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Neurosurgery Rounds > 1. Neuroanatomy > Flashcards

1. Neuroanatomy Flashcards

1
Q

How to distinguish ICA and ECA in the neck?

A

ECA has multiple branches in the neck

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2
Q

Major Branches of ECA

A 
SALFOPSI
Superior thyroid
Ascending pharyngeal
Lingual
Facial
Occipital
Posterior auricular
Superficial temporal
Internal maxillary
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3
Q

Where do common carotid arteries arise?

A

Right: brachiocephalic trunk
Left: aortic arch

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4
Q

What is the carotid siphon?

A

Intracavernous and supraclinoid segment of ICA

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5
Q

Findings in occlusion of anterior choroidal artery?

A

Hemiparesis, hemianesthesia, hemiopsia

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6
Q

Posterior cerebral artery divides into which two arteries?

A

Calcarine

Parietooccipital

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7
Q

What artery supplies the choroid plexus of temporal horn?

A

Posterior cerebral artery

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8
Q

Virchow-Robin spaces

A

Spaces between blood vessels and arachnoid/pia within brain and spinal cord

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9
Q

Which large anastomotic vein joins the superior sagittal sinus?

A

Vein of Trolard

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10
Q

Which large anastomotic vein joins veins of sylvian fissure with transverse sinus

A

Vein of Labbe

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11
Q

What is the largest branch of the intracavernous portion of carotid artery?

A

Meningohypophyseal trunk

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12
Q

Three main superficial cerebral veins

A

Vein of Trolard
Vein of Labbe
Superficial middle cerebral vein

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13
Q

Clinical symptom of large unruptured cavernous sinus carotid aneurysm

A

Ipsilateral 6th nerve palsy (most proximal spatial relationship to carotid artery)

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14
Q

Wallenberg syndrome (lateral medullary syndrome) - artery

A

Occlusion of ipsilateral vertebral artery. Infarct supplied by PICA

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15
Q

What artery supply the thalamus?

A

Posterior communicating and perimesencephalic portion of posterior cerebral artery

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16
Q

What artery supply the lateral geniculate nucleus?

A

Anterior choroidal and lateral posterior choroidal (dual supply)

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17
Q

Artery involved in trigeminal neuralgia

A

SCA

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18
Q

Artery involved in hemifacial spasm

A

AICA

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19
Q

Artery involved in glossopharyngeal neuralgia

A

PICA

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20
Q

Artery supply of internal capsule

A

Lateral lenticulostriate branches from MCA
Medial striate from ACA
Direct branch from ICA

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21
Q

Which vessel has highest risk of injury in Chiari decompression surgery?

A

PICA

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22
Q

Vessels supply superior, middle, and inferior cerebellar peduncles?

A

SCA, AICA and PICA respectively

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23
Q

Where is motor strip in relation to the skull?

A

~5 cm behind coronal suture

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24
Q

What external landmark on skull marks the lateral margin of sphenoid ridge and sylvian fissure?

A

Pterion

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25
Q

What part of mandible does the temporalis muscle attaches to?

A

Coronoid process of mandible

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26
Q

Which muscle of mastication does the parotid duct cross

A

Masseter muscle

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27
Q

Which cranial fossa is the largest and deepest?

A

Posterior

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28
Q

Suboccipital triangle bounded by which 3 muscles?

A

Rectus capitis posterior major
Superior oblique
Inferior oblique

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29
Q

What sutures make up the asterion?

A

Lambdoid, parietomastoid, occipitaomastoid

Define lower half of junction of transverse and sigmoid sinuses

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30
Q

Which bones make up the osseous nasal septum?

A

Ethmoid and vomer

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31
Q

Compartments of jugular foramen

A

Pars venosa (posterolateral): sigmoid sinus, jugular bulb, CN X, XI

Pars nervosa (anteromedial): CN IX and Jacobson’s nerve (tympanic branch of IX)

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32
Q

What structure does abducens nerve go through to enter the cavernous sinus?

A

Dorello’s canal

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33
Q

What structures go through internal acoustic meatus

A

CNVII (facial), CNVIII (vestibulocochlear) and labyrinthine artery (internal auditory)

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34
Q

Major parts of temporal bone

A

Squamous and petrous parts

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35
Q

cribriform plate is part of what bone?

