Neuro Test 2 LGT:

ghazaleh moayedi, OMS-II

Zombie Food Pyramid

 Asch: Brainstem-Intro and External
Structures (3 questions)
Spend some time with Thieme pgs 226-229 if the
Netters pics are not working for you
Read the transcripts!
Dont confuse the cerebral and cerebellar
peduncles!
One pair of cerebral (used to hold up old brain and 3 cerebellar
(brachium conjunctivum, restiform body, and middle)
Quick and dirty:
Mesencephalon: CN III & IV
Pons: CN V VIII
Medulla: CN IX-XII
Wheres CN I & II?
What structure forms the
inferior posterior (dorsal)
boundary of the
mesencephalon?
What structure separates
the pons from the medulla
oblongata dorsally?
What part of the brainstem
houses the preolivary
sulcus and what structure
emerges from it?
What part of the brainstem
houses the superior and
inferior colliculi?

What are their functions,

respectively?
What part of the brainstem houses the
pyramids and what are their
importance?
Asch: Internal Brainstem-Organization
Nuclei, and Tracts (3 questions)
I know this stuff is nuts! I think the
next two images are the most
important. I studied ALL the images
in great detail and we only ended up
having 1 on our exam. Learn from
my mistake and dont spend too
much time on this stuff.
 Level 4
Caudal Pons (Abducens n.- Facial n.& nuclei)

