brainstem 2 and 3 Flashcards
1
Q
medial medullary syndrome is caused by a lesion to
A
the anterior spinal artery
2
Q
what structures are affected in a medial medullary syndrome?
A
pyramid, XII, ML
3
Q
how would a pt. present with medial medullary syndrome?
A
contralateral hemiplegia to the body, ipsilateral tongue deviation, contralateral sensory loss in the body
4
Q
what is lateral medullary syndrome also known as?
A
PICA and wallenberg syndrome
5
Q
structures affected in a wallenberg syndrome
A
spinal trigeminal nucleus, lateral spinothalmic tract, vestibular nuclei, nucleus ambiguus, descending autonomic fibers, ICP
6
Q
how would a pt. present with a lateral medullary lesion?
A
ipsilateral loss of pain and temperature from the face, contralateral loss of pain and temperature from the body, vertigo, dizziness, nausea, vomiting, nystagmus, dysphagia, dysarthria, ipsilateral horners syndrome, ipsilateral ataxic gait
7
Q
what does dysarthria mean?
A
trouble articulating speech
8
Q
what runs throught the MCP as it connects the pons to the cerebellum?
A
pontocerebellar fibers
9
Q
what are the three levels that the pons is studied at?
A
caudal pons at the facial nucleus
mid pons at the level of the trigeminal nuclei
rostral pons at the locus ceruleus
10
Q
what happens the the pupil if a pt. has horners syndrome?
A
gets smaller
11
Q
what is the ‘locus’ coeruleus associated with? and where is it located?
A
located in the pons and is associated with response to physiological stress and panic
“muchas loca”
12
Q
ventral pons/basilar pons has what 3 components?
A
descending cortical fibers, pontine fibers, pontocerebellar fibers
13
Q
dorsal pons/pontine tegmentum has what 3 components?
A
ascending and descending tracts, reticular formation, cranial nerve nuclei
14
Q
bbbb
A
e
15
Q
what is the funcitoning component of CN VIII?
A
SSA only
16
Q
N1 of auditory pathway is located in the
A
spiral ganglion
17
Q
N2 of auditory pathway is located in the
A
dorsal cochlear nuclei
18
Q
N3 of auditory pathway is located where?
A
in the trapezoid body
19
Q
what does the trapezoid body carry to the contralateral superior olivary nuclei?
A
ventral cochlear nuclei
20
Q
most of the fibers in the auditory cortex relay information to what
A
the MGB
21
Q
after the auditory fibers leave the MGB what do they form?
A
auditory radiations of the internal capsule
22
Q
after the auditory radiations leave the internal capsule what structure do they continue to?
A
primary auditory cortex
23
Q
where is the primary auditory cortex located?
A
upper part of the superior temporal gyrus
24
Q
what broadman area is heschl’s gyrus known as?
A
41
25
is hearing affected with a MCA syndrome?
no due to the bilateral representation of in the cerebral cortex
26
when would ipsilateral deafness occur with a lesion?
if in the organ of corti, cochlear nerve, cochlear nuclei
27
where would the lesion be a pt. presents with bilateral deafness
lateral lemniscus, medial geniculate body, auditory radiations
28
what causes menieres disease?
maybe a change in fluid in the tubes of the inner ear
29
what are the symptoms of menieres disease
loss of balance and hearing for mins to hrs, tinnitis, vertigo, aural fullness, nausea, vomiting, sweating,
30
where are the vestibular receptors located
the maculae
31
what type of equilibrium signals head position relative to trunk and where in there ear is this sensed?
static; the macula of the saccula and utricle
32
what kind of equilibrium signals head movement to maintain gaze on a selected target?
and where exactly in the ear is this loacted?
kinetic
| located in the crista ampullaris of semicircular ducts
33
what is the kinetic equilibrium for according to the vestibular nuclei
signals head movement and provides information to maintain gaze on a selected target
34
N1 of the vestibular nuclei
scarpa's ganglion/vestibular ganglion
35
where is scarpas ganglion located?
IAM = internal auditory meatus
36
N2 of the vestibular nerve
vestibular nuclei
37
vestibular nuclei can continue to what structures?
spinal cord, cerebellum, cranial nerves, DMNX
38
all __ of the vestibular nuclei connect to which lobe of the cerebellum?
