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Thomadaki Neur II

NYCC Neuro II Thomadaki Spring 2010

origin of CN I Olfactory cells olfactory mucosa of upper portion of nasal cavity
CN I processes transverse the _____________ plate and synapse in the _______________ bulb. cribriform, olfactory
which stria projects directly from the olfactory tract to the primary olfactory cortex? Lateral olfactory stria
primary olfactory cortex components: (3) piriform cortex, parts of amygdala, part of entorhinal cortex
location of primary olfactory cortex (piriform, amygdala, entorhinal): anterior parahippocampal gyrus
The lateral olfactory stria projects directly from olfactory tract/bulb to primary olfactory cortex. The medial olfactory stria sends fibers via the anterior commissure to the? contralateral olfactory bulb
medial olfactory stria to? lateral olfactory stria to? medial to contralateral bulb, lateral directly to primary olfactory cortex (piriform, amygdala, entorhinal)
Olfaction is the only sense which does what? reaches the cortex directly, as it does not pass through the thalamus
how to examine CN I? odorants applied to each nostril with eyes closed
Lesion of CN I Olfactory Anosmia (without a nose/smell -ia)
What kind of nerves are most PNS nerves? (pseudounipolar, unipolar, bipolar, multipolar) pseudounipolar
What kind of nerves are CN I Olfactory nerves? Bipolar
origin of CN II cells ganglion cells of retina
CN II fibers partially cross the optic chiasma, proceed into the optic tract, and synapse in the Lateral geniculate body
Fibers from the optic tract form what lengthy structure visible to naked eye? superior brachium
what forms the superior brachium? Optic tract fibers of CN II
function of superior brachium sends light reflex info to superior colliculus
what is inside the lateral geniculate body? lateral geniculate nucleus
CN II fibers from optic tract reach lateral geniculate nucleus, synapse, and go where? primary visual cortex (cuneus and lingual gyri) via the optic radiation
gyri that make up the primary visual cortex (2) cuneus, lingual
how do lateral geniculate nucleus fibers reach the primary visual cortex (cuneus and lingual gyri)? via the optic radiation
why do CN II fibers partially cross in the optic chiasma, instead of remaining ipsilateral or contralateraly completely? so that the left halves of both eyes' visual fields ultimately end in the right visual cortex and vice versa
examination of CN II is through visual _____________, visual ______________, and visual ______________ acuity, field mapping, reflexes
lesion CN II Anopsia (without optic -ia)
origins of CN III Oculomotor oculomotor nucleus, Edinger-Westphal nucleus
The oculomotor nucleus of CN III is of motor or sympathetic origin? motor
Is the Edinger-Westphal nucleus motor or parasympathetic? parasympathetic (you wouldn't want to have to control your own light accommodation or depth perception)
For exits of cranial nerves through skull, please remember what mnemonic? Come On Sofia Sofia Sofia! Roll over, Sofia. I AM In A Mood for Jugs, Jugs, Jugs. Hey! ~Cribriform, Optic canal, SupraOrbital Fissure, SOF, SOF V1, Rotundum V2, Ovale V3, SOF, Internal Acoustic Meatus, I.A.M., Jugular Foramen, JF, JF, Hypoglossal canal
What is level of CN III nucleus? midbrain at level of superior colliculus, anterior portion of periaqueductal grey (page 361: Thieme Pocket Atlas Human Anatomy)
what composes the metathalamus? geniculate bodies (medial and lateral)that lie inferolateral to the pulvinar
The optic tract is divided into a medial root and a lateral root (not in notes; this is for clarification of CN II targets). The lateral root goes to the Lateral geniculate body. The medial root goes to the superior colliculus. Now differentiate? LATERAL fibers in optic tract cross then synapse in LGB (nucleus) to primary visual cortex via optic radiation. MEDIAL fibers form superior brachium and go to superior colliculus with light reflex info. These are the 2 roots of the optic tract.
(LR6 SO4)3 lateral rectus CN6, superior oblique CN4, all others innervated by CN3
CN III level of nuclei midbrain at superior colliculus level, anterior portion of periaqueductal grey
exit of CN III interpeduncular fossa
everything dorsal to half of cerebral aqueduct at midbrain is called the tectum
everything ventral to half of cerebral aqueduct at midbrain is/are called cerebral peduncle (cerebral crus and tegmentum)
what dark stained feature can be seen at the level of the inferior colliculus midbrain in horizontal section? substantia nigra
what feature distinguishes midbrain horizontal section at level of superior colliculus? red nucleus
what conveys fibers mostly from the dentate nucleus to the red nucleus and thalamus? superior cerebellar peduncle
name for nerve fibers traveling in the pyramidal tract to the spinal cord corticospinal fibers
nerve fibers traveling to the second order neurons of the pontine nuclei corticopontine fibers
fibers connecting the red nucleus to the inferior olive rubro-olivary fibers
fibers connecting the dentate nucleus and inferior olive cerebro-olivary
The nucleus of the oculomotor nerve CN III which sits ventral to the periaqueductal grey at the level of superior colliculus is the motor or the parasympathetic nucleus of CN III? motor (motor is dorsal and it is sitting on the dorsal half of the entire horizontal section, despite being located just ventral to the PAG)
Exit of CNIII? Interpeduncular fossa
motor function of CNIII all eye muscles except SO4 and LR6
parasympathetic nucleus location of CN III Edinger-Westphal nucleus
supplies preganglionic parasympathetic fibers to the eye, constricting the pupil, accommodating the lens, and convergence of the eyes. Implicated in the mirroring of pupil size in sad facial expressions. Edinger-Westphal nucleus of CNIII Crazy facts about EWN: When seeing a sad face, participants' pupils dilated or constricted to mirror the face they saw, which predicted both how sad they perceived the face to be, as well as activity within EWN region.
parasympathetic functions of Edinger-Westphal nucleus for CNIII pupillary constriction (sphincter pupillae) and thickening of lens during accommodation/depth perception (ciliaris)
2 muscles of CNIII Edinger-Westphal nucleus sphincter pupillae and ciliaris (pupil constriction and accommodation)
ganglion that receives oculomotor CNIII fibers ciliary ganglion
what kind of fibers does the ciliary ganglion receive? preganglionic parasympathetics from CNIII Oculomotor Edinger-Westphal nucleus
After synapsing inside the ciliary ganglion, what happens to preganglionic parasympathetic fibers from Edinger-Westphal nucleus? They become POSTganglionic parasympathetic fibers and travel to sphincter pupillae and ciliaris muscles.
