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Greenberg > Chapter 1 - Gross Anatomy > Flashcards

Chapter 1 - Gross Anatomy Flashcards

1
Q

Isthmus

A

Connects the sinuous middle frontal gyrus to the pre-central gyrus

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2
Q

“subcentral gyrus”

A

Present in 98% of patients

Between central sulcus and sylvan fissure (lateral sulcus)

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3
Q

Inferior parietal lobule components

A

Angular gyrus

Supramarginal gyrus

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4
Q

Termination of the Sylvian fissure

A

Supramarginal gyrus

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5
Q

Termination of the superior temporal sulcus

A

Angular gyrus

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6
Q

Brodmann’s area 3, 1, 2

A

Primary somatosensory cortex

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7
Q

Brodmann’s area 41 & 42

A

Primary auditory areas (transverse gyri of Heschl)

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8
Q

Brodmann’s area 4

A

Precentral gyrus, primary motor cortex (aka “motor strip”)

Large concentration of giant pyramidal cells of Betz

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9
Q

Brodmann’s area 6

A

Premotor area or supplemental motor area.

Immediately anterior to motor strip, it plays a role in contralateral motor programming.

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10
Q

Brodmann’s area 44

A

Dominant hemisphere: Broca’s area (classically “motor speech area”)
Parts of the Pars triangularis & pars opercularis of the inferior frontal gyrus

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11
Q

Brodmann’s area 17

A

Primary visual cortex

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12
Q

Brodmann’s area 40 & part of 39

A

Wernicke’s area (dominant hemisphere)

May also include approximate posterior third of superior temporal gyrus

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13
Q

Inferior portion of Brodmann’s area 8

A

Frontal eye field

Initiates voluntary eye movement to the opposite direction

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14
Q

Pars marginales pleural

A

partes marginales

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15
Q

The cingulate sulcus terminates posteriorly in the _________

A

pars Marginales

  • seen on the medial surface of the brain
  • visible on 95% of CTs and 91% of MRIs
  • extend a greater distance into the hemispheres
  • posterior to the widest biparietal diameter on axial CT
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16
Q

AC-PC line

A
  • Connects the anterior commissure and the posterior commissure on a mid-line saggital image
  • Used in functional neurosurgery
  • Used as the baseline for axial MRI & recent CT scanners
  • Talairach definition: superior edge of AC & inferior edge of PC
  • Schaltenbrand definition: middle of AC & PC
  • Talairach vs Schaltenbrand definition: difference of 5.81 deg +/-1.07 deg
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17
Q

Anterior commissure

A

Horizontally positioned white matter tract that crosses in front of the fornix

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18
Q

Posterior commissure

A

The white-matter band at the level of the pineal that crosses at the posterior third ventricle

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19
Q

Orbitomeatal line vs. Talairach AC-PC

A

Orbitomeatal line (used in old CTs) is ~9 deg steeper

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20
Q

Somatotopic organization of the primary sensory cortex: Medial surface of the brain

A

Genitals (inferior)
Toes
Foot
Leg (corner)

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21
Q

Somatotopic organization of the primary sensory cortex:

Convexity of brain

A 
Hip
Trunk
Neck 
Head
Shoulder
Arm
Elbow
Forearm
Wrist
Hand
Fingers
Thumb 
Eye
Nose
Face
Upper lip
Lips
Lower lip
Teeth, gums
Intraabdominal
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22
Q

Somatotopic organization of the primary motor cortex:

Medial surface of the brain

A

Toes
ankle
knee

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23
Q

Somatotopic organization of the primary motor cortex:

Convexity of the brain

A 
Hip 
Trunk
Shoulder
Arm
Elbow
Wrist
Hand
Fingers
Thumb
Neck
Brow
Eye
Face
Lips
Jaw
Tongue
Swallowing
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24
Q

Central sulcus on axial imaging

A
  • visible on 93% of CTs and 100% of MRIs
  • curves posteriorly as it approaches the intrahemispheric fissure
  • often terminates in the paracentral lobule, just anterior to the pars marginalis
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25
Q

Parieto-occipital sulcus (or fissure) on axial imaging

A
  • more prominent over the medial surface

- on axial imaging is longer, more complex, and more posterior than the pars marginalis

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26
Q

Post-central sulcus on axial imaging

A
  • usually bifurcates and forms an arc or parenthesis (“lazy-Y”) cupping the pars Marginalis
  • the anterior limb does not enter the pars Marginalis bracket and the posterior limb curves behind the pars Marginalis to enter the interhemispheric fissure
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27
Q

