Table Of Content

* 41 4 .& o LIPPINCOTT WILLIAMS WILKINS A Wolterr Kluwcr Company Philadelphia Baltimore New York London Buenos Aires Hong Kong Sydney Tokyo Acquitirions Editor: Eli~abcthA . Nicginrki Editorid Director oj Detuhplnm~t:J ulie hdnrtiner DcrvL~pnmtE ditor: Karln h4. Schroedcr . Srr~ior.\ tamgirrg Editor: Alny G. Dinkel a Co&t-ight 0 I&W by Lippincott \Villiims & Wilkips. All rights reserved. +is &k is prcltectd by copyright. No part of it may k rrduced. stored in a rerrieval $-stem, or tnnsrnitrd, in any form or by any means-electronic, mech;lnical, phor~opyr,e cording. or othenrise--without the prior written permission of the publisher, ex- cept for briefquotations einturdied in critical articles, reviews, and testing and e\.nluation ma- teriaL by the publisher ro sch=ls that have adopted its accompanying textbook. Print& in h e United States of America. For information, \\-rite Lippincon Williams & Wilkh, 227 East Washington Square. Philadelphia, PA 191@6. = ~iterialasp pearing in this bcd prepared by individuals as part of their official duties as U.S. Go\-ernnenc employees are not covered by the ah-e-mentioned copyright. Fix, Jaiies D. Hish-yield n~~tronnatom/ yJa mes D. Fix.-2nd ed. - . ..--..--- p. ;c m. - (High-yield series) - :.:- Includes index. ISBN @-653-30721-5 1. Neuroanatom).-Ourlines, syllabi. etc. 2. Neuroanatomy-Examinations. questions. ecc I. Title. 11. Series. iDNLh!: I. Nervous System-anatomy Sr histology-Esamination Questions. 2. Xervous Sptem-anatomy & histolo~--Outlines.3 . Nen-ous System Diseasec-Esamination Questions. 4. Nervous System Diseasej--Outlines. \WL 18.2 Fj66h ZkW] . Qxftjl .F%8 2039 61 1' .Sf07f;~2l 99-051352 Care has been caken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the authors, edirors, and publisher 2re nor responsible . fcr erron or omissions or for any consequences from application of the information in this book and make no u.arranc)., express or implied. uith respect to the contena of the publication. The authors, editors, and publisher have esened ever{ efforr ro ensure that drug selection * and dosge set forth in this text.are in accordance with current recommendations and practice at the time of pubiicacion. However, in view of ongoing research, changes in governmen: reg- ulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the ~ackagein serr for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when chi rec- ommended agen: is a new or infrequently ernploycd drug. Some drugs and5ediwl devices presented in this publication have F d an d Drug Ad---- . minixration (FDA) clearance for limited use in restrictcli research settings. It is the resensi- biliry of the health care provider to ascertain the FDA status of each drug or device plahned ' for use in their clinical practice. '4 . . . . . 1 The second edition of Hi.&-Yield Ne~troni~aroi~s ~stlivll neuronnatainv at its irreduc;ible minimum. con* raining most, if not all, of the national board themes. The sole purpose of the book is to get you I ' through the nert-ous system topics covered on the Uniced States Medical Licensing Exatnination (USMLE) Step 1. Substi~ntiasl dditions ha\-e been inade to accointnodate student requests and sug- gestions. NEW TO THIS EDITION . . Mini-atlas of nuclear ~nagneticin lasing scans Carorid and vertebral digital subtraction angiography Nuclear magnetic angiopra~h!