what carries impulses away from the eye via the ciliary ganglion? short ciliary nerves that are the postganglionic parasympathatics of the ciliary ganglion and the postgang sympathetics of the nasociliary branch of VI Ophthalmic of Trigeminal
Internal carotid plexus of nerves carry what to the ciliary ganglion for dilator pupillae muscle of the eye? postganglionic sympathetic fibers (post gang because they are from the cervical sympathetic ganglion upper and they wrap around the internal carotid artery like a meshwork or latticework)
innervation of dilator pupillae muscle of eye postganglionic SYMpathetics from internal carotid plexus of nerves, and prior to that, as preganglionic sympathetics from upper cervical sympathetic ganglion
why do we test eyelid movement for CNIII Oculomotor? levator palpebrae muscle of upper lid
What nerve is responsible for orbicularis oculi (squint)? Facial n. VII
Examination of CNIII function includes: (3) accommodation and light reflexes (ciliaris and sphincter pupillae muscles), vertical and medial movements (all except LR and SO), eyelid movement (levator palpebrae)
lesion to CNIII ptosis (levator palpebrae), diplopia (medial rectus fail causes double vision due to lateral strabismus), lateral strabismus (medial rectus fail), mydriasis (sphincter pupillae fail on light reflex), cycloplegia (ciliaris fail on accommodation)
It is controlled by parasympathetic fibers that originate from the Edinger-Westphal nucleus, travel along the oculomotor nerve (CN III), synapse in the ciliary ganglion, and then enter the eye via the short ciliary nerves. It controls iris contraction. Sphincter pupillae (also called Iris sphincter muscle)
The ciliary muscle not only controls accommodation for viewing objects at different distances but also regulates flow of aqueous humor into Schlemm's canal
If you can't find Edinger-Westphal nucleus in a book, it is because the updated name is the accessory nuclei of oculomotor nerve/tract
lesion to CN III Oculomotor ptosis, lateral strabismus, diplopia, cycloplegia, mydriasis
origin of CN IV Trochlear n. trochlear nucleus just posterior to PAG towards middle of cerebral peduncle area
level of trochlear nucleus CN IV midbrain at inferior colliculus, in the anterior portion of the PAG (anterior meaning towards the ventral but before superior cerebellar decussation)
exit of CN IV Trochlear the two nerves decussate in the superior medullary velum and exit inferior to the inferior colliculi
book def of trochlear nerve exit: nerve exiting on the dorsal side, caudal to the tectal plate. What does this nerve do? Extraocular eye movement: supplies the Superior Oblique (SO4) muscle of the eye
motion of Superior Oblique muscle of eye intorsion, adduction
test for CN IV Trochlear function intorsion, adduction (down and inward, "walking down stairs" muscle)
lesion to CN IV Trochlear presentation diplopia (double vision) when looking downward and inward and head tilt to opposite side (to use the good nerve - remember, CN IV decussates so contralateral fcn)
why is the head tilted to the opposite side of the lesion on the left CN IV Trochlear n.? to bring the left eye (left CN IV) in towards the nose and down, since the right eye cannot do this
level of Abducent CN VI lower pons at level of facial colliculus (remember a lesion to facial colliculus/nuclei ruins LR6 too and presents with facial nerve problems as well as medial strabismus)-due to facial nerve genu wrapping around CN VI nucleus
exit of CN VI pontomedullary jcn between basilar pons and pyramid, pierces dura mater and travels in cavernous sinus, then enters superior orbital fissure
function of CN VI Abducent LR6 - controls lateral rectus muscle of eye
lesion of CN VI Abducent medial strabismus, diplopia
level of Abducent CN VI lower pons at level of facial colliculus (remember a lesion to facial colliculus/nuclei ruins LR6 too and presents with facial nerve problems as well as medial strabismus)-due to facial nerve genu wrapping around CN VI nucleus
exit of CN VI pontomedullary jcn between basilar pons and pyramid, pierces dura mater and travels in cavernous sinus, then enters superior orbital fissure
function of CN VI Abducent LR6 - controls lateral rectus muscle of eye
lesion of CN VI Abducent medial strabismus, diplopia (tilts head towards good side when walking downstairs)
origin of CN V (V1,V2,V3)- How many nuclei are there, first of all? 4: Nucleus of spinal tract of V, Mesencephalic nucleus, Chief Sensory nucleus, Motor nucleus
level of Nucleus of Spinal Tract of V (pain and temp for face and head) C5 up through midpons
level of Chief Sensory Nucleus of V (touch of face) midpons
level of Mesencephalic Nucleus of V (proprioreception) midpons/midbrain
level of MOTOR nucleus of V (mastication muscles) midpons
exit of V from brain? midpons
Sofia! Roll Over, (exits for V divisions): SOF - V1 Ophthalmic division, Rotundum - V2 Maxillary division, Ovale - V3 Mandibular division
V1 is __________, V2 is __________, V3 is ________. sensory, sensory, mixed
What is another term for the meningeal branch of V3? Nervus Spinosus
Nervus spinosus (p. 403 Pocket Atlas) Meningeal branch of V3 which re-enters the skull, ascends with the meningeal artery through the foramen spinosum (ergo, "nervus spinosum")
another name for greater petrosal nerve and deep petrosal nerve together Vidian nerve
what forms the Vidian nerve? greater petrosal nerve (facial) + deep petrosal nerve (plexus around interal carotid artery)
largest of peripheral parasympathetic ganglion pterygopalatine ganglion
contents of pterygopalatine fossa maxillary artery, maxillary nerve, pterygopalatine ganglion
get me to the lacrimal gland Vidian nerve (parasymp facial greater petrosal + symp icpn) pterygopalatine canal. Goes to P.p.ganglion as pregangs. V2 Maxillary branch receives sensory from ppg, sends to zygomaticotemporal, then lacrimal branch of V1 Ophthalmic.
