disease pathophysiology signs and symptoms · pdf filedisease pathophysiology signs and...

of 18

Disease Pathophysiology Signs and Symptoms Treatment PG#Trigeminal Neuralgia Irritation of nerve branches? Intense pain over distribution of one or more branches

of the trigeminal nervePain initiated by touch/temperature change

CN Self Study

Bell's Palsy Damage to facial motor nucleus Lower motor neuron paralysis of muscles of facial expression - ipsilateral

Lack of blinking due to damage of orbicularis oculiParalysis of stapedius muscle - hyperacousis

CN Self Study

Glossopharyngeal Neuralgia

Excessive nerve firing Paroxysmal pain beginning in the throat and radiating down the neck

Consider brainstem nuclei stimulation decreasing BP and bradycardia

CN Self Study/

Vignette

Peripheral Nerve Crush/Severance

Regenerated motor endplates establish on muscle fibers in one spot. Fewer axons reach the muscle and motor

units will be larger due to additional collaterals

Mooney 12

Upper Motor Neuron Lesion

Lesion in CNS - descending tracts/somata in cortex and brainstem

Weakness without muscluar atrophy, HYPERactive reflexes (positive Babinski - toe extension)

Mooney 9

Lower Motor Neuron Lesion

Lesion in PNS - spinal roots/nerves, somate in brainstem and spinal cord

Weakness with muscular atrophy, HYPOactive reflexes or areflexia, fasciculations

Mooney 9

Broca's Aphasia Lesion of pre-motor cortex resulting in inability to properly select correct syntactic/grammatical units

from multiple possibilites

Labored, halting and repeated speech, loss of syntax, disorderd grammar, fragmentation of individual words

Mooney158

Parkinson's Failure of the SMA neurons to become active to generate internal movement sequences

Mooney160

Dysmetrias Inability of pre-motor cortex and primary motor cortex to get accurate feedback from dentate nucleus

Dentate nucleus terminates in VL thalamus

Inaccuracy of movement position or timing as in finger-nose-finger test

Mooney160

General Cerebellum Lesions

Dizziness and vertigo, dysequilibriumImpaird eye control - nystagmus

Gait disturbances and difficulty in coordination with tendency to fall, abnormal stance

AtaxiaIPSILATERAL

Symptomatic refiefPhysical therapy and

rehabilitation

Li25

of 18

Disease Pathophysiology Signs and Symptoms Treatment PG#Vestibulocerebellum

LesionNodulus and bilateral flocculi lesion disrupts vestibular

inputDistorted equilibrium

Abasia, ataxia, nystagmus and tendency of fallingLi20

Spinocerebellum Lesion Vermis and intermediate hemisphere lesion disrupts muscle spindle and GTO input

Ipsilateral truncal and limb ataxia, gait disturbance and scanning speech

Hypotona, asynergia, altered tendon reflex

Li21

Corticopontocerbellum Lesion

Lateral cerebellar hemisphere lesion disrupts cerebral planning input and motor correction (tonal correction

of complex motion)

Distal ataxia, dysmetria, asynergia, dysdiadochokinesia, intention tremor, hypotonia, delay in initiation of

motor task, inability to estimate weight

Li 22

SCP Infarct Hypotonia Ipsilateral

Cerebellar Congenital Malformations

Dandy-Walker: Absence of vermis (open 4th ventricle)Rhomencephalosynapsis

Cerebellar Idiopathic/Hereditary

Channelopathies: KCNA1 point mutation and CACNA1A missense mutation

Spinocerebellar ataxia 3 (Machado-Joseph) CAG repeat expansion

Spinocerebellar ataxia 6 - Loss of Purkinje cells and neurons

Intension tremors, palatine myoclonus, multiple system atrophy

Pyramidal and extrapyramidal signs

Cerebellar Trauma Hydrocephalus, mass effect, herniationCerebellar Tumor Metastasis

