Exam 3

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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)

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

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 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.

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.

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

- 3rd 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

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

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

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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)

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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