NEUROANATOMY

REVIEW
David Jho
CEREBRAL CTX
 BRODMANN’S AREAS

6
4 3,1,2
5,7
9
8
40
10 39 19
22
45,4428 41,42 18
11
34
17
12
 BRODMANN’S AREAS
8 = Frontal Eye Field
6 = SMA & Premotor ctx 5,7 = PPC (apraxia, dom. side)
6
4 3,1,2
4 = Primary motor ctx
3,1,2 = Primary somatosensory ctx 5,7
9
41,42 = Primary8auditory ctx (Transverse gyrus
of Heschl)
40
45,44 = Broca’s speech area (Inf Frontal Lobe;
10
expressive dysprosody) 39 19
22
45,44
22 = Wernicke’s speech
28 area (arcuate
41,42 18
11 fasciculus
34 connect to Broca’s; 17
12
receptive dysprosody)
40 = Supramarginal gyrus (Rt/Lt confusion,
dyscalculia, understanding speech)
39 = Angular gyrus (dyslexia & dysgraphia)
 BRODMANN’S AREAS
39, 40 = Inf parietal lobe (Gerstmann’s syndrome) on dominant
side
a) Rt/Lt confusion
6
4 3,1,2
b) dyscalculia
c) finger agnosia 5,7
9
8
d) dyslexia & dysgraphia
e) lower quadrantanopia (visual radiations to cuneus)
40
Parietal lobe, non-dominant hemisphere (Sup or Inf39
parietal lobes)
10 39 19
22
a) contralateral sensory neglect & astereognosis
45,44
b) construction apraxia
28 41,42 18
11
34
c) lower quadrantanopia (visual radiations to cuneus) 17
12
9,10,11,12 = Prefrontal ctx
Post part of orbital gyrus = smell
Uncus = serves as part of primary olfactory ctx (medial temporal lobe)
34 = Primary olfactory ctx (medial temporal lobe—seizures can have smell aura)
LIMBIC SYSTEM
 PAPEZ CIRCUIT (Limbic System)
HIPP Fornix Septal area Hypothal

Fornix VAFP/VAPP Stria

Ventral AmygdaloFugal Pathway
Ventral AmygdaloPetal
Pathway
terminalis

Mamillary body Amygdala

Mamillothalamic tract
Olfactory, Sensory, Autonomic
Ant nuc of thalamus
Wernicke’s Encephalopathy
Ant limb of internal capsule
(Thiamine/Vit B1 defic)
1) Nystagmus
Cingulate gyrus 2) Ataxia
3)
Perforant Mental status change
Cingulum
pathway Korsakoff’s confabulatory syn
Entorhinal ctx 1) Mem loss & confabulation
 PAPEZ CIRCUIT (Limbic System)
HIPP Fornix
Fornix Septal area Hypothal

Fornix
Fornix VAFP/VAPP Stria
Stria
Ventral
Ventral AmygdaloFugal
AmygdaloFugal Pathway
Pathway
Ventral
Ventral AmygdaloPetal
AmygdaloPetal Pathway
Pathway terminalis
terminalis

Mamillary body Amygdala

Mamillothalamic
Mamillothalamic tract
tract
Olfactory,
Olfactory, Sensory,
Sensory, Autonomic
Autonomic
Ant nuc of thalamus
Wernicke’s Encephalopathy
Ant
Ant limb
limb of
of internal
internal capsule
capsule (Thiamine/Vit
(Thiamine/Vit B1
B1 defic)
defic)
1)
1) Nystagmus
Nystagmus
Cingulate gyrus 2)
2) Ataxia
Ataxia
3)
3) Mental
Mental status
status change
change
Perforant
Perforant Cingulum
Cingulum
pathway
pathway Korsakoff’s confabulatory syn
Entorhinal ctx 1)
1) Mem
Mem loss
loss &
& confabulation
confabulation

Mediodorsal nuc of the thalamus (associated with Ant nuc)

Orbitofrontal ctx (associated with HIPP)

