Neuro Anatomy

Front 1

Which myotome is:

should abduction

Back 1

C5 (C6)

deltoid

Front 2

Which myotome is:

Elbow flexion and extension

Back 2

extension - C7 (C6, C8)

flexion C7 - (C6, C8)

Front 3

Which myotome is:

Hand - fingers, thumb (flexion)

abduction, adduction

Back 3

fingers - C8 (C7, T1)

thumb C8 (C7, T1)

Abd/adduction - T1

Front 4

Which myotome is:

Hip flexion and extension

Back 4

flexion S1 (L5, S2)

Extension L2 (L1, L3)

Front 5

Which myotome is:

Knee flexion/extension?

Back 5

Extension L3/4

Flexion L5/S1

Front 6

Which myotome is:

Ankle -

Dorsiflexion
plantarflexion

Back 6

dorsiflexion - L4 (L5)

Plantarflexion S1 (S2)

Front 7

What are the dorsal, lateral and ventral funiculus?

Back 7

collective name for all the tracts within the white matter of the spinal cord in the lateral, dorsal and ventral areas

Front 8

which horn of the spinal cord is associated with sensory and motor?

Back 8

sensory - dorsal horn

motor - ventral horn

Front 9

what levels of the spinal cord contain SNS fibres?

Back 9

T1-L2/3 has the intermediate zone (lateral horn)

contains pre-ganglionic SNS neurons

Front 10

What sensory information is carried in the dorsal column tract?

Back 10

discriminatory touch, proprioception, pressure, vibration

Front 11

What are the dorsal, lateral and ventral funiculus?

Back 11

collective name for all the tracts within the white matter of the spinal cord in the lateral, dorsal and ventral areas

Front 12

which horn of the spinal cord is associated with sensory and motor?

Back 12

sensory - dorsal horn

motor - ventral horn

Front 13

what levels of the spinal cord contain SNS fibres?

Back 13

T1-L2/3 has the intermediate zone (lateral horn)

contains pre-ganglionic SNS neurons

Front 14

What sensory information is carried in the dorsal column tract?

Back 14

discriminatory touch, proprioception, pressure, vibration

Front 15

LABEL

Back 15

Front 16

Label

Back 16

Front 17

LABEL

Front 18

Label

Front 19

what does the spinothalamic tract carry?

where is it?

Back 19

pain and temperature from contralateral side
(also simple touch and pressure)

anterolateral (around ventral horn)

Front 20

where are the cell bodies associated with the neurons in the spinothalamic tract?

Back 20

DRG

they project to the Thalamus - VP

Front 21

Dorsal spinocerebellar tract carries what kind of information and where does it go?

Back 21

unconscious proprioception

Cerebellum

Front 22

At what vertebral level does the SC finish?

Back 22

L2

Front 23

What is the cauda equina?

Back 23

tail of the SC

attaches to the filum terminale

Front 24

what is the blood supply to the SC

Back 24

Anterior and posterior spinal arteries

Feed by vertebral arteries and radicular arties

Front 25

Following a left sided hemisection of the spinal cord at C8, after the period of spinal shock, which of the following are correct:

(a) Increased deep tendon reflexes in the left leg
(b) Anaesthesia (loss of all sensation) in the right thigh
(c) Analgesia (loss of all pain) in the left leg
(d) Inability to recognize direction of passive movement of left great toe when the
eyes are shut.
(e) Babinski sign on the right side
(f) Atrophy and flaccid paralysis of the ulnar muscles (C8) in the left hand
(g) Spasticity and voluntary paralysis of the left lower limb
(h) Absent touch sensation on the right side of the chest
(i) Pain loss in right leg and right side of abdomen.

Back 25

Note the following tracts would be cut by the lesion – the left descending corticospinal tract, the left ascending spinothalamic tract (bringing pain and temperature information from the right leg), the right gracile tract (discriminatory touch from the right leg)
(a) correct loss of corticospinal tract on the left means that muscles on the left are paralysed. The muscles are still connected to the spinal cord by a reflex arc and with time the reflexes become exaggerated. This is called upper motor neuron paralysis. The muscles are paralysed but still have muscle tone and reflexes due to the presence of an intact reflex arc.
(b) false – although the gracile tract is lost on the left side pain and temperature would still be present.
(c) false – as for (b) the R spinothalamic tract carrying pain and temperature information from the left leg is intact.
(d) true – this is a feature associated with loss of conscious proprioceptive information on the left side. Information carried by the gracile tract.
(e) false – this sign is associated with loss of the corticospinal tract but this tract would only be lost on the left side.
(f) true – the lesion at C8 would damage both ventral horn cells and ventral root at that level on the left. Hence motor fibres to ulnar muscles would be lost. Since these muscles would not have any nerve supply they would be paralysed and would not have a reflex arc. This is called lower motor neuron paralysis and leads to rapid atrophy of the affected muscles and the muscles are flaccid.
(g) true – typical upper motor neuron paralysis of the left leg due to loss of corticospinal tract.
(h) false – dorsal columns (cuneate tract) are unaffected for the chest region.
(i) true – the left spinothalmic tract bringing pain and temperature information
from the right leg would be cut by the lesion.

