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326 Cards in this Set
- Front
- Back
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what 2 diseases is LMN lesions only due to destruction of anterior horns
flaccid paralysis |
poliomyelitis
Werdnig-Hoffman disease |
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mostly white matter of CERVICAL region
random and asymmetric lesions due to demyelination scanning speech intention tremor nystagmus |
MS
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combined UPPER and LOWER motor neuron deficits with NO sensory deficits
both upper and lower motor neuron signs |
ALS
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complete occlusion of anterior spinal artery
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spares the dorsal columns and tract of Lissauer
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degeneration of dorsal roots and dorsal columns
impaired proprioception locomotor ataxia |
tabes dorsalis
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crossing of fibers of spinothalamic tract damaged
bilateral loss of pain and temp sensation |
syringomyelia
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demyelination of DC, lateral CST, spinocerebellar tracts
ataxic gait, hyperreflexia, impaired position and vibration sense |
Vitamin B12 deficiency
Freidrich's ataxia |
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caused by virus transmitted fecal-oral
replicates on oropharynx and SI before spreading to blood stream leads to destruction of cells in ANTERIOR HORN of SC --> LMN destruction |
poliomyelitis
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symptoms of poliomyelitis
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malaise
headache fever nausea abdominal pain sore throat muscle weakness and atrophy fasciculations and fibrillation and hyporeflexia |
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CSF of poliomyelitis
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lymphocytic pleocytosis with slight elevation of protein
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AR present as FLOPPY BABY
tongue fasciculations die by 7 months associated with DEGENERATION OF ANTERIOR HORNS LMN involvement ONLY |
Werdnig-Hoffman
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BOTH LMN and UMN signs
no sensory, cognitive, oculomotor deficts caused by defect in superoxide dismutase 1 |
ALS
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degeneration of DC and DR due to tertiary syphilis --> impaired propioception and locomotor ataxia
associated with Charcot's joints shooting lighting pain Argyll Robertson pupils (reactive to accomodation but NOT TO LIGHT) absence of DTRs |
tabes dorsalis
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AR trinucleotide repeat disorder GAA, frataxin
leads to impairment in MITOCHONDRIAL FUNCTIONING staggering gait frequent falling nystagmus dysarthria hypertrophic cardiomyopathy kyphoscholiosis in childhood |
Freidrech's Ataxia
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hemisection of spinal cord
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Brown-Sequard
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sx of brown-sequard
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ipsilateral UMN signs
ipsilateral loss of tactile vibrations, proprioception sense below lesion contralateral pain and temp loss below lesion ipsilateral loss of all sensation at level of lesion LMN signs at level of lesion if lesion occurs above T1 --> Horner's syndrome |
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AR present as FLOPPY BABY
tongue fasciculations die by 7 months associated with DEGENERATION OF ANTERIOR HORNS LMN involvement ONLY |
Werdnig-Hoffman
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sx of horner's syndrome
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ptosis
anhidrosis miosis associated with lesions of SC above T1 |
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BOTH LMN and UMN signs
no sensory, cognitive, oculomotor deficts caused by defect in superoxide dismutase 1 |
ALS
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degeneration of DC and DR due to tertiary syphilis --> impaired propioception and locomotor ataxia
associated with Charcot's joints shooting lighting pain Argyll Robertson pupils (reactive to accomodation but NOT TO LIGHT) absence of DTRs |
tabes dorsalis
|
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AR trinucleotide repeat disorder GAA, frataxin
leads to impairment in MITOCHONDRIAL FUNCTIONING staggering gait frequent falling nystagmus dysarthria hypertrophic cardiomyopathy kyphoscholiosis in childhood |
Freidrech's Ataxia
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hemisection of spinal cord
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Brown-Sequard
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sx of brown-sequard
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ipsilateral UMN signs
ipsilateral loss of tactile vibrations, proprioception sense below lesion contralateral pain and temp loss below lesion ipsilateral loss of all sensation at level of lesion LMN signs at level of lesion if lesion occurs above T1 --> Horner's syndrome |
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sx of horner's syndrome
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ptosis
anhidrosis miosis associated with lesions of SC above T1 |
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posterior commissure interconnects
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pretectal nuclei --> mediating consensual pupillary light reflexes
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what receives retinal input via the brachium of SC?
projects to ipsilateral and contralateral Edinger-Westphal nucleus |
pretectal nucleus
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UMN lesion of Facial nerve results in
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contralateral weakness of lower face and spares forehead
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LMN lesion of facial nerve results in
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paralysis of facial muscles in both upper and lower face
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projects binaural auditory information to inferior collicular nucleus
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lateral leminiscus
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conducts auditory information from inferior collicular nucleus to medial geniculate
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brachium of inferior colliculus
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trochleat nucleus of CN 4 gives rise to GSE fibers which encircle periaqueductal gray matter, decussate in
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superior medullary velum
exist midbrain from its dorsal aspect to innervate SO muscle |
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what gives rise to GVE preganglionic parasympathetic fibers that terminate in the ciliary ganglion?
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Edinger-Westphal nucleus of CN3
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what contains vestibular fibers that coordinate eye movement?
interconnect the ocular motor cranial nerves |
MLF
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located in tegementum at level of CN3
receieves bilateral input from cerebral cortex receives contralateral input from cerebellar nuclei |
red nucleus
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what pathway?
serves as pain, temp, light touch pathway from face and oral cavity |
ventral trigeminal
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ventral trigeminal contains GSA fibers from what CN?
