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NSx Neuroanatomy > Brainstem > Flashcards

Brainstem Flashcards

1
Q

Midbrain=

A

Mesencephalon

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2
Q

Pons=

A

Metencephalon (along with cerebellum)

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3
Q

Medulla=

A

Myelencephalon

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4
Q

CN nuclei in midbrain?

A

3 and 4

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5
Q

CN nuclei in pons

A

5, 6, 7, 8

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6
Q

CN nuclei in medulla

A

9, 10, 11, 12

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7
Q

Level of CN3 exiting midbrain

A

Ventral midbrain at the level of the superior colliculus in the interpeduncular sulcus

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8
Q

Superior colliculus associated with?

A

Visual system

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9
Q

Inferior colliculus associated with?

A

Hearing

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10
Q

Which is the only cranial nerve to exit from the dorsal brainstem and at what level?

A

Trochlear.

Inferior colliculus

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11
Q

Why does the trochlear nerve exits from the posterior brainstem?

A

Pineal gland is the embryological rudimentary eye.

Trochlear nerve was likely associated with that.

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12
Q

Where does the trigmeinal emerge from the pons?

A

Mid-pontine level.

Anterolateral region.

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13
Q
A
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14
Q

What level do the 6, 7 ,8th cranial nerves emerge?

A

Ponto-medually junction

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15
Q

In what order from medial to lateral do the 6th, 7th and 8th CN emerge?

A

6 medial, 7 then 8 most laterally.

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16
Q

6th 7th nerve palsy.

Location of lesion?

A

?medial ponto-medullary sulcus/junction.

As more medial structures and internal genu of facial nerve intimately related to CN6 nuclei

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17
Q

7th 8th nerve palsy

A

Lateral pontomedullary problem/IAM

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18
Q

Etymology of vagus

A

Wanderer

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19
Q

Location of hypoglossal nerve

A

Emerges from the ventral medulla at the sulcus between pyramid and olive.

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20
Q

3 divisions from ventral to dorsal of brainstem

A

Basis

Tegmentum

Tectum

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21
Q

Tegmentum etymology

A

Covering

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22
Q

Tectum etymology

A

Roof

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23
Q

Descending tracts found in which portion of brainstem?

A

Basis

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24
Q

Ascending tracts found in which portion of brainstem?

A

Tegmentum

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25
Q

Relation between motor and sensory nuclei in braistem

A

Motor medial, sensory lateral.

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26
Q

Supplementary motor grey matter in medulla

A

Superior and inferior olivary nuclei

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27
Q

Location of supplementary grey matter in the brainstem

A

Ventral tegmentum

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28
Q

Supplementary grey matter in pons

A

Pontine nuclei

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29
Q

Supplementary grey matter nuclei in midbrain

A

SN and red nuclei

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30
Q

Cranial nerve nuclei arrangement

A

Dorsal tegmentum

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31
Q

Location of special grey matter in brainstem

A

Tegmentum lateral to motor nuclei

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32
Q

In simple terms what is the reticular formation

A

As grey matter and white matter ascends in the brainstem and decussates the grey matter is broken up into the indiviudal nuclei but also fragments of grey matter interspersed with white matter in the ventral tegmentum which is the reticular formation

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33
Q

Neurones in the anterior horn are?

A

Motor

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34
Q

Draw the general arrangement of structures in the medulla.

A
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35
Q

Dorsal sensory neurones develop embryologically from the?

A

Alar plate

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36
Q

Ventral motor neurones develop embryologically from the?

A

Basal plate

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37
Q

Lateral grey horn neurones are involved in?

A

Visceral function

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38
Q

Arrangement of efferent neurones from medial to lateral in SC

A

General somatic efferents

General visceral efferents

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39
Q

Arrangement of afferent fibres from lateral to medial in SC

A

General somatic afferents

General visceral afferents

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40
Q

Location of hypoglossal nuclear tract

A

Tegmentum of medulla medially adjacent to fourth ventricle (GSE)

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41
Q

Location of vagus nuclear tract

A

Dorsal nucleus is lateral to hypoglossal nuclei (GVE) in tegementum of medulla.

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42
Q

From what embryological structure do the special muscles in head and neck derive?

A

Branchial pouch

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43
Q

Where are the SVE nuclei found in the medulla

A

Anterolateral to the GVE tract as the nucleus ambiguus

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44
Q

Where are the CN nuclei for 3 and 4 found?

