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Head and Face Pain > CN V System, Pain Generators, and Processing > Flashcards

CN V System, Pain Generators, and Processing Flashcards

1
Q

What are the Peripheral Nociceptive Tissues?

A
  1. Meninges
  2. Skin
  3. Cornea
  4. Head, Face, Neck mm.
  5. LL. of the neck and TMJ
  6. Vasculature
  7. Periosteum
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2
Q

What are Peripheral Nociceptive Tissues?

A

Tissues that carry free nerve endings capable of generating nociceptive stimuli.

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3
Q

What is more important about Peripheral Nociceptive Tissues?

A

Many of these tissues also have R/C capable of generating stimuli that are inhibitory to the nociceptive stimuli.

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4
Q

What can be concluded about the modulation of Peripheral Nociceptive Tissues?

A

Either an up regulation of nociception or a down regulation of inhibitory input may contribute to the generation of head and face pain

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5
Q

What can contribute to the generation of head and face pain?

A

increased A-delta and C-Fiber stimulation or decreased LDA stimulation

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6
Q

What are the three divisions of the Trigeminal Nerve?

A

V1 - Ophthalmic
V2 - Maxillary
V3 - Mandibular

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7
Q

What are the contributors to the Trigeminal Nerve?

A
  1. Cervical Afferents
  2. Outer Ear contributions from CN VII, IX, X
  3. Trigemina Ganglion
  4. Geniculate Ganglion VII
  5. Superior Ganglia of IX
  6. Superior Ganglia of X
  7. Spinal Trigeminal Tract fibers from V, VII, IX, X
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8
Q

What is the cervical afferent contribution to the Trigeminal Nerve?

A

The convergence of the upper cervical polymodal afferents with the spinal trigeminal nucleus.
Ex: Lack of dermatomal HA distribution

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9
Q

What might cause a nerve to generate pain?

A
  1. Compression
  2. Inflammation
  3. Infection
  4. Demyelination
  5. Deafferentation
  6. Hypoxia
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10
Q

What are the three main divisions of the trigeminal nuclei?

A
  1. Principle Sensory Nucleus
  2. Spinal Trigeminal Nucleus
  3. Mesencephalic Nucleus
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11
Q

Where is the principle sensory nucleus located?

A

Lateral Pons

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12
Q

What does the principle sensory nucleus process?

A

Fine Touch

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13
Q

Where is the spinal trigeminal nucleus located?

A

Just caudal to the principle nucleus, it runs to the upper cervical segments and is contiguous with Lamina II

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14
Q

What does the spinal trigeminal nucleus process?

A

Nociception and Pain

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15
Q

Where is the mesencephalic nucleus located?

A

Rostral to the principle nucleus into the midbrain

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16
Q

What does the mesencephalic nucleus process?

A

Proprioception

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17
Q

What is the nociceptive carrying portion of the trigeminal lemniscus?

A

The Ventral Trigeminothalamic Tract

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18
Q

What are the 2 divisions of the ventral trigeminothalamc tract?

A
  1. Paleo-trigeminothalamic Tract

2. Neo-trigeminothalamic Tract

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19
Q

What does the Paleo-Trigeminothalamic tract do?

A

the P-TT Tract carries the affective aspect of pain.

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20
Q

Where does the Paleo-Trigeminothalmic tract carry information to?

A

The Frontal Lobe, Anterior Cingulate Gyrus, and Prefrontal Cortex

21
Q

What does the Neo-Trigemintohalampic Tract do?

A

The N-TT Tract carries the sensory discriminative aspects of pain.

22
Q

Where does the Neo-Trigeminothalmic tract carry information to?

A

The VPM of the Thalamus, the Somatosensory Cortex, and the Anterior Insular Cortex.

23
Q

What else does the Ventral Trigeminothalmaic Tract do?

A

Takes Fine Touch, Pressure, and Proprioception more rostrally.

24
Q

What does the Dorsal Trigeminothalamic Tract do?

A

Carries fire touch and proprioception ipsilaterally .

25
Q

Where do the Dorsal and Ventral Trigeminothalamic Tracts join?

A

The D-TT joins the V-TT rostrally.

26
Q

What are the Trigeminal Collaterals?

A
  1. Hypoglossal Nuc
  2. Facial Nuc.
  3. Trigeminal Motor Nuc
  4. Mesencephalon
  5. Sup. Salivary Nuc
  6. Nuc. Ambiguous
  7. Reticular Fm
  8. PAG
  9. Dorsal Motor Nuc of X
27
Q

What reflex is associated with the Facial Nucleus?

A

Corneal Reflex

28
Q

What reflex is associated with the Mesencephalon?

A

Jaw Jerk Reflex

29
Q

What reflex is associated with the Dorsal Motor Nuc of X

A

Vomiting Reflex

30
Q

What reflex is associated with the Sup Salivatory Nuc?

A

Lacrimal Reflex

31
Q

What reflex is associated with the Reticular Fm?

A

Sneezing Reflex

32
Q

Which arteries supply the spinal trigeminal tract in the medulla?

A

The vertebral artery and the PICA

33
Q

Which arteries supply the spinal trigeminal nucleus in the medulla?

A

The vertebral artery and the PICA

34
Q

Which arteries supply the spinal trigeminal tract in the pons?

A

The basilar artery

35
Q

Which arteries supply the spinal trigeminal nucleus in the pons?

A

The basilar artery

36
Q

Which arteries supply the trigeminothalamic fibers in the midbrain?

A

The posterior cerebral artery and the superior cerebral artery

37
Q

Which arteries supply the VPM of the thalamus?

A

The posterior cerebral artery

38
Q

Which arteries supply the posterior limb of the internal capsule?

A

The middle cerebral artery

39
Q

What constitutes the afferent connection from the cerebral blood vessels to the trigeminal ganglion?

A

The Trigeminovascular System

40
Q

What is the efferent effect of the trigeminovascular system hypothesized to contribute to?

A

The generation of Migraine and Cluster HA’s

41
Q

Which structure is activated by the Trigeminovascular System with Migraines?

A

The Meningeal Vasculature

42
Q

What order neurons bring all sensory information from the head and neck to the thalamus?

A

2nd Order Neurons

43
Q

What nucleus in the thalamus receives all sensory input from the head and neck?

A

The VPM

44
Q

Where does localization of sensory information from the head and neck occur?

A

The Lateral Somatosensory Cortex via 3rd Order Neurons

45
Q

Where is the Trigeminal Motor Nucleus located?

A

Superior and Medial to the principle sensory nucleus.

46
Q

Where does the Trigeminal Motor Nucleus have outputs to?

A

The muscles of mastication

47
Q

What does the anterior cingulate gyrus play a role in?

A

The Limbic Control System

48
Q

Which structure involves interoception?

A

The Anterior Insular Cortex

49
Q

Which structure plays a role in affect, executive function, and decision?

A

The Prefrontal Cortex

Head and Face Pain (8 decks)

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