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Neuroanatomy > The Brainstem, Cranial Nerves And The Visual Pathway > Flashcards

The Brainstem, Cranial Nerves And The Visual Pathway Flashcards

1
Q

Location of midbrain

A

Most superior part of brainstem

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2
Q

2 parts of the midbrain

A

Tectum
Tegmentum

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3
Q

Location of Tectum

A

Smaller part of the midbrain located dorsal of the cerebral aqueduct

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4
Q

Tectum

A

Contains 2 pairs of rounded bumps = colliculi

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5
Q

Role of superior colliculi

A

Involved in regulating eye movements and reflexes associated with visual stimuli, such as turning or moving the head quickly when something quickly enters our field of vision

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6
Q

Role of inferior colliculi

A

Involved sound location, pitch discrimination and reflexes associated with auditory stimuli, such as turning our head on hearing a loud noise

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7
Q

Location of tegmentum

A

Larger part of midbrain located ventrally of cerebral aqueduct

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8
Q

What separates the tegmentum and Tectum

A

Cerebral aqueduct

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9
Q

Which colliculi are involved with visual stimuli

A

Superior colliculi

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10
Q

Which colliculi are involved with auditory stimuli

A

Inferior colliculi

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11
Q

Substantia nigra

A

Important in motor control by producing dopamine

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12
Q

Cerebral peduncles

A

On most ventral surface of tegmentum
Large white matter bundles that connect the midbrain to the thalami

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13
Q

Red nuclei

A

Support motor control of limbs

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14
Q

What 3 structures does the tegmentum contain

A

Substantia nigra
Cerebral peduncles
Red nuclei

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15
Q

Which nuclei does the midbrain contain

A

Nuclei of the oculomotor (CN III) and trochlear (CN IV) nerves
Edinger-Westphal nuclei (involved in pupillary light reflex)

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16
Q

Pons

A

Large, rounded middle part of the brainstem
Contains the Pneumotaxic and aponeustic centres involved in regulation of breathing

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17
Q

Which artery lies on the ventral surface of the pons

A

Basilar artery

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18
Q

Middle cerebellar peduncles

A

Large white matter connections to the cerebellum on the dorsal surface of the pons

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19
Q

What is located on the ventral surface of the pons

A

Basilar artery

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20
Q

What is located on the dorsal surface of the pons

A

Middle cerebellar peduncles

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21
Q

Where is the fourth ventricle situated

A

Dorsal surface of pons between 2 middle cerebellar peduncles

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22
Q

Which nuclei are in the pons

A

Nuclei of the trigeminal (CN V), abducens (CN VI), facial (CN VII), vestibulocochlear (CN VIII) nerves

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23
Q

Which centres are involved in the regulation of breathing

A

Pneumotaxic and Apneustic

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24
Q

Where are the Pneumotaxic and apeneustic centres located

A

Pons

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25
Q

Location of medulla oblongata

A

Connects pons to spinal cord

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26
Q

Anterior median fissure

A

Groove on ventral surface of medulla oblongata that separates the 2 medullary pyramids

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27
Q

Medullary pyramids

A

2 distinct lumps on ventral surface of medulla separated by anterior median fissure

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28
Q

Which tracts run through the medullary pyramids

A

Corticospinal tracts

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29
Q

Medullary olives

A

Prominent ridges immediately lateral to the medullary pyramids

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30
Q

2 nuclei in the dorsal column medial lemniscus

A

Fasciculus gracilis
Fasciculus cuneatus

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31
Q

Dorsal column medial lemniscus

A

Sensory nerve pathway in dorsal part of medulla

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32
Q

Which fibres decussate in the medulla

A

Corticospinal
Dorsal column medial lemniscus

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33
Q

Where do the corticospinal tracts decussate

A

Medulla

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34
Q

Where do the dorsal column medial lemniscus decussate

A

Medulla

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35
Q

Which nuclei are in the medulla

A

Nuclei of the Glossopharyngeal (CN IV), vagus (CN X), accessory (CN XI) and Hypoglossal (CN XII) nerves