A

Just lateral to midline in midbrain

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45
Q

What is the remaining GSE nuclei and where is it found?

A

Midline in the pons (GSE column)

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46
Q

Where are the nuclei involved in lacrimation and salivation

A

Latearl to GSE tract as the superior and inferior salivary nuclei in the pons.

(Superior portion of the superior salivary gland contributes to lacrimation)

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47
Q

Structures supplied by nucleus ambiguus?

A

Muscles of the larynx and pharynx

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48
Q

Location of facial nerve nuclei

A

In the SVE column at the pontomedullary junction.

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49
Q

Location of the motor nucleus of trigeminal

A

Midpons in the SVE column.

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50
Q

CNs receiving fibres from the nucleus ambiguus

A

9, 10 and cranial portion of 11

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51
Q

Location of GVA tract

A

Lateral to GVE

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52
Q

Location of SVE in brainstem

A

Lateral to the GVA

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53
Q

Components of nucleus solitarius?

A

Medially- GVA

Laterally- SVA

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54
Q

SVA in medulla

A

Taste

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55
Q

What carries taste fibres from the vallecula of the tongue?

A

X

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56
Q

Which nerves carry taste sensation and to what do they connect?

A

7, 9, 10

Nucleus solitarius

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57
Q

Location of special somatic afferent in brainstem

A

Medial to general somatic

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58
Q

What recieves auditory stimuli?

A

Ventral and dorsal cochlear nucleus, ventral and dorsal to inferior cerebellar peduncle

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59
Q

Fine touch trigeminal sensation goes to?

A

Principle nucleus

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60
Q

Pain and temperature sensation in trigeminal goes to which nucleus?

A

Spinal

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61
Q

Proprioceptive information goes to which trigeminal nucleus?

A

Mesencephalic

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62
Q

Rhombencephalon=

A

Pons, medulla and cerebellum

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63
Q

What is the inferior border of the medulla?

A

Pyramidal decussation

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64
Q

With which nuclei of the thalamus do reticular formation systems connect?

A

Intralaminar nuclei of thalamus

Which then connect with all parts of cortex.

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65
Q

Most important function of ascending reticular formation

A

Consciousness

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66
Q

What are the functions of the medullary reticular formation?

A

Cardiac centre

Vasomotor centre

Respiratory centre- Inspiratory centre

Gastrointestinal centre

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67
Q

Location of area postrema?

A

Adjacent to fourth ventricle

Next to chemoreceptor trigger zone

Near GIT connecting nervous system.

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68
Q

What is significant about the area postrema

A

Portion of the medulla in which there is a break in BBB to allow chemical substances to influence neurones in area postrema.

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69
Q

Ascending pathways of medulla

A

Dorsal column-

Fasciculus gracilis + cuneatus

Nucleus cuneatus and gracilis

Internal arcuate fibres

Medial leminisci

Spinothalamic-

Anterior and lateral tracts.

Spinotectal tract

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70
Q

Dorsal column sensations

A

Fine touch

Proprioception

Vibration

Two-point discrimination

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71
Q

What happens to dorsal column tracts on reaching medulla?

A

Synapse with nucleus gracilis and nucleus cuneatus which is located in the posteroinferior portion of the medulla.

Second order neurones originate there and decussate

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72
Q

Where do second-order dorsal column fibres synapse?

A

VPL nucleus of thalamus

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73
Q

What is the name of the decusssating dorsal column fibres in the inferior medulla?

A

Internal arcuate fibres

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74
Q

How do the second order fibres of dorsal column ascend?

A

Medial lemniscus

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75
Q

Left medial lemniscus fibres carry what modality?

A

Dorsal column from right body.

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76
Q

Spinotectal tract involved in?

A

Spinovisual/ Spinoauditory reflexes

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77
Q

What forms in the medulla from the spinothalamic and spinotectal tracts?

A

Spinal lemniscus

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78
Q

Which tracts make up the spinal lemniscus?

A

Anterior and lateral spinothalamic tracts

Spinotectal tract

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79
Q

Right spinal lemniscus injury

A

Left spinotectal and spinothalamic information

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80
Q

Descending pathways of the medulla

A

Corticospinal

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81
Q

What proportion of corticospinal fibres decussate at the level of the medulla?

A

90%

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82
Q

LMN to lower limb come from which corticospinal tract?

A

Lateral corticospinal tract

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83
Q

Axial musculature LMN come from which corticospinal tract?

A

Anterior (i.e. do not decsusate in medulla but cross at the level of crossing)

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84
Q

How is the medulla connected to the cerebellum?

