Brainstem+Cerebral Cortex

OUTLINE
Neurology:
1. Brainstem Anatomy
● A. Midbrain
● B. Pons
Brainstem ●
●
●
C. Tectum
D. Medulla
D. Introduction to the Rule of 4’s
Anatomy 2. Rule of 4’s

● A. Introductory Review
Neurology: Brainstem Anatomy Bootcamp.com
Brainstem
Syndrome Embryonic Blood Supply Significant Structures
Origin
CN III-IV nuclei
Substantia Nigra
Branches of Posterior Cerebral Artery Red Nucleus
Midbrain Mesencephalon
and Superior Cerebellar Artery Pretectal Area
Medial Longitudinal Fasciculus
Superior Cerebellar Peduncles
• Tectum of Brainstem
• Superior Colliculi à Lateral Geniculate Body àVision
• Inferior Colliculi à Medial Geniculate Body à Auditory
Brainstem
Origin
CN III-IV nuclei
Substantia Nigra
Metencephalon Ventral: Basilar Artery CN V-VIII* nuclei

Pons (hindbrain) Lateral: Anterior Inferior Cerebellar Reticular Activating System
Artery Medial Longitudinal Fasciculus
Brainstem
Origin
CN III-IV nuclei
Substantia Nigra
Metencephalon Ventral: Basilar Artery CN V-VIII* nuclei

Pons (hindbrain) Lateral: Anterior Inferior Cerebellar Reticular Activating System
Artery Medial Longitudinal Fasciculus
CN VIII* nuclei
Medial: Anterior Spinal Artery and/or CN IX-XII nuclei
Myelencephalon Vertebral Arteries Area Postrema
Medulla (hindbrain) Lateral: Posterior Inferior Cerebellar Inferior cerebellar peduncules
Artery
Corticobulbar Tract
• Rule 1:
• CN I and II NOT in the midbrain
Lesions
• CN III-IV nuclei in midbrain
• CN V-VIII* nuclei in pons
• CN VIII*-XII nuclei in medulla Injury Site
• Rule 2:
• CN III, IV, VI, XII in midline (divisible by 12)
• Rule 3:
• 4 primary midline structures begin with “m”
• Motor pathway (CST)
• Medial lemniscus (dorsal column pathway) Bulbar Palsy LMN
• Medial longitudinal fasciculus (does not extend into medulla)
• Motor Nuclei of cranial nerves (CN III, IV, V, VI, VII, IX, X, XI XII)
• Rule 4:
• 4 lateral or side structures begin with “s”
• Spinothalamic pathway
Pseudobulbar
• Sensory Nuclei of CN V
UMN
•
•
Sympathetic pathway
Spinocerebellar tract
Palsy
≣ ⟽ ⟾
Item 1 of 1 Test Your Knowledge
◽" Mark Difficulty: ✪✪ Bootcamp.com
Question ID: 0005 Previous Next
A laboratory scientist is attempting to test whether dopaminergic depletion

⚪ A. Mammillary body in mice via an intra-striatal infusion of 6-hydroxydopamine (6-OHDA)
⚪ B. Medial temporal lobe produces similar effects to those seen in the setting of Parkinson Disease
⚪ C. Dorsal medulla in humans. 6-OHDA is known to be neurotoxic to dopaminergic and
⚪ D. Ventral midbrain noradrenergic neural tissue. The researcher uses desipramine to
⚪ E. Substantia gelatinosa selectively protect noradrenergic receptors in select mice. Object
recognition time and cognitive testing using rodent variants of tests used
in humans were evaluated to determine if mice experienced similar effects
to humans with Parkinson Disease. Mice were also given physostigmine
and rivastigmine to evaluate the nature of reversal of disease process.
Which neuroanatomical location is most likely directly impacted by the
neurotoxicity of 6-OHDA?
≣ ⟽ ⟾
A laboratory scientist is attempting to test whether dopaminergic depletion

