Lecture 11- clinical syndromes of the brainstem Flashcards
the basilar has ____ axons from cerebral cortex, corticospinal , corticobrainstem , corticopontine , and corticoreticular tracts
descending
the basilar has motor nuclei from what 3 things
substantia nigra , pons and inferior olive
where are Pontocerebellar axons found
basilar
the tegmentum is also called what
reticular formation
the tegmentum contains ___ nuclei and ___ sensory tracts
sensory
ascending
what CN nuclei is located near the tegmentum
CN V (trigemenal)
what does the medial longitudinal fasciclus do
coordinated head and eye movements
the medial longitudinal fascicular is near what division of the longitudinal brainstem
tegmentum
the tectum divison is located in the ____ only
midbrain
which part of the longitudinal divison of the brainstem have structures for reflexive movements of intrinsic/ extrinsic eye muscles and head
tectum
what are the 3 things of the tectum that are structures for reflexive movements of intrinsic/ extrinsic eye muscles and head
pretectum
inferior and superior colliculi
the basis pedunculi includes what 2 things
cerebral peduncles and substantia nigra nucleus
cerebral peduncles are ___ tracts from the cortex
motor
substantia nigra nucleus is part of the ___ ____ circuits
basal ganglia
the midbrain tegmentum has ascending ___ tracts
sensory
the midbrain tegmetum contains the ___ cerebellar peduncle
superior
what division of the midbrain contains the red nucleus
midbrain tegmentum
what division of the midbrain contains the pedunculopontine nucleus
midbrain tegmentum
what nuclei of CN are located in the midbrain tegmentum
3 and 4
the midbrain tegmentum contain the ___ longitudinal fasciculus
medial
what part of the midbrain division is the periaqueductal gray located
midbrain tegmentum
the tectum division of the midbrain contains the ___ area
pretectal
in the midbrain division of the tectum it contains which 2 colliculi
inferior and superior
the superior cerebella peduncle is mostly ___ info from the ____
sensory
cerebellum
the red nucleus is ___ matter and is part of the cognitive/motor circuit
gray
what is the function of the periaqueductal gray
nociceptive inhibition , coordinates reaction to pain , threats and emotions
which colliculi relays info from cochlear n to superior colliculi and thalamus
inferior
what does the superior colliculi do
motor and sensory information to orient head/eyes to external stimuli
the pons forms the __ wall of the __ ventricle
anterior
4th
what forms the posterior wall of the 4th ventricle
cerebellum
T/F: most vertical tracts go thru pons without synapsing
T
most vertical tracts go thru the pons witout synapsing however what are the two exceptions
corticopontine tract and corticobrainstem tracts
where does the corticopontine tract synapse on
the pontine nuclei
after the corticopontine tract synpase on the pontine nuceli what happens to the pontocerebellar fibers
they cross and enter middle cerebellar peduncle to synapse in contralteral cerebellar hemisphere
where does the corticobrainstem tract synapse
with neurons of trigeminal mtor nucleus and facial nucleus
in the basilar of the pons there is ___ tracts , ___ nuclei , and ___ axons
descending
pontine
pontocerebellar
what are the three descending tracts of the basilar
corticospinal , corticobrainstem and corticopontine axons
the tegmentum of the pons includes what 6 things
sensory tracts
reticular formation
autonomic pathways
medial longitudinal fasciculi
CN 5,6,7,8
what ventricle is on the posterior surface of the upper medulla and narrows in lower to form central canal of SC
4th
what CN exits between pyramid and inferior olive on the medulla
CN XII (hypoglossal)
CN IX , X from ___ groove . ___ to olive
lateral 2x
in the upper medulla most CN nuclei is in the ___ part from ___ to ____
dorsal
medial to lateral
which CN nuclei is in the dorsal part from the medial to lateral in the upper medula
CN XII, X (dorsal motor), solitary nucleus ( afferents from VII and IX) , autonomic afferents from IX, X , vestibular nuclei VII