Ansa lenticularis = VA Fugal Pathway

 Klüver-Bucy Syndrome
(bilateral ablation of ant temporal
lobes including amygdala)
a) Docility
b) Hypersexuality
c) Hyperphagia
d) Visual agnosia

AMYGDALA—coordinates behavioral & emotional responses to complex sensory

input by integrating somatosensory and viscerosensory information.
Output via Stria Terminalis posteriorly by tail of caudate and arches over thalamus
to anterior hypothalamus.
Output via Ventral Amygdalofugal pathway (VAFP) to Caudate/Septal Area.
 HYPOTHALAMUS
a) Homeostasis (autonomic, endocrine, & limbic systems)
b) Half of hypothalamus is enough
 Preoptic area Ant Hypothal Nuc
(Medial Preoptic Nuc) (dissipates heat,
(sexually dimorphic, parasympathetic)
regulates gonadotropic Post Hypothal Nuc
hormones) (conserves heat,
Suprachiasmatic nuc sympathetic)
(direct retinal input, Parvocellular
circadian rhythms) PVN

PVN & SON

(produce oxytocin
ADH/vasopression,
Lat
at Nuc
destruction causes DI)
(appetite center,
SUPRAOPTICO-
stim induces eating, Dorsomedial Nuc HYPOPHYSIAL
destruction causes (stim causes
TRACT
starvation) obesity & savage behavior)
Magnocellular
Ventromedial Nuc Arcuate Nuc PVN
(satiety (DOPA-ergic neurons
inhib prolactin release)
center, stim stops
TUBERO-
eating, destruction causes INFUNDIBULAR
obesity & savage behavior) TRACT
 HYPOTHALAMIC FIBER SYSTEMS
Fornix
From HIPP to mamillary nuclei (then Mamillothalamic tract to Ant Thal Nuc)

Medial Forebrain Bundle (MFB)

a) in lat hypothalamus, lat to fornix; can be damaged in hypothal injury
b) unmyelinated, major connection b/n cerebral ctx & BS
c) no synaptic relay through thalamus
d) has monoaminergic neurons from the locus coeruleus (NE),
raphe nuclei (5-HT), and ventral tegmental area (DA).

Hypothalamo-spinal tract
Descending autonomic fibers for sympathetic neurons (thoracic
intermediolateral horn) and parasympathetic neurons (sacral lateral
horn)
Lesion or interruption above T1 can cause Horner’s syndrome (miosis,
ptosis, anhidrosis, & apparent enophthalmos)
 HYPOTHALAMIC FIBER SYSTEMS
Stria terminalis
Stria terminalis is the major pathway of Amygdala to hypothalamus & septal area.
STRIA = STRANDS (Sup to fornix & divides caudate from thalamus)
Lamina terminalis (from optic chiasm to rostral 3rd ventricle; closure of ant
neuropore) LAMINA = LAYER
Stria medullaris thalami (hypothalamus & septal area in roof of 3rd ventricle inf to
fornix to thalamus & epithalamic habenular nuclei; relay from limbic forebrain
to midbrain reticular formation) MEDULLARIS is also in the MEDULLA
Stria medullaris of 4th ventricle (central sulcus to Inf Cereb Ped; arcuate nuc of
pyramids)
Sulcus Limitans (divides Alar & Basal plates) SULCUS = GROOVE
HYPOTHALAMIC FIBER SYSTEMS

(strands)
HYPOTHALAMIC FIBER SYSTEMS

Ant neuropore
(anencephaly)
vs
Lamina terminalis (layer) Post neuropore
(spina bifida)
HYPOTHALAMIC FIBER SYSTEMS

(medial & also in medulla)

HYPOTHALAMIC FIBER SYSTEMS
 EMBRYOLOGIC DEVELOPMENT
Neural Tube (CNS, pregang ANS)

Neural Crest (PNS including DRG, postgang

ANS)

Sulcus Limitans (divides Alar & Basal plates)

Alar plate (sensory), Basal plate (motor)

