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Neuro > Brainstem and Cranial Nerves > Flashcards

Brainstem and Cranial Nerves Flashcards

1
Q

Edinger-Westphal n.

A

Parasymp of CN III
Superior colliculus, only a little bit higher than oculomotor nucleus (Edinger-Westphal is with red nucleus)

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2
Q

Trochlear n.

A

Decussate at Inferior colliculus
Contralateral
Emerges immediately below inferior colliculus
Motor to superior oblique m.

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3
Q

mesencephalic n. of CN V

A

Extends from midbrain down to midpons
Propioception of face

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4
Q

Chief n. of face

A

Fine touch of face

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5
Q

Nucleus spinal tract of CN V

A

Extends from midpons to upper cervical cord
Pain of face

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6
Q

Motor n. of CN V

A

Muscles of mastication
At the same level as sensory n. Of CN V
Between mesencephalic nuclei &tract and spinal nuclei &tract of CN V

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7
Q

Caudal pons CN nuclei

A

Abducens n. = lateral rectus m.
Parabucen n. (PPRF)
Facial n.
Superior salivatory n.

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8
Q

Parabucen n. (PPRF) fxn

A

horizontal conjugate eye movement

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9
Q

Superior salivatory n. fxns

A

Secretion from lacrimal gland, submandibular, sublingual salivary glands

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10
Q

Pontomedullary jxn nuclei

A

Inferior salivatory n. –> CN IX, parotid gland secretion

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11
Q

Medulla nuclei

A

Nucleus ambiguus (CN IX, X, XI)
Dorsal motor n of CN X
hypoglossal n.
Solitary n.

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12
Q

Nucleus ambiguus

A

Motor to muscles of pharynx & larynx

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13
Q

Dorsal motor nuc. of CN X

A

parasymp. of CN X

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14
Q

Hypoglossal n.

A

motor to tongue m.

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15
Q

Solitary n.

A

taste & visceral sensation

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16
Q

Accessory n.

A

Spinal part of CN XI
Motor to trapezius and SCM m.

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17
Q

CN III palsy

A

Diplopia, lateral squint, ptosis, dilated pupil, decreased light reflex

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18
Q

CN IV palsy

A

Difficulty in looking down e.g. down the stairs

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19
Q

CN V palsy

A

Decreased sensation of face, corneal reflex

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20
Q

CN VI palsy

A

Medial squint, diplopia

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21
Q

CN VII palsy

A

Weakness of ipsilateral facial muscles

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22
Q

CN VIII palsy

A

Neurosensory hearing loss

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23
Q

CN IX, X palsy

A

decreased gag reflex, uvula deviation (away from lesion), hoarseness

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24
Q

CN XII palsy

A

Ispilateral tongue atrophy, deviation towards the same side

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25
Q

Medial brainstem lesions

A
  1. Motor (pyramidal) tract
  2. Medial lemniscus
  3. Motor nuclei & CN 3, 6, 12
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26
Q

Lateral brainstem lesions

A

To the Side
Spinocerebellar
Spinothalamic / spinal lemniscus
Sensory nucleus of CN V, VIII
Sympathetic pathway

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27
Q

Midbrain is supplied by … branches

A

PCA

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28
Q

Rostral pons is supplied by … branches

A

paramedian b. of basilar, superior cerebellar a.

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29
Q

Midpons is supplied by … branches

A

Paramedian b of basilar, short circumferential of basilar

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30
Q

Caudal pons is supplied by … branches

A

Paramedian b of basilar, AICA

31
Q

Medulla is supplied by … branches

A

Anterior spinal a, PICA

32
Q

Extrinsic vs intrinsic brainstem lesions

A

Extrinsic:
- Multiple CN palsies
- Unilateral hearing loss
- No or late long-tract signs (hemiparesis, hemianesthesia)

Intrinsic: early long tract signs, deterioration of consciousness

33
Q

Parinaud syndrome

A

Often due to pinealoma or geminoma of the pineal gland.
Compression of tectum (posterior midbrain) causes:
- Impaired light reflex, upward gaze, convergence, accomodation
Can cause noncommunicating hydrocephalus