pterygopalatine ganglion and fossa are also known as the sphenopalatine ganglion and fossa
The maxillary V2 division enters the skull via ______________ and exits the skull to supply area under eye via _________________. foramen Rotundum (Roll), infraorbital foramen
TRIGEMINAL nerve is sensory to face, scalp, teeth, anterior 2/3 of tongue (Lingual n.), oral and nasal mucosa, dura mater and cerebral blood vessels
What kind of cells are the sensory fibers of Trigeminal V (1,2,3) that are sensory to face, scalp, teeth, most of tongue, oral and nasal mucosa, dura mater and cerebral blood vessels? pseudiunipolar cells
where are the cell bodies of Trigeminal V? trigeminal ganglion (semilunar ganglion) on either side of sella turcica and in the mesencephalic nucleus in the case of proprioception
what does the mesencephalic nucleus contain? cell bodies of Trigeminal CN V for proprioreception of face and head
The Trigeminal V is MOTOR to muscles of mastication (masseter, temporalis, medial and lateral pterygoid), tensor tympani and tensor veli palatini muscles, mylohyoid and anterior belly of digastric
all the muscles of the palate (levator palati, palatoglossus, palatopharyngeus, musculus uvulae) are all supplied by pharyngeal plexus of nerves EXCEPT tensor palati, supplied by V3 Mandibular division of Trigeminal
Anterior belly of digastric and mylohyoid muscle are supplied by motor V3 mandibular branch of Trigeminal
buccal n., nerve to medial pterygoid, meningeal branch, lingual n., inferior alveolar n., auriculotemporal n. are all branches of V3
If a patient cannot clench teeth, it is due to a lesion of V3 Mandibular division of trigeminal
tongue pain will refer to ear, because the __________ and _______________ nerves arise from the same V3 trunk. lingual and auriculotemporal (tympanic branch for tympanic plexus=nerve to tensor tympani lesion results in hyperacousis, lesser petrosal to otic to parotid gland)
V is motor to muscles of mastication, tensor tympani and tensor veli palatini, mylohyoid and anterior belly of digastric
V is sensory to face, scalp, teeth, most of tongue, oral and nasal mucosa, dura mater and cerebral blood vessels
V1 OPHTHALMIC innervates scalp, forehead, upper eyelid, conjunctiva, roots, ala and sides of nose
V2 MAXILLARY innervates lower eyelid, upper lip, back part of ala, cheek, anterior temple
V3 MANDIBULAR (mixed) innervates 5 o'clock shadow region: motor and sensory. Sensory to lower lip, lower cheek, jaw, ear and post temple. Motor to masticatory muscles, tensor tympani and tensor veli palatini, mylohyoid and anterior belly of digastric
If you lose sensation to your upper lip, what division of V is lesioned? V2 Maxillary
Cervical plexus innervates skin over region of mandible; it is called the Great Auricular Nerve
how to test V? cotton swab TOUCH, pinprick PAIN, TEMPERATURE, corneal reflex, jaw reflex, masticatory movements
lesion to V trigeminal neuralgia (tic douloureux), facial anesthesia or numbness, inability or difficulty biting down, hyperacousis
Lesion Trigeminal V trigeminal neuralgia, fascial anesthesia, inability or difficulty biting down, hyperacousis
does the tensor tympani nerve receive fibers from the trigeminal ganglion? why or why not? no, because it is motor and the ganglion only contains sensory
Does the trigeminal ganglion contain motor nuceli? no, only sensory
Location of Facial CN VII nuclei and names of the nuclei (3) Facial, Nucleus of Solitary Tract, Superior Salivatory Nucleus are all at the lower pons - level of facial colliculus,
what does genuflect mean to bend at the knee, "genu" means knee/bend
The Facial CN VII leaves the cerebellopontine angle and enters the skull through Internal Acoustic Meatus
Lodged in the petrous portion of the temporal bone are the pseudounipolar ganglion cells that form the chorda tympani. What is the name of this ganglion? Geniculate ganglion
A rectangular bend of the facial nerve in the facial canal where it turns posterior in the medial wall of the middle ear (external geniculum), complex loop of facial nerve fibres around the abducens nucleus (internal geniculum). geniculum
The equivalent of a spinal ganglion located at the geniculum of the facial nerve in the petrous part of the temporal bone. It contains pseudounipolar ganglion cells that form the chorda tympani. Geniculate ganglion
The Facial n. is derived from what pharyngeal/branchial arch? 2nd
The Facial n. is derived from the 2nd pharyngeal arch (remember V-VII-IX-SuperX-RecurrentX are the nerves associated with arches 1,2,3,4,6). What muscles are 2nd arch derived/what muscles does Facial innervate? facial muscles of expression, stapedius, stylohyoid, posterior belly of digastric
Facial nerve gives off three branches in the facial canal: Greater petrosal n., Chorda Tympani, Nerve to Stapedius
Facial n. gives off Greater petrosal nerve to do what? join with deep petrosal from interal carotid nerve plexus to form Vidian, hit pterygopalatine ganglion, postgang parasymp travel up to V2 (Maxillary) Zygomatic, then Zygomaticotemporal branch V2, then V1 (Ophthalmic) to Lacrimal n. to Lacrimal gland
Facial n. gives off Chorda Tympani n. to do what? join with Lingual nerve of V3 and travel in mandibular foramen to innervate anterior 2/3 of tongue with special sensation TASTE (Chorda tympani runs through inner ear petrous part so taste may be affected by ear injury)and?
Chorda tympani not only provides special sense of taste to anterior 2/3 of tongue, it also provides preganglionic parasympathetics (with Lingual of V3) to submandibular ganglion, supplying submandibular and sublingual salivatory glands
Nerve to Stapedius is from Facial n.
Injury to nerve to Stapedius, like injury to tensor tympani of V3, causes hyperacousis by injury of nerve to stapedius from facial
3 Facial nerve nuclei Facial, Nucleus of Solitary tract, Superior Salivatory nucleus
what forms the sensory root to the Facial nerve called NERVUS INTERMEDIUS (Intermediate Nerve - p.407) preganglionic parasympathetic fibers from Facial nuclei + central axons of Geniculate ganglion carrying taste from anterior 2/3 of tongue (chorda tympani) form sensory root to this nerve called Nervus Intermedius
nonmotor portion of the facial nerve. It emerges from the brainstem bw Facial and Vestibulocochlear nerves and conveys autonomic and taste fibers. After various anastomoses, it merges with the facial nerve in the petrous portion of temporal bone. Intermediate Nerve/Nervus Intermedius
Peripheral branches of Facial VII Two Zebras Bit My Cat: temporal, zygomatic, buccal, marginal mandibular, cervical
function of Facial VII MOTOR motor to muscles of facial expression, auricular muscles, stapedius, post belly of digastric and stylohyoid
function of Facial VII special senses taste from anterior 2/3 of tongue (chorda tympani) which travels with lingual n. (branch of V3)
Where are the cell bodies of the Chorda Tympani n. from Facial VII? in the geniculate ganglion (ergo, the Chorda tympani n. is the aggregate of peripheral axons from the geniculate ganglion)
function of Facial VII glandular parasympathetic to lacrimal (via Vidian-pterygopalatine g.-temporozygomatic n.-lacrimal n.) and Serous/Mucous glands of nasopharynx. Submandibular and Sublingual Salivatory glands via chorda tympani traveling with lingual to Submandibular ganglion.
