Question 1

What structure running vertically in the Brainstem divids it into sensory and motor sections bilaterally? Which is medial and which is lateral?

Accepted Answer

SULCUS LIMITANS.

1.Medial: Motor.
2.Lateral: Sensory.

Question 2

What important sensory structures are located/originating in the Pons?

Accepted Answer

1.Chief Trigeminal Nucleus (2 pt touch).

Question 3

What important motor structures are located/originating in the Pons?

Accepted Answer

1.Adbucens Nuc.
2.Superior Salivary Nuc (SNS).
3.Trigeminal Nuc.
4.Facial Nuc.

Question 4

What replaces the Inferior Olive as you move from the medulla to the pons?

Accepted Answer

Central Tegmental Tract (CTT).

**Located lateral to the ML (medial Lemniscus)

Question 5

In the medulla the CST and ML are located adjacently on the midline, is this the case in the Pons?

Accepted Answer

NO, ML moves away from CST (seperated by fibers) and it moves closer to ALS.

**Therefore a lesion in the Pons could cause contralateral 2 pt discrimation loss and analgesia.

Question 6

What is the main coordinator b/w the Cortex and Cerebellum?

Accepted Answer

PONS via Middle cerebellar peduncle.

Question 7

What structure connects the Thalamus and Cerebellum?

Accepted Answer

Superior Cerebellar Peduncle.

Question 8

Describe Alternating Hemiparesis. What structures are involved in Superior, Middle, Inferior Alternating Hemiparesis?

Accepted Answer

It is a loss of Ipsilateral CN (CN Palsy) and Contralateral upper/lower extremity motor:
1.Superior: CN III.
2.Middle: CN VI.
3.Inferior: CN XII.

Question 9

Where is the ONLY place that a lesion could CN VI (lateral Rectus) Palsy?

Accepted Answer

In the subarachnoid space via menengioma.

Question 10

What would Bilateral CN VI palsy be a sign of?

Accepted Answer

Cerebellar Tumor.

**Tumor growth will compress the brainstem against the clivus.

Question 11

When CN VI passes inferiorly to the Petrous Sphenoid Ligament to enter the cavernous sinus, what structure does it lie on top of?

Accepted Answer

Carotid A.

**An aneurysm will affect VI, then also III, IV, and V1.

Question 12

Can you get Lateral GAZE palsy from peripheral N damage?

Accepted Answer

NO!! just stop it.

Question 13

If a patient present with lateral gaze palsy (inability to look towards on direction bilaterally, no diplopia), how can you differentiate if the lesion is in the Abducens Nuc or in the Cortex/PPRF?

Accepted Answer

ABDUCENS: The patient would have a Neg Doll's Head sign and No movement with a Caloric test.

CORTEX/PPRF: Patient would have Pos Doll's Head sign and movement with caloric test b/c VOR is intact.

Question 14

How does the innervation around the mouth differ from the eye and forehead?

Accepted Answer

MOUTH: ONLY by contralateral Cortex.


EYES/FOREHEAD: Bilateral cortical control.

Question 15

Describe the location of a lesion in a patient with complete hemifacial weakness?

Accepted Answer

The lesion is of the peripheral type:
1.Facial Nuc (ipsilateral).
2.Facial radiations.
3.Facial N.

Question 16

Describe the location of a lesion in a patient with an inability to grimace, but forehead still wrinkles and can still close eyes (may not be able to burry eyelashes)

Accepted Answer

Lesion is in the Cortex on the Contralateral side of the mouth paralysis.

Question 17

Bell's Palsy (hemifacial weakness from loss of CN VII) is caused by what?

Accepted Answer

Inflammation in the facial canal.

Question 18

What does the Geniculate Ganglion contain?

Accepted Answer

cell bodies of the Chondra Tympani (branch of CN VII) controlling the taste from Ant 2/3 of the tongue.

Question 19

Could venous swelling in the neck from infection, trauma, hormonal change affect CN VII?

Accepted Answer

YES, Venous BL could back up all the way to the Petrosal Sinus which would compress CN VII causing hemi-facial paralysis.

Question 20

As CN VII enters the internal Auditory Meatus, what all fibers does it contain?

Accepted Answer

1.Facial Motor Nuc fibers.
2.Saltitory Nuc (Chondra Tympani).
3.Superior Salivatory & Lacrimal Nuc.

Question 21

How will a patient present if they have a lesion of CN VII in the subarachnoid space?

Accepted Answer

1.No Lacrimation.
2.Hyperacusis (no control over N to stapedius).
3.No taste from Ant 2/3 of tongue.
4.Hemi-facial paralysis.

Question 22

How will a patient present if they have a lesion of CN VII BELOW the superficial Petrosal N?

Accepted Answer

1.Hyperacusis (no control over N to stapedius).
2.No taste from Ant 2/3 of tongue.
3.Hemi-facial paralysis.

**Can still LACRIMATE.

Question 23

How will a patient present if they have a lesion of CN VII BELOW the N to Stapedius?

