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129 Cards in this Set

  • Front
  • Back
Pontine tract
Medial lemniscus
Cranial nerves
Reticular formation
Pontine nuclei
Reticular formation
Cranials
Superior colliculus
Red nucleus
Medial lemniscus
Substantia nigra
Cerebral peduncle
Cuneate nucleus
Gracile nucleus
Cranials
Reticular formation
Medial lemniscus
Pyramid
What are the functions of the brainstem reticular formation?
(i) Arousal-Mood Setter
- samples somatic/visceral worlds
- sets forebrain activity (arousal/mood)
(ii) Autonomic Policeman
- monitors somatic/visceral world
- influences crucial reflexes
What are the 4 neurotransmitters of the brainstem reticular formation?
1. serotonin
2. acetylcholine
3. dopamine
4. noradrenaline
Where are the cell bodies of serotinergic neurons of the reticular formation located?
The Raphe nuclei
What are the functions of the serotinergic neurons of the brainstem formation?
- behaviour
- mood (depression)
- aggression (dampens down)
- pain (dampens)
- blood flow control
What are the functions of the cholinergic neurons of the brainstem reticular formation?
- arousal
- memory (attention)
- ANS control (cardiovascular, baroreceptors)
- pain (dampens)
- dreamer (active when dreaming)
What are the functions of the dopaminergic neurons of the brainstem reticular formation?
- behaviour regulation
- focus
- pleasure/motivation
What are the functions of the noradrenergic neurons of the brainstem reticular formation?
- ANS control
- pleasure/motivation
- blood flow control
- neural plasticity
- global attention
Where are the cell bodies of the cholinergic neurons in the brainstem reticular formation located?
BRF cholinergic groups
Where are the cell bodies of the dopaminergic neurons in the brainstem reticular formation located?
Substantia nigra, ventral tegmental area
Where are the cell bodies of the noradrenergic neurons in the brainstem reticular formation located?
Locus coeruleus
Which neurons in the brainstem project only to the forebrain?
The dopaminergic neurons
A lesion to which part of the brainstem would cause coma?
Brainstem reticular formation
A lesion to which part of the brainstem would cause cerebellar signs?
cerebellar peduncles
A lesion to which part of the brainstem would cause nystagmus, vertigo, nausea?
Vestibular nuclei
A lesion to which part of the brainstem would cause speech impairment?
Nucleus ambiguus (X)
A lesion to which part of the brainstem would cause vomiting?
BRF (vomit centre)
A lesion to which part of the brainstem would cause motor loss?
Corticospinal tract
A lesion to which part of the brainstem would cause sensory loss?
Trigeminal nuclei/
spinothalamic tract
Vomit centre on BRF (medulla)
Vestibular nuclei (medulla)
Cerebellar peduncle (medulla)
Nucleus ambiiguus (medulla)
Corticospinal tract (medulla)
Spinothalamic tract (medulla)
Trigeminal nuclei (medulla)
Edinger-Westphal
- Autonomic parasympathetic nucleus for CN III (ciliaris and sphincter pupillae)
CN III Somatic motor nucleus (motor eye)
CN IV Somatic motor nucleus (motor eye)
Vm - CN V Pharangeal (branchial) motor nucleus (motor to muscles of mastication)
CN VII Pharyngeal (branchial) motor nucleus (motor to face)
Vp - Principal nucleus of CN V (somatic sensory head)
CN VI Somatic motor nucleus (abducens - motor eye)
Superior salivary (CN VII) and inferior salivary (CN IX) autonomic nuclei

VII - sublingual and submandibular glands
IX - parotid gland
Vestibular/ cochlear (CN VII) nucleus (special sensory - hearing, equilibrium)
Cochlear (CN VII) nucleus (special sensory - hearing, equilibrium)
Vsp - Spinal tract of CN V (somatic sensory head)
NAm - Nucleus ambiguus (pharyngeal motor CN IX & X)
SoIT - Nucleus of the Solitary Tract (visceral sensory)
Rostral part - CN VII, IX, X (Taste)
Caudal part - CN IX, X (sensory pharynx, larynx)
DMX - Dorsal motor X (parasymp to thorax and gut)
Somatic motor nucleus for XII (motor to tongue)
What is the key clinical difference between Bells Palsy and a stroke affecting the facial muscles?
Forehead spring occurs with stroke, as the forehead receives bilateral innervation

