Neuro ~ Block 2

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1.

_____ are the only means by which the nervous system can exercise control over body movements, whether voluntary or involuntary.

Lower motor neurons aka Alpha motor neurons A # of different parts & pathways of the nervous system can influence these lower motor neurons but they alone can elicit muscle contraction. Destruction of the lower motor neurons suppling a muscle or interruption of their axons causes complete paralysis of that muscle

2.

______ & _____ are always medial to the internal capsule and ______ & _____ are always lateral to the internal capsule

Thalamus and Caudate nucleus = Medial Globus pallidus & putamen = Lateral The internal capsule looks like arrowheads or 2 letter Vs with their points facing inward

3.

_______ is continuous with the spinal cord.

The medulla The medulla is the last section and is just caudal to the pons and continuous with the spinal cord.

4.

_______ is required for myelin formation What happens if we are lacking it?

NUTRITIONAL DEFICIENCY Vitamin B12 - required for myelin formation (lack of cobalamin (not found in fruit or vegetables) causes Pernicious Anemia and degeneration of myelin), Vitamin E. Lack of intrinsic factor (produced in stomach and used in small intestine to absorb cobalamin) causes tingling and numbness (paresthesias) of hands and feet. Degeneration of myelin in the dorsal columns is greater than degeneration in corticospinal tract. Dementia can occur with degeneration of cerebral white matter.
5.

________ looks like a dohnut in cross ection

The Nucleus Solitarius The tracts are in the middle and the Nucleus surrounds it

6.

_________ is the point where the lower motor neurons for the ipsilateral half of the face (CN 7) wrap around the abducens nucleus (CN 6). _________ process and coordinate eye movements.

Internal genu of the facial nerve - (facial colliculus)

7.

Superior colliculi Inferior colliculi process auditory information received bilaterally from the cochlear nuclei from the lateral lemniscus.

8.

_________ process auditory information received bilaterally from the cochlear nuclei from the lateral lemniscus.

Inferior colliculi (Note: Superior colliculi process and coordinate eye movements. Remember eyes before hearing

9.

_________ provide an appropriate pattern of muscle contractions about one or more joints _________ will divide and create a tumor

An Efferent set of motor neurons will provide an appropriate pattern of muscle contractions about one or more joints. Glia will divide and create a tumor there is a high probability Axons won't divide

10.

11. 12.

__________ can lead to Inhibition of motor neurons ____________ can occur with degeneration of cerebral white matter. ______________contains interneurons involved in the pupillary light reflex. What are the sensory and motor components of this reflex? What does bright light do to the eye

Muscle Tension can lead to Inhibition of motor neurons Dementia can occur with degeneration of cerebral white matter. (Nutritional Deficiencies)

13.

Pretectal region contains interneurons involved in the pupillary light reflex. Remember CN 2 = sensory CN 3 = motor Bright light constricts the eye - miosis

14.

____________overlie the cerebral aqueduct.

Inferior and superior colliculi overlie the cerebral aqueduct. Midbrain Inferior colliculi process auditory information received bilaterally from the cochlear nuclei from the lateral lemniscus. Superior colliculi process and coordinate eye movements.

15.

___________is the most ventral part of the brain stem Where is it seen? Where is it not seen?

basis most ventral part of the brain stem (pons and midbrain only, not seen in medulla) - location of large collection of fibers and tracts: corticospinal, corticobulbar, and corticopontine tracts.

16.

__________lies ventral to the aqueduct (midbrain) and ventral to the fourth ventricle in the pons and medulla. What is it's significance?

tegmentum The location of the main bulk of the brain stem cranial nerve nuclei and the reticular formation. note this is a midbrain cut
17.

_________is the site of origin or termination of 9 of the 12 cranial nerves. "Mickey Mouse" cross section means we are where ? How will we know whats rostral and dorsal?

The brain stem

18.

Midbrain His ears are ventral

19.

A 39 year old man was thrown fromt he bed of a pickup truck in a motor vehicle accident, ststaining vertebral fractures at T5-T6 & C4-C5. About 2 years later he bagan noticing progressive changes: What does he have & what changes are you suspecting?

Central canal in his spinal cord. (Syringomyelia) Progressive weakness and atrophy of his hand muscles. A band of bilateral loss of pain, & temp sensation & weakness & atrophy at levels where the damage extends to the anterior horns 1) Collateral of primary afferents may ascend one or more segments in Lassauer's tract before synapsing, so input from theses is spared if the cut is made at the highest dermatome level of pain. 2) The axons that form the spinothalamic tract cross the midline w/ a rostral inclination so a cut at any given level spares fibers that arise contralaterally @ that level b/c they join the tract rostral to the cut. Cordotomy provides promt contralateral analgesia however analogous to the recovery following posterior column damage, the analgesia is seldom permanent. After a varying interval (generally several months) the patients pain usually returns

20.

A cordotomy is an operation that destroys the spinalthalamic tract. It is sometimes performed on patients suffering from intractable pain. The operation consists of cutting the lateral funiculus from the denticulate ligament to the line of ventral rootlets. The cut is usually made several segments rostral to the highest dermatome level of pain for 2 reasons :

21.

A disease of the central part of the spinal cord in which a tube like enlargement of the central canal develops, typically at a lower cervical or upper thoracic level.

Syringomyelia As the syrinx enlarges, surrounding neural tissue is destroyed. The 1st damage is to fibers crossing through the limited available area around the central canal. The next area damanged is usually the anterior horn The result is a distinct combination loss of pain & temp sensation bilaterally over the arms and shoulders ( as a result of damage to crossing fibers) & weakness and atrophy of the muscles of the hand ( as a result oof anterior horn damage) Of course if the syrinx occured at a different spinal level, the symptoms would be referred to a different part of the body

22.

A distinct region of grey matter that caps the posterior horn

The substantia gelatinosa In myelin stained preparations this region looks pale compared to the rest of the grey matter b/c it deals mostly with finely myelinated and unmyelinated sensory fibers that carry pain & temp information
23.

A lateral spinal cord lesion will cause A lesion causing drooping = What system gets damaged?

Loss of contralateral pain and temperature starting a few segments below the level of the lesion Ptosis; Horner's Syndrome (Loss of Sympathetic) diplopia (CN VI palsy ipsilateral). A lesion of the abducens nucleus will cause ipsilateral, lateral gaze palsy. A lesion of the abducens nucleus AND ipsilateral MLF will cause ipsilateral, lateral gaze palsy AND an internuclear ophthalmoplegia (INO). "one and a half syndrome." A lesion of the cerebral hemisphere will cause gaze to the side of the lesion.

24.

25.

A lesion of the abducens nerve will cause

26.

A lesion of the abducens nucleus AND ipsilateral MLF will cause

ipsilateral, lateral gaze palsy AND an internuclear ophthalmoplegia (INO). "one and a half syndrome."

A lesion of the abducens nerve will cause diplopia (CN VI palsy ipsilateral). A lesion of the abducens nucleus will cause ipsilateral, lateral gaze palsy. A lesion of the cerebral hemisphere will cause gaze to the side of the lesion.

27.

A lesion of the abducens nucleus will cause

ipsilateral, lateral gaze palsy.

A lesion of the abducens nerve will cause diplopia (CN VI palsy ipsilateral). A lesion of the abducens nucleus AND ipsilateral MLF will cause ipsilateral, lateral gaze palsy AND an internuclear ophthalmoplegia (INO). "one and a half syndrome." A lesion of the cerebral hemisphere will cause gaze to the side of the lesion.
28.

A lesion of the cerebral hemisphere will cause gaze to the side of the lesion.

A lesion of the abducens nerve will cause diplopia (CN VI palsy ipsilateral). d. A lesion of the abducens nucleus will cause ipsilateral, lateral gaze palsy. e. A lesion of the abducens nucleus AND ipsilateral MLF will cause ipsilateral, lateral gaze palsy AND an internuclear ophthalmoplegia (INO). "one and a half syndrome." Lesion of the vagus causes dysphagia (difficulty swallowing with nasal regurgitation of food), loss of gag reflex, and cough, dysarthria with hoarseness with fixed vocal cord. a) Bilateral lesion of the vagus (rare) is fatal with complete laryngeal paralysis (aphonia, dyspnea and aphagia).

29.

A lesion of the Vagus will cause:

30.

A lesion of what blood supply would knock out the upper motor neuron of Cranial nerve 7? A motor disease that attacks the motor neurons of the anterior horn

Middle Cerebral Artery could knock it out

31.

Poliomyelitis
32.

A patient has an right UMN lesion of the facial nerve ... what do we expect to see

Inability to move the lower left portion of the face The upper portion of the face has bilateral innervation The lower has unilateral innervation therefore with a Corticobulbar lesion (UMN) will cause only lower face palsy contralateral to the lesion.

33.

A patient has been told they were in a knife fight, in which they were stabbed on the left hand side with a knife Ultimately they suffered from Brown sequard. What effects should we anticipate?

Hemi section = Brown sequard syndrome 1) A Small band of loss of total sensation roughly at the level of the lesion (left) bc the dorsal horn has been damage 2) We will have a loss of pain and a loss of fine touch of Alternating symptoms Left side we will have a loss of fine touch, vibration & proprioception (ipsilateral) Right side we will have a loss of pain and temp. (Contralateral) 2 totally different losses = a spinal cord lesion
34.

A patient has Horner's Syndrome How will we know what eye?

The pinpoint eye is always the side of the lesion ... IPSILATERAL The classic signs of Horner's Syndrome are: MIOSIS - decreased pupil size (dilator muscle not innervated) (Normally NEpi is released) PTOSIS - drooping upper eyelid (Muller's smooth muscle not innervated). ANHIDROSIS - lack of sweating on the face and neck.
35.

A patient is in somnolence What do you suspect has undergone ischemia?

Somnolence = unconsciousness = coma Pontomesencephalic reticular formation or bilateral thalami (bilateral thalamus)

36.

A patient presents unable to move her upper and lower face What has she damaged?

LMN lesion Bells Palsy (herpetic facial paralysis) - facial nerve lesion (LMN) will cause ipsilateral total (upper and lower) face paralysis. If the upper face isn't working then we know we have damaged CN7 and we go to the pons to find out why... we won't be able to CLOSE the eye Bells palsy is Ipsi
37.

A patient presents unable to move the lower left portion of her mouth - what has she damaged?

UMN lesion on the RIGHT side Corticobulbar lesion (UMN) - will cause only lower face palsy contralateral to the lesion.
38.

A patient presents with an unsteady gait What do you suspect has undergone ischemia?

Cerebellar pathways Long sensory = Medial Lemniscus Corticospinal tracts Eye movement pathways or visual cortex 3,4,6 Supranuclear or infranuclear eye movement pathways 3,4,6

39.

A patient presents with blurred vision What do you suspect has undergone ischemia?

40.

A patient presents with diplopia and a dysconjugate gaze What do you suspect has undergone ischemia?

41.

A patient presents with dysarthria and dysphagia What do you suspect has undergone ischemia?

Corticobulbar pathways or brainstem cranial nerve nuclei

42.

A patient presents with Horners on her right side and can still feel pain felt on her left side ... we know she must have damaged _____ A patient presents with Horners on her right side and no pain felt on her left side ... we know she must have damaged _____ A patient presents with numbness and tingling particularly bilateral or perioral What do you suspect has undergone ischemia?

She damaged somewhere in the PNS system ... Outside the CNS Somewhere in the CNS : Brainstem or Spinal cord Long somatosensory pathways or Trigeminal system

43.

44.

45.

A posterior spinal artery defect would result in what kind of Motor and Sensory problems - Account for all tracts

Dorsal column medial leminsucs will be the most effected (posterior columns)
46.

A somatotopic representation is located in the corticospinal tract Fiber controlling upper extremities are located :

Upper extremities are located medial to those controlling lower extremities Dysarthria We want Rubrospinal tract to pick up the slack Nicotinic and Muscarinic acetylcholine receptors Nicotinic receptors are ionotropic receptors, transmitter gated ion channels that mediate fast EPSPs Muscarinic receptors are metabotropic receptors, G protein coupled receptors that mediate a variety of 2nd messenger effects Nicotinic are more common in the PNS Muscarinic receptors are more common in the CNS

47.

A speech disorder characterized by difficulty speaking properly, due to paralysis of the muscles of speech. A woman has a stroke and damages her Lateral Corticospinal tract... why do we put her into physical therapy immediately? Acetylcholine has 2 types of receptors

48.

49.

50.

ALS lesions are always ________

Contralateral - no matter whether the lesion is in the brain or spinal cord This is called Alternating Symptoms Loss of Pain in the Spinal cord = Contralateral Symptoms Loss of Pain in the Brain stem = Contralateral Symptoms

51.

Alternating symptoms in which long tracts symptoms are referred to one side and cranial nerve symptoms are referred to another side are hallmark of

Brainstem lesions

52.

An acute inflammatory demyelinating polyneuropathy (AIDP) An immune mediated demyelination of peripheral nerves When does it typically present?

Guillain-Barr Syndrome (usually 1-2 weeks following viral illness.)

53.

An acute polyneuropathy disorder affecting the peripheral nervous system. Ascending paralysis, weakness beginning in the feet and hands and migrating towards the trunk. Some subtypes cause change in sensation or pain as well as dysfunction of the autonomic nervous system. It can cause life-threatening complications, in particular if the breathing muscles are affected or if there is autonomic nervous system involvement. The disease is usually triggered by an infection.

Guillain-Barr syndrome (GBS)

54.

An anterior spinal artery defect would result in what kind of Motor and Sensory problems - Account for all tracts

An anterior spinal artery infarct can damage the anterolateral pathways (no pain and temperature below the lesion bilaterally). Motor signs include: upper motor neuron (corticospinal tract) spastic paralysis below lesion and ventral horn cells (lower motor neuron signs at the level of the lesion - "Al" is down) flaccid paralysis. (the distal musculature & trunk will be effected ) Incontinence is common as descending pathways tend to be more ventral in the spinal cord. (Note we lose everything except for the Dorsal columns fine touch & proprioception will be ok )

55.

An upper motor neuron lesion caused by corticospinal damage has very different effects from thoes of a lower motor neuron lesion

Charcateristically the muscle involved show hyperactive reflexes. The resting tension is increased (they are hypertonic) & there is paralysis or weakness (paresis) particularly of fine voluntary movements. This complex of symptoms is referred to as spastic paralysis A # of pathological reflexes are associated w/ upper motor neuron lesions. The best known is Babinski's sign

56.

Approximately 15% of the corticospinal cord fibers continue into the spinal cord with out crossing. What are these fibers called & where do they go? Are there more nuclear bag fibers or nuclear chain fibers in a muscle spindle?

Anterior Corticospinal tract ... they enter the spinal cord ipsilaterally w/out crossing & enter the anterior white matter columns to form the anterior corticospinal tract. More nuclear chain fibers Most muscle spindles contain 2 or 3 nuclear bag fibers and at least twice that many nuclear chain fibers

57.

58.

arises from "top of the basilar artery" at level of rostral pons supplies superior cerebellum and bit of rostral laterodorsal pons

SCA (superior cerebellar artery)

59.

arises from basilar artery (just after vertebrals fuse) at level of caudal pons supplies lateral caudal pons and a small portion of cerebellum

AICA (anterior inferior cerebellar artery)

60.

arises from vertebral artery at level of medulla supplies lateral medulla and inferior cerebellum

PICA (posterior inferior cerebellar artery) PICA : will be on the upper portion of the butterfly Vertebral arteries will be on the lower portion
61.

Arousal & Awareness of pain ... think

Spinoreticular tract Spinoreticular release Glutamate to the reticular formation The Ret thalamic activates the panic button to the ILN which notifies the cortex -> for arousal

62.

As the nerve enters the dorsal horn of the spinal cord, it eventually synapses and has to release glutamate? What process allows for Glutamates release?

In the CNS we have voltage gated channels (Thus we have to be able to general an action potential via voltage gated sodium and potassium channels. We need the voltage in order to open the voltage gated calcium channel in the dorsal horn. Once this Calcium channel opens the calcium comes in and binds to Synaptotagmin "tag your it" & allows for the fusion of vessels and the release of GLUTAMATE Then the 2nd neuron / projection neuron carries on it's way to the thalamus. (Note these Voltage gated channels are normally closed 24/7)

63.

As you look at the brainstem from a Ventral point of view - What features should immediately stand out? At the level of the pons what cortico fiber will go both Ipsi and Contra lateral

Cranial Nerves Arteries - especially the Basilar artery (It is bringing oxygen and glucose to the middle of the pons) CN 7 Ipsi & contra for Upper face Contralateral for lower face

64.

65.

At what location is the first synapse for the DC-ML pathway? Atrophy ... we need to be thinking

The 1st neuron always connects with the 2nd neuron on the same side. There is an ipsilateral kiss and it's at the CAUDAL MEDULLA

66.

A lower motor neuron lesion Look at C8 or C7 and one of the fingers may be skinnier (yes you can have a little atrophy with a UMN but it would be from disuse... if we baby our patients their muscles will atrophy from disuse)

67.

Automatic posture and gait movements = What tract

Reticulospinal tracts (2) #3 in pic (3a) One originates in pontine reticular formation = medial reticulospinal tract. (3b) Other originates in the medullary reticular formation = lateral reticulospinal tract (medial motor system)
68.

axons project to effector organs Give ganglion and nerve

Vagus (CN X) various TERMINAL ganglia Ex. of effector organs to lungs, heart GI tract).

69.

axons project to lacrimal glands and nasal mucosa. Give ganglion and nerve

Facial nerve (CN VII) sphenopalatine ganglion Facial nerve (CN VII) submandibular ganglion

70.

axons project to submandibular and submaxillary salivary glands. Give ganglion and nerve

71.

axons project to the eye ciliary muscle and constrictor (sphincter) muscle of the iris Give ganglion and nerve

Occulomotor nerve (CN III) ciliary ganglion

72.

axons project to the parotid gland. Give ganglion and nerve

Glossopharyngeal (CN IX) otic ganglion

73.

Axons will synapse with projection neuron cell bodies in the nucleus and cross over here as the internal arcuate fibers to become the medial lemniscus.

