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128 Cards in this Set
- Front
- Back
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Brainstem extends from _ to _
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foramen magnum
tentorial notch |
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Brainstem
(3 major components) |
Medulla
Pons Midbrain |
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Brainstem
(general components) |
Tracts - ascend and descend
cranial nerves III - XII and their nuclei Other nuclei Reticular formation Cardiac and Respiratory Centers Cerebral Aqueduct, 4th Ventricle, upper central canal all pass through |
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Brainstem
External Landmarks Medulla |
Grooves con't with SC:
-dorsal median sulcus and ventral median fissure -dorsolateral, ventrolateral, and dorsal intermediate sulcus Pyramids -Pyramidal decussation Olives Fasciculus gracilis and cuneatus Gracile and cuneate tubercles Cranial nerves IX, X, XII |
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Brainstem
External Landmarks Pons |
Basilar sulcus
Facial colliculus CN V, VI, VII, VIII |
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Brainstem
External Landmarks Midbrain |
Basis pedunculus - cerebral peduncles
-interpeduncular fossa Superior and inferior colliculi = tectum = corpora quadrigemina CN III, IV Dorsal side (must remove cerebellum to see): Superior, middle, and inferior cerebellar peduncles Rhomboid fossa -cerebellopontine angle -sulcus limitans Superior and inferior medullary velum |
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Cranial Nerve Nuclei
Somatic (general) motor nuclei (name) |
Oculomotor nucleus - III
Trochlear nucleus - IV Abducens nucleus - VI Hypoglossal nucleus - XII (Spinal accessory nucleus) - XI |
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Cranial Nerve Nuclei
Branchial motor nuclei (name) |
Trigeminal motor nucleus - V
Facial motor nucleus - VII Nucleus Ambiguus - IX, X |
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Cranial Nerve Nuclei
Visceral motor (pregang PSNS) nuclei (name) |
Edinger-Westphal (Ed-West) nucleus - III
Superior and inferior salivatory nuclei - VII and IX Dorsal vagal nucleus - X |
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Cranial Nerve Nuclei
Visceral sensory nuclei (name) |
Nucleus/tractus solitarius (NTS) - IX, X
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Cranial Nerve Nuclei
General sensory nuclei (name) |
Mesencephalic nucleus of V
Chief sensory nucleus of V Trigeminospinal nucleus - V, VII, IX, X |
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Cranial Nerve Nuclei
Special Sensory nuclei (name) |
NTS - VII, IX, X
Vestibular nuclei (sup,medial,lateral,inferior) Cochlear nuclei (dorsal and ventral) - VIII |
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Somatic (general) motor nuclei
Oculomotor nucleus (CN, innervation) |
III
*medial rectus *levator palpebrae superioris (superior rectus, inferior rectus, inferior oblique) |
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Somatic (general) motor nuclei
Trochlear nucleus (CN, innervation) |
IV
(superior oblique) |
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Somatic (general) motor nuclei
Abducens nucleus (CN, innervation) |
VI
*Lateral Rectus |
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Somatic (general) motor nuclei
Hypoglossal Nucleus (CN, innervation) |
XII
*genioglossus (hyoglossus, styloglossus, intrinsic tongue muscles) |
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Somatic (general) motor nuclei
Spinal accessory nucleus (CN, innervation) |
XI
*Trapezius *sternocleidomastoid |
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Branchial motor nuclei
Trigeminal motor nucleus (CN, innervation) |
V
*muscles of mastication* (temporalis, masseter, medial and lateral pterygoid, tensor tympani, tensor veli palatini, anterior belly digastric, mylohyoid) |
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Branchial motor nuclei
Facial motor nucleus (CN, innervation) |
VII
*muscles of facial expression* (stapedius, post belly digastric, stylohyoid) |
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Branchial motor nuclei
Nucleus ambiguus (CN, innervation) |
IX, X
*stylopharyngeus (IX)* *laryngeal muscles* (constrictors, pharyngeal, palatal, involved in respiration) |
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Visceral motor (pregang PSNS) nuclei
Edinger-Westphal nucleus (CN, innervation) |
III
*sphincter pupillae - Iris* *ciliary body (after synapse in ciliary ganglion) |
