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high NE


low NE


high DA


low DA

parkinson's and depression

low seratonin

anxiety and depression

low Ach

Alzheimer's huntington, REM sleep

low gaba

anxiety, huntington

glutamine + vit b6


NE synth location

locus cerules/reticular formation/solitary tract

DA synth formation

ventral tegmentum, SNc

seratonin synth location

raphae nucleus

ACh synth location

basal nucleus of meynert

GABA synth location

nucleus accumbens

DA ptwy: mesocotical block

ventral tegmentum of MB to cortex.
blocked: increase positive Sx of schizophrenia

Da ptwy: mesolimbic

ventral tegmentum of MB to limbic system.
blocked: relief of pschosis (+Sx)

DA ptwy: nigrostriatal

substantia nigra par compacta to striatum (caudate and putamen).
blocked: parkinson dz/ stimulation: extrapyramidal a/e

DA pwty: tuberoinfendibular:

arcuate nucleus of hypoth to pituitary
blocked: increases prolactin- sx: amnorrhea, gynecomastia, galactorrhea

reticualr acivating system

locus cerelus, reticular formation and raphae nuclei. Mediates cosciousness and alertness bc synth 5ht,NE. Damge: coma.

free nerve ending

pain and temp.
a-delta and c-fiber


free nerve ending. slow unmyelinated. warm temp

A delta fibers

free nerver ending. fast, meylinated, cold temp

meissner's corpuscle

large, meylinated. hairless skin (superficial skin)
position and dynamic touch
fast adapting

pacinan corpuscle

lg, meylinated (deep skin), ligaments, joints. fast adapting
vibration and pressure

merckle's disk

hair follicle.(superficial skin)/ slow adapting
position, static touch-edges, textures


encapsulated/ slow adapting/
deep layers. sole of foot

BBB composition

1. tight junctions b/w NON-fenestrated capillary endothelial cells (destruction- vasogenic edema)
2. BM 3. astrocyte processes

BBB permeability

glucose and AA cross via carriers- slow
lipid-soluable and non-polar- fast via diffusion

non BBB, fenestrated capillaries in brain

1. area postrema- vomiting after chemo (CZT at medulla)
2. OVLT- osmotic sensing 3. neurosecretory products- ex: ADH

supra optic nucleus

hypothalamus nuclei- makes ADH

paraventricular nucleus-

hypothalamus nuclei- makes oxytocin

lateral area of hypothalamus

FN- hunger. Inhibited by leptin
destructionn- anorexia, failure to thrive (infants)
zap lateral you shrink laterally

ventromedial area of hypothalamus

FN- satiety. stimulated by leptin
destruction by craniopharyngioma- hyperphagia
zap ventromedial you grow ventral and medial

antetior hypothalamus

cooling, parasymp.
A/C- anterior cooling

posterior hypothalamus

heating, symp

suprachiasmatic nucleus

circadian rhythm

thalamus: VPL

input: spinothalmic / dorsal coums and medial lemniscus
info: pain and temp (from body)
output: primary somatosensory cortex.

thalamus: body sensation


thalamus: VPM

input: trigeminal and gustatory ptwy
info: face sensation and taste
output: primary somatosensory cortex

thalamus LGN

input: CN II
info: vision
output: calcarine sulcus (occipital lobe)

thalamus: MGN

input: superior olive and inferior colliculus of pons
info: hearing
output: auditory cortex (temporal lobe)

thalamus: communication w/ prefrontal cortex . damage?

mediodorsal (MD) nucleus
dmaage: memory loss

thalamus: cerebellum (dentate n.) and basal ganglia


thalamus: VA

basal ganglia to prefrontal, premotor, and orbital cortices

thalamus: anterior nuclear group

mamillothalmic tract to cingulate gyrus
part of papez circuit

thalamus: pulvinar

integration of vision, auditory, and somesthetic input

cerebellum input

contralateral cortex via middle cerebellar peduncle
ipsilateral proprioception via inferior cerebellar peduncle
nerves: climbing and mossy fiber

cerebellum output

contralateral cortex via superior cerebellar peduncle
nerves: purkinje fibers
modulates movement


vermis and paravermis via fastigial and interposed nuclei
interposed n = globise and emboliform


flocculonodular lobe and vermis via fastigial nuclei


lateral hemispheres via dentate

cerebellum nuclei

lateral to medial: dont eat greasy food
dentate, emboliform, globose, fastigial

lateral cerebellum

voluntary movement of extremities

medial cerebellum

balance, truncal coordination, ataxia
injury: ipsilateral - falls to injured side bc info crosses twice