Front 26

What is the difference between a vertebral level and a spinal level? Answer true or false
(a) Spinal level has the same meaning as a vertebral level (b) The spinal cord ends at vertebral level L2 (c) All spinal nerves pass below numerically corresponding vertebrae and are hence
numbered as such (d) C1 has no dorsal root
(e) A vertebral insult below vertebral body L2 results in spinal cord injury

Back 26

a -F
b - T
c - F
d - T
e - F

Front 27

Which of the following symptoms are typical of upper motor neurons lesions (UMN) and which are typical of lower motor neuron (LMN) lesions?
(a) Paralysis: no voluntary movement.
(b) Micturition no voluntary control
(c) Pyramidal stance/gait: upper limb held in flexion; lower limb extension- affects antigravity muscles most.
(d) No reflex (areflexia): diminished or absent tendon reflexes
(e) Muscle atrophy/flaccidity: deprived of motor fibres. Denervated muscle fibres atrophy in time, causing wasting of muscle.
(f) Exaggerated tendon reflex (hyperreflexia): particularly in antigravity muscles (namely flexors of arm/fingers [biceps]; extensors
(g) Twitches: Flickers of muscle fibres visible with naked eye.
(h) Paralysis: varying degrees of voluntary movement loss of leg [quads], plantaflexors [gastrocs]).
(i) Spasticity (hypertonia): no control of muscle tension.

Back 27

(a) Paralysis: no voluntary movement. Widespread paralysis typical of UMN, local paralysis of affected muscle LMN.
(b) Micturition no voluntary control. UMN lesion such as a transected cord gives a reflex bladder no voluntary control. If cauda equine damaged (LMN) bladder loses its nerve supply giving a flaccid paralysis of the bladder no voluntary control.

(c) Pyramidal stance/gait: upper limb held in flexion; lower limb extension- affects antigravity muscles most (UMN).

(d) No reflex (areflexia): diminished or absent tendon reflexes (LMN)
(e) Muscle atrophy/flaccidity: deprived of motor fibres. Denervated muscle fibres
atrophy in time, causing wasting of muscle. (LMN)
(f) Exaggerated tendon reflex (hyperreflexia): particularly in antigravity muscles
(namely flexors of arm/fingers [biceps]; extensors (UMN)
(g) Twitches: Flickers of muscle fibres visible with naked eye (LMN).
(h) Paralysis: varying degrees of voluntary movement loss of leg [quads],
plantaflexors [gastrocs]) (UMN)
(i) Spasticity (hypertonia): no control of muscle tension (UMN)

Front 28

True/false
(a) There are limited anastomosis in the spinal cord
(b) The anterior spinal artery arises from lumbar arteries
(c) The posterior spinal artery supplies the ventral funiculus of white matter (d) The great radicular artery of Adamkiewicz supplies the lower thoracic and upper
lumbar levels
(e) The spinal cord has a rich blood supply

Back 28

a) There are limited anastomosis in the spinal cord - true
(b) The anterior spinal artery arises from lumbar arteries - false
(c) The posterior spinal artery innervates the ventral funiculus of white matter - false
(d) The great radicular artery of Adamkiewicz supplies lower thoracic and upper
lumbar levels - true
(e) The spinal cord has a rich blood supply - false

Front 29

Select correct statement
(A) There is no recovery of motor function after spinal cord lesion
(B) Recovery of motor function is limited to use of proximal musculature (C) Recovery of motor function is limited to use of distal musculature
(D) Recovery of motor function is limited to use of lower limbs only
(E) Recovery of motor function is limited to use of facial muscles only

Back 29

B

Front 30

Select correct statement
(a) Flexor reflex involves the involvement of γ motor cells
(b) Stretch reflex requires an interneurone
(c) Muscle tone is regulate by the lateral horn of the grey matter
(d) Neuromuscular spindles are innervate by α motor cells
(e) Golgi tendon organs have Ib sensory afferents

Back 30

E

Front 31

What are the consequences of a dorsal root lesion (red X in figure below)?

