Neuro - Lectures 18-19

main concepts to over in detail!

Lecture 18
Basal Ganglia

 Function
 Basal Ganglia Areas
o Caudate Nucleus
o Putamen
o Globus Pallidus
o Subthalamic Nucleus
o Substantia Nigra
 pars compacta
 pars reticulata
 Basal Nuclei
o Corpus Striatum components
o Neostriatum components
o Lentiform Nucleus components
o Paleostriatum components
 Inputs - arrive at striatum
 Outputs - leave via internal globus pallidus and substantia nigra (pars
reticulata)
 Pathways
o Direct -- double (-) = (+)
 ACh won't inhibit = direct signal to thalamus
o Indirect -- single (-) = (-)
 ACh WILL inhibit = indirect signal to thalamus via sub-
thalamus
 Lesions
o caudate nucleus
o caudate nucleus (head of left)
 Disorders
 Movement
 bradykinesia
 hypokinesia
 akinesia
 Rigidity
 Dystonia
 Ballism
 Athetosis
 Chorea
 Tics
o Parkinson's - Lead pipe- loss of pigmentation at substantia nigra-
dopa
o Huntington's – Chorea- degeneration of stritum at cudate-gaba
o Wilson's – Copper- degeneration of lentiform w/ liver cirrhosis
o Kernicterus - Indirect bilirubin- globus pallidus
Lecture 19
Cerebrum
https://radiopaedia.org/articles/cerebrum

Know the functions of each of the following and what happens if there is a lesion in that area!!! -- also important
to know brodmann areas + corresponding #

Frontal Lobe - voluntary motor, motivation, aggression, smell, mood

Parietal Lobe - reception/evaluation of sensory (EXCEPT smell, hearing, vision)
Temporal Lobe - smell, hearing, memory, abstract thought, judgement
Occipital Lobe - visual input

Central Sulcus
Pre-central Gyrus - Motor
Post-central Gyrus - Sensory
Corpus Callosum
Neocortex
Allocortex

Forebrain - largest + highly developed

 communication fibers in brain

o association fibers
o commissural fibers
o projection fibers
 Cerebral layers
o I - molecular
o II - external granular
o III - external pyramidal
o IV - internal granular
o V - pyramidal
 betz cells
o VI - multiform
 Functional areas + associating Brodmann areas
o frontal eye - 8
o premotor - 6
o primary motor - 4
o primary sensory - 3, 1, 2
o angular gyrus - 39
o Wernicke's -22
o Broca's - 44, 45
o auditory 41, 42
 Blood Supply
o MCA (middle cerebral artery)
o ACA (anterior cerebral artery)
o PCA (posterior cerebral artery)
 NOTE: these arteries arise from the circle of willis
and correspond with the brain areas described by
the homunculus
 example: Legs on the homunculus are
midline, so they will be supplied by the
anterior cerebral artery which supplies the
medial portion of the cerebrum --
 occlusion to the ACA will cause defects to
the legs
 Dominant hemisphere
o Wada Test -- aphasia
 Split brain syndrome
 Aphasia --> know all of these in detail
o Broca's
o Wenicke's
o Conduction
o Transcortical
 Gerstmann Syndrome
o agraphia/dysgraphia
o acalculia/dyscalculia
o finger agnosia
 Apraxia
o ideomotor apraxia
o ideational apraxia
o construction apraxia
o gait apraxia
 Dysprosodides
o expressive - broca
o receptive -- wernicke

Neuro - Lectures
main concepts to over in detail!
Attached are questions for lectures 20-24

Lecture 20
Higher Cortical Function
The first 11 pages are review from the lecture on Cerebrum!!!

 Broca's area
 Wernicke's area
 Arcuate Fasciculus -- connects B + W
 Aphasias:
o Broca's -- can't speak fluently
o Wernicke's -- can't comprehend
o Conductive -- repetition problems
o Global -- all the problems
o Gertsmann Syndrome -- alexia + agraphia

Learning

 Associative (Pavolv) - 2 stimuli

 Non-associative - 1 stimuli
o Habituation
o Sensitization

Memory --> 2 types of LONG term memory:

 explicit (declarative)
 o semantic - meaningful
o episodic - events/time related
 implicit (non-declarative)
o priming -- apply new memory to previous memory
o procedural memory -- procedures (walking, biking, driving)
o learned emotion -- happy when good things happens, sad when bad things
happen
o conditioned reflexe
o s -- Pavlov (dog + salivation)

