REVISION OF NEUROANATOMY

BY DR. ABDUL WAHEED ANSARI

CHAIRPERSON & PROFESSOR OF ANATOMY, RAKCOMS. RAKMHSU.

A case of midnight madness• A 53-year-old woman arrived in the ED

late at night.• Her partner was concerned that she

suddenly was not acting “right.” • The patient had complained of

headache throughout the day.• She felt ill and went to bed early

complaining of a headache. • She awakened in the late night hours

and seemed confused, repeating words, and not clearly recognizing her partner.

• EMS was called and she was transported to the emergency department.

• Such is the history in meningitis case.

With the fever and altered mental status, the possibility of a CNS infection is considered.

• CT showed sinus disease but no intracranial abnormalities. The LP was cloudy, in the above case.

• The dura mater is supplied by branches from trigeminal nerve, in the anterior cranial fossa.

• The branches of glossopharyngeal , vagus and upper cervical nerves supply the dura mater in the posterior cranial fossa.

• Bacterial infection causes meningitis. This case was having fever due to sinus infection and bacteria spread into the cranial cavity and infects the meninges, resulting in confusion status of this lady.

THE ARACHNOID MATER

The arachnoid granulations are situated all along the superior sagittal sinus and they drain the CSF from the subarachnoid spaces and cisterns into the superior sagittal sinus. They reduce the CSF pressure.A head injury, meningitis, or brain tumor can sometimes cause an accumulation of CSF in the ventricles. This condition is called hydrocephalus and can quickly become life-threatening unless there is immediate medical intervention. How can hydrocephalus kill a person?A) It causes a sharp rise in blood pressure.B) Cranial nerves are compromised.C) Aerobic respiration quickly shuts down.D) The subarachnoid space and central canal of the spinal cord are deprived of CSF.E) Raised intracranial pressure compresses and can damage delicate nervous tissue.

When police suspect a person is driving while intoxicated they will perform field sobriety tests to determine if the person should be arrested for Driving While Impaired. The tests are designed to see if a suspect exhibits signs of ataxia. Ataxia is a condition that disrupts muscle coordination which can cause abnormal walking movements and changed speech pattern.

Which part of the brain does alcohol inhibit resulting in ataxia ?• A) Cerebellum• B) Cerebrum• C) Medulla oblongata• D) Midbrain• E) Diencephalon

Jane scored an A on her algebra exam. She has always been good with numbers. This ability to reason and be good in math most likely is a function of :

• A. Right cerebral hemisphere• B. Left cerebral hemisphere• C. Right cerebellar hemisphere• D. Left cerebellar hemisphere• E. Both cerebellar hemispheres

Cerebral dominance

• In general, the left hemisphere is dominant in language: processing what you hear and handling most of the duties of speaking. It's also in charge of carrying out logic and exact mathematical computations. When you need to retrieve a fact, your left brain pulls it from your memory.

• The right hemisphere is mainly in charge of spatial abilities, face recognition and processing music. It performs some math, but only rough estimations and comparisons. The brain's right side also helps us to comprehend visual imagery and make sense of what we see. It plays a role in language, particularly in interpreting context and a person's tone.

In general, the left–hemisphere is more involved in

• A. Holistic processing• B. Language • C. Perceptual processing• D. Spatial processing• E. Visual processing

Embryology of CNS

At the embryonic stage, in what week does the nervous system begin to develop?A. Week 2B. Week 3C. Week 4D. Week 5E. Week 7

FUNCTIONAL AREAS OF CEREBRUM

Which of the following functional areas of the cerebrum is responsible for speech?A. Primary Somatosensory AreaB. Primary Motor AreaC. Broca’s areaD. All of the aboveE. None of the above

BRAIN STEM

Which part of the brain controls heart rate and blood pressure?A. DiencephalonB. MidbrainC. PonsD. Medulla OblongataE. Cerebellum

CRANIAL NERVES

Which cranial nerve is responsible for regulating visceral activity?A. IB. IIIC. XD. XIE. XII

FUNCTIONAL AREASAn elderly woman becomes frustrated after her recent stroke while trying to wish her grandson a “happy birthday”. She is only able to say that she is thinking of a word that begins with the letter “h”. The woman has suffered damage to:A. Brocca’s Speech AreaB. Occipital lobeC. InsulaD. Temporal lobeE. Hypothalamus

Extrapyramidal tractA common manifestation of Parkinson disease is characterized by tremors, where involuntary muscle contractions interfere with voluntary muscle contractions. This could be partially explained by loss of neurons that help control subconscious muscle activities. Dopamine releasing neurons associated with subconscious muscle activities can be found in the:• A. Cerebral peduncles• B. Tectum• C. Substantia nigra• D. Red nuclei• E. Periaqueductal gray

Medial Squint case Every kid loves to make crazy faces. The most common is to cross their eyes inward. Unfortunately, some kids are born with crossed eyes known as strabismus. Which nerve has been damaged?