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CN7,9,10
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receive discriminative tactile and pressure from contralateral
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principal sensory nucleus of CN5
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VTT terminates in the ___ of thalamus
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VPM
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1st order neurons in VTT
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trigeminal ganglion
mediate pain and temperature sensation give rise to axons that descend in spinal trigeminal tract mediate light touch sensation and give rise to bifurcating axons that ascend and descend in spinal trigeminal nucleus |
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2nd order neurons of VTT located in
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spinal trigeminal nucleus
give rise to decussating axons that terminate in the VPM of the thalamus |
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3rd order neurons of VTT
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located in VPM nucleus
project via posterior limb of internal capsul to the face area of the postcentral gyrus 3,1,2 |
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dorsal trigeminothalamic tract subserves
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discriminative tactile and pressure sensation from face and oral cavity
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1st order neurons are
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trigeminal ganglion that synapse in the principal sensory nucleus of CN5
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2nd order neurons are
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principal sensory nucleus of CN5 project to ipsilateral VPM nucleus of thalamus
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3rd order neurons of DTT located in
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VPM nucleus
project via posterior limb of internal capsule to face area of postcentral gyrus areas 3,1,2 |
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located in the rostral pontine tegmentum
receives discriminative tactile input from face |
principal sensory nucleus
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located in spinal cord C1-C3, medulla, pons
receives pain and temp input from face and oral cavity projects via crossed VTT tract to VPM |
spinal trigeminal nucleus
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GSA proprioception
consists of large pseudouniplar neurons input from muscle spindles and pressure/joint receptors project to trigeminal motor nucleus to mediate muscle stretch (jaw jerk) reflex and regulate force of bite receives input from muscle of mastication and EO muscles, teeth and hard palate and TMJ |
mesencephalic nucleus
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located in rostral pontine tegementum at the level of principal sensory nucleus of CN5
innervates muscles of mastication receives bilateral corticobulbar input receives input from mesencephalic nucleus |
trigeminal motor nucleus
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jaw jerk reflex
monosynaptic myotatic reflex afferent and efferent limb? |
both V-3
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corneal reflex afferent and efferent limb?
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ophthalmic nerve V-1
facial nerve VII |
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3rd order neurons of DTT located in
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VPM nucleus
project via posterior limb of internal capsule to face area of postcentral gyrus areas 3,1,2 |
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recurrent paroxysms of sharp, stabbing pain in one or more branches of trigeminal nerve
can result from redundant loop of SCA impinging on trigeminal root |
trigeminal neuralgia
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located in the rostral pontine tegmentum
receives discriminative tactile input from face |
principal sensory nucleus
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what is the DOC for trigeminal neuralgia?
|
carbamazepine
or imipramine |
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located in spinal cord C1-C3, medulla, pons
receives pain and temp input from face and oral cavity projects via crossed VTT tract to VPM |
spinal trigeminal nucleus
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herpes zoster opthalamicus
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viral infection affecting opthalmic nerve
corneal ulceration with infection may result in blindness |
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GSA proprioception
consists of large pseudouniplar neurons input from muscle spindles and pressure/joint receptors project to trigeminal motor nucleus to mediate muscle stretch (jaw jerk) reflex and regulate force of bite receives input from muscle of mastication and EO muscles, teeth and hard palate and TMJ |
mesencephalic nucleus
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located in rostral pontine tegementum at the level of principal sensory nucleus of CN5
innervates muscles of mastication receives bilateral corticobulbar input receives input from mesencephalic nucleus |
trigeminal motor nucleus
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jaw jerk reflex
monosynaptic myotatic reflex afferent and efferent limb? |
both V-3
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corneal reflex afferent and efferent limb?
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ophthalmic nerve V-1
facial nerve VII |
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recurrent paroxysms of sharp, stabbing pain in one or more branches of trigeminal nerve
can result from redundant loop of SCA impinging on trigeminal root |
trigeminal neuralgia
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what is the DOC for trigeminal neuralgia?
|
carbamazepine
or imipramine |
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herpes zoster opthalamicus
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viral infection affecting opthalmic nerve
corneal ulceration with infection may result in blindness |
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results in miosis ptosis facial pain trgeminal palsy
lesions of trigeminal ganglion and sympathetic fibers may involve 3,4, 6 |
paratrigeminal syndrome
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extramedullary tumor of vestibulocochlear nerve that is found in cerebellopontine angle or internal acoustic meatus
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acoustic neuroma
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loss of sensation occurring in an onion-skin distribution
face is represented somatotopically as a number of semicircular territories fibers innervating mouth area terminate near obex fibers innervating back of head terminate in upper cervical levels |
central lesion of spinal trigeminal tract and nucleus
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acoustic neuroma results in
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unilateral tinnitus
unilateral hearing loss facial weakness and loss of corneal reflex loss of pain and temperature sensation and loss of corneal reflex |
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caused by aneurysm of cavernous sinus
involve CN 3,4,6, 5-1, 5-2, postganglionic sympathetic fibers of the orbit |
Cavernous sinus syndrome
destroy CN 3--> INO (parasympathetic paresis) interrupt of symp --> horner syndrome |
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lacrimal reflex involve afferent and efferent limb?
