Exam 3

D. Stage 5

High frequency, low voltage, and desynchronized waves and inhibition of muscle tone are characteristic of which sleep stage? A.stage 1 B. Stage 3 & 4 C. Stage 2 D. Stage 5

C. stage 2

K complexes and sleep spindles are characteristic of which sleep stage? A. stage 1 B. stage 5 C. stage 2 D. stage 3 & 4

C. Activation of adenylate cyclase

Sympathetic nerves cause relaxation of the bladder by A. Inhibition of intracellular Ca2+ release B. Activation of phospholipase C C. Activation of adenylate cyclase D. Inhibition of adenylate cyclase E. Activation of L-type Ca2+ channels in the membrane

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Taxonomy of Memory

a tremor that appears when muscles are not being used (Parkinson's) -present in hands, thumb, forefinger (pill-rolling tremor), lips, tongue, and chin

resting tremor

Leg dysthesias ("creeping/crawling") exacerbated by inactivity, relieved by movement; results in sleep onset delay 70 - 90 % RLS patients have PLMD; 30 % PLMD have RLS Prevalence 10 %; 30 % > age 65; 19 % of pregnant women Dopaminergic mechanism Diagnostic clues: exacerbation by caffeine, TCAs, SSRIs; positive family history; association with Fe deficiency anemia, ESRD, neurologic lesions

restless leg syndrome

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The main afference to the hippocampal formation comes fro

...

The main afferent to the hippocampal formation comes from:

Posterior inferior cerebellar artery

identify B

superior cerebellar artery

identify c

D. All of the above

"Broca's aphasia" and "Wernicke's aphasia" are confusing terms because: A. That disorders o which they refer rarely, if ever, exist in their pure forms B. the disorders to which they refer do not always result from damage to Broca's and Wernicke's area, respectively C. They are predictions of the Wernicke-Geschwind model rather than common neuropsychological disorderss D. All of the above E. None of the above

A. Anterior nucleus The interventricular foramen, in which this tumor is located, is the space between the column of the fornix (which is rostromedial to the foramen) and the anterior nucleus of the thalamus (which is caudolateral to the foramen). Enlargement of the left lateral ventricle results from blockage of CSF flow from the left lateral ventricle into the third ventricle. The confusion experienced by this man may partially reflect the interruption of messages from this nucleus to the cingulate cortex as well as the increased intracranial pressure. The centromedian is located in the internal medullary lamina within the thalamus, and the dorsomedial nucleus is in the medial area of the thalamus bordering on the third ventricle; both project to broad areas of the cerebral cortex. The ventral anterior (VA) and ventral lateral (VL) nuclei are located in the lateral area of the thalamus adjacent to the internal capsule; the VA is a thalamic nucleus involved with the limbic system, and the VL is a relay nucleus intimately involved in motor function.

34-year-old man presents with confusion and persistent headache. MRI reveals an enlarged lateral ventricle on the left side, presumably resulting from a dime-sized tumor located in the left interventricular foramen. Based on the location of this tumor, which of the following diencephalic structures is most directly impinged upon? A. Anterior nucleus B. Dorsomedial nucleus C. Ventral lateral nucleus D. Ventral anterior nucleus E. Centromedian nucleus

E. Right parietal lobe This patient is displaying Hemispatial neglect Remember lesions of the Midbrain can result in things like parkinsons, eye movement issues and motor loss and Frontal lobe lesions can cause issues with personality, behavior and upper extremity issues

75-year-old man with history of hypertension has a stroke. He is seen in a neurology clinic, where he states that he has been having trouble getting dressed in the morning, and his wife notes that she has seen him shaving only the right side of his face. Which of the following structures did the man's stroke most likely involve? A. Left frontal lobe B. Left midbrain C. Right frontal lobe D. Right midbrain E. Right parietal lobe

C. Posterior vermis syndrome Posterior vermis syndrome is generally indicative of brain tumors in children, frequently a medulloblastoma. Symptoms include vomiting, morning headache, stumbling gait, frequent falls, diplopia, papilledema, AND sixth nerve palsy. Tabes dorsalis is posterior column syndrome that results from untreated syphilis. Olivopontocerebellar degeneration has an autosomal dominant mode of inheritance and results in gait ataxia, dysarthria, intention tremor, AND possibly parkinsonian signs (rigidity and akinesia). Sturge-Weber syndrome is neurocutaneous congenital disorder caused by an arteriovenous malformation in the telencephalon. Brown-Séquard syndrome is paralysis, ataxia, AND loss of sensation as a result of a spinal cord hemisection

A 10-year-old boy has a headache, early-morning vomiting, staggering gait, adiadochokinesia, finger-to-nose sign, heel-to-shin sign, bilateral Babinski signs, choked disk, abducent palsy, AND scanning speech, as in "I DID not GIVE any TOYSTO my son for CHRISTmas." What is the most likely diagnosis? A. Brown-Séquard syndrome B. Olivopontocerebellar degeneration C. Posterior vermis syndrome D. Sturge-Weber syndrome E. Tabes dorsalis

E. Both A and B Remember Horner Syndromes symptoms:: Anhidrosis - Lack or inability to sweat Ptosis - Eyelid drooping Miosis - Excessive constriction of pupil Enophthalmos (Sunken in eyeballs)

A 10-year-old boy is brought to your office by his father. As shown in the picture the pupil in the boy's right eye is noticeably smaller. When you shine a light in his eye the pupil shows normal miosis, but the recovery dilation of the pupil is slower than the left eye. What other symptoms would you expect to see in this patient? A. Anhidrosis B. Ptosis C. Sweating D. Dry mouth E. Both A and B

C. Decreased release of norepipneprhine in the right eye

A 10-year-old boy is brought to your office by his father. As shown in the picture the pupil in the boy's right eye is noticeably smaller. When you shine a light in his eye the pupil shows normal miosis, but the recovery dilation of the pupil is slower than the left eye. The boys smaller pupil is caused by? A. Increased release of norepinephrine in the right eye B. Decreased release of acetylcholine in the right eye C. Decreased release of norepipneprhine in the right eye D. Increased contraction of radial muscle the right eye E. Decreased parasympathetics stimulation of the right eye

C. Decreased release of norepinephrine in the right eye

A 10-year-old boy is brought to your office by his father. The pupil in the boy's right eye is noticeably smaller. When you shine a light in his eye, the pupil shows normal mitosis (pupil constriction), but the recovery dilation of the pupil is slower than the left eye. The boy's smaller pupil is caused by: A. Increased release of norepinephrine in the right eye B. Decreased release of acetylcholine in the right eye C. Decreased release of norepinephrine in the right eye D. Increased contraction of radial muscle in the right eye E. Decreased parasympathetic stimulation of the right eye

E. Both A and B

A 10-year-old boy is brought to your office by his father. The pupil in the boy's right eye is noticeably smaller. When you shine a light in his eye, the pupil shows normal mitosis (pupil constriction), but the recovery dilation of the pupil is slower than the left eye. What other symptoms would you expect to see in this patient? A. Anhidrosis B. Ptosis C. Sweating D. Dry mouth E. Both A and B

D. Tuberal region The tuberal region is the site where the gonadotrophic-releasing hormones are synthesized or where they pass through in route to the anterior pituitary. Thus, a lesion in this region would most likely affect development and growth of sex organs. The other regions mentioned as alternate choices in this question contain few, if any, gonadotrophic-releasing hormones, and lesions of these other regions would therefore not likely result in retardation in development of sexual organs.

A 16-year-old boy exhibited retardation in development of sexual organs. It was discovered that the likely cause of the disorder was a hematoma in a region of the hypothalamus. The most likely site of the lesion was the: A. Preoptic region B. Lateral hypothalamus C. Mammillary bodies D. Tuberal region E. Posterior hypothalamic nucleus

A. Amygdala The amygdala has been linked to the process of fear conditioning in animals and to the regulation of fear in humans. A rare disorder, referred to as the Urbach-Wiethe disease, involves calcification of mainly the amygdala, and patients who have this disorder have difficulty in recognizing stimuli normally associated with fear, although other emotions are clearly present in these patients. Other choices include regions that are not associated with this disorder or with the regulation of fear responses.

A 17-year-old boy was brought to a psychologist for psychological testing because he was unable to express any feelings of fear. Further analysis confirmed this impression and indicated that other emotions were quite normal. A subsequent MRI revealed calcification in a region of the brain. Where in the brain was the lesion found? A. Amygdala B. Hippocampal formation C. Anterior cingulate gyrus D. Prefrontal cortex E. Septal area

A. Amygdala

A 17-year-old boy was brought to a psychologist for testing because he was unable to express any feeling of fear. Further analysis confirmed this impression and indicated that other emotions were quite normal. A subsequent MRI revealed calcification in a region of the brain. Where was the lesion? A. Amygdala B. Hippocampus C. Anterior cingulate gyrus D. Prefrontal cortex E. Septal area

A. Obtain an EEG and a neuroimaging study You would obtain an EEG and neuroimaging study to confirm diagnosis BEFORE you initiate an anti epileptic drug

A 21-year-old woman presents to the ER after experiencing a first-time convulsive seizure A friend observed the patient suddenly falling at home and convulsing for 45 seconds. Afterwards, the patient was lethargic for 15 minutes but then recovered completely without residual neurological deficit. She sustained a tongue bite during the seizure and was incontinent of urine. What is the most appropriate next step in the management of this patient? A. Obtain an EEG and a neuroimaging study B. Initiate an anti-epileptic drug C. Obtain a serum neuron-specific enolase level D. Perform a lumbar puncture for CSF analysis

A. Corpus callosum

A 22-year-old right handed female evaluated after a surgery to control intractable seizures. She is asked to stare at a point. On examination she can name the objects to the right of the point but is unable to name the ones to the left of the point. Which of the following structures is most likely affected? A. Corpus callosum B. Dorsolateral prefrontal cortex C. Angular gyrus D. Inferotemporal cortex E. Supramerginal gyrus

D. Amygdaloid nucleus

A 23-year--old man is brought to the emergency department after an automobile collision. A CT scan shows bilateral damage to the uncut. Which of the following structures is also most likely damaged in this patient? A. anterior thalamic nucleus B. CIngulum C. Head of caudate nucleus D. Amygdaloid nucleus E. Nucleus accumbent

A. Prefrontal cortex The prefrontal cortex receives significant inputs from all regions of cortex and from limbic regions and the mediodorsal thalamic nucleus. Accordingly, damage to neurons in the prefrontal cortex will disrupt a number of processes, which include affect and intellectual functions. The premotor cortex is associated with motor functions, the posterior parietal cortex and inferior parietal lobule with sensory functions, and the posterior entorhinal cortex with the transmission of sensory signals to the hippocampal formation and amygdala. This region may also play a role in seizure activity related to the temporal lobe. But there is little evidence that it is associated with intellectual functions. Thus, a lesion of this region could not account for the dysfunctions described in this case.

A 23-year-old man was involved in an automobile accident and had a head injury in that accident. Soon afterward, the patient began to experience a variety of intellectual difficulties, as evidenced by poor scores on temporal and other discrimination tasks. In addition, the injured person also displayed a rather flat emotional personality where few emotional responses were expressed in the presence of varied emotional stimuli. After an MRI scan, brain trauma was noted in the cerebral cortex. The primary focus of the trauma was the: A. Prefrontal cortex B. Premotor cortex C. Posterior parietal cortex D. Inferior parietal lobule E. Posterior entorhinal cortex

B. cerebellar hemisphere, right side. Dysmetria, dysdiadochokinesia, intention tremor, AND nystagmus are classic cerebellar signs. In the finger-to-nose test, the patient past-points on the side of the lesion. The medial medulla has no cerebellar pathways. In contrast, the lateral medulla has cerebellar pathways; lesions result in cerebellar ataxia and could be misdiagnosed as a cerebellar hemispheric lesion. The globus pallidus is atrophied in Huntington's disease and in Wilson disease, AND it is damaged bilaterally by carbon monoxide intoxication

A 30-year-old woman complains of unsteadiness while standing or walking. She tends to deviate to the right. Neurologic examination reveals the following signs: dysmetria on the right, dysdiadochokinesia, AND a nystagmus that is more marked when she looks to the right side. The lesion is most likely found in the: A. cerebellar hemisphere, left side. B. cerebellar hemisphere, right side. C. globus pallidus, left side. D. medial medulla, left side. E. medial medulla, right side.

C. Spasmodic vasoconstriction induced by sympathetic activation

A 45-year-oldwoman comes to your clinic complaining that her fingers are always cold. She indicates that her fingers turn white whenever she feels stressed. At other times, her fingers look normal. This woman's disorder is most likely caused by: A. Spasmodic vasodilation induced by sympathetic activation B. Spasmodic vasoconstriction induced by parasympathetic activation C. Spasmodic vasoconstriction induced by sympathetic activation D. Spasmodic vasodilation induced by parasympathetic activation E. Both A and B

A. Anterior nucleus The interventricular foramen, in which this tumor is located, is the space between the column of the fornix (which is rostromedial to the foramen) and the anterior nucleus of the thalamus (which is caudolateral to the foramen). Enlargement of the left lateral ventricle results from blockage of CSF flow from the left lateral ventricle into the third ventricle. The confusion experienced by this man may partially reflect the interruption of messages from this nucleus to the cingulate cortex as well as the increased intracranial pressure. The centromedian is located in the internal medullary lamina within the thalamus, and the dorsomedial nucleus is in the medial area of the thalamus bordering on the third ventricle; both project to broad areas of the cerebral cortex. The ventral anterior (VA) and ventral lateral (VL) nuclei are located in the lateral area of the thalamus adjacent to the internal capsule; the VA is a thalamic nucleus involved with the limbic system, and the VL is a relay nucleus intimately involved in motor function.

A 34-year-old man presents with confusion and persistent headache. MRI reveals an enlarged lateral ventricle on the left side, presumably resulting from a dime-sized tumor located in the left interventricular foramen. Based on the location of this tumor, which of the following diencephalic structures is most directly impinged upon? A. Anterior nucleus B. Dorsomedial nucleus C. Ventral lateral nucleus D. Ventral anterior nucleus E. Centromedian nucleus

B. Complex partial seizure The characteristics described in this patient—impaired consciousness, staring, automatisms, and in particular, its locus in the temporal lobe—are typical of complex partial seizures. Other choices do not reflect the characteristics described in this case. In a simple partial seizure, there is no loss or impairment of consciousness. Generalized seizures, including tonic-clonic seizures and absence seizures, spread diffusely over the cerebral cortex and are not specific to the temporal lobe.

A 38-year-old man was admitted to a local hospital after showing signs of seizure activity. He would show periods of impairment of consciousness, and during the seizure, he would stare and not respond to any commands. The primary focus of the seizure was the temporal lobe. The patient also showed automatisms (i.e., automatic, stereotypic, and nonpurposeful movements, which included chewing and smacking). Which type of seizure did this person have? A. Simple partial seizure B. Complex partial seizure C. Generalized seizure D. Tonic-clonic seizure E. Absence seizure

D. Insufficient parasympathetic stimulation of muscarinic receptors in the bladder

A 40 y/o woman comes to the hospital for a surgical procedure. The surgeon injects local anesthesia near the sacral region of the spinal cord. During recovery, the woman complains of pain from her full bladder. A catheter is inserted because the patient's suffering from: (a) Insufficient sympathetic stimulation of B2 adrenergic receptors in the bladder A. Insufficient parasympathetic stimulation of B2 adrenergic receptors in the bladder C. Insufficient sympathetic stimulation of muscarinic receptors in the bladder D. Insufficient parasympathetic stimulation of muscarinic receptors in the bladder E. Insufficiency sympathetic stimulation of a1 adrenergic receptors in the bladder

C. vitamin B1 Lack of thiamine B1 results in Wernicke-Korsakoff syndrome; the classic clinical triad of Wernicke encephalopathy is confusion, gait ataxia, AND ophthalmoplegia. Korsakoff syndrome is profound memory impairment and confabulation.

A 40-year-old man was admitted to the hospital and was examined by a staff neurologist. Examination revealed the following: alcohol abuse, paralysis of conjugate gaze, nystagmus, confusion, AND memory loss. These symptoms are likely owing to a deficiency in __________. A. niacin B. vitamin A C. vitamin B1 D. vitamin B6 E. vitamin B12

B. amygdala Bilateral ablation of the inferior temporal cortex results in damage to the amygdala resulting in hypersexuality, hyperphagia, docility, AND psychic blindness (Klüver-Bucy syndrome).

A 40-year-old woman was referred to a psychiatric unit with signs of nymphomania that were first manifest after a car accident. The responsible lesion would most likely be in the _______________. A. alveus B. amygdala C. cornu ammonis D. dentate gyrus E. subiculum

E. Temporal lobe The episodic dyscontrol syndrome is associated with cases involving the temporal lobe and is, in many cases, related to tumors of this region. Alternative choices involve other regions not associated with impulsive aggression characteristic of episodic dyscontrol. The premotor cortex is related to motor functions; functions of the mammillary bodies are largely unknown; the posterior cingulate cortex is associated with memory functions and not with aggression; and the prefrontal cortex is more closely associated with intellectual functions and affective processes but not episodic dyscontrol.

A 43-year-old man was seen by a psychiatrist after having displayed continuous impulsive fits of anger and aggression against others. The psychiatrist concluded that the patient exhibited behavior characteristic of a disorder identified as the "episodic dyscontrol syndrome." Following an MRI, a tumor was detected in the forebrain region of the patient. The location of the tumor was the: A. Premotor cortex B. Posterior cingulate cortex C. Mammillary bodies D. Prefrontal cortex E. Temporal lobe

E. Medial nucleus of the hypothalamus

A 45-year-old man is brought to your office after he was arrested for fighting with his coworkers. He has been losing his temper very frequently. Previously he was a very easygoing guy, but coworkers report that he has had frequent outbursts of anger over the past year. You examine patient's CT and notice that he has a tumor near the base of the brain that impinges on the: A. Lateral nucleus of the hypothalamus B. Paraventricular nucleus of the hypothalamus C. Arcuate nucleus of the hypothalamus D. Mammillary body of the hypothalamus E. Medial nucleus of the hypothalamus

C. Spasmodic vasoconstriction induced by sympathetic activation This is Raynaud's syndrome Also remember blood vessels are sympathetic only

A 45-year-old woman comes to your clinic complaining that her fingers are always cold. She indicates that her fingers turn white whenever she feels stressed. At other times, her fingers looked normal. This woman's disorder is most likely caused by? A. Spasmodic vasodilation induced by sympathetic activation B. Spasmodic vasoconstriction induced by parasympathetic activation C. Spasmodic vasoconstriction induced by sympathetic activation D. Spasmodic vasodilation induced by parasympathetic activation E. Both A and B

F. Paraventricular nucleus of hypothalamus

A 47-year old female is referred to a local clinic because of polyuria linked to excessive thirst/drinking. She denies any family history of diabetes. A CT (computed tomography) scan reveals an infarcted area in a region of the diencephalon. You suspect a lesion in which structure? A. Posterior nucleus of hypothalamus B. Anterior nucleus of thalamus C. Ventro-postero lateral nucleus of thalamus D. Habenular nucleus of epithalamus E. Arcuate nucleus of thalamus F. Paraventricular nucleus of hypothalamus

C. Foster Kennedy Foster Kennedy syndrome includes ipsilateral anosmia, optic atrophy, AND contralateral papilledema; pressure on the olfactory tract causes ipsilateral anosmia, whereas pressure on the optic nerve causes ipsilateral optic atrophy and a central scotoma and contralateral papilledema. Edinger and Westphal described this parasympathetic nucleus of the rostral midbrain, more appropriately called the accessory oculomotor nucleus. Brown-Séquard is associated with a spinal cord lesion, spinal cord hemisection. Klüver and Bucy described the limbic lobe syndrome. Wernicke-Korsakoff syndrome consists of Wernicke encephalopathy and Korsakoff psychosis.

A 50-year-old woman presents with ipsilateral anosmia, optic atrophy, AND contralateral papilledema. The syndrome is: A. Brown-Séquard. B. Edinger-Westphal. C. Foster Kennedy. D. Klüver-Bucy. E. Wernicke-Korsakoff.

D. Solitary nucleus A primary target of neurons in the region of the carotid sinus is the solitary nucleus, which directly modulates cardiovascular mechanisms via a series of complex descending neurons that ultimately affect autonomic nuclei in the spinal cord (see Chapter 21). Other choices involve neurons that are unrelated to the regulation of blood pressure. The red nucleus is associated with motor functions, and the other choices are associated with sensory functions.

A 54 year-old man felt light-headed and then experienced a sudden loss of consciousness (called syncope) after standing for a while. To help the patient recover, the physician at hand messaged the region of the carotid sinus, which was successful in helping the patient to recover. Which of the following structures of the brainstem was most likely directly modulated as a result of the physician's actions? A. Red nucleus B. Vestibular nuclei C. Superior olivary nucleus D. Solitary nucleus E. Pretectal region

C. GABA in the neostriatum, reduction of neostriatal inhibition on the lateral (external) pallidal segment The lateral segment of the globus pallidus projects γ-aminobutyric acid (GABA)-ergic fibers to the subthalamic nucleus. This connection represents the first limb of the indirect pathway connecting the striatum, subthalamic nucleus, and thalamus. In turn, the subthalamic nucleus provides an excitatory, glutamatergic input to the medial pallidal segment; and the medial segment inhibits the ventrolateral and ventral anterior nuclei of thalamus (which normally excite motor regions of cortex) by virtue of its GABAergic projection. Thus, when the inhibitory GABAergic input to the lateral pallidal segment is lost, as is the case in Huntington's disease, the GABAergic input into the subthalamic nucleus from the lateral pallidal segment is more pronounced. Consequently, there is a weaker excitatory input into the medial pallidal segment from the subthalamic nucleus, resulting in less inhibition from the medial pallidal segment on the thalamic nucleus and motor regions of cortex. Hence, the loss of neostriatal GABA is manifested in the form of a hyperkinetic effect on motor responses. The other choices are incorrect for the following reasons. The role of serotonin in the globus pallidus is unknown and therefore is not likely to play any significant role in this structure related to a hyperkinetic disorder. Substance P is excitatory and therefore could not be related to inhibitory processes. Acetylcholine is an excitatory transmitter, loss of which would not produce a reduction in inhibition. Loss of dopamine in the neostriatum is associated with a hypokinetic rather than a hyperkinetic disorder.

A 55-year-old man was recently diagnosed with Huntington's disease. This disorder may best be understood in terms of the loss of which substance with which result? A. Serotonin in the globus pallidus, increased excitation of ventral anterior thalamic nucleus B. Substance P in the neostriatum, increased inhibition in the medial pallidal segment C. GABA in the neostriatum, reduction of neostriatal inhibition on the lateral (external) pallidal segment D. Acetylcholine and GABA in the neostriatum, reduction of inhibition on the medial (internal) pallidal segment E. Dopamine in the neostriatum, a reduction of neostriatal inhibition on the medial pallidal segment

C. Inferior temporal gyrus The inferior temporal gyrus receives tertiary inputs from the interblob regions of visual cortex, which mediate shapes, contours, and edges of figures. A lesion of the inferior temporal gyrus will result in the capacity for recognition of faces. The superior temporal gyrus is associated with auditory recognition and discrimination, the middle temporal gyrus is associated with movement of objects, and the superior and inferior banks of calcarine sulcus are the primary receiving areas of cortex of visual inputs from the retina.

A 56-year-old woman who previously had no perceptual or difficulties with her vision suddenly was unable to recognize faces, whereas other aspects of vision remained intact. An MRI scan revealed the presence of a brain lesion. Where was the locus of this lesion? A. Superior temporal gyrus B. Middle temporal gyrus C. Inferior temporal gyrus D. Superior bank of calcarine sulcus E. Inferior bank of calcarine sulcus

D. Lateral geniculate nucleus The primary visual cortex receives input vital to vision from the lateral geniculate body on the same side via the optic radiations. Both eyes send information to each lateral geniculate body; this is why lesions caudal to the optic chiasm result in visual loss in both visual fields. The medial geniculate nucleus relays auditory information to the temporal lobe via the auditory radiations; the ventral lateral nucleus relays information from the cerebellum and basal nuclei to the somatomotor cortex. All of these thalamocortical systems pass through various limbs of the internal capsule. The pulvinar has connections with the visual cortex; these connections are not specifically concerned with vision, but with visual-motor function. The lateral dorsal nucleus is located in the upper portions of the thalamus and has no particular clinical importance.

