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229 Cards in this Set
- Front
- Back
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The brainstem is functionally grouped into 4 groups, which are...
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1. CN nuclei/related structures
2. Long Tracts 3. Cerebellar circuitry 4. Reticular formation and related structures |
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The brainstem consists of ___ + ___ + ___
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midbrain, pons, medulla
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Where is the sulcus limitans located?
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In the brainstem on the lateral wall of the 4th ventricle
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The sulcus limitans divides the ___ from the ___
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Motor nuclei ventromedially and sensory nuclei dorsolaterally
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The tectum of the midbrain consists of the ____ and ___, which lie dorsal to the _____
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superior colliculus, inferior colliculus, cerebral aqueduct
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The tegmentum of the midbrain lies ___ to the cerebral aqueduct.
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Ventral
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The tegmentum of the midbrain lies ___ to the 4th ventricle in the pons and medulla
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Ventral
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The corticospinal and corticobulbar tracts lie in the ____ of the midbrain.
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Basis
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Where do the superior and inferior colliculi lie in the midbrain?
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In the tectum
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The superior colliculi are more ___ than the inferior colliculi.
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rostral
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The oculomotor nuclei and red nuclei are contained in the _____
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Superior colliculi
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The trochlear nuclei and brainstem conjunctivum are contained in the ___
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Inferior colliculi
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The brainstem conjunctivum are aka ___
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Decussation of the superior cerebellar peduncles
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The cerebral peduncles are located in the midbrain. What do they consist of?
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Substantia nigra + basis pedunculi
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The medial geniculate nucleus is located ____ to the lateral geniculate nucleus in the rostral midbrain
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medial and dorsal
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The basis pedunculi is located ___ to the substantia nigra in the rostral midbrain
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ventral and lateral
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The red nucleus (parvocellular division) is located ___ to the cerebral aqueduct and ___ to the substantia nigra in the rostral midbrain
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ventral + lateral
dorsal + medial |
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In the caudal midbrain, the mesencephalic trigeminal tract is located ___ to the periaqueductal gray matter and ___ to the fascicles of the trochlear nerve (CN 4)
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lateral, dorsal lateral
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A lesion in the caudal midbrain immediately dorsolateral to the periaqueductal gray matter will most likely affect...
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The inferior colliculi
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In the caudal midbrain, the trochlear nucleus is surrounded by the ___. This little "complex" is located immediately ventral to the ___.
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Medial longitudinal fasciculus (MLF)
periaqueductal gray matter |
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The ___ is located between the L and R superior cerebellar peduncle and decussation in the rostral midbrain.
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Median Raphe Nucleus
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Immediately caudal to the midbrain is the ___.
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Rostral pons
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The ventral pons consists of the ___ and ____.
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Basis pontis, pontine nuclei.
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The basis pontis contains the ____ and ____ tracts.
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corticospinal and corticobulbar
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The pontine nuclei are involved in ____ function
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cerebellar
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The ___ separates the pontine tegmentum from the cerebellum
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4th ventricle
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In the pontomesencephalic junction, the ____ and ___ are located immediately ventrolateral to the cerebral aqueduct.
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mesencephalic trigeminal nucleus/tract and the dorsal longitudinal fasciculus
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In the pontomesencephalic junction, the MLF is ____ to the reticular formation and ____ to the dorsal longitudinal fasciculus.
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dorsal
ventral |
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A lesion on the dorsolateral surface of the pontomesencephalic junction will most likely impinge upon which of the following?
- dorsal longitudinal fasciculus - trigeminal lemniscus - lateral lemniscus and nucleus - corticospinal fibers |
lateral lemniscus and nucleus
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A lesion that is midline immediately posterior to median raphe nucleus will most likely impinge upon which of the following?
- middle cerebellar peduncle - pontine nuclei - superior medullary velum - reticular formation |
reticular formation
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The 4th ventricle begins in the ___.
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Pons (rostral-mid, specifically)
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In the rostral/mid pons, the MLF is located midline and ___ to the 4th ventricle.
