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Neuro Exam II > Vestibular System and Cerebellum > Flashcards

Vestibular System and Cerebellum Flashcards

1
Q

What are the 3 functions of the vestibular system?

A
  1. Mediate awareness of movement
  2. Adjust posture relative to position of head
  3. Generate eye movements that compensate for head movements
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2
Q

What afferents and efferents mediate our awareness of movement in the vestibular system.

A

–Afferents from CN VIII
–Efferents to the thalamus, to cortex

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3
Q

What efferents and afferents are involved in the vestibular system’s capacity to adjust posture relative to position of the head?

A

–Afferents from CN VIII
–Efferents to the cerebellum

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4
Q

What are the efferents and afferents that are responsible for the ability to generate eye movements that compensate for head movements?

A

–Afferents from CN VIII
–Efferents to reticular formation, cranial nerve nuclei controlling extraocular muscles

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5
Q

Inside the temporal bone, there is a bony/osseous labyrinth. What type of lymph is found here?

A

Perilymph

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6
Q

Within the bony labyrinth of the temporal bone is the membranous labyrinth which contains sensory organs bathed in what?

Describe the Na+ and K+ levels of this.

A

Endolymph

Has low Na+ and High K+

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7
Q

Meniere’s disease is characterised by vertigo, tinnitis and hearing loss. What is this caused by?

A

Defective circulation or absorption of endolymph

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8
Q

There are kinetic and static labyrinths, what is the kinetic labyrinth responsible for?

What are the organs of this labyrinth?

A

Responds to head movement, specifically angular velocity, movements like shaking head yes/no.

Semicircular canals, with ampullae and cristae

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9
Q

The static labyrinth responds to changes in head position and linear velocity.

What are two examples, of how this comes into play?

What are the associated organs?

A

Riding elevator and walking.

Vestibule: Utricle, saccule, maculae

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10
Q

What is the orientation of the kinetic labyrinth ducts?

A

Each side of the head has 3 paired semicircular canals - orthogonal orientation implies pairing.

Each lateral duct works in concert with the opposite lateral duct.

Superior duct works in concert with posterior duct on contralateral side.

Superior, lateral and posterior ducts work in y, x and z directions.

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11
Q

What is the relative position of ampullae in regards to the semicircular canals and the utricle?

A

Ampullae are tethered to the end of each of their respective semicircular canals by vestibular ganglions. Ampullae fall between semicircular canals and the utricle. See slide 10, Vestibular system lecture for visualization.

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12
Q

What are the cristae? What important aspect of the vestibular system do they contain?

A

A crista is a ridge of tissue that sits in the ampulla (enlargement of semicircular canal before the utricle). Cristae contain sensory hair cells and support cells.

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13
Q

What is a cupula? How does it relate to crista, hair cells, and ampulla?

A

A cupula is a gelatinous mass holding the cilia of the hair cells of the crista. The cupula sits in the ampulla of the semicircular cells.

Hair cells sit the crista, and synapse on the nerve. Nerve crosses utricle back to ganglion.

The crista sits on the cupula.

The cupula sits in the ampulla.

The ampulla sits in an enlargement of the semicircular canals, between the canals and the utricle.

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14
Q

What kinds of cilia do vestibular hair cells contain? How are they arranged?

A

All vestibular hair cells contain:

  1. Stereocilia - many
  2. Kinocilium

Stereocilia are arranged shortest to tallest, leading up to the kinocilium, which is the tallest cilia.

All kinocilia in a given crista are arranged in the same direction.

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15
Q

What does deflection of cilia in hair cells towards the kinocilium create? Away from the kinocilium? How does this work?

A

Deflection of the stereocilia towards the kinocilium creates a depolarization. Deflection of the stereocilia away from the kinocilium creates a hyperpolarization.

Mechanism works via stereocilia being linked to each other and the kinocilium with tip links. Tip link will have a K+ ion channel, and will be pulled open with deflection of stereocilia towards kinocilium.