A

Ethmoid bone

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36
Q

What goes through the jugular foramen?

A

Nerves: CNIX (glossopharyngeal), CNX (vagus), CN XI (accessory)
Artery: posterior meningeal artery
Vein: internal jugular vein
Sinus: inferior petrosal sinus

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37
Q

What are the bones that form the orbit?

A 
Frontal
Sphenoid
Zygomatic
Ethmoid
Lacrimal
Maxilla
Palatine
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38
Q

What structures pass through the annulus of zinn?

A

Tendinous ring of 4 rectus muscle
CNII (Optic), CNIII (Oculomotor), CNVI (Abducens), nasociliary nerve (branch of opthalmic V1 nerve)

Opthalmic artery

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39
Q

What pass through pterygopalatine fossa?

A

Maxillary artery
Maxillary nerve
Pterygopalatine ganglion

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40
Q

What pass through the inferior orbital fissure?

A 
Infraorbital nerve (maxillary) - innervate lower eyelid/upper lip
Zygomatic nerve (maxillary) - skin over zygomatic/temporal bone (sensory)
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41
Q

What bones are approximated at pterion?

A

Frontal, parietal, temporal, sphenoid

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42
Q

What structure separates optic canal from superior orbital fissure?

A

Optic strut

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43
Q

5 parts of lateral ventricle?

A 
Frontal horn
Temporal horn
Occipital horn
Body
Atrium
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44
Q

Choroid plexus and flocculus protrude from which foramen?

A

Foramen of Luschka

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45
Q

Which cranial nerve nuclei positioned in lateral recess near foramen of luschka?

A

Dorsal/ventral cochlear nuclei of CNVIII

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46
Q

What are circumventricular organs?

A

Areas where BBB is absent

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47
Q

Where is BBB absent?

A 
Pineal gland
Subforniceal organ
Organum vasculosum of lamina terminalis
Median eminence of hypothalamus
Neurohypophysis (posterior pituitary)
Area postrema
Subcommissural organ
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48
Q

What forms lateral walls of frontal horns of lateral ventricle? Medial wall? Roof?

A

Caudate nucleus, septum pellucidum, corpus callosum

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49
Q

Outlet of 4th ventricle

A

2 lateral foramina of luschka

1 medial foramen of magendie

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50
Q

What separates chiasmatic cistern from interpeduncular cistern?

A

Liliequist membrane

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51
Q

Where do sympathetic fibers of head originate from?

A

Hypothalamus

Through brainstem and cervical spinal cord to T1-L2

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52
Q

Where in brain are cholinergic neurons found?

A

Basal nucleus of Meynert

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53
Q

Norepinephrine-containing neurons

A

Locus cereuleus

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54
Q

Sympathetic innervation to head and neck?

A

Stellate ganglion

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55
Q

What ganglions form the stellate ganglion

A

Inferior cervical ganglion fuse with first thoracic ganglion to form cervical thoracic (stellate) ganglion

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56
Q

Type of nerve fiber of vidian nerve

A

Parasympathetic fibers from greater superficial petrosal nerve
Sympathetic fibers from deep petrosal nerve around ICA

Nerve passes in the pterygoid canal with vidian artery

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57
Q

Type of nerve fiber of intermediate nerve (nervus intermedius)

A

Sensory and parasympathetic division of facial nerve
Preganglionic parasympathetic fiber from superior salivary nucleus that synapse in pterygopalatine and submandibular ganglia
Taste from anterior 2/3 of tongue

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58
Q

What provides the parasympathetics of parotid glands?

A

Glossopharyngeal nerve - originate from inferior salivatory nucleus and travels through CN IX -> synapse at otic ganglion -> parotid gland

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59
Q

What are leptomeninges?

A

Arachnoid and pia mater

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60
Q

Embryologic origin of meninges

A

Pia: ectoderm
Arachnoid: ectoderm
Dura: mesoderm

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61
Q

How much CSF is produced each day

A

450mL

~150mL in average body at a time.

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62
Q

What separates the interpeduncular cistern from the chiasmatic cistern?

A

Liliequist membrane

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63
Q

Brodmann’s area for Broca

A

Area 44

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64
Q

Brodman’s area for Wernicke

A

Area 22

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65
Q

Brodman’s area for primary auditory cortex

A

Area 41

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66
Q

Which area of hippocampus is most vulnerable to hypoxia?

