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Patho- Neuro > Neuro Mod 5 > Flashcards

Neuro Mod 5 Flashcards

1
Q

Anterior Spinal Artery

A

i. branch directly off of vertebral artery

ii. descends to supply anterior regions of spinal cord

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2
Q

PICA (posterior inferior cerebellar artery)

A

i. Supplies:
1. lateral medulla and cerebellum
ii. Occlusion: PICA syndrome – see notes below
1. The PICA depends solely on VA for blood supply
2. Therefore VA occlusion may “create” PICA syndrome

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3
Q

Basilar Artery

A
  1. R/L vertebral arteries merge to form basilar artery
  2. Ascends anterior to brainstem
  3. Divides into R/L posterior cerebral arteries to form part of Circle of Willis
  4. Branches of basilar artery
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4
Q

Branches of the Basilar Artery

A

a. R/L Posterior cerebral arteries
b. Long circumflex branches
c. Pontine branches

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5
Q

Pontine Branches of the Basilar Artery

A

i. small vessels that emerge from basilar artery to supply pons
1. motor tracts – corticospinal tract

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6
Q

Long Circumflex Branches of the Basilar Artery

A

i. Superior cerebellar artery
1. Supplies superior cerebellum and portions of midbrain
2. Infarction: Perinaud Syndrome (Dorsal Midbrain Syndrome)
ii. Anterior inferior cerebellar artery
1. Supplies anterior/inferior quarter of cerebellum
2. Infarction: AICA or lateral pontine syndrome

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7
Q

Acute complete occlusion of Basilar Artery associated with poor prognosis includes what signs?

A
  1. LOC – coma (loss of consciousness – reticular system)
  2. Bilateral motor/sensory loss
  3. Cerebellar signs (hypotonia, disequilibrium, dyssynergia)
  4. Cranial nerve damage
  5. Visual changes
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8
Q

Chronic or gradual onset for Basilar Artery Occlusion

A

i. TIA’s with partial symptoms

ii. Prodromal of partial symptoms that proceed major occlusion

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9
Q

Function of the corticospinal tracts

A
  1. Contralateral motor tracts to trunk/extremities
    ii. located in anterior regions of mid-brain, pons and medulla
    iii. decussate (cross midline) in junction of medulla/spinal cord
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10
Q

Lesion to the corticospinal tract

A
  1. ABOVE decussation: contralateral hemiparesis of trunk/extremities
  2. BELOW decussation: ipsilateral hemiparesis of trunk/extremities
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11
Q

Function of corticobulbar tracts

A

i. Function:
1. Motor tracts to cranial nerves (head/face)
ii. All are bilateral innervation EXCEPT:
1. Lower face (CN 7)
2. Tongue (CN 12)

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12
Q

Whats happens with a lesion to the corticobulbar tract?

A
  1. contralateral hemiparesis of lower face & tongue

2. other head/face motor structures maintain function at some level due to bilateral connections

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13
Q

Corticopontine tract function and lesion

A

i. Function:
1. Motor tracts to cerebellum via pontine nuclei
ii. Lesion:
1. Potential cerebellar signs – cerebellar dyssynergias

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14
Q

Function and lesion of spinal trigeminal tract

A

ii. Function:
1. ipsilateral pain and temp sensory input from face
iii. Lesion:
1. Ipsilateral loss of pain/temp from face

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15
Q

Where is the spinal trigeminal tract located?

A

i. located in pons and medulla
1. descends to medulla and crosses midline
2. ascend to thalamus via ventral trigeminal-thalamic tract (part of spinal lemniscus)

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16
Q

Where is the Descending autonomic sympathetic tracts located and what occurs when there is a lesion?