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16
Q

Which cilia on hair cells synapses on the local vestibular nerve fiber?

A

Only the kinocilium synapses onto the nerve fiber. Nerve fibers eventually feed back onto vestibular ganglion.

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17
Q

What is the name for the type of transduction that hair cells do?

A

Mechanotransduction

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18
Q

How does the extracellular environment around hair cells allow them to create a tip-linked depolarization?

A

Depolarization of hair cells via tip links is dependent upon an influx of K+.

Hair cells are surrounded by endolymph, which is high in K+ and low in Na+. Opening of ion channels via tip links allows K+ to flow into cell, creating a depolarization.

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19
Q

How does angular velocity affect the endolymph, cupula, and stereocilia?

A

Angular movement of the head shifts endolymph in semicircular canals

Pressure from endolymph moves the cupula, as they are the same density.

Overall, results in movement and stimulation of stereocilia.

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20
Q

How do stereocilia deflect in response to angular velocity? What affects movement of endolymph itself (think general physics)?

A

Stereocilia generally deflect in the opposite direction of vector of velocity.

This is due to inertia.

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21
Q

What molecules move during the transduction process in inner ear hair cells?

A

Cupola deflection happens

Stereocilia and kinocilium all tilt in same direction

High K+ in endolymph causes influx (remember, typical AP is due to Na+ influx)

Ca++ influx happens, causes release of NT glutamate

Glutamate released from hair cells onto vestibular nerve fiber

Ribbon synapses are sued for massive release

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22
Q

What is so special about ribbon synapses? Where are they?

A

Ribbon synapses lie between hair cells and vestibular nerve fibers.

Ribbon synapses don’t need an AP (action potential) to fire. Instead, they release NT in proportion to the amount of glu released by the hair cell. Ribbon synapses are capable of responding to massive amounts of glu.

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23
Q

How is cilia movement facilitated by cupular displacement in different cristae in the kinetic labyrinths?

A

Kinetic Labyrinths:

Lateral cristae - cupular displacement towards utricle

Superior and posterior cristae - cupular displacement away from the utricle

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24
Q

What can activate the medial longitudinal fasciculus?

A

MLF is activated by lateral movement of the head

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25
Q

Which way do eyes move with the vestibular ocular reflex (VOR)?

A

Eyes move opposite of head movement, i.e. head moves right and eyes move left.

VOR can also affect gaze in up/down direction, using different cranial nuclei and extra-ocular muscles (EOmm).

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26
Q

What CN ganglion provides input into the MLF and VOR? What kind of neurons are in this ganglion?

A

Pseudounipolar neurons in vestibular ganglion, vestibular part of CN VIII

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27
Q

What is the path of the VOR in regards to eye movements with lateral movement? (Remember, path will differ with different head movements.)

A

Input into pseudounipolar neurons in vestibular ganglion

First synapse onto vestibular nuclei

Vestibular nuclei decussates and fires on PPRF (ParaPontine Reticular Formation)

PPRF will send a neuron to fire on ipsilateral abducens nuclei (CN VI)

  • ipsi lateral rectus mm engaged

PPRF will send another neuron that immediately decussates and travels up to contralateral oculomotor nucleus (CN III) via the MLF

  • contralateral medial rectus mm engaged
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28
Q

What will happen with a lesion to the left abducens nucleus?

A

Left eye won’t turn forward and might drift medially when head is turned to the right

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29
Q

What also travels through the MLF?

A

Medial vestibulospinal pathway

Medial carries information from medial vestibular nuclei for head position stability to bilateral mm

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30
Q

What EOmm does CN III innervate?

A

Superior rectus

Inferior rectus

Medial rectus

Inferior oblique

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31
Q

What EOmm does trochlear nerve innervate?

A

Superior oblique

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32
Q

What EOmm does abducens innervate?

