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Patho II Final > Neuro Mod 7 > Flashcards

Neuro Mod 7 Flashcards

1
Q

Anterior view midbrain landmarks?

A

Midbrain (cerebral peduncles), pons, medulla (pyramids and pyramidal decussation), cranial nerves 1-12

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2
Q

Which cranial nerves (in anterior view) do not emerge from the brainstem?

A

1 & 2

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3
Q

Which cranial nerves (in anterior view) emerge from the midbrain (brainstem)?

A

3 & 4

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4
Q

Which cranial nerves (in anterior view) emerge from the pons (brainstem)?

A

5, 6, 7, 8

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5
Q

Which cranial nerves (in anterior view) emerge from the medulla (brainstem)?

A

9, 10, 11, 12

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6
Q

Medulla pyramids descend in the _______ _______ ______

A

corticospinal motor tract

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7
Q

Medulla pyramidal decussation represent the descending portion of the corticospinal motor tract that ________ _______

A

Crosses midline

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8
Q

A majority of medulla pyramidal decussation cross midline and descend in the spinal cord as _____ _____ ______

A

Lateral corticospinal tract

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9
Q

Some medulla pyramidal decussation do not cross midline and descend in the spinal cord as ______ _______ ______

A

Anterior corticospinal tract

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10
Q

Posterior view brainstem landmarks?

A

Superior colliculus, Inferior colliculus, CN4, 4th ventricle

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11
Q

Which CN is the only one to emerge from the posterior brainstem?

A

CN4

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12
Q

Sagittal view landmarks of the brainstem?

A

Midbrain, pons, medulla, superior colliculus, inferior colliculus, 4th ventricle, cerebral aqueduct

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13
Q

What are the three horizontal regions of the brainstem?

A

Brainstem, pons, medulla

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14
Q

External midbrain structures?

A

CN3, CN4, cerebral peduncles (descending motor tracts), superior colliculus (sub-cortical visual reflexes), inferior colliculus (sub-cortical auditory reflexes)

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15
Q

Internal midbrain structures?

A

Cerebral aqueduct, periaqueductal gray area (PAG), nuclei for CN3&CN4, red nucleus, substantia nigra, descending motor tracts in cerebral peduncles

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16
Q

Structures of the pons?

A

CN5 - CN8, motor tracts that descend from anterior pons, 4th ventricle

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17
Q

Structures of the medulla?

A

CN9 - CN12, pyramids (descending motor tracts), pyramidal decussation (descending motor tracts that cross midline)

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18
Q

What are the three vertical columns of the brainstem?

A

Tectum (posterior column), Tegmentum (middle column), Basis (anterior column)

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19
Q

Location of tectum?

A

Posterior column of brainstem, everything posterior to cerebral aqueduct

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20
Q

Structures of the tectum?

A

Superior colliculus, inferior colliculus

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21
Q

Function of superior colliculus (tectum)?

A

Some visual info from eye connects directly, creates circuitry for visual reflexes (pupillary light relfex, orienting eyes toward/away from stimuli)

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22
Q

Function of inferior colliculus (tectum)?

A

Some auditory info from ear connects directly, creates circuitry for auditory reflexes (loud sound -> shrug shoulders/duck head in protective position)

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23
Q

Location of tegmentum?

A

Middle column of brainstem, everything between cerebral aqueduct/4th ventricle, and basis

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24
Q

Structures of the tegmentum?

A

Reticular formation, ascending somatosensory tracts, nuclei of CN3 - CN12, descending motor tracts of spinal cord that originate from brainstem nuclei

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25
Q

Function of ascending somatosensory tracts in tegmentum?

A

Proprioception, light touch, pain and temp from body & head

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26
Q

Midbrain portion of the tegmentum holds nuclei of which cranial nerves?

A

CN3 & CN4

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27
Q

Pons portion of the tegmentum holds nuclei of which cranial nerves?

A

CN5 - CN8

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28
Q

Medulla portion of the tegmentum holds nuclei of which cranial nerves?

A

CN9- CN12

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29
Q

Which descending motor tracts of the spinal cord that originate from the brainstem do the tegmentum hold?

A

Rubrospinal tract, Tectospinal tract, Reticulospinal tract, Vestibulospinal tract

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30
Q

Where does the Rubrospinal tract originate?

