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355 Cards in this Set
- Front
- Back
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name the cranial nn
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I Olfactory
II Optic III Oculomotor IV Trochlear V Trigeminal V1 Ophthalmic V2 Maxillary V3 Mandibular VI Abducens VII Facial VIII Vestibulocochlear IX Glossopharyngeal X Vagus XI Accessory XII Hypoglossal |
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name the types of afferents in cranial + spinal
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General somatic afferent (GSA)
Touch, pain, temperature, proprioception General visceral afferent (GVA) Chemo-, mechano- stretch reception from viscera Special afferent (SA) (ONLY IN CRANIAL NERVES) Special senses (olfaction, vision, hearing, taste, balance) ****Taste is best categorized as visceral afferent when interpreting brain stem anatomy |
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name the types of efferents in cranial + spinal
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General somatic efferent (GSE)
Motor to skeletal muscle General visceral efferent (GVE) Motor to smooth muscle, glands and cardiac muscle Branchial efferent (BE) (ONLY IN CRANIAL NERVES) Motor to skeletal muscle derived from pharyngeal arch mesoderm |
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name the 3 nn that special afferent (SA) only
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I Olfactory
II Optic VIII Vestibulocochlear |
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name the 4 nn that are efferent only
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III Oculomotor (GSE, GVE)
IV Trochlear (GSE) VI Abducens (GSE) XII Hypoglossal (GSE) |
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Pharyngeal arch nerves
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GVA, GSA, SVA, GVE, and BE
V Trigeminal (arch 1) VII Facial (arch 2) IX Glossopharyngeal (arch 3) X Vagus, superior laryngeal (arch 4) X Vagus, recurrent laryngeal (arch 6) XI Accessory BE |
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Pharyngeal =
BE = |
branchial
GSE in branchial arches |
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match the pharyngeal arch to its nerve
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which part of the brain are the following nn associated?
CN I – CN II – CNs III & IV – CNs V-VIII - CN IX-XII - |
CN I – Telencephalon
CN II – Diencephalon CNs III & IV – Mesencephalon CNs V-VIII - Metencephalon CN IX-XII - Myelencephalon |
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what are the 2 exceptions of this rule:
A given nucleus generally contributes to only one nerve |
both involve vagus)
Nucleus of the Solitary Tract: VII, IX and X Nucleus ambiguus: IX and X |
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name the nuclei of CN III
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all efferent (all efferent nerves are factors of 12---3, 4, 6, 12)
Oculomotor nucleus: motor to MR, IR, SR, IO and levator palpebrae (SOMATIC EFFERENT) Edinger-Westphal nucleus: parasympathetics to eye, constrict pupil and accommodate lens (VISCERAL EFFERENT) |
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____ is the most ‘diffuse’ cranial nerve nuclei, because no matter what level of the brainstem you section, you will see some nucleus of it
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CN V (trigeminal)
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where is the motor trigeminal nucleus and the main sensory nucleus?
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motor trigeminal nucleus is located in the mid-pons,
The best landmark is trigeminal nerve fibers running through the middle cerebellar peduncles. The fibers appear as a hand gripping a pale egg. The pale egg is the motor nucleus. |
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One of the nuclei of the trigeminal nerve
The spinal nucleus of V is easiest to see in the caudal medulla, although it extends throughout the entire medulla. The adjacent spinal tract of V: pain afferents before they synapse. For facial pain, temp, itch. |
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one of the nuclei of the trigeminal nerve
The mesencephalic nucleus is a thin ribbon of cells that runs along the fourth ventricle and cerebral aqueduct, just outside the periaqueductal grey. Has cell bodies of stretch receptors for jaw proprioception, |
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The abducens nucleus along with the internal genu of the facial nerve make up the ________, a hump at the caudal end of the medial eminence on the dorsal aspect of the pons.
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facial colliculus
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the nuclei of the facial nerve?
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SVE: Motor to muscles of facial expression and stapedius (Facial nucleus)
GVE: parasympathetics to submandibular and sublingual via chorda tympani (superior salivary) SSA: taste from anterior 2/3 of tongue (nucleus of the solitary tract, rostral) GSA: sensory from outer ear (spinal trigeminal) |
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what does the facial nerve wrap around?
what's the two bumps called? what section is this? |
Facial Genu: from nucleus, nerve wraps around the ABDUCENS nucleus
-the ‘bump’ is the Facial Colliculus the pons |
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what's the intermediate nerve?
what does it carry? |
distinct root of CN VII, sometimes referred to as the
“sensory root” despite having a visceral motor component (everything but somatic motor..) carries: -parasymp -GVA from ear -SVA from tongue |
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name the 2 nuclei here?
they both happen to carry what kind of info? |
vestibular + cochlear
(carry special sensory) Cochlear nucleus: - Special sensory - from organ of Corti - Hearing Vestibular nucleus: - Special sensory from semicircular ducts and macculae of utricle and saccule - Balance and acceleration |
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name the 4 nuclei of glossopharyngeal (CN IV) (medial to lateral)
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okay
BRACHIAL MOTOR: Nucleus ambiguus: - to stylopharyngeous VISCERAL MOTOR: Inferior salivary nucleus: - parasympathetics parotid gland - via otic ganglion SPECIAL VISCERAL SENSORY: Nucleus of solitary tract: - taste from post 1/3 of tongue - via sup. ganglion of GP nerve SOMATIC AFFERENTS: Spinal trigeminal nucleus: ear, pharynx - via sup. and inf. ganglia of GP nerve |
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nuclei of CN X? (4)
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BRACHIAL MOTOR
Nucleus Ambiguus: Pharynx and larynx VISCERAL EFFERENT Dorsal Motor Nucleus of Vagus: Parasympathetics viscera (heart, bronchi, gut) above left colic flexure VISCERAL SENSORY Nucleus of the Solitary Tract Caudal part: visceral sensory, such as gut distension Rostral part of nucleus for taste from pharynx SOMATIC SENSORY Spinal Trigeminal Nucleus: Outer ear |
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where is the Accessory spinal nucleus:
what info does it carry and what muscles does it innervate |
- spinal cord (C1-C5)
- branchial motor - to trapezius and sternocleidomastoid |
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hypoglossal nucleus
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motor to tongue muscles
The nerve arises from the hypoglossal nucleus and emerges from the medulla oblongata in the preolivary sulcus separating the olive and the pyramid. It then passes through the hypoglossal canal. |
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nuclei of the parasymps?
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Lens and pupil
Edi-Westphal and CN III Lacrimal, submandibular, and sublingual glands superior salivatory nucleus and CN VII – nervus intermedius Otic ganglion to parotid gland inferior salivatory nucleus and CN IX Thoracic viscera, foregut and midgut dorsal motor nucleus of the vagus and CN X |
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nerve dist of tounge
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from VII (taste ant. 2/3 tongue) via geniculate ganglion and chorda tympani
from IX (taste post. 1/3) via petrosal ganglion from X (taste epiglottis/tongue) via nodose ganglion |
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what nucleus is responsible?
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nucleus ambiguous
Pharyngeal Elevators NA helping coordinate gag reflex? |
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summary of all nerves
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EASY
CN I & II…don’t even count CN IV: motor only, (trochelar n.) CN VI: motor only, (abducens n.) CN XII: motor only, (hypoglossal n.) MEDIUM CN III has motor (occulomotor n.) and carries parasympathetics to eye (Edinger-Westphal n.) CN VIII: sensory only (vestibular n. & cochlear n.) CN XI: motor only, (cervical (C1-C5) & nucleus ambiguus) HARD CN V: sensory (spinal trigeminal n., main sensory n., mesencephalic n. ) and motor (motor trigeminal n.) CN VII: motor (facial n.), sensory (N. of solitary tract) and parasympathetics (superior salivary n.), remember that the nervus intermedius carries the sensory portion of CN VII. CN IV: sensory (N. of solitary tract), motor (N. ambiguus) and parasympathetics (inferior salivary n.) CN X: sensory (N. of solitary tract), motor (N. ambiguus) and parasympathetics (dorsal n. of X) |
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all cranial nerves are ventral except
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trochlear
(its the only one that decussates too) |
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name the part of the brain each cranial nerve leaves from
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four locations….
Supratentorial 2 nerves: Olfactory and Optic Within this you have 1 in the telencephalon and 1 in diencephalon Midbrain 2 nerves: Oculomotor and trochlear Pons 4 nerves: Trigem, Abducens, Facial, Vestibulocochlear Medulla 4 nerves: Glossopharyngeal, Vagus, Accessory, Hypoglossal So moving caudally, it is 2,2,4,4 |
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Solitary nucleus is Sensory (visceral)
which nerves ? aMbiguus is Motor. which nerves? |
7,9,10
9,10 |
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you know about the 2, 2, 4, 4, rule right?
why is this rule not perfect? |
5, 7, 8 aren't so clean
5) although all divisions of CN5 enter the pons, the sensory nucleus of CN5 extends from the midbrain to spinal cord 7) 7 is both in pons and medulla 8) 8 is in pons and medulla |
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CN11 is a social climber and really not a cranial nerve....it's a spinal nerve which creeps through the foramne magnum, touches the ______ and comes back down again via the jugular foramen
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vagus
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which CN exits anterior/ventral to the inf olive?
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12 (motor to tongue)
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All the nuclei except that of the _____ nerve supply nerves of the IPSILATERAL side of the body.
