Neuro Exam 4

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What are the general Somatic efferent cranial nerves? What do they innervate (general)?: 3, 4, 6, 12

-innervate skeletal muscle
What are the general Visceral efferent cranial nerves? What do they innervate (general)?: 3, 7, 9, 10

-inervate smooth muscle
(pupil secretion, gland secretion, heart, trachea, bronchi, esophagus, lower organs)
What are the special Visceral efferents (Branchials) and what do they do?: 5, 7, 9, 10, 11, accessory motor

-innervate muscles of face, pharynx, larynx, neck
-control facial expression, mastication, swallow, phonation, head turning, shoulder elevation
What is the general somatic afferent nerve? What does it do?: 5
-mediate sensory input such ans touch and pain from skin and muscles of head, neck, and face
What are the general visceral afferents and what do they do?: 9, 10
mediates general sensaion (pain and temp) from pharyinc, palate, larynx, aorta, abdomen
What are the special somatic afferents and what do they do?: 2, 8 (audition), 8 (vestibular-acoustic)

-proprioception, equilibrium, sound transmission/processing
What are the special visceral afferents and what do they do?: 1, 7, 9, 10

-mediates taste and smell
What is the name of Cranial I and what does it do? What level of the PNS is it at?: -olfactory

-mediates taste and smell

-forebrain
What is the name of Cranial II and what does it do? What level of the PNS is it at?: -optic nerve

-proprioception
-vision

-forebrain
What is the name of Cranial III and what does it do? What level of the PNS is it at?: oculomotor

-innervate skeletal and smooth muscle. Controls medial/superior/inferior rectus, inferior oblique. Assists in raising eyelid

-Midbrain, upper pons region
What is the name of Cranial IV and what does it do? What level of the PNS is it at?: -Trochlear nerve

-movements of the eye (superior oblique)
-reflextive constriction of pupil

-midbrain level
What is the name of Cranial V and what does it do? What level of the PNS is it at?: -trigeminal nerve

-sensory: head, face, oral cavity
-motor: mastication/speech
-relfex: jaw jerk
(3 branches)

-pons level
What are the 3 branches of the trigeminal nerve and what do they do?: -ophthalmic: touch, pain, temp, proprioception (head, scalp, eyelid, nose, sinuses, tentorium cerebelli)
-maxillary: nose, cheeks, upper lip, palate, maxillary gingivia and teeth
-mandibular: lower teeth and mouth
What is the name of Cranial VI and what does it do? What level of the PNS is it at?: -abducens nerve

-lateral rectus of eye

-pons level
What is the name of Cranial VII and what does it do? What level of the PNS is it at?: -facial nerve

Motor: face, stapedius, scalp (facial expression)
sensory: taste (anterior 2/3)
visceral: taste, oral secretions, tears
3 nuclei
-medulla level
What are the 3 nuclei of the facial nerve?: -facial motor

-superior salivatory

-nucleus solitarius
What is the name of Cranial VIII and what does it do? What level of the PNS is it at?: -auditory nerve

-hearing, equilibrium, orientation of head in space
What is the name of Cranial IX and what does it do? What level of the PNS is it at?: -glossopharyngeal

-motor and sensory
-taste in post. 1/3, reflex/ pain/ temp/ tension of pharynx, tonsils, velum, post tongue
-3 nuclei

-medulla level
What are the 3 nuclei of the glossopharyngeal nerve?: -inferior salivatory
-nucleus ambiguous
-nucleus solitarious
What is the name of Cranial X and what does it do? What level of the PNS is it at?: -vagus nreve

-motor: phonation, swallow, larynx, cardiac, respiratory, intestines, esophagus, pharynx, stomach, (10%, but very impt)
-sensory (90%)

-medulla level
-3 nuclei
what are the 3 nuclei of the vagus nerve?: -dorsal motor
-nucleus ambiguous
-nucleus solitarius
What are the 3 branches of the vagus nerve?: -pharyngeal (elevates soft palate)
-superior laryngeal nerve (SLN) (sensory to VFs and larynx, motor to cricothyroid)
-Recurrent laryngeal nerve (RLN) (adducts and abducts VFs)
What are the reflexes associated with the vagus nerve?: -swallow, gag, sneeze, breathing, cardiac rate, vomit
What is the name of Cranial XI and what does it do? Where in the PNS is it?: -spinal accessory

-turn head left and right
-shrug shoulders

-medulla level
What is the name of Cranial XII and what does it do? Where in the PNS is it?: -hypoglossal

-motor: tongue intrinsic/extrinsic
-reflex: eat, suck, chew

-medulla level
Describe the disorder of Athetosis, and where the neuronal breakdown is: -slow, writhing movements of limbs and speech muscles.

