Neuroscience Week 5: Brainstem Flashcards
(146 cards)
1
Q
The Reticular Formation It consists of centers that
7 listed
A
- Integrate cranial nerve reflexes
- Help conduct and modulate SLOW pain
- Influence voluntary movements
- Regulate autonomic nuclei
- Associate with diffuse modulating systems
- Integrate sleep and respiration
- ACTIVATE the cerebral cortex
2
Q
Which sensory systems provide input to the reticular formation?
A
Almost all of them
3
Q
Reticular Formation inputs
A
4
Q
Ascending reticular activating system
A
5
Q
Locus Coeruleus
A
the major source of noradrenergic innervation to all cortical regions
6
Q
Raphe Nuclei
A
diffuse serotonergic innervation and involved in alertness and wakefulness
7
Q
Basal forebrain
A
- Cholinergic innervation, originate in the nucleus of Meynert of the basal forebrain
- thought to degenerate in Alzheimer’s Disease
8
Q
Ventral Tegumental Area
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- Dopaminergic innervation of the cerebral cortex
- arises from Ventral tegmental area and projects to aspects of the limbic system
- such as the cingulate gyrus and prefrontal cortex
- awareness, alertness, motivation
9
Q
Widespread projection systems in the nervous system
A
10
Q
Orexin system
A
- many functions but promote wakefulness and reward pathways
- enhance dopamine signaling that can trigger incentive or reward
- can modulate ARAS and therefore modulate wakefulness and alertness
11
Q
Histaminergic Neurons
A
- The tubomammilary nucleus of the hypothalamus can also control cortical activity and promote alertness
- can remember by thinking of benadryl which makes you drowsy if you take it
12
Q
Recap of Aras
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numerous roles
13
Q
Importance of ARAS
A
14
Q
Bilateral inactivation of the pontomesencephalic reticular formation, thalamus and the cerebral cortex results in?
A
Coma
15
Q
Brainstem Reticular Formation consists of centers that
7 Listed
A
16
Q
ARAS Originates
A
midbrain and upper pons
17
Q
ARAS is responsible for?
A
- arousal
- attention
18
Q
If cortex presses down on the brainstem can cause
A
- Coma if ARAS is being pressed on
- Particularly with Uncal Herniation
19
Q
Blood supply to the brainstem
A
20
Q
Identify region and blood supply
A
21
Q
Identify region and blood supply
A
22
Q
Identify region and blood supply
A
23
Q
Identify region and blood supply
A
24
Q
Identify blood supply
A
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Identify brainstem anatomy
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Identify region, contents, anatomy and blood supply
Cervicomedullary junction
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Trigeminal spinal pathway
* 1st neuron trigeminal ganglion in upper pons
* 2nd order is trigeminal caudal nucleus in caudal medulla and spinal cord
* decussates
* ventroposteriolateral thalamus
* Sensory cortices
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Trigeminal Pathway
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Identify region, contents, anatomy and blood supply
Caudal (lower) Medulla
30
Identify region, anatomy, blood supply and describe medial medullary syndrome
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Identify region, contents, anatomy and blood supply
Rostral (upper) Medulla
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Identify region, anatomy, blood supply and describe Lateral medullary syndrome
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Identify region, contents, anatomy and blood supply
Caudal to mid Pons
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Identify region, anatomy, blood supply and describe medial pontine syndrome
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Identify region, anatomy, blood supply and describe Lateral pontine syndrome
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Identify region, contents, anatomy and blood supply
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Full Basilar Stroke AKA
Locked-in syndrome
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Identify region, anatomy, blood supply and describe Locked-in Syndrome
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Identify region, contents, anatomy and blood supply
Caudal midbrain
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Identify region, contents, anatomy and blood supply
Rostral Midbrain
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Identify region, anatomy, blood supply and describe Weber's Syndrome
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Identify Syndromes associated with various arteries
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Identify arteries associated with various syndromes
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Identify arteries and associated syndromes
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Map of cranial nerve nuclei
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Red nucleus lesion in the midbrain
Tremor and ataxia because you cannot finetune your movements
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Cerebral peduncle lesion in the midbrain will cause
UMN lesion in the face and lower extremities
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MLF lesion in the midbrain will cause
horizontal gaze palsy
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Benedikt Syndrome identify where the lesion is and effects
50
Benedikt Syndrome structures affected
Red nucleus
CN 3
Medial lemniscus
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Weber Syndrome identify lesion location and effects
52
Describe Pseudobulbar palsy
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Parinaud syndrome identify lesion location and effects
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Identify structures and which segment
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Pons vestibular nuclei lesion effects
4 listed
* nausea
* vomiting
* nystagmus
* vertigo
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Pons CN VII Tract lesion
* facial droop
* loss of corneal reflex
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Pons Medial Lemniscus Lesion
* loss of proprioception
* loss of vibration
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Pons Corticospinal tract Lesion
