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S2 Neuroscience > Medulla > Flashcards

Medulla Flashcards

1
Q

while cranial nerves can be found at some location within the medulla

A

8-12

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2
Q

closed medulla

-location

A

C1 to the caudal end of the 4th ventricle

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3
Q

nuclei within the closed medulla

A 
inferior olivary nucleus or complex
nucleus cuneatus
nucleus gracilis
hypoglassal nucleus
spinal trigeminal nucleus (spinal nucleus of V)
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4
Q

tracts within the closed medulla

A 
pyramids
spinothalamic tracts (spinal lemniscus)
ventral trigeminothalamic tract
fasciculus cuneatus
fasciculus gracilis
medial longitudinal fasciculus (medial vestibulospinal tract)
lateral vestibulospinal tract
medial lemniscus
internal arcuate fibers
spinal trigeminal tract
dorsal spinocerebellar tract
hypoglossal nerve fibers
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5
Q

open medulla

-location

A

caudal end of 4th ventricle to the pontomedullary junction

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6
Q

nuclei within the open medulla

A 
inferior olivary nucleus
spinal nucleus of V
hypoglossal nucleus
dorsal motor nucleus of the Vagus
nucleus ambiguus
vestibular nuclei
dorsal cochlear nucleus
ventral cochlear nucleus
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7
Q

dorsal motor nucleus of the
Vagus
-sympathetic or parasympathetic

A

parasympathetic

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8
Q

what is within nucleus ambiguus

A

LMNs for CN IX and X

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9
Q

tracts within the open medulla

A 
pyramids
medial lemniscus
hypoglossal nerve fibers
ventral trigeminothalamic tract
medial vestibulospinal tract (MLF)
medial longitudinal fasciculus (MLF)
lateral vestibulospinal tract
inferior cerebellar peduncle
olivocerebellar fibers
lateral spinothalamic tract
spinal trigeminal tract
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10
Q

CN XII

-function

A

motor nerve

supplies both intrinsic and extrinsic muscles of the tongue

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11
Q

CN XII

-LMN cell body location

A

hypoglossal nucleus

-near midline of medulla (ventral to the central or 4th ventricule)

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12
Q

CN XII

-LMN axon location

A

pass inferolateral to the medial lemniscus and pyramids

exit medulla as rootlets in the ventrolateral (preolivary) sulcus, adjacent to the pyramids

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13
Q

what comes out of the preolivary sulcus

A

CN XII fibers

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14
Q

CN XII UMNs

  • name
  • arise from…
  • descend with _____ to ____
  • synapse where?
A

corticobulbar fibers
arise from tongue region of precentral gyrus (primary motor cortex)
descend with the corticospinal tract to the medulla
most fibers cross midline in medulla and synapse in the contralateral hypoglossal nucleus

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15
Q

hypoglossal nucleus

  • receives _____ sensory information from _____
  • how does it receive this information
  • this reflex pathway controlling the tongue is involved in…
A

receives indirect sensory information from solitary nucleus and sensory trigeminal nuclei
receives information via multisynaptic connections in the reticular formation
reflex pathway involved in swallowing, suckling, and chewing

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16
Q

solitary nucleus

-function in relation to CN XII

A

taste

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17
Q

sensory trigeminal nuclei

-function in relation to CN XII

A

bolus of food in the oral cavity

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18
Q

LMN lesion of the hypoglossal nerve or nucleus

  • results in…
  • clinical signs
A

results in paralysis and muscle wasting of both the intrinsic and extrinsic muscles of the ipsilateral side
clinical signs
-upon protrusion of the tongue, it deviates toward the side of the lesion due to unopposed action of the intact contralateral genioglossus muscle
-patients have difficulty with eating and speaking (dysarthria)

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19
Q

UMN lesion of the hypoglossal nerve

  • where does it occur
  • results in…
A

occurs at a level prior to the cross
results in weakness of only the extrinsic muscles (primarily genioglossus) on the side contralateral to the site of the lesion

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20
Q

which way will the tongue deviate if a UMN for CN XII is injured?

A

contralateral side

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21
Q

stroke of paramedian branch of anterior spinal artery may result in damage to…

A

hypoglossal nerve fibers
adjacent pyramid
medial lemniscus
ventral trigeminothalamic tract

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22
Q

stroke of paramedian branch of anterior spinal artery will produce what symptoms?

A 
LMN symptom (ipilateral)
UMN symptoms involving the pyramid (contralateral)
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23
Q

the combination of LMN and UMN signs that are seen on opposite sides of the neuraxis with injury to the paramedian branch of the anterior spinal artery occur where…
-this combo of Sx is called…

A

occur where a motor cranial nerve exits along the midline adjacent to the descending corticospinal fibers
combo of Sx is called an alternating hemiplegis

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24
Q

CN XI

  • location of LMNs
  • functions of LMNs in each location
A

nucleus ambiguus
-innervate a few of the laryngeal muscles (cranial component)
cervical levels of spinal cord (dorsal to ventral horn)
-innervate SCN and trapezius

25
Q

CN XI

-axons of spinal component: location

A

leave spinal cord and ascend into cranial cavity through foramen magnus to re-exit the skull as the accessory nerve through the jugular foramen

26
Q

CN XI

-axons of the cranial component: location of the ones that leave the cranium

A

small number exit medulla along with vagus nerve

27
Q

CN XI UMNs

  • descend with
  • decussate at…
  • terminate where
A

descend with corticospinal fibers
decussate at the pyramidal decussation
terminate in the cervical region (C2-4)

28
Q

CN XI

-clinical testing

A 
turn head (SCM)
shrug shoulders (trap)
cranial component is indistinguishable from vagus nerve
29
Q