-globus pallidus or its decending projections to the reticular formation
Describe the disorder of Ballism, and where the neuronal breakdown is: -violent, forcefull flinging movements of arms/legs/neck

-subthalamic nucleus contralateral to side with dyskinesia
Describe the disorder of Chorea, and where the neuronal breakdown is: -series of rhythmic involluntary movements

-Sydenham's: postinfectious condition
-Huntington's: genetic
Describe the disorder of Tremors, and where the neuronal breakdown is: -constantly alternating motor activity.

-resting: substantia nigra
-intentional/action: cerebellar lesions
Describe the disorder of Parkinson's Disease, and where the neuronal breakdown is: -tremor at rest, muscle rigidity, bradykinesia, akinesia, shuffling gate, expressionless face, flexed posture, dysarthia

-substantia nigra (dopamine production)
Describe the disorder of Huntington's Chorea, and where the neuronal breakdown is: -forgetfullness, personality changes, clumsy motor movements, choreiform morvements

-atrophy in caudate nucleus, prefrontal and parietal lobes
Describe the disorder of Wilson's Disease, and where the neuronal breakdown is: -increased muscle rigidity, tremor, dysarthirc speech, progressive dementia

-disorder of copper metabolism, degeneration of basal ganglia
Describe the basid 5 neuronal loops interconnecting the BG, thal., cerebell, and cortex: 1. cortex, striatum, globus pallidus, thalams (VL and VA)
2. striatum, subst. nigra, striatum
3. GP, subthalamic nuc., GP
4. thalamus, striatum, cerebell.
5. cerebell, red nucleus, thalamus (VL and VA), cortex
Itentify the structures: 1. GP External
2. Striatum
3. Stubstantia Nigra
4. Subthalamic Nucleus
5. GP Internal
6. Thalamus
describe the (dis)inhibiting effects of dopamine on the structures in the BG loops, starting with the Sub. Nigra: Sub. nigra: disinhibs striatum, which disinhibs SN, GP internal and external.

GP internal disinhibs thalamus which inhibs cortex which in hibs striatum

GP external disinhibs subthalam. nuc, which inhibs GP internal
Regarding Conjugate Gaze, how do cortical lesions and midbrain lesions present differently?: CORTICAL: look TOWARD side of lesion

MIDBRAIN: Look CONTRALATERAL to side of lesion
Which cranial nerves receive BILATERAL UMN innervaion?: -III (>contra)
-IV (>contra)
-V
-VI (>contra)
-VII (greater contra to lower face)
-IX
-X
-XI
-XII (greater contra)
Which cranial nerves play a role in MOTOR speech?: V
VII
IX
X
XI
XII
Differential diagnosis based on weakness in the face. -entire LATERAL half of face?: -IPSIlateral LMN lesion
-Bells Palsy
(lesion on same side as weakness, lower motor neuron)
Differential diagnosis based on weakness in the face. -Lower quadrant only?: -Unitaleral UMN lesion of CONTRALTERAL cortex
(lesion on opposite side as weakenss, Upper motor neuron)
Differential diagnosis based on weakness in the face. -entire LOWER half of face?: -BILATERAL UMN lesion
-Supranuclear palsy
-will have weakness on UPPER face as well
-also spasticity and rigidity
(both sides of upper motor neruons wipe out both lower quadrants of face and present with spasticity)
Describe pathologies of Cranial III: -external: extrinsic occular muscles paralized. IPSI eye looks laterally, IPSI eyelid droop (ptosis), problems looking up/down/medial
-internal: parasympathetic loss to iris. problems dialating eye
Describe pathologies of Cranial IV: -contralateral eye fixed upward and medially
Describe pathologies of Cranial VI: -Ipsilateral eye turns medially
Describe SENSORY pathologies of Cranial V: -ipsi loss of sensation to face, tongue, teeth, gingivia, nose, orbits, mouth
-impaired sneezing/blinking
-tic douloureux (buring pain)
Describe MOTOR pathologies of Cranial V: LMN: jaw deviates to side of lesion. No jaw reflex

