Neuro 1.1

• What type of image is
this?
a) T1 CT scan
b) T2 CT scan
c) T1 MRI scan
d) DTI

• What type of image is
this?
a) T1 CT scan
b) T2 CT scan
c) T1 MRI scan
d) DTI
T1/T2 are subsets of MRI
scans.
T(wh)one, white matter is
white.

• Which of the following brain imaging
modalities does NOT involve radiation?
a) CT
b) Invasive angiography
c) Nuclear medicine brain flow
d) MRI
e) SPECT

• In CT which of these tissues appears darkest?
A) BLOOD
B) BONE
C) CSF
D) GRAY MATTER
E) WHITE MATTER

• Functional MRI is based upon the fact that:
– blood flow is faster in more active brain regions
– Blood oxygenation is higher in more active brain
regions
– Deoxyhemoglobin levels rise in more active brain
regions
– glutamate reuptake is greater in more active brain
regions
– magnetic resonance is higher in more electrically
active neurons

• Which of the following structures is located in
the central nervous system?
a) DRG
b) CN 7
c) CN 3
d) Olfactory bulb
e) Trigeminal ganglion

• Which of the following structures is correctly
paired with its CNS level?
• A. facial colliculus : telencephalon
• B. mammillary bodies : midbrain
• C. optic chiasm : diencephalon
• D. pyramid : pons
• E. tectum : medulla

Embryonic Origin of CNS
LV
3rd
4th
CA

• A 23 YO male is brought, unconscious, to the
emergency department after a motorcycle accident.
Suspecting head trauma, the physician orders a CT scan
which reveals blood in the CSF, concentrated in the
quadrigeminal cistern. Which of the following
diagnoses is most appropriate for this patient?
a) Epidural hemorrhage
b) extracranial hemorrhage
c) Intraparenchymal hemorrhage
d) Interventricular hemorrhage
e) Subarachnoid hemorrhage

• You successfully administer an epidural anesthetic to a woman in labor.
You originally inserted the needle into the sacral hiatus, and correctly
placed the tip of the needle:
a) between the pia mater and subarachnoid space
b) between the dura mater and the periosteum of a vertebra
c) between the periosteum and the bone of a vertebra
d) into the subarachnoid space of the spinal cord
e) into the central canal of the spinal cord.

• A 20 YO student protestor is brought into the ED for
treatment of head injuries and bleeding after being
struck in the head by a rock. Neurological exam
indicates some disorientation and lethargy. A CT scan
reveals that the patient has suffered an epidural
hematoma, based upon which definitive observation?
a) Blood extending down into sulci
b) Lenticular shape of bleeding that does not cross suture
lines
c) Subfalcine herniation
d) Thin crescent of bleeding separating the dural layers
e) Ventricular distortion or obliteration due to elevated
intracranial pressure.

(not necessarily testable for this test,
but a useful teaching point)
• A 20 YO student protestor is brought into the ED for
treatment of head injuries and bleeding after being
struck in the head by a rock. Neurological exam
indicates some disorientation and lethargy. A CT scan
reveals that the patient has suffered an epidural
hematoma, based upon which definitive observation?
a) Blood extending down into sulci
b) Lenticular shape of bleeding that does not cross suture
lines
c) Subfalcine herniation
d) Thin crescent of bleeding separating the dural layers
e) Ventricular distortion or obliteration due to elevated
intracranial pressure.

• One of your patients has a neurological autoimmune
disease. Cells of her immune system are attempting to
migrate from the bloodstream into her brain. To do
this, an immune system cell must first cross the
endothelium of a brain capillary, and then cross a
second layer made of the cellular processes of
a) Astrocytes
b) Ependymal cells
c) Microglia
d) Neurons
e) Oligodendrocytes