A

Inferior cerebellar peduncle

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85
Q

What is the accessory cuneate nucleus?

A

Nucleus at dorsal portion of medulla near to cuneate nucleus.

Receives fibres from upper limb which subsequently enter the cerebellum via the inferior cerebellar peduncle as the cuneocerebellar pathway

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86
Q

Cuneocerebellar fibres carry

A

Proprioceptive information from the upper limb via the accessory cuneate nucleus in the medulla to the cerebellum via the inferior cerebellar peduncle

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87
Q

Origin of dorsal spinocerebellar tract

A

Fibres from lower limb, travel ipsilaterally along with cuneocerebellar pathway into the cerebellum via inferior cerebellar peduncle (though not via accessory cuneate nucleus)

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88
Q

Origin of ventral spinocerebellar pathway

A

Lower limb, second order neurone decussates , pass through medulla, pons and then through superior cerebellar peduncle where they decussate again to return to their original side.

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89
Q

What is the difference between dorsal spinocerebellar tract and ventral cerebellar tract?

A

Dorsal ipsilateral and passes through inferior cerebellar peduncle.

Ventral decussates ( in SC and then within the cerebellum) twice and passes through superior cerebellar peduncle.

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90
Q

Lower limb proprioception carried by?

A

Dorsal and ventral spinocerebellar tract

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91
Q

Upper limb proprioception carried by?

A

Cuneocerebellar tract (via accessory cuneate nucleus)

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92
Q

What are the posterior parthways of the medulla?

7

A

Cuneocerebellar tract

Dorsal spinocerebellar tract

(Ventral spinocerebellar tract)

Olivocerebellar tract

Arcuato-cerebellar tract

Reticulo-cerebellar pathway

Central tegmental pathway

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93
Q

Passage of olivocerebellar tract?

A

From olivary nucleus in medulla to contralateral cerebellum via inferior cerebellar peduncle

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94
Q

What area in the midbrain communicates with the inferior olivary nucleus?

A

Red nucleus via rubro-olivary fibres

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95
Q

Function of rubro-olivarycerebellar tract?

A

Important control of motor movements

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96
Q

Function of corticopontocerebellar tract

A

Allows cerebral cortex to influence cerebellar function

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97
Q

Components of corticopontocerebellar tract

A

Corticopontine tract-> pontine nuclei-> cerebellum via middle cerebellar peduncle

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98
Q

What are arcuate nuclei?

A

Inferiorly dispalced pontine nuclei found in the medulla

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99
Q

What fibres are present in the central tegmental pathway

A

Rubro-olivary

Reticulothalamic fibres

Central taste pathway (from nucelus solitarius to thalamus)

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100
Q

What nucleus of the thalamus receives taste information?

A

VPM nucleus

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101
Q

Which nerve emerges from the preolivary sulcus in the medulla?

A

12

102
Q

Which nerves emerge from post-olivary sulcus?

A

9

10

11

103
Q

Which cranial nerve fasciculus passess between the pyramid and olive of the medulla?

A

12

104
Q

Where do the parasympathetic fibres of the vagus nerve originate?

A

Dorsal vagal nucleus

105
Q

Where do general visceral afferent fibres of the vagus nerve terminate?

A

Medial portion of nucleus of tractus solitarius

106
Q

Where do special visceral afferent fibres of the vagus nerve terminate?

A

Lateral portion of tractus solitarius

107
Q

Where do special efferent (branchial motor) fibres of vagus nerve originate?

A

Nucleus ambiguus

108
Q

Which branch of vagus carries touch pain and temperature from the external ear?

To which nucleus is it connected?

A

Arnold’s nerve (auricular branch of vagus)

Trigeminal nuclear system

109
Q

Which nuclei are associated with vagus nerve?

A

Dorsal vagal nuclei

Nucleus of tractus solitarius

Nucleus ambiguus

Trigeminal nucleus

110
Q

Where does touch pain and temperature sensation carried from the poserior 1/3rd of the tongue terminate?

A

Spinal trigeminal nucleus

111
Q

Which thalamic nuclei does the trigeminal lemniscus terminate in

A

VPM

112
Q

9th communicates with which nuclei?

A

Nucleus ambiguus

Spinal nucleus of trigeminal system

Nucleus solitarius

113
Q

Origin of cranial part of 11th?

A

Nucleus ambiguus

Travels with vagus to phayrynx

114
Q

Where are the vestibular nuclei found?