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trochlear
(only one that decussates) |
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For ______ fibers, the cell bodies are in the nuclei themselves, and synapse on a LMN
--No ganglia, just cell bodies in nucleus For _______ fibers, the cell bodies are in a ganglion, a peripheral structure Ex: VIII. The ganglia are Scarpa’s and spiral g. BUT, the nuclei are vestibular and cochlear n. So, do have associated CN nuclei, but cell bodies are sitting in periphery, in ganglia |
MOTOR
SENSORY |
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Questions to classify CN types
Is it motor (E, efferent) or sensory (A, afferent)? Innervate structures from somites (somatic) or brachial arch derivatives (visceral)? Is it simple (G, general) or complex (S, special)? What are the possibilities? |
- GSA
- GVA - GVE - GSE - SSA (vision and hearing) - SVA (taste and smell) - SVE (branchial cleft muscles) - no such thing as SSE… |
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draw coordination pathway between CN III and VI
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INO think MLF think MS!
Lesion in medial longitudinal fasiculus (MLF) Produces a medial rectus palsy with lateral gaze. Lesion is in which side? Nystagmus is in which eye? The one that abducts, LEFT How’s convergence? Intact (b/c nothing wrong w/ CNIII or MR) |
Lesion is in which side?
RIGHT Nystagmus is in which eye? The one that abducts, LEFT How’s convergence? Intact (b/c nothing wrong w/ CNIII or MR) |
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name all the nuclei of V:
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SVE: motor to muscles of mastication & tensor tympani (motor trigeminal nucleus)
GSA: --light touch & proprioception for face (main sensory nucleus of trigeminal) --Pain & temperature (spinal trigeminal nucleus) --Jaw proprioception (mesencephalic nucleus, actually contains cell bodies…so more like a ganglion than a nuclei) |
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what's the nucleus?
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spinal trigeminal--pain, temp of face
one of the 4 nuclei of trigeminal along with: motor trigeminal nucleus main sensory of the trigeminal mesencephalic |
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TRIGEMINAL's relationship with DC-ML and STT:
Light touch & prorioception: CNV to ______ nucleus decussates (mostly) and travels up to the ________of the thalamus via the medial lemniscus -we can toss mesencephalic nucleus in here as well since it deals with proprioception as well -Pain & temperature: CNV to ______ nucleus (& tract), decussates and travels up to the VPM of the thalamus via the anterolateral system Remember: VPM & VPL are in the thalamus. VPM is for the HEAD VPL is for the BODY |
main sensory
VPM spinal trigeminal VPM |
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ID this lesion....
UMN or LMN? |
LMN (lose ipsilateral face, both upper and lower)
w/ UMN lesion, you lose contralateral lower face |
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nuclei of CN VIII?
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VIII – Vestibulocochlear
SSA: sound from cochlea (cochlear, cell body in spiral ganglion) SSA: balance information from semicircular canals, utricle and saccule (vestibular, cell body in scarpa’s ganglion) Don’t memorize the ganglion…I just wanted to remind you that the sensory cell bodies are in ganglions, NOT the nucleus |
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what's the deal with CN 8?
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Cochlear
Actually 2 Nuclei with 3 divisions ----Dorsal: vertical sound localization. Fibers to inferior colliculus Ventral ----Anteroventral: horizontal sound localization. Bilateral projection to superior olivary complex ----Posteroventral: hair cell sensitivity. Bilateral projection to superior olivary complex Vestibular Actually 4 Nuclei Lateral: deals with posture and balance Medial: deals with head movements Superior: helps orient eye movements (via abducens nucleus) Inferior |
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XI - Spinal accessory
GSE: motor to _______ and ______ Actually has 2 components Spinal, which make up most of the fibers. Originates in the cervical spinal cord (spinal accessory nucleus) The spinal part actually is the only nerve to enter the skull from outside and then leave again! Convoluted Path: Start in cervical cord--> enter skull via foramen magnum -->travel in vicinity of medullary CNs --> leave via jugular foramen Cranial, with very few fibers (nucleus ambiguus) |
sternocleidomastoid, trapezius
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what nerves go through the nucleus of the solitary tract?
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solitary= 1=>carry 1 sense which is TASTE!!
VII: anterior 2/3 of tongue (chorda tympani) via geniculate ganglion IX: posterior 1/3 of tongue via petrosal ganglion X: epiglottis via nodose ganglion ** tract is inside the nucleus |
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what nerves go through the nucleus of the solitary tract?
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solitary= 1=>carry 1 sense which is TASTE!!
VII: anterior 2/3 of tongue (chorda tympani) via geniculate ganglion IX: posterior 1/3 of tongue via petrosal ganglion X: epiglottis via nodose ganglion ** tract is inside the nucleus |
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what nerves go through the nucleus of the solitary tract?
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solitary= 1=>carry 1 sense which is TASTE!!
VII: anterior 2/3 of tongue (chorda tympani) via geniculate ganglion IX: posterior 1/3 of tongue via petrosal ganglion X: epiglottis via nodose ganglion ** tract is inside the nucleus |
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nucleus ambiguus has motor to what muscles?
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Motor to pharynx, larynx and esophageal mm
(nerves 9, 10) |
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name all the parasympathetic nuclei?
4 of them |
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Superior colliculus: important in orienting head & eyes
Ganglion cells --> brachium of superior colliculus -->_______ -->thalamus --> cortex (visual) Inferior colliculus: important in _______ Cochlear nuclei/superior olive -->inferior colliculus --> brachium of inferior colliculus --> ____ (of thalamus) |
superior colliculus
sound localization MGN |
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label!
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Gag reflex
Touching back of oropharynx, causes gagging or reflex elevation of pharynx Usually stated that IX is afferent limb of reflex and X is efferent limb, but . . . Lesion of IX does not eliminate it; X must also innervate back of oropharynx. |
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you can see all the peduncles in the caudal pons
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neocortex:
6 layers Allocortex how many layers? Comes in 2 main types: Archicortex (3 layers): hippocampus and dentate gyrus Paleocortex: amygdala and olfactory cortex |
less than 6
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what's the main output layer?
(biggest for the primary motor cortex) input layer? |
4-input
5-main output I: nothing much here II: output III: output IV: input (thin in primary motor cortex, THICK in primary sensory cortex) V: main output (THICK in primary motor cortex, THIN in primary sensory cortex) VI: output |
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tentorium cerebelli is?
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extension of the dura mater that separates the cerebellum from the inferior portion of the occipital lobes.
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faux cerebri goes bw the?
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descends vertically in the longitudinal fissure between the cerebral hemispheres.
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The pituitary gland lies between the two paired ___________
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cavernous sinuses.
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An abnormally growing pituitary adenoma, sitting on the bony sella turcica, will expand in the direction of least resistance and eventually compress the ________
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cavernous sinus
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where's the sensory loss of axillary nerve damage?
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regiment's patch
- loss of sensation on lateral shoulder - superior lateral cutaneous n. of arm |
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Meninges is from _____except for those of the prosencephalon which come from ________
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mesoderm
neural crest |
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In cross-section, the peripheral region of the cord contains neuronal white matter ______containing sensory and motor neurons. Internal to this peripheral region is the gray, butterfly shaped central region made up of ________
. This central region surrounds the central canal, which is an anatomic extension of the spaces in the brain known as the ______ and, like the ventricles, contains ______. |
tracts
nerve cell bodies. ventricles cerebrospinal fluid. |
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the brain consists of what 3 components
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cerebrum (cerebral hemispheres + the diencephalon)
brainstem (midbrain, pons, medulla) cerebellum |
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brain classified into what 6 postembryonic divisions
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telencephalon
diencephalon mesencephalon pons medulla oblongata cerebellum |
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telencephalon consists of the
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CEREBRAL HEMISPHERES (which comprises both cerebral cortex and white matter...the cerebral hemispheres contain the lateral ventricles)
BASAL GANGLIA |
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the cerebral hemispheres are interconnected by the
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CORPUS CALLOSUM
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the cerebral hemispheres contain 6 lobes. name them
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frontal
parietal temporal occipital insula limbic |
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name the gyri of the frontal lobe
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precentral gyrus
superior frontal gyrus middle frontal gyrus inferior frontal gyrus gyrus rectus and orbital gyri anterior paracentral lobule |
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name the gyri of the parietal lobe
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postcentral gyurs
superior parietal lobule interior parital lobule (= supramarginal gyrus + angular gyrus) precuneus posterior paracentral lobule |
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name the gyri of the temporal lobe
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transverse temporal tyri of Heschl
superior temporal gyrus middle temporal gyrus inferior temporal gyrus lateral occipitotemporal gyrus |
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gyri of occipital lobe
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cuneus
lingual gyrus |
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the insular lobe lies buried wi the ___________
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lateral sulcus
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basal ganglia are the ___________ of the telencephalon
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subcortical nuclei
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basal ganglia includes the
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caudate nucleus
putamen globus pallidus amygdaloid nuclear complex (amygdala) |
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telencephalon consists of:
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cerebral hemispheres
basal ganglia lateral ventricles cerebral cortex white matter |
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corticospinal tract damage commonly caused by_____
what can happen? |
interruption of the blood supply to the internal capsule
arm muscle weakness and impaired fine motor skills |
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the reticular formation forms the central core of the_____ has neurons with widespread connections
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brain stem
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on the dorsal brain stem surface, there are
(4) landmarks |
dorsal columns
dorsal column tubercles 4th ventricle colliculi |
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the _____ are 4 bumps in the dorsal midbrain
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colliculi
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name 4 landmarks on ventral surface of brainstem
all 4 of these landmarks of are compenents of the _________ system |
pyramids
olives base of the bons basis pedunculi motor |
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bc of the ________decussation, one side of the brain controls muscles of the opp side of the body
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pyramidal
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recieving input from all the sensory modalities, neurons of the reticular formation can affect
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neuronal excitability
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the inferior olivary nucleus contains neurons whose axons project to the _______, where they form one of the strongest excitatory synapes in the entire central nervous system
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cerebellum
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the central canal of the spinal cord expands to form the _____ in the ______
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4th ventricle
rostral medulla |
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the (4th) ventricular floor is formed by the __________
the roof consists of a thin tissue formed by the apposition of 2 glial layers during development: ______ and _____ |
dorsal medulla
pia & ependyma |
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The superior sagittal sinus sits in the_____________ (superiorly) and the inferior sagittal sinus runs through the inferior part of the falx cerebri.