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afferent 5-1
efferent 7 |
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what branch of trigeminal innervates the external ear, EAM, tympanic membrane, lower lip, chin, posterior portion of temple, teeth of lower jaw
oral mucosa of cheeks, floor of mouth anterior 2/3 of tongue,TMJ and cranial dura? |
mandibular
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what part of ear?
conducts sound waves to tympanic membrane? |
outer ear: auricle and EAM
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what part serves as an amplified and impedance matching device
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middle ear
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middle ear receives sensory innervation from
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CN9
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tensor tympani is innerv by
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trigeminal
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stapedius is innerv by
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facial
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scala vestibuli contains
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perilymph
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scala vestibuli transmits traveling waves toward
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helicotrema, scala tympani, round window
traveling waves extend to potion of basilar membrane that has same resonant frequency through basilar membrane and via scala tympani to round window |
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what contains the organ of Corti
and endolymph |
cochear duct (scala media)
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basilar membrane separates the cochlear duct from scala tympani
has ptch localization along its length apex ____ base ____ |
apex low frequency 20 hz
base high frequency 20,000 hz |
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spiral ganglion of CN8 is located in
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bony modiolus of cochlea
consists of bipolar neurons of cochlear division of vestibulocochlear nerve CN8 |
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IHC synapse with
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numerous afferent fibers
makes contact with one hair cell majority of dibers in chochlear nerve come from IHC |
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OHC synapse with afferent fibers that contact numerous OHCs
-outnumber inner hair cells |
3:1
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superior olive is located in the
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Pons at the level of the facial nucleus
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SO projects bilaterally to
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lateral leminiscus
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SO plays a role in
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sound localization and binaural processing
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basilar membrane separates the cochlear duct from scala tympani
has ptch localization along its length apex ____ base ____ |
apex low frequency 20 hz
base high frequency 20,000 hz |
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causes of conduction deafness
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obstruction by wave (Cerumen) or foreign body
otosclerosis - neogenesis of labyrinthine spongy bone around the oval windoe most frequent cause of progressive conduction deafness inflammation of middle ear --> otitis media |
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spiral ganglion of CN8 is located in
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bony modiolus of cochlea
consists of bipolar neurons of cochlear division of vestibulocochlear nerve CN8 |
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nerve deafness causes
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1. Presbycusis - hearing loss with aging; degeneration of the organ of Corti
2. acoustic neuroma - internal auditory meatus or in Cerebellopontine angle unilateral deafness and tinnitus |
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IHC synapse with
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numerous afferent fibers
makes contact with one hair cell majority of dibers in chochlear nerve come from IHC |
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in unilateral conduction deafness, Rinne test shows
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pt fails to hear vibrations in air AFTER bone conduction
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OHC synapse with afferent fibers that contact numerous OHCs
-outnumber inner hair cells |
3:1
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basilar membrane separates the cochlear duct from scala tympani
has ptch localization along its length apex ____ base ____ |
apex low frequency 20 hz
base high frequency 20,000 hz |
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superior olive is located in the
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Pons at the level of the facial nucleus
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spiral ganglion of CN8 is located in
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bony modiolus of cochlea
consists of bipolar neurons of cochlear division of vestibulocochlear nerve CN8 |
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IHC synapse with
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numerous afferent fibers
makes contact with one hair cell majority of dibers in chochlear nerve come from IHC |
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SO projects bilaterally to
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lateral leminiscus
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OHC synapse with afferent fibers that contact numerous OHCs
-outnumber inner hair cells |
3:1
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SO plays a role in
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sound localization and binaural processing
|
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causes of conduction deafness
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obstruction by wave (Cerumen) or foreign body
otosclerosis - neogenesis of labyrinthine spongy bone around the oval windoe most frequent cause of progressive conduction deafness inflammation of middle ear --> otitis media |
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superior olive is located in the
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Pons at the level of the facial nucleus
|
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nerve deafness causes
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1. Presbycusis - hearing loss with aging; degeneration of the organ of Corti
2. acoustic neuroma - internal auditory meatus or in Cerebellopontine angle unilateral deafness and tinnitus |
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SO projects bilaterally to
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lateral leminiscus
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in unilateral conduction deafness, Rinne test shows
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pt fails to hear vibrations in air AFTER bone conduction
|
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SO plays a role in
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sound localization and binaural processing
|
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causes of conduction deafness
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obstruction by wave (Cerumen) or foreign body
otosclerosis - neogenesis of labyrinthine spongy bone around the oval windoe most frequent cause of progressive conduction deafness inflammation of middle ear --> otitis media |
|
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nerve deafness causes
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1. Presbycusis - hearing loss with aging; degeneration of the organ of Corti
2. acoustic neuroma - internal auditory meatus or in Cerebellopontine angle unilateral deafness and tinnitus |
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in unilateral conduction deafness, Rinne test shows
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pt fails to hear vibrations in air AFTER bone conduction
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Doll's head eye phenomenon (oculocephalic reflex)
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intact brainstem/vestibular nuclei when eyes move conjugately in opp direction
doll's head eye fixed when lesion in vestibular nuclei and MLFs |
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normal caloric nystagmus
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cold water-nystagmus to opposite side and pastpointing to same side
hot water - nystagmus to same side and past pointing to opposite side |
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comatose subjects' caloric nystagmus
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no nystagmus
brainstem intact--> eye deviate to side of cold irrigation bilateral MLF transection, abducted eye deviates to side of cold lower brainstem damage to vestibular nuclei, eye do not deviate |
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decerebrate posturing
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transect brainstem between red nucleus and vestibular nuclei
results from tonic activity of pontine reticular formation and lateral vestibular nucleus extension, adduction, hyperpronationg, extension of feet with plantar flexion |
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decorticate rigidity results from
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lesions of internal capsule or cerebral hemisphere
characterized by motor pattern that is typical of chronic spastic hemiplegia known as bilateral spastic hemiplegia |
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sensation of irregular whirling
illusion of mvmt |
vertigo
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inner ear disease
increase in endolymphatic fluid pressure vertigo, tinnitus, hearing loss, nausea, vomiting, sensation of fullness, and pressure in ear |
Meniere's disease
characterized by presence of horizontal nystagmus |
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inflammation of labyrinth
due to bacterial, viral, toxic causes symptoms like meniere's |
labyrinthitis
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unilateral labrynthectomy
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predominantly horizontal nystagmus directed to opposite side
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bilateral simultaneous labyrinthectomy
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no nystagmus
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most common cause of recurrent vertigo
elicited by certain head positions paroxysms of vertigo is accompanied by nystagmus not associated with heading loss or tinnitus |
benign positional vertigo
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consists of MR paresis on attempted lateral gaze
associated w/ monocular horizontal nystagmus result of demyelinating plaque most commonly seen in MS |
MLF syndrome
INO **MEDIAL RECTUS PARESIS on lateral Gaze!! |
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most common cause of recurrent vertigo
elicited by certain head positions paroxysms of vertigo is accompanied by nystagmus not associated with heading loss or tinnitus |
benign positional vertigo
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consists of MR paresis on attempted lateral gaze
associated w/ monocular horizontal nystagmus result of demyelinating plaque most commonly seen in MS |
MLF syndrome
INO **MEDIAL RECTUS PARESIS on lateral Gaze!! |
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where is the lesion?
