[LEC] Lec 5.2 - Neuroana 3.docx

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**___Brain Vesicles**

Starts to develop at ___of gestation

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**Primary Brain Vesicles**

Starts to develop at 3rd wk of gestation

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**___Brain Vesicles**

At ___ of gestation

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**Secondary Brain Vesicles**

At 5th wk of gestation

**PBV: Prosencephalon**

* SBV: ______
* Adult structures: ___ __&__ ___
* SBV: _____
* Adult structures: _____ (4)

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**PBV: Prosencephalon**

* SBV: Telencephalon
* Adult structures: Cerebrum, Basal Ganglia
* SBV: Diencephalon
* Adult structures: Subthalamus, Hypothalamus, Epithalamus, Thalamus

**PBV: Mesencephalon**

* SBV: ___
* Adult structures: (3) ___ →__(______ & _)

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**PBV: Mesencephalon**

* SBV: Mesencephalon
* Adult structures: Midbrain, Tectum, Cerebral Peduncle (Tegmentum & CNS cerebri)

**PBV: Rhombencephalon**

* SBV: _____
* Adult structures: (2) _____
* SBV: ____
* Adult structures: _____

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**PBV: Rhombencephalon**

* SBV: Metencephalon
* Adult structures: Pons & Cerebellum
* SBV:Myelencephalon
* Adult structures: Medulla Oblongata

**_____System**

* **Cavities within the brain filled with ____**

**Ventricular System**

* **Cavities within the brain filled with CSF**

VENTRICLES:


1. **Lateral Ventricles**

* ____
* _____ (Cerebral hemispheres)


2. **3rd Ventricle**

* _____ 


3. **Sylvian Aqueduct / Cerebral Aqueduct**

* Small
* Connects _____ ventricles
* ____ 


4. **4th Ventricle**

* **______**

VENTRICLES:


1. **Lateral Ventricles**

* 2: L & R
* Telencephalon (Cerebral hemispheres)


2. **3rd Ventricle**

* Diencephalon 


3. **Sylvian Aqueduct / Cerebral Aqueduct**

* Small
* Connects 3rd & 4th ventricles
* Mesencephalon 


4. **4th Ventricle**

* **Rhombencephalon**

1. **Cerebrospinal Fluid (CSF)**

* Clear, colorless fluid 
* __Chief producer:__ choroid plexus
* Originates from plasma content of the blood
* (N) production = 500 mL/day
* (N) amount (brain & sc) = 130 – 150 mL (adults)

→ Lower/\~90 mL: children

**________**

* Clear, colorless fluid 
* __Chief producer:__ ______
* Originates from ______content of the blood
* (N) production = ____ mL/day
* (N) amount (brain & sc) = ____ mL (adults)

→ Lower/___ mL: children

CSF Functions

* **H**omeostasis (maintain ECF in the body)
* **N**ourishes brain and spinal cord
* **D**rains unwanted substances
* **S**hock absorption (Cushion)

CSF Functions

* **H**____ (maintain ECF in the body)
* **N**___
* **D**___
* **S**___ (Cushion)

__**CSF Flow**__

* *“Come Let’s Formally Take Sylvia For Lunch Mamaya Sa Aristocrat”*


1. **C**horoid plexus
2. **L**ateral ventricles
3. **F**oramen of Monro
4. **T**hird ventricle
5. **S**ylvian Aqueduct
6. **F**ourth ventricle
7. Foramen of **L**uschka (more laterally)
8. Foramen of **M**agendie (more medial)
9. **S**ubarachnoid Space

* Terminate at vertebral level: S2


10. **A**rachnoid Villi

* Absorbs SAS
* Drains in superior sagittal sinus 🡪 R atrium

CSF Flow

* *“Come Let’s Formally Take Sylvia For Lunch Mamaya Sa Aristocrat”*


1. **C**___
2. **L**___
3. **F**___
4. **T**___
5. **S**___
6. **F**___
7. F__ (more laterally)
8. F___(more medial)
9. **S**___

* Terminate at vertebral level: ___


10. **A**rachnoid Villi

* Absorbs ___
* Drains in superior _____ → _

**Meninges**

* Membranous connective tissue layers that cover brain and spinal cord

**Layers**

* Dura mater
* Strongest & outermost
* Arachnoid space
* Pia mater
* Innermost

Q: Lumbar tap: L3L4 / L4L5 at the subarachnoid space

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__**_______**__

* Membranous connective tissue layers that cover brain and spinal cord

__**Layers**__

* ____
* Strongest & outermost
* ____
* ____
* Innermost

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Q: ______: L3L4 / L4L5 at the subarachnoid space