34
Q

Benedikt syndrome

A

Paramedian midbrain syndrome
- CN III palsy
- Ipsilateral fixed and dilated pupil (ophthalmoplegia)
- contralateral loss of conscious proprioception, fine touch, and vibration from trunk and extremities
- Red nucleus: contra cerebellar dystaxia with intention tremor

35
Q

Uncal herniation classical triads

A
  1. Ipsilateral fixed dilated pupil (CN III palsy)
  2. Contralateral hemiparesis due to compression of pyramidal tract
  3. Coma due to compression of reticular formation

In some cases, Kernohan phenomenon causes the contralateral cerebral peduncle to the compressed against the tentorial notch

36
Q

Pontine lesions anatomical analysis using CN V

A
  1. Contralateral hemianesthesia is caused by a lesion ABOVE MIDPONS
  2. Alternating hemianesthesia is caused by a lesion BELOW MIDPONS
37
Q

Entire face hemiparesis is caused by

A

Ipsilateral LMN lesion of facial nerve (below caudal pons)

38
Q

Corticobulbar tract lesion causes

A

Contralateral lower portion of face hemiparesis
(UMN lesion of facial nerve)

39
Q

Stapedius muscle is innervated by

A

CN VII

40
Q

Tensor tympani is innervated by

A
41
Q

AICA syndrome

A

Lateral inferior pontine syndrome
- CN VII
CN VIII
CN V
Cerebellum
Spinothalamic (contralateral)
Descending symp. tract

42
Q

Lateral midpontine syndrome

A

Circumferential branch of basilar occlusion
- CN V nerve root
- Brachium pontis: ipsilateral limb and gait dystaxia

43
Q

Locked-in syndrome or pseudocoma patients

A

Results from infarction of the base of superior pons, infarctions include corticobulbar and corticospinal tracts resulting in quadriplegia and paralysis of lower CN.

They can only use CN III, CV IV (blink and move eyes vertically)

44
Q

Hypoglossal palsy location

A

Medulla, dorsal near 4th ventricle

45
Q

Wallenburg syndrome

A

PICA syndrome

46
Q

What causes coma?

A
  1. Dysfunction of upper brainstem
  2. Bilateral dyencephalic dysfunction
  3. Diffuse lesions in both cerebral hemispheres (white matter)
47
Q

Brain death criteria

A
  1. Irreversible cessation of all functions of the brain, including the brainstem (absence of brainstem reflexes)
  2. Apnea even after PaCO2 increases
  3. Coma (no cortical mediated responses to pain)
48
Q

Storage phase of micturition is mediated by

A
  1. Increased sympathetic decreased parasymp via HYPOGASTRIC NERVE causes relaxation of detrusor m. and contraction of internal urethral sphincter
  2. LMN from Onuf n. promotes contraction of external urethral sphincter via PUDENDAL NERVE
49
Q

Signals of bladder wall stretch is sent to

A

the PAG periaqueductal gray in the midbrain
which sends it to the insula

50
Q

Higher control of micturition

A

Frontal lobe: prefrontal cortex, SMA, ant. cingulate gyrus
Insular lobe

Controls the switch from storage to voiding via the PAG

51
Q

Pathway of voiding phase of micturition

A
  1. Higher cortical areas tell PAG to start voiding
  2. PAG activates PMC
  3. PMC inhibits hypogastric, pudendal
  4. PMC activates sacral parasymp. nucleus to stimulate contraction of detrusor
52
Q

Suprapontine/supraspinal lesions affect micturition…

A
  1. Decreased inhibitor signals to PAG, PMC = detrusor hyperactivity (once bladder reaches threshold –> uncontrolled voiding reflex)
  2. Urinary frequency, urgency, nocturia, and occasionally urge incontinence
53
Q

Suprasacral cord lesions affect micturition …

A
  1. Detrusor overactivity and loss of voluntary control of striated sphincter
  2. Dyssynergic straited sphincter causes functional obstruction with poor bladder emptying
54
Q

Sulcus limitans

A

Separates hypoglossal trigone (above) and vagal trigone (below) in the floor of 4th ventricle, posterior to pons and medulla

55
Q

What are the sensory pathways in the brainstem?

