus - efferent to red nucleus

112
Q

Inferior peduncles -

A

afferent from spinal cord/medulla (cuneocerebellar, rostrocerebellar, and posterior spinocerebellar)

113
Q

Middle peduncle -

A

afferent from cerebral cortex to cerebellum via pontine nucleus

114
Q

Superior peduncle -

A

efferent from cerebellar nuclei to brain stem and cortex (anterior spinocerebellar)

115
Q

How does CSF enter subarachnoid space from Cerebellum?

A

2 lateral foramen of Lushka

Median foramen of Magendie

116
Q
Afferent input to cerebellum:
Spinal cord (body) -
A

To vermis and perivermal cortex of anterior and adjacent posterior lobes

117
Q

Dorsal spinocerebellar from body to cerebellum carries what?

A

proprioception of legs

118
Q

Ventral spinocerebellar from body to cerebellum carries what?

A

monitor ventral horn activity of leg spinal cord segments

119
Q

Cuneocerebellar from body to cerebellum carries what?

A

proprioception of arms

120
Q

Rostrocerebellar from body to cerebellum carries what?

A

monitor ventral horn activity of arm spinal cord segments

121
Q

Inferior olivary nucleus acts as relay receiving input from where and sends output to where?

A

Receives:
1. Spinal cord proprioception
2. Sensory motor cerebral cortex -> red nucleus -> inferior olivary nucleus
Output:
1. To ant and post lobes of cerebella hemis

122
Q

The vestibular apparatus acts as direct connection between what nuclei and what lobe?

A

Vestibular nuclei and the flocculonodular lobe

123
Q

Reticular formation carries afferent signals to what part of cerebellum?

A

Vermis and paravermis of ant and post lobes

124
Q

The cerebral cortex sends afferent signals to cerebellum via these three tracts?

A
  1. Red nucleus -> inferior olivary nucleus -> ant and post lobes of cerebellum hemi
  2. Deep pontine nuclei -> ant and post lobes and cerebellar hemi
  3. Reticular formation -> vermis and paravermis of ant and post lobes
125
Q

The tectum sends signals to cerebellum -

A

superior/inferior colliculi to ant and post lobes of cerebellar hemi

126
Q

The mesencephalic trigeminal nucleus sends signals where in cerebellum?

A

vermal and paravermal regions

127
Q

Afferent neurons from input sources to cerebellum have what 2 fiber types?

A
  1. Mossy

2. Climbing

128
Q

What are mossy fibers?

What 3 things do they synapse with?

A
  • Glutamate excitatory fibers from all areas of afferent input except inferior olivary nucleus
  • Synapse with:
    1. Deep cerebella nuclei
    2. Excitatory granule cells of cortex
    3. Inhibitory golgi cells of cortex
129
Q

What are climbing fibers?

What 2 things do they synapse with?

A
  • Glutamate excitatory fibers from inferior olivary nucleus that synapse with:
    1. Deep cerebellar nuclei
    2. Purkinje cells of cortex making the refractile to granule cell stimulation
130
Q

The cerebellar cortex granule cell layer has what two cell types?

A

Innermost layer:

  1. Granule cells
  2. Golgi cells
131
Q
Granule cells
What NT? Excitatory/Inhibitory?
What type of neuron? What cells do they stimulate?
What will they influence?
What cell will they also stimulate?
A

Glutamate excitatory cells with diverging collaterals capable of exciting many purkinje cells by parallel fiber activation to influence broad regions of body musculature simultaneously (also stimulates basket cells)

132
Q

Golgi cells
What NT? Excitatory/Inhibitory?
What two possible fibers stimulate golgi cells?

A
  • GABA inhibitory interneurons that inhibit granule cells
  • Stimulated by afferent fibers or granule cells themselves
  • Limit granule cell excitation to a burst
133
Q

Granule cells turn itself off by activating what type of cell?

A

Golgi

134
Q

Purkinje cell layer (middle layer) has what cell types?

A

Purkinje cells

135
Q

Purkinje cells
What NT? Excitatory/Inhibitory to what nuclei?
What are they stimulated by?
What are they inhibited by?

A
  • GABA inhibitory cells which inhibit deep cerebellar nuclei
  • Stimulated by granule cells via parallel fiber activation
  • Inhibit by basket cells
136
Q

Vermal perkinje cells project to -

A

fastigial nucleus

137
Q

Anterior and posterior lobe purkinje cells project to -

A

dentate nucleus

138
Q

Paravermal purkinje cells project to -

A

interposed nucleus

139
Q

Some anterior lobe purkinje cells project to

A

vestibular nucleus

140
Q

Purkinje cell interconnections can be changed to facilitate what?

A

Motor learning

141
Q

The molecular layer (surface layer) contains basket cells.

What are they stimulated by and why?

A
  • Stimulated by granule cells to inhibit Purkinje cells adjacent to those stimulated by granule cells to focus granule cell stimulation
142
Q

Mossy fiber and climbing fiber afferents initially excite deep cerebellar nuclei to stimulate what?

A

Excitatory cerebellar efferent signals

143
Q

Mossy fiber and climbing fiber afferents also activate what type of cell in the cerebellar cortex?

A

Purkinje cells

144
Q

Purkinje cells have what affect of deep cerebellar nuclei

A

inhibition

145
Q

Deep cerebellar nuclei are disinhibited when what occurs to purkinje cells?

A

Purkinje cells are inhibited by golgi cell mediated granule cell inhibition to stop purkinje stimulation

146
Q

Efferents from cerebellum are (inhibitory/excitatory) and come from the where?

A

Excitatory and come from deep cerebellar nuclei

147
Q

Cerebellar pathways:
Mossy fiber afferent stimulation from
vestibular system ->

A
  1. (+) -> fastigial nucleus -> vestibular nucleus -> head/eye = balance + vestibulospinal tract (axial posture and tone)
  2. Cerebellar cortex (flocculonodular lobe + posterior vermis) -> purkinje cell inhibition -> (-) on fastigial nucleus
148
Q

Cerebellar pathways:

Mossy fiber afferent stimulation from pontine/medularry reticular nucleus ->

A
  1. (+) fastigial nucleus -> reticular nucleus -> reticulospinal tract (axial posture + tone)
  2. Cerebella cortex (vermal and paravermal) -> purkinje cell inhibition -> (-) fastigial nucleus
149
Q

Cerebellar pathways:

Mossy fiber afferent stimulation from the 4 spinocerebellar tracts ->

A
  1. (+) fastigial nucleus -> reticulospinal, vestibulospinal tracts and MLF
  2. Cerebellar cortex (vermal and paravermal) -> purkinje cell inhibition -> (-) fastigial nucleus
150
Q

Cerebellar pathways:

Cerebral cortex -> red nucleus

A
  • > Red nucleus -> inferior olivary nucleus -> climbing fiber afferent stimulation from inferior olivary nucleus:
    1. (+) Interposed nucleus -> red nucleus -> rubrospinal tract (hand extensors)
    2. Cerebellar cortex (lateral anterior and posterior lobes) -> purkinje cell inhibition -> (-) interposed nucleus
151
Q

Cerebellar pathways:

Cerebral cortex -> deep pontine nucleus

A
  • > mossy fiber afferent stimulation from deep pontine nucleus ->
    1. (+) dentate nucleus -> Ventrolateral thalamus -> motor cortex -> fine movement
    2. Cerebellar cortex (vermal and paravermal) -> purkinje cell inhibition -> (-) dentate nucleus