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36
Q

Medulla

A

Contains vital centres responsible for regulating respiration, heart rate, blood pressure and initiating vomiting

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37
Q

Where are the centres responsible for regulating respiration, heart rate, blood pressure and initiating vomiting located

A

Medulla

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38
Q

Bulbar palsy

A

This term refers to dysfunction of the cranial nerves that arise from the medulla (glossopharyngeal, vagus, accessory and hypoglossal). Symptoms include difficulty speaking and swallowing, excessive saliva production, wasting and fasciculations of the tongue and an absent gag reflex. Causes include diseases which affect peripheral nerves such as motor neurone disease and Guillain-Barré syndrome.

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39
Q

Which part of the brainstem do nerves affected by bulbar palsy originate in

A

Medulla

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40
Q

Is the olfactory nerve sensory or motor

A

Sensory

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41
Q

Is the optic nerve sensory or motor

A

Sensory

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42
Q

Is the oculomotor nerve sensory or motor

A

Motor + parasympathetic

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43
Q

Is the trochlear nerve sensory or motor

A

Motor

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44
Q

Is the trigeminal nerve sensory or motor

A

Both

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45
Q

Is the abducens nerve sensory or motor

A

Motor

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46
Q

CNS origin of the olfactory nerve

A

Cerebrum

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47
Q

CNS origin of the optic nerve

A

Diencephalon

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48
Q

CNS origin of the oculomotor nerve

A

Midbrain

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49
Q

CNS origin of the trochlear nerve

A

Midbrain

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50
Q

CNS origin of the trigeminal nerve

A

Pons

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51
Q

CNS origin of the abducens nerve

A

Pons

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52
Q

Which skull base Foramen does the olfactory nerve exit

A

Cribriform plate

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53
Q

Which skull base Foramen does the optic nerve exit

A

Optic canal

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54
Q

Which skull base Foramen does the oculomotor nerve exit

A

Superior orbital fissure

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55
Q

Which skull base Foramen does the trochlear nerve exit

A

Superior orbital fissure

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56
Q

Which skull base Foramen does the abducens nerve exit

A

Superior orbital fissure

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57
Q

Which skull base Foramen does the ophthalmic branch of the trigeminal nerve exit

A

Superior orbital fossue

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58
Q

Which skull base Foramen does the maxillary branch of the trigeminal nerve exit

A

Foramen rotundum

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59
Q

Which skull base Foramen does the mandibular branch of the trigeminal nerve exit

A

Foramen ovale

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60
Q

3 branches of trigeminal nerve

A

Ophthalmic
Maxillary
Mandibular

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61
Q

Function of the olfactory nerve

A

Olfaction (smell)

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62
Q

Function of the optic nerve

A

Sight

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63
Q

Function of the oculomotor nerve

A

Eye movements (SR, IR, MR, IO)
Eyelid opening (LPS_
Pupillary constriction
Accommodation

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64
Q

Function of the trochlear nerve

A

Eye movement (SO)

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65
Q

Function of the abducens nerve

A

Eye movements (LR)

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66
Q

Function of the ophthalmic branch of the trigeminal nerve

A

Sensation from upper 1/3 of face - as far as top of head to anterior surface of the eye

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67
Q

Function of the maxillary branch of the trigeminal nerve

A

Sensation from the middle 1/3 of face - including most of the internal nasal cavity, upper teeth and palate

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68
Q

Function of the mandibular branch of the trigeminal nerve

A

Sensation from the lower 1/3 of face - including general sensation to anterior 2/3 of the tongue, mandibular teeth and gums
Motor to the muscles of mastication
Motor to tensor tympani muscle