True/false
Loss of sensory input from that particular dermatome Loss of motor output for that particular myotome Loss of both sensory and motor function for that area Degeneration of cells in the dorsal horn Degeneration of cells in the dorsal root ganglion

Back 31

Loss of sensory input from that particular dermatome T Loss of motor output for that particular myotome F Loss of both sensory and motor function for that area F Degeneration of cells in the dorsal horn F Degeneration of cells in the dorsal root ganglion T

Front 32

Back 32

A Dorsalrootganglion
B Dura/Arachnoid mater
C Anterior spinal artery
D Conus medullaris
E Filum terminale

Front 33

Pick the most appropriate symptoms for the above lesion
(a) lower motor neuron loss on ipsilateral side
(b) upper motor neuron loss on ipsilateral side
(c) loss of pain/temperature on both sides
(d) loss of touch on both sides
(e) upper motor neuron loss on contralateral side

Back 33

A) lower motor neuron loss on ipsilateral side - true due to loss of ventral horn cells

B) upper motor neuron loss on ipsilateral side – false

C) loss of pain/temperature on both sides – true the pain and temperature fibres of the spinothalamic tract cross in the ventral white commissure which lies just below the gray matter connecting the two ventral horns. This area has been shaded. Both spinthalamic tracts would be affected.

(d) loss of touch on both sides – partly true – simple touch carried in the STT would be lost but discriminatory touch carried in gracile and cuneate tracts would be intact.

(e) upper motor neuron loss on contralateral side – false corticospinal tracts unaffected

Front 34

Back 34

A Denticulate ligament
B Dorsal Root
C Anterior spinal artery
D Great radicular artery
E Caudal equina

Front 35

i) Name the tract labeled A. What type of information does this tract convey?

ii) What is B?

iii) What would be the symptoms following a lesion encompassing the region indicated by C?

iv) Name the tract labeled D. What type of information does this tract convey?

Back 35

i) Cuneate tract. Carries upper body discriminatory touch, proprioception, pressure and vibration. ii) dorsal horn iii) Lesion is encompassing the ventral horn. Thus the motor neurons supplying the lesioned segments would be interrupted and thus the muscle they supply would have no tone and would show considerable wasting.
iv) Gracile tract. Carries lower body discriminatory touch, proprioception, pressure and vibration.

Front 36

LABEL

Back 36

Front 37

LABEL

Back 37

Front 38

Back 38

Front 39

Back 39

Front 40

Back 40

Front 41

Back 41

Front 42

Back 42

A– B– C– D– E–
A superior sagittal sinus
B lateral ventricle
C 3rd ventricle
D 4th ventricle
E Foramina of Luschka

Front 43

Back 43

A– B– C– D– E–
A tentorium cerebelli
B midbrain/cerebral aqueduct
C 3rd ventricle
D Foramen of Magendie E Cisterna Magna

Front 44

What is the epidural space?
Choose the correct statement:

(A) in the cranium, it is a potential space between dura and bone
(B) in the cranium, it is a potential space between dura and arachnoid
(C) in the cranium, it is a potential space between pia and arachnoid
(D) in the vertebral canal, it is a potential space between dura and bone
(E) in the vertebral canal, it is a potential space between dura and arachnoid

Back 44

(A) in the cranium, is a potential space between dura and bone

Front 45

What is the difference between a "myelomeningocele" and a "meningocele"?
Answer true or false

(i) A myelomeningocele does not involve the spinal cord
(ii) A myelomeningocele is different to the term "spina bifida".
(iii) A meningocele does not involve the meninges
(iv) A myelomeningocele is nearly always associated with hydrocephalus

Back 45

(i) F (ii) F (iii) F (iv) T

Front 46

Where would the choroid plexus be found in the brain and why is this important clinically?
Answer true or false

(i) The choroid plexus is the only place where cerebrospinal fluid is made
(ii) About 500ml of cerebrospinal fluid is made each day
(iii) Choroid plexus is found in the lateral ventricles only
(iv) There is no feedback pathway to the choroid plexus limiting production of CsF
(v) There are marked fluctuations in the concentrations of ions in the CsF during the day

Back 46

(i)F (ii)T(iii)F(iv)T(v)F

Front 47

What is the clinical significance of the blood brain barrier (BBB)?
Choose the correct statement:

(A) A BBB is found at the level of the extracranial cerebral vessels
(B) The BBB has no control entry of particular substrates into the CNS
(C) The capillaries of the brain have many fenestrations
(D) The BBB at the choroid plexus is not absolute
(E) excludes toxins

Back 47

(D) The BBB at the choroid plexus is not absolute

Front 48

With respect to the ventricular system
Answer true or false

(i) The mesencephalic aqueduct connects the lateral ventricles to the third ventricle
15