4, flocculonodular lobe
39
lateral vestibular nuclei connect to which tract in the spinal cord
vestibulospinal tract
40
the medial vestibular nuclei connect to which tract in the spinal cord via which funiculus?
medial vestibulospinal tract via the MLF
41
which CN's does the vestibular nuclei go to via the MLF for which overall function?
3,4,6 for head and eye movement
42
via the reticular formation where does the medial vestibular nucleus go to?
DMN X and the lateral horn of the spinal cord
43
over stimulation of DMN X will result in?
pallor, nausea, vomiting as in motion sickness
44
this nucleus is responsible for visceral function to the heart rate and vomiting?
DMNX
45
disturbance of the vestibular nerve will result in?
vertigo, nystagmus,
46
caloric test is a measure of what?
vestibular function
47
when putting cold water into the ear what direction should the eye go in a caloric test vs hot water?
cold: goes away
| hot; goes towards
48
facial nerve functional compnents
SVE, GVE, SVA, GVA and GSA
49
motor root of CN VII SVE supplies what
mm. of facial expression, auricular muscles, post. belly of digastric, stylohyoid. stapedius
50
origin of motor nucleus of VII
in the caudal pons
51
CN VII nervus intermedius functional component
GVE, SVA, GVA
| parasympathetic and sensory component of the facial CN
52
functions of the nervus intermedius
GVE: preganglionic parasympathetic
SVA: taste sensation to the post. 2/3 of tongue
GVA: sensations from glands innervated by facial nerve
53
geniculate sensory ganglion contains cell bodies for what?
SVA, GVA, GSA
54
where is the geniculate sensory ganglion located?
external genu of the facial nerve
55
superior salivatory nucleus functional compnent
GVE
56
superior salivatory nucleus origin of fiibers
parasympathetic fibers
57
the preganglionic fibers of superior salivatory nucleus synapse where
pterygopalatine ganglion and the submandibular ganglion
58
as the superior salvitory nucleus synapse onto the pterygopalatine ganglion they go throufh which nerve
the greater petrosal
59
as the superior salivatory nucleus synapse onto the submandibular ganglion they go through which nerve
chorda tympani
60
SVA and GVA fibers of CN VII synapse at which tract?
solitary
61
SVA and GVA fibers of which CNs synapse at the solitary nucleus?
7,9,10
62
a pt. may present with these symptoms if they have a lesion LMN to the CN VII
ipsilateral facial paralysis, decreases sensation of taste, dry eye, dry mouth, dry nose, and hyperacusis
63
what is hyperacusis
paralysis of the stapedius
64
extracranial causes of facial nerve lesion
cancer, damage during surgery
65
UMN lesion of the corticobulbar fibers will cause paralysis to what side of the face and portion?
contralateral ; lower portion only
66
which CN's transmit general sensation from the posterior part of the auricle and external auditory meatus?
cn's fibers within the geniculate ganglion of CN VII, superior ganglion of CN IX and superior ganglion of CN X
67
CN VI GSE fibers control what
lateal eye movement and conjugate gaze
68
what are the 2 neurons located in the nucleus of VI
motor and internuclear neurons
69
function of internuclear neurons that lead to the MLF?
sends fibers to the medial rectus of the eye on the other side through the MLF
70
abducent nerve lesion
lateral rectus paralyzed causing internal strabismus (squinting) and diplopia,
71
right MLF lesion will result in?
medial rectus of the left eye not working = internuclear ophthalmoplegia
72
the largest cranial nerve
trigeminal
73
CN V trigeminal functional compnents?
GSA, SVE
74
GSA of CN V supplies what?
sensations from the face and meninges
75
SVE of CN V supplies?
motor to the 8 muscles derived from the 1st branchial arch
76
which of the branches V1, V2 or V3 is mixed senosry and motor?
V3 = mandibular
77
which branch of CN V supplies cornea and conjunctiva?
V1
78
which branch of CN V supplies sensory the anterior 2/3 of the tongue?
V3= mandibular
79
which of the branches of CN V supplies motor to mm. of mastication?
V3
80
Do all 3 branches of CN V supply sensory fibers to the cranial dura matter
yes
81
how many nuclei does CN V have?
4
82
how many of the nuclei of CN V are motor and sensory?