Hand “knob”

A
  • knob-like protrusion (shaped like an inverted omega) on axial imaging
  • has a posteriorly projecting hook-like appearance with the posterior limit of the Sylvian fissure on sagittal imaging
  • superior aspect of the precentral gyrus
  • contains alpha motor neurons for hand function
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28
Q

Pterion

Estimated location

A

2 finger-breadths above the zygomatic arch

1 thumbs breadth behind the frontal process of the zygomatic bone

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29
Q

Asterion

A

Junction of the lambdoid, occipitomastoid and parietomastoid sutures

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30
Q

Asterion location relative to internal structures

A

Usually lies within a few millimeters of the posterior-inferior edge of the junction of the transverse and sigmoid sinuses (not always reliable)

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31
Q

Lambda

A

Junction of the lambdoid and sagittal sutures

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32
Q

Junction of the coronal suture and superior temporal line.

A

Stephanion

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33
Q

Posterior margin of the foramen magnum in the midline

A

Opisthion

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34
Q

Junction of the coronal and saggital sutures

A

Bregma

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35
Q

Taylor Haughton lines

A
  • Can be constructed on an angiogram, CT/MRI scout film, or skull Xray
  • Can be used to approximate the Sylvian fissure and the motor cortex
  • Frankfurt plane
  • Nasion-inion across calvaria and divided into 4ths
  • Posterior ear line
  • Condylar line
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36
Q

Reid’s baseline

A

From inferior margin of the orbit through the center of the external auditory meatus

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37
Q

Inion

A

Marks external occipital protuberance

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38
Q

Condylar line

A

Perpendicular to the baseline (Frankfort) through the mandibular condyle

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39
Q

Posterior ear line

A

Perpendicular to the baseline through the mandibular condyle

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40
Q

Rolandic fissure

A

central sulcus

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41
Q

Approximating the motor cortex

A
  1. Superior aspect is almost straight up from the external acoustic meatus near the midline
  2. Approximate by connecting a point 2 cm posterior to the arc extending from the nation to the inion to a point 5 cm straight up from the external acoustic meatus
  3. Connect T-H lines
  4. a line drawn 45 deg to Reid’s base line starting at the pterion points in the direction of the motor strip
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42
Q

Connecting T-H lines to approximate the central sulcus

A

Connect the point where the posterior ear line intersects the circumference of the skull (~1 cm behind the vertex, 3-4 cm behind the coronal suture) to the point where the condylar line intersects the line representing the Sylvian fissure

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43
Q

Sylvian fissure (lateral fissure) approximation - with skin

A

Line connecting the lateral canthus to the point 3/4 of the way posterior along the arc running over convexity from nasion to inion

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44
Q

squamosal suture

A

Between the temporal and parietal bones

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45
Q

sphenosquamous suture

A

Between the sphenoid and temporal bones

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46
Q

Sylvian fissure approximation on skull

A

Sylvian fissure follows the squamosal suture and then deviates superiorly to terminate at Chater’s point

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47
Q

Chater’s point

A

6 cm above the external acoustic meatus on a line perpendicular to the OML

48
Q

Lateral ventricles location in the non-hydrocephalic adult

A
  • 4-5 cm below the outer skull surface
  • Center of body of ventricles sit in the mid pupillary line
  • Frontal horn is intersected by a line passing perpendicular to the calvaria along the mid pupillary line
  • anterior horns extend 1-2 cm anterior to the coronal suture
49
Q

Average length of the third ventricle

A

~2.8 cm

50
Q

Scapular line - vertebral landmark

A

T2-T3

51
Q

Inferior scapular pole - vertebral landmark

A

~T6 posteriorly

52
Q

Intercristal line

A

Line drawn between the highest point of the iliac crest across the back
Crosses the midline either at the interspace between L4 and L5 spinous processes or at the L4 spinous process itself

53
Q

Porus acusticus

A

Internal auditory canal

- filaments of the acoustic portion of VIII penetrate tiny openings of the lamina cribrosa of the cochlear area

54
Q

Transverse crest

A

Separates the superior vestibular area and facial canal (above) from the inferior vestibular area and cochlear area

55
Q

Vertical crest

A

“Bill’s bar” - named after Dr. William House
- separates the meatus to the facial canal anteriorly (containing VII and nervus intermedius) from the vestibular area posteriorly (containing the superior division of the vestibular nerve)