The Nervus Intermedius is the _________portion of the Facial CN VII. non-motor
What does the nervus intermedius do? carries pregang parasymps -forms Greater Petrosal Nerve. GPN joins sympathetic deep petrosal n.-becomes Vidian n. Synapses @ pterygopalatine ganglion. Postsynaptic fibers go to V2 Maxillary, then zygomaticotemporal, then lacrimal branch V1, then gland.
The nervus intermedius is a branch of ________ nerve and carries non-motor _________ & __________fibers (as it helps build the chorda tympani to taste and glands). Facial CN VII, autonomic, taste
nervus intermedius can only carry non-motor preganglionic parasympathetics because: the deep petrosal off int.carotid plexus of nerves carries the sympathetics, and must be preganglionic because it is headed towards pterygopalatine ganglion as the greater petrosal nerve
Not only does the pterygopalatine ganglion send postganglionic fibers to the lacrimal gland via a pathway we've traced ad nauseum, it also sends postgangs to the ___________nerves for serous and mucous glands of the soft palate, hard palate & nasopharynx. palatine
what tiny nerve travels through the petrous portion right over the ossicles and we have to be careful not to destroy it in dissection? Chorda tympani
Preganglionic parasympathetic fibers from Nervus Intermedius (the ______________ portion of VII) travel with CN VII through the internal acoustic meatus and join the __________ nerve (also a branch of VII). non-motor, chorda tympani
chorda tympani is always the __________ root and internal carotid plexus of nerves is always the _________ root parasympathetic, sympathetic
the chorda tympani exits the ear cavity through the petrotympanic fissure
After exiting the ear canal via the petrotympanic fissure, the chorda tympani nerve joins the _________ nerve, a branch of V3, and heads to the ________________ ganglion. lingual, submandibular
Postganglionic parasympathetics from the chorda tympani and sympathetics from the internal carotid plexus supply the _________ and _________ glands via the submandibular ganglion. submandibular and sublingual salivatory glands
how does the special sensation of taste get back to the brain from the anterior 2/3 of the tongue? fibers join the chorda tympani in the mouth and follow back to their cell bodies in the geniculate ganglion. Central axons (postgang parasymps) join the Nervus Intermedius on their way to synapse in the SALIVATORY Nucleus (7-9-10)
how do you examine VII function? facial expression movements & Taste! (yes, boys and girls, you lick your patient's face)
Lesion to Facial CN VII Bell's Palsy (LMN paralysis ipsilateral hyperacousis, paralysis, inability to wrinkle forehead, raise eyebrows, shut eye, smile, tear flow over sagging eyelid, loss of taste from anterior 2/3 tongue)
Bell's Palsy is a(n) __________ motor neuron and is therefore only on the __________ side. lower, ipsilateral
facial paralysis on the contralateral lower 1/4 quadrant of the face means upper motor neuron lesion (very bad)
The Facial VII enters the skull via the ____________________ and leaves the petrous portion of the temporal bone via the _______________. Internal acoustic meatus, stylomastiod foramen
Why does it make sense for VII to leave the skull via the stylomastoid foramen? Because it innervates the stylomastoid and posterior belly of digastric muscles.
Origin of VIII Vestibulocochlear nerve vestibular nuclei, cochlear nuclei
How does the Facial n. communicate with the tympanic plexus of nerves? via a communicating branch it gives off right before exiting the stylomastoid foramen
level of VIII Vestibular nuclei in brainstem vestibular nuclei: lateral aspect of 4th ventricle (under vestibular area), cochlear nuclei: at the acoustic tubercle (in the cerebellopontine angle)
exit of VIII Vestibulocochlear nerve Cerebellopontine angle (with VII Facial and Nervus Intermedius)
function VIII Vestibulocochlear nerve vestibular: balance and equilibrium, cochlear: hearing
Examination of Vestibular part of VIII: caloric test, Barany chair test
Examination of Cochlear part of VIII~ Weber and Rinne tests, audiogram
Lesion of VIII vestibular part vertigo, nystagmus, dysequalibrium
Lesion of VIII cochlear part of nerve loss of hearing, tinnitus
How does VIII Vestibular reach the inner ear (what foramen)? Internal acoustic meatus
Three nuclei of Glossopharyngeal CN IX (the 3 wisemen of the tongue and pharynx): Nucleus of Solitary tract, Nucleus Ambiguus, Inferior Salivatory Nucleus
Nucleus of the Solitary Tract (7-9-10) taste and autonomic (same as nervus intermedius) from level of medulla
Nucleus Ambiguus (9.10.11) motor from level of medulla
Inferior Salivatory Nucleus (IX ONLY)p.335 pocket atlas of human anatomy #26 gives rise to parasympathetic secretory fibers of IX at level of pons
Roughly, where are the Solitary nucleus, Nucleus ambiguus, and Inferior salivatory nucleus of the Glossopharyngeal CN IX? Behind the olive - it makes sense for the Glossopharyngeal nerve to emerge from the post-olivary sulcus with X and XI here.