A

CA1 (Sommer’s ector)

CA3 is resistant

67
Q

What is the indusium griseum?

A

Remnant of hippocampus that courses over the dorsal surface of corpus callosum (supracallosal gyrus) - medial and lateral longitudinal striae

68
Q

What makes up the neostriatum?

A

Caudate and putamen

69
Q

What white matter projects from Wernicke to Broca?

A

Arcuate fasciculus

70
Q

Gustatory area receives input from which nucleus?

A

Ipsilateral nucleus solitarius

71
Q

What is ischemic penumbra?

A

Decreased blood flow where neurons survive but not function. Gray matter require more blood supply than white matter

72
Q

Lesion to right Meyer’s loop

A

Left upper quadrantanopia

73
Q

Lesion of posterior part of middle frontal gyrus

A

Cortical lateral conjugate gaze center - causes conjugate eye deviation toward ipsilateral side

74
Q

Hypothalamus receives fibers from amygdala through which bundle?

A

Stria terminalis

75
Q

Classic syndrome from dominant parietal lobe lesion

A

Gertsmann - agraphia without alexia, L/R confusion, finger agnosia, acalculia

76
Q

Where is lesion for patient with hemineglect

A

Posterior parietal association cortex

77
Q

Where in internal capsule do corticobulbar fibers run

A

Genu

78
Q

Where in internal capsule are corticospinal tract located

A

Posterior limb

79
Q

Main neurotransmitter of corticothalamic tract

A

Glutamate

80
Q

Satiety center

A 
Medial hypothalamus (stimulation causes decreased food intake)
Hunger in lateral
81
Q

Where is ADH made?

A

Supraoptic and paraventricular nuclei of hypothalamus

82
Q

Which part of hypothalamus lowers body temperature

A

Anterior (stimulation causes dilation of blood vessels/sweating)

83
Q

Where does corticospinal tract originates?

A

Layer 5 of cerebral cortex -> corona radiata -> posterior limb of internal capsule -> cerebral peduncles and pyramids of medulla -> lamina 7 in spinal cord

84
Q

What makes up inferior parietal lobule

A

Angular and supramarginal gyri

Parietal lobe is divided into superior and inferior lobules by the interparietal sulcus.

85
Q

Prosopagnosia - which part is damaged?

A

Temporal association cortex - impairment in visual processing - recognize voice (auditory) but not recognize familiar faces

86
Q

Papez circuit of the brain

A

hippocampus -> fornix -> mamillary bodies -> mammillothalamic tract -> anterior thalamic nucleus -> cingulate gyrus -> parahippocampal gyrus -> entorhinal gyrus -> hippocampus

87
Q

Afferent fibers of pupillary light reflex cross the contralateral edinger-westfall nucleus through which structure?

A

Posterior commissure

88
Q

Sensation from face - which thalamic nucleus

A

VPM (VPL for body)

89
Q

Which layer of cerebral cortex receives thalamocortical afferents?

A

Layer IV (internal granular)

90
Q

Which layer of cerebral cortex has the main efferent neurons

A

V (internal pyramidal layer) - send axons through white matter to internal capsule

91
Q

Layers of cerebral neocortex

A

I (molecular): most superficial, synaptic area
II (external granular): densely packed neurons
III (external pyramidal)
IV (internal granular): primary receiving station of cerebral cortex
V (internal pyramidal): send axon to internal capsule
VI (fusiform): primary origin of corticothalamic fibers

92
Q

Primary reason for macular sparing in occipital cortex lesion

A

Macula has dual supply from MCA and PCA to occipital poles

93
Q

Occipital (striate) cortex has dominance columns, except which 2 areas?

A
  1. where blind spot is located

2. monocular temporal crescent of both eyes

94
Q

of cortical layers of cerebellum

A

3

  1. molecular
  2. purkinje
  3. granular
95
Q

Only output cells of cerebellar cortex

A

Purkinje cells (inhibitory)

96
Q

Cerebellar glomeruli consist of?