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Ventral
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In the rostral/mid pons, a lesion of the pontine nuclei will be seen on a scan ___ to the middle cerebellar peduncle and ___ to the superior cerebellar peduncle.
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medial, ventral/anterior
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In the rostral/mid pons, the principal sensory trigeminal nucleus is seen medial to the ___ and ventrolateral to the ___
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middle cerebellar peduncle, superior cerebellar peduncle
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In the rostral/mid pons, the superior vestibular nucleus of CN 8 is ___ to the 4th ventricle and ___ to the principal sensory trigeminal nucleus
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lateral, dorsomedial
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In the rostral/mid pons, the trigeminal nerve fascicles are ___ to the middle cerebellar peduncles
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medial
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In the rostral/mid pons, the medial lemniscus is located ___ to the lateral lemniscus
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medial. Duh.
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In the caudal pons, the nodulus of cerebellum extends into the ____ on the posterior side.
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4th ventricle
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In the caudal pons, the knee or the genu of CN 7 can be found here...
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adjacent to midline on the floor of the 4th ventricle
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In the caudal pons, the ___ can be found immediately dorsolateral to the genu of CN 7
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Dorsal longitudinal fasciculus
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In the caudal pons, the ___ is found immediately anterior to the dorsal longitudinal fasciculus and lateral to the genu of CN 7
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Nucleus of CN 4 (abducens nucleus)
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The deep cerebellar nuclei include (from medial to lateral):
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Fastigial, Globose, Emboliform, Dentate
(fat girls eat donuts) |
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In the caudal pons, the corticospinal and corticobulbar tracts are the most ___ structures compared with the others.
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ventral/anterior
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In the caudal pons, the CN 7 nucleus is found ___ to the genu of CN 7, ___ to the dorsal longitudinal fasciculus, and ___ to the abducens nucleus.
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ventrolateral, ventrolateral, ventrolateral
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In the caudal pons, the ___ cerebellar peduncle is located medial to the dentate nucleus, whereas the ___ and ___ cerebellar peduncles are localted lateral.
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superior
middle inferior |
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In the caudal pons, you can see the cerebellar peduncles from medial to lateral:
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superior, inferior, middle
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Where can the inferior olivary nucleus be seen?
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rostral medulla
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Where to the posterior columns and nuclei start appearing?
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caudal medulla
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In the rostral medulla, the nucleus solitarius gives rise to CN __, __, and __.
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7, 9, 10
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In the rostral medulla, the nucleus solitarius surrounds the ___.
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solitary tract of CN 7, 9, 10
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In the rostral medulla, the spinal trigeminal tract is located immediately medial to the ___ and carries fibers for CN ____
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inferior cerebellar peduncle
CN 5, 7, 9, 10 |
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In the rostral medulla, the spinal trigeminal tract is located immediately lateral to the ___
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Spinal trigeminal nucleus
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In the rostral medulla, the nucleus ambiguus is located ___ to the spinal trigeminal nucleus
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medial
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The nucleus ambiguus gives rise to tracts that form CN ___.
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9, 10, 11
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In the rostral medulla, what is located adjacent to midline and posterior to the pyramid (corticospinal tract) and anterior to the solitary tract of CN 7, 9, and 10?
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Medial lemiscus
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In the rostral medulla, what nuclei are located posterior/dorsal to the nucleus solitarius?
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Medial and Inferior vestibular nuclei (CN 8)
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In the rostral medulla, the ___ nuclei are located immediately medial to the nucleus solitatius.
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dorsal motor nucleus of CN 10
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In the rostral medulla, what nucleus is located immediately medial to the dorsal motor nucleus of CN 10?
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Hypoglossal nucleus CN 12
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In the rostral medulla, the reticular formation is located medial to the ___ and lateral to the ___
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nucleus ambiguus
medial lemniscus |
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What are the 3 parts to the inferior olivary nucleus?