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falx cerebri
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what's the other name of the central fissure?
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Rolandic fissure.
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the central sulcus separates the_____ and______ lobes
and primary ________ cortex from primary _____cortex |
frontal and parietal
somatosensory, motor |
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what's in the longitudinal/saggital fissure?
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The falx cerebri, the superior sagittal sinus, and the inferior sagittal sinus
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The frontal lobe lies _______ to the Sylvian Fissure.
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anterior/rostral
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cuneatus: upper limbs
_______: lower limbs |
gracilis
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where's the superior colliculus?
and what does it do? |
A portion of the optic tract projects directly to superior colliculus. It also receives somatic sensory and auditory input. These convergent inputs from different sensory systems are important for orienting eye and head movements to stimuli in the environment.
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_________are involved in the limbic system (part of Papez circuit).
-It is involved in memory, along with other structures. -Of note, from a pathological perspective, it can be severely damaged in those with alcohol abuse (secondary to thiamine deficiency), called Wernicke-Korsakoff syndrome. |
mamillary bodies
The mammillary bodies are a pair of small round bodies, located on the ventral surface of the brain at the posterior end of the hypothalamus, that form part of the limbic system (part of the Papez circuit). They are located at the ends of the anterior arches of the fornix. |
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why is the uncus important?
where is it? |
the uncus is a very important structure because of its location spatially within the brain. When pressure builds up in the brain (secondary to mass effect from a rapidly growing lesion, acute hydrocephalus, an acute bleed, generalized brain edema, etc.), this structure can herniate (be pushed down).
temporal lobe |
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CNXI originates in the __________ and is purely a motor nerve fiber. It controls muscles in the neck and shoulders (sternocleidomastoid and trapezius, respectively) and some of the muscles in the throat involved in swallowing.
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medulla and cervical spinal cord
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____ is a portion of the diencephalon located lateral and ventral to the pineal gland. It is a part of a circuit with the midbrain medial dopaminergic and the serotonergic systems.
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habenula
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The ophthalmic and maxillary nerves are purely ______. The mandibular nerve has both sensory and motor functions.
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sensory
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where and what is the tuber cinereum?
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tuber cinereum is a hollow eminence of gray matter situated between the mammilary bodies and the optic chiasm and is a part of the hypothalamus.
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the tuber cinereum is continuous with a thin lamina, the ________
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lamina terminalis
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The______projects from the tuber cinereum.
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infundibulum aka pituitary stalk
A small outgrowth of the ventral wall of the embryonic brain from which the pars nervosa (the posterior lobe) of the pituitary gland develops is also called the infundibulum. infundibulum is composed of infundibular stem (curved arrow), median eminence of hypothalamus, from which it arises, and pars tuberalis (straight arrow). |
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On head CT what often appears as a hyperdensity (due to the calcium)?
should not be confused with real pathology. |
pineal gland
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Axons of______ ganglion cells exit the eye as CN II.
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retinal
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The _______cerebellar peduncle is the major output (efferent) pathway of the cerebellum.
Most of the efferent fibers originate within the dentate nucleus of the cerebellum and project to various midbrain structures (including the red nucleus), the ventral lateral/ventral anterior nucleus of the thalamus, and the medulla. |
superior
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The middle cerebellar peduncle is composed entirely of_______(input to cerebellum) fibers originating within the pontine nuclei and is part of a pathway that begins in sensory and motor cortex, goes through pons and enters the cerebellum via the middle cerebellar peduncles. These fibers make the middle cerebellar peduncle the largest of the three cerebellar peduncles.
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afferent
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The ________cerebellar peduncle carries both input and output fibers involved in integrating proprioceptive sensory input with motor and vestibular functions such as maintanance of posture and balance. Proprioceptive information is relayed to the cerebellum through the inferior peduncle from the dorsal spinocerebellar tracts.
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inferior
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the pneumonic LR6 SO4 (I think of the anion SO4 -- sulfate).
refers to what? |
Lateral rectus is innervated by VI, superior oblique by IV. The rest of the extraocular muscles are under the motor control of III.
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______is an elevated area located on the dorsal pons that is formed by motor fibers of the facial nerve as they loop over the abducens nucleus. The facial nerve (CN VII) controls the muscles of facial expression.
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facial colliculus
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_______is where the fourth ventricle narrows to become the central canal of the spinal cord (in the caudal medulla). The decussation of dorsal column fibers occurs at the level of the obex.
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obex
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The ________ colliculus is a part of the auditory pathway and is important in sound localization.
1) Ascending fibers from the ipsilateral and contralateral nuclei of the lateral lemniscus synapse in the inferior colliculus as well as 2) contralateral inputs from the dorsal cochlear nucleus and 3) ipsilateral and contralateral inputs from the superior olivary nuclei. All these convergent inputs are important for sound localization. |
inferior
The lateral lemniscus is a tract of axons in the brainstem that carries information about sound from the cochlear nucleus to various brainstem nuclei and ultimately the contralateral inferior colliculus of the midbrain. Three distinct, primarily inhibitory, cellular groups are located interspersed within these fibers, and are thus named the nuclei of the lateral lemniscus. |
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The ______ relays information between the cerebellum and cortex, aids in relaying sensory and motor information, and regulates respiration.
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pons
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brachium of the ______connects the ______ with the ______ geniculate nucleus. This pathway is part of the auditory system
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inferior colliculus
inferior colliculus medial |
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The _______is a small lobe of the cerebellum. It is associated with the nodulus of the vermis, and together, these two structures compose the vestibular part of the cerebellum.
The flocculus receives input from the ________ system and regulates balance. Also, many floccular projections descend to the spinal cord and connect to the motor nuclei involved in control of _______ |
flocculus
vestibular eye movement |
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Dorsal cell types are ______ - need notochord to induce ventral cell types
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default
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nerve fibers are_________
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specialized
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1 “muscle” generally = how many nuclei?
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1
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the components of the intermediate gray matter
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-Lateral horn
-sacral parasym nucleus (S2-S4) -The remainder - variety of sensory interneurons and projection neurons |
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Long ascending fibers project to (3)
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thalamus, cerebellum and brain stem
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Long descending fibers project from (2)
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cerebral cortex and brainstem
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Medial Lemniscus (in Medulla)
is where fibers of secondary neurons in medulla ______ and then project to ____ |
dessucate
- project to thalamus |
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COW
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bw dura and arachnoid, there is always
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potential space
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how are subdural hematomas caused?
|
blow to front or back of skull shears off cerebral veins as they enter superior sagittal sinus
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identify each color
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Tentorium cerebelli: divides the brain into the (rostral) ________spaces and the (caudal) ______ space, or posterior fossa
Falx cerebri: divides the ___________space itself into the left and right sides |
supratentorial
infratentorial supratentorial |
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the arachnoid and pia together are referred to as
|
leptomeninges
|
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name the 3 primary brain vesicles?
now name the secondary brain vesicles from each? now name the walls of each? the cavities of each? DRAW IT OUT! |
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name the imp subarachnoid cisterna?
(3) |
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name all the paired structures you see in the dorsal brainstem
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colliculi (2 sets, paired), cerebellar peduncles (3 sets, paired)
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where's the straight gyrus?
(=gyrus recti) |
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name components of basal ganglion
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caudate nucleus
globus pallidus +putamen (= lenticulate nucleus) claustrum, amygdala |
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pons lies against the _______, part of the cranium..."slides" down into the foramen magnum
sometimes the brainstem can herniate into the foramen magnum by sliding over this structure |
clivus
|
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where is the largest subarachnoid cistern?
|
lumbar cistern (bw verebrae L2 and S2)
|
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the _______ is the narrow zone of a funnel of motor and sensory fibers that converge upon the brain stem from the cerebral cortex
|
internal capsule
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in general, cerebral lesions tend to cause contralateral malfunctioning, whereas ________lesions cause ipsilateral malfunctioning
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cerebellar? check
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3 main connections bw the cerebellum and the brain stem?
|
superior, middle, and inferior cerebellar peduncles
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the spinocerebellar pathway enter the cerebellum via the ____ and _____ peduncles
|
superior and inferiour cerebellar peduncles
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most lateral to medial.
start at Sylvian Fissure; note the basic organization: alternating between gray matter and white matter. insula (gray matter, cortex) extreme capsule (white matter) claustrum (gray matter) external capsule (white matter) putamen -> GPe -> GPi (gray, together are lenticular n.) internal capsule (white matter) thalamus (gray matter) thalamic adhesion (crosses midline) |
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red: putamen
green: nucleus accumbens blue: caudate nucleus yellow: internal capsule |
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where is the substantia nigra located?
