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DPT704: Neuro Hank > Cranial Nerves - Medulla > Flashcards

Cranial Nerves - Medulla Flashcards

1
Q

What is Cranial Nerve XII?

A

Hypoglossal Nerve

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2
Q

Is CN XII Hypoglossal sensory or motor?

A

motor

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3
Q

What does CN XII Hypoglossal supply?

A

both intrinsic and extrinsic muscles of the tongue

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4
Q

Where are the cell bodies of the LMN of CN XII Hypoglossal located?

A

Hypoglossal Nucleus

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5
Q

Where is the Hypoglossal Nucleus located?

A

near the midline of the medulla (ventral to the central canal or 4th ventricle)

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6
Q

Where do the CN XII Hypoglossal LMN axons pass and in relation to what two structures?

A

The axons pass inferolateral next to the medial lemniscus and pyramid

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7
Q

Where do the CN XII Hypoglossal LMN axons exit the medulla?

A

as rootlets in the ventrolateral (preolivary) sulcus

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8
Q

What are UMN of CN XIII Hypoglossal known as?

A

Corticobulbar fibers (cortical control)

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9
Q

Where do CN XIII Hypoglossal UMN Corticobulbar fibers arise from?

A

tongue region of the precentral gyrus (Primary motor cortex)

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10
Q

Where do CN XIII Hypoglossal UMN Corticobulbar fibers descend

A

with the corticospinal tract to the medulla

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11
Q

What do most of the CN XIII Hypoglossal UMN Corticobulbar fibers do at the medulla and where do they synapse?

A

most of the fibers cross the midline and synapse in the contralateral hypoglossal nucleus.

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12
Q

Where does the hypoglossal nucleus receive indirect sensory information from and what type of info?

A

Solitary Nucleus (Taste)
and
Sensory Trigeminal Nuclei (bolus of food in oral cavity)

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13
Q

How does the hypoglossal nucleus receive indirect sensory information from the Solitary Nucleus and Sensory Trigeminal Nuclei?

A

by way of multisynaptic connections in the reticular formation

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14
Q

What is this reflex pathway of controlling the tongue involved in?

A

swallowing, suckling, and chewing

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15
Q

Clinically, what does a LMN lesion of the CN XIII Hypoglossal or nucleus result in?

A

paralysis and muscle wasting of both intrinsic and extrinsic muscles on the ipsilateral side.

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16
Q

How does the tongue respond in a LMN lesion of CN XIII Hypoglossal?

A

upon protrusion of the tongue, it deviates toward the side of the lesion due to the unopposed action of the intact contralateral genioglossus muscle.

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17
Q

What will patients have difficulty with in a LMN lesion of the CN XIII Hypoglossal?

A

eating and speaking (dysarthria)

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18
Q

Clinically, what does a UMN lesion of the CN XIII Hypoglossal that occurs at a level prior to the crossing result in?

A

results in weakness of only the extrinsic muscles (primarily genioglossus) on the side contralteral to the site of the lesion.

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19
Q

Which way will the tongue deviate upon voluntary protrusion in a UMN lesion of the CN XIII Hypoglossal that occurs at a level prior to the crossing?

A

it deviates away from the side of the lesion due to the crossing fibers and unopposed action of the intact contralateral genioglossus muscle

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20
Q

A stroke of the paramedian branch of the anterior spinal artery may result in combinations of damage to the

A
  • hypoglossal nerve fibers,
  • the adjacent pyramid
  • medial lemniscus
  • ventral trigeminothalamic tract
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21
Q

Would would be the result of a stroke of the paramedian branch of the anterior spinal artery - hypoglossal nerve fibers?

A

LMN symptoms involving the tongue

-paralysis and muscle wasting of both intrinsic and extrinsic muscles on the ipsilateral side

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22
Q

Would would be the result of a stroke of the paramedian branch of the anterior spinal artery - hypoglossal nerve fibers -the adjacent pyramid?