which nucleus are more lateral on the upper medulla
spinal trigeminal nucleus and nucleus ambigus
spinal trigminal nucleus is for what
pain
and temp
the nucleus ambiguus is motor for what
swallowing and vocalization muscles
where is the nuclei of CN VIII of the upper medulla at
medullopontine junction
the inferior olivary nuclei of the upper medulla receive infro from many cortical and sc motor areas and then project where and thru what
to contralateral cerebellum thru olivocerebellar tract
which four tracts go from the medulla to cerebellum via inferior cerebellar peduncle
spinocerebellar, olivocerebellar , vestibulocerebellar , reticulocerebellar
which tract is the only tract to enter medulla from cerebellum
cerebellovestibular
which tract crosses at the inferior border of medulla
lateral corticospinal tract
in the inferior medulla the ___ tracts travel posteriorly
sensory
whcih CN are in the mid brain
CN III , IV
which CN is in the PONS
trigeminal V,
abducencs VI ,
facial VII ,
vestibulocochlear VIII
what are the 2 arteries that come off the vertebral artery
anterior spinal artery
posterior inferior cerebellar artery
what anterior inferior cerebellar artery and superior cerebellar artery come off which artery
basilar
what are the 3 artieres that provide brainstem blood supply
vertebral artery
basilar artery
posterior cerebral artery
the anterior spinal artery and PICA is in what part of the brainstem
medulla
the basilar artery and AICA are in what part of the brainstem
pons
the posterior cerebral artery and midbrain branches of basilar artery is in what part of the brainstem
midbrain
what conveys signals from/to cortex and spinal cord ( vertical trats)
brainstem
the dorsal column/medial lemniscus , spinothalamic , spinocerebellar , and trigeminal lemniscus are sensory or motor tracts?
sensory tracts
what are the four examples of the motor tracts
corticospinal , corticobulbar , corticopontine , and corticoreticular
the rubrospinal tracts , vestibulospinal tract , reticulospinal tract and tectospinal tracts are examples of what kind of tracts
brainstem tract
the brainstem modulates consciousness thru what 2 things
reticular formation and reticular activation system
the brain stem also regulated vital signs like what
HR
BP
breathing pattern
what are the 4 cardinal signs of brainstem dysfunctions after a lesion of the brainstem
dysphagia , dysarthria , diplopia , dysmetria
damage to the brainstem could cause what to the vitals
heart to stop beating
BP to increase
breathing to cease
lesions of the brainstem can causes what 4 things
cardial signs of brainstem dysfunction
disorders of vital function
disorders of consciousness
motor and sensor loss
if there is damage to the reticular formation and/or reticular activatiing system what can happen
disorders of consciousness
people in vegetative and minimally conscious states have loss of tissue in what 3 places
subcortical
thalamic
brainstem
what type of lesions may cause a mix of ipsilaterla and contralateral signs
brainstem
single cranial nerve or cranial nerve nuclei lesions likely result in ____ signs
ipsilaterla
lesions of lateral corticospinal and dorsal column tracts in the brainstem usually causes ___ signs bc these tracts cross the ___ of the ____ medulla
contralateral
midline
inferior
what is blocked for a anteriomedial midbrain syndrome ( weber’s)
blockage of PCA or basilar artery
what are the primary structure affected by anteromedial midbrain syndrome
corticospinal tract
oculomtor nerve nucleus
red nucleus
what are the clinical manifestations of the corticospinal tract if it is damaged in Webers syndrome
contralateral hemiparesis bc where it crosses is below the midbrain
what is the clinical manifestations of the oculomtor nerve nucleus if damaged with anteromedial midbrain syndrome (weber’s)
ispi decreased eye movement
ipsi paralysis of eyelid
ipsi dilated pupil
what are clinical manifestations if red nucleus is affected in anteromedial midbrain syndrome (Weber’s)
axtaia
emotional thing