A

Lateral rectus

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33
Q

What does a lesion to CN III result in?

A

Eye cannot move up, down, and up & out

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34
Q

What does a lesion in CN IV result in?

A

Eye can’t move down and out

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35
Q

What does a lesion in CN VI result in?

A

Eye cannot move laterally

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36
Q

What connects the nuclei for all the EOmm together?

A

MLF - connects CN nuclei for III, IV and VI

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37
Q

What clinical test will test the vestibulo-ocular reflex? How does it work? What is the name for the eye movements that result

A

Caloric reflex test - creates caloric nystagmus

Cold water into ear canal will cause eyes to move towards stimulus

Warm water into ear canal will cause eyes to move away from stimulus

Test works by utilizing convection/heat transfer to change currents of the endolymph in semicircular canals, which will cause different stimuli to be sent to the vestibular ganglion.

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38
Q

What type of information is carried in the MLF of the VOR?

A

Vestibular information, equilibrium of head in space

39
Q

What is the point of origin/primary cell body and receptors involved in the ascending portion of the MLF of VOR?

A

Origin/primary cell body - vestibular nerve fiber going into pseudounipolar neurons in vestibular/Scarpa’s ganglion

Receptors - ribbon receptors

40
Q

Where is the first synapse in the ascending portion of the VOR of the MLF?

A

Vestibular ganglion neuron synapses onto vestibular nucleus in medulla - home of 2nd neuron

41
Q

Where does the ascending portion of the VOR of the MLF travel?

A

After synapsing onto 2nd neuron in vestibular nuclei, 2nd neuron:

decussates and heads up to pons, synapses onto PPRF in pons

PPRF will send out 2 neurons:

1 - will synapse onto CN VI nucleus ipsilateral to the PPRF

  • will innervate ipsi lateral rectus

2 - will decussate into contralateral MLF, ascends to midbrain to go to contralateral CN III nucleus

  • will innervate contra CN III EOmm
42
Q

Where does the ascending portion of the VOR of the MLF decussate?

A

Decussates twice:

1 - 2nd neuron from vestibular nucleus in medulla will decussate before pons

2 - 4th neuron from CN VI nucleus in pons will decussate before traveling to CN III in midbrain with MLF

43
Q

Where does the descending aspect of the VOR of the MLF travel to?

A

Neurons from medial vestibular nucleus in medulla will bilaterally descend spinal cord and activate neck muscles

  • helps to stabilize the head
  • travels in medial longitudinal fasciculus, with medial vestibulospinal tract
44
Q

What is nystagmus?

A

Rhythmic, involuntary eye movements

  • different velocities
  • can frequently ‘overshoot’ a bit and eye will quickly track back
45
Q

What is the vestibulo-ocular reflex?

A

Nystagmus used to compensate eye position during head movement

46
Q

What is the optokinetic reflex?

A

Nystagmus during movement of visual stimuli across retina

  • tracking of objects moving across field of vision during driving, running
47
Q

What is saccades? Where does it originate from in the brain?

A

Rapid voluntary eye movements to move image into fovea

Originates from superior colliculus

(To remember: think of a hetero middle school boy confronted by a pair or breasts.)

48
Q

Is nystagmus slow or fast?

A

Fast and slow phases are involved

49
Q

What is “doll’s head” nystagmus? What structures in the brain control it? What is it useful for?

A

Moving head of an unconscious person will elicit nystagmus followed by fast, jerky movements in the opposite direction.

Nystagmus - from MLF (pons)

Jerky contralateral movement - from superior colliculus (midbrain)

Can use to localize suspected damage to brainstem - missing component indicates level damage is at

50
Q

What afferent signals into the vestibular system is responsible for generating eye movements that compensate for head movements? Efferent signals?

A

Afferents - from CN VIII

Efferents - go to reticular formation, CN nuclei for EOmm - III, IV and VI

51
Q

What structures are an important part of the static labyrinth?