headaches inability to walk loss of hearing on right side tinnitus vertigo nausea widebased ataxic gait dysphagia facial weakness on right side sensory loss over face on right side absent gag reflex diplopia |
CP angle
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where is the lesion?
headaches inability to walk loss of hearing on right side tinnitus vertigo nausea widebased ataxic gait dysphagia facial weakness on right side sensory loss over face on right side absent gag reflex diplopia |
CP angle
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where is the lesion?
headaches inability to walk loss of hearing on right side tinnitus vertigo nausea widebased ataxic gait dysphagia facial weakness on right side sensory loss over face on right side absent gag reflex diplopia |
CP angle
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tilting the head forward would maximally stimulate
|
macula of utricle
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tilting the head forward would maximally stimulate
|
macula of utricle
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tilting the head forward would maximally stimulate
|
macula of utricle
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elevated 30 degrees from horizontal
cold water injected in left EAM if brainstem is intact, what happens? |
deviation of eyes to the left
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elevated 30 degrees from horizontal
cold water injected in left EAM if brainstem is intact, what happens? |
deviation of eyes to the left
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elevated 30 degrees from horizontal
cold water injected in left EAM if brainstem is intact, what happens? |
deviation of eyes to the left
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cause of symptoms of CN5,7,8
|
acoustic schwannoma impinges on cranial nerves resulting in loss of ipsilateral face and loss of corneal reflex
CN7 lesions result in lower motor neuron paralysis *ipsilateral muscles of facial expression), loss of corneal reflex CN8 leads to loss of hearing, nystagmus, vertigo, tinnitus, nausea, vomiting |
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cause of symptoms of CN5,7,8
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acoustic schwannoma impinges on cranial nerves resulting in loss of ipsilateral face and loss of corneal reflex
CN7 lesions result in lower motor neuron paralysis *ipsilateral muscles of facial expression), loss of corneal reflex CN8 leads to loss of hearing, nystagmus, vertigo, tinnitus, nausea, vomiting |
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cause of symptoms of CN5,7,8
|
acoustic schwannoma impinges on cranial nerves resulting in loss of ipsilateral face and loss of corneal reflex
CN7 lesions result in lower motor neuron paralysis *ipsilateral muscles of facial expression), loss of corneal reflex CN8 leads to loss of hearing, nystagmus, vertigo, tinnitus, nausea, vomiting |
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cupriolithiasis in benign positional vertigo
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dislocation of otoliths that move freely with mvmt of head
|
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cupriolithiasis in benign positional vertigo
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dislocation of otoliths that move freely with mvmt of head
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cupriolithiasis in benign positional vertigo
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dislocation of otoliths that move freely with mvmt of head
|
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consists of medial rectus palsy on attempted lateral gaze
nystagmus in abducting eye is evidence convergence is intact |
MLF syndrome
|
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consists of medial rectus palsy on attempted lateral gaze
nystagmus in abducting eye is evidence convergence is intact |
MLF syndrome
|
|
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consists of medial rectus palsy on attempted lateral gaze
nystagmus in abducting eye is evidence convergence is intact |
MLF syndrome
|
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CNI damage results in
|
anosmia often due to fracture of ethmoid bone
|
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CNI damage results in
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anosmia often due to fracture of ethmoid bone
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CNI damage results in
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anosmia often due to fracture of ethmoid bone
|
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CN 2 is not a true peripheral nerve but a tract of
|
diencephalon
lies within subarachnoid space enters the skull via the optic canal myelinated by oligodendrocytes axons that contain via optic chiasm and optic tracts to lateral geniculate body |
|
|
CN 2 is not a true peripheral nerve but a tract of
|
diencephalon
lies within subarachnoid space enters the skull via the optic canal myelinated by oligodendrocytes axons that contain via optic chiasm and optic tracts to lateral geniculate body |
|
|
CN 2 is not a true peripheral nerve but a tract of
|
diencephalon
lies within subarachnoid space enters the skull via the optic canal myelinated by oligodendrocytes axons that contain via optic chiasm and optic tracts to lateral geniculate body |
|
|
ipsilateral blindness and loss of direct pupillary light reflex due to
|
regeneration of optic nerve
|
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ipsilateral blindness and loss of direct pupillary light reflex due to
|
regeneration of optic nerve
|
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ipsilateral blindness and loss of direct pupillary light reflex due to
|
regeneration of optic nerve
|
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when it is subjected to increased ICP,
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papilledema--> choked optic disk
|
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when it is subjected to increased ICP,
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papilledema--> choked optic disk
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when it is subjected to increased ICP,
|
papilledema--> choked optic disk
|
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CN III functions
|
pure motor
moves eye constrict pupil accomodates converges |
|
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edinger-westphal nucleus
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project to ciliary ganglion of orbit via CNIII
|
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ciliary ganglion
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project postganglionic parasympathetic fibers to sphincter muscle of iris and to ciliary muscle (accomodation)
|
|
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oculomotor paralysis
|
frequently due to transtentorial herniation
results in diplopia ptosis look down and out dilated and fixed pupil and paralysis of accomodation |
|
|
causes of CN3 impairment
|
uncal herniation
aneurysm DM oculomotor palsy due to damage to central fibers and sparing pupilloconstrictor fibers |
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CN7 mediates
|
facial mvmts taste salivation lacrimation
2nd pharyngela arch |
|
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CN III functions
|
pure motor
moves eye constrict pupil accomodates converges |
|
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GSA component of CN7
|
cell bodies in geniculate ganglion
innerv posterior surface of external ear projects centrally to spinal trigeminal tract and nucleus |
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edinger-westphal nucleus
|
project to ciliary ganglion of orbit via CNIII
|
|
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SVA of CN7
|
geniculate ganglion
projects to solitary nucleus and tract innerv taste buds from anterior 2/3 of tongue |
|
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ciliary ganglion
|
