Repetera-utvalda Flashcards
1
Q
What structure connects the nuclei of the lateral lemniscus?
A
Probst comissure
2
Q
What structure connects the inferior colliculi?
A
the inferior collicular commissure
3
Q
The efferent transmission from striatum is limited to 2 targets. Which?
A
Substantia nigra
Globus Pallidus
4
Q
What three cranial nerves are connected to nucleus ambiguus?
A
IX, X and XI.
5
Q
How is cranial nerve (what afferents and efferents) IX connected to nucleus ambiguus?
A
special visceral efferents to styleopharyngeus and pharyngeal constrictor.
Visceral afferents from the middle ear, tongue, pharynx and the carotid sinus.
6
Q
How is CNX connected to nucleus ambiguus?
A
by special visceral efferents to larynx and pharynx
7
Q
How is CNXI connected to nucleus ambiguus?
A
By special efferent visceral fibres to the laryngeal muscles.
8
Q
where is the parietal lobe situated?
A
- behind the central sulcus
- above the Sylvian fissure
- merging posteriorly to the occipital lobe -
- The medial border is defined by a line from the parietooccipital sulcus to the pre-occipital notch
9
Q
Another name for the central sulcus
A
Rolandic fissure
10
Q
Where is the primary auditory area situated
A
transverse gyri of Heschl
11
Q
Where is the supplemental motor area situated?
A
immediately anterior of the motor strip.
12
Q
What is pars marginalis?
A
The sulcus terminating gyrus singuli posteriorly. Its the most prominent groove on axial images just posterior to the widest biparietal diameter, straddling the midline and extending a greater distance into the hemispheres. (medial surface of the brain)
13
Q
What is the AC-PC line?
A
AC= anterior commissure. PC= posterior comissure.
The line connects the two in a sagittal plane where PC level the pineal gland
14
Q
What is tenia fornicus?
A
The attachement of the choroid plexus of the lateral ventricle to the fornix
15
Q
Name the 3 deep cerebellar nuclei
A
- Dentate
- the interposed nuclei (globose and emboliform)
- Fastigial
16
Q
To what part of the brain is the VA nucleus projecting?
A
To the frontal lobe
17
Q
Where is the red nucleus located?
A
In tegmentum, Just medial to substantia nigra, anterior to the oculomotor and edinger westphal nuclei and the aqueduct.
18
Q
Is the pyramidal tract localised ventral or dorsal in in the spinal cord?
A
Dorsolateral
19
Q
Is the pyramidal tract localised ventral or dorsal in in the inferior medulla oblongata, inferior to the decussation?
A
Its dorsal (dorsolateral)
20
Q
Is the pyramidal tract localised ventral or dorsal in in the superior medulla oblongata, superior to the decussation?
A
Ventral
21
Q
Where is the pyramidal tract located in the internal capsule?
A
In the posterial limb of the internal capsule.
22
Q
What is Arnolds nerve?
A
The auricular branch of the vagus nerve; sensory innervation to ear canal, tragus and auricle.
23
Q
what is brachium conjunctivum?
A
It is the superior cerebellar peduncle
24
Q
What is downgaze palsy?
A
Inability to direct eyes downwards - sunrise setting.
25
What is upgaze palsy?
Sunset sign.
26
Where is hippocampus situated?
In the mesial temporal horn.
27
What are the two parts of hippocampus?
*Ammons horn - hippocampus proper
* dentate gyrus
28
What three extremely important features are kept in the dorsal hippocampus?
* spatial memory
* verbal memory
* learning conceptual information
29
What are the clinical findings after a thalamoperforating artery emboli?
decreased level of alertness due to the VA nucleus of thalamus that is försörjd by this artery projecting to large areas of the frontal lobe.
30
Clinical signs of injury to the trigeminal spinal nucleus and tract?
The effect is numbness. -
The spinal trigeminal nucleus is a nucleus in the medulla that receives information about deep/crude touch, pain, and temperature from the ipsilateral face.
In addition to the trigeminal nerve (CN V), the facial (CN VII), glossopharyngeal (CN IX), and vagus nerves (CN X) also convey pain information from their areas
31
Clinical signs of injuries to the sympathetic fibres?
Horners sign ipsilaterally
32
Signs of injury to the lateral spinothalamic tract
contralateral limb numbness to pain, temp .
33
What big vessel is the most common to create CN VII compression?
AICA
34
What vessel supply the superior, middle and inferior cerebellar peduncles respectively?
*SCA
* AICA
* PICA
35
Which artery is the most common to be responsible for compression of CN V?
SCA
36
Where is the bladder reflex coordination situated?