Cell Types - Neurons
Key features: large cell body with nucleus, mitochondria, and Nissl Substance (RER);
dendrites for receiving NT input from neighboring neurons, axon hillock for
integration of dendritic input, axon for conduction of electrical impulses, terminal
branches for release of NT into synaptic cleft.
Several morphologies:
Bipolar: retinal, auditory, and olfactory sensory neurons
Pseudounipolar: peripheral sensory neurons of somatic and visceral nervous system
Multipolar: complex dendritic pattern, most CNS cells and motor neurons
Golgi Type I: Long projection neurons of the CNS
Golgi Type II: Short inhibitory interneurons

Cell Types - Astrocytes
Astrocytes are star-shaped glia with many thin processes radiating from a central cell body.
The processes wrap around capillaries in the CNS, preventing the free diffusion of soluble blood
components into the CNS tissues. This is called the blood brain barrier (BBB).
The area in between astrocyte processes and the capillary wall is called the Virchow-Robins space, and
these spaces are often enlarged in the elderly and people with neurodegenerative disease (inflammation).
Some processes also modulate synaptic activity.
During early development, astrocytes help guide migrating baby neurons to their proper location.
astrocytes that are near brain surfaces extend processes to those surfaces, forming a continuous covering
around the brain, the glia limitans which attaches to a basement membrane.
Laminin and dystroglycan mediate the connection between astrocytes and the basmement membrane
In cobblestone lissencephaly a mutation in one of the above proteins leads to an incomplete glia
limitans.
The Glial Fibrillary Acidic Protein (GFAP) stain is used to visualize astrocytes.
-Gliosis refers to the hypertrophy/hyperplasia of astrocytes in response to disease/injury. This helps
reinforce the integrity of the BBB and initiates a protective inflammatory response. The reactive astrocytes
that develop following an injury are called gemnistocytic astrocytes.

Crest Cells
The neural crest gives rise to the following neural elements (Figure 15):
• Sensory neurons of the cranial and spinal sensory ganglia.
• Postganglionic neurons of the sympathetic and
parasympathetic ganglia.
• Supporting cells of the PNS (Schwann cells and satellite cells
of the ganglia).
The neural crest also gives rise to non-neural elements:
• The cells of the pia mater and arachnoid mater.
• Some branchial cartilage and some cranial mesenchyme.
• Pigment-producing cells of the skin and subcutaneous
tissues (melanocytes).
• Chromaffin tissue (secretory cells of the adrenal medulla).

• The foot processes of CNS astrocytes do all of
the following EXCEPT:
– contribute to the blood-brain barrier
– Form the glia limitans that surrounds the brain
– Surround neuronal cell bodies and dendrites
– surround points of synaptic contact
– wrap around axons to form their myelin sheath

Cell Types-Other glia
Oligodendrocytes are egg-shaped glia with a clear cytoplasmic halo surrounding a dark nucleus. They
are abundant in white matter tracts. They extend several cellular processes that wrap several times
around multiple axons, creating myelin sheaths that greatly speed up signal conduction along the
axons.
-Oligodendrocytes do not respond to injury. Any damage to oligodendrocytes (i.e. demyelinating
disease) is irreversible.
Microglia are the resident macrophages of the CNS. They phagocytose particulate matter and cellular
debris, as well as help initiate inflammatory and repair pathways following injury via cytokine release.
The microglia aggressively proliferate in response to local injury, promoting an inflammatory response and clearing any necrotic
tissue.
Ependymal cells are the cells of the choroid plexus which continuously filter the blood and secrete
CSF into the ventricles. Choroid plexus is a specialized version. No basement membrane.

• Which of the following is NOT present in CNS
white matter?
– astrocyte cell bodies
– Microglial cell bodies
– myelin
– neuronal cell bodies
– oligodendrocyte cell bodies

• Which of the following is NOT present in CNS
white matter?
– astrocyte cell bodies
– MicrogliaL cell bodies
– myelin
– neuronal cell bodies
– oligodendrocyte cell bodies

BEWARE THE CNS DEVELOPMENT
LECTURE!