Rhombencephalic lip (in roof of 4th ventricle

becomes Cerebellum)
EMBRYOLOGIC DEVELOPMENT

PRIMARY VESICLES SECONDARY VESICLES

Telencephalon (lateral ventricles)
Prosencephalon
Diencephalon (3rd ventricle)
Mesencephalon Mesencephalon (cerebral aqueduct)
Metencephalon (upper 4th ventricle)
Rhombencephalon Myelencephalon (lower 4th ventricle, central
canal)
THALAMUS
BLOOD SUPPLY
1. PCA (post circulation)
2. PCOM (ant
circulation)
3. Ant Choroidal a (ICA)
 THALAMIC NUCLEI

Int medullary lamina

ar
IIntra Ant

ul
ti c
lam

Re
inar
r
CM MD

VA
VL

VPL VPM Pulvinar

Ext
Ext medullary lamina
lamina
LGN
MGN

= ANT-MED (limbic)
= ANT-LAT (EPS)
= POST (sensory)
= NON-SPECIFIC (relay)
 THALAMIC NUCLEI VA/VL (GP+SN)
Ant+MD (Papez)
r
VPL (sensory--body)
la

Inttra Ant
cu
et i

lam
iinar
R

MD VPM (sensory--head)
CM
VA
LGN (vision)
VL
MGN (hearing)
VPL VPM Pulvinar
Pulvinar (visual sensory
LGN
MGN association)
Intralaminar
= ANT-MED (limbic) CM (very diffuse to cerebral
ctx, ends in layer I for
= ANT-LAT (EPS) cortical excitability)
Reticular (GABA-ergic to thal)
= POST (sensory)
= NON-SPECIFIC (relay)
Mamillary bodies

Cingulate gyrus

Prefrontal ctx
ar

Ant
ul
ic

Inttra
alaam
et

innar
R

CM MD

VA
VL

VPL VPM Pulvinar

LGN
MGN
 ar

Ant
ul
ic

Inttra
alaam
et

innar
R

CM MD

VA
VL
GP, SN
VPL VPM Pulvinar
(EPS) Area 6
LGN
MGN
Area 4
GP, SN,
cerebellum Area 4 + EPS
(EPS +
dentatothalamic
tract)
 ar

Ant
ul
ic

Inttra
alaam
et

innar
R

CM MD

VA
VL
Integration of somesthetic,
visual, & auditory
VPL VPM Pulvinar
Areas 18,19
LGN
MGN
Areas 3,1,2
Areas 41,42
Sensory--body Hearing
Sensory--face
Vision Area 17
 THALAMIC NUCLEI Caudate Caudate
Fornix
ar
Ant
ul
tic

IInnttrra
lam
Re

iinnaar
r
MD
CM
VA Ant Ant VA
VA LD or DL
(VL) (VL)
VL LP
Interthalamic
adhesion

VPL VPM Pulvinar

Cerebral Cerebral
peduncle peduncle
LGN
MGN
Mamillary
bodies

Ant Ant
VL VL Pulvinar Pineal MD Pulvinar
CM MD MD CM gland

Sup colliculus

VPL VPL LGN LGN

VPM VPM MGN Midbrain MGN
Zona Incerta

STN
Pons
 HIPPOCAMPUS
HIPPOCAMPAL FORMATION (3-layered archicortex; declarative mem)
a) Dentate gyrus—HIPP input & output to HIPP
pyramidal cells b) Hippocampus
proper or Cornu Ammonis (CA)—to fornix then septal area
c) Subiculum—to fornix then mamillary nuc

Alzheimer’s Disease affects neurons in Nuc Basalis of Meynert (ACh), Locus

Coeruleus (NE), Entrorhinal ctx, and CA1/Subiculum of HIPP.
 HIPPOCAMPUS
Mammillary
bodies
Postcommissural
Fornix
(connects bilateral CA) Fimbria of
Fornix

Alveus

Schaef
6-layer vs 3-layer CA3
fer coll
aterals
NEOCORTEX ARCHICORTEX CA1
CA4
DENTATE
GYRUS t p ath
r f oran
Pe
Entorhinal ctx
(with pyriform ctx are
paleoctx) SUBICULUM
Alvear path
 HIPPOCAMPUS
Mammillary
Mammillary
bodies
bodies
Postcommissural
Fornix
Fornix
(connects
(connects bilateral
bilateral CA) Fimbria
Fimbria of
of
Fornix
Fornix

Alveus

6-layer vs 3-layer CA3

Schaeff
er colla
terals
NEOCORTEX ARCHICORTEX CA1
CA4
DENTATE
GYRUS ath
ra nt p
f o
Per
Entorhinal ctx
(with pyriform ctx are
paleoctx) SUBICULUM
Alvear path

Dentate gyrus has afferents entirely within HIPP formation.