A

UMN symptoms involving the pyramid

Contralateral axial and appendicular musculature - Initial flaccid paralysis followed by: Abnormal cutaneous reflexes (Babinski sign), Abnormal reflexes: clonus, clasp knife), Spasticity – velocity dependent hypertonia, Abnormal timing of muscle activation (slower onset, prolonged contraction), Paresis or plegia (weakness)

(corticospinal fibers prior to decussating and forming the lateral corticospinal tract)

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23
Q

Would would be the result of a stroke of the paramedian branch of the anterior spinal artery - hypoglossal nerve fibers -medial lemniscus?

A

Loss of Contralateral Body Sense:

  • Sterogenesis
  • -Conscious Proprioception
  • -Two Point Discriminative Touch
  • Vibratory
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24
Q

Would would be the result of a stroke of the paramedian branch of the anterior spinal artery -ventral trigeminothalamic tract?

A

Somatosensation of the Face by CN V Trigeminal Nerve

Contrallateral loss of Nociception and Thermal Sensation

Contralteral Touch (discriminative and light non-discriminative) and Conscious Proprioception should be preserved due to bilateral represetation via dorsal trigeminothalamic tract?

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25
Q

What is alternating hemiplegia?

A

Combination of lower and upper motor neuron signs that are demonstrated on opposite sides of the neuraaxis as seen with a stroke with the paramedian branch of anterior spinal artery.

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26
Q

Where are the regions that alternating hemiplegia occur?

A

Where a motor cranial nerve exits along the midline adjacent to the descending corticospinal fibers.

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27
Q

What are the two other likely regions this might occur?

A

III - Oculomotor
VI - Abducens

although these two are for tongue?
VII - Facial Nerve
XI - Glossopharyngeal

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28
Q

CNXI - Accessory Nerve contains a few LMN in ___

A

nucleus ambiguus

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29
Q

CNXI - Accessory Nerve LMN in nucleus ambiguus innervate a few of the ____

A

laryngeal muscles (cranial component)

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30
Q

CNXI - Accessory Nerve cell bodies innervating the sternocleidomastoid and trapezius muscles (spinal components) are located in

A

cervical levels of the spinal cord dorsal to the ventral horn

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31
Q

Where do CNXI - Accessory Nerve axons of the spinal component go?

A

they leave the spinal cord and ascend into the cranial cavity to re-exit the skull as the accessory nerve

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32
Q

Where do CNXI - Accessory Nerve axons of the cranial comonent go?

A

a small number of fibers exit the medulla long with the vagus nerve.

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33
Q

CNXI - Accessory Nerve UMN (corticobulbar fibers) descend with the ___

A

corticospinal fibers

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34
Q

After CNXI - Accessory Nerve descend with the corticospinal fibers they ___

A

decussate at the pyramidal decussation

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35
Q

Where do CNXI - Accessory Nerve terminate?

A

in the cervical region (C2-4)

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36
Q

Clinically, how do you test for involvement of the spinal part of CNXI - Accessory Nerve?

A

the patient is asked to turn the head (sternocleidomastoid) or shrug the shoulders (trapezius).

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37
Q

T/F: The cranial component of CNXI - Accessory Nerve is indistinguishable from CNX - Vagus Nerve?

A

True

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38
Q

CNX - Vagus Nerve UMN (corticobulbar) innervate ___

A

nucleus ambiguus

39
Q

CNX - Vagus Nerve UMN (corticobulbar) innervate nucleus ambiguus ipsilaterally, contralaterally, or bilaterally?

A

bilaterally i.e., both sides.

40
Q

T/F: because CNX - Vagus Nerve UMN innervates nucleus ambiguus bilaterally, a unilateral lesion of the upper motor neuron can be easily distinguished.

A

FALSE: a unilateral lesion of the upper motor neuron would not be easily distinguished

41
Q

CNX - Vagus Nerve LMN located in nucleus ambiguus innervate what? (3)

A 
Skeletal Muscles of the 
1. Soft Palate
2. Larynx
3. Pharynx
including vocalis muscle (true vocal folds).
42
Q

Where is Nucleus ambiguus located?

A

reticular formation

43
Q

T/F: Nucleus Ambiguus is not easily identified.

A

True

44
Q

Nucleus Ambiguus contains lower motor neurons for what Cranial Nerves? (3)

A

CN IX - Glossopharyngeal
CN X - Vagus
Cranial Part of CN XI - Accessory Nerve

45
Q

Where are preganglionic parasympathetic cell bodies for CNX - Vagus Nerve located primarily?

