Term
|
Definition
| contains neurons involved in sensory processing; includes general (somatic) sensory afferent column and visceral sensory afferent column |
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Term
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Definition
| structure separating sensory area from motor area |
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Term
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Definition
| autonomic control, reflexes, motor processing, and sensory processing |
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Term
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Definition
| area containing interneurons that process motor information and output neurons that send efferent information away from CNS; divided into visceral (autonomic preganglionic) efferent section next to the sulcus limitans and the LMNs more ventrally |
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Term
| developmental stages of the spinal cord |
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Definition
| marginal, mantle, and ependymal |
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Term
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Definition
| white matter of spinal cord |
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Term
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Definition
| gray matter of spinal cord |
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Term
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Definition
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Term
| division of white matter in spinal cord |
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Definition
| posterior, lateral, and anterior columns |
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Term
| division of gray matter in spinal cord |
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Definition
| posterior, intermediate, and anterior regions |
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Term
| axial section at cervical level (characteristics) |
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Definition
| has high ratio of gray:white matter; 8 nerves with only 7 vertebrae; nerves exit above vertebrae |
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Term
| axial section at thoracic level (characteristics) |
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Definition
| decrease in neural processing of info here; has small amounts of gray matter; reflects less complex innervations |
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Term
| axial section at lumbar level (characteristics) |
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Definition
| has more space for dorsal and ventral rootlets to expand; has relatively low amounts of white matter; has conus medullaris and cauda equina |
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Term
| external cord features on anterior surface of cord |
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Definition
| one deep fissure along midline that spans entire length; rootlets are somatic and visceral efferents |
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Term
| external cord features on the posterior surface |
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Definition
| has median sulcus that runs length of cord; has intermediate sulcus to separate column nuclei that runs from C1 to thoracic; rootlets contain somatic and visceral afferents |
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Term
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Definition
| region of the spinal cord that has rootlets from higher vertebral levels via the cauda equina; also contains filum terminale and dural sac; level where lumbar puncture happens |
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Term
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Definition
| ligament that anchors conus medullaris to the bottom of the vertebral column |
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Term
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Definition
| specific distinctions of gray matter of the spinal cord that contain certain tracts/nuclei |
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Term
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Definition
| called the substantia gelatinosa; forms synapses between C fibers; located dorsally |
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Term
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Definition
| called nucleus proprious; more medial compared to gelatinosa; cells are proprioceptive |
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Term
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Definition
| called the lower motor neurons; located near the outer edge of the ventral horn of gray matter; contains cell clusters of alpha motor neurons |
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Term
| 4 ascending cerebellar pathways |
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Definition
| dorsal spinocerebellar tract, ventral spinocerebellar tract, rostral spinocerebellar tract, and cuneocerebellar tract |
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Term
| 2 somatosensory ascending tracts |
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Definition
| dorsal columnar medial lemniscus tract and anterolateral tract |
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Term
| dorsal column medial lemniscus tract |
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Definition
| responsible for epicritic perception (discriminative touch, vibratory sense, and conscious muscle joint sense); initiates as axons ipsilateral to the receptive field of primary dorsal root ganglia sensory neurons; primary neuron terminates in ipsilateral brainstem and decussates at the caudal medulla |
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Term
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Definition
