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1 Anatomy

What are the dermatomes of the following landmarks: thumb, middle finger, little finger, breast nipple, umbilicus, medial knee, big toe, and little toe? Thumb: C6, Little finger: C8, Umbilicus: T10, Big toe: L5, Middle finger: C7, Breast nipple: T4, Medial knee: L3-L4, Little toe: Sl

What are the major ascending tracts in the spinal cord? (I) dorsal column tracts, (2) spinothalamic tract, (3) dorsal spinocerebellar tract, and (4) ventral spinocerebellar tract.

At what vertebral level does the spinal cord end? Ll-L2.

What is the cauda equina? Gathered roots of L2 and below; they occupy the spinal canal below the cord.

What are the major descending tracts in the spinal cord? The major descending tracts are (1) intermediolateral columns, (2) lateral corticospinal tract, (3) lateral reticulospinal tract, (4) lateral vestibulospinal tract, (5) medial reticulospinal tract, (6) medial vestibulospinal tract, (7) medial longitudinal fasciculus, and (8) ventral corticospinal tract and (9) medial reticular tract.

What type of information is carried in the dorsal columns? The dorsal columns convey tactile discrimination, vibration, and joint position sense.

Where do dorsal column fibers decussate? At what locations do they synapse? dorsal columns decussate in the lower medulla, after synapsing in the nucleus gracilis and

The

2 cuneatus. They also synapse in the VPL of the thalamus before going to the cortex.

What type of information is carried in the spinothalamic tract? The spinothalamic tract conveys pain, temperature, and crude touch.

Where do the spinothalamic fibers decussate? At what locations do they synapse?

These

fibers decussate at the level they enter the spinal cord, after synapsing in Rexed's lamina 1-3 (substantia gelatinosa). They also synapse in the VPL of the thalamus before going to the cortex.

Where do the motor fibers originate? The motor fibers originate from the precentral gyrus (Brodmann's area 4). Initiation of movement arises from the premotor cortex (Brodmann's area 6), which lies anterior to the precentral gyrus.

What is the medial longitudinal fasciculus (MLF)? The medial longitudinal fasciculus is also an efferent of the lateral vestibular nucleus. This tract ascends to the sixth and third cranial nuclei, as well as descends to the spinal cord. Its main function is to coordinate head and truncal posture with eye movements.

Which disease affects the substantia nigra? What is the pathology? The primary efferent neurotransmitter from the substantia nigra is dopamine. Parkinson's disease damages the substantia nigra. Pathologically, the neurons lose their melanin so the nucleus becomes depigmented. Many neurons also contain inclusion bodies called Lewy bodies.

What is the function of cranial nerve III? Cranial nerve III innervates all the extraocular

3 muscles except for the lateral rectus and superior oblique. It innervates the medial rectus, superior rectus, inferior rectus, inferior oblique muscles and superior levator palpebrae muscle. Furthermore it has a parasympatical function as well (innervation of the pupil).

What is the function of cranial nerve VII? Cranial nerve VII, the facial nerve, innervates the muscles of facial expression (special visceral efferent), innervates the lacrimal, submandibular and sublingual glands (general visceral efferent), supplies taste sensation to the anterior two-thirds of the tongue (special visceral afferent), supplies sensation to the external ear (general somatic afferent) and innervates the stapedial muscle.

What is meant by the term motor unit? The motor unit is one motor nerve (lower motor neuron) and all the muscle fibers innervated by it.

What is the role of the gamma efferent nerves? The gamma efferent nerve fibers keep the muscle spindles "tight" by innervating and contracting the intrafusal fibers in the muscle spindle. This ensures that the spindle remains sensitive to any stretch.

What is the afferent pathway for the pupillary light reflex? Retinal ganglion cells concerned with the light reflex travel with the optic nerve and tract and then break away to project down to the midbrain pretectal nucleus. From the pretectal nucleus, fibers project bilaterally, decussating via the posterior commissure to each Edinger-Westphal nucleus.

Where is the lesion that causes a field defect only in one eye? If only one eye is affected, the lesion must be prechiasmal.