Fasciculus and Nucleus Cuneatus (Axons from the dorsal column that cross over and enter the triangle thing in the middle till it builds up & becomes the medial lemniscus) (In the caudal medulla but a little bit up from the Spinomedullary Junction) Note the CST (2 balls on the bottom) haven't crossed yet ... it's cell bodies are still on the ipsi side
74.

Bilateral control of axial and girdle muscles = what tract?

Anterior (ventral) corticospinal tract (doesn't cross the midline) (medial motor system) #1
75.

Blink to Threat reflex What nerve is sensory? What nerve is motor?

Sensory - CN 2 (vision) Motor - CN 7 (7 closes the eye)

76.

Blood supply to the anterior 2/3rds of the spinal cord, including the anterior horns and anterior lateral white matter columns

Anterior spinal artery supplies the gray sections

77.

Blood supply to the posterior column and part of the posterior horns

Posterior spinal arteries

78.

Brain stem lesions producing ipsilateral Horner's Syndrome may also result in : (think other tracts affected) Why?

Contralateral loss of pain and temperature sensations from the limbs and body. The reason being b/c the descending fibers of the Corticospinal Tract & Hypothalamospinal SNS Fibers travel with the ascending spinothalamic fibers (ALS) in the lateral part of the brain stem. ALS is always CONTRA

79.

Brainstem losses are always _________

Contralateral Whether its the ALS tract or DC-ML tract .. b/c we are dealing w/ Projection neurons

80.

C7

81.

C7

Extension of Elbow Flexion of wrist (median / ulnar nerve) Extension wrist (Radial nerve) C7 = Middle finger C7 = Dorsal portion of hand Palm of Hand (note hand is C5 - C8) C6= Thumb & Index C8 = Ring finger & pinky
82.

Causes one or more joints to flex. Cell body for the body resides = Cell body for the face resides =

Flexion reflexes Dorsal root ganglion This is in the PNS (outside the CNS)

83.

84.

Trigeminal Ganglion (CN V) It's a ganglion so it's still in the PNS

85.

Central 7 means what? Where is our lesion?

The upper face was sparred - so we know we have an UMN lesion coming down onto lower CN 7 If the upper face is working then we know CN7 is working fine ... we will only lose the bottom half of the face (Remember the CN is a LMN ) Our lesion is on the Contralateral side ... go look at the pons

86.

CNX Sensory functions: Motor functions:

Sensory = Thoracic and Abdominal viscera

Motor = Speech, swallowing, thoracic & abdominal viscera (parasympathetic )

87.

Compare the crossing of the DC-ML and the crossing of the Corticospinal tract Contains the autonomic centers for respiratory, cardiovascular, and gastrointestinal control. Contains the caudal portion of the Trigeminal Nuclei (spinal nucleus of CN 5) and caudal parts of two of the four Vestibular Nuclei (CN 8). Contrast how we can tell the difference (using eyes) between Horner's and Ocular motor nerve damage

The DC-ML crosses just a tad rostral to the pyramidal decussation Medulla If we compress the medulla its a medical emergency

88.

89.

Medulla

90.

Horners = ptosis is on the same side as the nonfunctional pupillary dilator - on the same side as the SMALLER pupil (pblm w/ sympathetic)

3rd CN = ptosis caused by CN3 damage is on the same side as the nonfunctional pupillary sphincter therefore on the same side as the DILATED / LARGER pupil - also the ptosis is more pronounced & is usually accompanied by defective eye movements and lateral strabismus
91.

Control the proximal axial and girdle muscles involved in postural tone, balance, orienting movements of the head & neck, automatic gait related movements

The 4 medial motor systems Anterior Cortiospinal (the 10% that doesn't cross) Vestibulospinal Reticulospinal Tectospinal Anterior corticospinal tract Note this never crosses - it's the 10% that goes straight down from the primary motor cortex and never crosses at the decussation

92.

Controls bilateral axial and gridle muscles

93.

Controls muscles for swallowing (gag reflex) and phonation. State Nerve and Nuclei

Nucleus Ambiguus CN X Vagus - motor

94.

Corneal reflex What nerve is sensory? What nerve is motor?

Sensory - CN 5 Motor - CN 7 Sensory Pain, temp and itch It will be a contralateral loss Remember - Brainstem is ALWAYS contralateral

95.

Cut the spinal thalamic tract in the pons on the right side what am I going to lose?

96.

Damage the LMN of the corticospinal tract. What will happen & where?

Motor Weakness/paralysis ipsilateral to the lesion

97.

Damage the UMN in the spinal cord of the corticospinal tract. What will happen & where?

Motor Weakness/paralysis ipsilateral to the lesion (note bc we have already crossed in the medulla)

98.

Damage to cranial nerves and nuclei will result in lesions where? What type of loss?

ipsilateral head sensory and / or motor deficits.

99.

Damage to the ocular motor nerve will cause what findings in the eye (List what we will see)

The eye ipsilateral to the lesion will deviate laterally bc the medial rectus will be paralyzed and the lateral rectus will be unopposed (Lateral strabismus) Diplopia (double vision) & is unable to move the affected eye medially verticle movements are also impaired bc of paralysis of the superior and inferior recti and inferior oblique Ipsilateral levator palpebrae superioris is paralyzed so ptosis occurs Pupillary sphincter & ciliary muscles are unfunctional The pupil on the effected side will be DILATED / mydriasis as a result of the now unopposed pupillary dilator muscle & it won't constrict in response to light, the lens can't be focused for near vision

100.

Damage to the pons of the corticospinal tract. What will happen & where?

Motor Weakness/ paralysis contralateral to the lesion (note b/c we haven't crossed yet) ex. Problem with the Basilar artery

How could a lesion in the pons occur?

101.

DC-LM Lesion in the Brainstem produces loss on what side?

Loss of Fine touch, proprioception in the Brain stem = CONTRALATERAL Symptoms BRAINSTEM LOSSES ARE ALWAYS CONTRALATERAL

Loss of Fine touch, proprioception in the Spinal cord = Ipsilateral Symptoms

102.

DC-LM Lesion in the Spinal Cord produces loss on what side?

Loss of Fine touch, proprioception in the Spinal cord = IPSILATERAL Symptoms

Loss of Fine touch, proprioception in the Brain stem = Contralateral Symptoms

103.

DCML At each successive spinal level, fibers entering the posterior columns add on laterally to thoes already present. As lamination results, w/ layers of fibers from sacral levels most ____ and layers from cervical layers most ____

Sacral levels will be medial and cervical levels will be lateral This sort of arrangement is somatotopic organization

104.

Degeneration of myelin in ____________ is greater than degeneration in ___________

Degeneration of myelin in the dorsal columns is greater than degeneration in corticospinal tract. (Due to Nutritional Deficiencies)

105.

DEGENERATIVE / DEVELOPMENTAL spina bifida, syringomyelia, amyotrophic lateral sclerosis (ALS) (Lou Gehrig's disease - motor neuron disease.) Upper motor neurons or lower motor neurons or BOTH can be involved. Note in Pic LMN and UMN knocked out Corticospinal tract and ALS track both wiped out Weakness for sure some muscles may have atropy and fasciculations and others may not. We may see a Babinski relfex It's not always bilateral - these are ugly , slow progressive death senstences & the one thing we are worried about is the diaphram b/c they won't be able to breathe

106.

Dermatomes overlap substantially so that injury to an individual dorsal root does not lead to complete loss of sensation in the relevant skin region. Is the overlap more extensive for : touch, pressure and vibration or for pain and temperature?

The overlap is more extensive for sensations of touch, pressure and vibration than for pain and temperature. Thus testing for pain sensation provides a more precise assessment of a segmental nerve injury than does testing responses to touch, pressure or vibration.

107.

Describe a Pseudounipolar cell and where they can be found

DC-ML Our Primary neuron has no free nerve endings : it's a PSEUDOUNIPOLAR CELL The same cell -PSEUDOUNIPOLAR CELL goes from our foot all the way up to the medulla and it's myelinated by 2 different types of glial cells CNS = oligodendrocytes & PNS = Schwann cells Its' one huge long axon. It's a "peripheral process "in the beginning & has been myelinated by Schwann cells The same neuron - as soon as it gets to the CNS, we call it a "central process" which has oligodendrocytes myelinating it

108.

Describe Syringeomeylina What do you "lose" What can you tell your patient about this lesion?

We were in some type of an accident - typically an accident, in which we suffered from whiplash. We didn't damage the tract - just the fiber The lesion will cause BILATERAL symptoms For just the bilateral dermatomes (2or 3 segments below the black hole b/c it takes the ventral white commissure fibers time to rise before it joins the ALS) Classically A "Cape like" pattern of loss of Pain, you take your sharp needle and they cant feel pain, temp or itch - it's a growing cylinder - it can grow all around - Each year you'll note on the chart that it is growing and keeps going out - all you can do is correctly diagnose - there isn't much that you can do - the projection fibers are all squashing to go thru to the ALS - its going to grow out to the ventral horn and eventually cause motor problems of weakness / paralysis
109.

Describe the Accomodation sequence... what happens when we Contract the ciliary muscle?

Normally : ciliary muscles (which control the shape and therefore the refractive power of the lens) Signals from the Edinger-Westphal nuclei travel via the ipsilateral oculomotor nerve to reach the ciliary and constrictor pupillae muscles of the eye. Contraction of the ciliary muscle causes the lens to increase its curvature / gets rounder (and thus its refractive power), while contraction of the constrictor pupillae reduces the size of the pupillary aperture. Signals from the oculomotor nuclei travel via the ipsilateral oculomotor nerve to the medial rectus muscles causing them to contract and resulting in convergence of the eyes on the object of interest.

110.

Describe the Corneal reflex (ex. pain on sclera) Be sure to list sensory and motor components Is this a monosynaptic response or polysynaptic?

Sensory CN 5 (Trigeminal) comes in and transduces pain from the sclera It goes to the reticular formation and activates it The RF will then activate CN7 (Facial) which will allow us to close the eye. The reticular formation helps us do the bilateral response Polysynaptic

111.

Describe the Lateral Corticospinal Tracts pathway:

(aka the Pyramidal tract) ~Its fibers originate in the cerebral cortex (in the precentral gyrus) ~descend thru the cerebral peduncle, basal pons & medullary pyramid ~decussate at the spinomedullary junction (pyramidal decussation) and ~end in the anterior horn or the intermediate gray matter They terminate on the motor neurons of the anterior horn or more often on smaller interneurns that in turn synapse on these motor neurons.

112.

Describe the pathway of the Spinal Trigeminal Tract?

Primary sensory axons from ipsilateral face (tract) provide pain, temperature, itch, and crude touch sensation for the face, mouth, anterior 2/3 of the tongue, nasal sinuses, and supratentorial dura, (CN 5) as well as encoding pain and temperature from the outer ear on cranial nerves 7, 9 and 10.

They travel past the Trigeminal ganglion enter the pons but then travels downwards to the spinal cord where it synapses at the Spinal trigeminal nucleus . (At the Spinal Trigeminal Nucleus) - projection neuron cell bodies in the nucleus send axons which cross the midline to travel in the trigeminothalamic tract and synapse in the VPM nucleus of the thalamus.

113.

Describe the RECIPROCAL INHIBITION reflex

RECIPROCAL INHIBITION: Ia afferent fibers synapse (release Glutamate) on a single inhibitory spinal INTERNEURON which produces inhibitory synaptic potentials (release GABA or Glycine) in lower motor neurons innervating the antagonist muscles 1) Excitation of motor neurons with the simultaneous inhibition of their antagonist motor neurons causes one group of muscles to be excited while their antagonists are inhibited. (the antagonistic muscle DO NOT CONTRACT) 2) The neuronal circuit that causes this reciprocal relation is called reciprocal innervation same as feed forward inhibition.

114.

Describe the Reflex arc: polysynaptic withdrawal reflex (step on a tack)

Increased firing of afferent sensory fibers from CUTANEOUS receptors / nociceptors (diverse group of fibers A transmitting extreme pain, temperature etc): 1) Stimulates the excitatory interneurons in the spinal cord to activate the alpha motor neurons that supply flexor muscles in the ipsilateral limb (We activate the FLEXOR MUSCLE by releaseing ACh) a) Reverberating circuits of interneurons within the spinal cord cause prolonged contraction of the flexor muscles. 2) Stimulates inhibitory interneurons in the spinal cord to prevent the activation of alpha motor neurons that supply the ipsilateral extensor muscles. (We don't release anything to the MUSCLE b/c we released GLYCINE to the alpha motor neuron) Crossed extension reflex - part of the withdrawal reflex. 1) Commissural interneurons evoke the opposite pattern of activity in the contralateral side of the spinal cord. 2) Contralateral effect helps to maintain balance.

115.

Describe the tract that leaves the hypothalamus

The sympathetic nervous system (SNS) innervates the eye, face, and scalp. Descending tract from the hypothalamus DOES NOT CROSS the midline as it descends through the brain stem and spinal cord to innervate the preganglionic SNS neurons.

116.

Despite the somatotopic arrangement, the fibers of the internal capsule are compact enought that lesions at this level generally produce Destruction of the lower motor neurons suppling a muscle or interruption of their axons causes :

Weakness of the entire contralateral body (face, arm and leg) However occasionally capsular lesions can also produce more selective motor deficits complete paralysis of that muscle Lower motor neuron lesions cause flaccid paralysis, indicating that the muscle is limp and uncontracted. Reflex contractions can no longer be elicited and the muscle slowly atrophies this occurs in poliomyelitis ( a viral disease that attacks the motor neurons of the anterior horn) and in injuries in which the ventral roots are damaged

117.

118.

di- means Ex.

both sides of the body are equally affected ex. facial diplegia symmetrical facial weakness

119.

Discuss the medial lemniscus axons transition as it works its way up the spinal cord.

The medial lemniscal axons carrying info from the lower limbs are located ventrally, where as the axons related to the upper limbs are located dorsally. As the medial lemniscus ascends through the pons & midbrain, it rotates 90 degrees laterally so that the fibers representing the upper body are eventually located in the medial portion if the tract & those representing the lower body are in the lateral portion.
120.

Do ALS neurons REALLY cross Immediately?

After the kiss the projection neuron do start crossing however It takes the projection neuron 2-3 segments to cross over to the ALS tract from there, once it crosses, it goes straight up to the ipsiside thalamus (VPL) This is clinically relevant b/c when we have a lesion such as a Hemi section of the spinal cord We won't feel the loss of pain until 2-3 spinal cord segments BELOW the cut/ lesion b/c the tracts are all ascending up at an angle

121.

Do neurons divide and regenerate? Dominated by the 'dynamic' subtype of nuclear bag fiber whose biochemical properties emphasize the 'velocity' of fiber stretch Ends at cervical cord level: controls head and neck muscles.

No but Glia cells do Thus an axon in the white matter of the CNS can't grow back

122.

Group Ia afferents

123.

medial VST #2 ( Vestibulospinal tracts (VSTs) of the medial motor system)

124.

Facial (CN VII) Where is the nuclei? Be specific

Facial (CN VII) - Superior salivatory nucleus (PONS). The PNS PREganglionic neuron cell body is located in specific brain stem nuclei. Lower motor neuron lesion Involuntary twitchings

125.

Fasciculations ... we need to be thinking

126.

Fasciculus and Nucleus Cuneatus axons will synapse with projection neuron cell bodies in the nucleus and cross over as the internal arcuate fibers to become ______________

The medial lemniscus. Note this picture is the rostral medulla - the Medial Lemniscus tract has been formed and is in the center of the picture (praying hands) Note the Corticospinal tract hasn't crossed yet
127. 128. 129. 130. 131.

Fast excitatory transmitter in the CNS Fast excitatory transmitter in the PNS Fast inhibitory transmitter in the brain Fast inhibitory transmitter in the spinal cord Fine touch & dental pressure for CNV will synapse at what nuclei?

Glutamate Acetycholine GABA (GABA - A receptors are mostly int he brain) Glycine - mostly in the spinal cord

Chief nucleus aka major trigeminal sensory nucleus (Paccinian corpusle)

132.

First-order neuron axon fiber tract that carries information about fine touch, proprioception, pressure and vibration from the legs and lower trunk. First-order neuron axon fiber tract that carries information about fine touch, proprioception, pressure and vibration from the upper trunk (above T6) and arms and neck. First-order sensory neurons always ___________with second order neurons first then the axons of the second-order neurons ________ the midline.

Fasciculus gracilis (T6 and below) Fasciculus cuneatus more lateral to gracile (above T6) First-order sensory neurons always SYNAPSE with second order neurons first (On the same side) then the axons of the second-order neurons CROSS the midline. Synapse then Cross!!!

133.

134.

135.

Flexed Upper arms and Extended lower extremities ... this is classic for what kind of lesion?

An UMN loss of the Lateral CorticoSpinal Tract All that we have left is the Rubrospinal cord tract Rubrospinal causes flexion of the upper extremities - normally this is offset w/ the Lateral cortical spinal tract & we get the normal angles ... obv when the Lat. Cotical spinal is out - we will only see the flexion The vestibulospinal senses the change and tells the leg muscles to extend

136.

Flexion of Upper Arms What tract?

Rubrospinal

137.

Force with which a muscle resists being lengthened Function = Movement of contra lateral limbs what tracts should I be thinking

Tone ( stiffness of a muscle) Think of the stretch reflex

138.

Lateral corticospinal tract Rubrospinal tract (Lateral Motor Systems)

139.

GABA receptors are _______ gated

Transmitter/ ligand gated When they open they are permeable to Cl- ions

140.

Ganglia reside in the ______ the exception to this is : Genitals - describe it's position in the humunculus

Ganglia reside in the PNS The exception to this is the Basal Ganglia : Cuneate, Putamen and Globus Pallidus which resides in the CNS The genitals are only included in the Sensory (Postcentral Gyrus) They are not part of the motor cortex (note we have a total of 4 humunculi)

141.

142.

Glossopharyngeal (CN IX) Where is the nuclei? Be specific

Glossopharyngeal (CN IX) - Inferior salivatory nucleus (MEDULLA). The PNS PREganglionic neuron cell body is located in specific brain stem nuclei. Motor.... No general somatic skeletal muscle innervation. 1) Innervation of stylopharyngeus muscle. a) Nucleus Ambiguus. b) Elevates the pharynx during talking and swallowing (part of gag reflex with vagus). 2) Parasympathetic innervation of parotid gland. a) Inferior Salivatory Nucleus.