A

Red nucleus in brainstem

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31
Q

Where does the Tectospinal tract originate?

A

Tectum in midbrain

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32
Q

Where does the Reticulospinal tract originate?

A

Reticular nuclei in lower 2/3 of brainstem

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33
Q

Where does the Vestibulospinal tract originate?

A

Vestibular nuclei in lower brainstem

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34
Q

Location of basis?

A

Most anterior part of brainstem

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35
Q

What are the three descending spinal tracts of the basis that begin in the motor cortices?

A

Corticospinal tract, Corticobulbar tract, Corticopontine tract

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36
Q

Corticospinal tract pathway of the basis?

A

Motor tracts that begin in primary motor cortex/end in spinal cord to supply muscles in the body

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37
Q

Corticobulbar tract pathway of the basis?

A

Motor tracts that begin in primary motor cortex/end in spinal cord to supply muscles in the face/head

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38
Q

Corticopontine tract pathway of the basis?

A

Motor tracts that begin in premotor cortices/end in cerebellum via the pontine nuclei

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39
Q

Location of the reticular formation?

A

Cluster of nuclei located in tegmentum throughout the length of the brainstem
*2 sections

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40
Q

Where is the rostral reticular formation?

A

Upper pons and midbrain

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41
Q

Where is the caudal reticular formation?

A

Lower pons and medulla

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42
Q

Overall function of the reticular formation?

A

Regulates and modulates most areas of the CNS

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43
Q

What syndrome is not completely understood yet is suggested to be d/t reticular formation dysfunction?

A

SIDS (Sudden infant death syndrome)

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44
Q

Function of the caudal reticular formation?

A

Modulates respiratory and CV nuclei of the brainstem, modulates motor functions, Modulates nociception pathways,

45
Q

Motor function modulation by the caudal reticular formation?

A

Postural muscle tone, gait, horizontal eye movement, micturation (sphincter control), etc.
& complex physiologic motor reflexes: swallow, vomit, cough, sneeze, shivering, laughing, crying, etc.

46
Q

Nociception function modulation by the caudal reticular formation?

A

Initial incoming nocicpetion from spinal cord/cortex stimulates reticular nuclei that send signals down spinal cord to inhibit incoming nociception/pain

47
Q

What is the rostral reticular formation also known as?

A

Reticular activating system (RAS) or ascending reticular activating system (ARAS)

48
Q

Function of rostral reticular formation? What could occur if it was damaged?

A

Modulates consciousness (levels)
*3 components of consciousness: alertness, awareness, attention
*damage to upper brainstem can result in potential coma/impaired consciousness

49
Q

States of impaired consciousness?

A

Brain death, coma, vegetative state, minimal conscious state, stupor, lethargy, delirium, status epilepticus, akinetic mutism, sleep (normal or abnormal)

50
Q

States that mimic impaired consciousness?

A

Locked in syndrome, dissociative disorders

51
Q

Features of coma?

A

Remain unconscious, no meaningful response to stimuli, low glasgow scores, CNS cells still alive but metabolism significantly reduced, generally not permanent (after 2-4wks will either progress or digress into diff category)

52
Q

Areas affected w/ coma?

A

Severely depressed: cortex, sub-cortical regions (diencephalon, upper brainstem/reticular nuclei), CNS arousal systems (RAS)

53
Q

Reflexes that remain intact w/ coma?

A

Spinal cord reflexes, brainstem reflexes

54
Q

Features of vegetative state?

A

Similar to coma: remain unconsious, no meaningful response to stimuli (slightly higher glasgow score), CNS cells still alive but metabolism significantly reduced
Different than coma: will display some sub-cortical function (sleep/wake cycle, some arousal reflexes)

55
Q

Areas affected w/ vegetative state?

A

Severely depressed: cortex
Partially depressed: sub-cortical region

56
Q

Reflexes that remain intact w/ vegetative state?

A

Spinal cord reflexes, brainstem reflexes, some arousal reflexes (arousal/open eyes or turn head to stimuli, random sounds/movement)

57
Q

Features of brain death?

A

Extreme irreversible form of coma, no evidence of cortex, diencephalon, brain stem function ***ABSENT BRAINSTEM REFLEXES, metabolism/perfusion near zero

58
Q

Areas affected w/ brain death?

