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Chapter 14 Brainstem III: Internal Structures and Vascular Supply

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  1. Chapter 14 Brainstem III: Internal Structures and Vascular Supply Chenjie Xia Wednesday, Oct. 20, 2010

  2. Orientation First

  3. Brainstem X-sections Review

  4. Superior colliculus Cerebral aqueduct Oculomotor nucleus (CNIII) Reticular formation Red nucleus Basis pedunculi Substantia nigra Rostral Midbrain

  5. Inferior colliculus Cerebral aqueduct Trochlear nucleus Superior cerebellar peduncle and decussation Caudal Midbrain

  6. Fourth ventricle Middle cerebellar peduncle Corticospinal, corticobulbar, corticopontine fibers Rostral to mid-pons

  7. Inferior cerebellar penduncle Inferior olivary nucleus Medial lemniscus Pyramid (corticospinal tract) Rostral Medulla

  8. Cervicomedullary junction Gracile nucleus and fascicle Cuneate nucleus and fascicle Anterolateral system Pyramidal decussation

  9. Brainstem Vasculature Review

  10. Posterior Circulation Arteries

  11. Arterial Territories

  12. Penetrators & Circumferentials

  13. Neuro-Jeopardy!!! 100 100 100 100 200 200 200 200 300 300 300 300 400 400 400 400 500 500 500 500

  14. Brainstem Internal Structures 100 • Which of the following lesions can cause coma? • 1) Unilateral cortical lesion • 2) Bilateral cortical lesions • 3) Unilateral thalamic lesion • 4) Bilateral thalamic lesions • 5) Midbrain tegmentum • 6) Ventral pons

  15. Brainstem Internal Structures 100 • Which of the following lesions can cause coma? • 1) Unilateral cortical lesion • 2) Bilateral cortical lesions • 3) Unilateral thalamic lesion • 4) Bilateral thalamic lesions • 5) Midbrain tegmentum • 6) Ventral pons

  16. Back to Jeopardy

  17. Brainstem Internal Structures 200 • Which syndrome would a lesion in this area cause?

  18. Brainstem Internal Structures 200 • “Locked-in syndrome” • Lesion of ventral pons • Disruption of bilateral corticospinal, corticobulbar tracts, i.e. unable to move • Sensory and RAS preserved, i.e. conscious and able to feel • Oculomotor nucleus (midbrain tegmentum) preserved, i.e. able to do vertical eye movements and eyelid elevation

  19. Back to Jeopardy

  20. Brainstem Internal Structures 300 • Name the 2 main functions of the RF

  21. Brainstem Internal Structures 300 • 1) Maintain alert, conscious state • Rostral RF • Continuous with certain diencephalic nuclei • 2) Mediate motor, reflex and autonomic functions • Caudal RF • Continuous with the intermediate zone of the spinal cord

  22. Back to Jeopardy

  23. Brainstem Internal Structures 400 What respiratory pattern results from a lesion in these areas?

  24. Brainstem Internal Structures 400 • Cheyne-Stokes breathing • Apneustic breathing • Ataxic breathing or respiratory arrest

  25. Back to Jeopardy

  26. Brainstem Internal Structures 500 • Describe the components of the Guillain-Mollaret’s triangle • Lesion in this triangle causes which syndrome?

  27. Brainstem Internal Structures 500 • Palatal myoclonus

  28. Brainstem Internal Structures 500 • BONUS: How can you distinguish symptomatic from essential palatal myoclonus?

  29. Brainstem Internal Structures 500

  30. Back to Jeopardy

  31. Acetylcholine Dopamine Histamine Norepineprhine Serotonin Locus ceruleus Nucleus basalis of Meynert Raphe nucleus Substantia nigra Tuberomammillary nucleus Miscellaneous 100

  32. Acetylcholine Dopamine Histamine Noradrenaline Serotonin Locus ceruleus Nucleus basalis of Meynert Raphe nucleus Substantia nigra Tuberomammillary nucleus Miscellaneous 100

  33. Back to Jeopardy

  34. Miscellaneous 200 • Which main NT is involved in Parkinson’s disease? • Can you name the 3 pathways involving this NT? (which one is most prominently involved in PD?)

  35. Miscellaneous 200

  36. Miscellaneous 200 • Parkinson’s disease: • Deficiency of DA in SN pars compacta • Affecting the nigrostriatal pathway, i.e. projection of DA neurons from the SN  striatum • 2 other pathways • Mesolimbic pathway: positive Sx of schizophrenia • Mesocortical pathway: cognitive deficits, negative Sx of schizophrenia

  37. Back to Jeopardy

  38. Miscellaneous 300

  39. Miscellaneous 300

  40. Back to Jeopardy

  41. Miscellaneous 400 • A decrease in hypocretins / orexins cause which clinical syndrome? • Name the 4 classic findings of this syndrome.

  42. Miscellaneous 400 • Classic findings in narcolepsy: • 1) Excessive daytime sleepiness • 2) Cataplexy • 3) Sleep paralysis • 4) Hyponagogic or hypnopompic hallucinations

  43. Back to Jeopardy

  44. Miscellaneous 500 • Which main neurotransmitter is supposedly involved in Alzheimer’s disease? • And where do these neurotransmitters originate from?

  45. Miscellaneous 500 • Cholinergic neurons in the basal forebrain • Nucleus basalis of Meynert cortex • Medial septal nuclei + nucleus of diagonal band hippocampus • Role in memory and learning

  46. Miscellaneous 500 • Cholinergic neurons in the pontomesencephalic region • 1) PTN + LTN thalamus  Cortex • 2) PTN + LTN BG, tectum, cerebellum, pons, medulla, sc • Role in arousal and motor systems

  47. Back to Jeopardy

  48. Brainstem Vascular Supply 100 • Can you name 2 signs on exam which highly suggest brainstem ischemia?

  49. Brainstem Vascular Supply 100 • Crossed signs (sensory or motor) • Wrong-way eyes (eyes looking away from weakness) • Eye movement abnormalities • Pupillary abnormalities

  50. Back to Jeopardy