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98 Cards in this Set

  • Front
  • Back
Where are the preganglionic neurons of the parasympathetic system?
Brainstem regions associated with Cranial Nerve III (Oculomotor), Cranial Nerve VII (Facial), Cranial Nerve IX (Glossopharyngeal), and Cranial Nerve X (Vagus)

Sacral Parasympathetic Nucleus (S2-S4)
Where are the preganglionic neurons of the sympathetic system?
Lateral horns of the Thoracic vertebra - at the Intermedolateral Nucleus.
What are the three major divisions of the brainstem?
Midbrain

Pons

Medulla
What are the two parts of the metencephalon?
Pons, Cerebellum
What brainstem structure is in the myelencephalon?
Medulla
What brainstem structure is in the mesencephalon?
Midbrain
What are the names for the anterior and posterior portions of the midbrain and pons?
Anterior = Basilar

Posterior = Tegmentum
What cranial nerves are associated with the medulla?
Part of V
VIII, IX, X, XI, XII
What cranial nerves are found on the anterior portion of the medulla?
CN IX, X
CN XII
CN XI
With what pathway are the cuneate and gracile tubercles associated?
The cuneate and gracile tubercles contain the cell bodies of the of the 3rd neuron of the PC/ML tract

Synapses with the fasciculus gracilus and fasciculus cuneatus.
What nerves are found at the cerebellopontine angle?
CN VII, VIII
What is the reticular formation?
Present throughout the brainstem tegmentum, means "little net" or "meshwork" - contains diffuse nuclei, little organization.
What are the Raphe nuclei, where are they located?
Raphe nuclei are found in the reticular formation in the brainstem, they contain Serotonin 5 HT, Enkephalin, and CCK which help block transmission of pain information.
What is the role of nuclei in the ventral lateral reticular areas?
Cell bodies here help control heart rate and respiration.
Describe the Pyramidal (motor) Decussation region. Where is it?
Axons of descending upper motor neurons in the corticospinal tract leave the pyramids, cross to the contralateral side, and change their name to become the lateral corticospinal tract (within the lateral funiculus).

Medulla
What is the Spinal Trigeminal Tract?
Axons relaying sensory information (pain, temperature) from the face.
What is the Spinal Trigeminal Nucleus? Where is it?
Cell bodies upon which axons from the spinal trigeminal tract synapse - the cell bodies will then relay the information (face-pain/temperature) to the cortex.

Medulla
What are internal arcuate fibers? Where are they?
The axons from gracile and cuneate nuclei which project to the medial lemniscus and exit to the cortex.

Brainstem
What is the hypoglossal nucleus? Where is it?
Cell bodies of CN XII that innervate the ipsilateral tongue muscles

Mid-Medulla
Where do the hypoglossal nerve axons exit?
Between the pyramids and olives at the level of the Mid-Medulla
What is the Dorsal Motor nucleus of the Vagus nerve? Where is it?
Preganglionic parasympathetic cell bodies for CN X

Mid-Medulla
Describe the Solitary Nucleus and Solitary Tract. Where are they?
The nucleus receives information from CN VII, CN IX, and CN X and transmits that information.

Mid-Medulla
What is the role of the medial longitudinal fasciculus?
Coordinates left and right eye movement
What is the Nucleus Ambiguus? Where is it?
Cell bodies of CN IX and CN X whose axons innervate the larynx and pharynx muscles

Mid-Medulla
Which peduncle carries axons from the posterior spinocerebellar tract?
The inferior cerebellar peduncle
What is the role of the inferior olivary nucleus? Where is it?
Transmits information to the cortex.

Mid-Medulla
What are the inferior and medial vestibular nuclei? Where is it?
Cell bodies part of CN VIII vestibular portion.

Rostral Medulla
What are the dorsal and ventral cochlear nuclei? Where is it?
Cell bodies that are part of CN VIII auditory portion?

Rostral Medulla
What is the Abducens Nucleus? Where is it?
Cell bodies of CN VI whose axons will innervate the lateral rectus EOM.

Caudal Pons
What is the Facial Nucleus? Where is it?
Cell bodies from CN VII - axons that innervate the ipsilateral facial muscles

Caudal Pons
What is the Superior Olivary Nucleus? Where is it?
Part of the auditory pathway

Caudal Pons
What is the Lateral Lemniscus? Where is it?
Part of the auditory pathway

Pons and Medulla
What is the Trapezoid body? Where is it?
Part of the auditory pathway

Caudal Pons
What are the Pontine nuclei? Where are they?
Cell bodies that project into the cerebellum via the middle cerebellar peduncle.

