David Jho
NEUROANATOMY
REVIEW
CEREBRAL CTX
BRODMANN’S AREAS
8
6
4 3,1,2
17
18
19
39
40
41,4245,44
22
9
10
11
12
34
28
5,7
BRODMANN’S AREAS
8
6
4 3,1,2
17
18
19
39
40
41,4245,44
22
9
10
11
12
34
28
5,7
8 = Frontal Eye Field
6 = SMA & Premotor ct...
BRODMANN’S AREAS
8
6
4 3,1,2
17
18
19
39
40
41,4245,44
22
9
10
11
12
34
28
39, 40 = Inf parietal lobe (Gerstmann’s syndrom...
LIMBIC SYSTEM
PAPEZ CIRCUIT (Limbic System)
HIPP
Mamillary body
Ant nuc of thalamus
Cingulate gyrus
Entorhinal ctx
Septal area Hypothal
...
Mediodorsal nuc of the thalamus (associated with Ant nuc)
Orbitofrontal ctx (associated with HIPP)
Ansa lenticularis = VA ...
Klüver-Bucy Syndrome
(bilateral ablation of ant temporal
lobes including amygdala)
a) Docility
b) Hypersexuality
c) Hyperp...
HYPOTHALAMUS
a) Homeostasis (autonomic, endocrine, & limbic systems)
b) Half of hypothalamus is enough
Suprachiasmatic nuc
(direct retinal input,
circadian rhythms)
Preoptic area
(Medial Preoptic Nuc)
(sexually dimorphic,
reg...
a) in lat hypothalamus, lat to fornix; can be damaged in hypothal injury
b) unmyelinated, major connection b/n cerebral ct...
HYPOTHALAMIC FIBER SYSTEMS
Stria terminalis is the major pathway of Amygdala to hypothalamus & septal area.
STRIA = STRAND...
HYPOTHALAMIC FIBER SYSTEMS
(strands)
HYPOTHALAMIC FIBER SYSTEMS
Lamina terminalis (layer)Lamina terminalis (layer)
Ant neuropore
(anencephaly)
vs
Post neuropor...
HYPOTHALAMIC FIBER SYSTEMS
(medial & also in medulla)
HYPOTHALAMIC FIBER SYSTEMS
EMBRYOLOGIC DEVELOPMENT
Alar plate (sensory), Basal plate (motor)
Neural Crest (PNS including DRG, postgang
ANS)
Neural Tu...
EMBRYOLOGIC DEVELOPMENT
Telencephalon (lateral ventricles)
Diencephalon (3rd
ventricle)
Mesencephalon (cerebral aqueduct)
...
THALAMUS
1. PCA (post circulation)
2. PCOM (ant
circulation)
3. Ant Choroidal a (ICA)
BLOOD SUPPLY
VA
VPL VPM
LGN
MGN
Pulvinar
ReticularReticular
Ant
VL
MD
IntralaminarIntralaminar
CMCM
Int medullary laminaInt medullary l...
= ANT-MED (limbic)
= ANT-LAT (EPS)
= POST (sensory)
= NON-SPECIFIC (relay)
VA/VL (GP+SN)
Ant+MD (Papez)
VPL (sensory--body...
VA
VPL VPM
LGN
MGN
Pulvinar
ReticularReticular
Ant
VL
MD
IntralaminarIntralaminar
CMCM
Mamillary bodies
Cingulate gyrus
Pr...
VA
VPL VPM
LGN
MGN
Pulvinar
ReticularReticular
Ant
VL
MD
IntralaminarIntralaminar
CMCM
Area 6
Area 4
GP, SN
(EPS)
Area 4 +...
VA
VPL VPM
LGN
MGN
Pulvinar
ReticularReticular
Ant
VL
MD
IntralaminarIntralaminar
CMCM
Areas 3,1,2
Sensory--body
Sensory--...
VA
VPL VPM
LGN
MGN
Pulvinar
ReticularReticular
Ant
VL
MD
IntralaminarIntralaminar
CMCM
THALAMIC NUCLEITHALAMIC NUCLEI Caud...
HIPPOCAMPUS
HIPPOCAMPAL FORMATION (3-layered archicortex; declarative mem)
a) Dentate gyrus—HIPP input & output to HIPP
py...
HIPPOCAMPUS
Entorhinal ctx
(with pyriform ctx are
paleoctx)
DENTATE
GYRUS
CA1
CA3
CA4
Alveus
Fimbria of
Fornix
Postcommiss...
Dentate gyrus has afferents entirely within HIPP formation.
CA1 projects to Subiculum and precommissural fornix.
CA3 proje...
EPS SYSTEM
Pyr system (CS tract)Pyr system (CS tract)
1. Weakness
2. Spasticity
3. Inc tone
4. No atrophy
5. Babinski
UMN lesion
1. W...
DIRECT PATHWAYDIRECT PATHWAY
INDIRECT PATHWAYINDIRECT PATHWAY
Ctx Striatum
D1 recepParkinson’s
SNc
GPi/SNr VA/VL
thalamus
...
DIRECT PATHWAYDIRECT PATHWAY
INDIRECT PATHWAYINDIRECT PATHWAY
Ctx Striatum
D1 recepParkinson’s
SNc
GPi/SNr VA/VL
thalamus
...
DIRECT PATHWAYDIRECT PATHWAY
INDIRECT PATHWAYINDIRECT PATHWAY
Ctx Striatum
D1 recepParkinson’s
SNc
GPi/SNr VA/VL
thalamus
...