| responsible for protopathic sensation (light/crude touch, pressure, pain, temp); contains axons of contralateral 2nd order neurons (Rexed 2); decussates at spinal level; while ascending rostrally axon enters tract ventromedially; info from legs carried in most anterior/lateral portion, while upper body info is ventral/medial |
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Term
| dorsal spinocerebellar tract |
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Definition
| tract whose axons of 2nd order neurons originate in the ipsilateral dorsal grey (Rexed 7); transmits proprioceptive information of trunk and lower limbs |
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Term
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Definition
| proprioceptive axons are within cuneate fascicle (no clear delineation) |
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Term
| ventral spinocerebellar tract |
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Definition
| axons of this tract originate mostly in contralateral dorsal grey matter (Rexed 7 and 8); receives muscle joint information of trunk and upper and lower limbs (*note: axons may decussate and terminate in cerebellum) |
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Term
| rostral spinocerebellar tract |
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Definition
| a poorly delineated pathway; head/arm equivalent of VSCT |
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Term
| descending pathways that are flexor biased |
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Definition
| lateral corticospinal and rubrospinal tracts |
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Term
| descending pathways that are extensor biased |
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Definition
| medullary/pontine reticulospinal, tectospinal, and ventral corticospinal tracts |
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Term
| lateral anterior portion of ventral horn contains: |
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Definition
| loci of motor neurons for distal muscles |
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Term
| medial anterior portion of ventral horn contains: |
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Definition
| contains motor neurons for proximal muscles |
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Term
| corticospinal tract trajectory |
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Definition
| starts in primary motor cortex, then proceeds through the posterior limb of the internal capsule to the basis pedunculi of the midbrain, then to the basis pontis, then to the medullary pyramid; it then decussates at the cervicomedullary junction and ends up in the lateral intermediate zone and motor nuclei |
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Term
| lateral corticospinal tract |
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Definition
| tract with contralateral motor cortex origin; axons in this tract innervating upper body motor neurons are in the medial portion while the lower body motor neurons are more lateral |
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Term
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Definition
| primary nerve fibers carrying protopathic sensory info enter dorsal horn 1-2 levels below secondary synapse and travel caudally; axons of secondary neurons decussate via ventral white commissure and THEN enter tract |
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Term
| somatotopic organization of DCML |
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Definition
| in this tract lower body input is medial while upper is lateral; gracile fascicle is responsible for legs and lower trunk, and cuneate fascicle is responsible for the upper trunk/arms/neck; dorsal intermediate septum separates tracts |
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Term
|
Definition
| primary neurons are pseudo-bipolar and their axons enter the dorsal horn and ascend ipsilateral dorsal column; first synapse and subsequent decussation is at the dorsal column nuclei; peripheral fibers include type A-alpha and A-beta fibers |
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Term
|
Definition
| if injury occurs it will present on the ipsilateral side because decussation occurs at medulla |
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Term
|
Definition
| injury to periphery of this pathway presents contralaterally because there is decussation at the spinal level |
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Term
| unilateral lesion in ipsilateral lateral corticospinal tract |
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Definition
| somatic motor control at and below lesion is absent (ipsilateral to lesion); contralateral motor function remains intact |
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Term
| unilateral spinal lesion in ipsilateral DCML |
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Definition
| ipsilateral to lesion, epicritic sensation at and below level is lost; contralateral epicritic sensation spared |
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Term
| unilateral spinal lesion in ipsilateral ALS |
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Definition
| protopathic sensation at/below and ipsilateral to lesion remains while contralateral is lost |
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Term
|
Definition
| in this lesion there is total loss of vibration/position sense, pain/temp, and motor function below level of lesion |
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Term
|
Definition
| in this lesion type vibration/position sense and motor function are lost on the side ipsilateral to the lesion; pain and temperature sense loss occurs on the contralateral side and above level of injury (1-2 levels) on ipsilateral side |