what's just ventral to it? |
midbrain
cerebral peduncle is just ventral to the substantia nigra, however, they are NOT part of the basal ganglia. |
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The triangular structure (forever remember these three structures together) is the lenticular nucleus. Some anatomist thought a triangle looked like a lentil. This nucleus is made of the putamen and the two parts of the globus pallidus (internal and external components). The yellow dot is in the middle structure, which is the GPexternus. More medial to it (or more 'internal' to the brain) is the GPinternus. The putamen makes up the big lateral edge of the triangle, and is not specifically labeled in this picture. While the caudate and thalamus are ALSO part of the functions of the basal ganglia, they are more medial to the internal capsule and not part of the 'triangle.' The insular cortex, or insula, is the most lateral structure of gray matter on the cortical surface between the frontal/parietal and temporal lobe. Note the structures dotted with red, and see how they form a triangular shaped region of gray matter
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what is this? what does it do?
|
THALAMIC RETICULAR NUCLEUS (TRN).
modulates the output of the thalamus according to alertness levels receives input from the brainstem reticular formation regulates the output of thalamic relay nuclei sends exclusively inhibitory outputs to thalamic relay nuclei It regulates the output of thalamic relay nuclei by inhibiting neurons within thalamic relay nuclei like the LGN or VL. The TRN receives input from the brainstem reticular formation, which is involved in controlling states of awareness. The TRN therefore shuts down relay nuclei (puts them into "burst mode") when the brainstem reticular formation signals "sleep," and puts the relay nuclei in "tonic mode" where it can relay information faithfully when the brainstem reticular formation is signalling "awake." The thalamic relay nuclei derive from the middle portion of the embroyonic diencephalon. The TRN derives from a different portion of the embroyonic diencephalon, the VENTRAL portion (not dorsal portion) of the embroyonic diencephalon. Ventrolateral nucleus (VL) relays cerebellar inputs to cortex. The fornix connects hippocampus to mamillary body. The LGN is the bent structure at the caudal pole of the thalamus and relays visual information to the cortex. |
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tell me about anterior nucleus, lateral genticulate, ventral posterior lateral (VPL) and VPM.
|
1) ANTERIOR NUCLEUS is a relay nucleus that receives input from the mamillary bodies via the mamillo-thalamic tract.
2) The LATERAL GENTICULATE nucleus is the primary relay nucleus for the visual system. 3) The Ventral Posterior Lateral nucleus (VPL) is the primary relay nucleus of the somatosensory system, receiving input from the body portions of the medial leminscus and anterolateral system. 4) VPM receives somatosensory information from the head. The subthalamic nucleus is in the diencephalon, but not in the thalamus. It is associated with the basal ganglia. The amygdala is not in the diencephalon and is a structure associated with the limbic system. The mamillary bodies hang off the posterior part of the hypothalamus, are not part of the thalamus, and are connected to the hippocampus through the fornix. The pineal gland is part of the epithalamus (not the thalamus). It secretes melatonin. |
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what's the Papez circuit?
|
cingulate gyrus-->hippocampal formation-->(fornix)-->mamillary bodies-->(mamillothalamic tract)-->thalamus (anterior thalamic nuclei)-->cingulate gyrus
|
|
|
what's the disorder?
Characterized by visual agnosia, oral or tactile exploratory behavior, hypersexuality, bulimia, memory loss. Caused by bilateral temporal damage (trauma, infection, Alzheimer’s disease, cerebrovascular disease). |
KlüverBucy Syndrome
|
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You have the basic Papez circuit down. What are the additions? (include the amygdala, association cortex, prefontal cortex, hypothalamus)
|
(bold= Papez addition)
|
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The_______________ is devoted mainly to motivation, emotion and memory; it is located on the medial and inferior surfaces of the cerebral hemispheres in portions of the parietal temporal and frontal lobes.
|
limbic association cortex
|
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what are the 4 areas of the limbic association cortex?
|
- located on the medial surface of the cerebral cortex (temporal, parietal and frontal lobes).
consists of four areas -cingulate -parahippocampal -medial orbital -temporal pole |
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the limbic association cortex gets input from
output to? |
input from the higher order sensory areas of the cortex and the two other association cortices
output to hippocampal formation and amygdala. |
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the hippocampal formation gets input from _________
consists of 3 components: |
entorhinal cortex (part of the parahippocampal gyrus)
3 components: dentate gyrus hippocampus proper subiculum The entorhinal cortex (EC) is an important memory center in the brain. The EC forms the main input to the hippocampus and is responsible for the pre-processing (familiarity) of the input signals. |
|
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nuclei of the amygdala?
|
basolaterel
central corticomedial Central nucleus Input: brainstem Output: hypothalamus, autonomic nuclei (in brainstem) Basolateral nucleus CONCEPT: reciprocal cortico-cortical Back and forth between hippocampus medial-dorsal nuc of thalamus cortex (a lot in frontal lobe) Corticomedial nucleus Back and forth between olfactory Back and forth with hypothalamus via stria terminalis **note that basolateral has nothing to do with hypothalamus, olfaction |
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what nucleus of the amygdala is described?
Attach emotional significance to a stimulus. Learning the emotional significance of complex stimuli. Behavioral responses to emotional stimuli (via the central nucleus). |
Basolateral nucleus
|
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what nucleus of the amygdala is described?
Behavioral responses to emotional stimuli. - Direct and indirect (via hypothalamus) regulation of the autonomic nervous system. |
central nucleus
|
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what nucleus of the amygdala is described?
Regulates behaviors triggered by olfactory stimuli (via hypothalamus). |
corticomedial nucleus
|
|
zones of the hypothalamus?
|
Periventricular: Release of endocrine hormones from the anterior Pituitary
Middle: Release of endocrine hormones from the posterior Pituitary Lateral: Integrates information from the limbic system |
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nuclei of the hypothalamus...
|
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name the tract (1 of 7 of the limbic system:
Cortical axons in the cingulate and parahippocampal gyri that terminate in the entorhinal cortex. |
cingulum
|
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fornix tract: axons from pyramidal neurons in _________ and ________
that terminate in _________ |
hippocampus & subiculum
mamillary body |
|
label #3
It's one of the main output pathways of the amygdala, consists of axons from corticomedial nucleus of the amygdala that terminate in the _______ |
3) Stria terminalis:
thalamus |
|
label 4
it's one of the tracts of the limbic system Ventral amygdalofugal pathway: one main output pathway of the amygdala, consists of axons from basolateral and central nuclei of the amygdala that terminate in the ______, ______, and _________ |
ventral amygdalofugal pathway
thalamus, association cortex and dorsal motor nucleus of the vagus. |
|
what's the tract?
from ______ to the ________ nucleus of the ______ |
mamillothalamic tract
mamillary body to anterior nucleus of the thalamus |
|
name the tracts
|
6. Dorsal longitudinal fasciculus
7. Medial forebrain bundle: Both include hypothalamic axons that terminate in the brainstem. |
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The ________ (of the cerebellum) receives input from the vestibular system and regulates balance. Also, many floccular projections descend to the spinal cord and connect to the motor nuclei involved in control of eye movement.
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flocculus
|
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THALAMIC RETICULAR NUCLEUS (TRN) regulates the output of thalamic relay nuclei through inhibitory outputs that can suppress the activity of neurons within thalamic relay nuclei.
The TRN receives input from the _________, which is involved in controlling states of awareness. |
brainstem reticular formation
|
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the _________ of the dorsal thalamus receives input from the mamillary bodies through the mamillo-thalamic tract.
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Anterior nucleus
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The mamillary bodies hang off the _______ part of the hypothalamus
|
posterior
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in Papez's view, what leads to behavioral respone to the emotional state?
what's the current view? |
PAPEZ:
limbiccortex->hippocampus-> hypothalamus->behavioral response CURRENT VIEW: limbic cortex-->amygdala-->hypothalamus->behavioral response |
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match the component of the limbic system to the function; conscious feeling, memory, autonomic/endocrine/skeletomotor behavioral response
LIMBIC ASSOCIATION CORTEX |
conciousness
|
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|
match the component of the amygdala to the function; conscious feeling, memory, autonomic/endocrine/skeletomotor behavioral response
AMYGDALA |
autonomic/endocrine/skeletomotor behavioral response
(along with hypothalamus) |
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match the component of the limbic system to the function; conscious feeling, memory, autonomic/endocrine/skeletomotor behavioral response:
HIPPOCAMPAL FORMATION |
memory
|
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the hippocampus is involved in _____ memory
while the neocortex, striatum, amygdala, Cerebellum and reflex pathways are involved in _______ |
explicit
implicit |
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|
what's the mossy fiber pathway and the schaffer collateral pathway?
|
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after conditioning and testing...