143.

Glossopharyngeal is a mixed sensory and motor nerve. What does it's "motor" component control? State the nucleus involved

144.

Glossopharyngeal is a mixed sensory and motor nerve. What does it's "sensory" component control? State the nucleus involved

1) Special Visceral Sensory - taste from posterior 1/3 of tongue. ~Rostral Solitarius "gustatory" nucleus with vagus. 2) General Visceral Sensory - Carotid body and sinus: chemo- and baro- receptors. ~Caudal Solitarius "cardiorespiratory" nucleus with X. 3) General somatic sensation from middle ear, outer ear, pharynx and posterior 1/3 of the tongue. ~Primary sensory neuron in the superior glossopharyngeal ganglion. ~Spinal Trigeminal Nuclei - second order sensory neuron with X. c. Lesion of the glossopharyngeal nerve causes loss of gag reflex with CN X.

145.

Golgi tendon organs fiber = _____ It regulates:

Ib fiber regulates tension It is thought that Golgi tendon organs contribute to fine adjustments in the force of muscle contraction during ordinary motor activities & that other receptors initiate additional forms of autogenic inhibition at higher tension levels

146.

HEMI SECTION OF THE SPINAL CORD LESION on the Right side. What getting cut? What will we lose feeling of? Where?

2 Tracts get cut! ALS & DC-LM We cut thru the ALS but we won't feel the loss of pain until like 2-3 spinal cord segments below the cut/lesion b/c the tracts are all ascending up at an angle: Contralateral side The DCLM also got damaged!!! DC are also going up Dorsal columns are axons of the FIRST neuron (central process) on the ipsilateral side If we damage the hemisection, we cut the pain & temp on the CONTRALATERAL side and we cut thru dorsal column but here it is IPSILATERAL So for instance, we will have a Loss vibration on the right but lost pain on the left If a patient has lost pain on one side and vibration on the other side we know we have damaged the spinal cord If they are both on the same side we have a lesion of the brain stem

147.

hemi- means Ex.

one side of the body ex. hemiplegia no movement of one side of the body

148. 149.

hemiparesis hemiplegia

weakness of one side of the body no movement on one side of the body.

150.

Hemisection of the LEFT spinal cord due to a penetrating injury or knife wound to the lateral spinal cord can cause : ___________ What symptoms will we see (account for sensory and motor) What neuron are we damaging?

Brown-Squard syndrome: In the SPINAL CORD ... b/c the symptoms are asymmetric 1) ipsilateral UMN signs (LEFT foot Babinski sign... b/c the UMN crosses at the cervicomedullary junction - by the time it hits the spinal cord it has crossed) 2) ipsilateral loss of vibration sense, joint position and proprioception, sense of fine touch. (LEFT) 3) contralateral loss of pain and temperature, itch and crude touch. (RIGHT) We are damaging an UMN still!
151.

Higher CNS influence coordinates the actions of :

Higher CNS influence coordinates the actions of : groups of muscles and leads to overall motor coordination with appropriate modification of reflex expression as needed.

152.

How are Basic reflex patterns of movement at the spinal cord level modulated ?

They are Modulated by: higher CNS levels & other spinal pathways with both excitatory and / or inhibitory influences on reflex arc interneurons in the spinal cord.

153.

How are the cell bodies in the cortex arranged? Is it grey matter or white matter

In sheets. There are 6 sheets of cell bodies Cell bodies are Gray Matter

154.

How are the nuclei of the cranial nerves arranged? How are the nuclei in the spinal cord arranged?

In discrete, discontinuous cell columns

The cell columns in the spinal cord are continuous

155.

How can Muscle cramp can be inhibited? This is an ex of:

Muscle cramp can be inhibited by contracting the antagonist of the cramped muscle. Ex. of Reciprocal Inhibition
156.

How can we tell if we are looking at a cervical from lumbar section of the spinal cord?

There is less white further down the spinal cord bc many of the fiber tracts have already been given off So in a lumbar section we see a BIG grey matter/ cell bodies section ("butterfly") and not as much white axons
157.

How do nuclear bag fibers & nuclear chain fibers differ?

The 2 classes differ in ~the arrangement of their nuclei ~the intrinsic architecture of their myofibrils & ~their dynamic sensitivity to stretch

158.

How do the medial motor systems descend?

They descend ipsilaterally OR bilaterally They tend to terminate on interneurons that projectto both sides of the spinal cord, controlling movements that involve multiple bilateral spinal segments Thus unilateral lesions of the medial motor system produce no obvious deficits.

159.

How do watershed infarcts produce man in a barrel syndrome? Explain how our patient will present

b/c regions of the homunculus involved often include trunk and proximal limbs Thus these watershed infarcts can produce proximal arm and leg weakness
160.

How does Guillain-Barr syndrome (GBS) present? How do we treat it ?

An acute polyneuropathy disorder affecting the peripheral nervous system. ***Ascending paralysis, weakness beginning in the feet and hands and migrating towards the trunk. Some subtypes cause change in sensation or pain as well as dysfunction of the autonomic nervous system. It can cause life-threatening complications, in particular if the breathing muscles are affected or if there is autonomic nervous system involvement. If it affects the diaphram we will put them on a breathing machine for a period of time. The Schwann cells in the PNS are regenerative ... so the peripheral myelin will grow back

161.

How does the 3rd order neuron send its axons to the postcentral gyrus or paracentral lobule? What is the name for the 3rd order neuron?

The third order neurons in the thalamus send their axons to the postcentral gyrus or paracentral lobule (primary sensory cortex) in the cerebral cortex by way of the POSTERIOR limb of the internal capsule. Thalamocortical fiber/ axon/tract ... just can't be a nerve Inferior cerebellar peduncle connects medulla to the cerebellum.

162.

How is the medulla connected to the cerebellum ?

163.

How many skeletal eye muscles do we have? List them: Which ones are associated w/ CN 3

12 total : 6 on each side

1. Inferior rectus (3) 2. Inferior Oblique (3) 3. Superior Rectus (3) 4. Medial Rectus *** (3) 5. Lateral Rectus 6.Trochlear (4) 7.Abducens (6) Levator Palpebrae Superioris (is also innervated by 3 These muscles elevate the eylids) Smooth muscle Parasympathetic N.S innervation of constrictor pupillae & ciliary muscles(3)

164.

How many spinal segments does it take for the 2nd order neurons fibers to cross? How many synapses does the Lower motor neuron have?

It takes 2-3 spinal segments for the fibers to cross Thousands Its the Final Common Pathway Everybody has to synapse on the cell body in order for the muscle to contract Sensory

165.

166.

Ia fiber comes from Ib fiber comes from

A muscle spindle primary ending It transduces LENGTH a Golgi tendon organ Stimualtion has an effect that varies depending on the position & activity of the limb at the time of stimualtion It sometimes has an effect opposite that of stimualting a Ia fiber: the alpha motor neuron that innervate the muscle connected to that tendon organ are inhibited This effect is a form of autogenic inhibition & involves an inhibitory interneuron between the afferent and afferent fibers

167.

168.

If a disturbance causes the muscle length to increase , the spindle increases its firing rate causinf the motor neuron to fire and the muscle to ________

Shorten Decreases in muscle length produce the opposite effect The system corrects for deversions from the desired muscle length

169.

If a patient has lost pain & vibration on the same side we know we have damaged ________

The brain stem If a patient has lost pain on one side and vibration on the other side we know we have damaged the spinal cord

170.

If a patient has lost pain on one side and vibration on the other side we know we have damaged ________

The spinal cord If they are both on the same side we have a lesion of the brain stem

171.

If I step in glass with my right foot What part of my parietal cortex will light up? What artery supplies this area? The left side of my paracentral lobule (remember the humunculus... leg and foot is paracentral lobule) The Anterior CerebralArtery supplies this area (blue)

172.

If our patient is in a state of complete extension what do we know for sure IS INTACT? If there is a DC-ML lesion what functions are lost completely

EXTENSION = Vestibulospinal tracts are important mediators of postural adjustments and head movements Ex if the room is tilting Complex discrimination tasks are more severely affected than simple detection of stimuli. Damage would cause impairment but not abolition of tactile perception PROPRIOCEPTION & KINESTHESIA are classically considered to be totally lost after posterior colum destruction. This results in a type of ATAXIA (Incoordination of movement); the brain is unable to direct motor activity properly w/out sensory feedback about the current position of parts of the body. This ataxia is particularly pronounced when the pts. eyes are closed, preventing visual compensation.

173.

174.

If we damage the motor tract what will our symptoms be? If we damage the sympathetic hypothalamic fibers where will we see the symptoms? If we had a lesion of the Basilar artery what structure will not be receiving adequate blood supply? GO thru the tracts - where will we see the ALS

If we damage the motor tract what will our symptoms be? Motor - the symptoms will be paralysis / weakness descending sympathetic hypothalamic fibers lesion always results in a Horner's Syndrome ipsilateral to the side of the lesion in the brain stem. Pons ALS = contralateral loss of pain and temp ML= contra loss Motor- Body (We haven't crossed yet) so we will see our symptoms contralateral to the lesion Motor - Face Cranial nerves are all secondary - ipsi symptoms Note alternating symptoms for motor

175.

176.

177.

If we have a berry aneurysm impinging on the eye - we will lose parasympathetic ... what will the eye look like?

We will have a large pupil bc we will LOSE Parasympathetic ... Normally : ciliary muscles (which control the shape and therefore the refractive power of the lens) the constrictor pupillae muscle of the iris (which constricts the pupil). Due to the bilateral projections from the pretectal nuclei to the Edinger-Westphal nuclei, light shined into one eye produces pupillary constriction in both eyes.

178.

If we have a Berry anyeurysm of the left Posterior cerebral artery that is impinging on the ocular motor nerve What kind of problems can we expect?

we will have problems with motor of the eye on the left Cranial nerves that are Motor will all be "ALs" Lower Motor Neurons ... they innervate ipsilaterally Note if we had a berry aneurysm in which we were inpinging on CN3, our parasympathetic nerve fibers would go down 1st b/c they form a sheath on the outside of CN3

179.

If we have a capsular stroke and lesion the Lateral Corticospinal cord, how will our patient present?

Their UPPER EXTREMITIES would be constantly FLEXED Normally we maintain a normal joint angle due to the Lateral corticospinal tract & Rubrospinal tract dual actions on eachother. A lesion in which we damage the lateral corticospinal tract would allow us to have sole rubrospinal action ... which would lead to constant flexion of the UPPER EXTREMITIES
180.

If we have a lesion and burn out the VPM where will we see symptoms?

VPM is the face Pain, Temp, Itch and Fine touch, Vibration all go thru there. By the time the tracts get the the VPM they have already crossed thus we will see symptoms on the CONTRA lateral side of the face ... it's the secondary neurons that are on their way to the VPM
181.

If we have a loss of pain due to a spinal cord injury... were will our symptoms be? If we have a patient in the ER and all we see is their legs and arms fully extended ... what tract do we know is INTACT?

Contralateral to the lesion A Lose of pain in the spinal cord the symptoms will be on the other side VestibuloSpinal

182.

Note - if you took an unconscious patient and yanked their hair ... really hard and you got a response - you would also know that the vestibulospinal tract was working ... (at the cervical cord level this tract control the head and neck muscles)

183.

If we have an ALS lesion of the spinal cord what will we lose and where ? If we knock out a UMN will we have flaccidity or spasticity? If we lesion one of the extraocular muscles of the eye with a lesion of CN3 what can we expect to see?

We lose Projection neurons (#2) we'll have contralateral loss of pain, temp and itch

184. 185.

Spasticity

Occulomotor Nerve CN III - Motor (somatic and parasympathetic). The CN 3 innervates the inferior oblique and inferior, superior, and medial recti extraocular muscles. Lesion causes diagonal diplopia, loss of horizontal gaze.
186.

If we lose our primary sensory neuron will we see a motor response?

NO If we lose the afferent sensory coming in we won't be able to generate an efferent

187.

If we see Babinski sign on the right we know we have damaged...

UMN (of the left side - b/c we are high in the cortex and we prob haven't crosses yet) (Hyper-reflexia and Increased muscle tone = UMN)

188.

Immediate loss of all reflex activity below the point of transsection of the spinal cord. IMPRECISE term Give ex.

Spinal shock - immediate loss of all reflex activity below the point of transsection of the spinal cord. Palsy Imprecise term for weakness or no movement ex. facial palsy weakness or no movement of the face muscles.

189.

190.

In order to have our 1st synapse ... What ion must come in to the axon terminal to cause fusion of the vesicle with the terminal end of the neuron membrane? Then what happens?

Calcium comes into the axons & it binds to synaptotagmin As the glutamate is released it DIFFUSES to neuron #2 from high [ ] when the vesicle fused to low [ ] of the cell body / dendrite of vesicle #2

191.

In order to lift my right foot what do I need to do to my muscles

In order to lift my right foot I need to flex it -> stimulate flexors by releasing ACh -> inhibit the extensor muscle (they will have no action potentials b/c they didn't get any neurotransmitter) (Flexion reflex)

In the left foot I do the opposite! Left foot I stimulate the extensor and I inhibit the flexor (crossed extension)
192.

In reference to the Internal Capsule ... Where does the Corticospinal tract lie? In the ALS system, what does the 1st neuron release at the first synapse?

The corticospinal tract lies in the POSTERIOR LIMB of the internal capsule Gluatmate The EPSP gives the right voltage to open up the voltage gated channels. Then a little further down on the neuron, we can get an action potential, it's at the axon hillock bc that's where the voltage gated sodium and potassium channels are. We only have the voltage gated channels at the axon hillock - we don't have it on the cell bodies. The axon potential moves along the projection neuron straight up right thru to the 3rd and depending on what part of the body we then take it right to the cortex.

193.

194.

In the DC-ML pathway our sensory neuron enters the spinal cord, goes to the medulla and synapses. At that point in time what are our fibers called?

On the ipsilateral side we have Internal Arcuate Fibers then they cross (in the medulla) and then we call the fibers Medial Lemniscus Nasal regurg CN 10 (and 9 as well) We have trouble in our medulla Cell body for 10 = Innervation of skeletal pharyngeal and laryngeal muscles (old gill arches). *Nucleus Ambiguus* Controls muscles for swallowing (gag reflex) and phonation.

195.

In the hospital you give a woman a drink with a straw, however she is unable to drink from it but rather it goes up her nose. What do you think she has lesioned? Where is the cell body for it?

196.

In the monosynaptic reflex arc what happens to the synergist? In the Posterior Column - Medial Lemniscal Pathway What happens after the initial synapse in the caudal medulla?

We want it to Contract and help to close the joint angle (the synergistic Lower motor neuron goes to this)

197.

The axons of the second-order neurons immediately cross over (decussate) as the internal arcuate fibers and then form the medial lemniscus (ML) fiber tract. The second synapse occurs in the thalamus (VPL.) The axons of the third-order neuron travel from the thalamus to the primary somatosensory cortex (they synapse in layer 4 of the neocortex) by way of the POSTERIOR limb of the internal capsule
198.

In the Posterior Column - Medial Lemniscal Pathway Where do the axons of the third-order neuron travel to? Be specific as to how they get there

The axons of the third-order neuron travel from the thalamus to the primary somatosensory cortex (they synapse in layer 4 of the neocortex) by way of the POSTERIOR limb of the internal capsule

199.

In the stretch reflex, what happens then there is a Sudden unloading of a skeletal muscle Increased muscle tone and abnormal reflexes seen below the point of transection about two weeks after a spinal cord transection. Influence axial musculature bilaterally.

the muscle is inhibited from contracting. Spasticity Ex. Babinski 's sign

200.

201.

MEDIAL motor systems Anterior Cortiospinal (the 10% that doesn't cross) Vestibulospinal Reticulospinal Tectospinal

202.

Information that reaches the cerebellum is used in the ____________; we are not consciously aware of cerebellar activity Information that reaches the thalamus is relayed to the cerebral cortex and preceived ______ Inhibitory reflex, provides negative feedback to prevent development of too much tension in a muscle.

Used in the regulation of movements Information that reaches the thalamus is relayed to the cerebral cortex and preceived "Consciously"

203.

204.

Inverse myotatic reflex

205.

Innervate static nuclear bag fibers & the nuclear chain fibers, signal the level of 'sustained' fiber stretch by firing tonically at a frequency in proportion to the degree of stretch w/ little dynamic sensitivity Integrates somatic sensory information with vision and hearing to help orient body and head to stimuli. Involved in postural tone, balance, orienting movements of the head and neck, automatic gait-related movements.

Group II afferents

206.

midbrain tectum (Spinomesencephalic (spinotectal) tract )

207.

MEDIAL motor systems Anterior Cortiospinal (the 10% that doesn't cross) Vestibulospinal Reticulospinal Tectospinal

208.

Is Corticobulbar innervation of the LMN in cranial nerves UNILATERAL or BILATERAL.

BILATERAL Each LMN of the brain stem receives input from axons arising from both the right and left cerebral motor cortex. EXCEPTION: CN 7 - facial nerve LMN to the lower face receives only contralateral UMN innervation.

209.

Is there a synapse in the DRG?

No there is no synapse in the DRG There are no neurotransmitters there either. It's just a bunch of cell bodies : There are cell bodies in there for everybody - ALS tract, DCML tract etc

210.

Jaw Jerk reflex Where does it happen? Sensory receptor = The action potentials encode = Motor

Brainstem ... sometimes called a 55 Afferent Sensory 1st : The stretch receptor is the muscle spindle. Ia is the fiber The action potentials encode muscle stretch/ length CN 5 for the face (Note CN 1 for the back of the head ) Motor : CN5 motor division the alpha fiber lower motor neuron, innervates muscle of mastication. It's cell body will be medial & in the pons

211.

Knocking out what Ganglion will lead to Horners syndrome? L5

Knocking out the superior Cervical Ganglion

212.

Big Toe Hamstrings - Flexion (Lower leg - right above the knee)
213.

Lack of intrinsic factor (produced in stomach and used in small intestine to absorb cobalamin) causes :

Lack of intrinsic factor (produced in stomach and used in small intestine to absorb cobalamin) causes tingling and numbness (paresthesias) of hands and feet. (Due to Nutritional Deficiencies)

214. 215.

