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Brainstem & cerebellum Flashcards

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1
Q

Pseudobulbar affect

A

Uncontrollable bouts of laughter or crying without feeling the usual associated emotions caused by abnormal reflex activation of laughter & crying in the brainstem

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1
Q

Lesions of the optic nerve result in

A

Monocular visual loss or monocular scotomas; can be partial

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2
Q

Hypertropia

A

Abnormal vertical deviation of one eye

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2
Q

What are the most common causes of acute ataxia in children?

A

Accidental drug ingestion, varicella-associated cerebellitis, migraine

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3
Q

One-and-a-half syndrome

A

Ipsilateral internuclear ophthalmoplegia plus ipsilateral lateral gaze palsy (only mvmt unaffected is CL lateral rectus) Caused by lesions to the MLF + adjacent abducens nucleus OR MLF + PPRF

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3
Q

How is the trigeminal nerve examined?

A

Light touch, pain by pinbrick, hot/cold, corneal reflex, jaw reflex, jaw movements

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3
Q

What are the most common causes of chronic ataxia in adults?

A

Brain metastases, chronic toxin exposure, MS, degenerative disorders

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4
Q

Bulbar palsy

A

Dysarthria, dysphagia, & hypoactive jaw/gag reflex not associated with cognitive changes (pseudo is)

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5
Q

Ptosis

A

Drooping of eyelid

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5
Q

Infarcts that involve both the lateral brainstem & the cerebellum are most likely in what vascular territories?

A

PICA & AICA

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6
Q

A complete lesion of the cavernous sinus results in

A

Total ophthalmoplegia + fixed, dilated pupil

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7
Q

Brainstem controlling centers for vertical eye mvmts are located in the

A

Rostral midbrain reticular formation & pretectal area

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7
Q

Middle cerebellar peduncle

A

Brachium pons; connects to pons; carries mainly inputs

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7
Q

What is the function of the lateral cerebellar hemispheres?

A

Motor planning for extremities

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7
Q

Where do cerebellar output pathways cross?

A

1) as they exit in decussation of superior cerebellar peduncle 2) as corticospinal & rubrospinal tracts descend to spinal cord

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8
Q

CN X

A

Vagus; parasympathetics to heart, lungs, digestive tract; pharyngeal & laryngeal muscles; taste from epiglottis & pharynx

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8
Q

Ataxia-hemiparesis

A

Syndrome in which patients have a combo of unilateral UMN signs & ataxia, usually affecting the same side; often caused by lacunar infarcts, most often in corona radiata, IC, or pons

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9
Q

UMN vs LMN lesions of CN VII (facial)

A

UMN - spares forehead; LMN - affects entire half of face

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10
Q

Appendicular apraxia

A

Ataxia on movement of the extremities; caused by lesions of the intermediate & lateral portions of the cerebellar hemisphere, which affects the lateral motor systems

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11
Q

Function of the caudal reticular formation

A

Maintains important motor, reflex, & autonomic functions

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12
Q

The superior cerebellar artery supplies what structures?

A

Upper lateral pons, superior cerebellar peduncle, most of superior half of cerebellar hemispheres

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13
Q

Horner’s syndrome

A

Ptosis, miosis, anhidrosis Caused by loss of sympathetic innervation

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13
Q

Benign anisocoria

A

Slight pupillary asymmetry in 20% of the general population

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13
Q

The posterior inferior cerebellar artery supplies what structures?