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Visceral motor (pregang PSNS) nuclei
Superior and inferior salivatory nuclei (CN, innervation) |
VII and IX
*Submandibular gland (VII) - after synapse in subman gang *Sublingual gland (VII) after syn in subman gang *Lacrimal gland (VII) - after syn in pterygopalatine ganglion *parotid gland (IX) - after synapse in otic ganglion (nasal mucosal glands -VII- after syn in pterygopalatine ganglion) |
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Visceral motor (pregang PSNS) nuclei
Dorsal vagal nucleus (CN, innervation) |
X
(pulmonary, esophageal, cardiac plexuses, alimentary tract) |
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Visceral sensory nuclei
NTS (CN, innervation) |
IX, X
(info from baroreceptors, chemoreceptors, viscer stretch, involved in respiration) |
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General sensory nuclei
Mesencephalic nucleus of V (CN, innervation) |
V
(info from proprioceptive and vibratory receptors - especially chewing muscles) |
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General sensory nuclei
Chief sensory nucleus of V (CN, innervation) |
V
(info from tactile receptors in face) |
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General sensory nuclei
Trigeminospinal nucleus (CN, innervation) |
V, VII, IX, X
*pain and temperature on face* (PT for tongue, external ear, pharynx, larynx, etc.) |
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Special sensory nuclei
NTS (CN, innervation) |
VII, IX, X
*taste* (info from *taste* recepors in ant 2/3 tongue - VII, post 1/3 - IX, epiglottis - X) |
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Special sensory nuclei
Vestibular nuclei (superior, medial, lateral, inferior) (CN, innervation) |
VIII
*balance* (info from *balance* and equilibrium receptors in inner ear) |
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Special sensory nuclei
Cochlear nuclei (dorsal and ventral) (CN, innervation) |
VIII
*hearing* (info from hearing receptors in inner ear) |
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Cranial Nerves
Lesions have _ effects |
ipsilateral
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Cranial Nerves
Oculomotor nerve Oculomotor nucleus (modality, role, lesion) |
somatic motor
moves eye up, down, medially and raises eyelid Lesion = eye rests at down and out position, diplopia, *lateral strabismus*, *ptosis* |
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Cranial Nerves
Oculomotor nerve Edinger-Westphal nucleus (modality, role, lesion) |
visceral motor - PSNS
constricts pupil, rounds up lens for near vision lesion = *dilated pupil (*mydriasis*), loss of pupillary reflex |
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Cranial Nerves
Trochlear Nerve (name nucleus) |
Trochlear nucleus
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Cranial Nerves
Oculomotor Nerve (name nuclei) |
Oculomotor nucleus
Edinger-Westphal nucleus |
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Cranial Nerves
Trochlear nerve Trochlear nucleus (modality, role, lesion) |
somatic motor
moves eye down and out Lesion = diplopia (usually not injured alone) |
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Cranial Nerves
Trigeminal Nerve (name nuclei) |
Mesencephalic nucleus
Chief sensory nucleus Trigeminospinal nucleus Trigeminal motor nucleus |
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Cranial Nerves
Trigeminal Nerve Mesencephalic, chief sensory, and trigeminal nuclei (modality, role, cell bodies location, lesion) |
general sensory
sensory info from face, ant 2/3 tongue, teeth (ophthalmic, maxillary, and mandibular divisions) - cell bodies of sensory neurons in trigeminal ganglion or mesencephalic nucleus Lesion = *lose sensation to face*, anterior 2/3s tongue, teeth (*hypalgesia*); loss of corneal blink reflex |
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Cranial Nerves
Trigeminal nerve Trigeminal motor nucleus (modality, role, lesion) |
branchial motor
chewing (mastication), dampening sound? (tensor tympani) Lesion = *can't clamp down on jaw as forcefully*, muscle atrophy |
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Cranial Nerves
Abducens nerve (modality, role, lesion) |
somatic motor
moves eye laterally Lesion = diplopia, *medial strabismus* |
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Cranial Nerves
Facial nerve (name nuclei) |
Facial motor nucleus
Superior salivatory nucleus Nucleus/Tractus Solitarius Trigeminospinal nucleus |
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Cranial Nerves
Facial nerve Facial motor nucleus (modality, role, lesion) |
