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Z MD1 neurology > brainstem > Flashcards

brainstem Flashcards

0
Q

what constitutes the brainstem

A

pons, medulla and mid brain

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1
Q

functions of the brainstem (in general)

A
  • reflexive and unconscious behaviour
  • modulation of various arousal and conscious states
  • important in ANS control
  • cranial nerves arise from here
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2
Q

where does the brainstem extend from/to

A

from the mamillary bodies (rostrally) to the pyramidal decussation (caudally)

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3
Q

dorsal and ventral external aspects of the midbrain

A
  • dorsal - superior and inferior colliculi

- ventral - cerebral peduncles with interpenduncular fossa

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4
Q

what forms the facial colliculi

A

the abducens nucleus and the fibres of cranial nerve 8 (facial nerve)

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5
Q

dorsal and ventral external aspects of the pons

A
  • dorsal - facial colliculi

- ventral - cerebellar peduncles

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6
Q

dorsal and ventral external aspects of the medulla

A
  • dorsal –> caudally there are dorsal columns and nuclei - gracile and cuneate tubercle
  • ventral –>rostrally - inferior olivary nuclei, caudally - pyramidal decussation
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7
Q

what is the tegmentum

A

that part of the brainstem that is continuous with the spinal cord

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8
Q

what is the tectum

A

the superior and inferior colliculi of the midbrain

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9
Q

what is contained in the tegmentum

A

the cranial nerves and the reticular formation

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10
Q

what is contained in the basis of the brainstem

A

decending motor fibres and things that help control it

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11
Q

function of the cranial nerves

A

supply somatic and visceral motor and sensory information to the head

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12
Q

which cranial nerve does not exit the brainstem ventrally

A

CN IV

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13
Q

which cranial nerves are exclusively motor

A

3, 4 and 6 - control eye movements

11 and 12

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14
Q

which cranial nerves are exclusively sensory

A

1, 2 and 8 - smell, sight and balance

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15
Q

which cranial nerves are mixed nerves

A

5, 7, 9 and 10

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16
Q

what is the rule of 4 for cranial nerves

A

4 cranial nerves exit the medulla (9-12)
4 cranial nerves exit the pons (5-8)
4 cranial nerves exit above the pons (1-4)

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17
Q

what arrives from the alar plate and basal plate developmentally

A

alar plate - sensory nuclei

basal plate - motor nuclei

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18
Q

what is the positioning of the motor and sensory nerves in the brainstem

A

motor - closer to the midline

sensory - more laterally

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19
Q

what are the 3 motor columns within the brainstem

A

general somatic motor
brachial motor
general visceral

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20
Q

what are the 3 sensory columns within the brainstem

A

general and special visceral
general somatic
special somatic

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21
Q

what is the reticular formation

A

a network of scattered cell bodies throughout the dorsal brainstem (like a spread out nuclei)

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22
Q

the reticular formation is continuous with…

A
  • certain nuclei in the thalamus

- intermediate grey of the spinal cord

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23
Q

basic function of the rostral reticular formation (in midbrain and upper pons)

A

maintain alert conscious state

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24
Q

basic function of caudal brainstem (pons and medulla)

A

do things similar to the spinal cord - survival reflexes

variety of important motor reflex and autonomic functions

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25
Q

what are the 4 projection systems of the ascending reticular activating system and where are they

A

noradrenergic - locus ceruleus
dopaminergic - substantia nigra
serotonergic - dorsal raphe
cholinergic

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26
Q

what is the function of the ventrolateral medullary reticular formation

A

regulates the visceral functions of the vagus nerve
(GI - swallowing, vomiting
respiratory - rhythm, coughing, hiccupping, sneezing
cardiovascualr)

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27
Q

3 major long fibre tracts through the brainstem

A

dorsal column-medial lemniscus system
anterolateral system
corticospinal system

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28
Q

where does the corticospinal tract decussate

A

at the pyramidal decussation

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29
Q

which structures are associated with the basis (ventral) part of the midbrain, pons and medulla

A

midbrain - cerebral peduncles, substantia nigra, red nuclei
pons - CB nuclei, middle cerebellar peduncle
medulla - inferior olivary nuclei

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30
Q

explain the orientation and anatomy of the columns through the spinal cord

A

3 sensory columns - lateral

3 motor columns - medial

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31
Q

What are the 12 cranial nerves

A 
olfactory
optic
occulomotor
trochlear
trigeminal
Abducent
Facial
Vesticulocochlear
Glossopharyngeal
Vagus
Accessory spinal 
Hypoglossal
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32
Q

What are the foramina associated with the first 4 cranial nerves

A 
olfactory = cribiform plate
optic = optic canal
occulomotor = superior orbital fissure
Trochlear = superior orbital fissure
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33
Q

what are the foramina associated with the trigeminal nerve

A

orbital branch = superior orbital fissure
maxillary branch = formaen rotundum
mandibular branch = formamen ovale

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34
Q

what is the foramina associated with cranial nerves 6-12

A

abducent = superior orbital fissure
facial = internal acoustic meatus –> stylomastoid foramen
vestibulocochlear = internal acoustic meatus
glossopharyngeal, vagus and accessory = jugular foramen
hypoglossal = hypoglossal canal

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35
Q

which brainstem “column/s” is the olfactory nerve associated with?