- . Additional figures of cranial nen-e function conlponents 1 . Chapter on aphasia. aprasia. and dysprosody Index J TO THE STUDENT To make the most. of chis book, study the illustrations, computed tomography scans, and magnetic resonance images carehlly, and read the legends. Many board-type questions come from this source. In fact, the answers to at least 20 common USMLE questions are found wichin this preface. Finally, remember these tips as you scan the chapters: Chapter I: The mini-atlas provides you \vith the essential examination strucrures labeled on com- puced tomography scans and magnetic resonance images. Chogter 2: Cerebrospinal fluid pach\vays are \\'ell demonstrated in Figure 2-1. Cerebrospinal fluid is I produced by the choroid plesus and absorbed by the arachnoid villi that jut into the venous sinuses. Chapter 3: The essential arteries and the functional areas that they irrigate are shown. Study the carotid and verrebral angiograms and the epidural and subdural hematomas in computed tomography scans and magnetic resonance images. .,.. I Chapter 4: The neural crest and its derivatives, the dual origin of the pituitary gland, and the differ- 1 ence between spina bifida and the Arnold-Chiari ~nalformationa re presented. Study the figures that - illustrate the Arnold-Chiari and Dandy-Walker malformations. Chnprer 5: What is the difference betiyeen Lewy and Hirano bodies'? Nerve cells contain Niss! sub- I stance in their perikaq-a and dendrites, but not in their axons. Remember that Nisslsubstance (rough endoplasmic reticulum) plays a role in protein synthesis. Study Figure 5-2 on the localization and pre\*alenceo f common brain and spinal cord tumors. Remember that, in adults, glioblascoma multi- I fortne is che most common brain tumor, follo\\~edb y astrocycoma and meningioma. In children, as- trocyroma is the most common brain tumor, followed by rnedulloblastoma and ependymoma. In the spilial cord, ependymoma is the most common tuhor. J I Chnptcr 6: Tile adult spinal cord tcrrninatcs (conus ter~ninalis)ac the lo\ver border of the first lumbar \vertebra. Thc newborn's spinal cord extends to thc third lumbar vcrtcbra. In adults, the cauda equina I csrentls froni \-crtcbral le\*clsL -2 to Co. Cliaf)tC)7' : The tracts of the spinal cord arc rcduccd to four: corticospinnl (pyramidal), dorsal co!::-:nz, pnii~n llcl tctnpcraturc, and Horncr's. Know the111c old. I . . I . . . - . . I - - . x Preface ......................................................................................................................................................................................................... I Choptrr S: Study thc eight classic natic~t~n\\lo nr~lle 3ic)ns of the spiunl cord, Four l~ca\].l~itt ers arc: Rro\rrn-SCqu;~rJs yi~tlrotne,B ,? nCitnminosis (si~baci~ctec li~~l\iii~lecJg ct~eration)s, yringo1lIyelia, a11L4 I ;~llls~~r~l;~ltepril~~ls iclce rosis (Lou Cellrig's d ireasc). Chaptc~-9S: tt~dytl ~tern ns\:crse sections uirhc brain SC~InIIn,c i locali:e the crmial ner\.e ~~ucleSit.u dy t]le ventral surface r)f the brain steln, and id~nrifytl lc exiting and e!~reringc ranial ner\.i.s. On tlte I . L{orsal rtlrfa& of the brain srcrtn, identify tht ur~lye siting crnninl ner\*e, the trochle;lr nerve. . chapter IO: Cri~nianl erve.(CN) 11-1 is the afferent limb of the corneal retles. CN \!-I, CN V-2;C N 111, CN iV, CN VI, a11d the postg;~i~glioniscy inpathetic fibers are all found in the cavernous sinus. I Chapter 11: Figure 11.1 shotvs the auditory pathivay. \What iIre the causes of conJucrio~.ra nd sen- sorineural denthess? Describe the IVeber and Rinne tuning fork-t ests. Remember t11at the auditoV I 1.ren.e and the organ of corti and derived fro111 the otic placoclc. Chaprer 12: This chilpt& describes the rs.o types of \.ertibuli~rn ;*stagmus: postrotational and caloric' (CO\VS acronym). Vestibule-ocular refleses in the'unconscious