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Y2 CONTROL & MOVEMENT > SDL 4 - Brainstem, Cerebellum & Cranial Nerves > Flashcards

SDL 4 - Brainstem, Cerebellum & Cranial Nerves Flashcards

1
Q

What are the 5 major subdivisions of the brain?

Which of the 5 subdivisions make up the brainstem?

A
  1. Telencephalon
  2. Diencephalon
  3. Mesencephalon
  4. Metencephalon
  5. Myelencephalon

The brainstem is made up from the mesencephalon, metencephalon and myelencephalon

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2
Q

Label the cranial nerves

A
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3
Q

Which structures are labelled?

what are their functions?

A

Cerebral peduncle:

  • ​contain the large ascending (sensory) and descending (motor) nerve tracts that run to and from the cerebrum from the pons

Interpeduncular fossa:

  • separates the cerebral peduncles

Decussation of pyramids:

  • motor fibres from the 2 pyramids cross over and pass down opposite sides of the spinal cord

Anterolateral sulcus:

  • rootlets of hypoglossal nerve emerge here
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4
Q

What is the name of the ridge that is visible on either side of the ventral midline of the medulla?

What is its function?

A

The pyramids lie either side of the ventral midline

they are formed by an accumulation of descending nerve fibres carrying motor information

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5
Q

What happens to the fibres of the pyramidal tract at the caudal end of the medulla?

A

The descending fibres decussate (cross over) the midline of the CNS at the caudal end of the medulla

As they decussate, they partially obliterate the midline longitudinal fissure

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6
Q

Label the dorsal view of the brainstem

A
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7
Q

In which regions of the brainstem is the central canal expanded to form the fourth ventricle?

A

It is located dorsal to the pons and upper medulla oblongata

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8
Q

What are the distinguishing features of the ventral surface of the medulla oblongata?

A
  • 2 pyramids separated by the anterior median fissure
  • Anterolateral sulcus that separates the pyramids from the olive
  • Posterolateral sulcus that emerges dorsal to the olives
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9
Q

What are the distinguishing features of the ventral surface of the pons?

A
  • Cerebellopontine angle - where the medulla and pons join the cerebellum laterally
  • Basilar groove for basilar artery
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10
Q

What are the distinguishing features of the ventral surface of the midbrain?

A
  • Cerebral peduncles
  • separated by the interpeduncular fossa
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11
Q

What are the outlines of the transverse sections through different brainstem levels

A
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12
Q

What are the main functions of the cerebellum?

A

Coordination of movement

maintenance of balance and posture

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13
Q

Where is the cerebellum located?

A

It is below the occipital lobes of the telencephalon

(separated from it by the tentorium cerebelli)

It is located posterior to the brainstem and to it via three paired cerebellar peduncles

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14
Q

Label the cerebellum from above

A
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15
Q

Label the cerebellum viewed from the position of the pons

A
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16
Q

Are peduncles white or grey matter structures?

A

White matter

They contain a nerve tract that permits communication between the cerebellum and the other parts of the central nervous system

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17
Q

To which region of the brainstem does each cerebellar peduncle connect?

A

Superior:

  • connects midbrain to cerebellum

Middle:

  • connects pons to cerebellum

Inferior:

  • connects medulla to cerebellum
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18
Q

Which vessels provide the arterial supply to the cerebellum?

A

From ventricular arteries:

  • posterior inferior cerebellar artery (PICA)

From basilar artery:

  • anterior inferior cerebellar artery (AICA)
  • superior cerebellar artery (SCA)
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19
Q

What are the major functions of the cerebellum?

A

coordinates voluntary movements such as posture, balance, coordination, and speech, resulting in smooth and balanced muscular activity

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20
Q

What 3 abnormal signs are associated with cerebellar damage?

A

Past-pointing:

  • if the eyes are closed, a pointing finger overshoots its intended mark towards the side of the cerebellar damage

Intention tremor:

  • Broad, low frequency tremor
  • The amplitude of an intention tremor increases as an extremity approaches the endpoint of deliberate and visually guided movement

Dysdiadochokinesis:

  • impaired ability to perform rapid alternating movements
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21
Q
A
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22
Q

How is dysdiadochokinesis tested for?

A

Ask the patient to tap the palm of one hand with the fingers of the other

then rapidly turn over the fingers and tap the palm with the back of them, repeatedly

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23
Q

How is intention tremor tested for?

