Brainstem

Question 1

Four functional groupings

Answer 1

Cranial nerve nuclei
Sensory and motor tracts
Cerebellar circuitry
Reticular formation

Question 2

Brainstem lesions are often associated w/

Answer 2

CN abnormalities, long tract findings, ataxia, impaired RF function

Question 3

Upper midbrain

Answer 3

Level of superior colliculi

Oculomotor nucleus
Red nucleus
Reticular formation
Sensory and motor tracts

Question 4

Lower midbrain

Answer 4

Level of inferior colliculi

Trochlear nucleus
Reticular formation
Sensory and motor tracts

Question 5

Upper mid Pons

Answer 5

Pons between middle cerebellum peduncles

Superior and middle peducnlcles
Reticular formation
Sensory and motor tracts

Question 6

Lower pons

Answer 6

Cerebellar peduncles

Abducens
Facial
Vestibular nuclie
Reticular formation
Sensory and motor tracts

Question 7

Upper medulla

Answer 7

Hypoglossal nucleus
Nucleus ambiguous and solitaries
CN X
Inferior cerebellar peduncle
Vestibular nuclei
Reticular formation
Sensory and motor tracts

Question 8

Lower medulla

Answer 8

Dorsal columns and nucleus
Medial meminiscus
Internal accurate fibers
Reticular formation
Sensory and motor tracts

Question 9

Upper reticular formation

Answer 9

Midbrain and upper pons work w/ diencephalic nuclei.

Alert, conscious state in forebrain

Question 10

Lower reticular formation

Answer 10

Lower pons and medulla work w/ CN nuclie and SC.

Autonomic, motor, flex functions

Question 11

Regulation of LOC

Answer 11

RF

Cortical and subcortical networks that carry out major functions of consciousness (medial and lateral frontoparietal association cortex w/ upper BS and diencephalon)

Question 12

Lesion leading to a coma

Answer 12

Upper brainstem RF
Bilateral regions to cortex
Bilateral lesion of thalamus

Question 13

Coma

Answer 13

Unarousable unresponsiveness in which pt lies w/ eyes closed.
Minimum duration of 1 hour.

Many brainstem reflexes, meaningful responses by cortex are absent

Not generally permanent

Question 14

Brain death

Answer 14

Extreme and irreversible form of coma

Nor forebrain or brainstem fx

EEG is a flat pattern

Question 15

NonREM sleep

Answer 15

Medulla

Beginning of sleep cycle

Question 16

REM sleep

Answer 16

Pons
Inhibit muscle activity
Dreaming occurs

Question 17

Respiration

Answer 17

Medulla
Caudal nucleus solitaries
Pre-botzinger complex

Inspiration - phrenic C3-5

Insp and exp - thoracic segments

Question 18

HR and BP

Answer 18

Multiple levels

Caudal nucleus solitarius from baroreceptors

Extend to PS and symptoms oreG neurons in BS and SC

Question 19

Decorticate posturing

Answer 19

Abnormal flexor posturing

Lesion to midbrain or above

Question 20

Decerebrate posturing

Answer 20

Abnormal extensor posturing

Lesion below midbrain

Question 21

Pseudobulbar affect

Answer 21

Abnormal, frequent, uncontrollable outbursts of crying or laughing

Brainstem lesion

Question 22

Pontomedullary RF : reflexes

Answer 22

Coughing
Hiccupping
Sneezing
Yawning
Shivering
Gagging
Vomiting
Swallowing
Laughing
Crying

Question 23

Blood supply - midbrain

Answer 23

PCA

Question 24

Blood supply - upper and lower pons

Answer 24

Basilar artery

Question 25

Blood supply - medulla

Answer 25

Vertebral artery

Question 26

Blood supply - primary blood supplier

Answer 26

Anterior spinal artery

Question 27

Blood supply - medulla (all)

Answer 27

Vertebral, anterior spinal (medial), PICA (lateral)

Question 28

Blood supply - lower pons

Answer 28

Basilar, AICA

Question 29

Blood supply - upper pons

Answer 29

Basilar, superior cerebellar

Question 30

Blood supply - midbrain (all)

Answer 30

PCA, superior cerebellar

Question 31

Practice filling in

Answer 31

Vascular territories

Question 32

Medial midbrain syndrome (Weber’s)

Answer 32

Midbrain basis PCA and top of basilar Oculomotor motor nerve fascicles, cerebral peduncle Ipsilateral oculomotor pasly, contralateral hemiparesis

Question 33

Medial pontine syndrome (fovilles)

Answer 33

Medial pontine basis and tegmentum Basilar, ventral and dorsal territories Corticospinal and corticobulbar tract—> Contra face, arm, leg weak, dysarthria; facial colliculus—> ipsilateral face weak and horizontal gaze palsy medial lemniscus—> contra decreased position and vibration sense

Question 34

Locked in syndrome

Answer 34

Bilateral infarct to ventral pons (basilar artery) Bilateral CTS and CBT Affects horizontal eye movements Vertical eye movements and eyelid elevation spared

Question 35

Lateral medullary syndrome (wallenberg’s)

Answer 35

Lateral medulla Vertebral artery Inferior cerebella peduncles, vestibular nuclei —> ipsilateral ataxia, vertigo, nystagmus nausea Trigeminal nucleus and tract __> ipsilateral facial decreased pain and temp sense ST tract —> contra body decreased pain and temp sense Descending symp fibers 00> ipsilateral horner’s Nuclues ambiguus—> hoarseness, dysphasia Nucleus solitarius —> ipsilateral decreased taste

Question 36

Medial medullary syndrome

Answer 36

Medial medulla Paramedics branch of cerebral and anterior spinal Pyramidal tract —> contra arm or leg weak Medial lemniscus —> contra decreased position and vibration Hypoglossal nucleus and exiting CN XIII fascicles —> is pi tongue weak

Question 37

5Ds

Answer 37

``` Diplopia Dizziness Drop attack Dysarthria Dysphagia ```

Question 38

3Ns

Answer 38

Nausea Numbness/tingling Nystagmus