branchial motor
facial expression, dampen sound? (stapedius) Lesion = *droopy face*, can't close mouth or eye very well; loss of corneal blink reflex |
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Cranial Nerves
Facial nerve Superior salivatory nucleus (modality, role, lesion) |
visceral motor - PSNS
produces saliva and tears Lesion = *decreased saliva*, *dry eye* |
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Cranial Nerves
Facial nerve Nucleus/Tractus Solitarius (modality, role, lesion) |
special sensory
taste to ant 2/3 tongue cell bodies of sensory neurons in geniculate ganglion Lesion = diminished taste |
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Cranial Nerves
Facial nerve Trigeminospinal nucleus (modality, role) |
general sensory
sensory from external ear cell bodies of sensory neurons in geniculate ganglion |
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Cranial Nerves
Vestibulocochlear nerve (name nuclei) |
Vestibular nuclei
Cochlear nuclei |
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Cranial Nerves
Vestibulocochlear nerve Vestibular nuclei (modality, role, cell body location, lesion) |
special sensory
balance and equilibrium cell bodies of sensory neurons in vestibular ganglion Lesion = *vertigo* with nausea, *vomiting*, nystagmus |
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Cranial Nerves
Vestibulocochlear nerve Cochlear nuclei (modality, role, cell body location, lesion) |
special sensory
hearing cell bodies of sensory neurons in spiral (cochlear) ganglion Lesion = *deaf* or diminished hearing in that ear |
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Cranial Nerves
Glossopharyngeal nerve (name nuclei) |
Nucleus ambiguus
Inferior salivatory nucleus Nucleus/tractus solitarius Trigeminospinal nucleus |
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Cranial Nerves
Glossopharyngeal nerve Nucleus ambiguus (modality, role, lesion) |
branchial motor
swallowing Lesion = *dysphagia* |
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Cranial Nerves
Glossopharyngeal nerve Inferior salivatory nucleus (modality, role, lesion) |
visceral motor - PSNS
production of saliva Lesion = decreased saliva |
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Cranial Nerves
Glossopharyngeal nerve NTS (modality, role, cell bodies, lesion) |
visceral and special sensory
carotid sinus and body, taste to post 1/3 tongue cell bodies of sensory neurons in inferior ganglion Lesion = diminished taste |
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Cranial Nerves
Glossopharyngeal nerve Trigeminospinal nucleus (modality, role, cell bodies, lesion) |
general sensory
sensory from post 1/3 tongue, pharynx, middle ear cell bodies of sensory neurons in superior ganglion Lesion = diminished sensation, *loss of gag reflex* |
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Cranial Nerves
Vagus nerve (name nuclei) |
Nucleus ambiguus
Dorsal vagal nucleus NTS Trigeminospinal nucleus |
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Cranial Nerves
Vagus nerve Nucleus ambiguus (modality, role, lesion) |
branchial motor
swallowin (palate, pharynx); speaking (larynx); respiration Lesion = *dysphagia*, *palate doesn't rise symmetrically*, hoarse voice (*dysphonia*) |
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Cranial Nerves
Vagus nerve Dorsal vagal nucleus (modality, role) |
visceral motor -
PSNS to lungs, heart, GI tract |
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Cranial Nerves
Vagus nerve NTS (modality, role, cell bodies) |
visceral and special sensory
info from aortic bodies, gut receptors, taste cell bodies of sensory neurons in inferior (nodose) ganglion |
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Cranial Nerves
Vagus nerve Trigeminospinal nucleus (modality, role, cell bodies) |
general sensory
sensory from external ear, lower pharynx, larynx cell bodies of sensory neurons in superior (jugular) ganglion |
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Cranial Nerves
Spinal Accessory nerve (name nucleus) |
Spinal Accessory nucleus (*C1-C5*)
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Cranial Nerves
Spinal Accessory nerve Spinal Accessory nucleus (modality, role, lesion) |
somatic motor
to trapezius, SCM Lesion = *can't shrug shoulders or turn head against resistance* |
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Cranial Nerves
Hypoglossal nerve Hypoglossal nucleus (modality, role, lesion) |
somatic motor
to tongue muscles Lesion = *tongue deviates to side of lesion* (genioglossus), *atrophy of tongue* |