Pons
What is the Trigeminal Motor Nucleus? Where is it?
Cell bodies whose axons will innervate the muscles of mastication.

Mid-Level Pons
What is the Principal Sensory Nucleus? Where is it?
Cell bodies receiving tactile, vibratory sense from the face.

Mid-Level Pons
Where is the Mesencephalic Nucleus (and Tract)? What is it?
Pseudounipolar neurons relaying proprioceptive information from the mastication muscles

Mid-Level Pons and Rostral Pons
What is the Locus Ceruleus? Where is it?
Locus Ceruleus is a group of cells with a smoky blue hue, containing NE and the axons project through the CNS including the cortex, diencephalon, limbic system, brainstem, cerebellum, and spinal cord. There are low discharge rates while sleeping, and higher during stress.

Rostral Pons
What and where is the inferior colliculus?
Part of the auditory pathway

Caudal Midbrain
What and Where is the Trochlear Nucleus?
The Trochlear Nucleus sends out an axon to innervate the superior oblique muscle of the eye.

Caudal Midbrain
At what level does decussation of the superior cerebellar peduncles occur?
Caudal Midbrain
Where is the Substantia Nigra? What is it?
Part of the basal nuclei, cell bodies contain Dopamine - degeneration of these cell bodies results in Parkinson's Disease.

Midbrain
What and where is the superior colliculus?
Part of the visual pathway

Rostral Midbrain
What is the Oculomotor Nucleus? Where is it?
Cell bodies project to innervate 4 EOM - the parasympathetic nucleus to CN III is called the Edinger-Westphal Nucleus - contains the preganglionic parasympathetic cell bodies whose axons will synapse on the ciliary ganglion and cause pupillary constriction.

Rostral Midbrain
What is the Edinger-Westphal Nucleus? Where is it?
It contains the preganglionic parasympathetic cell bodies whose axons will synapse on the ciliary ganglion and cause pupillary constriction.

Rostral Midbrain
What is the Red Nucleus?
Projects axons as the Rubrospinal Tract - influences lower motor neurons
With what level of the brainstem is the cerebral aqueduct associated?
Midbrain
With what level of the brainstem is the 4th ventricle associated?
Posterior to the Medulla and Pons, the central aqueduct runs through the Caudal Medulla
What arteries supply blood to the Caudal Medulla?
ASA
VA
PICA
PSA* (unique to this level of the Medulla)
What arteries supply blood to the Mid-Medulla?
ASA
VA
PICA
What arteries supply blood to the Rostral Medulla?
ASA
VA
PICA
AICA* (unique to this level of the Medulla)
What arteries supply blood to the Pons?
Medially to Laterally branching from the Basilar Artery...

Paramedian Artery
Short Circumferential Artery
Long Circumferential Artery
What arteries supply blood to the Midbrain?
PCA
Basilar Artery
SCA
QA
What is the role of CN I and its basic path?
Olfactory Nerve

Very short, it relays information from the olfactory epithelium to the pyriform cortex (special sensory) - passes through the cribiform plate.

Synapses on the olfactory bulb and the tract bifurcates at the olfactory trigone to the medial and lateral striae, which enter the pyriform area (within the parahippocampal/occipitotemporal gyri)
What is the role of CN II and its basic path?
CN II is the Optic Nerve, it relays information from the neurons in the eye and pass through the optic chiasm. They synapse on the lateral geniculate nucleus of the thalamus which projects to the visual cortex of the occipital lobe.
What is the role of CN III and its basic path?
Occulomotor nerve - innervates 4/6 extraocular muscles and also has a parasympathetic visceral component (pupillary constriction) - Nerve exits the midbrain through the interpeduncular fossa, pierces dura mater, and travels through the cavernous sinus, to the superior orbital fissure, and through the tendinous ring in the orbit where it divides into superior and inferior branches.
What muscles are innervated by the superior branch of the Oculomotor nerve?
Superior rectus
Levator palpebrae superioris
What muscles are innervated by the inferior branch of the Oculomotor nerve?
Inferior rectus
Inferior oblique
Medial rectus
What is CN IV and what is its basic path?
CN IV is the Trochlear nerve, which innervates the Superior Oblique muscle of the eye (inward rotation, downward movement)
What is CN V and what is its basic path?
CN V is the Trigeminal Nerve, which has 3 branches: V1 (ophthalmic), V2 (maxillary), V3 (mandibular).