CEREBELLUM
Functional vs
Anatomical
Divisions
Cerebellar Synonyms
1. FLOCCULONODULAR LOBE = Vestibulocerebellum.
2. VERMIS = Medial zone or part of Spinocerebellum.
3. ...
1. FLOCCULONODULAR LOBE = balance & eye movement.
2. VERMIS = balance & axial motor functions.
3. PARAVERMIS = distal moto...
1. Sup Cerebellar Ped (dentatothalamic tract, VSCT)
2. Middle Cerebellar Ped (pontocerebellar fibers)
3. Inf Cerebellar Pe...
Stellate Basket
Purkinje
Golgi
Granule
ION
Olivocerebellar tract to CLIMBING FIBERS
PARALLELFIBERS
Spinocerebellar
Pontoce...
Stellate Basket
Purkinje
Golgi
Granule
ION
Olivocerebellar tract to CLIMBING FIBERS
PARALLEL FIBERS
Spinocerebellar
Pontoc...
Cerebellar Deep Nuclei receive excitatory afferents from Climbing fibers and Mossy
fibers (collaterals on their way to the...
Flocculo-nodular lobe projects to Medial and Lateral Vestibular Nuclei.
Medial Vestibular Nuclei assist coordinating eye m...
Rubrospinal tracts (gross mvmts unlike CS tracts) & crosses immed in midbrain.
Rt cerebellum to Lt Red Nucleus to Rubrospi...
BV’s & CN’s
Berry aneurysms (ACOM,
MCA, PCOM, basilar)
asymptomatic unless large or
rupture (possible death)
Pituitary adenoma
Acousti...
ICA-MCA aneurysm can put
pressure on side of optic
chiasm.
Basilar tip aneurysm can
put pressure on CN3’s.
Lat striate or
...
Autoregulation allows
constant blood flow over
wide bp range (local
metabolite control).
Pupillary light reflex is CN2
aff...
ANT LIMB = ACA (medial striate aa) + MCA (lateral striate aa)
GENU = ICA (Ant Choroidal a)
POST LIMB = ICA (Ant Choroidal ...
Scalp infections down through
valveless emissary vv.
Epidural lens,
Subdural falx,
Subarachnoid (ventricles),
Intraparench...
Communicating vs
Non-communicating
Hydrocephalus (HCP)
HCP ex-vacuo (big ventricles,
no inc ICP)
Pseudotumor cerebri (nml ...
HERNIATION SYNDROMES
Subfalcine
Transtentorial
Foraminal
VISUAL SYSTEM
to LGN,
optic radiations,
then
occipital lobe
NASALTEMPORAL TEMPORAL
Ipsilateral blindness
Nasal hemianopia
Bitemporal hem...
LGN
Crossed fibers to layers
1, 4, 6
Uncrossed fibers to layers
2, 3, 5
to LGN,
optic radiations,
then
occipital lobe
Crossed
fibers to
layers 1, 4, 6
LGN
Uncrossed fibers to layers
2, 3, 5
to LGN,
optic radiations,
then
occipital lobe
Calcarine fissure
Parietal lobe visual
radiations to cuneate
gyrus
Temporal lobe visual
radiations (Meyer’s
loop) to lingu...
to LGN,
optic radiations,
then
occipital lobe
Constricted field (glaucoma)
Upper altitudinal hemianopia
(bilateral lingual...
Sup Colliculus
Vertical gaze
MLF
Coordinates CN3 & CN6
(internuclear
ophthalmoplegia
in MS)
a) carries info from
pontine H...
Left?
to LGN,
optic radiations,
then
occipital lobe
Right?
Right?
to LGN,
optic radiations,
then
occipital lobe
Left?
True Diplopia
CN3 = accommodation, many
mvmts
CN4 = down-and-ou...
Voluntary Conjugate Gaze
Lt Area 8
(FEF)
Rt CN6
Lt Medial
Longitudinal
Fasciculus
(MLF)
Rt Pontine Paramedian
Reticular Fo...
Voluntary Conjugate Gaze
Lt Area 8
(FEF)
Rt CN6
Lt Medial
Longitudinal
Fasciculus
(MLF)
Rt Pontine Paramedian
Reticular Fo...
HEARING
1. Medial Superior Olive (SON) is 1st
place with binaural processing.
2. Lesion above cochlear nuclei (Lateral lem...
HEALING
1. ANTEROGRADE degeneration is Wallerian degeneration—axons
& myelin sheaths disappear. (e.g., Mid-thoracic crush ...
HEALING
1. Target-derived neurotrophic factor = Nerve Growth Factor (NGF)
tropic (differentiation; turning toward stim) & ...
Neurohistology
Sensory neurons = Pseudounipolar, myelinated
(DRG and CN 5, 7, 9, 10)
Special senses = Bipolar (smell is un...
6-Layered Neocortex
Layer I (Molecular)
Layer II (External Granular)
Layer III (External Pyramidal)—cortico-cortical fiber...
SENSORY & MOTOR
HOMUNCULI
Lots to lips, tongue, hand, & index finger
Paracentral lobule = feet/legs
RABIES
Rabies is caused by a Rhabdovirus that enters a peripheral nerve and travels
retrograde up the nerve to the DRG.
Fr...
THE END
Neuroanatomy - Welcome to UIC
Neuroanatomy - Welcome to UIC
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  • Damage to mammillothalamic tract = wernicke-korsakoff syndrome
  • Destroy PVN/SON = Central Diabetes Insipudus
  • Stria = strands
  • Zona incerta--a flat, obliquely disposed plate of gray matter in the subthalamic region situated between the thalamic fasciculus (tegmental field H1 of Forel) and the lenticular fasciculus (tegmental field H2). Medially, cells of this nucleus are adjacent to the prerubral area (tegmental field H) and, laterally, they are continuous with the reticular nucleus of the thalamus. Z. i. is a derivative of the ventral thalamus; it receives afferents from the precentral motor cortex and the cerebellum.
