Page1of3 NervousSystemWrittenExamIITables byDMFA

DisordersoftheBasalGanglia
Disorder Defect
lossofdarklypigmented
dopaminergicneuronsinthe
substantianigraparscompactis(SNc,
Parkinsonss nigrostriatalpathway
inhibitionofthalamuswhichcauses
underexcitementofmotorcortex
lossofstriatalGABAergic(andsome
cholinergic)neuronsinthecaudate
andputamen(striatonigral
Huntingtons
pathwaySNr)
Autosomaldominant,CAGtriple
repeatsonChr4,onset3545yrs
Hemiballism Lesionofsubthalamicnucleus
L33bDr.Schetz
Signs&Symptoms
Tremor,cogwheelrigidity,
akinesia,abnormalposture,
expressionlessface,slow
monotonousspeech,
micrographia
Nomentaldeficit
choreaformmovements(rigidity
ifearlyonset),cognitive
dysfunction,
psychiatricdysfunction(often
depression)
Contralateralinvoluntaryand
violentflailingmovements
Treatment
1.muscarinicanticholinergics(usefulinearlystages)inhibitorydopaminergic
controlofcholinergicinterneuronsinstriatumislostinPDandblocking
muscarinicreceptorspreventstheoveractivityofthecholinergicinterneurons.
2.Levodopa(LDOPA)adopamineprecursorthatrestoresthelostdopamine.
Givenincombinationwithcarbidopa(anperipheralAAADinhibitior)sothatL
DOPAisnotconverttodopamineintheperiphery.
3.Amantadineanantiviralagentthatalsoactsasaweakantiglutamatergic
(reducescorticalglutamatergicexcitation)
4.selegilineanMAOBinhibitorthatprolongstheactionsofdopamine,by
preventingisdegradation.
5.pallidotomylesioningoftheGPi(reducesexcessiveinhibitionofthethalamus
bythisnucleusinPD,whichresultsinenhancedstimulationofthecortex)
6.Lesioningofthesubthalamicnucleus.
None
Spontaneouslyresolvesafterseveralweeks

BasalGangliaandExtrapyramidalStructures L33bDr.Schetz
Structures Inputsfrom Outputs to Image
GPe GABA,inhibitory
Cortexglutamate(+)
SNrGABA,inhibitory
Caudatenuclei SNcdopamine(D1)(+),direct
BasalGanglia

InterneuronsACh(muscarinic),(+)
Striatum

SNcdopamine(D2)(),indirect
InterneuronsGABA()(95&)
GPe GABA,inhibitory
Cortexglutamate(+)
Putamen SNrGABA,inhibitory
SNcdopamine(D1)(+),direct
(maininput) InterneuronsACh(muscarinic)(+)
SNcdopamine(D2)(),indirect
InterneuronsGABA()(95%)
Thalamus (VL&VA) GABA()
Globuspallidis
StriatumGABA,inhibitory STNGABA()
(GPimainoutput)
Rednucleus
Extrapyramidal

Cortex
Subthalamicnucleus SNrGlutamate(+)
Structures

GPiGABA,inhibitory

Compacta
Reticulata
StriatumDopamine(D1)(+),direct
StriatumGABA()
Substantianigra StriatumDopamine(D2)(),indirect
GPiGABA()
Reticulata
STNGlutamate(+)
ThalamusGABA()

Thalamocorticaltract
Anteriorlimb Frontopontinetract
Internal
Capsule

Caudateputameninterneurons

Anterior
Corticospinal,corticobulbar,corticorubraltracts;siteforpuremotorstroke
Posteriorlimb
Posterior
Sensoryfibers

MotorTracts L33cDr.Schetz
Tract Function Origins Course Termini
Posteriorinternalcapsule,
Corticobulbar Face,CNnuclei Facialpartofmotorhomunculus Brainstemnuclei
middlepartofcruscerebri
87%decussateinpyramids
55%Frontal(4,6),35%sensory(3,1,2), Thalamus(VL),brainstem,spinalcord
Corticospinal Voluntarymovementofbody 3%donotcrosstrunk
10%other,5%Betzcells Directpathwayonlyfordistalextremities
10%decussatelowerlevels
Cerebellumequilibrium,
Corticopontine
posture,gait
Interneuronsinspinalcordwhichproject
Rubrospinal Flexormuscletone Rednucleus
toflexormusclemotorneurons
Reticulospinal Biogenicamines Reticularformation Interneuronsandmotorneurons
/motorneurons,somedirectlyonto
Vestibulospinal Balance,extensormuscletone Vestibularnucleusinbrainstem
extensormusclemotorneurons
Tectospinal Sightandsoundcues

