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63 Cards in this Set

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What structures are in the base of the rostral medulla?
Inferior olive, pyramids and most of the medial lemniscus
What structures are in the tegmentum of the rostral medulla?
Inferior cerebellar peduncle, reticular formation, STT

CN X, XII, Nucleus ambiguus, V spinal, Vestibular (8-12 and V spinal)
What structures are in the base of the caudal pons?
pontine nuclei, pyramids
What structures are in the tegmentum of the caudal pons?
Tracts: medial lemniscus, STT, medial longitudinal fasciculus

Nuclei: Reticular formation, raphe nuclei

CN: V, VI, VII
What structures are in the base of the rostral pons?
pyramids, pontine nuclei
What structure are in the tegentum of the rostral pons?
Tracts: ML, STT, MLF

Nuclei: Raphe nuclei, reticuar formation, locus ceruleus

CN: V
Other: sup cerebellar peduncle
What structures are in the base of the caudal midbrain?
Pyramids, substantia nigra
What structures are in the tegmentum of the caudal midbrain?
Tracts: ML, STT, MLF

Nuclei: Reticular formation,

CN: VI

Other: des superior cerebellar peduncle
What structures are in the base of the rostral midbrain?
Substantia Nigra, Corticospinal fibers (pyramids), Ventral tegmental area
What structures are in the tegmentum of the rostral midbrain?
Tracts: MLF, STT, ML

Nuclei: Red, Reticular formation

CN: III
What nuclei make up the ambiguus nucleus and what is it's function?
9, 10, 11

Motor to larynx, pharynx and palate
What CN nucleus caries sensation from the face?
Spinal of V
What CN allows for mastication?
V
What CN controls muscles of facial expression
VII
What portion of the brainstem does the corticospinal tract pass through?
base
What portion of the brainstem does the dorsal column system pass through?
Tegmentum
What nuclei is involved w/ corneal reflex?
Reticular formation
Where does MCP receive message from?
contralateral cerebral cortex
What cells do cerebral output synapse onto?
granule cells
What structures in the pons are served by the paramedian branch of the basilar art?
MLF, VI, ML, CSP
What structures in the pons are served by the long circumferential branch of basilar?
V, VII
What blood supply goes to the midbrain?
Choroidal arteries off post cerebral
What blood supply serves the medulla?
PICA
What is the medial longitudinal fasciculus?
Pathway that interconnects vestibular and eye muscle nuclei
Trace Medial longitudinal fasciculus pathway (use R turn)
Turn head to R --> R VIII --> R Vestibular nucleus --> L VI nucleus-->
1. L LR
2. R MR

--> Eyes turn to left to compensate for head turn to right
Activation of the R corticobulbar tract --> what response?
R - forehead
L- forehead
L- lower neurons
What do dominant hemisphere lesions present as?
Aphagia, R Visual field deficit (homonymous hemianopsia/quadrantanopsia), L Gaze preference, hemiparesis/sensory loss (face/arm>leg)
What do non-dominant hemispheric lesions present as?
L visual field defect
L hemiparesis/sensory loss
R gaze preference
L hemineglect
What do ACA blocks present as?
Apathy, leg weakness>>arm/head, +/- aphagia
What do brainstem lesions present as?
Dysconjugate gaze/diplopia
Vertigo/tinnitus
Dysarthria/dysphagia
dec consciousness
N/V
Hiccups/Respirations
Where does lethargy localize?
bicerebral hemispheres
Where does seizure localize?
cortex
Where does memory impairment localize?
Thalamus/medial temporal lobe
Where does dec consciousness localize?
pons (RAS)
Where does dysarthria/dysphagia localize?
weakness in XII or IX/X
A lesion to a CN will result in a defect in which side?
ipsilateral
What is syringomyelia?
cystic cavitation of SC (mostly cervical) asc/ w/ brain abnormalities, remote SC trauma or tumor w/i SC
What structures are compromised in syringomyelia?
Ant horns, ant white commissure and possibly lat columns
What is tabes dorsalis?
Sequelae of neurosyphilis where there is selective damage to dorsal column
How does tabes dorsalis present?
loss of proprioception, absent Achilles reflex
What occurs in vit B12 or HIV vacuolar myopathy?
Subacute degeneration of post and lat columns
How does vit B12 and HIV vacuolar myopathy present?
spastic paraparesis w/ sensory loss (--> sensory ataxia)
What structures are affected in an ant spinal art infarction?
ant 2/3 of cord - lateral column and STT
How does ant spinal art infarction present?
spastic paraparesis and loss of pain/temp w/ intact vibration and proprioception
What is HTVL-1?
Chronic progressive demyelinating inflammatory myelopathy
What structures are affected in HTVL-1?
corticospinal tract +/- minor sensory loss
What is Brown-Sequard syndrome
lateral hemisection of cord --> ipsilateral weakness and hyperreflexia
w/
contralateral sensory loss
What is the Cushing's Response?
Triad of htn, bradycardia and irregular respiration...occurs when brainstem is compressed
What are the 4 types of herniation?
Subfalcine
central
uncal
cerebellar
What is the dx tool of choice to look for herniation?
CT w/o contrast
What is the immediate tx for herniation?
1. Elevate head 30o
2. Intubate and hyperventilate
3. Mannitol IV push
4. Dexamethasone IV
5. Hyperthermia
6. Hypertonic saline
How does hyperventilation help w/ inc intracranial pressure?
dec pCO2 --> vasoconstriction --> dec blood flow to brain
What supplies blood to the the medial part of the medulla
Anterior spinal artery
What portion of the braistem does the STT run through?
tegmentum
What is decerebrate posturing and what is it due to?
Arm rigidly extended and internally rotated, wrist flexed and leg extended

- extensive brainstem damage
What is decorticate posturing and what is it due to?
Arm flexed and adducted over chest, leg extended

- extensive damage to cortex
What are the signs of upper motor neuron damage?
diffuse hyperreflexia, clonus, Hoffmann and Babinski sign
Where is muscle atrophy seen?
lower motor neuron dz
What portion of the SC do spinothalamic tract run?
Anterior lateral
What portion of the SC do corticospinal tracts run?
lateral column
Where is Wernicke's area located?
Upper temporal lobe
Where is Broca's area located?
Parietal in precentral gyrus
What are the signs of lateral medullary syndrome and what artery is involved?
Horner's syndrome - loss of symp tone and loss of pain/temmp on ipsilateral side of face

- PICA