A

special sensory column

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36
Q

which brainstem “column/s” is the optic nerve associated with?

A

special sensory column

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37
Q

which brainstem “column/s” is the occulomotor nerve associated with?

A

somatic motor column
and
visceral efferent column - Edinger-Westfal nucleus

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38
Q

which brainstem “column/s” is the trochlear nerve associated with

A

somatic motor column

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39
Q

which brainstem “column/s” is the trigeminal nerve associated with?

A

mandibular branch - branchial arch column
and
somatic sensory column

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40
Q

which brainstem “column/s” is the abducent nerve associated with?

A

somatic motor column

41
Q

which brainstem “column/s” is the facial nerve associated with?

A

brachial arch column
and
visceral efferent column - superior salivatory nucleus
and
visceral afferent column - gustatory nucleus of the nucleus solitarius
and
somatic sensory column

42
Q

which brainstem “column/s” is the vestibulocochlear nerve associated with?

A

special sensory column - dorsal and ventral cochlear nuclei and 4 vestibular nuclei

43
Q

which brainstem “column/s” is the glossopharyngeal nerve associated with?

A

branchial arch column- nucleus ambiguus-stylopharyngeus
and
visceral efferent column - inferior salivatory nuleus
visceral afferent column - gustatory nucleus of nucleus solitarius
and
somatic sensory column

44
Q

which brainstem “column/s” is the vagus nerve associated with

A

branchial arch column - nucleus ambiuus-levator palati
and
visceral efferent column - dorsal motor nucleus of the vagus
and visceral afferent - gustatory nucleus of the nucleus solitarius
and
somatic sensory column

45
Q

which brainstem “column/s” is the hypoglossal nerve associated with

A

somatic motor column

46
Q

which nerves have associated ganglia? and what are they called?

A

optic nerve = retina

trigeminal nerve = trigeminal ganglia

47
Q

function/s of olfactory nerve

A

sense of smell

48
Q

function/s of optic nerve

49
Q

function/s of occulomotor nerve

A
  • innervates superior rectus, medial rectus, inferior rectus and inferior oblique muscles of the eyeball
  • elevates eyelid via innervation of levator palpebrae superioris
  • controls focussing and pupil constriction
50
Q

function/s of trochlear nerve

A

innervates superior oblique muscle of the eyeball

51
Q

function/s of the trigeminal nerve

A
  • innervates muscles of mastication
  • innervates tensor tympani muscle of the inner ear
  • sensory innervation of the face
52
Q

function/s of the abducent nerve

A

innervates lateral rectus muscle of the eyeball –> abduction of the eyeball

53
Q

function/s of the facial nerve

A
  • innervates the muscles of facial expression
  • innervates stapedius muscle of the ear
  • innervates part of the digastric muscle
  • innervates orbicularis occuli (to close the eye)
  • taste from anterior 2/3 of tongue and soft palate
  • sensation from small region near the external auditory meatus
  • innervation to the lacrimal, sublingual and submandibular salivary glands
54
Q

function/s of the vestibulocochlear nerve

A

hearing and balance

55
Q

function/s of the glossopharyngeal nerve

A
  • innervates stylopharyngeus muscle for soft palate elevation
  • taste from posterior 1/3 of tongue
  • sensation from posterior 1/3 of tongue, pharynx, middle ear and carotid body
  • PNS innervation to parotid gland
56
Q

function/s of the vagus nerve

A

MOSTLY AUTONOMIC

  • PNS innervation to many organs
  • input from baroreceptors and chemoreceptors of the aortic arch
  • motor innervation to many striated muscle (including palatoglossus and levator palati)
  • sensory from pharynx, larynx and oesophagus
57
Q

function/s of accessory nerve

A

innervates sternocleidomastoid and the upper part of trapezius to allow shrug of shoulders and turn of the neck

58
Q

function/s of the hypoglossal nerve

A

innervation to the intrinsic and extrinsic muscles of the tongue (except palatoglossus)

59
Q

which nerves provide innervation to places other than the face and head

A

glossopharyngeal (IX) and vagus (X)

60
Q

which nerves do not originate in the brainstem

A

spinal accessory nerve

61
Q

explain the order of the 3 motor columns in the brainstem (in reference to the midline)

A

somatic motor - most medial
branchial motor - middle
visceral motor - most lateral

62
Q

which cranial nerves have their nuclei in the somatic motor column

A

3, 4, 6 = eyeball movement

12 = tongue

63
Q

which cranial nerves have their nuclei in the branchial arch column

A

5 = mastication
7 = facial muscles for expression
9 + 10 = muscles for pharynx and larynx

64
Q

what is the nucleus ambiguus?