A 58-year-old man presents with the complaint of difficulty seeing. The history reveals that the man has hypertension and that he is largely noncompliant regarding his medications. The examination reveals that he has a right homonymous hemianopia, and an MRI shows a lesion of the primary visual cortex. Which of the following relays vital input to this damaged area of cortex? A. Pulvinar nucleus B. Ventral lateral nucleus C. Medial geniculate nucleus D. Lateral geniculate nucleus E. Lateral dorsal nucleus

A. Fastigial nucleus Fastigial nucleus - Receives input from vestibular nuclei and sends projections to cerebellum - vermis Dentate nucleus - largest, involved in planning and initiating movements Globose nucleus and Emboliform nucleus are both interposed nuclei, connected to spinocerebellar tracts

A 60-year-old female is seen by a neurologist after complaining about losing her balance. Further examination reveals the presence of truncel ataxia and nystagmus. The neurologist concludes that she is suffering from a vascular lesion limited to a single structure that normally sends a direct projection to he vestibular nuclei. Which of the following cerebellar structures is affected by this lesion? A. Fastigial nucleus B. Dentate nucleus C. Globose nucleus D. Emboliform nucleus

B. Wide dynamic range neurons in the dorsal horn receive nociceptive synapses from the heart and arm

A 60-year-old man comes to your clinic complaining pain radiating from his chest down his left arm. He has difficulty breathing and is feeling lightheaded. You suspect that he feels pain in his arm because: A. The same nociceptive neurons project to the heart and arm B. Wide dynamic range neurons in the dorsal horn receive nociceptive synapses from the heart and arm C. Nociceptive afferents from the heart and arm converge onto the same thalamic neurons D. Glutamate and substance P released from the nociceptive afferents from the heart also activate nociceptive fibers from the arm E. Nociceptive afferents from both the arm and heart are being activated

C. Amygdala Lesions of the amygdala or adjoining pyriform cortex produce a disorder referred to as the "Klüver-Bucy syndrome." It is characterized by placidity, hypersexuality, visual agnosia, oral tendencies, and loss of fear of objects that previously produced fear. Damage to the septal area, parts of the hippocampal formation, cingulate gyrus, and prefrontal cortex are typically associated with increases in aggression, which is opposite of what occurs in the Klüver-Bucy syndrome.

A 63-year-old man was transferred from a psychiatric clinic to the local hospital for a neurological examination because he showed signs of a Klüver-Bucy syndrome. A magnetic resonance imaging (MRI) scan revealed the presence of a small tumor in the brain. The locus of this tumor likely included the: A. Hippocampal formation B. Septal area C. Amygdala D. Prefrontal cortex E. Anterior cingulate gyrus

D. Prefrontal cortex Aka Orbitofrontal cortex

A 63-year-old woman was experiencing difficulties in a card sorting test (as a measure of cognitive function) and failed to accurately perceive the vertical when seated in a tilted chair. An MRI scan revealed the presence of a lesion in the: A. Hippocampal formation B. Septal area C. Amygdala D. Prefrontal cortex E. Cingulate gyrus

D. Prefrontal cortex Lesions of the prefrontal cortex produce unique intellectual and perceptual deficits, which are not generally associated with the other choices provided (hippocampus, amygdala, septal area, and cingulate gyrus). In a card-sorting task, the patient will not vary her strategy for sorting cards even when asked to do so. In a perceptual task, when the patient is placed in a tilted chair in the dark and asked to identify the true vertical, she is unable to do so, although normal individuals have little difficulty in doing so.

A 63-year-old woman was experiencing difficulties in a card-sorting test (as a measure of cognitive function), and failed to accurately perceive the vertical when seated in a tilted chair. An MRI scan revealed the presence of a lesion in the: A. Hippocampal formation B. Septal area C. Amygdala D. Prefrontal cortex E. Cingulate gyrus

C. Tactile sensation from his foot Flashes of light (17, 18 and 19) Postcentral gyrus, primary sensory, medial aspect = lower extremity

A 64-year-old man is awake while undergoing brain surgery to relieve a severe tremor. During the course of the operation, the surgeon stimulates the medial aspect of the post central gyrus at the paracentral lobule. As a consequence of this situation, the patient will most likely describe which of the following? A. Flashes of light B. Tactile sensation from his hand C. Tactile sensation from his foot D. Movement in his hand E. Movement in his foot

E. Increased sympathetic stimulation of a1 adrenergic receptors on vascular going to the brain

A 65-year-old man is laying down on his bed. The doorbell sounds and he quickly jumps up. However, he feels dizzy and falls back onto the bed. What should have happened to prevent dizziness? A. Increased sympathetic stimulation of B2 adrenergic receptors on vascular going to the brain B. Increased signaling from stretch receptors carotid sinus C. Decreased parasympathetic stimulation of vascular smooth muscle D. Increased parasympathetic stimulation of SA node in heart E. Increased sympathetic stimulation of a1 adrenergic receptors on vascular going to the brain

E. Increased sympathetic stimulation of alpha1 adrenergic receptors on vascular going to brain This patient is suffering from Orthostatic hypertension

A 65-year-old man is laying down on his bed. The doorbell sounds and he quickly jumps up. However, he feels dizzy and falls back onto the bed. What sounds have happened to prevent his dizziness? A. Increased sympathetic stimulation of Beta2 adrenergic receptors on vascular going to brain B. Increased signaling from stretch receptors carotid sinus C. Decreased parasympathetic stimulation of vascular smooth muscle. D. Increased parasympathetic stimulation of SA node in heart E. Increased sympathetic stimulation of alpha1 adrenergic receptors on vascular going to brain

D. Strengthening of nociceptive synapses in the dorsal horn by the activation of NMDA receptors

A 65-year-old woman with poorly controlled Diabetes develops a severe infection in her right foot. Due to her poor circulation, the wound does not heal even with antibiotics. The decision is made to amputate her foot to prevent the spread of infection. Four months post-op, she comes to your office complaining sharp burning pain whenever the surface of the amputated limb is touched. This pain syndrome was likely caused by: A. Activation of NMDA receptors that cause the continued release of substance P B. Increased synthesis of NMDA by nociceptive afferents in the spinal cord C. LTP of nociceptive afferents by activation of NMDA receptors by high glucose levels D. Strengthening of nociceptive synapses in the dorsal horn by the activation of NMDA receptors E. NMDA receptor mediated strengthening of synapses onto interneurons in the dorsal horn

A. Global aphasia

A 67-year-old male presents to the emergency room after a severe headache and a period of confusion. On examination he presents with a blood pressure of 180/120 and pulse of 120 beats per minute. He fluently states "algorithm ititusun caliber mouse". He cannot repeat sentences. when asked to close his eyes, he opens his mouth. Which of the following is the most likely diagnosis? A. Global aphasia B. Broca's aphasia C. Alexia D. Conduction aphasia E. Wernicke's apashia

A. Ventral posterolateral This is a hemorrhage located within the territory of the thalamogeniculate artery, a branch of P2. This vessel generally serves the geniculate nuclei (as its name implies), the pulvinar, the centromedian, and ventral posteromedial and posterolateral nuclei. This vascular territory may extend more rostrally to include caudal portions of the ventral lateral nucleus (VL pars caudalis). As is the case in this patient, and as is commonly seen in many cerebral strokes, only part of a vascular territory may be involved. This lesion is located primarily in the left ventral posterolateral nucleus; this correlates with the onset of major deficits on this woman's right side; this woman has major sensory losses. None of the other nuclei in this vascular region receives any significant input from the body. The anterior, ventral anterior, and dorsomedial (rostral portions) nuclei receive their blood supply predominately from the thalamogeniculate artery (a branch of P1). Caudal portions of the dorsomedial nucleus are served by the medial posterior choroidal artery.

A 67-year-old woman presents with the sudden onset of deficits affecting the right side of her body. The results of the examination clearly suggest a stroke; this is confirmed by the results of an MRI, which is shown below. Based on the location of this lesion, which of the following thalamic nuclei is most likely the major focus of this hemorrhagic event? A. Ventral posterolateral B. Dorsomedial C. Ventral posterior D. Pulvinar E. Anterior

B. Middle cerebral artery The lenticulostriate branches of the middle cerebral artery supply the internal capsule, including the region of the posterior limb and genu. The key point here is that these regions of the internal capsule contain corticobulbar and corticospinal fibers that mediate functions of the head and body that were affected in the patient, likely producing right central palsy. Thus, of the choices given in this question, only the middle cerebral artery is correct because its branches supply these regions and none of the other arteries supply fibers that mediate these functions. Note that both the anterior spinal and vertebral arteries are present at medullary levels, whereas the corticobulbar fibers mediating motor control of the jaw exit at the level of the pons. The anterior cerebral artery, which passes on the medial aspect of the cortex, does not supply neurons that mediate speech (located laterally on the cortex). -branches of the middle cerebral artery supply descending fibers in the internal capsule, which are associated with the motor functions disrupted in this patient. Other choices involving fiber bundles on the right side of the brain are wrong because the right side of the body was affected in this case, requiring an answer that included damage to the left corticospinal tract. The left postcentral gyrus is not directly involved in motor functions, and the left medullary pyramids lie below the level where corticobulbar fibers exit to innervate motor neurons of the facial nerve.

A 68-year-old man is admitted to the emergency department (ED) after initially complaining of dizziness. In the ED, the patient indicated that he could not move his right arm or leg, and his speech was slurred. The tongue was directed to the right side when the patient was asked to protrude it, and the patient's jaw drooped to the right side as well. Sensory functions on each side of the body appeared normal as well as motor functions on the left side. The patient had a stroke involving the: A. Anterior cerebral artery B. Middle cerebral artery C. Posterior cerebral artery D. Anterior spinal artery E. Vertebral artery

E. Left medullary pyramids

A 68-year-old man is admitted to the emergency department (ED) after initially complaining of dizziness. In the ED, the patient indicated that he could not move his right arm or leg, and his speech was slurred. The tongue was directed to the right side when the patient was asked to protrude it, and the patient's jaw drooped to the right side as well. Sensory functions on each side of the body appeared normal as well as motor functions on the left side. The stroke involved the: A. Right precentral gyrus B. Left postcentral gyrus C. Left internal capsule D. Right internal capsule E. Left medullary pyramids

A. Left ACA Right LE weakness -Hyperreflexia -L4/S1 = patellar and achilles reflexes (R) Remember Anterior = Lower extremities Middle = Upper extremities PICA would deny dysphasia or sensory loss

A 68-year-old woman presents to your clinic with the complaint of gradually worsening weakness in her right leg. She states that the weakness is so profound that she is nearly incapable of moving it. On exam, she has hyperreflexia of her right patellar and Achilles reflexes. She presents full voluntary movements and strength in all muscle groups of both upper limbs and left leg. The patient denies dysphagia or showed any signs of dysarthria or dysphonia. You suspect a brain tumor could be causing her symptoms and send her for an MRI, which shows a parasagittal meningioma (this is a benign tumor of the meninges). According to the patient's symptoms, the tumor is most probably occluding the following arterial vessel: A. Left ACA B. Right ACA (c) Right MCA D. Left MCA E. PICA

A. Vertebrobasilar artery system Verteobrobasilar artery system (is made up by multiple arteries) Lenticulostriate is a branch of the middle cerebral artery Dysphagia (Difficulty swallowing) and Dysphonia (Hoarseness) both deal with CN IX/X Ataxia = problem with gate Hemiparesis = L body paralysis

A 70-year-old man is brought to the ER following an ischemic stroke. MRI shows an infarcted area in the brain on the right side. The neuro exam reveals dysphagia (difficulty swallowing), dysphonia (hoarse voice), ataxia (impaired balance/coordination), and a left hemiparesis (left body paralysis). This combination of deficits would most likely indicate a vascular occlusion of which of the following arteries? A. Vertebrobasilar artery system B. ACA C. Lenticulostriate D. MCA

D. Ventral posterolateral Axons arising from cells of the dentate, emboliform, and globose nuclei exit the cerebellum in the superior cerebellar peduncle, course through the decussation of this peduncle, and enter the ventral lateral (VL) nucleus of the dorsal thalamus. Lesions of these nuclei result in very characteristic motor deficits. While the VL also receives fibers from the basal nuclei, it projects to several regions of the cerebral cortex; its most important target is the somatomotor cortex (area 4). The anterior nucleus receives input from the limbic system and projects to the cingulate gyrus. Several brain regions, such as the amygdale, basal regions of the forebrain, and olfactory tubercle, project to the dorsomedial nucleus, which, in turn, projects to large areas of the orbital and frontal cortex. The centromedian nucleus receives input from the spinal cord, basal nuclei, cerebellum, and reticular formation and projects to the basal nuclei and wide areas of the cerebral cortex. The posterior column-medial lemniscus and anterolateral systems project to the ventral posterolateral nucleus, which, in turn, projects primarily to the somatosensory cortex (areas 3, 1, and 2).

A 70-year-old man presents with a sudden onset of motor symptoms. The examination reveals dysmetria and dysdiadochokinesia, most pronounced on his right side. MRI shows a lesion in the area outlined in the image below. Which of the following thalamic nuclei is the main target of the axons arising from the neurons damaged by this lesion? A. ventral lateral B. Centromedian C. Dorsomedial D. Ventral posterolateral E. Anterior

A. The patient presents an intentional tremor of the right hand

A 72-year-old male patient who has chronic hypertension had a sudden onset of nausea and vomiting. Son arrival to walk he fell down. He was immediately taken to the emergency department of local hospital. A CT scan and MRI of his head and an angiogram of the brain vasculature revealed a stroke involving the left superior cerebellar artery. The neurologic examination revealed dysarthria, nystagmus, tremor, and ataxia. In this patient, there ws a short-term bleed that affected the superior cerebellar peduncle producing tremor. How would you describe this tremor? A. The patient presents an intentional tremor of the right hand B. The patient presents a resting tremor of the right hand C. The patient presents an intentional tremor of the left hand D. The patient presents a resting tremor of the left hand

A. Ventrolateral medulla Respiratory neurons are situated in several sites within the lower brainstem. The major sites include the ventrolateral aspect of the medulla, dorsal aspects in proximity to the solitary nucleus and parabrachial region (dorsolateral tegmentum) of the pons. Other possible choices do not include any regions known to be associated with respiratory functions.

A 72-year-old man was admitted to a major New York hospital with a diagnosis of amyotrophic lateral sclerosis (ALS). Some time later, he displayed respiratory failure. Examination of the diaphragm and the associated peripheral nerve (i.e., phrenic nerve) appeared to be normal. An magnetic resonance imaging (MRI) scan indicated a discrete brain lesion. On this basis, the neurologist concluded that the lesion was localized to the: A. Ventrolateral medulla B. Basilar pons C. Midbrain tegmentum D. Lateral hypothalamus E. Motor cortex

B. Hippocampal formation Lesions of the hippocampal formation produce a short-term memory disorder in which the patient cannot remember what was told to him a few minutes earlier. There is significant anterograde amnesia with considerably less retrograde amnesia. Intellectual functions show little diminution. Other regions presented as alternative answers have not been shown to be related to a short-term memory disorder, although they do play important roles in other intellectual or emotional functions.

A 75-year-old man began to experience difficulties in remembering what a friend told him 5 minutes earlier. After encountering this error over a period of weeks, his wife took him to a neurologist where an MRI was administered. It was noted that a small brain lesion with consequent loss of brain tissue was present as determined from the MRI. The most likely locus of the lesion was the: A. Prefrontal cortex B. Hippocampal formation C. Amygdala D. Septal area E. Anterior cingulate gyrus

B. Hippocampus

A 75-year-old man began to experience difficulties in remembering what a friend told him 5 minutes earlier. After encountering this error over a period of weeks, his wife took him to a neurologist where an MRI was administered. It was noted that a small brain lesion with consequent loss of brain tissue was present as determined from the MRI. The most likely locus of the lesion was the: A. Prefrontal cortex B. Hippocampus C. Amygdala D. Septal area E. Anterior cingulate gyrus

E. Right parietal lobe The patient is exhibiting hemi-spatial neglect (contralateral).

A 75-year-old man with a history of hypertension has a stroke. He is seen in neurology clinic, where he states that he has been having trouble getting dressed in the morning and his wife notes that she has seen him shaving only the right side of his face. Which of the followings structures did the man's stroke most likely involve? A. Left frontal lobe B. Left midbrain C. Right frontal lobe D. Right midbrain E. Right parietal lobe

D. Posterior parietal cortex Sensory neglect is associated most prominently with lesions of the posterior parietal cortex. A lesion of the premotor cortex would result in apraxia; a lesion of the primary somatosensory cortex (i.e., postcentral gyrus) is associated with paresthesias such as abnormal tingling sensations and numbness of a side of the body opposite to that of the lesion. The occipital cortex is associated with primary and secondary visual functions. Lesions of this area would produce varying levels of blindness depending on the extent of the lesion. And lesions of the middle temporal cortex are associated with loss of ability to detect horizontal movement of objects.

A 75-year-old woman had a stroke, and several days after the event, the patient presented with a left-side paralysis in which the patient denies the presence of the limbs that are paralyzed. In addition, when asked to sketch a flower presented to her, she draws a picture of a flower with all the petals shown on the right side and nothing on the left side. This is commonly referred to as sensory neglect. The area of the stroke that resulted in the sensory neglect syndrome included primarily the: A. Premotor cortex B. Postcentral gyrus C. Occipital cortex D. Posterior parietal cortex E. Middle temporal cortex

D. Supraoptic recess of third ventricle The cavity of the diencephalon is the third ventricle; in this axial CT, it appears somewhat hourglass shaped with the rostral part being larger and the caudal part being somewhat smaller. This ventricle communicates caudally with the fourth ventricle via the cerebral aqueduct, which is seen in this image as a small black spot in the midbrain, and with the lateral ventricles through the interventricular foramina (there are two, one from each lateral ventricle into the midline third ventricle). The inferior portion of the third ventricle is located between the hypothalami (one hypothalamus on either side) and has two recesses. In this axial CT, the lowermost portion of the third ventricle is seen as two continuous areas: the more rostral and larger part of the black area is the supraoptic recess (at the arrow) and the more caudal and smaller part is the infundibular recess. This latter is the part of the ventricle that extends into the stalk of the pituitary. The foramen of Magendie is the opening of the fourth ventricle into the cisterna magna.

A 77-year-old man is brought to the Emergency Department (ED) following a precipitous event at his home. His wife explains that he had a sudden severe headache, became nauseated, vomited, and passed out. He regained consciousness by the time he arrived at the ED. CT of this man's brain reveals the image below. Which of the following is indicated at the tip of the arrow in this image? A. Suprapineal recess of third ventricle B. Cerebral aqueduct C. Foramen of Magendie D. Supraoptic recess of third ventricle E. Interventricular foramen

E. Basal nucleus of Meynart

A 78-year-old man was admitted to a neurological clinic because he was having memory difficulties. The diagnosis was that the patient was experiencing the early stages of Alzheimer's Disease. His disorder most likely involved loss of or damage to the neurons in the: A. Reticular formation B. Hypothalamus C. Central nucleus of the amygdala D. Dentate gyrus E. Basal nucleus of Meynart

E. Basal nucleus of Meynert Alzheimer's disease has been correlated with cell loss in the basal nucleus of Meynert, which is a group of large cells located in the ventral aspect of the basal forebrain adjacent to the horizontal limb of the diagonal band and substantia innominata. These cells are cholinergic and project to wide areas of the cerebral cortex. In Alzheimer's disease, there is a sharp reduction in the cholinergic content of cortical tissue. The regions shown in the other choices do not contain cholinergic neurons that are known to project to the cerebral cortex.

A 78-year-old man was admitted to a neurological clinic because he was having memory difficulties. The diagnosis was that the patient was experiencing the early stages of Alzheimer's disease. His disorder most likely involved loss of or damage to neurons in the: A. Reticular formation B. Hypothalamus C. Central nucleus of amygdala D. Dentate gyrus E. Basal nucleus of Meynert

D. Reduced quantities of GABA released from the neostriatum Reduced quantities of dopamine released onto the neostriatum would cause hypokinesis

A basic mechanism that characteristics a hyperkinetic disorder involves: A. Reduced quantities of dopamine released onto the neostriatum B. Increased quantities of dopamine released onto the medial pallidal segment C. Reduced quantities of serotonin released onto the neostriatum D. Reduced quantities of GABA released from the neostriatum

D. Reduced quantities of GABA released from the neostriatum The condition the patient is experiencing is Huntington's Disease.

A basic mechanism that characterizes a hyperkinetic disorder involves: A. Reduced quantities of dopamine released onto the neostriatum B. Increased quantities of dopamine released onto the medial pallidal segment C. Reduced quantities of serotonin onto the neostriatum D. Reduced quantities of GABA released from the neostriatum

D. Reduced quantities of GABA released from the neostriatum

A basic mechanism that characterizes a hyperkinetic disorder involves: A. Reduced quantities of dopamine released onto the neostriatum B. Increased quantities of dopamine released onto the medial pallidal segment C. Reduced quantities of serotonin released onto the neostriatum D. Reduced quantities of GABA released from the neostriatum

D. Reduced quantities of GABA released from the neostriatum In this condition (Huntington's disease), GABA release from the neostriatum upon the medial pallidal segment reduces the inhibitory effects of the medial pallidal segment upon the thalamus, thus allowing for greater excitation of the frontal lobe, causing the hyperkinetic effect. Other choices are incorrect. Reduced quantities of dopamine in the neostriatum play little or no known role in upon the globus pallidus. Serotonin and acetylcholine are also not known to play any significant roles in this process.

A basic mechanism that characterizes a hyperkinetic disorder involves: A. Reduced quantities of dopamine released onto the neostriatum B. Increased quantities of dopamine released onto the medial pallidal segment C. Reduced quantities of serotonin released onto the neostriatum D. Reduced quantities of GABA released from the neostriatum E. Increased quantities of acetylcholine released onto the medial pallidal segment

C. Reduced quantities of dopamine onto the neostriatum In a hypokinetic disorder (Parkinson's disease), the disorder occurs because there is reduced dopamine release. Dopamine acts on both dopamine D1 and D2 receptors in the neostriatum. D1 receptors are excitatory upon GABAergic neurons that project to the lateral pallidal segment, whereas D2 receptors are inhibitory to GABAergic neurons that project to the medial pallidal segment. The ultimate effect here is that when dopamine release is reduced, there is greater excitation in the medial pallidal segment. This results in greater inhibition from the medial pallidal segment upon its target neurons in the thalamus and frontal lobe, which receives direct input from the thalamus. Other choices are incorrect. Dopamine does not appear to act directly upon the medial pallidal segment; GABA input to the medial pallidal segment is increased, not reduced. Norepinephrine and serotonin appear to play little or no known roles in this mechanism.

A basic mechanism that characterizes a hypokinetic disorder involves: A. Reduced noradrenergic input to the neostriatum B. Increased GABA input to the medial pallidal segment C. Reduced quantities of dopamine onto the neostriatum D. Increased quantities of dopamine released into the medial pallidal segment E. Reduced quantities of serotonin released onto the neostriatum

C. Ventromedial hypothalamus The primary substrate by which limbic structures regulate rage behavior is their output projections to the hypothalamus, which constitutes the primary mechanism for the expression of this form of aggression. The other choices presented in this question receive few or no projections from the amygdala and septal area and, in addition, these regions are not associated with the mechanism governing rage behavior.

A converging target of the efferent projections of the amygdala and septal area that form the anatomical substrate for regulation of rage behavior is the: A. Posterior cingulate gyrus B. Anterior thalamic nucleus C. Ventromedial hypothalamus D. Caudate nucleus E. Ventral tegmental area

B. Posterior hypothalamus and produces cutaneous vasoconstriction, reduced sweating, and shivering

A hypothetical recording of a neuron in the hypothalamus in response to different temperatures is shown in the graph to the right. Based on the response pattern this neuron is likely located in the: A. Lateral hypothalamus and produces cutaneous vasoconstriction, reduced sweating and shivering B. Posterior hypothalamus and produces cutaneous vasoconstriction, reduced sweating, and shivering C. Anterior hypothalamus and produces cutaneous vasodilation, sweating, and reduced metabolism D. Posterior hypothalamus and produces cutaneous vasodilation, sweating, and reduced metabolism E. Anterior hypothalamus and produces cutaneous vasocnstriction, reduced sweating and shivering

C. Subfalcine

A large cerebral hemorrhage has forced the right cingulate gyrus towards the left hemisphere. Identify the herniation: A. Transtentorial B. Uncal C. Subfalcine D. Tonsillar E. Extracranial

B. Aphasia and damage to the medial forebrain bundle

A lesion in the lateral hypothalamus would result in which of the following? A. Hyperphagia and damage to the stria terminalis B. Aphasia and damage to the medial forebrain bundle C. Dysphagia and damage to the stria medullaris D. HTN and damage to the mammillotegmental fibers

A. Premotor cortex Remember Apraxia (Ideomotor) and that a lesion to the premotor cortex would prevent a signal from getting to the primary motor cortex

A lesion in this region results in the inability to complete a skillful movement such as unlocking a door on command. A. Premotor cortex B. Primary motor cortex C. Supplementary motor cortex D. Prefrontal cortex

B. Aphagia—medial forebrain bundle Lesions of the lateral hypothalamus have been associated with aphagia. The major pathway passing through the lateral hypothalamus is the medial forebrain bundle. It contains descending fibers, which arise from different groups of neurons in the lateral hypothalamus and septal area, and ascending fibers that pass to different regions of the forebrain, which also arise from the lateral hypothalamus as well as from the brainstem, including monoaminergic cell groups. The medial hypothalamus is the region that most directly is associated with hyperphagia. Dysphagia is associated with lesions of the lower brainstem and, in particular, neurons associated with cranial nerves IX and X. Hypertension is most closely associated with the posterior hypothalamus and the region of the medial hypothalamus. Lesions of the lateral hypothalamus are not known to result in hypertension. Fever is associated with excitation of the preoptic region and septal area. Lesions of the lateral hypothalamus would most likely not cause major increases in body temperature.