Lamina X corresponds to Large diameter sensory axons are coiled around the central part of each class of intrafusal fiber forming Lateral corticospinal tract Site of origin?

The zone of gray matter surrounding the central canal so called "annulospiral" primary endings (group Ia afferents) Origin = Primary motor cortex ( Precentral Gyrus) and other frontal & parietal areas Decussation = primary decussation at the cervicomedullary junction

216.

Site of decussation? Level of Termination? Function: Termination = Entire cord (predominatly at cervical & lumbosacral enlargements) Function = Movement of contra lateral limbs

217.

Lateral Medullary Syndrome (Wallenburg Syndrome) could occur with loss of what blood supply? What symptoms will be seen? Whats the prognosis?

vertebral artery more common than PICA Pica will be on both sides of the upper part of the butterfly ... this is the posterior portion inferior cerebellar peduncle: ipsilateral ataxia vestibular nuclei: vertigo, nausea, nystagmus CN V (spinal trigeminal tract and nucleus): ipsilateral facial loss pain and temperature nucleus ambiguus: hoarseness, dysphagia nucleus solitarius: ipsilateral decreased taste descending sympathetic fibers***: ipsilateral Horner's Syndrome spinothalamic tract (ALS)***: contralateral body, decreased pain and temperature Lateral tegmentum involved, not too much motor affected and prognosis is good
218. 219.

leg paralysis Lesion of _____ will cause the gag reflex

no movement of the leg Lesion of the glossopharyngeal nerve causes loss of gag reflex with CN X. (both are in the medulla)

220.

LESION OF THE ALS Damage the right side of the SPINAL CORD What will we lose & where ?

We damaged the PROJECTION neuron (#2) and we got loss of pain, temp and touch CONTRALATERAL to the lesion ALS LESIONS ARE ALWAYS CONTRALATERAL

221.

LESION of the ALS in the brainstem (Right medulla) What will we lose & where ?

We damage just the ALS tract in Sensory deficit & CONTRALATERAL symptoms If we mess w/ Brainstem or Spinal cord lesions in the ALS symptoms will ALWAYS BE CONTRALATERAL Cuz pain can't wait ... it synapses immediately and sends it's axons up to the thalamus contralaterally

222.

LESION of the DCML to the Gracilis tract of the spinal cord What will we lose (be specific) & where ?

Note we Damage the PRIMARY central process in the central column (not the projection neuron as in the ALS system) For ex. we Damage the Gracilis tract ... Just that location - it will prob never happen clinically but w/e What happens? Sensory deficit The sensory lost is fine touch, vibration and proprioception and it's going to be on the same side "ipsilateral" to the lesion

223.

LESION of the DCML to the right side of the medulla in the brain stem: What will we lose & where ?

We damaged Right medial lemniscus (this is our projection neuron / #2 ) Sensory loss : Proprioception, Fine touch & vibration Contral lateral loss BRAINSTEM LOSSES ARE ALWAYS CONTRALATERAL

224.

Lesions in the brain stem to ________ (list) _________ tracts will result in a body contralateral deficit.

Lesions in the brain stem to any of the long tracts will result in a body contralateral deficit. corticospinal tract spinothalamic tract medial lemniscus there are exceptions

EXCEPT! descending sympathetic hypothalamic fibers lesion always results in a Horner's Syndrome ipsilateral to the side of the lesion in the brain stem. EXCEPT! cerebellar peduncle damage will result in ipsilateral motor ataxia.

EXCEPT! damage to cranial nerves and nuclei will result in ipsilateral head sensory and / or motor deficits.
225.

List 3 groups of cell bodies ...aka "nuclei" found in the reticular formation

Locus Ceruleus (aka Blue Spot) Raphe Nucleus Substantia Nigra

226.

List some signs of dysfunction that would be present w/ a Medulla lesion

Medulla - signs of dysfunction respiratory arrest vertigo ataxia nausea vomiting autonomic instability hiccups

227.

List the components in the Anterolateral System (ALS system)

Spinalthalamic *** Spinoreticular Spinomesencephalic (spinotectal)

228.

List the Humunculus starting laterally

(Genital) Sensory only (Scalp goes where?) Toe Leg Knee Hip Trunk Shoulder Arm Elbow Wrist Hand Fingers THUMB Neck Brow Eye Face Lips Jaw Tongue Swallowing

229.

List the Posterior Column - Medial Lemniscal Pathway What does this pathway mediate?

fine touch, proprioception, pressure and vibration

The FIRST-order neurons in the fasciculus gracilis and fasciculus cuneatus enter the spinal cord and travel on the same side up the spinal cord. They synapse ipsilaterally onto SECOND-order neurons in the nucleus gracilis and nucleus cuneatus respectively in the caudal medulla. The axons of the second-order neurons immediately cross over (decussate) as the internal arcuate fibers and then form the medial lemniscus (ML) fiber tract. The second synapse occurs in the thalamus (VPL.) The axons of the third-order neuron travel from the thalamus to the primary somatosensory cortex (they synapse in layer 4 of the neocortex) by way of the POSTERIOR limb of the internal capsule
230.

LMN are located where

1) In the Spinal cord in the Ventral/ Anterior horn There is somatotopy there: The more lateral neurins in the ventral horn will run the fingers and wrist; the more medial ones will run the trunk 2) Brainstem

231. 232.

Location of pain ... think Locus Ceruleus: Aka = Where is it found & what does it do

Spinalthalamic tract aka Blue Spot Found in the reticular formation of the brainstem. It makes & delivers NorEpi with every single action potential 4th ventricle! As soon as we take the cerebellum off thats all we can see. Glossopharyngeal IX = conveyor of taste and pharyngeal sensations Trigeminal nerve = general sensory for the head Facial Nerve = Motor nerve for facial expression Vagus = carries parsympathetic outflow to the thoracic and abdominal viscera Internal Carotid

233.

Looking at the brainstem dorsally - we take off the cerebellum ... what is the major thing that we are looking at? Main job of CN IX Main job of CN V Main job of CN VII Main job of CN X Major Anterior circulation to the brain is from :

234. 235. 236. 237. 238.

239.

Major Posterior circulation to the brain is from what artery? Mixed Cranial Nerves

Vertebral Arteries Mixed - Both Sensory and Motor 5, 7, 9, and 10 all are in the Brainstem 5 is mostly sensory!!! (it will be more lateral)

240.

241.

Modification of the reflex resonse so that it reflects the area being stimulated

Local sign The foexor reflex isnt an all or none phenomenon for a given limb. Rather it shows different patterns depending on which portion of the limb is stimulated. (each pattern being appropriate to withdraw the stimulated area) It would be imprudent to flex a lower extremeity when a painful stimulus was applied to the anterior surface of the thigh bc this would drive the thigh into the stimulus . In such a situation, it would make more sense to activate the extensors.

242.

mono- means Ex.

one limb ex. monoparesis weakness of one arm or leg

243.

Motor Cranial Nerves :

Motor 3, 4, 6, 11, and 12 * in brainstem 3,4,6 are all "eye"

244.

moves head to opposite side and rotates and elevates the scapula. Muscle stretch leads to ________ of motor neurons Muscle stretch Leads to Excitation of Motor Neurons What is this reflex called?

Spinal Accessory CN 11 Excitation Monosynaptic reflex or myotatic reflex

245.

246.

247.

Neurons that innervate axial muscles are _____ to those that innervate limb muscles. No movement State term Ex

Neuron that innervate axial muscles are medial to those that innervate limb muscles.

248.

-plegia or Paralysis ex. hemiplegia no movement on one side of the body. leg paralysis no movement of the leg

249.

Nociceptors regulate:

Nociceptors (pain, temperature, crude touch & itch)

250.

Nociceptors: What are they? Where are their cells bodies located?

Pain, temp and crude touch sensory neurons For the body = In the dorsal root ganglia For the face = In the Trigeminal Ganglia Note they have free nerve endings!

251.

Normal muscle tone (stiffness or tension in the muscle) can be felt or judged by: Normally only _____ have a powerful enough influence to cause a reflex withdrawl Normally our Lower motor neurons are hovering at what membrane potential?

simple passive stretch of the muscle Nociceptors aka flexor reflex

252.

253.

We are normally hovering around -67, -68 ... right near threshold. We are at this "chronically depolarized" level b/c we have lots of descending info coming down from the supraspinal sections releasing Glutamate onto our LMN which is depolarizing the membrane IF we had a lesion we become HYPERPOLARIZED and go back to a level around -70 b/c we no longer have the descending depolarizations

254. 255.

Nuclear bag fibers can be further subdivided into subclasses: Occulomotor nerve (CN III) Where is the nuclei? Be specific Once we are in the brainstem ... what type of neurons are we dealing with?

Dynamic & Static Occulomotor nerve (CN III) - Edinger-Westphal nucleus (MIDBRAIN). The PNS PREganglionic neuron cell body is located in specific brain stem nuclei. Nuclei (secondary - projection neuron cell bodies) are seen at ALL brainstem levels. The one exception = Mesencephalic of CN5 which is a primary neuron

256.

257.

Pacinian corpuscles, Merkel's Disks, muscle spindles mediate _________

Conscious proprioception, fine touch, vibration & pressure to the VPM Ventral posteromedial nucleus (VPM) of the thalamus

258.

Pain and temp afferents for the right side og the face come into the middle cerebral peduncle of the pons and heads downwards toward the spinal cord (Primary neuron axon of Spinal trigeminal tract) It synapses on the ipsi side of the spinal cord, crosses (secondary neuron / Trigeminalthalamic tract) and heads ________

259.

Pain modulation / Endogenous relief ... think

Spinomesencephalic tract

260.

Pain, temp and itch, crude touch for CNV will synapse at what nuclei?

Spinal trigeminal nucleus Pain leaves the free nerve fibers - goes past the Trigeminal ganglion enter the pons but travels downwards to the spinal cord where it synapses at the Spinal trigeminal nucleus . Then a 2ndary neuron will cross the midline to travel in the trigeminothalamic tract & synapse in the VPM of the thalamus
261. 262.

Painful stimuli elicits ________ para- means Ex.

Painful stimuli elicits coordinated withdrawl reflexes both legs Ex. paraparesis weakness in both legs

263.

Participates in central modulation of pain

midbrain periaqueductal gray (PAG) (Spinomesencephalic (spinotectal) tract )

264.

Pin point pupil eye symptoms on the same side as the lesion = Provide the predominant autonomic tone to the head and thoracoabdominal viscera above the splenic flexure. Provides coordination of head and eye movements quadri- or tetra means Ex.

... The cranial nerves associated with the parasympathetic nervous system (PNS) (CN 3, 7, 9, and 10). Note we are talking Postganglionic neurons

265.

266.

Tectospinal tract - Ends in the cervical cord. (medial motor system)

267.

all four limbs ex. quadriplgia tetraplegia paralysis of all 4 limbs

268.

Raphe Nucleus Where is it found & what does it do?

Found in the reticular formation these neurons release serotonin 5- HT The cell bodies are in a nucleus specifically with axons that go throughout the cerebrum & if they have an action potential they will secrete Serotonin in the post synaptic membrane to be spread throughout the cortex

269.

Reflex arc: polysynaptic Contraction of a muscle ?????

Contraction of a muscle increased muscle tension. Ib afferent is our fiber (Inverse myotatic reflex) Too much tension causes the muscle to stop contracting!
270.

Reflexes ~ Length to muscle use : Too much tension use Pain use:

Length to muscle use : Stretch reflex Too much tension use: inverse myotatic reflex Pain use: Flexion / With-drawl

271.

Respond to small stretches

Group Ia afferents This is bc the Ia afferent activity is dominated by the 'dynamic' subtype of nuclear bag fiber whose biochemical properties emphasize the 'velocity' of fiber stretch

272.

Responsible for the transmission of tactile, proprioceptive, pain, temp info from the head to the cerebral cortex, cerebellum and reticular formation Runs length of the spinal cord: controls extensor tone.

CN V Trigeminal system

273.

lateral VST #2 ( Vestibulospinal tracts (VSTs) of the medial motor system)

274.

S1

275.

Scalp - describe it's position in the humunculus Be specific

The scalp is only included in the Sensory (Postcentral Gyrus) It is not part of the motor cortex C1 level (note we have a total of 4 humunculi)

276.

Sensory and motor loss due to high blood pressure in the Lenticulostriate

CAPSULAR STROKE (the Lenticulostriate supply the blood for the Internal Capsule ... they come off the Middle Cerebral Artery )

277.

Sensory cranial Nerves

Sensory 1, 2, and 8** * #8 is in the brainstem : tegmentum of the pons; it's lateral b/c its sensory

278.

Sensory neurons from the vestibular portion of the membranous labyrinth encoding acceleration go to _______ nuclei located in the _______ Simplest and fastest (< 1 msec) of all reflexes SNS innervation of this muscle keeps the eye open

CN 8 Vestibular Nuclei - located in the pons

279. 280.

monosynaptic reflex arc. Mullers smooth muscle (Nor Epi is released) sannea panam

281.

Spinal Trigeminal Nucleus - projection neuron cell bodies in the nucleus send axons which cross the midline to travel in the trigeminothalamic tract and synapse in the VPM nucleus of the thalamus. What location?

Spinomedullary Junction Motor (central canal) Note the corticospinal tract crossing

282.

State Nerve Motor for muscles of facial expression

CN 7

283.

State nerve Motor for muscles of mastication

CN 5

284.

State Nerve Motor for palate, pharynx and larynx

CN 10

285.

State nerve Motor for sternocleidomastoid and trapezius muscles

CN 11

286.

State Nerve Motor for Tongue

CN 12

287.

State the Functional importance of the stretch reflex: (4)

1. The steady (tonic) afferent information from the stretch reflex is important for maintaining posture and the position of the limb when a load is applied or removed. 2. Provides recovery of original length (posture) from any displacement. (e.g. riding a bus - muscles contract to prevent falling after muscle stretch.) 3. Provides muscle tone (stiffness of muscle = force with which a muscle resists being lengthened). 4. Regulates smooth motor movements.

288.

State the pathway for the Spinothalamic tract:

"Pain can't wait" Free nerve endings ... 1. The first-order neuron (nociceptor) transduces information about pain and temperature sense (passes the DRG) enters the spinal cord & immediately synapses in the dorsal horn (lamina I and V.) GLUATMATE @synapse 2. The axons from the 2nd order neuron CROSS immediately in the white ventral commissure (takes 2-3 spinal segments for the fibers to cross.) 3. The axons from the 2nd-order neuron synapse with neurons in the thalamus VPL nuclei (spinothalamic tract), brainstem reticular formation (spinoreticular tract), and midbrain (spinomesencephalic tract). 4. The 3rd order neuron then sends their axons to the postcentral gyrus or paracentral lobule (primary sensory cortex) in the cerebral cortex by way of the POSTERIOR limb of the internal capsule.
289.

State the pathway of the Lateral Corticospinal tract (be sure to inculde structures as landmarks)

Pyramidal cells Axons from the Cerebral Cortex descend downwards to the internal capsule Go thru the posterior limb of the internal capsule go thru the 'ventral portion of the cerebral peduncles' Descend thru the "ventral pons" where they form somewhat scattered fascicles Collect in the ventral surface of the medulla to for the medullary pyramids At the caudal portion of the medulla 85% of the pyramidal tract fibers cross at the pyramidal decussation to enter the *lateral white matter columns* of the spinal cord forming the lateral corticospinal tract. Finally, the axons of the lateral corticospinal tract enter the spinal cord central gray matter to synapse on anterior horn cells. Note a somatotopic representation is present in the lateral corticospinal tract w/ fibers controlling the upper extremities located medial to those controlling the lower extremities

290.

State the Reflex Arc : MONOSYNAPTIC

1) Passive stretch of a muscle. (e.g. lengthening of the rectus femoris muscle by tapping the patellar tendon - deep tendon reflex = stretch reflex). 2) Increase discharge from the afferent Ia sensory endings that innervate the muscle spindles. 3) Ia sensory ending synapses (monosynaptic) directly on the alpha motor neuron of its own (homonymous) muscle and other synergistic muscles. 1) II sensory afferent fibers also excite alpha motor neurons (monosynaptically and polysynaptically). d. Ia and II sensory endings cause excitation of the motor neurons and stimulate contraction of the stretched muscle. e. The synergistic muscles also contract resisting the lengthening of the stretched muscle.

291.

State the steps of the Inverse myotatic reflex

Inverse myotatic reflex - inhibitory reflex, provides negative feedback to prevent development of too much tension in a muscle. a. Contraction of a muscle increased muscle tension. b. Increase discharge from the afferent Ib sensory endings in the Golgi tendon organ. c. Afferent Ib fibers from the Golgi tendon organ make INHIBITORY synapses with their homonymous alpha motor neurons (via Ib inhibitory spinal interneuron) and excitatory connections with the motor neurons of antagonist muscles. For ex. we will inhibit our flexor and Contract our Extensor

292.

State whether the sign will be Increased or decreased in a UMN or LMN lesion or both. Reflexes

UMN = Increased (with acute UMN lesions, & tone may be decreased due to acute spinal shock) ~Hyper-reflexia after a period of time LMN = Decreased UMN = Increased Muscle tone of arm = flexed Muscle tone of leg = Extension LMN = Decreased UMN = No ... (mild atrophy 'may' develop due to disuse) LMN = Yes - look at C8 - the finger will look skinnier

293.

State whether the sign will be Increased or decreased in a UMN or LMN lesion or both. Tone

294.

State whether the sign will be present in UMN or LMN lesions or both. Atrophy

295.

State whether the sign will be present in UMN or LMN lesions or both. Fasciculations

UMN = No LMN = Yes fascicilations = abnormal muscle twitches caused by spontaneous activity in groups of muscle cells. Ex. of a benign fasciculation not associated w/ motor neuron damage is the eyelid twitching often experienced during periods of fatigue, caffeine excess & eye strain.

296.

State whether the sign will be present in UMN or LMN lesions or both. Weakness

UMN = yes (Spasticity after some time) LMN = yes (Flaccid)

297.

Stretch from the jaw jerk reflex / Proprioception for the face will synapse at what nuclei?