Uni UMN: mild affect on mastication

Bilateral UMN: jaw hangs down
Describe pathologies of Cranial VII: -Bells Palsy
-loss of taste in ant. 2/3 of tongue
-excessive secretions
-hyperacusis
-facial paralysis, varying depending on lesion site
Describe pathologies of Cranial IX: -loss of taste, loss of gag reflex`
Describe pathologies of Cranial X: ABOVE pharyngeal branch: weak/paralized velum, VF, larynx (breathy, hypernasal, hoarse)

BELOW pharyngeal branch: VF paralized, weak larynx (brathy and hoarse)
Describe pathologies of Cranial XII: LMN: ipsi weakness/atrophy (tongue toward side of weakness, ie same side)

UMN: contra weakness, tongue deviates toward CONTRA side (which is weak)
Describe the brainstem neuroanatomy, and what functions are regulated at this level (GENERAL): -reticular formation, red nucleus, cranial nerves, vestibular nerves

-modulates muscle tone, posture, reflexes. Sensory motor mechanism
Describe the functions of the Reticular Formation: -cortical arousal
-pain processing
-modulate tone of spinal and cranial nerves
-regulate vital vegitative activities
-regulate sensorymotor activities
-recieve and project to most CNS levels
Describe the Reticular Facilitatory Mechamism: -Midbrain, pons, medulla
-intrinsically excitatoy
-excites alpha-LMNs
-increases muscle tone
-inhibited by motor cortex and BG
Describe the Reticular Inhibitory Mechanism: -lower and medial BS
-not intrinsic--other sources excite it
-reduces muscle tone
-inhbited by motor cortex and BG
Describe muscle Flexation: -medial reticular formation
-contract ipsilateral flexors, relax extensors
Describe muscle Extention: -lateral reticular formation
-contract ipsi extensors, relax flexors
Describe BS neuropathy ABOVE the vestibular nucleus: -disconnect cortex and BG from BS
-DECEREBRATE regidity
Describe BS neuropathy BELOW the vestibular nucleus: -disconnects vestibular and reticular regions from SC
-servere hypotonia and flaccis paralysis
-spinal shock
Describe the basic functions of the Basal Ganglia: -modify cortically driven motor movements
-regulate muscle tone
-adjust automatic motor movements
-suppress extraneous movements
-templates for skilled movement
What general types of disorders result from BG lesions?: -MOTOR disorders

NOT paralysis, because there are not UMNs or LMNs
Describe the location of the Caudate Nucleus: -one in each hemisphere
-adjacent to lateral ventricles
-anterior and posterior horns
-post. horn ends in amygdala
Describe the location of the Putamen: -anteriorly connected to head of CN
-lateral to GP
-ext capsule, claustrum, insular cortex are all lateral to Putamen
Describe the location of the Globus Pallidus: -sandwiched between post. limb of IC and Putamen
-consists of external (lateral) and internal (medial) sections
What are the inhibitory functions of the following Neurotransmitters? -dopamine -acetylcholine -GABA -enkephalin -substance P: -dop: from sub nigra to striatum (CN and Putamen)
-ACh: regulates thalamus and GP
-GABA: striatum, GPi and GPe, subthalmic--inhibits SN
-enk: control of pain
-P: suppressor for control of pain, inhibits SN
In general, what muscles of speech (sides) are affected by... -UMN lesions, one side -UMN lesions, BOTH sides -LMN lesions, one side: uni UMN: contralateral side affected more
bilat UMN: both sides affected
LMN: same side as lesion affected
What are the 6 muscles of the eye, and what does each muscle do?: superior rectus (move eye UP)
inferior rectus (move eye DOWN)
medial rectus (move medial)
lateral rectus (move lateral)
superior oblique (move angle up)
inferior oblique (move angle down)
Which cranian nerves control which mucles of the eye?: III: medial/superior/inf rectus, inf oblique
V: Lateral recuts
IV: superior oblique

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