Neuroanatomy 2 pages 23-

Question 1

where does the inferior oblique make the eye go?

Answer 1

looking up and in

Question 2

where does the superior oblique make the eye go?

Answer 2

looking down and in

Question 3

are CN3 nuclei close together? to they traverse laterally?

Answer 3

yes in midbrain

medially

Question 4

what arteries does CN 3 travel between?

Answer 4

posterior cerebral artery and superior cerebellar artery

Question 5

when does CN3 get trapped in herniation?

Answer 5

when temporal lobe uncus slips unter tentorium cerebelli

Question 6

What nerves go through cavernous sinus?

Answer 6

CN 3, 4, V1, V2, 6

Question 7

A lesion compresing CN3 externally will do what?

Answer 7

the parasympathetics fibers causing the pupil to dilate, it will have ptosis and extra-ocular muscle weakness

Question 8

what commonly compresses CN3 that is not a herniation?

Answer 8

posterior communicating artery aneurysm

Question 9

what are the key features of a CN3 palsy?

Answer 9

ptosis, mydriasis and ophthalmoplegia

Question 10

what are the key feutrues of horners?

Answer 10

ptosis, miosis, anhidrosis

Question 11

CN3 ophthalmoplegia looks like what?

Answer 11

down and out

Question 12

diabetes damage of CN3 has what features?

Answer 12

ptosis and ophthalmoplegia

not miosis

Question 13

CN4 originates in the posterior midbrain then it does what?

Answer 13

decussates behind sylvian aqueduct then circumnavigates the brainstem

Question 14

what does a patient look like with a right CN IV palsy?

Answer 14

tilt their head to the left

defected depression of the adducted right eye

Question 15

what lesion causes ipsilateral CN3 palsy and a contralateral hemiparesis?

Answer 15

lesion of the cerebral peduncle

Question 16

A lesion of the tract near the red nucleus will result in what?

Answer 16

oculomotor palsy and a tremor

Question 17

Midbrain damge often results in CNIII palsy plus damage to any one of the followin, what is the other symptom that matches each location- cerebral peduncle?, RAS?, red nucleus?

Answer 17

-contralateral hemiparesis
-coma
tremor

Question 18

a lesion within the pons damaging the CN6 nuclesu will result in what? and if the nucleus of CN7 is involved? what if it involved the corticospinal tract?

Answer 18

1. gaze palsy
2. gaze palsy and facial palsy
3. gaze palsy and associated contralateral hemiparesis

Question 19

what nerve is commonly damaged due to incresed ICP due to its lengthy intracranial course?

Answer 19

CN6

Question 20

how do we remember what cranial vault holes the V branches go?

Answer 20

standing room only
sup orbital fissure
rotundum
ovale

Question 21

what are the 3 separate nuclei of the trigeminal system?

Answer 21

mesencephalic in midbrain
main sensory in pons
decending in medulla

Question 22

a brainstem lesion affecting the descending nucleus is depicted with what pattern of sensory loss?

Answer 22

expanding circle

pain and temp

Question 23

mesencephalic nucleus is concerned with?

Answer 23

proprioception

Question 24

the main sensory trigeminal nucleus is concerned with what?

Answer 24

light touch

Question 25

what is the corneal reflex afferent? efferent?

Answer 25

V1 | VII

Question 26

what might cause ptosis, ophthalmoplegia and sensory loss over V1 and V2?

Answer 26

cavernous sinus problems like thrombus

Question 27

extra axial facial nerve lesion may cause facial paralysis with what other findings although a lesion to the actual nucleus itself won't?

Answer 27

taste salivation and lacrimation | an intra-axial lesion of just pons will never cause this

Question 28

does a lesion of CN7 lead to quiter sounds?

Answer 28

no louder sounds (hyperacusis)

Question 29

what part of the tongue does CN VII taste?

Answer 29

ant. 2/3

Question 30

a supranuclear lesion of CNVII will do what to the forehead and orbicularis oris?

Answer 30

spare it and let them blink

Question 31

CN 7 nucleus lesion or of the nerve spare the forehead?

