Trigeminal Reflexes and Cardiovascular Function

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Questions and Answers

Which reflex is NOT mentioned as being studied in relation to the trigeminal nerve?

  • Trigeminal reflex
  • Diving reflex
  • Trigeminocardiac reflex
  • Facial reflex (correct)

The heart is solely innervated by the sympathetic nervous system.

False (B)

What type of nervous reflexes are induced by the trigeminal nerve affecting cardiovascular function?

Somato-autonomic nervous reflexes

The heart's function during trigeminal reflexes is regulated by an increased __________ response.

<p>parasympathetic</p> Signup and view all the answers

Match the following reflexes with their characteristics:

<p>Diving reflex = Causes bradycardia and decreased heart rate Trigemino-Cardiac reflex = Involves facial nerve stimulation and cardiovascular response Trigeminal reflex = Rapid changes in cardiovascular function due to somato-autonomic response</p> Signup and view all the answers

What is the main role of the trigeminal nerve in cardiovascular responses?

<p>It induces rapid cardiovascular changes through somato-autonomic reflexes. (A)</p> Signup and view all the answers

The sympathetic activity during trigeminal reflexes can be increased, decreased, or remain unchanged.

<p>True (A)</p> Signup and view all the answers

The combination of increased parasympathetic and __________ activity regulates cardiac function during trigeminal reflexes.

<p>sympathetic</p> Signup and view all the answers

What is the primary function of the diving response in humans?

<p>To protect against hypoxic damage (C)</p> Signup and view all the answers

The trigeminocardiac reflex can occur during surgery in the cerebellopontine angle.

<p>True (A)</p> Signup and view all the answers

What nerve is essential for initiating the nasopharyngeal response in rats?

<p>anterior ethmoidal nerve</p> Signup and view all the answers

The diving bradycardia mechanism is part of the __________ reflex.

<p>trigeminocardiac</p> Signup and view all the answers

Match the authors with their contributions related to trigeminocardiac reflexes:

<p>Lang S = Defense against hypoxic damage Rybka EJ = Initiation of nasopharyngeal response Schaller B = Surgery in the cerebellopontine angle Gooden BA = Mechanisms of the human diving response</p> Signup and view all the answers

What does the research by Hollandsworth et al. focus on?

<p>Activation of the medullary dorsal horn by nasal stimulation (A)</p> Signup and view all the answers

Coronary vasospasm can occur during percutaneous trigeminal rhizotomy.

<p>True (A)</p> Signup and view all the answers

What effect does intense vasoconstriction have during the diving reflex?

<p>Stops blood flow to peripheral capillary beds (A)</p> Signup and view all the answers

The diving reflex is equally effective in humans as it is in natural diving animals.

<p>False (B)</p> Signup and view all the answers

What is the role of the ethmoidal nerve in the nasopharyngeal reflex?

<p>Innervates the nasal passages and external nares</p> Signup and view all the answers

The diving reflex is one of the most powerful ________ reflexes of the organism.

<p>somato-autonomic</p> Signup and view all the answers

Match the following components of the diving reflex with their effects:

<p>Vasoconstriction = Reduces blood flow to peripheral capillaries Increased sympathetic tone = Preserves blood pressure Reduced heart rate = Decreases cardiac output Nasal irritation = Activates the nasopharyngeal reflex</p> Signup and view all the answers

What potential risks do patients undergoing surgical interventions in the trigeminal territory face?

<p>Cardiovascular depression (D)</p> Signup and view all the answers

The sympathetic response of the diving reflex in humans may significantly increase blood pressure.

<p>True (A)</p> Signup and view all the answers

What substances can activate the nasopharyngeal reflex?

<p>Irritating gases, water, or electrical stimulation</p> Signup and view all the answers

The ________ reflex is activated by stimulating the nasal mucosa.

<p>nasopharyngeal</p> Signup and view all the answers

In diving animals like seals, what is a primary effect of the diving reflex?

<p>Increased sympathetic tone (A)</p> Signup and view all the answers

What is the trigeminocardiac reflex associated with?

<p>Reduction in heart rate (C)</p> Signup and view all the answers

The trigeminocardiac reflex was first described in the year 1988.

<p>False (B)</p> Signup and view all the answers

What physiological response is produced by the stimulation of the trigeminal branches?

<p>Reflex cardiovascular symptoms, including hypotension and bradycardia</p> Signup and view all the answers

In 1975, Kumada et al. observed a reflex that induced gastrointestinal symptoms including gastric __________.

<p>hypermotility</p> Signup and view all the answers

Match the researchers with their contributions regarding trigeminal reflexes:

<p>Aschner = Described heart rate reduction due to eyeball compression Shelly and Church = Suggested the term trigeminocardiac reflex Lang et al. = Described intense reflex bradycardia Kumada et al. = Studied respiratory effects</p> Signup and view all the answers

What did Shelly and Church propose in relation to the trigeminal reflex?

<p>The term 'trigeminocardiac reflex' (C)</p> Signup and view all the answers

The trigeminovagal reflex is characterized by a decrease in vagal tone.

<p>False (B)</p> Signup and view all the answers

What type of response occurs with low frequency stimulation in the trigeminal reflex?