1 is motor while 3 is sensory
83
wbat is the the main sensory nuclei of CN V?
cheif/principle nucleus
84
what type of sensation does that principle nucleus recieve?
tactile discrimination and pressure sensation
85
where in the pons is the princple nucleus located?
mid pon lateral to the motor nucleus
86
name the 3 sensory GSA fibers of CN V
mesencephalic, principle, spinal
87
mesencephalic nucleus recieves info for what?
proprioception from the face
88
spinal nucleus of CN V recieves what kind of informaiton from the face
pain and temperature from face mouth, and internal nose
89
the spinal trigeminal nucleus extends from what structures
c2 --> medulla --> mid pons
90
mesencephalic nucleus is located where in the brainstem?
the midbrain in the gray matter lateral to the cerebral aquaduct
91
where is the SVE portion of CN V located?
mid pons medial to the main sensory nucleus
92
how is the SVE portion of CN V tested?
jaw jerk test
93
CN V SVE innervates which muscles
mylohyoid, atnerior belly of digastric, tensor tympani, and tensor veli palantine muscles
94
the ventral trigeminothalmic tract (VTTT) mediates what sensations from the face and oral cavity?
contrateral pain and temperature
95
VTTT N1 is located where?
trigeminal ganglion
96
what tract do the N1 axons of VTTT descend in
spinal trigeminal tract
97
where are the N2 of the VTTT located?
spinal trigeminal nucleus
98
where do the N2 axons of the VTTT terminate?
the contralteral VPM of the thalamus
99
N3 of the VTTT are located where
the VPM of the thalamus
100
what broadman areas are associated with the VTTT N3 axons?
312
101
the dorsal trigeminothalmoc tract mediates what kind of sensation from the face?
ipsilateral tactile discrimination and pressure sensation from the face and oral cavity
102
what is the source of input of the DTTT tract
meissners and pacinian corpuscles
103
N1 of DTTT is located where and synapse where?
trigeminal ganglion --> principle sensory nucleus
104
N2 of DTTT is located where?
principle sensory nucleus
105
Do the N2 or the N1 of the DTTT decussate?
N2 fibers
106
where are the N3 located of the DTTT
in the VPM of the thalamus
107
at which broadman areas does the DTTT synapse at?
312
108
what are both the DTTT and the VTTT referred to as?
trigeminal lemniscus
109
fibers of what nucleus cross midline and ascend with the VTTT?
main sensory nucleus
110
the afferent nerve resonsible for corneal blink reflex?
ophthalmic nerve
111
the efferent limb nerve involved in the corneal blink reflex
facial
112
which branch of CN V is responsible for sneezing reflex?
V1
113
does tic douloureux happen more in women or men?
women
114
VPL of the thalamus recieves information from what
the body
115
VPM recieves information from where
the face
116
blood supply to the pons from the basilar artery branches
AICA
| pontine/paramedian , superior cerebellar arteries
117
AICA is supplies what portion of the pons?
caudal popns
118
what portion of the pons is supplied by the pontine/paramedian arteries?
medial caudal and mid pons
119
what portion of the pons does the superior cerebellar arteries?
rostral pons
120
medial inferior pontine syndrome?
injury to corticospinal tract --> contralateral spastic hemiplegia
injury to the medial lemniscus --> contralateral loss of proprioception
Abducens nerve injury --> ipsilateral rectus paralysis
121
lateral inferior pontine syndrome?
```
injury to the
facial nucleus
cochlear nerve
vestibular nerve
spinal nucleus
spinal lemniscus
ICP
MCP
descending sympathetic fibers
```
122
MLF syndrome is seen in what neurological syndrome?
MS
123
name the three parts of the midbrain?
tectum
tegmentum
crus cerebri
124
tectum s formed by
2 superior and two inferior colliculi
125
tegmentum contains what structures?
* cranial nerve nuclei
| * sylvius and periaqueductal gray matter and sensory patheways
126
Crus cerebri also known as
basis pedunculi/cerebral peduncle
127
front of the midbrain is called
crus cerebri
128
what structure of the midbrain seperates the crus cerebri from hte tegmentum
substantia nigra
129
what is located between the two crura cerebri?
interpenduncular fossa
130
2 levels of the midbrain?
caudal and rostral
131
what is located in the caudal midbrain?
inferior colliculi, trochlear nucleus, decussation of the SCP
132
Rostral MB contains what?
superior colliculus, oculomotor nuclei, red nucleus
133
where does the Lateral lemniscus end?