CA1 projects to Subiculum and precommissural fornix.
CA3 projects to CA1 and precommissural fornix.
CA4 (hilus of dentate gyrus) receive afferents from dentate and project to
bilateral dentate (hippocampal commissure).
Subiculum provides main efferents to POST-COMMISSURAL FORNIX
(to thalamus and hypothalamus).
EPS SYSTEM
 Pyr system (CS tract)
UMN lesion LMN lesion
1. Weakness 1. Weakness
2. Spasticity 2. Dec DTR
3. Inc tone 3. Dec tone
4. No atrophy 4. Atrophy
5. Babinski 5. Downgoing toes

EPS (Basal Ganglia) Cerebellum

1. Intention tremor
1. Chorea (Huntington’s, Syndenham’s)

2. Ataxia (fall towards lesion,

2. Athetosis (choreoathetosis in HD,
gait & trunk dystaxia,
Tardive dyskinesia when
dysrhythmokinesia,
antipsychotics block DA receptors &
dysdiadochokinesia,
make super-sensitive)
dysmetria)
3. Hemiballismus (stroke)
3. Nystagmus
4. Parkinson’s vs Diffuse Lewy Body Dz
(resting tremor, bradykinesia, truncal
 Lenticular nuc = Put + GP
Glutamate GABA Striatum/Neostriatum = Put + Caud
(Glycine in SC) Corpus striatum = Put + Caud + GP

Input from Ctx--Net excitation

DIRECT PATHWAY Input from D1 recep—Net excitation

Ctx Striatum GPi/SNr VA/VL Ctx

thalamus
Parkinson’s D1 recep

SNc

Input from Ctx—Net inhibition

INDIRECT PATHWAY Input from D2 recep—Net excitation

Ctx Striatum GPe STN GPi/SNr VA/VL Ctx

thalamus
Parkinson’s D2 recep

SNc
Striatum (GABAergic neurons) have both D1 recep (Gs; contain excitatory
Substance P) and D2 recep (Gi; contain inhibitory Enkephalin).

Net LOSS of excitation in Parkinson’s Dz.

Pallidotomy destroys segments of GPi to reduce inhibition of thalamus (interrupts

direct & indirect pathways). GPi and GPe are usually always on.

Input from Ctx--Net excitation

DIRECT PATHWAY Input from D1 recep—Net excitation

Ctx Striatum GPi/SNr VA/VL Ctx

thalamus
Parkinson’s D1 recep

SNc
Input from Ctx—Net inhibition
INDIRECT PATHWAY Input from D2 recep—net excitation

Ctx Striatum GPe STN GPi/SNr VA/VL Ctx

thalamus
Parkinson’s D2 recep

SNc
 GPe is constantly on. In Huntington’s chorea, the striatum (ACh & GABAergic
medium spiny neurons) are destroyed so GPe overstimulates Ctx.

Damage to STN results in Hemiballismus due to decreased stim of thalamic

inhibition to Ctx.

Input from Ctx--Net excitation

DIRECT PATHWAY Input from D1 recep—Net excitation

Ctx Striatum GPi/SNr VA/VL Ctx

thalamus
Parkinson’s D1 recep

SNc
Input from Ctx—Net inhibition
INDIRECT PATHWAY Input from D2 recep—net excitation