<p>Tachypnea</p> Signup and view all the answers

The central occurrence of the trigeminovagal reflex was first published by __________ and colleagues.

<p>Schaller</p> Signup and view all the answers

Which of these symptoms is NOT associated with the trigeminal reflex?

<p>Tachycardia (B)</p> Signup and view all the answers

What effect does the nasopharyngeal reflex have on sympathetic tone?

<p>Increases sympathetic tone (A)</p> Signup and view all the answers

The trigeminal reflex is known to decrease blood pressure in patients with cardiovascular diseases.

<p>False (B)</p> Signup and view all the answers

What are two significant hemodynamic changes induced by trigeminal reflexes?

<p>Bradycardia and blood pressure modifications</p> Signup and view all the answers

The nasopharyngeal reflex is considered a powerful oxygen-preserving __________.

<p>reflex</p> Signup and view all the answers

Match the following complications with their related factors:

<p>Coronary spasms = Key factor in pathophysiology of complications Asystole = Severe arrhythmia induced by trigeminocardiac reflex Ventricular fibrillation = Complication observed during neurosurgeries Bradycardia = Common cardiovascular response elicited by reflexes</p> Signup and view all the answers

What physiological process is primarily affected by the sympathetic/parasympathetic interaction during trigeminal reflexes?

<p>Vasospasm (D)</p> Signup and view all the answers

The diving reflex and the nasopharyngeal reflex have no common characteristics.

<p>False (B)</p> Signup and view all the answers

How might cholinergic discharge affect coronary arteries in patients with atherosclerosis?

<p>It could trigger paradoxical vasoconstriction.</p> Signup and view all the answers

The changes in vascular flow at the carotid level suggest blood flow redistribution to the __________.

<p>brain</p> Signup and view all the answers

What potential complication might arise as a consequence of the trigeminocardiac reflex during neurosurgeries?

<p>Severe arrhythmias (D)</p> Signup and view all the answers

Flashcards

Trigeminal reflexes

Nervous system connections between the trigeminal nerve and the heart that rapidly change heart function.

Diving reflex

A specific trigeminal reflex, primarily related to heart function during water immersion.

Trigeminocardiac reflex

Another specific trigeminal reflex, connecting facial stimulation to changes in heart function.

Somato-autonomic nervous reflexes

Connections between body sensations (somatosensory) and automated bodily functions (autonomic).

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Cardiac function regulation

How the heart's actions are controlled, including the sympathetic and parasympathetic nervous systems.

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Sympathetic nervous system

Part of the autonomic nervous system involved in 'fight-or-flight' responses.

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Parasympathetic nervous system

Part of the autonomic nervous system promoting 'rest-and-digest' actions.

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Dually innervated heart

The heart receives signals from both the sympathetic and parasympathetic systems, allowing complex responses.

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Nasopharyngeal Reflex

A variation of the diving reflex activated by stimulation of the nasal mucosa (nose and throat). It also reduces heart rate and blood flow to peripheral tissues.

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Trigeminal-vagal Reflex

A nerve connection between the trigeminal nerve (facial sensations) and the vagus nerve (heart control), leading to rapid changes in heart function.

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Ethmoidal Nerve

A nerve in the nasal passages that plays a key role in activating the nasopharyngeal reflex.

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Vasoconstriction

Narrowing of blood vessels, reducing blood flow to a specific area.

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Species Differences in Diving Reflex

While the diving reflex is present in both humans and diving animals, the intensity of its effects (especially the sympathetic response) varies significantly.

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Anesthesia Impact on Reflexes

Anesthetics can influence the effectiveness of trigeminal-vagal reflexes, making them more unpredictable.

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Sympathetic tone

The level of activity in the sympathetic nervous system.

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Peripheral vascular resistance

Opposition to blood flow through blood vessels away from the heart.

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Carotid resistance

Opposition to blood flow in the carotid arteries, supplying blood to the brain.

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Blood pressure changes

Variations in blood pressure caused by trigeminal reflexes.

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Cardiac complications

Problems that arise in the heart due to trigeminal reflexes.

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Asystole

Complete absence of heart electrical activity.

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Ventricular fibrillation

Chaotic and ineffective quivering of the heart's ventricles.

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Coronary spasm

Sudden narrowing of the coronary arteries, reducing blood flow to the heart muscle.

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Diving Bradycardia

A slowing of heart rate triggered by immersing the face in cold water. This is a key component of the diving reflex.

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Maxillary vs. Mandibular

Both maxillary and mandibular nerve stimulation can trigger the trigeminocardiac reflex, but the responses might be different.

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Trigeminocardiac Reflex Pathway

The pathway of the trigeminocardiac reflex involves the trigeminal nerve, brainstem, and vagus nerve, leading to rapid heart rate changes.

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Diving Reflex: Sympathetic Response

The diving reflex involves increasing sympathetic activity, which constricts blood vessels and conserves oxygen.

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Subtenon Block

A type of local anesthetic injection used to block the trigeminal nerve, potentially affecting the trigeminocardiac reflex.