Memory Defects

 Amnesia
o Retrograde
o Anterograde
 Dementia
 Alzheimers
o hippocampus
o amyloid plaques -- weaken vessel walls, causes hemorrhage
o neurofibrillary tangles
o cholinergic transmission impairment
o highest risk = down syndrome
 Wernicke-Korsakoff Disease
o chronic alcohol abuse
o thiamine deficiency
o "Wernicke's encephalopathy" -- reversible
 confusion, ataxia, nystagmus
o "Korsakoff's psychosis" -- irreversible
 memory impairment
 infarction occurs in
 mammillary bodies/ thalamus/ limbic system

Lecture 21
Reticular Formation + EEG
sleep vs. awake

 superior spinal cord + brain stem + inferior diencephalon

 Reticular Formation
o Anatomy
 median = raphe nuclei
 medal = magnocellular nuclei
 lateral = parvocellular nuclei
o RAS (reticular activating system) --> ascending portion = sensory
 activation of RAS = awake
 inhibition of RAS = sleep
o sleep centers located in hypothalamus
 depressed by: alcohol, sleep inducing drugs, tranquilizers
 severe injury to RAS = irreversible coma
o Function
 maintain consciousness
 filters sensory info
 regulation of: HR + BP + RR
 EEG (electroencephalogram)
o summation of EPSPs + IPSPs
o used to distinguish epileptic seizures + brain death
o 4 wave forms
  alpha - "A for awake adult"
 8-12 Hz (parietal + occipital)
 Beta - awake + tense
 13-30 Hz (frontal)
 Theta - light sleep (adults), awake (children)
 4-7 Hz (parietal + temporal)
 Delta - "D for deep sleep"
 <4 Hz
 Sleep
o consolidates learning and memory (lecture 19)
o growth!!! --> high GH secretion
o 90 min cycles
 NREM
 idle brain, movable body
 REM
 awake brain, paralyzed body
 Stages
 I-
 II - Sleep Spindles (12-14Hz) + K complexes
(longest)
 III -
 IV - deep sleep -- hardest to arouse
 REM sleep = paradoxical -- easiest to arouse
o Circadian control -- suprachiasmatic nucleus (SCN)
 pineal gland stimulated + melatonin releeased
 Jet Lag = when your SCN is thrown off
o Awake
 norepinephrine ('adrenaline')
 serotonin
 histamine
o Sleep
 acetylcholine ('choline' -- PNS)
 GABA
o Sleep Disorders
 Insomnia
 Narcolepsy
 cataplexy
 sleep paralysis
 excessive daytime sleepiness
 Bruxism
 Nocturnal Enuresis
 Sleep Apnea
 Hypesomnia
 Parasomnic Disorders
 night terrors + nightmares
 somnambulism

Lecture 22
Thalamus + Hypothalamus

Thalamus
Relay station for ALL sensory except smell

 VPM - sensory face "M for makeup"

 VPL - sensory body "L for legs"
 Medial geniculate body - ears "M = music to ears"
 Lateral geniculate body - eyes
  sensory, motor, emotion, vegetative
 Internal capsule = lenticulostriate artery
o anterior limb
 lenticulostriate artery
 anterior cerebral artery
o genu
 lenticulostriate artery
o posterior limb
 lenticulostriate artery
 anterior choroidal artery
 Thalamic Lesions
o sensory loss
o thalamic syndrome -- unilateral pain symptoms
o abnormal, involuntary movements

Hypothalamus
4 F's -- Fight, Feed, Fleed, Fornicate (F***)

 REGULATION!
o internal environment, water, temperature, food intake, sleep/wakefulness
 Temperature
o anterior nucleus = cool
o posterior nucleus = warm "hot booty"
o TSH - thyroid hormone
o set point
 skin circulation, metabolic rate, sweating, behavior
o fever
 phases
 benefits
o hyperthermia
 Eating
o lateral nucleus - eat! (when you eat, you grow laterally)
o ventromedial nucleus - satiety (tall and skinny)
o lesions??
 Suprchiasmatic nucleus
o circadian rhythm
 Mammillary nuclei -- memory consolidation
 Paraventricular nuclei
o magnocell
o parvocell
 supraoptic nuclei
o ADH - water reuptake
o oxytocin
 Lesions
o genital dystrophy + abnormalities of sex development
o aggression
o rage
o sleep disorders

Lecture 23
Limbic System --> "extra limb"
Motivation, Addiction, Emotion, Sexual Activity, Autonomic Responses