basal ganglia: direct ptwy

NT: dopamine receptor: D2R
SNc + , + striatum, - GPi, + thalamus = movement

basal ganglia: indirect ptwy

NT: dopamine receptor D2R
+SNc, - striatum, +GPe, -Subthalmic n.& Gpi, +thalamus = movement

basal ganglia: GPi

decrease/inh mov

basal ganglia: GPe

inhibits STN and Gpi = increases movement

basal ganglia: STN

stimulated GPi = inhibits movement

basal ganglia and PD

loss of DA= less direct ptwy , more indirect ptwy = less motion

basal ganglia and HD

neuronal death via NMDA-R : glutamate toxicity
atrophy of striatal nuclei (main inh of mov)

multiple sysmtem atrophy:

parkison-like, autonomic dysFN, ataxia
inclusion w/ alpha synuclein in oligodendroglia cells

paramedian pontie reticular formation (PPRF) lesion

eyes look away from lesion

frontal eye fields lesion

eyes look towards lesion

cerebellar hemisphere lesion

intention tremor, limb ataxia, ipsilateral

cerebellar vermis lesion

TRUCAL ataxia, dysarthia

reticular activating system (MB) lesion

reduced levels of arousal and wakefulness = coma

superior colliculi lesion

paralysis of upward gaze

left parietal lobe lesion

gerstman syndrome- agraphia, acalculia, finger agnosia, left and right disorientation

bilateral amygdale lesion

kluber-bucy syndrome: hyperorality, hypersexuality, disinhited behavior

central pointine myelinosis

acaute paralysis, dipliopia, loss consciousness.
bc rapid correction of HYPO-natremia

broca's aphasia

nonfluent aphasia but understands
INFERIOR frontral gyrus

wernecke's apahsia

fluent aphasia, but impaired comphrehension
SUPERIOR temporal gyrus

global apahsia

nonfluent and impair comprehension. both broca and wernecke

conduction aphasia

poor repetition. pt understands and is able to speak but no connection. At arcuate fasciculus

non-dominant broca aphasia

expressive dysprosody- can't express emotions/inflection on speech "monotone"

non-dominant wernecke apahsia

receptive dysprosody- inability to comphrehend emotion or inflectionin speech

weber's syndrome

midbrain infarct occlusion of paramedian branches PCA
contralateral hemiparesis (CST) & oculomotors CN III palsy

CN 3

rostral midbrain.
levator palpebrae, superior, inferiorm, and medial rectus. inferior oblique/ pupillary sphincter- ciliary muscle

Cn 4

caudal midbrain- superior oblique

CN 6

caudal pons- lateral rectus

anterior spinal art

contralat- hemiparesis (LE), ipsilateral paralysis of CN9
pain and temp are ok

PICA/ lateral medullary/wallenberg

contralat- pain and temp in BODY
ipsilat- dysphagia, decrease gag reflex, dipliopia, nystagmus, horner's, facial tmep and pain, ataxia

AICA/ lateral inferior pontine synd

ipsilateral facial paralysis (cn7), cochlear n. & nystagmus (cn8), facial pain & temp


contralat- hemianopoa w/ MACULAR SPARING


contralat- face, arm paralysis/sensation, apahsia(dominant), left side neglect (non-dominant)


contralat- leg-foot motor and sensory

anterior communicating art

MC site of berry aneurysm. visual problems- bitemporal hemianopsia

posterior communicating art

CN 3 palsy- down and out

lateral striate

from MCA. pure motor hemiparesis (arms & legs)
internal capsule, caudate, putamen, GP. "arteries of stroke"

watershed zone

b/w ACA and MCA or MCA and PCA
HYPOtension,upper leg + arms weakness, high order visual process

basilar art

locked in syndrome. only CN3 is intact!

aneurysm causes

APKD, marfan, ehlers danlos

charcot bouchard microaneurysm

ass w/ chronic HTN- small vessel in basal ganglia and thalamus

stroke at thalamus

only sensory loss in cotralateral side both arms and legs. no motor defecit. but difficult to walk bc loss of proprioception


CCB used after aneurysm to decrease risk of vasospam

parenchymal hematoma

HTN, amyloid angiopathy- lobar stroke, DB, CA
at basal ganglia and internal capsule

intraventricular hemorrhage

PREMES < 32 wks , low birth wgt < 1500

ischemic stroke

emboli. a-fib, carotid dissection, patent foramen ovale, endocarditis, lacunar stroke-HTN.
cystic cavity w/ reactive gliosis.