contralateral Hemiparesis
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Pons CN VI Tract Lesion
problems with lateral gaze
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Pons Spinothalamic Tract Lesion
* loss of pain and temperature sensation
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Pons Trigeminothalamic tract Lesion
* loss of pain of the face
* loss of temperature sensation of the face
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MLF Lesion in the pons
* horizontal gaze palsy
* intranuclear opthalmoplegia
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Pons 4th ventricle Lesion
noncommunicating hydrocephalus
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Pons PPRF Lesion
intranuclear opthalmoplegia
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Structures need to look laterally
3 listed
* MLF
* PPRF
* Abducens nucleus
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Medial pontine syndrome location and effects
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Medial pontine syndrome structures damage
4 listed
* Corticospinal tract
* CN 6
* CN 7
* Lateral gaze structures MLF, CN 6 nucleus, PPRF
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Medial pontine syndrome symptoms
4 listed
* Contralateral hemiparesis
* CN 6 palsy
* ipsilateral Facial weakness/droop
* ipsilateral Gaze palsy
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Lateral pontine syndrome lesion location and effects
70
Lateral pontine syndrome damaged structures
6 listed
* Vestibular nuclei
* Spinothalamic tract
* CN V nucleus
* Sympathetic tract
* CN 7 nucleus
* Cochlear nucleus
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Lateral pontine syndrome Common cause
AICA stroke
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horner's syndrome symptoms and side affected in respect to the lesion
3 listed
Ipsilateral
* in a decreased pupil size
* a drooping eyelid
* decreased sweating
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Lateral pontine syndrome symptoms associated with structures
6 listed
* Vestibular nuclei: Nystagmus, vertigo, N/V
* Spinothalamic tract: Contralateral pain/temp
* V nucleus: Ipsilateral face pain/temp
* Sympathetic Tract Horner's syndrome
* VII nucleus: Ipsilateral facial droop, loss of corneal reflex
* Cochlear nuclei: hearing loss
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Medulla Nucleus solitarius and dorsal motor nucleus of X function
* where autonomic sensory information comes in from structures such as carotid sinus, aortic arch
* goes out to affect autonomic functions of the Vagus nerve
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Identify segment and structures
medulla
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Medulla Nucleus Ambiguous
Shared motor nucleus of IX, X, XI
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Medulla CN XII
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Medulla Medial Lemniscus
Proprioception and vibration
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Medulla Pyramids
is corticospinal tract
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pyramidal dysfunction AKA
loss of corticospinal tract
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Medulla Inferior olivary nucleus
involved with cerebellum
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Medulla Spinothalamic tract
contralateral pain and temperature
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Medulla trigeminothalmic tract and nucleus
facial pain andc temperature
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Medulla Hypothalamospinal tract
* Sympathetic innervation from the thalamus
* damage will give Horner's Syndrome
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Medulla Vestibular nuclei
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Medial Medullary Syndrome lesion location and effects
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Medial Medullary Syndrome structures damaged
* Corticospinal tract
* medial lemniscus
* CN 12
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Medial Medullary Syndrome common causes
ACA stroke
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Medial Medullary Syndrome Symptoms and associated structures
* Corticospinal tract: Contralateral hemiparesis
* Medial lemniscus: contralateral loss of proprioception/vibration
* CN 12: Falccid paralysis of tongue (LMN) deviates to ipsilateral to lesion
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Lateral medullary syndrome AKA
Wallenberg Syndrome
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Wallenberg Syndrome AKA
Lateral medullary syndrome
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Lateral medullary syndrome damaged structures
5 listed
* Vestibular nuclei
* Sympathetic tract
* spinothalamic tract
* Spinal V nucleus
* Nucleus ambiguous
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Lateral medullary syndrome Symptoms and associated structures
* Vestibular nuclei: Nystagmus, vertigo, N/V
* Sympathetic tract: Horner's Syndrome
* Spinothalamic tract: Contralateral pain/temp
* V nucleus: Ipsilateral face/pain
* Nucleus Ambiguous (IX, X): Hoarseness, dysphagia
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Lateral medullary syndrome common cause
PICA stroke
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Lateral medullary syndrome looks a lot like?
How to distinguish them?
* Lateral pontine syndrome
* distinguish by hoarseness and dysphagia in lateral medullary syndrome
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Rule of 4s
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4 CNs in
* Medulla
* Pons
* Above pons
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4 CNs divide into 12
* 3, 4, 6, 12
* have midline motor nuclei
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4 CNs do not divide into 12
5, 7, 9, 11
All are lateral
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4 midline columns
* Motor nucleus
* Motor pathway
* MLF
* Medial lemniscus
* All start with M
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4 Lateral (side) columns
* Sympathetic
* Spinothalamic
* Sensory
* Spinocerebellar
* All start with S
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How to localize lesions using the rule of 4s?
