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TMDEJA REVIEW Neuroscience NOTICE Medicine is an ever-changing science. As new research and clinical experience bro. Deja Review Microbiology & Immunology, Second Edition. Home · Deja Deja Review Behavioral Science, Second Edition Deja Review Neuroscience. In this post, we have shared an overview and download link of Deja Review Neuroscience PDF 2nd Edition. Read the overview below and.
Spasticity What is the term used to describe repetition of reflex contractions? Lesion of the corticospinal tract above the red nucleus What descending motor tracts are likely responsible for decorticate posturing? Spinothalamic tract anterolateral system Where are the first-order neurons of the anterolateral system? Readers are encouraged to confirm the information contained herein with other sources. Arousal, autonomic function, reflexes, and behavior Which ascending spinal tract transmits information about tactile discrimination, proprioception, and vibration sense? Caloric What is the mnemonic used to remember normal caloric responses in a comatose patient? Clarke column ipsilateral spinal cord segments C8-L2 Where do axons carrying unconscious proprioceptive information rostral to C8 terminate?
Axons What is the name of the region of the axon in which action potentials are generated? Initial segment or axon hillock What is another name for a neuronal cell body? Soma Nissl substance describes which neuronal organelles?
Ribosomes and rough endoplasmic reticulum Which type of axonal transport uses dynein motors? Fast retrograde transport Which type of axonal transport uses kinesin motors?
Fast anterograde transport Along which cytoskeletal elements do dynein and kinesin motors travel? Microtubules Name the type of neuron described below: Neuron with unidirectional axon found in the peripheral ganglia Pseudounipolar Neuron with a single dendrite and an axon, common to the retina Bipolar Neuron with triangular shape and large apical dendrites found primarily in the cortex Pyramidal Cerebellar neuron with extensive planar dendritic arborization Purkinje Which cells are the major support cells of the CNS?
Astrocytes What are the major functions of astrocytes? Maintain ionic gradient Reuptake certain neurotransmitters Detoxify ammonia Secrete neurotrophic factors Which protein is used as a cell-specific marker for astrocytes? Glial fibrillary acidic protein GFAP Embryology and Histology 5 What word is used to describe the astrocytic response to injury, which leaves a scar in the brain? Gliosis What is the name used to describe the accumulations of heat shock proteins and filaments seen in reactive astrocytes?
Rosenthal fibers What is the name of the fatty wrapping around axons which increases conduction velocity? Myelin What is the name for the gaps between myelin wrapping in which one finds a high density of sodium channels? Oligodendroglia Infection of oligodendroglia by the JC virus results in what disease? Progressive multifocal leukoencephalopathy see Chap. Schwann cells Do Schwann cells wrap unmyelinated peripheral axons? Yes Which cell type is capable of wrapping multiple axons?
Oligodendroglia Which cell type wraps only single axons? Microglia Microglia are heavily implicated in CNS pathology associated with infection by what virus? Phagocytosis of debris, including dead or dying neurons Which type of cells line the ventricles? Ependymal cells Cerebrospinal fluid CSF is produced in what structure?
Choroid plexus 6 Deja Review: Nonfenestrated capillaries Endothelial tight junctions Astrocytic endfeet What is the major determinant of whether a drug will readily cross the blood-brain barrier?
Lipid solubility What kind of molecules are capable of crossing the blood-brain barrier? Water Gases Lipid-soluble molecules Glucose facilitative diffusion via Glut1 transporter Amino acids both passive and active transporters What is the generic term for midline structures of the brain lacking the blood-brain barrier?
Circumventricular organs Name the circumventricular organs. Pineal gland, median eminence, area postrema, subfornical organ, and subcommissural organ Which circumventricular organ is responsible for vomiting in response to toxin consumption?
Meninges Name the three layers of meninges from outermost to innermost. Dura mater 2. Arachnoid 3. Pia mater Which layer s of the meninges are also known as pachymeninges, and which are known as leptomeninges? Subarachnoid space; S2 Which spinal nerve bundles are contained in the cauda equina? L2-Co coccygeal nerve 9 10 Deja Review: Neuroscience Is the subdural space a real or potential space? Potential space What are the contents of the epidural space?
Adipose tissue, lymphatics, and venous plexus At what vertebral level does the conus medullaris terminate in the adult and newborn? L1 adult , L3 newborn Identify the spinal cord levels between which the following structures are located: Anterior spinal artery supplies the ventral two-thirds of the cord This vessel is formed from merged branches of what paired arteries? Vertebral arteries Which vessel s supply the posterior spinal cord? Posterior spinal arteries 2 What is the name for segmental arteries that give collateral supply to the anterior and posterior spinal arteries?
Radicular arteries What radicular arteries are primarily responsible for supply of the thoracic, lumbar, and sacral regions of the spinal cord? Intercostal and lumbar arteries What two other major vessels contribute collateral supply to the caudal spinal cord? Great anterior medullary artery of Adamkiewicz and ascending sacral artery Occlusion of the anterior spinal artery results in characteristic sparing of which spinal tracts? Lateral corticospinal tract Where does this tract lie within the spinal cord?
Dorsolaterally within the lateral column funiculus What other descending motor tract travels in the lateral column spinal cord? Rubrospinal tract In which spinal cord tract do the nondecussating axons of upper motor neurons travel? Ventral corticospinal tract Where does this tract lie within the spinal cord? Ventromedially within the ventral column Where are the cell bodies of lower motor neurons located in the spinal cord?
Ventral horn often referred to as anterior horn cells Describe the location of motor neurons for flexor muscles relative to motor neurons for extensor muscles. Flexor motor neurons lie dorsal to extensor motor neurons within the ventral horn. Describe the location of motor neurons for distal muscles relative to motor neurons for proximal muscles within the ventral horn.
