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44 Cards in this Set
- Front
- Back
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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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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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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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Locus coeruleus
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Medulla - Pons junction near floor of 4th ventricle
Noradrenergic neurons to all CNS |
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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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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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What level does the spinal cord end at? (for LP?)
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L1-2
L4 for LP |
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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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UMN lesion signs (5)
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Babinski
Spastic paralysis Increased stretch reflexes Clonus Mild atrophy |
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T2
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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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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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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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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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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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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 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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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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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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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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