Descending tracts

Lateral corticospinal
Rubrospinal
Lateral reticulospinal
Medial reticulospinal
Vestibulospinal
Tectospinal
Anterior corticospinal

Pyramidal system
Provides voluntary control of skeletal muscles
Owes name to pyramidal cells of primary moter cortex
Consists of:
Descending pathways (UMN)
Motor cells in the ant gray horn of SC and motor nuclei of CN are final common
pathway for the control of skeletal muscle activity, referred to as LMN

Lesions of Corticospinal tract

Above level of decussation, manifest contralaterally
Ex: stroke involving right motor cerebrum – left-sided paralysis
Below level of decussation, manisfest ipsi
Ex: spinal cord lesion on right side – right-sided paralysis

Char of LMN lesion except:

(+) Babinski sign
Flaccid paralysis
Severe atrophy
Muscle fasciculations
UMNL LMNL
Paralysis Spastic Flaccid
Atrophy - +
Fasciculations - +
Clonus + -
Pathologic reflexes + -
Muscle tone Increased Decreased

Geniculate ganglion is the sensory neuron of what CN?

Trigeminal
Facial
Vagus
Glossopharyngeal

Pure sensory: 1,2,8

Pure motor: 3,4,6,11,12
Mixed: 5,7,9,10
Midbrain: 3,4
Pons: 5,6,7,8
Medulla: 9,10,11,12
C Sensory neuron
N
 1 Olfactory cell Olfaction/smell
2 Rods and cones Vision
5 Semilunar/gasserian/trigeminal ganglion Mucous memb of ant 2/3 of tongue;
skin of face
7 Geniculate ganglion Taste buds of ant 2/3 of tongue
8 Spiral ganglion Hearing and equil
9 Petrosal ganglion Mucous memb and taste buds of
post 1/3 of tongue
1 Ganglion nodosum Larynx, heart, lungs, GIT
0

CN Motor neuron Effector

3 Main oculomotor nucleus
Edinger Westphal nucleus
4 Trochlear nucleus
6 Abducens nucleus
5 Motor nucleus of
trigeminal
Superior salivatory
nucleus
9 Nucleus ambigous
Inferior salivatory nucleus
10 Nucleus ambiguus
Dorsal motor nucleus
11 Spinal accessory nucleus
12 Hypoglossal nucleus
EOM
Ciliary and sphincter
papillae musc
Superior oblique
Lateral nucleus
Muscles of facial
expression
Lacrimal, submandibular
and sublingual gland
Musc of deglutition
Parotid gland
Muscle of phonation
Visceral organs and glands
SCM, traps
Muscles of tongue

General sensation receptors

Touch: Meissner’s corpuscle, Merkel’s disc Hair follicle endings, Golgi Mazzoni
Pressure: Pacinian corpuscle
Pain: free nerve endings
Temperature: Krause end bulb (cold), Ruffini’s corpuscle
Proprioception: tendon and muscle spindles

Organ of Corti is the receptor for:

Vision
Hearing
Equilibrium
Olfaction

Special sensation receptors

Vision: rods (night vision), cones (daylight and color)
Gustation: taste buds
Olfaction: olfactory cells
Hearing: Hair cells of Organ of Corti
Equilibrium: utricle and saccule

Concerned with regulation of muscle tone is the function of what lobe of cerebellum
Anterior
Posterior
Floculonodular
None
Anterior: paleo or spinocerebellum-limbs via spinal connections
Maintain coordination of limb movements while movements are being executed;
regulation of muscle tone
Posterior: neo or cerebrocerebellum-cerebral cortex
Flocculonodular: archi or vestibulocerebellum-vestibular apparatus
Responsible for coordination of paraxial muscles associated with equilibrium

Inability to stop a movement at the proper place is called:

Dysmetria
Ataxia
Dysdiadochokinesia
Asynergia

Posterior lobe syndrome

Ataxia: (loss of coordination of voluntary movements); rate, range and force of
movements are abnormal resulting to intentional tremor
Dysmetria: __________ when attempting to touch a target
Dysdiadochokinesia: inability to perform RAM
Flocculonodular lobe syndrome:
Truncal ataxia: disturbance of balance manifested chiefly by a lack of coordination
of paraxial musc; no control over the axial musckes; attempts to walk on a wide
base with the trunk constantly reeling and swaying
The 3rd and 4th ventricles communicate through
Foramen of Monroe
Foramen of Luschka
Aqueduct of Sylvius
Foramen of Magendie

CSF Flow:
Lateral vent  intervent foramen or foramen of Monroe  3rd vent  aqueduct of
sylvius or iter  4th vent  foramen of Magendie and Luschka  subarach space 
arachnoid villi  superior saggital sinus  transverse sinus  sigmoid sinus  int
jugular vein
CSF is located in what space?
Epidural
Subdural
Subarachnoid
Extradural
Regulatory center for temp and hormonal balance
Epithalamus
Thalamus
Hypothalamus
Subthalamus