- Stroke will result in loss of lower facial muscles on contralateral side
- Bells palsy will result in loss of upper and lower facial muscles on the ipsilateral side
1. Anterior communicating artery
2. Anterior cerebral artery
3. Internal carotid artery
4. Middle cerebral artery
5. Posterior communicating artery
6. Posterior cerebral artery
7. Superior cerebellar artery
8. Basilar artery
9. Anterior inferior cerebellar artery
10. Vertebral artery (cut)
11. Posterior inferior cerebellar artery
1. Middle meningeal artery
2. Buccal artery
3. External carotid artery
4. Superior thyroid artery
5. Common carotid artery
6. Internal carotid artery
7. Facial artery
8. Maxillary artery
9. Superficial temporal artery
1. Middle cerebral artery
2. Posterior communicating artery
3. Pontine arteries
4. Anterior spinal artery
5. Vertebral artery
6. Posterior inferior cerebellar artery
7. Anterior inferior cerebellar artery
8. Basilar artery
9. Superior cerebellar artery
10. Posterior cerebral artery
11. Anterior choroidal artery
12. Opthalmic artery
13. and 14. Anterior cerebral artery
15. Anterior communicating artery
Which is the more common form of stroke: infarction or haemorrhage?
Infarction (80%) vs Haemorrhage (20%)
What are the most common extracranial and intracranial sites for atherosclerosis?
Extracranial (most common) ICA near common carotid bifurcation
Intracranial at origin of MCA and at ends of basilar artery
What are the 4 acute pathologic features of brain infarct?
• Softening
• Swelling (raised intracranial pressure can cause brain stem compression and death)
• Neutrophils (as part of acute inflammation)
• Ischemic (“red cell”) neuronal change
What are the 3 post-acute pathologic features of brain infarct?
• Foamy macrophages (start at about 3 days) - remove debris
• Reactive astrocytes (start at about 10 days) - form glial scar
• Cavitation
What is the difference between the ischaemic core and the ischaemic penumbra?
Core - necrotic cell death
Penumbra - some tissue survival, retains viability if blood flow restored
What type of infarct:
• Causes small (up to 20 mm) infarct in deep structures of brain (basal ganglia, thalamus, internal capsule) and in the brain stem
• Is associated with arterial hypertension
• Is often clinically silent
Lacunar infarct (small penetrating artery)
What is CADASIL?
• Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy
• Presents with TIAs or migraine, can progress to subcortical dementia
• Notch 3 receptor gene mutations
When are boundary zone infarcts most often seen?
When abrupt hypotension is followed by rapid recovery
Where are boundary zone infarcts more often seen?
Between
– Middle and anterior cerebral arteries
– Middle and posterior cerebral arteries
Which groups of people are more likely to get venous infarcts?
Babies (dehydrated) and pregnant women (hypercoagulable)
Where are the most common locations of berry aneurysms?
What is the most common cause of subarachnoid haemorrhage?
Ruptured berry aneurysm
What are the 5 key symptoms of stroke?
1. Amaurosis fugax (transient monocular visual loss)
2. (hemi-)paresis/weakness
3. Sudden speaking probem
4. Hemianopia
5. Double vision
How do you predict the risk of stroke in patients with atrial fibrillation?
CHADS1:
C - Congestive Heart failure (1)
H - Hypertension (1)
A - Age >75y (1)
D - Diabetes (1)
S - Prior TIA or Stroke (2)
Cerebral aquaduct

(caudal midbrain)
Inferior colliculus

(caudal midbrain)
Midbrain periaqueductal gray

(caudal midbrain)
Trochlear (IV) nucleus

(caudal midbrain)
Spinothalamic tract

(caudal midbrain)
Medial lemniscus

(caudal midbrain)
Substantia nigra

(caudal midbrain)
Cerebral peduncle - CsT/RubroST

(caudal midbrain)
Closed medulla (motor decussation)
1. Central canal
2. Gracile tract
3. Cuneate tract
4. V spinal
5. Autonomic nuclei
6. Spinothalamic tract
7. Spinocerebellar tract
8. Pyramids (CsT decussating)
Midbrain

1. Posterior cerebral (long circumferential branches)
2. Posterior cerebral (short circumferential branches)
3. Posterior cerebral (paramedian branches)
Pons

1. AICA (anterior inferior cerebellar artery)
2. Basilar artery (short circumferential branches_
3. Basilar artery (paramedial branches)
Open Medulla