In locus coerulius in pons
37
What muscle is supposed to involuntarily contract when the bladder is distended and what muscle is supposed to relax?
The detrusor muscle contract and the inner sphincter relax, run by parasympathetic innervation from locus coerelius.
38
What parts of the brain are suppressing the bladder reflex; innervating the external sphincter of the bladder and inhibiting the detrusor muscle by somatic voluntary control through the pyramidal tract and pudendal nerve?
Medial frontal cortex and the genu of corpus callosum.
39
What spinal tract serves for voluntary contraction of the external sphincter?
The pyramidal tract
40
What problem with the bladder might come from cortical lesions?
Urgency incontinence
41
What nerve is the parasympathetic innervating of the bladder? Where is its ganglia situated?
Pelvic splanchnic nerve and ganglia in the detrusor musclewall.
42
How can the parasympathetic ganglia in the bladder-detrusor-m be targeted in case of cortical urgency incontinence?
Anticholinergic medicins and botox may be used to inhibit exitation of the Ach nerves of the involuntary contraction.
43
What is the dual stream model?
Its a language-speech model.
44
What is area 1 and 2 in "dual stream"?
1= primary auditoy areas -initial processing of language.
2= anterior and middle temporal lobe.
Together involved in speech recognition and lexical concepts.
45
What is area 3, 4 and 5 in dual stream ?
3= wernickes area (subserved language "reception"-"fluent aphasia")
4= premotor cortex
5= Brocas area (motor speech-expressive aphasia annoying for the pt)
46
What is the venral stream of "dual stream"
Ventral stream =
Bilateral - both hemispheres involved. information send from area 1 (primary auditory areas) to area 2 (anterior and middle temporal lobe) and back - speech recognition and lexical concept.
47
What is the dorsal stream of the "dual stream concept"?
Primarily in only the dominant hemisphere.
It maps phonological information onto motor areas (region 4 and 5). Region 3 (Wernickes area) is also involved in the dorsal stream.
48
Lesions of bladder functions above the brainstem give a special type of problem. Which?
A depletion of the pontine refelx centre makes a constant feeling of urgency and sometimes leackage.
49
How is supraspinal bladder dysfunction treated?
1. Anticholinergic treatment to stop the pelvic splanchnic nerve innervation of detrusor.
2. Timed voiding.
50
What three -different!- nerves are involved in bladder funtion?
1. Filling of bladder - sympathethic fibers (adrenergic) in the Pelvic nerve
2. Emptying of the bladder - Parasympathetic (Ach) fibers in the pelvic splanchnic nerve
3. Voluntary inhibition of emptying - Somatic motor nerves through the pudendal nerve.
51
What type of innervation allows the detrusor mucle to contract and the inner sphincter to relax?
Parasympathetic fibres. (Ach from the pelvic splanchnic nerve through synapse in the detrusor muscle wall ganglia innervate contraction)
52
How is the bladder generally allowed to be relaxed when not distended?
Sympathetic fibers heavily innervate the bladder neck and trigone.
53
What receptor is active in bladder neck and trigonum closure to let the bladder fill?
Alpha-1 adrenergic receptors.
54
What receptors are active to stimulate detrusor muscle relaxation and allow filling of the bladder?
Beta-3 adrenergic receptors.
55
What two important features does the pelvic nerve have to allow detrusor relaxation and bladder neck/trigonum contraction during filling of the bladder?
The pelvic nerve carries sympathetic fibers and stimulate Alpha adrenergic receptors in the neck/trigonum and Beta-3 adrenergic receptors in the detrusor muscle.
56
What is the neurotransmittor of UPPER motor neurons?
Glutamate.
57
What is the neurotransmittor of lower MOTOR neurons and what receptor is functioning?
Ach on nicotine receptor.
58
What is the neurotransmittor of the postganglionic parasympathetic neurons and trough WHAT receptor?
Ach. Muscarinic AchR.
59
Which are the neurotransmittors of the postganglionic sympathetic neurons?
Epinephrine (adrenalin) and Norepinephrine.
60
What are the 5 major adrenergic receptors?
Alpha 1, 2.
Beta 1, 2 and 3.
61
where are beta 1 receptors localized?
in the myocardium
62
Where are beta 2 receptors localized?
In the bronchioles of the lungs and the arteries of skeletal muscles.
63
What is the function of stimulation of beta receptors?
the Beta 1 receptor cause contraction and the beta 2 receptor cause relaxation ( of smooth muscles).
64
What is a common name for NE and E?
catecholamines.
65
will Beta 1 receptor activation cause increased or decreased heart rate and contractility?
