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FA: Neuroanatomy


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to what vertebral level does the spinal cord extend? to where does the subarachnoid space extend?
lower border of L1, L2

where should spinal tap be performed?
"to keep cord alive, keep the needle between L3 and L5"

L3-L4 or
count out all the spinal nerves.
31 total (like 31 flavors!)

8 cervical
12 thoracic
5 lumbar
5 sacral
1 coccygeal
dorsal column is organized like our is that?
legs are medial and arms are outside (ie. nucleus gracilis and nucleus cuneatus)
spinal cord lesion: lower motor neurons only, flacid paralysis. disease?
poliomyelitis/Werdig-Hoffmann disease
spinal cord lesion: mostly white matter of cervical region; random and asymmetric lesions. disease?
multiple sclerosis
spinal cord lesion: combined upper and lower motor neuron deficits with no sensory deficit. disease?
spinal cord lesion: only dorsal columns are spared in the cross section. what happened?
complete occlusion of the ventral artery
spinal cord lesion: impaired propioception and locomotor ataxia. disease?
tabes dorsalis from tertiary syphillis; nucleus gracilis is taken out
spinal cord lesion: vental white commissure and ventral horns are affected. disease?
spinal cord lesion: all dorsal columns are taken out as well as lateral corticospinal and spinocerebellar tracts. disease?
vitamin B12 deficiency or Friedrich's ataxia
if hemisection of spinal cord occurs above T1, what is an additional finding?
Horner's syndrome
what are 4 findings below the lesion in hemisection of the spinal cord (Brown-Sequard syndrome)?
1. ipsilateral motor paralysis and spasticity
2. ipsilateral loss of tactile, vibration, proprioception sense
3. contralateral pain and temperature loss
4. ipsilateral loss of all sensation at that level
lateral corticospinal tract: function, decussation, origin
movement of contralateral (to cortex location) limbs

pyramidal (medulla)

primary motor cortex
dorsal column medial lemniscus: function, decussation, origin
tactile, vibration, sensation

arcuate fibers at medulla

Pacini's, Meissner's tactile disks, muscle spindles and Golgi tendon organs
spinothalamic tract: function, decussation, origin
pain, temperature

ventral white commissure at spinal cord level

free nerve endings, pain fibers
when a lumbar puncture is performed, what structures are crossed? is the pia pierced?
1. skin/superficial fascia
2. ligaments (supraspinous, interspinous, ligamentum flavum)
3. epidural space
4. dura mater
5. subdural space
6. arachnoid
7. subarachnoid space - CSF

the PIa is NOT PIerced!
C2 dermatome
posterior half of skull
C3 dermatome
high turtle neck collar
C4 dermatome
low-collar shirt
T4 dermatome
nipple (teat pore is T4)
T7 dermatome
xiphoid process
T10 dermatome; why important?
at the belly butTEN; appendicitis pain referral
L1 dermatome
inguinal ligament
L4 dermatome
includes the knee caps (down on L4's or "all fours")
S2, S3, S4 dermatomes
erection and sensation of penile and anal zones

S2,3,4 keep the penis off the floor
via what nerve is gall bladder pain referred to the shoulder?
the phrenic nerve
physical support, repair, K+ metabolism
central myelin production
schwann cells
peripheral myelin production
ependymal cells
inner lining of ventricles
does dopamine cross the BBB?
no! that's why L-dopa is used in parkinsonism
what makes up the BBB?
it is guarded by the CIA

1. Choroid plexus epithelium
2. Intracerebral capillary endothelium
3. Arachnoid
what crosses the BBB readily?
nonpolar / lipid soluble molecules
how do glucose and aa's cross the BBB?
by carrier-mediated transport mxns.
what are the hypothalamic functions?

