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MRCS Anatomy > Raftery Neuroanatomy > Flashcards

Raftery Neuroanatomy Flashcards

1
Q

What separates the 2 cerebral hemispheres?

A

Longitudinal fissure

Filled by falx cerebri (
dura mater)

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2
Q

What is the cerebrum derived from embryologically?

A

Prosencephalon

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3
Q

Which parts of the cranial fossae does the cerebrum fill?

A

Anterior and middle cranial fossae

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4
Q

What structure is the cerebrum located above inferoposteriorly?

A

Tentorium cerebelli

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5
Q

Major subdivisions of the brain

A

Forebrain
Midbrain
Hindbrain

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6
Q

Parts of the forebrain

A

Cerebral hemisphere or telencephalon (lateral ventricle)

Diencephalon - contains thalamus and hypothalamus (third ventricle)

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7
Q

Parts of midbrain

A

Mesencephalon (cerebral aqueduct)

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8
Q

Parts of hindbrain

A

Pons
Medulla
Cerebellum (fourth ventricle)

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9
Q

Which fossa does the frontal lobe lie in?

A

Anterior cranial fossa

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10
Q

Which fossa does the temporal lobe lie in?

A

Middle cranial fossa

Temporal pole at anterior extremity
Uncus on medial surface

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11
Q

2 types of tissue making up the cerebrum

A

Grey matter

White matter

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12
Q

What is grey matter?

A

Forms the external surface of each cerebral hemisphere (aka cerebral cortex)

Associated with processing and cognition

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13
Q

What is white matter?

A

Forms bulk of deeper parts of brain

Consists of glial cells and myelinated axons connecting various grey matter areas

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14
Q

What causes the convoluted external appearance of cerebrum?

A

Sulci (grooves/depressions)

Gyri (ridges/elevations)

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15
Q

What connects the 2 cerebral hemispheres?

A

Corpus callosum (white matter)

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16
Q

What separates the frontal and parietal lobes?

or the precentral (motor) from postcentral (sensory) gyrus?

A

Central sulcus

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17
Q

What separates the temporal from frontal and parietal lobes?

A

Lateral sulcus

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18
Q

What separates the occipital from parietal lobe?

A

Parieto-occipital sulcus on medial surface of hemisphere

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19
Q

What is the lunate sulcus?

A

A groove located in the occipital cortex

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20
Q

What are the calcarine and postcalcarine sulci?

A

Concerned with visual centres

Lie on medial aspect of occipital lobe

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21
Q

What is the superior temporal gyrus?

A

Ridge located below the lateral sulcus

For receiving and processing sound

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22
Q

Important areas of frontal lobe

A

Motor cortex in precentral gyrus
Broca’s area
Frontal cortex

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23
Q

What are the association areas of the frontal lobe responsible for?

A 
Higher intellect
Personality
Mood
Social conduct
Language (dominant hemisphere side only)
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24
Q

Fibres of motor cortex

A

Afferents from thalamus and cerebellum

Pass through internal capsule

To motor nuclei and cranial and spinal nerves

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25
Q

Location of Broca’s area

A

Posterior part of inferior frontal gyrus of dominant hemisphere

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26
Q

Functions of frontal cortex

A

Lateral - intellect

Medial and orbital - affective behaviour

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27
Q

Important areas of parietal lobe

A

Sensory cortex in postcentral gyrus

Parietal association cortex

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28
Q

What are the association areas of the parietal lobe responsible for?

A

Language and calculation (dominant)

Visuospatial functions (non-dominant)

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29
Q

Important areas of temporal lobe

A

Auditory cortex

Temporal association cortex

Uncus

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30
Q

Fibres of auditory cortex

A

Afferents from medial geniculate body

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31
Q

Location and function of temporal association cortex

A

Surrounds auditory cortex

Perceiving auditory stimuli and their integration with other sensory modalities

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32
Q

Function of uncus

A

Olfactory stimuli

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33
Q

Important areas of occipital lobe

A

Visual cortex

Occipital association cortex

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34
Q

Location and function of visual cortex

A

Surround calcarine and postcalcarine sulci

Vision of opposite half-field of sight

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35
Q

What happens if there is damage to frontal lobe?