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Term
| circulation of spinal cord (3 parts): |
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Definition
| radicular arteries, ant. and post. spinal arteries, and vasocorona |
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Term
|
Definition
| branches off ant. artery and penetrates ant. spinal cord; goes to one side or the other and alternates side of penetration; supplies 2/3 of gray and white matter |
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Term
|
Definition
| fed by both ant. and post. radicular arteries; supply more external portions of SC |
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Term
|
Definition
| arteries whose purpose is to replenish the oxygenated blood supply to the SC |
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Term
|
Definition
| loss of blood supply; causes loss of vibration and position sense bilaterally |
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Term
|
Definition
| loss of blood supply; causes loss of pain/temperature sensation and motor function bilaterally |
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Term
|
Definition
| branch of ant. spinal artery supplies ventral funiculus and most of lat. funiculus of white matter and ventral horn/intermediate zone/deep dorsal horn of gray matter |
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Term
| sulcal artery occlusion at L1 (example) |
|
Definition
| causes signs/symptoms in lower trunk/leg; ipsilateral loss of pain/temp and motor function; contralateral and epicritic sensation remains intact; lesion includes: ventral horn, ALS, LCST, and ipsilateral sympathetic preganglionic |
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Term
|
Definition
| feeds into ant. spinal artery as major source of blood supply for lumbar levels and below; ant. spinal artery not adequate source; important consideration for abdominal surgery since it can be easily nicked |
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|
Term
| artery of Adamkiewicz occlusion |
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Definition
| this occlusion is identical to anterior cord syndrome but from the waist down; bilateral motor loss and protopathic sensory loss |
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Term
|
Definition
| muscle spindle and Golgi tendon organ |
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|
Term
| muscle receptor functions |
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Definition
| provides critical info to CNS about muscle status; basically length and tension; also: play role in movements and reflexes |
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Term
|
Definition
| mechanoreceptors, resemble Ruffini endings and Pacinian corpuscles; do not contribute much to proprioception; important for detecting limits of movement |
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Term
|
Definition
| spinal motor neurons that innervate extrafusal muscle fibers |
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Term
|
Definition
| class of spinal motor neurons concerned w/ regulation of muscle spindle length; innervate intrafusal muscle fibers |
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Term
|
Definition
| rapidly adapting; provide info to CNS about rate of change and direction of movement; innervate nuclear bag and chain fibers |
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Term
|
Definition
| smaller, slowly adapting; provide info about static position of limbs; innervate mainly chain fibers |
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Term
|
Definition
| is a highly specialized sensory receptor; 3-4mm in length; fusiform in shape; located in the belly of skeletal muscle; stretch activates afferents but contraction does not! |
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Term
|
Definition
| can respond to efferents; modified striated muscle fibers; enclosed within spindle; 2 types are nuclear bag and nuclear chain fibers |
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Term
|
Definition
| large muscle mass that generates true force for moving limbs; parallel to MS |
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Term
|
Definition
| slender capsule located in tendon of extrafusal muscle; functionally in series with tendon of extrafusal muscle; tension evokes 1b afferent discharge; has incredible sensitivity to small changes in muscle tension; responds to both stretch and contraction |
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Term
|
Definition
| low activity is adequate for static conditions while activity is heightened for rapidly changing muscle length; activity of this system sensitizes muscle spindles |
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Term
| descending pathways control of muscle |
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Definition
| causes co-activation of alpha and gamma MNs; provides normal tonic drive of gamma MNs; important for normal spinal reflex; CNS lesions can affect tonic drive of gamma MNs and muscle tone (spastic paralysis) |
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Term
|
Definition
| stereotypic reaction evoked in response to stimulus; many somatic and autonomic functions mediated by cord are this in nature |
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Term
|
Definition
| reflex containing afferent and efferent components; ex: myotactic reflexes |
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Term
|
Definition
| reflex center consists of 1 or more interneurons; ex: flexor withdrawal, cross extensor |
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Term
|
Definition
| when the muscle spindle senses stretch, the 1a afferent fires and synapses on all LMNs (hundreds) of homonymous muscle in Rexed 9; relaxation of antagonist muscle is caused by reciprocal inhibition |