Responsible for general sensory and branchial motor (V3)
What is CN VI and what is its basic path?
Abducens nerve - innervates the Lateral Rectus muscle of the eye, rotates it laterally.

Starts in the abducens nucleus, exits at the pontomedullary junction, and crosses over to the opposite side exiting the superior orbital fissure.
What is CN VII and what is its basic path?
Facial nerve

4 divisions: Branchial motor efferents to the muscles of facial expression; Visceral motor efferents to glands and mucous membranes; General sensory efferents from the ear; Special sensory afferents (taste from anterior 2/3 of tongue)
What is CN VIII and what is its basic path?
Vestibulocochlear nerve - a special sensory efferent nerve for vestibular (balance and posture) and auditory processing.
What is CN IX and what is its basic path?
Glossopharyngeal nerve, 5 components

General sensory to posterior 1/3 of tongue, skin, external ear, internal surface of TM, pharynx
Visceral sensory from carotid body and sinus
Special sensory taste from posterior 1/3 of tongue
Branchial motor to stylopharyngeus
Visceral motor (parasympathetic) to Parotid Gland
What is CN X and what is its basic path?
Vagus nerve, travels from brainstem to splenic fixture of the colon to innervate visceral organs and relays sensory information back.

4 modalities:
General Sensory (posterior meninges, external ear, pharynx, larynx)
Visceral Sensory (larynx, trachea, esophagus, thoracic and abdominal viscera, stretch and chemoreceptors in aortic arch)
Branchial motor (muscles of larynx and pharynx)
Visceral motor (smooth muscle and glands of larynx, pharynx, thoracic and abdominal viscera, cardiac muscle)
What is CN XI and what is its basic path?
CN XI is the spinal accessory nerve, it innervates the SCM and Trapezius muscle. It has bodies in the ventral horn of C1-C5, travels up through the foramen magnum and out the jugular foramen.
What is CN XII and what is its basic path?
Hypoglossal Nerve - the nucleus is in the medulla and the axons project through the hypoglossal canal to innervate the intrinsic and extrinsic tongue muscles.
Where are the cell bodies of CN IV?
Inferior Colliculus
Where do the temperature and pain components of the Trigeminal Nerve go?
They synapse on the Spinal Trigeminal Nucleus, whose axons decussate and synapse on the contralateral dorsal thalamus, which projects to the postcentral gyrus lateral area.
Where do the touch and vibratory components of the Trigeminal Nerve go?
They ascend and synapse on the dorsal thalamus, which projects up to the postcentral gyrus lateral area.
Where does the proprioceptive component of the Trigeminal Nerve go?
Projects to the cerebellum, the cell body is in the mesencephalic nucleus.
Where are the cell bodies of the Facial Nerve?
Facial Motor Nucleus - projects to the ipsilateral facial muscles.
Describe the path of the Efferent Motor Component of the Facial Nerve.
Emerges at the Pontine level of the brainstem, enters the internal acoustic meatus through the facial canal (nerve to stapedius branches here), emerges through the stylomastoid foramen, gives off branches to the stylohyoid, posterior belly of the digastric, occipitalis, passes through the parotid gland and gives off five branches: Temporal, Zygomatic, Buccal, Mandibular, Cervical
Describe the path of the Visceral Motor Efferent Pathway of the Facial Nerve.
Starts from parasympathetic preganglionic cell bodies in the superior salivary nucleus of the Pons, axons project to the Facial Canal, divide into the greater petrosal and chorda tympani nerves.

Greater petrosal nerve - enters the pterygopalatine canal and synapses on the pterygopalatine ganglion. Parasympathetic postganglionic axons project through the lacrimal gland and mucous glands of the nasal and oral cavities.