A

Impairment of emotions and intellect

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36
Q

What happens if there is damage to motor cortex?

A

Weakness in contralateral side of body

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37
Q

What does the basal ganglia consist of?

A

Subcortical nuclei grouped functionally rather than anatomically

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38
Q

Why is anatomy of the basal ganglia complex?

A

It is spread throughout the forebrain

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39
Q

Parts of basal ganglia

A

Corpus striatum (caudate nucleus, putamen, globus pallidus)

Claustrum

Amygdaloid nucleus

Thalamus

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40
Q

How can the components of the basal ganglia be divided?

A

Input nuclei
Intrinsic nuclei
Output nuclei

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41
Q

What forms the input nuclei of basal ganglia?

A

Caudate nucleus

Putamen (neostriatum)

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42
Q

What forms the intrinsic nuclei of basal ganglia?

A

External globus pallidus
Subthalamic nucleus
Pars compacta of substantia nigra

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43
Q

What forms the output nuclei of basal ganglia?

A

Internal globus pallidus

Pars reticulata of substantia nigra

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44
Q

What is the most rostral aspect of the neostriatum called?

A

Nucleus accumbens (Acb) - part of functionally separate domain called ventral striatum

Where caudate nucleus and putamen join together

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45
Q

Where does the subthalamic nucleus lie?

A

In diencephalon

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46
Q

Where does the substantia nigra lie?

A

In mesencephalon

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47
Q

2 parts of substantia nigra

A 
Pars reticulata (anterior)
Pars compacta (posterior)
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48
Q

Location of caudate nucleus

A

Collection of gray matter forming lateral wall of lateral ventricle

Follows telencephalic expansion during development

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49
Q

What separates the caudate nucleus from putamen during development?

A

Descending white matter fibres

Aka internal capsule

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50
Q

What does the lentiform nucleus consist of?

A

Globus pallidus
Putamen

Anatomically related but no functional relationship

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51
Q

Location of putamen with respect to lentiform nucleus

A

Lateral aspect of lentiform nucleus

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52
Q

Location of globus pallidus with respect to lentiform nucleus

A

External globus pallidus lies on the concave inner surface of lentiform nucleus

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53
Q

What separates the putamen from GPe?

A

Lateral medullary lamina

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54
Q

What separates the GPe from GPi?

A

Medial medullary lamina

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55
Q

What is the collection of WM fibres lateral to the putamen called?

A

External capsule

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56
Q

What is the thin bundle of grey matter lateral to the external capsule called?

A

Claustrum

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57
Q

What lies lateral to the claustrum?

A

Extreme capsule (WM tracts separating claustrum from neocortical insula)

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58
Q

What causes the dark appearance of substantia nigra?

A

Neuromelanin produced by cells of SNc

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59
Q

Location of subthalamic nucleus

A

Below the thalamus, above substantia nigra

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60
Q

Function of basal ganglia

A

Feedback mechanism to cerebral cortex

Motor refinement - prevent unwanted/exaggeratedmovements to start, reduce excitatory input to cortex

Modulate cognitive and emotional responses

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61
Q

Inputs and projections of putamen

A

Inputs from motor and somatosensory cortices

Project back to motor areas

Hence related to motor loop

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62
Q

Inputs and projections of caudate nucleus

A

Input from cortical association areas

Project to prefrontal areas

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63
Q

Inputs and projections of ventrial striatum (including nucleus accumbens)

A

Limbic inputs

Hence related to emotions

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64
Q

Arterial supply to basal ganglia

A

Mainly MCA

Main artery - lenticulostriate artery (most circulation to striatum and lenticular nucleus)