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Dorsal accessory
Principal (teethlike looking part) Medial accessory |
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In the caudal medulla, the nucleus that is adjacent to midline in the posterior/dorsal portion is called the __ nucleus and the nucleus immediately lateral to it is called the ___ nucleus.
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Gracile nucleus, cuneate nucleus
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In the caudal medulla, the ___ nucleus/tract is immediately ventrolateral to the cuneate nucleus/tract.
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Spinal trigeminal nucleus/tract for CN 5, 7, 9, 10.
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In the caudal medulla, the nucleus solitarius, dorsal motor nucleus of vagus, and the hypoglossal nucleus are all surrounding the ___
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central canal
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T/F: In the caudal medulla, the reticular formation is located adjacent to midline and immediately medial to the nucleus ambiguus.
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F: In the caudal medulla, the reticular formation is located lateral to the medial lemniscus (which are adjacent to midline) and immediately medial to the nucleus ambiguus.
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In the caudal medulla, the ___ is/are the most anterior/ventral structure(s)
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Pyramid (corticospinal tract)
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In the caudal medulla, name 3 structures that are located immediately anterior/ventral to the central canal.
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medial vestibulospinal tract
tectospinal tract medial lemniscus/sensory decussation |
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In the caudal medulla, a lesion on the dorsolateral surface will most likely impede on which of the following structures?
- gracile fascicle - cuneate fascicle - rubrospinal tract - arcuate nucleus |
cuneate fascicle
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Describe the location of the gracile nuclei and fascicle in the cervicomedullary junction.
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Adjacent to midline in the posterior aspect
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Describe the location of the cuneate nuclei and fascicle in the cervicomedullary junction.
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Immediately lateral to the gracile nuclei (which are adjacent to midline)
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Describe the location of the spinal trigeminal tract and nuclei in the cervicomedullary junction.
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Immediately lateral to the cuneate nuclei and posterior to the dorsal spinocerebellar tract and rubrospinal tract
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The spinal trigeminal nucleus has 3 portions seen in the cervicomedullar junction. Name them.
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Marginal zone
Substantia gelatinosa Magnocellular nucleus |
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The corticospinal tract crosses via the _____ in the _____ portion of the cervicomedullary junction.
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pyramidal decussation
anterior |
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In the cervicomedullary junction, the dorsal and ventral spinocerebellar tracts are located ___
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laterally
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In the cervicomedullary junction, the ___ is located immediately medial to the spinocerebellar tracts
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anterolateral system
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In the cervicomedullary junction, the ____ is located immediately medial to the anterolateral system.
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Spinal Accessory nucleus (CN 11)
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The pyramidal decussation is located immediately anterior to the ___
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central gray matter
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A lesion in the anterior portion of the cervicomedullary junction will most likely impinge on which of the following?
- lateral vestibulospinal and reticulospinal tracts - central gray matter - rubrospinal tract - cuneate fascicle |
lateral vestibulospinal and reticulospinal tracts
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In the cervical spinal cord, a midline lesion on the posterior aspect will most likely impinge upon...
- lissauer's tract - anterior corticospinal tract - rubrospinal tract - gracile fasciculus |
gracile fasciculus
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In the cervical spinal cord, a lesion on the anterolateral aspect will most likely impinge upon...
- gracile fasciculus - cuneate fasciculus - rubrospinal tract - substantia gelatinosa |
rubrospinal tract
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In the cervical spinal cord, a large lesion of the central canal area will most likely SPARE which of these?
- dorsal spinocerebellar tract - lateral corticospinal tract - spinal accessory nucleus - tectospinal tract |
dorsal spinocerebellar tract
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In the cervical spinal cord, the anterior corticospinal tract is located...
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adjacent to midline, anteriorly
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In the cervical spinal cord, what is located immediately lateral to the anterior corticospinal tract?
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Medial vestibulospinal tract
Tectospinal tract |
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In the cervical spinal cord, where are the anterior corticospinal tract, medial vestibulospinal tract, and tectospinal tract located in relationship to the ventral horns?