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CNs in the midbrain and lesion effects
CN 3 eye turned down and out
CN 4 Eye unable to look down when looking towards nose
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CNs in the pons and deficits
* Trigeminal: Ipsilateral facial sensory loss
* Abducens: Ipsilateral abduction weakness
* Facial: Ipsilateral facial weakness/droop
* Auditory: Ipsilateral deafness
105
CNs in the medulla and associated deficits
* Glossopharyngeal: Ipsilateral sensory loss
* Vagus: ipsilateral palatal weakness uvula points away
* Spinal accessory: Ipsilateral shoulder weakness
* Hypoglossal: Ipsilateral weakness of tongue
106
Corticospinal tract sits _______ in brainstem
midline
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Medial leminiscus sits _______ in brainstem
Midline
108
Medial longitudinal fasciculus sits _________ in brainstem
Midline
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Motor Nucleus and nerves (3,4,6, and 12) sit __________ in brainstem
Midline
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CN 3 motor nucleus and nerve sit ________ in brainstem
midline
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CN 4 motor nucleus and nerve sit ________ in brainstem
midline
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CN 6 motor nucleus and nerve sit ________ in brainstem
midline
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CN 12 motor nucleus and nerve sit ________ in brainstem
midline
114
Corticospinal tract damage in the brainstem results in?
Contralateral weakness except below pyramidal decussation (cervicomedullary junction
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Medial Lemniscus damage in the brainstem results in?
Contralateral loss of proprioception and vibration except below medullary decussation
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Medial longitudinal fasciculus damage in the brainstem results in?
ipsilateral Intranuclear opthalmoplegia
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CN 3 damage in the brainstem results in?
ipsilateral motor loss and corneal reflex?
118
CN 4 damage in the brainstem results in?
ipsilateral motor loss of the superior oblique, cant look down and in
119
CN 6 damage in the brainstem results in?
ipsilateral motor loss for eye abduction
120
CN 12 damage in the brainstem results in?
lick your wounds ipsilateral loss of tongue motor
121
Spinocerebellar pathway sits __________ in the brainstem?
Laterally/side
122
Spinothalamic tract sits __________ in the brainstem?
Laterally/side
123
Sensory nuclei of CN 5 sits __________ in the brainstem?
Laterally
124
Sympathetic pathway sits __________ in the brainstem?
Laterally/side
125
Spinocerebellar pathway damage in the brainstem results in?
Ipsilateral ataxia
126
Spinothalamic damage in the brainstem results in?
Contralateral loss of pain/temp
127
Sensory nucleus of CN 5 damage in the brainstem results in?
Ipsilateral pain/temp loss in face
128
Sympathetic pathway damage in the brainstem results in?
Ipsilateral Horner's Syndrome
129
Trigeminal Nerve Caveats
* Lesion: loss of ipsilalteral pain/temp in the face
* Rule of 4 pons nucleu and side (lateral tract)
* Don't localize to pons
* Use for lateral tract localization
130
Vestibulocochlear caveats
* Don't use vestibular signs to localize to the pons
* Vestibular signs can be medulla/pons
* only use Lesion: hearing loss to localize CN 8 to the pons not the vestibular signs
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Case 1
* MCA or ACA - would give more arm than leg or vice-versa so this is a place where all motor fibers are together
132
Blood vessel supply of the brainstem
5 listed
* PCA gives stroke syndrome of the midbrain
* Basilar artery gives a medial stroke syndrome in the pons
* AICA gives a lateral stroke syndrome in the pons
* PICA gives a lateral stroke syndrome in the medulla
* ASA gives a medial stroke syndrome in the medulla
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Case 2
complete motor loss again so it cant be MCA or ACA
134
Left medial midbrain lesion means
* Weber syndrome
* stroke of the branches of PCA
135
Case 3 which structures are affected
136
Case 3 answer
left face/pain and temp don't use this as to localize to the pons but instead use it as evidence of sensory dysfunction in the CN 5 tract (S tract in rule of 4s)
Spinocerebellar
sensory of 5
Sympathetic
Spinothalamic
These are all Ss
CNs 9 and 10 localizes to medulla
137
Left lateral medulla lesion is
Wallenberg syndrome
Left PICA stroke
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Stroke of which artery produces Wallenberg syndrome?
Left PICA
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Stroke of which artery produces Left lateral medulla lesion
Left PICA
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Case 4 structures affected
141
Case 4 answer
Right lateral pontine syndrome
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Right lateral pontine syndrome usually caused by
often caused by tumors such as schwannomas
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Cerebellopontine angle syndrome AKA
lateral pons often caused by tumors like schwannomas
144
How to best utilize the rule of 4s?
* first identify the involvement of the CNs 3, 4, 6 or 12 to indicate medial syndrome
* look for the involvement of S tracts to indicate a lateral problem
* Look for M tract involvement to indicate a medial problem
145
Locked-in syndrome AKA
Full basilar stroke
146
Locked-in syndrome symptoms
4 listed