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65
Q

Minor arterial supply to basal ganglia

A

ACA
Anterior choroidal artery

Both are branches of ICA

Supply more anterior aspect of ganglia (i.e. head of caudate nucleus and nucleus accumbens)

Esp large artery - medial striate artery (of Heubner)

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66
Q

Arterial supply of substantia nigra and subthalamic nucleus

A

PCA
Posterior communicating arteries

(as location more posterior)

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67
Q

Venous drainage of basal ganglia

A

Striate branches of internal cerebral vein

Drain into great cerebral vein

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68
Q

Types of cells in pineal gland

A

Pinealocytes = secrete hormones

Glial cells = support cells

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69
Q

What happens to the pineal gland as we age?

A

Accumulation of calcified material called brain sand

Can be identified on XR/CT head

70
Q

Attachment of pineal gland

A

To diencephalon by pineal stalk

71
Q

What is the base of the pineal stalk continuous with?

A

Posterior wall of third ventricle

72
Q

What is contained in the superior and inferior parts of the base of pineal stalk?

A

Superior = habenular commissure

Inferior = posterior commissure

73
Q

Which structure is in close proximity to the pineal gland?

A

Superior colliculi of the midbrain

74
Q

What does the pineal gland possess?

A

Adrenergic sympathetic fibres from superior cervical sympathetic ganglia

No nerve cells

75
Q

Arterial supply to pineal gland

A

Posterior choroidal arteries (set of 10 branches from PCA)

76
Q

Venous drainage of pineal gland

A

Internal cerebral veins

77
Q

Commonest type of pineal gland tumour

A

Germ cell tumour

78
Q

What syndrome can a pineal gland tumour cause?

A

Parinaud syndrome = inability to move eyes upwards due to compression of superior colliculi

Hydrocephalus = obstruction of cerebral aqueduct

79
Q

What can happen in children with pineal gland tumours?

A

Accelerated onset of puberty

as function is to inhibit sexual development

80
Q

Does the pineal gland contain a BBB?

81
Q

Nervous pathway from retina to pineal gland

A

Retina to

Suprachiasmatic nucleus of hypothalamus to

Tegmentum of midbrain to

Pineal gland

Latter part may involve reticulospinal tract

82
Q

Which hormone is produced by the pineal gland?

83
Q

What happens to melatonin after they are produced by pineal gland?

A

Released into blood/CSF to

Anterior lobe of pituitary gland to

Inhibit release of gonadotrophic hormone

84
Q

What is the smallest region of the brainstem?

A

Midbrain (2cm in length)

85
Q

As the midbrain ascends, where does it travel through?

A

Tentorium cerebelli

86
Q

2 main parts of midbrain

A

Tectum = posterior to cerebral aqueduct

Paired cerebral peduncles = located anteriorly and laterally

87
Q

Internally, what are the cerebral peduncles further separated by?

A

Substantia nigra

Into crus cerebri (anterior) and tegmentum (posterior)

88
Q

What does the tectum contain?

A

2x superior colliculi
2x inferior colliculi

(collectively called corpora quadrigemina)

89
Q

What are the colliculi separated by?

A

Cruciform sulcus

90
Q

What structure is superior to the colliculi?

A

Pineal gland

91
Q

What extends laterally from each colliculi?

A

Quadrigeminal brachium

92
Q

What emerges inferior to the colliculi?

A

Trochlear (CN IV) nerve

before sweeping across to anterior surface

93
Q

Pathways of superior and inferior quadrigeminal brachium

A

Superior = between superior colliculus and retina of eye

Inferior = from lateral lemniscus and inferior colliculus to medial geniculate body

94
Q

What structures does the midbrain contain?

A

Cerebral peduncles (corticobulbar and corticospinal tract)

Red nucleus

Substantia nigra

Nuclei of CN III and IV

Portion of sensory nucleus of CN V

95
Q

What are the cerebral peduncles separated anteriorly in the midline by?