T: Thirst and water balance (supraoptic nucleus)
A: Adenohypophysis control via releasing factors
N: Neurohypophysis releases hormones made in hypothalamic nuclei
H: Hunger (lateral nucleus) and satiety (ventromedial nucleus)
A: Autonomic regulation (anterior hypoth. regulates parasympathetics), circadian rhythms (suprachiasmatic nucleus)
T: Temperature regulation (posterior hypoth. regulates heat conservation and production when cold. Anterior hypothalamus coordinates cooling when hot)
S: Sexual urges and emotions (Septate nucleus)
what part of the hypothalamus regulates cooling when hot?
Anterior nucleus (A/C)
Lateral geniculate nucleus (LGN)

Lateral to Look
Medial geniculate nucleus (MGN)

Medial for Music
Ventral posterior nucleus, lateral part (VPL)
body senses (proprioception, pressure, pain, touch vibration)
Ventral posterior nucleus, medial part (VPM)
facial sensation, including pain
Ventral anterior/lateral nuclei (VA and VL)
what are the functions of the limbic system?
5 F's

sudden jerky, purposless movements

basal ganglia lesion (eg. Huntington's)
slow, writhing movements, especially fingers

basal ganglia lesion
sudden, wild flailing of 1 arm ("half ballistic" - throwing a ball)

contralateral subthalamic nucleus lesion; loss of inhibition of thalamus through globus pallidus
lesion: Broca's area
motor (expressive) aphasia with good comprehension

BROca's is BROken speech
lesion: Wernicke's area
sensory (fluent/receptive) aphasia with poor comprehension

Wernicke is Wordy but makes no sense
lesion: arcuate fasciculus
conduction aphasia; poor repetition with good comprehension, fluent speech
lesion: amygdala (bilateral)
Kluver Bucy syndrome (hyperorality, hypersexuality, disinhibted behavior)
lesion: frontal lobe
frontal release signs (eg. personality changes and deficits in concentration, orientation, judgement)
lesion: right parietal lobe
spatial neglect syndrome (agnosia of the contralateral side of the world)
lesion: reticular activating system
lesion: mammilary bodies (bilateral)
Wernicke-Korsakoff's encephalopathy (confabulations, anterograde amnesia)
lesion: basal ganglia
tremor at rest
lesion: cerebellar hemisphere
intention tremor, limb ataxia
lesion: cerebellar vermis
truncal ataxia and dysarthria
anterior cerebral artery
supplies medial surface of brain, leg-foot area of motor and sensory cortices
middle cerebral artery
supplies lateral aspect of brain, trunk-arm-face area of motor and sensory cortices, Broca's and Wernicke's speech areas
what artery supplies Broca's and Wernicke's speech areas?
middle cerebral artery
where is the most common circle of Willis aneurysm? what problems can such an aneurysm cause?
anterior communicating artery

visual field defects
what blood vessel is likely involved in a CN III palsy?
posterior communicating artery
what arteries supply the interal capsule, caudate, putamen and globus pallidus?
lateral striate

"arteries of stroke"
in general, strokes in the anterior circle cause...
general sensory and motor dysfunction, aphasia
in general, strokes in the posterior circle cause...
cranial nerve deficits (vertigo, visual defects), coma, cerebellar deficits (ataxia)
what brain herniation can compress anterior cerebral artery?
cingulate herniation under the falx cerebri
name the 4 herniation syndromes.
1. cingulate herniation under falx cerebri
2. downward transtentorial (central) herniation
3. uncal herniation
4. cerebellar tonsillar herniation into the foramen magnum
uncal herniation: ipsilateral dilated pupil/ptosis. cause?
CN III is stretched
uncal herniation: contralateral homonymous hemianopsia. cause?
compression of ipsilateral posterior cerebral artery
uncal herniation: ipsilateral paresis. cause?
compression of contralateral crus cerebri (Kernohan's notch)
uncal herniation: Duret hemorrhages - paramedian artery rupture. cause?
caudal displacment of brainstem
what are the 3 vagal nuclei?
nucleus Solitarius: visceral Sensory information (eg. taste, gut distention; VII, IX, X)

nucleus aMbiguous: Motor innervation of pharynx, larynx, upper esophagus (IX, X, XI)

dorsal motor nucleus: sends autonomic (parasympathetic) fibers to heart, lungs, upper GI
CN XII lesion (LMN). deviation?
tongue deviates TOWARD side of lesion
CN V motor lesion. deviation?
jaw deviates TOWARD side of lesion
unilateral lesion of cerebellum. deviation?
patient falls TOWARD side of lesion
CN X lesion. uvula deviation?
AWAY from side of lesion
how does a CN XI lesion present?
weakness turning head to contralateral side of lesion; shoulder droop ON the side of the lesion
achilles reflex?
S1, S2