Ctx Striatum GPe STN GPi/SNr VA/VL Ctx

thalamus
Parkinson’s D2 recep

SNc
CEREBELLUM

Functional vs
Anatomical
Divisions
 Cerebellar Synonyms

1. FLOCCULONODULAR LOBE = Vestibulocerebellum.

2. VERMIS = Medial zone or part of Spinocerebellum.
3. PARAVERMIS = Intermediate zone or part of Spinocerebellum.
4. CEREBELLAR HEMISPHERES = Lateral zone or Cerebrocerebellum
or Pontocerebellum.
 Cerebellar Function

1. FLOCCULONODULAR LOBE = balance & eye movement.

2. VERMIS = balance & axial motor functions.
3. PARAVERMIS = distal motor execution.
4. CEREBELLAR HEMISPHERES = motor planning.
Cerebellar Peduncles
1. Sup Cerebellar Ped (dentatothalamic tract, VSCT)
2. Middle Cerebellar Ped (pontocerebellar fibers)
3. Inf Cerebellar Ped (OlivoCT, Dorsal SpinoCT, CCT,
vestibulocerebellar tract) - Spine to cerebellum
 Motor Ctx
(corticopontine
& CS tracts)

Corticopontine
MOLECULAR Stellate Basket fibers VL (thalamus)
LAYER

PARALLEL FIBERS
Pontine Dentatothalamic tract
nuc (Sup Cereb Ped)

Pontocerebellar Red Nuclei

tract (rubrospinal
(contralat) tract)
PURKINJE Cereb Deep Nuc
Purkinje
CLIMBING FIBERS

LAYER Dentate
Emboliform
Fastigial
GOLGI MOSSY Globose
Golgi
LAYER FIBERS
Spinocerebellar
Pontocerebellar
Granule Vestibulocerebellar
(cerebellar &
ION vestibular nuc)
Olivocerebellar tract to CLIMBING FIBERS
Vestibulospinal tract
 4 Cerebellar Deep Nuclei

5 Types ofCerebellar Cells

(know if excit or inhib;
know if projects out of
cerebellum or not)

Motor Ctx
(corticopontine
& CS tracts)

Corticopontine
MOLECULAR
MOLECULAR Stellate Basket fibers VL (thalamus)
LAYER
LAYER

PARALLEL FIBERS
Pontine Dentatothalamic tract
nuc (Sup Cereb Ped)

Pontocerebellar Red Nuclei

tract (rubrospinal
(contralat) tract)
PURKINJE
PURKINJE
Purkinje Cereb
Cereb Deep
Deep NucNuc
CLIMBING FIBERS

LAYER
LAYER Dentate
Dentate
Emboliform
Emboliform
Fastigial
Fastigial
GOLGI MOSSY Globose
Globose
GOLGI Golgi
LAYER
LAYER FIBERS
Spinocerebellar
Spinocerebellar
Pontocerebellar
Pontocerebellar
Granule Vestibulocerebellar
Vestibulocerebellar
(cerebellar
(cerebellar &
&
ION vestibular
vestibular nuc)
nuc)
Olivocerebellar tract to CLIMBING FIBERS
Vestibulospinal tract
 Cerebellar Deep Nuclei receive excitatory afferents from Climbing fibers and Mossy
fibers (collaterals on their way to the Granule layer).
Purkinje cell (only ones that project out of ctx) inhibitory fibers from Cerebellar Ctx to
Cerebellar Deep Nuclei. Climbing fibers from Inf Olivary Nuc via Inf Cerebellar Ped.
Pontocerebellar fibers via Middle Cerebellar Ped.
Granule cell (only excitatory) endings (Parallel Fibers) go to Molecular layer but not out
of Cerebellar Ctx. Stellate, Basket, & Golgi cells (inhibitory) do not project out of
Cerebellar Ctx either.
Motor Ctx
(corticopontine
& CS tracts)

Corticopontine
MOLECULAR
MOLECULAR Stellate Basket fibers VL (thalamus)
LAYER
LAYER

PARALLEL FIBERS
Pontine Dentatothalamic tract
nuc (Sup Cereb Ped)

Pontocerebellar Red Nuclei

tract (rubrospinal
(contralat) tract)
PURKINJE
PURKINJE Cereb
Purkinje Cereb Deep
Deep NucNuc
CLIMBING FIBERS

LAYER
LAYER Dentate
Dentate
Emboliform
Emboliform
Fastigial
Fastigial
GOLGI MOSSY Globose
Globose
GOLGI Golgi
LAYER
LAYER FIBERS
Spinocerebellar
Spinocerebellar
Pontocerebellar
Pontocerebellar
Granule Vestibulocerebellar
Vestibulocerebellar
(cerebellar
(cerebellar &
&
ION vestibular
vestibular nuc)
nuc)
Olivocerebellar tract to CLIMBING FIBERS
Vestibulospinal tract
 Flocculo-nodular lobe projects to Medial and Lateral Vestibular Nuclei.