  • Subfalcine = parasagittal gyrus
    Uncal = parahippocampal gyrus (ipsilat PCA, ipsilat CN3, contralat cerebral peduncle)
    Tronsillar = Duret hemorrhages in midbrain & pontine tegmentum (death)
  • Neuroanatomy - Welcome to UIC

    1. 1. David Jho NEUROANATOMY REVIEW
    2. 2. CEREBRAL CTX
    3. 3. BRODMANN’S AREAS 8 6 4 3,1,2 17 18 19 39 40 41,4245,44 22 9 10 11 12 34 28 5,7
    4. 4. BRODMANN’S AREAS 8 6 4 3,1,2 17 18 19 39 40 41,4245,44 22 9 10 11 12 34 28 5,7 8 = Frontal Eye Field 6 = SMA & Premotor ctx 5,7 = PPC (apraxia, dom. side) 4 = Primary motor ctx 3,1,2 = Primary somatosensory ctx 41,42 = Primary auditory ctx (Transverse gyrus of Heschl) 45,44 = Broca’s speech area (Inf Frontal Lobe; expressive dysprosody) 22 = Wernicke’s speech area (arcuate fasciculus connect to Broca’s; receptive dysprosody) 40 = Supramarginal gyrus (Rt/Lt confusion, dyscalculia, understanding speech) 39 = Angular gyrus (dyslexia & dysgraphia)
    5. 5. BRODMANN’S AREAS 8 6 4 3,1,2 17 18 19 39 40 41,4245,44 22 9 10 11 12 34 28 39, 40 = Inf parietal lobe (Gerstmann’s syndrome) on dominant side a) Rt/Lt confusion b) dyscalculia c) finger agnosia d) dyslexia & dysgraphia e) lower quadrantanopia (visual radiations to cuneus) Parietal lobe, non-dominant hemisphere (Sup or Inf parietal lobes) a) contralateral sensory neglect & astereognosis b) construction apraxia c) lower quadrantanopia (visual radiations to cuneus) 9,10,11,12 = Prefrontal ctx Post part of orbital gyrus = smell Uncus = serves as part of primary olfactory ctx (medial temporal lobe) 34 = Primary olfactory ctx (medial temporal lobe—seizures can have smell aura) 5,7
    6. 6. LIMBIC SYSTEM
    7. 7. PAPEZ CIRCUIT (Limbic System) HIPP Mamillary body Ant nuc of thalamus Cingulate gyrus Entorhinal ctx Septal area Hypothal Amygdala Mamillothalamic tract Ant limb of internal capsule Fornix Fornix VAFP/VAPPVentral AmygdaloFugal Pathway Ventral AmygdaloPetal Pathway Cingulum Perforant pathway Wernicke’s Encephalopathy (Thiamine/Vit B1 defic) 1) Nystagmus 2) Ataxia 3) Mental status change Korsakoff’s confabulatory syn 1) Mem loss & confabulation Olfactory, Sensory, Autonomic Stria terminalis
    8. 8. Mediodorsal nuc of the thalamus (associated with Ant nuc) Orbitofrontal ctx (associated with HIPP) Ansa lenticularis = VA Fugal Pathway PAPEZ CIRCUIT (Limbic System)PAPEZ CIRCUIT (Limbic System) HIPP Mamillary body Ant nuc of thalamus Cingulate gyrus Entorhinal ctx Septal area Hypothal Amygdala Mamillothalamic tractMamillothalamic tract Ant limb of internal capsuleAnt limb of internal capsule FornixFornix FornixFornix VAFP/VAPPVAFP/VAPPVentral AmygdaloFugal Pathway Ventral AmygdaloPetal Pathway Ventral AmygdaloFugal Pathway Ventral AmygdaloPetal Pathway CingulumCingulumPerforant pathway Perforant pathway Wernicke’s Encephalopathy (Thiamine/Vit B1 defic) Wernicke’s Encephalopathy (Thiamine/Vit B1 defic) 1) Nystagmus 2) Ataxia 3) Mental status change 1) Nystagmus 2) Ataxia 3) Mental status change Korsakoff’s confabulatory synKorsakoff’s confabulatory syn 1) Mem loss & confabulation1) Mem loss & confabulation Olfactory, Sensory, AutonomicOlfactory, Sensory, Autonomic Stria terminalis Stria terminalis
    9. 9. Klüver-Bucy Syndrome (bilateral ablation of ant temporal lobes including amygdala) a) Docility b) Hypersexuality c) Hyperphagia d) Visual agnosia AMYGDALA—coordinates behavioral & emotional responses to complex sensory input by integrating somatosensory and viscerosensory information. Output via Stria Terminalis posteriorly by tail of caudate and arches over thalamus to anterior hypothalamus. Output via Ventral Amygdalofugal pathway (VAFP) to Caudate/Septal Area.
