BRS Neuroanatomy

402 Pages·2011·9.9 MB·English

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BOARD
REVIEW
SERIES
N
EUROANATOMY
4TH EDITION
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B
OARD
R
EVIEW
S
ERIES
N
EUROANATOMY
4 E
TH DITION
James D. Fix, Ph.D.
Professor Emeritus of Anatomy
Marshall University School of Medicine
Huntington, West Virginia
Questions Contributor:
Deon M. Harvey, Ph.D.
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Copyright © 2008 Lippincott Williams & Wilkins
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The publisher is not responsible (as a matter of product liability, negligence, or otherwise) for any
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ing to general principles of medical care which should not be construed as specific instructions
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Printed in China
Library of Congress Cataloging-in-Publication Data
Fix, James D.
Neuroanatomy / James D. Fix.—4th ed.
p. ; cm. — (Board review series)
Includes bibliographical references and index.
ISBN-13: 978-0-7817-7245-7
ISBN-10: 0-7817-7245-1
1. Neuroanatomy—Examinations, questions, etc. I. Title. II. Series.
[DNLM: 1. Neuroanatomy—Examination Questions. WL 18.2 F566n 2002]
QM451 .F59 2002
611(cid:2).8(cid:2)076—dc21
2001037710
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To Ilse, for her constant support and understanding.
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Preface
BRS Neuroanatomy, fourth edition, is a concise review of human neuroanatomy intended prima-
rily for medical and dental students preparing for the United States Medical Licensing
Examination (USMLE) Step 1 and other examinations. It presents the essentials of human neu-
roanatomy in a concise, tightly outlined, well-illustrated format. There are over 600 board-type
questions with complete answers and explanations, some included at the end of each chapter and
some in a comprehensive examination at the end of the book.
New to This Edition
• Magnetic resonance angiograms
• Color used throughout to enhance neuroanatomic pathways
• Color used to block in tables and highlight clinical correlations
• Cerebellar atrophies
• Localization of sensory disorders
To the Student
To make the most of this book, carefully study the illustrations, computed tomography scans,
magnetic resonance images, and angiograms, as well as the figure legends; much of the board
question information lies within the images and legends. The answers to at least 30 common
USMLE questions are outlined below;refer to these tips as you review the chapters:
Chapter 1: The mini-atlas provides you with the essential examination structures labeled on
computed tomography scans, magnetic resonance images, and gross stained sections.
Chapter 2: Meninges and cerebrospinal fluid (CSF). Three membranes envelop the brain and
spinal cord. What is their function? CSF is produced by the choroid plexusand absorbed by the
arachnoid villi that jut into the dural venous sinuses. Name a noninvasive tumor that arises
from the arachnoid granulations. Distinguish between normal-pressure hydrocephalus and
pseudotumor cerebri (benign intracranial hypertension).
Chapter 3: Blood supply of the central nervous system (CNS). The essential arteries and the
functional areas that they irrigate are shown: The anterior spinal artery (ASA) perfuses the ante-
rior two-thirds of the spinal cord including the corticospinal and spinothalamic tracts. In the
medial medulla the ASA supplies the corticospinal tract and medial lemniscus. In the lateral
medulla the posterior inferior cerebellar artery (PICA) irrigates the nucleus ambiguus, the inferior
cerebellar peduncle, spinal trigeminal nucleus and tract, and the spinothalamic tract. In the pos-
terolateral pons the PICA irrigates the nucleus of facial nerve, nucleus and tract of the trigeminal
nerve. In the rostral midbrain the posterior cerebral artery (PCA) irrigates the intra-axial fibers of
cranial nerve III and the corticospinal tracts. Know the arterial circle of Willis!What is the most
common cause of nontraumatic intraparenchymal hemorrhage? Study the distribution of the
anterior, medial, and posterior cerebral arteries!
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PREFACE vii
Chapter 4: Development of the nervous system.The neural tube(neuroectoderm) gives rise
to the CNS. Failure of the neuropores to close results in neural tube defects such as anen-
cephaly. Name the derivatives of the neural crest. Know the following congenital malfunc-
tions: spina bifida, meningohydroencephalocele, Arnold-Chiari, and Dandy-Walker mal-
functions.
Chapter 5: Neurohistology. Where are pseudounipolar and bipolar neurons found? What
is Wallerian degeneration? What is Nissl substance? Hortega cells arise from monocytes,
which enter the CNS via abnormal blood vessels. Schwann cells are myelin-forming periph-
eral neuroglial cells. The glioblastoma multiforme is the most rapid-growing and fatal
glioma.
Chapter 6: The adult spinal cord terminates (conus terminalis)at the lower border of the first
lumbar vertebra. The newborn’s spinal cord extends to the third lumbar vertebra. The adult cauda
equinaextends from vertebral levels L2 to Co.
Chapter 7: Tracts of the spinal cord are reduced to four: corticospinal tract, spinothalamic tract,
dorsal column-medial lemniscus, and hypothalamospinal tract. Transection of this descending
autonomic tract results in Horner syndrome.
Chapter 8: Lesions of the spinal cord. Review the eight classic national board lesions of the
spinal cord: poliomyelitis, multiple sclerosis, dorsal column disease(syphilis, locomotor atax-
ia, tabes dorsalis), amyotrophic lateral sclerosis (ALS), hemisection of spinal cord (Brown-
Séquard syndrome), subacute combined degeneration(vitamin B neuropathy), syringomyelia,
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andanterior(ventral) spinal artery syndrome.
