Norden- brainstem Anatomy

Question 1

The nuclei for which CN’s lie in the brainstem?

Answer 1

III-X and XII

Question 2

Major landmark structures present in the ventral medulla at both rostral and caudal levels?

Answer 2

Pyramids

Question 3

Where is the pyramidal decussation? (Where 85% of corticospinal axons deccusate)

Answer 3

In the caudal medulla

Question 4

In medulla, a unilateral lesion to the descending sympathetic axons will cause _?

Answer 4

Ipsilateral horner’s syndrome

Question 5

Horner’s syndrome symptoms?

Answer 5

Ptosis, miosis, anhydrosis

Question 6

What part of the medulla do the fasciculus gracilis and fasciculus cuneatus synapse in ?

Answer 6

Caudal medulla

Question 7

What three sensory components are in the trigeminal nerve ?

Answer 7

1. Pain and temperature
2. Fine touch, conscious proprioception, vibration
3. Unconscious proprioception

Question 8

When the first order neurons of the semilunar ganglion enter the brainstem (at the level of the pons), what are they called as they descend in the dorsolateral area?

Answer 8

Spinal trigeminal tract

Question 9

Where does the spinal trigeminal tract synapse to ?

Answer 9

The spinal trigeminal nucleus

Question 10

Axons from the second order spinal trigeminal nucleus decussate at various levels and ascend as part of the ______, before synapsing onto the medial division of the ventral posterior nucleus (VPM)

Answer 10

Trigeminothalamic tract

Question 11

A lesion of the spinal tract/ nucleus of V results in?

Answer 11

Loss of pain and temperature in the ipsilateral face.

Question 12

Above about the midpons, a lesion of the trigeminothalamic tract result in loss of ?

Answer 12

Temperature and pain to the contralateral face.

Question 13

The cerebellum is connected to the brainstem by which three paired fiber pathways?

Answer 13

Inferior (restiform body)

Middle (brachium pontis)

Superior (brachium conjuctivum)

Peduncles

Question 14

The inferior cerebellar peduncle is a major feature of the dorsal part of the ____

Answer 14

Rostral medulla

Question 15

Works to relay unconscious proprioceptive information fromo above C8 to the cerebellum

Answer 15

Accessory cuneate nucleus

Question 16

What part of the medulla are the olives in ?

Answer 16

Rostral

Question 17

How do axons from the inferior olive project to the cerebellum?

Answer 17

Through the inferior cerebellar peduncle

Question 18

This important cranial nerve lies most medial in the dorsal medulla

Answer 18

Hypoglossal nucleus

Question 19

What muscle of the tongue does the hypoglossal nerve NOT innervate?

Answer 19

Palatoglossus (X)

Question 20

What is the main function of the genioglossus?

Answer 20

Protrude tongue

Question 21

Lies in the dorsal medulla, lateral to the hypoglossal nucleus; parasympathetic axons of _ will innervate viscera of the thorax and abdomen

Answer 21

Dorsal motor nucleus of the vagus nerve

Question 22

Receives gustatory afferents rostrally and visceral afferent fibers caudally

Answer 22

Nucleus of the tractus solitarius

Question 23

Contains LMN’s for CN IX and X

Answer 23

Nucleus ambiguus

Question 24

Contains LMN’s that innervate striated muscles of the soft palate, larynx, pharynx, and upper esophagus.

Also preganglionic sympathetic axons involved in control of heart rate

Answer 24

Nucleus ambiguus

Question 25

Difficulty swallowing

Answer 25

Dysphagia

Question 26

Difficulty speaking; pt will have hoarse voice

Answer 26

Dysphonia

Question 27

LMN lesion of nucleus ambiguus will cause what symptoms?