(ii) The mesencephalic aqueduct passes through the medulla
(iii) The foramina of Luschka connect the fourth ventricle to the cerebellomedullary cistern
(iv) The lateral ventricles house the pineal gland
(v) Ependymomas develop from the cells that line the ventricles

Back 48

(i) F (ii) F (iii) T (iv) F (v) T

Front 49

What is the relationship between cerebral vessels and the pia mater?
Answer true or false

(i) The cerebral vessels lie on top of the pia
(ii) The cerebral vessels lie within the subarachnoid space
(iii) The pia adheres tightly to the CNS
(iv) The subarachnoid space lies between the pia and arachnoid
(v) The pia lines the optic nerve

Back 49

(i) T (ii) T (iii) T (iv) T (v) T

Front 50

With so much CsF being produced each day, how and where is it cleared?
Answer true or false

(i) The arachnoid granulations are the only major sites of CsF production
(ii) The subarachnoid space is a very robust structure, capable of withstanding much insult
(iii) Many arachnoid granulations lie in the fourth ventricle
(iv) The flow of CsF through the arachnoid granulations is from subarachnoid space to dural
venous sinus
(v) Subarachnoid cisterns are pools of CsF continuous with the CsF of the subarachnoid space
around the cerebrum

Back 50

(i)F (ii)F (iii)F (iv)T (v)T

Front 51

What is the mesencephalic Aqueduct?

Back 51

cerebral aqueduct

Front 52

how does CSF get form the ventricles to the subarachnoid space?

Back 52

Foramen of magendie and paired foramina of Luschka

Enters the cerebellomedullary cistern (cisterna magna)

Front 53

What are the functions of and consequences of a lesion to CN:

III

Back 53

supplies all extrinsic eye muscles: medial, superior, and inferior rectus, inferior oblique and levator palpebrae muscles.

Damage results in diplopia (double vision), ptosis (drooping eyelid), and outward deviation of the eye.

Front 54

What are the functions of and consequences of a lesion to CN:

IV

Back 54

supplies the superior oblique muscle.

Damage results in upward deviation of the eye and thus diplopia.

Front 55

What are the functions of and consequences of a lesion to CN:

V

Back 55

supplies general sensory to the face (touch, proprioception, pain, heat), the muscles of mastication as well as tensor tympani, tensor palati and digastric.

Damage results in decreased sensitivity of face (possible numbness), brief attacks of pain, weakness and wasting of jaw muscles and asymmetric chewing.

Front 56

What are the functions of and consequences of a lesion to CN:

VI

Back 56

supplies the lateral rectus muscle.

Damage results in inward deviation of the eye and thus diplopia.

Front 57

What are the functions of and consequences of a lesion to CN:

VII

Back 57

supplies the muscle of facial expression, stapedius muscle, taste to the anterior 2/3rds of the tongue and lacrimal and salivary glands.

Damage results in paralysis of the facial expression muscles and loss of taste of ant 2/3rds of tongue.

Front 58

What are the functions of and consequences of a lesion to CN:

VIII

Back 58

supplies the vestibular apparatus and the cochlear.

Damage results in deafness (sometimes tinnitus) and disequilibrium.

Front 59

What are the functions of and consequences of a lesion to CN:

IX

Back 59

supplies sensation to the palate and taste to the posterior 1/3rd of the tongue and stylopharyngeal muscle.
Damage results in pain spasms in posterior pharynx and loss of taste in posterior 1/3rd of tongue.

Front 60

What are the functions of and consequences of a lesion to CN:

X

Back 60

supplies autonomics and transmits sensory information to/from the viscera and heart, muscle of pharynx and larynx. It also supplies the muscles of the pharynx and larynx.

Therefore damage results in hoarseness, poor swallowing and loss of gag reflex.

Front 61

What are the functions of and consequences of a lesion to CN:

XI

Back 61

supplies trapezius and sternocleidomastoid muscles.

Damage results in wasting in the neck with weak neck rotation - cant shrug.

Front 62

What are the functions of and consequences of a lesion to CN:

XII

Back 62

supplies the intrinsic muscles of the tongue, hyoglossus, styloglossus and genioglossus muscles.

Damage results in wasting of tongue and tongue deviation to side of lesion on protrusion.

LMN - fasiculations of resting tongue

Front 63

Back 63

Front 64

What is contained within the pyramids?

Back 64

corticospinal tract

(descending motor fibres)

Front 65

Function of the Olives?

Back 65

Olivary Nuclei

Supply information regarding motor control to the cerebellum - "Coordination of movement"

Front 66

Function of the Superior Cerebellar Peduncle?