A lesion of the lateral hypothalamus is discovered after an examination in which a magnetic resonance imaging (MRI) scan was performed. Which of the following disorders would likely be present, and which pathway would most likely be damaged? A. Hyperphagia—stria terminalis B. Aphagia—medial forebrain bundle C. Dysphagia—stria medullaris D. Hypertension—mammillotegmental fibers E. Fever—corticohypothalamic fibers

C. Aphagia - medial forebrain bundle Lesions of the lateral hypothalamus have been associated with aphagia. The major pathway passing through the lateral hypothalamus is the medial forebrain bundle. It contains descending fibers, which arise from different groups of neurons in the lateral hypothalamus and septal area, and ascending fibers that pass to different regions of the forebrain, which also arise from the lateral hypothalamus as well as from the brainstem, including monoaminergic cell groups. The medial hypothalamus is the region that most directly is associated with hyperphagia. Dysphagia is associated with lesions of the lower brainstem and, in particular, neurons associated with cranial nerves IX and X. Hypertension is most closely associated with the posterior hypothalamus and the region of the medial hypothalamus. Lesions of the lateral hypothalamus are not known to result in hypertension. Fever is associated with excitation of the preoptic region and septal area. Lesions of the lateral hypothalamus would most likely not cause major increases in body temperature.

A lesion of the lateral hypothalamus is discovered after an examination in which a magnetic resonance imaging scan was done. Which of the following disorders would likely be present, and which pathway would most likely be damaged? A. Hypertension - mammillotegmental fibers B. Fever - corticohypothalamic fibers C. Aphagia - medial forebrain bundle D. Dysphagia - stria medullaris E. Hyperphagia - stria terminalis

C. Narcolepsy The constellation of symptoms described in this case is characteristic of narcolepsy. In narcolepsy, the patient has frequent bouts of sleep during the day, an inability to sleep at night, and loss of muscle tone. Sleep apnea is characterized by an interruption of breathing during sleep, with considerable snoring. A cortical or brainstem stroke would significantly disable the patient, and the symptoms associated with these lesions are totally distinct from those described in this case and would likely involve paralysis and, perhaps, coma. Although depression commonly is associated with problems in sleeping, it does not involve either loss of muscle tone or frequent bouts of sleep during the day as described in this case.

A middle-aged male professor of neuroscience at a northeastern medical school began to experience intermittent episodes of uncontrollable sleep, even while giving lectures to the first-year medical class. At the request of colleagues and students, it was suggested that he see a neurologist in the university hospital. The neurologic examination revealed temporary loss of muscle tone in the trunk and extremities, and in the sleep clinic, he experienced some hallucinations and tended to remain awake at night. The neurologist concluded that the patient was suffering from: A. A brainstem stroke B. A cortical stroke C. Narcolepsy D. Depression E. Sleep apnea

D. Depression The paramedian reticular formation of the caudal pons in the region of the abducens nucleus contains the horizontal gaze center. It serves to integrate cortical and vestibular inputs for the control of conjugate horizontal gaze. Damage to this region would result in loss of coordination of the eyes, causing double vision. The other choices involve regions that are not associated with the regulation of eye movements. Damage to these regions would cause significantly different neurologic deficits that are unrelated to double vision.

A middle-aged male professor of neuroscience at a northeastern medical school began to experience intermittent episodes of uncontrollable sleep, even while giving lectures to the first-year medical class. At the request of colleagues and students, it was suggested that he see a neurologist in the university hospital. The neurologic examination revealed temporary loss of muscle tone in the trunk and extremities, and in the sleep clinic, he experienced some hallucinations and tended to remain awake at night. The neurologist concluded that the patient was suffering from: A. A brainstem stroke B. A cortical stroke C. Narcolepsy D. Depression E. Sleep apnea

C. Narcolepsy

A middle-aged male professor of neuroscience began to experience intermittent episodes of uncontrollable sleep, even while giving lectures to the first-year medical class. At the request of colleagues and students, it was suggested that he see a neurologist in the university hospital. The neuro exam revealed temporary loss of muscle tone in the trunk and extremities, and in the sleep clinic, he experienced some hallucinations and tended to remain awake at night. What is this patient suffering from? A. A brainstem stroke B. A cortical stroke C. Narcolepsy D. Depression E. Sleep apnea

A. Dentate nucleus

A middle-aged male was admitted to the hospital, having suffered a stroke in the region of the cerebellum. The patient presented with loss of ability to produce coordinated movements of the right upper limb. The patient denies loss of balance. A CT scan and MRI of his head revealed a lacunar infarct that was limited to a single structure within the medullary substance of the right cerebellar hemisphere which contributes to the regulation of coordinated movements. Which is the most likely site of the lesion? A. Dentate nucleus B. Fastigial nucleus C. Globose nucleus D. Emboliform nucleus E. Interpositus nucleus

E. Inferior parietal lobule A lesion of the inferior parietal lobule can produce varying forms of agnosias. One form of agnosia associated with a lesion of this region is a finger agnosia where the patient has difficulty in recognizing the different fingers on his hand. Such a lesion is an example of a Gerstmann syndrome, which may also include other syndromes (i.e., agraphia, inability to write; alexia, inability to read; and acalculia, inability to perform calculations). Other regions associated with alternate choices do not relate to the disorder described in this case. The premotor cortex is associated with apraxia, the prefrontal cortex with loss of affective and intellectual functions, the primary somatosensory cortex with paresthesias, and the posterior parietal cortex with sensory neglect and apraxia.

A middle-aged man was referred to a neurologist after he presented with a finger agnosia in which he was unable to recognize the different fingers on his hand. The patient did not present with other neurological signs. Where was the locus of the lesion? A. Premotor cortex B. Prefrontal cortex C. Midline of primary somatosensory cortex D. Posterior parietal cortex E. Inferior parietal lobule

A. Release of serotonin in the dorsal horn of spinal cord Stimulation of raphe magnus neurons in the midline medulla is expected to result in the release of serotonin at their terminals in the dorsal horn and excite (not inhibit) enkephalin-containing interneurons located in the dorsal horn. Enkephalin is released in the dorsal horn, acts on opiate receptors on the terminals of central processes of nociceptive dorsal root ganglion cells, and decreases the release of transmitters involved in nociception (glutamate and substance P). Enkephalin also inhibits the second-order spinothalamic neurons located in the dorsal horn by activating their dendritic opiate receptors. Thus, nociception is attenuated by enkephalins by presynaptic and postsynaptic mechanisms. Acetylcholine is not involved in pain-sensing mechanisms in the spinal cord. Although norepinephrine can activate enkephalin-containing interneurons, it is released by the stimulation of pontine noradrenergic neurons (not central processes of dorsal ganglion cells).

A neuroscientist wanted to design an experiment to investigate the brain mechanisms that regulate pain. This investigator discovered that, when electrical stimulation was applied to the midline of the medulla, pain sensation was attenuated. Which of the following possibilities could account for this observation? A. Release of serotonin in the dorsal horn of spinal cord B. Release of acetylcholine in the substantia gelatinosa C. Release of norepinephrine from the central processes of dorsal root ganglion cells D. Increased release of substance P from the central processes of dorsal root ganglion cells E. Inhibition of enkephalinergic interneurons in the substantia gelatinosa

C. Arnold-Chiari Malformation This is a herniation of brainstem cerebellum through the foramen magnum Encephalocele - Faliure of neuropore closure, can be seen when the baby is born Medulloblastoma - Most common brain tumor in children Cerebellar tumor of the vermis - A herniation would be present, but this doesnt explain the hydrocephalus seen Remember Vermis = Vestibular Syrinx = Fluid filled cyst in the brain

A newborn infant has an obvious spina bifida in the lumbar region with hydrocephalus. XR and CT examination reveals enlargement of the lateral ventricles and a herniation of the brainstem and cerebellum through the foramen magnum. The neurologist concludes that the most likely diagnosis of the infant is: A. Encephalocele B. Medulloblastoma C. Arnold-Chiari Malformation D. Cerebellar tumor of the vermis

B. Frontal cortex The frontal cortex, particularly the prefrontal region, plays an important role in cognitive functions and in the regulation of emotional behavior. Parts of the frontal lobe (i.e., Broca's area) and superior aspect of the temporal lobe (Wernicke's area) mediate the motor and receptive components of speech. Neither the parieto-occipital region nor inferior temporal cortex is directly involved in these functions. The corpus callosum mediates the transmission of information from one side of the cortex to the other, and the caudate nucleus is associated with the cognitive aspects of motor functions.

A patient exhibits a variety of behavioral and language problems, such as a failure to inhibit responses that are socially inappropriate. Such an individual is most likely to have dementia involving the: A. Parieto-occipital region B. Frontal cortex C. Inferior temporal cortex D. Corpus callosum E. Caudate nucleus

D. Hemorrhagic stroke of the left anterior cerebral artery The anterior cerebral artery supplies, in part, the motor and somatosensory neurons associated with the leg region of the cerebral cortex. A stroke involving the left anterior cerebral artery will damage neurons in the left medial sensorimotor region, thus causing weakness and loss of sensation in the right leg. The other choices are incorrect because they involve different regions of the cerebral cortex that are not involved in sensorimotor regulation of the leg region.

A patient exhibits clumsiness, weakness, and somatosensory loss of the right leg. The most likely cause of these symptoms is a: A. Seizure of the left frontal lobe B. Tumor of the left prefrontal cortex C. Tumor of the right cerebellar hemisphere D. Hemorrhagic stroke of the left anterior cerebral artery E. Left frontal lobe concussion resulting from an automobile accident

E. Dorsolateral midbrain An extensive region of the dorsolateral brainstem, extending from the midbrain to the medulla, contains descending forebrain axons associated with the regulation of autonomic functions. Therefore, damage to this region would affect autonomic functions, leading in part to such conditions as Horner's syndrome. The other regions listed as alternate choices contain few if any autonomic neurons.

A patient experiences cardiovascular disturbances, including the presence of Horner's syndrome. A subsequent MRI scan indicated the presence of a brainstem lesion. The most likely locus of the lesion was the: A. Dorsomedial medulla B. Ventromedial medulla C. Dorsomedial pons D. Ventromedial midbrain E. Dorsolateral midbrain

C. Anterior hypothalamus The anterior hypothalamus (and preoptic region) is referred to as a heat loss region. Specialized receptors and the neurons with which they are associated in this region respond to increases in body temperature by discharging, resulting in autonomic changes such as vasodilation and perspiration, leading to a lowering of body temperature. A lesion of this region would disrupt this mechanism and would thus lead to hyperthermia. Other choices in this question include regions where this kind of mechanism is not present, and thus, they are unrelated to thermoregulation in this manner. The posterior hypothalamus is believed to be a heat conservation region where an opposing autonomic mechanism is present, leading to an elevation in body temperature when body temperature decreases below a normal level.

A patient had experienced continuous bouts of hyperthermia (i.e., high temperature) and was seen by a neurologist. A neurological examination suggested the presence of a hypothalamic lesion. The most likely site of the lesion was the: A. Mammillary bodies B. Posterior hypothalamus C. Anterior hypothalamus D. Paraventricular nucleus E. Tuberal region

B. Ventromedial hypothalamus The clinical literature has revealed that tumors present in the ventromedial hypothalamus induce bouts of impulsive, violent behavior (and also obesity). Because it is known that stimulation (i.e., excitation) of the neurons in this region can induce rage behavior in animals such as the cat, it is quite likely that the presence of the tumor causes this kind of behavior because it can have a stimulation-like effect on the neurons in this region. Rage behavior in humans has not been associated with any of the other regions mentioned as alternate choices in this question.

A patient presented with extensive bouts of impulsive, aggressive behavior. A large tumor was discovered in the forebrain region. The likely locus of this lesion was the: A. Lateral hypothalamus B. Ventromedial hypothalamus C. Supraoptic nucleus D. Preoptic region E. Mammillary bodies

A. Parkinson's disease

A patient presented with repetitive involuntary movements of the tongue but no signs of tremor at rest, impoverished movements, or flailing movements at rest. On the basis of the information provided, what is the most likely diagnosis? A. Parkinson's disease B. Hungington's disease C. Tardive disease D. Tourette's syndrome E. Hemiballism

C. Tardive dyskinesia This condition mostly appeared due to prolonged use of anti-psychotic drugs.

A patient presented with repetitive involuntary movements of the tongue but no signs of tremor at rest, impoverished movements, or flailing movements at rest. On the basis of the information provides, what is the most likely diagnosis? A. Parkingson's Disease B. Huntington's Disease C. Tardive dyskinesia D. Tourette's Syndrome E. Hemiballism

C. Tardive Dyskinesia Huntington disease - Degenerative Tardive Dyskinesia - Due to prolonged psychotic drug use Tourettes syndrome - Has a vocal component Hemiballism - Flailing

A patient presented with repetitive involuntary movements of the tongue but no signs of tremor of rest, Impoverished movements, or flailing movements at rest. On the basis of the information provided, what is the most likely diagnosis? A. Parkinsons disease B. Huntington disease C. Tardive Dyskinesia D. Tourettes syndrome E. Hemiballism

C. Tardive dyskinesia Tardive dyskinesia is characterized by repetitive, involuntary movements of the tongue. All of the other diseases mentioned in this question display distinctly different behavioral characteristics and repetitive, involuntary movements of the tongue are not one of them.

A patient presented with repetitive involuntary movements of the tongue but showed no signs tremors at rest, impoverished movement, or flailing movements at rest. On the basis of the information provided, what is the most likely diagnosis: A. Parkinson's disease B. Huntington's disease C. Tardive dyskinesia D. Tourette's syndrome E. Hemiballism

D. Substantia nigra The case described in this question involved a patient with Parkinson disease. In this disease, there is a lesion of the substantia nigra, resulting in a loss of dopamine neurons that project to the caudate and putamen. Lesions of all of the other structures result in different kinds of movement and other disorders (e.g., cortical lesion could result in an upper motor neuron paralysis, depending on the site of the lesion; a caudate lesion is associated with a hyperkinetic disorder; pure lesions limited to the red nucleus have not been clearly identified; and a lesion of the subthalamic nucleus is associated with hemiballism).

A patient presents with a bradykinesia characterized by slowness in movement and a pill-rolling tremor at rest. It was determined that the patient had a brain lesion. The most likely locus of the lesion is the: A. Red nucleus B. Caudate nucleus C. Putamen D. Substantia nigra E. Subthalamic nucleus

D. Basilar pons The disorder described in this case is referred to as a "locked-in" syndrome in which the patient has no movement except eye movements. A large infarct of the basilar pons would cause damage to corticospinal and many corticobulbar fibers associated with cranial nerves. Thus, such a lesion could account for the loss of movements of all limbs and cranial nerve functions except those associated with cranial nerves III, IV, and VI, which control movement of the eyes (that are preserved in this case, thus allowing the patient to move or blink his eyes). Lesions of the dorsal medulla, tegmentum of the pons, and tegmentum of midbrain would not affect corticospinal or corticobulbar fibers. A lesion of the ventromedial medulla would damage corticospinal fibers but would only damage hypoglossal axons and would not affect other cranial nerves. Therefore, such a lesion could not explain the disorder in this case.

A patient presents with a marked loss of all motor functions with the exception of eye movements and autonomic and somatomotor reflexes. An MRI scan provided evidence of a large brainstem lesion. Which of the following regions would correctly reflect the locus of this lesion? A. Dorsal medulla B. Ventromedial medulla C. Tegmentum of the pons D. Basilar pons E. Tegmentum of the midbrain

D. Dopaminergic inputs to the neostriatum This would lead to increased tremor and rigidity = Cog wheeling This patient is suffering from parkinsons disease

A patient presents with reduced facial expression (masked facies), spontaneous movements (bradykinesia) that revealed most clearly when walking, monotonous speech, and increased in muscle tone in the arms, and a rhythmic tremor (4 - 7 Hz) in the fibers, including a pill-rolling tremor. This order can be directly linked to loss of: A. Glutamatergic input from the neocortex to the neostriatum B. GABA-ergic input to the lateral (external) pallidal segment C. Glutamatergic input to the medial (internal) pallidal segment D. Dopaminergic inputs to the neostriatum E. Cholinergic inputs to the neostriatum

C. l-3,4-Hydroxyphenylalanine (l-DOPA) plus a dopamine-decarboxylase inhibitor (Sinemet) The patient described for these questions has Parkinson's disease. It is a hypokinetic disorder characterized by a reduction in spontaneous movements and facial expression, tremor (4 to 7 hertz [Hz]), pill-rolling tremor, and monotonous speech. This disease results from a reduction or loss of dopaminergic input to the neostriatum from the pars compacta of the substantia nigra. One pharmacological approach used for the treatment of Parkinson's disease has been to administer Sinemet, which consists of a mixture of l-3,4-hydroxyphenylalanine (l-DOPA), the precursor of dopamine, coupled with a dopamine-decarboxylase inhibitor. This drug serves as a means of providing dopamine to brain regions, such as the neostriatum, in place of the dopamine that would normally be provided from the pars compacta of the substantia nigra to the neostriatum.

A patient presents with reduced facial expression, spontaneous movements (slower than normal) that are revealed most clearly when walking, monotonous speech, an increase in muscle tone in the arms, and a rhythmic tremor (4 to 7 Hz) in the fingers, including a pill-rolling tremor. Which of the following pharmacological treatment strategies would be most appropriate for this patient? A. Cholinergic (muscarinic) agonist (Pilocarpine) B. GABAA agonist (Muscimol) C. l-3,4-Hydroxyphenylalanine (l-DOPA) plus a dopamine-decarboxylase inhibitor (Sinemet) D. Serotonin reuptake inhibitor (Prozac) E. GABAB agonist (Baclofen)

D. Dopaminergic inputs to the neostriatum The patient described for these questions has Parkinson's disease. It is a hypokinetic disorder characterized by a reduction in spontaneous movements and facial expression, tremor (4 to 7 hertz [Hz]), pill-rolling tremor, and monotonous speech. This disease results from a reduction or loss of dopaminergic input to the neostriatum from the pars compacta of the substantia nigra. One pharmacological approach used for the treatment of Parkinson's disease has been to administer Sinemet, which consists of a mixture of l-3,4-hydroxyphenylalanine (l-DOPA), the precursor of dopamine, coupled with a dopamine-decarboxylase inhibitor. This drug serves as a means of providing dopamine to brain regions, such as the neostriatum, in place of the dopamine that would normally be provided from the pars compacta of the substantia nigra to the neostriatum.

A patient presents with reduced facial expression, spontaneous movements (slower than normal) that are revealed most clearly when walking, monotonous speech, an increase in muscle tone in the arms, and a rhythmic tremor (4 to 7 Hz) in the fingers, including a pill-rolling tremor. This disorder can be directly linked to loss of: A. Glutamatergic inputs from neocortex to the neostriatum B. GABAergic input to the lateral (external) pallidal segment C. Glutamatergic input to the medial (internal) pallidal segment D. Dopaminergic inputs to the neostriatum E. Cholinergic inputs to the neostriatum

C. Subthalamic nucleus

A patient presents with violent involuntary ballistic movements that are jerky and irregular and mainly involve the upper extremity on one side of the body. The lesion was most likely located in the: A. Neostriatum B. Paleostriatum C. Subthalamic nucleus D. Pars reticulata of the substantia nigra E. Claustrum

C. Subthalamic nucleus Hemiballism is associated with a discrete lesion of the subthalamic nucleus. It consists of wild, uncontrolled movements of the distal musculature (limb) on the side contralateral to the site of the lesion. It is believed to constitute a "release" phenomenon in which the pallidal-thalamic fibers, which are inhibitory to ventral anterior and ventrolateral nuclei of thalamus, are prevented from discharging due to the loss of excitatory input from the glutamatergic fibers that arise from the subthalamic nucleus and that project to the medial pallidal segment. The other choices for question 1 are not correct for the following reasons. Lesions of the neostriatum are associated with Huntington's disease and other forms of choreiform movements, which can affect both the upper and lower limb. Lesions of the paleostriatum (globus pallidus) have not been associated with hemiballism; likewise, lesions of the pars reticulata of the substantia nigra have not been associated with hemiballism. The claustrum is not linked to motor functions.

A patient presents with violent involuntary ballistic movements that are jerky and irregular and mainly involve the upper extremity on one side of the body. The lesion was most likely located in the: A. Neostriatum B. Paleostriatum C. Subthalamic nucleus D. Pars reticulata of the substantia nigra E. Claustrum

B. Excitatory input to the medial (internal) pallidal segment Hemiballism is associated with a discrete lesion of the subthalamic nucleus. It consists of wild, uncontrolled movements of the distal musculature (limb) on the side contralateral to the site of the lesion. It is believed to constitute a "release" phenomenon in which the pallidal-thalamic fibers, which are inhibitory to ventral anterior and ventrolateral nuclei of thalamus, are prevented from discharging due to the loss of excitatory input from the glutamatergic fibers that arise from the subthalamic nucleus and that project to the medial pallidal segment. The other choices for question 1 are not correct for the following reasons. Lesions of the neostriatum are associated with Huntington's disease and other forms of choreiform movements, which can affect both the upper and lower limb. Lesions of the paleostriatum (globus pallidus) have not been associated with hemiballism; likewise, lesions of the pars reticulata of the substantia nigra have not been associated with hemiballism. The claustrum is not linked to motor functions.

A patient presents with violent involuntary ballistic movements that are jerky and irregular and mainly involve the upper extremity on one side of the body.The motor dysfunctions characteristic of this disorder can best be accounted for in terms of loss of: A. Inhibitory input to the caudate nucleus B. Excitatory input to the medial (internal) pallidal segment C. Dopaminergic input to the caudate nucleus and putamen D. γ-Aminobutyric acid (GABA)-ergic input to the lateral (external) pallidal segment E. Glutamatergic input to the caudate nucleus

B. Wernicke's

A patient suffers a stork of the left middle cerebral artery and now does not seem to understand written or spoken language. What type of aphasia do they have? A. Broca's B. Wernicke's C. Global D. Transcortical motor

B. Wernicke's area Because of the poor comprehension as well

A patient suffers a stroke of the left middle cerebral artery and now does not seem to understand written or spoken language. What type of aphasia do they have? A. Broca's area B. Wernicke's area C. Global D. Transcortical

C. Mediodorsal nucleus The mediodorsal thalamic nucleus receives converging inputs from limbic structures and projects massively to the prefrontal cortex. Because such extensive inputs to the prefrontal cortex that mediate affective processes from the mediodorsal nucleus were disrupted by the lesion, there is a resulting loss of capacity for the expression of affective responses. None of the other structures relate to affective processes. The ventral anterior and ventrolateral nuclei are associated with motor functions. The pulvinar nucleus is believed to be associated with auditory and visual discrimination learning and perhaps other aspects of learning; the anterior nucleus is more closely associated with memory processes.

