Neurology 1- M2 > 09 15 2014 Brainstem > Flashcards

09 15 2014 Brainstem Flashcards

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1
Q

function of brainstem

A
  1. conduit function
  2. cranial nerve function
  3. integrative function
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2
Q

Sensory CNs

A

1,2,8

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3
Q

Motor CNs

A

3,4,6,9,11

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4
Q

Mixed CNs

A

5,7,9,10

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5
Q

Mnemonics

A
  1. Some
  2. Say
  3. Money
  4. Matters
  5. But
  6. My
  7. Brother
  8. Says
  9. Big
  10. Brains
  11. Matter
  12. most
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6
Q

Motor Somatic Efferent nuclei

A

relates to the framework of the body (skeletal muscles that originates from embryonic somites– extra ocular and tongue muscles)

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7
Q

Motor Visceral General nuclei (efferent)

A

Relates to efferent fibers that activate the viscera or organs

-preganglionic parasympathetic for cranial, thoracic, and abdominal smooth muscle (viscera)

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8
Q

Motor visceral special nuclei (efferent)

A

activates striated muscle

  • muscle from embryonic branchial arches
  • facial expression, jaw muscles, laryngeal and pharyngeal muscles, sternocleidomastoid.
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9
Q

Sensory Somatic afferent nuclei

A

caries information about the changes in environment from the framework of the body

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10
Q

Sensory General Somatic Afferent nuclei

A

refers to the impulse that begin at or near the body surface

-pain, temperature, touch, pressure

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11
Q

Sensory Special Somatic Afferent

A

highly specialized sensory system–

  • vision (light)
  • hearing (sound)
  • Taste
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12
Q

Sensory General Visceral Afferent

A

receptors from in/around mucus membrane or in organ walls impulses about physical distention or chemical composition of substances or organic wall.

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13
Q

Sensory Special Visceral Afferent

A

refers to specialized chemical stimuli

-smell and tase

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14
Q

Hypoglossal nerve
(general)

(what in intervates is on another card)

A

motor– General somatic efferent GSE (ONLY)

  • LMN exits between olive and pyramid (medulla) LMN is ipsilateral
  • hypoglossal triangle – floor of fourth ventricle
  • Controls movement of tongue and maintains muscle tone

-UMN (corticobulbar tract) is mostly contralateral

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15
Q

What muscles does the hypoglossal nerve innervate?

A

innervates all intrinsic muscles and all but one of the extrinsic tongue muscles

-does not innervate palatoglossus muscle (CN X)

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16
Q

CN XII (Cn # 12) nucleus is innervated by:

A
  1. -Corticobulbar pathway (is mainly crossed for XII)
    - voluntary movement
  2. Reticular neurons for automatic movements
    - control of stereotyped movements while eating and swallowing.
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17
Q

Upper motor lesion in Hypoglossal cranial nerve?

A
  • Tongue deviates to the side opposite of the damage
  • if lesion on the left, the right side of the tongue is weak. Tongue is pushed to right side because of weakened muscles
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18
Q

lower motor lesion in Hypoglossal cranial nerve?

A
  • tongue deviates to the same side of damage
  • Damage is on the left (right corticobulbar tract has already crossed and is now on the left). The tongue deviates to the left because left muscles are weak.)
  • Muscle atrophy in tongue
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19
Q

What happens when you have a bilateral lesion of CN 12?

A
  • disability in speaking

- severe swallowing difficulty of food

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20
Q

Common causes of CN 12 lesions

A
  • motor neuron disease
  • demyelination
  • bleeding
  • tumors of medulla and base of skull

(LMN disease)

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21
Q

Spinal Accessory nerve - composition

A

MOTOR ONLY! composed of fibers from medial motor nuclei in ventral horn of caudal medulla and the accessory nucleus (close to pyramidal decussation).

