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127 Cards in this Set
- Front
- Back
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Brainstem nuclei associated with CN V
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Spinal and principle sensory nucleus of V
Mesencephalic V Motor nucleus of V |
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Brainstem nuclei associated with X
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Nucleus ambiguus
Dorsal motor nucleus of X Spinal nucleus of V (skin and outer ear) Nucleus solitarius |
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Brainstem nuclei associated with VII
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Facial nucleus
Superior salivatory nucleus Nucleus solitarius Spinal nucleus of V |
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Reticular formation (3, where?)
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Located medially throughout
1. Autonomic functions: BP, heart rate, respiration 2. Descending pathways for motor and pain 3. Neurotransmitters |
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Branchial motor nuclei of brainstem (4)
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Motor nucleus of V
Facial nucleus Nucleus ambiguus (IX, X) Spinal accesory XI |
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Inferior olivary nucleus
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Lateral in rostral medulla
Cell bodies that relay coordination info b/w cortex and cerebellum via inferior cerebellar peduncle |
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Inferior cerebellar peduncles
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Dorsolaterally in rostral medulla
Mostly comprised of olivocerebellar fibers Posterior spinocerebellar Cuneocerebellar Vestibulocerebellar |
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Where is major motor decussation?
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Caudal medulla
Pyrimidal fibers cross to form corticospinal tracts |
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Where is major sensory decussation?
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Dorsal column pathway crosses in caudal medulla to form medial lemniscus
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Hypoglossal nucleus (where, action, in lesion?)
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Most of medulla in midline
Innervates tongue When lesioned, tongue deviates to side of lesion (weak side) |
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Nucleus ambiguus (where, action, in lesion?)
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In medulla lateral and ventral to somatic motor nuclei
Branchial motor nucleus for IX and X- swallowing and speech Lesion - hoarseness and difficulty swallowing |
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Dorsal motor nucleus of X (what type of innervations?)
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Medial ventral in medulla
Parasympathetic visceral motor for vagus traveling to ab and thorax |
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Spinal nucleus and descending tract of V
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Medulla to mid pons up to principal nucleus of V, lateral
Spinal nucleus of V receives pain afferents and tract carries pain afferents before synapsing |
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Nucleus solitarius
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Meduall thru caudal pons, medial
Principal visceral afferent nucleus of brainstem Taste - VII, IX, X Carotid - IX Vagus - X |
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Vestibular nucleus
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Mid medulla - mid pons laterally
Vestibular division of VIII terminates here after first synapsing in vestibular ganglion outside of brainstem |
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Cochlear nucleus
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Mid medulla to mid pons laterally
Cochlear (auditory) of VII synapse in spiral ganglion outside brainstem then go into cochlear nuclei |
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Pontine nuclei
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Transmit info from cerebral cortex to cerebellum
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How is auditory info distributed in CNS?
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Spiral ganglion -> Cochlear nucleus -> decussates -> ascends in lateral lemniscus -> medial geniculate -> auditory cortex
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CN VI nucleus
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Caudal pons medial
LMN that innervate lateral rectus |
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Parapontine reticular formation (lateral gaze center)
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Pons, adjacent to CN VI nuclei
Causes VI to move lateral rectus Uses MLF to CN III nucleus to move medial rectus Mediates horizontal gaze, responds to change in head position |
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Facial motor nucleus (upper vs lower)
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Caudal pons
Innervate facial muscles Upper part receives bilateral CB input, lower receives only contralateral |
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Principle sensory nucleus of V (where, what kind of sensation?, tract)
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Rostral pons
For general sensation Primary cell bodies are located in trigeminal ganglion Fibers leave main nucleus of V thru trigeminothalamic pathway to thalamus |
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Motor nucleus of V
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Rostral pons
Supply muscles of mastication |
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CN IV nucleus (unique feature?)
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Midbrain
To superior oblique Only CN to exit dorsally |
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Locus coeruleus
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Medulla - Pons junction near floor of 4th ventricle
Noradrenergic neurons to all CNS |
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Superior cerebellar peduncle decussation
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In medial midbrain
Has to cross because is carrying info from body from cerebellum, so crosses for cortex |
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CN III nucleus
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Midbrain
Motor to all 4 ocular muscles If lesioned, eye deviates laterally |
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Edinger-Westphal nucleus
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Midbrain
Parasympathetic preganglionic cells To ipsilateral ciliary ganglion for pupillary constriction in light reflex Fibers travel w/ CN III |
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What is contained in the cerebral peduncles? (3)
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Midbrain
Fibers that originate in cerebral cortex and form: Corticospinal/pyramidal tract Corticobulbar tract Corticopontine fibers of cortico-ponto-cerebellar tract |
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Mesencephalic nucleus of V
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Midbrain
Primary sensory cell bodies (only type of this in CNS) Proprioception for mastication |
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Substantia nigra (4)
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Midbrain
Separates cerebral peduncles from tegmentum Major source of dopaminergic input to striatum Damaged in Parkinson's |
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Superior and Inferior colliculus (where?)