    10. 10. HYPOTHALAMUS a) Homeostasis (autonomic, endocrine, & limbic systems) b) Half of hypothalamus is enough
    11. 11. Suprachiasmatic nuc (direct retinal input, circadian rhythms) Preoptic area (Medial Preoptic Nuc) (sexually dimorphic, regulates gonadotropic hormones) Ant Hypothal Nuc (dissipates heat, parasympathetic) at Nuc (appetite center, stim induces eating, destruction causes starvation) Ventromedial Nuc (satiety center, stim stops eating, destruction causes obesity & savage behavior) Dorsomedial Nuc (stim causes obesity & savage behavior) Arcuate Nuc (DOPA-ergic neurons inhib prolactin release) TUBERO- INFUNDIBULAR TRACT PVN & SON (produce oxytocin ADH/vasopression, destruction causes DI) SUPRAOPTICO- HYPOPHYSIAL TRACT Magnocellular PVN Post Hypothal Nuc (conserves heat, sympathetic) Parvocellular PVN
    12. 12. a) in lat hypothalamus, lat to fornix; can be damaged in hypothal injury b) unmyelinated, major connection b/n cerebral ctx & BS c) no synaptic relay through thalamus d) has monoaminergic neurons from the locus coeruleus (NE), raphe nuclei (5-HT), and ventral tegmental area (DA). Medial Forebrain Bundle (MFB) HYPOTHALAMIC FIBER SYSTEMS From HIPP to mamillary nuclei (then Mamillothalamic tract to Ant Thal Nuc) Fornix Descending autonomic fibers for sympathetic neurons (thoracic intermediolateral horn) and parasympathetic neurons (sacral lateral horn) Lesion or interruption above T1 can cause Horner’s syndrome (miosis, ptosis, anhidrosis, & apparent enophthalmos) Hypothalamo-spinal tract
    13. 13. HYPOTHALAMIC FIBER SYSTEMS Stria terminalis is the major pathway of Amygdala to hypothalamus & septal area. STRIA = STRANDS (Sup to fornix & divides caudate from thalamus) Lamina terminalis (from optic chiasm to rostral 3rd ventricle; closure of ant neuropore) LAMINA = LAYER Stria medullaris thalami (hypothalamus & septal area in roof of 3rd ventricle inf to fornix to thalamus & epithalamic habenular nuclei; relay from limbic forebrain to midbrain reticular formation) MEDULLARIS is also in the MEDULLA Stria medullaris of 4th ventricle (central sulcus to Inf Cereb Ped; arcuate nuc of pyramids) Sulcus Limitans (divides Alar & Basal plates) SULCUS = GROOVE Stria terminalis
    14. 14. HYPOTHALAMIC FIBER SYSTEMS (strands)
    15. 15. HYPOTHALAMIC FIBER SYSTEMS Lamina terminalis (layer)Lamina terminalis (layer) Ant neuropore (anencephaly) vs Post neuropore (spina bifida)
    16. 16. HYPOTHALAMIC FIBER SYSTEMS (medial & also in medulla)
    17. 17. HYPOTHALAMIC FIBER SYSTEMS
    18. 18. EMBRYOLOGIC DEVELOPMENT Alar plate (sensory), Basal plate (motor) Neural Crest (PNS including DRG, postgang ANS) Neural Tube (CNS, pregang ANS) Sulcus Limitans (divides Alar & Basal plates) Rhombencephalic lip (in roof of 4th ventricle becomes Cerebellum)
    19. 19. EMBRYOLOGIC DEVELOPMENT Telencephalon (lateral ventricles) Diencephalon (3rd ventricle) Mesencephalon (cerebral aqueduct) Metencephalon (upper 4th ventricle) Myelencephalon (lower 4th ventricle, central canal) SECONDARY VESICLESPRIMARY VESICLES Mesencephalon Prosencephalon Rhombencephalon
    20. 20. THALAMUS 1. PCA (post circulation) 2. PCOM (ant circulation) 3. Ant Choroidal a (ICA) BLOOD SUPPLY
    21. 21. VA VPL VPM LGN MGN Pulvinar ReticularReticular Ant VL MD IntralaminarIntralaminar CMCM Int medullary laminaInt medullary lamina Ext medullary laminaExt medullary lamina THALAMIC NUCLEITHALAMIC NUCLEI = ANT-MED (limbic) = ANT-LAT (EPS) = POST (sensory) = NON-SPECIFIC (relay)
    22. 22. = ANT-MED (limbic) = ANT-LAT (EPS) = POST (sensory) = NON-SPECIFIC (relay) VA/VL (GP+SN) Ant+MD (Papez) VPL (sensory--body) VPM (sensory--head) LGN (vision) MGN (hearing) Pulvinar (visual sensory association) Intralaminar CM (very diffuse to cerebral ctx, ends in layer I for cortical excitability) Reticular (GABA-ergic to thal) VA VPL VPM LGN MGN Pulvinar ReticularReticular Ant VL MD IntralaminarIntralaminar CMCM THALAMIC NUCLEITHALAMIC NUCLEI
    23. 23. VA VPL VPM LGN MGN Pulvinar ReticularReticular Ant VL MD IntralaminarIntralaminar CMCM Mamillary bodies Cingulate gyrus Prefrontal ctx
    24. 24. VA VPL VPM LGN MGN Pulvinar ReticularReticular Ant VL MD IntralaminarIntralaminar CMCM Area 6 Area 4 GP, SN (EPS) Area 4 + EPS GP, SN, cerebellum (EPS + dentatothalamic tract)
    25. 25. VA VPL VPM LGN MGN Pulvinar ReticularReticular Ant VL MD IntralaminarIntralaminar CMCM Areas 3,1,2 Sensory--body Sensory--face Vision Hearing Area 17 Areas 41,42 Integration of somesthetic, visual, & auditory Areas 18,19
    26. 26. VA VPL VPM LGN MGN Pulvinar ReticularReticular Ant VL MD IntralaminarIntralaminar CMCM THALAMIC NUCLEITHALAMIC NUCLEI Caudate AntVA (VL) Ant VA (VL) Cerebral peduncle Cerebral peduncle Mamillary bodies Fornix Interthalamic adhesion Caudate MDMD CMCM VL VL VPL VPL VPMVPM Ant Ant STN Zona Incerta LD or DL LP MDPulvinar Pulvinar Pons Midbrain Sup colliculus Pineal gland MGN MGN LGN LGN
    27. 27. HIPPOCAMPUS HIPPOCAMPAL FORMATION (3-layered archicortex; declarative mem) a) Dentate gyrus—HIPP input & output to HIPP pyramidal cells b) Hippocampus proper or Cornu Ammonis (CA)—to fornix then septal area c) Subiculum—to fornix then mamillary nuc Alzheimer’s Disease affects neurons in Nuc Basalis of Meynert (ACh), Locus Coeruleus (NE), Entrorhinal ctx, and CA1/Subiculum of HIPP.
