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Neuroscience > Neuroscience Week 5: Brainstem > Flashcards

Neuroscience Week 5: Brainstem Flashcards

1
Q

The Reticular Formation It consists of centers that

7 listed

A
    1. Integrate cranial nerve reflexes
    1. Help conduct and modulate SLOW pain
    1. Influence voluntary movements
    1. Regulate autonomic nuclei
    1. Associate with diffuse modulating systems
    1. Integrate sleep and respiration
    1. ACTIVATE the cerebral cortex
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2
Q

Which sensory systems provide input to the reticular formation?

A

Almost all of them

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3
Q

Reticular Formation inputs

A
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4
Q

Ascending reticular activating system

A
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5
Q

Locus Coeruleus

A

the major source of noradrenergic innervation to all cortical regions

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6
Q

Raphe Nuclei

A

diffuse serotonergic innervation and involved in alertness and wakefulness

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7
Q

Basal forebrain

A
  • Cholinergic innervation, originate in the nucleus of Meynert of the basal forebrain
  • thought to degenerate in Alzheimer’s Disease
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8
Q

Ventral Tegumental Area

A
  • 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
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9
Q

Widespread projection systems in the nervous system

A
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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
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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
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12
Q

Recap of Aras

A

numerous roles

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13
Q

Importance of ARAS

A
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14
Q

Bilateral inactivation of the pontomesencephalic reticular formation, thalamus and the cerebral cortex results in?

A

Coma

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15
Q

Brainstem Reticular Formation consists of centers that

7 Listed

A
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16
Q

ARAS Originates

A

midbrain and upper pons

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17
Q

ARAS is responsible for?

A
  • arousal
  • attention
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18
Q

If cortex presses down on the brainstem can cause

A
  • Coma if ARAS is being pressed on
  • Particularly with Uncal Herniation
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19
Q

Blood supply to the brainstem

A
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20
Q

Identify region and blood supply

A
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21
Q

Identify region and blood supply

A
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22
Q

Identify region and blood supply

A
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23
Q

Identify region and blood supply

A
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24
Q

Identify blood supply

A
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25
Q

Identify brainstem anatomy

A
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26
Q

Identify region, contents, anatomy and blood supply

A

Cervicomedullary junction

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27
Q

Trigeminal spinal pathway

A
  • 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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28
Q

Trigeminal Pathway

A
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29
Q

Identify region, contents, anatomy and blood supply

A

Caudal (lower) Medulla

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30
Q

Identify region, anatomy, blood supply and describe medial medullary syndrome

A
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31
Q

Identify region, contents, anatomy and blood supply

A

Rostral (upper) Medulla

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32
Q

Identify region, anatomy, blood supply and describe Lateral medullary syndrome

A
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33
Q

Identify region, contents, anatomy and blood supply

A

Caudal to mid Pons

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34
Q

Identify region, anatomy, blood supply and describe medial pontine syndrome

A
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35
Q

Identify region, anatomy, blood supply and describe Lateral pontine syndrome

A
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36
Q

Identify region, contents, anatomy and blood supply

A
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37
Q

Full Basilar Stroke AKA

A

Locked-in syndrome

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38
Q

Identify region, anatomy, blood supply and describe Locked-in Syndrome

A
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39
Q

Identify region, contents, anatomy and blood supply

A

Caudal midbrain

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40
Q

Identify region, contents, anatomy and blood supply

A

Rostral Midbrain

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41
Q

Identify region, anatomy, blood supply and describe Weber’s Syndrome

A
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42
Q

Identify Syndromes associated with various arteries

A
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43
Q

Identify arteries associated with various syndromes

A
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44
Q

Identify arteries and associated syndromes

A
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45
Q

Map of cranial nerve nuclei

A
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46
Q

Red nucleus lesion in the midbrain

A

Tremor and ataxia because you cannot finetune your movements

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47
Q

Cerebral peduncle lesion in the midbrain will cause

A

UMN lesion in the face and lower extremities

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48
Q

MLF lesion in the midbrain will cause

A

horizontal gaze palsy

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49
Q

Benedikt Syndrome identify where the lesion is and effects

A
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50
Q

Benedikt Syndrome structures affected

A

Red nucleus

CN 3

Medial lemniscus

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51
Q

Weber Syndrome identify lesion location and effects

A
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52
Q

Describe Pseudobulbar palsy

A
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53
Q

Parinaud syndrome identify lesion location and effects

A
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54
Q

Identify structures and which segment

A
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55
Q

Pons vestibular nuclei lesion effects

4 listed

A
  • nausea
  • vomiting
  • nystagmus
  • vertigo
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56
Q

Pons CN VII Tract lesion

A
  • facial droop
  • loss of corneal reflex
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57
Q

Pons Medial Lemniscus Lesion

A
  • loss of proprioception
  • loss of vibration
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58
Q