A

Utricle - enlargement of bony canal

Saccule

Maculae - similar to cristae

52
Q

What is the macula?

A

Patch of support and hair cells in saccule and utricular walls

53
Q

What is the orientation of the 2 maculae? What features do they have that make their hair cells responsive to movement?

A

Saccular macula is vertical

Utricular macula is horizontal

Maculae have otoconia - CaCO3 ‘sand’ that lies on top of a membrane that overlies hair cell. Displacement of otoconia causes hair cells to depolarize or hyperpolarize.

Just like hair cells in kinetic labyrinth, movement of stereocilia towards kinocilium = depolarization. Away = hyperpolarization.

54
Q

When do otoconia displace hair cells?

A

During vertical or horizontal acceleration

Saccules - vertical acceleration

utricle - horizontal acceleration

Hair cells in each utricle and saccule are arranged as mirror images of each other.

55
Q

How is directionality conferred within the static labyrinths?

A

Conferred by which hair cells are specifically depolarized in the macula

Striola is mirror image point, a groove within the macula.

Sacculus hair cells (for vertical g’s) are arrayed outward, pointing anterior and posterior

Utricle hair cells (for horizontal g’s) are arrayed inward, pointing medial and posterior

56
Q

What happens to your static and kinetic labyrinth systems when you trip?

A

Static systems - fire onto lateral vestibular nucleus in mid-pons

Nucleus then has neurons that descend via ipsilateral lateral vestibulospinal tract to ventral horn to mm of legs and posture, or anti-gravity extensor mm, to walk upright.

Kinetic systems - fire onto medial vestibular nucleus in rostral medulla, which descends bilaterally down spinal cord in MLF and medial vestibulospinal tract to mm of neck and thorax - pulls head back to avoid faceplanting when falling.

Can also innervate riMLF to train eyes on ground.

57
Q

How does the VOR affect gaze in the upward/downward direction?

A

Output from vestibular ganglion synapse onto contralateral PPRF

PPRF neurons will travel up to CN III to affect superior rectus and inferior oblique to move gaze in down or up direction

58
Q

Where does the vestibulocerebellar tract take information?

A

Takes information from vestibular input into cerebellum for processing

Takes information direct from Scarpa’s ganglion, or from medial or inferior vestibular nuclei

Info is then taken to inferior cerebellar peduncle then into flocculus of cerebellum

59
Q

What components make up the inferior cerebellar peduncle? What tracts travel through here?

A

Inferior Cerebellar Peduncle = Juxtarestiform body + restiform body

Vestibulocerebellar tract - where head is in space, ipsi

Dorsal spinocerebellar tract - fine proprioception from lower body, ipsi

Ventral spinocerebellar tract - gross proprioception from lower body, ipsi

Trigeminocerebellar tracts - proprioception of face, ipsi

Olivocerebellar tracts - tonic activity for motor memory, ipsi

Efferents to vestibular nuclei

60
Q

What circuits associated with the vestibular system adjusts posture relative to position of head?

A

Afferents from CN VIII

Efferents to cerebellum

61
Q

Where is conscious awareness of movement processed? How is relayed from the brainstem to the cortex?

A

Lateral and medial vestibular nuclei have bilateral projections to the VPM of the thalamus

From VPM there is bilateral projection to primary sensory cortex and superior parietal lobule (which has conscious awareness of being off-balance, and conscious awareness of equilibrium of limb.)

62
Q

What associated structures of the vestibular system mediates awareness of movement?

A

Afferents from CN VIII

Efferents to thalamus, cortex

63
Q

What is vertigo? What are 2 common causes?

A

Vertigo = illusions of movement

EtOH - makes cupula change density, can have movement of cupula without endolymph movement

Aging/trauma - detachment of otoconia to semicircular duct, pushes cupula

64
Q

What is PICA/Lateral Medullay/Wallenburg’s Syndrome? What are the symptoms?