A

Absent: cortex, sub-cortical arousal, brainstem functions

59
Q

Reflexes that remain intact w/ brain death?

A

Spinal cord reflexes

60
Q

What is the glasgow coma scale?

A

Clinical utility to indicate severity of acute brain injury, correlates w/ outcomes following brain injury

61
Q

3 domains assessed w/ glasgow coma scale?

A

eye opening, verbal response, motor activity

62
Q

Glasgow threshold of 3-8 indicates what?

A

Severe TBI (3 is lowest possible, wholly unresponsive), 8 is strongly considered for intubation)

63
Q

Glasgow threshold of 9-12 indicates what?

A

Moderate TBI

64
Q

Glasgow threshold of 13-15 indicates what?

A

Mild TBI (13 highest score: opens eyes spontaneously, oriented/alert, obeys commands)

65
Q

What is the Uniform determination of death act (UDDA)?

A

Passed in 1980s, establishes neurological definition of death as “irreversible cessation of all functions of the brain including the brainstem”

66
Q

Who developed guidelines for conducting brain death exams?

A

American Academy of Neurology (AAN)

67
Q

Legal criteria to determine death vary from state to state, but in general require what?

A

Neuro evaluation by 2 independent physicians (if long period of time passed, 1 is usually sufficient)

68
Q

1st step of establishing brain death (AAN outlines)?

A

Determine if pre-req’s for brain death met:
-confirm coma not caused by meds/therapy/illicit drugs/toxins
-confirm no severe abnormalities in body temp, BP, or body chemistry (electrolytes/acid-base)
-confirm pt is mechanically ventilated

69
Q

2nd step of establishing brain death (AAN outlines)?

A

Perform brainstem reflex tests: confirm all brainstem reflexes/responses absent

70
Q

3rd step of establishing brain death (AAN outlines)?

A

Perform apnea tests: confirm no respiratory activity when ventilator removed

71
Q

4th step of establishing brain death (AAN outlines)?

A

Perform ancillary tests if needed:
-if any of first 3 steps not met must be done
-confirms no cerebral bloodflow or metabolism of brain
-cerebral angiogram, cerebral scintigraphy, transcranial US, EEG, etc.

72
Q

Brainstem reflex tests?

A

Noxious/deep pressure reflex, Pupillary light reflex, Vestibulo-ocular reflexes (VOR): head turning/caloric tests, Pharyngeal (gag) reflex/tracheal (cough) reflex

73
Q

Noxious/deep pressure reflex procedure?

A

Apply deep pressure to condyles/TMJ, subraorbital area, or nail beds
If intact: grimace/facial muscle movement

74
Q

CN’s involved w/ Noxious/deep pressure reflex?

A

CN5 (V1, V2, V3): sensory part
CN7 (facial nerve): motor part

75
Q

Pupillary reflex procedure?

A

Shine light in one eye, observe for direct and consensual response

76
Q

CN’s involved w/ pupillary reflex?

A

CN2: sensory, visual input
CN3: motor, parasympathetic portion, muscles of iris

77
Q

Vestibulo-ocular (VOR) reflex head turning test procedure?

A

Manually rotate head to one side (eyes should rotate to opposite side)
Failure to rotate = doll’s eyes

78
Q

CN’s involved w/ Vestibulo-ocular (VOR) reflex?

A

CN8: sensory, vestibular input from inner ear (semicircular canals)
CN 3, 4, 6: motor, extraocular muscles of eye

79
Q

Vestibulo-ocular (VOR) reflex caloric test procedure?

A

Irrigate each ear w/ 60ml ice water, eye should move toward irrigated ear (tricks semicircular canals that head is being turned to opposite side being irrigated)

80
Q

Corneal reflex test procedure?

A

Touch cotton swap to cornea, eyes should blink

81
Q

CN’s involved w/ corneal reflex?

A

V1 branch of CN5: sensory, sensation from cornea
CN7: motor, facial muscle (orbicularis oculi)

82
Q

Pharyngeal gag reflex procedure?

A

Touch tongue depressor to posterior oropharynx, should produce gag (pharynx contracts)

83
Q

CN’s involved w/ pharyngeal gag reflex?

A

CN 9: sensation from oropharynx
CN10: motor, pharyngeal muscle

84
Q

Tracheal (cough) reflex procedure?