A

Lateral medulla, most of inferior half of cerebellum, inferior vermis

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14
The anterior inferior cerebellar artery supplies what structures?
inferior lateral pons, middle cerebellar peduncle, strip of ventral cerebellum
15
Paramedian pontine reticular formation (PPRF)
Important horizontal gaze center that provides input from cortex & other pathways to abducens nucleus
15
Parinaud's syndrome
Impairment of vertical gaze, large & irregular pupils w/ light-near dissociation, eyelid abnormalities, impaired convergence
16
Smooth pursuit
Slower eye mvmts, not under voluntary control, allow stable viewing of moving objects
17
Common causes of internuclear ophthalmoplegia
MS plaques, pontine infarcts, MLF neoplasms
18
What is the most commonly injury cranial nerve in head trauma?
Trochlear
19
CN XI
Accessory; innervates the sternomastoid & upper part of trapezius muscle
21
Esotropia
Abnormal medial deviation of one eye
21
CN XII
Hypoglossal; innervates intrinsic muscles of the tongue
22
CN IX
Glossopharyngeal; motor to salivary glands & muscles of pharynx; sensory from posterior 1/3 of tongue, pharynx, middle ear
23
Locked-in syndrome
Large pointine lesions disrupt bilateral corticospinal tracts & abducens nuclei, eliminating body mvmts & horizontal eye mvmts
23
CN VIII
Vestibulocochlear; hearing & vestibular sensation
25
Oculomotor palsy
Paralysis of all extraocular muscles except lateral rectus & superior oblique (eye is "down and out"), upper lid is closed, pupil is dilated & unresponsive to light
26
Ataxia
Disordered contractions of agonist & antagonist muscles, lack of normal coordination between movements at different joints seen with cerebellar dysfunction
27
Trigeminal neuralgia (tic douloureux)
Recurrent episodes of brief pain in the distribution of the trigeminal nerve
28
What is the function of the cerebellar vermis & flocculonodular lobe?
Proximal limb & trunk coordination, balance & vestibulo-ocular reflexes
29
What are the most common causes of chronic ataxia in children?
Cerebellar astrocytoma, medulloblastoma, Friedreich's ataxia, ataxia-telangiectasia
31
Lesions to the PPRF lead to
Ipsilateral lateral gaze palsy
33
Marcus Gunn pupil
Afferent pupillary defect; the direct response to light in the affected eye is decreased/absent while consensual response of the affected eye to light in the opposite eye is normal Caused by decreased sensitivity to light secondary to lesions of optic nerve, retina, or eye
35
Accommodation response
Occurs when a visual object moves from far to near, involves pupillary constriction, accommodation of the lens ciliary muscle, and convergence of the eyes
36
Argyll Robertson pupil
Light-near dissociation (pupil accommodates but doesn't react to light) plus small & irregular pupils; associated with neurosyphilis
37
Bilateral acoustic neuromas are associated with
Neurofibromatosis Type 2
37
Pseudobulbar palsy
Used to describe dysarthria & dysphagia caused by UMN lesions in corticobulbar pathways (e.g., frontal lobe) not the brainstem; is associated with cognitive changes
37
Pupillary effects of opiate use
B pinpoint pupils
39
True vertigo
Spinning sensation of mvmt that is caused by lesions anywhere in the vestibular pathways
40
Friedrich's ataxia
Hereditary (excessive trinucleotide repeats), progressive gait ataxia Speech may be affected, but cognition intact; emotional lability may be present
41
Right-way eyes
Cerebral hemisphere lesions normally impair eye mvmts in the CL direction, resulting in gaze preference toward sign of lesion, way from side of weakness
42
Symptoms of vagus nerve damage
Hoarseness, poor swallowing, loss of gag reflex
43
Exotropia
Abnormal lateral deviation of one eye
44
Medial longitudinal fasciculus (MLF)
Interconnects III, IV, VI, X nuclei
45
Pupillary effects of barbiturate overdose
B small pupils
47
Caloric test
Test of vestibulocochlear function that involves irrigating the ear
48
Which cranial nerves are located in the pons?
5-8
50
Effects of damage to the abducens nerve versus the abducens nucleus
Nerve - impaired abduction of IL eye Nuclei - IL gaze palsy in both eyes
51
Inferior cerebellar peduncle
Restiform body; connects to medulla; carries mainly inputs
53
Early symptoms of acoustic neuroma
Hearing loss, tinnitus, unsteadiness
55
Divisions of the trigeminal nerve
Ophthalmic, maxillary, mandibular
56
Trochlear palsy
Causes vertical dipolopia & hypertropia (eye is up & in)
57
Supranuclear pathways
Involve brainstem & forebrain circuits that control eye mvmts through connections with CN III, IV, & VI
59
Which cranial nerves are located in the medulla?
9-12
61
CN V
Trigeminal; general sensation for face, mouth, anterior 2/3rds of tongue; muscles of mastication & tensor tympani muscle
62
CN VII
Facial; motor for facial muscles, most salivation, anterior 2/3 tongue taste
63
What is the typical presentation of a cerebellar stroke?
Vertigo, nausea & vomiting, horizontal nystagmus, limb ataxia, unsteady gait, HA
64
What is the function of the intermediate cerebellar hemispheres?
Distal limb coordination
65
Ciliary muscle
Adjusts thickness of lens in response to viewing distance
66
What are the most common causes of acute ataxia in adults?
toxin ingestion, ischemic or hemorrhagic stroke
68
Function of the rostral reticular formation
Maintains alert conscious state in brain
69
Nuclear & infranuclear pathways
Involve brainstem nuclei of III, IV, & VI; the peripheral nerves arising from these nuclei, & the eye mvmt muscles
70
Damage to glossopharyngeal nerve leads to
spasms of pain in posterior pharynx
72
Pupillary effects of anticholinergic agents
Dilated pupils
73
Wrong-way eyes
Eyes look toward side of weakness; possible causes include seizure activity, large lesions such as thalamic hemorrhage, lesions of pontine basis & tegmentum
75
CN III
Oculomotor; innervates all extraocular muscles, except superior oblique & lateral rectus; also controls pupillary constriction & accommodation reflex
76
Internuclear ophthalmoplegia
Eye ipsilateral to lesion does not fully adduct on attempted horizontal gaze, nystagmus in opposite eye
77
CN VI
Abducens; innervates lateral rectus muscle, causes abduction of eye (turns eye out)
78
Sensory ataxia
Occurs when posterior column-medial lemniscus pathway is disrupted, resulting in loss of joint position sense
79
UMN vs LMN damage to CN XII (Hypoglossal)
UMN = CL tongue weakness LMN = IL tongue weakness
80
Herpes zoster causes sensory loss in the distribution of what cranial nerve?
V - trigeminal
82
Saccades
Rapid eye mvmts that bring target of interest into field of view
83
Conductive vs. sensorineural hearing loss
Conductive = abnormalities of external auditory canal or middle ear Sensorineural = disorders of cochlea or 8th nerve
84
Superior cerebellar peduncle
Brachium conjunctivum; connects to midbrain; carries mainly outputs
85
CN IV
Trochlear; innervates superior oblique muscle, causes depression & intorsion of eye
86
Common causes of oculomotor palsy
Diabetic neuropathy, head trauma, intracranial aneurysms, tentorial herniation, ophthalmoplegic migraine in children
87
Truncal ataxia
Wide-based, unsteady "drunklike" gait; caused by lesions in the vermis, which primarily affect the medial motor systems
88
Orbital apex
Region where nearly all nerves, arteries, & veins of the orbit converge before communicating with the intracranial cavity via the optic canal & superior orbital fissure
89
Bell's palsy
unilateral paralysis of the muscles supplied by the facial nerve

ABPP (34 decks)

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