Increased. When activated it increases SA nodal activation and AV nodal as well as ventricular muscular firing.
The stroke volume and cardiac output will increase.
66
What does Alpha 1, 2 and 3 receptors do and where are they localized?
Alpha 1- Cause smooth muscle relaxation. -Vasculature, prostate, urethral sphincter, pylorus etc.
Alpha 2- Found on presynaptic nerve terminals and inhibit further NE release.
67
where are beta 3 receptors localized?
Gallbladder, urinary bladder and brown adipose tissue. Cause relaxation of the bladder. the rest is basically unknown.
68
What is the neurotransmitter for Nicotine receptors?
Ach
69
Where are nicotine-Ach receptors localized?
In the CNS and PNS.
70
Which is the neurotransmittor and through what receptor is presynaptic to postsynaptic signals transmitted in the sympathetic AND parasympatetic NS?
Ach through Nicotin-AchR
71
what is the exclusive neurotransmittor in the autonomic ganglion?
Ach. (exitation by nicotine ach R, ((((relaxation by muscarinic ach R))))))
72
What are nicotine-Ach R involed in in the ventral tegmental area and substantia nigra?
Its important in drug behaviour due to its role in DOPAMINE release.
73
What effect has Botox on Ach?
It inhibits Ach exocytosis from postganglionic nerves to muscarinic receptors.
- Good use in neuropathic bladders.
74
Where is the injury in long term memory deficits?
mesial temporal lobe.
75
What is the triangle of Guillan-Mollaret?
Olivary nucleus
Dentate nucleus
Red nucleus
76
Sensation from body and face go to different nuclei of Thalamus. Which?
face -- VPM
body -- VPL
77
Where does the Medial dorsal Thalamic nucleus do?
Attention, planning, organization, abstract thinking, multi-tasking, and active memory
*It relays inputs from the amygdala and olfactory cortex
projects to the prefrontal cortex and the limbic system and in turn relays them to the prefrontal association cortex.
78
From where does afferents go to The anterior nucleus (the anterior nuclear group) and where do they project?
From the mamillary nucleus To the cingulate gyrus
79
What function is going from the mamillary nucleus to the anterior nucleus of Thalamus and further on to the cingulate gyri?
Emotions and behaviour
80
What is the loop mamillary nucleus-anterior nucleus-cingulate gyri transfering emotions and behaviour information called?
Its the Papez circuit
81
Where does the centromedial nuclei send efferents?
* basal nuclei
* subthalamus
* substantia nigra
it is functioning in consert with the basal nuclei.
82
From where are afferents to the ventrolateral nucleus?
From the cerebellar nuclei and globus pallidus
83
To where are efferents send from the VLN?
To area 4 - the premotorcortex.
84
From where are afferents to the ventral intermediate nucleus (Vim) coming?
From the dentate nucleus.
85
Where are efferents from the ventral intermediate nucleus (Vim) send?
Efferent tracts arise from Vim and project principally to the primary motor cortex (M1) (Jones, 2007), with minor projections to the SMA, pre-SMA and premotor cortex (Sakai, 2013).
86
What is the name of the pathway connecting Vim to ...from ....?
Collectively, the pathway connecting dentate to motor cortex via the Vim is known as the dentato-thalamo-cortical pathway (DTCp)
87
To what Thalamic nucleus is afferents send from cerebellar nuclei and efferents to Area 4?
Vim (Ventral intermediate nucleus)
88
From where does the VL N (ventrolateral) recive afferents and send efferents?
Afferents: Both ipsilateral and contralateral cerebellothalamic fibres.
Efferents: To Area 4 (motorcortex)
89
Which are the lateral nuclei of thalamus?
* medial and lateral geniculate nuclei
-THE DORSAL GROUP-
* Lateral dorsal
* Lateral posterior
* Pulvinar
-THE VENTRAL GROUP-
* Ventral anterior
* Ventral lateral
* Ventral posterior
90
In what nucleus are parvocellular and magnocellular parts present?
Dorsomedial nucleus of thalamus
91
What R the 3 parts of the medial thalamus called?
Intrathalamic adhesion
Median
Medial
92
What are the three entities constituting the diencephalon?
* Hypothalamus
* Epithalamus
* Thalamus
93
Describe the gross OUTER anatomy of Thalamus
Its a twosided egg shaped symmetrical mass, situated on each side of the third ventricle. Connected by a band of GREY matter called the interthalamic adhesion.
94
Describe the gross INNER anatomy of thalamus
Each side of thalamus is divided intp three main areas that each contain a collection of nuclei - anterior, -lateral and -medial part. They are separated by a Y shaped vertical sheet of white matter called the internal medullary lamina.
