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Neuropath > Neuroanatomy > Flashcards

Neuroanatomy Flashcards

1
Q

What are the 6 layers of the cortex (superficial to deep)?

A

Molecular (plexiform) layer
External granular layer
External pyramidal layer
Internal granular layer
Internal pyramidal layer
Multiform (fusiform) layer

(MP EG EP IG IP MF)

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2
Q

What are the 3 FUNCTIONAL layers of the cortex?

A
  1. Supragranular layers (I-III)
  2. Internal granular layer (IV)
  3. Infragranular layers (V & VI)
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3
Q

Where do intracortical connections primarily originate and terminate (layer)?

A

Functional: supragranular layers (I-III which are molecular/plexiform, external granular, and external pyramidal)

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4
Q

What are the 2 main types of intracortical connections?

A

Associational (intrahemispheric)
&
Commissural (to contralateral hemisphere, usu thru corpus callosum)

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5
Q

What does the internal granular layer do, i.e. where do its connections come from?

A

Receives thalamocortical connections, esp from thalamic nuclei
Most prominent in primary sensory cortices

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6
Q

What do the infragranular layers mostly do?

A

Connect cortex & subcortical regions

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7
Q

Where are the infragranular layers most developed?

A

Motor cortex

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8
Q

Which part of the brain has extremely small or non-existent granular layers and is aka the “agranular” cortex?

A

Motor cortex

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9
Q

What layer gives rise to all of the principal cortical efferent projections to basal ganglia, brainstem, and spinal cord?

A

Layer V (internal pyramidal)

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10
Q

Where does layer VI go?

A

Mostly to the thalamus
aka the multiform or fusiform layer

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11
Q

What’s Nelson’s syndrome?

A

In the setting of Cushing’s disease (ACTH) s/p bilateral adrenalectomy, but the adenoma keeps growing and secreting ACTH

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12
Q

Does Nelson’s syndrome have Crooke’s cells?

A

Crooke’s cells are found in pituitaries of Cushing’s disease, but not in the pituitary surrounding the adenomas of Nelson’s syndrome (so no)

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13
Q

What structures make up the diencephalon?

A
  • Thalamus
  • Hypothalamus including the Neurohypophysis
  • Subthalamus
  • Epithalamus
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14
Q

What structures make up the epithalamus?

A

Ant & post paraventricular nuclei
Medial & lat Habenular nuclei
Stria medullaris thalami
Posterior commissure
Pineal Body

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15
Q

What are 3 changes you see in mammillary bodies in Wernicke’s?

A
  1. Soft granular parenchyma (& atrophy?)
  2. Abnormal capillaries with microhemorrhage (slides & grossly)
  3. Reactive astrocytes
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16
Q

What are the 3 hereditary motor & sensory neuropathies?

A
  1. Charcot-Marie-Tooth
  2. HMSN II
  3. Dejerine-Sottas neuropathy
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17
Q

What’s the disease with onion bulbs on EM and what are they?

A

Charcot-Marie-Tooth

Schwann cell hyperplasia i.t.s.o repetitive de- & remyelinations

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18
Q

What’s the protein you should telegraph for Charcot-Marie-Tooth?

A

PMP22
peripheral myelin protein 22

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19
Q

What’s the first test you do to eval for Charcot-Marie-Tooth? and why

A

Single-gene testing for PMP22 duplication/deletion
PMP22 duplication (a 1.5-Mb duplication at 17p11.2 that includes PMP22) accounts for as much as 50% of all CMT

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20
Q

what is the most common neoplasm family that happens in the pineal region?

A

germ cell tumors!
(germinoma > teratoma > choriocarcinoma&raquo_space; yolk sac & embryonal)

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21
Q

describe the path of the gag reflex (lol WHAT)

A

Touch receptors in pharyngeal mucosa (CNIX)
Solitary nucleus
Nucleus ambiguus
CNX
Muscles of palate

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22
Q

Brown Sequard 3 main issues with ipsi or contralateral (NOT levels, NOT tracts)

A
  1. Ipsilateral flaccid paralysis/loss of cutaneous sensation
  2. Ipsilateral spastic paralysis & loss of vibration sense, proprioception, & fine touch
  3. Contralateral loss of pain & temp
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23
Q

Brown Sequard issue & why it happens bc of the tracts affected (NOT levels)