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Cranial Nerves
Hypoglossal nerve (name nucleus) |
hypoglossal nucleus
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Other Brainstem nuclei
(name all 14!) |
Nucleus of superior colliculus
Nucleus of inferior colliculus Substantia nigra - pigmented Red nucleus Locus ceruleus Basal pontine nuclei Superior olivary nucleus Nucleus prepositus (hypoglossi) Inferior olivary nuclear complex Botzinger and pre-Botzinger complex Lateral cuneate nucleus Lateral reticular nucleus Nucleus gracilis Nucleus cuneatus |
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Other Brainstem Nuclei
Nucleus of superior colliculus (location, role) |
midbrain
visual and somatosensory systems |
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Other Brainstem Nuclei
Nucleus of inferior colliculus (location, role) |
midbrain
auditory system |
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Other Brainstem Nuclei
Substantia nigra (characteristic, location, role, disease) |
*pigmented*
midbrain dopamine Parkinson's disease |
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Other Brainstem Nuclei
Red nucleus (location, role, char) |
midbrain
motor nucleus very vascular |
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Other Brainstem Nuclei
Locus ceruleus (location, role) |
midbrain and pons
synthesis of norepi |
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Other Brainstem Nuclei
Basal pontine nuclei (location, role) |
pons
cell bodies of neurons that send info to contra cerebellum |
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Other Brainstem Nuclei
Superior olivary nucleus (location, role) |
pons
auditory system |
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Other Brainstem Nuclei
Nucleus prepositus (hypoglossi) (location, role) |
medulla
control of horizontal eye mvments |
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Other Brainstem Nuclei
Inferior olivary nuclear complex (location, role) |
medulla
associated with cerebellum |
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Other Brainstem Nuclei
Botzinger and pre-Botzinger complex (role) |
involved in respiration
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Other Brainstem Nuclei
Lateral cuneate nucleus (location, role) |
medulla
receives PVT info from upper limb, sends to cerebellum |
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Other Brainstem Nuclei
Lateral reticular nucleus (location, role) |
medulla
receives PT info from body, sends to cerebellum |
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Other Brainstem Nuclei
Nucleus gracilis (location, role) |
medulla
receives PVT info from facilus gracilis (lower limb) contains cell bodies of neurons whose fibers cross and ascend as medial lemniscus |
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Other Brainstem Nuclei
Nucleus cuneatus (location, role) |
medulla
receives PVT info from fasciculus cuneatus (upper limb) contains cell bodies of neurons whose fibers cross and ascend as medial lemniscus |
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Major Ascend Pathways
Sensory General characteristics |
usually 3 neurons in chain from receptor to cerebral cortex
2 order neurons (lemniscus) cross before synapse in thalamus |
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Major Ascend Pathways
Medial lemniscus (cell bodies location, course, receives, lesion) |
cell bodies in nucleus gracilis and cuneatus
fibers cross to opposite side, ascend and syn in thalamus receives and carries PVT info from dorsal columns Lesion = hypesthesia - contralat body |
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Major Ascend Pathways
Spinal lemniscus (cell bodies location, course, receives, lesion) |
cell bodies in nucleus proprius in SC
fibers cross in SC, ascend and syn in thalamus - called spinothalamic tract in spinal cord receives and carries PT info from body Lesion = hypalgesia - contralateral body |
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Major Ascend Pathways
Trigeminal lemniscus (cell body location, course, aka, receives, lesions) |
cell bodies in trigeminospinal nucleus
fibers cross to oppo side, ascend and syn in thalamus aka VTTT (ventral trigeminothalamic tract) receives and carries mostly PT info from face fibers enter at pons and descend in trigeminospinal tract to syn in trigeminospinal nucleus Lesion of trigeminal lemniscus = hypalgesia - contra face Lesion of trigeminospinal tract = hypalgesia - ipsi face |
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Major Ascend Pathways
Lateral lemniscus (cell bodies location, path, receives, lesion) |