Chapter 9: Brainstem. Study the transverse sections of the brainstem and localize the cranial
nerve nuclei. Study the ventral surface of the brainstem and identify the exiting and entering cra-
nial nerves. On the dorsal surface of the brainstem, identify the only exiting cranial nerve, the
trochlear nerve.
Chapter 10: Trigeminal system.The trigeminal nerve (CN V) is the largest cranial nerve. Which
is the smallest? Name the afferent and efferent limbs of the corneal and jaw jerk reflexes. Study
the sensory pathway of the ventral trigeminothalamic tract. Where is the cave of Meckel? What
is tic douloureux? Trigeminal neuralgia? Which trigeminal nerve branches pass through the cav-
ernous sinus?
Chapter 11: Auditory system.Study the auditory pathway and its way stations: hair cells of the
organ of Corti S cochlear nuclei S superior olivary nucleus S lateral lemniscus S nucleus of
inferior colliculus Sbrachium of inferior colliculus Smedial geniculate body Sauditory radia-
tions Sauditory cortex, transverse gyrus ofHeschl, Brodmann areas 41 and 42.
Chapter 12: Vestibular system.Study the vestibular pathways; recall the anatomy and function
of the sensory hair cells found in the utricle and saccule.Lesions of the vestibular system result
in nystagmus. What is vestibular, postrotational, optokinetic and caloric nystagmus? What
is Ménière disease? What is benign positional vertigo?
Chapter 13: Cranial nervesand their major functions: CN I smells. CN II sees. CN III moves the
eyeball and elevates the upper eye lid. CN IV depresses, intorts, and abducts the eyeball. CN V
provides sensory innervation of the face and innervates the muscles of chewing. CN VI abducts
the eyeball. CN VII moves the face, tastes, salivates, and cries. CN VIII hears and mediates bal-
ance. CN IX tastes, swallows, and mediates input from the carotid sinusthat via baroreceptors
regulate arterial blood pressure. It also mediates input from the carotid bodythat monitors the
carbon dioxide and oxygen concentration of the blood. CN X phonates, swallows, and innervates
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viii PREFACE
the viscera of the neck and the thoracic and abdominal cavities. Understand the carotid sinus
reflex;what is the gag reflex?
Chapter 14: Lesions of the brainstem.The seven most important lesions of the brainstem are
the anterior spinal artery syndrome (Figure 14-1), the anterior inferior cerebellar artery syn-
drome(Figure 14-1), the posterior inferior cerebellar artery syndrome(Figure14-2), the medi-
al longitudinal fasciculus (MLF) (Figures 9-6 and 9-7). The MLF syndrome is seen in multiple
sclerosis.Three important midbrain lesions are Parinaud, Benedikt,and Weber.Name the cra-
nial nerves involved in these syndromes!
Chapter 15: Cerebellum.Figure 15-4 shows the most important cerebellar circuit. The inhibito-
ry gamma-aminobutyric acid (GABA) –ergic Purkinje axons give rise to the cerebellodentatothal-
amic tract. What are mossy and climbing fibers? What is von Hippel-Lindausyndrome? Review
the cerebellar atrophies!
Chapter 16: Thalamus.Review the nuclei of the thalamus, the afferent and efferent connections.
Study the blood supply to the thalamus, the basal ganglia, and the internal capsule.
Understanding the thalamus will get you some points on the United States Medical Licensing
Examination (USMLE).
Chapter 17: Visual system.Study the histology of the retina. Study the visual pathways and visu-
al field defects (e.g. hemianopsias and quadrantanopias). Know the visual reflexes, such as the
pupillary light reflex and pupillary dilation pathway; these connections are clinically important
and appear on the boards. Don’t forget Horner syndrome;it’s on there!
Chapter 18: Autonomic nervous system.The important anatomy of the autonomic nervous sys-
tem is clearly seen in Figures 18-1 and18-2.
Chapter 19: Hypothalamus. Figures 19-2and19-5show that the paraventricular and supraop-
tic nuclei synthesize and release antidiuretic hormone and oxytocin. The suprachiasmatic nucle-
us receives direct input from the retina and plays a role in the regulation of circadian rhythms.
Wernicke encephalopathy results from the deficiency of thiamine (vitamin B ); lesions are
1
found in the mamillary bodies, thalamus, and midbrain tegmentum (Figure 19-6).
Chapter: 20: Olfactory, gustatory, and limbic systems.Bilateral lesions of the amygdala result
in Klüver-Bucy syndrome. Recall the triad of hyperphagia, hypersexuality, and psychic blindness.
Memory loss is associated with bilateral lesions of the hippocampus. Know the Papez circuit, a
common board topic (Figure 20-4).
Chapter 21: Basal ganglia and the striatal motor system. Figure 21-4 shows the circuitry of
the basal ganglia and their associated neurotransmitters.Parkinson disease is associated with
depopulation of neurons in the substantia nigra. Huntington disease results in a loss of nerve cells
in the caudate nucleus and putamen. Hemiballism results from infarction of the contralateral sub-
thalamic nucleus.
Chapter 22: Neurotransmitters and their pathways. The pathways of the major neuro-
transmitters are shown in separate brain maps. Glutamate is the major excitatory transmitter
of the brain; GABA is the major inhibitory transmitter. Purkinje cells in the cerebellum are
GABA-ergic.
Chapter 23: Cerebral cortex.This chapter describes the cortical localization of functional areas
of the brain. How does the dominant hemisphere differ from the nondominant hemisphere?
Figure 23-4 outlines the effects of the various major hemispheric lesions. What symptoms
result from a lesion of the right inferior parietal lobe? What is Gerstmann syndrome?