Back 66

Fibres from the cerebellum to to midbrain (red nucleus) + thalamus.

MOTOR outflow --> motor coordination

Front 67

Function of the gracile and cuneate tubercles?

Back 67

Gracile and Cuneate nuclei

synapse between ascending sensory fibres in DCT to 2nd neuron which then decussate --> thalamus via ML

Front 68

Function of the inferior cerebellar peduncle?

Back 68

Information TO cerebellum about POSITION and BALANCE

From Spinocerebellar fibres and vestibular fibres

Front 69

Function of the Pons and MCP (middle cerebellar peduncle)?

Back 69

Pons receives MOTOR input from corticopontine fibres ---> these give rise to pontocerebellar fibres.

Major connection between cerebral cortex and cerebellum

Front 70

Function of Cerebral peduncles?

Back 70

Carry corticospinal, corticobulbar, corticopontine fibres

corticobulbar fibres are motor to the face/head

Front 71

Function of the inferior colliculus?

Back 71

HEARING

Front 72

Function of Superior colliculus ?

Back 72

Role in Vision

Front 73

Back 73

Front 74

What Section of the brainstem is this through?

Back 74

Closed Medulla

Front 75

Which level of the brain stem is this section?

Back 75

Open Medulla

Front 76

What level of the brain stem is this section?

Back 76

Pons

Front 77

What level of the brain stem is this?

Back 77

Midbrain

Front 78

What is the main blood supply to the brainstem?

Back 78

vertebral arteries --> which form the basilar Artery

Front 79

What are the branches of arteries that feed the brainstem and cerebellum?

Back 79

PICA
AICA
SCA
Basilar
Vertebral

Front 80

Back 80

Front 81

Label the Blood supply

Back 81

Front 82

Label the blood supply.

Back 82

Front 83

What % of strokes occur in the brainstem?

Back 83

25%

Front 84

What are the single artery brainstem syndromes?

Back 84

These are the syndromes resulting from occlusion of the
1) paramedian/basal midbrain arteries,
2) basilar penetrating arteries in the pons,
3) superior cerebellar artery,
4) anterior inferior cerebellar artery and
5) posterior inferior cerebellar artery in the medulla,
6) vertebral artery, and
7) anterior spinal artery.

Front 85

What are the signs associated with a stroke involving:

Paramedian/basal arteries in the MIDBRAIN.

Back 85

Midline structures
corticospinal, corticobulbar, RF, III nuclei

"locked in with ocular palsy"

S&S - sudden onset vomitting, transient LOC, acute quadriplegia (corticospinal), bilateral facial paralysis, loss of speech (corticobulbar - IX, X, XII), Loss of voluntary eye movements (III)

Front 86

What are the signs associated with a stroke involving:

Paramedian/basal arteries in the PONS.

Back 86

Midline - corticospinal, corticobulbar, RF, (III Spared!)

"locked in syndrome withOUT occular palsy"

S&S - sudden onset vomitting, transient LOC, acute quadriplegia (corticospinal), bilateral facial paralysis, loss of speech (corticobulbar - IX, X, XII)

Front 87

What are the signs associated with a stroke involving:

Superior cerebellar artery

Back 87

Ipsilateral cerebellar ataxias (loss of Middle and/or superior peduncles), N&V, slurred speech, loss of pain + temp (contralateral), partial deafness and horners syndrome

Front 88

What are the signs associated with a stroke involving:

Anterior inferior cerebellar artery

Back 88

2nd most common

Anterior cerebellum + caudal pons

--- also the labyrinthne/internal auditory A. had origin on AICA (supplies inner ear) --> nystagmus and vertigo?

Vertigo, vomitting, falling/lean to one side, horizontal nystagmus, *absent sensation on 1 side of face,*ipsilateral facial paralysis, *ispilateral hearing loss



NOTE: facial paralysis and hearing loss are NOT signs of Wallenberg syndrome/lateral medullary syndrom - which can be confused for AICA stroke

Front 89

What are the signs associated with a stroke involving:

Posterior inferior cerebellar artery

Back 89

Most Common

Lateral medullary syndrome / Wallengerg's syndrome

Lateral Medulla + cerebellum

N&V, Dizzy, vertigo, fall to 1 side / ataxia (cerebellum), diplopia, nystagmus (vestibular), reduced pain on insilateral face (Vsp, contralateral loss of pain and temp on body,
No motor weakness, but discoordinated, Horners syndrome (SNS VII), hoarse voice (X - N. Am, dysphagia (X - N.Am)

Front 90

What are the signs associated with a stroke involving:

Vertebral A

Back 90

Lateral Medulla (complete block = wallenberg Syndrome also)

Structures: Vsp, IO, N Am, SNS, S Th


ipsilateral facial pain (Vsp), contralateral body pain loss (S Th), Ipsilateral ataxia and gait ataxia (IO), hoarseness _ dyphagia (N Am), Horner's syndrome

Front 91

What is characteristic Horner's syndrome?