Medial Vestibular Nuclei assist coordinating eye movement with body.

Lateral Vestibular Nuclei assist postural control.

Be careful not to confuse Dentate nuclei (cerebellum) and Dentate gyri (HIPP).
Motor Ctx
(corticopontine
& CS tracts)

Corticopontine
MOLECULAR
MOLECULAR Stellate Basket fibers VL (thalamus)
LAYER
LAYER

PARALLEL FIBERS
Pontine Dentatothalamic tract
nuc (Sup Cereb Ped)

Pontocerebellar Red Nuclei

tract (rubrospinal
(contralat) tract)
PURKINJE
PURKINJE Cereb
Purkinje Cereb Deep
Deep NucNuc
CLIMBING FIBERS

LAYER
LAYER Dentate
Dentate
Emboliform
Emboliform
Fastigial
Fastigial
GOLGI MOSSY Globose
Globose
GOLGI Golgi
LAYER
LAYER FIBERS
Spinocerebellar
Spinocerebellar
Pontocerebellar
Pontocerebellar
Granule Vestibulocerebellar
Vestibulocerebellar
(cerebellar
(cerebellar &
&
ION vestibular
vestibular nuc)
nuc)
Olivocerebellar tract to CLIMBING FIBERS
Vestibulospinal tract
 Rubrospinal tracts (gross mvmts unlike CS tracts) & crosses immed in midbrain.

Rt cerebellum to Lt Red Nucleus to Rubrospinal tracts crossing left-to-right to

innervate Rt arm & leg.

Cerebellar tests = finger-to-nose (dysmetria & intention tremor), foot tap/heel shin,
pronator drift with poor adjustment, dysdiadochokinesia, nystagmus on extreme gaze.
Romberg test = vision, vestibular, DC-ML. (not SC tract, which is unconsc proprio).
Motor Ctx
(corticopontine
& CS tracts)

Corticopontine
MOLECULAR
MOLECULAR Stellate Basket fibers VL (thalamus)
LAYER
LAYER

PARALLEL FIBERS
Pontine Dentatothalamic tract
nuc (Sup Cereb Ped)

Pontocerebellar Red Nuclei

tract (rubrospinal
(contralat) tract)
PURKINJE
PURKINJE Cereb
Purkinje Cereb Deep
Deep NucNuc
CLIMBING FIBERS

LAYER
LAYER Dentate
Dentate
Emboliform
Emboliform
Fastigial
Fastigial
GOLGI MOSSY Globose
Globose
GOLGI Golgi
LAYER
LAYER FIBERS
Spinocerebellar
Spinocerebellar
Pontocerebellar
Pontocerebellar
Granule Vestibulocerebellar
Vestibulocerebellar
(cerebellar
(cerebellar &
&
ION vestibular
vestibular nuc)
nuc)
Olivocerebellar tract to CLIMBING FIBERS
Vestibulospinal tract
BV’s & CN’s
Berry aneurysms (ACOM,
MCA, PCOM, basilar)
asymptomatic unless large or
rupture (possible death)
rupture—SAH, hemorr stroke
(seizures, HCP)
worst HA of life (10/10)

ADPKD, Ehlers-Danlos, Uncus =

where
Marfan’s Amygdala is
located

Pituitary adenoma

Acoustic neuroma
(Schwannoma) at CPA
ICA-MCA aneurysm can put
pressure on side of optic
chiasm.

Basilar tip aneurysm can

put pressure on CN3’s.