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69
Q

Where are the olfactory bulbs located

A

Superior surface of the Cribriform plate either side of the crista galli

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70
Q

Where are the olfactory cortices

A

Temporal lobes

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71
Q

V1 branch of trigeminal nerve

A

Ophthalmic

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72
Q

V2 branch of trigeminal nerve

A

Maxillary

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73
Q

V3 branch of trigeminal nerve

A

Mandibular

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74
Q

Muscles of mastication supplied by the mandibular nerve (V3)

A

Temporalis
Masseter
Medial pterygoid
Lateral pterygoid

75
Q

5 branches of the facial nerve

A

Temporal
Zygomatic
Buccal
Marginal mandibular
Cervical

76
Q

Where does the facial nerve branch into 5

A

Within the parotid salivary glands

77
Q

Chorda tympani

A

Branch of the facial nerve
Supplies taste to anterior 2/3 tongue
Parasympathetic secretomotor function to the submandibular and sublingual salivary glands

78
Q

Which Foramen does the facial nerve leave the skull by

A

Stylomastoid Foramen in the temporal bone

79
Q

Where is the Stylomastoid Foramen

A

Temporal bone

80
Q

Pathway of facial nerve

A

Passes through internal auditory meatus alongside vestibulocochlear nerve
Gives off a branch to the lacrimal glands
Progresses through middle ear cavity - branch to Stapedius muscle and Chorda tympani
Leaves skull via Stylomastoid foramen
Enters parotid gland where branches into 5

81
Q

Which nerve supplies a branch to the lacrimal gland

A

Facial nerve- parasympathetic

82
Q

Which nerve gives off a branch to the Stapedius muscle in the middle ear cavity

A

Facial nerve

83
Q

2 branches of facial nerve in middle ear cavity

A

Chorda tympani
Branch to Stapedius

84
Q

Is the facial nerve sensory or motor

A

Both + parasympathetic

85
Q

Is the vestibulocochlear nerve sensory or motor

86
Q

Is the Glossopharyngeal nerve sensory or motor

A

Both + parasympathetic

87
Q

Is the vagus nerve sensory or motor

A

Both + parasympathetic

88
Q

Is the accessory nerve sensory or motor

89
Q

Is the Hypoglossal nerve sensory or motoru

90
Q

CNS origin of the facial nerve

91
Q

CNS origin of the vestibulocochlear nerve

92
Q

CNS origin of the Glossopharyngeal nerve

93
Q

CNS origin of the vagus nerve

94
Q

CNS origin of the accessory nerve

A

Spinal cord C1-C5

95
Q

CNS origin of the Hypoglossal nerve

96
Q

Which cranial nerve originates from the spinal cord C1-C5

A

Accessory nerve (CN XI)

97
Q

Which skull base foramen does the facial nerve exit

A

Internal auditory meatus
Then Stylomastoid foramen

98
Q

Which skull base foramen does the vestibulocochlear nerve exit

A

Internal auditory meatus

99
Q

Which skull base foramen does the Glossopharyngeal nerve exit

A

Jugular foramen

100
Q

Which skull base foramen does the vagus nerve exit

A

Jugular foramen

101
Q

Which skull base foramen does the accessory nerve exit

A

Jugular foramen

102
Q

Which skull base foramen does the Hypoglossal nerve exit

A

Hypoglossal canal

103
Q

Which skull base foramen does the accessory nerve enter the skull

A

Foramen magnum

104
Q

Function of the facial nerve

A

Motor to muscles of facial expression
Motor to Stapedius muscle
Sensation to the ear canal
Secretomotor function to the submandibular and sublingual salivary glands, and lacrimal glands
Taste to anterior 2/3 tongue

105
Q

Function of the vestibulocochlear nerve

A

Balance and hearing

106
Q

Function of the Glossopharyngeal nerve

A

Motor to the stylopharyngeus muscle
Sensation from the pharynx
Taste and sensation for posterior 1/3 tongue
Sensation from carotid baroreceptors
Secretomotor function to parotid gland

107
Q

Function of the vagus nerve

A

Motor to muscles of soft palate, pharyngeal muscles and internal laryngeal muscles
Sensation from the external ear and ear canal
Taste from the epiglottis
Parasympathetic to thoracic and abdominal organs