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Dorsal midbrain (tectum)
Inferior - from lateral lemniscus auditory Superior - from retina |
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Flow of CSF in ventricles
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Lateral -> foramens of Munro -> 3rd -> aqueduct of Sylvius -> 4th -> subarachnoid space medially by foramen of Magendie laterally by the 2 foramens of Luschka
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What level does the spinal cord end at? (for LP?)
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L1-2
L4 for LP |
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Hydrocephalus (communicating vs non)
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Failure to absorb CSF, swelling of ventricles
Communicating -> ventricles still communicate w/ lumbar CSF Non-communicating -> don't due to block |
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Types of glia
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Astrocytes
Oligodendrocytes Microglia Scwhann (peripheral) |
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Astrocytes
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Synaptogenesis
Metabolic support Signaling Form glial scars |
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Microglia
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Phagocytosis
Surveillance |
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Cervical and lumbar enlargements
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Cervical: C5-T1
Lumbar: L3-S2 |
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Clarke's nucleus
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Relay info to cerebellum
T1-L2/3 |
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Intermediolateral cell column
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Preganglionic sympathetic neurons
T1-L2/2 |
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Accessory nucleus (function, where)
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Motor neurons for trap and SCM
Medullary -> C5 |
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One general feature of secondary and tertiary neurons
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2 - decussate
3 - cell body in thalamus |
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Dorsal column pathway: modality, route, location
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Vibratory, touch, joint position
Dorsal funiculus 1 - DRG -> fasciculus cuneatus or gracilis 2 - nucleus C or G -> decussate to ML 3 - thalamus -> S1 |
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Gracilis vs Cuneatus
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Gracilis - medial T6 and below
Cuneatus - lateral T5 and above |
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Dorsal column pathway somatotopic organization
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Sacral enter first so are most medial
Headless man with feet medially |
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Spinothalamic tract: modality, route, location
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Pain and temp
Anterior funiculus 1 - DRG -> ipsilateral Lissauer's for 2 levels -> 2 - Dorsal horn -> ducussate in ventral white commisure 3 - thalamus -> S1 |
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Spinothalamic tract: somatotopic organization
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Headless man with feet pointing laterally
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Corticospinal tract: modality and route
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Voluntary motor
Lateral funiculus 1 - cortex -> decussate in caudal medulla 2 - motor neurons in ventral horn |
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Corticospinal tract: somatotopic organization
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Headless man with feet laterally
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Clonus
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Rapid beating of an extremity when one of its muscles it placed under rapid and sustained tension
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UMN lesion signs (5)
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Babinski
Spastic paralysis Increased stretch reflexes Clonus Mild atrophy |
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LMN lesion signs
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Segmental distribution of deficit
Decreased stretch reflexes Flaccid paralysis Pronounced atrophy Fasciculations as signs of atrophy |
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C4
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Clavicle
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L1
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Inguinal crease
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L5
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Lateral calf
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Biceps
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C5
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Triceps
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C7
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Gastroc
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S1-2
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Brown-Sequard syndrome
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Hemisection of spinal cord
Ipsilateral loss of position and vibration and UMN Contralateral loss of pain and temp |
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Syringomyelia (3)
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Suspended sensory loss due to damage of spinothalamic fibers as they cross in ventral white commisure
LMN due to damage to anterior horn cells Pain and temp normal above and below lesions |
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Amyotrophic lateral sclerosis
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Signs: combined UMN and LMN, with LMN predominating
Corticospinal tract and ventral horn cells lesion Normal sensory pathways |
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Tabes Dorsalis
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Predominant posterior column findings
Loss of position and vibratory Romberg sign |
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Subacute combined degeneration
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B12 deficiency -> present w/ pernicious anemia
Posterior columns and corticospinal tract Loss of pos/vib sense w/ UMN |
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Anterior spinal artery syndrome
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Occlusion of artery causes lesion in ventral cord
Affects corticospinal and spinothalamic tracts below lesion |
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Anterograde transport and neuropathy
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Away from cell body
Sustains muscle Vincristine and vinblastine disrupt MT organization and so cause neuropathy |
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Wallerian degeneration (3)
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Dying-forward - degeneration from point of injury peripherally
Chromatolysis Regeneration is possible |
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Segmental demyelination (5, histologic feature?)
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Axon is intact
No chromatolysis Remyelination can occur Rapid recovery Onion bulbs |
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Distal axonal degeneration (6, most common cause?)