A

Insert tracheal suctioning catheter to carina (should produce cough)

85
Q

CN’s involved w/ tracheal cough reflex?

A

CN10: sensation from trachea, motor supply of pharyngeal muscle

86
Q

Which arteries supply the brainstem?

A

Vertebral artery, basilar artery, posterior cerebral artery

87
Q

Vertebral artery supply of brainstem?

A

Small branches supply most of medulla
Branch that supplies lateral medulla/cerebellum: PICA (posterior inferior cerebellar artery)

88
Q

Basilar artery supply of brainstem?

A

Pontine arteries (small branches that supply pons), AICA (anterior inferior cerebellar artery) - branches that supplies lower pons/cerebellum

89
Q

Brainstem vascular syndromes that are caused by lesions of different arteries in the brainstem/cerebellum?

A

Weber’s syndrome, Pure motor hemiparesis, Locked-in syndrome, Wallenberg’s syndrome (lateral medullay syndrome)

90
Q

Blood vessel involved with Webers syndrome?

A

Small branches of R or L PCA (unilateral stroke of anterior midbrain)

91
Q

Blood vessel involved with motor hemiparesis?

A

R or L pontine arteries of basilar artery along R or L anterior pons (unilateral stroke of anterior pons)

92
Q

Blood vessel involved with Locked-in syndrome?

A

Basilar artery & bilateral paramedian branches along pons (bilateral stroke of anterior pons)

93
Q

What is the most common brainstem stroke?

A

Wallenberg Syndrome (lateral medullary syndrome)

94
Q

Blood vessel involved with Wallenberg Syndome?

A

Vertebral artery, PICA, or small branches of PICA
*either directly or indirectly supply lateral medulla (unilateral stroke of lateral medulla)

95
Q

Regions/structures damaged w/ Webers syndrome?

A

Basis of midbrain
-cerebral peduncle: damages descending motor tracts
-oculomotor nerve (CN3): damaged as exits front of midbrain
**may occasionally extend into substantia nigra

96
Q

Regions/structures damaged w/ PMH?

A

Basis of pons
-descending motor tracts

97
Q

Regions/structures damaged w/ Locked-in syndrome?

A

Basis of upper pons
-R and L descending motor tracts

98
Q

Regions/structures damaged w/ Wallenberg syndrome?

A

Lateral medulla and maybe inferior cerebellum
-lesion damages structures of lateral medulla: nuclei of CN5, 8, 9, 10, sympathetic tract, spinothalamic tract

99
Q

Clinical findings w/ Weber syndrome?

A

Contralateral hemipalegia, ipsilateral CN3 palsy (diplopia, ptosis, abnormal pupillary light reflex), Parkinsonian sx if substantia nigra affected

100
Q

Clinical findings w/ PMH?

A

Contralateral hemiplegia

101
Q

Clinical findings w/ Locked in syndrom?

A

Quadriplegia w/ intact sensation
*all motor function impaired except CN3 (& maybe CN4)
Unable to speak, move but can hear, see, think, and feel all somatosensory sensation
*vertical gaze or blinking may be spared since CN3/4 located above lesion

102
Q

Locked in syndrome may mimic coma, but has what reflexes intact?

A

Spinal cord and brainstem reflexes, arousal/sleep-wake cycle, may have eye movement w/ purposeful response to stimuli

*cant move but can understand everything going on in environment

103
Q

Clinical findings w/ Wallenberg syndrome d/t damage of CN5 nuclei/tracts?

A

Loss of pain/temp to the face

104
Q

Clinical findings w/ Wallenberg syndrome d/t damage to spinothalamic tract?

A

Loss of pain/temp to the body

105
Q

Clinical findings w/ Wallenberg syndrome d/t damage of CN8 vestibular nuclei?

A

Vertigo, N/V, nystagmus

106
Q

Clinical findings w/ Wallenberg syndrome d/t damage of CN 9 &10?

A

Hoarseness, dysphagia

107
Q

Clinical findings w/ Wallenberg syndrome d/t damage of sympathetic tract?

A

Horner’s syndrome: ptosis, miosis, anhydrosis

108
Q

Clinical findings w/ Wallenberg syndrome d/t damage of cerebellum/cerebellar peduncle?

A

Ataxia (lack of coordination)

Patho II Final (4 decks)

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