108
Q

Function of the accessory nerve

A

Motor to trapezius and sternocleidomastoid muscles

109
Q

Function of the Hypoglossal nerve

A

Motor to muscles of the tongue

110
Q

Function of stylopharyngeus muscle

A

Assists with facilitating swallowing

111
Q

Which nerve carries unconscious sensory information from carotid chemoreceptors and baroreceptors to medulla

A

Glossopharyngeal

112
Q

Function of sternocleidomastoid muscle

A

Turning the head and nodding

113
Q

Function of trapezius muscle

A

Responsible for shrugging and numerous movements of the scapula

114
Q

Which muscle of the tongue is not supplied by the Hypoglossal nerve

A

Palatoglossus (vagus nerve)

115
Q

Which nerve supplies the palatoglossus muscle

116
Q

Unilateral Hypoglossal nerve damage

A

cause that side of the tongue to be paralysed and atrophy, meaning the other side will overpower it. This leads to a characteristic finding of the tongue pointing towards the side of the lesion.

 

117
Q

Which nerve supplies motor innervation the the intrinsic and extrinsic muscles of the tongue

A

Hypoglossal

118
Q

Which nerve supplies motor innervation to the soft palate, palatine folds and pharyngeal constrictors

119
Q

Which nerve supplies general sensation to the ear canal and Pinna

120
Q

Which nerve carries taste sensation from the epiglottis

121
Q

How to test for the olfactory nerve

A

the clinician can simply ask the patient if their sense of smell has changed, or they can ensure the patient is able to identify certain strong-smelling compounds, such as coffee, chocolate, vanilla, or cinnamon.

122
Q

How to test for the optic nerve

A

this nerve is tested in several ways. Firstly, visual acuity is tested using a Snellen chart (a chart with letters of decreasing sizes). Visual fields (peripheral vision), accommodation to near and far objects, colour vision, and the pupillary light reflex also test the optic nerve.

123
Q

How to test for the oculomotor and trochlear and abducens nerve

A

this nerve is tested alongside CN IV (trochlear) and CN VI (abducens) by a clinician asking a patient to follow their finger as they move it across the patient’s field of vision. The clinician can observe the movements of the patient’s eyes to ensure they are moving as they should. The pupillary light reflex also tests the oculomotor nerve.

124
Q

How to test for the trigeminal nerve

A

the motor and sensory parts of the trigeminal nerve are tested separately. Firstly, sensation is tested by simply ensuring the patient can feel a brush of cotton wool against their skin in the three regions of the face (forehead, cheek, jaw) on both sides. Sensation may be further tested by ensuring the patient is able to tell the difference between sharp and crude touch, or by testing the blink reflex when the cornea of the eye is touched. Motor function is tested by palpating a patient’s jaw muscles as they clench their teeth or asking the patient to forcibly open their mouth against resistance.

125
Q

How to test for the facial nerve

A

the motor function of the facial nerve is its only function that is routinely tested. This is achieved by asking the patient to perform a series of facial movements, such a raising their eyebrows, closing their eyes tightly, blowing their cheeks out or showing all their teeth. The clinician looks for any asymmetry in their movements.

126
Q

How to test for the vestibulocochlear nerve

A

the simplest way this nerve is tested is by blocking the one of the patient’s ears and whispering a number or word in the other ear and asking the patient to repeat it to check their hearing. The test is repeated with the other ear. The function of the ear, cochlear and vestibular system can be tested more thoroughly with other tests using tuning forks and dedicated equipment in specialist clinics.

127
Q

How to test for the Glossopharyngeal nerve

A

this nerve is tested by assessing the patient’s gag reflex. A tongue-depressor (a blunt wooden ‘lolly-stick’) is pressed against the oropharynx and a normal finding would be the patient ‘gagging’ or looking like they will vomit. This tests the sensory function of this nerve.