A

Lower pons

Upper medulla

115
Q

Location of cochlear nuclei

A

Rostral medulla

116
Q

Location of area postrema

A

Floor of 4th ventricle near the obex

117
Q

Obex of fourth ventricle

A

Where the fourth ventricle narrows to become SC

118
Q

What are the three major levels of medulla

A

Level of motor decussation

Level of sensory decussation (internal arcuate fibres)

Midolivary level

119
Q

What level is the spinal part of accessory nerve seen?

A

Pyramidal decussation in caudal medulla

120
Q

What causes the shallow longitudinal depression on the ventral surface of pons?

A

Basilar artery

121
Q

What are the fibres that are bridging the two cerebellar hemispheres in the ventral pons?

A

Corticopontine fibres that travel to ipsilateral basal pontine nuclei and then to the contralateral cerebellar hemisphere

122
Q

What is the posterior surface of the pons?

A

Upper half of the floor of the fourth ventricle

123
Q

What is the longitudinal depression in the floor of the fourth ventricle?

A

Median sulcus

124
Q

What are the fibres running transversely at the pontomedullary junction in the floor of 4th verntricle?

A

Stria medullaris

125
Q

What are the longitudinal elevations adjacent to median sulcus in pontine floor of fourth ventricle?

A

Facial colliculus formed by internal genu of CN7 as it encircles CN6

126
Q

What longitudinal sulcus is found lateral to the facial colliculus?

A

Sulcus limitans

127
Q

What is the elevation found between median sulcus and sulcus limitans in pontine floor of fourth?

A

Median eminence

128
Q

What is found lateral to sulcus limitans in floor of fourth?

A

Vestibular area

129
Q

How many cochlear nuclei are there?

Where are they found?

A

4, two ventral, two dorsal

Laterally in caudal pons

130
Q

How many vestibular nuclei are there?

A

4

Superior, inferior, medial, lateral

131
Q

Which vestibular nuclei are found in caudal pons

A

Part of superior, medial and lateral nuclei. Not inferior.

132
Q

What is found in the superior part of the sulcus limitans?

A

Substantia ferruginea

133
Q

What is founf ventral to the substantia ferruginea in the pontine tegmentum?

A

Locus coeruleus (Nadr)

134
Q

What demarcates the basal and tegmental pons?

A

Trapezoid body

135
Q

What is the trapezoid body?

A

Decussating fibres from the ventral and dorsal cochlear nuclei which cross over and then ascend

136
Q

What happens to ascending fibres from the trapezoid body?

A

End up at posterior midbrain at the nucleus of the inferior colliculus

137
Q

Where do ascending fibres from the cochlear nuclei travel to after synapsing in nucleus of the inferior colliculus?

A

Medial geniculate body of the thalamus

138
Q

What is the lateral leminisicus?

A

Ascending auditory fibres from the trapezoid body of cochlear nuclei

139
Q

What structure connects nucleus of inferior colliculus with medial geniculate body of thalamus?

A

Inferior brahcium

140
Q

How do fibres get from middle geniculate body to auditory cortex?

A

Via auditory radiations

141
Q

In which pontine levels may the trapezoid body be seen?

A

In both upper and lower

Though they arise in the lower section from cochlear nuceli, some pass obliquely upwards

142
Q

What is found embedded within the trapezoid body?

A

Nuclei of trapezoid body

143
Q

What nucleis is found within the lateral lemniscus?

A

Superior olivary nucleus

144
Q

What are found in the basal pons?

A

Pontine nuclei

145
Q

Function of pontine nuclei?

A

Receive corticopontine fibres from all parts of the cortex. Give off pontocerebellar fibres contributing to middle cerebellar peduncle

146
Q

Through which portion of the pons do corticonuclear and corticospinal neurones pass?

A

Basal pons

147
Q

Which ascending tracts pass through the pons?

A

Medial lemniscus (dorsal)

Spinal lemniscus (spinothalamic + spinotectal)

Lateral lemniscus

Ventral spinocerebellar tract (which ascends to superior cerebllar peduncle)

148
Q

The superior portion of which nucleus present in the caudal pons provides contributions to facial nerve and carries taste from anterior 2/3rds of tongue?

A

Nucleus of tractus solitarius

149
Q

Where do the parasympsthetic fibres contributing to the facial nerve arise?

A

Superior salivatory nucleus

150
Q

What is the somatic sensory component of the facial nerve?