At the Mesencephalic trigeminal nucleus note this is the exception: A primary nerve fiber travels from the muscle spindle into the the nucleus
298.

Stretch imposed on the muscle deforms the intrafusal muscle fibers, which in turn initiates action potentials by activating ______________gated ion channels in the afferent axons innervating the spindle. Striking the patellar tendon activates muscle spindle primary endings , which then monosynaptically excite alpha motor neurons that innervate the stretch muscle Striking the patellar tendon initiates a stretch reflex. It also causes inhibition, thru an interneuron of the motor neurons to the antagonist hamstring muscles. This sequence of events is called:

Activating mechanically gated ion channels

299.

Monosnaptic reflex Myotatic reflex Reciprocal Inhibition

300.

301.

Substantia Nigra Where is it found and what does it do? Sympathetic NS causes Muellers Muscle to release ________ to keep the eyelid open Synapse late = Synapse right away =

Found in the reticular formation Substantia Nigra and the VTA (Ventral Tegmental area) release Dopamine NorEpi dorsal column-medial lemniscus system anterolateral system (ALS) Consists of 3 pathways: Spinalthalamic *** Spinoreticular Spinomesencephalic (spinotectal) "Pain cant wait"

302.

303. 304.

305.

Syringomyelia usually happens at what location?

Ventral White Commissure We'll have bilateral loss of pain, temp and itch
306.

T/F Ia afferent action potential alone is not enough to fire an action potential in an alpha motor neuron. T4

True

307.

Nipples
308.

T10

Umbilicus Belly button area

309.

The "Butterfly" cross section means we are where?

Rostral Medulla The Curly Hair on top means Ventral & corresponds to The inferior Olivary nucleus Aboe the curly hair - the "bow" is the Pyramid which houses the CorticalSpinalTract
310.

The 1st order sensory neuron is called a ________ What does it do?

A "tranducer" (ex nociceptor) It's a sensory neuron The first order (aka Primary) neuron transduces environmental physical energy into electrochemical energy Note this is a change in RECEPTOR (MEMBRANE) potential (NOT action potential) Electrotonic: small & can summate

311.

The Abducens Nerve is also called : What does it innervate?

The horizontal gaze center. Motor nerve Innervates the lateral rectus muscle (abducts the eye) & internuclear neuron innervating the occulomotor nerve (CN III) via the MLF. 1) Keeps the two eyes yoked together for horizontal eye movements. It's nuclei location is near the midline, in the floor of the fourth ventricle [just lateral to the MLF (medial longitudinal fasciculus)].

312.

The blood supply to the spinal cord arises from branches of _______ arteries

Branches of the vertebral arteries and spinal radicular arteries The vertebral arteries give rise to the anterior spinal artery that runs along the ventral surface of the spinal cord 2 psterior spinal arteries arise from the vertebral or posterior inferior cerebellar arteries & supply the dorsal surface of the cord

313.

The Bouton

Has main acesss to the axon hillock This is the if we are going to have a short circuit - that says don't fire - we are going to activate it from a higher center.

314.

The centrally projecting branch of the sensory neuron forms monosynaptic excitatory connections with those alpha motor neurons in the ventral horn of the spinal cord that innervate the same (homonymous) muscle & via local circuit neurons forms inhibitory connections with those alpha motor neurons that innervate antagonistic (heteronymous) muscles This is an ex of :

Reciprocal innervation & results in rapid contraction of the stretched muscle and simultaneous relaxation of the antagonist muscle

315.

The classic signs of Horner's Syndrome are:

The classic signs of Horner's Syndrome are: MIOSIS - decreased pupil size (dilator muscle not innervated). Normally Nor Epi is released PTOSIS - drooping upper eyelid (Muller's smooth muscle not innervated). ANHIDROSIS - lack of sweating on the face and neck. Note Pts. Left eye
316.

The clinical syndrome of bilateral upper extremity paresis with intact motor functioning of the lower extremities, giving the appearance of being confined within a barrel. What is the pathogenesis of this syndrome?

Man In Barrel Syndrome (MIBS) refers to

MIBS is believed to be cerebral hypoperfusion leading to border zone infarctions between the territories of the anterior and middle cerebral arteries. "the watershed areas"

317.

The collapse of resistance seen when a spastic, hypertonic limb is forcibly flexed or extended

Clasp knife response This exhibits autogenic inhibition In certain pathological conditions that follow damage to DESCENDING motor pathways the resisitance of muscles to manipulation is greatly increased. Thus one would have considerable difficulty flexing the leg of an individual w. such a consition. If sufficient force is applied however, the leg slowly flexes until at some pt. all resisitance suddenly disappears & the leg collpases in flexion, like a clasp knife snapping shut

318.

The coticobulbar / corticonucleasr tract lies in what limb of the internal capsule?

Genu of the internal capsule The genu is at the transition between the anterior and posterior limbs, at the level of the foramen Monro

319.

The coticospinal tract goes thru what limb of the internal capsule? The cranial nerves are all lower motor neurons ... they are all "ALs" What does this mean as far as innervation goes?

Posterior limb They will all innervate skeletal muscle ipsilaterally Motor neurons = 3,4,6, 11, 12

320.

321.

The cranial nerves associated with the parasympathetic nervous system (PNS) are located :

in the CNS brainstem and in the sacral S2-4 intermediate horn (CN 3, 7, 9, and 10).

What nerves?

The PNS preganglionic neuron cell body is located in specific brain stem nuclei. a. Occulomotor nerve (CN III) - Edinger-Westphal nucleus (MIDBRAIN). b. Facial (CN VII) - Superior salivatory nucleus (PONS). c. Glossopharyngeal (CN IX) - Inferior salivatory nucleus (MEDULLA). d. Vagus (CN X) - Dorsal motor nucleus of CN X (MEDULLA).

322.

The DC- ML tract goes thru what limb of the internal capsule? The descending fibers of the Corticospinal Tract & Hypothalamospinal SNS Fibers travel with what other tract in the lateral part of the brainstem? Why is this significant?

Posterior Internal Capsule As does the ALS tract

323.

ascending spinothalamic fibers (ALS) in the lateral part of the brain stem. Brain stem lesions producing ipsilateral Horner's Syndrome may also result in contralateral loss of pain and temperature sensations from the limbs and body.

324.

The excitatory pathway from a spindle to the alpha motor neuron innervating the same muscle

A monosynaptic reflex aka "stretch" , deep tendon or myotonic reflex It is the basis of the knee, ankle, jaw, biceps, triceps response tested in a routine physical

325.

The facial colliculus marks the presence of what nerve?

It is the location of the abducens nucleus Fibers destined for the facial nerve loop over it on their way out of the brainstem 7 heard there was "sex" midline but then turned back around

326.

The facial nerve is a mixed nerve What does the facial nerve's "motor" component innervate?

Facial Nerve CN VIIMixed nerve - smile motor>>>>sensory MOTOR Branchial motor control to muscles of facial expression, stapedius muscle, and part of the digastric muscle. PNS - Lacrimal glands (tears) and salivary glands (except parotid) (salivates.)

327.

The facial nerve is a mixed nerve What does the facial nerve's "sensory " component innervate?

Visceral sensory from the anterior 2/3 of the tongue (taste). Somatic sensory from the external ear. Normally held in an inhibited state by descending influences from the brainstem, so that only noxious stimuli result in a strong reflex If these descending influences are removed, either surgically in experiments or as a result of some pathological condition reflex flexion can result from harmless tactile stimulation. This indicates that most or all of our cutaneous receptors feed into the pathway, but ordinarily only nocireceptors have a powerful enough influence to cause a relfex of withdrawal.

328.

The flexor reflex pathways in the spinal cord are normally held in what kind of a state ? By whom?

329.

the Ib fiber is involved in what kind of reflex? The IML is at what location of the spinal cord? It is gray matter or white matter?

Autogenic inhibition Tension

330.

T1 Grey matter = cell bodies

331.

The internal capsule continue sinto the midbrain cerebral peduncles. Where is the white matter located in the cerebral peduncles?

The white matter is located in the VENTRAL portion of the cerebral peduncles and is called the basis pedunculi (note the middle 1/3rd of the basis pedunculi contains the corticobulbar and corticospinal fibers w/ the face, arm & leg axons arranged from medial to lateral

332.

The Inverse myotatic reflex provides negative feedback to prevent development of ___________

too much tension in a muscle. Its an inhibitory reflex

333.

The light reflex =

CN 2 in CN 3 out (last block but might show up again)

334.

The LMN innervates the __(side)______ skeletal muscle

The LMN innervates ipsilateral skeletal muscle

The LMN on the left controls the left side of the tongue; the LMN on the right controls the right side of the tongue LMN on the rith - controls the right hand LMN on the left side controls the left hand
335.

The LMN of the right side of the body innervates what portion of the tongue?

The right side LMN are always acting ipsilaterally LMN innervate skeletal muscle ipsilaterally

336.

The location of the main bulk of the brain stem cranial nerve nuclei and the reticular formation.

The brain stem tegmentum tegmentum - meaning "covering" lies ventral to the aqueduct (midbrain) and ventral to the fourth ventricle in the pons and medulla. note this is a midbrain cut
337.

The Lower Motor Neuron in the monosynaptic reflex is called:

The fiber is Alpha quality "AL" Alpha for Lower Motor Neuron It has the largest diameter & is myelinated by Schwann cells it goes to the periphery and causes contraction of the stretched muscle

338.

The Lower motor neuron is located "where" in a cross section

In the ventral Gray matter / butterfly "Al can fly"

339.

The main effector upper motor neurons for voluntary movement lie within what layer of the primary motor cortex The main muscle we are trying to contract is called

UMN cell body is found in Layer 5 (V) The cells are called Betz cells.

340.

The homonymous muscle (A Lower motor neuron goes to the This is the muscle that contracts

341.

The Medial Lemniscal tract is initially vertical midline ... what happens as it ascends through the brain stem?

On the way to the thalamus, the ML tract moves into a more lateral and inclined position. Note A (Arms) travels Above (L) Legs as it works its way up the spinal cord
342.

The most rostral portion of the brain stem begins with the ________ just below the diencephalon.

midbrain (mesencephalon)

343.

The motor fibers for the muscles of mastication synapse at what nuclei? Where is this nuclei located?

Motor nucleus of CN 5 Trigeminal Nerve (upper to mid pons) Motor to muscles of mastication and tensor tympani muscle: motor nucleus of 5.
344.

The peripheral body region innervated by sensory fibers from a single nerve root level

Dermatome The dermatomes for the different spinal levels form a map over the surface of the body. (Review dermatome map in anatomy or neuroscience text Box 9a page 191.)

345.

The PNS preganglionic neuron cell bodies are located in specific brain stem nuclei. List them:

3 7 9 & 10 a. Occulomotor nerve (CN III) - Edinger-Westphal nucleus (MIDBRAIN) (and parasympathetic) b. Facial (CN VII) - Superior salivatory nucleus (PONS). c. Glossopharyngeal (CN IX) - Inferior salivatory nucleus (MEDULLA). d. Vagus (CN X) - Dorsal motor nucleus of CN X (MEDULLA).

346.

The post ganglionic cell body is found in the ___________ and when its depolarized it will release NEpi on Muellers muscle to keep the eyelid up The postganglionic neurons of these cranial nerves innervate glands, smooth muscle, and cardiac muscle (NOT striated muscle) above the splenic flexure.

Superior Cervical ganglion

347.

The cranial nerves associated with the parasympathetic nervous system (PNS) (CN 3, 7, 9, and 10). Note Postganglionic neurons

348.

The preganglionic parasympathetic neurons for the entire body lie in what segments of the spinal cord? The preganglionic sympathetic neurons for the entire body lie in what segments of the spinal cord?

S2 to S4 note this secion isn't in the "lateral horn"

349.

Segments T1 to L3 most of them are located in column of cells called intermediolateral cell column (the pointy lateral horn on the spinal grey matter)

350.

The receptor responsible for the monosynaptic reflex =

Muscle spindle primary ending (It's in the muscle attached to the tapped tendon )

351.

The resting potential is normally_____ How do we get a receptor potential? What kind of ion channel did we use to get the receptor potential?

Resting potential = -70mV We get a receptor potential by having histamine go & open a ligand gated ion channel which results in Na+ coming in... This then takes our potential to 68mV In the Free nerve endings of a nociceptor / primary sensory neuron we transduce histamine into a receptor. What kind of ion channel did we use to get the receptor potential? Voltage, ligand or mechanically gated ion channels? LIGAND... As physicians, we are interested in blocking the ligand gated channels so that we don't transduce pain

352.

The second order neuron sends an axon that ALWAYS ______________

The second order neuron sends an axon that ALWAYS crosses the midline to terminate in the thalamus (VPL - ventral posterior lateral nucleus of the thalamus). Note the second order neuron is the 'projection' neuron that goes right to the thalamus

353.

The simplest, fastes route through the CNS

Monosnaptic reflex Myotatic reflex b/c the stretch reflexes are usually elicited by tapping a tendon, they are often referred to as deep tendon reflexes (DTRs) Tapping the patellar tendon = Knee jerk reflex or Tapping the Achilles tendon

354.

The somatopic map is preserved in the internal capsule, so motor fibers for the face are _____

Face are most anterior those for the arm and leg are progressively more posterior (see page 224 in Clinical book)

355.

The spinomesencephalic tract or Spinal tectum Where does it start/ end What does it do? What is released?

Starts int he spinal cord and ends in the midbrain Whats the roof of the mid brain? Superior and Inferior Colliculi are right there A part of the ALS system terminates there and there is a group of neurons that modulate PAIN there (Morphine is released). We have **endogenous Opiates** that we can release and it starts with stimulating the spinomesencephalic tract Our head will immediately turn to the point of damage / to the area of pain The mid brain tectum coordinates the hearing with vision for an unconscious head movement to the side of pain Lengthen (load) a muscle with an intact nerve supply and it will contract. the eye, face, and scalp.

356. 357.

The Stretch (myotatic) reflex states that if we The sympathetic nervous system (SNS) innervates

358.

The tectum is composed of: Where is it seen?

tectum - meaning, "roof" seen in the midbrain composed of the superior and inferior colliculi which lie dorsal to the cerebral aqueduct
359.

The tertiary sensory neurons in the thalamus VPL send axons by way of the________________ to the somatosensory cortex. The tongue is pointing to the left What have you lesioned?

The tertiary sensory neurons in the thalamus VPL send axons by way of the "posterior limb of the internal capsule" to the somatosensory cortex.

360.

Lesion of the left lower motor neuron causes the tongue to point to the left side of the lesioned hypoglossal nerve or nucleus upon protrusion. or A lesion of the right upper motor neuron to CN 12 causes the tongue to point away from the lesioned (affected) side upon protrusion. (thus it would point left) The UMN goes bilaterally but for the tongue a lesion tends to read more "contra" Thus i
361.

The transmitter released by motor neurons at the neuromuscular junction & by many neurons of the Autonomic nervous system

Acetylcholine (An amine) It's distribution in the CNS is more restricted.

362.

The Trigeminal CN 5is a mixed nerve but it's mostly... State it's nuclei : Where is the nuclei found

Sensory Mostly Sensory run from midbrain to upper cervical spinal cord Sensory = Mesencephalic Nucleus (exception primary neuron) Chief Nucleus Spinal trigeminal Nucleus (this big one that goes all the way down) Motor nucleus
363.

The vertebral artery supplies what important brain structures?

All blood supply to the MEDULLA comes from the vertebral artery or from the main branch of that artery, the posterior inferior cerebellar artery (PICA), which provides the major blood supply to the posterior lateral medulla and the posterior cerebellum Think of it this way - the vertebral artery is travelling along side the vertebrae - as it makes its way up towards the brain, whats the 1st structure its going to hit? The medulla!

364.

The vertebrobasilar system supplies blood to what structures?

The vertebrobasilar system (posterior brain circulation), supplies blood to structures in the posterior fossa (brain stem and cerebellum). a. paired vertebral arteries b. single basilar artery @ pontomedullary junction c. paired posterior cerebral arteries (PCA) @ pontomesencephalic junction d. paired posterior communicating arteries (PComAs) to anterior circulation
365.

The Vestibulospinal tracts (VSTs) has two tracts from vestibular nuclei. What are they and what do they do?

Vestibulospinal tracts (VSTs) two tracts from vestibular nuclei. #2 a) lateral VST - runs length of the spinal cord: controls extensor tone. b) medial VST - ends at cervical cord level: controls head and neck muscles.
366.

The watershed area corresponds to what area in the body? The word decerebrate means: The lesion must be in what location?

The trunk Extended Pons - signs of dysfunction: impaired consciousness extensor (decerebrate) posturing - lesion below RED NUCLEUS!) irregular and apneustic respiration abducens palsy or horizontal gaze palsy bilateral small but reactive pupils

367.

We just have the Vistibulospinal tract working -

368.

The word decorticate means: The lesion must be in what location?

flexed Midbrain - signs of dysfunction: impaired consciousness flexor (decorticate) posturing - lesion above RED NUCLEUS!) CN 3 palsy unilateral or bilateral pupil dilation ataxia The rubrospinal tract is ok

369.

There is a clot that stops all blood supply to the Posterior Cerebral Artery ... what tract MUST be down

The PCA supplies the cerebral peduncles therefore the 3 tracts that go thru there must go down corticospinal, corticobulbar & corticopontine tracts

370.

There is an embolus lodged at the top of the basilar artery. What symptoms do you expect to see

Midbrain pblm Oculomotor palsy = Deviation of eye downward and outward Drooping of eyelid Dilated, nonresponsive pupil (The above symptoms w/ Contralateral upper motor neuron paralysis = Weber Syndrome)

371.

These fibers accumulate until the eventually form the medial lemninscus tract Thin layer of gray matter that covers the substantia gelatinosa This combination provides for rapid, dexterous movements at individual joints or digits.

Internal Arcuate fibers Lamina I (aka marginal zone) Both lateral motor tracts Lateral corticospinal tract & Rubrospinal tract ** gives us a normal joint angle **

372. 373.

374.

This is the only structure w/ a prominent tectum

The mid brain - Mickey Mouse 's Lipstick (on top) Note the black shaded in area = the Cerebral peduncles The bottom portion of his lipstick = the Superior Colliculi The ocular motor nerv leaves thru the top of the ears in the space between the Cerebral Peduncles / Ears

375.