Motor neurons of limb muscles lie lateral to motor neurons of axial muscles. Identify the spinal cord level of the following clinically important reflex arcs: Conscious proprioception, vibration sense, and two-point discrimination 12 Deja Review: Neuroscience Which receptors supply sensory information to the dorsal column—medial lemniscal system? Pacinian corpuscles, Meissner corpuscles, Merkel disks, Ruffini endings, muscle spindles, and Golgi tendon organs What somatosensory information in the dorsal column—medial lemniscal system is supplied by the muscle spindle and Golgi tendon organ?
Proprioception Where are the cell bodies of primary neurons of the dorsal column—medial lemniscal system located? Dorsal root ganglion Where do the primary neurons of the dorsal column—medial lemniscal system terminate?
Ipsilateral cuneate and gracile nuclei caudal medulla Where are the cell bodies of secondary neurons of the dorsal column—medial lemniscal system located? Axons from the cuneate and gracile nuclei decussate as internal arcuate fibers, eventually forming the medial lemniscus. Somatosensory information from the lower extremities travels along which axon bundle in the dorsal columns?
Gracile fasciculus Somatosensory information from the upper extremities travels along which axon bundle in the dorsal columns?
Cuneate fasciculus Information from which spinal levels travels in the cuneate fasciculus? T6 and above Describe the somatotopic organization of the dorsal columns. Caudal nerve roots contribute to medial fibers of the dorsal columns.
Rostral nerve roots contribute to lateral fibers. Will a unilateral lesion of the dorsal column—medial lemniscal system below the level of the medial lemniscus result in contralateral or ipsilateral loss of somatosensory information? Ipsilateral loss of somatosensory information Spinal Cord 13 Where would you expect somatosensory loss from a lesion of the left gracile fasciculus?
Left lower extremity Where would you expect somatosensory loss from a lesion of the right medial lemniscus? Left upper and lower extremities Integrity of which ascending spinal tract is tested by asking the patient to stand with eyes closed Romberg sign? Dorsal columns What somatosensory information travels in the anterolateral system? Pain and temperature Which tract is responsible for getting pain and temperature information to the primary somatosensory cortex?
Spinothalamic Which epidermal receptors mediate somatosensory information to the anterolateral system? Free nerve endings Where are the cell bodies of primary afferent neurons of the anterolateral system located?
Dorsal root ganglion Upon entering the spinal cord, where do axons of primary neurons in the anterolateral system travel? Lissauer tract Where are the cell bodies of secondary neurons of the anterolateral system located? Ipsilateral dorsal horn Where do axons of the anterolateral system decussate in the spinal cord? Ventral white commissure After decussating, where do axons from secondary neurons of the anterolateral system travel?
Contralateral spinal cord as the spinothalamic, and spinoreticular, spinomesencephalic tracts Which deficit in pain and temperature sensation results from spinal cord hemisection? Partial ipsilateral loss of pain and temperature at the level of the lesion. Complete contralateral loss of pain and temperature two segments below the lesion. Neuroscience Which tract accounts for the pattern of ipsilateral pain and temperature sensory loss following hemisection? Lissauer tract sends pain and temperature information one or two levels above and below the site of termination of primary neurons.
Describe the somatotopic organization of the spinothalamic system.
Caudal nerve afferents are found lateral and rostral afferents medial. What somatosensory information is transmitted in the spinocerebellar and cuneocerebellar tracts? Dorsal root ganglion In which nucleus are the cells that form the dorsal spinocerebellar tract found? Clarke column ipsilateral spinal cord segments C8-L2 Where do axons carrying unconscious proprioceptive information rostral to C8 terminate?
Accessory cuneate nucleus ipsilateral What is the name given to the tract formed by axons arising from the accessory cuneate nucleus? Cuneocerebellar tract Where do axons of the spinocerebellar and cuneocerebellar tracts terminate?
Ipsilateral cerebellum What is believed to be the function of the ventral spinocerebellar tract? Feedback about improper limb movements What is different about the trajectory of the ventral spinocerebellar tract? While the dorsal spinocerebellar tract is uncrossed, the ventral spinocerebellar tract decussates in the spinal cord and enters the cerebellum via the superior cerebellar peduncle. How do axons of the ventral spinocerebellar tract terminate in the ipsilateral cerebellum?
The tract crosses again in the cerebellum before reaching its final destination. Principles of Neural Science. New York, NY: McGraw-Hill; Neuroscience Which region of the spinal cord has the highest gray-to-white matter ratio? Sacral region Which two regions of the spinal cord contain enlargements for afferent and efferent projections of the extremities? Cervical and lumbar What fasciculus is present only at cervical and high thoracic levels above T7 of the spinal cord?
Cuneate fasciculus Identify these clinically important spinal cord lesions: Horner syndrome What affected spinal areas are associated with the symptoms of syringomyelia?
Ventral white commissure anterolateral system 2. Ventral horn Which congenital malformation with cerebellar herniation is associated with syringomyelia? A year-old man who recently underwent gastric bypass surgery 8 months ago presents with weakness, skin pallor, and confusion.
A neurologic test reveals decreased position and vibration sense, lower extremity ataxia with a positive bilateral Babinski reflex, and positive Romberg sign. Complete blood count CBC reveals a mean corpuscular volume MCV of , decreased reticulocyte count, and hypersegmented neutrophils on peripheral blood smear.
Serum homocysteine and methylmalonic acid levels are elevated. On further questioning, patient admits to urinary incontinence. Physical examination reveals diminished reflexes in the lower extremities. MRI reveals spinal stenosis. Cauda equina syndrome A year-old male is seen in the ER after burning his hands while cooking. Further evaluation reveals symptoms of progressive fine motor loss in his hands bilaterally.