95
There are three functional groups of Thalamus nuclei. What are they called?
* Relay nuclei
* Association nuclei
* Nonspecific nuclei
96
What "are" the functions of the nonspecific nuclei?
They show broad and diffuse projections throughout the cerebral cortex and are belived to be involved in general functions such as consiousness and attention.
97
How do the association nuclei project and what are their function?
They recieve info from the cerebral cortex and project back to ASSOCIATION areas. They regulate the integration and interpretation of the sensory information.
98
Which are the three association nuclei?
* Anterior nucleus
* Pulvinar nucleus
* Dorsomedial nucleus.
99
Name 5 Relay nuclei.
* VA - The ventral anterior nucleus
* VL - The ventral lateral nucleus
* VP - The ventral posterior nucleus
* The medial geniculate nucleus
* The lateral geniculate nucleus
100
What is the anterior border to Thalamus?
The interventricular foramen of Monro and the internal cerebral vein
101
What is the posterior border to Thalamus? What interesting relations are there in this area (name 8)?
*The atrium of the lateral ventricle.
*Stria terminalis,
*choroid plexus of third ventricle,
*body of fornix,
*internal cerebral vein, superior *thalamostriate vein,
*caudate nucleus,
*internal capsule,
*corpora quadrigemini and
*splenium of corpus callosum.
102
What is the lateral border of Thalamus?
The posterior limb of the internal capsule.
103
What is the dorsal border of Thalamus?
The floor of the lateral ventricle, stria medullaris
104
What is the ventral border of Thalamus?
Its the hypothalamic sulcus on the lateral wall of third ventricle (separates it from the hypothalamus)
105
What is the function of the medial geniculate body?
Its processing auditory inputs.
106
There is a dorsal cover of Thalamus. What is it called?
Its the stratum zonale.
107
Where, in relation to Thalamus, does the internal cerebral vein run?
Along the dorso(topmost)medial length of the Thalamus.
108
What is situated superficial to the stratum zonale of Thalamus?
The caudate nucleus.
- The head of the caudate nucleus lies anterosuperiorly to the thalamus with the body travelling superior and laterally to the body of the thalamus.
109
What is the location of the pulvinars in relation to the pineal gland?
They are both lateral to the pineal gland.
110
The Habenular and the posterior commissure are both in the same direction to the pulvinar of Thalamus. What direction?
They are, just as the pineal gland, both medial to the pulvinars. (situated in between the pulvinars)
111
What Thalamic structures are located just inferiorly and lateral to the pulvinar?
The medial and lateral geniculate bodies.
112
What structure is lying anteroinferiorly to Thalamus and what is inbetween them?
Hypothalamus. Inbetween is the hypothalamic sulcus.
113
What is situated just directly inferior to Thalamus?
The Cerebral peduncle and the cerebral aqueduct of Sylvi.
114
What does Tegmentum mean?
Floor.
115
What three parts of the brain send afferent fibers to the ventral anterior and the ventral lateral nuclei?
* cerebellum
* Substantia Nigra
* Globus Pallidus
116
What are the ventral lateral and the Ventral anterior nuclei of Thalamus usually called?
Motor Thalamus
117
What thalamic nucleus sends fibres to the limbic system (the cingulate gyri)?
Anterior nuclei
118
Which nucleus of Thalamus connects to the motor cortex?
The ventral lateral nucleus, (The ventral anterior-mostly premotorcortex) and the Vim.
119
Which nuclei of the thalamus relay info to the primary somatosensory cortex?
The ventral posterolateral -VPL and the ventral posteromedial -VPM nuclei.
120
Absence EP can be due to involvement of one of the Thalamic nuclei. Which?
THalamic reticular nucleus
121
Which thalamic nuclei are involved in sleep wake regulation and focused consciousness?
* Thalamic reticular nucleus
* Intralaminar nucleus
122
Which nucleus of thalamus connects mainly to the premotor cortex?
The VA - ventral anterior nucleus
123
Which part of thalamus recieves sensory fibres from the spinal cord?
The ventral posterolateral VPL nucleus
124
What thalamic nucleus connects primarily to the preFRONTAL cortex?
the mediodorsal nucleus
125
what nucleus is mostly used for Parkinson surgery?
Actually, thalamic targets are not most efficient for neither rigidity nor dyskinesias. GPi is the most efficient for rigidity and dyskinesia to dr Blomstedt and is also FDA approved.
But the subthalamic nucleus STN, can treat both tremors, akinesia, rigidity and dyskinesias and allow for decrease in doses of medicatons even in patients with advanced stages of Parkinsons diseae WHICH MAKES IT the PREFERED TARGET for DBS according to him. It is also FDA approved.