project postganglionic parasympathetic fibers to sphincter muscle of iris and to ciliary muscle (accomodation)
|
|
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GVE of CN7
|
lacrimal
submandibular, sublingual glands |
|
|
oculomotor paralysis
|
frequently due to transtentorial herniation
results in diplopia ptosis look down and out dilated and fixed pupil and paralysis of accomodation |
|
|
loss of general sensation from face and mucous membranes of oral and nasal cavities
what CN? |
5
|
|
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causes of CN3 impairment
|
uncal herniation
aneurysm DM oculomotor palsy due to damage to central fibers and sparing pupilloconstrictor fibers |
|
|
CN7 mediates
|
facial mvmts taste salivation lacrimation
2nd pharyngela arch |
|
|
GSA component of CN7
|
cell bodies in geniculate ganglion
innerv posterior surface of external ear projects centrally to spinal trigeminal tract and nucleus |
|
|
SVA of CN7
|
geniculate ganglion
projects to solitary nucleus and tract innerv taste buds from anterior 2/3 of tongue |
|
|
GVE of CN7
|
lacrimal
submandibular, sublingual glands |
|
|
loss of general sensation from face and mucous membranes of oral and nasal cavities
what CN? |
5
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flaccid paralysis of muscles of mastication
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V
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deviation of jaw to weak side
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V
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paralysis of tensor tympani
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V
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convergent strabismus (esotropia) inability to abduct eye bc of unopposed action of medial rectus
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VI
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horizontal diplopia - maximum separation of double images when looking toward paretic lateral rectus muscle
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VI
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Bell palsy
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CN7
trauma to facial canal LMN lesion |
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lose taste of anterior 2/3 of tongue
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7th
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lesions of vestibular nerve causes
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disequilibrium
nystagmus vertigo |
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lesion of cochlear nerve causes
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hearing loss
tinnitus |
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afferent limb of gag reflex
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CN9
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lose carotid sinus reflex
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CN9
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lose carotid sinue reflex
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CN9
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lose taste from posterior third of tongue
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CN9
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SVE component of stylopharyngeus muscle
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arises from nucleus ambiguus of lateral medulla
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vagus mediates
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phonation
swallowing elevation of palate taste viscera of neck, thorax, abdomen |
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lose carotid sinus reflex
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CN9
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lesion of vagus causes
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ipsilateral paralysis of soft palate pharynx larynx dysphonia
loss of gag (efferent) anesthesia of pharynx and larynx aortic aneurysms and tumors of neck and thorax frequently compress vagus |
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lose carotid sinue reflex
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CN9
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lesion of CN11
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paralysis of SCM (difficulty turning head to opposite side of lesion), trap (ipsilateral shoulder droop)
paralysis of larynx |
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lose taste from posterior third of tongue
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CN9
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CN12 lesion causes
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hemiparalysis of tongue
when protruded points toward weak side due to unopposed action lack wounds if LMN |
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SVE component of stylopharyngeus muscle
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arises from nucleus ambiguus of lateral medulla
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vertical diplopia
unsure when descending stairs eliminate double vision by tilting his chin to paretic side |
superior oblique
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vagus mediates
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phonation
swallowing elevation of palate taste viscera of neck, thorax, abdomen |
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anosmia results from damage of
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CN1
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lesion of vagus causes
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ipsilateral paralysis of soft palate pharynx larynx dysphonia
loss of gag (efferent) anesthesia of pharynx and larynx aortic aneurysms and tumors of neck and thorax frequently compress vagus |
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lesion of CN11
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paralysis of SCM (difficulty turning head to opposite side of lesion), trap (ipsilateral shoulder droop)
paralysis of larynx |
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CN12 lesion causes
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hemiparalysis of tongue
when protruded points toward weak side due to unopposed action lack wounds if LMN |
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vertical diplopia
unsure when descending stairs eliminate double vision by tilting his chin to paretic side |
superior oblique
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anosmia results from damage of
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CN1
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severe pain in ear and throat
episodic pain triggered by swallowing, chewing, coughing, laughing loss of gag reflex analgesia of tongue dysphagia |
CN9
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cranial nerve's fibers are myelinated by oligos
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CN2
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difficulty in turning head away from side of neck that is injured
visible shoulder droop |
CN11
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innervates parotid gland
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CN9
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efferent limb of corneal reflex
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CN7
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efferent limb of gag reflex
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CN10
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innervates infratentorial dura
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CN10
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severe pain in ear and throat
episodic pain triggered by swallowing, chewing, coughing, laughing loss of gag reflex analgesia of tongue dysphagia |
CN9
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pure motor nerve
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CN11
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cranial nerve's fibers are myelinated by oligos