1
2 6
8
10 2 10
3 4

5 9

7 7
 Level 9
Rostral Midbrain - Sup. colliculus

Pineal

1 1

2
4
7 3

5 5

8 8
9
9

CN III
 Asch: CN III, IV, and VI Anatomy (3
questions)
When in doubt, neural crest cells!
CNs that innervate muscle are LMN
Dont worry about the SVE, GSE, etc.
He might refer to them as such on
the test, but just focus on knowing a
few of the most important functions
for each CN
Know your palsies, its what
doctoring is about!
 CN III: Oculomotor
Remember where it exits the
brainstem!
Edinger-Westphal nucleus: must
know!
SO4 LR6 AO3 oculomotor is all
others
Importance in Horners syndrome
 CN IV: Trochlear
Remember its position in the
brainstem!
Enters orbit through superior orbital
fissure above the common tendinous
ring
SO4 LR6 AO3 CNIV does superior
oblique
CNIV Palsy- diplopia when looking
down and in (stem will discuss
reading pt reading)
 CN VI: Abducens
MLF! Spend time with the MLF
picture from Thieme
Lesion of CN VI nucleus causes
simultaneous ipsilateral CNVI palsy and
contralateral CN III palsy b/c of MLF
CNVI especially vulnerable to injury
CNVI palsy
Eyeball adducted and cannot be rotated
laterally past the mid position of gaze
 Asch: CN V and VII (3
questions)
CNV: Trigeminal
Muscles of mastication, 1st branchial arch
Know the divisions, names, etc: review all this stuff
from the practical, it will show up on the written
General sensory of head
Know its course through the brain/skull
Pain/temp/crude touch: Trigeminal ganglion (1 st order
neurons) cross apex of petrous portion of temporal bone
pierce middle cerebellar peduncle brainstem/spinal
tract spinal nucleus (2nd order neurons) contralateral
projection to VPM (3rd order neurons) posterior limb of
internal capsule primary and secondary sensory cortices
Notice the difference for discriminative touch
 CN VII
Know the pathway
Taste to anterior 2/3 of tongue
Chorda tympani (taste fibers and pre-ganglionic
parasympathetic fibers) travel w/ lingual n.
(CNV)
Know your disorders
Bells palsy: ipsilateral hemifacial paralysis b/c
LMN
Hemispheric stroke would be contralateral b/c
would be knocking out blood to contralateral
UMN
Asch: CN IX, X, XI, and XII Anatomy
(3 questions)
CN IX: Glossopharyngeal
Transferrs pain from otitis media,
tonsillitis, and pharyngitis
Parotid gland secretion
Herrings n. baroreceptors of carotid
sinus
Taste post. 1/3 of tongue
Pharyngeal plexus of nn jugular ganglion
jugular foramen tractus solitarius and
nucleus solitarius
 Vagus: CN X
The Wanderer
CNX = PNS
GI and respiratory secretions (rest and digest!)
Main control system of heart SA Node (nucleus
ambiguus), Vasovagal syncope
The ear!? Typmanum and external acoustic meatus
Baroreceptors of aortic arch
Taste at base! (of the tongue, duh!)
Recurrent laryngeal and clinical significance
PALATOGLOSSUS!!!! The exception!
 CN XI: Spinal Accessory
Motor to traps and SCM (with help of
C3&4)
Some innervation with vagus to
muscles of larynx (nucleus
ambiguus)
CN IX Palsy:
Shoulder drop with inability to shrug
Inability to rotate head against
resistance to side opposite injured nerve
 CN XII: Hypoglossal
Motor to the tongue (except what by
who?)
What bone contains the hypoglossal
canal?
Occipital bone
Crosses both carotids 1 cm above
bifucation-C3 surgical importance!
Genioglossus m causes deviation
of tongue to affected side
 Asch: Brainstem Lesions (3
questions)
Wallenbergs: posterior lateral
medullary infarction, blood supply
from posterior inferior cerebellar
a.branch of vertebral a.
Paurinauds: MLF, upward gaze,
blood supply from anterior spinal
a.branch of vertebral a.
Spend some time with his chart, all
the lesions are fair game, but he def
loves these two
 Asch: Cerebrovascular System (3
questions)
TIA/ RIND
RIND longer? Term not really used anymore
Amaurosis fugax: thrombus breaks off and gets into
occipital artery, transient blindness
Subclavian Steal Syndrome stealing blood for
your brain by retrograde perfusion to the subclavian
b/c of hamburgers in your arteries
Know your Circle of Willis (check out made
ridiculously simple for a great review)-middle
cerebral not part of circle of willis
Know what goes through the carotid canal
(caroticotympanic a.)
 Cont
How do the optic nerve fibers get through the eye?
Lamina cribrosa
ICA does not branch until petrous portion of
temporal bone
No brachiocephalic v on left side
Anterior communicating artery has a high incidence
of berry aneurysm anterior circulation of the brain
Posterior cerebral a. must leave infratentorial posterior
cranial fossa to cross tentorium cerebella in order to
supply structures of cerebrum. This makes the vessel
vulnerable to injury as it can be stretched and compressed by
the free edge of the tentorium In passage
 Forster: Reticular Formation (3
questions)
See Thieme pgs230-231