**Hydrocephalus**

* Excessive build-up / accumulation of fluids within the brain specifically in the ventricles

___________

* Excessive build-up / accumulation of fluids within the brain specifically in the ventricles

**Hydrocephalus Types** 


1. Non-communicating type

* (+) Obstructive 
* Impaired CSF Flow
* Common in children
* Ex. Hydrocephalus 
* Secondary to __**Arnold-Chiarri Malformation**__
* Caudal displacement of brainstem and cerebellum in the foramen magnum
* Spina bifida myelomeningocele: most common 90%

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**Hydrocephalus Types** 


1. ______

* __ Obstructive 
* Impaired ____
* Common in ____
* Ex. ____
* Secondary to __**______**__
* Caudal displacement of brainstem and cerebellum in the foramen magnum
* _____: most common ___

__**Hydrocephalus Types**__


2. Communicating type

* (-) obstruction
* Normal CSF Flow
* Common in adults
* Problems with CSF reabsorption
* Ventricles will enlarge
* Ex. **Normal Pressure Hydrocephalus** dt TBI
* Triad:
* **D**ementia
* **I**ncontinence
* **G**ait apraxia

**Management**

* Ventriculoperitoneal shunt (for both types)

__**Hydrocephalus Types**__


2. _______

* ___ obstruction
* ___ CSF Flow
* Common in ___
* Problems with CSF ____
* _____ will enlarge
* Ex. **Normal Pressure Hydrocephalus** dt TBI
* Triad:
* **D**___
* **I**___
* **G**___

**Management**

* _____ shunt (for both types)

__**Hydrocephalus Signs/Symptoms**__

* MC: children


1. **Papilledema**

* bulging of the optic disc
* promote retinal arteries (nasisira → pwede mabulag)
* optic nerve entrapment: common in hydrocephalus
* may lead to CN2 dysfunction: monocular blindness
* ↑intracranial pressure = ↑ intraocular pressure


2. **Cushing sign**

* Triad
* Bradycardia
* Bradypnea
* Hypertension = ↑ Intracranial pressure


3. **Cracked pot sign**

* Tsound in fontanelle


4. **Sunset eye sign/ Setting eye sign**

* Inferior ocular deviation
* affects post midbrain above superior colliculus → control eyes
* impaired upward gaze


5. **Others**

* Sunken fontanelle
* macrocephaly
* prominent dilated veins
* cognitive dysfunction → mental retardation

__**Hydrocephalus Signs/Symptoms**__

* MC: _____


1. **______**

* bulging of the _____
* promote _____ (nasisira → pwede mabulag)
* ____nerve entrapment: common in hydrocephalus
* may lead to ____ dysfunction: monocular blindness
* __ intracranial pressure = _ intraocular pressure


2. **________**

* Triad
* Brady___
* Brady___
* Hyper____ = ↑ Intracranial pressure


3. **____**

* T sound in ____


4. **_______**

* _____ocular deviation
* affects ____ midbrain above superior colliculus → control eyes
* impaired _____ gaze


5. **Others**

* ___ fontanelle
* ____cephaly
* prominent _____ veins
* cognitive dysfunction → _______

**Cerebrum**

* Big brain
* divided into 2 hemispheres
* contralateral representation 
* Connected by corpus callosum 
* largest commissural fibers
* lesion: ideational apraxia OR problems in bimanual task and imitation

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**_______**

* Big brain
* divided into __ hemispheres
* _____ representation 
* Connected by _______
* largest commissural fibers
* lesion: _____ apraxia OR problems in _ task and imitation

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**LEFT (MALL)**

* Dominant
* Mathematical
* Analytical
* Logic
* Language

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__**Clinical Correlation**__


1. Aphasia
2. Acalculia
3. Ideational Apraxia
4. Ideomotor Apraxia

→ slow and cautious behavior

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**____ (MALL)**

* Dominant
* M___
* A___
* L___
* L___

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__**Clinical Correlation**__


1. A____
2. A____
3. _____ Apraxia
4. _____ Apraxia

→ ______ behavior

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**RIGHT (MICA)**

* Non-Dominant
* Music and memory (memoright)
* Insight and judgment (insright)
* Creativity
* Arts