 Cortical Structures Ring of cortex -- connected by cingulum

o parahippocampal gyrus
 o cingulate gyrus + subcallosal grus
 Subcortical Structures
o hippocampus - memory
o amygdala - sex drive/emotions
o septal nuclei - reward
 Papez Circuit
o emotions!
o connects limbic system + hypothalamus
 Motivation
o Reward
o Avoidance
 Addiction -- nucleus accumbens
o domapinergic fibers
 Emotions
o Fear - hypothal + amygdala
o Anxiety - frontal temporal
 a2-GABA recptors
 treat with benzos
o Rage - non-violent, over reacts
o Placidity - under reacts
o Aggression - violent
 Sexual Activity
o inhibition
 neocortex lesion in males
 ant hypothalamus lesion in females
o hyperactivity
 bilateral lesion of limbic system + destruction of amygdala
 Lesions -- rarely occur from vascular incidents ==> caused by trauma OR infection!!!
o Hippocampus - must be bilateral
 memory (short term)
o Amygdala - must be bilateral
 emotion (fear, anxiety, aggression, rage)
o Anterior Temporal Lobe
 seizures
 Kluver-Bucy Syndrome
o bilateral temporal lobectomy -- involves amygdala!!
 Placcid
 Hypersexual
 Hyperphagia/Hyperorality
o how?? bilateral surgical removal or temporal lobes, cerebral atrophies,
meningoencephalitis (toxoplasmosis, herpes or AIDS)

Lecture 24
Autonomic Nervous System

 Somatic vs. Autonomic

 Autonomic NS
o Sympathetic - fight/flight --> tiger is chasing you! What happens?
 T+L
 adrenergic = NE (synonymous with "adrenaline")
 exception = sweat glands (ach)
 Motor Neurons
 short pre fiber (type B - mye)
 long post fiber (type C - unmye)
 effector NT = NE
  NOTE: adrenal glands ONLY receive sympa innervation + have
no post-synaptic fibers --> makes sense because adrenal
glands secrete NE!!
o Parasympathetic - rest/digest
 C+S
 cholinergic = Ach (acetylcholine)
 Motor Neurons
 long pre fiber (type B - mye) -- "resting" so they take
their time getting there
 short post fiber (type C - unmye)
 effector NT = Ach
 ANS disorders
o Orthostatic Hypertension
 less SNS
 vasodilation - low BP + less blood flow to brain
o Raynaud's Disease
 more SNS
 spasms in periphery = vasoconstriction
o Hirschsprung's Disease = mega colon!!
 less PNS, more SNS
o Achalasia Cardia
 less PNS
 difficulty swallowing
 no relaxation
o Riley-Day Syndrome
 loss of neurons -- higher pain threshold!!
 less tear gland secretion
 less vasomotor control
 less swallowing
o Horner's Syndrome
 PAM - ptosis, anhydrosis, myosis
 ("PAM is horny")

Neuro - Lectures 25 + 26 + 27
main concepts to over in detail!

Lecture 25
Vision

 fibrous tunic
o cornea + sclera
 vascular tunic
o choroid + ciliary body + iris
 lens
 retina
o optic disc = blind spot (no rods or cones)
o macula lutea
o fovea centralis
o layers
 pigmented layer
 neural layer
 photoreceptor layer
 in dark = glutamate
 bipolar neurons
 amacrine + horizontal
 ON/OFF cells
  light on = on
 light off = off
 ganglion cell layer
 glands
o melbonian glands
o sebaceous glands
o lacrimal glands -- dacryocystitis
 PNS - CN VII
 Image focusing
o accommodation = increase refractory power of lens!
 ciliary muscle contracts to release tension
 PNS - CN III
 Refractive Error
o Hypermetropia = far sighted
 image focused behind retina
 fix convex lens
o Myopia = near sighted
 image focused in front of retina
 fix with concave lens
o Astigmatism = oblong corneal shape
 fix with cylindrical lens
o Presbyopia
 due to aging = loss of elasticity
 old people can't read close print
 Photopigments
o Rods
 slow adaptation to dark (20 min)
 fast adaptation in light (seconds)
 light sensitive, more in #
 loss of rods = night blindness + loss of periph vision
o Cones
 day vision -- color vision!
 3 types of cells (red, blue, green)
 loss of cones = decreasd acuity (legal blindness)
 Photoreceptor Mechanims
o light hits retina which causes photoisomerization of retinal
 11-cis Retinal converted to all-trans retinal
 regeneration of 11-cis retinal REQUIRES vitaminA
o Metarhodopsin II activates G protein transducin
o Na+ channels carry current in
o DARK = increased cGMP = Na+ influx (depol)
o LIGHT = less cGMP = Na+ channels close (hyperpol)
 do NOT generate AP's . . . EPSP/IPSPs only
 Visual Pathway Lesions
o monocular scotoma
o monocular visual loss
o bitemporal hemianopia - optic chiasm
o contralateral homonymous hemianopia
o contralateral superior quadrantanopia
o contralateral inferior quadrantanopia
 Visual Reflexes
o Light Reflex - Midbrain
o Accommodation reflex - LGB
o Blink Reflex
 Clinical Aspects
o Strabismic Amblyopia
o Night Blindness
o Retinitis Pigmentosa
 o Color Blindness
 blue = tri
 red = pro
 green = deu
o Argyll-Robertson Pupil
o Adie's Pupil
o Marcus-Gunn Pupil
o Weber Syndrome
o Parinaud Syndrome
o Cataracts
o Glaucoma