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CN2
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branch of maxillary artery
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foramen spinosum
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difficulty in turning head away from side of neck that is injured
visible shoulder droop |
CN11
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innervates buccinator
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CN7 muscle of facial expression
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innervates parotid gland
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CN9
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severe pain in ear and throat
episodic pain triggered by swallowing, chewing, coughing, laughing loss of gag reflex analgesia of tongue dysphagia |
CN9
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efferent limb of corneal reflex
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CN7
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efferent limb of gag reflex
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CN10
|
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cranial nerve's fibers are myelinated by oligos
|
CN2
|
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innervates infratentorial dura
|
CN10
|
|
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difficulty in turning head away from side of neck that is injured
visible shoulder droop |
CN11
|
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pure motor nerve
|
CN11
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innervates parotid gland
|
CN9
|
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efferent limb of corneal reflex
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CN7
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branch of maxillary artery
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foramen spinosum
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efferent limb of gag reflex
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CN10
|
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innervates buccinator
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CN7 muscle of facial expression
|
|
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innervates infratentorial dura
|
CN10
|
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pure motor nerve
|
CN11
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branch of maxillary artery
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foramen spinosum
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innervates buccinator
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CN7 muscle of facial expression
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maxillary nerve goes through
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foramen rotundum
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nerve that projects to otic ganglion
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lesser petrosal nerve of CN9 passes through innominate canal to synapse with postganglionic neurons of otic ganglion
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Cn3,4,6,5-1 pass through
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superior orbital fissure
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what syndrome and what infarction?
contralateral hemiparesis of trunk and extremities contralateral loss of proprioception, distiminative tactile sensation and vibration sensation from trunk and extremities hypoglossal nerve roots -ispilateral flaccid paralysis of tongue |
medial medullary
occlusion of anterior spinal artery |
|
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what syndrome? what infarct?
vestibular nuclei: nystagmus, nausea, vomiting, vertigo ICP: ipsilateral cerebllar signs Nucleus ambiguus of CN9, 10, 11 CN9: loss of gag vagus nerve roots: lesion of nucleus ambiguus spinthalamic: contralateral loss of pain and temp spinal trigeminal nucleus and tract: isilateral loss of pain and temp sensation from face descending symp: ipsilateral horner syndrome |
Wallerian (lateral medullary) syndrome
PICA |
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maxillary nerve goes through
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foramen rotundum
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results from occlusion from paramedian br of basilar artery
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Medial inferior pontine syndrome
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nerve that projects to otic ganglion
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lesser petrosal nerve of CN9 passes through innominate canal to synapse with postganglionic neurons of otic ganglion
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sx of medial inferior pontine syndrome
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abducent nerve roots: ispilateral lateral rectus paralysis
CBT: weakness of lower face CST: contralateral hemiparesis of trunk and extremities base of pons: ipsilateral limb and gait ataxia medial leminiscus: contralateral loss of proprioception, discriminative tactile sensation, vibration sensation from trunk and extremities |
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Cn3,4,6,5-1 pass through
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superior orbital fissure
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ipsilateral facial paralysis
loss of taste from anterior 2/4 loss of corneal and stapedial reflexes unilateral deafness nystagmus nausea, vomiting, vertigo Spinal trigeminal nucleus and tract MCP ICP STT: loss of pain and temp sensation from trunk and extremitis ispilateral horners |
AICA
lateral inferior pontine syndrome |
|
|
what syndrome and what infarction?
contralateral hemiparesis of trunk and extremities contralateral loss of proprioception, distiminative tactile sensation and vibration sensation from trunk and extremities hypoglossal nerve roots -ispilateral flaccid paralysis of tongue |
medial medullary
occlusion of anterior spinal artery |
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lateral superior pontine syndrome caused by what infarct?
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SCA
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what syndrome? what infarct?
vestibular nuclei: nystagmus, nausea, vomiting, vertigo ICP: ipsilateral cerebllar signs Nucleus ambiguus of CN9, 10, 11 CN9: loss of gag vagus nerve roots: lesion of nucleus ambiguus spinthalamic: contralateral loss of pain and temp spinal trigeminal nucleus and tract: isilateral loss of pain and temp sensation from face descending symp: ipsilateral horner syndrome |
Wallerian (lateral medullary) syndrome
PICA |
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infarction of base of superior pons
infarct CST, CBT resulting in quadriplegia |
locked-in syndrome
may result from central pontine myelinolysis |
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results from occlusion from paramedian br of basilar artery
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Medial inferior pontine syndrome
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sx of medial inferior pontine syndrome
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abducent nerve roots: ispilateral lateral rectus paralysis
CBT: weakness of lower face CST: contralateral hemiparesis of trunk and extremities base of pons: ipsilateral limb and gait ataxia medial leminiscus: contralateral loss of proprioception, discriminative tactile sensation, vibration sensation from trunk and extremities |
|
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ipsilateral facial paralysis
loss of taste from anterior 2/4 loss of corneal and stapedial reflexes unilateral deafness nystagmus nausea, vomiting, vertigo Spinal trigeminal nucleus and tract MCP ICP STT: loss of pain and temp sensation from trunk and extremitis ispilateral horners |
AICA
lateral inferior pontine syndrome |
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lateral superior pontine syndrome caused by what infarct?