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Medial
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In the cervical spinal cord, if someone wanked upon an area of the posterior aspect immediately medial to the dorsal root of the spinal nerve, what structure did he most likely wank upon?
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Cuneate fasciculus
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Name the somatic motor nuclei (GSE).
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oculomotor
trochlear abducens |
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Where is the oculomotor nucleus located?
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rostral midbrain, ventral to the periaqueductal gray area
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Where is the trochlear nucleus located?
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caudal midbrain, ventral to the periaqueductal gray area
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What forms the ventral border of the oculomotor and trochlear nuclei, interconnecting them with the abducens and vestibular nuclei?
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MLF
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The hypoglossal trigones are located...
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on the floor of the 4th ventricle in the medulla
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In the 4th ventricle, name the 3 nuclei from medial to lateral
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hypoglossal
dorsal motor 10 solitary |
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The branchial motor nuclei include the trigeminal motor nucleus, facial nucleus, nucleus ambiguus, and spinal accessory nucleus. These generally lie ___ to the somatic motor nuclei and eventually end up in the ___
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lateral
tegmentum |
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The spinal accessory nucleus is located...
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in the upper 5 cervical segments
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The trigeminal nuclear complex consists of _____ and runs from the ___ to the _____.
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mesecephalic, chief sensory, and spinal trigeminal nuclei
midbrain upper cervical spinal cord |
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The mesencephalic trigeminal nucleus and tract run along the ___ edge of the periaqueductal gray matter and subserve ____.
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lateral
proprioception |
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The chief trigeminal sensory nucleus is located _____ and is _____ to the trigeminal motor nucleus.
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in the upper/mid pons
dorsolateral |
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The spinal trigeminal nucleus and spinal trigeminal tract run the length of the ___ and ___
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lateral pons
medulla |
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The spinal trigeminal nucleus is the ___ extension of the ____ of the spinal cord.
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rostral
dorsal horn |
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The spinal trigeminal nucleus conveys ____ from the ____
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pain and temperature sensation
face |
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The chief trigeminal nuclei convey ___ from the ___.
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fine discriminative touch
face |
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The dorsal and ventral cochlear nuclei wrap around the lateral aspect of the ___ at the pontomedullary junction
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inferior cerebellar peduncle
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T/F: the hearing pathways decussate at multiple levels, not at a single level.
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True
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The vestibular nuclei (superior, inferior, medial, lateral) are located on either side of the brainstem on the ___ in the ___
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lateral floor of 4th ventricle
pons and rostral medulla |
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The ___ vestibular nucleus is the largest.
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Medial
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Where do fibers of the lateral vestibular nucleus go?
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They traverse the inferior vestibular nucleus and descend to the spinal cord
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All visceral afferents (special AND general) travel to the...
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nucleus solitarius
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The nucleus solitarius is located ___ to the dorsal motor nucleus of CN 10
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lateral
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The rostral nucleus solitarius is for ___ (what kind of afferent?) and CN ___ go to it.
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gustatory (taste)
7, 9, 10 |
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The caudal nucleus solitarius is for ___ (what kind of afferent?) and CN ___ go to it.
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cardiorespiratory and GI
9, 10 |
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The taste pathway goes rostrally via the _____ tract to the ____ of the thalamus, and then to the cortical taste area.
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central tegmental
VPM |
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What is locked-in syndrome (simple definition)
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absent motor function but intact sensation and cognition
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What is the usual cause of locked in syndrome?
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Infarct of ventral pons affecting the bilateral corticospinal and corticobulbar tracts
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In locked in syndrome, which of the following are spared?
- sensory pathways - motor pathways - reticular activating systems - eye movement - lower limb movement |
sensory pathways
eye movement |
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Usually, locked in patients eventually succumb to...
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respiratory infection or complication of paralysis
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Ataxia due to cerebellar issues tend to be contralateral or ipsilateral?
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ipsilateral because the fibers either cross twice or not at all
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Cerebellar outputs are via...
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superior cerebellar peduncle
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The superior cerebellar peduncle conveys fibers that decussate...