56
Q

5 nerves of the internal auditory canal

A
  1. Facial nerve (VII) (superior position)
  2. Nervus intermedius
  3. Acoustic portion of the VIII
  4. Superior branch of the vestibular nerve
  5. Inferior branch of the vestibular nerve
57
Q

Nervus intermedius - in the IAC

A
  • Somatic sensory branch of the facial nerve
  • Primarily innervating mechanoreceptors of the hair follicles of the inner surface of the pinna and deep mechanoreceptors of nasal and buccal cavities and chemoreceptors in the taste buds on the anterior 2/3 of the tongue
58
Q

Superior branch of the vestibular nerve - in the IAC

A
  • Passes through the superior vestibular area to terminate in the utricle and in the ampullae of the superior and lateral semicircular canals
59
Q

Inferior branch of the vestibular nerve - in the IAC

A
  • Passes through inferior vestibular area to terminate in the saccule
60
Q

Average length of frontal horn anterior to foramen of Monro

A

25 mm

61
Q

Average distance from cloves to floor of 4th ventricle at level of fastigium

A

36.1 mm (33.3-40.0 mm)

62
Q

Fastigium

A

apex of the 4th ventricle within the cerebellum

63
Q

Average length of the 4th ventricle at the level of the fastigium

A

14.6 mm (10.0-19.0 mm)

64
Q

Average distance from fastigium to opisthion

A

32.6 mm (30.0-40.0 mm)

65
Q

Angle of the mandible - vertebral landmark

A

C1-C2

66
Q

1 cm above the thyroid cartilage (=hyoid bone) - vertebral landmark

A

C3-C4

67
Q

Level of thyroid cartilage - vertebral landmark

A

C4-C5

68
Q

Crico-thyroid membrane - vertebral landmark

A

C5-C6

69
Q

Carotid tubercle - vertebral landmark

A

C6

70
Q

Cricoid cartilage - vertebral landmark

A

C6-C7

71
Q

Nasal slits contents

A

Anterior ethmoidal n, a, v

72
Q

Superior orbital fissure contents

A
  • CN III, IV, VI, ophthalmic, division of V (includes nasocilliary, frontal and lacrimal nerves)
  • Superior ophthalmic v
  • Recurrent meningeal branch from lacrimal a
  • Orbital branch of the middle meningeal a
  • Sympathetic filaments from ICA plexus
73
Q

Inferior orbital fissure contents

A
  • CN V2
  • Zygomatic n
  • Filaments from pterygopalatine branch of maxillary n
  • Infraorbital a & v
  • Vein between inferior ophthalmic v & pterygoid venous plexus
74
Q

Foramen lacerum

A
  • Usually nothing
  • Vidian artery in 30%
  • ICA traverses upper portion
75
Q

Carotic canal

A
  • Internal carotid a

- Ascending sympathetic nerves

76
Q

Incisive foramen

A
  • Descending septal artery

- Nasopalatine n

77
Q

Greater palatine foramen

A

Greater palatine n, a, v

78
Q

Lesser palatine foramen

A

Lesser palatine n

79
Q

Internal acoustic meatus

A 
CN VII
CN VIII (state-acoustic)
80
Q

Hypoglossal canal

A
  • CN XII

- Meningeal branch of the ascending pharyngeal a.

81
Q

Foramen magnum

A
  • Spinal cord (medulla oblongata)
  • CN XI (spinal accessory) entering the skull
  • Vertebral a
  • Anterior & posterior spinal arteries
82
Q

Foramen cecum

A

Occasional small vein

83
Q

Cribriform plate

A

Olfactory nerves

84
Q

Optic canal

A
  • CN II (optic)

- ophthalmic a

85
Q

Foramen rotundum

A
  • CN V2 (maxillary division)

- Artery of the foramen rotundum

86
Q

Foramen ovale

A
  • CN V3 (mandibular div)

- Portio minor (motor for CN V)

87
Q

Foramen spinosum

A
  • Middle meningeal artery & vein
88
Q

Jugular foramen

A
  • Internal jugular vein

- CN IX, X, XI

89
Q

Stylomastoid foramen

A
  • CN VII

- Stylomastoid artery

90
Q

Codyloid foramen

A

Vein from transverse sinus

91
Q

Mastoid foramen

A
  • Vein to mastoid sinus

- Branch of occipital artery to dura mater

92
Q

Vascular supply of the internal capsule

A
  1. Anterior choroidal
  2. Lateral striate branches (aka capsular branches) of MCA (most of anterior and posterior limbs)
  3. Direct branches of the internal carotid a (genu)
93
Q

