Exam IV- BrainStem

Question 1

What is the name for the more ventral portion of the brainstem?

Answer 1

The basilar region

Question 2

What is the more posterior/dorsal region of the brainstem?

Answer 2

The tegmentum

Question 3

What is posterior to the cerebral aqueduct in the midbrain?

Answer 3

The tectum

Question 4

Where is the reticular formation in the brainstem?

Answer 4

The tegmentum area (dorsal portion of midbrain, pons, & medulla)

Question 5

Where will I find Ascending pathways in the brainstem?

Answer 5

The tegmentum, makes sense because sensory is always dorsal

Question 6

Where will I find Descending pathways in the brainstem?

Answer 6

The basilar region, makes sense because motor is always ventral

Question 7

Where do the spinalThalamic ascending pathways cross?

Answer 7

The spinal cord, by the time we get to the brainstem they are crossed.

Question 8

Where does the DC-ML ascending pathway cross?

Answer 8

The medulla

Question 9

What does DC-ML stand for? What is its function?

Answer 9

Dorsal Column-Medial Lemniscal, fine touch and conscious proproception from the body

Question 10

What is the function of the Trigeminal Lemniscal pathway?

Answer 10

Fine touch and conscious proprioception from the face

Question 11

What is the function of the SpinoThalamic Pathway?

Answer 11

Pain and temperature from the body

Question 12

What is the function of the Trigeminal Thalamic pathway?

Answer 12

Pain and temperature from the face

Question 13

For the ascending pathways, what is the result of a lesion BELOW the decussation?

Answer 13

An IPSIlateral deficit

Question 14

For the ascending pathways, what is the result of a lesion ABOVE the decussation?

Answer 14

CONTRAlateral deficit

Question 15

For the ascending pathways what is the result of a lesion AT the decussation?

Answer 15

BIlateral deficit

Question 16

What is the main function of the rostral portion of the Reticular Formation? What is the fancy science name of this portion?

Answer 16

Alertness, like the alarm clock!…PontoMesencaphalic

Question 17

What is the main function of the caudal portion of the Reticular Formation? Whats the fancy scientific name for this portion?

Answer 17

Vital Functions….PontoMedullary

Question 18

What is the name of the system that regulates alertness, sleep/wake, consciousness in the rostral reticular formation?

Answer 18

(ARAS) Ascending Reticular Activating System

Question 19

What is a classic result of a lesion to the Rostral Reticular Formation?

Answer 19

A coma

Question 20

What are the 5 N.T.s associated with the Rostral Reticular Formation? What is a main fxn of each?

Answer 20

1. Ach(alertness,memory) 2.NorEpi(alertness,mood) 3.Dopamine(movement,initiative,memory) 4.Seratonin(mood) 5. Histamine(alertness)

Question 21

What are the four main inputs to the Rostral Reticular Formation? Think of reasons you can’t sleep :)

Answer 21

1.Fronto-Parietal Assoc. Cortices (Thinking too much in bed)2. Limbic&Cingulate Cortices 3.Thalamus 4. SpinoReticular Tract(part of Spinothalamic System CANT SLEEP W PAIN/Temperature)

Question 22

What are the 6 main functions of the Caudal Reticular formation?

Answer 22

1. Respiration 2. Heart Rate 3. Blood Pressure Regulation 4. Descending Motor Control 5. C.N. Reflexes 6. LOTS of Involuntary movements (coughing, hiccups…)

Question 23

What are the 6 brainstem lesions we discussed?

Answer 23

1.INFERIOR Alternating Hemi-Ple-Gia 2.Wallenberg’s Syndrome 3.Acoustic Neuroma 4. MIDDLE Alternating Hemi-Ple-Gia 5. Trigeminal Alternating Hemi-Ple-Gia 6. SUPERIOR Alternating Hemi-Pel-Gia (Weber’s)

Question 24

Where is the source of Inferior Alternating Hemiplegia? What blood supply problem?

Answer 24

Source: AnterioMedial Medulla Blood: Anterior Spinal Artery

Question 25

What are the three main structures affected with Inferior Alternating Hemiplegia?

Answer 25

1. Hypoglossal Nuc/Nerve 2. Pyramid 3. Medial Lemniscus

Question 26

What are 2 symptoms of Inferior Alternating Hemiplegia?

Answer 26

1. IpsiLateral paralysis of tongue (towards side of lesion) 2.UMN=ContraLat sensory/motor loss (ABOVE DECUSS=CONTRA)

Question 27

Where is the source of Wallenberg's Syndrome? What artery is the problem?

Answer 27

Where: Lateral Lesion of medulla Blood: PICA

Question 28

What are 3 main symptoms of Wallenberg's syndrome?

Answer 28

1. Loss of pain and temperature 2. Difficulty swallowing 3. DIZZINESS!! main one!!!

Question 29

Where is the source of an Acoustic Neuroma (Schwannoma)?

Answer 29

The cerebellaponitne angle (remember the picture!?). NO blood problem because its a tumor

Question 30

What are the CNs involved with Acoustic Neuroma? Since you know the CNs what are the symptoms?

Answer 30

7: Bell's, HyperAccusis 8:Tinnitus, Nystagmus and if its big enough 5. Alternating Hemianesthesia

Question 31

Where is the source of a Middle (Abducens) Alternating HemiPlegia? What is the blood supply problem?

Answer 31

The Caudal Pons, branches of the Basilar Artery

Question 32

What are the 4 structures affected in the Middle(Abducens) Alternating HemiPelgia?

Answer 32

1. VI (ABDUCENS) 2. VII 3.CorticoSpinal Tract 4. Medial Lemniscus

Question 33

What are the 4 main symptoms of MiddleA.H.? Think structures affected!

Answer 33

1. IPSIlat adduction of eye (c/o VI being out) 2. Positive Babinski sign (c/o Cort.Spin.Tract) 3. Bell's (VII) 4. CONTRA lat sensory loss (ML )

Question 34

Where is the problem with a Trigeminal Alternating Hemiplegia? Blood Supply?

Answer 34

Where: the Mid Pons BLOOD: Basilar Art

Question 35

How many structures are affected my Trigemninal AH? What are the 3 MAIN structures and what are some symptoms?

Answer 35

There are 7 freaking structures affected.....#1) V: Ipsilat BITE DOWN, SENSATION (all freaking over) #2)Ascending and #3)Descending Tracts: Body sensation and Motor

Question 36

Where is the problem with Weber's Syndrome? (SUP A.H.) Blood Supply?

Answer 36

Where: The Midbrain BLOOD: Basilar Art., Post Cerebral Art

Question 37

What are the 3 structures involved in Superior AH/Weber's? What are the LMN lesion signs? What are the UMN lesion signs?

Answer 37

III, CorticoSpinal, CorticoBulbar....LMN: Ptosis, Pupil Dilation, External Strabismus, Inability to move the eye in any of the III motor directions......UMN: pos babinski, CONTRAlat paralysis CONTRA lower face

Question 38

Which part of the face receives BILATERAL input from UMNs?

Answer 38

The UPPER part of the face

Question 39

Which part of the face receives CONTRALATERAL input from UMNs?

Answer 39

The LOWER part of the face