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ABPP > Brainstem & cerebellum > Flashcards

Brainstem & cerebellum Flashcards

1
Q

Pseudobulbar affect

A

Uncontrollable bouts of laughter or crying without feeling the usual associated emotions caused by abnormal reflex activation of laughter & crying in the brainstem

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1
Q

Lesions of the optic nerve result in

A

Monocular visual loss or monocular scotomas; can be partial

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2
Q

Hypertropia

A

Abnormal vertical deviation of one eye

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2
Q

What are the most common causes of acute ataxia in children?

A

Accidental drug ingestion, varicella-associated cerebellitis, migraine

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3
Q

One-and-a-half syndrome

A

Ipsilateral internuclear ophthalmoplegia plus ipsilateral lateral gaze palsy (only mvmt unaffected is CL lateral rectus) Caused by lesions to the MLF + adjacent abducens nucleus OR MLF + PPRF

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3
Q

How is the trigeminal nerve examined?

A

Light touch, pain by pinbrick, hot/cold, corneal reflex, jaw reflex, jaw movements

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3
Q

What are the most common causes of chronic ataxia in adults?

A

Brain metastases, chronic toxin exposure, MS, degenerative disorders

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4
Q

Bulbar palsy

A

Dysarthria, dysphagia, & hypoactive jaw/gag reflex not associated with cognitive changes (pseudo is)

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5
Q

Ptosis

A

Drooping of eyelid

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5
Q

Infarcts that involve both the lateral brainstem & the cerebellum are most likely in what vascular territories?

A

PICA & AICA

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6
Q

A complete lesion of the cavernous sinus results in

A

Total ophthalmoplegia + fixed, dilated pupil

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7
Q

Brainstem controlling centers for vertical eye mvmts are located in the

A

Rostral midbrain reticular formation & pretectal area

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7
Q

Middle cerebellar peduncle

A

Brachium pons; connects to pons; carries mainly inputs

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7
Q

What is the function of the lateral cerebellar hemispheres?

A

Motor planning for extremities

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7
Q

Where do cerebellar output pathways cross?

A

1) as they exit in decussation of superior cerebellar peduncle 2) as corticospinal & rubrospinal tracts descend to spinal cord

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8
Q

CN X

A

Vagus; parasympathetics to heart, lungs, digestive tract; pharyngeal & laryngeal muscles; taste from epiglottis & pharynx

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8
Q

Ataxia-hemiparesis

A

Syndrome in which patients have a combo of unilateral UMN signs & ataxia, usually affecting the same side; often caused by lacunar infarcts, most often in corona radiata, IC, or pons

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9
Q

UMN vs LMN lesions of CN VII (facial)

A

UMN - spares forehead; LMN - affects entire half of face

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10
Q

Appendicular apraxia

A

Ataxia on movement of the extremities; caused by lesions of the intermediate & lateral portions of the cerebellar hemisphere, which affects the lateral motor systems

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11
Q

Function of the caudal reticular formation

A

Maintains important motor, reflex, & autonomic functions

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12
Q

The superior cerebellar artery supplies what structures?

A

Upper lateral pons, superior cerebellar peduncle, most of superior half of cerebellar hemispheres

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13
Q

Horner’s syndrome

A

Ptosis, miosis, anhidrosis Caused by loss of sympathetic innervation

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13
Q

Benign anisocoria

A

Slight pupillary asymmetry in 20% of the general population

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13
Q

The posterior inferior cerebellar artery supplies what structures?

A

Lateral medulla, most of inferior half of cerebellum, inferior vermis

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14
Q

The anterior inferior cerebellar artery supplies what structures?

A

inferior lateral pons, middle cerebellar peduncle, strip of ventral cerebellum

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15
Q

Paramedian pontine reticular formation (PPRF)

A

Important horizontal gaze center that provides input from cortex & other pathways to abducens nucleus

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15
Q

Parinaud’s syndrome

A

Impairment of vertical gaze, large & irregular pupils w/ light-near dissociation, eyelid abnormalities, impaired convergence

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16
Q

Smooth pursuit

A

Slower eye mvmts, not under voluntary control, allow stable viewing of moving objects

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17
Q

Common causes of internuclear ophthalmoplegia

A

MS plaques, pontine infarcts, MLF neoplasms

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18
Q

What is the most commonly injury cranial nerve in head trauma?