Cerebellar InfectionsCerebellar Paroxysmals Migraines

Cerebellar Neurotoxicity Phenytoin: Atrohpic cerebellar effectsHeavy metals

Cerebellar Metabolic/Endocrine

Disorders

Thiamine deficiencyVitamin E deficiency

HypothyroidismCerebellar

Inflammation/ Auto-Immune

Cerebellar Non-neurological causes

Psychiatric, phobia, anxiety, malingering

of 18

Disease Pathophysiology Signs and Symptoms Treatment PG#Megacolon

(Hirschsprung's Disease)Failure of the neural crest cells to migrate into the

colonExtreme dilation and hypertrophy of th colon with fecal retention and absence of ganglion cells in the

myenteric plexus

Margiotta172

Horner's Syndrome Traumatic damage to the head and neck interrupts sympathetic pathway connecting hypothalamus/brain

stem/ preganglionic neurons in the upper thoracic cord

Ptosis - pupillary constriction - enopthalmos (sinking eyeball) - flushing and decreased sweating in the head

and neck

Margiotta172

Horner's Syndrome Ptosis - inability to raise eyelidAnhidrosis - inability to sweat normally

Miosis - pupillary constriction

CN Vignettes

Familial Dysautonomia (Riley-Day Syndrome)

Loss of neurons in the autonomic and sensory ganglia. Autosomal recessive trait

Abnormal sweating - blood pressue instability - difficult in feeding due to inadequate muscle tone in the GI

tract - progressive sensory loss

Margiotta172

C5 Peripheral Nerve Lesion

Loss of all sensory modalities of C5 dermatomeWeakness of biceps muscle (mediate by C6)

Paralysis of rhomboid/levator scapulaeLoss of reflex

CBC47

Dorsal Root Lesion All modalities in C5 dermatomeNo motor impact

Loss of reflex

CBC47

Ventral Root Lesion No sensory lossWeakness/paralysis

Loss of reflex

CBC47

Complete Spinal Cord Transection

Bilateral loss of all modalitiesAT lesion: Lower motor neurons signs

BELOW lesion: Upper motor neuron signsAreflexia at level of lesion

Hyper-reflexia below level of lesion

CBC 49

Brown Sequard Syndrome

Hemisection of the spinal cord Dorsal Column - Loss of proprioception ipsilateralAnterolateral Tract - Loss of pain/temp contralateral

AT lesion: Lower motor neuron signsBELOW lesion: Upper motor neuron signs -

ipsilaterally

CBC 49

of 18

Disease Pathophysiology Signs and Symptoms Treatment PG#Syringomyelia Lesion of the central gray of the spinal cord Bilateral loss of pain/temp at lesion

No motor lossReflex arcs are intact

CBC 50

Poliomyelitis Lesion of ventral horn cells of the spinal cord No sensory lossLower motor neuron signs specific to level

Reflexes depressed at lvel

CBC 50

ALS Lesion of ventral horn and corticospinal tracts of the spinal cord

No sensory lossMixed LMN/UMN signs

CBC 51

Central Cord Syndrome Lesion of central spinal cordHyperextension of neck by airbag deployment

Contusion injury

Bilateral pain/temp lossLMN signs at level of lesion - limited to upper limbSparing of sacral levels of cord due to somatotopy

CBC 51

Anterior Cord Syndrome

Lesion of anterior cordConsider anterior spinal artery

Bilateral pain/temp loss at level of lesion and belowDorsal column not involved - proprioception

maintainedLMN signs at level of lesion

UMN signs below level of lesionReflexes in accordance with LMN/UMN

CBC 52

Lower Motor Neuron Lesion

No sensory impactMuscle weakness/paralysis

Hypoactive deep reflexes - areflexiaDecreased muscle tone (absent final common pathway

will lead to atrophy)Fasciculations - axonal degeneration phenomenon -

acetylcholine release

CBC 48

Upper Motor Neuron Lesion

No sensory impactMuscle weakness/paralysis depending on LMN

involvementPOSITIVE BABINSKI (extension of big toe due to

myelin loss)Increased muscle tone

Hyperactive deep reflexesLoss of fine voluntary movements

CBC 48

of 18

Disease Pathophysiology Signs and Symptoms Treatment PG#Temporal Lobe Epilepsy Temporal intermittent rhythmic delta