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SCA
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|
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infarction of base of superior pons
infarct CST, CBT resulting in quadriplegia |
locked-in syndrome
may result from central pontine myelinolysis |
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medial midbrain syndrome-infarct of
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PCA and aneurysms of circle of Willis
occulomotor nerve roots corticobulbar tracts corticospinal tracts |
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paramedian midbrain syndrome
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occlusion or hemorrhage of paramedian midbrain branches of PCA
CN3, red nucleus, medial leminiscus |
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dorsal midbrain syndrome (parinaud) is caused by
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pinealoma or germimoma of pineal region
Superior colliculus and pretectal area --> paralysis of upward and downward gaze, pupillary disturbances, absence of convergence cerebral aqueduct --> noncommunicating hydrocephalus |
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INO
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frequent sign of MS
medial rectus palsy on attempted lateral gaze and monocular nystagmus normal convergence |
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lesion of abducens nucleus result in
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MLF signs and lateral recut paralysis with internal strabismus
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medial midbrain syndrome-infarct of
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PCA and aneurysms of circle of Willis
occulomotor nerve roots corticobulbar tracts corticospinal tracts |
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16 yo short with bullet in head
lodged in left medullary pyramid |
ontains the uncrossed CST
causes spastic paresis on right side with all pyramidal signs |
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paramedian midbrain syndrome
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occlusion or hemorrhage of paramedian midbrain branches of PCA
CN3, red nucleus, medial leminiscus |
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lateral strabisumus exotropia is seen in
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midbrain
|
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dorsal midbrain syndrome (parinaud) is caused by
|
pinealoma or germimoma of pineal region
Superior colliculus and pretectal area --> paralysis of upward and downward gaze, pupillary disturbances, absence of convergence cerebral aqueduct --> noncommunicating hydrocephalus |
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right arm and leg dystaxia, nystagmus, hoaresness,miosis, ptosis on right
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lateral medullary (wallerian)
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INO
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frequent sign of MS
medial rectus palsy on attempted lateral gaze and monocular nystagmus normal convergence |
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miosis, ptosis, hemianhidrosis on left
laryngeal and palatal paralysis left side facial anesthesia left side loss of pain and temp sensation from trunk and extremities on right |
Wallerian lateral medullary
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lesion of abducens nucleus result in
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MLF signs and lateral recut paralysis with internal strabismus
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severe ptosis
eye looks down and out right side fixed dilated pupil right side spastic hemiparesis left side lower facial weakness on left side |
rostral midbrain medial basis pedunculi right side
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16 yo short with bullet in head
lodged in left medullary pyramid |
ontains the uncrossed CST
causes spastic paresis on right side with all pyramidal signs |
|
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lateral strabisumus exotropia is seen in
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midbrain
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right arm and leg dystaxia, nystagmus, hoaresness,miosis, ptosis on right
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lateral medullary (wallerian)
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miosis, ptosis, hemianhidrosis on left
laryngeal and palatal paralysis left side facial anesthesia left side loss of pain and temp sensation from trunk and extremities on right |
Wallerian lateral medullary
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severe ptosis
eye looks down and out right side fixed dilated pupil right side spastic hemiparesis left side lower facial weakness on left side |
rostral midbrain medial basis pedunculi right side
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6th nerve palsy right side
facial weakness left side hemiparesis left side limb and gait dystaxia right side |
caudal pontine base
median zone right side |
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paralysis of upward and downward gaze
absence of convergence absence of pupillary reaction to light |
CNIII lesion rostral midbrain
Pineal gland tumor |
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ptosis,miosis, anhydrosis on left
loss of vibration sensation in Right leg loss of pain and temp from trunk extremities and face right side severe dystaxia, intention tremor, left arm |
lateral superior pontine syndrome
interrupt descending sympathetic pathway to cilipspinal center of budge |
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what caused the severe dystaxia, intention tremor in left arm?
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SCP lesion
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6th nerve palsy right side
facial weakness left side hemiparesis left side limb and gait dystaxia right side |
caudal pontine base
median zone right side |
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weakness of pterygoid and masseter muscles -left side
corneal reflex absent left side facial hemianesthesia left side |
5th nerve! midpontine tegmentum lateral zone left side
|
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paralysis of upward and downward gaze
absence of convergence absence of pupillary reaction to light |
CNIII lesion rostral midbrain
Pineal gland tumor |
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loss of stapedius reflex
loss of corneal reflex inability to purse lips loss of taste sensation on apex of tongue |
7th nerve loss
caudal lateral pontine tegmentum |
|
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ptosis,miosis, anhydrosis on left
loss of vibration sensation in Right leg loss of pain and temp from trunk extremities and face right side severe dystaxia, intention tremor, left arm |
lateral superior pontine syndrome
interrupt descending sympathetic pathway to cilipspinal center of budge |
|
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paramedian infarction of base of pons involves
|
corticospinal pyramidal cortiboculbar corticopontine tracts pontine nuclei transverse pontine fibers
|
|
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what caused the severe dystaxia, intention tremor in left arm?