1) would a person (with damage to hippocampus) remember colors shown? how about damaged amygdala? damage to both structures? 2) would person with damaged hippocampus show autonomic conditioned response? damaged amygdala? damaged both hippocampus + amgydala? |
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Cerebellar Peduncles
3 pairs Superior: _______ (out of cerebellum) only Middle: _______(into cerebellum) only Inferior: Both |
efferent
afferent |
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Caudal Medulla
1 Nucleus gracilis 2 Fasiculus cuneatus (remaining fibers) 3 Nucleus cuneatus 4 Spinal trigeminal tract 5 Spinal trigeminal nucleus 6 Spinothalamic tract (pain and temperature) 7 Corticospinal tract in the pyramids (volitional movement) 8 Medial lemniscus (light tough and proprioception) 9 Internal arcuate fibers (decussation of the DC-ML tract) |
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Rostral Medulla
Dorsal motor nucleus of vagus Fourth ventricle Hypoglossal nucleus Vestibular nuclei Inferior cerebellar peduncle (afferent from spinocerebellar tract, afferent from and efferent to inferior olive and vestibular nuclei…dealing with coordination/balance) Spinothalamic tract Corticospinal tract (pyramids) Medial Lemniscus (DC-ML) Inferior olive Spinal trigeminal nucleus Nucleus of the Solitary tract and the solitary tract (pointing to the dotted line) Sulcus limitans |
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Pons
2. Inferior cerebellar peduncles 3. Facial nerve 4. Facial nucleus 6. Corticospinal tract (and some other stuff) 8. Medial lemniscus 9. Spinocerebellar tract 11. Abducens nucleus 12. Fourth ventricle |
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Midbrain
Cerebral aqueduct Periaqueductal gray Superior colliculus Brachium of the inferior colliculus Anteriolateral system (spinothalamic) Medial lemniscus Cerebral peduncle (corticospinal) Substantia nigra Medial longitudinal fasciculus (MLF) Superior cerebellar peduncle |
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t/f
pia is HIGHLY vascular arachnoid is AVASCULAR |
true
|
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2 of the 5 intracranial hematomas:
Intraparenchymal: often tumors/lesions bleed into brain tissue, esp. basal ganglia and internal capsule. Commonly caused by __________ Intraventricular: blood into the ventricles, often in premature neonates |
hypertension
|
|
the 5 types of intracranial hematomas
name them |
epidural
subdural subarachnoid intraparenchymal intraventricular |
|
what's in these layers?
|
I: nothing much here
II: output III: output IV: input (thin in primary motor cortex, THICK in primary sensory cortex) V: main output (THICK in primary motor cortex, THIN in primary sensory cortex) VI: output What is the output anyway? 3 types: Coritococortical neurons, callosal neurons, descending projection neurons |
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in which lobes are the Wernick's and Broca's areas?
|
Broca: frontal
Wernick's: temporal |
|
do you see the taco?
label |
1 is the septum pellucidum
3 is the Internal Capsule 2 is caudate, 4 is putamen, 5 is globus pallidus, -remember, it is 2 parts!!! 6 is nucleus accumbens |
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name some primary relay nuclei of the thalamus
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where does the structure (encircled by the orange) get its input?
output? |
this is the anterior nucleus of the thalamus
PAPEZ!!! input from mamillary bodies, output to cingulate gyrus |
|
MID-THALAMUS:
what's the orange? blue? |
orange: VentroLateral
blue: DorsoMedial VL = Cerebellum DM= Prefrontal Ctx Limbic Ctx -higher order |
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caudal thalamus!
(now we see the ventromedial nucleus...for the face) |
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Posterior thalamus
|
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|
what can you see in the most posterior parts of the thalamus?
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The ______ and __________ are highly connected (by the stria terminalis) and both can affect the endocrine system (e.g., via hypothalamus => pituitary) and autonomic system (e.g., via amygdala => dorsal motor nucleus of the vagus).
|
amygdala + hypothalamus
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|
components of CSF circulation in the brain?
|
ventricles
subarachnoid space (inc cisterns) |
|
|
middle meningeal artery comes from
|
external carotid-->maxillary artery-->middle meningeal
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basilar artery gives rise to what
|
so 2 vetebrals (coming from the subclavian artery??) join to form the BASILAR
BASILAR gives POSTERIOR CEREBRAL and POSTERIOR COMMUNICATING |
|
|
internal carotid gives rise to what
|
the anterior cerebral artery (ACA) and middle cerebral artery (MCA)
|
|
|
the vetebral artery gives rise to
|
posterior inferior cerebeller....then both vetebral merge to form BASILAR
|
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|
choose from:
ACA: MCA: PCA: SCA: AICA: PICA: Medial aspect of hemispheres |
ACA
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|
|
choose from:
ACA: MCA: PCA: SCA: AICA: PICA: inf. cerebellum |
AICA (anterior inferior cerebellar)
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|
|
choose from:
ACA: MCA: PCA: SCA: AICA: PICA: lateral hemispheres and BG structures, internal capsule |
MCA
|
|
|
choose from:
ACA: MCA: PCA: SCA: AICA: PICA: cerebellar hemispheres |
SCA
|
|
|
choose from:
ACA: MCA: PCA: SCA: AICA: PICA: midbrain, thalamus, occipital lobe |
PCA
|
|
|
choose from:
ACA: MCA: PCA: SCA: AICA: PICA: cerebellum and medulla |
PICA
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Capillaries in the brain are ___________ endothelial cells and connected via gap junctions
|
unfenestrated
|
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|
what drains in dural venous sinuses?
all drain into? |
blood and CSF
IJV |
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|
Walls of the dural venous sinuses composed of __________ lined with _____________
how does it differ from other blood vessels? |
dura matter
endothelium lack the vessel wall layers (ie, no tunica media) |
|
|
the straight sinus connects what?
is it anterior or posterior? |
superior and inferior sagittal sinus
posterior |
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|
superior petrosal sinus --> _________sinus --> sphenoparietal sinus and ________vein
|
cavernous sinus
opthalmic vien |
|
|
the great cerebral vein (of Galen)
Drains from: _______ Drains to: _________ |
Drains from: internal cerebral veins
Drains to: straight sinus |
|
|
the __________houses the ICA after it enters the calvaria, as well as these cranial nerves
|
cavernous sinus
|
|
|
what's housed by the cavernous sinus?
|
ICA, cranial nerves
III (Oculomotor) IV (Trochlear) VI (Abducens) V1-Opthalmic V2-Maxillary |
|
|
the cavernous sinus is an entry of
|
infection
|
|
|
transverse sinus gives rise to sigmoid + _____
|
superior petrosal sinus
|
|
|
which 2 sinuses drain directly into IJV
|
Inferior petrosal sinus
Sigmoid sinuses |
|
|
CSF fills ______, __________ and ________
|
Fills subarachnoid space, ventricles and spinal canal
Circulates through ventricles and into subarachnoid space |
|
|
CSF secreted by ________ in choroid plexus in ____________
|
epithelial cells
ventricles in brain |
|
|
what happens to the CSF on a daily basis?
|
more is produced than exists...the rest gets dumped into venous system via arachnoid villi
|
|
|
The posterior cerebral arteries comes off the basilar artery. They course around the midbrain and supply the ______lobe and portions of the medial and inferior temporal lobe.
|
occipital
|
|
|
The dura is most adherent to the _______, which connect the various bones of the skull.
|
sutures
|
|
|
in an epidural hematoma, blood between _______ and dura
|
naked bone
dura has 2 layers: 1) periosteum of the bone 2) meningeal layer clinically, both are considered dura |
|
what kind of epidural can result?
|
Epidural Hematoma:
Trauma -> fracture & concussion Tearing/stripping of both layers from inner table Laceration of outer periosteal layer Laceration of meningeal vessels Inner (meningeal dura) intact Blood between naked bone and dura Epidural hematomas form between the skull and the outer layer (dura mater) of tissue covering the brain (meninges) |
|
|
how can you get a subdural hematoma?
|
Blow to front or back of head
shearing of cerebral veins |
|
|
what are major branches of the ICA
|
inc ophthalmic artery, the anterior choroidal artery, the middle cerebral artery and the anterior cerebral artery.
|
|
|
Extradural (Epidural) hematoma
e.g., blow to ___ ruptures ________ |
pterion
middle meningeal artery |
|
|
which subclavian artery would you inject with contrast to demonstrate both the carotid and vetebral circulations?
|
right
bc the right subclavian connects to the right common carotid (= brachiocephalic artery) so dye in the right subclavian will get to the right common carotid the left subclavian, however, connects directly to the aorta remember the ABC'S (aorta, brachiocephalic artery, carotid (left), subclavian (left) |
|
|
occlusion of which area of willis will result in total unilateral blindness
|
opthalmic artery (first branch of the ICA)
|
|
|
From the paired lateral ventricles (LV), CSF passes through the paired interventricular foramina of Monro (yellow arrow) into the single midline third ventricle (TV). CSF then flows down the single midline aqueduct of Sylvius (a channel shaped like a toothpick; green arrow) into the single midline fourth ventricle (FV). CSF leaves the ventricular system through the two lateral foramina of Luschka and the midline foramen of Magendie. Here, CSF is shown exiting through the foramen of Magendie (blue arrow) and entering the cisterna magna (CM). Within the subarachnoid space (SAS), CSF flows over the convexities of the brain and the folia of the cerebellum, and around the brainstem (curved arrows). From the CM, CSF also courses inferiorly to surround the spinal cord (orange arrow).
|
|
CSF is produced by
specialized ependymal cells of the choroid plexus Choroid is found in all components of the ventricular system except |
1. cerebral aqueduct
2. occipital and frontal horns of the lateral ventricles |
|
whats the path of CSF flow
start from the lateral ventricle? |
Lateral ventricles
via the foramina of Monro into the third ventricle via the cerebral aqueduct of Sylvius into then the fourth ventricle THEN… 2 options (technically 4 different holes/spaces) can pass into the central canal of the spinal cord OR into the cisterns of the subarachnoid space via three small foramina: the central foramen of Magendie (one, Medial) and the two lateral foramina of Luschka (paired, Lateral). |
|
|
CSF recycled at the level of the
|
arachnoid villi
|
|
|
Decreased absorption of CSFcan lead to
|
“normal” pressure hydrocephalus (NPH)
|
|
|
describe the pathway of CSF flow
(name the ventricles and the foramina) |
|
|
|
The anterior cerebral artery courses within the _______fissure and around the rostral end of the _________
|
longitudinal
corpus callosum |
|
|
The common carotid arteries divide in the ____---to form the external and internal carotid arteries.
|
neck
|
|
|
The internal carotid artery arises from the bifurcation of the __________ In its passage through the carotid canal and along the side of the body of the _______ bone, it has a double curvature and resembles the letter .
|
common carotid
sphenoid S |
|
|
middle cerebral artery runs through the ______sulcus (also called the Sylvian fissure), along the surface of the_______ and supplies blood to parts of the frontal, temporal and parietal lobes.
|
lateral
insular cortex |
|
|
The middle cerebral artery largely supplies the lateral aspect of the brain where ________, _______, and _______areas are located in both sensory and motor cortex as well as ____ and _______ speech areas
|
trunk, arm, face
Broca's and Wernicke's speech areas. |
|
|
Occlusion of the middle cerebral artery may result in paralysis and sensory loss in the contralateral/ipsilateral (?)