reversible. < 24 hrs

dural venous sinus

superior sagital sinus (main location of CSF return) --> confluence of the sinus --> transverse sinus--> sigmoid sinus --> int. jugular v.

where does the sigmoid sinus become IJV

jugular foramen

foramen of monro

latreal ventricle to 3rd ventricle

cerebral aqueduct

3rd to 4th ventricle


made in choroid plexus/ reabsorbe by choroid sinus

foramen of luschka

4th ventricle to subarachnoid space. LATERAL

foramen of magendie

4th ventricle to subarachnoid space. MEDIAL

normal pressure hydrocephalus

wet, wobbly, wacky. NO increase in volume.
dementia, ataxia, urinary incontinence


young, obese female w/ daily HA worse in AM and papilledema
N- ventricles, no tumor/masses. but HIGH csf press.
tx- lose wgt, acetozolamide

fasciculus cuneatus

dorsal column- upper extremities

fasciculus gracilis

dorsal column- lower extremities. (more medial)

lateral CST

arms are medial, legs are lateral

polio & werdnig hoffmann dz

LMN lesion - destructoin anterior horns- flaccid paralysis

anterior spinal art and cord

lose everything but dorsal columns and tract of lissauer. (proprioception, touch and temp ok)

3 syphilis

DRG and dorsal column lesion

vit b12, vit E def, friedreich ataxia

dorsal coumn, lateral CST, spinocerebellar tract
ataxia, hyperreflexia, impair vibration. ok temp & pain

polio CSF

lymphocytic pleocytosis no protein.



friedreich ataxia

AR. repeat dz- GAA. frataxin protein. inpaired mitochondria. freq falling, nystagmus, dysarthia, hypertrophic CMP, kid- kyphoscoliosis. loss of CN8, 10, 12, cerebellum

brown sequad syndrome

ipsilateral- UMN. tactile, vibration, sensation, LMN
contralat- pain and temp below lesion


posterior half of skull


turtle neck shirt


clavicle region. low collar shirt


xiphoid process




inguinal lig


kneecaps "down in all fours"


erection and sensation of penile and anal zone

reflex s1,2


reflex L3,4


reflex C5.6


reflex C7,8


moro reflex "hang on for life"

baby opens arms when thinks is falling backwards

CN that lie medial in brain stem

CN 3-MB, CN 6- pons, CN 12- medulla.

CN 7

motor- facial mov, eyelid closing, stapedius muscle in ear
sensory- taste ant 2/3 tongue, lacrimation, salivation


sensory- taste post 1/3 tongue, salivation-parotid, monitoring carotid body & sinus-chemo R
motor- swallowing, stylopharyngrus (elevates pharynx, larynx)

Cn 10

sensory- taste epiglottic region, aortic chemo & baro-R,
motor- palate elevation, midline uvula, talking, coughing
thoracoabd viscera

corneal reflex and lacrimation

afferent- V1
efferent- cn 7

jaw jerk

V3 sensory, v3 motor both via masseter

gag reflex

cn9 afferent,
cn 9, 10 efferent

vagal nuclei: n. solitarius

visceral sensation- taste, baro-R, ut distantion. CN 7,9,10

vagal nuceli: n. ambiguous

motor innervation pharynx, larynx, upper esophagus- Cn 9, 10, 11

dorsal motor nucleus

vagal nuclei. sends autonomic (parasymp) fibers to heart, lung, GI

ear: webber test

turning fork in middle top head.
n- hear it on both ears = midline
conduction defect- ipsilateral
sensory defect = contralateral

ear: rinne test

fork at mastoid then at ear.
conduction defect= AC<BC

ear: webber-R
Rinne LE: AC>BC, RE: BC>AC

R- webber--> R-conduction or L- sensory
rinne- LE ac>bc normal
rinne-RE bc>ac conduction

cavernous sinus

CN 3,4,5 (V1, V2) ,6
internal carotid and post ganglionic symp

carvernous sinus syndrome

ophthalmoplegio, ophthalmic and maxillary sensory loss
ass- w/ infections b/w nose and lip.

uvula deviation to the left

1. Cn 10 and nucleus ambiguous on the RIGHT
2. corticobulbal tract/motor cortex on the LEFT

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