    28. 28. HIPPOCAMPUS Entorhinal ctx (with pyriform ctx are paleoctx) DENTATE GYRUS CA1 CA3 CA4 Alveus Fimbria of Fornix Postcommissural Fornix Mammillary bodies SUBICULUM (connects bilateral CA) Perforant path Alvear path 6-layer NEOCORTEX vs 3-layer ARCHICORTEX Schaeffer collaterals
    29. 29. Dentate gyrus has afferents entirely within HIPP formation. CA1 projects to Subiculum and precommissural fornix. CA3 projects to CA1 and precommissural fornix. CA4 (hilus of dentate gyrus) receive afferents from dentate and project to bilateral dentate (hippocampal commissure). Subiculum provides main efferents to POST-COMMISSURAL FORNIX (to thalamus and hypothalamus). HIPPOCAMPUSHIPPOCAMPUS Entorhinal ctx (with pyriform ctx are paleoctx) DENTATE GYRUS CA1 CA3 CA4 AlveusAlveus Fimbria of Fornix Fimbria of Fornix Postcommissural Fornix Postcommissural Fornix Mammillary bodies Mammillary bodies SUBICULUM (connects bilateral CA)(connects bilateral CA) Perforant path Perforant path Alvear pathAlvear path 6-layer NEOCORTEX 6-layer NEOCORTEX vsvs 3-layer ARCHICORTEX 3-layer ARCHICORTEX Schaeffer collateralsSchaeffer collaterals
    30. 30. EPS SYSTEM
    31. 31. Pyr system (CS tract)Pyr system (CS tract) 1. Weakness 2. Spasticity 3. Inc tone 4. No atrophy 5. Babinski UMN lesion 1. Weakness 2. Dec DTR 3. Dec tone 4. Atrophy 5. Downgoing toes LMN lesion EPS (Basal Ganglia)EPS (Basal Ganglia) 1. Chorea (Huntington’s, Syndenham’s) 2. Athetosis (choreoathetosis in HD, Tardive dyskinesia when antipsychotics block DA receptors & make super-sensitive) 3. Hemiballismus (stroke) 4. Parkinson’s vs Diffuse Lewy Body Dz (resting tremor, bradykinesia, truncal instability, dementia) CerebellumCerebellum 1. Intention tremor 2. Ataxia (fall towards lesion, gait & trunk dystaxia, dysrhythmokinesia, dysdiadochokinesia, dysmetria) 3. Nystagmus
    32. 32. DIRECT PATHWAYDIRECT PATHWAY INDIRECT PATHWAYINDIRECT PATHWAY Ctx Striatum D1 recepParkinson’s SNc GPi/SNr VA/VL thalamus Ctx Glutamate GABA (Glycine in SC) Lenticular nuc = Put + GP Striatum/Neostriatum = Put + Caud Corpus striatum = Put + Caud + GP Ctx Striatum D2 recepParkinson’s SNc GPi/SNr VA/VL thalamus CtxGPe STN Input from Ctx--Net excitation Input from D1 recep—Net excitation Input from Ctx—Net inhibition Input from D2 recep—Net excitation
    33. 33. DIRECT PATHWAYDIRECT PATHWAY INDIRECT PATHWAYINDIRECT PATHWAY Ctx Striatum D1 recepParkinson’s SNc GPi/SNr VA/VL thalamus Ctx Ctx Striatum D2 recepParkinson’s SNc GPi/SNr VA/VL thalamus CtxGPe STN Input from Ctx—Net inhibition Input from D2 recep—net excitation Striatum (GABAergic neurons) have both D1 recep (Gs; contain excitatory Substance P) and D2 recep (Gi; contain inhibitory Enkephalin). Net LOSS of excitation in Parkinson’s Dz. Pallidotomy destroys segments of GPi to reduce inhibition of thalamus (interrupts direct & indirect pathways). GPi and GPe are usually always on. Input from Ctx--Net excitation Input from D1 recep—Net excitation
    34. 34. DIRECT PATHWAYDIRECT PATHWAY INDIRECT PATHWAYINDIRECT PATHWAY Ctx Striatum D1 recepParkinson’s SNc GPi/SNr VA/VL thalamus Ctx Ctx Striatum D2 recepParkinson’s SNc GPi/SNr VA/VL thalamus CtxGPe STN Input from Ctx—Net inhibition Input from D2 recep—net excitation GPe is constantly on. In Huntington’s chorea, the striatum (ACh & GABAergic medium spiny neurons) are destroyed so GPe overstimulates Ctx. Damage to STN results in Hemiballismus due to decreased stim of thalamic inhibition to Ctx. Input from Ctx--Net excitation Input from D1 recep—Net excitation
    35. 35. CEREBELLUM Functional vs Anatomical Divisions
    36. 36. Cerebellar Synonyms 1. FLOCCULONODULAR LOBE = Vestibulocerebellum. 2. VERMIS = Medial zone or part of Spinocerebellum. 3. PARAVERMIS = Intermediate zone or part of Spinocerebellum. 4. CEREBELLAR HEMISPHERES = Lateral zone or Cerebrocerebellum or Pontocerebellum.