Which nucleus send taste and autonomic for nerves 7-9-10? Where is it located? Solitary nucleus/nucleus of solitary tract, located medulla
Which nucleus sends parasympathetic secretory for IX only? Inferior salivatory nucleus
Which nucleus lies just posterior to the inferior olive and gives rise to motor fibers of 9.10 as well as the cranial portion of XI? Nucleus Ambiguus
Function of IX Glossopharyngeal motor to stylopharyngeus (via N. ambiguus), taste post 1/3 tongue, sensory to middle ear, tympanic cavity, Eustachian tube, tonsils, naso-oro-pharynx, uvula, soft palate. Parasymp to parotid gland via Otic gang, Afferent parasymps from carotid body/sinus
5! 7! 9! 10Super! 10Recurrent! pharyngeal arch to cranial nerve (1st, 2nd, 3rd, 4th, 6th arches)
Glossopharyngeal n. lies between what two vessels? Internal carotid artery & Internal Jugular vein
IX exits what foramen Jugular foramen (Jugular vein, IX,X,XI, emissary vessels)
Glossopharyngeal winds around the surface of the muscle it innervates stylopharyngeus (between superior and middle pharyngeal constrictors)
The Glossopharyngeus is deep to what muscle of the tongue? hyoglossus (with lingual artery)
preganglionic parasympathetic fibers from inferior ganglia of IX Glossopharyngeal form _________ nerve (branch) that heads to the tympanic plexus of nerves in the middle ear cavity. tympanic nerve/branch of Glossopharyngeal
The tympanic nerve enters the tympanic plexus of the middle ear and is joined by _________ fibers from the carotid plexus of nerves (superior cervical ganglion climbing meshwork). sympathetic (carotid plexus is ALWAYS sympathetic)
The sympathetic fibers from internal carotid plexus and parasympathetic fibers from IX tympanic branch form the ______________nerve. Lesser Petrosal nerve
Where is the Lesser Petrosal n. (IX and carotid plexus parents) headed? from the tympanic plexus, it heads to the OTIC ganglion, synapses, and then postganglionic fibers enter the Auriculotemporal n. (V3) to the Parotid. Remember the A.T.nerve wraps around the middle meningeal artery in the temporal fossa dissection.
which nerve wraps around the middle meningeal artery (branch of maxillary artery) and heads to the parotid gland? Auriculotemporal n. of V3 (from otic ganglion)
examination IX Glossopharyngeal taste and general sensation of posterior 1/3 tongue and oropharyx, sensory part of gag reflex
Lesion of IX Glossopharyngeal abberations in blood pressure (hyper or hypotension), sometimes pain as IX neuralgia or loss of sensation in the naso-oro-pharyngeal area, absent gag reflex (IX is the afferent limb of gag reflex)
Vagus CN X origin (4) dorsal motor nucleus, nucleus ambiguus, solitary nucleus, nucleus of spinal tract of Trigeminal CN V
does the Lesser Petrosal n. carry sympathetics, parasympathetics or both? both
origin of Vagus CN X parasympathetics dorsal motor nucleus in medulla, solitary tract (parasymp and taste)in medulla
origin of Vagus CN X motor nucleus ambiguus in medulla
origin of Vagus CN X sensory nucleus of spinal tract of Trigmeninal V in medulla
origin of Vagus CN X taste and parasympathetics solitary nucleus of medulla
where are all the nuclei of Vagus X located? medulla
where does Vagus X exit the brain? post-olivary sulcus
list the 4 nuclear origins of Vagus X in the medulla dorsal motor nucleus (parasymp), nucleus ambiguus (motor), solitary nucleus (taste and parasymp), nucleus of spinal tract of Trigeminal (sensory)
Vagus X is parasympathetic (dorsal motor nucleus) to the _________ & _________. thorax & abdomen
Vagus X is motor (nucleus ambiguus) to the _______________, intrinsic __________ muscles, ________ muscles (except tensor veli palatini), and upper ____________ for phonation and swallowing. MOTOR VAGUS: pharyngeal constrictors, laryngeal and palatine muscles (except tensor veli palatini), esophageal muscles for phonation and swallowing
Vagus X is responsible for taste fibers from the ___________& ________. larynx and epiglottis
Vagus X is sensory to the pharynx, _______, the _______ of the external ear, and the ___________ of the posterior cranial fossae. pharynx larynx conchae meninges
Vagus X is sensory (nucleus of spinal tract of Trigeminal) to the (4) Sensory X: pharynx larynx conchae meninges (posterior fossae)
Vagus X is taste (solitary nucleus) to the larynx and epiglottis
Vagus X is motor (nucleus ambiguus) to pharyngeal constrictors, intrinsic laryngeals, palatine (except tensor veli palatini -V), upper esophagus for phonation and swallowing
Lesion to Vagus X (parasympathetic, motor, taste, sensory) hoarseness, dysphagia, loss of gag reflex, uvular deviation to STRONG side
Accessory XI cranial and spinal origin nucleus ambiguus and disperse cell bodies in the medulla and cervical segments
exit of XI Accessory out of brain post-olivary sulcus
Accessory XI splits into a cranial and spinal root
function of Accessory XI Cranial: joins Vagus X to supply pharyngeal constrictors, laryngeal and soft palate muscles
spinal Accessory XI function motor to SCM and trapezius
Lesion to XI Accessory inability to rotate head and shrug shoulder (ie, look behind to back out of driveway)
Hypoglossal CN XII origin Hypoglossal nucleus of medulla
exit of CN XII pre-olivary sulcus (the only one)
function of Hypoglossal CN XII motor to all of tongue except palatoglossus supplied by Vagus (like all palatine muscles)
lesion to Hypoglossal CN XII ipsilateral tongue paralysis and atrophy
CN XII is motor to all tongue muscles that end in "glossus" except ______________. Why? glossus, because the Vagus supplies all palate muscles except tensor veli palatini (V)
what is another term for Upper Motor Neuron? supranuclear
Which is the only cranial nerve to consistently exhibit supranuclear (upper motor neuron) symptoms? Facial CN VII
Supranuclear (upper motor neuron) symptoms of cranial nerves are rare, (except for the facial nerve), because the Corticobulbar tract innervates most of them __________. bilaterally
What does the Corticobulbar tract do? runs with corticospinal tract to synapse all MOTOR nuclei of nerves on both sides, so cut one there are no symptoms because the other one takes over.
What is the conflict with corticobulbar tract? it bilaterally innervates upper but not lower
contralateral fibers of corticobulbar tract synapse with both upper and lower motor neurons, while ipsilateral fibers synapse only with _________ motor neurons. upper
If the UMN fibers of right corticobulbar tract are cut, why is only the lower half LEFT of the face affected? Because the lower half of the face is LMN and ipsilaterally, the UMN and LMN of the right side are still supported by the left side's corticobulbar tract, but the left lower half LMN of face that was only supported by the right corticobulbar is now shot.
where do the facial symptoms of a stroke normally occur and why lower 1/4 quadrant of face due to lack of contralateral LMN (lower face) by stricken corticobulbar tract. Only the ipsilateral support of unaffected c.b.tract remains to support UMN innervation (upper face) of affected side.
nickname for basal ganglia grey matter of the cerebrum
"ganglia" in basal ganglia is a misnomer. Why? Because the Basal Ganglia (BG) are not a collection of peripheral cell bodies but are a collection of cell bodies within the CNS (like a nucleus).
