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Neuro
Kaplan5c - The Brain Stem (blood supply, lesions, reticular formation)
15
Accounting
Pre-School
04/15/2013

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Cards

Term
What does the basilar run on? What are it's branches?
Definition
-The length of the pons

-AICA is it's lowest branch
-Labyrinthine is next (to the ear with CN8)
-Pontine
-Superior cerebellar
-Divides into the post. cerebral once it reaches midbrain
Term
What serves ant. medulla?

Lateral medulla?
Definition
-Ant. spinal artery

-PICA***
Term
What serves medial pons?

Lat. pons?
Definition
-Pontine arteries

-AICA (caudal), superior cerebellar (rostral)
Term
What serves midbrain?
Definition
-Posterior cerebral art. branches get the whole thing
Term
Medial medullary syndrome?
Definition
-From occlusion of vertebral or **ant. spinal

-Pyramids-->Contra. spastic hemiparesis
-CN 12-->Tongue towards lesioned side
-Med. lemniscus-->Contra. pain and temp.
Term
Wallenberg syndrome?
Definition
-Aka lateral medullary syndrome
-From loss of **PICA

-CN 5 (spinal), 8-10 (nuc. mostly)
-Spinothalamic tract & descending hypothalamus

-**Ipsi. palate droop & hoarseness (from **nuc. ambiguus)
-**Contra. pain & temp. in body + *ipsi. horners (long tract); together, these mean brain stem

-There are a few others such as ipsi. limb ataxia (inf. cerebellar ped., not weakness), ipsi. pain and temp from face (spinal 5), and nystagmus (away) & vertigo (vestibular n.), but those above are the most definitive for localization (10 + two long tracts)
-Notice the pain and temp are apposing
Term
Medial pontine syndrome?
Definition
-From paramedian branches of basilar a. (pontine)
-Localized to caudal pon

-Corticospinal-->Contra. spastic hemiparesis
-Abducens nerve (exits ventrally)-->Medial strabismus

-May also have some facial n. and medial lemniscus involvement (ipsi. Bells + Horner's & contra. body p&t)
-Similar to medial medullary synd., but abducens localizes it (as well as CN7), rather than tongue involvement
Term
Lateral pontine syndrome?
Definition
-From **AICA or *sup. cerebellar occlusion

Long tracts;
-Spinothalamic & descending hypothalmic
CN and Nuc.;
-**Facial & vestibulocochlear nn. (when caudal)
-Trigeminal (when rostral)
-Spinal V (always)

-Similar to lat. medullary, but now we get either ipsi. bells and *hearing, or ipsi. loss mastication & anesthesia
-Still get the contra loss of pain and temp. & ipsi. horners
Term
Pontocerebellar angle syndrome?
Definition
-From **acoustic neuroma of CN8 (from vestibular n. Schwann cells)

-*No long tract involvement
-Commonly involves 7, then 5; loss of hearing, then Bell's, then anesthesia; all ipsi.

-Very similar to lateral pons, but outside brainstem b/c there are **no tracts involved (no body signs)
Term
Weber syndrome?
Definition
-Aka medial midbrain syndrome
-From **posterior cerebral a. occlusion**

-Corticospinal-->contra hemiparesis
-CN 3-->ipsi. down and out (+ eye PANS lost)

-Also catches the corticobulbar fibers (*contra. lower* face weakness)
Term
Parinaud syndrome?
Definition
-Aka dorsal midbrain syndrome
-From **pineal gland tumor

-Superior colliculi-->bilateral loss of **vertical conjugate gaze (can't look up)

-Often also will involve pretectal area (diminished *pupillary response) & aqueduct (*nc hydrocephalus)
Term
What can we expect overall for cortex, brain stem, and spinal cord lesions?
Definition
-Cortex; all contra.
-Stem; ipsi. face, contra. body
-Spinal; Motor and touch ipsi., P&T contra.

-See 402
Term
What are the major components for the reticular formation? What are their special neurotransmitters and action?
Definition
1. Raphe nuclei-->serotonin (5-HT)-->mood and non REM sleep

2. Locus caeruleus-->NE-->arousal (REM sleep when shut off)

3. Periaqueductal gray-->opiod receptors-->descend to modulate pain in dorsal horn
-These are innervated by pain fibers from spinothalamic

-The reticular formation is a chemically significant portion of the brainstem and is involved in regulating things like respiration, cardiovascular responses, arousal, and sleep
-Not really important in lesions however
Term
What disease is associated with the reticular formation?
Definition
-Alzheimers
-Raphe and locus coeruleus
Term
Overall, what are the medially effected CNs and locations?
Definition
-3; midbrain
-6; pons (caudal)
-12; medulla

-See drawing on 401
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