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Metabolic damage
Most distal degenerates first and procedes back to cell body Stocking-glove distribution Chromatolysis Slow recovery Usually toxic/metabolic neuropathies |
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Distal vs proximal weakness are associated with which types of degeneration?
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Distal - axonal
Proximal - demyelinating |
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Clinical signs of axonal neuropathy (5)
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Stocking glove
Slow and chronic Loss of reflexes distally Muscle wasting distally Low amplitude Compound muscle action potentials (CMAP) |
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Guillian-Barre Syndrome
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Autoimmune against peripheral myelin occuring after GI or respiratory infection
Primarily motor Rapidly progressive Areflexia and ataxia Conduction block in NCSs |
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Ach receptor at NMJ properties
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Ionotropic
Binding of Ach opens Na+ channel Receptor has main immunogenic region which is near the Ach binding site |
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Myasthenia Gravis: pathophysiology
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Auto-Ab to main immunogenic region of AchR ->
Increased nAChR turnover Blocking of Ach binding sites Reduced EPP |
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Myasthenia Gravis: clinical features (common muscles affected 4)
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MUSCLE WEAKNESS
Fatiguable weakness to striated muscle OCULAR, Diplopia, ptosis Slurred speech |
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Myasthenia Gravis: treatment
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AChase inhibitors - pyridostigmine
Autoimmune Thymectomy - for patients w/ thymoma Corticosteroids |
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Lambert Eaton Myasthenic Syndrome: pathophys
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PRE-SYNAPTIC
Ab to presynaptic voltage gated calcium channel -> Reduced Ca influx -> Reduced Ach release into synapse |
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Lambert Eaton Myasthenic Syndrome: clinical features (3)
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Paraneoplastic - associated w/ SCLC
Slowly progressive proximal muscle weakness in hips and shoulders Repetitive stimulation can alleviate weakness, releases more calcium |
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Lambert Eaton Myasthenic Syndrome: treatment
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Search for tumor
Immunosuppresives - prednisone |
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Mechanism of spinal cord injury (7)
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Injury ->
Swelling longitudinally -> Damaged axons -> Glial cells form glial scar blocks regeneration -> Release of glutamate -> Excitotoxicity and cell death -> Depletion of growth factors to neurons and more cell death |
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Spinal cord regeneration: neuronal survival (3)
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Swelling increases damage -> Methylprednisone
Glutamate causes excitotoxicity -> block AMPA-R Supply growth factors |
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Spinal cord regeneration: inhibitors
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Inhibitors in myelin prevent sprouting -> block/kill oligodendrocytes
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Features suggestive of myopathy (4)
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Proximal distribution of weakness
Symmetric weakness Normal muscles (no atrophy) Normal deep tendon reflexes |
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Polymyositis: clinical features and treatment (pathophys, onset)
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Primary inflammatory myositis
T-cell mediated autoimmune disease -> muscle fiber damage Adult onset Proximal weakness Responds to immunosuppresives |
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Dermatomyositis: clinical features and treatment
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Primary inflammatory myositis
Ab to endothelial cells -> vascular injury -> ischemic muscle damage Childhood or adult onset Rash early feature |
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Inclusion-body myositis: clinical features and treatment
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Primary inflammatory myositis
Adult onset Quadriceps weakness No response to immunosuppresives |
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Metabolic myopathies present with . . .
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Exercise intolerance
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Muscle atrophy vs degeneration
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Atrophy - response of muscle to damage to anterior horn cell, shrinking of fiber, can return to normal if renervated
Degeneration- breakdown of muscle fiber -> elevated CK |
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Duchenne muscular dystrophy
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Muscle breakdown and degeneration -> macrophages
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Inflammatory myopathies
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Characterized by lymphocytes in muscle
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Re-innervation of a muscle fiber
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Converts muscle to whatever type (slow or fast) the new axon is -> type grouping
If re-innervation fails -> grouped atrophy |
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Periaqueductal gray
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Sounds cerebral aqueduct in midbrain
Perception of pain? |
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Tectum+ tegmentum
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Tectum - dorsal to periaqueductal gray in midbrain, contains white and gray matter
Tegmentum - inferior to central grey in midbrain (present at all levels), nuclei for III, IV, red, decussation of SCBP |
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How do cranial nerves exit brainstem?
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Somatic (3,4,6,12)- ventromedially
Branchial - (5, 7, 9, 10, 11) - laterally IV - dorsally |
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Loss of pain and temp on opp sides of face and body suggests . . .
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Lesion in upper outer quadrant of brainstem affecting:
spinothalamic + spinal descending V |
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Cranial nerve lesion and brainstem localization
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Midbrain - III - IV
Pons - V-VIII Medulla - IX - XII |
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Quadrant of brainstem and localization of disease
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Medial - corticospinal and medial lemniscus
Lateral - spinothalamic |
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Damage to long circumferential vessels of medulla
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Loss of pain and temp in ipsilateral face and contralateral body
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Damage to paramedian penetrating artery affects . .