Lat striate or
Lenticulostriate aa of
cerebral hemorrhage
(internal capsule).

Occlusion of PCA
distal to PCOM can
result in Ant choroidal
to Post choroidal aa.

Labyrinthine a from
AICA or Basilar a.
Post Spinal a from
PICA or Vertebral a.
 Autoregulation allows
constant blood flow over
wide bp range (local
metabolite control).

Pupillary light reflex is CN2

afferent and CN3 efferent.

CN2 lesion preserves a

consensual reflex. CN3
lesion causes blown-pupil,
down-and-out eye, droopy
eyelid, & efferent loss.

Corneal blink reflex is

CN5 (V1) afferent and
CN7 efferent.
Ankle jerk = S1
Knee ext = L2,3,4
Brachiorad = C5
Biceps = C6
Triceps = C7
Abdominal = T8-T12
Babinski = L5-S1
 Internal Capsule
BLOOD SUPPLY
ANT LIMB = ACA (medial striate aa) + MCA (lateral striate aa)
GENU = ICA (Ant Choroidal a)
POST LIMB = ICA (Ant Choroidal a) + MCA (lateral striate aa)
Scalp infections down through Epidural lens,
valveless emissary vv. Subdural falx,
Subarachnoid (ventricles),
Intraparenchymal
bleeds

Pineal tumors (Perinaud’s syn)

block cerebral aqueduct and/or
impose on sup colliculus
Communicating vs HCP ex-vacuo (big ventricles,
Non-communicating no inc ICP)
Hydrocephalus (HCP) Pseudotumor cerebri (nml or
slit ventricles, inc ICP)
Above or below
4th ventricle

Choroid plexus Creates CSF,

Arachnoid villi/granulations Absorb CSF
HERNIATION SYNDROMES
Subfalcine
Transtentorial
Foraminal
VISUAL SYSTEM
 TEMPORAL NASAL TEMPORAL

Ipsilateral blindness

Nasal hemianopia

Contralateral
hemianopia with
macular sparing

Bitemporal hemianopia

to LGN,
optic radiations,
then
Contralateral hemianopia occipital lobe
 LGN
Crossed fibers to layers
1, 4, 6

Uncrossed fibers to layers

2, 3, 5

to LGN,
optic radiations,
then
occipital lobe
 LGN
Crossed
fibers to
layers 1, 4, 6
Uncrossed fibers to layers
2, 3, 5

to LGN,
optic radiations,
then
occipital lobe
LGN to OCCIPITAL LOBE
Parietal lobe visual
radiations to cuneate
gyrus

Contralateral lower
quadrantanopia

Calcarine fissure
Temporal lobe visual
radiations (Meyer’s
loop) to lingual gyrus

to LGN,
optic radiations,
Contralateral upper then
quadrantanopia occipital lobe
Constricted field (glaucoma)

Central scotoma
(optic neuritis in MS)

Lower altitudinal hemianopia

(bilateral cuneate gyri)

to LGN,
optic radiations,
Upper altitudinal hemianopia
then
(bilateral lingual gyri)
occipital lobe
Sup Colliculus
Vertical gaze

MLF
Coordinates CN3 & CN6
(internuclear
ophthalmoplegia
in MS)
a) carries info from
pontine Horizontal Gaze
Centers to oculomotor
complex in midbrain.
b) Inc activity during mvmt
c) Helps during turning of
head (conjugate gaze)
Left? Right?

to LGN,
optic radiations,
then
occipital lobe
 Right? Left?

True Diplopia
CN3 = accommodation, many
mvmts
CN4 = down-and-out
CN6 = lateral

to LGN,
optic radiations,
then
occipital lobe
 Voluntary Conjugate Gaze
Lt Area 8 Rt Pontine Paramedian Lt Medial
Reticular Formation Rt CN6 Longitudinal Lt CN3
(FEF)
(PPRF; lat gaze center) Fasciculus [Rt Gaze]
(MLF)
Internuclear Ophthalmoplegia

Pupillary Light Reflex

Optic Sup Colliculi Ciliary
LGB
n/chiasm/ (pretectal ganglia
tract area) (CN3)
(CN2)
Argyll-Robertson’s pupils (syphilis)

