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Neuro > Medulla (CN IX, X, XI, XII) > Flashcards

Medulla (CN IX, X, XI, XII) Flashcards

1
Q

Describe the cranial nerves associated with the medulla

A

IX Glossopharyngeal
X Vagus
XI Accessory
XII Hypoglossal

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2
Q

What is the CN XII Hypoglossal responsible for?

A

Motor: Movement of the extrinsic and intrinsic muscles of the tongue

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3
Q

What is the CN XI Accessory responsible for?

A

Motor: Movement of the trapezius and SCM

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4
Q

What is the CN X Vagus responsible for?

A
  • Motor: Soft palate, larynx, pharynx, glands, cardiac m., smooth m. of thorax and abdomen
  • Sensory: Pain and pressure from larynx, pharynx, thorax, abdomen
  • Reflexes: Carotid sinus, carotid body, cough/gag/swallow
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5
Q

What is CN IX Glossopharyngeal responsible for?

A
  • Motor: Stylopharyngess m., parotid gland

- Sensory: pharynx and posterior 1/3 of tongue (gag reflex), taste from posterior 1/3 of tongue

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6
Q

Where do the cell bodies of the LMNs of the hypoglossal nerve live?

A

Hypoglossal nucleus of medulla

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7
Q

Where is the hypoglossal nucleus located in the medulla?

A

New the midline, ventral to the central canal (aka 4th ventricle)

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8
Q

Where do the axons of the hypoglossal nerve pass and where do the exit the medulla?

A

The pass inferolateral next to the medial lemniscus and pyramid to exit medulla as rootlets in the ventrolateral (preolivary) sulcus.

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9
Q

Where do the UMNs of the hypoglossal n. arise and what tract do the UMNs travel with?

A

Arise in the tongue region of the pre central gyrus and descend with the corticospinal tract to the medulla

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10
Q

Where do the UMNs of the hypoglossal n. cross the midline and what do they synapse with?

A

They cross the midline at the medulla and synapse with contralateral hypoglossal nucleus

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11
Q

Where does the hypoglossal nucleus receive sensory info from?

A

Receives indirect sensory info from solitary nucleus (taste) and sensory trigeminal nuclei (bolus of food in the mouth) by way of reticular formation. Reflex pathway controls tongue for swallowing, suckling, chewing.

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12
Q

A LMN lesion of the hypoglossal n. or nucleus results in paralysis to what and is it ipsilateral or contralateral?

A

Tongue muscles; ipsilateral side.

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13
Q

What direction will the tongue deviate with a LMN lesion to the hypoglossal n.? What difficulties will this patient have?

A

Toward the side of the lesion (paralysis of tongue muscles ipsilateral to lesion). Difficulties eating and speaking.

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14
Q

What is difficulty speaking called?

A

Dysarthria

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15
Q

An UMN lesion of the hypoglossal n. results is weakness of what? On what side compared to lesion?

A

Weakness of extrinsic muscles of tongue only (genioglossus). On contralateral side to lesion.

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16
Q

What direction will the tongue deviate with an UMN lesion to the hypoglossal n.?

A

Away from the lesion.

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17
Q

A stroke of the _____ branch of _______ artery may result in combinations of damage to hypoglossal n. fibers, adjacent pyramid, medial lemniscus and ventral trigeminothalamic tract.

A

Paramedian branch of the anterior spinal artery

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18
Q

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

A

Hypoglossal n. fibers, adjacent pyramid, medial lemniscus and ventral trigeminothalamic tract.

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19
Q

The result of a stroke to the paramedian branch of the anterior spinal artery would result in LMN symptoms involving _______ and UMN symptoms involving ________.

A

tongue; pyramid

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20
Q

What sensory deficits would be seen with a stroke in the paramedian branch of the anterior spinal artery?

A

Loss of taste from posterior 1/3 of tongue (solitary nuc), bolus in mouth (sensory trigeminal nuc)

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21
Q

What is alternating hemiplegia?

A

When a unilateral lesion affects both UMNs and LMNs, causing ipsilateral and contralateral deficits. They occur most commonly when the CN exits near the midline. So CN III at the base of the midbrain and CN VI at base of pons

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22
Q

Where to the LMNs of the CN XI Accessory live? What do they innervate?

A

Nucleus ambiguous; Cranial component innervates laryngeal m.s

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23
Q

Where do the cell bodies of CN XI Accessory live? What do they innervate?

A

cervical levels of spinal cord (dorsal to ventral horn); SCM and trapezius

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24
Q

Where do the axons of CN XI Accessory n. go once they exit the spinal cord?

A

They ascend into the cranial cavity and re-exit the skull as the accessory n. The cranial component has a small number of fibers that exit the medulla with Vagus n.

25
Q

What do the UMN of CN XI Accessory travel down with, where do they decussate, and where do they terminate?

A

Corticospinal fibers; pyramidal decussation; cervical region C2-4

26
Q

How do you clinically test for CN XI?

A

Pt turns head (SCM) or shrugs shoulders (traps).

27
Q

What nerve is the cranial component indistinguishable from?