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in the midbrain at the level of the inferior colliculus
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Once the sup. cerebellar peduncle fibers decussate at the level of the inferior colliculus, some go rostral to the ___ at the level of the superior colliculus, whereas other fibers go to the ___ of the thalamus and thus to the motor cortex.
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red nucleus
ventral lateral nucleus |
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The rostral (parvocellular) portion of the red nucleus sends fibers via the ___ to the inferior olivary nucleus in the ___, which in turn sends fibers back into the cerebellum via the ___.
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central tegmental tract
rostral medulla inferior cerebellar peduncle |
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The cerebral peduncles convey input via ____ fibers to the pontine nuclei, which then relays inputs from the ____ to the cerebellum.
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corticopontine fibers
middle cerebellar peduncle |
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Information from the spinal cord is relayed to the cerebellum via the ____.
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Inferior cerebellar peduncle
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The central core of nuclei that runs the entire length of brainstem is...
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the reticular formation
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The reticular formation is continuous rostrally with certain ____ nuclei and caudally with the ___
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diencephalic
intermediate zone of the spinal cord |
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The rostral reticular formation is associated with...
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alert/consciousness/arousal
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The caudal reticular formation is associated with
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motor/reflex/autonomic
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The reticular formation is located within...
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the brainstem tegmentum
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The consciousness system is formed mainly by the ___
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medial and lateral frontoparietal association cortex (and also arousal circuits of rostral reticular formation)
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The consciousness system regulates
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level of consciousness... duh.
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Level of consciousness involves...
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alertness
attention awareness |
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Where in the brain can a lesion cause a coma?
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rostral reticular formation and/or bilateral cerebral cortex or bilateral thalamus (especially the medial and intralaminar regions)
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Which of the following neurotransmitters does the upper brainstem use to project to cortical and subcortical forebrain structures?
- NE - ACh - Glutamate - Serotonin (5-HT) - Dopamine (D) - Orexin - Histamine |
NE
5-HT D |
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Which of the following neurotransmitters does the upper brainstem use to project to thalamus, hypothalamus, and basal forebrain?
- NE - ACh - Glutamate - Serotonin (5-HT) - Dopamine (D) - Orexin - Histamine |
ACh
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Which of the following neurotransmitters does the pontomesencephalic reticular formation use to project to thalamus, hypothalamus, and basal forebrain?
- NE - ACh - Glutamate - Serotonin (5-HT) - Dopamine (D) - Orexin - Histamine |
Glutamate
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Which of the following neurotransmitters do the posterior hypothalamic neurons use to project to cortical and subcortical targets?
- NE - ACh - Glutamate - Serotonin (5-HT) - Dopamine (D) - Orexin - Histamine |
Histamine
Orexin |
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Which of the following neurotransmitters does the basal forebrain use to project to the cerebral cortex?
- NE - ACh - Glutamate - Serotonin (5-HT) - Dopamine (D) - Orexin - Histamine |
ACh
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Which of the following neurotransmitters do the rostral and medial thalamic nuclei use to project to the cerebral cortex?
- NE - ACh - Glutamate - Serotonin (5-HT) - Dopamine (D) - Orexin - Histamine |
Glutamate
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Just know this: pain is transmitted via the anterolateral pathway to the pontomesencephalic reticular formation (rostral) and this relays info to the thalamus, hypothalamus, basal forebrain, and limbic system. These in turn feed to higher levels which then feed back to the RF. Word.
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Got it? Good.
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What are the main excitatory and inhibitory neurotransmitters in the CNS?
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Excite: glutamate
Inhibit: GABA |
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ACh functions as ___ in the CNS
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neuromodulation
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Neuromodulating cholinergic neurons in the CNS are found mainly in ____ and ____
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pedunculopontine tegmental nuclei
laterodorsal tegmental nuclei |
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Cholinergic inputs to the thalamus mainly have a(n) ____ effect mediated indirectly by (excitatory/inhibitory) projections from the thalamus to the cortex.