On physical examination, patient is found to have decreased pain and temperature sensation on his shoulders bilaterally in a cape-like distribution. He denies any recent trauma or medical illness, but says that he was seen 5 years ago after sustaining minor injuries in a motor vehicle accident.
Syringomyelia A year-old female presents with recent onset of pain in her right eye with progressing visual loss. Her gait is found to be unsteady and she is unable to stand without closing her eyes and supporting herself. On further questioning, the patient is found to have double vision. Multiple sclerosis Spinal Cord 19 A year-old male is brought to the ER after sustaining traumatic injury in a motor vehicle accident.
On physical examination, patient is found to have decreased two-point discrimination, vibration, and proprioception on the left side below the umbilicus, and loss of pain and temperature sense on the right side two levels below the umbilicus. Sulcus limitans How are the alar and basal plates functionally distinct? Alar is dorsolateral and basal is ventromedial. Figure 3. Adapted with permission from Martin JH, ed. Text and Atlas. Neuroscience Table 3. What is the large and vaguely defined group of nuclei extending from caudal medulla to the diencephalon?
Reticular formation In what processes is the reticular formation involved? Arousal, autonomic function, reflexes, and behavior Which ascending spinal tract transmits information about tactile discrimination, proprioception, and vibration sense? Dorsal columns What nuclei contain second order neurons of the dorsal column medial—lemniscal system?
Nucleus gracilis legs and nucleus cuneatus arms Where is the decussation of the dorsal column—medial lemniscus system? Internal arcuate fibers in the caudal medulla Brainstem and Cranial Nerves 25 In what tract do axons of the dorsal column—medial lemniscus system ascend to the thalamus after decussating?
Medial lemniscus What thalamic nucleus contains third order neurons of the dorsal column—medial lemniscus system? Ventral posterolateral nucleus VPL What spinal tract transmits pain and temperature information from the contralateral side of the body? Spinothalamic tract anterolateral system Where are the first-order neurons of the anterolateral system?
Dorsal root ganglion DRG Where are the second-order neurons of the anterolateral system? Ipsilateral dorsal horn of the spinal cord Where does the lateral spinothalamic tract decussate? Ventral white commissure of spinal cord In which thalamic nucleus does the spinothalamic tract terminate? Spinal trigeminal tract Where are the second-order neurons of the spinal trigeminal system located?
Ipsilateral spinal trigeminal nucleus Describe the course of axons from second-order neurons of the spinal trigeminal tract: Axons from the spinal trigeminal nucleus decussate and ascend as the contralateral ventral trigeminothalamic tract terminating in the thalamus. In which thalamic nucleus does the ventral trigeminothalamic tract terminate? Ventral posteromedial nucleus VPM Where are fibers of the corticospinal tract located in the medulla? Medullary pyramids At what level do the descending fibers of the corticospinal tract decussate?
Medulla-spinal cord junction 26 Deja Review: Neuroscience Second-order neurons of which tract originate in the accessory cuneate nucleus?
Cuneocerebellar tract What is the function of the cuneocerebellar tract? Transmits unconscious proprioceptive information from the upper limbs to cerebellum What tract transmits proprioceptive information from the lower limbs to the cerebellum?
Dorsal spinocerebellar tract What spinal nucleus is analogous to the accessory cuneate nucleus and extends from C8 to L2? Nucleus dorsalis of Clarke Which cerebellar peduncle transmits the dorsal spinocerebellar and cuneocerebellar tracts to the cerebellum? Inferior cerebellar peduncle To which descending motor pathways do efferents from the inferior cerebellar peduncle contribute?
Vestibulospinal and reticulospinal tracts Which proprioceptive tract enters the cerebellum via the superior cerebellar peduncle? Ventral spinocerebellar tract What tract extends from the mesencephalon to the medulla and conveys information from the red nucleus to the inferior olivary nucleus? Central tegmental tract What are the excitatory fibers that project from the inferior olivary nucleus to the cerebellum called? Climbing fibers What are the other major excitatory input fibers into the cerebellum?
Mossy fibers Axons of which other neurons are contained within the central tegmental tract? Second-order taste neurons SVA projecting from the rostral solitary nucleus, viscerosensory neurons GVA projecting to the parabrachial nucleus of the pons and posteromedial nucleus of the thalamus Brainstem and Cranial Nerves 27 PONS Identify the labeled structures in Fig.
Neuroscience Identify the labeled structures in Fig. First arch—muscles of mastication Second arch—muscles of facial expression and stapedius Motor nucleus of CN VI Innervate lateral rectus What descending motor pathways course through the base of the pons? Corticobulbar, corticospinal, and corticopontine tracts What is the function of the corticobulbar tract? Motor innervation to all motor cranial nerve nuclei except nuclei involved in extraocular movements Are projections of the corticobulbar tract bilateral or unilateral?
Mostly bilateral Which cranial nerve nuclei do not receive bilateral corticobulbar input? Lower division of CNVII contralateral input sometimes hypoglossal What deficit in facial movement is associated with unilateral damage to the corticobulbar tract?
Inability to move all ipsilateral facial muscles, including muscles of the forehead 30 Deja Review: Neuroscience What clinical test is used to determine whether the lesion is central or peripheral? Eyebrow raise upper division Smile lower division Which cerebellar peduncle carries fibers from pontine nuclei to the cerebellum? Middle cerebellar peduncle What tract provides the major input to the pontine nuclei? Corticopontine tract What is the function of the corticopontine tract?
Communicate motor information from cortex to cerebellum What nucleus receives discriminatory touch, pressure, and vibration inputs from the face? Contralateral ventral posterior medial nucleus of the thalamus VPM Within the pontine segment of the medial lemniscus, where are fibers innervating the arms and legs found, respectively?