patient arc also discussed (sek Fig- . . I ure 12-3). Chaptzr 13: This chapter on the cranial nerves 'is pivotal. It spawns Inore ncuroanatomy examination questions than any other chapter. Carefully study all of the figures and legends. The seventh cranial I nrr\.e deserves special consideration (see Figures 13-3 and 13-4). Understand the diiierence bet\veen an uFFer motor neuron and a lo~ver.mot@nre uron (Bell's pals!.). Chapizr I?: The three most iln~ortanlte sions of the brain stem zre occlusion of the anterior spinal I artery (Figure 13-I), occlusion of the posterior inferior cerebellar artery (Figure 14-1 ) , and medial longitudinal fasciculus syndrome (Figure 14-2). \VeL.er's syndrotne is the most common tllidbrain le- I sion (Figure 14-31. Chapter IS: Figure 15-1 shows the most important cerebellar circuit. The inhibitor). y-aminobuq-ric acid (GABA)-ergic Purkinje cells give rise co the cerebellodentatothalamic tract. What are mossy I and climbing fibers? . Chaprer 16: Figure 16-1 shows eveqthing you need to know about what goes in and what comes our of the thalamus. Know the anatomy of the internal capsule; ic \\rill be on the esamination. What is I the blood supply of the internal capsule (stroke)? ; y. Chapwr 17: Know the lesions of the visual s!-stem. Ho\\rsare quadrantan~~icarse ated? There are two major lesions of the optic chiasma. Know thein! \Vhac is Mej-er's loop? 1 Chaprcr IS: The important anatomy of the autonomic nervous system is clear!). seen in Figures 18-1 and IS-2. I Chapter 19: Figures 19-1 ilnd 19-2 shour tl~attl ~pea rat.entricular and supraoptic nuclei synthesize and release antidiuretic l~ormonca nd osptocin. The suprachins~nacicn ucleus receives direct input from the retina andplays a role in the regulation of circadian rhythms. I Chapter 20: Bilateral lesions of the amygdala result in Kliiver-Bucy syndrome. Recall the triad hyper- phagia, hypcrsexuality, and psychic blindness. Memory loss is associated \\.it11 bilateral lesions of the hippocampus. \Vernicke9se nccphalopnthy results from a deficiency of tllia~nine( vitainin B,). Lesions I are found in the rnamillnry Lxxlics, thali~mia~n~d, ~nidbraint cg~ncntu~(nF igure 20-3). Know the Pa- Fez circuit, 3 common bo;ird iji~estion. I Chap[cr 2 I : Figure 2 1-3 sl~oiirt he circuitr). of the basnJ ganglia ntld thci r associn tcd neurorranst~t~- i tcrs. Parkinson's discasc is associatctf \\.it11 a depol?\~lariono f netirons in the suhstantia nigra. Hunt- ington's discnse results in n loss of ncr\.c cells in thc cautinrc nuclr~~ansd put;lnlcrl. I-fcrniballis~nr c- I sults from infarction of thr contrnl;ltcr;ll subthalamic nuclcus. ChnptCr2 2: In this chnprc.r, the ~>nth\r*;loyf st l~c11 1;ljonr curotrn~~t t,c~is~ ;~Isi< : :;i>c,:t*n i 11 sc.!,;)::r re 1c,r-n.:!l t!>;>ps< :i?,.ir:.;,~~is:i 1tc1 1~:~ ~:\jorcxci[~tst;~o:i~~s,~,~~it~t, o:rf: i)t: \)I;\,:', ;,''\~i~;.~,i , ; i.;~ ;:;,:I.( ,: ;. :>17;!--.t ,i .,z 7 , ,,;! - I . .-.-...-... .................. ............:. ............:. .......... .........,.......-.I.".C...G.. *..*. 5 ...- - - - ilrc vnBA-ergic. In Alzheilllrrk disease, there is n loss -LLL~-C~~LIIII nccr).lcbolinrrgic nct~ronrin tllr 1.nsal nucleus of Mcynerr. In Parkinson's disease, there is n loss dopnmincrgic netlmns in the si~l,)mnrinn igr;,. ~hnprk2r3 : This c11;r~reidescrihzsth e corricnl locslirilrion of fitnctionnl areis of rl;e hrnin. Holv di .the donlinnnt heo~is~~ld~ifrferre f rolll the nonti.ominnnr hemisphere? Figure 23-4 slrows the effects various lllajor llelnisplreric lesions: \Vllat s!