Pons Corticospinal tract Lesion

A

contralateral Hemiparesis

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59
Q

Pons CN VI Tract Lesion

A

problems with lateral gaze

60
Q

Pons Spinothalamic Tract Lesion

A
  • loss of pain and temperature sensation
61
Q

Pons Trigeminothalamic tract Lesion

A
  • loss of pain of the face
  • loss of temperature sensation of the face
62
Q

MLF Lesion in the pons

A
  • horizontal gaze palsy
  • intranuclear opthalmoplegia
63
Q

Pons 4th ventricle Lesion

A

noncommunicating hydrocephalus

64
Q

Pons PPRF Lesion

A

intranuclear opthalmoplegia

65
Q

Structures need to look laterally

3 listed

A
  • MLF
  • PPRF
  • Abducens nucleus
66
Q

Medial pontine syndrome location and effects

A
67
Q

Medial pontine syndrome structures damage

4 listed

A
  • Corticospinal tract
  • CN 6
  • CN 7
  • Lateral gaze structures MLF, CN 6 nucleus, PPRF
68
Q

Medial pontine syndrome symptoms

4 listed

A
  • Contralateral hemiparesis
  • CN 6 palsy
  • ipsilateral Facial weakness/droop
  • ipsilateral Gaze palsy
69
Q

Lateral pontine syndrome lesion location and effects

A
70
Q

Lateral pontine syndrome damaged structures

6 listed

A
  • Vestibular nuclei
  • Spinothalamic tract
  • CN V nucleus
  • Sympathetic tract
  • CN 7 nucleus
  • Cochlear nucleus
71
Q

Lateral pontine syndrome Common cause

A

AICA stroke

72
Q

horner’s syndrome symptoms and side affected in respect to the lesion

3 listed

A

Ipsilateral

  • in a decreased pupil size
  • a drooping eyelid
  • decreased sweating
73
Q

Lateral pontine syndrome symptoms associated with structures

6 listed

A
  • 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
74
Q

Medulla Nucleus solitarius and dorsal motor nucleus of X function

A
  • where autonomic sensory information comes in from structures such as carotid sinus, aortic arch
  • goes out to affect autonomic functions of the Vagus nerve
75
Q

Identify segment and structures

A

medulla

76
Q

Medulla Nucleus Ambiguous

A

Shared motor nucleus of IX, X, XI

77
Q

Medulla CN XII

A
78
Q

Medulla Medial Lemniscus

A

Proprioception and vibration

79
Q

Medulla Pyramids

A

is corticospinal tract

80
Q

pyramidal dysfunction AKA

A

loss of corticospinal tract

81
Q

Medulla Inferior olivary nucleus

A

involved with cerebellum

82
Q

Medulla Spinothalamic tract

A

contralateral pain and temperature

83
Q

Medulla trigeminothalmic tract and nucleus

A

facial pain andc temperature

84
Q

Medulla Hypothalamospinal tract

A
  • Sympathetic innervation from the thalamus
  • damage will give Horner’s Syndrome
85
Q

Medulla Vestibular nuclei

A
86
Q

Medial Medullary Syndrome lesion location and effects

A
87
Q

Medial Medullary Syndrome structures damaged

A
  • Corticospinal tract
  • medial lemniscus
  • CN 12
88
Q

Medial Medullary Syndrome common causes

A

ACA stroke

89
Q

Medial Medullary Syndrome Symptoms and associated structures

A
  • Corticospinal tract: Contralateral hemiparesis
  • Medial lemniscus: contralateral loss of proprioception/vibration
  • CN 12: Falccid paralysis of tongue (LMN) deviates to ipsilateral to lesion
90
Q

Lateral medullary syndrome AKA

A

Wallenberg Syndrome

91
Q

Wallenberg Syndrome AKA

A

Lateral medullary syndrome

92
Q

Lateral medullary syndrome damaged structures

5 listed

A
  • Vestibular nuclei
  • Sympathetic tract
  • spinothalamic tract
  • Spinal V nucleus
  • Nucleus ambiguous
93
Q

Lateral medullary syndrome Symptoms and associated structures

A
  • 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
94
Q

Lateral medullary syndrome common cause

A

PICA stroke

95
Q

Lateral medullary syndrome looks a lot like?

How to distinguish them?

A
  • Lateral pontine syndrome
  • distinguish by hoarseness and dysphagia in lateral medullary syndrome
96
Q

Rule of 4s

A
97
Q

4 CNs in

A
  • Medulla
  • Pons
  • Above pons
98
Q

4 CNs divide into 12

A
  • 3, 4, 6, 12
  • have midline motor nuclei
99
Q

4 CNs do not divide into 12

A

5, 7, 9, 11

All are lateral

100
Q

4 midline columns

A
  • Motor nucleus
  • Motor pathway
  • MLF
  • Medial lemniscus
  • All start with M
101
Q

4 Lateral (side) columns

A
  • Sympathetic
  • Spinothalamic
  • Sensory
  • Spinocerebellar
  • All start with S
102
Q

How to localize lesions using the rule of 4s?