A

Finger-to-nose test

the physician has the individual touch their nose with their finger while monitoring for irregularity in timing and control of the movement

if someone has intention tremor, they will have coarse side-to-side movements that increase in severity as the finger approaches the nose

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24
Q

Which cranial nerves attach to the midbrain?

A
  • Oculomotor nerve (III)
  • Trochlear nerve (IV)
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25
Q

Which cranial nerves attach to the pons?

A
  • Trigeminal nerve (V)

Pontomedullary junction:

  • abducens nerve (VI)
  • facial nerve (VII)
  • Vestibulocochlear nerve (VIII)
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26
Q

Which cranial nerves attach to the medulla oblongata?

A
  • Glossopharyngeal nerve (IX)
  • vagus nerve (X)
  • Accessory nerve (XI)
  • hypoglossal nerve (XII)
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27
Q

Which cranial nerves emerge from the cerebellopontine angle?

A
  • Vestibulocochlear nerve (VI)
  • facial nerve (VII)
28
Q

Which cranial nerve emerges from the interpeduncular fossa?

A
  • Oculomotor nerve (II)
29
Q

Which cranial nerve emerges immediately lateral to the medullary pyramid?

A
  • Hypoglossal nerve (XII)
  • this emerges in the anterolateral sulcus
30
Q

Which cranial nerves emerge lateral to the olive?

A
  • Vagus nerve (X)
  • Glossopharyngeal nerve (IX)
  • Accessory nerve (XI)

These emerge in the posterolateral sulcus

31
Q

Which cranial nerves emerge from the dorsal surface of the brainstem?

A
  • Trochlear nerve (IV)
32
Q

Where are the true peripheral olfactory nerves?

A

The paired structures on the inferior surface of the brain (olfactory bulbs and tracts) are CNS structures

they receive information from the true peripheral olfactory nerves

the olfactory nerve comes from the nasal epithelium

It enters the cranial cavity via the cribiform plate of the ethmoid bone

33
Q

What does damage to the olfactory nerve usually cause?

A

Anosmia:

  • the inability to smell anything at all

Hyposmia:

  • reduced ability to smell

Dysosmia:

  • smells are mixed up
  • e.g. The pleasant smell of a rose might smell like garbage
34
Q

What aspects of vision are subserved by the optic nerve?

A

The optic nerve transmits visual information from the retina to the brain

it is involved with the light reflex and the accommodation reflex

35
Q

How is the light reflex tested in clinic?

A

Light shone in one eye should cause both pupils to constrict (miosis)

a lower intensity of light should cause the pupils to dilate

36
Q

How is the accommodation reflex tested in clinic?

A

Accommodation means change in the lens shape when looking at a distant object and a close object

this is tested by asking the patient to focus on an object as it is moved further away, closer and side to side

37
Q

What is supplied by the oculomotor (III), trochlear (IV) and abducens (V) nerves?

A

They supply the muscles that move the eye

38
Q

Where do cranial nerves III, IV and VI attach to the brainstem?

Where to they pass out of the skull?

A
39
Q

What are the 3 divisions of the trigeminal nerve?

What type of nerve is it?

A

V1 - opthalmic

V2 - maxillary

V3 - mandibular

the trigeminal nerve is a mixed nerve as it contains motor and sensory fibres

40
Q

What is supplied by the motor and sensory branches of the trigeminal nerve?

A

Sensory:

  • skin, teeth and mucous membranes of the face
  • anterior scalp
  • dura

Motor:

  • four main muscles of mastication
  • tensor tympani muscle
41
Q

Where are the cell bodies of (most of) the trigeminal sensory fibres located?

A

There are 3 sensory nuclei - mesencephalic, principal sensory and spinal nuclei

they extend from the midbrain to the medulla

42
Q

Through which foramina do the three divisions of the trigeminal nerve exit the cranial cavity?

A
43
Q

How do the divisions of the trigeminal nerve form?

A

Each division has several branches that carry either sensory, motor or autonomic fibres

44
Q
A
45
Q

What nerves hang from the pterygopalatine ganglion?

what do they supply?

A

Greater and lesser palatine nerves

They supply the roof of the mouth, soft palate, tonsil, and lining membrane of the nasal cavity

46
Q

How do you test the functioning of the sensory component of the trigeminal nerve?

A

Pin or cotton swab test

One or both sides of the face are touched with a pin or cotton swab

the patient is asked whether they felt anything and where they felt it

47
Q

What are the 2 reflexes associated with the trigeminal nerve?