A

Mossy fibers stimulate granule cells

Golgi type 2 cells inhibit them

97
Q

Where do climbing fibers originate from

A

Contralateral inferior olive - cross to inferior cerebellar peduncle and ascend olecular layer -> stimulate dendrites of purkinje cells

98
Q

Which cerebellar peduncle contains only afferent fibers

A

Middle

99
Q

Another name for superior, middle and inferior peduncles

A

Brachium conjunctiva, brachium pontis, restiform body

100
Q

Only afferent tract that runs through superior cerebellar peduncle

A

Ventral spinocerebellar tract (proprioceptive info to cerebellum from lower extremities/trunk)

101
Q

2nd order neuron of olfactory

A

Mitral cells -> lateral olfactory area -> lateral/intermediate/medial olfactory areas

102
Q

Pineal region tumor - syndrome

A

Parinaud syndrome: upper gaze palsy, dissociated light near response, retraction nystagmus, absence of convergence

103
Q

Weber syndrome

A

CN3 palsy and contralateral hemiparesis. Infarct of medial midbrain.

104
Q

Millard-Gubler syndrome lesion

A

At base of pons - 6/7 nerve palsy and contralateral hemiplegia

105
Q

Function of red nucleus

A

Maintains flexor muscle tone

106
Q

What are at level of midbrain

A 
Red nucleus
pyramidal tract (corticonuclear/spinal fibers), oculomotor nerve
107
Q

Input of red nucleus

A

Deep cerebellar nuclei and cerebral cortex

108
Q

What are internal arcuate fibers

A 
Crossing fibers of dorsal column fibers
Dorsal column (gracile fasciculus/cuneate) -> medulla synapse at nuclei -> migrate ventrally around central gray matter of medulla and cross midline -> ascend as medial lemniscus to reach VPL of thalamus.
109
Q

Where is vertical gaze center

A

Rostral interstitial nucleus on medial longitudinal fasciculus

110
Q

Crossed nasal retinal visual fibers go to which layers of LGN

A

Layer 1,4,6

Ipsilateral to 2,3,5

111
Q

Which trigeminal nucleus receives pain/temp of face

A

Spinal trigeminal nucleus. Extends from ponds to C2 and merges caudally with substantia gelatinosa.

112
Q

Which trigeminal nucleus receives prorioception from face

A

Mesencephalic nucleus

113
Q

Lateral lemniscus carry?

A

2nd order neuron of auditory pathway -> ascends to inferior colliculus

114
Q

Sensation from external auditory canal carried by vagus nerve arrives at which nucleus

A

Travel through Arnold’s nerve to superior (jugular) ganglion of CN10 -> spinal trigeminal tract -> spinal trigeminal nucleus

115
Q

General visceral sensation of vagus nerve arrives at which nucleus

A

Travel to inferior ganglion of 10 -> solitary tract to solitary nucleus in medulla.

116
Q

Which CN most susceptible during carotid endarterectomy

A

CN11 (hypoglossal)

117
Q

Hypoglossal nerve palsy in skull base tumor

A

Tumor infiltration into anterior portion of ipsilateral occipital condyle

118
Q

Optic chiasm nml anatomic location?

A

Above diaphragma sellae

May be prefixed and lie over tuberculum sellae or post fixed over dorsum sellae

119
Q

Which CN carry general visceral efferent?

A

3, 7, 9, 10

120
Q

Where does trochlear nerve decussate

A

Within superior medullary velum

121
Q

What triggers a glossopharyngeal neuralgia attack?

A

Swallowing, talking, chewing

122
Q

Hering’s nerve

A

Branch of CN9 (sensory limb of carotid body)

Detects changes in blood O2 and CO2 concentration

123
Q

Digastric muscle innervation

A

Anterior - CN5

Posterior - CN7

124
Q

Which CNs pass through foramen magnum

A

Accessory

125
Q

Unilateral vagal injury - symptoms

A

Hoarseness, dyspnea, dysphagia, ipsilateral decreased cough reflex, uvular deviation

126
Q

Hypoglossal nerve innervates?

A

All intrinsic/extrinsic muscles of tongue except palatoglossus (CN10)

127
Q

CN most often involved with tumors of upper cervical canal

A

Spinal accessory (torticollis/weakness of trapezius and SCM muscles)

128
Q

Largest avascular organ in body

A

Intervertebral disk

129
Q

Most common dermatome syndrome with craniocervical dx

A

C2

130
Q

Where does pyramidal decussation begin and complete decussation?

