CN V System, Pain Generators, and Processing

Question 1

What are the Peripheral Nociceptive Tissues?

Answer 1

1. Meninges
2. Skin
3. Cornea
4. Head, Face, Neck mm.
5. LL. of the neck and TMJ
6. Vasculature
7. Periosteum

Question 2

What are Peripheral Nociceptive Tissues?

Answer 2

Tissues that carry free nerve endings capable of generating nociceptive stimuli.

Question 3

What is more important about Peripheral Nociceptive Tissues?

Answer 3

Many of these tissues also have R/C capable of generating stimuli that are inhibitory to the nociceptive stimuli.

Question 4

What can be concluded about the modulation of Peripheral Nociceptive Tissues?

Answer 4

Either an up regulation of nociception or a down regulation of inhibitory input may contribute to the generation of head and face pain

Question 5

What can contribute to the generation of head and face pain?

Answer 5

increased A-delta and C-Fiber stimulation or decreased LDA stimulation

Question 6

What are the three divisions of the Trigeminal Nerve?

Answer 6

V1 - Ophthalmic
V2 - Maxillary
V3 - Mandibular

Question 7

What are the contributors to the Trigeminal Nerve?

Answer 7

1. Cervical Afferents
2. Outer Ear contributions from CN VII, IX, X
3. Trigemina Ganglion
4. Geniculate Ganglion VII
5. Superior Ganglia of IX
6. Superior Ganglia of X
7. Spinal Trigeminal Tract fibers from V, VII, IX, X

Question 8

What is the cervical afferent contribution to the Trigeminal Nerve?

Answer 8

The convergence of the upper cervical polymodal afferents with the spinal trigeminal nucleus.
Ex: Lack of dermatomal HA distribution

Question 9

What might cause a nerve to generate pain?

Answer 9

1. Compression
2. Inflammation
3. Infection
4. Demyelination
5. Deafferentation
6. Hypoxia

Question 10

What are the three main divisions of the trigeminal nuclei?

Answer 10

1. Principle Sensory Nucleus
2. Spinal Trigeminal Nucleus
3. Mesencephalic Nucleus

Question 11

Where is the principle sensory nucleus located?

Answer 11

Lateral Pons

Question 12

What does the principle sensory nucleus process?

Answer 12

Fine Touch

Question 13

Where is the spinal trigeminal nucleus located?

Answer 13

Just caudal to the principle nucleus, it runs to the upper cervical segments and is contiguous with Lamina II

Question 14

What does the spinal trigeminal nucleus process?

Answer 14

Nociception and Pain

Question 15

Where is the mesencephalic nucleus located?

Answer 15

Rostral to the principle nucleus into the midbrain

Question 16

What does the mesencephalic nucleus process?

Answer 16

Proprioception

Question 17

What is the nociceptive carrying portion of the trigeminal lemniscus?

Answer 17

The Ventral Trigeminothalamic Tract

Question 18

What are the 2 divisions of the ventral trigeminothalamc tract?

Answer 18

1. Paleo-trigeminothalamic Tract

2. Neo-trigeminothalamic Tract

Question 19

What does the Paleo-Trigeminothalamic tract do?

Answer 19

the P-TT Tract carries the affective aspect of pain.

Question 20

Where does the Paleo-Trigeminothalmic tract carry information to?

Answer 20

The Frontal Lobe, Anterior Cingulate Gyrus, and Prefrontal Cortex

Question 21

What does the Neo-Trigemintohalampic Tract do?

Answer 21

The N-TT Tract carries the sensory discriminative aspects of pain.

Question 22

Where does the Neo-Trigeminothalmic tract carry information to?

Answer 22

The VPM of the Thalamus, the Somatosensory Cortex, and the Anterior Insular Cortex.

Question 23

What else does the Ventral Trigeminothalmaic Tract do?

Answer 23

Takes Fine Touch, Pressure, and Proprioception more rostrally.

Question 24

What does the Dorsal Trigeminothalamic Tract do?

Answer 24

Carries fire touch and proprioception ipsilaterally .

Question 25

Where do the Dorsal and Ventral Trigeminothalamic Tracts join?

Answer 25

The D-TT joins the V-TT rostrally.

Question 26

What are the Trigeminal Collaterals?

Answer 26

1. Hypoglossal Nuc 2. Facial Nuc. 3. Trigeminal Motor Nuc 4. Mesencephalon 5. Sup. Salivary Nuc 6. Nuc. Ambiguous 7. Reticular Fm 8. PAG 9. Dorsal Motor Nuc of X

Question 27

What reflex is associated with the Facial Nucleus?

Answer 27

Corneal Reflex

Question 28

What reflex is associated with the Mesencephalon?

Answer 28

Jaw Jerk Reflex

Question 29

What reflex is associated with the Dorsal Motor Nuc of X

Answer 29

Vomiting Reflex

Question 30

What reflex is associated with the Sup Salivatory Nuc?

Answer 30

Lacrimal Reflex

Question 31

What reflex is associated with the Reticular Fm?

Answer 31

Sneezing Reflex

Question 32

Which arteries supply the spinal trigeminal tract in the medulla?

Answer 32

The vertebral artery and the PICA

Question 33

Which arteries supply the spinal trigeminal nucleus in the medulla?

Answer 33

The vertebral artery and the PICA

Question 34

Which arteries supply the spinal trigeminal tract in the pons?

Answer 34

The basilar artery

Question 35

Which arteries supply the spinal trigeminal nucleus in the pons?

Answer 35

The basilar artery

Question 36

Which arteries supply the trigeminothalamic fibers in the midbrain?

Answer 36

The posterior cerebral artery and the superior cerebral artery

Question 37

Which arteries supply the VPM of the thalamus?

Answer 37

The posterior cerebral artery

Question 38

Which arteries supply the posterior limb of the internal capsule?

Answer 38

The middle cerebral artery

Question 39

What constitutes the afferent connection from the cerebral blood vessels to the trigeminal ganglion?

Answer 39

The Trigeminovascular System

Question 40

What is the efferent effect of the trigeminovascular system hypothesized to contribute to?

Answer 40

The generation of Migraine and Cluster HA's

Question 41

Which structure is activated by the Trigeminovascular System with Migraines?

Answer 41

The Meningeal Vasculature

Question 42

What order neurons bring all sensory information from the head and neck to the thalamus?

Answer 42

2nd Order Neurons

Question 43

What nucleus in the thalamus receives all sensory input from the head and neck?

Answer 43

The VPM

Question 44

Where does localization of sensory information from the head and neck occur?

Answer 44

The Lateral Somatosensory Cortex via 3rd Order Neurons

Question 45

Where is the Trigeminal Motor Nucleus located?

Answer 45

Superior and Medial to the principle sensory nucleus.

Question 46

Where does the Trigeminal Motor Nucleus have outputs to?

Answer 46

The muscles of mastication

Question 47

What does the anterior cingulate gyrus play a role in?

Answer 47

The Limbic Control System

Question 48

Which structure involves interoception?

Answer 48

The Anterior Insular Cortex

Question 49

Which structure plays a role in affect, executive function, and decision?

Answer 49

The Prefrontal Cortex