Unilateral or shiftingRW 23

Epileptiform Generalized: Generalized spike and wave discharge Spikes/ spike and slow waves/ sharp waves on EEGEEG rapid reversal of polarity

Progressive patterns are indicative of ictal activitySeizure: Clinical event associated with an abnormal,

excessive and hypersynchronous electrical discharge in a group of cortical neurons

RW 24

Stroke/HSV/Tumor Period lateralized epileptiform discharges are repetitive sharp waves on slow background and indicated

structural lesion

RW 25

CJD Rapidly degenerative dementia with 1 Hz spike/wave discharge

Subacute Sclerosing Panencephalitis

Follows measles infection and presents with generalized symptoms

1:1 correspondence of discharges to myoclonic jerks

RW 25

Amnesia Damaged to the hippocampus Anterograde - inability to make new declarative memories

Retrograde memories are often intact

Margiotta92

Seizure Loss of dentate gyrus mossy cells Dormant basket cells do not inhibit dentate granule

cellsGranule axon sprouting leads to recurrent excitation

Margiotta92

Kluver-Bucy Syndrome Damage to anterior temporal lobe including amygdalaTrauma - acceleration into windshield - temporal lobes

contact orbital bone damaging the amygdala

DocilityHyperphagia and hypersexuality

Dramatic changes in emotional behavior

Margiotta92

Urbach-Wiethe Disease Calcification of the anterior temporal lobes resulting in selective damage to both amygdala

No deficits in language memory or intelligenceUnable to recognize or portray fear

Lack of learned fear response

Margiotta 79

Hypothermia Abnormally low core temperature caused by cold exposure

Self study

Heat Exhaustion Hypotension due to excessive sweating and vasodilation Self study

of 18

Disease Pathophysiology Signs and Symptoms Treatment PG#Fever Chemically induced alteration in set point of central

thermoregulatory systemSelf

studyHeat Stroke Increase body temperature resulting from progression

of heat exhaustionSelf

studyWeber Syndrome Midbrain stroke with contralateral weakness

Corticospinal Tract LesionCerebral peduncle damage

Occulomotor symptomsUpper motor neuron signs

Weakness/loss of voluntary muscles

CN Vignettes

Benedict Syndrome Midbrain stroke with contralateral tremorRed nucleus lesion

Occulomotor symptomsClassic tremor - cerebellar signs

CN Vignettes

Occulomotor Lesion Herniation of temporal lobe uncusSubfalcine herniation/ transtentorial herniation

(midbrain level)/ tonsillar hernation

Occulomotor symptoms CN Vignettes

Infection Infection of thrombosis of cavernous sinus Occulomotor signs - abducens signs - V1/V2 - trochlear

CN Vignettes

Internuclear Ophthalmopelgia

Dysfunction in the medial longitudinal fasiculusPathway - paramedican pontine reticular formation to

abducens nucleus and contralateral occulomotor nucleus

Lateral conjugate gaze is lost CN Vignettes

Lateral Medullary Syndrome

Lesion in the medulla affecting the spinral trigeminal nucleus - vagus - nucleus ambiguous

Ipsilateral decrease in pain sensation - uvula deviation to contralateral side - hoarseness - decreased sensation

to pin prick on contralateral side

CN Vignettes

Learning Disabilities Genetic/ drug/ pregnancy complications/ toxins/ poor learning environment - lack of expsoure of

nervous system to appropriate stimulation

Developmental speech and language disorders - academic skills disorders - coordination and attention

disorders

Wall 114

Amnesia CVA - tumors - trauma - vitamin B1 deficiency - Alzheimer's disease

Pathological inability to learn or rememberAnterograde: Inability to establish new memories

Retrograde: Inability to retrieve memories from the past

Time or category specificity

Wall 114

Developmental Dyslexia Impairment of the ability to learn verbal sounds and speech

Phonological processing deficiency

Difficulty in reading in children who have the intelligence necessary for reading

ForWord LanguageEmphasize auditory processing and oral

language skills

Wall 115

of 18

Disease Pathophysiology Signs and Symptoms Treatment PG#Familial Brain Tumors NF1: Chromosome 17