A

From ear

Travel in nervus intermedius to trigeminal sensory nucleus

151
Q

Fine touch and two-point discrimination come to which trigeminal nucleus?

A

Principle pontine

152
Q

Pain and temperature sensation from the face pass to which trigeminal nucleus?

A

Spinal trigeminal

153
Q

What is the location of the MLF?

A

Medially in pontine tegmentum adjacent to floor of 4th ventricle

154
Q

Wnat are the structures shaded green?

Shaded black?

A

Cerebral peduncle

Crus cerebri

155
Q

def: tegmentum

A

covering

156
Q

def: tectum

A

roof

157
Q

What is the boudnary between crus cerebri and tegmentum of midbrain?

A

Substantia nigra

158
Q

What is the boundary between the tegmentum and tectum of midbrain?

A

Cerebral aqueduct

159
Q

Which brainstem area helps to mediate visuospinal reflexes?

A

Superior colliculus in tectum of midbrain

160
Q

Which brainstem area helps to mediate audio spinal reflexes

A

Inferior colliculus of midbrain tectum

161
Q

Tectospinal tract concerned with

A

Audio/visual spinal reflexes

162
Q

What is the posterior part of the SN?

A

Pars compacta

Anteriorly is the pars reticularis

163
Q

What structures descendn in the crus cerebri of the midbrain

A

Corticopontine fibres (medially and laterally)

Corticospinal fibres (midportion)

Corticonuclear fibres (medially)

164
Q

What grey matter is found in the inferior colliculus?

A

Nucleus of inferior colliculus

165
Q

What grey matter is found around cerebral aqueduct?

A

Periaqueductal grey matter

166
Q

What structures will be seen going to and from inferior colliculus at its level in the midbrain?

A

Lateral lemniscus

Inferior brachium

Commissure of inferior colliculus

167
Q

What are the ascending fibres in the tegmentum of the midbrain at level of inferior colliculus?

A

Cerebellorubro fibres (from dentate nucleus to red nucleus)

Medial lemniscus

Spinal lemniscus

Lateral lemniscus (not seen at level of superior colliculus)

168
Q

Fibres from dentate nucleues of left cerebellum syanpse on which red nucleus?

A

From dentate nucleus of leftcerebellum decussate going to right red nucleus and then thalamus

169
Q

Which cranial nerve nucleus is found at the level of inferior colliculus in periaqueductal grey matter?

A

Trochlear

170
Q

What fascicle is found medially in periaquductal grey matter of midbrain?

A

MLF

171
Q

What is located lateral to CN4 in periaqueductal grey matter of midbrain?

A

Mesencephalic nucleus of trigeminal

172
Q

What other important nuclei found in periaqueductal grey matter at level of inferior colliculus in midbrain?

A

Locus coeruleus

Central tegmental nucleus

Nucleus raphe

173
Q

What is the function of centrall tegmental nucleus and nucleus raphe of midbrain?

A

Have descending pathways carrying enkephalin like substances to dorsal horn to modulate spinothalamic tract

174
Q

What is the function of the interpeduncular nucleus?

A

Recevies fibres from habenular system via fasciulus retroflux, involved in regulation of eating behaviours

175
Q

What is the function of central tegmental tract?

ROST

A

Connects reticular formation with thalamus (reticulothalamic)

Connects red nucleus with olivary nucleus (rubro-olivary)

176
Q

What is found in the tegmentum of the midbrain at the level of superior colliculus rather than the dentatorubral fibres?

A

Red nucleus

177
Q

Which lemniscus is no longer seen in midbrain at level of superior colliculus?

A

Lateral lermniscus

178
Q

What is found in the superior colliculus of midbrain?

A

Nucleus of superior colliculus

179
Q

What is the function of the red nucleus of the midbrain?

A

Additional descending pathway (rubrospinal pathway), for flexor attitude- i.e. sitting down + involved in hand movements

180
Q

Vestibuolospinal pathway is for which attitude

A

Extensor or standing up

181
Q

Which to cranial nerve nuclei are found in the periaqueductal grey matter at the level of superior colliculus

A

Somatic nucleus of CN3 and EW nucleus

182
Q

What are fibres travelling ton and from nucleus of superior colliculus

A

Superior brachium (connects with LG body)

Tectospinal

Commissure of superior colliculus

183
Q

Where isn the pretectal nucleus

A

Tectun of midbrain ventral and rostral to nucleus of superior colliculus

184
Q

Function of pretectal nucleus

A

Involved in pupillary reflex

185
Q

What is the name of the connection between the pretectal nuclei?