A
  1. Ipsilateral flaccid paralysis d/t LMN loss (anterior corticospinal tract)
  2. Ipsilateral spastic paralysis d/t loss of moderation by UMN of lateral corticospinal tract; loss of vibration sense, proprioception, & fine touch d/t posterior/dorsal columns (fasciculus Gracilis (leGs) &/or fasciculus cuneatus (arms))
  3. Contralateral loss of pain & temp d/t spinothalamic tract
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24
Q

Brown Sequard ipsi/contra consequences WITH LEVELS

A
  1. Ipsi flaccid + band of sensory loss AT level of lesion
  2. Ipsi spastic + contra loss of vibration/proprio/fine touch BELOW level of lesion
  3. Contra loss of pain & temp 1-2 levels below lesion
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25
Q

What are the ELEVEN (ugh) structures served by the anterior choroidal artery?

A
  1. Choroid plexus (LV & 3rd vent)
  2. Optic chiasm & tract
  3. Internal capsule
  4. LGN
  5. Globus pallidus
  6. Tail of the caudate
  7. Hippo
  8. Amygdala
  9. Substantia nigra
  10. Red nucleus
  11. Crus cerebri
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26
Q

Which structure served by the anterior choroidal artery also has partially redundant blood supply, and where does it come from?

A

Posterior limb of internal capsule
Lenticulostriate arteries from MCA

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27
Q

What vessels can cause lateral medullary syndrome?

A

PICA (specifically lateral medullary segment)
Vertebral artery

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28
Q

What’s the eponym for lateral medullary syndrome?

A

Wallenberg

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29
Q

What are the 7 structures affected in lateral medullary syndrome?

A
  1. Vestibular nuclei
  2. Inferior cerebellar peduncle
  3. Central tegmental tract
  4. Lateral spinothalamic tract
  5. Spinal trigeminal nucleus & tract
  6. Nucleus ambiguus (incl vagus & glossopharyngeal nerves)
  7. Descending sympathetic fibers
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30
Q

LMS: what happens when the vestibular nuclei are infarcted?

A

Vomiting
Vertigo
Nystagmus

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31
Q

LMS: what happens when the inferior cerebellar peduncle is infarcted?

A

Ipsilateral ataxia, dysmetria (past pointing), dysdiadochokinesia

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32
Q

LMS: what happens when the central tegmental tract is infarcted?

A

Palatal myoclonus

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33
Q

LMS: what happens when the lateral spinothalamic tract is infarcted?

A

Contralateral loss of pain & temp from BODY (limbs & torso)

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34
Q

LMS: what happens when the spinal trigeminal nucleus & tract are infarcted?

A

ipsilateral loss of pain & temp from FACE

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35
Q

LMS: what happens when the nucleus ambiguus is infarcted?

A

Ipsilateral laryngeal, pharyngeal, & palatal hemiparalysis (dysphagia, hoarseness, diminished gag d/t efferent limb of CNX)

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36
Q

LMS: what happens when the descending sympathetic fibers are infarcted?

A

Ipsilateral Horner’s syndrome (ptosis, miosis, & anhidrosis)

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37
Q

What is Grinker’s myelinopathy?

A

Anoxic leukoencephalopathy or delayed post-hypoxic leukoencephalopathy
(white matter & BG)

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38
Q

Key finding in FCD Ia

A

Abnormal radial cortical lamination (a-b; r-t)

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39
Q

Key finding in FCD Ib

A

Abnormal tangential cortical lamination (a-b; r-t)

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40
Q

Key finding in FCD Ic

A

Abnormal radial AND tangential cortical lamination (i.e. Ia + Ib)

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41
Q

Key finding in FCD IIa

A

Dysmorphic neurons

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42
Q

Key finding in FCD IIb

A

Dysmorphic neurons AND balloon cells (b for balloon, IIb is for the 2 Ls in ballon)

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43
Q

Key finding in FCD IIIa

A

Temporal lobe, a/w hippo sclerosis

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44
Q

Key finding in FCD IIIb

A

Adjacent to glial or glioneuronal tumor

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45
Q

Key finding in FCD IIIc

A

Adjacent to vascular malformation

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46
Q

Key finding in FCD IIId

A

Adjacent to any other lesion acquired during early life (trauma, ischemic injury, encephalitis, etc)

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47
Q

What’s the Guillain-Mollaret triangle?

