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PSYC 424: Neuropsychology > Chapter 3 > Flashcards

Chapter 3 Flashcards

1
Q

three major subdivisions of the brainstem

A

1) medulla
2) pons
3) midbrain

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2
Q

cranial nerves

A

twelve; attached to ventral surface of brain
- most serve sensory and motor functions of head and neck region
- responsible for facial displays of emotion

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3
Q

four main functions of the cranial nerves

A

sensory, motor, special sensory/motor, parasympathic

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4
Q

cranial nerves at the medulla

A

cranial nerves 12, 11, 10, 9, and 5

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5
Q

medulla

A

the caudal medulla resembles the rostral spinal cord in structure and function and contains the same pathways and sensory and motor nuclei

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6
Q

cranial nerve I

A

olfactory

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7
Q

cranial nerve II

A

optic

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8
Q

cranial nerve III

A

oculomotor

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9
Q

cranial nerve IV

A

trochlear

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10
Q

cranial nerve V

A

trigeminal

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11
Q

cranial nerve VI

A

abducens

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12
Q

cranial nerve VII

A

facial

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13
Q

cranial nerve VIII

A

vestibulocochlear

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14
Q

cranial nerve IX

A

glossopharyngeal

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15
Q

cranial nerve X

A

vagus

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16
Q

cranial nerve XI

A

acessory

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17
Q

cranial nerve XII

A

hypoglossal

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18
Q

trigeminal nerve (cranial nerve V)

A
  • very long nucleus divided into several parts that extends down as low as the lower medulla and goes up as high as the midbrain
  • motor from motor nucleus of trigeminal to muscles of mastication
  • sensory divided into three parts: pain and temperature, tactile, position sense
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19
Q

three parts of the trigeminal nerve (cranial nerve V)

A

mesencephalic trigeminal nucleus, pontine trigeminal nucleus, spinal trigeminal nucleus

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20
Q

sensory functions of the trigeminal nerve (cranial nerve V)

A
  • pain and temperature: from face to caudal parts of nucleus of spinal tract (ST)
  • tactile: two-point discimination to chief (main) sensory nucleus; touch-pressure to rostral part of nucleus of ST
  • position sense: from jaw muscles to mesencephalic nucleus
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21
Q

three divisions (branches) of the trigeminal nerve carry the sensations from the face to the brain

A
  • opthalmic (V1)
  • maxillary (V2)
  • mandibular (V3)
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22
Q

opthalmic (V1) branch of the trigeminal nerve

A

includes the cornea

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23
Q

maxillary (V2) branch of the trigeminal nerve

A

includes the nose, upper teeth, and roof of pharynx

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24
Q

mandibular (V3) branch of the trigeminal nerve

A

includes inside mouth, lower teeth, anterior two-thirds of tongue

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25
Q

muscles of mastication

A

responsible for mostly jaw movement; chewing

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26
Q

central pathways for the trigeminal nerve (carries sensory information)

A
  • pain fibers from spinal nucleus travel close to fibers from the spinothalamic tract (STT)
  • tactile and proprioception fibers from main sensory and mesencephalic nucleus travel close to fibers from medial lemniscus (ML)
  • all then reach the thalamus
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27
Q

axons from medial lemniscus, trigeminal tracts, and spinothalamic tract all terminate in…

A

ventral posterior nuclei of thalamus (VPI for spinal; VPm for trigeminal)
- from the thalamus, axons ascned in posterior limb of internal capsule and terminate in somatosensory cortex

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28
Q

trigeminal motor nucleus

A

corticobulbar fibers descend from motor cortex through internal capsule, both crossed and uncrossed, and then synapse in the motor nucleus of V (corticobulbar tract)
- efferents of motor nucleus of trigeminal are to muscles of mastication

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29
Q

sensory deficits of trigeminal nerve

A
  • loss of pain and temperature on the face (ipsilateral)
  • loss of touch-pressure on the face (ipsilateral)
  • loss of position sense (proprioception) in jaw (ipsilateral)
  • loss of corneal reflex
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30
Q

tests for sensory deficits of trigeminal nerve

A
  • pin pricks, vibration, light touch on various areas of the face
  • moving jaws and asking for direction of movement
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31
Q

testing loss of corneal reflex due to deficit in trigeminal nerve

A
  • touch the edge of the cornea with a wisp of cotton; bot eyes should close, i.e., blink
  • if the left side of the trigeminal nerve is damaged, hen touching the left eye’s cornea will not cause a blink; patient will not feel the touch; however, when you touch the right eye, both eyes will blink normally
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32
Q

motor deficits of trigeminal nerve

A

ipsilateral signs of muscle paralysis in the jaw (the jaw deviates to the side of the lesion)

