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88 Cards in this Set
- Front
- Back
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landmark of rostral end of brainstem
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Tentorium cerebelli (meets thalamus and hypothalamus)
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Tectum
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Superior/Inferior Colliculi on dorsal side of midbrain
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borders of the fourth ventricle
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floor is pons and rostral medulla
superior is cerebral aqueduct into midbrain inferior is foramen of Lushka and Magendie into subarachnoid space @ obex |
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Treatment of Trigeminal Neuralgia
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Carbamazepine
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Demyelinating disease which can cause Trigeminal Neuralgia
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Multiple Sclerosis
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Lesions of Trieminal nuclei in the brainstem cause ____ (ipsi/contra) loss of facial sensation/pain/temp
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ipsilateral, do not cross before entering nuclei
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List of possible causes of CN V sensory loss
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Herpes Zoster
ICA anuerysm @ petrous portion Cavernous Sinus Disorder Orbital Apex Disorder Trigeminal/Vestibular Schwanomma |
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Facial sensory loss on one side, sensory loss of body of opposite side characteristic of
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Lesions to Spinal Trigeminal and Spinothalamic tracts in lateral brainstem lesions in pons of rostral midbrain
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strictly somatic motor nuclei
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3,4,6,12
all adjacent to midline derived from occipital somites |
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Branchial motor nuclei
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Trigeminal motor nucleus
Facial Nucleus Nucleus Ambiguus Spinal Accessory |
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Anosmia
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Loss of smell
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Anosmia with ispilateral optic atrophy and contralateral papilledema
Disease? Cause? |
Foster-Kennedy Syndrome
Tumors/Large Lesions usually meningiomas |
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Trace Route of Parasympathic innervation of pupillary constrictors and ciliary muscles
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Preganglionic neurons in Edinger-Westphal exit with CNIII (@interpeduncular fossa) and synpase at ciliary ganglion
from ciliary ganglion postganglionic fibers synpase muscles |
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Muscles innervated by V3 of trigeminal
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Muscles of Mastication
Tensor Tympani Tensor Fascia Lata Anterior Digastric Med/Lat pterygoid Mylohyoid Temporalis |
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sensory innervation to occipital region
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C2
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pain innervation to supratentorial dura matter
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CN V
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Sensory innervation to external acoustic meatus
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CN VII, IX, X
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sensory inneravation of posterior fossa dura
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CN X
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Function of mesencephalic trigeminal nucleus
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proprioception
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function of Chief Trigeminal sensory nucleus
+pathway/nucleus on thalamus |
Fine touch
Dental pressure Trigeminal lemniscus to VPM |
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Function of Spinal Trigeminal Nucleus
pathway to thalamus/nucleus |
Crude touch, pain, temperature
trigeminothalamic tract to VPM |
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Trigeminal system analogous to anterolateral system of spinal cord
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Spinal Trigeminal Tract
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Trigeminal system analogous to posterior columns
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Chief Trigeminal sensory nucleus
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describe somatotopical organization of Spinal Trigeminal Nucleus (crude touch, pain, temp)
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Rostal = perioral, caudal = towards back of head
V1 = anterior, V3 = posterior |
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First Line therapy for Trigeminal Neuralgia
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Carbamazepine
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What component of the Facial Nerve will be spared in lesions distal to the geniculate ganglion
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Parasymathetics of Greater Petrossal to the lacrimal glands
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What components of the Facial Nerve are spared in a lesion distal to the middle ear
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Muscles of Facial Expression
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Exit of the Facial Nerve from the skull
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stylomastoid foramen
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Trace the innervation to the lacrimal gland and nasal mucosa
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CN VII out internal acoustic meatus
Branches to Greater Petrossal Synpase @ sphenopalantine ganglion Gland and mucosa |
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Trace the path of the Chorda Tympani
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Exits Facial Nerve before stylomastoid foramen, travels upwards through middle ear and exits petrotympanic fissure, joins lingual nerve, synapse @ submandibular ganglion, innervates submandibular/sublingual glands
also taste to anterior 2/3 tongue |
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Trace taste pathway from anterior 2/3
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Chorda Tympani
Rostral Nucleus Solitarious Central Tegmental Tract VPM Somatosensory Cortex |
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Result of UMN facial nerve lesion
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spares upper face on contralateral side
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Result of LMN facial nerve lesion
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Ipsilateral complete loss of facial muscles
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Features of Bell's Palsy
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LMN type muscle loss
Hyperaucusis Dry Eye Loss of ipsilateral taste |
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Crocodile Tears
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patient tears up upon sight off food because of cross-innervation during recovery from Bell's Palsy
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CNs of Corneal Reflex
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CN V afferent
CN VII efferent contacting eye with cotton swab |
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CNs of Jaw Jerk Reflex
what is a positive response |
Mesenchymal Trigeminal afferent
Motor Trigeminal Nucleus efferent brisk, jaw moves outward ALS |
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Cause of activation of hair cells in cochlea
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movement of basilar membrane relative to tectorial membrane
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Innervation of middle ear cavity
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CN IX
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Innervation of outer surface of tympanic membrane
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CN V (Auriculotemporal branch)
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Innervation of inner surface of tympanic membrane
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CN IX
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Trace pathway from Organ of Corti to Somatosensory Cortex through Dorsal Cochlear Tract
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Organ of Corti
Spiral Ganglion Cells Dorsal Nucleus Dorsal to Inferior Cerebral Peduncle CONTRALATERAL Superior Olivary Nucleus Lateral Lemniscus Inferior Colliculus Medial Geniculate Nucleus Primary Auditory Nucleus |
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Difference with Ventral Tract?