A

CONTRALATERAL dentate
Ipsilateral red
Ipsilateral inf olivary

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48
Q

What’s hypertrophic olivary degeneration (why do you get it and why is it weird)

A

Primary lesion in dentato-rubro-olivary pathway > Transneuronal degen of inf olivary nucleus > HYPERTROPHY of inf olivary nucleus (not atrophy!)

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49
Q

Where do parallel fibers come from?

A

Granule cells in cerebellar cortex

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50
Q

What do parallel fibers form?

A

Excitatory synapses onto dendrites of Purkinje cells & dendrites of inhib interneurons basket cells & stellate cells (molec layer)

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51
Q

Grumose degeneration

A

Degeneration of dentate nucleus of cerebellum: accumulation of granular eo material which is actually swollen/degen Purkinje axons (it looks like axonal spheroids on neurofilament or synapto IHC, just in the cerebellum

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52
Q

Name 3 things that can show grumose degeneration

A
  1. PSP
  2. Dentatorubropallidoluysian atrophy
  3. Spinocerebellar ataxia type 3
53
Q

What are the 2 main (broad) categories of “disorders of forebrain induction”?

A

Holoprosencephaly
&
agenesis of the corpus callosum

54
Q

Define holoprosencephaly.

A

Developmental defect of forebrain (prosencephalon which includes telencephalon and diencephalon) where you have incomplete separation of the cerebral hemispheres into R & L

55
Q

What are the 3 types of holoprosencephaly?

A
  1. Alobar/complete (worst) (no separation, one ventricle)
  2. Semilobar/incomplete (some separation, usu posterior)
  3. Lobar (focal fusion along midline, either at OFC or cingulate)
56
Q

What are the issues with noses/smell that you can get with holoprosencephaly?

A
  1. No olfactory bulbs
  2. Anosmia
  3. Congenital nasal pyriform aperture stenosis
57
Q

What are 3 infections that have been a/w holoprosencephaly?

A

Toxoplasmosis
Syphilis
Rubella

58
Q

What are 3 teratogens that have been a/w holoprosencephaly?

A

Ethanol
Retinoic acid
Cholesterol synthesis inhibitors

59
Q

What is the frequency of genetic etiology of holoprosencephaly?

A

50% of cases have cytogenetic abnormalities

60
Q

What is the most common genetic etiology of holoproscencephaly?

A

Trisomy 13
(75% of trisomy 13 cases have holoprosencephaly)

61
Q

Gene for Smith-Lemli-Opitz syndrome

A

DHCR7 on chromosome 11
(functions in cholesterol synthesis)

62
Q

What structure is usually missing in partial agenesis of the CC?

A

Splenium (posterior)

63
Q

Name 3 syndromes a/w agenesis of the CC

A
  1. Aicardi
  2. Andermann
  3. Meckel
64
Q

What are 3 broad categories of “malformations of cortical development”?

A
  1. Lissencephaly
  2. Heterotopias
  3. Cortical dysplasias with cytomegaly
65
Q

Name 3 cortical malformations that occur due to abnormal neurogenesis.

A
  1. Microcephaly
  2. Hemimegalencephaly
  3. Focal cortical dysplasia
66
Q

Name 3 cortical malformations that occur due to abnormal neuronal migration.

A
  1. Periventricular heterotopia
  2. Subcortical band heterotopia
  3. Lissencephaly
67
Q

Name 1 cortical malformation that occurs due to abnormal arrest in neuronal migration

A

Cobblestone (type 2) lissencephaly

68
Q

What gene is associated with autosomal recessive lissencephaly?

A

RELN (7q22)

69
Q

What gene is a/w Miller-Dieker syndrome?

A

LIS1 & 14-3-3’ YWHAE continuous deletion (17p13.3)

targeted LoFxn alleles of Pafah1b1 & 14-3-3’

70
Q

What gene is associated with autosomal dominant lissencephaly?

A

LIS1 & 14-3-3’ YWHAE continuous deletion (17p13.3)

targeted LoFxn alleles of Pafah1b1 & 14-3-3’

71
Q

What is the mode of inheritance of Miller-Dieker syndrome?

A

Autosomal dominant (haploinsufficiency)

72
Q

What is the mode of inheritance of isolated lissencephaly sequence?

A

Autosomal dominant

73
Q

What gene is a/w isolated lissencephaly sequence?

A

LIS1 deletion alone (17p13.3)

targeted LoFxn alleles of Pafah1b1

74
Q

What genes are a/w X-linked lissencephaly?