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Laterally exiting nerves like VI
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Lateral brainstem syndromes (4) (which lateral cranial nerves?)
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Spinothalamic - controlateral loss of pain and temp in body
Descending V - ipsilateral loss of pain and temp in face Lateral cranial nerves - ambiguus, facial, trigeminal NO BODY WEAKNESS |
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Medial brainstem syndromes (3)
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Corticospinal - contralateral hemiparesis
Medial lemniscus - contralateral loss of position and vibratory Medially exiting cranial nerves - XII, VI, III |
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Lateral medullary infarct (Wallenberg) (5)
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Contralateral loss of pain and temp (spinothalamic)
Ipsi loss of pain and temp in face (desc V) Hoarseness, deviated uvula to strong side(ambiguus) Ipsilateral Horner (sympathetics) Ipsilateral ataxia (ICBP) |
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Medial medullary infarct (Hughlings Jackson) (3)
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Contralateral hemiparesis (CST)
Ipsilateral tongue paralysis (to weak side) (XII) Contralateral loss of pos. and vib (ML) |
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Lateral pontine syndrome (5)
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Contra pain and temp loss (ST)
Ipsi pain and temp face loss (V) Ipsi paralysis of face, LMN type (VII) Ipsi loss of facial sensation and paralysis of mastication muscles (V) Ipsilateral ataxia (MCBP) |
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Medial pontine syndrome (2)
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Contralateral hemiparesis (CST)
Ipsilateral paralysis of eye abduction (VI) |
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Medial midbrain syndrome (Weber) (2)
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Contralateral hemiparesis (CST)
Ipsilateral III palsy |
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Acoustic neuroma (3)
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Lesion extrinsic to stem
Begins w/ cranial nerves signs: VIII (vestibular before cochlear) then V and VII Late occurrence of long tract signs (ataxia from MCBP and hemiparesis) |
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Basilar artery occlusion (5)
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Benign tumor
Bilateral hemiparesis (both CST) Bilateral sensory loss (ascending systems) Variable CN signs Reticular system: coma if involved, locked-in if spared |
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How is cerebellum related to cortex and body (ispi vs contralateral)?
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Contralateral to cortex and ipsilateral to body
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Cerebellar input
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Motor cortex
Cortico pontine MCBP Vestibular via ICBP Spinocerebellar to vermis |
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Vestibular cerebellar and spinocerebellar input
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Vestibular - via ICBP to flocculonodular lobule
Spinocerebella - from trunk and legs to vermis and paravermis |
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Cerebellar output (4 step pathway)
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Cerebellar cortex ->
Deep cerebellar nuclei -> SCBP VL thalamus Motor cortex |
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Cerebellar cortex cells
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3 layers
Internal granular Purkinje Molecular |
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Cerebellar cortex circuit
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Input ->
Synapse on internal granule cells from mossy fibers -> Axons to molecular layer -> Synapse on Purkinje cells -> Output to deep nuclei of cerebellum |
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Cerebellar areas
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Vestibulocerebellum (flocculonodular)
Spinocerebellum (vermis) - from olives, spinocerebellar Neocerebellum (most of cerebellum) - input from cortex to pontine, output back to cortex via VL |
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4 signs of cerebellar disease
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Incoordination (ataxia)
Equilibrium + gait - wide base walk Nystagmus Hypotonia - decreased resistance to passive movement |
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Flocculonodular syndrome (2)
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Balance and oculomotor control
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Spinal cerebellum - midline tumors
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Truncal + leg incoordination
Chronic alcoholics |
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Lateral syndrome (Cerebellar degneration)
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Acute - cerebellar hemorrhage/infarct, anoxia, heat stroke
Subacute - alcoholics, paraneoplastic, tumors, MS Chronic - spinocerebellar degen, metabolic disease |
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SCBP
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Output from CB
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MCBP
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Cortico-pontine-cerebellar fibers
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ICBP
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Spinocerebellar, vestibulocerebellar
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Hemispheric syndrome (symptoms, unilateral vs bilateral)
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Ataxia, dysmetria, intention tremor, dysdiadochokinesis
Unilateral - tumor, vascular Bilateral - cerebellar degneneration |
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Vergence
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Eyes are aligned for binocular vision: converge for near and diverge for far
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Horizontal vs vertical double vision: caused by?
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Horizontal - VI palsy
Vertical - IV palsy |
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Vertical eye movements
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Mediated by MLF of midbrain
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Internuclear ophthalmoplegia
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Interruption in axons of MLF lead to weakness of adduction of ipsilateral eye
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