Anterior choroidal artery areas of supply

A

All of retrolenticular part (including optic radiation) and ventral part of posterior limb of IC

94
Q

Anterior thalamic subradiation

A

Connects medial and anterior thalamic nucleus to frontal lobe

95
Q

Superior thalamic subradiation

A
  • Connects rolandic areas to ventral thalamic nuclei

- General sensory fibers from body & head to terminate in post central gyrus

96
Q

Posterior thalamic subradiation

A
  • Connects occipital & posterior parietal to caudal thalamus
97
Q

Inferior thalamic subradiation

A
  • Connects transverse temporal gyrus of Heschl to MGB
98
Q

Ligaments connecting the atlas to the occiput

A
  • Anterior atlantooccipital membrane (anterior margin of foramen magnum to anterior arch of C1)
  • Posterior atlantooccipital membrane (posterior margin of foramen magnum to posterior arch of C1)
99
Q

Ligaments connecting the axis (odontoid) to the occiput

A
  • Tectorial membrane
  • Alar ligaments
  • Apical odontoid ligament: tip of dens to foramen magnum
100
Q

Alar ligaments - connection from odontoid to occiput

A
  • Occipital-alar portion: side of dens to occipital condyle

- Atlanta-Alar portion: side of the dens to the lateral mass of C1

101
Q

Ligaments connecting the axis to the atlas

A
  • transverse atlantal ligament (horizontal component of the cruciate ligament)
  • Atlanta-alar portion of the alar ligaments
  • descending band of the cruciate ligament
102
Q

Strongest ligament of the spine

A

transverse atlantal ligament (or transverse ligament)

103
Q

Separation of dorsal and ventral nerve roots in the spinal nerves

A

Dentate ligament

104
Q

Interomediolateral gray nucleus

A

Only present from T1 to ~L1 or L2 where there are sympathetic (thoracolumbar outflow) nuclei

105
Q

Laminae according to the scheme of Rexed

A

Lamina II - substantia gelatinosa
Laminae III & IV - nucleus proprius
Lamina VI - in the base of the posterior horn

106
Q

Pain and temp 1st order neurons

A
  • Small, finely myelinated afferent
  • Soma in the DRG
  • Enter cord at dorsolateral tract (zone of Lissauer)
  • Synapse in the substantia gelatinosa
107
Q

Pain and temp 2nd order neurons

A
  • Axons cross obliquely in the anterior white commissure ascending ~ 1-3 segments while crossing to enter the lateral spinothalamic tract
  • Synapse in the VPL of the thalamus
108
Q

Pain and temp 3rd order neurons

A
  • Pass through the internal capsule to post central gyrus (Brodman 3,1,2)
109
Q

Fine touch receptors

A
  • Meissner’s
  • Pancinian corpuscles
  • Merkel’s disks
  • Free nerve endings
110
Q

Fine touch 1st order neurons

A
  • Heavily myelinated afferents
  • Soma in dorsal root ganglion (no synapse)
  • Short branches synapse in nucleus proprius of posterior gray
  • Long fibers enter the ipsilateral posterior columns without synapsing (below T6: fasciculus gracilis; above T6 fascicles cuneatus)
  • Synapse: nucleus gracilis/cuneatus, just above pyramidal decussation
111
Q

Fine touch 2nd order neurons

A
  • Axons form internal arcuate fibers, decussate in lower medulla as medial lemniscus
  • Synapse in VPL of thalamus
112
Q

Fine touch 3rd order neurons

A

Pass through internal capsule primarily to the post central gyrus

113
Q

Light (crude) touch receptors

A
  • Meissner’s
  • Pancinian corpuscles
  • Merkel’s disks
  • Free nerve endings
  • Peritrichial arborizations
114
Q

Light (crude) touch - first order neuron

A
  • Large, heavily myelinated afferents (Type II)
  • Soma on dorsal root ganglion (no synapse)
  • Some ascend uncrossed in posterior columns (with fine touch);
  • most synapse in Rexed VI & VII
115
Q

Light (crude) touch - second order neuron

A
  • Axons cross in the anterior white commissure (a few don’t cross)
  • Enter anterior spinothalamic tract
  • Synapse in VPL of thalamus
116
Q

Light (crude) touch - third order neuron

A

Pass through internal capsule primarily to postcentral gyrus

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