cell bodies in dorsal or ventral cochlear nuclei
most fibers cross to oppo side (in trapezoid bundle) some stay on same side, ascend some synapse in inferior colliculus receives and carries auditory info from inner ear (Lesion - some "hearing deficit", difficult localize sound) |
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Major Descend Pathways
Motor General |
will synapse on lower motor neurons in SC or brainstem or on pontine nuclei
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Major Descend Pathways
Corticospinal tract (cell bodies, cross in, lesion) |
cell bodies in cerebral cortex
cross in pyramidal decussation Lesion = hemiplegia/paresis, UMN signs - contra body |
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Major Descend Pathways
Corticonuclear (corticobulbar) tract (cell bodies, path, lesion) |
cell bodies in cerebral cortex
fibers descend and synapse on LMNs in contralat and ipsilat trigeminal motor nuclei, contralat and ipsilat upper facial motor nuclei, only the contralat lower facial motor nucleus, contralat and ipsilat ambiguus nuclei, and contralat hypoglossal nucleus Lesions = if above facial motor nucleus - weakness of lower, not upper, face - Central VII - contralat face tongue may deviate to contralat side |
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Major Descend Pathways
Corticopontine tract (cell bodies, path) |
cell bodies in cerebral cortex
fibers descend and syn on basal pontine nuclei in pons - pontocerebellar fibers cross and pass to contralat cerebellum in middle cerebellar peduncle |
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Major Descend Pathways
"Extrapyramidal" tracts (name) |
Rubrospinal
reticulospinal vestibulospinal tectospinal |
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Other Tracts
(name) |
Cuneocerebellar tract
Dorsal spinocerebellar tract Dentatorubral and dentatothalamic tracts Central tegmental tract (CTT) Olivocerebellar tract Olivo-olivary tract Medial longitudinal fasciculus (MLF) Descending autonomic tract |
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Other Tracts
Cuneocerebellar tract (carries _ from _ to _ by way of _) |
carries upper limb PVT info from lateral cuneate nucleus to cerebellum by way of inferior cerebellar peduncle
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Other Pathways
Dorsal spinocerebellar tract (carries _ from _ to _ by way of _) |
carries lower limb PVT info from Clarke's nucleus to cerebellum by way of inferior cerebellar peduncle
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Major Descend Pathways
Dentatorubral and dentatothalamic tracts (carry info from _ to _ and _ by way of _ and _) |
carry info from cerebellum to contralat red nucleus and thalamus by way of superior cerebellar peduncle and decussation of brachium conjunctivum
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Major Descend Pathways
Central tegmental tract (TCC) (to _) |
info to inferior olivary nuclear complex (IOC)
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Major Descend Pathways
Medial longitudinal fasciculus (MLF) (connects) |
connect III, IV, and VI nuclei with vesticular nuclei and the neck
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Major Descend Pathways
Descending autonomic tract (carries _ to pregang neurons in _ and _ Lesion = ?) |
carries autonomic info to pregang neurons in lateral horn and sacral autonomic nucleus
Lesion = ipsilateral Horner's syndrome |
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Classical Brainstem Lesions
General rule |
usually the result of occlusion of vascular supply or bleeding
often involves "crossed" or "alternating" hemiplegia in which the body is affected on the side opposite the lesion and cranial nerve deficits are found on the same side as the lesion. |
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Classical Brainstem Lesions
Medial medullary syndrome (level of the neuroaxis, artery) |
medulla
vertebral or anterior spinal artery |
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Classical Brainstem Lesions
Lateral medullary (Wallenberg's) syndrome (location, artery) |
medulla
PICA |
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Classical Brainstem Lesions
(Medial) basal pontine syndrome (location, artery) |
pons
pontine branches of basilar artery |
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Classical Brainstem Lesions
Weber's syndrome (location, artery) |
midbrain
PCA |
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Nervous System Lesions
Questions to ask? |
From case history, was onset *sudden or *gradual?