the inferior colliculus
134
periaquaductal gray matter contain what
endorphin producing cells that supress paon
135
what is the most slender CN?
trachlear
136
where does the trochlear nerve exit
dorsally (only one that exits this way)
137
what CN is located in central gray matter and dorsal to the MLF
trochlear
138
what muscle does CN 4 innervate?
superior oblique
139
job of SO muscle
moves eye down and lateral
140
does CN 4 move the contralateral or ipsilateral eye?
contralateral
141
decussation of SCP is where?
midbrain at the caudal portion
142
where can the axons of the SCP synapse?
red nucleus or the thalamus
143
what levels of the midbrain is the crus cerebri located?
both levels
144
what level is the crus cerebri more pronounced?
rostral
145
what are the medial and lateral parts of crus cerebri known as?
corticopontine fibers
146
where do corticopontine fibers pelay on
pontine nuclei
147
the axons the the transverse pontine fibers enter the cerebellum through what?
the MCP
148
substantia nigra has __ parts
2
149
the dorsal part of the substantia nigra is known as
substantia nigra compacta
150
the substantia nigra compacta contain what?
melanin and substantia nigra reticularis
151
what is the substantia nigra connected to?
the basal ganglia
152
red nucleus is between what structures?
cerebral aqueduct and the substantia nigra
153
where does the rubrospinal tract decussate?
ventral tegmental decussation
154
red nucleus is located in what portion of the midbrain?
rostral
155
red nucleus recieves afferents from where?
the motor cortex and cerebellum
156
lesions to the red nucleus will result in what>
athetoid and writhing movements
157
superior colliculi is connected to the lateral geniculate body via what
superior brachium
158
the superior colliculus recieves afferent fibers from
optic nerve
visual cortex
spinal cortex
inferior colliculus
159
the SCP projects to what structures
LGB --> primary visual cortex (BA 17)
160
job of the SCP?
idenifies lines, shapes and colors
161
what nucleus of the secondary visual cortex does the SCP project to?
pulvinar
162
what are the BA of the secondary visual cortex?
18, 19
163
what is the largest nucleus in the thalamus?
pulvinar
164
pulvinar nucleus of the secondary visual cortex is responsible for what
visual association with things you have seen before
165
SCP output to what structure of the spinal cord?
tectospinal tract
166
how would a lesion to the superior colliculus present
loss of spinovisual reflexes
167
where are the oculomotor nuclei located?
ventral part of the periaqueductal gray matter and dorsal to the MLF of the rostral midbrain
168
name the two motot nucleu of the occulomotor nuclei
main motor GSE
| parasympathetic nucleus = edinger westphal (GVE
169
what are the muscles that the GSE portion of the occulomots supply
medial, superior, inferior rectus, inferior oblique and levator palpebrau superioris
170
where does the edinger westphal synapse at
ciliary ganglion
171
ciliary ganglion is responsible for
pupillary constriction
172
CN III exits throught the interpeduncular fossa as it passes through which structures
PCA and the Superior cerebellar arteries
173
CN III enters the orbit through which fissure
superior orbital fissure
174
lesion of the CN III or nuclei will result in what ipsilaterally?
```
eye will move down and outward
ptosis
mydriasis
loss of accommodation and convergene
verticle diplopia
```
175
fibers of the optic tract enter wich nucleus>
pretectal
176
where to the fibers of the pretectal nucleus run through>
the EW nucleus
177
after the fibers of the pretectal nucleus synapse at E-W nucleus where do they go next
ciliary ganglion
178
eyes converge through the contraction of what
bilateral contraction of the medial recti
179
relaxation of what ligametns allow for the eye to accommodate
suspensory
180
accommodation means that the lens becomes more what
convex
181
argyl robertson pupil
small bilateral pupils that do not constrict which is found in late stage syphylis
182
webers syndrome
damage to the PCA involving CNIII
| Crus cerebri
183
benedikts syndrome involves
lesion to the PCA involving:
red nucleus
medial lemniscus
CN III
184
Rostral midbrain blood supply
PCA
185
Caudal midbrain blood supply
PCA and superior cerebellar artery
186
Rostral pons blood supply
superior cerebellar a
187
mid pons blood supply
pontine/paramedian a.
188
open medulla lateral blood supply
PICA
189
medial open medulla blood supply
vertebral/ anterior spinal a
190
caudal medulla blood supply
anterior and posterior spinal arteries