A

motor nucleus associated with cranial nerves IX and X

65
Q

what are the two parts of the nucleus ambiguus associated with cranial nerves IX and X

A 
IX = motor innervation to stylopharyngeus
X = motor innervation to levator palati
66
Q

which cranial nerve is the Edinger Westfal nucleus associated with

A

cranial nerve 3 = occulomotor nerve

67
Q

which cranial nerve is the superior salivatory nucleus associated with

A

cranial nerve 7 = facial nerve

68
Q

which cranial nerve is the dorsal motor nucleus of the vagus associated with

A

cranial nerve 10 = vagus nerve

69
Q

which cranial nerve is the inferior salivatory nucleus associated with

A

cranial nerve 9 = glossopharyngeal nerve

70
Q

what are the 4 nuclei in the visceral efferent column in the brainstem

A

Edinger-Westfal nucleus - III
Superior salivatory nucleus - VII
inferior salivatory nucleus - IX
dorsal motor nucleus of the vagus - X

71
Q

explain the order of the 3 sensory columns in the brainstem (in reference to the midline)

A

visceral sensory - most medial
somatic sensory - middle
special sensory - most lateral

72
Q

which cranial nerves have their nuclei in the visceral sensory/afferent column of the brainstem?

A

VII, IX, X - taste

IX and X - autonomic

73
Q

which nucleus is associated with the visceral sensory/afferent column of the brainstem?

A

the nucleus solitarius

74
Q

what are the rostral and caudal divisions of the nucleus solitarius

A

rostral: gustatory nucleus - receives input from VII, IX and X for taste
Caudal: visceral sensory division - receives input from IX (baroreceptors and chemoreceptors from carotid body and sinus) and X (afferents from heart and abdominal viscera)

75
Q

Which cranial nerves have their nuclei in the somatic sensory column of the brainstem?

A

V - facial sensation

VII, IX and X - skin behind ear and lining of external auditory meatus

76
Q

Which cranial nerves have their nuclei in the special sensory column of the brainstem?

A

I - smell
II - vision
VIII - hearing and balance

77
Q

what are the 6 extraoccular muscles

A 
superior rectus
inferior rectus
medial rectus
lateral rectus
superior oblique
inferior oblique
78
Q

which nerves act together for occular movement

A

III, IV and VI

79
Q

which nerves pass through the common tendinous ring when passing to the eyes

A

occulomotor (III) and VI (abducent)

80
Q

which nerves exit the cranium through the superior orbital fissure

A

III, IV, VI and V1

81
Q

which nerves exit the cranium through the auditory canal

A

VII and VIII

82
Q

which nerves exit the cranium through the jugular foramen

A

IX, X, and XI

83
Q

what are the 3 main reflexes to test brainstem function

A

pupillary light reflex
sensory reflex
gag reflex

84
Q

which nerves are you testing in the pupillary light reflex

A

II (sensory arm of reflex)

III (motor arm)

85
Q

3 sensory branches of the trigeminal nere

A

orbital (V1)
maxillary (V2)
mandibular (V3)

86
Q

what are the 4 nuclei contained within the trigeminal nucleus

A

chief sensory nucleus
mesencephalic nucleus
spinal trigeminal nucleus
motor nucleus

87
Q

which nuclei of the trigeminal nucleus are like the dorsal ganglia of the dorsal column in the anterolateral system

A

the chief sensory nucleus and the spinal trigeminal nucleus

88
Q

with what other structure does the motor root of the trigeminal nerve travel with

A

the mandibular division of the sensory root of the trigeminal nerve

89
Q

which cranial nerves are you testing with the corneal blink reflex

A

V1 - trigeminal - opthalmic branch - (sensory)

VII - facial - (motor)

90
Q

what is the corneal blink reflex testing (generally)

A

pontine function

91
Q

2 branches of the facial nerve

A

facial nerve proper (branchial motor)

nervus intermedius

92
Q

what are the 6 terminal branches of the facial nerve

A 
posterior auricular
temporal
zygomatic
buccal
mandibular
cervical
93
Q

which gland does the facial nerve pass through but not innervate

A

the parotid gland

94
Q

which nerve innervates the parotid gland

A

glossopharyngeal nerve (PNS)

95
Q

what is the function of stylopharyngeus muscle

A

allows our palate to elevate while we talk

96
Q

what is the pathway of the glossopharyngeal nerve

A

exits the skull via the jugular foramen –> follows the stylopharyngeus to reach the oropharynx and the tongue

97
Q

which nerves innervate the pharynx and larynx

A

vagus (motor and sensory) and glossopharyngeal (sensory)

98
Q

what is the gag reflex used to test (in general)

A

test of medulla function

99
Q

what cranial nerves are being tested with the gag reflex

A

IX (sensory)

X (motor)

100
Q

pathway of the spinal accessory nerve

A

ENTERS the cranium via the foramen magnum

then travels with X roots and exits via the jugular foramen

101
Q

which nuclei can receive input or provide efferent output to more than one cranial nerve

A

nucleus solitarius
nucleus ambiguus
trigeminal nucleus

Z MD1 neurology (17 decks)

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