• Deletions or missense mutations of sonic
hedgehog (SHH) can produce incomplete
separation of forebrain structures during
development, including the formation of a single
midline cyclopean eye. This most common
developmental forebrain malformation is called:
– anencephaly
– Dandy-Walkersyndrome
– holoprosencephaly
– lissencephaly
– Waardenburg syndrome

LECTURE!
• In contrast to the classical radial migration, wehre
newly generated neuroblasts stay within the brain
regions where they were generated and mature into
variosu types of neurons, newly generated neuroblasts
from the medial and lateral ganglionic eminences
migrate long distances tangentially to mature into what
type of cell?
a) Astrocytes
b) Cholinergic neurons
c) Dopaminergic neurons
d) GABAergic interneurons
e) Glutaminergic neurons

LECTURE!
• In contrast to the classical radial migration, where
newly generated neuroblasts stay within the brain
regions where they were generated and mature into
various types of neurons, newly generated neuroblasts
from the medial and lateral ganglionic eminences
migrate long distances tangentially to mature into what
type of cell?
a) Astrocytes
b) Cholinergic neurons
c) Dopaminergic neurons
d) GABAergic interneurons
e) Glutaminergic neurons
Not all migration occurs radially. Recent
work has determined that cortical
interneurons arise from proliferative
centers along the ventricles, the lateral
ganglionic eminence (LGE) and the medial
ganglionic eminence (MGE). Cells from
these two regions migrate throughout the
cerebral cortex. See Box 22F for more
information about this long-distance
migration.!

• During cell fate specification, the concept of
competence refers to:
a) Gradient of signaling molecules that generates
multiple cell types
b) A transcriptional switch that permits a cell to secrete
inducing factors
c) The ability of a cell to maintain an uncommitted
state almost indefinitely
d) The capacity of a cell to respond to inducing factors
e) The signaling that instructs a cell to end its
migraiton.

Understand dorsal/ventral functions
NRG = neureglin (seen in migration slide)

• Axonal injury can result in the death of schwann cells in the
PNS and oligodendrocytes in the CNS. The difference in the
amount of subsequent axonal regeneration between the
PNS and CNS is thought to be due, in part, to:
a) the ability of central neurons to generate an axonal growth
cone
b) The formation of guidance channels by hypertrophic
astrocytes
c) The lack of growth promoting signals in replacement schwann
cells
d) The more efficient clearance of myelin debris by peripheral
macrophages
e) The persistence of an oligodendrocyte basal lamina in the
CNS.

Response to Neuronal Injury - PNS

Response to Neuronal Injury - CNS
Current Strategies for CNS regeneration include forcing expression of trophic factors
in the damaged neurons to maintain survival, adding neural stem cells to the
damaged area, and blocking the inhibitory signals released by the myelin debris.

Which of the following statements accurately describes
the regenerative response of the peripheral nervous
system to injury?
• A glial scar may form as a barrier to regeneration.
• Ensheathing Schwann cells die, but their basal laminae
remain intact.
• Myelindebrisisinefficientlycleared,leavingremnantsthat
areinhibitory.
• Surrounding cells express factors inhibitory for
regrowth.
• There is limited activation of growth-promoting genes
in injured neurons.

Identify these structures
A. Central Sulcus
B. Temporal Lobe
C. Pons
D. Medulla
E. Corpus Callosum
F. Uncus
G. Cerebellum
H. Parieto-occpital sulcus
I. Spinal Cord
J. Midbrain
1.
2.

Identify these structures
A. Central Sulcus
B. Temporal Lobe
C. Pons
D. Medulla
E. Corpus Callosum
F. Uncus
G. Cerebellum
H. Parieto-occpital sulcus (1)
I. Spinal Cord
J. Midbrain (2)
1.
2.