NF2: Chromosome 22VHL: Chromosome 4 - kidney cancer association

Medhkour

Supratentorial Tumor Increased ICP - increased CSF - hydrocephalus - endocrine disturbances

TIA symptoms - progressive cognitive decline - N/V - headache

Medhkour

GBM Increased EGFR - decreased PTEN and decreased p53 activity

Genes: EGFR/ p53/ PTEN/ p16

necrosis - pseudo palissading - endothelial proliferation - nuclear pleomorphism

Medhkour

Meningioma Arise from arachnoid cellsGene: NF2

Rarely invade cortex - malignant by location Medhkour

Infratentorial Tumor Increased ICP Cerebellar disturbances - N/V - headache - papiledema (optic disc swelling due to increased ICP)

Medhkour

Medial Longitudinal Fasiculus Lesion

Non-paired movement of medial rectus and contralateral lateral rectus

Incongruent information leaving cortical layer 4C to higher cortical layers

Static deviation of one eye or the eyes fail to move together - conjugate eye movement failure -

Eye Movement Self Study

Pathological Nystagmus Lesions of cerebellum or inferior cerebellar peduncle Oscillatory movements happen in the absence of normal sensory activation

Eye Movement Self Study

Prosopagnosia Temporal lobe damage Inability to recognize faces - level of awareness without a level of recognition

Wall141

Drug Target Effect Mechanism of Action PG #Viagra (Sildenafil) Inhibition of

phosphodiesterase type 5Erection Inhibits phosphodiesterase type 5 in the corpus cavernosum leads to

increased levels of cGMP resulting in smooth muscle relaxation and increased blood flow to corpus cavernosum

Margiotta169

Methadone/ LAAM/ Buprenorphine

Opioid receptors Activation of opioid receptorsProduces less euphoria than drugs of abuse - still inherent risk for

addictionBuprenorphine - Partial agonist with longer duration

Yamamoto38

Naloxone Mu opioid receptors Competitive antagonist Yamamoto38

VareniclineNicotine Gum/Patches

Nicotinic Receptors Counteract activity of psychostimulantsVarenicline - Partial agonist

Yamamoto38

Tract Input/Origin of Tract Decussation Pathway Termination of Tract Primary FunctionVestibulospinal

Medial Vestibulospinal Tract

Lateral Vestibular Tract

Input from vestibulocochlear nerve

(utricle, saccule)

Medial Vestibular Nucleus

Lateral Vestibular Nucleus

Descends medial longitudinal fasciculus

Length of lumbosacral cord

Proximal cervical region

Anti-gravity/ Lower limb extensors

Head orientation/stabilization

Posture

Reticulospinal Multiple inputs

Reticular formation (collection of nuclei along midline of midbrain/pons)

Axial/proximal musculatureExtensors

Attention/arousalExcitatory to extensors:

PostureAnticipation of movement

Colliculospinal(Tectospinal)

Visual input from superior colliculus

Midbrain/pons border

Ventral tegmental

Cervical portion of the cord

Neck muscles

Coordinates head movements with eye

movementsVisual orientation

Rubrospinal Input from cerebellum and cerebral cortex

Red nucleus

Ventral tegmental Length of cordCervical - upper limb

flexors

Primarily controls upper limb

Coordination of distal muscles (hand,wrist)

Corticospinal Cortex:Primary motor/ pre-

motor/ somatosensory

Pyramidal (caudal medulla)

No decussation (decussates at cord level in ventral

grey)

Posterior limb of internal capsule

Midbrain - cerebral peduncle (crus cerebri)

Pons - corticospinal tractMedulla - Pyramidal tract

Decussates: Lateral corticospinal tract

Motor neurons of distal musculature

Doesn't Decussate: Anterior corticospinal tract

Fine movement/agility

Proximal musculature

Modality Advantages DisadvantagesComputed Tomography Increase in density discrimination (fine detail possible

Cross-sectional anatomyFunctional information (infarcts)

