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Clarifications from last lecture
ParasympatheticRest and digest
Sympathetic
Fight or flight
Steven Hawking does have ALS.
Hes had it most of his adult life.
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Medulla Ventral Surface
Cranial Nerves (9-12)Glossopharyngeal (IX)
Vagus (X)
Accessory (XI)
Hypoglossal (XII)
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Medulla - Dorsal Surface
Posteromedian sulcus Posterolateral sulcus
ClavaGracile tract protuberance
Cuneate tubercle
Cuneate tract protuberance
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Fourth Ventricle
Contains CSF Choroid Plexus
Makes CSF
Space between
Medulla/Pons and
Cerebellum/medullaryvelums
Velum veil Thin membrane
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Internal Structure
3 levelsMotor (pyramidal) decussation
Sensory (lemniscal) decussation
Inferior olive
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Motor Decussation Level
Pyramidal decussation Corticospinal
Lower extremities
Lateral
Decussate last
Upper extremities
Medial
Decussate first
Corticobulbar
Cortex to cranial nerve
nuclei
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Pyramidal Decussation
Bilateral upperextremity paralysis
Rostral lesion
Hemiplegia cruciata
crossed
Opposite arm/leg
Caudal lesion
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Motor Decussation Level
Dorsal column nuclei Cuneate
C1 to T7
Gracile Below T7
Spinal trigeminal nucleus
Trigeminal nerve Pain, temperature, light
touch
Ipsilateral face
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Sensory Decussation Level Medial lemniscus
DC-ML Kinesthesia Discriminative touch Contralateral
Accessory cuneatenucleus Not part of DC-ML
Spinocerebellar system Fibers from above C8 Projects to cerebellum
Hypertension activates Bradycardyia Hypotension
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Inferior Olive Level
Inferior olivarynuclear complex
Principal olive
Dorsal accessoryolive
Medial accessoryolive
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Inferior Olive Level
Restiform body Inferior cerebellar
peduncle
Foot 2 other cerebellar
pedunclesMiddle
Pons
Superior Midbrain
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Medulla: Cranial Nerve Nuclei
Cranial Nerves 8-12Vestibulochoclear (VIII)
Glossopharyngeal (IX)
Vagus (X)
Accessory (XI)
Hypoglossal (XII)
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Hypoglossal (XII)
Hypoglossalnucleus
Motor
Tongue
Nerve
Travels betweenolive and pyramid
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Hypoglossal Lesions (andSurrounding Structures)
Nerve Nerve and medial
lemniscus (DC-ML)
Nerve and pyramid
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Accessory Nerve: Roots
SpinalSpinal cord
Ventral horn C1-C6
Nucleus ambiguus
Cranial
Medulla
Accessory nucleus
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Accessory Nerve: Output Larynx
Recurrent laryngealnerve
Galen and the silent pig
Some neck muscles
Lesions
Winged scapula
Sagging shoulder
Weak turning head toopposite side
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Vagus Nerve
Dorsalmotornucleus
Vestibularinput
Motion
sickness Nausea,
vomiting,
heart rate
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Glossopharyngeal Nerve Motor
Nucleus ambiguus Pharynx
Swallowing
Speech
Inferior salivatorynucleus Dry mouth
Fear/anxiety
Salivation Food odor
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Glossopharyngeal Nerve Sensory
Posterior 1/3 oftongue
Carotid sinus nerve Chemoreceptor/bar
oreptor
Increase pressureactivates it
It causes vagus
nerve to slow heartrate
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Nucleus Solitarius
2 zonesTaste
Facial nerve
Anterior 2/3 of tongue
Glossopharyngeal nerve
Posterior 1/3 of tongue
Vagus nerve Epiglotts
Output to posterior thalamus
Then primary gustatory cortex
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Nucleus Solitarius
2 zonesCardio-respiratory (also
visceral)
Input Glosspharyngeal
Vagus
Output Nucleus ambiguus
Dorsal motor nucleus of Vagus
Medullary reticular formation
Parabrachial pontine nucleus Visceral to amygdala &
hypothalamus
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Medulla and Respiratory Function
Nucleus solitarius
Inspiration
Nucleus ambigguus
Inspiration Expiration
Sleep apnea
Stop breathing when sleeping
Lesions of nucleus ambiguus & reticular formation
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Sneezing
Nasal mucosa
Trigeminal nerve
Sneezing center
Medulla 2 phases
Nasal nasal secretion
Respiratory muscular output
Close eyes, deep breath, close pharynx, forceful expiration,explosive air release through mouth and nose
You cant sneeze with your eyes open
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Vomiting Instinctive defensive reaction
Triggers Motion
Adverse drug reactions
Trauma Toxin ingestion
Chemoreceptor trigger zone in floor of fourth ventricle[devoid of blood-brain barrier]
Taste receptors
Vestibular
Autonomic input from intestines
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Medulla: Clinical Correlates
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Medial Medullary Syndrome
Occlusion of anteriorspinal artery orvertebral artery
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Lateral Medullary Syndrome Occlusion of
vertebral artery orposterior inferior
cerebellar artery Horners
Miosis small pupil
Droopy eyelid ptosis
Lack of facial sweat -anhidrosis
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Lateral Medullary Syndrome:
Sensory Patterns
#1 26%
#2 24%
#3 18%
#4 20%
#5 8%
#6 4%