LMN in medulla and cervical cord (C1-C5)

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22
Q

Spinal Accessory nerve : branchial motor part

A

Ipsilateral innervation of sternomastoid and trapezius muscle.
(spinal part)

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23
Q

Spinal Accessory nerve: Visceral motor part

A

Joins CN X to control larynx

accessory part

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24
Q

Lesion of Spinal Accessory nerve

A

Head turns to side opposite of lesion.

Explanation:
Sternomastoid m. turns head to opposite side. So a lesion would cause the more powerful side to take over, so therefore, the head will face the side that has been lesioned

  • ipsilateral shoulder drop
  • weakened voice or hoarseness
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25
Vagus Nerve General
BOTH Motor and Sensory Forms Vagal triangle (floor of 4th ventricle)
26
Vagus Nerve (efferents vs. afferents)
2 Efferents: (MOTOR) 1. General Viseral Efferent (GVE) Preganglionic parasympathetic heart, lungs, GI (to splenic flexure) - neurotransmitter ACh 2. Special Visceral Efferent (SVE) -Pharyngeal and laryngeal muscles (swallowing and vocalization) 3 Afferents: (SENSORY) 1. General Somatic Afferent - pharynx, meninges, small region of external ear. 2. Special Visceral Afferent - taste from epiglottis and pharynx 3. Genreal Visceral Afferent - chemoreceptors, baroreceptors of aortic arch
27
Where are the Vagus Cranial nerve GVE fibers located?
GVE- general visceral efferent -preganglionic parasympathetic heart lungs and GI - Dorsal motor nucleus of X
28
Where are the SVE fibers of CN # 10 located?
Special Visceral Efferents: -pharyngeal and upper esophageal muscles (Swallowing and gag reflex) -Larynx muscles (vocalization) Nucleus Ambiguus
29
Where are the GSA fibers located (for CN 10)?
GSA= general somatic sensory Pharynx, larynx, meninges, small region of outer ear - afferents join nucleus of CN 5
30
Where are the Special Visceral afferent fibers of the CN 10 located?
SVA - taste of epiglottis and posterior pharynx Nucleus Solitarius
31
Where are the GVA fibers of CN 10 located?
General visceral afferents- chemo receptors, baroreceptors of aortic arch, cardiorespiratory system, digestive system Nucleus Solitarius
32
Complete lesion of CN 10 can cause what? Unilateral lesion of vagus nerve can cause what?
- Fatal - widespread dysfunction of the palate, pharynx and larynx (if lesion of right CN 10) -right palatal arch sagging, deviation of uvula to the left, right vocal muscles paralysis
33
Glossopharyngeal Nerve (general)
BOTH sensory and motor
34
Glossopharyngeal Nerve | -efferents vs. afferents
2 Efferents (Motor) 1. GVE - general visceral efferent - preganglionic parasympathetic to parotid gland 2. SVE special visceral efferent -- stylopharyngeal muscles 3 Afferents (Sensory) 1. GSA- general somatic afferent - pharnyx, posterior 1/3 of tongue, middle ear, small region of external ear 2. SVA-- special visceral afferent - taste from posterior 1/3 of tongue 3. GVA- general visceral afferent - chemorecepors and baroreceptors from carotid body.
35
Where are the GVE fibers of CN 9 located?
General visceral efferent: -preganglionic parasympathetics to parotid gland - inferior salivary nucleus (in PONS) - --> work their way to otic ganglion = parasympathetic to parotid gland
36
Where are the SVE fibers of CN 9 located?
Special visceral efferent-- branchial motor - stylopharyngeal muscles - elevates pharynx during talking and swallowing Nucleus Ambiguus
37
Lesions at N. ambiguous causes what?
Affects CN 10: SVE fibers -pharynx, larynx, meninges, small region of outer ear Affects CN 9 : SVE fibers -pharynx, posterior 1/3 of tongue, middle ear, small region of external ear. LMN are going to be affected -- muscle atrophy!! - poliomyelitis - Ischaemic lesions - Intramedullary tumors - Motor Neurons disease - Neuroma - Myastenia gravis Glossopharyngeal neuralgia-- episodes of severe throat and ear pain.