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33
Q

test for motor deficits of trigeminal nerve

A
  • ask the patient to bite down hard (you should see the masseter [jaw] muscle contract)
  • open the mouth and move the jaw to one side, then move the jaw back to the center against resistance
  • lesions involving the motor nucleus or the motor root of the trigeminal nerve result in ipsilateral muscle paralysis, causing the jaw to deviate to the side of the lesion
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34
Q

hypoglossal nerve (cranial nerve 12)

A

strictly a motor nerve (no other components) that supplies muscles of the tongue
- corticobulbar fibers to the hypoglossal nucleus extend from the motor cortex to the hypoglossal nucleus in the medulla
- efferent fibers from the hypoglossal nucleus innervate the muscles of the tongue (each side controls half of the tongue muscles, i.e., the ipsilateral side)

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35
Q

lesions in the hypoglossal nucleus/nerve

A

result in ipsilateral paralysis and atrophy of the tongue
- signs: the tongue deviates to the side of the lesion when protruded

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36
Q

two divisions of the accessory nerve (cranial nerve 11)

A

cranial part, spinal part

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37
Q

cranial part of the accessory nerve (cranial nerve 11)

A

motor; arises from the nucleus ambiguus and functionally blends with the motor functions of cranial nerve 9 and cranial nerve 10 (larynx movement)

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38
Q

spinal part of the accessory nerve (cranial nerve 11)

A

arises from the accessory nucleus in the lower medulla, supplies two muscles in the neck: the trapezius and sternocleidomastoid

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39
Q

testing cranial nerve 11

A
  • primarily focuses on the spinal part and its innervation of the shoulder muscles
  • place your hands on the patient’s shoulders and press down as the patient elevates of shrugs their shoulders, then retracts them
  • place your right palm on the lateral side of the patient’s left cheek; ask the patient to turn their head to the left, resisting the pressure you apply in the opposite direction
  • accessory nucleus damage would be permanent
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40
Q

four functional components of the vagus nerve (cranial nerve 10)

A

motor, parasympathetic, sensory, taste

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41
Q

motor component of the vagus nerve (cranial nerve 10)

A

from the nucleus ambiguus (NA) to the muscles of the pharynx and larynx
- efferents from nucleus ambiguus (NA) that exit and travel along the fibers of cranial nerves 9 and 10 and cranial portion of cranial 11 are to: muscles of soft palate, pharynx, larynx

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42
Q

parasympathetic component of the vagus nerve (cranial nerve 10)

A

from the dorsal motor nucleus to the visceral organs in the thorax and abdomen

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43
Q

sensory component of the vagus nerve (cranial nerve 10)

A

from the palate, pharynx, and larynx, as well as a small area of the external ear

44
Q

taste component of the vagus nerve (cranial nerve 10)

A

from the epiglottis and the posterior tongue

45
Q

lesions in nucleus ambiguus

A

ipsilateral paralysis of pharyngeal and laryngeal muscles
- signs: hoarseness, difficulty swallowing (dysphagia), difficulties in articulation (dysarthria)

46
Q

dysphagia

A

difficulty swallowing

47
Q

dysarthria

A

difficulties in articulation

48
Q

four functional components of glossopharyngeal nerve (cranial nerve 9)

A

motor, parasympathetic, sensory, taste

49
Q

motor component of glossopharyngeal nerve (cranial nerve 9)

A

from the nucleus ambiguus to the muscles of the pharynx and larynx

50
Q

parasympathetic component of glossopharyngeal nerve (cranial nerve 9)

A

from the inferior salivatory nucleus to the salivary (parotid) gland

51
Q

sensory component of glossopharyngeal nerve (cranial nerve 9)

A

from the tonsillar area and upper pharynx; from the posterior one-third of the tongue

52
Q

taste component of glossopharyngeal nerve (cranial nerve 9)