A patient was seen by a psychiatrist after he seemed to have lost his ability to show emotional responses. A subsequent magnetic resonance imaging (MRI) scan revealed the presence of a lesion in the thalamus. The most likely locus of the lesion is: A. Ventral anterior nucleus B. Anterior nucleus C. Mediodorsal nucleus D. Pulvinar nucleus E. Ventrolateral nucleus

C. Mediodorsal nucleus

A patient was seen by a psychiatrist after he seemed to have lost his ability to show emotional responses. Subsequent MRI revealed the presence of a lesion of the thalamus. The most likely locus of the lesion is: A. Ventral anterior nucleus B. Anterior nucleus C. Mediodorsal nucleus D. Pulvinar nucleus E. Ventrolateral nucleus

B. reach into a bad containing several test items with right hand and pull out the object that was presented

A picture of a familiar object is flashed in the left visual field of a sit-brain patient, the patient can: A. say what the object was B. reach into a bad containing several test items with right hand and pull out the object that was presented C. Reach into a bag containing several test items with the left hand and pull out the object that was presented D. both A and B E. both A and C

E. both A and C

A picture of a familiar object is flashed in the right visual field of a sit-brain patient, the patient can: A. say what the object was B. reach into a bad containing several test items with right hand and pull out the object that was presented C. Reach into a bag containing several test items with the left hand and pull out the object that was presented D. both A and B E. both A and C

C. Auras: tingling, flashing lights, epigastric sensation, fear, déjà vu event

A simple partial or focal seizure includes: A. Impairment of consciousness B. Some impairment in responsiveness and alertness with amnesia for the event C. Auras: tingling, flashing lights, epigastric sensation, fear, déjà vu event D. Begin synchronously in both cerebral hemispheres E. Subtle neurocognitive deficits such as learning disabilities

A. auras: tingling, flashing lights, epigastric sensation, dear, déjà vu event

A simple partial or focal seizure includes: A. auras: tingling, flashing lights, epigastric sensation, dear, déjà vu event B. impairment of consciousness C. begin synchronously in both cerebral hemispheres D. some impairment in responsiveness and alertness with amnesia for the event

E. medulloblastoma Medulloblastomas are derived from the external granular layer of the cerebellar cortex. Medulloblastomas give rise to posterior vermis syndrome.

A tumor that is derived from the external granular layer of the cerebellar cortex is a(n) ___________. A. astrocytoma B. chordoma C. ependymoma D. germinoma E. medulloblastoma

Behavioral disinhibition may be due to disruption of connections between amygdala and orbitofrontal cortex

ADHD

➢ Often referred to as the molecular unit of currency of intracellular energy transfer ➢ Crucial for most cellular functions including synthesis of proteins, synthesis of membranes, cellular movement, cellular division etc. ➢ Apart from its role in energy metabolism ATP is also a neurotransmitter in both the central and peripheral nervous systems

ATP

"petit mal " seizures -lasts for 30 seconds or less -signs include staring and strange facial movements (child may no realize the seizure is happened) - stars between the ages of 4 and 12

Absence seizures

B. Broca's area

According to the Wernicke-Geshwind model, during speech, the output of Wernicke's area os transmitted to: A. The angular gyrus B. Broca's area C. Primary motor cortx D. Heschl's gyrus E. The plant temporal

area of fusion of the most anterior part of the putamen with the head of the caudate nucleus

Accumbens nucleus

ACh innervates eccrine (merocrine) sweat glands, which respond to heat stress.

Acetylcholine

➢ It is released at all neuromuscular junctions by spinal motor neurons ➢ In the autonomic nervous system it is the transmitter for all preganglionic neurons and for parasympathetic postganglioinic neurons ➢ It is a principal neurotransmitter of the reticular activating system which modulates arousal, sleep and wakefulness

Acetylcholine

Zones: Periventricular & Medial Lesion: Hyperprolactemia; loss GnRH Functions: Control of anterior pituitary, feeding

Acruate nucleus

A. CA1 hippocampal field

After a neuro exam, a 34-year-old man was diagnosed with temporal lobe epilepsy, the focus of which was estimated to be Sommer's sector. This region is associated with the: A. CA1 hippocampal field B. CA3 hippocampal field (c) Dentate gyrus (d) Central nucleus of amygdala (e) Nuclei of the diagonal band of Broca

A. CA1 hippocampal field "Sommer's sector" refers to the CA1 field of the hippocampus. This region of the hippocampus is particularly susceptible to anoxia at birth and to seizure discharges. Accordingly, neuropathology of this region can be noted under conditions where anoxia is likely to occur.

After a neurological examination, a 34-year-old man was diagnosed with temporal lobe epilepsy, the focus of which was estimated to be Sommer's sector. This region is associated with the: A. CA1 hippocampal field B. CA3 hippocampal field C. Dentate gyrus D. Central nucleus of amygdala E. Nuclei of the diagonal band of Broca

C. Medial pontine tegmentum The medial third of the pontine tegmentum contains descending motor fibers that form the medial reticulospinal tract that normally facilitates spinal reflexes and causes increased muscle tone (by exciting mainly gamma motor neurons) when these neurons discharge. Therefore, a lesion of this region would cause a reduction in muscle tone. Other regions listed as alternate choices do not contain descending axons that regulate motor regions of the spinal cord.

After a patient experienced loss of muscle tone, a thorough neurologic examination suggested the presence of a brainstem lesion. The most likely locus of such a lesion was the: A. Ventrolateral medulla B. Ventrolateral pons C. Medial pontine tegmentum D. Medial midbrain tegmentum E. Dorsolateral midbrain tegmentum

A. A sudden change in how brain cells send electrical signals to one another

Although the characteristics of a seizure may differ from person to person, seizures are caused by the same thing: A. A sudden change in how brain cells send electrical signals to one another B. A sudden change in how the spinal cord and brain talk to each other C. A sudden change in blood flow in the brain D. A sudden change in oxygen flow in the body

• Also due to damage to the left angular gyrus. • Involvement of left angular gyrus in alexia and agraphia show its responsible for language related visual input.

Agraphia

• Damage to the left angular gyrus (area of left temporal and parietal cortex just posterior to Wernicke's).

Alexia

A. a sudden change in how brain cells send electrical signal to one another

Although the characteristics of a seizure may differ from person to person, seizures are caused by which same thing? A. a sudden change in how brain cells send electrical signal to one another B. a sudden change in oxygen flow in the body C. a sudden change in blood flow in the brain D. a sudden change in how the spinal cord and brain talk to each other

The hippocampus, along with the entorhinal cortex and amygdala, are involved early on in the course of Alzheimer's dementia, and are typically found to be severely atrophied in the late stages of the disease. The hippocampus in particular is a site of significant formation of both neuritic plaques (collections of dystrophic neurites around a central Aβ amyloid core) and neurofibrillary tangles(intracytoplasmic bundles of filaments containing hyperphosphorylated tau protein that surround or even displace the nucleus of the neuron). Granulovacuolar degeneration (formation of small, clear cytoplasmic vacuoles each containing an argyrophilic granule) are also observed in abundance in the hippocampi of patients with Alzheimer's; and Hirano bodies (eosinophilic inclusion bodies composed primarily of actin filaments) may be observed particularly in hippocampal pyramidal cells.

Alzheimer's Disease

Afferent connections: Substantia innominata, temporal neocortex, medial geniculate nucleus, solitary nucleus, prefrontal cortex, brainstem monoamine neurons, pyriform and olfactory cortices Efferent connections: Medial and lateral hypothalamus, midbrain periaqueductal gray, prefrontal cortex, mediodorsal thalamic nucleus Functions: Fear, regulation of aggression and rage, functions associated with hypothalamus, including feeding, endocrine and autonomic processes Dysfunctions: Emotional disorders, e.g., aggression, rage, and loss of fear; disruption of other functions associated with hypothalamus, e.g., endocrine functions and eating disorders; temporal lobe epilepsy

Amygdala

Result in: -Reduced ability to identify motivational and emotional significance of events -Electrical stimulation of amygdala can lead to emotional attacks (rage) -Rabies virus (especially attacks the temporal lobe) leads to violent behavior

Amygdala lesions

The amygdalae are almond shapes bodies located in bilateral medial temporal lobe. -Deep Within temporal lobes -part of the limbic system Functions: • Essential for emotions including love, friendliness, affection, fear, rage, aggression -Autonomic responses associated with fear -Emotional responses -Proceessing and consolidating memory -Hormonal secretions • Consists of 13 nuclei • Afferents from sensory cortex and thalamus, olfactory system, and hippocampus • Efferents to hypothalamus, periaqueductal gray, striatum and thalamus

Amygdala location & function

B. The lateral nucleus of the hypothalamus

An 66-year-old woman woman who recently suffered a mild stroke starts to show wight loss. You try to get her to eat more but she says she is not hungry. You ask for a CT scan because you expect that the stroke damaged: A. The ventromedial nucleus of the hypothalamus B. The lateral nucleus of the hypothalamus C. The paraventricular nucleus of the hypothalamus D. The medial nucleus of the hypothalamus E. The mammillary body of the hypothalamus

C. Friedrich ataxia Friedreich ataxia is the most common hereditary ataxia, with an autosomal recessive mode of inheritance. It is often associated with chronic myocarditis; other symptoms include muscle weakness, loss of coordination, vision impairment, hearing loss, slurred speech, AND curvature of the spine (kyphoscoliosis). Friedreich ataxia has the same spinal cord pathology (posterior column syndrome) as subacute combined degeneration, which is caused by a vitamin B12 deficiency. Symptoms include loss of tactile discrimination; loss of joint and vibratory sensation; stereoanesthesia; sensory dystaxia; paresthesias and pain; hyporeflexia or areflexia; urinary incontinence, constipation, AND impotence; and Romberg sign. Subacute combined degeneration includes both sensory and motor deficits; amyotrophic lateral sclerosis is a pure motor syndrome; Werdnig-Hoffmann disease is a heredofamilial degenerative disease of infants that affects only lower motor neurons; and Brown-Séquard syndrome is paralysis, ataxia, AND loss of sensation as a result of spinal cord hemisection

An 8-year-old girl is examined by a neurologist who finds the followings deficits: ataxia, marked sensory hypesthesias, kyphoscoliosis, pes cavus, myocarditis, AND retinitis pigmentosa inherited as autosomal recessive trait. What is the name of this disease? A. Amyotrophic lateral sclerosis B. Brown-Séquard syndrome C. Friedrich ataxia D. Subacute combined degeneration E. Werdnig-Hoffmann disease

D. Nucleus ambiguus Swallowing is controlled by neurons of the 9th and 10th cranial nerves, which innervate the pharyngeal and laryngeal muscles. These neurons arise from the nucleus ambiguus, which contributes to the motor outputs of both cranial nerves. The inferior olivary nucleus serves as a relay for information from the spinal cord and red nucleus that is transmitted to the cerebellum and, thus, plays no role in swallowing. The pyramids at the level of the medulla contain mostly corticospinal fibers that control movements of the limbs. The spinal trigeminal nucleus receives inputs from the face associated mainly with pain and temperature. The hypoglossal nucleus regulates movements of the tongue.

An 80-year-old man was brought to the emergency room after complaining of an inability to swallow food. The structure most closely linked to this dysfunction is: A. Inferior olivary nucleus B. Pyramids C. Spinal trigeminal nucleus D. Nucleus ambiguus E. Hypoglossal nucleus

B. Bradycardia Remember posterior hypothalamus is involved in thermoregulation, increased blood pressure and pupil dilation = Sympathetics Hypertension = Increased sympathetics Dry mouth = Increased sympathetics Mydriasis = pupil dilation Bronchodilation = increased sympathetics

An 85-year-old patient comes to the clinic with an acute ischemic stroke. Brain imaging indicates that the posterior hypothalamus was affected. Which of the following symptoms might you expect to see in this patient? A. Hypertension B. Bradycardia C. Dry mouth D. Mydriasis E. Brochodilation

B. Bradycardia

An 85-year-old patient comes to the clinic with an acute ischemic stroke. Brain imaging indicates that the posterior hypothalamus was affected. Which of the following symptoms might you see in this patient? A. Hypertension B. Bradycardia C. Dry mouth D. Mydriasis E. Bronchodilation

A. Supraoptic nucleus Lesions of the supraoptic nucleus (and PVN) affect the release of vasopressin, which under normal conditions projects to the posterior pituitary and ultimately targets the kidneys, resulting in increased water absorption in that organ. Therefore, a lesion of the supraoptic nucleus would block this mechanism and result in increased water intake because of the failure of the kidney to absorb water. Other choices are incorrect because none of the regions mentioned in these choices contain vasopressin neurons.

An elderly male with diabetes insipidus excreted large amounts of urine and also drank extremely large amounts of water. An MRI suggested the presence of a hypothalamic lesion. Which of the following structures was the site of this lesion? A. Supraoptic nucleus B. Lateral hypothalamus C. Posterior medial hypothalamus D. Mammillary bodies E. Lateral preoptic region

C. Stria terminalis The investigator experimentally cut the stria terminalis because it arises from the medial amygdala and projects directly to the rostrocaudal extent of the medial hypothalamus. It serves as a very important source of excitatory input to this region of the hypothalamus. The mammillothalamic tract projects from the mammillary bodies to the anterior thalamic nucleus. The medial forebrain bundle contains ascending and descending fibers that pass through the lateral hypothalamus and do not directly link the amygdala with the medial hypothalamus. The stria medullaris contains fibers that pass mainly from the habenular nuclei to the ventral aspect of the rostral forebrain and has no direct relationship with either the medial hypothalamus or medial amygdala. Ventral amygdalofugal fibers connect mainly the lateral aspects of the amygdala with the lateral hypothalamus and parts of the brainstem. Again, this pathway does not mediate direct inputs from the medial amygdala to the medial hypothalamus.

An experiment was conducted in cats to determine the effects of stimulation of the medial amygdala on the activity of medial hypothalamic neurons. After determining that stimulation of the medial amygdala powerfully excited medial amygdaloid neurons, the investigator sought to further test the relationship between these regions by destroying the major pathway that links these two regions and then testing to see whether stimulation of the medial amygdala no longer affected medial hypothalamic neuronal activity. The most likely pathway that was destroyed by the investigator was the: A. Mammillothalamic tract B. Medial forebrain bundle C. Stria terminalis D. Stria medullaris E. Ventral amygdalofugal fibers

E. Stria terminalis

An experiment was conducted in cats to determine the effects of stimulation of the medial amygdala on the activity of medial hypothalamic neurons. After determining that stimulation of the medial amygdala powerfully excited medial amygdaloid neurons, the investigator sought to further test the relationship between these regions by destroying the major pathway that links these two regions and then testing to see whether stimulation of the medial amygdala no longer affected medial hypothalamic neuronal activity. The most likely pathway that was destroyed by the investigator was the: A. Ventral amygdalofugal fibers B. Mammillothalamic tract C. Medial forebrain bundle D. Stria medullaris E. Stria terminalis

The abnormal execution of multi-jointed voluntary movements characterized by lack of coordination

Ataxia refers to

Located at the junction of occipital, temporal and parietal lobes. Links information from primary and unimodal sensory areasImportant in perception and language.

Anterior Association area

Zones: Medial Lesion: Hyperthermia Function: Lateral anterior thermoregulation & sexual behavior

Anterior Nucleus

Poor regulation of amygdala activity by anterior cingulate and hippocampus

Anxiety disorders

D. Lateral nucleus

As a principal investigator with a team of scientists, you are determined to create a method by which individuals could elect to surgically alter their hypothalamus to control their weight. Which hypothalamic nucleus would cause starvation if it was lesioned or destroyed? A. Paraventricular nucleus B. Mammillary body C. Ventromedial nucleus D. Lateral nucleus E. Posterior nucleus

B. Primary motor cortex (4)

As a research scientist you are doing axonal tracing studies in the thalamus. You decide to inject an anterograde tracer in to the VL and VA nuclei of the thalamus. What is the major output of these nuclei? A. Primary somatosensory cortex (3,1,2) B. Primary motor cortex (4) C. Primary visual cortex (17) D. Cingulate gyrus and other limbic regions E. Primary auditory cortex (41,42)

B. Increased sympathetic stimulation of Beta2 adrenergic receptors D could be an answer as well but B is the better answer Running = increased sympathetics

As heart rate increased during cardiovascular exercise, respiration rate also increases. It is easier to breathe due to brochodilation caused by which of the following? A. Increased parasympathetic stimulation of muscarinic receptors B. Increased sympathetic stimulation of Beta2 adrenergic receptors C. Increased sympathetic stimulation of Alpha1 adrenergic receptors D. Increased sympathetic stimulation of Beta1 adrenergic receptors E. Increased parasympathetic stimulation of nicotinic receptors

B. Increased sympathetic of B2adrenergic receptors

As heart rate increased during cardiovascular exercise, respiration rate also increases. It is easier to breathe due to bronchodilation caused by which of the following? A. Increased parasympathetic stimulation of muscarinic receptors B. Increased sympathetic of B2adrenergic receptors C. Increased sympathetic stimulation of a1 adrenergic receptors D. Increased sympathetic stimulation of B1 adrenergic receptors E. Increased parasympathetic stimulation of nicotinic receptors

Ascending pathways for touch ascend on the same side of the spinal cord that they enter and cross over only at a later stage where they make their final synapse projecting to the thalamus on the contralateral side

Ascending sensory pathways decussate

Cognitive and affective processing disrupted (cingulate and amygdala)

Autism

granule cells

Axons of which cells are called mossy fibers?

pyramidal cells from the Cornu ammonis

Axons of which cells form the alveus - fimbria - fornix system of fibers?

Afferent connections: Brainstem monoamine neurons, in particular dopamine neurons from ventral tegmental area, some inputs from basal ganglia, some inputs from amygdala, from nucleus accumbens to substantia innominata Efferent connections: From nucleus accumbens to ventral tegmental area and to substantia innominata; from substantia innominata to hypothalamus, and to wide areas of cerebral cortex and limbic structures Function: Nucleus accumbens mediates mood states; basal nucleus of Meynert of substantia innominata is cholinergic and is believed to mediate memory functions of cerebral cortex Dysfunction: Dysfunctions of nucleus accumbens may be associated with addictive behavior; damage to basal nucleus of Meynert is associated with Alzheimer's disease

Basal forebrain: nucleus accumbens, substantia innominata

caudate nucleus, putamen, globus pallidus (external & internal segment), Subthalamic nucleus, and Substance nigra The basal nuclei control movements by influencing the motor cortex and have no direct control through descending tracts to the brainstem and spinal cord.

Basal ganglia

C. hippocampus Bilateral ablation of the hippocampus results in the inability to form long-term memories. The hippocampus plays a major role in learning and memory.

Bilateral ablation of the ___________ results in the inability to form long-term memories. A. amygdala B. cingulate gyrus C. hippocampus D. hypothalamus E. ventral tegmental area

alcohol intoxication, hypothyroidism, inherited cerebellar degeneration/ataxia, MS or non metastatic disease cause slowness and slurring of speech (dysarthria), loss of coordination of both arms and a staggering wide based unsteady gait (cerebellar ataxia).

Bilateral dysfunction of the cerebellum

...

Brain regions involved with language

• Lesions in the left inferior frontal region (Broca's area). • Nonfluent, labored, and hesitant speech. • Most also lost the ability to name persons or subjects (anomia). • Comprehension relatively intact. • Most also have partial paralysis of one side of the body (hemiplegia). • awareness of deficit. • If extensive, not much recovery over time.

Broca's aphasia

• left inferior prefrontal lobe in left hemisphere. • Damage leads to deficits primarily speech production (problems with expression).

Broca's area

"flooring Ron" in which they took turns telling jokes. The jokes that made me fall to the ground won the game."

Cataplexy

Abormal brain activity in the motor cortex -Focal onset seizures/parțial seizures -Begin on one side of the brain -localized to one area affected = simple partial Children may experience an "aura" prior to the seizure (involves changes in visual, auditory, or olfactory processing or strange feelings (Euphoria, fright, or deja vu)

Cause of generalized seizure

• Principal cell type is pyramidal cell • Emerges from dentate gyrus at CA4 followed by CA3, CA2 and, CA1 - CA2 and CA4 are transition zones - CA1 and CA3 are principal regions CA3 pyramidal neurons project to brain and CA1 via axon collaterals (Schaffer collaterals) • CA1 pyramidal neurons project to brain and inhibitory neuron (basket cell) back to CA1 neuron • Basket cell inhibits CA1 pyramidal cell via GABA • Mossy fibers from dentate gyrus to CA3 link structures • CA1 pyramidal cells are sensitive to anoxia and temporal lobe epilepsy

Cells of hippocampus

D. Ventroolateral medulla

Central control of cardiovascular function is mediated primarily from: A. Prefrontal cortex B. Dorsomedial pons C. Ventromedial medulla D. Ventroolateral medulla E. Midbrain tectum

• Consists of a unicellular layer of the somata of Purkinje neurons. • This layer is profuse dendritic arborizations of these Purkinje cells and extend towards the surface of the cortex into the molecular layer. • These dendrites are flattened and oriented at right angles to the long axis of the folium - The axons of the Purkinje cells are the only axons to leave the cerebellar cortex. - The majority of these axons do not leave the cerebellar cortex but end in the deep cerebellar nuclei. - Purkinje cells utilize GABA as their neurotransmitter which means that the output of almost the whole of the cerebellar cortex is mediated through the inhibition of cells in the cerebellar nuclei

Cerebellar cortex: Purkinje cell layer

also impair coordination of eye movements and the eyes exhibit a to and fro motion called nystagmus.- Nystagmus is very common in MS and when combined with dysarthria and intention tremor are diagnostic for MS. These three symptoms are called Charcot's triad.

Cerebellar lesions

- Within the white matter above the roof of the forth ventricle lie four pairs of nuclei From medial to lateral the nuclei are: 1. Fastigial nucleus 2. Globose nucleus 3. Emboliform nucleus 4. Dentate nucleus - Dentate nucleus is the largest • Consists of a thin layer of nerve cells folded into a crinkled bag that looks similar to the medulla inferior olivarynucleus from which it receives it afferent input. - The cerebellar nuclei also receive extra cerebellar afferents from the vestibular nuclei, reticular nuclei, pontine nuclei and spinocerebellar tracts. • All by means of collaterals of mossy fibers that are going to the cerebellar cortex. - From within the cerebellum, the nuclei receive dense innervation from the Purkinje cells of the cerebellar cortex itself. - The cerebellar nuclei constitutes the primary source of efferent fibers from the cerebellum to other parts of the brain. - The principle destination of these efferent fibers are the: • reticular and vestibular nuclei of the medulla and pons • red nucleus of the midbrain • ventral lateral nucleus of the thalamus

Cerebellar nuclei

• It is the largest part of the hindbrain. • It originates from the dorsal aspect of the brain stem and overlies the fourth ventricle. • Connected to the brain stem by the: - Inferior cerebellar peduncles joins the medulla - Middle cerebellar peduncles joins the pons - Superior cerebellar peduncles joins the midbrain • The function of the cerebellum is entirely motor and operates at an unconscious level. • Controls - The maintenance of equilibrium (balance) - Influences posture and muscle tone - Coordinates movement

Cerebellum

• Consists of two laterally located hemispheres - These hemispheres are joined at the midline by the vermis - The superior surface lies beneath the tentorium cerebelliwith the superior vermis raised forming the midline ridge. - The inferior vermis lies in a deep groove between the hemispheres. - The surface of the cerebellum is highly convoluted with the folds oriented transversely. - Between the folds lie fissures of different depths with some of these fissures used as landmarks to divide the cerebellum anatomically into three lobes. • Superior surface: - Deep primary fissure • Separates the small anterior lobe from the large posterior lobes • Inferior surface: - The visible posterior-lateral fissure • Demarcates the location of the small regions of the hemisphere (the flocculus) and vermis (the nodule) - Together these form the flocculonodular lobe • The cerebellum controls the maintenance of equilibrium, posture and muscle tone and it coordinates movement. It operates at an unconscious level. • The cerebellum is connected to the medulla, pons and midbrain by the inferior, middle and superior cerebellar peduncles respective.

Cerebellum - External features

- The cortex is highly convoluted that forms numerous transversely oriented folia. - In the cortex lie the cell bodies, dendrites and synaptic connections of the majority of cerebellar neurons. - The cellular organization of the cortex is the same for all regions • Divided histologically into three layers. - The three layers • Outer, fiber rich - molecular layer • Intermediate or Purkinje cell layer • Inner granular layer- Dominated by granule cells - Afferent projections terminate mostly in the cerebellar cortex where they are excitatory to cerebellar cortical neurons. - Afferent projections to the cerebellum arise form • Spinal cord - spinocerebellar • Inferior olivary nucleus -olivocerebellar fibers • Vestibular nuclei -vestibulocerebellar fibers • Pons - pontocerebellar fibers - Fibers enter the cerebellum through one the cerebellar peduncles and proceed to the cerebellar cortex as either as mossy or climbing fibers depending on their origin.• Mossy fibers - all afferents except the inferior olivarynucleus - Mossy fibers branch to supply several folia and end in the granular layer, in synaptic contact with the granule cells. • The axons of the granule cell pass towards the surface of the cerebellar cortex and enter the molecular layer and then bifurcate to produce two parallel fibers that are oriented along the long axis of the folium.