Respiratory and circulatory
regulation
Activity needed to maintain
consciousness (sleep apnea in
elderly patients)
Important autonomic functions
NT: serotonin, acetylcholine,
norepinephrine, dopamine,
epinephrine (cholinergic and
 Cont
Syncope: vasovagal fainting
Coma: more profound loss of
conciousness, can be caused by
lesion to reticular formation
Stupor and obtundation are lesser
degrees of depressed consciousness
and are characterized by variable
degrees of impaired reactivity
 cont
Intracranial causes of coma
Head injuries, CVA, CNS infections, tumors,
and increased intracranial pressure
Extracranial causes of coma
Vascular disorders(shock or hypotension
caused by severe hemorrhage or MI),
metabolic disorders (diabetic acidosis,
hypoglycemia, uremia, hepatic coma,
addisonian crisis, electrolyte imbalance),
intoxication, hyper/hypothermia, severe
systemic infections.
 Machu: A&P of ANS (6
questions)
See her objectives, she is as straight
forward as can be
Any specific questions from the
peanut gallery?
 Routh: Diencephalon and
Telencephalon (6 questions)
Parkinsons
micrographia, poverty of voluntary movement, slow speech,
masked face
Loss of pigmented neurons in substantia nigra=no inhibition
of basal gangli=overactivity of bg
TX: L-Dopa
Huntingtons
Destruction of Ach secreting GABA neurons of BG
Opposite of parkinsons
Chorea
Treat with drugs that block dopamine
Alzheimer's
Beta amyloid plaques and neurofibrillary tangles (Tau)
 Hormonesnstuff
Hypothalamus
Secretes stimulatory and inhibitory
hormones on pituitary
ADH and oxytocin? Did he tell yall this?
They are actually released by the
posterior pituitary
Anterior pituitary is FLAT PEG
Pineal Gland
Melatonin from seratonin
 Lobesnstuff
Frontal lobe: Brodmanns 4,6,8,44,45
Cognition and memory, LOBOTOMY!
Alzheimer's can affect frontal lobe: memory, inattentiveness, etc
Parietal lobe: Brodmanns 3,1,2
Processing of sensory input, body orientation
Info from VPL VPM L from limbs, M from ummmmm face!
Temporal lobe: Brodmanns 41,42,22,44,45
Primary auditory cortex, associative auditory cortex, wernickes, and brocas
Wernickes and Brocas communicate via arcuate fasiculus
Occipital lobe: Brodmanns 17,18,19
Primary sensory cortex and visual association cortex
Retina-optic nerve->chiasm-tract->lateral geniculate body of thalamus-
>optic radiations->brodman 17->brodman 18,19
Insular lobe
Found under opercula
Limbic lobe
 White Matter
Association fibers connect within a
hemisphere
Arcuate fasciculus
cingulum
Projection fibers connect deep to cortex or
cortex to deep
Corticospinal tract
Commisural fibers unite homologous
structures across hemispheres
Corpus collosum
 Routh: Somatosensory System (6
questions)
DCML
Pressure
Discriminative touch
Vibratory sense
proprioception
Spinothalamic
Lateral: pain and temperature
Ventral: light touch and pressure
 Spinocerebellar
Posture and coordination of limb
movement via proprioceptors in limbs
and trunk
Unconscious proprioceptive stimulii
synapse in cerebellum on same side
cross, then re-cross
VPL is Limbs, VPM is ummmmmm,
face
Go over the lesions again!
 Routh: Cranial Nerve VIII-Auditory
and Vestibular System (3 questions)
Review Thieme 142-153 and 366-369
Dont forget aucoustic shwannoma
and menieres dz
 Schetz: Control of Movement (9
questions)
Know all of his charts!
Granule cells are only excitatory
cells, rest are inhibitory (mossy fibers
synapse here)
Damage to vermis: trunk problems,
ataxia
Equilibrium problems and nystagmus
associated with vestibular nuclei
know the outputs of the cerebellar
peduncles
 cont
Dysdiadochokinesia: failure to make
rapid alternating movements fish
out of water
Know your basal ganglia!
Striatum: caudate and putamen
Lenticular: putamen and globus pallidus
Internal capsule is not a part of the BG
but does separate caudate and
lenticular nucleus
 cont
Posterior limb of the internal capsule
(anterior portion) corticospinal,
corticobulbar corticorubral, and (posterior
portion) sensory fibers
Only place in the brain you can have a
purely motor stroke
Go over dzs again!
Reflexes, UMN v LMN, any questions
on this?
 Schetz: Taste and Olfaction (3
questions)
Review the CIL/DSA slides he
provided. Only 3 questions and will
be really straight forward
 Sheedlo: Oral Cavity and Pharynx (6 questions)
Sheedlo: The Visual System-Pathway and Physiology,
CN II (6 questions)

Again, very straight forward.any

specific questions?
Shi: Brainstem Control of Eye Movement-
CN III, IV, and VI (3 questions)

Difference between decorticate and

decerebrate rigidity?
Decorticate has intact rubrospinal tract but
decerebrate lesion is between inferior and superior
colliculi spasticity of extensor muscles
SO4, LR6, AO3
Know your palsies
Know your vergence movements, near triad
Horners syndrome