Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
95 Cards in this Set
- Front
- Back
|
Where does the corticospinal tract travel in the brainstem?
|
anterior and medial
|
|
|
Where does the spinothalamic tract travel in the brainstem?
|
laterally
|
|
|
Show a pic.
|
|
|
|
So do they often get lesioned together?
|
no, they are in completely different areas
|
|
|
How does the medial leminiscus run? deduce?
|
starts of MEDIAL at the lower medulla and then moves laterally
Starts at dorsal column nuclei and needs to go to VPL thalamus |
|
|
Show a pic of the spinothalamic (spinolemeniscal) and medial leminiscus paths.
|
|
|
|
What runs antoparralell to the spinothalamic tract?
|
descending hypothalamic autonomic axons.
|
|
|
So what sx would a lateral brainstem injury cause? structures involved?
|
spinothalamic- contralateral loss of crude touch, pain, and temp
descending hypothalamic- central ipsilateral horner's syndrome |
|
|
What nerves will definitely be lesioned in a brainstem injury?
|
cranial nerves!
|
|
|
What CN's would be lesioned in a medial brainstem injury?
|
CN 3, 4, 6. 12
pure motor nerves |
|
|
What CN's would be lesioned in a lateral brainstem injury?
|
CN 5, 7, 9, 8, 10, 11
All mixed nerves And 8 is sensroy |
|
|
What blood vessels supply the medial vs lateral medulla?
|
medial- anterior spinal artery
lateral- PICA (posterior inferior cerebral arteries) |
|
|
What blood vessels supply the medial vs lateral pons?
|
medial- pontine arteries off the basilar
lateral- AICA (caudal) SCA (cephalad) |
|
|
What is the theme for blood supply of the lateral lower brainstem?
|
They are innervated by the 3 major cerebellar arteries in the level they go out.
|
|
|
What is entire midbrain supplied by?
|
branches of the PCA on it's way back to the visual cortex
|
|
|
Besides CN's, what else will be lesioned anywhere along the BS?
|
a long tract
(leminiscus, hypothalamus, corticospinal) |
|
|
Long tract and CN lesions will both show signs, but which one is good for localizing the lesion?
|
only CN can localize it
|
|
|
What side is affected for each lesion? What is the exception?
|
all are contralateral except for the descending hypothalamic (horner's) and CN's (except for 4)
|
|
|
Which part of the midbrain most commonly gets vascular accidents? What vessel is this?
|
medial midbrain
the thalacoperforating branch of PCA |
|
|
What is lesioned in medial medullary syndrome?
|
pyrimidal tracts
medial leminiscus CN 12 |
|
|
Give the sx for each of these.
|
pyrimidal tracts- CL spastic weakness
medial leminiscus- CL loss of proprioception and fine touch CN 12- ipsilateral tongue deviation |
|
|
SHow the genioglossal muscle
|
|
|
|
What action does the genoglossal muscle do? How are the two positioned?
|
they are positioned a right angles to one another and pull the tongue out and make it bend to it's side
|
|
|
If you had a lesion of left CN 12, what tet would you run to confirm and what sx would you see? (3)
|
have the pt stick their tongue out
deviation to affected side fasiculations or atrophy (LMN lesion) |
|
|
This is a fav on the boards. Lateral medullary syndrome. What is another name for it? What vessel is involved?
|
Wallenburg syndrome. PICA
|
|
|
At the very least, what will be affected (runs lateral throughout medulla)
|
spinothalamic- contralateral loss of touch pain temp
|
|
|
WHat will be affected along with it?
|
descending hypothalamic
|
|
|
What CN can be affected?
|
9, 10, 11
|
|
|
What muscles do CN 9 and 10 control? (esp 10) (3)
What major actions do they control? |
palate
larynx pharynx swallowing and talking |
|
|
What sx would show up and is this commonly to blame of the vagus? give one for each muscle.
|
larynx- dysphonia (low voice)
pharynx- dysphagia (difficulty swallowing) palate- palate droop all ipsilateral and frequently implicate vagus deficits |
|
|
Which parts of 2 big nuclei like to stick themselves in the lateral medulla?
|
nuclei of CN 8- bottom part of diamond
spinal nuclei of CN 5 |
|
|
What sx would each produce?
|
8- vertigo, nystagmus away from lesion, vomiting
5- ipsilateral loss of pain and temp on face |
|
|
What tasty nucleus is also involved? sx?
|
NTS- loss of taste ipsilaterally or trouble regulating BP
|
|
|
Do you need to find all these signs? Which ones do you need?
|
You just need a long tract sign and a CN to localize it.
|
|
|
What is another name for ventral midbrain syndrome?
|
Weber's syndrome (which we will cover now)
|
|
|
What 3 things are affected in the ventral midbrain?
|
1. CST
2. Corticobulbar 3. CN 3 |
|
|
name all the muscles that CN III supplies
|
all extraoccular muscle except SO4 and LR3
upper eyelid muscle pupil contrictor/cilliary muscle |
|
|
So what sx will arise from a CN II lesion?
|
ipsilateral...
1. ptosis 2. pupil dilation 3. lateral strabismus (lazy eye) |
|
|
Give a pic of occulomotor palsy
|
|
|
|
What sx does each of these bring about?