A

Posterior commissure

186
Q
A
187
Q
A
188
Q
A
189
Q
A
190
Q
A
191
Q
A
192
Q
A
193
Q
A
194
Q
A
195
Q

4 major elements of the brainstem

A

Long ascending and descending tract

CN nuclei and fascicles

Cerebellar nuclei and their connections

Reticular neurones and their processes

196
Q

Corpora quadrigemina

A

Superior and inferior colliculi

197
Q

First CN nuclei column

A

Immediately adjacent to the midline

Nuclei to somatic muscles

CN III, IV, VI, XII

198
Q

Second CN nuclei column

A

Nerves to branchial arch muscles (i.e. muscles of mastication, facial expression, pharynx, larynx, SCM and trapezius)

CN V (mandibular portion) - pons

Facial motor nucelus- pons

Nucleus ambiguus- IX and X, medulla

Nucleus of spinal accessory nerve- cervicomedullary region

199
Q

Third CN nuclei column

A

Preganglionic parasympathetic neurones that innervate smooth muscle and glands of head and neck

Edinger Westphal - III Ciliary ganglion

Superior salivatory nucleus- VII Submandibular and pterygopalatine ganglia

Inferior salivatory nucleus- IX, otic ganglion

Dorsal motor nucleus of vagal nerve

200
Q

What are the three major sensory nuclei in brainstem?

A

Trigeminal
Vestibular and cochlear nuclei

Solitary nucleus

201
Q

Organisaiton of trigeminal nucleus

A

Mesencephalic- proprioceptive

Principle- light touch

Spinal trigeminal- pain and temperature

Receives afferents from V, VII, IX, X

202
Q

Solitary nucleus

A

Located in medulla

Receives general and special visceral afferents from VII, IX, X

Mediates taste, general visceral sensations of organs.

The cel bodies are located outside brainstem and they possess central connections with thalamus, reticular formation and limbic system

203
Q

What are the four main tracts that traverse the brainstem?

A

Two ascending:

Spinothalamic

Medial lemniscus

Two descending:

Corticospinal

Corticobulbar

204
Q

Location of spinothalamic tract in brainstem

A

Lateral aspect of the tegmentum fo the brainstem adjacent to the descending tract.

Consists of 2o neurones originating in the dorsal gray of the spinal cord, which crosses the midline as the anterior white commissure and project to the VPL of thalamus

205
Q

As what do 2o spinothalamic tract neurones decussate?

A

As the anterior white commissure

206
Q

Where do 3o spinothalamic neuroens originate?

A

VPL nucleus of the thalamus

207
Q

Ipsilateral Horner’s

Contralateral hemisensory loss

A

Suggests lesion in lateral pons or medulla

208
Q

Location of medial lemniscus in brainstem

A

Second-order neurones originating in the nucleus cuneatus and gracilis in caudal medulla.

Decussate as the internal arcuate fibres and ascend as the medial lemniscus to the contralateral VPL.

Situated in the medulla close to the midline between the MLF posteriorly and the corticospinal and corticopontine tract anteriorly

In its rostral portion, it moves more laterally

209
Q

Corticospinal tract in the brainstem

A

Transmits motor-related impulses from cortex to laminae IV through IX

Traverse the corona radiata and posterior limb of the internal capsule and continue in the middle of the midbrain crura cerebri flanked either side by corticopontine fibres.

In the pons, the corticospinal tract is broken into small bundles by transverse pontocerebellar fibres which traverse to the contralateral cerebellar hemisphere via the middle cerebellar peduncle.

They come together again to form the medullary pyramids, decussating in the caudal medulla (15% continue as the anterior corticospinal tract which decussates at the anterior commissure in the cervicothoracic spine.

210
Q

What other function does the corticospinal tract perform in the pons

A

It also sends numerous collateral branches to the pontine nuclei, including those of the reticular formation

211
Q

Corticobulbar tract in the brainstem

A

Efferents from the motor cortex to motor cranial nerve nuclei

Except for the part of the facial, cortical input to these nuclei is more or less symmetrically bilateral.

This means that disruption to one of the corticobulbar tracts usually only results in mild paresis whereas bilateral lesions are usually significant.

212
Q

Which nuclei have afferent cerebellar connections

A

Pontine nuclei

Inferior olivary nucleus

Vestibular nuclei

Reticular formation

213
Q

Afferent cerebellar connections:

Pontine nuclei

A

Corticopontine fibres terminated in the pontine nuclei

These nuclei projects crossed fibres that proceed through the middle cerebellar peduncles to reach the contralateral cerebellar hemisphere.

