NEURO: Part 2 Flashcards
Name the 12 cranial nerves
Oh - Olfactory Oh - Optic Oh - Oculomotor To - Trochlear Take - Trigeminal A - Abducens Family - Facial Vacation - Vestibulocochlear Go - Glossopharyngeal Vegas - Vagus After - Accessory Hours - Hypoglossal
Sensory and Motor innervation of the 12 cranial nerves
Some Say Money Matters But My Brother Says Big Boobs Matter Most
Is branchial innervation sensory or motor
Motor
Describe the innervation of the vestibulocochlear nerve
Ipsilateral innervation by vestibular branch
Contralateral innervation by cochlear branch
Name the four parasympathetic nerves of cranials
3,7,9,10
Where in the brainstem is the nuclei for CN3 and CN4
Midbrain
Where in the brainstem is the nuclei for CN5,CN6,CN7,CN8
Pons
Where in the brainstem is the nuclei for CN9,10,11,12
Medulla
Where is brook’s area found
DOMINANT hemisphere on frontal lobe
How common is it to have broca’s area on the left side when you’re left-handed
60% still have it on left hemisphere
Damage to brook’s area can do what
Cause expressive aphasia
What is expressive aphasia
Difficulties forming sentences
They will understand what you are saying but can’t express words into meaningful language
What is the name of the comprehension of speech part of the brian
Wernicke’s area
Where is Wernicke’s area found
Dominant temporal lobe
Damage to Wernicke’s area results in what
Comprehension/receptive aphasias
What is comprehension aphasia
Difficulty understanding spoken or written language even though hearing and vision are not impaired
Adding unnecessary words and making sentences that make no sense
Unaware they are not speaking in clear sentences
What does the external carotid artery supply
Everything in the head and neck apart fro the brain
What artery supplies the brain
Internal carotid
What does the anterior cerebral artery supply
Motor cortex and top part of the brain
Ischaemic stroke in the ACA will effect what part of the body
Lower limbs
What does the middle cerebral artery supply
Majority of outer surface of the brain
Ischaemic stroke in the MCA will effect what region
Chin to hip
When can limbs be spared in MCA ischaemia
If there is an EMBOLIC stroke
Role of the posterior cerebral artery
Supplies peripheral vision
Ischaemic stroke in the posterior cerebral artery will cause what
Vision loss (not macular vision)
What artery does the Posterior inferior cerebellar artery come off
Vertebral artery
Where do most embolus tend to lodge into
PICA through the vertebral artery
Embolus in which vessel will result in lateral medullary syndrome
PICA because int supplies CN 9,10,11,12
What is lateral medullary syndrome
Dysphagia Slurred speech Ataxia Facial pain Nystagmus Loss of pain and sensation on opposite side of th body
What is the most common type of inter cranial aneurysm
Berry aneurysm
What is a berry aneurysm
A berry shaped dilatation of a blood vessel in the circle of willis
Where is a berry aneurysm common
Anterior cerebellar artery and Anterior communicating artery junction
Consequence of berry aneurysms
Subarachnoid haemorrhage
Clinical presentation of berry aneurysms
Thunderclap headache
Where does the ophthalmic artery branch off from
Internal carotid artery (just before it branches into middle cerebral artery)
Describe the structure of the aortic arch
Check book
What do the common carotid arteries branch off into
Internal (larger than external) and external carotid
At what level foes common carotid bifurcation occur at
C4
What condition is bifurcation of common carotid artery at risk of
Atherosclerosis
What does the internal carotid artery branch off into before bifurcating into the middle and anterior cerebral artery
Cervical
Petrous ICA
Cavernous sinus ICA
Supraclinoid ICA
Where is the cervical branch located
Anterior and medial to the internal jugular vein
Posterior and lateral to external carotid artery at origin
Describe the pathway of the cervical branch
Ascends behind and medial to the external carotid artery
Where is the petrous ICA found
Penetrates the temporal bone and runs horizontally in the carotid canal
What does the petrous Ica branch off into
Caroticotympanic artery which supplies middle and inner ear
What artery does petrous ICA connect to
Vidian artery to external carotid artery
Why is the connection of petrous to external carotid artery important
It means if ischameic block is in petrous, then external carotid can compensate
IN an RTA, what happens to the internal carotid artery
Petrous Ica is still anchored to the temporal bone but the cervical artery is now free - ICA can rupture can dissect with extreme rotation