A

i. Located in dorsal lateral regions of brainstem
1. hypothalamus connections to sympathetics descend through brainstem
2. sympathetics “originate” in upper T spine
ii. Lesion: Horner’s syndrome

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17
Q

Ascending Tracts of the Brainstem= Medial lemniscus Function

A
  1. Proprioception, discriminating touch and vibration from contralateral trunk/extremities and face
    a. Sensory input from face enters brainstem at pons via CN 5
    b. Pathway sometimes referred to as Dorsal Trigeminal Thalamic Tract (DTTT)
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18
Q

Ascending Tracts of the Brainstem= Medial lemniscus origin and lesion

A

i. Originates in medulla and carries dorsal column sensory information to thalamus
iii. Lesion: contralateral loss of propriception, discriminating touch and vibration trunk/extremities and face (if lesion is at/above pons)

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19
Q

Spinal lemniscus tract (combined pathway for lateral & anterior spinothalamic and spinotectal tracts)

A

i. Function:
1. Convey contralateral pain/temp from body and face
a. Body: sensory input from continuation of lateral spinal thalamic tract (LST)
i. LST is ascending as part of spinal lemniscus
b. Face: sensory input from ventral trigeminal thalamic tract (VTTT)
i. VTTT is ascending as part of the spinal lemniscus

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20
Q

Function of the spinothalmic tract

A

a. Function:
i. Contralateral pain and temperature of trunk/extremities
b. Lesion:
i. Contralateral loss of pain and temperature of trunk/extremities

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21
Q

Ventral trigeminal thalamic tract (VLTT) function and lesion

A

a. Function:
i. Contralateral pain and temp from face via CN 5, 7, 9, 10 input from descending spinal trigeminal pathway
b. Lesion:
i. Contralateral loss of pain and temperature of face

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22
Q

Medial longitudinal fasciculus (MLF)

A

i. Ascends through each region brainstem
ii. Function of MLF:
1. Mediates coordinated eye movement and reflexes
a. transmits information necessary for the coordination of most major categories of eye movements

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23
Q

Example of Medial Longitudinal fasciculus

A

horizontal conjugate gaze

a. MLF allows CN 3 and 6 to work synergistically for R/L horizontal gaze
i. Patient instructed to look left: right CN3 contracts medial rectus while left CN6 contracts left lateral rectus

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24
Q

MLF contains what?

A
  1. mostly ascending vestibular fibers that connect with CN 3,4 and 6
  2. also contains fibers from superior colliculus, reticular system that connect with motor fibers of neck
25
Q

Lesion in MLF

A
  1. Common in multiple sclerosis
  2. Deficit:
    a. abnormal horizontal conjugate gaze
    b. pathological nystagmus
26
Q

Mid-Brain Pathways

A

i. Superior peduncle connects to brainstem at mid-brain
1. Afferent: some resources dorsal spinocerebellum
2. Efferent: dentate, interposed and some or all of fastigal output

27
Q

Pons Pathway

A

i. Middle peduncle connects to brainstem at pons
1. Afferent: pontocerebellar tracts (corticocerebellar tracts)
a. Pontine nuclei in pons project to the cerebellum via middle peduncle
2. Efferent: NO efferent pathways in middle

28
Q

Medulla Pathway

A

i. Inferior peduncle connects to brainstem at mid-brain
1. Afferent:
a. spinocerebellum (ventral and/or dorsal spinocerebellar tracts)
b. vestibulocerbellar tracts projecting to flocculonodular lobe
2. Efferent:
a. Fastigial - some or no fastigal output (depending on resource)
b. Flocculonodular output projecting to vestibular nuclei

29
Q

Tectum of the Midbrain

A

i. Tectum is posterior (dorsal) region of mid-brain that contains
1. Superior and inferior colliculi

30
Q

Function of Superior Colliculi

A
  1. Function:
    a. Visual processing
    i. mediates visual reflexes (pupillary reflexes, optic reflexes)
    ii. mediates visual “behavior” toward objects – tracking, fixating, etc…
    iii. not needed for object recognition
31
Q