4 members of the Basal Gang: 1-Lentiform nucleus, 2-Caudate nucleus, 3-Subthalamic nucleus, 4-Substantia nigra
Caudate Nucleus looks like what? a caterpillar perched on a Brazil nut (lentiform nucleus)
The caudate nucleus is the boundary of the lateral ventricle
Like the caterpillar it resembles, the caudate nucleus has 3 parts: head (lateral wall of anterior horn of lateral ventricle), body (floor of body of lateral ventricle), and a tail (roof of inferior horn of lateral ventricle ending anteriorly in the amygdala)
the Caudate Nucleus caterpillar likes to eat ________ for energy. GABA
From outside to in, it is composed of the external capsule (white matter), the lentiform nucleus (gray matter), the internal capsule (white matter), and the caudate nucleus (gray matter). The alternating white and gray matter give it a striated appearance Corpus Striatum
A part of the corpus striatum is imbedded in the white substance of the hemisphere, and is therefore external to the ventricle; it is termed the extraventricular portion, or the _______________ __________. lenticular nucleus
A part of the corpus striatum projects into the ventricle, and is named the intraventricular portion, or the __________ _________. caudate nucleus
has been demonstrated that the caudate is highly involved in learning and memory, especially feedback processing. In general, it has been demonstrated that neural activity will be present within it while an individual is receiving feedback.What am I? Caudate nucleus
It may be dysfunctional in persons with obsessive compulsive disorder (OCD), in that it may perhaps be unable to properly regulate the transmission of information regarding worrying events or ideas between the thalamus and the orbitofrontal cortex Caudate nucleus
A recent meta-analysis of voxel-based morphometry studies comparing people with OCD and healthy controls found people with OCD have increased grey matter volumes in bilateral lenticular nuclei, extending to the caudate nuclei, while they have while decreased grey matter volumes in bilateral dorsal medial frontal/anterior cingulate gyri.
Caudate's food GABA
3 parts of Lentiform nucleus (Brazil nut that the caudate caterpillar is sitting on) Putamen (most lateral), Globus pallidus II, Globus pallidus I
Regulates movements and influence various types of learning. It employs dopamine to perform its functions. Also plays a role in degenerative neurological disorders, such as Parkinson's disease. Putamen of lentiform nucleus
The caudate and putamen contain the same types of neurons and circuits - many neuroanatomists consider the dorsal striatum to be a single structure, divided into two parts by a large fiber tract, the _________ ________, passing through the middle internal capsule
The nucleus accumbens and medial caudate receive input from frontal cortex and limbic regions. The ___________ and caudate are jointly connected with the substantia nigra, but most of their output goes to the globus pallidus. putamen
"hate circuit" involves the ? and the insula. It plays a role in the perception of contempt and disgust, and may be part of the motor system" for action! PUTAMEN jail! The amount of activity in the hate circuit correlates with the amount of hate a person declares, which could have legal implications concerning malicious crimes
The putamen uses _______, just like the caudate caterpillar. GABA
Interneurons between the caudate caterpillar and the putamen of the lentiform nucleus use _________ but release __________. Ach, GABA
Use _______ to communicate but GABA to put out! Ach
Which BG structure is most like the Globus Pallidus (I and II) substantia nigra
The link with the substantia nigra pars reticulata is due to the similarities in dendritic arborisation. The two constitute a particular set of the basal ganglia system (the pallidonigral set). Globus pallidus
what divides the globus pallidus I from globus pallidus II? medial medullary lamina
Globus Pallidus uses ________ neurotransmitter GABA
3 parts of Lentiform Nucleus and neurotransmitter putamen, globus pallidus I, globus pallidus II
what area of the BG would be lesioned if presented with hemiballismus subthalamic nucleus
subthalamic nucleus NT GLUTAMATE!
what is Luys' body? another term for the subthalamic nucleus
from where does the subthalamic nucleus receive its main input? globus pallidus
where do excitatory glutaminergic inputs to subthalamic nucleus come from? cerebral cortex - especially the MOTOR cortex - via the caudate/putamen and then globus pallidus II
The main target of subthalamic nuclear glutamate is to the medial pallidus/globus pallidus I
Strong reciprocal connections link the subthalamic nucleus and the external segment of the ______________. Both are fast-spiking pacemakers. Together, they are thought to constitute the "central pacemaker of the basal ganglia"[13] with synchronous bursts Globus pallidus II (external segment, lateral pallidus)
The lateropallido-subthalamic system is thought to play a key role in the generation of the patterns of activity seen in ____________ disease. Parkinson's
Chronic stimulation of the _______________, called deep brain stimulation (DBS), is used to treat patients with Parkinson disease subthalamic nucleus (STN)
Unilateral destruction or disruption of the subthalamic nucleus – which can commonly occur via a small vessel stroke in patients with diabetes, hypertension, or a history of smoking – produces ______________. hemiballismus
current theories place it as a component of the basal ganglia control system which may perform action selection. Dysfunction has also been shown to increase impulsivity in individuals presented with two equally rewarding stimuli. Subthalamic nucleus (STN)
neurotransmitter of subthalamic nucleus? Which pathway does it use (direct or indirect)? Indirect (from GP II to GP I)
Globus pallidus I medial pallidus - main target of STN glutamate output in indirect pathway
Two parts of the Substantia Nigra pars reticulata and pars compacta
pars compacta of substantia nigra produces DA (dopamine)
pars reticulata of substantia nigra produces GABA
interneurons between caudate and head of putamen use ______ to communicate with one another but produce and release ________. Ach (communicate!), GABA
name the 4 components of the BG with neurotransmitters 1-Lentiform nucleus/GABA (putamen, GPII, GPI), 2-Caudate nucleus/GABA (headbodytail), 3-Subthalamic nucleus/glutamate, 4-Substantia Nigra/DA & GABA (pars reticulata, DA pars compacta)
claustrum function unknown
what 2 structures are sometimes associated with the BG because of the general anatomical definition of the BG as the 'grey matter of the cerebrum'? claustrum and amygdala
what 2 structures tell the cortex to either stop or start motion? basal ganglia and thalamus
what are the 2 major pathways of input to and output from the basal ganglia? Direct & Indirect pathways
Members of the Corpus Striatum (2) Lentiform nucleus (putamen, GPI, GPII) and the Caudate nucleus
the lentiform nucleus (putamen, GPI, GPII) and the caudate nucleus (headbodytail) make up the Corpus (body) of the Striae so CORPUS STRIATUM
the Striatum is also called the neostriatum
Components of the neostriatum head of caudate nucleus & Putamen (Neo is the head of CN so putamen jail, Mr. Smith!)