38
Vascular supply to the medulla?
Medial : Anterior Spinal Artery Lateral : PICA Rostral: Vertebral artery- paramedian branches
39
Anterial spinal artery-- regions it hits in medulla
Pyramids, medial leminiscus, hypoglossyl nucleus
40
Vertebral artery helps supply what structure in the medulla?
Inferior olivary nucleus
41
What structures in the medulla does the PICA play a big role in?
Solitary nucleus, Nucleus Ambiguus
42
Meduallry syndrome. What if it happens on the left side?
Blockage of Anterior spinal artery 1. right corticospinal tract 2. left 1/2 of tongue 3. right touch/vibration lost
43
Lateral Medullary Syndrome?
Blockage of PICA | -hits N. Soletarious and other sensory parts (pain and temperature)
44
CN 5 (general)
Both motor and sensory Muscles of mastications, proprioception, touch and temperature, pain and temperature
45
Types of fibers in CN 5?
SVE: special visceral efferent (branchial motor) -muscles of mastication and tensor tympani muscle GSA: general somatic afferent: proprioception (pons--> midbrain); Touch and temperature (pons); Pain and temperature (pons --> spinal cord)
46
There are 4 main things that the CN 5 does? aka What pathways (sensory/ motor) does it contribute too?
1. motor (pons) 2. propriception (pons--> midbrain) 3. Touch and temperature (pons) 4. pain and temperature (mid pons--C2-C3 spinal cord)
47
Pain and temperature pathway of CN5:
GSA - general somatic afferent fibers - ipsilateral impulses of pain temerpature some touch from head, face and neck - spinal trigeminal tract 1st order neuron is in trigeminal ganglion 2nd order = Spinal nucleus of medulla 3rd = VPM (thalamus) (crossed projection to VPM)
48
Touch pathway of CN 5:
GSA- touch and pressure from face, mouth anterior 2/3 of tongue, nasal sinuses 1st order neuron : trigeminal ganglion 2nd order neuron in main/principle/chief nucleus --- crosses immediately to VPM. 3rd neuron continues to homonculus
49
Proprioception of CN 5:
GSA -- primary sensory neurons innervate muscles of mastication, project to motor nucleus of 5. 1st neuron is in CNS -- mesencephalic nucleus
50
Motor fivers for CN 5 pathway:
SVE: innervates muscles of mastication and tensor tympani Nucleus: Trigeminal motor nucleus -ocated mid pons medial to the chief sensory nucleus
51
What happens if there is a lesion in the CN5 ?
when chin opens, it deviates away from lesion
52
What is trigeminal neuralgia (Tic doloureux)
- recurrent episode of brief severe pain lasting from seconds to a few minutes (V2-V3) - facial sensation is normal
53
What are some things that may cause sensory loss via CN 5?
- trauma - Herpes Zoster - Aneurysms - Metabolic disease
54
Facial nerve (general) and fibers
Both sensory and motor 2 efferent 1. SVE - special visceral efferent: mucles of expression and stapedius muscle 2. GVE - general visceral efferent: pre ganglion sympathetic for lacrimal, and all salivary glands EXCEPT parotid (CN9) 3 afferent 1. GSA- general somatic afferent: small region of outer ear 2. SVA- special visceral afferent: taste to anterior 2/3 of tongue 3. GVA- general visceral afferent: mucosal membrane of nasopharynx
55
Facial motor nucleus (CN 7)
SVE: muscles of facial expression and stapedius Turns around abducens nucleus and forms the Facial colliculi -- fibers exit in corder of ponto-medllary junction. Present in pons close to mandibular nucleus of 5.
56
CN7 - role in corneal reflex? - receptor? - Afferent? - 1st synapse? - second synapse? - muscle?
1. cornea 2. opthalmic nerve of V 3. Spinal nucleus of trigeminal 4. Facial nucleus 5. orbicularis oculi
57