    37. 37. 1. FLOCCULONODULAR LOBE = balance & eye movement. 2. VERMIS = balance & axial motor functions. 3. PARAVERMIS = distal motor execution. 4. CEREBELLAR HEMISPHERES = motor planning. Cerebellar Function
    38. 38. 1. Sup Cerebellar Ped (dentatothalamic tract, VSCT) 2. Middle Cerebellar Ped (pontocerebellar fibers) 3. Inf Cerebellar Ped (OlivoCT, Dorsal SpinoCT, CCT, vestibulocerebellar tract) - Spine to cerebellum Cerebellar Peduncles
    39. 39. Stellate Basket Purkinje Golgi Granule ION Olivocerebellar tract to CLIMBING FIBERS PARALLELFIBERS Spinocerebellar Pontocerebellar Vestibulocerebellar (cerebellar & vestibular nuc) Spinocerebellar Pontocerebellar Vestibulocerebellar (cerebellar & vestibular nuc) CLIMBINGFIBERS Vestibulospinal tract MOSSY FIBERS Cereb Deep Nuc Dentate Emboliform Fastigial Globose Cereb Deep Nuc Dentate Emboliform Fastigial Globose Red Nuclei (rubrospinal tract) VL (thalamus) Motor Ctx (corticopontine & CS tracts) Pontine nuc Dentatothalamic tract (Sup Cereb Ped) Pontocerebellar tract (contralat) Corticopontine fibers GOLGI LAYER PURKINJE LAYER MOLECULAR LAYER
    40. 40. Stellate Basket Purkinje Golgi Granule ION Olivocerebellar tract to CLIMBING FIBERS PARALLEL FIBERS Spinocerebellar Pontocerebellar Vestibulocerebellar (cerebellar & vestibular nuc) Spinocerebellar Pontocerebellar Vestibulocerebellar (cerebellar & vestibular nuc) CLIMBING FIBERS Vestibulospinal tractVestibulospinal tract MOSSY FIBERS Cereb Deep Nuc Dentate Emboliform Fastigial Globose Cereb Deep Nuc Dentate Emboliform Fastigial Globose Red Nuclei (rubrospinal tract) VL (thalamus) Motor Ctx (corticopontine & CS tracts) Pontine nuc Dentatothalamic tract (Sup Cereb Ped) Dentatothalamic tract (Sup Cereb Ped) Pontocerebellar tract (contralat) Pontocerebellar tract (contralat) Corticopontine fibers Corticopontine fibers GOLGI LAYER GOLGI LAYER PURKINJE LAYER PURKINJE LAYER MOLECULAR LAYER MOLECULAR LAYER 4 Cerebellar Deep Nuclei 5 Types ofCerebellar Cells (know if excit or inhib; know if projects out of cerebellum or not)
    41. 41. Cerebellar Deep Nuclei receive excitatory afferents from Climbing fibers and Mossy fibers (collaterals on their way to the Granule layer). Purkinje cell (only ones that project out of ctx) inhibitory fibers from Cerebellar Ctx to Cerebellar Deep Nuclei. Climbing fibers from Inf Olivary Nuc via Inf Cerebellar Ped. Pontocerebellar fibers via Middle Cerebellar Ped. Granule cell (only excitatory) endings (Parallel Fibers) go to Molecular layer but not out of Cerebellar Ctx. Stellate, Basket, & Golgi cells (inhibitory) do not project out of Cerebellar Ctx either. Stellate Basket Purkinje Golgi Granule ION Olivocerebellar tract to CLIMBING FIBERS PARALLEL FIBERS Spinocerebellar Pontocerebellar Vestibulocerebellar (cerebellar & vestibular nuc) Spinocerebellar Pontocerebellar Vestibulocerebellar (cerebellar & vestibular nuc) CLIMBING FIBERS Vestibulospinal tractVestibulospinal tract MOSSY FIBERS Cereb Deep Nuc Dentate Emboliform Fastigial Globose Cereb Deep Nuc Dentate Emboliform Fastigial Globose Red Nuclei (rubrospinal tract) VL (thalamus) Motor Ctx (corticopontine & CS tracts) Pontine nuc Dentatothalamic tract (Sup Cereb Ped) Dentatothalamic tract (Sup Cereb Ped) Pontocerebellar tract (contralat) Pontocerebellar tract (contralat) Corticopontine fibers Corticopontine fibers GOLGI LAYER GOLGI LAYER PURKINJE LAYER PURKINJE LAYER MOLECULAR LAYER MOLECULAR LAYER
    42. 42. Flocculo-nodular lobe projects to Medial and Lateral Vestibular Nuclei. Medial Vestibular Nuclei assist coordinating eye movement with body. Lateral Vestibular Nuclei assist postural control. Be careful not to confuse Dentate nuclei (cerebellum) and Dentate gyri (HIPP). Stellate Basket Purkinje Golgi Granule ION Olivocerebellar tract to CLIMBING FIBERS PARALLEL FIBERS Spinocerebellar Pontocerebellar Vestibulocerebellar (cerebellar & vestibular nuc) Spinocerebellar Pontocerebellar Vestibulocerebellar (cerebellar & vestibular nuc) CLIMBING FIBERS Vestibulospinal tractVestibulospinal tract MOSSY FIBERS Cereb Deep Nuc Dentate Emboliform Fastigial Globose Cereb Deep Nuc Dentate Emboliform Fastigial Globose Red Nuclei (rubrospinal tract) VL (thalamus) Motor Ctx (corticopontine & CS tracts) Pontine nuc Dentatothalamic tract (Sup Cereb Ped) Dentatothalamic tract (Sup Cereb Ped) Pontocerebellar tract (contralat) Pontocerebellar tract (contralat) Corticopontine fibers Corticopontine fibers GOLGI LAYER GOLGI LAYER PURKINJE LAYER PURKINJE LAYER MOLECULAR LAYER MOLECULAR LAYER