Answer 27

``` (Will lose CN IX and X) Ipsilateral: Dysphagia Dysphonia Dyspnea Gag reflex gone Uvula deviates towards normal side ```

Question 28

Main blood supply to vestibular nuclei?

Answer 28

PICA (these nuclei are in dorsal medulla)

Question 29

Sensation of the room spinning?

Answer 29

Vertigo

Question 30

A number of vestibular nuclei lie in the dorsal medulla; in general, lesions of these (PICA) cause?

Answer 30

Vertigo, nausea, vomiting, nystagmus

Question 31

Ipsilateral lesions up to and including dorsal and ventral cochlear nuclei produce:

Answer 31

Ipsilateral deafness | AICA

Question 32

What is contained in the pontine tegmentum?

Answer 32

Nucleus of VI and VII | Ascending sensory pathways (medial, spinal, lateral lemnisci)

Question 33

Two functions of the abducens nucleus (which is located medially in the caudal pons)

Answer 33

Motor to lateral rectus muscle Conjugate horizontal eye movements

Question 34

What happens in LMN lesions of CN VI

Answer 34

Ipsilateral loss of abduction —> medial strabismus —> horizontal diplopia (which is worse when looking towards the side of lesion)

Question 35

CN VI weakness NOT due to lesion in the pons is referred to as

Answer 35

False localizing sign

Question 36

Vertical gaze center is in the midbrain, horizontal gaze center is in the _____

Answer 36

Pons

Question 37

What is the facial colliculus?

Answer 37

A bulge in the floor of the 4th ventrical which comes from axons of the motor nucleus of VII which run medially and dorsally over top of the abducens nucleus

Question 38

Unilateral lesion in the caudal pons involving the motor nucleus of CN VII or its output will produce?

Answer 38

Paralysis of the entire face ipsilateral to lesion

Question 39

UMN lesion to CN VII will cause?

Answer 39

Contralateral paralysis of the muscles of the lower face, with sparing of muscles of the upper face

Question 40

Trapezoid body and the superior olivary nucleus are located where?

Answer 40

Caudal pons

Question 41

Pontine nuclei will project to the contralateral cerebellum via

Answer 41

The middle cerebellar peduncle

Question 42

The major pathway that allows the cerebral cortex to communicate with the cerebellum

Answer 42

Middle cerebellar peduncle

Question 43

Unilateral lesions in the chief sensory nucleus of V will result in

Answer 43

Ipsilateral loss of discriminative touch, conscious proprioception, vibration.

Question 44

Relays unconscious proprioception from muscles of mastication and makes up the afferent component of the jaw jerk reflex.

Answer 44

Mesencephalic tract and nucleus

Question 45

Reticular formation nucleus that lies in the dorsolateral part of the rostral pontine tegmentum. Provides noradrenergic input to many different brain structures. Functions related to arousal, selective attention, stress response, pain modulation and mood

Answer 45

Nucleus locus coeruleus

Question 46

Midbrain contains nuclei of CN ? And ?

Answer 46

III and IV

Question 47

In the tectum of the midbrain. Plays a role in visual reflexes and facilitates sudden, reactive foveation

Answer 47

Superior colliculus

Question 48

The superior colliculus receives afferents from all of the major sensory pathways. Where does it send efferents?

Answer 48

Cervical spinal cord (to turn head) Horizontal and vertical gaze centers (to allow for conjugate eye movements) Pulvinar ( to relay visual info to extrastriate visual cortex )

Question 49

Which cranial nerve’s LMN is contralateral ?

Answer 49

CN IV

Question 50

LMN at the trochlear nucleus or initial segment lesion to CN IV causes what?

Answer 50

Contralateral extorsion and elevation of the eye

Question 51

What is the neurotransmitter in the rostroventral medullary area (part of regulation of pain of lat spinothalamic tract)

Answer 51

Glutamate

Question 52

What is the neurotransmitter in the nucleus raphus magnus (in the descending reg of pain in the lat spinothalamic tract)

Answer 52

5-HT or Serotonin

Question 53

What three major nuclei exist in the periaqueductal gray area of the midbrain?

Answer 53

Mesencephalic nucleus of V Neurons involved in the descending regulation of the transmission of pain by the lateral spinothalamic tract Vertical gaze center

Question 54

Connects the cerebellum with the red nucleus. Decussates in the midbrain at the level of the inferior colliculus

Answer 54

Superior cerebellar peduncle

Question 55