A

from the posterior one-third of the tongue to the nucleus of the solitary tract

53
Q

testing of motor functions of cranial nerves 9 and 10

A
  • hoarse voice
  • difficulty swallowing
  • check for palate or uvula displacement
  • ask the patient to say “Ah” and observe for symmetrical soft palate movement
54
Q

testing of sensory and motor functions of cranial nerves 9 and 10

A

test gag reflex
- touching one side of the pharyngeal wall in a normal individual elicits a bilateral response

55
Q

testing of parasympathetic function of cranial nerve 10 (vagus)

A

assess vagal tone by measuring the ECG

56
Q

testing of parasympathetic function of cranial nerve 9 (glossopharyngeal)

A

evaluate salivation from the parotid gland

57
Q

testing of taste function of cranial nerves 9 and 10

A

test taste sensation on the posterior one-third of the tongue

58
Q

medial medullary syndrome (anterior bulbar syndrome)

A
  • causes: occlusion of the anterior spinal artery (ASA) or branches of the vertebral artery that supply the ASA
  • structures involved: ML, pyramid, hypoglossal nucleus and nerve
  • clinical signs: contralateral loss of position sense and discriminative touch with a positive Romberg sign; contralateral hemiparesis (upper motor neuron [UMN] type); ipsilateral paralysis of half of the tongue –> lower motor neuron (LMN) signs: paralysis, atrophy, and fibrillation; deviation of the tongue to the side of the lesion upon. protrusion
59
Q

example of seeing pyramidal and hypoglossal deficits in a patient

A
  • contralateral hempiparesis (UMN type) –> slight weakness in the left arm and leg; when both arms are outstretched, the left arm drifts downward and rotates inward (pronator drift)
  • deviation of the tongue to the side of the lesion upon protrusion: over time, atrophy and fibrillation may become evident (i.e., LMN signs)
60
Q

lateral medullary syndrome (Wallenberg’s syndrome)

A
  • causes: occlusion of the posterior inferior cerebellar artery (PICA) (less frequently) or the vertebral artery (more frequently)
  • structures involved: spinal nucleus of V and its tract, spinothalamic tract, nucleus ambiguus, descending autonomic fibers from the hyothalamus
  • the lesion can be larger and include base of the interior cerebellar peduncle, vestibular nuclei
61
Q

clinical signs of lateral medullary syndrome

A
  • spinal nucleus of V/tract –> ipsilateral loss of pain and temperature sensation over the face
  • spinothalamic tract –> contralateral loss of pain and temjperature sensation over the body
  • nucleus ambiguus –> loss of gag reflex, dysphagia, hoarseness, and dysarthria
  • descending autonomic fibers from the hypothalamus –> horner’s syndrome on the ipsilatera side: miosis (small pupil), pseudoptosis (slight drooping of the eyelid), anhidrosis (absence of sweating on the face), enophthalmos (slight retraction of the eyeball)
  • base of the inferior cerebellar peduncle: ataxia, hypotonia, asynergia, nystagmus, dysmetria, tremor (intentional, as opposed to resting)
  • vestibular nuclei: vertigo/vomiting, ataxia, nystagmus/nausea
62
Q

nuclei

A

area where neuronal tracts of similar function come together to synapse

63
Q

two major regions of the pons

A

tegmentum, basis pontis

64
Q

tegmentum of the pons

A

dorsally located, containing cranial nerve nuclei and sensory tracts

65
Q

basis pontis of the pons

A

ventrally located, containing descending pathways, pontine nuclei, and motor tracts

66
Q

cranial nerves that arise in the pons

A

trigeminal (5), abducens (6), facial (7), vestibulocochlear (8) (lies at the medulla/pons border)

67
Q

two sensory components of vestibulocochlear nerve (cranial nerve 8)

A

audition (hearing) through the cochlear part of the nerve; vestibular (balance) through the vestibular component of the nerve

68
Q

auditory pathways of the vestibulocochlear nerve (cranial nerve 8)

A
  • one cranial nerve mediates hearing: the cochlear component of VIII
  • cochlear nerve projects to cochlear nuclei in brainstem (near vestibular nuclei)
  • from cochlear nuclei: multi-synaptic, both crossed and uncrossed pathways, to the auditory cortex of the brain
  • clinical significance of this arrangement: loss of hearing can only result fro damage to the ear or the cochlear nerve itself; any damage within the brain itself does not lead to hearing loss (can cause disturbances however) because of the bilateral representation
69
Q

vestibular pathways of the vestibulocochlear nerve (cranial nerve 8)