Back 91

ptosis, miosis, facial anhydrosis

damage to SNS fibres

Front 92

What are the signs associated with a stroke involving:

Anterior Spinal Artery

Back 92

Structures: pyramids, ML, Hypoglossal N

contralateral weakness of limbs, contralateral sensory loss, Ipsilateral tongue weakness

Front 93

i) Describe the symptoms after lesion to X? Choice of (more than one answer)
• Dysphonia
• Dysphasia
• Loss of pain, ipsilateral body
• Loss of pain, ipsilateral head
• Loss of pain, contralateral body
• Loss of pain, contralateral head
• Upper motor neurone lesion

ii) What artery may be affected if lesion at X?

iii) What are the structures marked Y and Z?

Back 93

i) Dysphonia (loss of nucleus ambiguus) Loss of pain contralateral body (loss of spinothalamic tract, contralateral side)

ii) Small branches off the vertebral artery
iii) Y: Cuneate nucleus
Z: pyramid

Front 94

Do major ascending and descending pathways pass through the brainstem?
Pick most appropriate answer
A. No. Most by-pass the brainstem, entering the cortex and spinal cord via the thalamus
B. Yes. All touch, pain and proprioceptive ascending pathways pass through the brainstem en route to the thalamus. But a lesion in the brainstem generating a death of axons would not result in any clinical symptoms. The somata of the cells have to be damaged for cell death and subsequent symptoms.
C. Yes. All touch, pain and proprioceptive ascending pathways pass through the brainstem en route to the thalamus. A lesion in the brainstem generating a death of axons would certainly result in any clinical symptoms. With a lesion to axons and/or somata, most central neural cells undergo degeneration.

Back 94

Correct answer is C: - The touch, pain and proprioceptive ascending pathways pass through the brainstem en route to the thalamus. These are the dorsal column tract and the spinothalamic tract, together with the spinocerebellar tract. Further, all motor descending pathways from the cortex pass through the brainstem en route to the spinal cord. These include may include the corticospinal tract and the corticobulbar tract of which terminates among cranial nerve nuclei in the brainstem. Hence, a brainstem lesion may manifest in clear sensory and/or motor functional disturbances.

Front 95

Back 95

A Inferiorcolliculus
B Middle cerebellar peduncle
C Cuneate tubercle
D Olive
E Pyramids

Front 96

Back 96

A Superior colliculus
B Superior cerebellar peduncle
C Obex
D Anterior inferior cerebellar artery
E Basilar artery
F Superior cerebellar artery G Olive

Front 97

i) What are the likely symptoms of this lesion?

ii) What artery supplies the region which is lesioned?

Back 97

i) contralateral weakness of both the upper and lower extremities, contralateral sensory loss, e.g. vibration, proprioception (not pain and temperature), and ipsilateral tongue weakness.

ii) anterior spinal artery

Front 98

i) Name 5 nuclei or tracts affected by this lesion

ii) Give 3 sensory effects caused by this lesion

Back 98

The lesioned region is supplied by the vertebral artery. It contains the spinal trigeminal nucleus, the inferior olivary nucleus, nucleus ambiguous, sympathetics, and the spinothalamic tract. As a result a blockage of this artery would result in loss of pain and temperature sensation in the ipsilateral face, ipsilateral facial pain (SpV), contralateral pain and temperature loss of the body (spinothalamic tract), ipsilateral ataxia and gait ataxia (IO), hoarseness and dysphagia (NA) and Horner's syndrome.

Front 99

i) What region of the brainstem does this T2-weighted anatomical image depict?

ii) What are the structures marked A-C? (C is an artery)

Back 99

i) Pons

ii)
A Middle cerebellar peduncle
B 4th ventricle
C basilar artery

Front 100

What is the function of and characteristic symptoms with a lesion to CN:

I

Back 100

transmits smell information from the olfactory epithelium to the olfactory cortex - does not pass through the thalamus.

Damage results in the loss of smell.

Front 101

What is the function of and characteristic symptoms with a lesion to CN:

II

Back 101

transmits visual information from the retina to the lateral geniculate nucleus of the thalamus.

Damage to the optic nerve will also result in a monocular visual defect due to loss of input from the ipsilateral eye. The patient will complain of blindness in that eye.