Arms are medial, legs are lateral. What is the white matter tract extending through the brainstem that contains fibers from vestibular nuclei and extraocular motor nuclei? Medial longitudinal fasciculus MLF What pontine structure controls lateral gaze? Axons project from the right PPRF to the ipsilateral abducens nucleus. Two types of neurons found in the abducens nucleus are stimulated: Projections to the left oculomotor nucleus stimulate left medial rectus.
Brainstem and Cranial Nerves 31 What deficit is associated with abducens nerve palsy? Medial deviation of the ipsilateral eye due to lateral rectus paralysis What deficit is associated with abducens nucleus injury? Lateral gaze palsy: Nucleus injury interrupts both ipsilateral and contralateral projections to oculomotor nucleus , whereas nerve injury only interrupts innervation of the ipsilateral lateral rectus muscle.
What is the name given to a lesion of the MLF? Internuclear ophthalmoplegia What is the most common cause of internuclear ophthalmoplegia? Multiple sclerosis What extraocular deficit is associated with internuclear ophthalmoplegia? The eye ipsilateral to the lesion does not adduct, and the contralateral eye exhibits nystagmus. How can clinicians verify that the medial rectus is not paralyzed in cases of internuclear ophthalmoplegia or abducens nucleus injury causing lateral gaze palsy?
Convergence is intact. What brainstem center controls vertical gaze control? Parinaud syndrome Which cortical centers control saccadic eye movements to the contralateral side? Ipsilateral 32 Deja Review: LR, lateral rectus and SO, superior oblique. What is the tectum? The roof of the midbrain, defined as all structures dorsal to the cerebral aqueduct, including the superior and inferior colliculi What is the tegmentum? Region of the midbrain between the cerebral aqueduct and the basis pedunculi What is the basis pedunculi?
What are the cerebral peduncles? Combination of the tegmentum and the basis pedunculi What structure connects the third and fourth ventricles?
Cerebral aqueduct of Sylvius What structure surrounds the cerebral aqueduct? Periaqueductal gray 34 Deja Review: Neuroscience What is the function of the periaqueductal gray?
Endogenous pain suppression What is the function of the locus coeruleus? Provides diffuse norepinephrine projections in the CNS Name the two divisions of the substantia nigra. Pars reticularis 2. Pars compacta Which division contains dopaminergic neurons?
Parkinson disease Where does the pars reticularis project? Thalamus, pedunculopontine nucleus, and the superior colliculus plays a role in controlling saccadic eye movement What is the ventral midbrain structure that contains dopaminergic neurons that project to the striatum and to the prefrontal cortex?
Ventral tegmental area What structure receives visual input directly from the retina, occipital lobes, and FEFs and mediates audiovisual reflexes, searching, and tracking?
Superior colliculus Name the nucleus that receives visual input from retinal ganglion cells and projects bilaterally to the E-W nuclei, mediating the pupillary light reflex. Pretectal nucleus Across what commissure does input to the contralateral E-W nucleus travel?
Posterior commissure What is the only cranial nerve that crosses the midline? CN IV trochlear Why is this important? All other cranial nerve injuries result in ipsilateral defects. What nucleus at the level of the superior colliculus mediates flexor tone?
Red nucleus In what tract do rubro-olivary fibers travel? Central tegmental tract Brainstem and Cranial Nerves 35 Through which cerebellar peduncle do cerebellar efferents enter the midbrain? Superior cerebellar peduncle At what level do the superior cerebellar peduncles decussate?
Vertebral artery or the caudal aspect of the basilar artery What structures are often injured in medial medullary syndrome? Hypoglossal nerve, pyramidal tract, and medial lemniscus What are the symptoms of medial medullary syndrome?
Ipsilateral paralysis of tongue, contralateral paralysis of arm and leg spares face , and contralateral loss of discriminative touch, vibration, and proprioception Occlusion of what artery causes lateral medullary Wallenberg syndrome? Vertebral, posterior inferior cerebellar artery PICA , or any of the lateral medullary arteries What structures are typically injured in lateral medullary syndrome? Neuroscience What are the symptoms of locked-in syndrome? Nearly all motor pathways are lesioned, leaving only extraocular muscle innervation intact.
Patients have paralysis of the body and facial muscles. What is an iatrogenic cause of locked-in syndrome? Central pontine myelinolysis— caused by correcting hyponatremia too quickly What tracts are injured in locked-in syndrome? Bilateral corticobulbar and corticospinal tracts Where is the typical location of this lesion? Base of the pons What causes dorsal midbrain Parinaud syndrome?
Damage to the posterior commissure, superior colliculus, and pretectal nucleus usually due to a pineal tumor compressing the tectum What are the symptoms of dorsal midbrain Parinaud syndrome? Vertical gaze palsy, with nystagmus on attempted vertical gaze, and loss of pupillary reflex Occlusion of what vessel s causes Benedikt syndrome? Paramedian arteries of the posterior cerebral artery What structures are injured in Benedikt syndrome?
Oculomotor nerve, red nucleus, and medial lemniscus What are the symptoms of Benedikt syndrome? Branches of the basilar and posterior cerebral arteries What structures are injured in Weber syndrome?
Oculomotor nerve and cerebral peduncle What are the symptoms of Weber syndrome? Ipsilateral third nerve palsy down and out, fixed pupil dilation, ptosis , diplopia, and contralateral hemiplegia Weber syndrome is caused by occlusion of what vessels? Short paramedian branches of the basilar and posterior cerebral arteries see Chap.