lability (crying and laughing at inappropriate times)
what syndrome is due to occulusion of anterior inferior cerebellar artery
lateral inferior pontine syndrome
what are the seven primary structures affected with lateral inferior pontine syndrome
cochlear nuclei ,
vestibular nuclei
imparied sympathics
trigeminal nuclei
salvatory nuclei
spinothalamic tract
facial nuclei
what structure is affected with the lateral inferior pontine syndrome if someone has ipsilateral hearing loss and ipsilateral horners syndrome
cochlear nuclei an imparied sympathics
what structure is affected with the lateral inferior pontine syndrome if someone has dysequilibrium , nausea and vomiting
vestibular nuclei
what structure is affected with the lateral inferior pontine syndrome if somen has ipsilateral facial pain and temperature sensory loss and decreased tears and salivation
trigeminal nuclei and salvatory nuclei
what structure is affected with the lateral inferior pontine syndrome if someon has contralateral pain and temperature sensation to body
spinothalamic tract
what structure is affected with the lateral inferior pontine syndrome if somen has ipsilateral weakness of facial expression
facial n
damage to which CN causes Bells palsy
CN VII
how will bells palsy facial weakness differe from facial weakness after cortical stroke
facial nerves is the whole face for bells palsy and cortical stroke is just lower half of face
describe someone with horners syndrome
pupil is contricted and droppy eye with dry skin
what syndome is likely due to basilar artery thrombosis or stenosis impacting ventral pons bilaterally
locked in syndrome
what are the primary structures involved with locked in syndrome
B corticospainal tracts
B corticobulbar tracts
B abducens nerve nuclei
what is the clinical manifestations if B corticospinal tracts are affected in locked in syndrome
paralysis below head
what is the clinical manifestations if B corticobulbar tracts are affected in locked in syndrome
paralysis to facial muscles , talking and chewing
what is the clinical manifestations if B abducens nerve nuclei are affected in locked in syndrome
cant move eyes to side
what is spared in locked in syndrome
reticular activating system/reticular formation
vertical gaze centers from midbrain
(CN 1-4)
what causes the medial medullary syndrome
due to blockage of anterior spinal artery
what are the primary structures affected in medial medullary syndrome
hypoglossal nuclei
DCML
CST
what is the clinical manifestations if the hypoglossal nuclei is affected in medial medullary syndrome
ispilateral tongue protrusion
what is the clinical manifestations if the DCML is affected in medial medullary syndrome
contralateral loss of vibration , prop, and light tough
what is the clinical manifestations if the CST is affected in medial medullary syndrome
contralateral hemiparesis
what is the most common brainstem stroke
lateral medullary syndrome (wallenbergs)
what are the primary structures affected in lateral medullary syndrome (9)
solitary nucleus
vestibualr nucleus
vagus nerve nuclus
trigeminal nerve
inferior cerebellar peduncle
salivatory nucleus
spinothalamic tract
descending sympathetic tract
nucleus ambiguus (CN IX, X , XII)
If soliatry nucleus m vestibular nucleus and vagus nerve nucleus is involved with lateral medullary syndrome (wallenberg’s) what would be the clinical manifestations
increase HR
equillbrium prob
increase HR
If trigeminal nerve , inferior cerebellar peduncle and salivatory nucleus is involved with lateral medullary syndrome (wallenberg’s) what would be the clinical manifestations
t: fascial sensation
I: issuses with cerebellum , ipsilateral ataxia
S: decrease salvation and tear gland
If spinothalamic tract , descending sympathetic tract and nucleus ambiguus is involved with lateral medullary syndrome (wallenberg’s) what would be the clinical manifestations
ST: decrease pain and temp contralaterally
D: ipsilateral horners syndrome
N: decrease gag reflex
what is the 2nd most common brainstem stroke
lateral inferior pontine syndrome