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arousal
excitatory |
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Cholinergic inputs to the cortex mainly come from ___
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Basal forebrain (nucleus basalis of Meynert)
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The hippocampal theta rhythm plays a role in ____
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memory
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The main cholinergic receptor in the CNS is...
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muscarinic
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Neurons using dopamine are mainly in the
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ventral midbrain: substantia nigra pars compacta and ventral tegmental area
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Disorders of the nigrostriatal pathway results in
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movement disorders (ie Parkinson)
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The mesolimbic pathway uses ___ (neurotransmitter)
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dopamine
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Where are NE neurons located in the CNS?
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locus ceruleus
lateral tegmental area |
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In general, NE effects on the thalamus are
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excitatory
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NE neurons in the lateral tegmental area of the caudal pons/medulla are involved in
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Sympathetic functions, ie blood pressure
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Neurons containing serotonin are found in the ___
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raphe nuclei of the midbrain, pons, and medulla
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The rostral raphe nuclei use ___ (transmitter) and play a role in ___
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serotonin
psychiatric disorders |
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The caudal raphe nuclei use ___ (transmitter) and play a role in ___
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pain modulation, breathing, temperature regulation, motor control
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Histamine is found in the neurons of the ___
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posterior hypothalamus in the tuberomammillary nucleus
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Histamine has an ___ effect on thalamic neurons and ___ effect on cortical neurons.
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excitatory
both excitatory and inhibitory |
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Which neurotransmitter acts directly in the ventral horn of the spinal cord to inhibit tonic muscle activity during sleep?
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Glycine
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Which neurotransmitter acts directly on the glycine neuron in the brainstem to inhibit tonic muscle activity during sleep?
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Glutamate
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During non-REM sleep, ___ (neurotransmitter) neurons in the ___ inhibit neurons in the ascending activating systems.
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GABAergic
ventral lateral preoptic area of the anterior hypothalamus |
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Narcolepsy is associated with 4 clinical findings:
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excessive daytime sleepiness
cataplexy (lose muscle tone while awake) hypnagogic/hypnopompic dreamlike hallucinations sleep paralysis |
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What is coma?
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unarousable unresponsiveness in which the patient lies with the eyes closed, minimum duration of 1 hour
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Coma can be localized to 2 locations:
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bilateral widespread regions of cerebral hemispheres
upper brainstem-diencephalic activating systems |
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Brain death is confirmed with an EEG showing electrocerebral inactivity less than __ microvolts in amplitude
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2
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The primary deficit in akinetic mutism is ___
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motor intuition, not consciousness
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A coma caused by toxic and metabolic disorders results in ___ pupils.
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Normal
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A coma caused by midbrain lesions or transtentorial herniation results in ___ pupils.
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Unilateral/bilateral blown pupils
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A coma caused by a pontine lesion results in ___ pupils
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small, bilaterally responsive to light
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A coma caused by opiate OD results in ___ pupils
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pinpoint bilateral
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Who shouldn't get IV thiamine, dextrose, and naloxone when suspected of a coma?
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Infants. They shouldn't be given dextrose unless they're hypoglycemic.
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Which spinal segments control phrenic nerve efferents?
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C3-5
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Midbrain lesions cause what kind of breathing?
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central neurogenic hyperventilation
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Crescendo-decrescendo breathing is most likely caused by lesions where?
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Bilateral lesions at or above the upper pons
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Where are the presympathetic neurons that maintain normal BP found?
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Rostral ventrolateral medulla
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Name some behaviors that are heavily dependent on pontomedullary reticular formation circuits...
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cough, hiccup, sneeze, yawn, shiver, gag, barf, swallow, laugh, cry
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The chemotactic trigger zone is located in the ___ along the _____ of the 4th ventricle.
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area postrema
caudal lateral wall |
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Why can the area postrema trigger nausea and vomiting?
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Incomplete BBB allows endogenous substances and/or toxins to contact the area
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___ (neurotransmitter) release from stomach/SI cells also cause nausea/vomiting because this neurotransmitter stimulates afferents traveling with the vagus to reach the ___ in the brainstem.