Neuroscience Medial medullary syndrome Lateral medullary syndrome Wallenberg Locked-in syndrome Benedikt syndrome Weber syndrome Figure 3. CN IV trochlear Which cranial nerves exit the midbrain? CN V trigeminal Pontomedullary junction: Mesencephalic trigeminal nucleus— contains cell bodies of stretch receptors found in muscles of mastication Brainstem and Cranial Nerves 41 Through what foramen does each cranial nerve pass?
Olfactory bulb What cranial nerve is made of retinal ganglion cell axons? CN II optic Where do the axons of the retinal ganglion cells synapse?
Oculomotor nucleus What CNS nucleus contains neurons that control the ciliary muscle and sphincter muscle of the pupil? E-W nucleus of oculomotor complex Describe the pathway of parasympathetic fibers originating in the E-W nucleus. Uncal transtentorial herniation resulting from increased intracranial pressure, aneurysm of posterior cerebral artery, and aneurysm of superior cerebellar artery What accounts for the different physical findings associated with compression and microvascular injury of CN III?
Parasympathetic fibers travel on the periphery of CN III, and are the first to be damaged by a compression injury. Motor fibers are located deep in the nerve, and are the most vulnerable to ischemic injury that occurs in diabetic neuropathy. What muscle does CN IV trochlear innervate? Superior oblique What is the action of the superior oblique? Turns eyeball inferomedially intorts What is the classic symptom associated with trochlear nerve palsy?
Incline the head anteriorly and toward the side of the normal eye What muscles do V1 ophthalmic , V2 maxillary , and V3 mandibular trigeminal nerve divisions innervate? V1 and V2 do not innervate any muscles. V3 innervates muscles of mastication temporalis, masseter, lateral pterygoid, medial pterygoid , tensor tympani, tensor palati, and anterior belly of digastric.
From what branchial arch are these muscles derived? First branchial arch What nerve innervates lateral rectus muscle? Compression due to increased intracranial pressure or spaceoccupying lesion, cavernous sinus thrombosis, and impingement by an atherosclerotic internal carotid artery Brainstem and Cranial Nerves 43 What nerve conveys general sensory information from the tongue?
CN IX What nerves convey taste? CN IX Posterior oropharynx and larynx: CN X In what peripheral sensory ganglia are primary sensory neurons involved in taste located? CN VII: All converge on the rostral solitary nucleus. What do neurons of the superior salivatory nucleus innervate? Lacrimal, submandibular, and sublingual gland Describe the course of these axons.
Axons controlling the lacrimal gland synapse in the pterygopalatine ganglion. Axons controlling the submandibular and sublingual gland synapse in the submandibular ganglion. What do neurons of the inferior salivatory nucleus innervate? Parotid gland Describe the course of these axons. Parasympathetic fibers originate in the inferior salivatory nucleus, travel via CN IX, and synapse in the otic ganglion, which projects to the parotid gland.
Muscles of facial expression, stapedius, posterior belly of digastric, and stylohyoid From which branchial arch are these muscles derived? Second branchial arch What type of neuron innervates the hair cells of the cochlea? Bipolar primary sensory neurons What peripheral sensory ganglion contains these bipolar sensory neurons? Spiral ganglion 44 Deja Review: Neuroscience In what nuclei do these bipolar sensory neurons synapse?
Ipsilateral cochlear nuclei found in the rostral medulla What are the functional roles of the anteroventral, posteroventral, and dorsal cochlear nuclei?
Stylopharyngeus From which branchial arch is this muscle derived? Nucleus ambiguus To what nucleus do sensory fibers innervating the external ear canal project?
Spinal trigeminal nucleus Which cranial nerves transmit the sensory fibers that innervate the external ear canal? Relay viscerosensory information from the larynx, trachea, gut proximal to splenic flexure , and aortic arch receptors carried by the vagus nerve In what ganglion do you find the cell bodies of vagal neurons innervating the caudal solitary nucleus?
Nucleus ambiguus—innervate all muscles of larynx, all muscles of the pharynx except stylopharyngeus , and all muscles of soft palate except tensor palate From which branchial arch are these muscles derived? Sternocleidomastoid and trapezius Brainstem and Cranial Nerves 45 From which branchial arch are these muscles derived? Hyoglossus, genioglossus, and styloglossus What muscle with the suffix -glossus is not innervated by the hypoglossal nerve?
Palatoglossus is innervated by the vagus Table 3. A year-old female with a history of atherosclerosis presents with left-sided loss of sensation on body, right-sided sensory deficit of face, and unsteadiness when walking. Physical examination is significant for sensory deficit of left side of body and right side of face, dysmetria, and ataxia. Brain imaging confirms the suspected diagnosis. Wallenberg syndrome lateral medullary syndrome A year-old female presented with diplopia, left ptosis, right hemiataxia and hyperactive tendon reflexes.
Left pupil was dilated and unresponsive to light. Radiological examination revealed stenosis of the posterior cerebral artery and a left-sided midbrain infarct. Benedikt syndrome A year-old woman with a history of atrial fibrillation complains of diplopia. She also feels weakness in her left arm and leg. Her husband noticed that her right eyelid was drooping. On physical examination, the right eyelid did not open fully and the right eye was laterally deviated. Only the left eye constricted in response to light.
She had facial weakness on the left. Motor strength was reduced on the left side of her body with normal sensation for the face and body. Weber syndrome A 6-year-old boy was noticed by his mother to have signs of precocious puberty. Physical examination revealed a bilateral paralysis of upward gaze and a questionable weakness of convergence. The pupils constricted upon convergence but not in response to light.