A
  • from labyrinth of inner ear to vestibular component of cranial nerve 8 to vestibular nuclei
  • from the vestibular nuclei, there are three central pathways
  • functions: keep eyes stable and on target even when the body is moving (i.e., maintain oculovestibular balance)
70
Q

three central pathways from the vestibular nuclei

A
  • to cerebellum
  • to spinal cord
  • to medial longitudinal fasciculus (MLF): this connects the cranial nerves that control eye movement to spinal tracts supplying muscles in the neck
71
Q

vestibular labyrinth

A
  • three semicircular canals
  • responsible for head movement
72
Q

clinical testing of cranial nerve 8

A
  • usually testing is for auditory nerve (hearing)
  • vestibular test is done only when patient complains of dizziness
  • usually, a vibrating fork is used and the patient is asked whether they can hear it, differentiate intensities (loudness), identify the source of the sound, etc.
73
Q

cerebellopontine angle tumor (acoustic neuroma)

A
  • originates in Schwann cells of the sheath surrounding cranial nerve 8 in the internal auditory canal
  • characterized by: tinnitus, hearing loss (gradual), loss of corneal reflex due to compression of cranial nerve 5 roots in the area and compression of the nucleus of spinal tract which is underneath, cerebellar signs
74
Q

signs of vestibular disorders

A

(VAN) –> vertigo/vomit, ataxia, nausea/nystagmus

75
Q

vertigo

A

illusory sensation of motion

76
Q

ataxia

A

ipsilateral postural disequilibrium; inability to stand upright without support; tendency to fall towards the side of the lesion; incoordination (drunk looking)

77
Q

nystagmus

A

ipsilateral oscillatory involuntary eye movements, i.e., induced when attempting to gaze in the direction towards the side of the lesion

78
Q

four functional components of facial nerve (cranial nerve 7)

A

taste, parasympathetic, sensory, motor

79
Q

taste component of facial nerve (cranial nerve 7)

A

from anterior to two-thirds of tongue to nucleus of solitary tract

80
Q

parasympathetic component of facial nerve (cranial nerve 7)

A

from salivatory and lacrimal nuclei to salivary and lacrimal glands

81
Q

sensory component of facial nerve (cranial nerve 7)

A

from small area behind the ear— non-significant

82
Q

motor component of facial nerve (cranial nerve 7)

A

from facial motor nucleus to muscles of facial expression
- corticobulbar fibers go: to the upper face (both crossed and uncrossed); to the lower face (only crossed)

83
Q

three cranial nerves mediate taste

A

facial nerve (cranial nerve 7), glossopharyngeal nerve (cranial nerve 9), vagus nerve (cranial nerve 10)

84
Q

taste loss is usually associated with…

A

a lesion in one of the nerves mediating taste
- because of the multi-synaptic and diffuse central pathways for taste and the poor localization of taste in the cortex, brainstem and cortical lesions are not usually associated with taste loss
- disturbances in taste functions are of minor significance to the patient

85
Q

lesions involving the supranuclear nucleus (facial nerve; cranial nerve 7)

A

cause contralateral muscle weakess, affecting only the lower face (central facial palsy)

86
Q

why do lesions involving the supranuclear nucleus (facial nerve; cranial nerve 7) only affect the lower face

A

because corticobulbar fibers cross for the lower face but there are uncrossed fibers (and also crossed) for the upper face

87
Q

lesions involving the facial nucleus or nerve (cranial nerve 7)

A
  • ipsilateral paralysis of facial muscles (peripheral palsy): both upper and lower facial muscles are affected
  • lesion outside the CNS can present as Bell’s palsy
88
Q

difference between motor functions of the trigeminal nerve (cranial nerve 5) and the facial nerve (cranial nerve 7)

A
  • trigeminal –> only to muscles of mastication (chewing)
  • facial –> only to muscles of facial expression (e.g., for smiling, frowning, etc.)
89
Q

clinical testing of facial nerve (cranial nerve 7)

A
  • only the motor function is routinely tested during clinical evaluation
  • inspect for facial droop or asymmetry
  • test muscles of facial expression: ask the patient to look up and wrinkle their forehead; examine for loss of wrinkling, assess muscle strength by applying downward pressure on each side
  • ask the patient to shut their eyes tightly: compare both sides
  • ask the patient to grin: compare the nasolabial folds
  • have the patient frown, show their teeth, and puff out their cheeks
90
Q

abducens nerve (cranial nerve 6)