126
Which is the most commonly used target for cervical dystonia DBS?
Its actually not thalamus, but GPi.
127
What target is used for treating essential tremor using DBS?
Previously Vim was used. Today zona inserta is more common.
SO, for TREMORs targets in thalamus seem to be the most efficient.
128
Where is Vim situated in correlation to VPL and VL nucleus?
It is in the intermediate zone between the ventral posterior lateral and ventral lateral nuclei.
129
What are the three coronal zones of the hypothalamus?
* Periventricular zone
* Medial zone - most nuclei dense
* Lateral zone.
130
What are the 4 sagittal areas of hypothalamus?
* Preoptic area
* Chiasmatic area
* Tuberal area (intermediate)
* Mamillary area
131
Projections to and from the Periventricular nucleus?
Recives fibers from the arcuate nucleus. And projects to the adenohypophysis.
132
Name two important features of the periventricular nucleus
* It is involved in mood regulation, and stimulation makes people laugh.
* It produces SOMATOSTATIN (DA) that is secreted into the hypophyseal portal system.
* Production of kisspeptin that kickstarts puberty and stimulate feelings of romance and sexual arousal.
133
What is the effect of somatostatin?
It inhibits Thyrotropin releasing hormone and growth hormone releasing hormone,
134
There are two well known nuclei in the preoptic area. What are they called?
The medial and lateral preoptic nucleus.
135
What is special about the preotic nucleus?
It is sexually dimorphic.
136
what does sexual dimorphism mean ?
The size differs between the male and the female brain.
137
What is the function of the medial preoptic nucleus?
It regulates the gonadotrophic hormones.
138
what happens if the medial preoptic nucleus is degraded?
* reduced sexual behaviour
* Hyperphagia = overeating and obesity.
139
What are the main features of the lateral preoptic zone?
arousal and sleep, and the transition between the two.
140
what other systems does the lateral preoptic nucleus work together with ?
* The reticular activating system
* The widely projecting OREXIN neuronal system that originates in the lateral hypothalamus.
141
what is the molecular function of the lateral preoptical nucleus?
It is activated during sleep and releases sleep related neurotransmittors like Serotonin, adenosine and prostaglandin D2.
142
What effect does the lateral preoptic nucleus have on the reticular activating system?
It inhibits the reticular activating system by releasing inhibiting neurotransmittprs such as GABA amd galanin
143
what do we know of the function of the anterior hypothalamic nucleus
* involved in cooling down the body (dissipation of heat)
- sweat
-vasodilation
* Stimulate parasympathetic nervous system.
144
What special pathway is associated to the suprachiasmatic nucleus?
It recives direct signals from the retina via the retinohypothalamic tract.
145
what is regulated by the suprachiasmatic nucleus?
The circadian rythm.
146
The circadian rythm is not entirely dependent on the suprachiasmatic nucleus. What is its main colaborators?
* The pineal göand!
* other hypothalamic nuclei.
147
what are the 2 main role of the supraoptic nucleus?
* Regulate water balance.
* induces contraction of the uterus and feelings of love.
148
how does the supraoptic nucleus regulate water balance?
It produce and release VASOPRESSIN (antidiuretic hormone) in responce to concentration of Na ions in the blood. or when blood volume or blood pressure decreases.
149
how does the supraoptic nucleus induce contraction of uterus and emotion of love?
It secretes OXYTOCIN.
150
What condition is seen with damage to the supraoptical nucleus?
Diabetes insipidus
151
what is the clinical signs of diabetes incipidus?
No vasopressin release makes it impossible for the kidneys to concentrate the urin and massive loss of water is seen during urination.
152
What markes the division between dorsal and ventral midbrain?
The aqueduct.
153
What is the dorsal part behind the the aqueduct called?
Tectum.
154
What is Tectum composed of?
1-2 superior colliculli
2 inferior colliculi
155
What is the function of the superior and the inferior colliculli?
Superior= centre of vision
Inferior = centre of hearing
156
What is the posterior part of the ventral midbrain called ( som sitter ihop med tectum)?
Its called midbrain tegmentum and is the prolongation of the pontine tegmentum.
157
What is crus cerebri made of?
Entirely pyramidal and cortico-pontiine fibres.
158
What is Substantia Nigra made off?
Deeply pigmented grey matter.
159
What centre is substantia nigra?
Its an extrapyramidal motorcentre
160
What does midbrain tegmentum contain?
* ascending tracts
* certain nuclei
* decussation and reticular formation of the midbrain.