Radiographic studies revealed a pineal tumor. Figure 4. Reproduced with permission from Martin JH, ed. Neuroscience Where do the corticospinal and corticobulbar tracts primarily originate? Precentral gyrus or primary motor cortex In which lobe of the cerebral cortex is the precentral gyrus located? Frontal lobe Name the large pyramidal neurons of the precentral gyrus which give rise to the corticobulbar and corticospinal tracts: Betz cells The Betz cells are found in which cortical layer?
Layer V Which cortical layers are strongly developed within the primary sensory cortex to receive afferent impulses? Thalamus Sensory information from the ventral posterolateral VPL and ventral posteromedial VPM nuclei of the thalamus ascends to what part of the cerebral cortex? Postcentral gyrus or primary somatosensory cortex The corpus callosum lies beneath which gyrus?
Cingulate gyrus What is the representation of the parts of the body along the sensory and motor strip of the cerebral cortex called? Homunculus The hypothalamus abuts which ventricle? Third ventricle What connects the hypothalamus to the pituitary?
Hypophyseal stalk or infundibulum The caudate nucleus is adjacent to which ventricle? Lateral ventricle What sulcus or groove separates the frontal and parietal lobes? Central sulcus The lateral Sylvian fissure separates the temporal lobe from which other two lobes? Parietal and frontal lobes Cerebral Anatomy 53 The calcarine fissure is found on the medial surface of which lobe? Occipital lobe The foramen of Monro connects which ventricles? Lateral and third ventricles From the fourth ventricle to the subarachnoid spaces, cerebrospinal fluid CSF flows through which foramen a?
Central Rolandic sulcus The medial portion of the frontal lobe is supplied by what artery? Anterior cerebral artery What artery supplies the lateral portion? Middle cerebral artery What frontal lobe regions are associated with execution of voluntary movement?
Primary motor, premotor, and supplementary motor areas Which frontal lobe region is responsible for social context and executive function? Planning, judgment, mental flexibility, abstract thinking, and working memory What is working memory? Type of memory used to store data for immediate mental processing and manipulation Which region of the prefrontal cortex is associated with executive function?
Dorsolateral prefrontal cortex What kind of manifestations might be expected with a lesion in this region? Impulsivity and perseverative errors Which region of the prefrontal cortex is associated with social context and empathy? Lateral orbitofrontal cortex A lesion of what cerebral lobe produces incontinence and loss of defecation control?
Frontal lobe particularly superior frontal gyrus and anterior cingulate 54 Deja Review: Neuroscience Which language center is located in the ventrolateral region of the frontal lobe within the dominant hemisphere?
Broca area A lesion in Broca area produces what symptoms? Expressive aphasia—loss of motor speech known as Broca aphasia Involvement of adjacent motor cortex can lead to what symptoms? Both the middle and posterior cerebral arteries The primary auditory cortex is located in which fissure? Sylvian fissure Where in the temporal lobe is the uncus found? Inferomedial aspect A seizure initiated within the uncus produces what type of sensory hallucinations? Smell and taste Learning and long-term memory functions are attributed to what medial temporal lobe structures?
Hippocampus and parahippocampal cortex How many cortical layers are found within the hippocampus and dentate gyrus? Three layers What structure s connect the left and right temporal lobes? Corpus callosum and anterior commissure Meyer loop or the geniculocalcarine pathway has visual fibers running through which lobe?
Hypersexuality, hyperphagia, hyperorality, visual agnosia, and fearlessness Where is Wernicke area located? Posterior aspect of the superior temporal gyrus What type of aphasia results from lesions of Wernicke area? What are the structures associated with the basic limbic circuit Papez circuit?
Memory and emotion What other structures are heavily connected to the limbic system? Amygdala, parahippocampal gyrus, and olfactory bulb Where are the hippocampus and amygdala located? Medial temporal lobe In the Papez circuit, the anterior nuclei of the thalamus receive information from which structure? Mammillary bodies via the mammillothalamic tract In the Papez circuit, the anterior thalamic nuclei send efferent projections to what structure?
Cingulate gyrus What is the name of the white matter tract from the hippocampus to the mammillary bodies? Motor regions primary, premotor, and supplementary motor cortex What other thalamic nucleus receives input from the basal ganglia? Neuroscience The VPL projects mainly to which cerebral gyrus? Postcentral gyrus What type of sensory information is relayed by the LGN? Vision The LGN nucleus receives information from what two structures?
Retina via the optic nerve and tract 2. Primary visual striate cortex In which sensory modality does the MGN play a role? Hearing Neurons in the MGN send a large bundle Transverse temporal Heschl gyrus of axons, known as the auditory radiations, to which part of the cerebral cortex?
Which thalamic nucleus sends information Pulvinar nucleus to association cortex for sensory integration? What thalamic nucleus has input and output connections with other thalamic nuclei and is involved in the reticular activating system?
Reticular nucleus What other thalamic nuclei are involved in the reticular activating system? Caudate nucleus and putamen dorsal Nucleus accumbens ventral striatum What structures make up the lentiform nucleus?
Putamen and globus pallidus What separates the lenticular lentiform nuclei from the caudate? Internal capsule The basal ganglia is supplied by what arteries? Lenticulostriate arteries and anterior choroidal artery What vessel supplies the inner globus pallidus?
Anterior choroidal artery The claustrum is separated from the lentiform nuclei by what structure? External capsule What is the function of the claustrum? Despite intricate connections with cortical areas, function remains unknown Cerebral Anatomy 57 What is the name of the dopaminergic pathway between the substantia nigra and striatum?
Cerebellar vermis What is the function of the cerebellar vermis? Maintaining axial muscle tone and postural control What neurons send efferent fibers from the cerebellar cortex to the deep nuclei? Spinocerebellar and cuneocerebellar tracts What are some of the symptoms associated with cerebellar lesions? Ataxia, intention tremor, hypotonia, and loss of coordination Does a hemispheric lesion of the cerebellum cause contralateral or ipsilateral dysfunction?