A
  • strictly motor
  • to one muscle of the eye –> lateral rectus
  • originates in the abducens nucleus in the pons and travels to the lateral rectus muscle
91
Q

lateral rectus muscle of the eye

A

responsible for abducting the eye; moves the eye outward, away from the midline of the body

92
Q

clinical significance of abducens nerve (cranial nerve 6)

A
  • if abducens nerve is lesioned, medial strabismus is present
  • only the affected eye does not abduct
  • when asked to gaze right, the right eye does not abduct (medial rectus unopposed); results in crossed eyes (medial strabismus)
93
Q

objectives in the midbrain

A
  • sensory pathways travel in the back
  • motor pathways travel in the front
94
Q

cranial nerves that arise in the midbrain

A

oculomotor (cranial nerve 3), trochlear (cranial nerve 4)

95
Q

cranial nerves that arise in the medulla

A

glossopharyngeal (9), vagus (10), accessory (11), hypoglossal (12)

96
Q

continuation of sensory pathways in the midbrain

A
  • medial lemniscus (ML)
  • spinothalamic tract
  • both pathways move laterally but remain dorsal relative to the motor pathways, which are ventral)
97
Q

motor pathways in the midbrain

A

corticospinal fibers (in the cerebral peduncles or crus cerebri)

98
Q

substantia nigra of the midbrain

A
  • part of the basal ganglia
  • associated with dopamine production and implicated in Parkinson’s disease
99
Q

cranial nerve structures of the midbrain

A
  • trochlear nucleus and nerve (cranial nerve 4): at the level of the inferior colliculus
  • oculomotor nucleus and nerve (cranial nerve 3): at the level of the superior colliculus
100
Q

trochlear nerve (cranial nerve 4)

A
  • controls movement of the superior oblique muscle
  • function: when the eye is turned medially, the superior oblique acts to depress the eye; when the eye is turned laterally, the superior oblique acts to intort the eye
  • origin: trochlear nucleus located in midbrain
  • course/termination: exits the brainstem and travels to the anterior court; there, it joins the oculomotor nerve and enters the orbit to innervate the superior oblique muscle
101
Q

clinical significance of trochlear nucleus (cranial nerve 4) lesions

A
  • nucleus supplies contralateral superior oblique muscle
  • lesions cause paresis in contralateral superior oblique muscle
  • causes diplopia (double vision) when looking down the stairs
  • intorts the eye (turns towards the nose), especially when the eye is looking out (i.e., abducted)
102
Q

cranial nerve 4 (trochlear) (or superior oblique) palsy

A
  • diplopia
  • complain of diplopia especially when walking downstairs or reading (requiring eye intorsion)
  • tilt head away from the side of the lesion (to compensate for the alignment of both eyes and help relieve the diplopia)
103
Q

two components of the oculomotor nerve (cranial nerve 3)

A
  • motor
  • autonomic (parasympathetic)
104
Q

motor component of the oculomotor nerve (cranial nerve 3)

A
  • innervated levator palpebrae superioris (the eyelid)
  • all ocular muscles except two: lateral rectus (abducens nerve, cranial nerve 6), superior oblique (trochlear nerve, cranial nerve 4)
  • supplies these ocular muscles: medial, superior, and inferior rectus; inferior oblique
105
Q

autonomic component of the oculomotor nerve (cranial nerve 3)

A
  • Edinger-Westphal nucleus located rostral and medial to the motor nucleus of oculomotor nerve (cranial nerve 3)
  • provides preganglionic parasympathetic innervation to the ciliary ganglion, which sends postganglionic fibers to constrict the pupil and contract the ciliary muscle (the latter acts to thicken the lens for accommodation)
  • pupil constricts when light is shined into it
106
Q

oculomotor nerve (cranial nerve 3) palsy

A
  • lesions of the Edinger-Westphal nucleus or oculomotor nerve (cranial nerve 3)
  • ipsilateral lateral (external) strabismus— eye is down and out
  • ipsilateral ptosis— if eyelid is retracted –> diplopia
  • ipsilateral mydriasis (dilated pupil)
  • loss of direct and consensual pupillary light reflexes in the ipsilateral eye

PSYC 424: Neuropsychology (14 decks)

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