161
What structures lie at the plane of caudal midbrain?
* Inferior colliculus
--- Efferents from inferior colliculus to geniculate nucleus of thalamus (and from there to auditory cortex in temporal lobe)
* The cerebral aqueduct SURROUNDED BY GREY MATTER - periaqueductal grey matter
* Trochlear nucleus Ventral to the peri-aqueductal grey matter (send efferents cross over and forward to sup oblique.)
* Decussation of superior cerebellar peduncles - in the central part of tegmentum.
* Medial lemniscus - just posterior of substantia nigra
* Spinal lemniscus just posterior to the medial lemniscus
* trigeminal lemniscus just posterior to the spinal lemniscus
* Lateral lemniscus - just posterior to the trigeminal lemniscus
162
Main structures of rostral midbrain at the level of the superior colliculus
* Superior colliculus
* Pretectal nucleus
* Peri-aqueductal grey matter
* Oculomotor nucleus and Edinger Westphal
* Red nucleus
163
From what CN nuclei does the medial longitudinal fasciculus recieve fibres and to what CN nuclei does it send efferents?
FROM the Vestibular nuclei.
TO the Occulomotor nuclei, the trochlear nuclei and abducent nuclei.
164
Where are efferents send from the 4 nuclei composing the vestibular nuclei near to vestibular area of floor of 4th ventricle in tegmental, caudal pons ?
1. Via the medial longitudinal fasciculus to:
* abducent nuclei
* trochlear nuclei
* occulomotor nuclei
2. Via the inferior cerebellar peduncle to cerebellar cortex.
3. Via medial and lateral vestibulospinal fasciculus to ?
4. Direct to the reticular formation of pons.
165
What two structures decussate and then form aschending Fs of the medial lemniscus?
Gracile and Cuneate tracts. (contralateral)
166
Connections of hearing sensory input from cochlear nerve to primary ausitory cortex
cochlear nerver to ventral and dorsal cochlear nucleus (ventrally and dorsally of inferior cerebellar peduncle). From both to the trapezoid body (? or superior olivary nucleus) crossing in the trapezoid decussation and up through lateral lemniscus via the nucleus of the lateral lemniscus to the inferior colliculus of the midbrain tectum.
From there via inferior brachium to medial geniculate body.
Then via the auditory radiation to auditory area of cerebral cortex.
There are also fibres that go straight from ipsilateral dorsal and ventral cochlear nucleus to inferior colliculus and even straight to auditory radiation. There are also fibres crossing after the inferior colliculus.
167
Between what structures does the medial longitudinal fasciculus span?
From level of inferior colliculus in midbrain and down into the spinal cord.
168
What is the function of the medial longitudinal fasciculus?
To control gaze by coordination of eye, head and neck movement.
169
What information is carried in the medial lemniscus?
Proprioception and fine touch sensation of contralateral side.
170
What part of substantia nigra consists of pigmented melanin-containing neurones?
Pars Compacta
171
To where does pars compacta project?
* Caudate nucleus and Putamen (Basal Ganglia in the forebrain)
172
What two sets of fibres does the pyramidal tract of crus cerebri contain?
1- Cortico-bulbar fibres
2 - Cortico-spinal fibres
173
What more than the pyramidal tract does crus Cerebri contain?
* Cortico-pontine (-cerebellar)
* Temporo-pontine (-cerebellar)
* Fronto-pontine (-cerebellar) fibres.
- Involve in coordination of movement.
174
What type of function does pars compacta involve?
Extra-Pyramidal motor functions.
175
What centre is the superior colliculus?
A centre of visual reflexes: Control movements of eyes and accomodation reflex.
176
What is the function of Edinger Westphal nucleus?
It is the parasympathic nucleus of the oculomotornerve, controlling sphincter pupillae (smooth muscle) and mediate pupillary light reflex (together w pretectal nucleus).
177
From where does the red nucleus recive afferents?
From motorcortex of the frontal lobe.
178
To where does nucleus ruber send efferents?
1. To the spinal cord - as rubro-spinal tract. It cross in ventral tegmental decussation.
2. To the inferior olivary nucleus as rubro-olivary Fs via central tegmental tract.
179
What does internuclear ophthalmoplegia (INO)mean?
Det påverkade ögat (contralateralt till hjärnstamslesionen) kan inte conjugera med det andra ögat i medial blickriktning för det skadade ögat utan tittar istället rakt fram.
Dock KAN det påverkade ögat adducera (ställa sig medialt) tillsammans med det andra ögat vid convergence.