128
Q

How to test for the vagus nerve

A

there are several ways to test the vagus nerve. The gag reflex above tests the motor function of the vagus nerve, but it can be further tested by asking the patient to open their mouth and say ‘ahhh’. This should cause elevation of the soft palate by muscles which are supplied by the vagus nerve. Coughing and swallowing also both require function of the vagus nerve.

129
Q

How to test for the accessory nerve

A

to test the trapezius muscle, a clinician can ask the patient to shrug their shoulders, and to test the sternocleidomastoid, a clinician asks the patient to turn their head against resistance.

130
Q

How to test for the Hypoglossal nerve

A

finally, the hypoglossal nerve is tested by asking the patient to protrude their tongue. Deviation of the tongue to one side or the other may imply damage to one of the hypoglossal nerves.

131
Q

Pituitary tumour

A

A tumour of the pituitary gland may cause it to enlarge. As it sits immediately beneath the optic chiasm, it can enlarge enough to compress the optic chiasm. This will cause the characteristic bitemporal hemianopia.

132
Q

Monocular vision loss

A

defect is caused by damage to an optic nerve, meaning all vision is lost from the ipsilateral eye.

133
Q

Damage to which nerve causes monocular vision loss

A

Optic nerve

134
Q

Visual fields

A

The areas we can see with each eye

135
Q

How are visual fields divided

A

Into a temporal field and nasal field

136
Q

Temporal field

A

Lateral half of the visual field

137
Q

Nasal field

A

Medial half of visual field

138
Q

Which part of the retina provides temporal visual field

A

Nasal retina

139
Q

Which part of the retina is provides nasal visual field

A

Temporal retina

140
Q

Location of optic chiasm

A

Immediately anterior to midbrain
Superior to pituitary gland

141
Q

Which visual information decussates at the optic chiasm

A

Information from the temporal visual fields (nasal retina) … so left eye information goes to right side of brain

142
Q

Pathway of optic tracts after optic chiasm

A

Travel to thalamus where synapse at the lateral geniculate nucleus

143
Q

Which nucleus do the optic tracts synapse at

A

Lateral geniculate nucleus

144
Q

Optic radiations

A

Superior and inferior pathways of optic fibres from lateral geniculate nucleus to primary visual cortex

145
Q

Parietal radiation

A

Superior optic radiation travels in the parietal lobe

146
Q

Temporal radiation/ Meyer’s loop

A

Inferior optic radiation travels in the temporal lobe

147
Q

What receives input from the optic tracts

A

Edinger-Westphal nucleus
Superior colliculi
Primary visual cortex

148
Q

What constitutes inferior fields of vision

A

Parietal radiations
Superior as-ears of the retina

149
Q

What constitutes superior fields of vision

A

Temporal radiation
Inferior parts of retina

150
Q

Bitemporal hemianopia is caused by damage to

A

Optic chiasm

151
Q

Bitemporal hemianopia

A

Vision loss of temporal visual fields due to damage to fibres that carry nasal retinal information

152
Q

Homogenous hemianopia is caused by damage to

A

An optic tract between the optic chiasm and the lateral geniculate nucleus

153
Q

Homogenous hemianopia

A

If left optic tract is damaged, information from the left temporal retina and right nasal retina is lost, so the left nasal visual field and right temporal visual field are lost (right side of vision in both eyes)

154
Q

Homonymous quadrantanopia

A

If the left parietal optic radiation is damaged, information from the left superior temporal retina and right superior nasal retina is lost, meaning the left inferior nasal visual field and the right inferior temporal visual field are lost. This would mean the patient has lost the bottom-right corner of their vision in both eyes, so would be termed a right inferior homonymous hemianopia.