A

DCX (Xq22.3-q23) (DOMINANT)
ARX (Xp22.13)

75
Q

What is the main difference in cortical morphology btwn LIS1 mutation and DCX mutation?

A

Both are 4 layer cortex, but
LIS1 is posterior
DCX is anterior

76
Q

What is the main difference in morphology between LIS1, DCX, and ARX mutations?

A

ARX = 3 layer
LIS1 & DCX = 4 layer

77
Q

Is ARX lissencephaly 3 layer or 4 layer?

A

Threeeeeeeeeeeeeeee

78
Q

What does LIS1 encode?

A

non-catalytic subunit of plt activating factor acetyl hydrolase
(dynein > neuronal migration)

79
Q

What are the facial features a/w Miller-Dieker? and are they d/t LIS1 or 14-3-3 mut?

A

microcephaly (lissencephaly)
bitemporal narrowing
micrognathia
vertical ridging in forehead

D/t 14-3-3 (or just not LIS1) bc LIS1 causes the lissencephaly

80
Q

Mode of inheritance of DCX lissencephaly

A

X-linked dominant (males)

81
Q

Mode of inheritance of ARX lissencephaly & the name of the syndrome

A

X-linked recessive
XLAG (X-linked lissencephaly with ambiguous genitalia)

82
Q

mode of inheritance of cobblestone/type 2 lissencephaly

A

autosomal recessive

83
Q

What does the cortex look like microscopically in cobblestone/type 2 lissencephaly?

A

Unlayered and totally disorganized

84
Q

What are the 2 other organ systems that can be abnormal in cobblestone/type 2 lissencephaly?

A

Muscular
Ocular

85
Q

why is it called cobblestone lissencephaly

A

the neurons? go to the MENINGES??? and they pooch the brain out and make the meninges super thick, so it looks cobblestoned

86
Q

gene for Fukuyama congenital muscular dystrophy

A

FCMD (9q31)

87
Q

Gene for muscle-eye-brain disease types
A, 5
B, 5
C, 5

A

FKRP (19q13.3)

88
Q

Gene for Walker Warburg syndrome

A

POMT1 (9q31-33)
POMT2 (14q24.3)

89
Q

2 genes a/w muscle-eye-brain disease (not the A, B, C)

A

POMGnT1 (1p34-33)
LARGE (22q12)

90
Q

what is the underlying theme of all the types of cobblestone lissencephaly genes?

A

All result in hypoglycosylation
(issues with glycosyl transferases) (alpha dystroglycans)

91
Q

What does Walker Warburg have clinically?

A

HARD + E
Hydrocephalus
Agyria (lissencephaly (cobblestone))
Retinal Dysplasia
Encephalocele (occipital)

also muscular dystrophy and also vermal agenesis/cerebellar dysplasia

92
Q

Define grey matter heterotopia

A

Neurons and glia that form a region of grey matter in an abnormal location

93
Q

What are the 2 main classes of grey matter heterotopia?

A

Nodular
Band/Laminar

94
Q

Gene and inheritance pattern of familial subependymal heterotopia?

A

Gene: FLNA on Xq28 (Filamin 1)
X-linked dominance (happens in females, lethal in males)

95
Q

Gene in periventricular nodular heterotopia with microcephaly (and inheritance i guess)

A

ARFGEF2
Auto recessive

96
Q

What gene is a/w band heterotopia?

A

DCX (double cortin)
(also a/w lissencephaly)

97
Q

Which layer of the cortex has the largest neurons?

A

Layer V

98
Q

what genetic abnormalities are FCD IIb a/w?

A

somatic mutations in mTOR pathway

99
Q

Genes a/w tuberous sclerosis

A

TSC1 chrom 9: hamartin
TSC2 chrom 16: tuberin
(tumor suppressors; when mutated, mTOR path is upregulated)

100
Q

where does the recurrent artery of Heubner come from?

A

anterior cerebral artery

101
Q

what does the recurrent artery of Heubner supply?

A

think Heubner’s HAMBUrgers

H: head of caudate + ant hypothalamus
A: anterior internal capsule + nucleus accumbens
M: Meynert + medial GP
B: diagonal band of Broca
U: parts of uncinate fasciculus

102
Q

where does the anterior choroidal artery come from?

A

internal carotid (not quite MCA)

103
Q

what does the anterior choroidal artery supply?