How does the entire cerebrum project to the neostriatum (striatum of head of caudate and putamen)? via glutaminergic fibers
what does the brain eat glutamate
describe the Direct/Movement+ pathway simply (remember the only (-)inhibitory neurotransmitter is GABA) Cerebrum via Glu and SNpc via DA project to Neotriatum. Neo via GABA to GPI and SNpr,(both projectGABA to Th). GP1 stops sending GABA to Thalamus (VA/VL) via GABA. Thalamus (VA/VL) via glutamate (brain's favorite!!) to cerebral cortex. Start movement...
"inhibition of inhibition" is the direct pathway meaning GP1 is already sending GABA to thalamus (VA/VL) to inhibit movement, when suddenly Neostriatum sends GABA to GP1, thus exciting GP1 and stopping its transmission of inhibitory GABA to the Thalamus- now Th is free & shoots Glu to cortex. MOVE!
What structures are "together" in the direct pathway and both receive GABA from Neostriatum? Pars reticulata of SN and GP1, both projecting GABA to the Thalamus' VA/VL
Indirect pathway first difference it is to inhibit movement, so this time the SNpc (Substantia Nigra pars compacta DA) dopaminergic fibers cause inhibition, even though the overall effect on the Neostriatum will be excitatory. Don't ask.
Indirect pathway first part to Neostriatum cortex projects glutaminergic (+)fibers to Neostriatum, but SN-pars compacta projects dopaminergic (-inhib this time) to Neostriatum. Overall effect is EXCITATORY.
What do the members of Neostriatum use to communicate amongst themselves, even though they output GABA? Acetylcholine (used by head of caudate and putamen to talk amongst themselves)
Indirect pathway for STOP movement from Neostriatum: Neo projects GABAergic fibers to GP2 and to STN (subthalamic nucleus), which is glutamate connected to GP1 and SNp.reticulata
Indirect pathway GP2 GP2 has been shushed by GABA from Neostriatum, so it stops its own flow of inhibitory GABA to the Subthalamic nucleus. Now the Subthalamic nucleus, set free, can release glutamate to the .SNp.reticulata and glutamate to GP1
Indirect pathway GP1 and SNp.reticulata After Subthalamic n. released Glu to SNpr and GP1, they both sent GABergic fibers to Thalamus VA/VL.
Indirect pathway Thalamus VA/VL: Thalamus VA/VL nuclei project Glutaminergic neurons to the supplementary and premotor cortex. Excitation of indirect path results in inhibition of motor cortex and paucity of movement.
Fail of direct pathway causes Aknesia, bradykinesia (hypokinetic disorders)
Crash of indirect pathway causes Tremors like chorea, ballismus, athetosis, dystonia (hyperkinetic disorders)
side effect of long term L-dopa use chorea
results from focal lesion to subthalamic nucleus (of indirect pathway to stop movement - releases Glu to SNp.reticulata and GP1) ballismus
athetosis writhing, i.e. cerebral palsy
dystonia torticollis
Akinesia (no movement) is rare. What is more common of the hypokinetic symptoms? Bradykinesia (slow movement)
Parkinson's disease results from a depletion of _________ cells in the ______________, causing a breakdown of the nigrostriatal circuitry. DA, substantia nigra
symptoms of Parkinson's include (7) Akinesia, Bradykinesia, Resting tremor, Cogwheel resistance, Flexed posture, Mask-like expression, Shuffling (festinating gait) and impaired balance
the most specific symptom to Parkinson's disease Resting (pill rolling) tremor: failure of Indirect system, slow alternating contraction of distal limb agonists and atagonists. More pronounced at REST. Dissapates during sleep (unconsciousness).
Cogwheel/lead pipe rigidity of Parkinson's is a staccato movement in direct opposition to clasp-knife rigidity of UMN diseases
Festinating or shuffling gait of Parkinson's an INCREASE in speed
Typical Parkinson's affects GP1 & GP2 responds to L-dopa
Atypical Parkinson's does not affect either GP1 nor GP2 and does not respond to L-dopa
Why can't a pharmacist give dopamine directly to a Parkinson's patient? What meds do pharmacists give? DA doesn't cross blood-brain barrier so we give L-dopa. Anti-cholinergic meds are useful.
Why are anti-cholinergic medicines helpful, along with L-Dopa, for Parkinson's patients? Ach is the comminicator between the Neostriatum members (head of caudate and putamen). When DA diminishes, Ach diminishes to keep sys in balance for awhile.
What surgical treatments for Parkinson's? (4) Dopamine stem cell transplant, Pallidotomy, GP1 pacemakers (since they ARE the pacemakers), and Thalamectomies
An autosomal Dominant hereditary disease with insidous onset in 40's or 50's Huntington's
What causes Huntington's? genetic slow degeneration of neurons in Neostriatum (striatum) *head of caudate and putamen that crosstalk with Ach but release GABA
Is chorea a symptom of Parkinson's? why or why not? no! Parkinson's is characterized by slow, tremulous movement (akinesia, bradykinesia, resting tremor). The only speed in Parkinson's is the increase in shuffling (festinating) gait.
Symptoms of Huntington's disease (3) Chorea, dementia, behavioral/psychiatric disturbances
Chorea (choreiform movements) involuntary twitching of the extremities and face in quick, jerky, non-repetitive movements that progressively worsens
progressive cognitive deterioration is called _________ and is characteristic of what disease? dementia, Huntington's
How long do Huntington patients live after onset? 15-20 yrs.
transient (reversible) childhood chorea associated with rheumatic fever Sydenham's Chorea/St.Vitu's Dance
St.Vitu's Dance is a reversible chorea from rheumatic fever and affects the neostriatum (Ach and GABA)
Degeneration of Globus Pallidus resulting in slow, sinuous, writhing movements of the distal extremities - HYPERkinetic disorder athetosis, i.e., cerebral palsy
Ballismus is a focal lesion of the subthalamic nucleus (glutamate to SNp.reticulata and GP1 in Indirect pathway of stopmovement)
Ballismus, a lesion of the subthalamic nucleus or its connections, is usually caused by a small stroke. It results in Ballismus: contralateral to affected subthalamic nucleus; involuntary movements of the proximal extremities and trunk
Wilson's disease results from the accumulation of Cu+ (copper) in the liver and basal ganglia
What disease does Wilson's disease resemble? Huntington's chorea, except there is a Cu+ ring around the eyeball (Kayser-Fleischer)
Wilson's disease is an autosomal __________ disease recessive; abnormal metabolism of copper
Dystonia Musculorum Deformans rare hereditary condition assoc. with injury of the Lentiform nucleus (putamen, GP1, GP2) resulting in co-contraction of agonist and antagonist muscles (ouch!)
torticollis, blepharospasm, dysphonia, and writer's cramp are all examples of focal dystonias
If you compared UMN & LMN lesions to cerebellar symptoms and basal ganglia symptoms, what is the major difference? Cerebellar and basal gang symptoms do NOT stop movement; they just make it inappropriate
Basal ganglia and cortical association areas are, in the general hierarchy of motor control, all about _________________. intention. intention. intention. intention. intention. intention. in inte intent intention!