(S1 nerve root)
patellar reflex?
L3, L4

(L4 nerve root)
biceps reflex?
C5, C6

(C5 nerve root)
triceps reflex?
C7, C8

(C7 nerve root)
Babinski sign?
big toe dorsiflexes and other toes fan

sign of UMN lesion except in first year of life
"kuh" test?
CN X palate elevation
"la" test?
CN XII (hypoglossal)
"mi" test?
CN VII (facial)
CSF from lateral to 3rd ventricle
foramen of Monro
CSF from 3rd to 4th ventricle
aqueduct of Sylvius
CSF from 4th to subarachnoid space?

Lateral: Foramen of Luschka
Medial: Foramen of Magendie
when you want both eyes looking to the left, how does it work neurologically?
nucleus of CN VI fires on the left (lateral rectus) and stimulates the contralateral CN III nucleus to fire via the MLF (medial longitudinal fasciculus)
how does the light reflex work?
signal sent to pretectal nucleus in midbrain -> Edinger Westphal nucleus is stimulated -> bilateral pupillary constriction (consensual reflex)
is convergence affected in MLF syndrome?
what disease often presents with MLF syndrome?
multiple sclerosis
CN through cribriform plate?
CN through optic canal?
CN through superior orbital fissure?
CN through foramen rotundum?
CN through foramen ovale?
CN through internal auditory meatus?
CN through jugular foramen?
CN through hypoglossal canal?
signs of LMN?
decreased reflexes
decreased tone
no Babinski sign
where is the principal visual cortex?
in the back of the occipital lobe
where are the association areas of the brain?
temporal lobe
where is the primary auditory cortex?
temporal lobe by the lateral fissure
where is Wernicke's area (associative auditory cortex)?
temporal lobe by the lateral fissure
where is Broca's area (motor speech)?
lower frontal lobe
loss of dorsiflexion (foot drop). nerve and roots?
common peroneal (L4-S2)
loss of plantar flexion. nerve and roots?

loss of knee jerk. nerve and roots?

loss of hip ADDuction. nerve and roots?

what are the functions of the common peroneal nerve? the tibial?
PED: Peroneal Everts and Dorsiflexes

TIP: Tibial Inverts and Plantarflexes; if Tibial is injured, can't stand on TIPtoes
what nerve innervates the intrinsic muscles of the hand? what happens when the nerve is damaged?
ulnar nerve

claw hand
brachial plexus: organization and nerve root #'s?
Randy Travis Drinks Cold Beer
Roots Trunks Divisions Cords Branches

damage to upper trunk (C5, C6)?
Waiter's tip (Erb's palsy)
what muscle does the axillary nerve innervate?
what nerve is damaged in "wrist drop"?
radial nerve
what structures does the radial nerve innervate?
it innervates the BEST!

Extensors of the wrist & fingers
what are the 3 muscles of the thumb? hypothenar?
OAF: Opponens pollicis, Abductor pollicis, Flexor pollicis brevis

OAF: Opponens digiti minimi, Abductor digiti minimi, Flexor digiti minimi
what landmark is important in a pudendal nerve block?
ischial spine
what is the thoracic outlet syndrome (aka. Klumpke's palsy)?
embryologic defect (anamolous cervical rib) which can compress the subclavian artery and inferior trunk of brachial plexus
what are the clinical presentations of thoracic outlet syndrome?
1. atrophy of thenar and hypothenar eminences
2. atroph of the interosseous muscles
3. sensory deficits on medial side of forearm and hand
4. disappearance of radial pulse when moving head to opposite side
what landmark do you look for in a lumbar puncture?
iliac crest
what 3 muscles close the jaw? which 1 muscle opens the jaw?
Medial pterygoid

Lateral pterygoid

nerve: V3
all muscles with the root "glossus" in the name (except palatoglossus, CN X) are innervated by what CN?
hypoglossal, CN XII
all muscles with the root "palat" in the name (ex. tensor veli palatani, CN V) are innervated by what CN?

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