A

Vagus n.

28
Q

Where do LMNs of CN X Vagus live? What do they innervate?

A

Nucleus ambiguous; skeletal m.s of soft palate, larynx, pharynx, inc. vocal m.

29
Q

Where is nucleus ambiguous located?

A

In the reticular formation

30
Q

What LMNs live in nucleus ambiguous?

A

motor neurons for CN IX, X and cranial part of XI.

31
Q

Where do the preganglionic parasympathetic cell bodies of CN X Vagus live?

A

dorsal motor nucleus of X

32
Q

Where do the axons of CN X Vagus exit the medulla as? What do they snaps with?

A

Exit as rootlets of X and synapse on postganglionic neurons in visceral walls of glands, cardiac m., and smooth m. of thorax and abdomen.

33
Q

What tract do the sensory fibers of CN X Vagus travel along? What sensations does it carry?

A

Solitary tract to end in solitary nucleus. Pain and pressure from pharynx, larynx, thorax and abdomen.

34
Q

Some sensory fibers of CN X Vagus may enter spinal trigeminal nucleus for what sensation?

A

Pain of the face

35
Q

UMNs of CN X Vagus innervate what nucleus bilaterally? What effect does this have clinically?

A

Nucleus ambiguous; makes it difficult to identify a unilateral lesion of the UMNs.

36
Q

CN X Vagus carries what part of the carotid sinus reflex?

A

Efferent part of reflex arc to the heart.

37
Q

What carries the afferent info of the carotid sinus reflex from the baroreceptors of carotid artery?

A

CN IX Glossopharyngeal carries it to the solitary nucleus, then relays it to dorsal motor nucleus of X.

38
Q

What does the efferent limb of the carotid sinus reflex arc stimulate?

A

The heart to slow it’s rate.

39
Q

What role does CN X Vagus have in the carotid body reflex? What is controlled?

A

Carries one sensory (afferent) component (chemoreception from lung bronchioles) to synapse in the medullary respiratory center. This controls breathing rhythm. Efferent limb controls inspiration of intercostals and diaphragm.

40
Q

What role does CN X Vagus have in the cough/ gag/ vomit reflex? What is controlled?

A

Sensory info from gut relayed to appropriate LMNs in nucleus ambiguous, spinal cord, preganglionic parasympathetic in dorsal motor nuc of X. (CN IX carries sensory fibers from oral/ nasal cavity in this reflex).

41
Q

Do lesions of CN X Vagus result in sensory or motor deficits?

A

Both!

42
Q

Unilateral lesions of LMNs of CN X Vagus result in what deficits?

A

Difficulty swallowing, hoarseness, inability to raise soft palate on IPSILATERAL side

43
Q

What is hoarseness called?

A

dysphonia

44
Q

Lesions of preganglionic parasympathetic fibers of CN X Vagus cause disruption what?

A

Some gut reflexes

45
Q

What deficits are associated with LMN lesions of CN X Vagus?

A

Hyperactivity causes gastric acid secretion = ulcers

46
Q

Large bilateral lesions of medullary reticular formation disrupts what?

A

Normal breathing rhythms and reflex control of vascular resistance to blood flow = coma. Poor prognosis.

47
Q

LMNs of CN IX Glossopharyngeal live where?

A

Rostral end of nucleus ambiguous. Innervate stylopharyngeus.

48
Q

What CNs have LMNs in nucleus ambiguous?

A

CN IX, X, XI.

49
Q

Preganglionic parasympathetic neuroni cell bodies of CN IX Glossopharyngeal live where?

A

reticular formation

50
Q

What do the axons of CN IX Glossopharyngeal synapse onto once they leave medulla?

A

Postganglionic neurons in otic ganglion.

51
Q

What does the otic ganglion innervate?

A

Parotid gland (follows auriculotemporal branch V3).

52
Q

Where do the central processes of sensory neurons of CN IX Glossopharyngeal synapse?

A

Caudal part of solitary nucleus.

53
Q

What do the sensory fibers of CN IX Glossopharyngeal carry?

A

Afferent limb of carotid sinus reflex

54
Q

Central processes synapse in ______ nuclei and carry what somatic sensations?

A

Sensory trigeminal (spinal nucleus of V); touch/ pressure/ pain from pharynx and posterior 1/3 of tongue (gag reflex). Also taste from posterior 1/3 of tongue to anterior solitary nucleus.

55
Q

What do the UMNs descend with and synapse with?

A

Corcitcobulbar fibers; bilaterally synapse on LMNs in nucleus ambiguus

56
Q

What reflexes does CN IX Glossopharyngeal carry?

A

Afferent limb for carotid sinus, gag, vomiting, swallowing. Also motor components participate in swallowing and salivation (taste).

57
Q

Unilateral lesions of CN IX Glossopharyngeal produce difficulties with what?

A

speech, swallowing, some visceral reflexes

58
Q

What reflexes are diagnostic for differentiating CN IX and X lesions are:

A

loss of gag reflex to touching the pharynx (IX afferent limb) compared to deviation of uvula (X, efferent limb).

Neuro (2 decks)

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