Describe the path taken by the cavernous sinus ICA
- Turns superiorly at foramen lacer to enter the skull via the carotid canal
- Joins cavernous sinus
When does the cavernous sinus ICA pierce the dura
At anterior crinoid process
What happens if an aneurysm ruptures beyond the anterior crinoid process of the cavernous sinus ICA
Subarachnoid haemorrhage = increased intracranial pressure
What do the small branches of the cavernous sinus ICA supply
- Dura
- CN3-6
- Posterior pituitary (meningo-hypophyseal artery and inferolateral trunk)
What artery does the cavernous sinus Ica attach to
External carotid with inferolateral trunk
What cranial nerves are found in the cavernous sinus
CN3,4,5 (ophthalmic and maxillary branch of trigeminal), 6
Anueyrms would have widespread problems here
Where does the supraclinoid process lead to
Branches above crinoid process and penetrates meninges
Breaches anterior crinoid and becomes intracranial
Branches of the supraclinoird ICA
Ophthalmic artery
Superior hypophyseal arteries/trunk
Posterior communicating artery
Anterior choroidal artery
What does the superior hypophyseal artery supply
Pituitary gland
Stalk
Hypothalamus
Optic chiasm
What does the anterior choroidal artery supply
- Choroid plexus
- Optic tract - vision
- Cerebral peduncle (sensory motor fibres)
- Internal capsule (all descending and ascending tracts pass through)
- Median temporal lobe
Describe the blood supply of the middle cerebral artery
Check book
M1,M2,M3,M4
M1 - Runs laterally to branch into lateral lentriculostriate arteries
M2 - Runs in the insular cistern
M3 - Emerge onto brain surface
M4 - Vessels on brain surface
Describe the branching of the anterior cerebral artery
Check book
A1: Runs medially to connect with contralateral ACA via anterior communicating artery (forms medial lenticulostriate artery)
A2: Runs in inter hemispheric tissue to gene of the corpus callous and 2 cortical branches
A3: Cortical branches from callosomarginal and pericallosal arteries
What does the medial lenticulostriate artery supply
Head of caudate nucleus and internal capsule
Where do vertebral arteries arise from
Subclavian arteries
Which vertebral artery is larger
Left
Through what foramen do the vertebral arteries move through
Foramina transversarium at C6
And then enter skull through foramen magnum
Describe pathway of vertebral arteries
Laterally at C2
Loop posteriorly at C1
What do the vertebral arteries supply
- Neck muscles
- Spinal meninges
- Spinal cord - infarct here can be bad
- Anastomoses with other neck vessels (external carotid branches)
Name the inter cranial vertebral artery branches
Anterior spinal artery
Small medullary perforators
Posterior inferior cerebellar artery
What artery branches from the basilar artery
Anterior inferior cerebellar arteries - supply cerebellum, CN7 + 8
Superior cerebellar arteries
What structures in the midbrain does the posterior cerebral artery supply
Thalamus
Geniculate bodies
Cerebral peduncles
tectum (contains colliculus)
What structures are supplied by the medial and lateral posterior choroidal arteries (branches of the posterior cerebral artery)
tectum
Thalamus
Chord of 3rd and lateral ventricles
What are the cortical territories of the posterior cerebral artery
- Inferior temporal lobe where anatomies with middle cerebral artery
- Posterior third of inter hemispheric surface where anastomoses with anterior cerebral artery
- Visual cortex and occipital lobe - visual defects in thrombus
Describe the visual field
CHECK BOOK
Under what structure is the optic chiasm located
Anterior to pituitary infundibulum
What structures are associated with audio
Inferior colliculus
Medial geniculate body
Role of medial rectus
Adduction
Role of lateral rectus
Abduction
Role of superior oblique
Intorsion and medial abduction
Role of inferior oblique
Extorsion and lateral adduction
Superior rectus role
Pulls eye up and medially
Rotates it
Role of inferior rectus
Pulls eye down and medially
Rotates it
Role of elevator palpebral superiors
Lifts upper eyelid
Innervation of the eye muscles
- CN3: Medial rectus, inferior oblique, superior rectus and inferior rectus
Abducens: Lateral rectus
trochlear nerve: Superior oblique
Facial nerve: Levator palpeerde superioris
LR6SO4
Loss of function of CN7 supply to eye is called what
Ptosis
How to examine eye movements
- Superior rectus: Laterally and look up
- Inferior rectus: Lateral and look down
- Lateral rectus: Lateral
- Medial rectus: Medially
- Inferior oblique: Medially and upwards
- Superior oblique: Medially and downwards