A. Oculomotor B. Trochlear C. Facial D. Abducens E. Trigeminal

Which major part of the brain is most important for the balancing technique during dancing?

• A. Cerebrum• B. Brain Stem• C. Cerebellum• D. Midbrain • E. Pons

Which of the following is responsible for production of cerebrospinal fluid in the ventricles of brain?

A. Oligodendrocytes + choroid plexuses in the walls of the ventricles. B. Astrocytes & gray matter. C. Ependymal cells+ choroid plexuses in the walls of the ventricles. D. Astrocytes + choroid plexuses in the walls of the ventricles.E. Microglial cells + Schwan cells

What is the part of the brain that contains the thalamus, pituitary gland, and the optic chiasm ?

A. Telencephalon B. DiencephalonC. MesencephalonD. MyelencephalonE. Metencephalon

A sixty-four-year old man was diagnosed with an acoustic neuroma (tumor of the VIII cranial nerve) where it entered the temporal bone. What other cranial nerve might also be affected since this nerve uses the same foramen as the VIII in its course?

A. AbducensB. FacialC. GlossopharyngealD. TrigeminalE. Vagus

Which of the following connect gyri to gyri in the opposite hemisphere via the corpus collosum?

A. Longitudinal fissureB. Short association fibersC. Commissural fibersD. Projection fibersE. Long association fibers

What part of the brainstem do the origin of cranial nerves VIII-XII come from ?

A. PonsB. TectumC. Medulla oblongataD. Optic tract E. Midbrain

What meninges is the pointer pointing to?

A. Arachnoid MaterB. Subarachnoid SpaceC. Dura MaterD. Pia MaterE. Epidural Space

What is the structure number 3 is on?

• A. Substantia Nigra• B. Superior colliculi• C. Inferior colliculi• D. Red Nucleus• E. Pineal Gland

What is (1) pointing to ?

• A. Substantia Nigra• B. Superior colliculi• C. Inferior colliculi• D. Red Nucleus• E. Pineal Gland

Which cranial nerve does the US president used to illustrate his surprise?

• A. IV• B. VII• C. V• D. XI• E. XII

Cranial nerves

A sixty-four-year old man was diagnosed with an acoustic neuroma (tumor of the VIIIth cranial nerve) where it entered the temporal bone. What other cranial nerve might also be affected since this nerve uses the same foramen as the VIIIth in its course?

A. VIB. VIIC. VIIID. IXE. X

If a patient comes into the emergency room and has injured his spine at C3, what is first main concern for the patient?

• A. The patient may never walk again• B. The patient is paralyzed from the waist

down• C. The patient is experiencing respiratory

arrest• D. The patient’s eye sight is affected• E. The patient’s hearing is affected

A case of respiratory paralysis

• A 26 y/o male was in a car accident. When the paramedics arrived on scene the crash victim was not moving and becoming cyanotic, but still appeared to have a slight level of consciousness.

• After endotracheal intubation and transfer over to the hospital, further review of his MRI indicated an injury to one of the patients cervical vertebrae.

• Which section of cervical vertebrae was his injury most likely located?

• A. Above C-2• B. Below C-5• C. C-7• D. Between

C-3 and C-5• E. Below C-8

What are the four glial types in the central nervous system?A. Astrocytes, Schwann, adipose, and satellite cellB. Astrocytes, oligodendrocytes, microglia, and ependymalC. Schwann, satellite, white matter, and gray matterD. Epineurium, perineurium, endoneurium, and astrocytesE. Continuous conduction, white matter, gray matter, and astrocytes

• Which Neuroglial cell is not in the CNS?

• A. Astrocytes• B. Microglial• C. Schwann cells• D. Ependymal• E. Oligodendrocytes

• What lines ventricles of the brain and central canal of the spinal cord?

• A. Oligodendrocytes• B. Microglia• C. Ependymal cells• D. Schwan cells• E. Pseudo unipolar

neurons

In the CNS if there was necrotic tissue or a foreign

substance what type of cell would remove them ?

• A. Microglia• B. Astrocytes• C. Ependymal cell• D. Schwann cell• E. Oligodendroglia

Out of all the meninges, which layer is known as the "delicate mother"?

• A. Dura-mater• B. Arachnoid mater• C. Pia-mater• D. Falx cerebri• E. Tentorium cerebelli

Which cranial nerve is responsible for the movement of the head and shoulders?

• A. I• B. IX• C. X• D. XI• E. VI

Pedro Aguayo Ramirez, known as Hijo del Perro Aguayo, fell unconscious on the ropes Friday after receiving a flying kick from Mysterio, according to video of the match in a municipal auditorium in Tijuana, Mexico.

• What was the cause of his death?