Front 102

What is the function of and characteristic symptoms with a lesion to CN:

III

Back 102

supplies 4 of the 6 extrinsic eye muscles: medial rectus, superior rectus, inferior rectus and inferior oblique. It also supplies the striated muscle of the levator palpebrae muscles which is necessary to raise the upper eyelid. This muscle also has a smooth muscle component supplied by sympathetic nerves.

Hence damage to either CN III or to the SNS nerve supply can lead to ptosis (drooping eyelid). Paralysis of the 4 extrinsic eye muscles supplied by CN III leads to very restricted eye movement of the affected eye and an abnormal positioning of the eye (outward deviation) which causes diplopia (double vision).


Cranial nerve III also contains PNS fibres which supply the constrictor pupillae muscle and the ciliary muscle which changes the shape of the lens for focussing (accommodation).

Damage to the parasympathetic part of CN III leads to a dilated pupil and loss of accommodation.

Front 103

What is the function of and characteristic symptoms with a lesion to CN:

IV

Back 103

this is a very small nerve that supplies only one extrinsic muscle of the eye – the superior oblique.

Damage results in upward deviation of the eye.

Front 104

What is the function of and characteristic symptoms with a lesion to CN: VI

Back 104

abducens: this small nerve supplies the remaining extrinsic muscle of the eye - the lateral rectus muscle.

Damage results in inward deviation of the eye and thus diplopia.

Front 105

Back 105

Front 106

Where does CN exit the skull?

I

Back 106

cribriform plate

Front 107

Where does CN exit the skull?

II

Back 107

Optic canal

Front 108

Where does CN exit the skull?


III

Back 108

superior orbital fissure

Front 109

Where does CN exit the skull?


IV

Back 109

SOF

Front 110

Where does CN exit the skull?

V

Back 110

V1 - SOF
V2 - Foramen Rotundum
V3 - foramen ovale

Front 111

Where does CN exit the skull?

VI

Back 111

SOF

Front 112

Where does CN exit the skull?

VII

Back 112

internal acoustic meatus --> stylomastoid foramen

Front 113

Where does CN exit the skull?

VIII

Back 113

Does exit skull but enters internal acoustic meatus

Front 114

Where does CN exit the skull?


IX

Back 114

Jugular foramen

Front 115

Where does CN exit the skull?

X

Back 115

Jugular foramen

Front 116

Where does CN exit the skull?

XI

Back 116

Jugular foramen

Front 117

Where does CN exit the skull?

XII

Back 117

Hypoglossal canal

Front 118

Back 118

Front 119

Back 119

Front 120

Back 120

Front 121

Label Cranial nuclei

Back 121

Front 122

Which cranial nuclei are associated with CN III?

Back 122

III
Edinger Westphal N - PNS

Front 123

What is the difference between a cranial nerve nucleus and a cranial nerve?
Pick most appropriate answer

(A) The cranial nerve nuclei are found only in the midbrain
(B) There are 12 cranial nerve nuclei, one for each nerve
(C) A given cranial nerve may associate with more than one cranial nerve nucleus
(D) All cranial nerves are associated with the cranial nerve nuclei of the brainstem
(E) The cell bodies of cranial nerve nuclei lie in sensory ganglia in the periphery

Back 123

C

Front 124

What is the difference between a cranial nerve and a spinal nerve?
True/False

(A) Cranial nerves may carry somatic sensory and motor fibres
(B) Cranial nerves do not carry sympathetic fibres
(C) Some spinal nerves innervate the head
(D) Sensory cell bodies of the cranial nerves lie in the superior cervical ganglia
(E) The dorsal root ganglia house motor cell bodies of the spinal nerves

Back 124

(A) T
(B) F
(C) T
D - F
E - F

Front 125

What is unusual about the trochlear nerve?
True/False

It is the only cranial nerve that crosses the midline
It is the only cranial nerve that emerges from the dorsal brainstem
It is the only cranial nerve nucleus that receives a bilateral cortical supply
When lesioned, patients have trouble looking up and out

Back 125

A - T
B - T
C - F
D - F

Front 126

If there is a lesion to the oculomotor (III) nerve, does that mean you cannot see?
Pick most appropriate answer

(A) The III nerve has sensory fibres from the retina
(B) The pupillary reflex depends on integrity of the VI nerve
(C) The III nerve has many preganglionic sympathetic fibres
(D) The Edinger Westphal nucleus provides sensory fibres to the III nerve
(E) The pretectum is important in the pupillary reflex