180
Signs of unilateral brain stem lesion:
1. ipsilateral CN dysfunction (ipsil facial paresis)
2. Contralateral spatic hemiparesis
3. Hyperreflexia (especially in the contralateral limbs)
4. Positive babinski reflex in contralateral side.
5. contralateral hemisensory loss (ipsilateral facial)
6. Ipsilateral incoordination
7. Internuclear opthalmoplegia
181
What structure in the brain stem is damaged to produce INO? (internuclear opthalmoplegia)
The medial longitudinal fasciculus.
182
secondary somatosensory cortex
43
183
the frontal eye field (for contralateral gaze)
8
184
Primary somatosensory cortex
3,1 and 2
185
Transverse gyri of Heschl
41 o 42.
186
Primary auditory areas
41 o 42
187
Precentral gyri
4
188
primary motor area
4
189
motor strip
4
190
premotor area
6
191
supplemental motorarea
6
192
brocas area
dominant hemisphere 44
193
"classical are called motor speech area"
44
194
primary visual cortex
17
195
wernickes area
dominant h, most of 40 and portions of 39. May also include approximately posterior 1/3 of STG
196
BrA 22
Primary auditory cortex
197
deletion of frontal Brodman area 8
impaired gaze towards contralateral side - the patient look towards the lesioned side.
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Irritative lesions (eg seizures) in frontal Brodman area 8
Activation of gaze towards contralateral side.
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Villarets syndrome
AKA posterior retropharyngeal syndrome
AKA nervous syndrome of the posterior retroparotid space.
CN IX, X, XI o XII + sympathetics
= Collet Sicard syndrome + horner syndrome.
= Collet Sicard syndrome with sympathetic involvement.
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Etiologies of Villarets syndrome
parotid tumors, metastases, external carotid aneurysm and osteomyelitis of the skull base
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Collet-Sicard syndrom
CN IX, X, XI and XII. No symp. involvement.
More likely w lesions outside the skull.
IF caused by IV lesion it would have to be so large that it would usually produce brainstem compression....---Long tract finding (not incl in the syndrome)
* unilateral paralysis of palate, vocal cords, SCM, trapezius, tongue.
*Loss of taste in post 1/3 of tongue,
*Anesthesia of soft palate, larynx and pharynx.
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Etiologies to Collet-Sicard syndrome
* Condylar and Jeffersons fractures
* Internal carotid dissection
* Primary and metastatic tumors
* Lyme disease
* Fibromuscular dysplasia
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What structures pass through the Jugular foramen?
From medial (foramen magnum) side to lateral:
Inferior Jugular Vein, CN XI, X, IX, Inferior Petrosal Sinus.
AND! posteriolaterally there is a large compartment passing the sinus sigmoideus!
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What structure passes through the sigmoid segment of foramen jugulare?
Inferior jugular vein
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What structures passes through Pars vascularis of foramen jugulare?
Inferior jugular vein, CN XI and CN X. + branching Arnolds nerve
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What structures passes through Pars Nervosa of foramen jugulare?
CN IX and Inferior petrosal sinus.
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Through what opening in the skull base is CN XII exiting?
The hypoglossal canal.
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What symtom in the face is seen from compression of the sympathics?
Horner syndrome
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What encompasses Horners syndrome?
Ipsilateral ptos, miosis, anhidrosis in the face (if not only sympathetics running along ICA is involved because the hidrosis sympathics run with ECA).
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what constitutes the foramen jugularis?
It is a opening inbetween the petrous part of the temporal bone, and the lateral side of the occipital bone. Usually there is a bony spine from the petrous part dividing it in two parts.
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What separates foramen jugulare from the carotid canal?
Only the carotid ridge.
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What does a supranuclear upward gaze palsy mean physiologically?
Upgaze palsy affecting both voluntary saccadic and pursuit movements, with perservation of vestibulo-ocular or oculocephalic (dolls eyes) reflexes in most cases. Horizontal eye movement spared.
213
What is Millard Gubler syndrome?
VII and VI palsy + contralateral hemiplegia
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Where is the injury situated in a Millard Gubler syndrome?
lesion in base of pons. Affecting both nerves (VI and VII) and the corticospinal tract.
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Where is the injury situated if the pt has ipsilateral facial palsy, ipsilateral inability to look laterally and contralateral hemiplegia?
base of pons. = Millard Gubler syndrome
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What is Benedikts syndrome?
Webers syndrome + red nucleus lesion.
This means:
* CN III lesion w relatively pupil sparing
* contralateral hemiparesis BUT NOT the arm which has hyperkinesia, ataxia and coarse intention tremor
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Where is a benedikts syndrome situated (what structures does it involve)?