CN7 role in sucking reflex - receptor? - Afferent? - 1st synapse? - second synapse? - muscle?
1. lips 2. Mandibular nerve CN V 3. Pontine nucleus of V 4. Facial nucleus 5. orbicularis oculi
58
CN7 role in blinking to light reflex - receptor? - Afferent? - 1st synapse? - second synapse? - muscle?
1. retina 2. Opthalmic nerve 3. Superior colliculus 4. Facial nerve 5. orbicularis oculi
59
CN7 role in blinking to noise - receptor? - Afferent? - 1st synapse? - second synapse? - muscle?
1. Cochlea 2. Cochlea nucleus 3. Inferior colliculus 4. Facial nucleus 5. orbicularis oculi
60
CN7 role in sound attenuation - receptor? - Afferent? - 1st synapse? - second synapse? - muscle?
``` cochlea cochlea nucleus superior olivary nucleus Facial nucleus Stapedius muscle ```
61
Superior Salivatory nucleus (SSNU)
GVE- general visceral efferents -- preganglion parasympathetic innervation for lacrimation and salivation (except parotid gland).
62
Facial nerve- rostral solitary nucleus
SVA- special visceral afferent : taste from anterior two thirds of tongue
63
Facial nerve-- pain, temperature, touch, pressure
GSA- general somatic afferent: back of the outer ear (also Cn 9, 10) Information travels into the spinal trigeminal nucleus and then information crosses as part of trigemino-thalamic projections to thalamus (VPM)
64
Vascular supply to pons?
Basilar artery 1. Superior cerebellar artery = rostral pons 2. Basilar paramedian arteris = medial region in pons cross section 3. AICA = lateral and caudal pons
65
Tracts in the pons that could be affected if anything happened to paramedial branches of the basilar artery
-pontine nucleus, Medial lemniscus, CST and coticobulbar tracts, abducens nucleus
66
Tracts in the pons that could be affected if anything happened to AICA
Lateral pons - STT - descending sympathetics - Spinal trigeminal nucleus and tract (V) - Facial nucleus and nerve fascicles (CN 7) - Middle cerebellar peduncle
67
Horner's syndrome
Strong pupillary constriction (only parasympathetic fibers are working)and drooping of eye lid, decreased sweating (anhidrosis), increased skin temperature, flushing of skin. - Descending from hypothalamus - goes through midbrain and pons (AICA) - intermediolateral column = pre ganglion sympathetics fibers that go out to ganglion chain (ACh) - Post-sympatic neuron follows arteries and innervates the dilator muscle (ciliary muscle)
68
Occularmotor nerve
MOTOR only -- GSE: eye muscles except lateral rectus and superior oblique. Also Innervates levator palpebrae superioris muscle Comes out in the interpeduncular fossa -- this is also where the prepontine cistern is. Edinger-Westphal nucleus (part of oculotomotor nucleus -GSE) -- sphincter pupillage, ciliary muscle (final destination after synapse in parasym. ganglion)
69
Trochlear Nerve
motor only--GSE: innervates the superior oblique muscle of the eye (down and out) Trochear nucleus
70
Lateral motor systems
Lateral corticospinal tract: movement of contralateral limbs Rubiospinal tract - movement of contralateral limbs (humans unknown)
71
Medial motor systems
Anterior corticospinal tract: control of bilateral axial and girdle muscles Vestibulospinal tract: medial VST: Positioning of head and neck; lateral VST =balance Reticulospinal tracts: automatic posture and gait-related movements Tectospinal tract: coordination of head and eye movement (uncertain in humans)
72
midbrain-- Blood supply and areas they can affect
SCA and proximal PCA -- superior colliculus Proximal PCA: lateral to cerebral aqueduct -Reticular formation, STT, Descending sympathetics, medical lemniscus, red nucleus, substance nigra, pyramidal tract (CST, corticobulbar tracts) Paremedian branches: affect medial oculomotor nucleus and nerve fascicles. Can affect medical 1/2 of red nucleus.
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