• A. A snapped vertebrae• B. Cerebral concussion• C. Extradural hemorrhage• D. Subarachnoid

hemorrhage• E. Cranial injury

A lesion in the following cranial nerve causes dysphagia and hoarseness of voice:

A. Vagus nerve.

B. Glossopharyngeal nerve.

C. Hypoglossal nerve.

D. Facial nerve.

E. Spinal accessory nerve.

The commissural fibers of the brain include all of the following EXCEPT:

A. Corpus callosum.

B. Cingulum.

C. Anterior commissure.

D. Posterior commissure.

E. Hippocampal commissure.

One of the following is not present in the interpeduncular fossa:

A. Tuber cinereum.

B. Infundibulum of the pituitary gland.

C. Mammillary bodies.

D. Posterior perforated substance.

E. Trochlear nerve.

The Rhombencephalon is made up of the:

A. Cerebrum and cerebellum.

B. Cerebrum, cerebellum and pons.

C. Cerebellum and thalamus.

D. Spinal cord, medulla and cerebellum.

E. Medulla, pons and cerebellum.

Which of the following structures separates the cerebellum from the cerebrum?

• A. Falx cerebri• B. Falx cerebelli• C. Tentorium cerebelli• D. Fourth ventricle• E. Diaphragma sellae

These cranial nerve nuclei are present in the floor of the 4th ventricle EXCEPT:

A. Abducent nucleus.B. Facial nucleus in the facial colliculus.C. Dorsal motor nucleus of the vagus.D. Hypoglossal nucleus.E. Vestibular nuclei.

The lateral ventricle communicates with the 3rd ventricle through:

• A. Aqueduct of Sylvius.

• B. Foramen of Magendie.

• C. Foramen of Monro.

• D. Foramen of Luschka.

• E. Central canal.

Which of the following parts of brain contain the 3rd ventricle?

• A. Metencephalon /pons and cerebellum

• B. Myelencephalon / medulla oblongata

• C. Mesencephalon / midbrain

• D. Telencephalon / cerebrum

• E. Diencephalon / thalamus and hypothalamus

Which of the following parts of brain contain 4th ventricle?

A. Telencephalon / cerebral hemispheresB. Diencephalon / between the two thalamiC. Mesencephalon / tectum and cerebral pedunclesD. Rhombencephalon / pons, cerebellum and medullaE. Cavum septum pellucidum.

What cells form the myelin sheaths around the axons in CN II and VIII?

A. Astrocytes and Schwann cells, respectively.B. Ependymal cells and Schwann cells, respectively.C. Oligodendrocytes and Schwann cells, respectively.D. Oligodendrocytes and fibroblasts, respectively.E. Schwann cells and oligodendrocytes, respectively.

The area of the cortex is supplied by which of the following arteries?

A. Anterior cerebralB. Middle cerebralC. Posterior cerebralD. Posterior communicatingE. Anterior communicating

The region of retina as shown by the arrow is characterised by:-

A. Absence of bipolar neurons, no blood vessels, no ganglion cells and no rodsB. Lot of rods, ganglionic cells and heavily vascularisedC. There are no rods and conesD. There is possibility of detachment of retinaE. All ten layers of retina seen here

What portion of the visual field is represented in the left lateral geniculate?

A. The superior half of the visual field of both eyes.B. The inferior half of the visual field of both eyes.C. The right half of the visual field of one eye.D. The right half of the visual field of both eyes.E. The left half of the visual field of both eyes.

Interruption of this nerve will result primarily in an inability to:-

• A. Open the eye• B. Close the eye• C. Constrict the pupil• D. Dilate the pupil• E. Abduct the eye

Name the arrowed structure shown below?

• A. Medial geniculate body

• B. Lateral geniculate body

• C. Hippocampus• D. Red nucleus• E. Substantia nigra

Identify the marked structure shown below?

• A. Lateral ventricle• B. III ventricle• C. Cerebral aqueduct• D. IV ventricle• E. Foramen of Monroe

A lesion in this region on the right side would result in ?

• A. Inability to wrinkle forehead on the right

• B. Inability to wrinkle on the left side

• C. Inability to smile on the right side

• D. Inability to smile on the left side

• E. The angle of her mouth is deviated to the right side

A pituitary tumor produces which of the visual defects

A. Bitemporal hemianopiaB. Ipsilateral hemianopiaC. Contralateral hemianopiaD. Ipsilateral blindnessE. Homonymous hemianopia

References

• http://biol251.wikispaces.com/Ch_14-Brain%26Cranial+Nerves

• http://biol251.wikispaces.com/Ch_13-SpinalCord• http://library.med.utah.edu/kw/hyperbrain/quiz/• http://library.med.utah.edu/kw/hyperbrain/quiz/• http://

pt.slideshare.net/dr_ansari2000/csf-productioncirculation-absorption