The cortical association area for motor judgement that works with the Basal Gang is the anterior frontal lobe {AF Motors}
Who fixes AF Motors? the Basal Gang
When you can't remember one side of your body exists, you have a lesion to the posterior parietal lobe
why are you going into a caretaking profession? because you didn't get enough love in your childhood. Now discard this one and get moving!
Two lobes of brain associated with the Basal Gang & intention of movement (motor control) Anterior Frontal lobe {AF Motors} and Posterior Parietal lobe (recall lesion)
what happens in a recall lesion to the posterior parietal lobe? The Basal Gang finds out they can't replace the recalled part and it just goes missing - the patient doesn't recognize that part of the body so there is no movement. He could PP on himself and not care because he doesn't recognize/recall that part.
lesion to PP lobe PP on self: patient doesn't recognize/recall that part of himself so it doesn't move. Basal Gang can't fix.
Job of AF lobe motor judgement: {AF Motors} Basal Gang works on AF Motors
The Basal Gang (PP on self and AF Motors) gathers what kind of information in order to prepare INTENTION of movement? visual, auditory, proprioceptive, etc. & information about the relative position of the body in space, the object, and the OVERALL INTENTION OF MOVEMENT
All hyperkinetic disorders go away during sleep
Intention is the first step in preparing movement. What is the second? Planning & Timing
3 Steps of preparing movement 1. Intention, 2. Planning&timing 3. Execution
What parts of the brain are involved in the second step of movement prep called planning&timing CEREBELLUM & primary motor cortex (area 4, precentral gyrus) & premotor and supplementary motor cortices (area 6)
area 4 and precentral gyrus comprise the primary motor cortex involved in planning and timing (2nd step in movement prep after intention)
area 6 is made up of the premotor and supplementary motor cortices involved in planning and timing (second step in movement prep after intention)
The CEREBELLUM is involved in what step of movement prep? planning and timing (with the primary, premotor & supplementary motor cortices)
plans the sequence and timing of muscle contraction and relaxation to ensure smooth movement (2 major things with subcategories:) CEREBELLUM & MOTOR CORTEX (primary, premotor, supplementary motor cortices)
What is the third step of movement prep and who does it? Execution! The brain and spinal cord, of course.
Target area (premotor and supplementary motor cortices of planning&timing-step 2) for movement? Area __ 6 - target of the Basal Ganglia
What area does the Basal Gang target shoot? 6 (area 6 of the premotor and supplementary motor cortices involved in planning&timing)
Intention, planning&timing, execution! parts please: Basal Ganglia and Cortical Areas (AF Motors, PPlobe), CEREBELLUM and Motor Cortices (primary 4, premotor6 and supplementary6), Brain and Spinal cord, of course.
What is the primary motor cortex involved in planning&timing of movement? PreCentral Gyrus.4
Area ___ is the Precentral Gyrus involved in 4, planning&timing
Area ____ is the premotor and supplementary motor cortices involved in planning&timing. 6
why do you lose both areas 4 and 6 with blood supply disruption, instead of only one area? have the same blood supply, hence bleed out or contusion to the precentral gyrus.4, or supplementary6 or premotor6 will affect the others
alpha neurons are somatically organized so they are convenient to tracts that control them
there is an alpha motor neuron _________ __________ safety switch
______ neurons are somatically organized so they are convenient to the tracts that control them. alpha
alpha neurons are ____________organized so they are convenient to the tracts that control them somatically
where is Broca's aphasia found? back of inferior frontal gyrus
location of Wernicke's aphasia supramarginal or angular gyri if inferior parietal lobe
The basal ganglia and cerebellum send information to the ________ of the thalamus, which then goes to Area 6 (premotor and supplementary) for planning&timing. VA/VL
what goes to the VA/VL of thalamus before going to Area 6? info from the basal ganglia and cerebellum
Ventromedial pathways move _______ muscles (ie, people who are belted into wheelchairs have a problem with these tracts) CoRe
Core muscles are moved by ________pathways. ventromedial
lateral pathways = distal limb muscles
2 major pathways that send information about execution of movement to the lower motor neurons in the spinal cord. Named for their position in the white matter. I. Lateral II. (Ventro)Medial
I. Lateral Pathways: a. ________________________tract b. ________________________tract a. Lateral Corticospinal tract (distal limb)b. Rubrospinal tract (distal limb)
II. (Ventro)Medial Pathway a. _________-ospinal tract b. _________-ospinal tract c. _________-ospinal tract d. _________-ospinal tract pontine reticulospinal, medullary reticulospinal, vestibulospinal, tectospinal
pontine reticulospinal, medullary reticulospinal, vestibulospinal, tectospinal tracts are all descending _______________pathways for core/proximal/axial muscle control Ventromedial
What is the difference in the Prs, Mrs, Vs,Ts from Corticobulbar tract? the Corticobulbar tract is descending LMN input to face and is therefore located in the brainstem
Why do we see mostly 1/4 lower quadrant face symptoms with corticobulbar lesions? input to LMN from corticobulbar is bilateral, so damage leaves one side lacking where message goes undelivered - the lower quadrant
name the 4 ventromedial descending pathways for axial/proximal/core muscle LMN Prs. (pontine reticulospinal), Mrs. (medullary reticulospinal), Vs. (Vestibulospinal), Ts. (tectospinal)
The Prs. and Mrs. vs. Tectum-almost-wrecked'em Core Muscle Mania!!!!!!!! The President (Prs.=pontine reticulospinal) and Missus (Mrs.=medullary reticulospinal) Versus (Vs.=vestibulospinal) Tectum-lmost-Wrecked'em (tectospinal) Core Muscle Mania!!!!
Created by: hecutler