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Term
|
Definition
| stimulus causes quad muscles to stretch; 1a afferent phasic discharge occurs; reflex causes extension; reflex contraction of homonymous and synergist makes it monosynaptic |
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|
Term
| relaxation of antagonist in patellar reflex |
|
Definition
| by reciprocal inhibition; considered a polysynaptic reflex |
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Term
|
Definition
|
|
Term
| brachioradialis reflex tests: |
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Definition
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|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| response to stretch, mediated by 1b GTO afferent; causes relaxation of synergist and mononymous; effects readily observed in extensor muscles; effects are more widespread than MS afferents; is considered a tension-feedback system; has a high threshold so that it does not constantly fire; responsible for initial increased muscle tension during muscle fatigue |
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Term
| withdrawal reflex and cross-extensor reflex |
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Definition
| reflex mediated by small diameter afferents (A-delta); activates ipsilateral flexors and inhibits ipsilateral extensors; crosses over SC and inhibits contralateral flexors while activating contralateral extensors; polysynaptic; afferents convey info about painful/noxious stimuli; serves to protect/escape; very fast |
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Term
| flexor withdrawal reflex (stepping on tack) |
|
Definition
| flexion occurs at the knee to avoid painful stimuli; mediated by multiple spinal levels; includes Lissauer's tract (central projecting processes of pain afferents); allows for response before expletive word is said (very quick) |
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Term
|
Definition
| decreased muscle tone leading to decreased resistance on muscle; limb is flaccid |
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Term
|
Definition
| increased tone leading to increased resistance; 2 types: spasticity and rigidity |
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Term
|
Definition
| clasp-knife type of increased resistance; also seen are hyperreflexia and clonus; low-threshold stretch reflex; typical of UMN lesion |
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Term
|
Definition
| sustained rhythmic contraction evoked by sudden maintained stretch; differs from fasciculation |
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Term
|
Definition
| typical of Parkinson's patients; cog-wheel type of increased resistance ("gives then locks"); not often associated with changes in stretch reflexes |
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Term
|
Definition
| immediate condition following transection; loss of all reflexes including sphincteric; flaccid paralysis below lesion; decreased sympathetic tone; concern about BP due to effect on vascular smooth muscle |
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Term
| spinal shock (chronic outcome) |
|
Definition
| areflexia disappears and hyperreflexia occurs in flexor muscles; UMN signs; some sphincteric/erectile reflexes occur w/o voluntary control; transmitter receptor supersensitivity causes increased stretch reflexes; removal of descending inhibitory influences from supraspinal levels causes disinhibition of reflex arcs; collateral sprouting associated with it |
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|
Term
| intrinsic spinal cord circuits following transection |
|
Definition
| sensory feedback triggers circuits for rhythmic motor activity; DOES NOT REQUIRE CEREBRAL CORTEX! |
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Term
|
Definition
| affects individual muscles in regards to weakness; pronounced atrophy; hypotonia observed; tendon reflexes depressed or lost; plantar reflex is flexion; fasciculation present |
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Term
|
Definition
| muscle weakness affects groups of muscles; atrophy is slight due to disuse because signal still goes to muscles; spastic hypertonicity; increased tendon reflexes; plantar reflex exhibits Babinski sign; fasciculation absent |
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Term
|
Definition
| dorsiflexion of big toe following stimulus on plantar surface; indicates CST (UMN) damage; normal in neonates |
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Term
|
Definition
| brisk muscle stretch reflexes, Babinski sign, weakness, increased muscle tone, muscle stiffness (spasticity), hyperreflexia, clonus (due to hyperactive MSR) |
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Term
|
Definition
| decreased muscle stretch reflexes, hyporeflexia, fasciculations, atrophy |
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|
Term
| structures susceptible to peripheral neuropathy |
|
Definition
| cell bodies, axons, Schwann cells, and vasculature |
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Term
|
Definition
|
|
Term
| motor neuron (CNS) cell body location |
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Definition
|
|
Term
| autonomic neuron (CNS/PNS) cell body location |
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Definition
|
|
Term
| sensory neuron (PNS) cell body location |
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Definition
|
|
Term
| significance of distance between motor and sensory cell bodies |
|
Definition
| ensures that peripheral neuropathy is restricted to either motor or sensory deficit |
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|
Term
| large diameter myelinated motor axons |
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Definition
|
|
Term
| large diameter myelinated sensory axons |
|
Definition