    43. 43. Rubrospinal tracts (gross mvmts unlike CS tracts) & crosses immed in midbrain. Rt cerebellum to Lt Red Nucleus to Rubrospinal tracts crossing left-to-right to innervate Rt arm & leg. Cerebellar tests = finger-to-nose (dysmetria & intention tremor), foot tap/heel shin, pronator drift with poor adjustment, dysdiadochokinesia, nystagmus on extreme gaze. Romberg test = vision, vestibular, DC-ML. (not SC tract, which is unconsc proprio). Stellate Basket Purkinje Golgi Granule ION Olivocerebellar tract to CLIMBING FIBERS PARALLEL FIBERS Spinocerebellar Pontocerebellar Vestibulocerebellar (cerebellar & vestibular nuc) Spinocerebellar Pontocerebellar Vestibulocerebellar (cerebellar & vestibular nuc) CLIMBING FIBERS Vestibulospinal tractVestibulospinal tract MOSSY FIBERS Cereb Deep Nuc Dentate Emboliform Fastigial Globose Cereb Deep Nuc Dentate Emboliform Fastigial Globose Red Nuclei (rubrospinal tract) VL (thalamus) Motor Ctx (corticopontine & CS tracts) Pontine nuc Dentatothalamic tract (Sup Cereb Ped) Dentatothalamic tract (Sup Cereb Ped) Pontocerebellar tract (contralat) Pontocerebellar tract (contralat) Corticopontine fibers Corticopontine fibers GOLGI LAYER GOLGI LAYER PURKINJE LAYER PURKINJE LAYER MOLECULAR LAYER MOLECULAR LAYER
    44. 44. BV’s & CN’s
    45. 45. Berry aneurysms (ACOM, MCA, PCOM, basilar) asymptomatic unless large or rupture (possible death) Pituitary adenoma Acoustic neuroma (Schwannoma) at CPA rupture—SAH, hemorr stroke (seizures, HCP) ADPKD, Ehlers-Danlos, Marfan’s worst HA of life (10/10) Uncus = where Amygdala is located
    46. 46. ICA-MCA aneurysm can put pressure on side of optic chiasm. Basilar tip aneurysm can put pressure on CN3’s. Lat striate or Lenticulostriate aa of cerebral hemorrhage (internal capsule). Occlusion of PCA distal to PCOM can result in Ant choroidal to Post choroidal aa. Labyrinthine a from AICA or Basilar a. Post Spinal a from PICA or Vertebral a.
    47. 47. Autoregulation allows constant blood flow over wide bp range (local metabolite control). Pupillary light reflex is CN2 afferent and CN3 efferent. CN2 lesion preserves a consensual reflex. CN3 lesion causes blown-pupil, down-and-out eye, droopy eyelid, & efferent loss. Corneal blink reflex is CN5 (V1) afferent and CN7 efferent. Ankle jerk = S1 Knee ext = L2,3,4 Brachiorad = C5 Biceps = C6 Triceps = C7 Abdominal = T8-T12 Babinski = L5-S1
    48. 48. ANT LIMB = ACA (medial striate aa) + MCA (lateral striate aa) GENU = ICA (Ant Choroidal a) POST LIMB = ICA (Ant Choroidal a) + MCA (lateral striate aa) Internal Capsule BLOOD SUPPLY
    49. 49. Scalp infections down through valveless emissary vv. Epidural lens, Subdural falx, Subarachnoid (ventricles), Intraparenchymal bleeds Pineal tumors (Perinaud’s syn) block cerebral aqueduct and/or impose on sup colliculus
    50. 50. Communicating vs Non-communicating Hydrocephalus (HCP) HCP ex-vacuo (big ventricles, no inc ICP) Pseudotumor cerebri (nml or slit ventricles, inc ICP) Choroid plexus Creates CSF, Arachnoid villi/granulations Absorb CSF Above or below 4th ventricle
    51. 51. HERNIATION SYNDROMES Subfalcine Transtentorial Foraminal
    52. 52. VISUAL SYSTEM
    53. 53. to LGN, optic radiations, then occipital lobe NASALTEMPORAL TEMPORAL Ipsilateral blindness Nasal hemianopia Bitemporal hemianopia Contralateral hemianopia Contralateral hemianopia with macular sparing
    54. 54. LGN Crossed fibers to layers 1, 4, 6 Uncrossed fibers to layers 2, 3, 5 to LGN, optic radiations, then occipital lobe
    55. 55. Crossed fibers to layers 1, 4, 6 LGN Uncrossed fibers to layers 2, 3, 5 to LGN, optic radiations, then occipital lobe
    56. 56. Calcarine fissure Parietal lobe visual radiations to cuneate gyrus Temporal lobe visual radiations (Meyer’s loop) to lingual gyrus LGN to OCCIPITAL LOBE to LGN, optic radiations, then occipital lobe Contralateral lower quadrantanopia Contralateral upper quadrantanopia
    57. 57. to LGN, optic radiations, then occipital lobe Constricted field (glaucoma) Upper altitudinal hemianopia (bilateral lingual gyri) Central scotoma (optic neuritis in MS) Lower altitudinal hemianopia (bilateral cuneate gyri)
    58. 58. Sup Colliculus Vertical gaze MLF Coordinates CN3 & CN6 (internuclear ophthalmoplegia in MS) a) carries info from pontine Horizontal Gaze Centers to oculomotor complex in midbrain. b) Inc activity during mvmt c) Helps during turning of head (conjugate gaze)
    59. 59. Left? to LGN, optic radiations, then occipital lobe Right?