Cerebellum Cortex

• Consists of an - outer layer of gray matter called the cerebellar cortex - inner core of white matter • Made up of largely afferent and efferent fibers that run to and from the cerebellar cortex • Buried deep within the white matter are four pairs of cerebellar nuclei which have important connections with the cerebellar cortex and with certain nuclei of the brain stem and thalamus

Cerebellum: Internal Structure

affects an entire hemisphere of the brain

Complex partial seizure

The expressive and receptive speech areas are intact but the nerve fibers that connect them are destroyed

Conduction aphasia is associated with lesions in

- 3​rd​ type of language disturbance corroborating the concept of distributed processing predicted by Werincke's model - Patients understand words they hear and have no motor difficulties when speaking but can't speak coherently - They typically omit parts of words, substitute incorrect sounds and have difficulties repeating phrases • Damage to pathway connecting Broca's and Wernicke's areas called the arcuate fasciculus. • Comprehension and spontaneous speech are intact but patient not able to repeat words they have just heard.

Conduction aphasiais characterized by

The internal segment of the GP is the upward continuation of the S.N. (pars reticulata).

Connections (Kandel)

B. Nucleus cuneatus First-order neurons mediating conscious proprioception from the body pass from the periphery through the dorsal columns of the spinal cord to the dorsal column nuclei of the lower medulla, where they terminate. Fibers associated with this type of sensation from the upper limbs terminate upon the nucleus cuneatus, whereas fibers associated with the lower limb terminate upon the nucleus gracilis. These nuclei then project their axons to the contralateral thalamus.

Conscious proprioception from the upper limbs to the thalamus is mediated through the: A. Nucleus gracilis B. Nucleus cuneatus C. Spinal trigeminal nucleus D. Inferior olivary nucleus E. Nuclei of reticular formation of rostral medulla

motor system, a pattern of connection in which one neuron receives input from many target cells, common at the output stage of the NS

Convergence

• Surgery for epilepsy: cut the corpus callosum • Major (but not only) pathway between sides. • Connects comparable structures on each side. • Permits data received on one side to be processed in both hemispheres. • Aids motor coordination of left and right side.

Corpus Callosum

...

Cortices

• They are the most abundant afference to the corpus striatum. • They are all glutaminergic and excitatory. • They arise from the entire cerebral cortex. - From sensory and motor cortices to putamen (for motor functions) - From cortical association areas to caudate (for cognitive aspects of movements) • The largest input is from the sensory-motor cortex. They project to the putamen.

Corticostriate afferents

C. Nystagmus Vermal region (fastigial nucleus --> vestibular nucleus --> balance)

Damage to the vermal region of the cerebellum results in: A. Dysdiadochokinesia B. Intention tremor C. Nystagmus D. Dysmetria

Disruptions of normal movement

Disorders in the human cerebellum result in

typical for sensory, a pattern of connection in which one neuron activates many target cells, also common at the input stage of the NS

Divergence

Is the neurotransmitter of the SIF cells

Dopamine

Zones: Medial Lesion: Rage Function: Emotion (rage)

Dorsomedial nucleus

A. There is an impairment in alertness B & D are apart of the simple partial seizures

During a complex seizure: A. There is an impairment in alertness B. There is no impairment of consciousness C. Epigastric sensations are present D. Déja vu sensations

D. Releasing norepinephrine to stimulate enkaplingeric interneurons

During fight-or-flight situations, neurons in the locus cerulean are activated to reduce pain transmission and increase survival. There neurons reduce pain by: A. Directly releasing GABA onto the second-order spinothalamic neurons B. Releasing serotonin which stimulates enkephalin-containing interneurons C. Blocking NMDA receptors to reduce pain-related synaptic plasticity D. Releasing norepinephrine to stimulate enkaplingeric interneurons E. Directly releasing enkephalin to inhibit second-order spinothalamic neurons

EEG represents electric potentials of brain cells & neuron clusters Desynchronized activity occurs during wake period More synchronous activity occurs during sleep sleep EEG useful to diagnose coma from brain death, diagnosis of sleep disorders and epilepsy.

Electroencephalography (EEG)

transient clinical events that result from the abnormal, excessive activity of a more or less extensive population of cerebral neurons which results in a paroxysmal disorganization of one or several brain functions Clinical events are due to an alteration in motor activities, sensation, or consciousness Chronic disorder of brain function characterized by the occurrence of periodic or unpredictable seizures. Affect 2.5 million Americans of all ages. 325,000 children<14 years have epilepsy Approximately 150,000 new cases each year. 1/26 will develop Epilepsy in their lifetime Second most common neurologic abnormality

Epilepsy

Partial (Focal) -Simple: no impairment of consciousness & auras: tingling, flashing lights, epigastric sensation, fear, dejavu -Complex: Some impairment in responsiveness and alertness with amnesia for the event -Evolving to generalized -Etiology: structural abnormalities, cortical dysplasia, focal gliosis Generalized: Begin synchronously in both cerebral hemispheres, May have a family history, Normal exam, normal development, normal imaging studies & Subtle neurocognitive deficits: learning disabilities -Absence, Tonic-Clonic, Atonic, Myoclonic, Tonic, Clonic

Epilepsy classifications

B. Reticular nucleus

Every nucleus of the thalamus sends axons to the cerebral cortex except: A. Anterior nucleus B. Reticular nucleus C. Ventral posterolateral nucleus D. Ventral lateral nucleus E. Medial geniculate nucleus

B. Reticular nucleus

Every nucleus of the thalamus sends axons to the cerebral cortex except: A. Anterior nucleus B. Reticular nucleus C. Ventral posterolateral nucleus D. Ventral lateral nucleus E. Medial geniculate nucleus

posterior region of the left frontallobe, and area later named Broca's area

Expressive aphasia is associated with lesions in

broca's aphasia, no speaking in spite of being able to understand language perfectly

Expressive aphasia is characterized by

- Primary afferent fibers carrying information about touch enter the ipsilateral dorsal column - They ascend ipsilaterally until they reach the medulla

Fibers of the primary ascending pathway for the sense of touch decussate at the levelof the

...

Fibers originating in the external segment of the globes pallid us terminate mainly in the

E. Subthalamus

Fibers originating in the external segment of the globus pallidus terminate mainly in the: A. Substantia nigra B. Ventrolateral thalamic nucleus C. Red nucleus D. Motor cortex E. Subthalamus

D. arcuate fasciculus

Fluent aphasia, paraphrasic errors, and object naming impairment are symptoms associated with a lesion to which of the following? A. corpus callosum B. Broca's area C. Wernicke's area D. arcuate fasciculus

B. The ventral tegmental area

Following a car accident, a 35-year-old woman presents to her physician, her husband indicates that she recently been displaying fearless behavior, as well as an inability to recognize when he is upset at her actions. Her behavior is probably due to damage to: A. The anterior portion of the temporal lobe B. The ventral tegmental area C. The basal ganglia D. The periaqueductal gray

Fornix is largest efferent pathway of hippocampus - Precommissural from subiculum and hippocampus - Postcommissural from subiculum • Postcommissural fornix ends in mammillary body -->thalamus --> cingulate --> hippocampus and amygdala

Fornix

Problems with: divergent thinking, or flexibility and problem solving ability attention and memory difficulty in interpreting feedback from the environment. Perseverating on a response risk taking, and non-compliance with rules , and impaired associated learning

Frontal Meningioma

is the chief inhibitory nerutotransmitter in the CNS. Plays a principle role in reducing neuronal excitability, and it directly responsible for the the regulation of muscle tone

GABA is y-Aminobutric acid

Produced by the entire brain 1. "Grand Mall" or Generalized tonic clonic -Symptoms: unconsciousness, convulsion, muscle rigidity 2. Brief loss of consciousness 3. Myoclonic -Symptoms: sporadic (isolated), jerking movements 4. Clonic -symptoms: repetitive, jerky movements 5. Tonic -symptoms: muscle stiffness & rigidity 6. Atonic -symptoms: loss of muscle tone

Generalized seizures types &symptoms

• Global aphasics have all of the disabilities of Broca, Wernicke, and Conduction combined. • They cannot comprehend, repeat sentences, or speak meaningfully

Global Aphasia

(otherwise known as diffuse hypoxic/ischemic encephalopathy) is the result of a severe hypotensive episode. Among the cells of the central nervous system, neurons are the most vulnerable to ischemia, although glial cells are sensitive as well. Different regions of the brain are also more susceptible than others: the pyramidal cells in the CA1 region of the hippocampus, Purkinje cells in the cerebellum, and pyramidal cells in the cortex are the most susceptible to global ischemia, and can be damaged even if the ischemic episode is short in duration.

Global cerebral ischemia

Tonic-clonic seizures - 5 phases: --the body & limbs of the child will flex, extend and shake - go into a period during which muscles contract and relax -postictal period: child may be sleepy, as well ass struggle with vision and speech, or complain of aches and pains

Grand Mal Seizures

- Parietal areas in one hemispherei) that results in deficits of attention to and awareness of the contralateral side in personal, peripersonal, or extrapersonal space - Defined by the inability of a person to process and perceive stimuli on one side of the body or the environment which is not due to a lack of primary sensory processing - It is MC reported following right brain damage and thus affecting the left side in space - Often presents with extinction which refers to a pts. inability to perceive stimulation onthe contralateral side if simultaneously presented with stimulation on the ipsilateral side - Both attentional and representational theories have been put forward

Hemispatial neglect is a neuropsychological condition affecting spatial processing following damage to

parietal areas in one hemispherethat results in deficits of attention to and awareness of the contralateral side in personal, peripersonal or extrapersonal space.

Hemispatial neglectis a neuropsychological condition affecting spatial processing following damage to

...

Higher order sensory cortex

Afferent connections: Cingulate gyrus, septal area, entorhinal and pyriform cortices, brainstem monoamine neurons Efferent connection: Medial hypothalamus and mammillary bodies, anterior nucleus of thalamus, septal area Functions: Short-term memory processes, modulation of hypothalamic processes, in particular, emotional and endocrine functions Dysfunctions: Temporal lobe epilepsy, short-term memory disorders; aggressive and rage behavior, possible endocrine dysfunctions

Hippocampal formation

•Making new memories •Involved in severe mental illness -Reduced volume in schizophrenia, PTSD, depression •Directly affected by estrogen (Wooley, NWU) •Neurogenesis

Hippocampal formation: why is it important?

• Place cells fire in a specific location (map) • Adopt preferred location within minutes of exposure to a novel environment • Spatial memory is maintained across time

Hippocampal place cells

• Referred to as Ammon's horn • Starts in middle of brain and flares out into temporal lobes • Hippocampal formation includes hippocampus, dentate gyrus, subiculum, presubiculum and area retroplanalis • Four main afferents - Entorhinal cortex - Septal area - Contralateral hippocampus - Neuromodulators • Some septal and hypothalamic fibers reach hippocampus through fornix • Inputs from cingulate, prefrontal, and association areas through entorhinal - Highly processed sensory information - Entorhinal to hippocampus through perforant pathway • Lateral to hippocampus • Medial to dentate gyrus • C-shaped layered structure

Hippocampus Characteristics

Results from congenital absence of ganglion cells in the myenteric plexus

Hirschsprung disease

Consists of anisocoria and lack of sweating

Horner's Syndrome Anisocoria (Unequal pupils) Hemianhidrosis (lack of sweating on half of the face)

Hippocampus

How do we make long-term memories stick?

From the dentate gyrus connections are made to CA3 of the hippocampus proper via mossy fibers and to CA1 via Schaffer collaterals. From these two CA fields information then passes through the subiculum entering the alveus, fimbria, and fornix and then to other areas of the brain.

How is the dentate gyrus linked to the hippocampus proper

• Bilateral removal of hippocampus • Anterograde amnesia for people and events • Epileptic - bilateral removal of hippocampus • Problem with long-term memory storage • Could learn skill (e.g., mirror drawing) • Therefore, multiple forms of memory - Procedural →"knowing how" (Motor skills, Association, Priming cues, & Puzzle solving skills) - Declarative →"knowing what or why" (Daily episodes, words and their meanings, & history)

Human Memory & memory

Huntington's disease excessive movement and decreased muscle tone -excess direct pathway output -insufficient indirect pathway output • This is the most well-known disease associated with degeneration of the striatum. Neuronal degeneration may also occur in the cerebral cortex; such patients suffer from progressive dementia. • The dyskinetic movements are: jerking of the head, grimacing movements in face, smacking of the lips and tongue, and gesticulation of distal parts of upper and lower limbs.

Hyperkinetic disorders

...

Hypothalamic-Pituitary (hypophyseal)Portal System (hypothalamus to anterior pituitary)

...

Hypothalamo-neurohypophyseal Tract (hypothalamus to posterior pituitary)

Neurons discharging abnormally Behaviors characteristics of seizure Behaviors characteristics of seizure type such as body shaking, type such as body shaking, decreased awareness, slumping, or decreased awareness, slumping, or falling

Ictal phase

External capsule

Identify

Tonsil

Identify

middle cerebellar peduncle

Identify

Thalamus

Identify #5

corpus callosum

Identify #6

Hippothalamus

Identify #7

mamillary bodies

Identify #8

Rostrum

Identify A

internal carotid artery

Identify A

superior frontal gyrus

Identify A

Genu

Identify B

Middle frontal gyrus

Identify B

corpus callosum

Identify C

Trunk

Identify D

precentral gyrus

Identify D

Fornix

Identify E

postcentral gyrus

Identify E

Splenium

Identify F

anterior communicating artery

Identify the artery indicated by the arrow

gyrus rectus

Identify the red region

B. Purkinje One layer thick

Identify this layer of the cerebellar cortex A. Molecular B. Purkinje C. Granular

B. Purkinje

Identify this layer of the cerebellar cortex. A. Molecular B. Purkinje C. Granular

E. Leptin The protein leptin is secreted by adipocytes in plasma, circulates in the blood, crosses the blood-brain barrier, and binds to the leptin receptor within the arcuate nucleus, leading to a reduction in food intake. Knowledge of this mechanism has led to the development of several commercially available drugs that have been sold for the purpose of weight reduction. (Please note that the authors of this text do not pass any judgment concerning the effectiveness of such drugs). Other choices involve peptides found in the hypothalamus that have been shown to have an effect on feeding just opposite to that of leptin (i.e., these peptides induce feeding).

If one could develop a drug that could lead to reduced food intake by activating a specific compound, which of the following compounds would the investigator target? A. Galanin B. Neuropeptide Y C. Orexin D. Norepinephrine E. Leptin

B. Tremor + rigidty

In Parkinson's disease, the "cog wheeling property" of limb movements is due to a combination of: A. Hypotonia + tremor B. Tremor + rigidty C. Intentional tremor + hypertonia D. Bradykinesia + intentional tremor

B. medial

In a normal individual, descending axons of neurons in the _________ vestibular nucleus also travel in the MLF and project to the cervical spinal cord for adjustment of head position to assist in maintaining fixation of gaze. A. lateral B. medial C. superior D. inferior

B. Decreased release of norepinephrine from vascular sympathetic terminals

In the rostral ventrolateral medulla (RVLM) there are alpha2 adrenergic receptors on excitatory terminals and on the RVLM projection neurons. On the excitatory terminals these receptors inhibit Ca2+ influx and on the projection neurons they increase opening of K+ channels. Stimulation of the alpha2 adrenergic receptors would produce A. Increased parasympathetic activity in the SA node B. Decreased release of norepinephrine from vascular sympathetic terminals C. Increased activation of the sympathetic ganglia D. Decreased activation of the nucleus ambiguous E. Increased stimulation of vascular alpha1 adrenergic receptors

B. Decreased release of norepinephrine from vascular sympathetic terminals

In the rostral ventrolateral medulla (RVLM), there are a2 adrenergic receptors on excitatory terminals and on the RVLM projection neurons. On the excitatory terminals, these receptors inhibit Ca2+ influx and on the projection neurons, they increase opening of K+ channels. Stimulation of these a2 adrenergic receptors would produce: A. Increase parasympathetic activity in the SA node B. Decreased release of norepinephrine from vascular sympathetic terminals C. Increased activation of the sympathetic ganglia (d) Decreased activation of the nucleus ambiguus (e) Increased stimulation of vascular a1 adrenergic receptors

A. Area 4

In which of the following cortical regions would you expect to find the primary motor cortex? A. Area 4 B. Area 40 C. Area 38 D. Area 17 E. Area 6

Dysmetria refers to

Inaccuracy in range and direction

...

Interpreting language

• Bilateral lesions in the medial temporal lobe, particularly amygdala • Clinical features -Tameness, loss of fear - Facial blunting (lack of response to stimuli) - Hyperphagia (extreme weight gain -Indiscriminate dietary behavior) - Hyperorality (examine objects orally) - Hypermetamorphosis (attend and react to visual stimuli) - Inappropriate sexual behavior (Greatly increased autoerotic sexual activity) - Visual agnosia (inability to visually recognize objects)

Kluver-Bucy Syndrome

Korsakoff syndrome is a disorder in which hippocampal damage results in the inability to both form new memories (loss of anterograde memory) and recall memories made prior to the damage (loss of retrograde memory). It is typically associated with thiamine (vitamin B1) deficiency, which is frequently associated with chronic alcohol abuse and its toxic effects on neurons, particularly those of the hippocampal formation and the Papez circuit (the mammillary bodies, cingulate gyrus, and anterior thalamic nucleus).

Korsakoff syndrome

• Amnestic syndrome due to thiamine deficiency • Associated with poor nutrition (e.g., alcoholism) • Damage to mammillary bodies and dorsomedial nucleus of thalamus • Symptoms include amnesia, attention deficit, disorientation • Recent memory affected more than remote

Korsakoff's Syndrome

retinal, optic tract, visual cortex, optic radiations

LGN is a visual relay nucleus that receives _______ input via the _____ _____. it projects to the primary ______ ______ via the _____ __________

• Stimulation releases glutamate into synaptic cleft • Binds with glutamate receptors on CA1 dendrites - AMPA --> depolarizes membrane through NA+ influx - NMDA --> normally blocked (magnesium) • Depolarization to -35 mV results in magnesium being expelled from NMDA receptor • Glutamate acting on NMDA receptors opens Na+/Ca2+ channel • Ca2+ triggers cascade of events resulting in LTP • Ca2+ activates protein kinases (e.g., PKA, MAPK, CaMKII) - synthesis of proteins and insertion of new AMPA receptors LTP as a memory mechanism • Induced within seconds • Long-lasting (days+) • Labile consolidation period (sensitive to disruption) • Induced at physiological frequencies (e.g., theta range) • Correlates with maze learning• Drugs that block learning block LTP • Enriched environments promote learning and LTP

LTP (long term potential) Mechanism

C. nucleus accumbens

Laboratory animals self-administer microinjections of addictive drugs directly into the: A. basal forebrain B. raphe nucleus C. nucleus accumbens D. hippocampus

• Paul Broca (1861) finds damage to left inferior frontal region (Broca's area) of a language impaired patient, in postmortem analysis. • Broca was the first to provide convincing evidence that language is localized to a particular region of the brain. • In language disorders - 90-95% of cases, damage is to the left hemisphere. - 5-10% of cases, to the right hemisphere.• Wada test is used to determine the hemispheric dominance. - Sodium amytal is injected to the carotid artery. - First to the left and then to the right. • Paraphasia -an incorrect word substituted for an intended or target word • Neologism-spoken words which cannot be identified as having come from the patient's language. • Apraxia is a deficit in planning the desired speech movements and produces errors phonemically similar to the target word, for example saying "yawyer" for "lawyer" • Agraphia- The inability and the loss of the ability to write and spell • Alexia-brain disorder affecting the ability to read

Language disorders

Zones: Lateral Lesion: Aphagia Function: Appetite and body weight control

Lateral Complex

Hunger or Feeding Center Lesions of Lateral: Lose weight aphagia Activated by Increased ghrelin released by empty stomach and decreased blood glucose

Lateral Hypothalamus

• Amygdala is necessary for learned fear - E.g., touching hot stove • Fear conditioning occurs across species • Defensive responses are species specific • Fear conditioning occurs when a cue is predictive of an aversive outcome • Amygdala neurons "learn" to fire to predictive cues • Loss of amygdala function results in impaired fear conditioning

Leanered fear

1. Lateral nucleus: -Hunger center inhibited by Leptin. -Damage leads to Anorexia and Aphagia. 2. Ventromedial nucleus (VMN): -Satiety center stimulated by Leptin -Damage leads to Hyperphagia and Obesity. 3. Anterior Hypothalamus: -Cooling center which senses elevated body temperature amd mediates response to dissipate heat via parasympathetic input. -Damage leads to Hyperthermia. 4. Posterior hypothalamus: -Heating center which senses decreased body temperature and mediates the conservation of heat via sympathetic input. -Damage leads to poikilothermia (inability to regulatetemperature). 5. Mammillary bodies: -Part of the Papez circuit involved in memory. -Damage in Korsakoff syndrome (thalamic deficiency in chronic alcoholism) leading to both anterograde and retrograde amnesia with confabulations. 6. Arcuate nucleus: -Produce releasing hormones and inhibitory factors, which pass through hypophyseal-portal veins to reach anterior pituitary gland. -Dopaminergic projections from arcuate nuclei inhibit prolactin secretion from anterior pituitary. -Damage leads to galactorrhea (milk discharge) and amenorrhea. 7. Preoptic nucleus: -GnRH release which stimulates of LH and FSH. -Damage before puberty leads to arrest of sexual development. -Damage after puberty leads to amenorrhea and impotence. 8. Paraventricular and Supraoptic Nuclei: -Synthesizes neuropeptides ADH and Oxvtocin which are transported via supraopticohypophyseal tract to posterior pituitary and stored there. -Damage leads to diabetes insipidus characterized by Polydipsea and Polyuria. 9. Suprachiasmatic nucleus: -Some of the periodic activities of mammals controlled by the suprachiasmatic nucleus are length and time of sleep, hormone levels, abody temperature, digestive functions, etc. -Damage leads to damage to the periodicity of these activities.

Lesion of Hypothalamus

B. Loss of bimanual coordination Loss of the tactile placing reaction = Cerebellum lesion Difficulties controlling individual finger movements = Primary motor cortex lesion Rigidity = Upper motor neuron lesion (midbrain) Intention tremor = Cerebellum lesion

Lesion of the supplementary motor cx would most likely result in: A. Loss of the tactile placing reaction B. Loss of bimanual coordination C. Difficulties controlling individual finger movements D. Rigiditye. Intention tremor

C. Hyperphagia Lesions of the medial hypothalamus result in a disorder called "hypothalamic hyperphagia," which is characterized by marked increases in food intake and obesity. Aphagia is produced by lesions of the lateral hypothalamus. Diabetes insipidus is associated with lesions of the supraoptic region. Destruction of the medial hypothalamus blocks sexual behavior. Thermal regulation is governed by the anterior (for heat loss) and posterior (for heat conservation) regions of the hypothalamus.

Lesions of the medial hypothalamus will result in: A. Aphagia B. Diabetes insipidus C. Hyperphagia D. Increased sexual behavior E. Failure to regulate body temperature

A. Hyperphagia Lesions of the medial hypothalamus result in a disorder called "hypothalamic hyperphagia," which is characterized by marked increases in food intake and obesity. Aphagia is produced by lesions of the lateral hypothalamus. Diabetes insipidus is associated with lesions of the supraoptic region. Destruction of the medial hypothalamus blocks sexual behavior. Thermal regulation is governed by the anterior (for heat loss) and posterior (for heat conservation) regions of the hypothalamus.

Lesions of the medial hypothalamus will result in: A. Hyperphagia B. Aphagia C. Diabetes insipidus D. Failure to regulate body temperature E. Increased sexual behaviour

A. Hyperphagia Lesions of the medial hypothalamus result in a disorder called "hypothalamic hyperphagia," which is characterized by marked increases in food intake and obesity. Aphagia is produced by lesions of the lateral hypothalamus. Diabetes insipidus is associated with lesions of the supraoptic region. Destruction of the medial hypothalamus blocks sexual behavior. Thermal regulation is governed by the anterior (for heat loss) and posterior (for heat conservation) regions of the hypothalamus.

Lesions of the medial hypothalamus will result in: A. Hyperphagia B. Aphagia C. Diabetes insipidus D. Failure to regulate body temperature E. Increased sexual behaviour

B. Loss of bimanual coordination (a) Loss of the tactile-placing reaction = cerebellum lesion (c) Difficulties controlling individual finger movements = primary motor lesions (d) Rigidity = UMNL (e) Intention tremor = cerebellum lesion

Lesions of the supplementary motor cortex would most likely result in: A. Loss of the tactile-placing reaction B. Loss of bimanual coordination C. Difficulties controlling individual finger movements D. Rigidity E. Intention tremor

Located in the anterior-ventral portion of the temporal lobe, the parahippocampal gyrus. Links emotion with many sensory inputs.