A

in the dorsal motor nucleus of X

46
Q

The preganglionic parasympathetic axons for CNX - Vagus Nerve go from the cell bodies on dorsal motor nucleus of X and ____

A

exit the medulla as rootlets of X

47
Q

Where do the axons of the preganglionic parasympathetic axons for CNX - Vagus Nerve synapse?

A

on postganglionic neurons in visceral walls of glands, cardiac muscle, and smooth muscle of the throax and abdomen.

48
Q

CNX - Vagus Nerve sensory fibers travel along the

A

solitary tract

49
Q

CNX - Vagus Nerve sensory fibers travel along the solitary tract and end in the

A

solitary nucleus

50
Q

CNX - Vagus Nerve sensory fibers component carry

A

pain and pressure from pharynx, larynx, thorax, and abdomen

51
Q

Where do some of the CNX - Vagus Nerve sensory fibers enter and why?

A

Spinal Trigeminal Nucleus because pain of the face.

52
Q

What are the three important reflexes carried by the CNX - Vagus Nerve?

A
  1. Carotid Sinus Reflex
  2. Carotid Body Reflex
  3. Cough, gag, and vomiting reflexes
53
Q

Carotid Sinus Reflex - Where does the afferent limb originate?

A

from baroreceptors along the carotid artery near the bifurcation into internal and carotid arteries

54
Q

Carotid Sinus Reflex - Which cranial nerve carries afferent information?

A

fibers of CN IX - Glossopharyngeal

55
Q

Carotid Sinus Reflex - CN IX - Glossopharyngeal carries afferent information to

A

solitary nucleus

56
Q

Carotid Sinus Reflex - CN IX - Glossopharyngeal carries afferent information to solitary nuclues, then relayed to the

A

dorsal motor nucleus of X

57
Q

Carotid Sinus Reflex - Which cranial nerve carries efferent information?

A

CNX - Vagus

58
Q

Carotid Sinus Reflex - The efferent limb, CNX - Vagus, of the reflex arc innervates what and does what?

A

the heart to slow heart rate

59
Q

Carotid Body Reflex - uses what cranial nerve for one of its sensory afferent components?

A

CNX - Vagus

60
Q

Carotid Body Reflex - What sensory afferent information does CNX - Vagus carry?

A

the chemoreceptor sensation from lung bronchioles

61
Q

Carotid Body Reflex - What sensory afferent information does CNX - Vagus carry chemoreceptor sensation from lung bronchioles, which synapse in the

A

“medullary respiratory center” (an area in the reticular formation)

62
Q

Carotid Body Reflex - What does it help control?

A

breathing rhythm

63
Q

Carotid Body Reflex - The efferent limb carries what information where?

A

descending information to spinal cord levels controlling inspiration (intercostals and diaphragm)

64
Q

Cough, gag, and vomiting reflexes - involves sensory fibers from what two cranial nerves from where?

A

CNIX - Glossopharyngeal (oral/nasal cavity)

CNX - Vagus (gut)

65
Q

Cough, gag, and vomiting reflexes - where is the sensory information relayed?

A

to appropriate lower motor neurons in nucleus ambiguus and spinal cord, and preganglionic parasympathetics in dorsal motor nucleus of X

66
Q

Do lesions of CNX - Vagus Nerve result in sensory or motor deficits?

A

both sensory and motor deficits

67
Q

Unilateral lesions of lower motor neurons of CNX - Vagus result in ___ (3)

A
  1. Difficulty swallowing
  2. Hoarseness (dysphonia)
  3. inability to raise the soft palate on ipsilateral side
68
Q

Lesions of the preganglionic parasympathetic fibers of CNX - Vagus Nerve cause

A

disruption of some gut reflexes (but are less important for diagnosis of lesion location than are deficits assocaited with somatomotor LMN component).

69
Q

Hyperactivity (excess firing) of preganglionic parasympathetic fibers of CNX - Vagus Nerve can cause

A

excess gastric acid secretion = ulcers

70
Q

Large bilateral lesions of the medullary reticular formation can

A

disrupt normal breathing rhythms and reflex control of vascular resistance to blood flow and result in coma.
Patient with this type of damage may need life support systems and have a poor prognosis.