This pathway controls movement of the extremities

Lateral Corticospinal tract It is the most clinically important descending motor pathway in the nervous system

376.

This Reflex acts to reduce ongoing muscle contractions and facilitate opposing muscle activity.

inverse myotatic reflex

377.

This reflex involves several spinal segments and all connections are synaptic

Flexor reflex b/c the flexor reflex involves an entire limb, its pathway must spread over several spinal segments to include the motor neurons innervating all the various flexor muscles of that limb. The spreading occurs in 2 ways 1) all primary afferent fibers bifurcate on entering the spinal cord & their processes then extend one or more segments in both rostral and caudal directions 2) The flexor pathway includes at least one interneuron which itself may have processes extending over several segments

378.

This reflex provides a possible protective mechanism to prevent intense muscle contraction from pulling the muscle from its bone attachment

inverse myotatic reflex

379.

This reflex provides a spinal mechanism for fine control of exploratory movements (active touch).

inverse myotatic reflex The Ib inhibitory interneurons can tune up for the fine muscle force needed to touch a fragile object or tune down for a more forceful push.
380. 381.

This system innervates the eye, face, and scalp. This system tends to counteract small changes in muscle tension by increasing or decreasing the inhibition of the motor neurons.

sympathetic nervous system (SNS)

inverse myotatic reflex Together with information from the muscle spindle (Ia and II fibers) these reflexes (myotatic and inverse myotatic) essentially oppose motion about a joint and thus contribute to the regulation of muscle tone.
382.

This tract is essential for rapid, dextrous movements at individual digits or joints

Lateral corticospinal tract Remember this tract crosses over at the caudal medulla and descends in the contralateral spinal cord to control the contralateral extremities

383.

This tract leaves the Diencephalon goes thru the cervical & stops at T1 and releases glutamate = Tract that mediates pain and temperature to the conscious level Tract that terminates in the brainstem medullary-pontine reticular formation. Information is sent on from there to the centromedian nucleus of the thalamic intralaminar nuclei.

Hypothalamic Spinal tract ( all of this is Ipsi) Spinothalamic tract Spinoreticular tract The thalamus intralaminar nuclei project diffusely to the entire cerebral cortex where pain reaches conscious level and promotes behavioral arousal. (Survival and arousal) Think of the reticular formation as a fast reflex - its in the inferior portion of the brainstem ... it's like the hot dog inside a hotdog bun

384.

385.

386.

Transduces environmental physical energy into electrochemical energy Trigeminal nerve Function Where is its cell body?

First order neuron aka sensory neuron Sensory & Motor Sensory for the face Motor for the muscles of mastication Cell body is MEDIAL (medial for motor) in the PONS

387.

388.

UMN send info to the pons - then where does the projectory neuron go? UMN Upper motor neurons of the corticospinal tract project from the cerebral cortex to :

The seconday neruon go thru the middle cerebral peduncle to the cerebellum From the cerebral cortex to lower motor neurons located in the anterior horn of the spinal cord. Lower Motor neurons in turn project via peripheral nerves to skeletal muscles

389.

390.

Unconscious proprioception - where do the tracts start?

Start In the spinal cord and they end in the cerebellum The cerebellum has nothing to do w/ consciousness - The cortex is what we need to relate to consciousness Ex: dorsal spinocerebellar tract ventral spinocerebellar tract

391.

Upper motor neuron fibers of the corticobulbar tract originate in the motor cortex - where do they terminate?

Terminate on MOTOR CN nuclei in pons and medulla. UMN innervate all CN nuclei that cause skeletal muscle to contract. tongue - CN 12 sternocleidomastoid and trapezius muscles CN 11 palate, pharynx and larynx CN 10 muscles of facial expression CN 7 muscles of mastication CN 5

392.

Used to test reflex arc components as well as level and quality of influences from the descending pathways from the brain (also intersegmental spinal pathways).

Deep tendon reflex ... ex. The Knee jerk test. Note: Ia afferent action potential alone is not enough to fire an action potential in an alpha motor neuron.

393.

Vagus (CN X) Where is the nuclei? Be specific

Vagus (CN X) - Dorsal motor nucleus of CN X (MEDULLA). The PNS PREganglionic neuron cell body is located in specific brain stem nuclei.

394.

Wat muscles does CN 3 innervate?

The CN 3 innervates ( 3 extra ocularmuscles:) inferior oblique and inferior, superior, and medial recti the levator palpebrae muscle. ~ Raises the eyelid. (Its PNS component innervates 2 intraocular muscles) 1) Sphincter pupillae muscle - contracts the muscle of the iris and constricts the pupil (miosis). (compare mydriasis - dilates SNS) 2) Ciliary muscle - contraction causes the lens to increase its curvature

395.

We damage the ALS tract What 3 questions should we ask our selves?

Damage the ALS tract: 1. Is it motor or sensory? Damage the axon of the projection neuron so we are messing with sensory 2. What type of sensory did I lose? We are going to lose pain, temp and itch 3. Where did I lose it? We can't feel pain temp and itch on the other side of the lesion We lose it contralateral to the lesion Lose of pain in the spinal cord the symptoms will be on the other side

396.

Weakness State term Ex.

paresis ex. hemiparesis weakness of one side of the body Frontal, Parietal and Temporal lobes The entire cortex sends info to the pons

397.

Were are the UMN that send info to the pons found? Were do we deal with our 'consciousness' thoughts?

398.

The cortex

Conscious = Cortex Unconscious = Cerebellum

399.

Wha do we find in the Lateral White ? What 'drives' the abducens nerve?

ALS Anterolateral System Driven by the center for control of horizontal eye movements PPRF (para median pontine tegmentum in the reticular formation). The frontal eye fields generate fast conjugate eye moments (saccades) to the contralateral side by innervating the contralateral PPRF. Allows for integration of inputs from the cortex and vestibular nuclei to provide smooth horizontal control of conjugate eye movements.

400.

401.

What 'smooth muscle' holds the eyelid up?

Mueller's Muscle; innervated by the Sympathetic division of the autonomic NS NEpi is released and it hits an Adrenergic receptor (That's a metabotropic - slow) Biogenic amines are slow Sympathetic NS causes Muellers Muscle to release NEpi to keep the eyelid open

402.

What allows up to not fall over after stepping on a tack with our left leg?

Crossed effects. It is a simultaneous and opposite pattern of activity in the contralateral limb As the left leg flexes and withdraws, the right leg extends and thus it is better to support the body.

403.

What are 2 things that the brain is in constant need of? What are our unconscious proprioception tracts?

Glucose & Oxygen The brain can't store either of these

404.

dorsal spinocerebellar tract ventral spinocerebellar tract Cerebellar = unconscious

405.

What are signs of a lower motor neuron lesion?

Muscle weakness, atrophy, fascicilations, and hyporeflexia fascicilations = abnormal muscle twitches caused by spontaneous activity in groups of muscle cells. Ex. of a benign fasciculation not associated w/ motor neuron damage is the eyelid twitching often experienced during periods of fatigue, caffeine excess & eye strain.

406.

What are signs of an upper motor neuron lesion?

Muscle weakness & a combination of increased tone and hyperreflexia sometimes referred to as spasticity Such as Babinski's sign, Hoffman's sign, posturing Note w/ an UMN lesion there may initially be flaccid paralysis with decreased tone and decreased reflexes, which gradually over hours or even months develop into spastic paralysis ... spinal shock is an ex. of this process

407.

What are the 2 main functions that happen via the spinomesencephalic tract

1. Modulate PAIN there (Morphine is released). We have **endogenous Opiates** that we can release and it starts with stimulating the spinomesencephalic tract 2. Our head immediately turns to the point of damage / to the area of pain The mid brain tectum coordinates the hearing with vision for an unconscious head movement to the side of pain

408.

What are the 2 subtypes of glutamate receptors: Which is more abundant?

Ionotropic Glutamate receptors (Most) FAST & DIRECT NMDA & non- NMDA Metabotropic Glutamate receptors SLOW - G-protein coupled

409.

What are the 3 main reasons why we have infarction of the brain stem: List their descriptions as well

embolism -often of cardiac origin. thrombosis - in situ often occurs at a point of pre-existing atherosclerotic stenosis. lacunar disease - small-vessel occlusion in the setting of chronic hypertension. 5,7,9,10,11 they all innervate striated muscle of branchial arch origin (they all contain brachial motor fibers)

410.

What are the branchiomeric nerves ?

411.

What are the cerebellar arteries?

SCA (superior cerebellar artery) AICA (anterior inferior cerebellar artery) PICA (posterior inferior cerebellar artery)
412.

What are the fast, direct, ligand gated Glutamate receptors?

Ionotropic 1) AMPA - run of the mill doesn't let Calcium in 2)Kainate - " " 3) NMDA - Lets Calcium in 1)Ciliary Muscle : Messes w/ the circular fram around the elastic lens As we contract the ciliary muscle we relax the zonules and the lens gets rounder (accomodation) (ACH is released) Signals from the Edinger-Westphal nuclei travel via the ipsilateral oculomotor nerve to reach the ciliary and constrictor pupillae muscles of the eye. Contraction of the ciliary muscle causes the lens to increase its curvature (and thus its refractive power), while contraction of the constrictor pupillae reduces the size of the pupillary aperture. Signals from the oculomotor nuclei travel via the ipsilateral oculomotor nerve to the medial rectus muscles causing them to contract and resulting in convergence of the eyes on the object of interest. 2. Constrictor Pupillae - sphincter muscle attached to the lens - does pupil size ACh -> constricts pupils

413.

What are the general Visceral efferent / motor muscles that Cranial Nerve 3 innervates?

414.

What are the lateral motor systems? What do they control?

Lateral Corticospinal Tract Rubropspinal tract These pathways control the movement of the extremities Lateral motor systems project to lateral anterior horn cells (RED)

415.

What are the medial motor systems?

Anterior Cortiospinal (the 10% that doesn't cross) Vestibulospinal Reticulospinal Tectospinal they project to medial anterior horn cells These pathways control proximal trunk muscles (BLUE)
416.

What are the Neoplasms that can be acquired in the CNS? What are the purely motor nerves

NEOPLASMS - epidural metastasis, schwannoma Glial cells are in the periphery & can divide - thats why we will see schwannomas III, IV, VI & XII (also XI but this is basically a spinal nerve)

417.

418.

What are the two major ascending spinal cord tracts? What are two clinical ways that you could "test" the DC-ML pathway What artery provides the upper motor neurons for the trunk?

anterolateral system dorsal column-medial lemniscus system

419.

Tested clinically by touching a vibrating tuning fork to the surface of the body A more effective test is having a patient try to identify a pattern drawn on the skin

420.

The watershed area a little MCA & a little ACA If the blood supply (low blood pressure) goes down they are in trouble bc they can get "Man in the Barrel" Both descending UMNs for the trunk are going to be down... yea they will go bilateral at the level of the spinal cord but as they are coming down you will be able to hit it on both sides Its a bilateral watershed infarction

421.

What artery supplied the cerebral peduncles

Posterior Cerebral Artery Note seeing that corticospinal, corticobulbar, and corticopontine tracts these would all go down if there was a problem w/ this artery
422.

What blood supply supplies the base of the Pons?

paramedian branches of the basilar artery, ventral territory Note the region squared off is actually called Para-medial pontine base
423.

What blood vessel supples the lateral medulla?

Vertebral artery and PICA PICA : will be on the upper portion of the butterfly Vertebral arteries will be on the lower portion
424.

What can be said about how often Neurons "fire" in CNS

Neurons are constantly firing, there is always a constant, tonic level of firing. If our neurons aren't firing they are dead

425.

What can we find in the Frontal lobe : Paracentral lobule and Precentral Gyrus?

Upper motor neurons Pyramidal motor neurons aka "M1" M stands for Motor and 1 stands for primary If we knock out M1 we will have spasticity

426.

What can we say is true of all Cranial Motor nerves?

They are all going to be "ALs" Lower Motor Neurons they innervate ipsilaterally So if we have a Berry anyeurysm of the left Posterior cerebral artery that is impinging on the locular motor nerve - we will have problems with motor of the eye on the left

427.

What causes Dysarthria? What causes it?

Dysarthria : This is a speech disorder characterized by difficulty speaking properly, due to paralysis of the muscles of speech. Speech is often stammered or stuttered. However, they have no problem understanding speech. Cause: Degenerative neurological disorders (progressive bulbar palsy or amyotrophic lateral sclerosis)

428.

What causes Medial Pontine Base ?

caused by lacunar disease = small vessel occlusion in the setting of chronic hypertension aka Ataxic Hemiparesis (ataxia same side as weakness). corticospinal tracts: contralateral leg, arm weakness corticobulbar tracts: contralateral face weakness ("central seven") with dysarthria. abducens nerve ipsilateral paralysis of lateral rectus. pontine nuclei and pontocerebellar tract contralateral ataxia
429.

What causes sodium to go into the Postsynaptic membrane

[ ] and electric gradient

430.

What cranial nerve comes out in between the 2 cerebral peduncles?

Ocular Motor CN 3 Rostral to 3 = Posterior cerebral artery branches off Caudal to 3 A berry anyurysm can impinge on this nerve

431.

What cranial nerve opens the eyelid

Cranial Nerve 3 - ocular motor its like a little pillar holding it open (muscle is the Levator Palpebrae)

432.

What cranial nerve pulls the eyelid down

7 (its like a hook that pulls it down)

433.

What cranial nerves are associated with the medulla.

CN IX - Glossopharyngeal nerve. CN X - Vagus nerve. CN XII - Hypoglossal nerve**** Tegmentum of Medulla

434.

What cranial nerves are associated with the midbrain.

CN III - Occulomotor nerve. CN IV - Trochlear nerve.

Midbrain = 2 nerves Tegmentum of Midbrain

435.

What cranial nerves are associated with the pons.

CN V - Trigeminal nerve. CN VI - Abducens nerve. CN VII - Facial nerve. CN VIII - Vestibulocochlear nerve. (4 letters in PONS and it goes from 5 to 8 = 4 nerves) Tegmentum of Pons

436.

What cranial nerves are not associated with the brain stem? What are they associated with?

Three of them 1,2 and 11 Olfactory (CN I) and Optic (CN II) nerves are associated with the forebrain. Spinal Accessory (CN XI) is associated with the cervical spinal cord.

437.

What disease attacks the myelin in the CNS?

Oligodendrocytes: MS Multiple sclerosis damages myelin in the CNS

438.

What diverges more in the spinal cord... Ia fibers ? or Ib fibers?

Afferent Ib fibers diverge in spinal cord more than Ia fibers.

439.

What do the MEDIAL motor systems control?

They control movements of the trunk (axial and girdle muscles). a) They are involved in postural tone, balance, orienting movements of the head and neck, automatic gait-related movements. b) These medial motor systems descend ipsilaterally and terminate on interneurons, some of whose axons cross in the ventral commissure. 1) These motor systems influence axial musculature bilaterally.

440.

What do we attribute the Hyper-reflexia to

1) Up regulation of Glutamate receptors 2) Increase in synaptic dendritic ends onto the cell body of "Al" our Lower Motor Neuron so that when a stretch reflex is fired we see hyper reflexia below the point of transection ... The hyper-reflexia never goes away ...it's called spasticity Also note, this particular reflex is mono synaptic

441.

What do we need on the cell body & dendrites of the projection neuron's post synaptic membrane?

We need a RECEPTOR! (Ion channel: Voltage, ligand or mechanical?) LIGAND!!! Gluatmate receptors! GLUT is the #1 NT therefore we need glutamate receptors on the post synaptic membrane

442.

What does AICA supply

AICA (anterior inferior cerebellar artery) arises from basilar artery (just after vertebrals fuse) at level of caudal pons supplies lateral caudal pons*** and a small portion of cerebellum
443.

What does GTO monitor?

Tension in the muscle or force w/in the muscle GTO = Golgi tendon organ Inverse myotatic reflex
444.

What does Lamina VII correspond to ?

the intermediate Gray matter & also includes large extensions into the anterior horn

445.

What does PICA Supply

PICA (posterior inferior cerebellar artery) arises from vertebral artery at level of medulla supplies lateral medulla and inferior cerebellum PICA : will be on the upper portion of the butterfly Vertebral arteries will be on the lower portion
446.

What does SCA supply?

SCA (superior cerebellar artery) arises from "top of the basilar artery" at level of rostral pons supplies superior cerebellum and bit of rostral laterodorsal pons
447.

What does the Anterior corticospinal tract control?

Bilateral control of axial and girdle muscles (medial motor system) #1

448.

What does the Ia afferent fiber transduce?

Length

449.

What does the stylopharyngeus muscle do? What Cranial nerve controls it? What nucleus is involved? What happens as we increase the # of synapses in a reflex arc? What happens if we damage the Intralaminar nucleus?

Stylopharyngeus muscle = Elevates the pharynx during talking and swallowing (part of gag reflex with vagus). CN9 - Glossopharyngeal a) Nucleus Ambiguus An increase in the number of synapses in the reflex arc increases the delay in motor response and may prolong the motor response. ILN talks to the ENTIRE cortex - its' an alerting system for the whole CNS If we knock out the ILN we will go into a coma. The ILN are the panic button, the entire cortex will light up. If there are damaged, our pt. is in a coma

450.

451.

452.

What happens if we have a lesion of the facial nucleus or facial nerve? Where will we see the symptoms?

Lesion of the facial nucleus or nerve: **Ipsilateral** It's a Lower Motor Neuron 1) Bell's Palsy - lesion of lower motor nerve in the facial canal (facial palsy). corner of the mouth droops can't close eyelids (orbicularis oculi)*** red and dry eyes can't wrinkle forehead*** hyperacusis - sounds are loud loss of blink reflex loss or altered taste (ageusia) pain in outer ear If it's a Lower motor neuron we are going to lose everything on one side of the face upper and lower (bottom right picture)
453.

What happens if we have a lesion of the LMN of the tongue?

Lesion of this lower motor neuron causes the tongue to point to the side of the lesioned hypoglossal nerve or nucleus upon protrusion.

454.

What happens if we have a supranuclear lesion on the right side of the facial nerve? Where will we see the symptoms?