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Clinical Correlation


1. Hemineglect
2. Dressing Apraxia
3. Constructional Apraxia
4. Agnosia

* unaware of impairment
* Difficulty expressing negative emotion
* positive outlook
* quick and impulsive

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**RIGHT (MICA)**

* Non-Dominant
* M____(memoright)
* I____ (insright)
* C___
* A___

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__Clinical Correlation__


1. H____
2. ____ Apraxia
3. ____ Apraxia
4. A____

* ____ of impairment
* Difficulty expressing ____ emotion, _ outlook


* ____ and _

__**CEREBRUM**__

* Language
* Aphasia (L hemi)
* L MCA occlusion
* Wernicke
* Broca’s
* Global

__**CEREBRUM**__

* Language
* ____ (L hemi)
* ____ occlusion
* W____
* B____
* G___

__**Anatomy of Cerebrum**__


1. **External Surface**

**A. gyrus**

* Folds or rounded elevations/ridges
* convulsions
* ↑ surface area of cerebrum

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**B. Sulcus**

* depression/ groove/ shallow furrow
* deeper furrow: **Fissure**

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b.1. Medial longitudinal fissure

* separate L and R cerebral hemisphere

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b.2. Rolandic fissure

* Central sulcus of Rolando
* separates frontal lobe (precentral gyrus) and parietal lobe (postcentral gyrus)

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b.3. Parietooccipital fissure

* separates parietal and occipital lobe

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b.4. Lateral Sylvian  fissure

* separates temporal from frontal and parietal lobe

__**Anatomy of Cerebrum**__


1. **___ Surface**

**A. ____**

* Folds or rounded elevations/ridges
* convulsions
* ↑ surface area of cerebrum

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**B. ______**

* depression/ groove/ shallow furrow
* deeper furrow: **____**

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b.1. _____

* separate L and R cerebral hemisphere

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b.2. _____

* Central sulcus of Rolando
* separates frontal lobe (precentral gyrus) and parietal lobe (postcentral gyrus)

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b.3. _____

* separates parietal and occipital lobe

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b.4. _____

* separates temporal from frontal and parietal lobe

**Internal Surface**


1. **Cerebral cortex**

* Outer gray matter containing nerve cell bodies
* superficial layer
* function: processing and cognition
* Processing: sensory and motor function
* Consist of nerve cells embedded in neuroglia (supporting cells)
* no myelin sheath

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2. **Cerebral Medulla**

* inner white matter containing myelinated fibers rendering its color
* deep layer
* function: connection/ Communication
* it consist of nerve fibers (myelinated) embedded in neuroglia

**_____ Surface**


1. **________**

* Outer gray matter containing nerve cell bodies
* superficial layer
* function: ______
* Processing: _____ function
* Consist of nerve cells embedded in ____ (supporting cells)
* ___ myelin sheath

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2. **________**

* inner white matter containing myelinated fibers rendering its color
* deep layer
* function: _______
* it consist of n______ embedded in neuroglia

__**Type of Nerve Fibers**__


1. Commissural fibers

* white matter fibers
* connects cortical regions between R and L cerebral hemisphere
* Ex. Corpus callosum 
* LesionL ideational apraxia / Prob with bimanual task and imitation

__**Type of Nerve Fibers**__


1. _______ fibers

* ____ matter fibers
* connects ____ regions between R and L cerebral hemisphere
* Ex. Corpus callosum 
* Lesion ____apraxia / Prob with bimanual task and _

__**Type of Nerve Fibers**__


2. Association fibers

* connects cortical regions within the same hemisphere
* Ex. Arcuate fasciculus
* parietal operculum: connects broca’s and wernicke's area (L hemisphere
* Lesion: conduction aphasia (repetition problem)
* ARC 
* Arcuate Fasciculus 
* Repetition problem
* Conduction Aphasia

__**Type of Nerve Fibers**__


2. _____ fibers

* connects ____ regions within the same hemisphere
* Ex.____ fasciculus
* ____ operculum: connects _ area (L hemisphere
* Lesion: _____ aphasia (repetition problem)
* ARC 
* A____ 
* R____
* C____

__**Type of Nerve Fibers**__


1. Projection fibers
* connects cerebral cortex with lower portion of the brain(brainstem, midbrain, pons, M.O) & SC
* Ex. Tracts
* Types
* Corticofugal
* Away information
* corticospinal tract
* Corticopetal 
* Toward
* spinothalamic tract

__**Type of Nerve Fibers**__


1. ____ fibers
* connects ____ with _ portion of the brain(brainstem, midbrain, pons, M.O) & SC
* Ex. Tracts
* Types
* ____
* Away information
* ___ tract
* ____
* Toward
* ___ tract