Answer 31

no- total ipsilateral facial paralysis

Question 32

what type of VIII lesion are more apt to cause imbalance or veering towards the side of the lesion?

Answer 32

central lesions

Question 33

a lesion of the pons damaging the vestibular nuclei results in what nystagmus?

Answer 33

vertical or horizontal/rotatory

Question 34

a lesion of the inner ear labyrinth or vestibulocochlear nerve results in what nystagmus?

Answer 34

horizontal

Question 35

a cerebellopontine angle lesion causes damage to what nerves?

Answer 35

CN5, 7, 8 ipsilateral deafness, vertigo, facial numbness and complete facial paralysis

Question 36

Lesions of pontine usually use CN VI and VII plus damage to the following structures, what are the signs of these- basis pontis? RAS? Trigeminal system? Spinothalamic pathway?

Answer 36

- contralateral hemiparesis - coma - ipsilateral facial sensory loss - contralateral body sensory loss

Question 37

CN 9 and 10 motor fibers arise in what nucleus?

Answer 37

nucleus ambiguus- supply the laryngeal and pharyngeal muscles

Question 38

The parasympathetic fibers of the vagus nerve arise from what nucleus?

Answer 38

dorsal motor nucleus

Question 39

IX X an XI exit skull through where?

Answer 39

jugular foramen

Question 40

lesions of 3 nerves can occur at the jugular foramen- what are the signs?

Answer 40

dysphagia dysarthria shoulder droop

Question 41

where does the CN12 leave the medulla?

Answer 41

exit between the inferior olive and corticospinal tracts

Question 42

CN 12 lesions deviates toward what?

Answer 42

the lesion

Question 43

what 6 signs make up wallenburg syndrome?

Answer 43

- ipsi facial pain/temp - contralateral body pain/temp - horner's - ipsilateral gait - vertigo, nausea, vomit, nystagmus(vestibular nuclei lesion) - dysphagia and hoarseness

Question 44

What are the 3 signs that make up medial medullary syndrome?

Answer 44

1- tongue deviates toward lesion 2. contralateral loss of vibration and proprioception 3. contralateral hemiparesis sparing the face

Question 45

conjugate horizontal gaze from the FEF leads to what movement of what CNs?

Answer 45

ipsi CN 3 medial rectus | contra CN6 lateral rectus

Question 46

review the path of conjugate gaze --

Answer 46

FEF, brainstem decuss, PRPF CN VI, MLF, CNIII, contralateral medial rectus

Question 47

What's the secrete for knowing it is a INO

Answer 47

paretic left medial rectus with right gaze becomes fully functional with convergence

Question 48

INO has what impairments?

Answer 48

impaired adduction of the ipsi eye with horizontal gaze horizontal nystagmus of the contralateral abducted eye

Question 49

With a pontine lesion the gaze deviation is where?

Answer 49

away from the lesion with a contalateral hemiparesis

Question 50

warm water in the ear causes the patients eyes to do what?

Answer 50

eyes to drift in opposite direction with fast beating nystagmus towards the irrigated ear

Question 51

cold water in the ear makes the patienseyes to do what?

Answer 51

drift towards the irrigated ear with fast beating nystagmus in the opposite direction

Question 52

Is nystagmus present in a comatose patient with an intact brainstem?

Answer 52

no

Question 53

Does COWS apply to the comatose patients?

Answer 53

NO!!!! fast phase nystagmus absent in coma

Question 54

what is absent in oculocephalic reflex that tells you the patient is in coma?

Answer 54

saccades

Question 55

abnormal cold caloric testing or Doll's head maneuver implicates what?

Answer 55

brainstem lesion damaging the RAS

Question 56

brow sequard?

Answer 56

ipsi motor and proprioception | contralateral pain and temp

Question 57

complete cord compression leads to what?

Answer 57

LMNs at first due to spinal shock, then spasticity, hyperreflexia, babinski positive and BOWEL / BLADDER. don't forget

Question 58

an expanding central cord lesion has what type of sparing?

Answer 58

sacral sparing and usually the dorsal columns are spared

Question 59

what effects sacral roots resulting in saddle anestesia?

Answer 59

midline lesion of cauda equina