Neuro Anatomy

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describe auditory path: SLIM41
-SON synapse (40% ipsi LDF -, 60% contra MDF +, acoustic stria bypasses this)
-travel in LL
-synapse IC
-synapse MGN
then travel in PLIC auditory radiations to Br 41 (transv gyrus of Herschel)
interpreting Webber test: sensorineural problem in silent ear or conductive problem in loud ear
interpreting Rinne: conductive longer than sensorineural
what happens in near synkinesis: 1) convergence
2) pupil constrict
3) lens accomod
path of light reflex: (general CN2 to para to CN3)
light 1 hemiretina projects to both pretectal.
ea pretectal project to both EWN
then to ciliary ganglion
injury to CN4: (no SO) no depression esp when ADD,
tilt head away from damaged side
(cross eyes or look at nose)
note: both superior mscles intort (inferior extort)
injury CN6: no LR-no abduction
no CN3: down and out, blown pupil can indicate incr ICP uncal herniation
path for smooth pursuit: R Br19 projects to R PPRF which projects to R 6 and, via MLF, L3 (ipsi6, contra3).
R6 innerv R LR, L3 innerv L MR
path for saccade: L FEF projects to R PPRF which projects to R 6 and, via MLF, L3 (ipsi6, contra3).
R6 innerv R LR, L3 innerv L MR
signs/sx pinealoma: (pretectal lesion)
1) lose EWN, dilate
2) lose 3, no convergence
3) no vertical
INO: (internuclear ophthalmoplegia) plaque on MLF.
when say look R or follow to right, L eye doesn't ADD.
convergence ok (mscls ok, bypasses MLF)
pt unable to show how cut w scissors: disorder of praxis, Dominant parietal
pt hemineglect: disorder ND parietal
pt construction apraxia: disorder ND parietal
injury to arcuate: conduction aphasia (unable to repeat "no if's and's or but's"
T/F Broca and Wernicke both can't repeat: T
fxn arcuate: connects auditory assoc and wernicke's with brocas
when vestibular hair cells of R depolarized what 3 paths follow: 1) contra PPRF (drift L, nystag R)
2) to R Brocas 3 causing vertigo
3) R extensors tighten (fall left)
NET: ispi nystag and vertigo, contra fall
Hypothal: preoptic: sex drive in males
with anterior: temp/osmoR behavioral response
Hypothal: paraventric: rel H (oxy to P Pit)
where circardian rhythm controlled: SCN of hypothalamus
Hypothal: supraoptic: osmo R/H2O, ADH
Hypothal: VM: stop eating
Hypo: arcuate: leptin R,
which part hypothal projects to p pit: paraventricular (directly project rel oxy and ADH)
which part hypothal projects a pit: arcuate, rel H at median eminence
CPCb path dysfxn causes: disdiakinesis
tremor
dysmetria
SCB dysfxn causes: truncal and postural instability
VCb dysfxn causes: truncal instability, equil, nausea, nystag, vertigo
fastigial of Cb impt for which path: SCb
dentate of Cb impt for: CPCb
gross layers of CB: (in to out)
granule
purkinje
molecular
dentate's location in Cb: lateral
fastigial's location in Cb: vermis
which Cb path uses floccunodular: VCb
general path of Cb paths: projection into Cb ends as mossy fiber goes to deep nucleus send collateral to granule of cortex which sends Purkinje which - deep nucleus. output is from the deep nuclei
superior visual world transmitted by what path: Meyer (in lower temporal)--optic radiations
inferior visual world transmitted by what path: superior parietal--optic radiations
macular sparing: local?: calcarine fissue
altitudinal visual field defect what assoc condition consider?: optic n blood supply, sp ciliary effects infr visual world.
think AION w jaw pain, scalp pain
homo quadratinopsia: lesion?: optic radiations (Meyer, lower temporal, or superior temporal)
nonhomon: lesion?: optic chiasm
(below=pit tumor, above=craniophar)
monocular visual field defect could be problem in what 2 general things (and exs of ea): 1) retina (retinal detach)
2) optic n (oligodendro, MS plaque, CRAO)
path of horiz doll's eye: VN to PPRF via MLF to 3.