__**Classification of Cells**__

**1. NEURON**

* Functional unit of the nervous system
* Composed of cell body, dendrites and axon

 **A:**

**ALPHA**

* extrafusal fibers

**BETA**

* __Motor:__ both intrafusal & extrafusal fibers
* __Sensory:__ Touch, pressure & proprioception 

**GAMMA**

* intrafusal fibers

**DELTA**

* fast/acute pain & temperature 

__**B**__ __fiber__

* Preganglionic Autonomic Nerve

__**C**__ __fiber__ 

* slow/chronic pain & temperature 
* Post ganglionic autonomic nerve fiber 

__**Classification of Cells**__

**1. ____**

* Functional unit of the nervous system
* Composed of cell body, dendrites and axon

 **A:**

**ALPHA**

* ___ fibers

**BETA**

* __Motor:__ both ____ fibers
* __Sensory:__ (3) ____ 

**GAMMA**

* _____ fibers

**DELTA**

* fast/acute ____ (2)

__**B**__ __fiber__

* _____ Autonomic Nerve

__**C**__ __fiber__ 

* ____ pain & temperature 

__**Classification of Cells**__

**2. GLIAL CELLS** (3 types)

* supporting cells (primary function)
* Do not conduct action potentials 
* __4 TYPES:__ __**MOA -E**__


1. **Microglia**

* macrophages in the CNS
* Primary fx: __Digest bacteria__ & worn out cells 

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2. **Oligodendrocytes**

* “COPS”
* __Form & maintain myelin sheath__ in CNS

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3. **Astrocytes**

* most abundant 
* FXN: 
* __provide structural support to the CNS__ (cytoskeleton)
* take up extracellular K+ ions
* replacement gliosis
* regulate extracellular neurotransmitters 
* cell multiplication 

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4. **Ependymocytes**

* Loc: cavities within the brain (ventricles)
* Fnx: assists in the circulation of CSF

__**Classification of Cells**__

**2. ____ CELLS** (3 types)

* supporting cells (primary function)
* Do not conduct action potentials 
* __4 TYPES:__ __**MOA -E**__


1. **_____**

* macrophages in the CNS
* Primary fx: _________ & worn out cells 

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2. **_____**

* “COPS”
* __________ in CNS

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3. **_____**

* most abundant 
* FXN: 
* __________ (cytoskeleton)
* take up extracellular ____
* replacement _____
* regulate ____ neurotransmitters 
* cell multiplication 

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4. **______**

* Loc: cavities within the brain (ventricles)
* Fnx: assists in the circulation of ____

**VIII. Cerebral Cortex**

**6 Layers:** 

**I. Molecular**

ii. **External Granular**

iii. **External** **Pyramidal** 

iv. **Internal Granular**

v. Internal **Pyramidal** 

* (+) medium & large sized pyramidal cells = Bers cells
* Origin of CST

vi. Multiform/ fusiform

**VIII. Cerebral Cortex**

**6 Layers:** 

**I. M____**

ii. **External ____**

iii. **External** **____**

iv. **Internal ___**

v. Internal **____**

* (+) medium & large sized pyramidal cells = ____ cells
* Origin of ____

vi. M_____

 __**Lobes of Cerebrum**__ 

**1. Frontal Lobe**

* largest lobe
* Fxns:
* Motor fxn
* personality & behavior
* seat of intelligence

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 __**Lobes of Cerebrum**__ 

**1. ___ Lobe**

* largest lobe
* Fxns:
* ___ fxn
* ____
* seat of____

 __**Lobes of Cerebrum**__ 

**2. Parietal Lobe**

* General sensation (touch, pain, temp) = PARAY!

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**3.Occipital Lobe**

* “ocSEEpital” 
* smallest lobe
* vision 

 __**Lobes of Cerebrum**__ 

**2. ____ Lobe**

* General sensation (___ 3) = PARAY!