A
  1. Pain & temperature: lateral spinothalamic, trigeminothalamic
  2. propioceptive
56
Q

Midbrain contents

A
  1. Tectum
  2. Tegmentum
  3. Cerebral peduncle
57
Q

What nuclei are found in the rostral pons?

A

Mesencephalic root of CN V and nuclei
Parabrachial nucleus

58
Q

Which nuclei are found in midpons?

A

Motor nucleus of CN V
Chief sensory nucleus of CN V
Mesencephalic root of CN V and nuclei

59
Q

Which nuclei are found in caudal pons?

A

Abducens nucleus (CN VI)
Facial nucleus (CN VII)
Lacrimal and superior salivatory nuclei (CN VII) Lateral and superior vestibular nuclei (CN VIII) Dorsal and ventral cochlear nuclei (CN VIII)

60
Q

What consciousness system is found in pons?

A

Pontine reticular formation – Raphe’ nuclei
Locus coeruleus

61
Q

Oculomotor light reflex center

A

Pretectal nuclei, midbrain
Posterior commisure

62
Q

Upward gaze center

A

Tectum of superior colliculi

63
Q

Convergence center

A

Nucleus of Perlia, midbrain

64
Q

Tectum of inferior colliculus

A

Auditory system

65
Q

Parabducens nucleus (Paramedian pontine reticular formation; PPRF) is…

A

Lateral gaze center in pons

66
Q

Medial longitudinal fasciculus MLF

A

Conjugate eye movement, pons

67
Q

Auditory system tract: cochlear

A
  1. Stereocilia on basilar membrane are stimulated
  2. Glutamate stimulates bipolar neurons in spiral ganglion
  3. Cochlear nerve
  4. Cochlear nuclei (bilateral projections = trapezoid body, in medulla)
  5. Superior olivary nucleus (medulla)
  6. Lateral lemnisci
  7. Inferior colliculus in midbrain
  8. Medial geniculate nuclei
  9. acoustic area of temporal lobe cortex
    Transverse temporal gyrus, more medial - primary
    Superior transverse gyrus, more lateral - auditory association area
68
Q

Trapezoid body

A

Bilateral projections of auditory system (cochlear) in medulla from cochlear nuclei to superior olivary nucleus

69
Q

Lateral lemnisci

A

Fibers from superior olivary nuclei to inferior colliculus to MGN

70
Q

What neurotransmitter is used to stimulate the spiral ganglion in hearing?

A

Glutamate

71
Q

Transverse temporal gyrus

A

Can only be seen by cutting away some portions of parietal / frontal lobe.
Primary auditory area

72
Q

Superior transverse gyrus

A

more lateral than transverse temporal gyrus - auditory association area

73
Q

Solitary nucleus

A

Nucleus location
Medulla oblongata of the brainstem
Ascending fibers to the nucleus
Lateral and caudal parts - taste sensation via vagus nerve (CN X)
Rostrocaudal part - visceral sensation from tonsils, tongue, palate, pharynx and posterior one-third of the tongue via glossopharyngeal nerve (CN IX)
Rostral part - visceral sensation from the roof of the oral cavity and anterior two-thirds of the tongue via facial nerve (CN VII)

A tract formed by the fibers of the glossopharyngeal nerve (CN IX), fibers of the inferior ganglion of the vagus nerve (CN X) and geniculate ganglion of the facial nerve (CN VII).
- Mnemonic: Non Stop Training (Ninth, Seventh, Tenth)
Function
Relays signals of satiety
Generates and synchronizes the peristaltic activity of the upper gastrointestinal tract during swallowing
Generates and coordinates respiratory patterns

Neuro (18 decks)

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