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A. BRAINSTEM
I. MEDULLA OBLONGATA
Level of Superior OCULAR REFLEXES Motor Tracts: Cerebral Aqueduct of -Edinger Westphal nuclei Presence of superior
colliculus such as: Sylvius colliculus nuclei at area of
-Corticospinal tract -Red nucleus tectum, oculomotor nerve
-reflex center for exiting the cerebral
eyeball peduncle
-Medial lemniscus
Level of Inferior colliculus AUDITORY REFLEXES Sensory Tracts: Cerebral Aqueduct of -Trochlear nucleus Presence of inferior
such as: Sylvius colliculus at the area of
-Trigeminal nerve tract tectum and the presence
-movement of head of trochlear nucleus
and trunk in response -Medial lemniscus
to auditory stimuli
-Decussation of superior
cerebellar peduncle
TRACTS FUNCTION Tectospinal tract Movement of head and eyes following image
Medial Longitudinal Fasciculus Eye movements; balance Corticobulbar tract Connects with the different cranial nuclei, motor
Medial Lemniscus Proprioception; light touch Lateral Spinothalamic tract Somatosensory of neck down
Lateral Lemniscus Auditory Anterior and Posterior Spinocerebellar Tract Unconscious proprioception
Corticospinal tract Motor Trigeminal Nerve tract Somatosensory of head and neck
I-Olfactory Pure sensory Olfactory receptor Location: upper part of nasal cavity Pass through the openings of the cribriform plate of ethmoid bone
nuerons above superior concha
Will synapse with olfactory bulb
IV- Trochlear Pure Motor Main motor nucleus of Location: inferior colliculus Only nerve that will:
trochlear nerve nuclei
Function: innervates superior oblique - Cross the midline
muscle - Exit the posterior surface
**longest cranial nerve INTRACRANIALLY
TRIGEMINOTHALAMIC TRACT
VI-Abducent Pure Motor Motor nucleus of CN VI Location: in the caudal portion of the Will exit the brainstem at the pontomedullary junction
pons (level of the facial colliculus)
Will also enter the superior orbital fissure
Function: innervates lateral rectus
muscle
(rostral)
VIII-Auditory Pure sensory - Lateral, medial, superior and inferior vestibular nuclei Vestibular nerve for conduction of signals that provide information
- Cochlear nuclei regarding the position and information regarding the movements of the
head for balance
Cochlear nerve for impulses concerned with sound from organ of Corti
in the cochlea
IX-Glossopharyngeal Motor Nucleus Ambiguus Innervates stylopharyngeus muscle Exit the brainstem BESIDE the upper medulla
Nucleus Ambiguus Main motor Arises at the sides of the upper medulla
Supplies all extrinsic SACCADE –rapid eye scanning -Lesion on one side of the cortex no paralysis because there is dual
muscles of the eye innervations of the CORTICOBULBAR TRACT
except the SUPERIOR SMOOTH PURSUIT –target moves and image is kept in
OBLIQUE and LEFT sharp focus -Lesion of the nerve BEFORE entering the superior orbital fissure
RECTUS paralysis will occur because oculomotor nerve is damaged
CONJUGATE GAZE –both eyes move in the same direction
III-Oculomotor -Lesion in the red nucleus affects the motor component of the CN III
VERGENCE –fixating on a single point because it lies near the oculomotor nucleus (main motor nucleus)
V-Trigeminal -Sensation to the face TRIGEMINAL NEUROLGIA –stab-like pain felt on the skin Lesions that will result in paralysis:
areas innervated by the mandibular branch
-Motor to muscles of - Lesion in Area 3,1,2
mastication, anterior WALLENBERG’S SYNDROME –crossed lesion - Lesion along the trigeminothalamic tract
belly of digastrics and Lesion in Area 4 no paralysis because motor component has dual
tensor tympani innervations by corticobulbar tract
VI-Abducent Innervates the Lateral -Lesion of CN VI BEFORE the pontomedullary junction no paralysis
Rectus muscle because there is dual innervations by corticobulbar tract
VII-Facial -Motor to muscles of Bell’s Palsy injury to facial nerve or nucleus; causes -Lesion of LEFT CEREBRAL HEMISPHERE lower half of the face is
expression IPSILATERAL facial muscle paralysis if one sided affected
-Taste of anterior 2/3 of Crocodile tears syndrome improper communication -Lesion AFTER the motor nucleus half of the face is affected
tongue between the superior salivatory nucleus and nerve
innervating lacrimal gland
-glandular substance
production
-balance
Innervates
stylopharyngeus muscle
LESIONS:
- Lesions from the cerebral cortex, thalamus, basal nuclei, midbrain, pons, upper medulla always contralateral
- For CRANIAL NERVE lesions above the tentorium cerebella, just be aware of 2 cranial nerves HYPOGLOSSAL and FACIAL NERVE (ventral nuclei) since these two are supplied ONLY by the CONTRALATERAL
corticobulbar tracrt so definitely you’ll have a lesion on the contralateral side of the face.
o Upper Limb = weakness on R o Facial deviation = L lower quadrant (because muscles on the left side of the face are
stronger than those on the left so it will deviate to the left)
o Lower Limb = weakness on R
o Tongue devation = deviate to the R (same reason)
o Pain sensation = loss of sensation on R
Tongue will always deviate/ point AWAY from the lesion
o Proprioception = lost on R
Eye gaze will always point TOWARDS the lesion
o Ligh touch = lost on R
**HEMISECTION OF THE SPINAL CORD CST and DC affected in IPSILATERAL SIDE while STT will be on the CONTRALATERAL SIDE
SUPRATENTORIAL INFRATENTORIAL