Axons from the red nucleus, which are involved in the indirect cortico-spinal system, arise from the cortex (area 4) and the cerebellum. They synapse where, primarily?

Answer 55

In the contralateral cervical spinal cord

Question 56

Isolated unilateral lesions of the red nucleus (are rare) will produce ?

Answer 56

A tremor of the contralateral upper limb (rubral tremor)

Question 57

Unilateral lesions in the brainstem above the level of the red nucleus

Answer 57

Decorticate (flexion of arm, extension of leg) posturing contralaterally

Question 58

Decorticate posturing

Answer 58

Flexion of arm, extension of leg

Question 59

Unilateral lesions below the red nucleus, but above the vestibular nuclei cause what?

Answer 59

Decerebrate posturing contralaterally

Question 60

What is decerebrate posturing?

Answer 60

Extension of both arm and leg

Question 61

The two subdivisions of the substantia nigra are?

Answer 61

Pars compacta Pars reticularis

Question 62

The main afferent subdivision of the substantia nigra. | Uses glutamate as neurotransmitter

Answer 62

Pars reticularis

Question 63

Projects neurons to caudate and putamen (deep nuclei) in the hemisphere. Dopamine used for neurotransmitter Degeneration of these causes parkinsons

Answer 63

Pars compacta

Question 64

Unilateral lesion in the middel 1/3 of the crus cerebri causes?

Answer 64

Contralateral spastic paralysis in both arm and leg. Babinski Other signs and symptoms from involvement of UMN’s of Cranial nerves

Question 65

The inability to carry out on command or mimic a voluntary motor movement, despite intact sensory, motor and language. Test by having patient show you how to brush their teeth

Answer 65

Apraxia

Question 66

What are 3 main inputs to the neostriatum?

Answer 66

Nigro-striatum Cortico-striatum Thalamo-striatum

Question 67

Restiform body

Answer 67

Inferior cerebellar peduncle

Question 68

Brachium pontis

Answer 68

Middle cerebellar peduncle

Question 69

Brachium conjuctivum

Answer 69

Superior cerebellar peduncle

Question 70

The inferior cerebellar peduncle is a major feature of ?

Answer 70

Dorsal part of the ROSTRAL medulla

Question 71

The accessory cuneate nucleus receives collaterals from?

Answer 71

Fasciculus cuneatus, above C8

Question 72

The dorsal nucles of the vagus nerve lies ____ to the hypoglossal nucleus

Answer 72

Lateral

Question 73

Lateral to the dorsal motor nucleus of X is the ?

Answer 73

Nucleus of the tractus solitarius

Question 74

The vestibular nuclei lie mostly in the __________. A lesion of PICA will affect these. Symptoms of lesions are vertigo, n/v, nystagmus

Answer 74

Dorsal medulla

Question 75

Cochlear nuclei blood supply

Answer 75

AICA

Question 76

Cardio and resp centers in the medulla lie predominantly where?

Answer 76

Caudally

Question 77

Nucleus of CN VII is located where?

Answer 77

Caudally in the pontine tegmentum

Question 78

A unilateral lesion in the caudal pons involving the motor nucleus of CN VII will produce what?

Answer 78

An ipsilateral paralysis of the entire face.

Question 79

The pontine nuclei receive collaterals from many corticospinal axons. Where do these project to?

Answer 79

They project to the contralateral cerebellum via the middle cerebellar peduncle

Question 80

Where are the pontine nuclei?

Answer 80

In the basal portion of the pons

Question 81

Facilitates reactive foveation

Answer 81

Superior colliculus

Question 82

The superior colliculus receives afferents from?

Answer 82

All major sensory pathways

Question 83

Where is the trochlear nucleus located?

Answer 83

Dorsal midbrain tegmentum. At the level of the inferior colliculus

Question 84

Nuclear groups in the periaqueductal gray

Answer 84

Mesencephalic nucleus of V Neurons involved int he descending regulation of the transmission of pain by the lateral spinothalamic tract Vertical gaze center

Question 85

Unilateral lesions below the red nucleus but ABOVE the vestibular nuclei will cause?

Answer 85

Contralateral decerebrate posturing

Question 86

Pars reticularis uses ___ as NT

Answer 86

GABA

Question 87

Pars compacta uses ____ as NT

Answer 87

Dopamine

Question 88

This nucleus has axons which travel back along CN VIII and terminate on the hair cells in the organ of corti. This allows for individual pitches (such as in speech) to be disproportionately accentuated for.

Answer 88

Superior olivary nucleus (SON)