1. PICA )posterior inferior cerebellar artery)
2. Vertebral artery
3. Anterior spinal artery
Closed medulla

1. Posterior spinal artery
2. vertebral artery
3. Anterior spinal artery
Occlusion of WHAT arteries results in damage to the midline corticospinal and corticobulbar tracts, damage to the reticular formation and loss of the oculomotor nuclei. This can result in locked in with ocular palsy syndrome. The patients typically have sudden onset of vomiting and may have transient loss of consciousness. There is acute onset quadriplegia (corticospinal tracts), bilateral facial paralysis (corticobulbar tracts), loss of speech (corticobulbar tracts for cranial nerve nuclei controlling larynx, pharynx, tongue and lips) and loss of voluntary eye movements (loss of oculomotor nuclei).
Midbrain paramedian/basal arteries
Occlusion of WHAT arteries results in damage to the midline corticospinal and corticobulbar tracts and damage to the reticular formation. The oculomotor nuclei are spared. This can result in "locked in syndrome without ocular palsy" so the patient still has voluntary eye movements. Facial muscles are paralysed due to damage to corticobulbar fibres.
Pontine paramedian/ basal arteries
Occlusion of WHAT artery causes: ipsilateral cerebellar ataxias (loss of middle and/or superior cerebellar peduncles), nausea and vomiting, slurred speech, loss of pain and temperature over the opposite side of the body.
Superior cerebellar artery
The second most common brainstem stroke involves WHAT artery. These patients present with sudden onset vertigo, vomiting and falling to one side. They have usually marked horizontal nystagmus but the characteristic features are absent sensation on one side of the face, ipsilateral facial paralysis and ipsilateral hearing loss. They also lean to the affected side when you make them sit.
Anterior inferior cerebellar artery
The most common brainstem stroke involves WHAT artery. They often present with:
(a) loss of pain and temp on the ipsilateral side of the face
(b) loss of pain and temp on the contralateral body. This odd combination of loss of pain and temperature sensation on the ipsilateral side of the head and contralateral side of the body is unique to this brainstem stroke.
(c) ipsilateral paralysis of soft palate, pharynx and larynx leading to dysphagia and dysarthria
(c) vertigo and nystagmus - saccadic dysmetria (overshoot) or saccadic pulsion
(d) ipsilateral ataxia
(vi) ipsilateral Horner’s syndrome characterised by ptosis, miosis and facial anhidrosis
Posterior inferior cerebellar artery - causes lateral medullary syndrome or Wallenberg's syndrome
A blockage of this artery would result in loss of pain and temperature sensation in the ipsilateral face, ipsilateral facial pain (SpV), contralateral pain and temperature loss of the body (spinathalamic tract), ipsilateral ataxia and gait ataxia (IO), hoarseness and dysphagia (NA) and Horner's syndrome.
Vertebral artery
An occlusion of this artery would result in contralateral weakness of both the upper and lower extremities (pyramidal tract before it crosses), contralateral sensory loss, e.g. vibration, propriception (not pain and temperature), and ipsilateral tongue weakness (hypoglossal nucleus).
Anterior spinal artery
The following are indicative of which condition in a patient with longstanding diabetes?