Accepted Answer

1.No taste from Ant 2/3 of tongue.
2.Hemi-facial paralysis

**Lacrimation and hearing is normal.

Question 24

How will a patient present if they have a lesion of CN VII BELOW the Chondra Tympani?

Accepted Answer

1.Hemi-facial paralysis.

**Everything else is still normal

Question 25

What is the best way to determine that the hemi-facial weakness is caused by a tumor in the PAROTID GLAND?

Accepted Answer

Digastric muscle works.

Neuro3 Brainstem

Neuro3 Brainstem - Pons

Question	Answer
What structure running vertically in the Brainstem divids it into sensory and motor sections bilaterally? Which is medial and which is lateral?	SULCUS LIMITANS. 1.Medial: Motor. 2.Lateral: Sensory.
What important sensory structures are located/originating in the Pons?	1.Chief Trigeminal Nucleus (2 pt touch).
What important motor structures are located/originating in the Pons?	1.Adbucens Nuc. 2.Superior Salivary Nuc (SNS). 3.Trigeminal Nuc. 4.Facial Nuc.
What replaces the Inferior Olive as you move from the medulla to the pons?	Central Tegmental Tract (CTT). **Located lateral to the ML (medial Lemniscus)
In the medulla the CST and ML are located adjacently on the midline, is this the case in the Pons?	NO, ML moves away from CST (seperated by fibers) and it moves closer to ALS. **Therefore a lesion in the Pons could cause contralateral 2 pt discrimation loss and analgesia.
What is the main coordinator b/w the Cortex and Cerebellum?	PONS via Middle cerebellar peduncle.
What structure connects the Thalamus and Cerebellum?	Superior Cerebellar Peduncle.
Describe Alternating Hemiparesis. What structures are involved in Superior, Middle, Inferior Alternating Hemiparesis?	It is a loss of Ipsilateral CN (CN Palsy) and Contralateral upper/lower extremity motor: 1.Superior: CN III. 2.Middle: CN VI. 3.Inferior: CN XII.
Where is the ONLY place that a lesion could CN VI (lateral Rectus) Palsy?	In the subarachnoid space via menengioma.
What would Bilateral CN VI palsy be a sign of?	Cerebellar Tumor. **Tumor growth will compress the brainstem against the clivus.
When CN VI passes inferiorly to the Petrous Sphenoid Ligament to enter the cavernous sinus, what structure does it lie on top of?	Carotid A. **An aneurysm will affect VI, then also III, IV, and V1.
Can you get Lateral GAZE palsy from peripheral N damage?	NO!! just stop it.
If a patient present with lateral gaze palsy (inability to look towards on direction bilaterally, no diplopia), how can you differentiate if the lesion is in the Abducens Nuc or in the Cortex/PPRF?	ABDUCENS: The patient would have a Neg Doll's Head sign and No movement with a Caloric test. CORTEX/PPRF: Patient would have Pos Doll's Head sign and movement with caloric test b/c VOR is intact.
How does the innervation around the mouth differ from the eye and forehead?	MOUTH: ONLY by contralateral Cortex. EYES/FOREHEAD: Bilateral cortical control.
Describe the location of a lesion in a patient with complete hemifacial weakness?	The lesion is of the peripheral type: 1.Facial Nuc (ipsilateral). 2.Facial radiations. 3.Facial N.
Describe the location of a lesion in a patient with an inability to grimace, but forehead still wrinkles and can still close eyes (may not be able to burry eyelashes)	Lesion is in the Cortex on the Contralateral side of the mouth paralysis.
Bell's Palsy (hemifacial weakness from loss of CN VII) is caused by what?	Inflammation in the facial canal.
What does the Geniculate Ganglion contain?	cell bodies of the Chondra Tympani (branch of CN VII) controlling the taste from Ant 2/3 of the tongue.
Could venous swelling in the neck from infection, trauma, hormonal change affect CN VII?	YES, Venous BL could back up all the way to the Petrosal Sinus which would compress CN VII causing hemi-facial paralysis.
As CN VII enters the internal Auditory Meatus, what all fibers does it contain?	1.Facial Motor Nuc fibers. 2.Saltitory Nuc (Chondra Tympani). 3.Superior Salivatory & Lacrimal Nuc.
How will a patient present if they have a lesion of CN VII in the subarachnoid space?	1.No Lacrimation. 2.Hyperacusis (no control over N to stapedius). 3.No taste from Ant 2/3 of tongue. 4.Hemi-facial paralysis.
How will a patient present if they have a lesion of CN VII BELOW the superficial Petrosal N?	1.Hyperacusis (no control over N to stapedius). 2.No taste from Ant 2/3 of tongue. 3.Hemi-facial paralysis. **Can still LACRIMATE.
How will a patient present if they have a lesion of CN VII BELOW the N to Stapedius?	1.No taste from Ant 2/3 of tongue. 2.Hemi-facial paralysis **Lacrimation and hearing is normal.
How will a patient present if they have a lesion of CN VII BELOW the Chondra Tympani?	1.Hemi-facial paralysis. **Everything else is still normal
What is the best way to determine that the hemi-facial weakness is caused by a tumor in the PAROTID GLAND?	Digastric muscle works.

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