CN X

-LMN location and function

A

located in nucleus ambiguus

-innervate skeletal muscles of the soft palate, larynx and pharynx, including vocalis muscle (true vocal folds)

30
Q

nucleus ambiguus

  • location
  • contains…
A 
located in reticular formation
-not easily identified
contains
-LMNs for CN X and IX
-LMNs for cranial part of CN XI
31
Q

CN X: preganglionic parasympathetic cell bodies

-location

A

dorsal motor nucleus of X

32
Q

CN X: preganglionic parasympathetic axons

  • location
  • synapse…
A

exit medulla as rootlets of X
synapse on postganglionic neurons in visceral walls of glands, cardiac muscle and smooth muscle of the thorax and abdomen

33
Q

CN X sensory fibers

  • travel along
  • end in
  • function
  • some fibers may enter…
A

travel along solitary tract to end in solitary nucleus
this component carries pain and pressure from pharynx, larynx, and thorax and abdomen
some of these fibers may enter spinal trigeminal nucleus (pain of the face)

34
Q

CN X UMNs

  • innervate…
  • -clinical implication
A

innervate nucleus ambiguus bilaterally

therefore, a unilateral lesion of the UMN would not be easily noticed

35
Q

important reflexes that are mediated by parts of the vagus nerve

A

carotid sinus reflex
carotid body reflex
cough, gag, and vomiting reflexes

36
Q

carotid sinus reflex

-CN X carries what part of the reflex

A

carries the efferent part of this reflex arc to the heart

37
Q

carotid sinus reflex: afferent limb

  • originates from…
  • afferent info carried by _____ to _____, then relayed to _____
A

originates from barareceptors along the carotid artery near the bifurcation into internal and external carotid arteries
carried by fibers of CN IX to the solitary nucleus, then relayed to the dorsal motor nucleus of X

38
Q

carotid sinus reflex: efferent limb function

A

innervates heart to slow heart rate

39
Q

carotid body reflex: function

A

helps control breathing rhythm

40
Q

carotid body reflex: role of CN X

A

carries one sensory (afferent) component, the chemoreceptor sensation from lung bronchioles, which synapse in the medullary respiratory center (area in the reticular formation)

41
Q

carotid body reflex: efferent limb is via…

A

via descending information to spinal cord levels controlling inspiration (intercostals and diaphragm)

42
Q

cough, gag and vomiting reflexes

-involves sensory fibers from…

A

oral/nasal cavity (CN IX)
OR
the gut (CN X)

43
Q

cough, gag and vomiting reflexes

-sensory information relayed to…

A

appropriate LMNs in

  • nucleus ambiguus and spinal cord
  • preganglionic parasympathetics in dorsal motor nucleus of X
44
Q

will as lesion of CN X result in sensory or motor deficits, or both

A

can result in both

45
Q

unilateral lesions of LMNs of CN X

-results in…

A

difficulty in swallowing
hoarseness (dysphonia)
inability to raise the soft palate on ipsilateral side

46
Q

lesions of the preganglionic parasympathetic fibers of CN X

  • cause disruption of some _____ reflexes
  • less important for diagnosis of lesion location than deficits associated with…
A

cause disruption of some gut reflexes

less important for diagnosis of lesion location than are deficits asosciated with somatomotor LMN component

47
Q

preganglionic parasympathetic fibers of CN X

-hyperactivity can cause

A

excess gastric acid secretion = ulcers

48
Q

large bilateral lesion of the medullary reticular formation

  • what can happen?
  • prognosis
A

can disrupt normal breathing rhythms and reflex control of vascular resistance to blood flow
-can result in coma
poor prognosis; may need life support

49
Q

CN IX LMNs

  • control
  • location
A

LMNs for stylopharyngeus muscle

located in rostral end of Nucleus Ambiguus

50
Q

which CNs have LMNs in the Nucleus ambiguus

A

IX, X, XI

51
Q

CN IX preganglionic parasympathetic neurons

  • cell body location
  • axon location and synapse
  • -function to…
A

cell body
-reticular formation
axons
-exit medulla to synapse on postganglionic neurons for innervation of parotid gland

52
Q

CN IX sensory neurons: central processes

  • synapse in…
  • carry…
A

synapse in caudal part of solitary nucleus

carries the afferent limb of the carotid sinus reflexes

53
Q

CN IX sensory neurons central processes

  • also synapses in…?
  • carries
A

synapse in sensory trigeminal nuclei
-primarily spinal nucleus of V
carries somatic sensation (touch, pressure, pain) from pharynx and posterior 1/3 of tongue (gag reflex)
also carries taste sensation from posterior 1/3 of tongue (mainly bitter sensation) to rostral part of solitary nucleus

54
Q

CN IX cortical control (UMN)

  • descends as part of…
  • synapse location
A

descends as part of corticobulbar system

synapses bilaterally on LMNs in nucleus ambiguus

55
Q

CN IX reflex involvement

A 
carries afferent (sensory) limb for several reflexes who efferent limb is carried by CN X, XII, and/or spinal cord LMN's
these reflexes include carotid sinus, gag, vomiting, and swallowing reflexes
56
Q

CN IX motor components

-participate in which reflexes

A

participate in swallowing and salivation - taste reflexes

57
Q

unilateral lesions of CN IX

  • can produce…
  • severity compared to CN X lesions
A

can produce difficulty with speech and swallowing
deficits less severe than with CN X lesions
can affect some visceral reflexes, similar to CN X

58
Q

what are the most diagnostic deficits which distinguish bewteen IX and X lesions

A

loss of gag reflex to touching the pharynx
-CN IX, afferent limb)
deviation of uvula
-CN X, efferent limb)

59
Q

where is the majority of the cochlear component of CN VIII found?

A

pons

S2 Neuroscience (25 decks)

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