Function of the Inferior Colliculi

A

a. Auditory processing
i. Mediates auditory reflexes
1. Startle reflex
a. abrupt response to a loud noise/stimulus
2. Vestibulo-ocular reflex (VOR)
a. stabilize images on retina as head/body move in space

32
Q

Tegmentum of the Midbrain

A

i. Located between ventricle and anterior (base) of mid-brain
(middle region)

33
Q

Nuclei for CN 3 (oculomotor) and CN 4 (trochlear)

A
  1. CN 3 all extra-ocular movements except: ABduction and ADduction/depression
  2. CN 4: ADduction/depression
34
Q

Substantia Nigra Function and Lesion

A
  1. Function:
    a. Site of dopamine production
    b. Functional part of basal ganglia
    i. Initiating/coordinating/modifying movement and muscle tone
  2. Lesion/pathology (see notes in module 2 Parkinson’s disease):
    a. Parkinsonism type of hypokinetic movement disorder
35
Q

Infarction or lesions involving the Red Nucleus

A

i. Isolated lesion to red nucleus or rubrospinal tract is rare
ii. Lesion above red nucleus
1. Contribute to decorticate rigidity
iii. Lesion below red nucleus
1. Contribute to decerebrate rigidity
iv. Cerebellar signs may also be associated with red nucleus damage

36
Q

Red Nucleus

A
  1. Origin of rubrospinal tract
    a. Major role in coordinating motor movement via cerebral cortex/cerebellar connections
    b. Origin of rubrospinal tract…facilitates flexor musculature (predominate UE)
  2. Fibers project (contralateral) to all spinal levels but predominate in cervical region (prox UE)…thus flexor spasticity of UE
37
Q

Other structures of midbrain tegmentum

A
  1. Cerebral aquaduct
  2. PAG or periaqueductal gray area (“central gray”)
  3. Ascending tracts
    a. Medial longitudinal fasciulus
    b. Medial lemniscus
    c. Spinal lemniscus
    d. Lateral lemniscus
  4. Superior cerebellar peduncle
38
Q

Basis pedunculi (base) of mid-brain

A

i. Anterior region of mid-brain that contains major motor tracts as they descend from cerebral cortex/internal capsule
1. corticospinal tracts
2. corticobulbar tracts
3. corticopontocerebellar tracts

39
Q

Reticular System

A

a. The reticular system is not really specific anatomical “location”
b. Network of nuclei located vertically throughout brainstem (reticular means “net-like structure”)
i. Diffuse differentiated regions in the brainstem
1. Nuclei located throughout tegmentum of each region of brainstem
2. Not as common to use term reticular formation…neuroscientist usually refer to specific nuclei

40
Q

function of ascending reticular formation

A

a. Regulates cortex
i. sleep-wake cycle wakefulness
ii. level of consciousness and alertness
iii. modify attention…ability to tune in/out environmental stimuli

41
Q

Pathways of ascending reticular formation

A

a. Connections between RAS – thalamus - cortex

b. RAS projects fibers to thalamus which then reach cortex

42
Q

3 function of the descending reticular formation

A

a. motor
b. autonomic nervous system role
c. pain modulation

43
Q

Motor function of the descending reticular formation

A

a. Maintains/modifies tone, posture, balance, stability and antigravity reflexes during movement
i. reticulospinal tract
1. Pontine (medial) reticulospinal tract - facilitates extension, inhibits flexion
2. Medullary (lateral) reticulospinal tract - facilitates flexion, inhibits extension
b. Plays role in vestibular (eye/ear/cerebellar) functions

44
Q

Ventilation pathways

A
  1. Ventilation: apneustic, pneumotactic, DRG and VRG
    a. Located in both pons and medulla: signals rate/depth of ventilation
    b. PONS:
    i. apneustic/pneumotactic nuclei - “fine tune” inspiration
    c. MEDULLA:
    i. DRG – inspiratory rate at rest
45
Q

Cardiovascular pathway

A

a. Located in medulla: signals Vagus or sympathetic to alter HR or contractility

46
Q

what medications play role with Pain modulation

A

a. Plays major role in the complex pathways of pain modulation
i. Anesthetics/psychotropic drugs: thought to act on reticular formation
1. recreational drugs, painkillers, anesthetics, hallucinogens

47
Q

May play a role in introvert and extrovert traits (reticular system)

A

i. Introverts: less stimulus needed to activate RAS , less desire to seek external stimulus
ii. Extroverts need more stimulus to activate reticular system, thus more desire to seek out external stimulus

48
Q

Lesion of reticular structures leads to what?