These are concerned with the initiation and planning of movements

They also relay information from LGN, superior colliculus and striate cortex regarding vision

214
Q

Afferent cerebellar connections

Inferior olivary nucleus

A

Nucleus located in the rostral medulla

Receives input from SC< brainstem, the cerebral cortex.

INvolves multiple sensory and motor impulses that cross the midline through the inferior cerebellar peduncle to reach the contralateral cerebellar hemisphere

215
Q

Afferent cerebellar connections

Vestibular nuclei

A

Located in rostral medulla

Traverse inferior cerebellar peduncle to terminate in ipsilateral cerebellar hemisphere providing information about eye movements, head movements and changes in position of head.

216
Q

Afferent cerebellar connections

Reticular formation

A

Reticulocerebellar fibres originating in medulla and pons project through inferior cerebellar peduncles to ipsilateral and contralateral cerebellar hemispheres.

Integrate and relay information from SC and higher cortex

217
Q

Which of the cerebellar afferents connections is uncrossed

A

Vestibulocerebellar fibres are ipsilateral

218
Q

Which brainstem nuclei receive cerebellar efferents

A

Red nucleus

Vestibular nuclei

Reticular formation

219
Q

Efferent cerebellar connections

Red nucleus

A

Located in midbrain tegmentum dorsal to SN

Receives cerebellar fibres from the contralateral hemisphere that cross the midline in the decussation of the superior cerebellar peduncles.

Efferent fibres from red nucleus descend as the crossed rubrospinal tract- relays cerebellar impulses that influence ipsilateral flexor muscle tone

220
Q

Cerebellar efferents from left hemisphere involved in rubrospinal tract effect which side of the body?

A

Left- decussate in the superior cerebellar peduncle

Then decussate again to descend as the rubrospinal tract

221
Q

Efferent cerebellar connections

Vestibular nuclei

A

Recieve input from ipsialteral cerebellar hemisphere via inferior cerebellar peducnle

Influence equilibrium and control of axial musculature (extensor muscle tone via uncrossed vestibulospinal tract)

Coordination of eye movements via uncrossed MLF

222
Q

Efferent cerebellar connections

Reticular formation

A

Cerebellloreticular fibres reach ipsilateral reticular formation in pons and medulla via inferior cerebellar peduncle

Influences extensor muscle tone via uncrossed pontine and medullary reticulospinal tract

223
Q

Two main zones of the reticular formation

A

Magnocellular zone

Parvocellular zone

224
Q

Magnocelular zone

A

Contains large cells that give rise to long ascending and descending pathways

Located in the medial 2/3rds of the retiuclar formation

225
Q

Parvocellular zone

A

Contains predominantly small cells cells that send axons to the medial central nuclei

More laterally located in retricular formation

226
Q

Which functional systems are influenced by reticular formation

A

Motor

Cardiorespiratory

Sensory

Consciousness

227
Q

Reticular formation

Motor control

A

Reticular neurones influence muscle tone via descending reticulospinal tracts to motor neurones.

These tracts originate in the medial portion of the medulla and pons to exert both facilitatory and inhibitor effects on muscle tone.

Receive both afferents and efferents from cortex and cerebellar zones so integrate a wide array of influences on motor control.

The pontine reticular spinal tract is facilitating to extensor tone but its held in check by the medullary reticular spinal tract (hence extensor posturing in lesions below red nucleus but above medulla)

228
Q

Reticular formation

Respiratory control

A

Respiratory related reticular neurones are spread throughout the brainstem

Dorsal respiratory centre located in the dorsal medulla and controls inspiration and is the main respiratory centre

Ventral respiratory centre located in ventrolateral medulla controls both inspiration and expiration but only during significant respiratory efforts

Pneumotaxic centre controls rate and patter of breathing, found in rostral pons

229
Q

Dorsal respiratory centre

A

Dorsal medulla

Main respiratory centre

Controls inspiration

230
Q

Ventral respiratory centre

A

Ventrolateral medulla

Controls both inspiration and expiration but only during significant respiratory efforts

231
Q

Pneumotaxic respiratory centre

A

Dorsal rostral pons

Controls rate and pattern of breathing

232
Q

Reticular formation

Cardiac control

A

Cardiovascular reticular neurones are involved in complex polysnaptic pathways, receiving afferents from many oruces and sending efferent impulses via reticulospinal tracts to end on sponal neurones

233
Q

Reticular formation

RAS

A

Modulates wakefulness and arousal

Receives collaterals from long ascending sensory pathways including medial meniscus and spinothalamic tracts

Efferents are conduced via centromedian nucleus of thalaus to widespread ares of cerebral cortex

234
Q

Blood supply of rostralmost midbrain

A

From PComm

235
Q

Blood supply of dorsolateral pons

A

Rostrally by SCA
Caudally by AICA

236
Q

How to localise brainstem lesions?

