click below
click below
Normal Size Small Size show me how
Nuero3 Brainstem
Neuro3 Brainstem - Medulla
Question | Answer |
---|---|
What are the bulbar cranial nerves? | 1.IX. 2.X. 3.XI. 4.XII. |
What is located w/in the Spinal Trigeminal Nucles? | Sensory Afferent trigeminal ganglia recieving sensation from the face. **Located w/in the medulla |
What is the Ventral Trigeminal Tract (VTT)? What is carried on it? | Travels from the spinal trigeminal Nucles to the thalamus. Carries: 1.Pain & Temp. 2.Crude touch. **Info from small fiber neurons. |
What is the extension of the Dorsal Horn in the medulla? | Spinal Trigeminal Tract. |
What is the Chief Sensory Nucleus? What is carried on it? | Forms the Dorsal thalamic tract and ascends bilaterally up to the thalamus carrying: 1.Discriminative/ Vibratory sense |
As the VTT ascends to the thalamus, what tract is it adjacent to? what is this significant? | SPINOTHALAMIC Tract. **this is important b/c cervical pain input can activate pain the face/head in previously sensitized areas. |
What do the Branchiomeric Neurons innervate? what is special about them? | Motor neurons from: 1.V. 2.VII. 3.IX & X. 4.XII. **They innervate skeletal muscle which developes from NEURAL CREST CELLS. **1-4 are extensions of ventral horn. |
What is the name of the Nucleus of CN X in the medulla? | Nucleus Ambiguous |
What type of infarcts are responsible for brainstem damage small enough to keep the person concious? Where can they occur? | LACUNAR INFARCTS. **We can get them LATERALLY or MEDIALLY. |
What happens to the Corticospinal tract as it nears the medulla? | CST moves anteriorly bilaterally and will decussate at the medulla and become the PYRAMIDS. |
How will a patient present with Nucleus Ambiguous damage? | 1.Dysphagia. 2.Dysphonia. 3.Dyspnea. **Will complain of haorsness & difficulty swallowing. |
What is Alternating Analgesia? | 1.Ipsilateral Analgesia of the face (SpTT). 2.Contralateral analgesia of the body (ALS). **this occurs with a lateral lacunar infarct in the medulla b/c 1&2 are located so close together. |
What are the Solitary and Dorsal Motor Nucleus? | 1.Solitary Nuc: Visceral Afferents which return via CN X. 2.Dorsal Motor Nuc: Visceral Efferent which travels on CN X (PNS). **These are both caudal and medial in the medulla. |
Where is the Hypoglossal Nuc in the medulla? | Caudal & Medial, just inside the Dorsal Motor Nuc. |
From Ant to Posterior, list the structures located medially (centrally) in the medulla | 1.Pyramids (CST). 2.ML (2pt discriminative touch). 3.MLF 4.Hypoglossal Nuc. |
What is located just lateral (lateral most) to the SpTT (Spinal Trigeminal Tract) in the medulla? What does it carry? | INFERIOR CEREBELLAR PEDUNCLE (ICP). **Carries Ipsilateral Proprioception |
List everything damaged by Lateral Lacunar Lesion | 1.ICP (Ipsilateral Ataxia). 2.SpTT (Ipsilateral Facial Analgesia). 3.ALS (Contralateral Body Analgesia). **Nuc Ambiguous may also be damaged. |
Will there be 2pt discriminative touch or motor loss in a patient suffering from a lateral lacunar infarct? | NO |
When determining the location of a lacunar lesion in medulla, what should you do to help localize? | Use your LONG TRACT SIGNS LATERAL: 1.Alternating Analgesia. 2.Ataxia. MEDIAL: 1.Ipsilateral Sensory loss. 2.Ipsilateral Weakness |
What are some ways to Rule out a cerebellar lesion? | 1.Tandum Walking. 2.Rapid Alternating hand movements. 3.Rhombergs |
With medial lacunar infarcts, damage to ML will not only cause sensory loss, but what else? | Concious PROPRIOCEPTIVE loss. **they split to join ML AND ICP. |
At the Pontomedullar junction, which two nuclei appear and which two have now disappeared? | THERE: 1.Facial Nuc (lateral). 2.Abducens Nuc (Posteior). GONE: 1.Hypoglossal Nuc (Posteromedial). 2.Nuc Ambiguous (lateral). |
What is the largest nerve root in the head? | Trigimenal: 1.50% pain/temp fibers. 2.Motor (mastication). 3.Sensory. |
Topography of face? | Like a bullseye: 1.Center: Oral and tip of nose. 2.Middle: Below the lower lip to bridge of nose. 3.Outer: Chin all the way around to the top of the forehead, extending out to the TMJ. |
Where does the topographic map of the face synapse in the brainstem? | 1.Center synapses at the superior Medulla/ pontomedullary junciton. 2.Middle synpases in the middle of the medulla. 3.Outer synpases in the inferior medulla. |
Could neck pain re-aggravate an old TMJ pain? | YES. B/c the TMJ sensory afferents return on the trigeminal nerve to the inferior medulla to synapse, Neck pain could jump up and aggravate these previously sensitized nuclei. |
Could a sphenoid sinus infection stimulate an old neck pain? | YES, the sensory afferents on the trigimenal from the sphenoid will synapse at the base of the medulla which is in very close proximity to the dorsal horn WDRs. |
What causes "Spontaneous" Facial pain | Medullar lesion in the spinal trigimenal Nuc. These nuclei will become irritated and fire inappropriately. **couldn't reproduce pain by physically touching the same spot that they hurt. |
What could cause Hiccups? | Lateral medullary lesion. |
Describe the topographic map within the ML from anterior to Posterior as it ascends up the medulla | 1.Sacral. 2.Lumbar. 3.Thoracic. 4.Cervical. **Radiations from XII Nuc could be damaged with any of these b/c they travel anterior. |
Where is the lesion if a patient has Hypoglossal Palsy with no other symptoms and NO long tract signs? | Periphery. |
Is the Vestibular Nuc located in the medulla? | YES, lateral to the Solitary Nuc (VA). |
From Medial to Lateral, what is the layout of the posterior medulla in terms of efferents and afferents? | 1.GSE. 2.GVE (Dorsal Motor). -SULCUS LIMITANS- 3.GVA (Solitary). 4.GSA (trigimenal). |
Where are the Branchiomeric nuclei located in the medulla? | Anterior, just medial to the sulcus limitans 1.Nuc Ambiguous (IX & X). 2.Facial Nuc. 3.Trigimenal (Pons) |
Is the Cochlear Nuc in the medulla? | Yes, just below the pontomedullar |