A

Lesion of part of vestibular nucleus, inferior cerevellar peduncle, spinal tract and nucleus of trigeminal nerve, nucleus ambiguus, and spinal lemniscus at level of rostral medulla.

Caused by thrombosis of vertebral or PICA artery.

Damage to vestibular nuclei = vertigo, inaccurate reachin, eyeballs deviate 10 degrees, head tilt to same side, fall towards same side

65
Q

What are the systemic symptoms of Wallenburg syndrome?

A

Spinocerebellar fibers disrupted = cerebellar ataxia

Sensory trigem damage = ipsilateral loss of nociception and thermosensitivity to face

Ipsilateral sympathetic pathway = Horner’s syndrome

Nucleus ambiguus - hoarsenss and dysphagia

Spinothalamic tract damage = contralateral loss of pain and temp in trunk and limbs

66
Q

What causes Romberg’s sign?

A

Defects in vestibular and somatosensory inputs to sense of orientation

Stopping visual inputs into sense of orientation to test vestibular and somatosensory inputs.

67
Q

What are the 4 functions of the cerebellum?

A

Planning movements

Limb and postural adjustments

Equilibrium and eye movements

Motor learning

68
Q

What defines the cerebellar lobes?

A

Fissures and longitudinal zones

Posterior and posterolateral fissures

Flocculonodular lobe across the inferior aspect

Vermis down median

Paravermis just lateral

Lateral zones on the lateral-most aspects

69
Q

What are the 3 functional divisions of the cerebellum? What are the relative ages in evolution of mammals? What are the associated lobes?

A

Vestibulocerebellum - “middle aged” - on flocculonodular node

Spinocerebellum - “old”/paleocerebellum - on vermis and paravermal nodes

Cerebrocerebellum - “new”/neocerebellum, on lateral zones

70
Q

How many cerebellar peduncles are there?

A

3: superior, middle and inferior

71
Q

What crosses through the middle cerebellar peduncle? Do these neurons decussate? What do these neurons become in the cerebellum?

A

Contralateral cortical input - corticopontocerebellar tracts

Cortical information descends to pons to nucleus on ipsilateral side and synapse

Fibers from pons nucleus decussate through pons into contralateral medulla and become mossy fibers

72
Q

What does the superior cerebellar peduncle transmit? What is this a major pathway for?

A

Sup cerebellar peduncle = major output pathway for cerebellum

Ventral spinocerebellar tracts - contralateral proprioceptive info from upper body

Efferents:

Contralateral red nucleus - goes to thumbs, because reasons

VL nucleus in thalamus

73
Q

What are the fiber types/order of cells in the cerebellar circuits? (review)

A

Mossy fibers –> granule cell –> bilateral parallel fibers –> Purkinje cells

74
Q

What happens to input neurons in the cerebellum? Do the cerebellar circuits remain segregated?

A

Cerebellar circuits form functional units with mixed-input connectivity

Input sources = segregated

mossy fibers = segregated

granule cells = go in segregated, go out mixed

parallel fibers = mixed

purkinje cells = mixed

See slide 55 for more info, schematics

75
Q

What are the 5 types of cells found in the cerebellum? What do they do?

A

Granule cells - bilateral parallel fibers

Purkinje cells - go to DCN or vestibular nuclei

Stellate cells - get input from parallel fibers, inhibit purkinje cells, in molecular layer

Basket cells - local inhibitory neurons on purkinje cells

Golgi II cells - input from parallel fibers, inhibit granule cells

76
Q

What are the layers of the cerebellar circuit, from superficial to deep?

A

Molecular layer

Purkinje layer

Granular layer

77
Q

What cells do the layers of the cerebellum contain?

A

Molecular - parallel fibers, purkinje dendrites, stellate cells

Purkinje - cell bodies of purkinje cells, basket cells

Granule cell layer - densely populated layer containing granule cells, cell bodies of golgi cells

78
Q

What 2 NTs define the basic cerebellar circuitry?