A

Jaw jerk reflex:

  • in someone with an upper motor neurone lesion, the jaw jerk reflex can become quite pronounced

Blink reflex:

  • stimulated by touching of the cornea by a foreign object
  • Also involves the facial nerve
48
Q

What is trigeminal neuralgia?

A

A chronic pain condition affecting the trigeminal nerve

mild stimulation of the face may trigger a jolt of excruciating pain

49
Q

what do the motor fibres in the trigeminal nerve innervate?

A

Muscles of mastication

they are innervated by the mandibular branch (V3)

masseter, temporal and medial and lateral pterygoids

50
Q

In a trigeminal nerve injury, which side will the jaw deviate to when opened against resistance?

A

The jaw deviates towards the lesion

This is due to weakness of the lateral pterygoid on the affected side

51
Q

What type of nerve is the facial nerve?

How do the fibres leave the brainstem?

A

It is a mixed nerve

The motor fibres to the muscles of facial expression and to the stapedius muscle leave the brainstem in a large motor root of the facial nerve

All other fibres leave the brainstem in a much smaller bundle - the nervus intermedius

52
Q

What are the sensory functions of the facial nerve?

A
  • Supplies a small area around the concha of the auricle
  • provides special taste sensation to the anterior 2/3 of the tongue
53
Q

Where are the parasympathetic functions of the facial nerve?

A

Supplies many of the glands in the head and neck including:

  • Submandibular and sublingual salivary glands
  • Nasal, palatine and pharyngeal mucosal glands
  • Lacrimal glands
54
Q

What is the pathway of the facial nerve through the skull like?

A

It follows a complex course through the skull, from the internal acoustic meatus to the stylomastoid foramen

It give various branches as it does so

55
Q

Label the branches of the facial nerve?

Where does this branching occur and what do these branches supply?

A

The facial nerve branches within the substance of the parotid gland

Temporal branches:

  • innervate frontalis, orbicularis oculi and corrugator supercilli

Zygomatic branches:

  • innervates orbicularis oculi

Buccal branches:

  • innervate orbicularis oris, buccinator and zygomaticus

Mandibular branches:

  • innervates the mentalis

Cervical branch:

  • innervates the platysma
56
Q

Label the following diagram

A
57
Q

What is the function of the nerve fibres making up the chorda tympani?

A

It originates from the taste buds, runs through the middle ear and carries taste messages to the brain

it joins the lingual nerve (branch of mandibular nerve), which supplies special taste sensation to the anterior 2/3 of the tongue

58
Q

What is the function of the greater petrosal nerve?

A

It innervates the lacrimal gland

59
Q

How are the motor functions of the facial nerve tested?

Which muscles are tested in each case?

A

Ask the patient to raise their eyebrows, screw up their eyes, purse their lips and show their teeth

  • frontalis raises the eyebrows
  • Orbicularis oculi screws up the eyes
  • Orbicularis oris purses the lips
  • zygomaticus allows for showing the teeth (smiling)
60
Q

What is Bell’s palsy?

A

It is caused by damage to the facial nerve

it results in facial paralysis and an inability to control the facial muscles on the affected side

symptoms include muscle twitching, weakness or total loss of the ability to move one (or both) sides of the face

61
Q

What other common condition can cause facial weakness?

A

Stroke

62
Q

How can you tell the difference between ipsilateral facial weakness due to Bell’s palsy and a stroke?

A
  • A stroke damages the motor cortex, leading to contralateral facial weakness of the lower face only
  • there is preservation of the muscles of the upper face on both sides, due to the dual innervation of the upper face
  • lesions that damage the facial nerve result in ipsilateral facial weakness involving both the upper and lower face
63
Q

Damage to the facial nerve may result in hyperacusis?

What is this and why does it occur?

A

A hearing disorder characterized by an increased sensitivity to certain frequencies and volume ranges of sound

(sounds sound much louder than they should)

Damage to the facial nerve affects the stapedial reflex, which dampens down the intensity of sounds

64
Q

What is the vestibulocochlear nerve (VIII)?

How is it tested?

A

The sensory nerve from the inner ear

It is tested through the Rinne’s and Weber’s tests

65
Q

What type of tumour may develop on the vestibulocochlear nerve adjacent to its attachment to the brainstem?

What is the consequence of this?

A

Acoustic neuroma

as the tumour enlarges, other cranial nerves may show signs of damage as they become compressed

If it compresses the trigeminal nerve, it causes constant or intermittent facial numbness and tingling

The facial nerve can rarely be affected in the same way

Y2 CONTROL & MOVEMENT (69 decks)

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