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Neurology > Principles of brainstem disease > Flashcards

Principles of brainstem disease Flashcards

1
Q

What are the 3 different areas of the Brain?

A

Forebrain, Cerebellum, Brainstem

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2
Q

What is the reticular formation and what is its function?

A

Diffuse network of nerves in the brain

  • All info goes through the RF before forebrain
  • Main influence of mentation
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3
Q

What are the different levels of mentation?

level of consciousness

A
  • Alert
  • Obtunded
  • Stuporous
  • Coma
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4
Q

What are the 3 parts of the forebrain?

A
  1. Association areas - Cerebral Cortex (Neocortex)
  2. Emotional areas - Limbic system (Archicortex)
  3. Olfactory areas - Olfactory bulb (Paleocortex)
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5
Q

What does pleurothotonus mean?

A

Body curved laterally - head turn

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6
Q

What does forebrain syndrome include?

  1. Mentation
  2. Posture/Gait
  3. Cranial nerves
A
  1. Altered mentation
  2. pacing, head pressing, pleurothotonus
  3. Contralateral blindness + decreased menace response with normal PLR
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7
Q

What does forebrain syndrome include?

  1. Postural reactions
  2. Spinal reflexes
  3. Palpation
  4. Pain - sensation/perception
A
  1. Deficits on contralateral limbs in positioning
  2. Normal to increased on contralateral limbs
  3. Muscle tone can be increased
  4. Hyperalgesia syndrome
    (thalamus); Pain on cervical spine, skull
    Hypoalgesia; decreased facial sensation
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8
Q

What are the factors used to analyse quality of mentation?

A
  • Altered awareness
  • Altered mood
  • Altered personality
  • Altered sleep/wake state
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9
Q

What does altered quality of mentation indicate?

A

Forebrain lesion

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10
Q

What does altered level of mentation indicate?

A

Brainstem lesion

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11
Q

Define Obtunded:

A

Animal is lethargic and less responsive to its environment but still has the capability to respond in a normal manner.

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12
Q

Define Stuporous:

A

Animal appears asleep when undisturbed but can be aroused by painful stimulus

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13
Q

Define Comatose:

A

Unconscious, does not respond to painful stimulus, reflex activity can be present

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14
Q

What is the function of the forebrain?

A

Control of autonomic and endocrine function (appetite, thirst, temperature, electrolyte and water balance), sleep, consciousness, or better wakefulness.
Involves olfactory function, vision, and emotional behavioural patterns

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15
Q

What clinical signs can be present if there is a brainstem lesion? (Think function)

A
  • Altered mentation - level = O/S/C
  • Cranial nerves deficit - III - XII
  • Proprioceptive deficits
  • Central vestibular syndrome
  • Abnormalities in respiratory and cardiovascular function
  • Hemi/tetraparesis (all limbs) (UMN)

(Hemi-paresis towards the side of the lesion)

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16
Q

Describe brainstem syndrome

  1. Mentation
  2. Posture/Gait
  3. Cranial nerves
A
  1. Altered mentation level
  2. Paresis -all 4 limbs ipsilateral, opisthotonus, decerebrate rigidity
  3. III-XII
17
Q

What does brainstem syndrome include?

  1. Postural reactions
  2. Spinal reflexes
  3. Palpation
  4. Pain - sensation/perception
A
  1. Deficits all four limbs or ipsilateral
  2. Normal to increased in all or ipsilateral limbs
  3. Muscle tone normal or increased
  4. Decreased facial sensation
    Pain on palpation high cervical, skull

others: cardio and resp abnormalities

18
Q

What are the Cranial nerves?

A 
I Olfactory            VII Facial
II Optic                  VIII Vestibulocochlear 
III Oculomotor      IX Glossopharyngeal
IV Trochlear          X Vagus
V Trigeminal          XI Accessory
 VI Abducens         XII Hypoglossal
19
Q

What does it do and how to test?

CN I: Olfactory

A

Smell; deficit would be Anosmia (loss of sense of smell). Very hard to assess

20
Q

What does it do and how to test?

CN II: Optic

A

Vision
Assess with menace, pupillary light reflex, and dazzle reflex

Pretectal nuclei - PLR

Cross over of optic nerves at the optic chiasm - around 75% to the other side

21
Q

What does it do and how to test?

CN III: Occulomotor

A

Innervates muscles of the eye:
Dorsal/ventral/medial rectus m
Ventral oblique m
Levator palpebrae superioris m

Deficits cause ventrolateral strabismus and parasympathetic dysfunction

22
Q

What does it do and how to test?

CN IV: Trochlear

A

Rotates the eye; in a dog,
deficit will not be noticeable (since they have round pupils);

Cat, will notice rotation of the pupil (since NOT round pupils)

23
Q

What does it do and how to test?

CN V Trigeminal

A

Facial sensation and motor to masticatory muscles
Deficits
- loss of facial sensation
- atrophy in the masticatory muscles, loss of jaw tone

24
Q

What does it do and how to test?

CN VI: Abducens

A

Innervates medial muscle of the eye; deficit will cause medial strabismus

25
Q

What are the branches of the trigeminal nerve?

A
  1. Opthalmic branch (dorsomedial canthus) and 2. maxillary branch (ventrolateral canthus) (palpebral reflex)
  2. Mandibular branch (lower jaw)
26
Q

What are the nerves involved in the palpebral reflex?

A

Sensory - CN V Trigeminal nerve and motor - CN VII Facial nerve

27
Q

What does it do and how to test?

CN VII: Facial

A

MOTOR
Facial expression
Masticatory muscles, temporal muscle mass, jaw tone
Taste to rostral 2/3 of tongue, lacrimation and salivation

Deficits will cause decreased tearing (dry eye), drooping on side of lesion

In horses, see ear droop, muzzle deviation away from lesion, reduced lacrimation

28
Q

What does it do and how to test?

CN VIII: Vestibulocochlear

A

Hearing: difficult to assess.
Vestibular deficits will cause vestibular syndrome - loss of balance

Test: CN III, IV, VI - oculovestibular reflex - spontaneous nystagmus in response to rotatory stimuli (reduced towards side of lesion)

29
Q

How would you test deafness?

A 
From owners perspective
Test: BAER - Brainstem auditory evoked responses
Two peripheral types - 
Conductive - failure of passage of sound
Sensorineural - sensory dysfunction
30
Q

What does it do and how to test?

CN IX: Glossopharyngeal

A

Sensory:
Caudal tongue and pharynx
Taste for caudal tongue

Motor:
Pharyngeal muscles

31
Q

What does it do and how to test?

CN X: Vagus

A

-Parasympathetic
Branches to the recurrent laryngeal nerve (roaring, poor flow of air)
- larynx/pharynx motor, larynx sensation

32
Q

What does it do and how to test?

CN XI: Accessory

A

Neck muscles

33
Q

What does it do and how to test?

CN XII: Hypoglossal

A

Intrinsic tongue muscles- motor

Deficits of nerve can be seen: disorder of Voice (dysphonia), food manipulation, swallowing, ipsilateral tongue muscle atrophy

34
Q

What are the dysfunctions of CN IX, X and XI?

A

Dysphagia —> megaoesophagus (congenital vs acquired)
Choking, gagging, loss of food through nares,
Reduced gag reflex

Neurology (13 decks)

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