Midbrain tegmentum plus red nucleus, brachium conjunctivum and fascicles of CN III.
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What is Webers syndrome?
CN III palsy w contralateral hemiparesis. see lacunar strokes p 1334.
third nerve palsies from parenchymal lesions may be relatively pupil sparing.
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Cerebellar mutism
AKA mutism w subsequent dysarthria
Speechlessness that follow various cerebellar injuries; trauma, cerebellit etc etc. Most often child after surgery. Unkown what structure causes this. ( på beito sade de vermis?)
220
What is cerebellar mutism SYNDROME?
Its cerebellar mutism +
ataxia + hypotonia + irritability
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What is posterior fossa syndrome?
cerebellar mutism syndrome +
CN deficits + neurobehavioural changes + urinary incontinence or retention
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What is the incidence of cerebellar mutism following surgery for cerebellar tumors?
11-29%
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Clinical characteristics of cerebellar mutism?
* onset time
* duration
*% w sequele
Onset between 1-6 days postop.
Limited duration 4d-4mo
long term linguistic sequele 98.8% of pt.
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What does the term " cerebellar diaschisis" mean?
"shocked all through" - cerebellar mutism har been linked to disruption of cerebello-cerebral circuits such as the dentatethalamocortical tract.
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What is Foster Kennedy syndrome?
Classical triad:
* ipsilateral anosmia
* ipsilateral central scotoma
* contralateral papilledema
occasionally ipsilateral proptosis will also occur.
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Why is ipsilateral central scotoma seen in foster Kennedy syndrome?
Due to pressure on the optic nerve and secondary optic atrophy.
227
Anton-Babinski syndrome
Unilateral asomatognosia.
may be obscured by aphasia if occuring on dominant side.
* anosognosia
* apathy
* allocheiria
* dressing apraxia
* extinction
* inattention to an entire visual field with deviation of head, eyes and body to unaffected side. ( w or wo hemianopsia)
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location of Anton-Babinski syndrome
parietal (usually detected if situated on non-dominant side)
229
Frontal lobe bilateral
apathy and abulia
230
Where is the injury in Foster Kennedy syndrome
Olfactory groove lesion
eg medial third sphenoid wing tumor
231
Injuries specific for the dominant parietal lobe?
* Aphasias
* Gerstmanns syndrome
* Bilateral astereognosis
232
Injuries specific to the non-dominant parietal region
* topographic memory loss
* anosognosia
* dressing apraxia
* integration of visual and proprioceptive sensation to allow manipulation of body and object and for certain constructional activities.
233
Findings in Injuries to occipital lobe
homonymous hemianopsia
234
What is pathology is seen in injuries to cerebellar vermis
truncal ataxia
235
Syndrome where injuries to the pineal region is seen?
Parinaud s syndrome
236
Another name of the Wallenberg syndrome?
The lateral medullary syndrome
237
What main structure is involved in the Wallenberg syndrome?
According to litterature it is PICA, but in reality VA is probably causing the typical symtoms more often.
238
What symtoms are seen in Wallenberg syndrome?
* injury to nucleus ambiguus give ipsilateral palatal, pharyngeal and vocal cord paralysis
* Additionally: ipsilateral FACIAL numbness, contralateral TRUNCAL numbness, ipsilateral horners syndrome, vertigo, nausea, vomiting and occasionally hick-ups.
239
What is vermian split syndrome?
* Nystagmus
* Gait disturbance
* Oscillation of head and neck
* truncal ataxia
* Equilibrium disturbance
!!! Peds - CEREBELLAR MUTISM!!!
240
What CN are affected in Vernets syndrome?
* Vagus nerve
* Accessory nerve
* Glossopharyngeal nerve
241
Describe classical findings of Gerstman syndrome
Dominant parietal lobe injury -
*Agraphia w/o alexia
*Left-right confusion
*Digit Agnosia
*Acalculia
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Pterion
H-shaped formation of sutures on the side of the calvarium representing the junction of four skull bones:
* the greater wing of the sphenoid bone.
*squamous portion of the temporal bone.
*frontal bone.
*parietal bone.
243
Asterion
At the lateral aspect of the skull formed at the junction of the occipital bone, the temporal bone, and the parietal bone.
244
Lambda
The lambda is the meeting point of the sagittal suture and the lambdoid suture. This is also the point of the occipital angle.
245
Opisthion
The median (midline) point of the posterior margin of the foramen magnum.
246
Where is SSS in relation to the sagittal suture?
In most individuals it is located just right of the sagittal suture.
247
anterior fontanelle
At the junction of coronal, sagittal and frontal sutures