A

Trochlear

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19
Q

CN XI

A

Accessory; innervates the sternomastoid & upper part of trapezius muscle

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21
Q

Esotropia

A

Abnormal medial deviation of one eye

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21
Q

CN XII

A

Hypoglossal; innervates intrinsic muscles of the tongue

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22
Q

CN IX

A

Glossopharyngeal; motor to salivary glands & muscles of pharynx; sensory from posterior 1/3 of tongue, pharynx, middle ear

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23
Q

Locked-in syndrome

A

Large pointine lesions disrupt bilateral corticospinal tracts & abducens nuclei, eliminating body mvmts & horizontal eye mvmts

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23
Q

CN VIII

A

Vestibulocochlear; hearing & vestibular sensation

25
Q

Oculomotor palsy

A

Paralysis of all extraocular muscles except lateral rectus & superior oblique (eye is “down and out”), upper lid is closed, pupil is dilated & unresponsive to light

26
Q

Ataxia

A

Disordered contractions of agonist & antagonist muscles, lack of normal coordination between movements at different joints seen with cerebellar dysfunction

27
Q

Trigeminal neuralgia (tic douloureux)

A

Recurrent episodes of brief pain in the distribution of the trigeminal nerve

28
Q

What is the function of the cerebellar vermis & flocculonodular lobe?

A

Proximal limb & trunk coordination, balance & vestibulo-ocular reflexes

29
Q

What are the most common causes of chronic ataxia in children?

A

Cerebellar astrocytoma, medulloblastoma, Friedreich’s ataxia, ataxia-telangiectasia

31
Q

Lesions to the PPRF lead to

A

Ipsilateral lateral gaze palsy

33
Q

Marcus Gunn pupil

A

Afferent pupillary defect; the direct response to light in the affected eye is decreased/absent while consensual response of the affected eye to light in the opposite eye is normal Caused by decreased sensitivity to light secondary to lesions of optic nerve, retina, or eye

35
Q

Accommodation response

A

Occurs when a visual object moves from far to near, involves pupillary constriction, accommodation of the lens ciliary muscle, and convergence of the eyes

36
Q

Argyll Robertson pupil

A

Light-near dissociation (pupil accommodates but doesn’t react to light) plus small & irregular pupils; associated with neurosyphilis

37
Q

Bilateral acoustic neuromas are associated with

A

Neurofibromatosis Type 2

37
Q

Pseudobulbar palsy

A

Used to describe dysarthria & dysphagia caused by UMN lesions in corticobulbar pathways (e.g., frontal lobe) not the brainstem; is associated with cognitive changes

37
Q

Pupillary effects of opiate use

A

B pinpoint pupils

39
Q

True vertigo

A

Spinning sensation of mvmt that is caused by lesions anywhere in the vestibular pathways

40
Q

Friedrich’s ataxia

A

Hereditary (excessive trinucleotide repeats), progressive gait ataxia Speech may be affected, but cognition intact; emotional lability may be present

41
Q

Right-way eyes

A

Cerebral hemisphere lesions normally impair eye mvmts in the CL direction, resulting in gaze preference toward sign of lesion, way from side of weakness

42
Q

Symptoms of vagus nerve damage

A

Hoarseness, poor swallowing, loss of gag reflex

43
Q

Exotropia

A

Abnormal lateral deviation of one eye

44
Q

Medial longitudinal fasciculus (MLF)

A

Interconnects III, IV, VI, X nuclei

45
Q

Pupillary effects of barbiturate overdose

A

B small pupils

47
Q

Caloric test

A

Test of vestibulocochlear function that involves irrigating the ear

48
Q

Which cranial nerves are located in the pons?