Is lesion PNS or CNS? If CNS then... Focal or diffuse? Focal lesions are determined by intersection diagnosis: Horizontal component - cranial or spinal nerve fibers crossing a... vertical component - major ascending of descending pathway Diffuse lesions cannot be localized |
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Hypalgesia
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impaired ability to perceive pain and temperature (PT)
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Hypesthesia
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impaired ability to perceive PVT
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Spastic paralysis/paresis
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increased muscle tone due to UMN lesion
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Flaccid paralysis/paresis
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decreased muscle tone due to LMN lesion
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monoplegia
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paralysis of one limb, usually lower
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hemiplegia
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paralysis of both limbs on one side
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paraplegia
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paralysis of both lower limbs
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diplegia
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paralysis of both upper limbs
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quadriplegia
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paralysis of all 4 limbs
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Ptosis, voluntary
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drooping eyelid due to paralysis of levator palpebrae superioris muscle (damage to III - somatic motor)
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Ptosis, involuntary
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drooping eyelid due to paralysis of the sympathetic innervation of superior tarsal muscle (smooth muscle)
(damage to spinal cord, symp chain or brainstem - visceral motor) |
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miosis
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constricted pupil (loss of sympathetics)
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mydriasis
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dilated pupil (lesion of EdWest or III - Parasympathetic)
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Enophthalmos
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retraction of eye within orbit (loss of sympathetics)
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O.D.
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oculus dexter, right eye
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O.S
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oculus sinister, left eye
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lateral strabismus
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eye will not move medially - in down and out position (damage to III)
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medial strabismus
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eye will not move laterally - in medial position (damage to VI)
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Diplopia
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double vision
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diplopia (double vision) with near vision
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damage to III
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diplopia with far vision
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damage to VI
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Dysphagia
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difficulty with swallowing
damage to nucleus ambiguus or IX and X |
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Dysphonia
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difficulty with phonation or speaking
damage to nucleus ambiguus or X |
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Anhidrosis
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lack of sweating on face (loss of sympathetics)
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Medial medullary syndrome
symptoms |
Hemiplegia/paresis - contralateral
loss of voluntary mvment contra to lesion due to damage of CST Hypesthesia - contralat loss of sensation of PVT contra to lesion due damage of medial lemniscus Tongue deviates to side of lesion due to paralysis of tongue muscles caused by damage to hypoglossal nerve on same side as lesion Might have dysarthria Ex of "crossed" or "alternating" hemiplegia |
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Lateral Medullary (Wallenburg's) Syndrome
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Hypalgesia of Body - contralat
loss of PT contra to lesion due to damage of spinal lemniscus Hypalgesia of Face - Ipsilat loss of PT on same side due to damage to trigeminospinal tract Dysphagia and Dysphonia destruction of nucleus ambiguus Horner's syndrome - Ipsilat: ptosis miosis enopthalmos anhidrosis due to loss of descend autonomic fibers might extend to vestibular nuclei and base of cerebellar peduncle |
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(Medial) Basal Pontine Syndrome
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Hemiplegia/paresis - contralat
due to damage of corticospinal fibers Medial strabismus - ipsi due to paralysis of lateral rectus on same side from lesion of abducens nerve |
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Weber's Syndrome
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Hemiplegia/paresis - contralat
due to damage of corticospinal fibers Central VII - contralat paralysis of lower half of face contra to lesion due to damage of corticonuclear fibers Lateral strabismus, voluntary ptosis, mydriasis, ipsi damage to oculomotor nerve |