1. CST 2. Corticobulbar 3. CN 3 |
1. CST - CL spastic weakness
2. Corticobulbar - CL spastic weakness of lower face 3. CN 3- ipsilateral CN 3 palsy |
|
What is the squiggly stuff? What is 8?
|
squiggly- olive
8- medial leminiscus (can see the plane now( |
|
|
What is diploplia?
|
double vision
|
|
|
Defin lacunar infarct
|
stroke of a small vessel in brain. (not IC, V, or the 3 CA's)
|
|
|
Where do the lacunaar infarct usually do damage?
|
basal ganglia (striate) and pons (parabasilar)
|
|
|
main cause of lacunar stroke?
|
prlonged HTN leading to lipohyalinosis
|
|
|
why hyalineosis?
|
just like arterioles elsewhere, brain small vessels don't get atherosclerosis
|
|
|
What else could cause a lacunar infarct? (controversial theories)
|
some argue they are just emboli
|
|
|
How much damage does a lacunar infarct do? What is the likelihood of getting more?
|
15mm of damage, but high chance of getting more since the HTN is prolonged and widespread
|
|
|
Show pic of lacunar infarct.
|
|
|
|
Is thrombosis or emolism more commonly the cause of stroke? mnemonic
|
thrombosis
most emboli become PE's |
|
|
What three conditions of the heart can give off emboli? Why?
|
CHF and MI
they both loweer EF and result in more blood at the end of systole, making stasis clots in the apex A fib also stasis |
|
|
does the embolus stay in one piece?
|
no, it breaks up into many pieces
|
|
|
Where do the stasis clots form?
|
in the wall of the heart
|
|
|
do you usually get thrombus detachment into emboli during a fib?
|
no, you get it after a fib when the force is more forceful
|
|
|
What is a microbiological explanation for brain emboli?
|
septicemia causing aerobic organisms to colonize the mitral valve leaflets
|
|
|
Why would particular organisms prefer the left heart?
|
more oxygen rich
|
|
|
What kind of stroke happens with global blood loss?
|
watershed
|
|
|
give some causes of watershed stroke.
|
narcotics overdose
septimcemia anaphylactic shock hemorrhage |
|
|
Show a watershed MRI damage
|
|
|
|
What are the two hemorrhagic causes of stroke?
|
intracerebral hemorrhage
subarachnoid hemorrhage |
|
|
Give some causes if ICH.
|
|
|
|
drug overdose?
|
cocaine and amphetamine
|
|
|
What IS an arteriovenous malformation?
|
dont have the regular order of smaller and more vast vessel
instead you have an artery going into a nidus and one big vein draining it |
|
|
show regular vessel progression
|
|
|
|
Show AVM.
|
|
|
|
What does nidus mean?
|
nest
|
|
|
What is dangerous about an AVm that makes it burst easily?
|
there is no gradual decrease of pressure so the blood flows FAST and HIGH PRESSURE throught the NIDUS.
|
|
|
Show an angiogram AVM.
|
|
|
|
How large will the hematoma get?
|
very large (till the pressure of the brain eqalizes it)
|
|
|
Where can the hematoma leak into?
|
ventricles or subarachnoid space.
|
|
|
Which vessels are subarachnoid and which are intraceerebral?
|
SA- circle of willis and the 3 CA's
Intracerebral- other smaller branched |
|
|
How dfoes a hematoma do damage? analogy?
|
ripping apart neurons it come accross
like a fire hose on a bowl of jello |
|
|
What % of aneurysms happen in the CoW?
|
85%
|
|
|
What are the risk factors for CoW aneurysm.
|
same as elsewhere
|
|
|
why estrogen deficiency? mnemonic
|
estrogen helps collagen
We get saggier skin at menopause |
|
|
Why do so many aneurysms happen in the CoW? Where is the most common?
|
there is high flow here (two arteries join)
junction of ACA and AcomA |
|
|
Show this most common berry aneurysm.
|
|
|
|
How quickly does bleeding last for SA hemorrhage?
|
couple seconds
|
|
|
What is the biggest risk of death in CoW aneurysm?
|
vasospasms that happen afterwards and cut off circulation to the head
|
|
|
When do vasospams happen?
|
within 3 days
|
|
|
Why do they happen?
|
rxn to breakdown of hemorrhaged blood
|
|
|
show a vasospasm related stroke
|
|
|
show what was lesioned and give answer from choices
|
dry face- lesion of descending hypothalamus
|
|
|
Which two nerves are involved in the blink reflex?
|
5 for sensory
7 for motor |
|
|
What is affected in Bell's palsy?
|
7th motor CN
|
|
|
what is another name for babinski's?
|
extensor plantar response (same as dorsiflexion and positive babinski's)
|
|
Where are we? What is answer?
|
in the pons
spastic weakness in CL limbs because it cuts off the CST |
|
|
What causes palate weakness
|
vagus lesion
|
|
|
What causes external strabismus? What is it?
|
the eye devitaed laterall and can't adduct.
CN 3 lesion. |
|
|
What causes tongue weakness?
|
CN12
|
|
give characteristics of this visual deficit. What is answer?
|
homonymous upper left quadrant blindness
right temporal lobe tumor |
|
|
Which characteristic eliminated pituitary adenoma?
|
homonymous
PA would be heterononymous |
|
|
what rules out the lingual gyrus lesion?
|
no macula sparing so it is not a visual cortex lesion
|
|
|
WHere is the lesion for all homonymous lesions?
|
contralateral
|
|
|
What eliminates optic tract lesion?
|
it would be half the visual field. (?)
|