A
103
Q

CNs in the midbrain and lesion effects

A

CN 3 eye turned down and out

CN 4 Eye unable to look down when looking towards nose

104
Q

CNs in the pons and deficits

A
  • Trigeminal: Ipsilateral facial sensory loss
  • Abducens: Ipsilateral abduction weakness
  • Facial: Ipsilateral facial weakness/droop
  • Auditory: Ipsilateral deafness
105
Q

CNs in the medulla and associated deficits

A
  • Glossopharyngeal: Ipsilateral sensory loss
  • Vagus: ipsilateral palatal weakness uvula points away
  • Spinal accessory: Ipsilateral shoulder weakness
  • Hypoglossal: Ipsilateral weakness of tongue
106
Q

Corticospinal tract sits _______ in brainstem

A

midline

107
Q

Medial leminiscus sits _______ in brainstem

A

Midline

108
Q

Medial longitudinal fasciculus sits _________ in brainstem

A

Midline

109
Q

Motor Nucleus and nerves (3,4,6, and 12) sit __________ in brainstem

A

Midline

110
Q

CN 3 motor nucleus and nerve sit ________ in brainstem

A

midline

111
Q

CN 4 motor nucleus and nerve sit ________ in brainstem

A

midline

112
Q

CN 6 motor nucleus and nerve sit ________ in brainstem

A

midline

113
Q

CN 12 motor nucleus and nerve sit ________ in brainstem

A

midline

114
Q

Corticospinal tract damage in the brainstem results in?

A

Contralateral weakness except below pyramidal decussation (cervicomedullary junction

115
Q

Medial Lemniscus damage in the brainstem results in?

A

Contralateral loss of proprioception and vibration except below medullary decussation

116
Q

Medial longitudinal fasciculus damage in the brainstem results in?

A

ipsilateral Intranuclear opthalmoplegia

117
Q

CN 3 damage in the brainstem results in?

A

ipsilateral motor loss and corneal reflex?

118
Q

CN 4 damage in the brainstem results in?

A

ipsilateral motor loss of the superior oblique, cant look down and in

119
Q

CN 6 damage in the brainstem results in?

A

ipsilateral motor loss for eye abduction

120
Q

CN 12 damage in the brainstem results in?

A

lick your wounds ipsilateral loss of tongue motor

121
Q

Spinocerebellar pathway sits __________ in the brainstem?

A

Laterally/side

122
Q

Spinothalamic tract sits __________ in the brainstem?

A

Laterally/side

123
Q

Sensory nuclei of CN 5 sits __________ in the brainstem?

A

Laterally

124
Q

Sympathetic pathway sits __________ in the brainstem?

A

Laterally/side

125
Q

Spinocerebellar pathway damage in the brainstem results in?

A

Ipsilateral ataxia

126
Q

Spinothalamic damage in the brainstem results in?

A

Contralateral loss of pain/temp

127
Q

Sensory nucleus of CN 5 damage in the brainstem results in?

A

Ipsilateral pain/temp loss in face

128
Q

Sympathetic pathway damage in the brainstem results in?

A

Ipsilateral Horner’s Syndrome

129
Q

Trigeminal Nerve Caveats

A
  • 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
Q

Vestibulocochlear caveats

A
  • 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
131
Q

Case 1

A
  • MCA or ACA - would give more arm than leg or vice-versa so this is a place where all motor fibers are together
132
Q

Blood vessel supply of the brainstem

5 listed

A
  • 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
133
Q

Case 2

A

complete motor loss again so it cant be MCA or ACA

134
Q

Left medial midbrain lesion means

A
  • Weber syndrome
  • stroke of the branches of PCA
135
Q

Case 3 which structures are affected

A
136
Q

Case 3 answer

A

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
Q

Left lateral medulla lesion is

A

Wallenberg syndrome

Left PICA stroke

138
Q

Stroke of which artery produces Wallenberg syndrome?

A

Left PICA

139
Q

Stroke of which artery produces Left lateral medulla lesion

A

Left PICA

140
Q

Case 4 structures affected

A
141
Q

Case 4 answer

A

Right lateral pontine syndrome

142
Q

Right lateral pontine syndrome usually caused by

A

often caused by tumors such as schwannomas

143
Q

Cerebellopontine angle syndrome AKA

A

lateral pons often caused by tumors like schwannomas

144
Q

How to best utilize the rule of 4s?

A
  • 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
Q

Locked-in syndrome AKA

A

Full basilar stroke

146
Q

Locked-in syndrome symptoms

4 listed

A

Neuroscience (96 decks)

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