-nlproms result froin n lesiorr of the inferior pariel lobe! \Vhat is Genrmanni sytrdrome? n Chnprcr 24: This clli~pterd escri1.e~ npmsi~ ' . . i i * ------- I - : . aphasia fr6m Wemicke's nphasia.'Whrr is cvnuucrlolr aphasiil! 1 his is h ~ n r d - r ~ lm~a~ter~-i a~l. n t I wish you good luck. - . . Jatncs D. Fix . . vi Contents ...................................................................................................................................................................................................... X. I'iglnellts ; ~ nitj~ cli~sion.c3 2 'XI. Tl~ccl asiihsari<~oti~l~ rtn.r.6 lvrs 31 XII. Tumors tjfrhc CNS ;t11;! ..I 'N S 33 ' XIII. C\~rntrc~-rucscc prk.rrs - > ............................. 6 Spinal Cord . 1. Ciri~y;r nJ I\-hite comrnut~ic;i~ri1t1i1~1~i 31 (4. 11. Tcnnin;~ciono f the conus ~~~rtrit~lli3~6r is . . . I . ~'>;atiol\ oithe ulj~jc~rnro ror and sensory rrl~cleio f r11i spilrnl c IV. Tlre cait.i;~ cquiu;~ 37 V. Tile my~~r.tcricct les 37 .................................. 7 Tracts of the Spinal Cord 38 I ' . . I. I~rtroducr~n3 S 11. Dona1 cL>lumn-medial Icmniscus pathtvay 33 Ill. Liltera1 srinochalamic tracc 42 . . I IV. Lateral cL-xicos~intdra ct SC7 V. H\-~c'th:llam@s~itnradc t -1-1 ................. 8 Lesions of the Spinal Cord I. Diseases or' the lllotor neurons and corticospir~atlr acts 45 I!. Sensory ~adi\va!. lesions 47 ' 111. CombincJ motor and sensor)- lesions -ti IV. Peripher.11 nen-@uss ystem (PNS) lesiot~s 1S V. Inten-ertckral disk herniation 4S ............................................. I 9 Brain Stem 49 I. Oremien- $9 11. Cross-section through che medulla 49 I Ill. Cross-seccion chrough the pons 5 1 IV. Cross-sectien through th: rostra1 midbrain 52 V. Corricokulbar fibers 52 10 Trigerninal System ...... : ........................*: ....... 53 ) I. Oren-ien- 53 11. The trigerninal ganglion 53 1 Ill. Trigerninothalamic path~vays 53 , IV. Triserninal refleses 55- - V. The cavernous sinus > I I I1 ........................................ Auditory System 58 I. Oven.ic\v 58 I 11. The auditor). path\vay 58 Ill. Hearing dc-ic-ccs 58 IV. Auditoq rests 59 I ........ .............. ... ............. 12 Vestibular System : 6 1 I. Oven.ie\\. 61 II. The labyrinth 61 I Ill. TIle rcstibular pnrh\v;~ys 62 IV. \Icscihulo-r~uliirr cflcsc$ 63. .......................................... 1 1*3- ~?r aniaNl erves 65 I. The olf;lcrc~ryn cr\.c 65 il. The opti:: :Icn,c hh I ;, . ;. ,.;,,, :()z r:, r.,,. I:,( ' : :;;; ,5 . vlll Contents .................................................................................................................................................................................................... .. I ........... .. .:... .:.. ., . ........ .......... .20L imbic System ; 10 . I. Intrtductic~n 12.7 . . I II. hliijtlr calnponcncc and ct~~~nectio1i0~7 i - Ill. The P;IVL.: circuit 125 IV. Clinicr~cl o;rclarikv\ 123 I .a ....................... 21 ' ' ~ a i a~l a & l i ia nd Stiiatal Motor System 11 I. Bnsnl gnnglia 11 1 ' ' ...................................... 22 Neurotransmitters 11: I I. Imporrant transn~irrcr;l~n J their ~iItll\\.~p1 15 . 11. Functio~laal nd clinical consiJer,~tions 120 11. The sis-layered ncoioxes 12 1 I Ill. Functional areas 12 i IV. Focal clc-itrucrivc hemispheric lesions and S~I~FCOIIISI ? 7. I V. Cerebral dominance 117 : I VI. Split-brain syndrome 17s VII. Other lesions of the COTUS callozunl 12s VIII. Brain and spinal tori tumors 12s 1 .......................... 24 Aprauia, Aphasia, and Dysprosody 129 I. Apra~ia 129 If. Aphasia 129 I Ill. Dysprosody 131 ............................................. . Appendix 133 I .................................................. Index 6: 137