Ch12 Brainstem I Flashcards
Motor Columns are
GSE
GVE
SVE
GSE- is adjacent to
midline
FSE CN are
3,4,6,12
Visceral motor nuclei are in two columns:
GVE
SVE
GVE is related to which nervous system?
parasympathetic
GVE CN are
3,7,9,10
SVE innervate muscles of
branchiomeric origi
SVE CN are
5,7,9,10,11
Sensory Columns, Visceral sensory columns: are
SVA
GVA
SSA
GSA
SVA is related to which censes
taste and smell
SVA CN are
1
7
9
10
GVA is sensory from
viscera
GVA CN are
9
10
SSA CN are
2 (sight)
8 (hearing & equilibrium)
GSA is sensory for
head (trigeminal)
GSA CN are
5
7
9
10
Olfactory Nerve (SVA) Specialized:
chemoreceptors
CN1 chemoreceptors are located on
the superior nasal cavity
nasal chemoreceptors send axons through
cribiform plate
Olfactory Nerve track doesn’t go though ____ while going to the temporal lobe
thalamus
CN1 lesions are causes
ansomia
hyeprosmia
parasmia
def: anosmia
loss of smell
def: hyperosmia
increased sensitivity to smell
def: parosmia
abnormal sensations of smell
CN1 lesions are caused by
- cocaine and other inhalants
- tumor of frontal lobe or pituitary gland
- viral infection
- trauma at the cribiform plate
Optic Nerve II testing includes
Inspection Funduscopic exam Visual Acuity Reflexes Confrontation testing of visual fields
Optic Nerve II Physiological problems: includes
cataracts
nyctalopia
uncorrected nearsightedness
define cataract
protein in the lens of the eye changes from clear to opaque
biggest contributor to cataract is
UV light exposure
cataracts is most common in what population?
elderly patients and welders
nyctalopia is due to
Vit A deficiency
nyctalopia causes
impaired night vision
in nyctalopia, cones takes longer to
recover vision when blasted by high beams
the inspection of CNII includes
exopthalmos
eye alignment
Pupils - PERRLA
Exopthalmos is ____ of eyes
bulging
PERRLA refers to
pupils-equal-round-reactive to light-accommodate
Funduscopic exam includes
disc
vessels
background
macula
How would you expect the pigments in a person with a darker skin:
more pigments
Trigeminal nerve V component
SVE
GSA
Trigeminal nerve 3 divisions
Ophthalmic
Maxillary
Mandibular
CN V Sensory lesions leads to
paresthesia
anesthesia
diminished absent reflexes
lesions in brainstem lead to _____ loss
ipsilateral
CN V Motor lesions leads to
muscle weakness
atrophy
diminished or absent jaw jerk reflex
Trigeminal Neuralgia aka
Tic Douloureux
Trigeminal Neuralgia Pt feels
stabbing electric pain in Trigeminal nerve distributions
Trigeminal Neuralgia frequency
rare
150 cases/ 1 m
Trigeminal Neuralgia is more common in what population?
women 30-50
Trigeminal Neuralgia attacks lasts about
1-2 min
Trigeminal Neuralgia attacks can happen over ____ per day
100 times
what tigers Trigeminal Neuralgia attacks
cold exposure touch pressure eating swallowing
Trigeminal Neuralgia Pts are prone to
sucide
Trigeminal Neuralgia is possibly caused by
- blood vessel compression
- M.S.
- tumor
- damage from dentistry/surgery
- subluxation (dentate ligament)
- idiopathic
Herpes Zoster aka
Varicella
Chickenpox
Shingles
Herpes Zoster Virus goes dormant and hides in
nerve ganglia
under what cirumstances the H zoster may become active again?
stress
describe Shingles
eruption of small, extremely painful vesicles along the distribution of the nerve
shingles can affect which nerves?
any cutaneous nerve
unilaterally, does NOT cross mid-line
Most common affected CN by shingles is
CN V
Facial nerve VII component
SVE
GSA
SVA
Facial nerve VII parasympathetic (GVE) - makes
tear
saliva
muscus
what problmes that interfere with CN VII
TMJ problems or damage to lacrimal gland
CN VII SVA function is
taste of sweet, salty, & sour on the anterior 2/3 of the tongue
Facial nerve VII lesions results in
Facial muscle weakness
facial Upper motor neuron lesion effect
spares forehead
forehead gets innervation from both nerves, both cerebral hemispheres
Lower motor neuron lesion affect
above and below the ey
Bell Palsy is
facial nerve paralysis
Bell Palsy rate
4/10000 people
Bell Palsy is accompanied with
pain around the ear
drooling
speech impediment
eyelid may not close
Bell Palsy onset is
sudden
Bell Palsy 80% recover in
2-6 weeks
if Bell Palsy recovery is delayed beyond 12 weeks then it becomes
permanent
Bell Palsy becomes permanent when
nerves begin to take over other muscle fibers; resembles a grimace that makes the unaffected side appear paralyzed
Bell Palsy can lead to increased sensitivity to
sounds on the affected side
tensor tempani muscle - innervated by
CN V
stapedius - innervated by
CN X
Ramsay Hunt Syndrome is described as
Bell’s Palsy + Shingles
in Ramsay Hunt Syndrome, H zoster attacks which nerve?