A

GABA and glutamate

All cells are glutaminergic except for Purkinjes, which are GABA-ergic

79
Q

What are climbing fibers in the cerebellum? Where do they come from, and what do they do?

A

Climbing fibers come directly from contralateral inferior olivary nucleus

Glutaminergic neurons

Synapse directly onto deep cerebellar nuclei and dendrites of Purkinje cells

80
Q

What does the basic cerebellar circuit allow for?

A

Circuit allows for comparison of ongoing movement and sensory feedback derived from it

Expectation from motor cortex

Proprioception from spinocerebellar tracts to provide sensations of ongoing movement

81
Q

What do olivary neurons do? How are they different from many other neurons? How do they travel to the cerebellum?

A

Olivary neurons provide tonic stimulation to the cerebellum

These neurons use electrical synapses and gap junctions

Travel from olivary nucleus, decussate immediately

Go into contralateral inferior cerebellar peduncle, provide tonic oscillations via climbing factors

Necessary for motor learning

82
Q

What circuits are associated with motor learning in the cerebellum?

A

Afferents - CN VIII, inferior olivary nucleus

Efferents - reticular formation, CN nuclei controlling EOmm

83
Q

How are deep cerebellar nuclei arranged? What are the names for them?

A

Arranged in columns:

Dentate - most lateral

Interposed (globose and emboliform) - medial, most anterior

Fastigial - medial, most posterior

84
Q

What is the organization/path of vestibular input to the cerebellum? What movements does this affect?

A

Input through inferior peduncle as mossy fibers

  • axons direct from Scarpa’s ganglia, or after 1st synapse in vestibular nuclei

Go to flocculonodular lobe

Go to fastigial nucleus

Output to vestibular nuclei and reticular formation

Affects eye movements and equilibrium

85
Q

What symptoms does a lesion to the fastigial nucleus or flocculonodular lobe present as?

A

Inability to move eyes back and forth effectively

86
Q

What is the organization/path of trunk and limb postural adjustments in the cerebellum? What motions does this affect?

A

Input through inferior peduncle as mossy fibers

  • input mostly from spinocerebellar tracts

Input goes to vermis and paravermal region

Then goes to fastigial nucleus and interposed nuclei

Output goes to vestibular nuclei and reticular formation, ultimately to thalamus and cortex

Motions affected - walking, posture, eye movements

87
Q

How is cortical input organized/transmitted into the cerebellum? What motions does this affect?

A

Cortical input represents “processed” and coordinated info

Input through MIDDLE peduncle as mossy fibers

  • from contralateral cerebropontocerebellar nuclei

Travel to lateral zones and intermediate zones

Travel to dentate and interposed nuclei

Output to red nucleus and inferior olivary nucleus, also to VA/VL of thalamus

Leaves via superior cerebellar peduncle

Decussates again after leaving

Affects planning and programming of voluntary movements, motor learning

88
Q

What circuits are associated with planning movements in the cerebellum?

A

Afferents from contralateral premotor/supplementary motor cortex

Efferents to thalamus, cortex

89
Q

What is an intention tremor?

A

AKA Cerebellar Tremor

Tremor that doesn’t go away with intentional movement, and worsens near endpoint of intentionally guided movement. Frequently leads to dysmetria.

90
Q

What is ataxia?

A

Lack of voluntary coordination of muscle movements

Frequently a sign of cerebellar pathology

91
Q

What is anterior lobe syndrome?

A

Caused by malnutrition from chronic alcoholism

Affects the area around vermis

Legs most strongly affected - broad, staggering gait with ataxia

92
Q

What is neocerebellar syndrome?

A

More common in upper limbs

Characterized by:

Hypotonia

Ataxia

Dysmetria

Intention tremor

Dysdiadochokinesia

93
Q
A

Neuro Exam II (13 decks)

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