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5-HT
nucleus solitarius |
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Modulation of pain transmission is mainly by the ___
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periaqueductal gray matter
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What is the last cervical vertebra through which the vertebral arteries ascend before piercing the dura to enter the foramen magnum?
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C2
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The basilar artery forms via the joining of the ___ arteries at the ___
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vertebral
pontomedullary junction |
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The medial medulla is supplied by which vessels?
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paramedian branches of the anterior spinal artery (caudal regions)
paramedians of the vertebral arteries (rostral regions) |
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The lateral medulla is supplied by...
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penetrating branches from the vertebral a and PICA
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the medial pons is supplied by
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paramedian branches of basilar a
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the lateral pons is supplied by
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circumferential branches of basilar a, but by the AICA in more caudal regions
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inner ear blood supply
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internal auditory labyrinth a (branch of AICA)
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rostral lateral pons blood supply
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small circumferential branches of basilar (lat pontine a)
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superior cerebellum blood supply
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Superior cerebellar a
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midbrain blood supply
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penetrating a of basilar and proximal Posterior cerebral a
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thalamus blood supply
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top of basilar and proximal PCA
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PCA supplies the
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thalamus, occipital lobe, midbrain
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In the midbrain, if you annihilate the proximal PCA, you will affect which structures?
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anterolateral system
RF descending SNS medial lemniscus red nucleus substantia nigra pyramidal tract (corticospinal/bulbar) |
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In the midbrain, if you decimate the paramedian branches at the top basilar a, which structures will you affect?
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CN 3 nucleus/fascicles
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In the rostral pons, if you eat the superior cerebellar artery, which structures will you affect?
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superior cerebellar peduncle
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In the rostral pons, if you dissect out the basilar artery's circumferential arteries, which structures will you affect?
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RF
descending SNS CN 5 middle cerebellar peduncle spinothalamic tract medial lemniscus |
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In the rostral pons, if you remove the basilar artery's paramedian branches and cook them in a large kettle, which structures will you affect?
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pyramidal tract (corticospinal/bulbar)
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In the caudal pons, if you take the AICA and circumferential a's of the basilar a and fry them with pancake batter, which structures will you affect?
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vestibular nuclei
CN 7 nucleus/fascicles Spinal trigem nucleus/tract middle cerebellar peduncle descending SNS anterolateral system |
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In the caudal pons, if you take a toothpick and pick out the paramedian branches of the basilar a, which structures will you affect?
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CN 6 nucleus
MLF pontine nuclei pyramidal tract (corticospinal/bulbar) |
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In the medulla, if you yank out the vertebral a and PICA, which structures will you affect?
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CN 8 nuclei
solitary tract/nucleus inferior cerebellar peduncle spinal trigeminal nucleus/tract CN 10 fascicles nucleus ambiguus descending SNS RF |
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In the medulla, if you cut the vertebral a's paramedian branches and the anterior spinal artery, dip them in butter, and pan fry them with some green onions, which structures will you affect?
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CN 12 nucleus/fascicle
medial lemniscus corticospinal (pyramidal tract) |
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Contralateral/one-sided/crossed sign symptoms are commonly more indicative of...
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brainstem involvement rather than cerebral
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Aphasia, hemineglect, hemianopia, and seizures indicate...
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hemispheric involvement rather than brainstem
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midbrain dysfunctions include...
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CN3 palsy, pupil dilation, ataxia, flexor posturing, impaired consciousness
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pons dysfunction....
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unilateral Babinski, weakness, perioral numbness, tingling face, bilateral upper or lower visual loss/blurring, irregular respirations, ocular bobbing, shivers, palatal myoclonus, abducens palsy, horizontal gaze palsy, small but reactive pupils
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medullary dysfunction...
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vertigo, ataxia, nystagmus, nausea, vomit, resp arrest, autonomic instability, hiccup
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How is thromboembolic disease caused by atrial fibrillation or mechanical cardiac valves treated?