A

Interpeduncular fossa

96
Q

What is the floor of interpeduncular fossa called?

A

Posterior perforated substance

as many perforating blood vessels can be identified

97
Q

What is seen exiting from between the peduncles?

A

Oculomotor (CN III) nerve

98
Q

What runs around the superior border of midbrain?

A

Optic tract

99
Q

What is found in the anterolateral surface of the midbrain at the level of inferior colliculus?

A

Paired crus cerebri

100
Q

What fibre tracts run within the crus cerebri?

A

Frontopontine fibres = most medially

Corticospinal fibres and corticobulbar tracts = motor fibres from primary motor cortex

Temporopontine fibres = posterolaterally

101
Q

What structure separates the 2 regions of the cerebral peduncles?

A

Substantia nigra (pigmented nucleus)

102
Q

What structure is located posterior to substantia nigra?

A

Tegmentum (continuous in that found in pons by the same name)

Note: continuous at midline unlike crus cerebri

103
Q

What is the cerebral aqueduct surrounded by?

A

Periaqueductal gray matter

104
Q

What lies within the periaqueductal gray matter?

A

Mesencephalic nucleus of trigeminal nerve

Trochlear nucleus (fibres continue around gray matter to exit the midbrain)

105
Q

What can be seen anterior to the fibres of the trochlear nucleus?

A

Medial longitudinal fasciculus

106
Q

What lies between the central gray matter and substantia nigra in the midbrain?

A

4 lemnisci

anterior to posterior: medial, spinal, trigeminal, lateral

107
Q

What can be found at the very posterior pole of the midbrain?

A

Tectum containing the inferior collliculus

108
Q

What occupies the central portion of the midbrain at the level of inferior colliculus?

A

Decussation of superior cerebellar peduncles

109
Q

What occupies the central portion of midbrain at the level of superior colliculus that used to contain decussation of cerebellar peduncles?

A

Large paired red nuclei with some decussation of rubrospinal tract anterior to it

110
Q

What is the trochlear nucleus replaced by at the level of superior colliculus?

A

Oculomotor nucleus

111
Q

Arterial supply of midbrain

A

Interpeduncular branches of basilar artery

PCA and its peduncular branches

Superior cerebellar artery

Posterior choroidal artery

112
Q

What does the pons develop from?

A

Embryonic metencephalon (part of hindbrain, developed from rhombencephalon)

alongside cerebellum

113
Q

Where is the pons located?

A

Anterior part of posterior cranial fossa

114
Q

Anatomical relations of pons

A 
Superior = midbrain
Inferior = medulla oblongata

Posterior = cerebellum, separated by the fourth ventricle

115
Q

How is the pons connected to the cerebellum?

A

By the middle cerebellar peduncle

116
Q

What forms the floor of the fourth ventricle?

A

Dorsal surface of lower pons

117
Q

What is the anterior (ventral) surface of the pons marked by?

A

Transverse pontocerebellar fibres wrapping around brainstem

Measures ~2.5cm in adults

118
Q

What demarcates the midline of ventral surface of pons?

A

Basilar groove

where basilar artery is located

119
Q

What is an important anatomical landmark defined by the angle between the lower border of pons and superior border of medulla?

A

Pontomedullary junction

120
Q

Which CNs originate from ventral surface of pons?

A

Trigeminal (CN V) = from lateral aspect of mid pons

Abducens (CN VI) = from pontomedullary junction, close to midline

Facial (CN VII) = from cerebellopontine angle, more lateral aspect of pontomedullary junction

Vestibulocochlear (CN VIII) = lateral to facial nerve

121
Q

Which nuclei does the pons contain?

A

Nuclei of CN 6-8

Motor nucleus of CN 5

122
Q

Relationship between pons and sensory nucleus of CN 5

A

Sensory nucleus of CN V extends from midbrain through pons and medulla to upper cervical cord

123
Q

Which tracts cross in lower pons?