| to muscle spindle, transmit light touch/vibration/position/spinocerebellar input |
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|
Term
| Roman numbering used with: |
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Definition
|
|
Term
|
Definition
|
|
Term
| small diameter myelinated motor axons |
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Definition
|
|
Term
| small diameter myelinated sensory axons |
|
Definition
| STRONG, transmit sharp/localized pain, cool temperature |
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|
Term
| small diameter autonomic myelinated axons |
|
Definition
| preganglionic axons making up white ramus |
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|
Term
| small diameter unmyelinated sensory axons |
|
Definition
| transmit aching/burning and less localized pain; also: warm temperature |
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|
Term
| small diameter autonomic axons |
|
Definition
| make up postganglionic fibers or gray ramus |
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|
Term
| 4 physical forces that produce compression/traction |
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Definition
| ischemia due to compression of vasa vasorum, myelin sheath compression, axon disruption (axonotmesis), and axon/associated supportive tissue disruption (neurotmesis) |
|
|
Term
| examples of compression in anatomically restricted areas |
|
Definition
| 1) spinal nerve compression by herniated disc 2) ulnar nerve entrapment in cubital tunnel 3) median nerve entrapment in carpal tunnel |
|
|
Term
| examples of penetrating nerve injury |
|
Definition
| GSWs and stabbings, mostly cause axon disruptions |
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|
Term
| endogenous nerve metabolism disturbance |
|
Definition
| diabetes or renal failure |
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|
Term
| exogenous nerve metabolism disturbance |
|
Definition
| alcohol or chemotherapeutic agents |
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|
Term
| genetic nerve metabolism disruptions |
|
Definition
| Charcot Marie Tooth disease |
|
|
Term
| idiopathic nerve metabolism disturbance |
|
Definition
| amytrophic lateral sclerosis |
|
|
Term
| examples of inflammatory attacks on Schwann cells/axon/cell body |
|
Definition
| response after infection/vaccination (Guillain Barre syndrome), paraneoplastic response associated with certain cancers |
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|
Term
|
Definition
| polio and West Nile viruses |
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|
Term
|
Definition
| herpes zoster (shingles) and HIV |
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|
Term
|
Definition
| agent causing leprosy (M. leprae) |
|
|
Term
| short term compression results in: |
|
Definition
| axon metabolism disturbed and AP propagation blocked by local ischemia; onset within minutes; recovery within minutes; large myelinated axons are most susceptible; sensory axons more affected than motor neurons |
|
|
Term
| prolonged local compression results in: |
|
Definition
| Schwann cells are damaged in area of compression; conduction block (neurapraxia) occurs; onset over several hours; recovery over weeks to a few months; axons remain intact distal to lesion and still respond to stimuli; minimal atrophy occurs distal to lesion; axonal transport preserved |
|
|
Term
|
Definition
| occurs by local dismantling and rebuilding of myelin; Schwann cells divide; newly formed internodes are shorter than normal (intercalated segments); typically fully clears |
|
|
Term
| physical disruption of axons results in: |
|
Definition
| Wallerian degeneration; immediate conduction changes; axonal changes within 5 days; atrophy and denervation; lack of trophic factors; recovery by regeneration of injured axons or sprouting (reinnervation); time course is months to 2 years; degree of recovery variable; aberrant reinnervation can occur |
|
|
Term
|
Definition
| neuronal changes in which the cell bodies swell, Nissl substance breaks up, and RNA synthesis increases |
|
|
Term
| axonal changes in physical disruption include: |
|
Definition
| myelin degeneration; axonal atrophy (axonotmesis); response to electrical stimuli absent distal to lesion; loss of transport of substances beyond lesion |
|
|
Term
|
Definition
| regenerating axons may end up with different destinations than original axons; can cause neuropathy |
|
|
Term
|
Definition
| abrupt drop in compound motor action potential amplitude along nerve as seen on EMG; is the hallmark of focal demyelinating lesion; response amplitude distal to lesion is normal because myelin and axon are intact; diffuse demyelination occurs |
|
|
Term
| nerve conduction study reveals axonal damage when: |
|
Definition
| low (or no) response at all stimulated sites along the nerve |
|
|
Term
| motor unit potential parameters measured during needle EMG |
|
Definition
| duration, amplitude, configuration stability, firing rate |
|
|
Term
| patterns of clinical abnormality in neuropathy |
|
Definition
| radiculopathy, plexopathy, mononeuropathy, polyneuropathy, and neuronopathy |
|
|
Term
|
Definition
| usually occurs in foramina; involves dorsal and ventral roots as well as spinal nerve; nerve becomes compressed in spinal foramen by herniated nucleus pulposus or osteophyte ("hard disc"); symptoms correspond to motor, sensory, and deep ache site territories of compressed nerve |
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|
Term
|
Definition
| pattern of nerve involvement in limb greater than single nerve or root lesion; ex: Erb's palsy following delivery, lumbar plexopathy in diabetic; causes: trauma, inflammation following vaccination/systemic infections, compression by cervical rib/retroperitoneal hematoma, hereditary condition, or idiopathic |
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|
Term
|
Definition