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anticoagulation therapy
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How is embolic disease caused by vertebral dissection treated?
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anticoag
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How does atherosclerotic disease causing vertebral stenosis or basilar stenosis result in the brainstem?
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Waxing and waning signs that may be sensitive to changes in BP
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Why is vertebral or basilar thrombosis life threatening?
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potential widespread brainstem infarction
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When should tPA therapy be given?
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thrombosis events within 4.5 hours of onset
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After the window of tPA therapy, what should be given?
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antiplatelet agents like aspirin
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Lateral medullary syndrome (Wallenberg's syndrome) is caused by
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vertebral thrombosis (more common than PICA)
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Lat medullary syndrome/Wallenberg's affects which structure(s)?
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Inf cerebellar peduncle (ataxia, vertigo, nystagmus)
vestibular nuclei (vertigo, nausea) trigeminal nucleus/tract (ipsilateral face pain/temp) spinothalamic tract (contralateral body pain/temp) descending SNS (ipsilateral Horner's) nucleus ambiguus (hoarse/dysphagia) nucleus solitarius (ipsilateral taste) |
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Medial medullary syndrome is less common but you probably have to know it anyway. It's caused by...
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paramedian branches of vertebral and ant spinal a's
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Medial medullary syndrome affects...
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pyramidal tract (contralateral arm/leg weak)
medial lemniscus (contralateral proprio/vibration) CN12 (ipsilateral tongue weak) |
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Medial pontine basis only (no tegmentum effects) is caused by...
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paramedian branches of the basilar artery (ventral territory)
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Medial pontine basis only (no tegmentum effects) affects...
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corticospinal/bulbar (contralateral weakness/dysarthria)
pontine nuclei/pontocerebellar fibers (contralateral ataxia) |
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Medial pontine basis and tegmentum is caused by
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paramedian branches of the basilar artery (ventral and dorsal territory)
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Medial pontine basis and tegmentum affects...
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everything that is affected without the tegmentum plus...
facial colliculus (ipsilateral face weak, horizontal gaze palsy) abducens nucleus/pontine RF (ipsilateral horizontal gaze palsy) medial lemniscus (contralateral proprio/vibration) MLF (internuclear ophthalmoplegia) |
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Lateral caudal pons is caused by (2)
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AICA
labyrinthine a. |
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Lateral caudal pons causes...
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AICA: middle cerebellar peduncle (ipsilateral ataxia), vestibular nuclei (vertigo/nystagmus), trigem tract/nucleus (ipsilateral face pain/temp), spinothalamic tract (contralateral body pain/temp), descending SNS (ipsilateral Horner's)
Labyrinthian: inner ear (ipsilateral hearing loss) |
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Dorsolateral rostral pons is caused by...
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superior cerebellar a
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Dorsolateral rostral pons causes...
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superior cerebellar peduncle (ipsilateral ataxia)
lateral tegmental structures (like AICA) |
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AICA infarcts mainly affect...
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caudal lateral pons
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SCA infarcts mainly affect...
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superior cerebellum
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Midbrain basis is whack. What vasculature got pwned?
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branches of posterior cerebellar and the top of the basilar a
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Midbrain basis is whack. What structures are pwned?
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CN 3 fascicles (ipsilateral oculomotor palsy)
cerebral peduncle (brain feet = contralateral hemiparesis) |
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Midbrain tegmentum is whack. What vasculature got pwned?
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same as midbrain basis.
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Midbrain tegmentum is whack. What structures are screwed?
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CN 3 fascicles
red nucleus, superior cerebellar peduncle fibers (contralateral ataxia) |
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Midbrain basis and tegmentum is whack. What vasculature got pwned?
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same as midbrain basis and midbrain tegmentum
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Midbrain basis and tegmentum is whack. What structures got pwned?
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CN 3 fascicles
brain feet red nucleus, substantia nigra, superior cerebellar peduncle fibers (contralateral ataxia, tremor, involuntary movements) |
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When is pontine hemorrhage most commonly seen?
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chronic HTN
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