SUPRANUCLEAR lesion of the facial nerve: (upper motor neuron damage) 1) Upper motor neuron lesion causes weakness in the inferior contralateral face. "central seven" "central facial paralysis" The top portion of the face gets bilateral innervation so it will be fine The bottom portion of the face only gets unilateral innervation. Thus we will see symptoms on the contralateral side (left) sided weakness
455.

What happens if we lesion CN11?

Lesion causes a weakness in turning the head to the contralateral side against resistance (steady, slight head turn towards the weak sternocleidomastoid muscle) and ipsilateral shoulder drop. The second neuron axon crosses in the ventral white commissure.

456.

What happens once a nociceptor synapses in the dorsal horn of the spinal cord?

Nociceptors (pain, temperature, and crude touch) synapse in the dorsal horn of the spinal cord and the second neuron axon crosses in the ventral white commissure.
457.

What happens once Pacinian corpuscles, Merkel's Disks, & muscle spindles first initially synapse in the In the N. Cuneatus & N. Gracilis of the caudal medulla?

The second neuron axon crosses in the internal arcuate fibers. Synapse in the N. Cuneatus (upper body sensation) N. Gracilis (lower body sensation) of the caudal medulla & the second neuron axon crosses in the internal arcuate fibers.

458.

What happens to Arm and Leg tone when we damage an UMN?

We will have flexed arms and extended legs w/ an UMN lesion Increased muscle tone We will show extended legs and flexed arms NOTE this means that we have a pattern of weakness in the flexors (lower limbs) or extensors (upper limbs)
459.

What happens to our reflexes when we remove the higher CNS centers? What happens when we lengthen a muscle with an intact nerve supply? What important structures lie in the medulla?

Removal of higher CNS centers will alter reflex activity (hyperreflexia and/or hyporeflexia can occur). It contracts Stretch (myotatic) reflex - Lengthen (load) a muscle with an intact nerve supply and it contracts. Contains the autonomic centers for respiratory, cardiovascular, and gastrointestinal control. Location of the CN 9, 10, 12 nuclei (motor neuron cell bodies located in medulla). Contains the caudal portion of the Trigeminal Nuclei (spinal nucleus of CN 5) and caudal parts of two of the four Vestibular Nuclei (CN 8).

460.

461.

462.

What initiates the flexor reflex?

The flexor reflex is initiated by cutaneous receptors (free nerve endings) & involves a whole limb Withdrawl from a painful stimulus; after accidentally touching something painfully hot or sharp - we automatically remove the offended hand from that vicinity by flexing the arm to which it is attached.

463.

What is a primary sensory neuron that has no myelin called ? What is Goldman's Equation in layman's terms?

A C fiber More to come next block Goldman's Equation: The membrane potential is always closest to the equilibrium potential of the most permanent ion (ex. Usually this is Potassium whose Equlibrium potential is -90mV) If we use a drug or something to knock the potassium channels off the field - then our membrane potential becomes the sodium potential = + 60mV If both Na and K ate 50% and 50% then our membrane potential will be somewhere in between

464.

465.

What is in the 'basis' of the brain stem?

Its the location of large collection of fibers and tracts: corticospinal, corticobulbar, and corticopontine tracts.

466.

What is plastered all along side of our lower motor neurons? What will they integrate?

"Al" is plastered w/ a million post-synaptic contacts It integrates many, many postsynaptic membrane potentials (increased muscle tone and abnormal reflexes - ex. Babinski 's sign) can be seen below the point of transection about two weeks after spinal cord transection. Spinal shock - immediate loss of all reflex activity below the point of transsection of the spinal cord. Arousal & conscious awareness Afferent limb of the arc is a Ia afferent w/its associated muscle spindle primary ending It transduces LENGTH

467.

What is Spasticity ? When does it occur? What is Spinal shock? When does it occur?

468.

469. 470.

What is the 'function' of the Spinoreticular tract What is the afferent sensory limb of the monosynaptic reflex?

471.

What is the arrangement in the Nucleus Solitarius?

~Rostral Nucleus Solitarius "gustatory." ~Caudal Nucleus Solitarius "cardiorespiratory." sensory viscera / aortic arch chemo & baro receptors Also it looks like a dohnut The tract is in the middle and the nucleus surrounds it

472.

What is the blood supply for the anterior and medial structures of the medulla such as the pyramid and the medial lemniscus What is the blood supply for the caudal medulla?

depend on some combination of vertebral branches and the anterior spinal artery The caudal medulla has a blood supply much like that of the spinal cord Anterolateral portions are supplied by the anterior spinal artery, small branches of the vertebral artery or both. Posterolateral portions are supplied by the posterior spinal artery, small branches of the PICA or both (posterior inferior cerebellar artery) (note rostral medulla recieves a varying supply of blood)

473.

474.

What is the blood supply for the lateral and posterior structures of the medulla such as the spinothalamic tract and the inferior cerebellar peduncle

Depend on branches of the vertebral artery, the PICA an to a lesser extent to the posterior spinal artery

475.

What is the blood supply to the MEDULLA?

MEDULLA - medial = basilar artery MEDULLA - lateral = vertebral artery and PICA *****Know this
476.

What is the blood supply to the MIDBRAIN ?

MIDBRAIN - supplied by PCA and penetrating branches "top of the basilar artery
477.

What is the blood supply to the PONS?

PONS - basilar artery

478.

What is the concern for the Motor neurons for fine touch and dexterity on the lateral side?

They don't have a back up The medial motor goes bilaterally so there is a backup

479.

What is the effect of a Lesion of the corticospinal cord occurring above the pyramidal decussation

Produce Weakness on the contralateral side This would also be true for a lesion of the : Cotrex Internal capsule midbrain Pons ? Medulla... depends on where Produce Weakness on the ipsilateral side Same would be true of a lesion of the spinal cord

480.

What is the effect of A Lesion of the corticospinal cord occurring below the pyramidal decussation

481.

What is the exception to the Bilateral LMN of the face innervation What is the function of ) Ciliary muscle?

CN 7 - facial nerve LMN to the lower face receives only contralateral UMN innervation contraction causes the lens to increase its curvature. CN 3

482.

483.

What is the function of the Sphincter pupillae muscle?

Sphincter pupillae muscle - contracts the muscle of the iris and constricts the pupil (miosis). (compare mydriasis - dilates SNS) CN3

484.

What is the functional importance of the flexion reflex?

protective reflex a. Flexor withdrawal reflex is the most powerful spinal reflex. b. Upon stepping on a sharp nail the stimulated leg is withdrawn from the painful stimulus while the crossed extensor component causes the other leg to extend and support body weight and balance.

485.

What is the general principle in all reflexes :

Reciprocal Inhibition: Reflex activity in a given muscle produces similar activity in the ipsilateral synergists & the opposite activity in its ipsilateral antagonists. Thus the standard tap on the patellar tendon causes not only excitation of the quadriceps motor neurons but also inhibition (thru an interneuron) of motor neurons to the hamstring muscles.

486.

What is the ILN (Intralaminar Nuclei) & what does it do?

ILN talks to the ENTIRE cortex - its' an alerting system for the whole CNS If we knock out the ILN we will go into a coma. The ILN are the panic button, the entire cortex will light up. If there are damaged, our pt. is in a coma

487.

What is the location of the 7th cranial nerve nuclei? What can you say about it's fibers?

Location of the 7th cranial nerve nuclei is just ventro-lateral to the abducens nucleus. Its fibers curve around the abducens nucleus.

488.

What is the main thing that we find in the reticular fromation?

Biogenic Amines Note the RF is like a hotdog in the bun in the brainstem. It's an old system that is stuck in the middle

489.

What is the major transmitter for brief, point to point excitatory synaptic events in the CNS?

Glutamate

490.

What is the major transmitter for brief, point to point inhibitory synaptic events in the CNS?

GABA & Glycine Glycine = particularly in the spinal cord GABA = brain & pretty much everywhere else including brainstem

491.

What is the mechanism of how the Spinoreticular tract functions to send arousal signals

We begin the ALS system as always, at the 1st synapse the Spinoreticular tract begins and starts traveling up the spinal cord. It comes to a FULL STOP at the brain stem at the reticular formation & releases the NeuroTransmitter = Glutamate. The reticular formation is a net and once it's activated it acts as a web and it activates everything around it ... It's function is Arousal. Then there is another neuron that will then leave the reticular formation & go up to the thalamus and synapse in the ILN of the thalamus (Intralaminar Nuclei). ILN talk to the ENTIRE cortex - its' an alerting system for the whole CNS If we knock out the ILN we will go into a coma. The ILN are the panic button, the entire cortex will light up. If there are damaged, our pt. is in a coma

492.

What is the most common area to get a stroke? What is it's blood supply? what nerves will be damaged 1st?

Rostral Medulla PICA ... supplies the brain laterally therefore we will see Sensory damage first

493.

What is the most powerful spinal reflex?

Flexor withdrawal reflex... a protective reflex Upon stepping on a sharp nail the stimulated leg is withdrawn from the painful stimulus while the crossed extensor component causes the other leg to extend and support body weight and balance.

494.

What is the Neurotransmitter for the preganglion to postganglionic sympathetic system 'handoff" What is the neurotransmitter released upon synapse at the primary somatic sensory cortex / postcentral gyrus ? What is the normal response of Sympathetic stimulation to the eye? What neurotransmitter is released & what does it to do?

ACh

495.

Glutamate is released Note Primary think Hummunculus Secondary & Tertiary think Association Cortex - they put the pieces together Normally NEpi is released onto the dilator muscle to dilate the eye

496.

497.

What is the only non-paired artery in the CNS?

Anterior spinal cord artery Its found on the anterior surface in the cleavage

498.

What is the only way to change a membrane potential?

Open an ION channel If we ever want to mess w/ the membrane potential all we have to do is open an ion channel!

499.

What is the preganglionic nucleus for the parasympathetic nervous system that is located in the midbrain?

Occulomotor nerve (CN III) - Edinger-Westphal nucleus (MIDBRAIN) (parasympathetic)

3.7.9.10.
500.

What is the relationship between the Parasympathetic nerve fibers and the Oculomotor nerve?

The parasympathetic fibers form a sleeve on the outside of the Ocularmotor nerves. Thus if we had a berry aneurysm in which we were inpinging on CN3, our parasympathetic nerve fibers would go down 1st

501.

What is the sensory neuron that generates the with-drawl reflex?

Nociceptor ... free nerve endings The action potentials are encoding Pain, temp & Itch 2 types : A delta fibers and C fibers
502.

What is the site of origin of descending pain control pathway. What is the VPL? What is there? If we had a lesion in the VPL in the Right thalamus what's the deficit?

PAG - Periaqueductal gray VPL = sensory, pain, temp, itch, fine, touch vibration, proprioception (yes the ALS trct & DCML tract) If we had a lesion in the VPL in the Right thalamus what's the deficit? Sensory for all of those systems On the Contralateral side b/c Brainstem is Contralateral

503.

504.

What kind of effect would INFECTIOUS MYELITIS have on the the body? Inflammation of the spinal cord due to - viral, including HIV, Lyme disease, Tertiary syphilis, and poliomyelitis.

Note : Poliomyelitis is A motor disease that attacks the motor neurons of the anterior horn Muscles bilaterally will be effected (this is a cervical section so we are dealing w/ a LMN) Our LMN is out therefore we will see Flaccid Paralysis ... 3 years down the line we will see Atrophy and Fasciculations
505.

What kind of effect would INFLAMMATORY MYELITIS have on the the body? Multiple sclerosis (autoimmune inflammatory disorder affecting central nervous system myelin), Lupus, Postinfectious myelitis

The lesions come and go ... then remit and then they can relapse In this pic Can't feel Fine touch & proprioception on the Right = (Ipsi) loss Pain & temp lost on right = a (contra lateral) See the anatomical
506.

What kind of potential will we get from our Projection neurons?

Projection neurons / cell bodies & dendrite have ligand gated channels. Ligand channels don't give us action potentials, they only give us post synaptic potentials (excitatory or inhibitory) EPSP (mostly)

507.

What kind of receptors elicit a reflex? Give ex What lamina correspond to the body of the posterior horn?

Sensory receptors elicit reflexes when they are excited Muscle receptor Nociceptor Lamina III through VI

508.

509.

What lobe is the sensory cortex in ? What's another name for this structure?

Parietal lobe Post central gyrus = sensory we have primary sensory tracts coming in BLUE
510.

What makes & delivers NorEpi with every single action potential What makes up a muscle spindle

Locus Ceruleus The spindles comprise 8 - 10 intrafusal fibers arranged in parallel with the extrafusal fibers that make up the bulk of the muscle. note there are 2 structural & functional classes of intrafusal fibers: nuclear bag fibers & nuclear chain fibers nuclear bag fibers can be further subdivided into subclasses: dynamic & static

511.

512.

What muscle is involved with cranial nerve #6 what specifically does it do?

CN6 = Abducens Innervates the lateral rectus, which abducts the eye.

513.

What muscles are involved in oxygenating and eating?

7&5 Especially 7 Brachiomeric Skeletal Muscle

514.

What myelinates our LMN?

Al - our LMN is myelinated by oligodendrocytes b/c he is located in the ventral horn of the spinal cord (in the gray matter b/c it's a cell body) He's in the CNS system
515.

What nerve allows us to smile? Where is it located?

CN 7 Facial In the Tegmentum of the Pons

516.

What nerve controls the parotid gland? What kind of innervation is it ? What nucleus is involved What nerve gives us sensation in the Jaw?

CN9 - Glossopharyngeal Parasympathetic innervation of parotid gland. Inferior Salivatory Nucleus.

517.

CN 5 Trigeminal

518. 519.

What nerves control Visceral Sensory and taste? What neural tracts (ascending or descending) can be found coursing through the brain stem and thus can be seen on all transverse sections of the brain stem?

7,9,10 5 Tracts: 1. Medial Lemniscus. (Sensory) 2. Anterolateral System. (Sensory) 3. Corticospinal Tract. 4. Descending Hypothalamospinal SNS Fibers. (These stop in T1 & T2 for the head) Note these descending fibers course with the ascending spinothalamic fibers (ALS) in the lateral part of the brain stem.

520.

What neuron determines the type of reflex?

The sensory neuron normally determines that type for reflex So if it's length / stretch ... it's gonna be contraction

521.

What Neurotransmitter goes to the antagonistic lower motor neuron? Will an action potential be generated

Glycine (in the spinal cord ) is released to the LMN of the antagonistic muscle This is the only place where there will NOT BE AN ACTION POTENTIAL (Reciprocal Inhibition) & therefore no NT is released at the muscle. Chloride will enter the channel & the membrane potential will become the equlibrium potential Chloride for chloride which is about -70 mV ... we therefore hyperpolarize the membrane and this is why no action potential is generated on the antagonistic muscle

522.

What nuclei are responsible for aortic arch chemo- and baro- receptors. Also state nerve

CN X - sensory General Visceral Sensory - aortic arch chemo- and baro- receptors. a) Caudal Nucleus Solitarius "cardiorespiratory."

523.

What nuclei are responsible for General somatic sensation from meninges and external ear. Also state nerve

CN X a) Primary sensory neurons in the superior (SG) vagal ganglia. b) Spinal Trigeminal Nuclei - second order sensory projection neuron.
524.

What nuclei are responsible for Innervation of skeletal pharyngeal and laryngeal muscles Also state nerve

Nucleus Ambiguus. CN X Controls muscles for swallowing (gag reflex) and phonation. -motor (note CN9 also does taste (S) and swallowing (M) )
525.

What nuclei are responsible for Parasympathetic innervation of smooth and cardiac muscles (viscera). Also state nerve

Dorsal motor nucleus of X >>> Nucleus Ambiguus. CN X - Motor

526.

What nuclei are responsible for taste from epiglottis and pharynx Also state nerve

CN X - sensory Special Visceral Sensory - taste from epiglottis and pharynx. a) Rostral Nucleus Solitarius "gustatory."
527.

What nuclei should we associate with CN10?

Vagus (medial to lateral) 1) Dorsal motor nucleus 2) Nucleus Ambiguus 3) Nucleus Solitaris (rostral = taste, caudal = sensory viscera) 4) Spinal Trigeminal
528.

What overlays the pons? What part of the brain stem tends to have the most strokes? What artery will be involved? What type of deficits should we associate with it?

The middle section of the brain stem is the pons, which is overlain by the cerebellum. What part of the brain stem tends to have the most strokes? Rostral Medulla The artery involved is the PICA Posterior inferior Cerebellar artery = PICA goes laterally and goes behind It's the one that will cause problems and causes stroke in the rostral medulla Its going laterally and backwards to the dorsal surface of the brain. Its supplying laterally so well see more sensory deficits than motor

529.

530.

What problems can we expect form a lesion of the sympathetic nervous system?

A lesion of the sympathetic pathway to the head will cause ipsilateral Horner's Syndrome. ( Remember Descending tracts from the hypothalamus DO NOT CROSS the midline as they descends through the brain stem and spinal cord to innervate the preganglionic SNS neurons) The classic signs of Horner's Syndrome are: MIOSIS - decreased pupil size (dilator muscle not innervated) (Note Pts. Left eye) PTOSIS - drooping upper eyelid (Muller's smooth muscle not innervated). ANHIDROSIS - lack of sweating on the face and neck.
531.

What protein is on the cell body / dendrites of the motor neuron What releases Glutamate to the preganglionic cell body?

Glutamate receptors The Hypothalamus on the Same side The tract leaves the Diencephalon goes thru the cervical & stops at T1 and releases glutamate = Hypothalamic Spinal tract ( all of this is Ipsi)

532.

533.

What skeletal muscle closes the eye? What skeletal muscle holds the eye lid up?

The orbicularis oculi closes the eye, while the contraction of the levator palpebrae muscle opens the eye Levator palpebrae = CN 3 opens the eyelid - its like a little pillar holding it open The orbicularis oculi closes the eye, while the contraction of the levator palpebrae muscle opens the eye

534.

535.

What structures are at the working ends of conscious proprioception, fine touch, vibration & pressure? What supplies blood to the midbrain?

