Anatomy

Question 1

A colleague of yours refers a patient to you that has a lacunar lesion. You know it’s in the limbic system inferior to the third ventricle; and it appears to be in the hippocampus. You want to tease out the exact location with a neurologic exam, so you begin asking the patient questions. Which question would confirm your suspicions?

A) The patient can still play the piano, which they’ve known their entire life
B) They can remember recent events of the past day and week
C) They are able to follow along with a segment of breaking bad which is new to them, and then explain what happened to you afterwords.
D) They have no trouble explaining to you that the formula E=mc2 is an equation from Albert Einstein.

Answer 1

A is correct

They hippocamus lesion will prevent the formation of explicit declarative memories of either a episodic or semantic nature, but leave implicit memory function intact; playing an instrument.

B, C, D, are all examples of declarative memories. B episodic and both C and D are semantic.

Question 2

You have a patient recovering from an ischemic stroke, and their spouse wants to know if they will have any impaired cognitive function as a result. You explain to them that one area of the brain is particularly susceptible to ischemic necrosis. What area is this, and how might the patient act differently as a result of their stroke? What might you say to give them realistic hope and assurance?

Answer 2

Hippocampus

May have lost some declarative memory. They may as a result forget events in their life, or facts they’ve learned along the way.

The hippocampus doesn’t work alone with regard to memory as this is a function of the limbic system as a whole.

Question 3

What’s Korsakoffs syndrome?

Answer 3

Think of a Russian drinker

Common in alcoholics
Confabulation without hesitation (making shit up)
Retro and Anterograde amnesia
NOT hippocampus

Mammillary bodies and thalamus

Question 4

What region of the brain is primarily affected by Alzheimers? How would you classify this disease?

Answer 4

Hippocampus

Dementia though dementia is not unique to this disease

Hydrocephalus ex vacuo-appears as if the ventricles are enlarging but the brain is atrophying.

Question 5

What makes up the original circuit of Papez? How about the recent additions?

Answer 5

Hippocampus, mammillary body, anterior thalamus, cingulate gyrus. DECLARATIVE MEMORY

Amygdala, hypothalamus, and prefrontal cortex
(organizing behavior in response to environment)
IMPLICIT MEMORY

Question 6

The pleasure center of the brain is called what? It’s associated with which other two structures of the basal forebrain?

Answer 6

Nucleus accumbens- associated with food, sex, laughter, impulsiveness, addiction and reward.

Septal area
Maynert

Question 7

What is the function of the nucleus of Meynert? What’s the relationship between this structure and alzheimer’s Disease?

Answer 7

Long term memory storage
Highly active first 10 yrs
lesion= learning and recognition defects

In Alzheimers their is a loss of cholinergic neurons in this location. Treat with AChE inhibitor to boost neurotransmitter ACh.

Question 8

The limbic system is the border of what? How is it defined?

Answer 8

Di and tel encephalon
Consciousness and unconsciousness

It’s defined functionally more than regionally

Question 9

What are the four regions of the limbic system?

Answer 9

Cingulate gyrus
Parahippocampal gyrus
Medial orbital gyrus
Gyri of the temporal lobe

Question 10

The mammillary bodies are attached to which region?

Answer 10

Hypothalamus

Think mammillary memory

Question 11

What’s the uncus?

Answer 11

protrusion of the parahippocampus

Question 12

What’s another name for the habenula?

Answer 12

epithalamus-part of the diencephalon

Question 13

Which region of the hypothalamus is separated by the third ventricle ? What are some clinically significant finding related to the destruction of some of its divisions?

Answer 13

Hypothalamus-samples hormones in the blood. Homeostasis

Mediolateral distruction leading to aphagia and adipsia (eat and drink)

Question 14

What would a lesion in the amygdala look like?

Answer 14

Placid, non aggressive, no fear.

Question 15

What’s Kluver Bucy syndrome

Answer 15

Bilateral destruction of temporal lobes-including amygdala hippocampus and parahippocampal gyrus

Loss of affect
Hypersexual, indiscriminate, and oral fixation
Also visual agnosia-didn’t recognized objects recently expected

Question 16

An x-ray image of a patients skull fracture doesn’t look like it was done correctly because the bone isn’t very white. You suspect an issue with the contrasting agent and decide to have the scan performed again.
What needs to change the second time around, and what contrasting agent should be used?

A) The image must be more radiolucent when imaging bone; use iodine contrast
B) The image must be more radiodense when imaging bone; use iodine contrast
C) same as A with gadolinium
D) same as B with gadolinium

Answer 16

B is correct
A dense organ absorbs more x-rays and produces a more radiopaque/whiter image.

Iodine is for x-ray and gadolinium for MRI

Question 17

How do you increase the contrast of a CT image?

Answer 17

It can be modified by windowing on a computer to maximize the desired contrast

Question 18

What are the advantages to CT scans?

Answer 18

Faster, cheaper, less sensitive to motion, better for bone calcifications and metal, no risk from metallic devices

Question 19

What are some indication for a brain CT scan?

Answer 19

Bone lesion
Brain mass
abscess
Hemorrhage
Hydrocephalus
Stroke
Trauma/skull fracture

Question 20

What are the advantages of MRI, and the indications for use on the brain?

Answer 20

Advantages- No radiation, better soft tissue evaluation, and anatomic detail, avoids bony artifacts

Indicatied:Tumor, metastatic disease, stroke/infarct, Infection, MS, post op.

Question 21

What is the difference between T1 and T2 weighted images?

Answer 21

TI fluid is black (Anatomical MRI)
T2 looks like a negative, and fluid is white (Functional MRI)

It helps to look for the eyes or lateral ventricles to determine fluid color