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Nuero3 Brainstem

Neuro3 Brainstem - Medulla

QuestionAnswer
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
Created by: WeeG