CN VII
Ramsay Hunt Syndrome pain (posterior ear) precedes paralysis by
24-72 hours
Ramsay Hunt Syndrome may involve which CN in addition to facial
CN V
Ramsay Hunt Syndrome is more likely to have ____ effects
residual
Vestibulocochlear aka
Cochleovestibular
Acoustic
Statoacoustic
CN VIII
Cochlear Nerve; Sensorineural deafness means
cochlea or the nerve is damaged
Sensorineural deafness characteristic
inner ear infection
Meniere disease
noise-induced deafness
toxicity
Cochlear Nerve; Conductive deafness means
mechanical deficit in getting sound to the cochlea
Conductive deafness characteristic
obstruction
eardrum damage
osteosclerosis
external or middle ear infection
Cochlear lesion signs
Tinnitus
Auditory scotomas
Tinnitus includes
ringing, buzzing, roaring in the ear
Auditory scotomas means
loss of hearing at certain frequencies
Schwannoma aka
coustic neuroma
cerebellopontine angle tumor
Schwannoma causes hearing loss with
tinnitus
Schwannoma damage is due to tumor growing on
the acoustic nerve
Schwannoma symptoms may include
facial pain and sensory loss from CNV involvement
may involve facial nerve
if Schwannoma reached CN 9 and 10 it can lead to
hydrocephalus
Vestibular Nerve lesions can cause
Dizziness
Impulsion
Vertigo
feeling of unsteadiness is called
Dizziness
abnormal feeling of motion is called
Vertigo
feeling of being pushed is called
Impulsion
Dizziness, Impulsion, Vertigo can cause
motion sickness
Peripheral Vestibular; timing
2-5 sec lag between motion & nystagmus; then it goes away in 30 sec
Peripheral Vestibular; Vertigo is
extreme
Peripheral Vestibular; caused by
Schwannoma
Vestibular Neuritis (viral)
Meniere Disease
BPPV
Peripheral Central; timing
constant nystagmus
Peripheral Central; Vertigo is
none
Peripheral Central; caused by
Ischemia (stroke) Infection (in CNS) inflammation (M.S.) Toxin METS
Endolymphatic Hydrops Meniere Syndrome aka
Endolymphatic Hydrops
Meniere is ____ ear disorder
inner
Meniere is caused by
too much fluid production increases pressure
overstimulates inner ear
Meniere leads to
overproduction of endolymph
progressive cumulative deafness, possibly with vertigo
overproduction of endolymph leads to
parasympathetic problems
Glossopharyngeal IX exits skull at
Jugular Foramen
Glossopharyngeal IX exits skull with
X & XI
Glossopharyngeal IX Lesions leads to
glossopharyngeal neuralgia
tachycardia
loss of gag reflex & dysphagia
loss of bitter taste on posterior 1/3 of tongue
tachycardia with no loss of oculocaridac reflex indicates a problem with
CN IX
tachycardia with a loss of oculocaridac reflex indicates a problem with
CN X
Vernet Syndrome aka
Jugular foramen syndrome
Vernet Syndrome location
Jugular foramen
Vagus nerve X unilateral Lesion ablative signs
hoarseness,
dyspnea
dysphagia
uvular deviation AWAY from the affected side
Vagus nerve X binilateral Lesion ablative signs
Death
Vagus nerve X irritative signs
increased parasympathetic tone
echelasia
echelasia means
food backed up in esophagus
or
stomach dilation
Spinal Accessory nerve XI is
SVE
Spinal Accessory nerve XI arise from
the anterior horns of C1- C5
Spinal Accessory nerve XI innervates
SCM & trapezius ipsilaterally
CN XI internal medullary branch goes back into skull & out from
jugular foramen
CN XI Lower motor neuron lesion signs
ipsilateral weakness of shoulder shrug and contralateral head rotation
CN XI Upper motor neuron lesion signs
deficit turning head to contralateral side
increased tone, but weakness
SCM is innervated (contra or ipsi-lateral)
ipsilateral
Hypoglossal nerve XII is
GSE
Hypoglossal is motore to
muscle of the tongue
Hypoglossal test
inspection for deviation
muscle test
Lesion Signs:
- Atrophy on the lesion side of tongue
- Deviation of tongue toward the lesion
- Fasciculation – twitching on the side of lesion