A

i. Damage may have obvious detrimental outcome on visceral/motor systems of the body
1. Ventilation and cardiovascular function
ii. Damage to the reticular activating system (RAS)
1. Altered level of consciousness
2. Range from mild – coma – death

49
Q

Locked in Syndrome

A

a. Infract in the base of pons
b. Vascular occlusion:
i. lower paramedian branches of basilar artery

50
Q

Functional deficit in locked in syndrome

A

i. Reticular system spared
1. the patient remains “awake” but unable to function
ii. Quadriplegia
1. Unable to move except:
a. blinking & move eyes vertically
b. communication accomplished only with eye movement
2. All motor tracts and lower CN impaired

51
Q

Sensory and prognosis for locked in syndrome?

A

iii. Sensory:
1. “can’t move but can feel pain”
a. Spinothalmic tract intact – so pain/temp not affected
2. BL loss of discriminatory touch, vibration and proprio (d/t loss of medial lemniscus pathway in medulla)
d. Prognosis
i. Poor

52
Q

Dorsal midbrain (Parinaud) syndrome

A

a. Blood vessel:
i. superior cerebellar arteries, small arteries of PCA/basilar artery
ii. NOTE: usually non-vascular cause – pineal or midbrain tumor compression
b. Lesion damages:
i. superior colliculus, pre-tectal area and cerebral aqueduct

53
Q

Functional deficits of Parinaud syndrome

A

c. Functional deficits:
i. Superior colliculi damage
1. Motor dysfunction of eye – gaze/tracking, pupillary reflexes, etc….
ii. Cerebral aqueduct damage
1. hydrocephalus

54
Q

PICA syndrome, Lateral medullary syndrome (aka Wallenberg syndrome)

A

a. PICA originates directly from VA
i. Supplies: lateral medulla and cerebellum
b. “PICA syndrome” result of?
i. PICA occlusion
ii. VA occlusion

55
Q

Impairments associated with PICA syndrome

A

i. Cerebellar tract signs:
1. hypotonia, disequilibrium, dyssynergia
ii. Descending sympathetic tracts

56
Q

Horner’s syndrome (ipsilateral)

A

a. Ptosis: drooping of eyelid (superior tarsal muscles innervated by sympathetics)
b. Anhidrosis: decreased sweating on face
c. Miosis: constriction of pupil
d. Enophthalmos: appearance of eye “sunken in”
e. Loss of ciliospinal reflex: pupil dilation in response to pain stimulus

57
Q

Cranial Nerve impairment associated with PICA syndrome

A
  1. CN 8 Vestibular nuclei (auditory intact)
    a. nystagmus, nausea, vomit & vertigo
  2. CN 9-11 (nucleus ambiguus)…..glossopharyngeal, vagus & accessory
    a. Paralysis of larynx, palate, pharynx…
    i. Dysarthria: difficulty speaking
    ii. Dysphagia: difficulty swallowing
    iii. Dysphonia: “hoarseness”
    b. Loss of gag reflex
  3. CN 12 (hypoglossal nerve)
    a. Most likely spared
58
Q

Damage to ascending sensory pathways

A
  1. Spinothalmic tract
    a. Contralateral loss of pain and temperature of body (not the face)
  2. Spinal trigeminal tract
    a. Ipsilateral loss of pain and temperature of face

Patho- Neuro (5 decks)

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