Chorda tympani nerve - passes through the petrotympanic fissure, travels through the floor of the oral cavity, synapses on the submandibular ganglion. Parasympathetic postganglionic axons innervate the submandibular and sublingual glands.
Describe the path and innveration of the Chorda Tympani Nerve.
It passes through the petrotympanic fissure, travels through the floor of the oral cavity, synapses on the submandibular ganglion. Parasympathetic postganglionic axons innervate the submandibular and sublingual glands.
Describe the path and innervation of the Greater Petrosal Nerve.
It enters the pterygopalatine canal and synapses on the pterygopalatine ganglion. Parasympathetic postganglionic axons project through the lacrimal gland and mucous glands of the nasal and oral cavities.
Describe the path of the General Sensory Pathway of the Facial Nerve.
Afferents from the wall of the external acoustic meatus and external surface of the TM enter the stylomastoid foramen. Cell bodies are located on the geniculate ganglion which projects its axons to the spinal trigeminal nucleus in the brainstem.
Describe the path of the Special Sensory Pathway of the Facial Nerve.
Relays taste information from the tastebuds of the anterior 2/3 of the tongue via the chorda tympani nerve, cell bodies are in the geniculate nucleus, axons project to the medulla and synapse on the nucleus solitarius.
Describe the General Sensory Pathway of the Glossopharyngeal Nerve.
Cell bodies are in the inferior glossopharyngeal ganglion, and axons project and synapse on the spinal trigeminal nucleus in the brainstem.
Describe the Visceral Sensory Pathway of the Glossopharyngeal Nerve.
Receives information from the chemoreceptors in the carotid body and baroreceptors in the carotid sinus. Cell bodies in the inferior glossopharyngeal ganglion and axons project and synapse on the nucleus solitarius.
Describe the Special Sensory Pathway of the Glossopharyngeal Nerve.
Cell bodies in the inferior glossopharyngeal ganglion, axons project on the nucleus solitarius in the medulla.
Describe the Branchial Motor Pathway of the Glossopharyngeal Nerve.
Corticobulbar tracts synapse bilaterally on the rostral nucleus ambiguus which contains bodies of the lower motor neurons that innervate the stylopharyngeus muscle.
Describe the Visceral Motor Pathway of the Glossopharyngeal Nerve.
Preganglionic parasympathetic cell bodies located in the inferior salivatory nucleus in the Medulla project their axons (lesser petrosal nerve) out of the jugular foramen and in through the foramen ovale to synapse on the otic ganglion where the postganglionic neuron will innervate the parotid gland.
Describe the General Sensory Pathway of the Vagus Nerve.
Information from larynx and pharynx travel via vagus (internal laryngeal nerve) and become the superior laryngeal nerve, where cell bodies are located in the inferior vagal ganglion. General sensory information from external ear and external auditory canal travel to superior vagal ganglion where cell bodies are, synapse in the spinal trigeminal ganglion in the brainstem.
Describe the Visceral Sensory Pathway of the Vagus Nerve.
Visceral information travels via vagus, via left and right gastric nerves of the vagus, through the esophageal hiatus, continues up through the thorax as the right and left vagus nerves, joined by nerves carrying sensory information from baroreceptors and chemoreceptors in the aorta, larynx, larynx above vocal folds, epiglottis, etc. Cell bodies are in the inferior vagal ganglion and enter the brainstem and synapse on the nucleus solitarius.
Describe the Branchial Motor Pathway of the Vagus Nerve.
Nucleus ambiguus (medulla) contains cell bodies of motor efferents of the vagus and leaves the brainstem as… pharyngeal branch (motor to the pharynx), superior laryngeal branch (divides internal sensory and external motor laryngeal nerves to innervate the inferior constrictor and cricothyroid muscles), recurrent laryngeal branch.
Describe the Visceral Motor Pathway of the Vagus Nerve.
Parasympathetic preganglionic cell bodies are in the dorsal motor nucleus of the vagus in the medulla, axons project to the ganglia located on or near the organ to be innervated.
How can you clinically test the integrity of CN I? Mention some possible causes of loss of integrity.
an anteroposterior skull fracture parallel to superior sagittal suture can tear olfactory axons in the cribriform plate resulting in ipsilateral loss of smell (anosmia). Frontal lobe tumors or meningiomas on the floor of the anterior cranial fossa can interfere with transmission of olfactory information
Damage to the primary cortical olfactory area in the temporal lobe from tumors or seizures can result in olfactory hallucinations (phantom smells)