71
Q

CNIX - Glossopharyngeal Nerve cortical control UMN in cortex descends as part of

A

corticobulbar synapses

72
Q

CNIX - Glossopharyngeal Nerve cortical control UMN in cortex descends as part of corticobulbar system to synapse on

A

lower motor neurons in nucleus ambiguus

73
Q

CNIX - Glossopharyngeal Nerve UMN synapses on nucleus ambiguus ipsilaterally, contralaterally, or bilaterally?

A

bilaterally

74
Q

Where are CNIX - Glossopharyngeal Nerve LMN’s located in nucleus ambiguus?

A

rostral end

75
Q

What cranial nerves have LMN’s in Nucleus Ambiguus?

A

CN IX - Glossopharyngeal
CN X - Vagus
Cranial Part of CN XI - Accessory Nerve

76
Q

CNIX - Glossopharyngeal Nerve LMN from nucleus ambiguus innervate

A

stylopharyngeus muscle

77
Q

CNIX - Glossopharyngeal Nerve preganglionic parasympathetic neuron cell bodies located in

A

reticular formation

78
Q

CNIX - Glossopharyngeal Nerve preganglionic parasympathetic neuron cell bodies located in reticular formation; axons exit the

A

medulla

79
Q

CNIX - Glossopharyngeal Nerve preganglionic parasympathetic neuron cell bodies located in reticular formation; axons exit the medulla to synapse on

A

postganglionic neurons in otic ganglion

80
Q

CNIX - Glossopharyngeal preganglionic parasympathetic nerves from the otic ganglion then innervate

A

the parotid gland (remember from anatomy that this component follows the auriculotemporal branch of V3

81
Q

CNIX - Glossopharyngeal sensory neurons central processes synapse in the (2)

A
  1. caudal part of the solitary nucleus

2. sensory trigeminal nuclei; primarily spinal nucleus of V

82
Q

CNIX - Glossopharyngeal sensory neurons central processes synapse in the caudal part of solitary nucleus and carry

A

the afferent limb of the carotid sinus reflexs

83
Q

CNIX - Glossopharyngeal sensory neurons central processes synapse in the sensory trigeminal nuclei; primarily spinal nucleus of V carries

A

somatic sensations (touch, pressure, pain) from pharynx and posterior 1/3 of tongue (gag reflex)

84
Q

CNIX - Glossopharyngeal sensory neurons central processes synapse in the sensory trigeminal nuclei; primarily spinal nucleus of V carries what information to anterior part of solitary nucleus?

A

taste sensation from posterior 1/3 of tongue (mainly bitter sensation)

85
Q

CNIX - Glossopharyngeal carries the afferent or efferent limb for several reflexes?

A

afferent (sensory)

86
Q

CNIX - Glossopharyngeal is the efferent limb for several reflexes whose efferent limb is carried by (3)

A

CNX - Vagus
CNXII - Hypoglossal
Spinal Cord LMN’s

87
Q

What reflexes does CNIX - Glossopharyngeal carry afferent (sensory) information for? (4)

A

Carotid Sinus Reflex
Gag Reflex
Vomiting Reflex
Swallowing Reflex

88
Q

The motor component of CNIX - Glossopharyngeal participates in what reflexes? (2)

A

Swallowing Reflex

Salivation-Taste Reflex

89
Q

Unilateral lesions of CNIX - Glossopharyngeal can produce

A

difficulty with speech and swallowing

90
Q

T/F: defitis from unilateral lesions from CNIX - Glossopharyngeal are less severe than with CNX - Vagus Nerve.

A

True

91
Q

Similar to CNX - Vagus, CNIX - Glossopharyngeal lesions can result in

A

some visceral reflexes

92
Q

What is the most diagnostic deficits which distinguish between CNIX - Glossopharyngeal and CNX - Vagus lesions?

A

Loss of gag reflex to touching the pharynx compared to deviation of uvula

93
Q

Loss of gag reflex to touching the pharynx would indicate a lesion with

A

CNIX - Glossopharyngeal (afferent limb)

94
Q

Loss of deviation of uvula would indicate a lesion with

A

CNX - Vagus (efferent limb)

DPT704: Neuro Hank (14 decks)

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