A

5-8

50
Q

Effects of damage to the abducens nerve versus the abducens nucleus

A

Nerve - impaired abduction of IL eye Nuclei - IL gaze palsy in both eyes

51
Q

Inferior cerebellar peduncle

A

Restiform body; connects to medulla; carries mainly inputs

53
Q

Early symptoms of acoustic neuroma

A

Hearing loss, tinnitus, unsteadiness

55
Q

Divisions of the trigeminal nerve

A

Ophthalmic, maxillary, mandibular

56
Q

Trochlear palsy

A

Causes vertical dipolopia & hypertropia (eye is up & in)

57
Q

Supranuclear pathways

A

Involve brainstem & forebrain circuits that control eye mvmts through connections with CN III, IV, & VI

59
Q

Which cranial nerves are located in the medulla?

A

9-12

61
Q

CN V

A

Trigeminal; general sensation for face, mouth, anterior 2/3rds of tongue; muscles of mastication & tensor tympani muscle

62
Q

CN VII

A

Facial; motor for facial muscles, most salivation, anterior 2/3 tongue taste

63
Q

What is the typical presentation of a cerebellar stroke?

A

Vertigo, nausea & vomiting, horizontal nystagmus, limb ataxia, unsteady gait, HA

64
Q

What is the function of the intermediate cerebellar hemispheres?

A

Distal limb coordination

65
Q

Ciliary muscle

A

Adjusts thickness of lens in response to viewing distance

66
Q

What are the most common causes of acute ataxia in adults?

A

toxin ingestion, ischemic or hemorrhagic stroke

68
Q

Function of the rostral reticular formation

A

Maintains alert conscious state in brain

69
Q

Nuclear & infranuclear pathways

A

Involve brainstem nuclei of III, IV, & VI; the peripheral nerves arising from these nuclei, & the eye mvmt muscles

70
Q

Damage to glossopharyngeal nerve leads to

A

spasms of pain in posterior pharynx

72
Q

Pupillary effects of anticholinergic agents

A

Dilated pupils

73
Q

Wrong-way eyes

A

Eyes look toward side of weakness; possible causes include seizure activity, large lesions such as thalamic hemorrhage, lesions of pontine basis & tegmentum

75
Q

CN III

A

Oculomotor; innervates all extraocular muscles, except superior oblique & lateral rectus; also controls pupillary constriction & accommodation reflex

76
Q

Internuclear ophthalmoplegia

A

Eye ipsilateral to lesion does not fully adduct on attempted horizontal gaze, nystagmus in opposite eye

77
Q

CN VI

A

Abducens; innervates lateral rectus muscle, causes abduction of eye (turns eye out)

78
Q

Sensory ataxia

A

Occurs when posterior column-medial lemniscus pathway is disrupted, resulting in loss of joint position sense

79
Q

UMN vs LMN damage to CN XII (Hypoglossal)

A

UMN = CL tongue weakness LMN = IL tongue weakness

80
Q

Herpes zoster causes sensory loss in the distribution of what cranial nerve?

A

V - trigeminal

82
Q

Saccades

A

Rapid eye mvmts that bring target of interest into field of view

83
Q

Conductive vs. sensorineural hearing loss

A

Conductive = abnormalities of external auditory canal or middle ear Sensorineural = disorders of cochlea or 8th nerve

84
Q

Superior cerebellar peduncle

A

Brachium conjunctivum; connects to midbrain; carries mainly outputs

85
Q

CN IV

A

Trochlear; innervates superior oblique muscle, causes depression & intorsion of eye

86
Q

Common causes of oculomotor palsy

A

Diabetic neuropathy, head trauma, intracranial aneurysms, tentorial herniation, ophthalmoplegic migraine in children

87
Q

Truncal ataxia

A

Wide-based, unsteady “drunklike” gait; caused by lesions in the vermis, which primarily affect the medial motor systems

88
Q

Orbital apex

A

Region where nearly all nerves, arteries, & veins of the orbit converge before communicating with the intracranial cavity via the optic canal & superior orbital fissure

89
Q

Bell’s palsy

A

unilateral paralysis of the muscles supplied by the facial nerve

ABPP (34 decks)

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