Limbic associated area

• Representation of the world in our brain • Learning is the creation or modification of this representation by experience • Memory traces are stored in the brain through: - Changes in structure or number of synapses - Changes in synaptic strength • Long-term potentiation (LTP)- Changes in synaptic strength- Long-lasting, activity-dependent synaptic enhancement (Bliss and Lomo, 1973)

Limbic function: Memory

Telencephalon: -Orbitofrontal cortex -Cingulate gyrus -Nucleus accumbens -Septal nucleus -Hippocampus -Fornix -Parahippocampal gyrus Amygdala Diencephalon: -Anterior nucleus of thalamus -MD nucleus of thalamus -Mamillary bodies of hypothalamus Midbrain: -Ventral tregmental area (VTA: in midbrain reticular formation) -Dorsal raphe nucleus -Interpeduncular nucleus

Limbic structures

Set of interconnected cortical and subcortical structures that form a border (or limbus) around the brain stem.

Limbic system

• Amygdala - emotions • Hippocampus/dentate gyrus -cognition (long-term memory) • Parahippocampal gyrus - spatial memory • Cingulate cortex - autonomic functions, attentional processing • Fornix - links hippocampus to mammillary bodies and septal nuclei • Hypothalamus - autonomic functions (hormones) • Thalamus - relay to cerebral cortex • Mammillary body - cognition (memory formation) • Pituitary gland - homeostasis (hormones) • Entorhinal and piriform cortex -sensation • Olfactory bulb - sensation (olfaction) • Nucleus accumbens - reward, pleasure, addiction • Orbitofrontal cortex - decision making

Limbic system

Homeostasis (autonomic and endocrine control) Olfaction Memory Emotions and drives

Limbic system functions

...

List the cholinergic basal forebrain nuclei.

• Long-lasting reduction in synaptic efficacy • Small increase in Ca2+ activates protein phosphatases (dephosphorylate proteins) • May be responsible for sculpting nervous system to respond to environment • LTP strengthens synapses critical for performance • LTD weakens synapses that interfere with performance

Long-term depression (LTD)

auditory, inferior colliculus, auditory cortex, auditory radiatons

MGN is an auditory relay nucleus that receives ________ input via the brachium of the ________ __________ and projects to the primary ________ ______ via the ________ __________

- Orbitofrontal cortex - Dorsomedial nucleus of the thalamus - Nucleus accumbens (BC of Ventral Tegmental Area and Medial Forebrain Bundle connections) -Cingulate gyrus -Spetal area -Amygdala -Parahoppocampal gyrus

Maclean's limbic system

-Sleep breather disorders (Sleep Apnea) -Movement Disorders (Restless Leg syndrome) -Parasomnias -Insomnias -Hypersomina

Main sleep disorder Groups

Zones: Medial Lesion: Loss of memory Function: Emotion and short term memory

Mammillary nucleus

C. Both A and B The hippocampal formation and the amygdala are both involved in Klüver-Bucy syndrome.

Match each characteristic with the structure it most appropriately describes. Is destroyed in Klüver-Bucy syndrome A. Amygdala B. Hippocampal formation C. Both A and B D. Neither A nor B

C. Both A and B Both the hippocampal formation and the amygdala are found in the parahippocampal gyrus of the temporal (limbic) lobe.

Match each characteristic with the structure it most appropriately describes. Is located in the temporal lobe A. Amygdala B. Hippocampal formation C. Both A and B D. Neither A nor B

A. Amygdala The amygdala projects via the stria terminalis and via the ventral amygdalofugal pathway. The stria terminalis is the most prominent projection from the amygdaloid complex.

Match each characteristic with the structure it most appropriately describes. Projects via the stria terminalis A. Amygdala B. Hippocampal formation C. Both A and B D. Neither A nor B

A. Amygdala The amygdala receives both direct and indirect olfactory input.

Match each characteristic with the structure it most appropriately describes. Receives direct olfactory input A. Amygdala B. Hippocampal formation C. Both A and B D. Neither A nor B

C. Stria medullaris The stria medullaris (thalami) contains septohabenular fibers (i.e., fibers that project from the septal nuclei to the habenular nuclei). The stria medullaris (singular) should not be confused with the striae medullares (plural). The striae medullares (rhombencephali) arise from the arcuate nuclei of the medulla and are seen on the floor of the rhomboid fossa.

Match the characteristic with the structure it best describes. Consists of septohabenular fibers A. Diagonal band of Broca B. Medial forebrain bundle C. Stria medullaris D. Stria terminalis E. Tractus retroflexus

A. Diagonal band of Broca The diagonal band of Broca is the medial border of the anterior perforated substance. This fiber bundle contains amygdaloseptal and septoamygdalar fibers. The nucleus of the diagonal band projects via the fornix to the hippocampal formation.

Match the characteristic with the structure it best describes. Forms the medial border of the anterior perforated substance A. Diagonal band of Broca B. Medial forebrain bundle C. Stria medullaris D. Stria terminalis E. Tractus retroflexus

D. Stria terminalis The stria terminalis is a major efferent pathway from the amygdala. It projects to the septal area and to the bed nucleus of the stria terminalis.

Match the characteristic with the structure it best describes. Is a major efferent pathway from the amygdala A. Diagonal band of Broca B. Medial forebrain bundle C. Stria medullaris D. Stria terminalis E. Tractus retroflexus

D. Stria terminalis The stria terminalis and the vena terminalis lie in the sulcus terminalis between the thalamus and the caudate nucleus.

Match the characteristic with the structure it best describes. Lies between the thalamus and the caudate nucleus A. Diagonal band of Broca B. Medial forebrain bundle C. Stria medullaris D. Stria terminalis E. Tractus retroflexus

E. Tractus retroflexus The tractus retroflexus contains habenulointerpeduncular fibers that project from the habenular nuclei of the epithalamus to the interpeduncular nucleus of the midbrain tegmentum.

Match the characteristic with the structure it best describes. Projects from the epithalamus to the midbrain tegmentum A. Diagonal band of Broca B. Medial forebrain bundle C. Stria medullaris D. Stria terminalis E. Tractus retroflexus

touch, hearing, proprioception, balance

Mechanoreceptors are involved in sensory coding for the sense of

Bidirectional bundle of myelinated axons(i.e., ascending and descending fibers) that traverses the entire lateral hypothalamic zone. ◼ Fibers enter and leave the MFB at many levels. ◼ Interconnects the septal area, the anterior perforated substance, the hypothalamus, the mesencephalic tegmentum and the autonomic nuclei ofthe brain stem. ◼ Other descending fibers of the MFB endin raphe reticular nuclei and in the solitarynucleus. ◼ Ascending axons from brainstem monoamine-containing neurons (locusceruleus, raphe nuclei, ventral tegmental area) also traverse the MFB on their way to innervate the cerebral cortex. Alongthe way, some terminate in thehypothalamus. ◼ The MFB also interconnects different hypothalamic levels

Medial Forebrain bundle

• Stimulation or separation from cortical structures induces defensive rage behavior (sham rage) • violent alternating limb movements, tail lashing, piloerection, extension of claws, hissing, dilation of pupils • Through projections to dorsal midbrain PAG • Regulated by limbic projections from amygdala, hippocampus, septal area, and prefrontal cortex

Medial Hypothalamus

...

Midbrain cadaver anatomy

a tumor result in loss of postural control and make it impossible to stand or sit without toppling over despite preserved coordination of the limbs. • Because of the pattern of ipsilateraland decussated pathways that enter and leave the cerebellum - unilateral lesions cause symptoms on the same side of the body. This is in contrast to cerebral lesions of the basal ganglia or internal capsule.

Midline lesions of the cerebellum

A. 2 years prior to ECT

Mr. JH had electroconvulsive therapy (ECT) for clinical depression. Over which period would he be expected to show the greatest retrograde memory loss? A. 2 years prior to ECT B. 2-4 years prior to ECT C. 4-8 years prior to ECT D. remote memories (greater than 10years prior)

...

Name the 3 components of the fornix system of fibers.

entorhinal cortex, subicular complex, & dental gyrus

Name the 3 regions comprising the hippocampal formation.

Lateral fissure

Name the structure indicated by the blue arrows

precentral gyrus

Name the structure indicated by the green section

Pareto-occipital sulcus

Name the structure indicated by the purple line

Basilar artery

Name the structure indicated by the red arrow

Cingulate gyrus

Name the structure indicated by the red arrow

Gyrus rectus

Name the structure indicated by the red arrow

Middle cerebral artery

Name the structure indicated by the red arrow

Parahippoccampal gyrus

Name the structure indicated by the red arrow

Superior cerebellar artery

Name the structure indicated by the red arrow

Internal carotid artery

Name the structure indicated by the red circle

Monoamines (also known as "biogenic amines") include three classes of neurotransmitters: Catecholamines Dopamine (DA), norepinephrine (NE, also called noradrenaline) and epinephrine (E, also called adrenaline) make up a class of neurotransmitters named on the basis of the hydroxylated phenol ring termed a catechol nucleus. Indolamines Serotonin (5-hydroxytryptamine; 5-HT); is the principal member of this group of compounds. The name serotonin is derived from the fact that this substance was first isolated from the serum based on its ability to cause an increase in blood pressure. Melatonin, a second indolamine, is restricted to the pineal and is released into the blood stream in a manner that is regulated by the diurnal cycle. Melatonin will not be covered further in this chapter. Histamine Histamine has been recognized as a neurotransmitter in the CNS only within the past fifteen years.

Name the various brainstem areas which provide monoamine neuronal projections to the limbic system. Name the different neurotransmitters associated with these area

caudate and putamen -Receives input from the cerebral cortex and other brain areas and provides output to the basal nuclei.

Neostriatum

Nitric oxide is the transmitter responsible for penile erection.

Nitric oxide

GABA (Gamma-acmino-butyric acid) Galanin Adenosine Melatonin

Non-REM

Norepinephrine innervates apocrine sweat glands; these glands of the axilla and anal region respond to emotional stress. -the neurotransmitter of the errector pili.

Norepinephrine

C. LC

Norepinephrine from __________ causes activation of enkephalin and reduces pain. A. DRN B. LTP C. LC D. NMDA

Corpus striatum Substantia nigra Subthalamus

Nuclei include

When the eyes are at rest, the output nuclei of the basal nuclei inhibits the superior colliculus. Whenever a voluntary saccade is made toward an object of interest, the gaze pathway is activated by area 8; the oculomotor loop of the basal nuclei is activated at the same time to disinhibit the superior colliculus.

Oculomotor loop of the basal nuclei

excite reticular activating system to induce wakefulness. GABA from ventrolateral preoptic nucleus (VLPO) inhibits reticular activating system causing sleep.

Orexin neurons in lateral hypothalamus

D. Synthesized in the paraventricular nucleus (PVN) and released into the posterior pituitary

Oxytocin is: A. Synthesized in the medial hypothalamus and released in the posterior pituitary B. Synthesized in the medial hypothalamus and released in the anterior pituitary C. Synthesized in the paraventricular nucleus (PVN) and released into the anterior pituitary D. Synthesized in the paraventricular nucleus (PVN) and released into the posterior pituitary

...

Pain Modulation by Enkephalin-releasing Interneurons in Dorsal Horn

Forel field H is the name given to the prerubral area of the subthalamus. • Pallidothalamic fibers arise from the internal segment of the globus pallidus and form two tracts: - Fasciculus lenticularis (FL - field H2 of Forel) - Ansa lenticularis (AL) • They both join the cerebellar output fibers (i.e., the dentato-rubro-thalamic fibers) forming the thalamic fasciculus (field H1 of Forel). Anatomical relation of pallidothalamic fibers to internal capsule These pallidothalamic fibers can be damaged by a capsular infarct.

Pallidothalamic fibers

• Transforms sensory experience into emotional response - Emotional expression (behavioral, autonomic) - Emotional experience (affect) - Emotional coloring (Neocortex) • Limbic lobe and Papez Circuit together • Distinguishes human emotions and responses to situations ("emotional brain")

Papez Circuit Pathways

D. Fornix

Papez circuit provides the anatomic substrate for the integration of cognitive, emotional, and expressive brain activities. Which of the following fiber tracts participates in paper circuit as main pathway from entorhinal cortex to hippocampal formation? A. Mossy fiber system B. Mesostriatal fibers C. Preforant path D. Fornix E. Alveus fibers

cingulate, parahippocampal

Paralimbic cortex forms a ring on the medial aspect of the brain consisting mainly of _____ and _____ gyri.

Zones: Periventricular & medial Lesion: Diabetes insipidus Function: FLuid Balance, milk let-down, parturition, autonomic & anterior pituitary control

Paraventricular nucleus

Hypokinetic disorder • 4 cardinal signs: - Akinesia, bradykinesia, hypokinesia - Resting tremor - Hypertonia manifested as rigidity • Lead-pipe rigidity - no tremor present • Cog-wheel rigidity - tremor present - Impaired postural reflexes • Other signs - Micrographia - Hypophonia - Dysarthria - Poker face (mask-like) - Pill-rolling movements • Gait and posture- Forward stoop (due to rigidity of trunk flexor - unexplained predilection ! !) - Simian posture (absent arm swing with forearm internally rotated) - Shuffling gait (festinating gait)

Parkinson's disease

Results from increased parasympathetic stimulation

Peptic ulcer disease

- Pts. sense the presence of a missing limb and this is often associated with pain- Phantom sensations have often been attributed to impulses entering the spinal cordfrom the scar of the nervous tissue in the stump- Imaging studies of somatosensory cortex, however, suggest that phantom sensations arerelated to a rearrangement of cortical circuits

Phantom pain sensations in amputees

• Contributes to peripheral sensitization

Phosphorylation regulates TRPV1 activity

A. Wernicke's area

Poor comprehension of speech and difficulty in finding the right words are symptoms associated with a lesion to which of the following? A. Wernicke's area B. arcuate fasciculus C. Broca's area D. corpus callosum

Patient may be confused , disoriented, or fatigued disoriented, or fatigued Patient may sleep Patient may sleepToddTodd''s paralysis

Post ictal phase

Zones: Medial Lesion: Hypothermia Function: Thermoregulation

Posterior Nucleus

• Lesion of left A. 5, 7- Agnosia-"not knowing." - Astereognosia -the inability to identify an object by active touch of the hands without other sensory input .- Agraphesthesia: inability to recognize characters drawn on the skin, a form of tactile agnosia . - Associative Agnosia- can perceive and draw objects, but they cannot name - Apperceptive agnosia -unable to draw objects, but remarkably can still name them - Dyscalculia: impairment of mathematical ability

Posterior parietal lobe damage (A. 5, 7)

• Lesion of right (non-dominant) A. 5, 7 - contralateral neglect syndrome: patient ignores all stimuli coming from the left. Will deny that his left limb is his own. - constructional apraxia: inability to copy a figure, often leaving out the left side. - spatial problems: poor map reading, difficulty in dressing - Prosody defects-speech with no affect, inability to interpret intonation of speech. - denial of deficits

Posterior parietal lobe damage (A. 5, 7)

D. sweat glands

Postganglionic sympathetic cholinergic fibers innervate the ________________________. A. detrusor B. ductus deferens C. lacrimal gland D. sweat glands E. trigone of the urinary bladder

Patient may experience an aura, or Patient may experience an aura, or premonition of seizurepremonition of seizurePatient may exhibit strange behavior

Pre Ictal Phase

Afferent connections: All parts of cerebral cortex, mediodorsal thalamic nucleus, brainstem monoamine neurons Efferent connections: Mediodorsal thalamic nucleus, hypothalamus, midbrain periaqueductal gray Functions: Cognitive, autonomic, and emotional processes, including the control over aggression and rage Dysfunctions: Loss of control over emotional processes, autonomic functions, flat personality, memory and intellectual deficits

Prefrontal cortex

Anterior association area.Links information from other association areas. Important in memory, planning, and higher-order concept formation

Prefrontal cortex

Zones: Medial & Lateral Lesion: Loss of GnRH Function: Lateral anterior thermoregulation & sexual behavior

Preoptic nucleus

B. Multiple Sclerosis

Presentation of dysarthria, nystagmus, and intention tremor is called Charcot's triad and may be indicative of what condition? A. Horner's Syndrome B. Multiple Sclerosis C. Parkinson's Disease D. Cerebellar ataxia

Face blindnessLesions of the visual posterior association area

Prosopagnosia

Acetylcholine Glutamae GABA Glycine (Muscles atonia)

REM

Also called paradoxical sleep EEG patterns similar to being awake High frequency, low voltage, desynchronized Most intense dreams Inhibition of all skeletal muscles except eyes & diaphragm young>adults Rehearsal and organization of recently experienced events (consolidation)

REM Characteristics

Rapid eye movement sleep, a recurring sleep stage during which vivid dreams commonly occur. Also known as paradoxical sleep, because the muscles are relaxed (except for minor twitches) but other body systems are active. -State of high brain metabolic and neuronal activity rates -Reduced muscle tone, muscular re-generation -Memory composition & development of neuromotor systems -average length 70 - 100 minutes

REM sleep

B. Pons

Rapid eye movement (REM) sleep is believed to originate in the: A. Caudal medulla B. Pons C. Midbrain D. Lateral hypothalamus E. Medial thalamus

B. Pons Electrophysiological studies have indicated that rapid eye movement (REM) sleep originates in the pontine reticular formation. Activation of this pathway modulates cortical activity in association with REM sleep. Other choices include regions that have never been associated with induction of REM sleep. The caudal medulla contains few reticular formation neurons, and the general region of the caudal medulla contains cell bodies and axons associated with transmission of sensory information to higher regions, cranial nerve function, and descending fibers to the spinal cord. The midbrain contains neurons comprising part of the reticular formation but lacks the cholinergic cell groups essential for generation of REM sleep, which is characteristic of those present in the pontine reticular formation. The lateral hypothalamus is associated with visceral processes, such as feeding, and contains ascending and descending fibers associated with limbic structures and monoaminergic systems that are unrelated to REM sleep. The medial thalamus is concerned with the transmission of impulses mainly to the frontal lobe and has no known relationship to REM sleep.

Rapid eye movement (REM) sleep is believed to originate in the: A. Caudal medulla B. Pons C. Midbrain D. Lateral hypothalamus E. Medial thalamus

Is a painful vasospastic disorder affecting the digits

Raynaud's disease

• Primary visual cortex to left angular gyrus, which transmits visual code to auditory code. • Then to Wernicke's area to arcuate fasciculus to Broca's to primary motor cortex to articulatory areas.

Reading aloud

Wernicke's areadifferent type of language disorder, speak fluently but not understand the language

Receptive aphasia

left ​posterior part of the cortex where the temporal meets the parietal and occipital, area later named as Wernicke's area

Receptive aphasia is associated with lesions in

-Sensation of pain in somatic zone from visceral organ -The pain from a myocardial infarction is often felt in left arm for example -Convergence of viscera and somatic pain afferents on wide dynamic range neurons in dorsal horn -The brain confuses the sources of pain

Referred pain

pain arising from deep visceral structures is felt at sites on the surface of the body. For example, pain stimuli arising due to myocardial ischemia are felt radiating to the sternum, arms, and wrists. This is called referred pain. One explanation for this phenomenon is that the sensory pain fibers innervating the heart follow the sympathetic innervation of this organ back to the spinal cord, and their cell bodies are located in thoracic dorsal root ganglia at T1 through T5. The neuronal cell bodies supplying the dermatomes of the upper thorax and upper limbs are also located in the same dorsal root ganglia (T1 through T5) and synapse on the same second-order neurons in the spinal cord segments (T1 through T5) where cardiac sensory pain fibers synapse. Because of this anatomical arrangement, the CNS structures involved in the perception of the pain sensations cannot clearly differentiate between the pain signals arising from the visceral organs and the dermatomes of the upper thorax and upper limbs, so the pain sensation is incorrectly ascribed to the aforementioned dermatomes instead of to a deeper visceral structure. This is because the inputs from the cutaneous nociceptors are more abundant than those from the visceral nociceptors.

Referred pain

• Primary auditory cortex to Wernicke's area where comprehended. • To respond, concept generated in Wernicke's area, goes via arcuate fasciculus to Broca's area, then to primary motor cortex and articulatory areas (face, lip, and tongue muscles, voice box, and muscles assoicated with lungs).

Responding to a heard question

B. The nucleus accumben is a component of the ventral striatum

Select the correct statement concerning the anatomy of the basal nuclei A. The caudal continuation of the internal pallidal segment is the subthalamus B. The nucleus accumben is a component of the ventral striatum C. The caudate nucleus is the tailed nucleus situated on the lateral side of the internal capsule D. The nucleus accumbent appears to be continuous with the tail of the caudate nucleus

Afferent connections: Hippocampal formation, hypothalamus, brainstem monoamine neurons Efferent connections: Hippocampal formation, medial hypothalamus, including mammillary bodies Functions: Modulates aggression and rage and other functions of the hypothalamus; also serves as a relay of hippocampal formation to hypothalamus Dysfunctions: Emotional disorders, including rage and aggression, and related functions of hypothalamus

Septal area

A. GABA

Serotonin from DRN causes ____________ release. A. GABA B. enkephalin C. glutamate D. norepinephrine

...

Sleep transitions from Wake neurotransmitters

the density of innervation

Somatotopic neural maps reflect

sees nothing

Split Brain Operation and Behavioral Testing A Hammer is Flashed in the LEFT visual field of a split brain patient.

see apple

Split Brain Operation and Behavioral Testing An apple is shown to the split brain patient in their RIGHT visual field.

...

Stages of sleep waves

D. Serotonin

Stimulation of the area labeled with the red arrow can reduce pain transmission. The decrease in pain is produced by activation of GABAergic interneurons in the dorsal horn by: A. Norepinephrine B. Enkephalins C. GABA D. Serotonin E. Acetylcholine

Zones: Medial Lesion: Loss of hormonal rhythms Function: Biological rhythms

Suprachiasmatic nucleus

Zones: Medial, lateral Lesion: Diabetes insipidus Function: Fluid balance, milk let-down, parturition

Supraoptic regulation

D. Posterior medial hypothalamus The posterior medial hypothalamus is referred to as the ergotropic triangle of the hypothalamus and is the region where surgical lesions have been placed to cause reductions in blood pressure. Lesions of this region also reduce aggressive and related forms of emotional responses. Presumably, the sites of the lesions serve to disrupt many of the descending fibers from the medial hypothalamus to the midbrain periaqueductal gray (PAG) matter and lower regions of the brainstem that integrate forebrain control of sympathetic activity as well as rage and violent forms of behavior. The preoptic region, lateral hypothalamus, and supraoptic nucleus have not been known to cause increases in blood pressure and are not associated specifically with the control of rage behavior. The preoptic region is closely associated with temperature regulation, the lateral hypothalamus is associated with feeding and predatory behavior, and the supraoptic nucleus is associated with control of functions of the posterior pituitary.

Surgical lesions designed to reduce blood pressure and associated emotional behavior were placed in the: A. Medial preoptic region B. Lateral preoptic region C. Posterior lateral hypothalamus D. Posterior medial hypothalamus E. Supraoptic nucleus

Posterior medial hypothalamus is the ergotropic hypothalamus it controls blood pressure and aggression Preoptic controls temperature Supraopti controls the posterior pituitary

Surgical lesions designed to reduce blood pressure and manifestations of violent and related emotional responses in schizophrenic patients have been made in the:

C. Activation of adenylate cyclase

Sympathetic nerves cause relaxation of the bladder by: A. Inhibition of intracellular Ca2+ release B. Activation of phospholipase C C. Activation of adenylate cyclase D. Inhibition of adenylate cyclase E. Activation of L-type Ca2+ channels in the membrane

Sleep paralysis Cataplexy Disrupted sleep Sleepiness Hypnagogic Hallucinations

Symptoms of narcolepsy

is characterized by recurrent, unprovoked seizures which originate from the temporal lobe, arguably the most epileptogenic region of the brain. These seizures can be either focal aware seizures (simple partial seizures which occur without loss of awareness), and focal impaired awareness seizures (complex partial seizures with loss of awareness), although generalized seizures can also occur. The CA1 field of the hippocampus, known as Sommer's sector, is particularly susceptible to the anoxia that can occur during temporal lobe epilepsy; this can be associated with agitation or aggression, anger, anxiety paranoia, and other emotional phenomena.