Ipsilateral During development, from what secondary vesicle is the cerebellum derived? Metencephalon What are the major functions of the cerebellum? Coordinate movements, body equilibrium, and muscle tone maintenance What are some of the symptoms of a lesion in the flocculonodular lobe? Left hemisphere Where is the planum temporale located? Superior surface of the temporal lobe posterior to Heschl gyrus The planum temporale is larger, in most cases, in which cerebral hemisphere?
Left hemisphere 58 Deja Review: Neuroscience Which language area is located within the planum temporale and superior temporal gyrus? Wernicke area Perception of written language is attributed to what cortical region? Aphasia Which type of aphasia patient presents with a lack of spoken or written comprehension, an inability to repeat spoken language, but speaks with volumes of words fluent devoid of meaning, and is unaware of their deficits?
Wernicke aphasia receptive Where is Wernicke area? Posterior aspect of the superior temporal gyrus What are phonemes? The smallest unit of sound recognized as language Alexia and agraphia are seen in lesions within what part of the brain? Inferior parietal lobe What type of aphasia presents with relatively preserved comprehension, a nonfluent sparse use of words, trouble naming objects, possible right-sided weakness, and the patient recognizing their ineptitude? Broca aphasia expressive What term is used to describe a patient who repeats words or phrases that they hear?
Echolalia What are neologisms? Made-up words or syllables that are not part of the language What term describes a defect in articulation despite normal mental functions and intact comprehension of both spoken and written language?
Dysarthria Patients suffering with agraphia cannot do what? Communicate through writing Cerebral Anatomy 59 What type of aphasia is produced by destruction of both Broca and Wernicke area as well as a major part of the territory between them? Global or total aphasia What is the most common cause of a global aphasia?
Occlusion of the left internal carotid artery or proximal middle cerebral artery An individual cannot write, repeat, or read and is basically mute. What type of aphasia is present? Global What type of visual deficit is sometimes found in patients with global aphasia?
Right homonymous hemianopsia What type of aphasia occurs by a lesion Conduction aphasia that separates the receptive and expressive language areas which spares comprehension but leaves the person unable to repeat? What pathway connecting Wernicke and Broca area is damaged in conduction aphasia?
Arcuate fasciculus What is the most likely etiology of conduction aphasia? Occlusion of the posterior temporal branch of the middle cerebral artery Which aphasia occurs following damage of the cerebral cortex, but preservation of the perisylvian language arc?
Transcortical or isolation aphasias Describe a transcortical motor aphasia: Speech is nonfluent, but repetition is intact. Lesions in what cortical area are associated with transcortical motor aphasia?
Dorsolateral frontal cortex or supplementary motor area What are the symptoms of transcortical sensory aphasia? Fluent speech, with poor comprehension, but intact repetition What lesion causes transcortical sensory aphasia?
Lesions of cortical regions joining temporal, parietal, and occipital lobes What are some common causes of isolation aphasia? Anoxia, CO poisoning, and occasionally Alzheimer disease What condition presents with a full capacity to write fluently, but an inability to read aloud, name colors, or understand written script? Alexia without agraphia word blindness 60 Deja Review: Left geniculocalcarine tract Patients with alexia without agraphia usually suffer from what visual field defect?
Right homonymous hemianopia Table 4. A year-old patient with a history of cardiac arrhythmia presents to the ER with right-sided facial paralysis and aphasia. Physical examination reveals dysarthria and nonfluent aphasia. ECG demonstrates absent P waves and irregular ventricular rate, suggesting atrial fibrillation.
Imaging reveals an ischemic lesion in the left inferior frontal lobe. Broca aphasia due to thromboembolic occlusion of middle cerebral artery MCA branches A year-old male presents to the ER after an apparent stroke. Physical examination reveals fluent speech, good comprehension, but poor repetition.
Imaging reveals a lesion involving the white matter between the left superior temporal and inferior frontal cortex. Conduction aphasia due to ischemia lesion of the arcuate fasciculus Cerebral Anatomy 61 A year-old male with history of HTN, deep venous thrombosis DVT , and endocarditis suffered a right MCA infarction with a lesion in the parietal lobe diagnosed by MRI 2 years ago.
His wife brought him to the office complaining that he has only been eating half of his dinner plate, saying that there is no more food on the plate. He has also stopped shaving the left side of his face. His wife is confused because his vision was not affected by his stroke and previous visual field testing was normal bilaterally. During a line bisection test, you find that he draws the midline on the right side of the line.
On line cancellation, he only crosses out lines on the right side. Depolarization What is the name for a change in membrane potential away from zero?
Hyperpolarization What determines the membrane potential of any cell? Relative concentration of ions in the cytoplasm and extracellular fluid What protein maintains the relative concentrations of sodium and potassium?
Equilibrium potential E Which two ions have a positive equilibrium potential under physiologic conditions, and would therefore depolarize the cell if made permeable? Sodium 2. Calcium Which two ions have a negative equilibrium potential under physiologic conditions?
Potassium 2. Chloride Which equation takes into account membrane permeability of multiple ions in order to calculate resting membrane potential? Goldman equation derived from Nernst equation Resting membrane potential is dominated by permeability to which ion?
Potassium Which cells are responsible for buffering excess extracellular potassium? Astrocytes 63 64 Deja Review: Action potential What are the four phases of an action potential? Permeability to which ion is responsible for the rising phase of an action potential?
Sodium Opening of what type of channels occurs at threshold? Voltage-gated sodium channels What event occurs at the peak of an action potential allowing for falling phase to occur?