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Ventral goes bilateral, passing contralaterally through trapezoid body
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Cutoff between unilateral/bilateral hearing loss?
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Unilateral hearing loss only possible DISTAL to cochlear nuclei
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Function of Superior Olivary Nuclei?
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Localization of sound
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Components of Superior Vestibular Ganglion?
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Utricle
Anterior Saccule Anterior/Lateral SemicircCanals |
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Components of Inferior Vestibular Ganglion
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Posterior Semicircular Canal
Posterior Saccule |
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Function of Vestibular Macule? (saccule vs. utricle)
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linear movements
Utricle - vertical Saccule - Horizontal |
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Results of Rinne Test with Conduction loss
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Bone Conduction > Air Conduction
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Rinne Test for sensorineural hearing loss
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Air > Bone, but decreased compared to normal ear
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Weber Test for sensorineural
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Quieter on affected side
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Weber Test for Conductive
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Louder on affected side
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MCC Conductive Hearing loss
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Cerumen
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Early clinical findings in Acoustic Neuroma (Schwannoma)
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Unilateral hearing loss
Tinnitus Unsteadiness |
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Clinical sign in Acoustic Neuroma first seen with CN V involvement?
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Corneal Reflex decrease
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Dix-Halpike causes maximal stimulation of which semicircular canal
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Posterior
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Peripheral lesion findings with Dix-Halpike
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Delay (2-5seconds)
Adaptation occurs no vertical nystagmus |
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Central lesion findings with Dix-Halpike
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no delay
no adaptation vertical nystagmus can occer |
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mechanism of BPPV
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otoliths pressing up against cupula (of ampulla)
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recurrent episodes of vertigo leading to progressive hearing loss and tinnitus with full feeling in ear
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Meniere's Disease
excess endolymph fluid in Scala Media |
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"fatal gastroenteritis"
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bleeds of the cerebellum causing severe nausea and dizziness
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MCC Central Vertigo
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Vertebrobasilar Ischemia/Infarct
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CN IX provides chemoreceptors and baroreceptors @ the ____
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carotid body
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only branchial muscle supplied by glossopharyngeal
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Stylopharyngeus
elevates pharynx during talking and swallowing |
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Parasympathic innvervation of CN IX?
describe pathway |
Inferior Salvatory Nucleus (Pons)
Lesser Petrosal Otic Ganglion PAROTID GLAND |
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Somatic innervation of posterior 1/3 of tongue
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CN IX
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Taste to posterior 1/3 of tongue
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CN IX
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Control of pharyngeal and laryngeal muscles
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CN X
voice box gag reflex swallowing |
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Innervation of Cricothyroid of larynx?
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Superior Laryngeal nerve
rest by Recurrent branch |
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Sensory to meninges of posterior fossa
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CN X
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CN X provides chemoreceptors and baroreceptors to the ____
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aortic arch
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Taste from epiglottis and posterior pharynx
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CN X
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LMN lesion of CN XI results
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Loss of shoulder shrug ipsilaterally
Decreased ability to turn head contralaterally |
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UMN lesion of CN XI results
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Contralateral weakness in shoulder shrug
Inability to turn head to opposite side (UMN and LMNs for SCM are ipsilateral to side of lesion, causing defect in turning to opposite) |
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Innervation of palatoglossus
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CN X
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UMN CN XII
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contralateral weakness, tongue deviates towards weakness
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LMN CN XII
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ipsilateral weakness, tongue deviates towards weakness
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Unilateral vocal cord paralysis and hoarseness
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Recurrent Laryngeal Nerve off CN X
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Glomus Tumors
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tumors resembling carotid bodies derived from CN IX which was compress CN IX/X/XI and/or be seen as a fleshy vascular mass in the middle ear
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MCC lesion affecting the Nucleus Ambiguus (swallowing,gag, vocal cords)
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Lateral Medullary Syndrome
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Gravelly sound voice
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Parkinson's
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Spasmodic Dysphonia
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Basal Ganglia dysfunction
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Dysarthria
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motor articulatory disorder
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Dysphagia
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Impaired swallowing
when neurological, has same causes as dysarthria and occurs together |
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Gag Reflex components
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CN IX afferent (some CN X)
CN X efferent |
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Stage Curtain Sign
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soft palate hangs low on affected side in CN X lesions
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Tumors with "knobs" or "dumbbell shaped"
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Consider Acoustic Neuromas
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deficit seen with damage to superior laryngeal nerve?
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since only cricothyroid, only minimal difficulty hitting high notes during singing
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