Availability/rapidDecreased invasiveness

RadiationCost

Overuse

Nuclear Medicine Physiologic informationSpecificity

RadiationCost

Time ConsumingLess spatial resolution

Ultrasound Safe Non-invasiveInexpensive

Visualizes motion

ArtifactQuality dependent on technician

No bone/air penetration

MRI Multi-planar abilityInsensitive to bone obstruction

Better soft tissue contrast

Patient claustrophobiaMedical device contraindication

Patient monitoring difficultHAZARDS:

Superconducting magnets always on - Nerve stimulation by changing magnetic fields - Radiofrequency energy

causing heating - Acoustic noise

of 18

Nerve Nucleus Clinical Presentation NotesIII Edinger Westphal Pupillary dilation (mydriasis)

Loss of accomodation for near visionLoss of pupillary reflex

III Occulomotor Nucleus Loss of convergence for near visionPtosis

Diplopia secondary to lateral strabismus

Ipsilateral

IV Troclear Nucleus Vertical diplopia ContralateralV Spinal Trigeminal Nucleus Facial anesthesia

Loss of pain/temperature for anterior 2/3 of tongueLoss of corneal reflex

V Mesencephalic Nucleus Loss of proprioceptive sensation for jaw positionV Motor Nucleus of V Loss of mastication

Diminished bite strength of side of lesionVI Abducens Horizontal diplosia

Convergent strabismus (unopposed action of medial rectus muscle)VII Superior Salivatory

NucleusParasympathetic

Dry mouth (sublingual and submandibular)Dry eyes (lacrimal)Dry nose (mucosa)

VII Facial Motor Loss of facial expression IpsilateralVII Solitary Tract Loss of taste to anterior 2/3 of tongueVII Spinal Trigeminal Nucleus Anesthesia of posterior external ear and wall of external acoustic meatus IpsilateralVIII Vestibular Nucleus Loss of balance

DizzinessAbnormal gait

Abnormal eye movement - nystagmusVIII Cochlear Nucleus Loss of hearing UnilateralIX Inferior Salivatory Nucleus

ParasympatheticDry mouth (parotid gland)

IX Nucleus Ambiguus Difficulty swallowing ( paralysis to stylopharngeus)IX Solitary Tract Loss of taste to posterior 1/3 of tongue

of 18

Nerve Nucleus Clinical Presentation NotesX Dorsal Motor Nucleus of

XParasympathetic

Hyperactive gastric secretions

X Nucleus Ambiguus Loss of laryngeal muscles indicated by hoarsenessDifficulty swallowing - uvula deviates to unaffected side

Loss of gag reflex and flaccidity of soft palate

Unilateral

X Spinal Trigeminal Nucleus Anesthesia of posterior external ear and wall of tympanic membraneLoss of parasympathetic vagal reflexes

Ipsilateral

X Solitary Tract Loss of taste from epiglottisXI Cranial Component -

Nucleus AmbiguusLoss of laryngeal muscles indicated by hoarseness

Difficulty swallowing - uvula deviates to unaffected sideLoss of gag reflex and flaccidity of soft palate

Unilateral

XI Spinal Component - Motor Nucleus of XI

Shoulder drop and weakness when turning head to side opposite leasion (sternocleidomastoid and trapezius affected)

XII Hypoglossal Nucleus Tongue deviates to side of lesion upon protrusion

13

Cranial Nerve Modality Nucleus Location of Damage Signs and SymptomsOcculomotor Somatic Occulomotor Lower motor neurons of

occulomotor nucleus - extraocular eye muscles

IpsilateralPtosis - levator palpebrae

Diplopia - lateral strabismusLack of convergence with near vision

Occulomotor Parasympathetic - Visceral

Edinger Westphal PreganglionicPostganglionic - ciliary

ganglion

Dilated pupilLack of pupillary reflex

Loss of accomodation for near visionTrochlear Somatic Trochlear Nucleus Lower motor neurons Vertical diplopia - superior obliqueTrigeminal Somatic Spinal Trigeminal Nucleus Primary sensory in

trigeminal ganglionSecond order nucleus

neurons

Anesthesia - lack of pain/temp sensations

Trigeminal Somatic Main Trigeminal Nucleus Primary sensory in trigeminal ganglion