A

Just below obex -> below exit of first cervical nerve root

131
Q

Foramen magnum tumor with hand weakness - which spinal tract?

A

Cortical spinal tract

132
Q

Enalrged intervertebral foramen on radiography

A

Nerve root tumor

133
Q

What ligament important to divide for proper visualization of ventral spinal tumor after dural opening in posterior appraoch

A

Dentate ligament

134
Q

Perioral tingling/numbness in syringobulbia is compression of which tract

A

Spinal trigeminal tract

135
Q

Which ligament is primary restraint against atlantoaxial anteroposterior translation

A

Transverse ligament

136
Q

What supplies sympathetic innervation to arm

A

T2 and T3 ganglia

137
Q

Dorsal ramus of the C1 nerve root

A

Suboccipital nerve

138
Q

What innervates cervical disk

A

Plexus formed by sinuvertebral nerve dorsally and plexus by cervical symp trunk ventrally

139
Q

Level of aortic bifurcation

A

midbody of L3

140
Q

What level spinal cord ends in adults

A

L1-L2

141
Q

Loss of sensation over webspace of 1-2 toes

A

Injury to deep fibular nerve

142
Q

Nerve root - loss of achilles reflex

A

S1

143
Q

Nerve roots with biceps reflex

A

C5-C6

144
Q

L5 nerve root - which reflex

A

None

145
Q

Pain and temp first order neurons synapse?

A

-> DRG -> dorsolateral tract and synapse at substantia gelatinosa

146
Q

XR of acute transverse myelitis

A

Usually normal; may have increased T2 weighted MR

147
Q

Pott dx

A

Tuberculous vertebral osteomyelitis - affects body rather than disks

148
Q

XR of infx vs tumor in spine

A

Destruction of disk space (infxn)

Destruction of body and not cross disk space (tumor)

149
Q

2 most common herniated disks

A

L4-L5

L5-S1

150
Q

Immunologically priviledged site of intervertebral disk

A

Nucleus pulposus - isolated from vascular/immune

151
Q

Spurling/s sign

A

radicular pain when exert downward pressure on vertex while tilting head to symptomatic side - narrowing of intervertebral foramen

152
Q

How do sympathetic fibers exit spinal cord

A

Ventral roots by white rami communicantes

153
Q

Sensory loss in axillary nerve injury

A

Lateral aspect of shoulder

154
Q

Posterior interosseous neuropathy - symptoms

A

Finger extension weakness including thumb with no wrist drop/sensory loss.
May be entrapped at arcade of Frohse (into supinator muscle)

155
Q

Meralgia paresthetica

A

Bernhardt-Roth syndrome
Entrapment of lateral femoral cutaneous nerve of thigh - purely sensory nerve and compression causing burning dysesthesia in lateral upper thigh

156
Q

Which muscle of thumb has dual innervation

A

Flexor pollicis brevis

- median and ulner nerves

157
Q

Site of entrapment of suprascapular nerve

A

Suprascapular notch beneath transverse scapular ligament

158
Q

True neurogenic thoracic outlet syndrome - which nerve roots

A

C8 and T1

Commonly due to cervical rib or elongated C7 transverse process

159
Q

Symptoms of anterior interosseous syndrome

A

Weakness of flexion of distal phalanges of thumb, index, middle fingers - “pinch sign”
No sensory loss (pure motor branch of median nerve)

160
Q

Wrist drop - what must be ruled out

A

Lead poisoning

161
Q

Nociceptive vs neuropathic pain

A

Nociceptors: well localized pain, constant, aching or throbbing; time-limited usually, respond well to opioids

Neuropathic - longstanding, triggered by injury, infiltrative/tumor compression/scar strangulation/inflammation by infxn - burning, lancinating, electric shock qualities

162
Q

Why is extensor carpi radialis muscle unique?

A

Innervated solely by C6 nerve root

163
Q

Ligament of Struthers?

A

Present in small % of people
Crossing cubital fossa above medial intermuscular septum - can compress median nerve and mimic carpal tunnel.

Thenar numbness more pronounced

164
Q

Arcade of Struthers

A

At elbow near medial head of triceps - may compress ulnar nerve

Neurosurgery Rounds (10 decks)

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