Pacinian corpuscles Merkel's Disks muscle spindles chiefly from the posterior cerebral artery with some contribution from the basilar and superior cerebellar arteries caudally In addition the anterior choroidal artery and the posterior communicating artery may send branches to the cerebral peduncle

536.

537.

What supplies blood to the pons

Basilar artery -paramedian and circumferential branches The anterior inferior cerebellar artery and the superior cerebellar artery contribute branches to the middle and superior cerebellar peduncles and to the posterior and lateral portions of the pontine tegmentum

538.

What tract 'localizes' pain?

Spinothalamic tract

539.

What tracts go thru the cerebral peduncles?

corticospinal, corticobulbar, and corticopontine tracts Note the Posterior Cerebral Artery supplies the cerebral peduncles
540.

What will cause loss of contralateral pain and temperature starting a few segments below the level of the lesion? What will happen to the eye with a lesion of the PNS component? How will the eye present physically?

A lateral spinal cord lesion

541.

of the CN 3 PNS component causes loss of near vision response and ptosis with dilated pupil and loss of light reflex. Eye ball is down and out at rest. EW nucleus innervates the 2 intraocular muscles Sphincter pupillae muscle & Ciliary muscle -> normally we release ACh here onto Muscarinic receptors and constrict the pupil and increase the curvature so that we can see near vision We see down and out b/c the Lateral rectus is still working (CN6) and CN4 is pulling the eye down. CN3 keeps the eye up so if it's gone our eye as well as our eyelid will be down

SANNEA PANAM
542.

What will probably be the 1st clinically detectable sign that something is pressing on the 3rd nerve?

A dilated pupil, unresponsive to light b/c the Edinger Westphal nucleus travels in a superficial location (as the sleeve) & therefore are susceptible to external pressures

543.

What's the neurotransmitter at the axon terminal involved in the first synapse?

Glutamate Note this is true for both pathways ALS and DC-ML (the locations for the 1st synapse are just in 2 different locations)

544.

Whats the dermatome for the back of the head? Whats the difference between an NMDA and a non-NMDA receptor?

C1 for the back of the head Both are Ionotropic receptors NMDA receptor - also binds asparatate : has both transmitter gated & voltage gated properties: Mg ion occupies the NMDA receptor channel at a normal resting potential & prevents current flow even in the presence of Glutamate. Depolarizing the postsynaptic membrane as a result of repetitive presynaptic activity & release of substantial gluatamte expels the Mg ion & allows the NMDA channel to open. Thus they open only if Glutamate is present AND there is pre-existing depolarization. These channels permit the Na, K and Calcium ions in. The resulting post-synaptic increase in [Ca] activate 2nd messenger cascades & augment transmission @ the synapse. Non-NMDA : Kainate & AMPA (converntional ligand / glutamate gated cation channels) : responsible for EPSPs Glutamate binds and the channel opens. Na and K can go thru (Note Glutamate never goes thru)

545.

546.

Whats the sensory receptor for the stretch reflex? When "just" our Lateral Cortical Spinal tract is lesioned we often see Flexed Upper arms and Extended lower legs ... How can you explain this

Muscle spindle is our transducer at the end of the Ia fiber Rubrospinal causes flexion of the upper extremities - normally this is offset w/ the Lateral cortical spinal tract & we get the normal angles ... obv when the Lat. Cotical spinal is out - we will only see the flexion The vestibulospinal senses the change and tells the leg muscles to extend When a muscle is stretched, the SPINDLE is also stretched & the rate of discharge in the afferent fibers is INCREASED It diverges and releases collaterals All of the collaterals/ terminals will release the same NT (ex. Glutamate) It could be 2 or 3 NT being released from one neuron but all terminals will release the same NT Glutamate is produced in the axon terminal and packaged in vesicles w/ synaptotagmin hanging off the vesicle The enzymes are made in the nucleus and are sent down to the axon terminal "make glutamate"

547.

548.

When a muscle is stretched, the ______ is also stretched & the rate of discharge in the afferent fibers is ______ When a sensory neuron comes into the dorsal horn what is the first thing that happens

549.

550.

When dealing w/ reflexes What is always 1st? 2nd?

Sensory is always 1st and motor second The reticular formation allows you to do it in that order

551.

When do we see more powerful and longer lasting reflexes? When Glycine binds to a Ligand gated inhibitory channel What ion enters? Then what happens?

When extensor (e.g. anti-gravity) muscles are stretched. (Characteristics of stretch reflexes)

552.

Chloride Its a specific channel! Chloride will enter the channel & the membrane potential will become the equlibrium potential Chloride for chloride which is about -70 mV ... we therefore hyperpolarizes the membrane and this is why no action potential is generated on the antagonistic muscle

553.

When looking at a myelin stained cross section Cell bodies will be : Tracts will be

Cell bodies will be white Axons / tracks will be black ex. the Spinal Trigeminal nucleus will be white (it's cell bodies - they aren't myelinated so they won't be stained black)
554.

When looking at the brainstem dorsally, what structures are prominently seen at the superior portion of the medulla ? We are looking dorsally so we should be thinking...... ?

Nucleus Gracilis and Nucleus Cuneatus We should be thinking SENSORY, dorsal = sensory Gracilis = "feet in the grass; T6 lower part of the body
555.

When the Cortical Spinal cord is descending down where will it synapse with the lower motor neuron?

At around C7 they will come out of the lateral white column and go into the medial gray to synapse. Glutamate will be released to the Lower Motor Neuron and an action potential will be generated which will flow to the fingers and Release Ach to the muscle

556.

When the foot is dorsi-flexed

During the swing phase of walking... keeping the toes clear of the ground The dorsiflexion action stretches the soleus. The monosynaptic stretch reflex involving the soleus is almost completely suppresses specifically during this phase of the step cycle, preventing it from contracting, extending the foot and possibly causing the toes to contact the ground

557.

When we ask your patient to describe the location of their pain why is it sometimes hard for them to describe the exact location...

For a couple of segments up and down we have "divergence" of Pain, Temp As sensory info comes in there are some fibers that shoot up and down for a segments ... Lisshours tract? In the ALS Pathway we have Divergence If we ask a pt. where the pain is it's hard for them to localize b/c it's a few segments up and down

558.

Where along our "pathway" will we see a Receptor Potential? How does this type of receptor operate?

We get a receptor potential in the periphery It's an electrotonic, local graded sensory potential if we want the potential to get bigger then we throw more histamine at it... it's graded!! A Local graded potential and the name of this one is a sensory or receptor potential Note: The for sure way to change a membrane potential is to open an ion channel!

559.

Where are CN 11 cell bodies?

Cell bodies are in the upper 5-6 cervical segments of the spinal cord in the spinal accessory nucleus (see arrow below) which protrudes between the dorsal and ventral horns of the spinal cord.
560.

Where are motor nuclei usually located?

Medially Think of Cranial Nerve #6 = Abducence Purely motor in the center of the pons

561.

Where are Postganglionic parasympathetic neuron cell bodies found? Where are sensory nuclei usually located?

Postganglionic parasympathetic neuron cell bodies are found in ganglia outside the CNS. Laterally Think of Cranial nerve #8 = Vestibulcochlear Purely sensory for hearing and balance

562.

563.

Where are the cell bodies for the Vestibulospinal tracts (VSTs) and the Reticulospinal tracts?

In the brainstem These are 2 are part of the medial motor system tracts

564.

Where are the cell bodies of the cranial nerves with mixed motor and sensory visceral function found ?

Mixed are found near the sulcus limitans which separates the motor from sensory areas in the brain stem and their nerve fibers exit the brain stem between the motor and sensory nerve fibers. 7,9,10 (5 is also mixed but think of it as being more sensory) These will be in between the "pure" sensory & "pure"motor (look at the right side)
565.

Where are the cell bodies of the cranial nerves with motor function found?

Motor = near the midline Their nerve fibers exit the brain stem ventrally near the midline (CN 3, 6, 12) (yes exception CN4 dorsal fiber exit) (motor medial).

566.

Where are the cell bodies of the cranial nerves with sensory function found ?

The cell bodies of those cranial nerves with sensory function are found near the lateral border of the brain stem Their nerve fibers exit the brain stem laterally (CN 8). (sensory lateral).

567.

Where are the postganglionic cell bodies of the sympathetic nervous system found? Where are the SNS preganglionic cell bodies are located ?

The postganglionic cell bodies lie in the superior cervical ganglion. Remember the Preganglionic cell bodies are in T1 - T2 of intermediolateral (IML)

568.

All the SNS preganglionic cell bodies are located in the intermediolateral (IML) cell column of the spinal cord (Rexed lamina VII) (T1 to L3). (Note Face = T1 & T2)

569.

Where are the SNS preganglionic cell bodies innervating the head are found Where are the superior colliculi located on Mid Brain Mickey?

in the intermediolateral (IML) of T1 - T2

570.

Its Mickey's double chin not that whole line is the Tectum / "Roof"

571.

Where can we find all of the neuronal components of the reflex arc? Where can we find the cranial nerve nuclei?

They are all present at the spinal cord level.

572.

In the tegmentum note this is a midbrain cut

573.

Where can we find the reticular formation?

In the tegmentum note this is a midbrain cut

574.

Where do nociceptors synapse?

Nociceptors (pain, temperature, and crude touch) synapse in the DORSAL HORN of the SPINAL CORD and the second neuron axon crosses in the ventral white commissure.

575.

Where do Pacinian corpuscles, Merkel's Disks, & muscle spindles first initially synapse ?

In the N. Cuneatus (upper body sensation) and N. Gracilis (lower body sensation) of the caudal MEDULLA and the second neuron axon crosses in the internal arcuate fibers.

576.

Where do second order sensory neurons for pain, temp, itch and crude touch terminate?

terminate in the VPL of the thalamus ventral posterior lateral nucleus of the thalamus (spinothalamic tract), Note the following terminations: brainstem reticular formation (spinoreticular tract), midbrain (spinomesencephalic tract).

577.

Where do the Axons of CNV secondary projection neurons terminate?

Axons of secondary - projection neurons terminate in the thalamus (VPM).

578.

Where do the fibers cross in the ALS system

Ventral White Commissure ALS tract : Pain fibers that crossover are called the Ventral White Commissure - sometimes it's called the Anterior commissure but we already have on of those Then it goes straight up to the thalamus and we will see neuron #3

579.

Where do the fibers cross in the DC-ML system Where do the Lateral motor systems axons terminate? Where do the Lateral motor systems control? Where do the Lateral motor systems travel?

Internal Arcuate Fibers Axons terminate on lateral groups of ventral horn motor neurons and interneurons.

580.

581.

Control movements of extremities (DISTAL MUSCLES) arms, legs, feet, hands.

582.

The LATERAL motor systems travel in the lateral columns of the spinal cord white matter. 1) Axons terminate on lateral groups of ventral horn motor neurons and interneurons. 2) Control movements of extremities (DISTAL MUSCLES) arms, legs, feet, hands.

583.

Where do the MEDIAL motor systems synapse?

These medial motor pathways synapse on medial ventral horn motor neurons and interneurons. Anterior Cortiospinal (the 10% that doesn't cross) Vestibulospinal Reticulospinal Tectospinal

584.

Where do the MEDIAL motor systems travel?

In anteromedial columns of the spinal cord white matter. 1) These medial motor pathways synapse on medial ventral horn motor neurons and interneurons. 2) They control movements of the trunk (axial and girdle muscles). a) They are involved in postural tone, balance, orienting movements of the head and neck, automatic gaitrelated movements. b) These medial motor systems descend ipsilaterally and terminate on interneurons, some of whose axons cross in the ventral commissure. 1) These motor systems influence axial musculature bilaterally.

585.

Where do the Reticulospinal tracts originate?

(3a) One originates in pontine reticular formation = medial reticulospinal tract. (3b) Other originates in the medullary reticular formation = lateral reticulospinal tract (medial motor system)
586.

Where does the Corticonuclear tract terminate?

Ends on the nuclei of the cranial nerves Aka "corticobulbar" Remember the Cranial nerves are all lower motor neurons that go to innervate skeletal muscle ipsilateraly

587.

Where does the lateral corticospinal tract synapse? Where does the ocular motor nerve emerge from? Where does the sensory signal for the stretch reflex originate? Where does the Spinoreticular tract terminate? Then what happens?

The upper motor neuron in primary motor cortex (precentral gyrus) sends an axon downward to cross over at the pyramidal decussation. The axon then continues downward in the CONTRALATERAL spinal cord before synapsing on LOWER MOTOR NEURONS (GREY MATTER) in the ANTERIOR HORN From the interpeduncular fossa between the cerebral peduncles

588.

589.

Originates in the muscle spindles They are the sensory receptors embedded within most muscles. Terminates in the brainstem medullary-pontine reticular formation. Information is sent on from there to the centromedian nucleus of the thalamic intralaminar nuclei.

590.

591.

Where is "AL" for the body located?

Our LMN / alpha motor neuron is located in the ventral horn of the spinal cord.... Inside the central nervous system - In the Grey Matter b/c its a cell body
592.

Where is Postganglionic parasympathetic neuron cell body for : Facial nerve (CN VII)

sphenopalatine ganglion - axons project to lacrimal glands and nasal mucosa. submandibular ganglion - axons project to submandibular and submaxillary salivary glands. otic ganglion - axons project to the parotid gland.

593.

Where is Postganglionic parasympathetic neuron cell body for : Glossopharyngeal (CN IX)

594.

Where is Postganglionic parasympathetic neuron cell body for : Occulomotor nerve (CN III)

ciliary ganglion - axons project to the eye ciliary muscle and constrictor (sphincter) muscle of the iris. KNOW THIS various terminal ganglia - axons project to effector organs (lungs, heart GI tract).

595.

Where is Postganglionic parasympathetic neuron cell body for : Vagus (CN X)

596.

Where is the anterior medial corticospinal tracts cell body?

It's ipsilateral ... b/c it never crossed at the pyrimidal decussation It kept going straight down and then in the spinal cord it crosses over and innervates BILATERALLY

597.

Where is the Red Nucleus located? Medial or Lateral

In the midbrain Motor - lateral - descending tracts are leaving there Does Flexion of Upper Extremities

598.

Where is the red nucleus? What happens if we stimulate it ?

In the midbrain of the brainstem Stimulate it and we will be flexed all the time Rubrospinal tract ... but this doesn't happen b/c the corticospinal cord works with it. If we do a capsular stroke and damage JUST the lateral corticospinal cord then we could see just Flexion of Arms

599.

Where is the Rubrospinal tract found? What does it do?

red nucleus midbrain [magnocellular part] - Increases flexor tone in the UPPER EXTREMITIES FLEXION!!!!!

600.

Where is the Second-order neuron body for the Spinothalamic tract Where is the substantia nigra located? Where is the Sympathetic system's Preganglionic Cell body located

Second-order neuron body is in: laminae I & 5 of the dorsal horn send axons that terminate in VPL of the thalamus.

601.

The substantia nigra is the largest nucleus in the midbrain. 1) Dark or black area is source of dopamine and GABA producing neurons.

602.

It's in the IML Intromedial Lateral Spinal Cord Preganglion Sympathetic NS cell bodies are in the CNS IML is at Spinal cord levels T1 - L2 / 3 For the eye we use T1

603.

Where will the UMN cell body be for the : Lateral Corticalspinal tract which innervates the right hand?

The UMN will be in the frontal lobe In the Left Precentral Gyrus Note the Lateral Cortical Spinal tract is in the Lateral White area ... tract - bundle of axons Medial in the Medulla Its paired The Axons come out to innervate skeletal muscle The left half of the tongue controls the left side of the tongue The right side of the tongue The LMN innervates ipsilateral skeletal muscle

604.

Where would the Cell body / nucleus be located for cranial nerve 12 ?

605.

Where would we look 1st if we had a problem w/ the gag reflex? Who fires the Glycinergic input that prevents a withdrawl reflex? Give an ex. of when we would need to fire this inhibitory neuron

Look at the Medulla Medulla houses 9,10,11, 12

606.

A higher center Something from the cortex We need these inhibitory neurons / boutons to be at the axon hillock Why would we want inhibition of the withdrawl reflex? Our baby is on fire - our hand wants to pull away b/c its hot but we need to save the baby. We input a major input of Glycine to inhibit the withdrawl reflex

607.

Who produces "Complex temporal firing patterns"

Networks of interneurons in the spinal cord: central pattern generators (e.g. rhythmic alternating activity - swimming, walking). Complex temporal firing patterns are produced by networks of interneurons in the spinal cord: central pattern generators (e.g. rhythmic alternating activity - swimming, walking).

608.

Why are upper cervical spinal cord injuries such a grave concern?

The phrenic nucleus, containing the motor neurons that innervate the diaphragm is located in the medial portion of the anterior horn in segments C3 to C5. Destruction of the descending pathways that control the phrenic nucleus and other respiratory motor neurons renders a patient unable to breathe

609.

With severe loss in bloodpressure can can see

Bilateral watershed infarcts in both the ACA-MCA & MCA-PCA watershed zones can occur w/ severe drops in systemic blood pressure. A sudden occlusion of an internal carotid artery or a drop in blood pressure in a patient w/ carotid stenosis can cause a watershed infarct since these vessels are both fed by the carotid
610.

Within this tract the second order neuron projects to the midbrain periaqueductal gray (PAG) which participates in central modulation of pain and the midbrain tectum which integrates somatic sensory information with vision and hearing to help orient body and head to stimuli.

Spinomesencephalic (spinotectal) tract

611.

You are told your diabetic patient is exhibiting features of Ataxic Hemiparesis: You recall that this lesion deals with the base of the pons. Whats the blood supply there? What symptoms are you expecting?

aka Ataxic Hemiparesis (ataxia same side as weakness). corticospinal tracts: contralateral leg, arm weakness (think it hasn't crossed yet) corticobulbar tracts: contralateral face weakness ("central seven") with dysarthria. abducens nerve ipsilateral paralysis of lateral rectus. pontine nuclei and pontocerebellar tract contralateral ataxia

612.

You obtain a facial LMN lesion What do you expect to see

IPSILATERAL Upper and Lower face paralysis Bells Palsy (herpetic facial paralysis) - facial nerve lesion (LMN) will cause ipsilateral total (upper and lower) face paralysis. If we lose the facial nerve we can't close the eye ... our eye will be OPEN Lesion is IPSI