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Condition
Poliomyeletis
AmyotrophicLateralSclerosis
SpinalMuscularAtrophy
SpinalCordTumor
HerniatedDisk
Corticospinallesions
Corticobulbarlesions
Decerebraterigidity
Myastheniagravis
Myotonia
Arteries
NervousSystemWrittenExamIITables byDMFA
MotorSystemLesions L33cDr.Schetz
Type Description Signs&Symptoms
LowerMN Motorneuronsdestroyedbyvirus Flaccidparalysisofentirelimb
Upper/LowerMN BilateraldegenerationofupperandlowerMNs Fasciculations,dementia,atrophy
LowerMN
LowerMN Affectsoneormorespinalsegments Flaccidparalysis,decreasedDTRs
LowerMN Bulgingdiskwhichimpingesmotorneuronsexitingspine
UpperMN Lesionincortexorbrainstemabovespinalmotorneurons Spasticparalysis,positiveBabinski,increasedDTRs
UpperMN LesionofbrainstemCNnuclei Speechdisorders,possiblementalretardation
Posteriorportionofbrainstemisseveredbyinjurytothe
Increasedactivitytoextensormuscles(duemostly
superiorborderofthepons
toincreasedgammamotorneuronactivitywhich
UpperMN Corticalandbasalgangliainhibitoryinfluencetothespinalcord
increasestheactivityofalphamotorneurons
areblocked,butthevestibulospinalandreticulospinal
resultinginmuscleextension)
excitatoryinfluencesremainintact
Fatigue,weaknessandinabilitytosustainmuscle
Neuromuscularjct. AutoantibodiestoAChR contraction(esp.eyesandmouth)andthat
resolvesafterrest
+ +
MutationsintheCl ,Na ,orK channelsthataffectthemuscle stiffness(e.g.,difficultyreleasingonesgriplike
Neuromuscularjct.
membrane afterahandshake)
Cerebrovascularsystem L31Dr.Aschenbrenenr
Vessel Origin Supplies/Branches Veins
Medial surfacesofcerebral
Anteriorcerebrala. Internalcarotida.
hemisphere
Lenticulostriateaa. Ruptureisleadingcauseof
A1branch
(medialstriateaa.) intracerebralhemorrhage
Recurrenta.ofHubner A2branch
Frontopolarbranch A2branch
Callosomarginalbr. A2branch
Pericallosal A2branch
Anteriorcommunicating HighincidenceofBerry
Ant.cerebralaa.
a. aneurysmformation
Superiolateral surfaceof
Middlecerebrala. Internalcarotida. hemispheres,deepbrain
*Cerebrovasculardisease*
Lenticulostriateaa. Ruptureisleadingcauseof
M1branch
(lateralstriateaa.) intracerebralhemorrhage
Temporopolara. M2branch
Precentral(Rolandic) M2branch
Postcentral(Rolandic) M2branch
Angularbranch M2branch
Post.temporalbranch M2branch
Posterior Optictract,choroidplexus,
Ant.choroidala.
communicatinga. thalamicnuclei
Anastomosisbetweenantand
Int.carotida.and
Post.communicatinga. postcirculations
basilara.
Hypothalamus,brainbase
Vertebralaa. Subclavianaa. Upper6vertebrae
Posteriorspinala. Vertebrala. Spinalcord
th
Post/latmedulla,4 ventricle,
Post.inf.cerebellara. Vertebrala.
choroidplexus
Medullarypyramids,medial
Anteriorspinala. Vertebrala. lemniscus,MLF,2/3ofspinal
cord
Basilara. Vertebralaa. Allbrainstemstructures
Ant.inf.cerebellara. Basilara. Cerebellum
Superiorcerebellara. Basilara. Deepcerebellarnuclei
Basilara.through Temporal l.,occipital l.,
Posteriorcerebrala.
tentoriumcerebelli midbraintectum,peduncles
Thalamogeniculatebr. Post.cerebrala. Hypothalamus,thalamus
Calcarinebr. Post.cerebrala. Visual cortex
Deepcerebralvv. Thalamostriate,caudate,septalvv.
GreatveinofGalen Deepcerebralvv.
Greatv.ofGalen,Basalv.ofRosenthal,inf.&sup.
Straight(dural)sinus
sagittalsinuses
Confluenceofsinuses Sup.sagittal,straight,occipitalsinuses
Transverse(lat)sinus Straight,superiorsagittalsinuses
Sigmoidsinus Superiorpetrosalsinus
Spenoparietal,intercavernous,circularsinuses,sup&
Cavernoussinus
infophthalmicvv.,pterygoidplexus
Inferiorpetrosalsinus Cavernoussinus
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ReticularFormationFunctions DSA10Dr.Forster
Nuclei Function
Raphemagnusinhibitspaintransmissioninmedullaoblongata,descendinbrainstemtoterminateonspinaltrigeminalnucleusandsubstantia
Median(Raphe) gelatinosa
Paramedian Paramedianpontinereticularformation(PPRF)horizontaleyemovementsw/CNsIII,VI,MLF

Medial Visceralmotorinspiratoryresponse,depressoreffectonthecirculatorysystem

Lateral Visceralmotorexpiratoryresponse,pressorcirculatoryeffect

NeurotransmittersinReticularFormation DSA10Dr.Forster
Peduncolopontinereticularnucleus,lateraldorsaltegmentalnucleus arousal,movement;implicatedwithprogressivesupranuclearpalsy
Cholinergic Locomotorcentercoordinatedwalkingmovements
NucleusbasalisofMeynertbasalforebrain,implicatedinAlzheimers
Dopamine Nigrostriatal(Parkinsons),mesolimbic(Schizophrenia),Mesocortical(cognitiveeffectsofParkinsons)

Norepinephrine Locusceruleus,lateraltegmentalNE
Ascending:attention,sleepwakestate,mood,e.g.ADD,narcolepsy
Epinephrine Descending:sympatheticfunctions,e.g.BP
Mostlywithinraphenuclei;discretetopography,restrictedareaofterminaldistribution
Serotonin Rostral:psychdisorders
Medulla:inhibitsdorsalhornneurons

Comas DSA10Dr.Forster
Lesionsthatcausecoma Upperbrainstem,midbrain/hypothalamus,diencephalon,bilateralcerebralcortex
Intracranialcauses Headtrauma,CVA,CNSinfections,tumors,intracranialpressure
Extracranialcauses Vasculardisorders,metabolicdisorders,intoxication,hyperthermia,systemicinfections
GlasgowComaScale Scalewhichincorporatesspontaneouseyeopening,Speech,Pain,Commands(verbalandmotor)
Noncomadeficits

Syncope:brief,suddenlossofconsciousness;stupor/obtundation:impairedreactivity