Test by closing one nostril and testing a scent.
How can you clinically test the integrity of CN II? How would it lose integrity?
Cataracts, damage from MS or CNS tumors, retinal blood vessels, presbyopia, myopia, hyperopia…
Use ophthalmoscope – visualize fundus with a sharp optic disc – if disc is not sharp, indicates vascular problem or CNS problem such as papilledema which indicates CSF buildup. Look at retina and macula.
Visual acuity – assess acuity with Snellen’s chart
Visual fields – stand across from patient, patient closes left eye and you close your right eye, with arm fully extended bring index finger from periphery into center of visual field – have patient indicate when they can see your finger.
How can you clinically test the integrity of CN III?
Test the motion of the extraocular muscles.
How can you clinically test the integrity of CN IV? How might it lose integrity?
Vascular lesion like an aneurysm of posterior cerebral or superior cerebellar arteries could damage the nerve. Also a pathological lesion in the cavernous sinus or superior orbital fissure, could also affect IV. Lesion of IV would exhibit lower motor neuron symptoms. Outward rotation of the eye, diplopia, weakness of downward rotation of the eye. Patients with a lesion of the trochlear nerve/nucleus will tilt their head to the unaffected side to correct the diplopia.

Test EOM.
How can you clinically test the integrity of CN V and its branches? How might its integrity be compromised?
Sensory lesions – tic doloureux (trigeminal neuralgia) – episodes of lancinating, severe pain of unknown etiology – treat with antiepileptics or analgesics or transection of nerves in trigeminal ganglion.
Motor lesions – lower motor neuron lesion to muscles of mastication – characterized by paralysis, atrophy of muscles and decreased strength of bites. Test sensory by having patient close eyes and use a cotton swab to lightly touch each side of the forehead, cheeks, and jaw.
Test motor by palpating the masseter and temporalis muscles, have patient clamp jaw tightly. Have patient open jaw, if there is a lesion the jaw will deviate to the lesioned side.
How can you clinically test the integrity of CN VI? How might its integrity be compromised?
Lesions of VI can be caused by aneurysms of PICA, basilar, or internal carotid artery, pathological conditions of the cavernous sinus. Would exhibit lower motor neuron symptoms, medial (internal) strabismus, diplopia.

Test EOM.
How can you clinically test the integrity of CN VII? How might its integrity be compromised?
Lesions cause paralysis of various regions of the face – if it affects the whole nerve, and its branches, results in Bell’s palsy.

Test motor component – examine muscles of facial expression by observing patient’s facial expressions while speaking, ask patient to raise eyebrows, close eyes tightly, press lips firmly together;
Blink reflex – involves CN V1, VII – a cotton swab is lightly touched on the cornea which causes the eyes to blink;
Test the special sensory component by putting a salty or sweet solution on the patients tongue and have the patient point to the chart to indicate the taste.
How can you clinically test the integrity of CN IX? How might its integrity be compromised?
Glossopharyngeal neuralgia is characterized by a sharp lancinating pain in the tonsil region that radiates to the ear. Pain sensation is triggered by yawning, swallowing, or food in the tonsilar region. NO cause can usually be identified for glossopharyngeal neuralgia, but sometimes from compression of the nerve caused by carotid aneurysms, oropharyngeal malignancies, peritonsillar infections, or lesions.
Gag reflex is a protective reflex which is initiated by CN IX, which is related to CN X and XII so respiratory and alimentary passages are closed and the tongue protrudes to expel the object
How can you clinically test the integrity of CN X? How might its integrity be compromised?
Perform the gag reflex to test the integrity of CN IX and CN X (motor). Touch the right and left sides of the pharynx – if circuitry is intact, pharyngeal walls contract when touched.

To test the integrity of CN X – observe posterior pharynx at rest and during phonation – if lesioned, the uvula deviates toward the normal side.
How can you clinically test the integrity of CN XI? How might its integrity be compromised?
Damage would cause lower motor neuron symptoms to the ipsilateral trapezius and SCM. Patient would not be able to raise the affected shoulder, or turn theirs to the opposite side if lesioned.
Test integrity to SCM by having patient tilt and turn chin to opposite side.
Have patient shrug shoulders against resistance. Once arm is abducted above 90 degrees, apply resistance and tell patient to raise arms. Observe any muscle wasting, or if scapula is rotated down and laterally.
How can you clinically test the integrity of CN XII? How might its integrity be compromised?
Lesions to the hypoglossal nucleus or the axons that project to the extrinsic tongue muscles would cause muscle weakness on the ipsilateral side, thereby causing the tongue to deviate to the affected (lesioned) side.
Observe tongue for fasciculations and atrophy, instruct patient to stick out tongue – if LMN lesion is present, tongue will deviate to lesioned side.