    60. 60. Right? to LGN, optic radiations, then occipital lobe Left? True Diplopia CN3 = accommodation, many mvmts CN4 = down-and-out CN6 = lateral
    61. 61. Voluntary Conjugate Gaze Lt Area 8 (FEF) Rt CN6 Lt Medial Longitudinal Fasciculus (MLF) Rt Pontine Paramedian Reticular Formation (PPRF; lat gaze center) Lt CN3 [Rt Gaze] Internuclear Ophthalmoplegia Pupillary Light Reflex Optic n/chiasm/ tract (CN2) Sup Colliculi (pretectal area) Ciliary ganglia (CN3) LGB Argyll-Robertson’s pupils (syphilis) Accommodation Optic n/chiasm/ tract (CN2) Optic radiation Visual ctxLGB Sup Colliculi (pretectal area) Ciliary ganglia (CN3)
    62. 62. Voluntary Conjugate Gaze Lt Area 8 (FEF) Rt CN6 Lt Medial Longitudinal Fasciculus (MLF) Rt Pontine Paramedian Reticular Formation (PPRF; lat gaze center) Lt CN3 [Rt Gaze] One-and-a-half Syndrome Pupillary Light Reflex Optic n/chiasm/ tract (CN2) Sup Colliculi (pretectal area) Ciliary ganglia (CN3) LGB Argyll-Robertson’s pupils (syphilis) Accommodation Optic n/chiasm/ tract (CN2) Optic radiation Visual ctxLGB Sup Colliculi (pretectal area) Ciliary ganglia (CN3)
    63. 63. HEARING 1. Medial Superior Olive (SON) is 1st place with binaural processing. 2. Lesion above cochlear nuclei (Lateral leminscus and up) will decrease hearing bilateral (more in contralateral ear). 3. Inner hair cells transduce sound, and Outer hair cells modify sound (olivocochlear efferents). Scala media (endolymph). 4. Lateral Superior Olive (SON) has intensity differences for horizontal position orientation. 5. High freq is closest to Oval window/Stapes (scala vestibule and NOT round window at the end of the scala tympani) for tonotopic organization, and high freq is dorsomedial in cochlear nuclei.
    64. 64. HEALING 1. ANTEROGRADE degeneration is Wallerian degeneration—axons & myelin sheaths disappear. (e.g., Mid-thoracic crush of spine and Pt dies. Cervical stain shows Wallerian degeneration of fasciculus gracilis.) 2. RETROGRADE degeneration is Chromatolysis—loss of Nissl substance (RER & free polyribosomes at cell body and dendrites are lost) 3. In the CNS, glial scars formed by astrocytes inhibit healing (reactive astrogliosis). 4. For successful axonal repair, macrophages must clean debris. 5. Axonal elongation is 2-4 mm/d in the CNS (oligodendrocytes) or PNS (Schwann cells).
    65. 65. HEALING 1. Target-derived neurotrophic factor = Nerve Growth Factor (NGF) tropic (differentiation; turning toward stim) & trophic (growth & survival) peptide for DRG and sympa in PNS and basal forebrain ACh neurons in CNS. 3. Neurotrophins (NGF, BDNF, NT3) + IGF1 + FGF + GDNF + CNTF 4. BDNF is synthesized in cell body & transported anterogradely down the axons (unlike NGF or GDNF).
    66. 66. Neurohistology Sensory neurons = Pseudounipolar, myelinated (DRG and CN 5, 7, 9, 10) Special senses = Bipolar (smell is unmyelinated-slow, hearing is myelinated-fast) (CN 1, 2, 8) Motor neurons = Multipolar, myelinated (aMN, ANS)
    67. 67. 6-Layered Neocortex Layer I (Molecular) Layer II (External Granular) Layer III (External Pyramidal)—cortico-cortical fibers Layer IV (Internal Granular)—thalamocortical fibers (VPL, VPM, LGN) Layer V (Internal Pyramidal)—CS, CB, & corticostriatal fibers (Betz giant pyramidal cells) Layer VI (Multiform)—corticothalamic projection & association fibers AFFERENT (Layer IV is big in Brodmann Area 3,1,2) EFFERENT (Layer V is big in Brodmann Area 4)
    68. 68. SENSORY & MOTOR HOMUNCULI Lots to lips, tongue, hand, & index finger Paracentral lobule = feet/legs
    69. 69. RABIES Rabies is caused by a Rhabdovirus that enters a peripheral nerve and travels retrograde up the nerve to the DRG. From there, it replicates and infects the CNS, resulting in encephalitis with a variety of neurologic symptoms leading to coma and respiratory or cardiac arrest.
    70. 70. THE END
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