A

Corticospinal tracts

124
Q

Important anatomical landmarks in floor of fourth ventricle

A

Medial eminence
Facial colliculus
Stria medullaris

125
Q

What does the medial eminence in the pons denote?

A

Midline of floor of fourth ventricle

126
Q

What is the facial colliculus in the pons formed by?

A

Bulging formed by fibres of the facial nerve looping around abducens nucleus

127
Q

What is the stria medullaris of fourth ventricle?

A

Bundle of nerve fibres crossing transversely from lateral aspect into the midline

They mark the posterior border between the pons and medulla

128
Q

What is the angle formed at the junction of the pons, medulla and cerebellum?

A

Cerebellopontine angle

Here, the cerebellar flocculus, ventricular choroid plexus and emerging CN 7 and 8 surround the lateral apertures of the fourth ventricle (foramen of Luschka)

129
Q

2 major components of pons

A

Ventral pons

Tegmentum

130
Q

What does the ventral pons contain?

A

Pontine nuclei = coordinate movement

Fibres from pontine nuclei cross the midline and form the middle cerebellar peduncles on their way to cerebellum

131
Q

What is the tegmentum?

A

Evolutionarily older part of pons

Forms part of reticular formation (set of nuclei found throughout brainstem that are responsible for arousal and attentiveness)

132
Q

Which tracts make up the pons?

A

Descending = corticospinal (body) and corticobulbar (voluntary motor control of face, H&N)

Ascending = medial lemniscus (fine touch, vibration, proprioception) and spinothalamic tracts (pain, temp)

133
Q

Nuclei receiving sensory information from trigeminal nerve

A

Trigeminal sensory nucleus

Spinal trigeminal nucleus

Mesencephalic nucleus

134
Q

Arterial supply of pons

A

Branches of vertebrobasilar system

Most by pontine arteries (branches of basilar artery)

Smaller part = anterior inferior cerebellar artery, superior cerebellar artery

135
Q

Venous drainage of pons

A

Anterior pontomesencephalic vein

Drains superiorly: basal veins –> cerebral veins

Inferiorly: inferior petrosal sinus –> internal jugular veins

136
Q

Symptoms of cerebellopontine angle (majority due to vestibular schwannomas)

A

Ipsilateral hearing loss + tinnitus (compression of cochlear component of CN 8)

Dysequilibrium + vertigo (more rarely, compression of vestibular component of CN 8)

Nystagmus (compression of cerebellar flocculus)

More serious Cx:
Facial paralysis (CN 7 compression)
Reduced corneal reflex (CN 5 and 7)
Trigeminal palsy (CN 5)
Ipsilateral cerebellar signs
137
Q

How is the medulla connected to the cerebellum?

A

By the inferior cerebellar peduncle

138
Q

What is the inferior margin of the medulla marked by?

A

Origin of first pair of cervical spinal nerves

just as the medulla exits the skull through the foramen magnum

139
Q

Structures visible on anterior surface of medulla

A

3 fissues/sulci
Pyramids
Olives
5 cranial nerves

140
Q

What lies in the midline of the anterior surface of the medulla?

A

Anterior median fissure

continuous along length of spinal cord, but interrupted temporarily by decussation of pyramids

141
Q

As move away from midline of medulla, what structures are visible?

A

Ventrolateral and posterolateral sulci

142
Q

What structure arises from the junction between pons and medulla?

A

Abducens nerve

143
Q

What structure extends out of the ventrolateral sulcus?

A

Hypoglossal nerve (CN 12)

144
Q

Which nerves join the medulla at the posterolateral sulcus?

A

Glossopharyngeal
Vagus
Accessory (CN 9-11)

145
Q

What lies in the midline of the posterior surface of the medulla?

A

Posterior median sulcus

146
Q

What structures lie lateral to the posterior median sulcus of medulla?