155
Q

Homonymous quadrantanopia is caused by damage to

A

Either the parietal or temporal optic radiation

156
Q
  1. Which structure divides the midbrain into the tectum and tegmentum?
A

Cerebral aqueduct

157
Q
  1. Where are the nuclei of the following cranial nerves?
    a. Oculomotor
158
Q
  1. Where are the nuclei of the following cranial nerves?
    b. Trigeminal
159
Q
  1. Where are the nuclei of the following cranial nerves?
    c. Facial
160
Q
  1. Where are the nuclei of the following cranial nerves?
    d. Vagus
161
Q
  1. Where are the nuclei of the following cranial nerves?
    e. Hypoglossal.
162
Q
  1. What are the functions of the superior and inferior colliculi?
A

The superior colliculi are involved in regulating eye movements and reflexes associated with visual stimuli, such as turning or moving the head quickly when something quickly enters our field of vision. The inferior colliculi are involved sound location, pitch discrimination and reflexes associated with auditory stimuli, such as turning our head on hearing a loud noise.

163
Q
  1. How many cranial nerves are sensory, motor, or both? How many contain parasympathetic fibres?
A
  1. Purely sensory: 3, purely motor: 5, both: 4, contain parasympathetics: 4.
164
Q
  1. Which cranial nerves are responsible for:
    a. Constriction of the pupil in response to bright light.
A

Oculomotor III

165
Q
  1. Which cranial nerves are responsible for:
    b. Motor control to the tongue.
A

Hypoglossal XII

166
Q
  1. Which cranial nerves are responsible for:
    c. Motor control to the muscles of mastication.
A

Trigeminal - mandibular division V3

167
Q
  1. Which cranial nerves are responsible for:
    d. Taste from the posterior 1/3 of the tongue.
A

Glossopharyngeal IX

168
Q
  1. Which cranial nerves are responsible for:
    e. Secretomotor function to the parotid salivary gland.
A

Glossopharyngeal IX

169
Q
  1. How can you test the following cranial nerves?
    a. Facial.
A

a. Ask the patient to make certain facial movements like raising their eyebrows, closing their eyes tightly, showing their teeth and blowing their cheeks out.

170
Q
  1. How can you test the following cranial nerves?
    b. Glossopharyngeal.
A

b. Stimulate the oropharynx with a tongue depressor to elicit the gag reflex.

171
Q
  1. How can you test the following cranial nerves?
    c. Hypoglossal.
A

c. Ask the patient to protrude their tongue and move it side to side.

172
Q
  1. How can you test the following cranial nerves?
    d. Trigeminal.
A

d. Test sensation in three on each side of the face (forehead, cheek, jaw). Also test tone in temporalis by palpating the sides of the head during teeth clenching and testing the lateral pterygoid by asking the patient to open their moth against resistance.

173
Q
  1. How can you test the following cranial nerves?
    e. Accessory.
A

e. Ask the patient to turn their head and shrug their shoulders against resistance to test the sternocleidomastoid and trapezius, respectively.

174
Q
  1. Enlargement of which structure may cause a bitemporal hemianopia?
A
  1. Pituitary gland. It will begin to compress the optic chiasm as it enlarges.
175
Q
  1. Which cranial nerves pass through the cavernous sinus
A

Oculomotor (III), Trochlear (IV), Ophthalmic (V1), Maxillary (V2) and Abducens (VI).

176
Q

What symptoms and signs might a patient display if there is disease of the cavernous sinus?

A

Symptoms: headache, bulging eyeball (exophthalmos), double vision (diplopia), paralysis of eye muscles (ophthalmoplegia) and sensory deficit on the face.

177
Q

Exophthalmos

A

Bulging eyeball

178
Q

Diplopia

A

Double vision

179
Q

Ophthalmoplegia

A

Paralysis of eye muscles

180
Q

Bulbopontine sulcus

A

Line between pons and midbrain

181
Q

Which fibres cross in the optic chiasm

A

Nasal retina fibres

182
Q

Superior retinal fibres form which radiation

183
Q

Inferior retinal fibres form which radiation

184
Q

To work out homonymous quadrantanopia

A

Opposite
Eg if lesion in left parietal radiation
Right inferior homonymous quadrantanopia

Neuroanatomy (8 decks)

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