|
SCP lesion
|
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weakness of pterygoid and masseter muscles -left side
corneal reflex absent left side facial hemianesthesia left side |
5th nerve! midpontine tegmentum lateral zone left side
|
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loss of stapedius reflex
loss of corneal reflex inability to purse lips loss of taste sensation on apex of tongue |
7th nerve loss
caudal lateral pontine tegmentum |
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paramedian infarction of base of pons involves
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corticospinal pyramidal cortiboculbar corticopontine tracts pontine nuclei transverse pontine fibers
|
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anterior lobe of cerebellum
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regulates muscle tone
|
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posterior lobe of cerebellum
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coordinate voluntary motor activity
|
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flocculonodular lobe
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receives input from vestibular system
plays a role in maintenance of posture and balance |
|
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median (vermal) zone of hemisphere projects to
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fastigial nucleus
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paramedian zone projects to
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interposed nuclei (emboliform and globose nuclei)
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lateral zone of hemisphere projects to
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dentate
|
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molecular layer of the cerebellum contain
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parallel fibers
arborization of purkinje stallate and basket underlies pia mater |
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purkinje layer
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between molecular and granular
|
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granule cell layer
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granule cells
golgi cells cerebellar glomeruli |
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only output for cerebellar cortex
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Purkinje cell
projects inhibitory output to cerebellar and vestibular nuclei excited by parallel and climbing fibers inhibited by GABA by basket and stellate cells |
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excited Purkinje, basket, stellate, and Golgi cells via parallel fibers
inhibited by golgi cells excited by mossy fibers |
Granule cells
|
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mossy fibers
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afferent excitatory fibers of spinocerebellar and pontocerebellar tracts
terminate as mossy fiber rosettes on granule cells excite granule cells to discharge via parellel fibers |
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climbing fibers
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afferent excitatory fibers of olivocerebellar tract
terminate on neurons of cerebellar nuclei and dendrites of pirkinje |
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what pathway plays a role in maintenance of posture, balance and coordination of eye movements
|
vestibulocerebellar pathway
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vestibulocerebellar pathway: receives its major input from vestibular receptors of kinetic and static labrynths
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maintain muscle tone and postural control over truncal and proximal muscles
|
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receives spinocerebellar and labrynthine input
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vermis
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vermis projects to
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fastigial nucleus
|
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vermal spinocerebellar pathway
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vermis --> fastigial nucleus --> ventral lateral nucleus of thalamus --> precentral gyrus
|
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what pathway maintains muscle tone and postural control over DISTAL muscle groups?
|
paravermal spinocerebellar pathway
paravermis--> interposed nuclei (emboliform and globose) |
|
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vermis projects to
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fastigial nucleus
|
|
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vermal spinocerebellar pathway
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vermis --> fastigial nucleus --> ventral lateral nucleus of thalamus --> precentral gyrus
|
|
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what pathway maintains muscle tone and postural control over DISTAL muscle groups?
|
paravermal spinocerebellar pathway
paravermis--> interposed nuclei (emboliform and globose) |
|
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inferior olive receives direct input from
|
dentate nucleus via SCP
|
|
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inferior olivary nucleus projects directly to dentate via
|
ICP
|
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pontocerebellar pathway
|
cerebellar hemisphere--> purkinje of dentate --> SCP --> contralateral Red nucleus --> inferior olivary nucleus --> contralateral ICP to cerebellum
|
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inferior olive receives direct input from
|
dentate nucleus via SCP
|
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inferior olivary nucleus projects directly to dentate via
|
ICP
|
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pontocerebellar pathway
|
cerebellar hemisphere--> purkinje of dentate --> SCP --> contralateral Red nucleus --> inferior olivary nucleus --> contralateral ICP to cerebellum
|
|
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cerebellar dysfunction
|
hypotonia
disequilibrium dyssynergia |
|
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hypotonia
|
loss of resistance normally offered by muscles to palpation or to passive manipulation
floppy ragdoll appearance |
|
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dyssynergia
|
loss of coordinated muscle activity
dysarthria dystaxia dysmetria inability to arrest muscular mvmt intention tremor dysdiadochokinesia - inability to perform rapid alternative mvmts nystagmus decomposition of mcmts rebound or lack of check - inability to adjust to changes in muscle changes loss of cerebellar component of stretch reflex |
|
|
cerebello-olivary degeneration
|
autosomal dominant mode of inheritance
loss of purkinje and granule cells gait ataxia, dysarthria, intention tremor |
|
|
olivopontocerebellar degeneration
|
AD
loss of purkinje, neurons of inferior olivary nucleus, neurons in pontine nuclei demyelination of dorsal columns and spinocerebellar tracts loss of SN and bG parkinsonian signs |
|
|
cerebello-olivary degeneration
|
autosomal dominant mode of inheritance
loss of purkinje and granule cells gait ataxia, dysarthria, intention tremor |
|
|
olivopontocerebellar degeneration
|
AD
loss of purkinje, neurons of inferior olivary nucleus, neurons in pontine nuclei demyelination of dorsal columns and spinocerebellar tracts loss of SN and bG parkinsonian signs |
|
|
what syndrome?
vomiting morning headache stumbling gait frequent falls diplopia papilledema 6th nerve palsy |
posterior vermis syndrome
frequently medulloblastoma |
|
|
what is this?
ataxia marked sensory hypersthesias kyphoscholiosis pes cavus myocarditis retinitis pigemntosa |
Freidrech's ataxia
|
|
|
what syndrome?
vomiting morning headache stumbling gait frequent falls diplopia papilledema 6th nerve palsy |
posterior vermis syndrome
frequently medulloblastoma |
|
|
what is this?
ataxia marked sensory hypersthesias kyphoscholiosis pes cavus myocarditis retinitis pigemntosa |
Freidrech's ataxia
|