Temporal lobe epilepsy

posterior thalamoperforating arteryclassic signs: contralateral hemiparesis, contralateral hemianesthesia, elevated pain threshold, spontaneous/agonizing/burning pain (hyperpathia), and athetotic posturing of the hand (thalamic hand)

Thalamic syndrome (Dejerine and Roussy) usually caused by occlusion of a

E. Tonsils

The MRI of a 30-year-old man reveals a tumor compressing the contents of the posterior cranial fossa. Which of the following cerebellar structures could herniate through the foramen magnum because of space occupying lesion? A. Uvula B. Lingual C. Flocculus D. Nodule E. Tonsils

E. Anterior limb of the internal capsule

The MRI of a 50-year-old man shows a large tumor invading the head of the caudate nucleus. The anterior portion of the putamen and a fiber bundle located between these two structures. Which is the fiber bundle? A. posterior limb of the internal capsule B. external capsule C. Posterior commissure D. Anterior commissure E. Anterior limb of the internal capsule

The answer is A: Anterior. The anterior nucleus of the dorsal thalamus receives input from the mammillary nucleus and other areas and projects to the cingulate gyrus. These are parts of a major pathway that functions in emotions and behavior; it is a large part of the Papez circuit. The centromedian nucleus has projections to the basal nuclei, subthalamus, and substantia nigra, functioning in concert with the basal nuclei. The dorsomedial projects to wide areas of the frontal lobe including its orbital aspect. Somatosensory information from the face and oral cavity is relayed to the face area of the postcentral gyrus; the ventral lateral nucleus receives input from the cerebellum and basal nuclei and projects to the somatomotor cortex (precentral and anterior paracentral gyri).

The MRI of a 53-year-old man reveals a lacunar infarct in the area of the thalamus that selectively projects to the cortical region indicated by the arrows in the image below. Which of the following thalamic nuclei represents the most likely location of this man's lesion?

▪Frontal Granular CortexLateral Prefrontal Association Area ------ 9, 10, 46 judgement, foresight, problem solving Orbitofrontal Cortex------ 11, 12, 47 emotion, olfaction, personality ❖Case of Phineas Gage

The Prefrontal Cortex Areas

B. Anterior commissure

The ____________________ contains fibers connecting the two temporal lobes. A. Globus Pallidus B. Anterior commissure C. Insula D. Internal Capsule

C. Memory for the emotional significance of experiences

The amygdala is thought to play a role in: A. Object recognition memory B. Memory for time C. Memory for the emotional significance of experiences D. Space and working memory E. Memory for language

B. Primary fissure Horizontal fissure = in superior inferior lobe Central fissure = in cerebrum

The anterior lobe of the cerebellum is separated from the posterior by the: A. Horizontal fissure B. Primary fissure C. Central fissure D. Posterolateral fissure

olfactory nuclei, amygdalae

The anterior portion of the anterior commissure connects the _____ on both sides of the brain, while the posterior portion of the anterior commissure connects the _____ of the left and right anterior temporal lobes.

A collection of subcortical nucleithat receive direct projections from much of the neocortex including sensory, motor and association areas involved in cognition, motivation and emotion

The basal ganglia

- Personal spacei) (one's body) - Peripersonal spacei) (near space-within arm's length) - Extrapersonal spacei) (far space-beyond arm's length)

The brain's representations of space in body-centered reference frames can be subdivided into

D. Inferior frontal gyrus

The broca's area is located in which of the following gyri?a A. Precentral gyrus B. Postcentral gyrus C. Superior temporal gyrus D. Inferior frontal gyrus E. Angular gyrus

C. Identify the various properties of cerebral dominance Much of the knowledge we have recently obtained concerning cerebral dominance has come from studies of patients whose corpus callosum has been cut to reduce the spread of seizure activity. These patients have been ideal subjects for determining which side of the cerebral cortex is dominant with respect to a variety of functions such as music, language, mathematics, and spatial perception. The corpus callosum plays a minimal role in transferring visual information and information concerning movements of the fingers. Removal of the corpus callosum is not necessary to characterize the different areas of the cortex that mediate speech functions. Also, sectioning of the corpus callosum would not serve any purpose in examining thalamocortical connections, which typically involve relationships on the same side of the brain.

The corpus callosum of each of 20 patients was severed to reduce the spread of seizure activity. The patients were then asked to participate in a research study to identify specific features of brain function. The most likely purpose of this study was to: A. Identify the different areas of the cortex that mediate speech functions B. Identify how the corpus callosum mediates visual functions C. Identify the various properties of cerebral dominance D. Identify the cortical sites mediating movement of the fingers E. Characterize thalamocortical relationships

A. Diffusely throughout the structures of the brain that participated in the original experience

The current consensus is that memories of experiences are likely stored: A. Diffusely throughout the structures of the brain that participated in the original experience B. Throughout the hippocampus C. In the CA1 subfield of the hippocampus D. In the diencephalon (e) In the rhinal cortex

A. Simple partial seizure Absence seizure, Tonic-clonic seizures and Grand mal seizures are all apart of Generalized seizures Post ictal stupor occurs immediately AFTER a seizure

The epileptic "aura" is most often associated with which of the following? A. Simple partial seizure B. Absence seizure C. Tonic-clinic seizure D. Grand mal seizure E. Post-ictal stupor

A. simple partial seizure

The epileptic "aura" is most often associated with which of the following? A. simple partial seizure B. absence seizure C. grand mal seizure D. tonic clonic seizure

B. Central Sulcus

The frontal lobe occupies the area in front of the ___________________ and above the lateral fissure. A. Precentral Gyrus B. Central Sulcus C. Occipitoparietal Sulcus D. Temporal Lobe

C. Superior temporal gyrus Pre-central gyrus - Area 4 Inferior frontal gyrus - Brocas area (44 & 45)

The hearing cortical area (Heschl gyrus) is located at: A. Precentral gyrus B. Inferior frontal gyrus C. Superior temporal gyrus D. Angular gyrus E. Superior frontal gyrus

C. Superior temporal gyrus (a) Precentral gyrus = Area 4 (b) Inferior frontral gyrus = Broca's 44/45 (d) Anglar gyrus = Language (e) Superior frontal gyrus = motor association, prefrontal cortex

The hearing cortical area is located at: A. Precentral gyrus B. Inferior frontral gyrus C. Superior temporal gyrus D. Anglar gyrus E. Superior frontal gyrus

memory

The hippocampus is most associated with:

E. All of the above

The hypothalamohypophyseal tract: A. Contains hormones packaged as granules B. Results in diabetes insipidus when severed C. Is involved in the milk letdown reflex D. Transmits nerve impulses that result in hormonal release E. All of the above

A. Cerebral cortex The largest input to the neostriatum arises from the cerebral cortex and its actions upon neurons in the neostriatum are excitatory because the neurotransmitter released by these cortico-striatal fibers is glutamate. The other choices in this question include structures with no known projections to the neostriatum.

The largest afferent source of excitatory fibers that supply the neostriatum includes which of the following: A. Cerebral cortex B. Globus pallidus C. Red nucleus D. Subthalamic nucleus E. Amygdala

A. Cerebral cortex

The largest afferent source of excitatory fibers that supply the neostriatum includes which of the following? A. Cerebral cortex B. Globus pallidus C. Red nucleus D. Subthalamic nucleus E. Amygdala

A. layer 1

The lateral geniculate nucleus contains six layers, which all have different function. Which layer(s) of the lateral geniculate nucleus will be responsible for the detection of motion from the contralateral eye? A. layer 1 B. layer 4 C. layer 2 D. layer 3

A. Involves a synaptic change similar to the synaptic change that has been hypothesized to be the basis of memory storage

The main reason why LTP is one of the most widely studied neuroscientific phenomenon is that it: A. Involves a synaptic change similar to the synaptic change that has been hypothesized to be the basis of memory storage B. Can easily be studied in humans C. Involves readily accessible neocortical circuits D. Occurs in only mammals E. Can be induced by both electrical and chemical stimulation

B. V-VI

The major outputs to the spinal cord, thalamus, and neostriatum arise in layers _________. A. III-V B. V-VI C. I-III D. IV-VI

anterior

The mammillothalamic tract travels from the hypothalamus to the _____ nucleus of the thalamus.

A. alcohol abuse Anterior vermis syndrome is a result of chronic alcohol abuse. Patients have dystaxia of the lower limb and trunk. Posterior vermis syndrome involves the flocculonodular lobe; it is most frequently caused by an ependymoma or a medulloblastoma. Patients have truncal dystaxia. Hemispheric syndrome usually is the result of a tumor (astrocytoma) or abscess; patients have arm, leg, trunk, AND gait dystaxia.

The most common cause of anterior vermis syndrome is _______________. A. alcohol abuse B. an abscess C. a tumor D. lead intoxication E. vascular occlusion

A. an astrocytoma Astrocytomas (30%) are the most common cerebellar tumors in children, followed by medulloblastomas (20%) and ependymomas (10%).

The most common cerebellar tumor in children is ______________. A. an astrocytoma B. an ependymoma C. glioblastoma multiforme D. medulloblastoma E. oligodendrocytoma

Fastigial nuclei

The most medial of the cerebellar nuclei are called

B. a1 adrenergic receptor of phospholipase C

The reduced blood flow in this woman's fingertips is caused by which of the following effects on vascular smooth muscle? A. a1 adrenergic receptor inhibition of intracellular Ca2+ release B. a1 adrenergic receptor of phospholipase C C. B2 adrenergic receptor activation of protein kinase A D. a1 adrenergic receptor activation of protein kinase A E. B2 adrenergic receptor activation of Ca2+ L-type channels in the membrane

- They receive inputs from a variety of sources in the spinal cord and brain stem - They project to medial temporal lobe structures including the amygdala and hippocampus but also send projections to components of the basal ganglia and cerebellum - They are thought to mediate cortical arousal and to participate in the integration of sensory submodalities

The nonspecific nuclei of the thalamus

They receive inputs from a variety of sources in the spinal cord and brain stem - They project to medial temporal lobe structures including the amygdala and hippocampus but also send projections to components of the basal ganglia and cerebellum - They are thought to mediate cortical arousal and to participate in the integration of sensory submodalities

The nonspecific nuclei of the thalamus

C. color; motion

The parvocellular system is specialized for responding to _________, the magnocellular for responding to _________. A. form; color B. brightness; contrast C. color; motion D. peripheral vision; dark adaptation

Uncinate fasciculus

The pathway that leaves the amygdala anteriorly and connects it to the orbitofrontal cortex and cingulate gyrus is called the:

B. Subicular cortex The "postcommissural fornix" refers to those hippocampal fibers that arise from the subicular cortex and innervate several regions of the diencephalon. These regions include the anterior thalamic nucleus, mammillary bodies, and the ventromedial region of the hypothalamus (medial corticothalamic tract in rodents). The hippocampus (i.e., cornuammonis) does not contribute to the postcommissural fornix, but only to the precommissural fornix and to commissural fibers of the fornix. The dentate gyrus does not project outside of the hippocampal formation. The septal area and entorhinal cortex do not contribute any fibers to the postcommissural fornix.

The postcommissural fornix arises from the: A. Hippocampus B. Subicular cortex C. Dentate gyrus D. Entorhinal cortex E. Medial septal nucleus

E. Medial septal nucleus

The postcommissural fornix arises from the: A. Hippocampus B. Subicular cortex C. Dentate gyrus D. Entorhinal cortex E. Medial septal nucleus

- Multisensory integration in the body-centered reference frames (important for body ownership and agency) - Feel the sense of touch and have a motor response to relate that to where you are in space & also the feeling that you have control over your movement

The posterior parietal cortex is known for its role in

D. floculonodular lobe, posterior lobe

The posterolateral fissure separates the __________ from the __________. A. anterior lobe, posterior lobe B. No answer text provided. C. floculonodular lobe, anterior lobe D. floculonodular lobe, posterior lobe

The majority of its neurons use the inhibitory transmitter GABA. It modulates activity in other thalamic nuclei based on its monitoring of the entirety of the thalamocortical stream of information

The reticular nucleus of the thalamus

C. GABA.

The predominant neurons of the striatal system contain: A. acetylcholine. B. dopamine. C. GABA. D. glutamate. E. serotonin.

the anterior and posterior lobes which together form the body of the cerebellum

The primary fissure of the cerebellum separates

A. anterior lobe, posterior lobe

The primary fissure separates the __________ from the __________. A. anterior lobe, posterior lobe B. No answer text provided. C. No answer text provided. D. floculonodular lobe, posterior lobe

neurons that project widely throughout the brain

The raphe nuclei A. Do not project to the spinal cord B. Contain dopaminergic neurons involved in the reward oathwaya C. Form part of the striatum D. Contain serotonergic neurons that project widely throughout the brain

B. Internal capsule

The recurrent artery of heubner penetrates the anterior perforated substance to supply the anterior portion of the _____________ and Basal nuclei. A. Putamen B. Internal Capsule C. External Capsule D. Pons

B. Alpha1 adrenergic receptor activation of phospholipase C Increases Calcium release

The reduced blood flow in this woman's fingertips is caused by which of the following effects on vascular smooth muscle? A. Alpha1 adrenergic receptor inhibition of intracellular Ca2+ release B. Alpha1 adrenergic receptor activation of phospholipase C C. Beta2 adrenergic receptor activation of protein Kinase A D. Alpha1 adrenergic receptor activation of protein kinase A E. Beta2 adrenergic receptor activation of Ca2+ L-Typr channels in the membrane

They have a specific and selective relationship with a particular portion of the neocortex

The specific nuclei of the thalamus

...

The stimulation of serotonergic projection from raphe nuclei to the dorsal horn of spinal cord will

A. Substance P The terminals of nociceptive afferents in the spinal cord release substance P and glutamate. Enkephalins and serotonin are not the transmitters released by the terminals of nociceptive afferents. These transmitters are released at different sites in the descending pain control circuits. Gamma aminobutyric acid and acetylcholine are inhibitory and excitatory neurotransmitters, respectively, in the central nervous system, and they are not involved in nociception.

The terminals of nociceptive afferents release which one of the following transmitters? A. Substance P B. Gamma aminobutyric acid C. Enkephalins D. Serotonin E. Acetycholine

B. Olfaction

The thalamus is involved in the sensory relay of many modalities to the cortex. Which sensory modality does not utilize the thalamus in any significant manner?A. Pain B. Olfaction C. Light touch D. Proprioception E. Vibratory sense

...

The vast majority of spinocerebellar fibers entering the cerebellum are classified as

Main nucleus to relay information to the somatosensory cortexReceives afferent information via the medial lemniscus. Projects to the primary somatosensory cortex

The ventral posterior nucleus of the thalamus

Complete seizure control with minimal side effects in 50-60% with single drug Combinations enable control of additional 15-20% Remaining 20-30% are intractable despite best efforts, and the availability of a wide variety of treatment options Pharmacotherapy: Antiepileptic drugs Non-Pharmacotherapy: -Diet: Ketogenic Modified Atkins -Surgery -Vagus Nerve Stimulator

Therapy & Treatment approaches

• Broca'saphasia: Nonfluent speech • Wernicke'saphasia: Fluent speech but unintelligible • Global aphasia: Total loss of language

Three major types of Aphasia

B. Fastigial nucleus Purkinje cells project inhibitory axons to all cerebellar nuclei: fastigial, globose, emboliform, AND dentate. In addition, they project to all vestibular nuclei: lateral, superior, medial, AND inferior. The superior olivary nucleus is an auditory relay nucleus, AND the inferior olivary nucleus is a cerebellar relay nucleus. The arcuate nucleus is an ectopic pontine nucleus that lies next to the pyramidal tract, AND its function is unknown. The ventral lateral thalamic nucleus receives input from the dentate nucleus.

To which of the following nuclei do the Purkinje cells of the cerebellum project the inhibitory axons? A. Arcuate nucleus B. Fastigial nucleus C. Inferior olivary nucleus D. Superior olivary nucleus E. Ventral lateral nucleus

Action tremor refers to

Tremor at the end of a movement when the patient attempts to stop the movement by using antagonist muscles

Arnold-Chiari malformation

Type I: herniation of cerebellar tonsils, asymptomatic/headache Type II: herniation of cerebellum and medulla, often causes hydrocephalus.

cause ipsilateral loss of coordination of the arm (intention tremor) and of the leg resulting in unsteady gait in the absence of weakness or sensory loss.

Unilateral cerebellar hemispheric lesions

...

Unimodal sensory cortex

Vasoactive intestinal peptide (VIP) is a vasodilator found in postganglionic parasympathetic fibers, co-localized with ACh.

Vasoactive intestinal peptide (VIP)

Satiety center Activated by Increase ghrelin, Increase blood glucose, Increase CCK (released when food enters duodenum), and Increase leptin (satiety signal released by fat cells) Lesions of Medial: More food: hyperphagia; obesity

Ventral Medial Hypothalamus

Zones: Medial Lesion: Hyperphagia Function: Appetite, body weight, insulin, regulation

Ventromedial nucleus

• Left temporal lobe, just posterior to the primary auditory cortex. • Damage leads to deficits to language comprehension (problems with reception) and speech is incomprehensible, despite having correct grammar, rhythm an intonation.

Wernicke's area

• Information from the left half of your field of vision goes to your right hemisphere. • Information from the right half of your visual field goes to your left hemisphere, which usually controls speech. • The data received by either hemisphere are quickly transmitted to the other across the corpus callosum. • In a person with damage to the corpus callosum, this information sharing does not take place.

Visual Fields & the Split Brain Patient

Histamine (TMN) • Determinant of wakefulness & consciousness • Involved in forebrain arousals• Inactive in REM Adrenergic (Various) • Regulate awake muscle tone/activity • Inactive in REM Dopamine (Ventral tegmentum of Midbrain) Serotonin (LC and midbrain raphe) • Highest in Wake/ Lowest in REM • Regulate muscle tone in REM (inhibits eye movements of REM and muscle twitch generation) Hypocretin (perifornical region of lateral Hypothalamus) • Drive the other arousal NT's

Wake neurotransmitters

Glutamate Acetylcholine Dopamine Norepinephrine Serotonin Histamine Orexin/hypocretin

Wake promoting neurotransmitters

• Lesions in posterior of the left superior temporal gyrus, extending to adjacent parietal cortex. • Fluent speech. • Syntactical but empty sentences. • Cannot repeat words or sentences. • Unable to understand what they read or hear. • poor comprehension. • unaware of deficit. • Usually no partial paralysis.

Wernicke's aphasia

D. Both A and C

Wernicke's area is: A. in the right parietal lobe B. in the right frontal lobe C. Just posterior to the left primary auditory cortex D. Both A and C E. both B and C

1. Repeating a spoken word • Arcuate fasciculus is the bridge from the Wernicke's area to the Broca's area 2. Repeating a written word • Angular gyrus is the gateway from visual cortex to Wernicke's area • This is an oversimplification of the issue: • not all patients show such predicted behavior

Wernicke-Geschwind Model

• Seven components in Left hemisphere: primary visual cortex, angular gyrus, primary auditory cortex, Wernicke's area, arucate fasciculus, Broca'sarea, and primary motor cortex

Wernicke-Geshwind model

Up to 80% of alcoholics have a deficiency in thiamine •Some of these people will go on to develop serious brain disorders such as Wernicke-Korsakoff syndrome (WKS) •Involves degeneration of mamillarybodies •WKS consists of two separate syndromes: •a short-lived and severe condition called Wernicke's encephalopathy•a long-lasting and debilitating condition known as Korsakoff'spsychosis.

Wernicke‐Korsakoff Syndrome

...

What are the two main targets of the septal area?

B. It is stored in the nerve endings until released

What happens to ADH and oxytocin once it reaches the posterior pituitary? A. It is stored in the cells of the posterior pituitary gland B. It is stored in the nerve endings until released C. It rapidly diffuses into the systemic circulation

- Sensory inputs are still crossed - Motor outputs are still crossed - Hemispheres can not exchange data

What happens when the corpus callosum is cut?

Altered states of consciousness have been recognized since ancient times (12 B.C.) The neuronal substrates of sleep and waking were first revealed in the 20th century State less likely to attract predators Immobility state with reduced responsiveness Sleep is a behavioral state of perceptual disengagement and unresponsiveness to the environment, distinguished by physiologically defined patterns of neural (EEG and EOG) and muscular (EMG) activity.

What is Sleep

The dorsal hippocampal commissure (DHC) is a white matter tract that provides interhemispheric connections between temporal lobe brain regions. Despite the importance of these regions for learning and memory, there is scant evidence of a role for the DHC in successful memory performance

What is the clinical importance of the hippocampal commissure?

Interneurons

What is the content of the molecular layer of the Hippocampal Formation?

The septal region is located rostral to the anterior commissure along the medial aspect of the cerebral hemispheres (eFig. 9.99). This region appears to play a role in pleasurable behaviors. Conversely, lesion studies indicate that damage to this area evokes behaviors of extreme displeasure or rage.

What is the name of the cells present within the ventral division of the septal area?

C. Stria terminalis

What pathway projects from the medial amygdala to the medial hypothalamus? A. Mammillothalamic tract B. Medial forebrain bundle C. Stria terminalis D. Stria medullaris

E. REM

What sleep stage is characterized by strong inhibition of muscle tone throughout the body? A. Slow wave sleep B. Stage 3 C. Stage 1 D. Stage 2 E. REM

A. Entorhinal cortex to hippocampus

Which of the following correctly describes the prefrontal pathway? A. Entorhinal cortex to hippocampus B. Amygdala to hippocampus C. Hippocampus to anygdala D. Hippocampus to entorhinal cortex E. Nucleus accumbent to entorhinal cortex

a brain structure located in the medial portion of the temporal cortex that participates in the brain circuits from which memory is derived The hippocampal formation is a prominent C-shaped structure bulging in the floor of the temporal horn of the lateral ventricle.

Where is the hippocampal formation (H.F.) located?

Cholinergic neurons located in the basal forebrain, including the neurons that form the nucleus basalis of Meynert, are severely lost in Alzheimer's disease

Which basal forebrain nucleus contains cholinergic neurons and is clinically associated with Alzheimer's when there is a reduction of its neuronal population?

postcommissural fornix

Which component of the fornix arises solely from the subicular cortex?

Fibers from the fornix that travel ventrally behind the anterior commissure are called the postcommissural fornix. These fibers originate in the subicular cortex and terminate either in the anterior thalamic nucleus or in the mamillary bodies of the hypothalamus. The postcommissural fornix innervates parts of the diencephalon, including the anterior thalamic nucleus, mammillary bodies, and parts of the medial hypothalamus.

Which component of the fornix innervates diencephalic regions?

...

Which component of the fornix supplies the septal area?

granule cells

Which is the primary cell type within the dentate gyrus?

pyramidal cells

Which is the primary cell type within the hippocampus proper?

...