A

Fasciculus gracilis
Fasciculus cuneatus

separated by posterior intermediate sulcus

147
Q

2 regions of medulla

A

Open and closed

difference based on whether CSF-containing cavities are surrounded by medulla (closed) or not (open)

148
Q

When does the medulla become open?

A

When the central canal opens into the fourth ventricle

149
Q

What runs from the nucleus gracilis and cuneatus around and anterior to the central gray matter to form the medial lemniscus?

A

Internal arcuate fibres

150
Q

What structures are found lateral to the medial lemniscus?

A

Trigeminal nucleus and spinal tract

Spinocerebellar tracts
Lateral spinothalamic tract

151
Q

At the level of decussation of medial lemniscus, what structures can be seen in the centre of the medulla?

A

Hypoglossal nucleus

Medial longitudinal fasciculus

Nucleus ambiguus (more lateral)

152
Q

What structure is found between the nucleus ambiguus and pyramids?

A

Inferior olivary nucleus

153
Q

What nuclei does the medulla contain?

A

Nucleus ambiguus (motor to CN 9-10)

Nucleus of tractus solitarius (sensory for CN 8-10)

Nuclei of CN 9-12

154
Q

Arterial supply of medulla

A

Complex: depends on level viewed

Anterior and posterior spinal arteries
Anteiror and posterior inferior cerebellar arteries
Vertebral arteries

155
Q

Which embryonic structure does the cerebellum arise form?

A

Metencephalon (superior division) of hindbrain (rhombencephalon)

Inferior division is called myencephalon

156
Q

What separates the cerebellum from the temporal and occipital lobes?

A

Tentorium cerebelli

157
Q

What separates the cerebellum from the pons?

A

Fourth ventricle

lies on same level of and posterior to pons

158
Q

What is embedded in the white matter of cerebellum?

A

4 cerebellar nuclei

  • dentate
  • emboliform
  • fastigi
  • globose
159
Q

3 ways of dividing the cerebellum

A

Anatomical lobes
Zones
Functional divisions

160
Q

3 anatomical lobes of cerebellum

A 
Anterior
(primary fissure)
Posterior
(posterolateral fissure)
Flocculonodular
161
Q

3 cerebellar zones

A

Vermis = midline

Intermediate zone = lateral to vermis

2 lateral hemispheres = lateral to intermediate zone

162
Q

3 functional areas of cerebellum

A

Cerebrocerebellum
Spinocerebellum
Vestibulocerebellum

163
Q

Cerebellar tonsil

A

Bulge of lateral lobe that projects inferiorly posterolateral to medulla

164
Q

What is the cerebrocerebellum?

A

Largest division of cerebellum

Formed by lateral hemispheres

Functions = planning movements, motor learning, coordinating muscle activation

Inputs from cerebral cortex and pontine nuclei

Outputs to thalamus and red nucleus

165
Q

What is the spinocerebellum?

A

Comprises vermis and intermediate zone

Functions = regulate body movements by allowing for error correction, receives proprioceptive information

166
Q

What is the vestibulocerebellum?

A

Functional equivalent to flocculonodular lobe

Functions = control balance and ocular reflexes, mainly fixation on a target

Inputs from vestibular system
Outputs to vestibular nuclei

167
Q

Arterial supply of cerebellum

A

3 paired of arteries:
Superior cerebellar (from basilar)
Anterior inferior cerebellar (from basilar)
Posterior inferior cerebellar (from vertebral)

168
Q

Venous drainage of cerebellum

A

Superior and inferior cerebellar veins

Drain into superior petrosal, transverse and straight dural venous sinuses

169
Q

What happens to the cerebellum when there is raised ICP?

A

The tonsil can herniate into the foramen magnum and compress the medulla oblongata e.g. after LP

170
Q

Manifestations of cerebellar dysfunction (DANISH)

A 
Dysdiadochokinesia
Ataxia
Nystagmus
Intention tremor
Scanning speech
Hypotonia

MRCS Anatomy (9 decks)

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