Identify the following:
But first…Plane of Section?
A
B
C
D
Image from: http://www.neuroanatomy.ca/cross_sections/sections_horizontal.html
From Natalie Popenko’s practice question cohort

Mammillary Body
Crus Cerebri aka Cerebral
Peduncle
Inferior horn of
Lateral Ventricle
Cerebral Aqueduct
Image from: http://www.neuroanatomy.ca/cross_sections/sections_horizontal.html
From Natalie Popenko’s practice question cohort

102.
103
104
101.
Numbers 101, 102, and 103
Correspond with which of the
Following Structures?
A. Fornix
B. Pons
C. Optic Nerve
D. Infundibular Stalk
(Infundibulum)
E. Oculomotor Nerve
F. Thalamus
G. Pineal Gland
H. Cingulate Gyrus
I. Central Sulcus

102.
103
104
101.
Numbers 101, 102, and 103
Correspond with which of the
Following Structures?
A. Fornix
B. Pons
C. Optic Nerve
D. Infundibular Stalk
(Infundibulum)
E. Oculomotor Nerve
F. Thalamus
G. Pineal Gland
H. Cingulate Gyrus
I. Central Sulcus
101: H) Cingulate Gyrus
102. D)Infundibular stalk
103: G) Pineal Gland

102.
103
104
101.
Structure 103 is associated
With which level of the CNS?
A. Telencephalon
B. Diencephalon
C. Metencephalon
D. Rhombencephalon
E. Spinal Cord
What the heck is #104?
A. Pituitary tumor
B. Pons
C. Mammillary body
D. Oculomotor Nerve
E. Uncus
Which ventricle is #104
Associated with?
A. Left Lateral Ventricle
B. Third Ventricle
C. Cerebral Aqueduct
D. Fourth Ventricle

Structure 103 is associated
With which level of the CNS?
A. Telencephalon
B. Diencephalon
C. Metencephalon
D. Rhombencephalon
E. Spinal Cord
What the heck is #104?
A. Pituitary tumor
B. Pons
C. Mammillary body
D. Oculomotor Nerve
E. Uncus
Which ventricle is #104
Associated with?
A. Left Lateral Ventricle
B. Third Ventricle
C. Cerebral Aqueduct
D. Fourth Ventricle 102.
103
104
101.

What view of the brain is this (BE SPECIFIC)
Please match the following structures with
The appropriate letters:
Crus Cerebri:
Trochlear Nerve:
Superior Colliculus:
Inferior Colliculus:
Pineal Gland:
C
B
E
A
D

What view of the brain is this (BE SPECIFIC)
Posterior view of the brainstem
Please match the following structures with
The appropriate letters:
Crus Cerebri: A
Trochlear Nerve: D
Superior Colliculus: E
Inferior Colliculus: B
Pineal Gland: C
C
B
E
A
D

C
F
D
B
G
A
H
EI
J
Please identify the following:
111. Anterior Commissure
112. Posterior Commissure
113. Septum Pellucidum
114. Lamina Terminalis
115. Massa Intermedia
116. (Dorsal) Thalamus

C
F
D
B
G
A
H
EI
J
Please identify the following:
111. Anterior Commissure
112. Posterior Commissure
113. Septum Pellucidum
114. Lamina Terminalis
115. Massa Intermedia
116. (Dorsal) Thalamus
111. B
112. A
113. F
114. I
115. H
116. J
Pineal gland is G
Cerebral peduncles?
Cerebellar peduncles?
Tectum?
Tegmentum?

What is the arrow pointing to?
A. Parieto-occipital sulcus
B. Cerebral Aqueduct
C. Occipital Lobe
D. Falx Cerebri
E. Tentorium Cerebelli

A. cerebral aqueduct
B. fourth ventricle
C. inferior cerebellar peduncle
D. interpeduncular fossa
E. middle cerebellar peduncle
F. oculomotor nerve
G. optic nerve
H. optic tract
I. prepontine cistern
J. third ventricle
K. trigeminal nerve
L. trochlear nerve
M. vagus nerve
N. vestibulocochlear nerve
What type of imaging is this?
A. CT with contrast
B. CT without contrast C. MRA
D. T1 MRI
E. T2 MRI

• A multipolar neuron resides in the gray matter of
the spinal cord, at T4. In order to send a message
to its target neuron, which resides in the gray
matter of S2, it must send a long efferent fiber
through the spinal cord. Which statement is NOT
correct?
a) It conducts an action potential
b) It contains intermediate filaments
c) It contains microtubules
d) It contains rough ER
e) It is myelinated

• Charcot Marie-Tooth disease results from a
defect in:
a) Myelination of peripheral axons
b) Nicotinic acetylcholine receptors
c) SNARE proteins
d) Synaptic vesicle recycling
e) Voltage-gated calcium channels.