Directionality prevents the action potential from spreading in both directions How are action potentials propagated in unmyelinated axons? Current spreads to depolarize adjacent membranes above threshold. Are individual action potentials from the same neuron different in terms of shape and peak voltage?
No, they are essentially identical. Does the peak voltage vary as a function of stimulus strength? No stimulus strength increases the frequency Permeability of which ion is responsible for the falling phase and undershoot? Potassium What is another name for the voltage-gated potassium channels responsible for the falling phase?
Delayed rectifier What toxin, isolated from the puffer fish, is used to block sodium channels? Tetrodotoxin What is the name for the period in which the cell is incapable of firing another action potential, regardless of stimulus? Absolute refractory period Rising phase Overshoot Falling phase Undershoot hyperpolarization Electrophysiology 65 What is the name of the period following the absolute refractory period in which only a strong stimulus can trigger an action potential?
Relative refractory period Which refractory period is due to the inactivation of sodium channels? Absolute refractory period Which refractory period is due to hyperpolarization?
Diameter 2. Myelination What is the term used to describe resistance to the flow of current down an axon or dendrite? Internal resistance axial resistance What is the term used to describe resistance to current flow across the membrane?
Length constant space constant Which two factors is the length constant dependent on? Internal resistance 2.
Membrane resistance How does a larger diameter increase conduction velocity? Decreases internal resistance What is the term used to describe the storing of charge on either side of the cell membrane? Time constant On what two factors is the time constant dependent? Membrane resistance 2. Membrane capacitance 66 Deja Review: Neuroscience How does myelination increase conduction velocity? Increases membrane resistance preventing ion leakage , decreases membrane capacitance Where is the highest density of voltagegated sodium channels in a myelinated axon?
Nodes of Ranvier What is the term used to describe the jumping of action potentials from node to node along myelinated axons? Action potential frequency What are the three primary anatomic types of synapses? Electrical synapse What type of channels, permeable to both ions and small second messengers, are responsible for electrical synapses?
Gap junctions What are the protein subunits of gap junctions called? Connexins Besides nervous tissue, what tissues are especially dependent on gap junctions?
Cardiac and smooth muscles What is the term for synapses requiring the release of neurotransmitter and binding to postsynaptic receptors for transmitting neural signals? Chemical synapses What ion channels are required for release of neurotransmitter when an action potential reaches the presynaptic terminal? Voltage-gated calcium channels Which type of neurotransmitters are synthesized in the rough endoplasmic reticulum rER and transported to the nerve terminal? Peptides Electrophysiology 67 Where are neuropeptides found in the synaptic terminal?
Secretory granules Where are classic amine and amino acid neurotransmitters synthesized? Cytosol of the synaptic terminal Where are amine and amino acid neurotransmitters found in the presynaptic terminal? Synaptic vesicles What mitochondrial enzyme is capable of metabolizing biogenic amine neurotransmitters? Monoamine oxidase MAO What postsynaptic protein performs a similar function? Exocytosis Recycling of membrane involves fusion of endocytic vesicles with which organelle? Endosome Which proteins, expressed on vesicles, regulate the organelles with which a vesicle is destined to fuse?
Botulinum toxin What are the actual sites of neurotransmitter release called? Glutamate Which neurotransmitters are classified as the biogenic amines? Neuroscience Which of the biogenic amines are classified as catecholamines? Dopamine, norepinephrine, and epinephrine From what amino acid can all of the catecholamines be synthesized?
Tyrosine What are the critical enzymes in the synthesis of each of the catecholamines? Melanin What is the amino acid precursor of serotonin? Tryptophan What molecule found in the pineal gland is also associated with tryptophan metabolism?
Melatonin What critical component for oxidative phosphorylation is associated with the tryptophan metabolic pathways? Niacin From which amine acid is histamine derived?
Histidine What is the word for the fixed amount of neurotransmitter released from an individual vesicle? Quantum What is the phrase describing the postsynaptic response to a quantum of neurotransmitter?
Miniature postsynaptic potential Where is the major norepinephrine nucleus sending out diffuse projections throughout the CNS? Locus coeruleus What color is locus coeruleus as a result of melanin as a byproduct of catecholamine metabolism? Blue What are the major serotonergic nuclei of the brainstem? Raphe nuclei What are the major dopaminergic nuclei?
Addiction Which diseases are associated with disturbances of dopaminergic transmission? Parkinson disease, schizophrenia, and attention-deficit hyperactivity disorder ADHD What are the major acetylcholinergic nuclei? Nucleus basalis of Meynert and medial septal nuclei Loss of neurons in the major acetylcholinergic nuclei is associated with what dementing illness?
Ionotropic 2. Metabotropic Which type of receptor acts through the opening of ion channels? Ionotropic Which type of receptor acts through G-proteins, second messengers, and signaling pathways? Metabotropic Which type of receptor has a faster response? Ionotropic Which type of receptor has a longer lasting response? Metabotropic A receptor that is coupled to the phosphorylation of a potassium channel, making it more likely to open, would fall into which category of receptor?
Metabotropic What is the term used to describe receptors on the presynaptic terminal which provide regulatory feedback on the amount of neurotransmitter being released? Autoreceptors Classify both the nicotinic and muscarinic ACh receptors as either ionotropic or metabotropic: Neuroscience What disease characterized by muscle weakness and double vision is sometimes caused by tumors or hyperplasia of the thymus?
Myasthenia gravis What is the mechanism behind the weakness associated with myasthenia gravis? Autoantibodies to the ACh receptor What radiologic finding is associated with myasthenia gravis? Enlarged thymus due to lymphoid hyperplasia What is the name of the diagnostic test for myasthenia gravis using edrophonium? Tensilon test What class of drugs is used in the treatment of myasthenia gravis?
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