Accommodation
Optic Optic Visual ctx Sup Colliculi Ciliary
LGB
n/chiasm/ radiation (pretectal ganglia
tract area) (CN3)
(CN2)
 Voluntary Conjugate Gaze
Lt Area 8 Rt Pontine Paramedian Lt Medial
Reticular Formation Rt CN6 Longitudinal Lt CN3
(FEF)
(PPRF; lat gaze center) Fasciculus [Rt Gaze]
(MLF)
One-and-a-half Syndrome

Pupillary Light Reflex

Optic Sup Colliculi Ciliary
LGB
n/chiasm/ (pretectal ganglia
tract area) (CN3)
(CN2)
Argyll-Robertson’s pupils (syphilis)

Accommodation
Optic Optic Visual ctx Sup Colliculi Ciliary
LGB
n/chiasm/ radiation (pretectal ganglia
tract area) (CN3)
(CN2)
 HEARING
1. Medial Superior Olive (SON) is 1st place with binaural processing.
2. Lesion above cochlear nuclei (Lateral leminscus and up) will
decrease hearing bilateral (more in contralateral ear).
3. Inner hair cells transduce sound, and Outer hair cells modify
sound (olivocochlear efferents). Scala media (endolymph).
4. Lateral Superior Olive (SON) has intensity differences for
horizontal position orientation.
5. High freq is closest to Oval window/Stapes (scala vestibule and
NOT round window at the end of the scala tympani) for tonotopic
organization, and high freq is dorsomedial in cochlear nuclei.
 HEALING
1. ANTEROGRADE degeneration is Wallerian degeneration—axons
& myelin sheaths disappear. (e.g., Mid-thoracic crush of spine
and Pt dies. Cervical stain shows Wallerian degeneration of
fasciculus gracilis.)
2. RETROGRADE degeneration is Chromatolysis—loss of Nissl
substance (RER & free polyribosomes at cell body and dendrites
are lost)
3. In the CNS, glial scars formed by astrocytes inhibit healing
(reactive astrogliosis).
4. For successful axonal repair, macrophages must clean debris.
5. Axonal elongation is 2-4 mm/d in the CNS (oligodendrocytes) or
PNS (Schwann cells).
 HEALING
1. Target-derived neurotrophic factor = Nerve Growth Factor (NGF)
tropic (differentiation; turning toward stim) & trophic (growth &
survival) peptide for DRG and sympa in PNS and basal forebrain
ACh neurons in CNS.
3. Neurotrophins (NGF, BDNF, NT3) + IGF1 + FGF + GDNF + CNTF
4. BDNF is synthesized in cell body & transported anterogradely
down the axons (unlike NGF or GDNF).
 Neurohistology
Sensory neurons = Pseudounipolar, myelinated
(DRG and CN 5, 7, 9, 10)

Special senses = Bipolar (smell is unmyelinated-slow, hearing is

myelinated-fast)
(CN 1, 2, 8)

Motor neurons = Multipolar, myelinated

(aMN, ANS)
 6-Layered Neocortex
Layer I (Molecular)
Layer II (External Granular)
Layer III (External Pyramidal)—cortico-cortical fibers
Layer IV (Internal Granular)—thalamocortical fibers (VPL, VPM, LGN)
Layer V (Internal Pyramidal)—CS, CB, & corticostriatal fibers (Betz
giant pyramidal cells)
Layer VI (Multiform)—corticothalamic projection & association fibers

AFFERENT EFFERENT
(Layer IV is big in (Layer V is big in
Brodmann Area 3,1,2) Brodmann Area 4)
SENSORY & MOTOR
HOMUNCULI
Lots to lips, tongue, hand, & index finger
Paracentral lobule = feet/legs
 RABIES
Rabies is caused by a Rhabdovirus that enters a peripheral nerve and travels
retrograde up the nerve to the DRG.
From there, it replicates and infects the CNS, resulting in encephalitis with a
variety of neurologic symptoms leading to coma and respiratory or cardiac
arrest.
THE END