4 Where is the lesion that causes left homonymous hemianopsia? Left homonymous hemianopsia can arise from the right optic tract, right lateral geniculate body, right optic radiations, or the right occipital cortex.

Where is the lesion that causes bitemporal heteronym hemianopsia? Bitemporal heteronym hemianopsia is caused by midline chiasmal lesions such as pituitary lesions (from below) or craniopharyngeal tumors (from above).

Where is the lesion that causes binasal heteronym hemianopsia? Binasal heteronym hemianopsia can be caused only by simultaneous lesions on the lateral optic nerves or chiasma, such as bilateral internal carotid artery aneurysms.

Which vessels make the circle of Willis? 1. The anterior circulation composed of the anterior cerebral arteries, and the anterior communicating artery which connects the two anterior cerebral arteries. 2. The posterior circulation, composed of the two posterior cerebral arteries. 3. The posterior communicating artery, which connects the middle cerebral with the posterior cerebral arteries, thus forming a true "circle.

What region is supplied by the anterior cerebral artery, the middle cerebral artery and the posterior cerebral artery? The anterior cerebral artery supplies the medial (midline) cerebral hemispheres, superior frontal lobes, and superior parietal lobes. The middle cerebral artery supplies the inferior frontal, infero-lateral parietal, and lateral temporal lobes. The posterior cerebral artery supplies the occipital lobes and medial temporal lobes.

What anatomic structure or structures produce CSF? The majority of CSF is produced by

5 the choroid plexus. A 25-30 % of CSF is also produced by the blood vessels in the subependymal region and pia.

What is the pathway of the optic nerve? The ganglion cells from the nasal half of the retina travel in the optic nerve, they decussate in the optic chiasm and join the contralateral optic tract to the lateral geniculate body. The ganglion cells from the temporal half of the retina travel in the optic nerve, stay in the ipsilateral optic tract, and project to the lateral geniculate body. In this way, the contralateral visual field is projected from each eye to the lateral geniculate body.

What is the pathway of the optic radiation? Second-order neurons from the lateral geniculate body project to the calcarine cortex (Brodmann's area 17). The superior visual field fibers wrap around the temporal horn on their way to the inferior lip of the calcarine fissure, while the inferior visual field fibers go along the inferior part of the parietal lobe. The macular area is served by the most medial area of the calcarine cortex.

What is the function of the frontal lobe? The frontal lobes (both right and left) are involved in voluntary eye movements, somatic motor control, planning and sequencing of movements, and emotional affect. The left frontal lobe is crucial for motor control of speech (Broca's area).

What is the function of the temporal lobe? The temporal lobes (both right and led) handle auditory and visual perception, learning and memory, emotional affect, and olfaction. The dominant temporal lobe influences comprehension of speech (Wernicke's area). The nondominant temporal lobe mediates prosody and spatial relationships.

6 What is the function of the parietal lobe? The parietal lobes (both right and left) handle cortical sensation, motor control, and visual perception. The dominant parietal lobe also handles ideomotor praxis. The non-dominant parietal lobe controls spatial orientation.

What is the function of the occipital lobe? The occipital lobes (both right and left) mainly handle visual perception and involuntary smooth pursuit eye movements.

Where is the lesion that causes Broca's aphasia? The lesion that causes Broca's aphasia usually involves the frontal operculum (Brodmann areas 45 and 44) and the deep frontal white matter, sparing the lower motor cortex and the middle paraventricular white matter.

What is Brocas aphasia?

Where is the lesion that causes Wernicke's aphasia? Classical Wernicke's aphasia usually indicates an extensive lesion of the postero-superior temporal region, including the superior and middle temporal gyrus and sometimes part of the laterotemporal-occipital junction.

What are the two main components of Wernickes aphasia? The first is impairment in the comprehension of written and spoken language. The second is an inability to speak substantive language; often these patients are unable to form some words correctly and seem to inject words in their sentences that do not fit (paraphasia).

Where is the lesion in conduction aphasia? The lesion usually involves the left inferior parietal lobule, especially the anterior supramarginal gyrus. Often, the lesion is in the subcortical white matter, affecting the arcuate fasciculus or the external capsule below the

7 arcuate fasciculus, both of which are connected to the temporal and frontal cortex.

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