⚪ A. Mammillary body in mice via an intra-striatal infusion of 6-hydroxydopamine (6-OHDA)
⚪ B. Medial temporal lobe produces similar effects to those seen in the setting of Parkinson Disease
⚪ C. Dorsal medulla in humans. 6-OHDA is known to be neurotoxic to dopaminergic and
" D. Ventral midbrain noradrenergic neural tissue. The researcher uses desipramine to
⚪ E. Substantia gelatinosa selectively protect noradrenergic receptors in select mice. Object
recognition time and cognitive testing using rodent variants of tests used
in humans were evaluated to determine if mice experienced similar effects
to humans with Parkinson Disease. Mice were also given physostigmine
and rivastigmine to evaluate the nature of reversal of disease process.
Which neuroanatomical location is most likely directly impacted by the
neurotoxicity of 6-OHDA?
OUTLINE
Cerebral
1. Cerebral Cortex
● A. Frontal Lobe
● B. Temporal Lobe
Cortex ●
●
●
C. Parietal Lobe
D. Occipital Lobe
E. Internal Capsule
Neurology: Cerebral Cortex Bootcamp.com
• Frontal Lobe
• Precentral Gyrusà Primary Motor Cortex
• Prefrontal Cortex à Personality, concentration, judgement
• Front Eye Fields à Conjugate gaze contralateral
• Broca's Area (dominant) à Speech production
• Lesion to Frontal Lobe
• Precentral Gyrusà Contralateral motor
• Prefrontal Cortex à Disinhibition
• Front Eye Fields à Eye deviation to the side of lesion
• Broca’s Area (dominant) à Expressive aphasia
• Blood Supply: Medial: ACA, Lateral: MCA
https://commons.wikimedia.org/wiki/File:Human_brain_frontal_(coronal)_section.JPG
https://commons.wikimedia.org/wiki/File:FrontalCaptsLateral.png
• Temporal Lobe
• Primary Auditory Cortex, input from medial geniculate body
• Wernicke’s Area (dominant) à Understanding speech
• Amygdalaà Memory, decision making, emotions
• Optic Radiations à Meyer’s Loop
• Lesion to Temporal Lobe
• Primary Auditory Cortex à ipsilateral hearing deficits
• Wernicke’s Area (dominant) à Receptive aphasia
• Amygdalaà Kluver-Bucy Syndrome
• Optic Radiations à Contralateral Superior quadrantanopia
• Blood Supply à Mostly MCA https://commons.wikimedia.org/wiki/File:Gray_718-amygdala.png
• Parietal Lobe
• Postcentral gyrusà Primary Somatosensory Cortex
• Angular Gyrus à Visual Cortex
• Optic Radiations à Superior Loop
• Lesion to Parietal Lobe
• Primary Somatosensory Cortex à Contralateral sensory loss
• Visual Association Cortex à Gerstmann Syndrome (dominant),
Hemineglect (nondominant)
• Arcuate Fasciculus à Conduction Aphasia
• Optic Radiations à Contralateral Inferior quadrantopsia
• Blood Supply à Medial: ACA, Lateral: MCA https://commons.wikimedia.org/wiki/File:Human_brain_frontal_(coronal)_section.JPG
• Occipital Lobe
• Primary Visual Cortex, input from lateral geniculate body
• Lesion to Occipital Lobe
• Primary Visual Cortex à Contralateral homonymous hemianopia, macular
sparing
• Blood Supply à PCA
• Internal Capsule
• Anterior Limb:
1. Ascending sensory fibers: Thalamocortical tracts
• Posterior Limb:
1. Descending motor fibers: Corticospinal tract
2. Ascending sensory fibers: Thalamocortical and somatosensory tracts (acoustic, visual)
• Genu:
1. Descending motor fibers: Corticobulbar tract
• Blood Supply à Lenticulostriate arteries

≣ ⟽ ⟾
A 77 year old right-handed female with a past medical history of

⚪ A. Left frontal lobe hypertension and hyperlipidemia presents to the emergency department
⚪ B. Right parietal lobe from a retired living facility for unusual behavior. Paramedics report that
⚪ C. Left parietal lobe the patient was playing a card game with residents of her facility and was
⚪ D. Left occipital lobe unable to hold her cards in her hands. Staff from her living facility also
⚪ E. Right occipital lobe report that she was unable to sign documentation over the past couple of
weeks saying that she ”could not remember how to write her signature”.
On physical exam cranial nerves III-XII are grossly intact with no deficits
in visual acuity. Reflexes are 2+ bilaterally and muscle strength is 5/5
bilaterally in the upper and lower extremities with the exception of
handgrip strength testing which was deferred by the patient. Sensory
deficits are present to touch and vibration along the right extremities. No
tremors are noted.
A mini mental status exam is preformed of which deficits are noted when
the patient is asked to count backward by sevens. The patient is also
unable to hold a pencil in her right hand. No deficits are appreciated in
speech or prosody.
A CT imaging study of the head reveals a small to medium-sized mass in

the cerebral cortex. Which of the following locations of the mass are most
consistent with the patient’s presentation?
≣ ⟽ ⟾
A 77-year-old right-handed female with a past medical history of

⚪ A. Right frontal lobe hypertension and hyperlipidemia presents to the emergency department
⚪ B. Right parietal lobe from a retired living facility for unusual behavior. Paramedics report that
$ C. Left parietal lobe the patient was playing a card game with residents of her facility and was
⚪ D. Left occipital lobe unable to hold her cards in her hands. Staff from her living facility also
⚪ E. Right occipital lobe report that she was unable to sign documentation over the past couple of
weeks saying that she ”could not remember how to write her signature”.
On physical exam cranial nerves III-XII are grossly intact with no deficits
in visual acuity. Reflexes are 2+ bilaterally and muscle strength is 5/5
bilaterally in the upper and lower extremities with the exception of
handgrip strength testing which was deferred by the patient. Sensory
deficits are present to touch and vibration along the right extremities. No
tremors are noted.
A mini mental status exam is preformed of which deficits are noted when
the patient is asked to count backward by sevens. The patient is also
unable to hold a pencil in her right hand. No deficits are appreciated in
speech or prosody.
A CT imaging study of the head reveals a small to medium-sized mass in

the cerebral cortex. Which of the following locations of the mass are most
consistent with the patient’s presentation?

Brainstem+Cerebral Cortex

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Brainstem+Cerebral Cortex

Uploaded by

Copyright:

Available Formats

OUTLINE

Anatomy 2. Rule of 4’s

Metencephalon Ventral: Basilar Artery CN V-VIII* nuclei

Metencephalon Ventral: Basilar Artery CN V-VIII* nuclei

A laboratory scientist is attempting to test whether dopaminergic depletion

A laboratory scientist is attempting to test whether dopaminergic depletion

• Blood Supply à Lenticulostriate arteries

A 77 year old right-handed female with a past medical history of

A CT imaging study of the head reveals a small to medium-sized mass in

A 77-year-old right-handed female with a past medical history of

A CT imaging study of the head reveals a small to medium-sized mass in

You might also like