Lecture 26
Hearing (Auditory + Vestibular)

Auditory

 Anatomy + Phys
o External Ear
 pinna (auricle)
 auditory meatus (external auditory canal)
 tympanic membrane (ear drum)
o Middle Ear
 ossicles
 utricle
 saccule
 eustachian tube (auditory)
o Internal Ear
 cochlea
 organ of Corti (spiral) = organ of hearing
 hair cells
 CN VIII
 Clinical
o tympanic reflex - both ear muscle contract  pull malleus n stapes apart-->
lowers sounds
 tensor tympani
 stapedius
o eustachian tube dysfunction – pressure on either side of TM=TM stretch =
pain
o impedance matching -- middle ear sound amplification
 ear drum - increased pressure oval window
 middle ear - increase force + less velocity of stapes
 Hearing Defects
o conduction deafness
 obstruction -- wax
 otosclerosis -- stapes is fixed due to bone formation oval
window
 otitis media – inflammation of middle ear due to infection
o sensorineural deafness
 presbycusis -- most common, degenerative w/ aging of corti
 acoustic neuroma - tumor compression
 Hearing Tests
o Rinne - determines if there is sensorineural deafness (AC>BC)
o Weber - determines "whether/weber" it's the L or R
o Schwabach - conduction test
o https://www.youtube.com/watch?v=cZYJL9Jg-3k
Vestibular

 vestibular apparatus
o CN VIII
o semicircular ducts
o otolith crystals -- part of hair cells detecting position of head
 utricle = horizontal
 saccule = skinny, vertical
 Vestibular nuclei
o MLF -- "MILF" --> route toward eye movment
 vestibulo-ocular reflex
 -- nuclei pass through MLF to get to eye muscles!
o oculocephalic reflex - dolls head
o vestibular nystagmus - fast component
o postrotational nystagmus - fast component
o caloric nystagmus -- tests for brainstem death
 COWS test (fast)
 cold opposite (slow, fast)
 warm same (slow fast)
 intact brainstem? cows works
 lower brainstem lesion - NO movement at
all
 bilateral MLF lesion - tricky one!!!
 cold water will move eye to
same side SLOW
 vestibular disorders
o motion sickness
o meniere disease -- CN8
o tinnitus
o vertigo

vestibular reflexes
https://www.youtube.com/watch?v=O_c0ohKc0qw
https://www.youtube.com/watch?v=5SPslYO1PT0 -- brain dead (min 4)
https://www.youtube.com/watch?v=Vjk1f99N13M -- awake
https://www.youtube.com/watch?v=ixySJdRxmdA -- awake
https://www.youtube.com/watch?v=j7EK6kV5Zx8 -- physiology of reflex
Remember:
creates currents based on temperature!
slow then fast in alive
nothing in lower brain stem lesion

Lecture 27
Smell (Olfactory + Gustatory)

 bipolar olfactory receptor

o neurons found just below cribiform plate
 (axons meet here)
 cribiform plate FRACTURE = anosmia,
cerebrospinal rhinorrhea, olfactory nerve damage
 olfactory hallucinations = parahippocampal uncus
lesion
o smell + taste are processed TOGETHER
o olfactory can regenerate!
o olfactory nerve = CN I
 Olfactory Pathway
o lateral olfactory area = conscious perception of smell
 o medial olfactory area = emotional reaction to odors
 Taste Buds
o vallate --> inverted V
o fungiform - mushroom like --> grow wild
o foliate papillae (leaf like) --> Lateral
o filliform --> finger like "feel-i-form"
 Taste Transduction
o salty
 Na+
 fast
o sour
 H+
 fast
o sweet
 G protein - cAMP
 slow
o bitter
 G protein - PLC
 slow
 Gustatory Pathway
o CN VII, CNIX, CNX
o ant 2/3, post 1/3, epiglottis, palate --> to solitary tract!
o VPM = takes in taste + touch input
o gustatory cortex = in parietal operculum + parainsular cortex