how INO effect doll's eye: lose both horiz and vert doll's eye bc both use MLF, but can move eyes vertically and can follow vertically
path of vertical doll's eye: VN to 3 and 4 (via MLF) from below
(so when pinealoma use this to check integrity of nerves)
when use vertical doll's eye: when pinealoma use this to check integrity of nerves 3, 4
if can't look up, but positive doll's: lesion in FEF path
water in ear-which way eyes go: COWS=cold opposite, warm same
Cushing reflex: (to increased ICP)
HTN, bradycardia, decr RR
what forms BBB: choroid plexus epithel, intracerebral capillary endotheliu,. arachnoid (BBB protected by CIA)
key: tight jxns nonfenestrated endothel
cingulate herniation: causes infarct ACA
-lower extrem weakness contralaterally
-urinary incontinence
uncal herniation causes: 1) CN3-ipsi ptosis, mydriasis
2) PCA-contra homo hemianopsia
3) contra crus-ipsi paresis
central herniation (both hemi herniate transtentorially): both pupils dilate, placcidity, coma
cerebellar tonsillar herniation into foramen magnum: complress medulla respir
-duret hemorrhages
what supplies blood for the choroid plexus: a choroidal a
medial striate comes off what?: ACA
medial striate supplies: caudate, putamen, ALIC
loss of medial striate a cause what symptoms: frontal ataxia, cb
lateral striate supplies: PLIC and genu, + caudate, putamen, GP
symptoms of loss of lateral striate a: lower contra face, hemiparesis, hemisensory
problem w anterior circle: sensory and motor problems
problem w posterior circle: Cb, vertigo, ataxia; visual defect, coma
loss of MCA results in: head/trunk motor and sensory, aphasia (Broca and Wernicke)
if lesion LS prox: total contralateral paralysis
ACA controls: leg/foot motor and sensory
lateral striate comes off of: MCA
medial striate comes off of: ACA
problem with a communicating: visual field
P communicating problem causes: CNIII palsy
(also supply hypothal and ventral thal)
PCA supplies: major supply midbrain, thal (LGN, MGN), optic radiations, visual cortex, hippocampus
central a of retina comes off: ophthalmic
what enters orbit with CNII: opthalmic a
what supplies blood to hypothalamus: p. commun (also ventral thal), 2 MC aneuryism
most common site aneuryism? causes?: a. communicating a,
bitemporal lower quadratanopia
blood supply to CNIII: P communicating
2nd MC aneuryism: P commun, supplies hypothal, ventral thal, CNIII
IC supplied by: lateral striate (off MCA), a choroidal a (part medial striate)
what does a choroidal a supply: PLIC, LGN, GP
where does a choroidal a comes from: off internal carotid (not part circle of willis)
what supplies CN 6: pontine a off basilar
cb supplied by: AICbA, SCbA, PICbA
what a supplies cochlea: SCbA
what supplies crus cerebri: CB (medial) by basilar, CS lower extremities PCA
what supplies PPRF: short basilars
what supplies MLF: short basilar
what supplies nu ambiguus: PICbA
what supplies CN7: AICbA
what are medial structures in pons: MLF, Nu6, PPRF
what order of structures brain starting at medulla/SC jxn: medulla
pons
midbrain
describe elements mid medulla: nucleus ambiguus, (9-11), with nuclei for those CN more central, tract for 5 extends down this far, olives hold DC, ST tracks are outside this,
4th vent, ICP, begin of VN
describe elements medulla/SC jxn: crossing of CS (at decussation of pyramids), nu cunneatus, faciles haven't yet crossed
where do DC paths cross: internal arcuate, medulla
where ST cross: AWC upper SC
describe low medulla: tracks: CS diffuse contra, crossing of DC to form ML/TGL man, ST man laterally,
CN: nu 12,10 medial, lateral NA
describe pons medulla: EAR SLIDE:
CN: CN 6-8 come in, Nu CN8, VN with ICP/MCP
tracks: CS diffuse contra, ML/TGL and ST men lying down,
(no 12, no NA,)
MLF present, tract 5
describe mid pons: ENTER 5--body now has head!! motor and sensory of 5
tracks: ML/TGL and ST lying down,
MLF and PPRF present
lateral: SCP/MCP
(note 6/7 in low pons)
describe upper pons: pear slide
CN4 comes in dorsally, crossing to its nucleus
MLF
CB/CS diffuse contra in pons, TGL/ML and ST lying above laterally
describe midbrain slide: CN 3 coming in at superior colliculus, cerebral aqueduct in center,
Crus!! FP,CS, POT paths
TGL/ML and ST outside crus
where does CN4 enter: upper pons (pear slide)
where find PPRF: mid pons, with connections CN6 of low pons and VN,
sends neurons via MLF to contra 3
where CN7 enter: pons medulla
where Nu 8: pons/medulla
when does TGL/ML and ST men have head: mid pons (CN5 enters)
ST secondary neurons' cell bodies are where: Rexed Lamina I,II, maringal nu, substantia gelat
fast pain uses what fiber? type mechano? releases?: A1, hi threshold mechanoR, which releases glutamate
slow pain uses what fiber, type mechanoR, releases: S1 vanilloid, uses unmyelinated C fiber, releases subP and glut
what are the triggers for slow pain path: acid, heat, capsaicin, bk
what are the cerebral targets for slow pain: cingulate gyrus, medial frontal lobe, insula

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