Second order nucleus neurons

Loss of sensation of touch

Trigeminal Somatic Mesencephalic Loss of proprioceptive inputTrigeminal Somatic Mandibular Division Decreased bite strength on ipsilateral sideAbducens Somatic Motor nucleus Lower motor neurons of

motor nucleusMedial deviation due to unopposed action of medial rectus

Horizontal diplosia - double vision upon lateral gaze toward side of lesion

Facial Parasympathetic - Visceral

Superior salivatory nucleus Preganglionic in superior salivatory

Postganglionic - submandibular ganglion

Dry mouth (submandibular and sublingual glands)

Facial Parasympathetic - Visceral

Superior salivatory nucleus Preganglionic - superior salivatory nucleusPostganglionic -

pterygopalatine ganglion

Dry eyes/nose (lacrimal and mucous glands)

Facial Somatic Facial motor nucleus Lower motor neurons of facial nucleus

Abnormal facial expressionBell's Palsy

Hyperacousis - stapedius muscle

14

Cranial Nerve Modality Nucleus Location of Damage Signs and SymptomsFacial Somatic Spinal Trigeminal Nucleus Primary sensory in

geniculate ganglionSecond order nucleus

neurons in spinal trigeminal

Anesthesia - lack of pain/temp sensations in posterior external ear and wall of external acoustic meatus

Facial Special Nucleus of solitary tract Primary sensory neuron in geniculate ganglion

Second order neuron in nucleus of solitary tract

Lack of taste to anterior 2/3 of tongue

Vestibulocochlear Special Vestibular Nucleus Vestibular ganglion cellsSecond order neurons in

vestibular nuclei

Loss of balanceDizziness

Abnormal gaitAbnormal eye movements

Vestibulocochlear Special Cochlear Nucleus Spiral ganglion cellsSecond order neuron in

cochlear nuclei

Ipsilateral deafness

Glossopharyngeal Parasympathetic - Visceral

Inferior salivatory nucleus Preganglionic in inferior salivatory nucleus

Postganglionic in otic ganglion

Dry mouth - parotid gland

Glossopharyngeal Special Nucleus of solitary tract Primary sensory in glossopharyngeal nucleusSecond order neurons in nucleus of solitary tract

Loss of taste to posterior 1/3 of tongue

Glossopharyngeal Somatic Nucleus ambiguous Lower motor neurons Paralysis to stylopharngeusDiminished strength when swallowing

Glossopharyngeal Somatic Spinal trigeminal nucleus Nucleus of solitary tract

Glossopharyngeal ganglia and second order neurons

in spinal trigeminal

Loss of pain/temperatureSolitary tract disrupts carotid body/sinus

Vagus Parasympathetic - Visceral

Dorsal motor nucleus of X Preganglionic in dorsal motor nucleus of X

Postganglionic in terminal ganglia near effectors

Hypersecretion of gastric fluids

Vagus Somatic Nucleus ambiguus Lower motor neurons Difficulty swallowing

15

Cranial Nerve Modality Nucleus Location of Damage Signs and SymptomsVagus Somatic/Visceral Spinal trigeminal nucleus

Nucleus of solitary tractPrimary sensory neurons in vagal/jugular ganglia

Loss of pain/temp in spinal trigeminalIpsilateral anesthesia of external acoustic meatus and tympanic

membraneLoss of visceral afferents in nucleus of solitary tract

Loss of parasympathetic vagal reflexesVagus Special Nucleus of solitary tract Primary sensory neurons

in vagal/jugular gangliaSecond order neurons in nucleus of solitary tract

Loss of taste to epiglottis

Accessory Somatic Lower motor neurons in ventral horn of C1-C4

Shoulder drop and weakness when turning head to side opposite of lesion

Sternocleidomastoid and trapeziusHypoglossal Somatic Hypoglossal nucleus Lower motor neurons Tongue deviates to side of lesion

Extrinsic and intrinsic muscles of the tongue

SYMPATHETIC PREganglionic POSTganglionic Target EffectT1-T3 Superior cervical ganglion Tarsal muscle Raises eyelidT1-T3 Superior cervical ganglion Lacrimal Gland Blood vessels supplyT1-T3 Superior cervical ganglion Pupillary Dilator Muscle Dilates pupil