Diencephalon
Contains functional centers for integration of all information passing from brainstem
and SC to the cerebral hemispheres
Subdivided into 4: Thalamus, hypo, sub and epi

Thalamus
Largest division
2 egg-shaped masses bordering 3rd ventr
Receives precortical sensory input from all sensory systems except olfactory
Plays an important role in sensory and motor system integration

Heschl’s gyrus is asso w/:

Visual area
Auditory area
Speech area
Sensory area
Cerebrum
Frontal lobe
Motor area; seat of mental activities
Parietal lobe
Somesthetic area
Occipital lobe
Visual center
Temporal lobe
Hearing center
Primary somesthetic area:
BA 3,1,2
BA 4
BA 41, 42
BA 17

Primary motor area – precentral gyrus BA 4

Primary somesthetic area – post-central gyrus BA 3,1,2
Primary visual area – BA 17
Primary auditory area – BA 41,42

Failure to carry out learned movements in the absence of sensory loss or motor
strength:
Ataxia
Apraxia
Alexia
Agnosia
Disorders of higher cerebral function:
AGNOSIA: failure to recognize stimuli perceived by the senses
Visual: failure to recognize objects visually in the absence of defect in VA “receptice
disability”
Tactile: inability to recognize objects by touch when tactile proprioceptive senses
are intact; lesions in Supramarginal gyrus
Auditory: failure to recognize what one hears with intact hearing; lesion in BA 22
Apraxia: “motor disability” inability to carry out learned/purposeful movements in
response to stimuli that normally elicit them
Artery that supplies visual area:
Ant cerebral
Mid cerebral
Post cerebral
Post comm.

Ext carotid:
Sup thyroid
Asc pharyngeal
Lingual
Facial
Occipital
Post auricular
Superficial temporal
Maxillary
Int carotid:

Subclavian
Divide into 3 parts by sc____ant
1st: vertebral, thyrocervical, int thoracic
2nd: costocervical
3rd
Ipsilateral arm and leg paralysis:
Hemiplegia
Monoplegia
Paraplegia
Quadriplegia
A px who shows unsteadiness with eyes closed may show the ff except:
Romberg’s
Loss of position sense
Loss of pain and temp
Loss of 2-pt discrimination
Charact of Sympa div of ANS:
Emerges from thoracolumbar div of CNS
Pregangl fibers are longer than postgang fibers
Limited branching of pregang fibers (1:1)
ALL
True re Bells palsy:
Absence of lacrimation
Inability to open eyelid
Loss of sommon sensation ant 2/3 of tongue
ALL
Musc of facial exp:
Zygomaticus: smile
Risorius: grin
Buccinator: blowing, sucking
Mentalis: chin
Supplied by facial nerve
Bells palsy: paralysis of musc of facial exp, no sensation on ant 2/3 of tongue, dry
mouth, no tears, hyperacussis
III: diplopia: eyes turned down and out; dilated and fixed pupil
V: facial hemianesthesia, paralysis of musc of mastication; deviation of jaw to weak
side; loss of gen sens of ant 2/3 of tongue
VII: facial paralysis; loss of corneal/blink reflex; hyperacussis; dry mouth, loss of
lacrimation
Loss of taste ant 2/3 of tongue
IX: dysphagia, loss of taste and common sensation of post tongue
X: dysphonia, dyspnea, dysarthria, dysphagia, loss of gag reflex, sagging of palatal
arch deviation of uvula
XI: meakness in turning head toward opposite side and shrugging shoulder
XII: hemiparalysis of tongue; deviation to weak side
A tumor in foramen ovale will paralyze:
Maxillary of trigeminal
Vagus
Mandibular of trigeminal
Facial
Cranial Fossa
Anterior
Foramina in cribriform plate: 1
Middle
Optic canal: 2, ophthalmic art
Sup orbital fissure: 3,4,6, opth nerve (5)
Foramen rotundum: maxillary n (5)
Foramen ovale: mandibular n (5)
Posterior
Jugular foramen: 9,10,11
Hypoglossal canal: 12
Int acoustic meatus: 7,8
Foramen magnum: medlla, meninges, vertebral art, 11, spinal roots
Wernicke’s area
BA 22
BA 44,45
BA 41, 42
BA 18,19
Patient knows what he wants to say but speech is slow, deleting many words:
Motor aphasia
Sensory aphasia
Agnosia
Agraphia
Exxagerated DTR and bilat babinski are indicative of lesion in:
AST
Dorsal column
Corticispinal tract
Ant horn of SC