| abnormality localized to single peripheral nerve or segment; caused by constriction or superficial vulnerability; examples: carpal tunnel, cubital tunnel, Saturday night palsy, foot drop, Bell's palsy, or meralgia paresthetica |
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|
Term
|
Definition
| has bilateral and symmetric pattern; deficits do not correspond to single nerve/root; distal segments involved (length dependent); sensation is usually more abnormal than motor function; abnormalities move more proximal if condition worsens; causes: metabolic disturbance (diabetes/renal failure), toxins (alcohol or chemotherapy), autoimmune (GBS), or hereditary (CMT) |
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|
Term
|
Definition
| sensory perception in cerebral cortex dependent on it working properly; allows voluntary movements by mediating motor pathways; essential for consciousness and subconscious control of cardiovascular and respiratory systems |
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Term
|
Definition
| central core of midbrain and pons |
|
|
Term
| parts of brainstem ventral to tegmentum |
|
Definition
| basis pedunculi, basis pontis, pyramids, substantia nigra (really mesencephalic), and pontine nuclei |
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Term
|
Definition
| consists of tegmentum and basis pedunculi; entire midbrain except tectum |
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Term
|
Definition
| consists of crus cerebri and substantia nigra |
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|
Term
|
Definition
| all white matter of the brainstem; contains CST and CBT descending tracts |
|
|
Term
|
Definition
| superior colliculus, PAG and cerebral aqueduct, oculomotor nuclei and 3rd exit, EW nucleus, red nucleus; thalamic nuclei and optic tracts around it |
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|
Term
|
Definition
| inferior colliculus, decussation of superior cerebellar peduncles, trochlear nucleus |
|
|
Term
| upper midbrain ABOVE mammillary bodies features: |
|
Definition
| pulvinar, med. geniculate nuclei, lat. geniculate nuclei (thalamic); optic tract passing to LGB, pineal gland |
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Term
|
Definition
| chief sensory V nucleus, motor V nucleus, mesencephalic V nucleus, superior cerebellar peduncle |
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|
Term
|
Definition
| facial colliculus, abducens and facial motor nuclei, sup/lat vestibular nuclei, spinal nucleus V, inferior cerebellar peduncle, solitary tract/nucleus |
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|
Term
| medulla near PMJ features: |
|
Definition
| cochlear nucleus/8th root |
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|
Term
|
Definition
| 12th nucleus/tract, DMNX, vestibular nuclei, nucleus ambiguus (also seen at PMJ), ICP, inferior olive |
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|
Term
|
Definition
| dorsal column nuclei (cuneate and gracilis), spinal central canal, decussation of pyramids, continuation of spinal n. and tract |
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|
Term
|
Definition
| has motor and parasympathetic components; LMNs exit ventromedially; Edinger Westphal nucleus contains preganglionic parasympathetic neurons exiting w/ corresponding nerve; nerve projects through midbrain structures |
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Term
|
Definition
| motor nucleus only; LMNs exit dorsally; control eye movements |
|
|
Term
| 3 trigeminal sensory nuclei |
|
Definition
| chief sensory responsible for epicritic; mesencephalic responsible for proprioception; spinal descending responsible for P/T |
|
|
Term
|
Definition
| LMNs to muscles of mastication; located medially to sensory portion |
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|
Term
|
Definition
| motor fibers arise at facial colliculus; eye movements and lateral gaze; LMNs exit medially; innervates lat. rectus |
|
|
Term
| facial nucleus components: |
|
Definition
| motor, parasympathetic, and sensory (special and general somatic) |
|
|
Term
|
Definition
| sends LMN fibers dorsomedially to facial colliculus; fibers then travel ventrally and laterally to nucleus; NOTE: vestibular/spinal nucleus V are lateral to exiting fibers!!! |
|
|
Term
| facial parasympathetic nucleus |
|
Definition
| aka superior salivatory nucleus; sends preganglionic parasympathetic fibers to exiting LMNs |
|
|
Term
| facial nerve special sense portion |
|
Definition
| taste fibers project into brainstem towards nucleus of solitary tract |
|
|
Term
| facial nerve general somatic sense |
|
Definition
| small projection to spinal trigeminal nucleus V |
|
|
Term
| vestibulocochlear nucleus |
|
Definition
| for special sensory use only, hearing |
|
|
Term
|
Definition
| located at upper medulla near PMJ; cochlear nerve projects to it; sensory only |
|
|
Term
|
Definition
| located in lower pons and upper medulla; several separate components; afferent vestibular fibers enter it; sensory only |
|
|
Term
|
Definition
| has sensory, parasympathetic, and motor components |
|
|
Term
|
Definition
| nucleus ambiguus sends LMNs to nucleus and nerve |
|
|
Term
| vagus parasympathetic nucleus |
|
Definition
| located in DMNX; preganglionic fibers arise from it; for H/N, lung, GI |
|
|
Term
|
Definition
| both special and general somatic portions; taste fibers from inf. vagal ganglion to solitary tract/nucleus (rostral part); sup. vagal ganglion fibers project to spinal tract V, gets protopathic info from small H/N region; viscerosensory info to caudal NST (cardiorespiratory!!!) |
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|
Term
|
Definition
| motor only; LMNs exit medially then lat to medullary pyramids; tongue muscles ipsilateral innervated; exit restricted to upper medulla but this nucleus is elongated along large part of medulla |
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|