A

the Choroid is DEEP in the EYE (deep structures, optic pathways)

  1. optic radiations/posterior internal capsule
  2. optic tract
  3. LGN/lateral thalamus
    LGN leads to everything near it: hippo + amygdala + tail of caudate + GPi + cerebral peduncle (lat) + choroid plexus in LV
104
Q

what is anterior choroidal artery syndrome?

A

Hemiplegia
Hemianesthesia
Contralateral hemianopia

105
Q

primary (only) efferent pathway from hippocampus

A

fornix

106
Q

what cell type does Wernicke’s NOT affect?

A

Neurons

107
Q

which is medial & which is lateral: fasciculus cuneatus and gracilis

A

medial: gracilis (when you say grace you put your hands together in the middle)

lateral: cuneatus

108
Q

Somatotopy of dorsal columns. Go!
+
aff or eff?

A

cuneate: cervical and thoracic (lat to med) (CuneaTe has C & T)

gracilis: lumbar (lat) and sacral (med - bc it’s sacrament, cause you’re saying grace)

both are Afferent (Ascending)

109
Q

somatotopy of lateral corticospinal tract
+
aff or eff?

A

medial to lateral: C > T > L > S

Efferent/dEscending

110
Q

somatotopy of anterolateral system

A

medial to lateral: C > T > L > S

Afferent (Ascending)

111
Q

how can you orient spinal cord based on BVs?

A

Posterior spinal arteries are Paired

Anterior is Alone

112
Q

what other thing are Arnold Chiari type 2 malformations a/w?

A

lumbosacral myelomeningocele
&
hydrocephalus

113
Q

what is a type 1 arnold-chiari

A

herniation of cerebellar tonsil thru foramen magnum

114
Q

what is a type 2 arnold-chiari

A

herniation of cerebellar vermis & downward displacement of brainstem (+/- buckling)

115
Q

what is a type 3 arnold-chiari

A

cerebello-encephalocele herniation thru occipitocervical or high cervical bony defect (like a big neck cyst with cerebellar herniation into it)
(this feels like a spina bifida but it’s like, maybe sometimes above the spine)

116
Q

what is syringobulbia and what does it usually occur with?

A

a slit-like cavity in the brainstem
usu a/w syringomyelia

117
Q

what is diastematomyelia?

A

a split in the spinal cord at midline by a spur of tissue (bony, cartilaginous, or fibrous)
(type of spina bifida)

118
Q

what is the main function of the BG

A

tonically inhibit movement

119
Q

what’s the direct pathway?

A

cortex > striatum > GPi > thalamus

(you inhibit the thalamus & brainstem, and when they are inhibited, THEIR inhibition decreases, which lets you move? i think? so double-inhibition)

has one synapse = direct
synapse is stratum > GPi

120
Q

what’s the indirect pathway

A

indirect = multisynaptic

cortex > striatum > GPe > subthalamic nucleus > GPi + SN pars reticulata

allows for fine-tuned BG output = more controlled movement (same result, movement, just has more synapses bc subthal is involved)

121
Q

which cranial nerve nuclei are in the midbrain?

A

III (has 2: Edinger-Westphal + Oculomotor)
IV (trochlear)
V (1 part: mesencephalic trigeminal)

122
Q

which cranial nerve nuclei are in the pons?

A

V (2 parts: trigeminal motor & principal sensory trigeminal)
VI (abducens)
VII (facial motor)
VIII (1: vestibular)

123
Q

what cranial nerves are in the salivatory nucleus (medulla)

A

superior: VII
inferior: IX & X

124
Q

what cranial nerves are in the nucleus ambiguus?

A

IX & X

125
Q

what cranial nerves are in the solitary nucleus?

A

VII
IX
X

126
Q

what are the NUCLEI (not cranial nerves necessarily) in the medulla?

A

Cochlear (VIII)
Solitary (VII, IX, X)
Salivatory (sup VII & inf IX & X)
Nucleus ambiguus (IX & X)
Hypoglossal (XII)
Dorsal motor nucleus of vagus (X)

127
Q

which cranial nerve nuclei are in the spinal cord?

A

accessory (XI)
spinal trigeminal (V, VII, IX, X)

128
Q

Dural innervation (ugh???)

A

Supratentorial: small meningeal branches of trigeminal (V1, V2, and V3)

Infratentorial: upper cervical nerves

129
Q
A

Neuropath (6 decks)

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