A

What cranial nerve nuclei involved= level of the lesion

What long tracts are involved= medial or lateral

237
Q

Right sided impairment of facial pain and temperature

Left sided impairment of body pain and temperature

Right limb and gait ataxia

Right Horner’s

Nausea vomiting/vertigo and nystagmus

Dysphagia and dysarthria

A

Right lateral medullary syndrome

Ipsilateral facial pain and temperature impairment due to the involvement of the spinal trigeminal nucleus and tract

Contralateral facial pain and temperature impairment due to the involvement of spinothalamic tract

Ataxia due to cerebellar connections

Ipsilateral Horner’s due to involvement of descending sympathetic tract

Vertigo etc due to vestibular tract

Dysphagia and dysarthria due to involvement of nucleus ambiguus

238
Q

Right-sided hemiparesis

Right-sided loss of vibration and positional sense

Tongue deviation to left

A

Left-sided medial medullary syndrome (Dejerine’s)

Contralateral hemiparesis due to involvement of corticospinal tract

COntralateral loss of dorsal tract due to the medial lemniscus

Left hypoglossal palsy due to involvement of hypoglossal nuclei.

Sparing of spinothalamic tract

239
Q

Quadriplegia with facial sparing

Complete paralysis of the tongue

Complete loss of vibratory and position sensation below the head

A

Bilateral medial medullary lesion

240
Q

Right-sided impairment of facial pain and temperature

Left-sided impairment of body pain and temperature sensation

Ipsilateral Horners

Nausea, vomiting, nystagmus

Ipsilateral limb and gait ataxia

Ipsilateral facial paralysis

Paralysis of gaze to the side of the lesion

Deafness and tinnitus

A

Right lateral pontine syndrome (Millard-Gubler)

Either due to AICA or SCA occlusion

Facial pain/temperature due to trigeminal

Spinothalamic tract

Sympathetic tract

Vestibular nuclei and connections

Impaired gaze to the side of the lesion due to PPRF involvement

Ipsilateral facial paralysis due to involvement of facial nerve

Deafness and tinnitus due to involvement of cochlear nerve or nucleus

241
Q

Right hemiparesis

Right-sided loss of vibration or the positional sense

Left-sided limb ataxia

Impaired abduction of the left eye

INO

Paralysis of gaze to side of lesion

A

Left medial pontine syndrome

Contralateral hemiparesis- corticospinal tract

Contralateral dorsal column- medial lemniscus

Ipsilateral cerebellar signs- cerebellar connections

Ipsilateral impaired abduction- CN 6

INO- MLF

Impaired conjugate gaze to ipsilateral side- PPRF

242
Q

Right sided hemiparesis

Left CN3 palsy

A

Left Weber’s syndrome

Ventral midbrain

243
Q

Right CN3 palsy

Left involuntary movements or tremor

Left impaired dorsal column

A

Right Benedikt’s syndrome

Central midbrain

Red nucleus

Medial lemniscus

244
Q

Impaired upgaze

Pupillary dilatation

Lid retraction

Convergence retraction nystagmus

Light-near dissociation

Sunsetting

A

Parinaud’s

245
Q

Pontine reticulospinal tract

A

Arises from pontine tegmentum and descend ipsilaterally in medial anterior funiculus

Predominantly excitatory

246
Q

Medullary reticulospinal tract

A

Arises from medial two-thirds of the medullary reticular formation

Most arise from nucleus reticularis gigantocellularis

Descends in lateral funiculi and projects bilaterally to multiple levels

Predominantly inhibitory

247
Q

Tectospinal tract

A

Originates from cells in the superior colliculus

Tract crosses dorsal tegmentum and descends in contralateral funiculus.

In medulla, fibres become incorporated into the MLF

Continues only cervical segments.

248
Q
A
249
Q
A

Dorsal cochlear nucleus

250
Q
A

NSx Neuroanatomy (25 decks)

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