Which is the primary cell type within the subiculum?

tests of explicit memory

Which of the following abilities would be deficients in a patient with bilateral resection of the medial temporal lobes

B. entorhinal cortex to hippocampus

Which of the following correctly describes the perforant pathway? A. amygdala to hippocampus B. entorhinal cortex to hippocampus C. hippocampus to amygdala D. hippocampus to entorhinal cortex

D. 7 Area 5 is also part of the somatosensory association cortex. a. 41 = Primary auditory b. 17 = Primary visual c. 1 = Primary sensory e. 2 = Primary sensory

Which of the following cortical areas is part of the somatosensory association cortex? A. 41 B. 17 C. 1 D. 7 E. 2

C. Trigeminothalamic system of fibers

Which of the following fiber systems reaches the VPM nucleus of the thalamus? A. Medial lemniscal system of fibers B. Olfactory fibers C. Trigeminothalamic system of fibers D. Spinothalamic system of fibers E. Fibers originating from gracile and cutaneous nuclei

A. Celiac

Which of the following ganglia does not contain postganglionic parasympathetic neurons? A. Celiac B. Ciliary C. Otic D. Pterygopalatine E. Submandibular

A. Dorsomedial nucleus, lateral nucleus, ventromedial nucleus

Which of the following grouping of nuclei of the hypothalamus all regulate feeding behaviors? A. Dorsomedial nucleus, lateral nucleus, ventromedial nucleus B. Dorsomedial nucleus, lateral nucleus, anterior nucleus C. Arcuate nucleus! lateral nucleus, paraventricular nucleus D. Arcuate nucleus, suprachiasmatic nucleus, posterior nucleus E. Ventromedial nucleus, posterior nucleus, paraventricular nucleus

B. Posterior zone

Which of the following hypothalamic areas contains the majority of cells of the parvocllular neuroendocrine system for the regulation of adenohypophysis? A. Tuberal region B. Posterior zone C. Mammillary region D. Lateral zone

C. posterior nucleus

Which of the following hypothalamic regions plays a role in thermal regulation (conservation of heat)? A. lateral nucleus B. anterior nucleus C. posterior nucleus D. dorsomedial nucleus

B. lateral nucleus

Which of the following hypothalamic regions when destroyed results in starvation? A. ventromedial nucleus B. lateral nucleus C. anterior nucleus D. dorsomedial nucleus

A. lateral nucleus

Which of the following hypothalamic regions when stimulated induces eating? A. lateral nucleus B. dorsomedial nucleus C. ventromedial nucleus D. anterior nucleus

D. Dendrites of neurons in deeper layers of the cortex (a) Granular cells = Layers II and IV (b) Cell bodies of neurons that project to adjacent areas of the cortex = Layer III (c) Axons from neurons in the thalamus = Layers IV, V, VI (e) Giant cells of Betz = Layer V

Which of the following is commonly found in Layer I of the neocortex? A. Granular cells B. Cell bodies of neurons that project to adjacent areas of the cortex C. Axons from neurons in the thalamus D. Dendrites of neurons in deeper layers of the cortex E. Giant cells of Betz

D. Dendrites of neurons in deeper layers of the cortex Granular cells = Layer 2 & 4 Cell bodies of neurons that project to adjacent areas of the cortex = Layer 3 & 5 Axons from neurons in the thalamus = Layers 4,5 and 6 Giant cells of Betz = Layer 5 Neocortex/Isocortex = 90% cerebral cortex Alocortex 10% (3 layers)

Which of the following is commonly found in layer 1 of the neocortex? A. Granular cells B. Cell bodies of neurons that project to adjacent areas of the cortex C. Axons from neurons in the thalamus D. Dendrites of neurons in deeper layers of the cortex E. Giant cells of Betz

D. Dendrites of neurons in deeper layers of the cortexe. Giant cells of Betz

Which of the following is commonly found in layer I of neocortex? A. Granular cells B. Cell bodies of neurons that project to adjacent areas of the cortex C. Axons from neurons in the thalamus D. Dendrites of neurons in deeper layers of the cortexe. Giant cells of Betz

B. Vision Limbic System functions: HOME(Homeostasis, Olfaction, Memory, & Emotions/drives)

Which of the following is not a function of the limbic system? A. Homeostasis B. Vision C. Olfaction D. Emotion and drives E. Memory

C. hippocampal formation → mamillary body → anterior thalamic nucleus → cingulate gyrus → entorhinal cortex

Which of the following is the correct sequence of the Papez Circuit Pathway? A. mamillary body → entorhinal cortex → cingulate gyrus → B. anterior thalamic nucleus → hippocampal formation B. entorhinal cortex → anterior thalamic nucleus → hippocampal formation → cingulate gyrus → mamillary body C. hippocampal formation → mamillary body → anterior thalamic nucleus → cingulate gyrus → entorhinal cortex D. anterior thalamic nucleus → mamillary body → cingulate gyrus → hippocampal formation → entorhinal cortex

A. Thalamus

Which of the following is the largest feature of the diencephalon? A. Thalamus B. Subthalamus C. Epithalamus D. Hypothalamus

B. Transient ischemic attack (TIA) Lacunar infarct is a small infarct that develops from the occlusion of lenticulostriate arteries T.I.A. = Baby stroke, has no lasting brain damage or effect. This could be indication of possibilities of strokes in the future

Which of the following is the least likely to leave lasting brain damage or residual symptoms? A. Lacunar infarct B. Transient ischemic attack (TIA) C. Ischemic stroke D. Hemorrhagic stroke

Acetylcholine

Which of the following neurotransmitter involved in the deep stage of sleep?

B. Premotor cortex - Area 5 Premotor cortex is Area 6

Which of the following pairings of the cortical area and Brodmann's area is FALSE? A. Primary motor cortex - Area 4 B. Premotor cortex - Area 5 C. Supplementary motor cortex - Area 6 D. Frontal eye fields - Area 8 E. Posterior parietal cortex - Area 7

B. Premotor cortex - area 5 Premotor cortex is actually in Area 6

Which of the following parings of cortical areas and brodmann's area is false? A. Primary motor cortex - area 4 B. Premotor cortex - area 5 C. Supplementary motor cortex - area 6 D. Frontal eye fields - area 8 E. Posterior parietal cortex - area 7

A. Golgi tendon organs Golgi tendon organs are activated by active contraction or stretching of the muscle and provide information regarding the activity of the muscle. Meissner's corpuscles and Merkel's receptors mediate the sensation of touch. Pacinian corpuscles are sensitive to vibration. Ruffini's corpuscle senses the magnitude and direction of stretch.

Which of the following receptors signal changes in muscle activity? A. Golgi tendon organs B. Meissner's corpuscle C. Pacinian corpuscle D. Merkel's receptor E. Ruffini's corpuscle

B. Posterior Area

Which of the following regions of the hypothalamus contains nuclei important for learning and memory circuits? A. Preoptic Area B. Posterior Area C. Tuberal Region D. Anterior Area E. Lateral Area

B. Lesions in the dorsolateral prefrontal cortex produce deficits in monitoring events within working memory (a) Lesions of Area 46 produce deficits in object recognition = FALSE, object recognition if Area 5/7 in the somatosensory cortex (c) Neurons in the frontal lobe respond primarily during remapping of the visual world = FALSE, this is located in the visual cortex in Area 17, 18, 19 (d) Lesions produce difficulty applying the visual system to visual task = FALSE, this is located in the visual cortex in Area 17, 18, 19 (e) Lesion in the right frontal lobe produce neglects of the left half of the world = Neglect of half of the world (hemi-spatial neglect) is associated with lesions in the parietal lobe

Which of the following statements is TRUE of the frontal lobe? A. Lesions of Area 46 produce deficits in object recognition B. Lesions in the dorsolateral prefrontal cortex produce deficits in monitoring events within working memory C. Neurons in the frontal lobe respond primarily during remapping of the visual world D. Lesions produce difficulty applying the visual system to visual task E. Lesion in the right frontal lobe produce neglects of the left half of the world

B. Lesions in the dorsolateral prefrontal cortex produce deficits in monitoring events within working memory Lesions of Area 46 (middle frontal gyrus) produce deficits in objection recognition (broadmann area 5 & 7) = Cognition and working memory Neurons in the frontal lobe respond primarily during remapping of the visual world. = Occipital located in back, Remember visual cortex area 17, 18 and 19 Lesions produce difficulty applying the visual system to visual task (Balint syndrome) = Outside located in back Lesion in the right PARIETAL lobe products neglects of the left half of the word = Hemineglect/Hemispatial world view

Which of the following statements is TRUE of the frontal lobe? A. Lesions of area 46 produce deficits in object recognition B. Lesions in the dorsolateral prefrontal cortex produce deficits in monitoring events within working memory C. Neurons in the frontal lobe respond primarily during remapping of the visual world D. Lesions produce difficulty applying the visual system to visual task (Balint syndrome) E. Lesion in the right frontal lobe produce neglects of the left half of the word

B. Primary motor, premotor, and supplementary cortices all send descending projections to the spinal cord Only Area 5 has Betz cells Primary motor, premotor and supplementary cortices all send descending projections to the spinal cord Area 8 includes both the frontal eye fields and the primary cortex Motor cortical areas are granular cortex Motor cortical areas are considered as part of the paleocortex

Which of the following statements regarding motor cortical areas is true? A. Only area 6 has Betz cells B. Primary motor, premotor, and supplementary cortices all send descending projections to the spinal cord C. Area 4 includes both the FEFs and the primary cortex D. Motor cortical areas are granular cortex E. Motor cortical areas are considered as part of the paleocortex

optic chasm and maxillary bodies

Which of the following structures marks the anterior limit of the hypothalamus?

D. Dorsomedial Ventral posterolateral. The posterior paracentral gyrus is the lower extremity portion of the primary somatosensory cortex; it receives thalamocortical projections from the ventral posterolateral (VPL) of the thalamus. Specifically, the more lateral part of the VPL nucleus selectively projects to the posterior paracentral gyrus. The other nuclei project as follows: dorsomedial to the cingulate gyrus and frontal lobe rostral to the precentral sulcus; lateral geniculate to the medial occipital cortex; ventral lateral to the somatomotor cortex; ventral posteromedial to the face area of the postcentral gyrus.

Which of the following thalamic nuclei projects to the posterior paracentral gyrus? A. Ventral posteromedial B. Ventral posterolateral C. Ventral lateral D. Dorsomedial E. Lateral geniculate

D. Thalamogeniculate As indicated by its name, the thalamogeniculate artery serves the medial and lateral geniculate bodies and the immediately adjacent structures: pulvinar, centromedian, ventral posterolateral and posteromedial nuclei, and others. The thalamogeniculate artery is a branch of the P2 segment of the posterior cerebral artery. The lenticulostriate arteries, branches of the M1 segment of the middle cerebral artery, serve the lenticular nucleus and adjacent posterior limb of the internal capsule. The medial striate (artery of Heubner) usually arises from the A2 segment of the anterior cerebral artery and serves the head of the caudate nucleus and parts of the anterior limb of the internal capsule. The quadrigeminal and thalamoperforating arteries originate from P1 and serve the tectum of the midbrain and anterior portions of the dorsal thalamus, respectively.

Which of the following vessels is the principal blood supply to the pulvinar nucleus of the dorsal thalamus? A. Thalamoperforating B. Lenticulostriate C. Medial striate D. Thalamogeniculate E. Quadrigeminal

A. Tonsillar herniation

Which of the following would be most likely to cause impaired movement coordination as well as impair the patient's ability to breathe, and is often seen in Arnold-Chiari malformations? A. Tonsillar herniation B. Uncal herniation C. Subfalcine herniation D. Extracranial herniation

B. Loss of direct pupillary reflex

Which one of the following deficits results from the destruction of the ciliary ganglion? A. Loss of corneal reflex B. Loss of direct pupillary reflex C. Loss of lacrimation D. Miosis E. Severe ptosis

The CA1 field, also known as Sommer's sector, contains the pyramidal cells located closest to the subiculum, whereas the two other fields CA2 and CA3 are closer to the surface

Which portion (field) of the hippocampal formation is called the Sommer's sector?

A. Centromedian nucleus

Which thalamic nucleus projects to the striatum? A. Centromedian nucleus B. Mediodorsal nucleus C. Ventral anterior nucleus D. Ventral lateral nucleus E. Ventral posterolateral nucleus

E. Right ventroposterolateral (VPL) nucleus of the thalamus

Which thalamic nucleus would be primarily responsible for processing input associated with activation of pacinian corpuscles in your left hand? A. Left dorsomedial nucleus of the thalamus B. Left pulvinar nucleus of the thalamus C. Left ventroposteromedial (VPM) nucleus of the thalamus D. Right lateral geniculate nucleus of the thalamus E. Right ventroposterolateral (VPL) nucleus of the thalamus F. Right ventral anterior nucleus of the thalamus

D. Papez Papez wrote A Proposed Mechanism of Emotion; the circuit is hippocampal formation → mamillary body → anterior thalamic nucleus → cingulate gyrus → entorhinal cortex → hippocampal formation (see Figure 17.4). Klüver-Bucy syndrome is characterized by placidity, hypersexuality, hyperphagia, AND psychic blindness (visual agnosia). Wernicke Korsakoff syndrome is characterized by alcohol abuse resulting in thiamine deficiency, conjugate gaze palsies, ataxia, confusion, AND memory loss. Liepmann is known for his classic book on ataxias. Brodmann is known for his brain maps, called the Brodmann areas.

Who wrote the classic paper A Proposed Mechanism of Emotionthat describes a major pathway of the limbic system? A. Brodmann B. Klüver and Bucy C. Liepmann D. Papez E. Wernicke and Korsakoff

Sommer's sector is one of the vulnerable areas in global cerebral ischemia. Generally, the hippocampus is responsible for longterm memory, and the CA1 area appears to help recall autobiographical memory and detailed memory.

Why are the cells of the Sommer's sector clinically important?

Remodel synaptic plasticity induced by wakefulness. Restore brain energy stores. Consolidation of certain kinds of learning Endocrine functions Restore body systems

Why do we sleep?

State of high brain metabolic and neuronal activity rates Reduced muscle tone, muscular re-generation

Why we need REM?

A. Acetylcholine Serotonin is the lowest in REM

With respect to the initiation of REM sleep, the neurotransmitter that is most closely associated with this process is: A. Acetylcholine B. Norepinephrine C. Dopamine D. Serotonin E. Substance P

A. Acetylcholine The pedunculopontine and lateral dorsal pontine nuclei are cholinergic neurons and therefore this neurotransmitter is linked to the initiation of REM sleep. REM sleep is associated with a reduction in catecholamines (norepinephrine and dopamine). Serotonin and substance P are not known to be associated with the initiation of REM sleep.

With respect to the initiation of REM sleep, the neurotransmitter that is most closely associated with this process is: A. Acetylcholine B. Norepinephrine C. Dopamine D. Serotonin E. Substance P

C. Asynchronous low voltage beta rhythm

You are performing a polysomnogrpahy in a 35-year-old female patient. When she is awake and with her eyes open, which of the following will be shown in the EEG? A. Theta wavves B. Synchronous alpha rhythm C. Asynchronous low voltage beta rhythm D. Delta waves

C. Prostaglandin-mediated phosphorylation of TRPV1 receptors

You spend a day at the beach with your friends and forget to reapply sunscreen. The next day, your shoulders and sunburnt and even the slightest touch causes pain. Which of the following is likely contributing to this allodynia? A. PKA-mediated dephosphorylation of TRPV1 receptors B. Prostaglandin stimulated K+ diffusion through TRPV1 receptors C. Prostaglandin-mediated phosphorylation of TRPV1 receptors D. Bradykinin-induced closure of TRPV1 receptors E. PKC-mediated inhibition of TRPV1 receptors

A. Dorsomedial nucleus

Your friend in your advanced genetics class is always falling asleep during lecture. At first you thought that she just wasn't sleeping at night or that the lecture had to be extremely boring for her. However! you then notice that she sometimes she falls asleep during group activities as well. Which hypothalamic nucleus may be related to her problem? A. Dorsomedial nucleus B. Paraventricular nucleus C. Anterior nucleus D. Arcuate nucleus E. Ventromedial nucleus

C. Orexin

Your friend in your advanced genetics class is always falling asleep during lecture. At first you thought that she just wasn't sleeping at night or that the lecture had to be extremely boring for her. You also notice that she is sleeping a lot and having trouble staying awake. This pt may be showing these symptoms because the lateral hypothalamus has projections to the RAS that release: A. ACh B. GABA C. Orexin D. Histamine E. Norepinephrine

C. Spinal nucleus of V (Trigeminal)

Your grandmother always drinks her coffee while it is still steaming hot. The temperature perception that she feels on her tongue is relayed directly to the thalamus by which of the following neurons? A. Main (principal/chief) sensory neuron of V (Trigeminal) B. Nucleus cuneatus C. Spinal nucleus of V (Trigeminal) D. Trigeminal ganglio E. VPM (Ventral posterolateral nucleus of the thalamus)

A. Anterior nucleus

Your patient had a stroke affecting the thalamus. After an MRI, the neurologist advised you that the "limbic" thalamus had been affected. Which of the following thalamic nuclei has both afferent and efferent limbic connections? A. Anterior nucleus B. Pulvinar C. Ventral posterolateral nucleus D. Ventral lateral nucleus E. Medial geniculate nucleus

B. DRN

___________ is the main serotonin producing center. A. LC B. DRN C. LTP D. NMDA

body temperature. destruction causes hyperthermia

anterior hypothalamus helps regulate and maintain

learning and memory

anterior nucleus is part of the Papez circuit which plays a role in

temperature, hyperthermia

anterior nucleus plays a role in ____________ regulation and stimulates the PNS. destruction results in ____________

cingulate gyrus

anterior nucleus projects to the

hypothalamic, mammillothalamic tract, hippocampal, fornix

anterior nucleus receives ____________ input from the mammillary nucleus via the ________________ _____ and receives ___________ input via the ______

hypothalamic-releasing factors, systemic circulation, dopamine

arcuate/infundibular nucleus produce ____________-_________ factors and causes release or nonrelease of adenohypophyseal hormones into the ________ ___________. contains dopaiminergic neurons and ________ is the prolactin-inhibiting factor (PIF)

- posterior communicating artery --> anterior thalamoperforating arteries - posterior cerebral artery --> posterior choroidal arteries and posterior thalamoperforating arteries - anterior choroidal artery (primarily serves the LGN)

blood supply of the thalamus:

- anterior: interventricular foramen - posterior free pole of the pulvinar - dorsal: free surface underlying the fornix and the lateral ventricle - ventral: plane connecting the hypothalamic sulci - medial: third ventricle - lateral: posterior limb of the internal capsule

boundaries of the thalamus:

tegmental nuclei, raphe nuclei, and locus ceruleus

brainstem nuclei include the

cortical damage trauma stroke neoplasm autoimmune effects

causes of acute epilepsy

motor cortex, globus pallidus, striatum, neocortex

centromedian nucleus is the largest of the intralaminar nuclei and reciprocally connected to the _____ ______. receives input from the _____ ________. projects to the ________, and projects diffusely to the _________

attention and arousal

centromedian nucleus plays a role in

hypothalamus

cerebral arterial circle surrounds the inferior surface of the ____________ and provides its blood supply

dysgenesis phenylketonuria vascular malformations genetic

congenital epilepsy causes

pituitary gland, supratentorial tumor, bitemporal hemianopia, hypothalamic syndrome

craniopharyngioma originates from embryonic _________ _____ tissue and is usually calcified. the most common ______________ _____ found in children. pressure on the optic chiasm results in a __________ __________. pressure on the hypothalamus causes ____________ ________ with adiposity, DI, and disturbance of temp regulation, and somnolence

Sensory and motor activities on one side of the body are primarily mediated by the cerebral hemisphere on the opposite

decussation

a deep cerebellar nucleus; involved in the control of rapid, skilled movements by the corticospinal and rubrospinal systems

dentate nucleus & output fibers

Parkinsonian tremor

destruction of the ventral lateral nucleus reduces

limbic and striatal systems

dorsomedial nucleus is part of what 2 systems?

savage

dorsomedial nucleus on the tuberal region when stimulated in animals, results in ______ behavior

affect, emotion, and behavior

dorsomedial nucleus plays a role in the expression of ______, _______, and ________ (limbic function)

amygdala, temporal neocortex, and substantia nigra

dorsomedial nucleus receives input from the

simple & dyscognitive

focal seizure subtypes

superior border

hypothalamic sulcus forms the

arcuate nucleus of the median eminence

hypothalamic-releasing and release-inhibiting hormones are produced in the

tuberohypophyseal tract to the hypophyseal portal systemhormones include: - dopamine - thyrotropin-releasing hormone - gonadotropin-releasing hormone - somatostatin (growth hormone inhibiting hormone) - growth hormone releasing hormone - CRH - PIF and prolactin releasing factor

hypothalamic-releasing and release-inhibiting hormones are transported via the

direct descending autonomic fibers that influence preganglionic sympathetic neurons of the intermediolateral cell column and preganglionic neurons of the sacral parasympathetic nucleus. interruption above T1 results in Horner syndrome

hypothalamospinal tract contains

homeostasis

hypothalamus functions primarily in the maintenance of

optic chiasm, interpeduncular fossa

hypothalamus lies between the ___________ and the _______________ _____

third ventricle

hypothalamus lies within the floor and ventral part of the walls of the

autonomic nervous system, endocrine system, and limbic system

hypothalamus subserves 3 systems:

posterior communicating artery

identify d

anterior inferior cerebellar artery

identify e

orbital gyri

identify the blue region

olfactory sulcus

identify the green region

lenticulostriate branches of the middle cerebral artery and results in tactile hypesthesia, anesthesia, hemiparesis (with Babinski sign), lower facial weakness, and homonymous hemianopia

infarction of the internal capsule most frequently results from occlusion of the

hypophysis, hypophyseal portal vessels

infundibulum is the stalk of the __________, contains the ___________ ______ _______ and the supraopticohypophyseal and tuberohypophyseal tracts

During purposeful movement toward a goal -As the patient voluntarily attempts to move his limb, he may display a tremor

intentional tremor

of white matter (myelinated axons) that separates the caudate nucleus and thalamus medially

internal capsule is a layer

diffusely to the neocortex and project to the dorsomedial nucleus

intralaminar nuclei project

spinothalamic and trigeminothalamic

intralaminar nuclei receive _____________ and _________________ input

brainstem reticular formation

intralaminar nuclei receive input from the _________ _________ _________, the ascending reticular activating system, and other thalamic nuclei

cerebral cortex

largest input the thalamus receives is from the

anterior nuclear complex

lateral dorsal nucleus is a posterior extension of the

lateral preoptic nucleus and lateral hypothalamic nucleus

lateral hypothalamic area includes 2 major nuclei:

medial forebrain bundle

lateral hypothalamic area is traversed by the

hunger, feeding center, starvation, emaciation

lateral hypothalamic nucleus is the ______ or _______ ______ and destruction causes __________ and __________

anorexia and starvation

lateral hypothalamic nucleus lesions cause

contralateral loss of pain and temperature sensation, and loss of tactile discrimination in the head; results in ipsilateral loss of taste

lesion of the ventral posteromedial nucleus results in

poikilothermia

lesions in the posterior nucleus result in ______________, the inability to thermoregulate

mammillary nuclei

mammillary bodies contain the

anterior, mammillothalamic

mammillary nuclei project to the __________ nucleus of the thalamus via the ________________ tract

hippocampal formation, fornix

mammillary nuclei receive input from the __________ _________ via the ______. receive input from the dorsal and ventral tegmental nuclei and the raphe nuclei via the mammillary peduncle

preoptic regionsupraoptic regiontuberal regionmammillary region

medial hypothalamic area divided into 4 regions:

inferior thalamic peduncle

mediodorsal nucleus of the thalamus via the

Alzheimer's disease

neurofibrillary tangles are seen in

striatum, motor cortex

parafascicular nucleus of the intralaminar nuclei projects to the ________ and the supplementary _____ ______

patterns of response to stimuli

parafascicular nucleus plays a role in changing

ADH, CRH, DI

paraventricular nucleus synthesize and release ___, oxytocin, and ___. regulates _____ _______, gives rise to the supraopticohypophyseal tract which projects to the neurohypophysis. destruction results in __

bitemporal hemianopia, hypothalamic syndrome

pituitary adenoma causes pressure on the chiasm and results in a __________ __________ (most cases show asymmetry of field defects) and pressure on the hypothalamus may cause ____________ ________

heat. destruction causes the inability to thermoregulate

posterior hypothalamus helps produce and conserve

thermal regulation

posterior nucleus plays a role in

medial preoptic nucleus - contains sexually dimorphic nucleus who development is dependent on testosterone levels

preoptic region contains the ______ ________ ______ which regulates the release of gonadotropic hormones from the adenohypophysis

starting from a focus and remaining localized -does not produce loss of consciousness Signs & symptoms: -motor signs: twitching &stiffness -parietal lobe: burning/ tingling/ numbess -occipital lobe: visual disturbances/ hallucinations -temporal lobe: Deja vu, unusual taste/smell/ feelings of fear

simple partial seizure

retina, circadian rhythms

suprachiasmatic nucleus receives direct input from the ______ and plays a role in the control of _________ _______

ADH and oxytocin

supraoptic nucleus synthesizes ___ and ________ and projects to the neurohypophysis via the supraopticohypophyseal tract

suprachaismatic, anterior, paraventricular, supraoptic

supraoptic region lies superior to the _____ ______ and contains _______________ nucleus, ________ nucleus, _______________ nucleus, and teh __________ nucleus

sensory and motor system integration

the thalamus plays an important role in

median eminence

tuber cinereum includes the ______ ________ which contains the arcuate nucleus

infundibulum and the mammillary bodies

tuber cinereum is the prominence between the

ventral posterolateral nucleus (VPL), ventral posteromedial nucleus (VPM), and ventral posteroinferior nucleus

ventral posterior nucleus contains three subnuclei:

Receives: - Vestibulothalamic tracts from vestibular nuclei Projects to: - Vestibular cortex in insular, frontal, parietal and temporal lobes

ventral posteroinferior nucleus receives and projects to:

contralateral loss of pain and temperature sensation as well as loss of tactile discrimination in the trunk and extremities

ventral posterolateral nucleus lesion results in

spinothalamic tracts and the medial lemniscus

ventral posterolateral nucleus receives

satiety, eat, hyperphagia, obesity, savage

ventromedial nucleus is a ______ center that when stimulated, inhibits the urge to ___. bilateral destruction involved with ___________, _______. and savage behavior

satiety center, overeating, obesity

ventromedial nucleus is the _______ ______ and destruction is involved in __________ and _______

The perforant pathway is a large neuronal projection that arises from layers II and III of the entorhinal cortex of the parahippocampal gyrus. It is the principal source of cortical input to the hippocampal formation.

what are the perforant pathways?

memory loss (Wernicke-Korsakoff syndrome)

when the dorsomedial nucleus is destroyed, it results in

eating

when the lateral hypothalamic nucleus is stimulated it induces

temporal cortex

where the hppocampal formation located?