• Charcot Marie-Tooth disease results from a
defect in:
a) Myelination of peripheral axons
b) Nicotinic acetylcholine receptors
c) SNARE proteins
d) Synaptic vesicle recycling
e) Voltage-gated calcium channels.
(can affect motor and sensory nerves of PNS)

• Review Chemical Synaptic Transmission
– Slower than electrical transmission
– How to Terminate transmitter action:
• Diffusion
• Reuptake
– Transporters (drug targets, cocaine affects dopamine
reuptake)
• Degradation

• Which statement about small molecular
(“classical”) transmitters is true?
– They do not activate G-protein coupled receptors.
– Substance P is a member of this family.
– They are synthesized in the cell body.
– They are synthesized from larger precursor
proteins.
– For many of these, synaptic action is terminated
by transporter proteins.

• Which of the following correctly describes the
relationship between the size of the EPP and the
MEPP at the neuromuscular junction?
– In low calcium solution, the MEPP will be larger than
the EPP.
– The EPP cannot be more than twice the magnitude of
the MEPP.
– The EPP is always a whole number multiple of the
MEPP.
– The EPP is always the same size as the MEPP.
– The MEPP is always larger than the EPP.

MYASTHENIA GRAVIS
• Muscle weakness
– Drooping eyelids (ptosis)
– Double vision (diplopia)
– Facial expression, chewing, swallowing
– TRIAD! (think uncal, tonsillar herniation)
• Treat with neostigmine (what kind of molecule
is this?)

MYASTHENIA GRAVIS
• Muscle weakness
• Treat with
– Immunosuppressants
– Thymectomy
– plasmapheresis
– neostigmine (what kind of molecule is this?)
acetylcholinesterase inhibitor.
• What type of receptor is being affected?

MYASTHENIA GRAVIS
• Muscle weakness
• Treat with neostigmine (what kind of molecule is
this?) acetylcholinesterase inhibitor.
• What type of receptor is being affected?
– Antibodies are binding to NICOTINIC Ach receptor.

• Dendritic spines are expected to contain:
– acetylcholinesterase
– dopamine transporters
– glutamate receptors
– SNARE proteins
– synaptic vesicles

• Neuromodulators influence the way a cell will respond
to another transmitter that produces an EPSP or IPSP.
In the example considered in class (and many other
instances), the neuromodulator does this by activating
a signaling pathway that alters the function of:
• synaptic vesicle proteins
• A transcription factor
• A voltage-gated ion channel
• an enzyme that synthesizes a neurotransmitter
• a plasma membrane transporter

MYASTHENIA SYNDROMES
• POSTSYNAPTIC:
– Myasthenia gravis
• Presynaptic:
– Congenital myasthenic syndromes
• Insufficient Ach release (defects in vesicle recycling)
– Lambert-Eaton myasthenic syndrome
• Autoimmune, response to voltage gated Ca2+ channels
• Associated with small cell lung cancer

TOXINS
• Affect presynaptic terminal:
– A-latrotoxin (black widow venom)
• Ca2+ release
• massive transmitter release
– Clostridium (makes botulinim and tetanus toxins)
• Proteases that cleave SNARE proteins
• Prevent release

• Which statement about botulinum toxin is
NOT true:
– It disrupts synaptic vesicle fusion.
– It is a protease that cleaves SNARE proteins.
– It is approved by the FDA for several uses.
– It is taken up by inhibitory interneurons in the
spinal cord.
– It results in paralysis of neuromuscular synapses.

Neuro 1.1

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Neuro 1.1

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