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**3.___Lobe**

* ___ lobe
* vision 

 __**Lobes of Cerebrum**__ 

**4. Temporal lobe**

* hearing (Broadmann’s area 41 & 42) 
* memory (near limbic lobe) 
* olfaction 

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**5. Island of Reil** 

* Aka: Insular lobe 
* Loc: deep into the lateral sylvian fissure 
* Fnx: decision making

__**Lobes of Cerebrum**__ 

**4. ____ lobe**

* ____ (Broadmann’s area 41 & 42) 
* memory (near limbic lobe) 
* olfaction 

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**5. _____**

* Aka: Insular lobe 
* Loc: deep into the____ fissure 
* Fnx: _____

__**Lobes of Cerebrum**__ 

**Limbic System**

* memory, emotion, & arousal
* Components: __PUCHA__
* **Parahippocampus** - memory encoding & retrieval
* **Uncus** - memory related to olfaction 
* **Cingulate gyrus** - emotion & behavior
* **Hippocampus** - converts short term memory to long term memory; declarative memory 
* **Amygdala** - sexual desire 
* lesion = Kluver Bucy syndrome

__**Lobes of Cerebrum**__ 

**_____ System**

* memory, emotion, & arousal
* Components: __PUCHA__
* **P____** - memory encoding & retrieval
* **U___** - memory related to olfaction 
* **C____** - emotion & behavior
* **H____** - converts short term memory to long term memory; declarative memory 
* **A___** - sexual desire 
* lesion = ____ syndrome

**Brodmann’s Areas** 

* 47 areas
* No representation on 13-16

**Brodmann’s Areas** 

* ___ areas
* No representation on ___

__**Brodmann’s Areas**__ 

**FRONTAL LOBE → B.A. 4**

**Primary Motor Area**

* **AKA**: Precentral gyrus 
* **Fxn:** execution of motor (contralateral side)
* **Lesion:** flaccidity

__**Brodmann’s Areas**__ 

**FRONTAL LOBE → B.A. __:**

**____ Motor Area**

* **AKA**: Precentral gyrus 
* **Fxn:** execution of motor (___ side)
* **Lesion:** ____

__**Brodmann’s Areas**__ 

**FRONTAL LOBE →** B.A. 6

**Premotor Area**

* **AKA**: secondary motor area/motor association area
* **Fxn:** 
* initiation, modulation, & coordination of movement
* **Lesion:** 
* Akinesia
* Incoordination
* spasticity 

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__**Brodmann’s Areas**__ 

**FRONTAL LOBE →** B.A. ___

**____ Area**

* **AKA**: secondary motor area/motor association area
* **Fxn:** 
* ____ of movement
* **Lesion:** 
* A___
* Incoordination
* s___

__**Brodmann’s Areas**__ 

**FRONTAL LOBE →** B.A. 8

**Frontal Eye Field** 

* **Fxn: conjugate eye movement** 
* **Lesion:** Frontal gaze Palsy
* ant. circulation syndrome (ICS, ACA, MCA)
* head turning to lesion

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\*Pontine Gaze Palsy

* counterpart of FGP
* post circulation syndrome (VBA/PCA)
* head looks away from the lesion 

__**Brodmann’s Areas**__ 

**FRONTAL LOBE →** B.A. 8

**_____ Field** 

* **Fxn: conjugate eye movement** 
* **Lesion:** ____ Gaze Palsy
* ___ circulation syndrome (ICS, ACA, MCA)
* Head ____ to the lesion

\*___ Gaze Palsy

* counterpart of FGP
* post circulation syndrome (VBA/PCA)
* head ___ from the lesion 

__**Brodmann’s Areas**__ 

**FRONTAL LOBE →** B.A. 9, 10, 11, 12

**Prefrontal Areas** 

* **Fxn:** 
* **Personality & behavior**
* **Intelligence**  

__**Brodmann’s Areas**__ 

**FRONTAL LOBE →** B.A. _____

**____ Areas** 

* **Fxn:** 
* **Personality & behavior**
* **Intelligence**  

__**Brodmann’s Areas**__ 

**FRONTAL LOBE →** B.A. 44 & 45

**Broca’s Area** 

* **Loc:** inferior frontal gyrus (snell) OR 3rd frontal convolution (sullivan) 
* **Fxn:** Motor speech area
* **Lesion:** Broca’s Aphasia
* Aka: “NAME”
* Non-fluent Aphasia
* Ant. Aphasia
* Motor Aphasia
* Expressive Aphasia
* comprehension intact but impaired fluency 

__**rodmann’s Areas**__ 

**FRONTAL LOBE →** B.A. ___

**____ Area** 

* **Loc:** ______ gyrus (snell) OR 3rd frontal convolution (sullivan) 
* **Fxn:** Motor speech area
* **Lesion:** ___ Aphasia
* Aka: “NAME”
* N___
* A____
* M____
* ____ Aphasia
* comprehension ___ but _ fluency