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Anesthetics' Effect on Reflexes

Anesthetics can alter the trigeminocardiac reflex, making it weaker or even unpredictable.

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What is the effect of stimulating the trigeminal nerve?

Stimulating branches of the trigeminal nerve can induce a variety of physiological changes, including a sharp decrease in heart rate, lowered blood pressure, apnea (temporary cessation of breathing), and increased stomach motility.

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What are the two stages of the respiratory response to trigeminal nerve stimulation?

Low frequency stimulation of the trigeminal nerve leads to tachypnea (rapid breathing), while higher intensity stimulation results in expiratory apnea (holding your breath after exhaling).

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Aschner Phenomenon

A classic example of a trigeminal reflex, where pressing on the eyeballs causes a significant decrease in heart rate.

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What is the role of the sympathetic and parasympathetic nervous systems in the trigeminal reflexes?

The sympathetic nervous system, responsible for 'fight-or-flight' responses, can be activated by trigeminal reflexes, leading to increased heart rate and blood pressure. The parasympathetic nervous system, responsible for 'rest-and-digest' responses, is often activated, leading to decreased heart rate and increased digestive activity.

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How do trigeminal reflexes affect cardiovascular regulation?

Trigeminal reflexes can significantly impact cardiovascular control by modifying heart rate, blood pressure, and blood flow distribution. They can lead to rapid changes in these cardiovascular functions, depending on the nature and intensity of the stimulus.

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What are the key differences between the trigeminal reflexes described in humans and animal models?

While the trigeminal reflexes show similarities across species, there are variations in their strength and the degree of involvement of the sympathetic nervous system, particularly in diving mammals.

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How can anesthesia impact trigeminal reflexes?

General anesthesia can influence the intensity and predictability of trigeminal reflexes. It can complicate the interpretation of these reflexes during medical procedures.

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Study Notes

Trigeminal Reflexes and Cardiovascular Function

  • Trigeminal nerve and heart are strongly connected through somato-autonomic reflexes, inducing rapid cardiovascular changes.
  • Diving and trigeminocardiac reflexes are the most studied trigeminal reflexes.
  • The heart receives dual innervation (sympathetic and parasympathetic), influencing how cardiovascular function is regulated during trigeminal reflexes.
  • These reflexes involve a combination of increased parasympathetic response and varying sympathetic activity.
  • Hemodynamic changes (e.g., heart rate, blood pressure) result from these autonomic alterations.
  • In oxygen-conserving reflexes (e.g., diving reflex), co-activation of sympathetic and parasympathetic systems reduces heart rate and maintains/increases blood pressure.
  • Trigeminocardiac reflex often involves bradycardia and hypotension due to parasympathetic activation and sympathetic inhibition.
  • Sudden cardiac innervation disturbances can cause arrhythmias or myocardial ischemia, especially during surgeries in the trigeminal territory.

Diving Reflex

  • Oxygen deprivation (even brief) can be harmful, but many species (birds, mammals, humans) have adapted to withstand hypoxia/anoxia.
  • Diving reflex is a key adaptation, triggering heart rate reduction (via vagal activation), increased blood pressure (via sympathetic response), and apnea.
  • Apnea can be voluntary (breath-holding) or reflexive (cold receptor stimulation on face, eyes, and nasal cavity).
  • Facial submersion rapidly triggers these responses.

Trigeminocardiac Reflex

  • Clinically and experimentally proven brainstem reflex.
  • Characterized by hypotension (20% drop in mean arterial blood pressure), bradycardia (<60 bpm) and response to trigeminal manipulation/disturbances.
  • May lead to asystole in severe cases.
  • Classified into central (ganglion to nucleus) and peripheral (peripheral divisions to ganglion) subtypes.
  • Peripheral reflex can be further divided into ophthalmocardiac and maxillomandibulocardiac reflexes.

Other Reflexes

  • Nasopharyngeal reflex: activated by irritating stimuli, water, or electrical stimulation.
  • Oculocardiac reflex: triggered by physical stimulation of eyes or adnexa.
  • Nasopharyngeal reflex involves increased parasympathetic tone (reduces heart rate and cardiac output) and increased sympathetic tone (greater peripheral vascular resistance), maintaining stable blood pressure.
  • Trigeminal reflex responses vary based on stimulus type, intensity, frequency, duration, involved nerve fibers, and analgesic/anesthetic use.

Hemodynamic Changes During Trigeminal Reflexes

  • Bradycardia and blood pressure modifications are prominent.
  • Sudden changes can affect patients with cardiovascular issues.
  • Potential for arrhythmias, asystole, and ventricular fibrillation during neuro-surgeries.
  • Coronary spasm a potential factor in complications.
  • Co-activation of sympathetic systems may reduce blood flow in damaged areas of the heart.

Conclusion

  • Trigeminal nerve stimulation triggers hemodynamic changes through somato-autonomic reflexes (e.g., diving, trigeminocardiac)
  • Hemodynamic changes are influenced by sympathetic/parasympathetic balance, stimulus factors, and other variables (e.g. anesthesia).
  • These reflexes and resulting disturbances are clinically relevant, requiring proper management during surgeries in the trigeminal territory.

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