_____, ______, and _______ as well as different types of aphasia (ex. Broca's, Wernicke's, or conduction). |
contralateral
trunck, face, upper limbs |
|
|
Occlusion of the posterior cerebral artery can result in ________defects, Weber syndrome (oculomotor nerve palsy and contralateral hemiparesis due to midbrain infarction), and ipsilateral deficits of CN V, VIII IX, X and XI.
|
visual field
|
|
|
The anterior cerebral artery supplies the dorsal and medial portions of the ___ and ____ lobes which includes the leg and foot areas of motor and sensory cortices.
Occlusion of the anterior cerebral artery may result in paralysis and sensory loss of the contralateral _________ |
frontal and parietal
foot and leg |
|
|
an occlusion to the anterior cerebral artery results in loss of strength and sensation in the_____ part of the body
whereas middle cerebral artery affects ____ |
lower
upper "LAH" (leg is medial, then arm, then hand) anterior cerebral does medial cerebrum, and middle cerebral does lateral cerebrum |
|
|
occlusion of the basilar artery at the junction of the 2 post cerebral arteries will result in _______ because they supply the visual cortex
|
total blindness!
(not true for either of the 2 vetebrals though..bc the intact vetebral covers the territory of the other) |
|
|
if either the post cerebral artery and the superior cerebellar artery have an aneurysm, which CN nerve can it affect
|
occulomotor (3)
Willis has hairy armpits! |
|
|
each cerebral hemisphere contains 1 internal capsule....(just behind Willis's head)
the anterior choroidal artery and striate arteries (the tiny arteries that arise from COW) supply the _______ |
internal capsule
|
|
|
in injecting the right carotid artery in an angiogram, how might one simultaneously fill the circulation in the left anterior and middle cerebral aa?
|
simultaneously compress the left carotid-->pressure differential allows blood to go to left circulation via ant communicating
|
|
identify all the aa here
|
rabi zidni ilma
|
|
|
rabizidni ilma
|
|
Lateral ventricles
the anterior or frontal horn (F) extends into the ______ lobe the posterior or occipital (P) horn into the _____ lobe the inferior or temporal (I) horn into the _____ lobe |
frontal
occipital temporal |
|
|
Subarachnoid _______ are expanded parts of the subarachnoid space
|
Cisterns
Ventral surface of diencephalon and brainstem Pontine cistern Interpeduncular cistern Chiasmatic cistern Dorsal surface of diencephalon and brainstem Cisterna magna (= cerebellomedullary cistern) Superior (= quadrigeminal) cistern |
|
Ventral surface of diencephalon and brainstem:
|
Pontine cistern
Interpeduncular cistern Chiasmatic cistern |
|
where are the 3 cisterns in the Ventral surface of diencephalon and brainstem:
there's 3! |
Pontine cistern
Interpeduncular cistern Chiasmatic cistern |
|
Subarachnoid Cisterns
in dorsal surface of diencephalon and brainstem |
Cisterna magna (= cerebellomedullary cistern)
Superior (= quadrigeminal cistern) |
|
|
how does ct of epidural hematoma look like?
|
|
|
what are these things?
|
circumventricular organs
chemical signaling (hormones) need to enter and leave the brain, so we have spots in the BBB that are breached, or ‘leaky’… OVLT: outlet for LHRH, somatostatin Median eminence: releases hormones into the hypophyseal portal system Subfornical organ: receptor site for Angiotensin II Subcommissural organ: Pineal gland: melatonin and serotonin Area postrema: in the fourth ventricle, sense emetics, make you vomit Area Postrema!! Makes you vomit, in response to circulating emetics– CLINICAL, so we give anti-emetics! |
|
|
skull fracture is to epidural hemorrhage as aneurysm is to
|
subarachnoid hemorrhage
|
|
|
Subarachnoid hematomas are caused by:
|
--Ruptured intracerebral aneurysm
of COW vessels:Ant. Communicating, branches of middle cerebral, distal basilar, posterior inferior cerebella Subarachnoid hematoma Sudden rupture (usually of aneurysm) Thunderclap headache Stiff neck vomiting |
|
|
The two layers of dura mater run together throughout most of the skull. Where they separate, the gap between them is called a dural venous sinus. These sinuses drain blood and cerebrospinal fluid
The arachnoid mater is one of the three meninges, the membranes that cover the brain and spinal cord. It is interposed between the two other meninges, the more superficial dura mater and the deeper pia mater, and is separated from the pia mater by the subarachnoid space.... that extend into the venous sinuses. These villi act as one-way valves. |
|
|
|
middle meningeal artery runs between ____ and ____layers of the dura
|
periosteal and meningeal
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Anterior choroidal artery is a branch of the _____
MCA territory includes Broca’s and Wernicke’s speech areas--> aphasias. Lateral striate-->strokes associated with hypertension; infarct of internal capsule causes pure motor hemiparesis. |
MCA
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Functions mainly in equilibrium, postural control and
coordination of voluntary movements (plus other stuff) |
cerebellum
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t/f
the cerebellum has a cortex with a somatotopic map of body |
t
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how is the cerebeller cortex different from cerebral cortex?
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None of the activity directly contributes to consciousness
- Hemispheres have ipsilateral representation of body parts (in contrast to cerebral cortex) |
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Three is the magic number!
for the cerebellum |
Divided sagitally into 3 regions
Divided horizontally into 3 lobes with 3 naming schemes Connected to brainstem by 3 peduncles Cerebellar cortex has 3 layers Cerebellar efferents arise from 3 nuclei Cerebellar blood supply come from 3 vessels There are 3 important cerebellar syndromes |
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cerebellum
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what are the nuclei of the cerebellum?
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what is this?
what comes through this? from where? |
Inferior cerebellar peduncle
- mostly afferent fibers from - spinal cord - Clarke’s nuc.- legs - lateral cuneate nuc. - arms - brainstem - inferior olivary nucleus - trigeminal nuclei - reticular formation - vestibular nuclei |
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what is this?
what does it carry? from where? |
Middle cerebellar peduncle
- entirely afferent fibers - largest peduncle - input from basilar pons Route of afferent information from the cerebral cortex via internal capsule, cerebral peduncles and pontine nuclei |
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what is this?
what does it carry? to where? |
Superior cerebellar peduncle
(= brachium conjunctivum) - mostly efferent fibers (except ant spinocerebellar tract) - output to cerebral cortex via thalamus and int. capsule |
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Purkinje cells
- giant dendritic tree - large cell body - project to _______ - inhibitory |
- project to cerebellar nuclei
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what are the cells projecting to the cortex of the cerebellum?
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climbing fibers, mossy fibers
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Climbing fibers
- originate only in _____ - each climbs dendrite of single Purkinje cell (molecular layer) - tens of thousands of synapses - excitatory synapses - alter Purkinje cell activity while learning new motor tasks |
inf. olivary nucleus
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Mossy fibers
- originate in many places - each projects to 100s of granule cells (granular layer) - __________ synapses - communicate with _____cells via granule cells and parallel fibers |
excitatory
Purkinge |
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what's posterior lobe syndrome?
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- lesion to posterior lobe
commonly caused by a variety of factors (e.g., strokes, tumors, trauma & degenerative diseases) - loss of coordination of voluntary movements (ataxia) intention tremor - only during voluntary movements dysmetria - overshoots or undershoots when reaching for target dysdiadochokinesia - inability to perform rapid alternating movements (e.g. repetitive pronation/supination of hand) -decrease in muscle tone INTENTION TREMOR, ABSENT AT REST! |
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what's anterior lobe syndrome?
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- lesion to anterior lobe
most common cause is malnutrition associated with chronic alcoholism loss of lower limb coordination - gait ataxia - (walk as if drunk, staggering) - difficult performing heel-shin test |
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Flocculonodular Lobe Syndrome?
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- lesion to flocculonodular lobe and posterior vermis
most commonly caused medulloblastomas in young children loss of control of axial muscles (truncal ataxia) - difficulty walking (wide-based gait with swaying trunk) - difficulty sitting or standing in severe cases |
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what does the cerebellum do?
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The cerebellum is involved in a feedback loop for muscle movement. When the cortex sends a message for motor movement to the lower motor neurons in the brain stem and spinal cord it also sends a copy of this message to the cerebellum.This is conveyed from pyramidal fibers in the cortex on the corticopontinecerebeller tract to the cerebellum. In addition, information gets to the cerebellum from muscle spindles, joints and tendons. This information (proprioception and kinesthesia) lets the cerebellum know about the movements that have been executed, so that it can determine how well motor commands coming from the cortex are being carried out. This has been called its comparator function.