Back 126

E

Front 127

Why is the abducent nerve a little stupid?
True/False

(A) VI nerve has its nucleus in the pons
(B) VI nerve adheres closely to the internal carotid artery (ICA)
(C) After lesion to VI nerve, the eye is abducted
(D) The VI nerve supplies the medial rectus
(E) The VI nerve carries preganglionic parasympathetic fibres to the eye

Back 127

A - T
B - T
C, D, E - False

Front 128

What are the structures supplied by the ophthamic nerve (V1)?
Pick most appropriate answers from list

Answer List: teeth, tongue, eye, forehead, neck, nose, ear

Back 128

The ophthamic nerve (V1) supplies eye, forehead and nose

Front 129

Which branch(es) of the trigeminal nerve carries motor fibres?
Pick most appropriate answers from list (you can choose more than one answer)

Answer List: ophthalmic, maxillary, mandibular

Back 129

The mandibular branch carries motor fibres

Front 130

Which branch(es) of the trigeminal nerve carries parasympathetic fibres?
Pick most appropriate answers from list (you can choose more than one answer)

Answer List: ophthalmic, maxillary, mandibular

Back 130

The maxillary and mandibular branches carry parasympathetic fibres

Front 131

Which branch(es) of the trigeminal nerve carries propriceptive fibres?
Pick most appropriate answers from list (you can choose more than one answer)

Answer List: ophthalmic, maxillary, mandibular

Back 131

The mandibular branch carries propriceptive fibres

Front 132

Which foramen does the maxillary nerve use to exit the skull?
Pick most appropriate answers from list (you can choose more than one answer)

Answer List: rotundum, ovale, spinosum, lacerum, stylomastiod, none

Back 132

Rotundrum

Front 133

What are the differences in symptoms between a peripheral and a central lesion of the trigeminal system?
True/False

(A) The ophthalmic nerve carries both touch and pain fibres
(B) A rostral lesion in medulla will result in a loss of pain/temperature sensation in
posterior regions of face on ipsilateral side
(C) A lesion in medulla will result in a loss of pain/temperature sensation in the body on
ipsilateral side
(D) A lesion in pons will result in a loss of tactile touch sensation in the face on ipsilateral
side
(E) After injection of anaesthetic into an upper tooth, sensory impulses traveling through
the maxillary nerve are affected.

Back 133

A, D, E - True
B, C - False

Front 134

What are the differences between the cranial accessory (XIc) and spinal accessory (XIs) nerves?
Pick most appropriate answer

(A) The XIc carries fibres from the nucleus ambiguus
(B) The XIs provides fibres to the X nerve
(C) The XIc innervates the trapezius and sternomastoid
(D) The XIc has sensory fibres from the larynx

(E) The cells that provide fibres to the XIc lie in the spinal cord

Back 134

A

Front 135

How do you tell the difference between an upper and lower motor neurone lesion with the muscles of facial expression?
True/False

(A) The facial nerve crosses to other side after emerging from brainstem
(B) The cells innervating the lower facial muscle
(C) A lesion within the internal capsule may result in a loss of use of the contralateral lower
facial muscles
(D) A lesion to the facial nerve after exit from the stylomastoid foramen may result in loss
of taste sensation
(E) The cells innervating the upper facial muscles receive a bilateral cortical supply

Back 135

A, B, D - FALSE
C, E - TRUE

Front 136

T/F for each:

Does the glossopharyngeal nerve have any motor fibres to the tongue?

The hypoglossal nerve is motor to most muscles of the tongue?

The glossopharyngeal nerve has sensory from the tongue?

The glossopharyngeal nerve has motor fibres to the pharynx?
The vagus nerve carries fibres form the nucleus ambiguus to the tongue ?

The dorsal motor nucleus of the vagus has parasympathetic fibres to the tongue?

Back 136

B,C, D- TRUE
A,E, F - FALSE

Front 137

Describe the symptoms after lesion to X?

Choices: • Dysphonia • Loss of pain, contralateral body • Dysphasia • Upper motor neurone lesion • Dysphagia • Aphasia

Back 137

Dysphonia (loss of nucleus ambiguus ; laryngeal muscles) Dysphagia (loss of nucleus ambiguus; pharyngeal muscles)

Front 138

Label Y and Z

Back 138

Y: spinal tract nucleus of trigeminal nerve Z: hypoglossal nucleus

Front 139

Label A, B, C

Back 139

A: Motor Facial nucleus ( Loss of facial muscles, upper and lower, ipsilateral side )

B: abducent nerve
C: Vestibular N

Front 140

Label

Back 140

(A) vestibular nucleus
(B) trigeminal nucleus (principal)
(C) trochlear nerve
(D) accessory nerve
(E) oculomotor nerve