T1-T2 Superior cervical ganglion Salivary Glands Constricts glandular blood vessels resulting in decreased salivary production

T1-T5 T1-T5 and all cervicalCervical postganglionic

travel in superior, middle and inferior cardiac nervesThoracic travel in thoracic

cardiac nerve

SA nodeMyocardium

Coronary vessels

Increase in heart rate - strength of contraction - dilates the coronary arteries

Inferior cervical and upper thoracic T1-T4

Bronchial tree - trachea - bronchii - lungs

Dilate bronchii and decrease secretions of bronchial glands

T5-L2/3 Splanchnic nerve (paravertebral bypass)

Celiac - foregutSuperior mesenteric -

midgutInferior mesenteric -

hindgut

Gut Reduces motility, secretions and blood flow

Liver and Pancreas Decrease pancreatic islet secretion, induces glycogenolysis and gluconeogenesis in the liver

T8-T11 directly via splanchnic nerve

Chromaffin cells Adrenal Medulla Secretes epinephrine, norepinephrine, cortisol

T11-L2 Inferior mesenteric ganglion

Bladder/Reproductive Constricts internal sphincter allowing bladder to fill

PARASYMPATHETIC PREganglionic POSTganglionic Target EffectCN III Edinger-Westphal Nucleus Ciliary Ganglion Ciliary and iris

constrictor musclesIris constriction

CN VII Lacrimal Nucleus Pterygopalatine Ganglion Lacrimal gland Increased tearsCN VII Superior Salivatory

NucleusSubmandibular Ganglion Submandibular and

sublingual glandsIncreased salivary secretions

CN IX Inferior Salivatory Nucleus Otic Ganglion Parotid gland Increased salivary secretions

CN X Dorsal Motor Nucleus of X

Terminal ganglia Bronchi and lungs - heart - GI tract

Decreases heart rate and contractility - constricts bronchial tree

Intermediolateral Sacral Cord at S2/S4

Pelvic ganglion plexus Colon - bladder - external genetalia

Relaxes bladder internal sphincter - contracts bladder wall - causes erection

ENTERIC Location Target EffectMyenteric (Auerbach's

Plexus)Lies between external

longitudinal and circular smooth muscle layers

Smooth muscle

Submucous (Meissner's Plexus)

Within connective tissue of submucosa between

circular muscle and the mucosa

Secretory glands

Pathway Phylogenesis Functional Division/Location

Input/Output Function Lesion

Vestibulocerebellum Archicerebellum(Vestibular Organs)

Nodulus and bilateral flocculi

INPUT: Primary and secondary vestibular inputs

OUTPUT: Bilateral vestibular nuclei -

contralaterall cerebellum - brainstem reticular

formation

Maintenance of equilibrium, stance (posture), gaze control

Distorted equilibriumAstasia, abasia, ataxis,

nystagmusTendency of falling

Spinocerebellum Paleocerebellum(Vertebrae)

Uvula, anterior vermis, intermediate hemispheres

INPUT: Dorsal spinocerebellar - muscle

spindleVentral spinocerebellar -

GTOOUTPUT: Vermis - lateral

vestibular nucleus - contralateral VL thalamus -

brainstem reticular formation

Paravermian hemisphere - Globose/Embiliform -

Contralateral red nucleus and contralateral VL

thalamus

Axial and promixal muscle toneSkeletal propulsion

Control of stretch reflex

Ipsilateral tuncal and limb ataxia, gait disturbances,

scanning speech

Corticopontocerebellum Neocerebellum(Cerebral cortex)

Lateral hemispheres INPUT: Climbing fibersOUTPUT:

Dentatorubrothalamic Tract

Compares planned and actual movement - precision and fine

tuning of movement - Modulates pyramidal and

extrapyramidal actions

Distal ataxia, dysmetria, asynergia,

dysdiadochokinesia, intenion tremor, hypotonia, delay in initiation of motor

task

disease pathophysiology signs and symptoms · pdf filedisease pathophysiology signs and...

Documents