brain stem lesion_lecture

Question 0

Is it possible for the damage condition results in activation of parts of brain?

Answer 0

Yes, example is seizure.

Question 1

Is the nervous system response to the damage injury type specific?

Answer 1

No

Question 2

What indicates that the lesion is likely to be at the brain stem?

Answer 2

If signs and symptoms involve cranial nerves on one side and the opposite side of the body.

Question 3

Where the lesion likely to be if symptoms involve motor cranial nerves and weakness in the body?

Answer 3

Probably medial brain stem. Since most cranial nerve connected to one side of the brain and connect to two things on the sam side of the head. Most tracts are crossed before they reach the brain stem.

Question 4

What are the exception to the motor cranial nerve - medial lesion generalization?

Answer 4

Facial, vagus and mastication

Question 5

What is the symptom if the brain stem lesion turns to be lateral?

Answer 5

Symptoms involves sensory cranial nerves and loss of pain and temperature sense in the body.

Question 6

Where does the lesion most commonly occur?

Answer 6

The level of lesion is probably at the level of the cranial nerve nucleus and /or its exit from the brain.

Question 7

Where most likely is the lesion if the symptom includes loss of facial pain and temperature sensation?

Answer 7

Spinal trigeminal tract/nucleus in lateral medulla

Question 8

Where is the lesion most likely if the symptoms involves weakness of lower face -with preservation of forehead strength?

Answer 8

Above pons on contralateral side in corticobulbar tract.

Question 9

Does stroke affect the muscles of upper face or lower face more often?

Answer 9

Lower face. Will learn later that the control mechanisms are different for upper and lower face.

Question 10

What is the symptoms involves lesion at the dorsal column-medial lemniscus pathway?

Answer 10

• loss of vibratory sense, joint position sense, well-localized touch and pressure.
• ipsilateral dorsal columns in caudal medulla; counterlateral above decussation.

Question 11

What are the possible symptoms related to damage in spinothalamic tract ( ALS)?

Answer 11

• loss of pain and temp sense on contralateral side of the body
• lateral brain stem and anterolateral cord

Question 12

What is the result of thalamic lesion?

Answer 12

Loss of sensation contralaterally.

Question 13

Where is the most likely location for the long tract?

Answer 13

Not really. Anywhere is possible.

Question 14

What are the landmarks that the corticospinal tract passes?

Answer 14

• posterior limb of IC
• cerebral peduncle
• base of pons
• medullary pyramid

Question 15

If the corticospinal tract symptoms are bilateral, where is the lesion most likely to be?

Answer 15

Pyramidal decussation

Question 16

What is the upper motor neuron sign?

Answer 16

A constellation of symptoms, involving the control neurons for the motor neurons, loss of motor function and increase in overactive reflexes. Also some pathological reflex, that is supposed to be suppressed in adulthood.

Question 17

What are the symptoms that most likely involve lesion with corticobulbar fibers?

Answer 17

Contralateral lower face; some weakness of contralateral tongue and soft palate.

Question 18

What is hypothalamospinal system?

Answer 18

A series of pathway that works their way, usually through multiple relays, that begins at hypothalamus and works their way down to the spinal cord. They synapse and drive the pre-synaptic sympathetic neurons. Turn to run on the lateral side of the brain stem. Most damage occur on the lateral side of the brain stem.

Question 19

Where is the lesion of the hypothalamospinal system most often located?

Answer 19

Ipsilateral lateral brain stem and spinal cord.

Question 20

Does damage to the cerebellar system produce ipsilateral symptoms or contralateral?

Answer 20

Ipsilateral.

Question 21

Damage to the superior cerebellar peduncle can produce both ipsilateral and contralateral symptom. What is the anatomical landmark for the division?

Answer 21

• below the middle part of the mibrain- ipsilateral

- from red nucleus up to VL of thalamus- contralateral

Question 22

If the symptom associated with the damage to the base of the pon is contralateral - what is the structure likely to be involved?

Answer 22

Pontine nuclei that project to the contralateral cerebellum

Question 23

If the symptom associated with the damage to the base of the pon is ipsilateral- what is the structure likely to be involved?

Answer 23

Middle cerebellar peduncle

Question 24

Which cranial nerves are associated with midbrain?

Answer 24

CN 3 and 4

Question 25

Which cranial nerves are associated with pons?

Answer 25

CN 5, 6, 7, 8

Question 26

Which cranial nerves are associated with medulla?

Answer 26

CN IX, X, and XII

Question 27

Which cranial nerves are associated with cervical spinal cord?

Answer 27

CN XI

Question 28

Are the nuclei in the basal plate sensory or motor? Name the three nuclei.

Answer 28

Motor nerves.

• GSE: general somatic motor (tongue, extraocular)
• GVE: general visceral motor (parasympathetic)
• SVE: motor to pharyngeal arch myosin (pharynx/larynx)

Question 29

Are the nuclei in the alar plate sensory or motor? Name the three nuclei.

Answer 29

Sensory
GSA- general somatic sensation
SSA - special somatic senses (vestibular, cochlear)
GVA - (visceral sensation) & SVA (taste)

Question 30

Which two nuclei are considered intermediate?

Answer 30

GVE and GVA. GVA is more lateral.

Question 31

In the caudal medulla, what does the spinal nucleus of the trigeminal nerve sense?

Answer 31

Pain and temp of the face.

Question 32

What is the motor nucleus of the trigerminal for?

Answer 32

Muscle of musculation

Question 33

What is the chief nucleus of the trigeminal nerve for?

Answer 33

All other function except for the motor, pain, and temp- touch, pressure…

Question 34

Where does the CN III coming out?

Answer 34

Interpeduncular fossa of the mesencephalon