The cerebellum plays a major role in the coordination of muscle activity for the production of smooth movement through its connections with the pyramidal and extrapyramidal systems and the descending reticular formation .Due to its role in the coordination of fine motor movements the cerebellum makes important contributions to the control of rapid, alternating muscle movements necessary for speech. |
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the role of each of the peduncles?
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The superior cerebellar peduncle (aka the superior brachium conjunctivum) connects the cerebellum to the midbrain and contains efferent fibers from the deep nuclei. These are the axons that send feedback to the motor cortex in the frontal lobe via the red nucleus in the midbrain and the thalamus.
The middle cerebellar peduncle or the middle brachium pontis is the largest of the peduncles and links the cerebellum with the pons. Via this connection, the cerebellum receives a copy of the information for muscle movement that the pyramidal tract is carrying down to lower motor neurons. The inferior cerebellar peduncle (aka restiform bodies) connects the cerebellum with the medulla, but also to the vestibular nuclei located in the lower pons and medulla and with cells of the reticular formation. |
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what's the feedback loop for motor movement?
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Precentral gyrus --> pontine nuclei -- > cerebellum -- > (after input from muscles innervated by lower motor neurons, and comparisons made by the cerebellum between output from the cortex and input from muscles) --> red nuclei --> thalamus --> precentral gyrus where adjustments are made.
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name all the components of the basal ganglia in the telencephalon, diencephalon, and mesencephalon?
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Telencephalon:
caudate nucleus nucleus accumbens putamen globus pallidus internus externus Diencephalon: subthalamic nucleus Mesencephalon (midbrain) substantia nigra pars reticulata pars compacta |
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what's the function of the basal ganglia?
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Play an important role in
- initiating and controlling voluntary movements forming motor habits - “Chunking” instrumental learning Action selection choosing one action from all the possible, mutually-exclusive options (cannot run and sit at the same time) Chunking Habits Group together repeated movements so that you can get to more and more complex behavior Hard-wire a series of movements together, so it is easier to perform them together without having to think of each next step Instrumental learning operational = procedural = reinforcement Individual makes action first, and then learns/associates the consequences Like the idea of classical conditioning from psychology, but with an action, instead Pavlovian bell-ringing. |
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CLINICALLY, the basal ganglia is referred to as the ‘______system because they modulate the pyramidal (or corticospinal) system.
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extrapyramidal’
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yes
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yes
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projections of each part of the substantia nigra?
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Pars compacta
SNc -->striatum = nigrostriatal tract Pars reticularis --Projections Thalamus Pedunculopontine nucleus (in reticular formation at ponto-mesencephalic jxn) Superior colliculus (saccades) |
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Multiple Parallel Circuit Loops connect BG to ____
what are these pathways? (3) |
cortex
SKELETOMOTOR loop: control facial, limb, trunk musculature (Putamen) PREFRONTAL loop: influence motivation and strategic planning of behavior; to prefrontal area (Caudate Nucleus) ANTERIOR CINGULATE/LIMBIC loop: emotionality, motivated-behavior; to anterior cingulate gyrus (Nucleus accumbens) |
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The striatal _______decides which action/thought/emotion to release from inhibitory clamp
Constitute 98% of the striatal neurons GABAergic |
medium spiny neuron
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why does the internal capsule look striped?
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You know how the internal capsule looks striped?
Links between caudate and putamen: Striatal cell bridges Developmentally, the striatum is one, and axons course to-from the cortex incompletely divide the striatum |
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although dopamine can be either excitatory/inhibitory depending on the receptor, overall effect of dopamine is to _____ inhibitory output of BG: so promotes movement
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reduces
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Output of the BG is like cerebellar cortex: It is INHIBITORY/EXCITATORY
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inhibitory!
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what's the NT used by medium spiny neurons in the striatum?
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GABA
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what NT is used by corticostriatal neurons: input to BG
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glutamate
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what NT is used by local neuronal circuits within the striatum
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ACh
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dopamine:
Facilitating the ___ loop Inhibiting the ____ loop |
direct loop (which reduces inhibition of what you WANT TO DO)
indirect loop (which increases inhibition of what you don't want to do !) so overall, dopamine reduces inhibition...promotes movement |
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hyperkinetic disorder (of basal ganglia) results from an _____of output to the thalamus
hypotkinetic disorder; _____ of output to the thalamus |
decrease
increase |
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A. Intention tremor, or a tremor that appears when a patient makes a voluntary movement, is caused by damage to the _______ that is ipsilateral/contralateral to the limb.
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lateral cerebellar hemisphere
ipsilateral |
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Parkinson's disease symptoms are caused by a loss of ___neurons in the substantia nigra pars ______that project to the striatum.
Huntington's disease involves degeneration of neurons in several areas of the brain, it is in the _____ that this degeneration is particularly severe. |
dopaminergic
compacta caudate nucleus |
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The___ and ____are involved in coordinating posture and gait; damage to these areas will result in leg ataxia even when the patient is neither walking nor standing
The flocculonodular lobe is connected mainly with the _____ nuclei, and is involved in balance and equilibrium. Damage to this area results in posture and gait impairment, but does not result in limb ataxia when a patient is lying down. |
vermis and paravermis
vestibular |
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A unilateral flailing arm and leg, known as hemiballismus, results from unilateral damage to a ______. As this nucleus is functionally related to the ____motor cortex (which controls the contralateral side of the body), the deficit is seen in the _____ limb. Hemiballismus, which can result from damage to the subthalamic nucleus, is thought to be accompanied by insufficient inhibitory activity of the globus pallidus internus on the thalamus.
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subthalamic nucleus
ipsilateral contralateral |
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Overshooting or undershooting targets that one is reaching for is called ____. It is one of the manifestations of damage to the lateral cerebellar hemispheres (and would affect limbs ipsilateral to the damage)
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dysmetria
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Parkinsonian symptoms are thought to be accompanied by overly strong inhibition of the thalamus by the ______ (often due to a lack of dopaminergic stimulation earlier in the basal ganglia pathway).
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globus pallidus internus
Careful ablation of parts of the globus pallidus internus (as well as to the VA/VL thalamic nuclei) has been found to partially ameliorate symptoms of both of these disorders, perhaps by correcting the inappropriate levels of thalamic inhibition. |
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One of the pathways that
conveys information from GP(internal) to motor thalamus is the _____ In addition to the ansa lenticularis (often called the jug handle), information from the more caudal part of globus pallidus can also reach the VA/ VL via the ___ While en route to the thalamus, the ansa and lenticular fasciculus fibers join other (e.g., cerebellothalamic) fibers that are also headed for VA/VL. This combined bundle is obvious in fiber stained sections and is called the |
ansa lenticularis
lenticular fasciculus. thalamic fasciculus. AL + LF = TF |
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ALL OF THIS CIRCUITRY (AL + LF = TF) IS ON
THE SAME SIDE OF THE BRAIN— UNCROSSED. Thus, the basal ganglia affect function mediated by the ipsilateral motor cortex. Since motor cortex controls the movements of the contralateral body.... Basal ganglia circuits affect movements of the ___________ |
contralateral
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There is a
population of cholinergic (ACh) neurons in the striatum whose axons do not leave the striatum (called interneurons or local circuit neurons). These cholinergic interneurons synapse on the GABAergic striatal neurons that project to GP(internal) AND on the striatal neurons that project to GP(external). The cholinergic actions INHIBIT striatal cells of the Direct pathway and EXCITE striatal cells of the Indirect pathway. Thus the effects of ACh are OPPOSITE the effects of dopamine on the direct and indirect pathways so the ACh effects on motor activity are opposite those of dopamine. ACh INHIBITS THE DIRECT AND EXCITES THE INDIRECT PATHWAY THE EFFECT OF THE CHOLINERGIC STRIATAL INTERNEURONS IS TO _______MOTOR ACTIVITY |
decrease
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what's the most well known hypokinetic syndrome?
|
Parkinson’s disease,
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One of the pathways that
conveys information from GP(internal) to motor thalamus is the _____ In addition to the ansa lenticularis (often called the jug handle), information from the more caudal part of globus pallidus can also reach the VA/ VL via the ___ While en route to the thalamus, the ansa and lenticular fasciculus fibers join other (e.g., cerebellothalamic) fibers that are also headed for VA/VL. This combined bundle is obvious in fiber stained sections and is called the |
ansa lenticularis
lenticular fasciculus. thalamic fasciculus. AL + LF = TF |
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|
ALL OF THIS CIRCUITRY (AL + LF = TF) IS ON
THE SAME SIDE OF THE BRAIN— UNCROSSED. Thus, the basal ganglia affect function mediated by the ipsilateral motor cortex. Since motor cortex controls the movements of the contralateral body.... Basal ganglia circuits affect movements of the ___________ |
contralateral
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|
There is a
population of cholinergic (ACh) neurons in the striatum whose axons do not leave the striatum (called interneurons or local circuit neurons). These cholinergic interneurons synapse on the GABAergic striatal neurons that project to GP(internal) AND on the striatal neurons that project to GP(external). The cholinergic actions INHIBIT striatal cells of the Direct pathway and EXCITE striatal cells of the Indirect pathway. Thus the effects of ACh are OPPOSITE the effects of dopamine on the direct and indirect pathways so the ACh effects on motor activity are opposite those of dopamine. ACh INHIBITS THE DIRECT AND EXCITES THE INDIRECT PATHWAY THE EFFECT OF THE CHOLINERGIC STRIATAL INTERNEURONS IS TO _______MOTOR ACTIVITY |
decrease
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ACh TURNS DOWN MOTOR ACTIVITY
ACh ____ striatal cells in the direct loop ACh _____ striatal cells in the indirect loop DA TURNS UP MOTOR ACTIVITY DA _____ striatal cells in the direct loop via D1 receptors DA ______ striatal cells in the indirect loop via D2 receptors |
inhibits
excites excites inhibits |
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what's the most well known hypokinetic syndrome?