• Postural lightheadedness
• Heat intolerance
• Erectile dysfunction
• GI dysmotility- bloating, constipation, diarrhoea
• Bladder dysfunction - retention, incontinence
• Glare sensitivity
Autonomic neuropathy
What syndrome is described?
• Any primary autonomic failure without central nervous system findings
• Postural lightheadedness, dizziness worse in the morning, worse after meals or exercise, in hot weather
• May have bladder symptoms, erectile dysfunction, constipation
• May report reduced sweating
Pure autonomic failure
Idiopathic orthostatic hypotension
Bradbury-Eggleston syndrome
Patient presents with:
- Orthostatic hypotension
- Features of parkinsonism
- Rigidity and bradykinesia > tremor
- No, poor or poorly sustained response to l-dopa
- Mild cerebellar or pyramidal signs
MSA - multiple system atrophy
Midodrine
Selective alpha agonist (sympathomimetic) used to treat orthostatic hypotension
What are the 4 P's - goals of stroke imaging?
• Evaluation of Parenchyma – Non contrast CT or MR
• Evaluation of Pipes – CT or MR angiography
• Evaluation of Perfusion – CT perfusion or MR perfusion
• Evaluation of Penumbra – CT perfusion
ACA infarction
PCA infarction
Watershed infarction
Lacunar infarcts (in thalamus, putamen, globus pallidus, caudate nucleus, and internal capsule)
Hypertensive intracerebral haemorrhage
1. Tentorium cerebelli
2. Herniation of temporal lobe
3. Skull fracture affecting middle meningeal artery
4. Midline shift of falx cerebri and third ventricle
5. Compression of cerebral peduncle
6. Herniation of cerebellar tonsil in foramen magnum
7. Compression of CN III
1. Lateral (Sylvian) fissure
2. Inferior frontal gyrus
3. Middle frontal gyrus
4. Superior frontal gyrus
5. Precentral gyrus
6. Central sulcus
7. Postcentral gyrus
8. Supramarginal gyrus
9. Angular gyrus
10. Parietooccipital sulcus
11. Calcarine fissure
1. Superior parietal lobule
2. Visual association cortex
3. Primary visual cortex
4. Multisensory association areas of cortex
5. Primary auditory cortex
6. Wernicke’s area
7. Secondary somatosensory cortex
8. Broca’s area
9. Primary somatosensory cortex
10. Premotor cortex
11. Frontal eye fields
12. Primary motor cortex
13. Supplemental motor cortex
1. Optic chiasm
2. Lamina terminalis
3. Anterior commissure
4. Thalamus
5. Fornix
6. Cingulate gyrus
7. Paracentral lobule
8. Corpus callosum
9. Cuneus
10. Calcarine cortex, upper bank
11. Calcarine sulcus (fissure)
12. Calcarine cortex, lower bank
13. Pineal gland
1. Superior sagittal sinus
2. Cortical gyrus
3. Lateral ventricle
4. Thalamus
5. Third ventricle
6. Corpus callosum
7. Lateral ventricle
8. Thalamus
9. Occipital lobe
10. Midbrain
11. Pons
12. Cerebellum
13. Medulla
1. Genu, corpus callosum
2. Head of caudate nucleus
3. Putamen
4. Columns of the fornix
5. Internal capsule
6. Thalamus
7. Hippocampal formation
8. Cingulate cortex
9. Lateral ventricle
10. Fornix
11. Colliculi
12. Hypothalamus
13. Cisterna magna
1. Subarachnoid space
2. Frontal pole, lateral ventricles
3. Hippocampal formation
4. Temporal pole, lateral ventricle
5. Optic radiations
6. Site of lateral ventricle
7. Subarachnoid space
8. Cerebellum
9. Medulla
10. Cisterna magna
11. Subarachnoid space
1. Genu of corpus callosum
2. Head of caudate nucleus
3. Columns of the fornix
4. Internal capsule (anterior limb, genu, posterior limb)
5. Insular cortex
6. Putamen
7. Globus pallidus
8. Claustrum
9. Tail of caudate nucleus
10. Choroid plexus of lateral ventricle
11. Occipital (posterior) horn of lateral ventricle
1. Trochlear nerve (CN IV)
2. Facial nerve (CN VII)
3. Inferior cerebellar peduncle
4. Vestibular area
5. Olive
6. Hypoglossal trigone
7. Vagal trigone
8. Gracile tubercle
9. Cuneate tubercle
10. Facial colliculus
11. Medial eminence
12. Superior medullary velum
13. Inferior colliculus
14. Superior colliculus
1. C5 cross section
2. T8 cross section
3. L3 cross section
4. Spinothalamic/spinoreticular tracts
5. Dorsolateral fasciculus (of Lissauer)
6. Fasciculus cuneatus
7. Fasciculus gracilis
8. Anterior white commissure
9. Lateral corticospinal tract
10. Vestibulospinal tract
11. Anterior corticospinal tract
1. Anterior horn of left lateral ventricle
2. Body of left lateral ventricle
3. Inferior (temporal) horn of left lateral ventricle
4. Posterior (occipital) horn of left lateral ventricle
5. Cerebral aqueduct
6. Fourth ventricle
7. Left lateral foramen of Luschka
8. Median foramen of Magendie
9. Third ventricle
10. Left interventricular foramen of Monro
11. Right lateral ventricle
1. Middle cerebral artery
2. Anterior cerebral artery
3. Internal carotid artery
4. Basilar artery
5. Vertebral artery
6. Common carotid artery
7. Subclavian artery
8. Brachiocephalic trunk
9. Aortic arch
1. Neural plate of forebrain
2. Neural groove
3. Neural folds
4. Future neural crest
5. Neural plate
6. Fused neural folds
7. Caudal neuropore
8. Neural crest