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Parkinson’s disease,
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In Parkinson’s disease, rigidity is present in all muscle groups, both flexor and extensor, so
that the resistance to passive movement is intense and consistent through the entire range of motion, so-called lead-pipe______ |
rigidity
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dopaminergic neurons
in substantia nigra pars compacta are lost in Parkinson’s disease. The degenerating nigral dopaminergic cells accumulate deposits of protein called _________ |
Lewy Bodies.
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Huntington’s disease
Chorea (quick uncontrolled movements), athetosis (slow writhing), poorly coordinated eye movements, cognitive changes (memory loss, personality changes, psychosis) Degeneration of GABA neurons, mainly in _____ → loss of thalamic inhibition → increased thalamic output, unwanted movements |
caudate nucleus
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what are the 3 main parallel loops?
with which part of the striatum & cortical areas are they associated with? function of each? each passes through a specific part of the striatum and is connected to a specific cortical area |
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all of the inputs to cerebellar cortex are mossy fibers, except for the inputs from the ______ in the _____; those are the climbing fibers
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inferior olivary complex
inferior peduncle |
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Each cerebellar hemisphere gets info from the______cerebral hemisphere, thalamus, and pontine nuclei, and is thus dealing with the ______ side of the body
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contralateral
ipsilateral |
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inferior peduncle gets input from:
STIR |
spinal cord
trigeminal nucleus inferior olivary nucleus reticular formation |
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Granule cells are the _____between mossy fibers and Purkinje cells; they send out long synapses called parallel fibers that synapse on many Purkinjes
(granule cells are also the only excitatory interneuron in cerebellar cortex) |
interneuron
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Upper motor neuron
Think, “a loss of inhibition from above” So, increased tone, spasticity, and reflexes, and positive Babinksi But also: pyramidal pattern weakness: results in flexed arms (weaker extensors), stretched legs (weaker flexors) Lower motor neuron Think, “no input to the muscle” So, decreased tone and reflexes, no Babinksi sign, atrophy, and weakness that can be proximal, distal, or everywhere But also: fasciculations |
yes
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twisting of body parts, often into relatively fixed positions (lack of coordination of opposing flexors and extensors)
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dystonia
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lack of coordination
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ataxia
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slow, writhing movements
writhe: to twist so as to distort |
athetosis
Chorea – jerky, dance-like movements |
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which CN nuclei are associated with the corticobulbar tract?
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V, VII, IX, X, XI, XII
Bilateral innervation (slightly stronger from contralateral side) Except lower facial nucleus only gets contra |
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how does blood travel to spinal cord?
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2 small posterior spinal arteries, one BIG anterior spinal artery
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name spinal nerve responsible for:
-abduction of arm -flexion of elbow -flexion of digits -abduction /adduction of digits: |
-abduction of arm: C5 (axillary nerve innervated deltoid)
-flexion of elbow: C(5)6 -flexion of digits: C8 -abduction /adduction of digits: T1 |
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what's the bicipital reflex?
|
Tests musculocutaneous n. and C5,C6 spinal nerves
bicipital: having two heads or points of origin as a biceps A reflex test that examines the function of the C5 reflex arc and to a lesser degree the C6 reflex arc. The test is performed by using of a tendon hammer to quickly depress the biceps brachii tendon as it passes through the cubital fossa. Specifically, the test activates the stretch receptors inside the biceps brachii muscle which communicates mainly with the C5 spinal nerve and partially with the C6 spinal nerve to induce a reflex contraction of the biceps muscle and jerk of the forearm. |
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List the nerves responsible for the myotomes:
- Flexion of Hip = - Extension of Knee = - Flexion of Knee = - Plantarflexion of Ankle = |
- Flexion of Hip = L1, L2
- Extension of Knee = L3, L4 - Flexion of Knee = L5 - S2 - Plantarflexion of Ankle = S1, S2 |
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what's the nn controlloing the following reflexes?
- Patellar tendon = (knee extends) - Calcaneal tendon = (ankle plantarflexes) |
- Patellar tendon = (L2), L3, L4
(knee extends) - Calcaneal tendon = S1, S2 (ankle plantarflexes) |
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Cells of the neural plate give rise to most of the spinal cord except _________ which comes from ________
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dorsal root neurons
(neural crest) |
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Alar plate -
Basal plate - Floor and roof plates - |
posterior (dorsal) horn
anterior (ventral) horn ependymal cells |
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The spinal cord is stabilized within the dura mater by the connecting _______which extend from the enveloping _____mater laterally between the dorsal and ventral roots.
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denticulate ligaments
pia mater |
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the dural sac of the spinal cord ends at
|
S2
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6–8 motor nerve rootlets branch out of right and left _______sulci in a very orderly manner. Nerve rootlets combine to form nerve _____
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ventro lateral
roots |
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sensory nerve rootlets form off right and left _____ sulci and form sensory nerve roots.
The ventral (motor) and dorsal (sensory) roots combine to form spinal nerves(mixed; motor and sensory), one on each side of the spinal cord. |
dorsal lateral
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________is the terminal end of the spinal cord. It occurs near lumbar nerves 1 (L1) and 2 (L2).
|
conus medullaris
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1. Conus medullaris
2. Filum terminale 3. Cauda equina |
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name the spinal cord levels and how many nerves are in each
|
C8, T12, L5, S5, C1 (coccygeal)
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conus medullaris is in the L1-L2 interspace and the ________ is at S2
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dural sac
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|
Also, because the spinal cord stops growing in infancy while the bones of the spine continue growing, the spinal cord in infants ends at about the level of the vertebra
|
L3.
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cervical-sacral = preganglionic parasympathetics
thoraco-lumbar (T1 - L2/3)= preganglionic _______ |
sympathetics
|
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he gray matter 'butterfly' is organized into laminar sheets of neurons, called _____________ laminae
|
Rexed's
|
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|
there are 10 Rexed's laminae, and first 6 belong to the dorsal horn,
the 7th is in the 'intermediate zone' and the lower 3 belong to the ventral horn. I-VI: Posterior/dorsal horn Lamina I: posteromarginal nucleus (called the 'Marginal zone' because it delineates the gray matter from the white matter of Lissauer's tract) Laminae II/III: together, called 'substantia gelatinosa' Laminae III/IV/V: nucleus proprius Lamina VI: nucleus dorsalis VII-IX: Anterior/ventral horn Lamina VII: intermediolateral nucleus Lamina VIII: motor interneurons Lamina IX: motor nuclei are here Lamina X: neurons surrounding the central canal |
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Unlike in the skull where the dura is attached to the bone, in the spinal column, there is space between the dura mater and vertebrae: ___________
|
epidural space
|
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|
Motor nuclei have both ____and ____ motor neurons
- ____ motor neurons control skeletal muscles - ______ motor neurons “tune” muscle spindle receptors |
alpha+gamma
alpha, gamma |
|
|
Motor nuclei are regionally clustered
- Nuclei for proximal muscles located ______ - Nuclei for distal muscles located ________ |
medially
laterally |
|
|
components of the posterior horn?
|
lissauer's tract
substantia gelatinosa Clarke's nucleus body |
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|
Lissauer’s tract
- lightly myelinated and unmyelinated fibers - project to _____ |
substantia gelatinosa
|
|
|
lateral horn is from___ to ___
and contains ____ |
T1 to L3
presynaptic sympathetic motor neurons |
|
|
t/f
Sympathetic second neuron cell bodies are in ganglia not associated with target organ. |
t
Skin and thoracic viscera: cell bodies in paravertebral ganglia of the sympathetic trunk. Abdominopelvic viscera: cell bodies in prevertebral ganglia. PREVETEBRAL ganglia: They are the site of relay of the postganglionic sympathetic fibres that supply abdominal and pelvic viscera. Examples These include the celiac ganglia (which can include the aorticorenal ganglion), superior mesenteric ganglia, and inferior mesenteric ganglia. PARAVETEBRAL: Only the cervical ganglia have specific names. They are arranged thus: * cervical ganglia - 3 ganglia * thoracic ganglia - 12 ganglia * lumbar ganglia - 5 ganglia * sacral ganglia - 4 ganglia |
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|
t/f
Outside head, parasympathetic second neuron cell bodies are in ganglia not associated with target organs. |
false
|
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_____fibers
- interconnect neurons at different spinal cord levels - important in coordinating reflexes |
Propriospinal fibers
|
|
|
components of arterial circulation in the brain?
|
circle of willis and branches
& meningeal aa (from maxillary, which is from ext carotid) |
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|
axillary nerve damage can cause what to do the deltoid?
|
|
|
|
what sensory loss can you get from axillary damage?
|
Sensory
- loss of sensation on lateral shoulder (Regiment's patch!!) - superior lateral cutaneous n. of arm |
|
|
list the 4 common causes of axillary nerve damage?
|
Common causes of damage
- Fracture of surgical neck of humerus - Dislocation of glenohumeral joint Improper use of crutches - Intramuscular injections |
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|
what can happen to deltoid muscle with axillary nerve damage?
|
paralysis or atrophy
|
