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Questions and Answers

Which artery is primarily associated with the posterior limb of the internal capsule?

  • Superior cerebellar artery
  • Ophthalmic artery
  • Anterior inferior cerebellar artery
  • Recurrent artery of Heubner (correct)
  • Which artery is implicated in the vascular supply to the medial geniculate nucleus?

  • Vertebral artery
  • Posterior communicating artery
  • Posterior cerebral artery (correct)
  • Anterior cerebral artery
  • Which condition corresponds with the involvement of the anterior limb of the internal capsule?

  • Glossopharyngeal neuralgia
  • Trigeminal neuralgia (correct)
  • CN III palsy
  • Horner’s syndrome
  • The blood supply to the posterior pituitary gland is mainly through which artery?

    <p>Superior cerebellar artery (D)</p> Signup and view all the answers

    Which structure is least likely to be associated with the splenium of the corpus callosum?

    <p>Anterior cerebral artery (A)</p> Signup and view all the answers

    Which artery is incorrectly matched with its typical neuralgia condition?

    <p>Superior cerebellar artery - Glossopharyngeal neuralgia (B)</p> Signup and view all the answers

    The dorsal nucleus is closely associated with which functions?

    <p>Autonomic regulation (D)</p> Signup and view all the answers

    Which cranial nerve is primarily associated with the pterygopalatine ganglion?

    <p>CN V (D)</p> Signup and view all the answers

    Which structure is primarily responsible for proprioceptive and fine touch sensations in the upper limb?

    <p>Medial lemniscus (C)</p> Signup and view all the answers

    Which nerve is commonly affected in conditions leading to wrist drop?

    <p>Radial nerve (D)</p> Signup and view all the answers

    What is a common result of median nerve injury at the wrist level?

    <p>Loss of thumb opposition (B)</p> Signup and view all the answers

    Which of the following conditions can result from compression of the radial nerve?

    <p>Saturday night palsy (C)</p> Signup and view all the answers

    What type of sensory loss is typically observed in a median nerve injury?

    <p>Loss of tactile sensation over the first three digits (D)</p> Signup and view all the answers

    Which of the following muscles is affected by radial nerve dysfunction?

    <p>Triceps brachii (A)</p> Signup and view all the answers

    What symptom is characteristic of median nerve entrapment?

    <p>Loss of grip strength (B)</p> Signup and view all the answers

    Which condition is likely to cause damage to both the median and ulnar nerves at the elbow?

    <p>Humeral shaft fracture (A)</p> Signup and view all the answers

    Which structure is primarily associated with the involuntary movement characteristic of hemiballismus?

    <p>Contralateral subthalamic nucleus (B)</p> Signup and view all the answers

    What vascular abnormalities are linked with hemiballismus in approximately 25% of cases?

    <p>Aneurysms or arteriovenous malformations (AVMs) (C)</p> Signup and view all the answers

    Disconnection lesions involving which nucleus results in hyperreflexia and increased extensor tone?

    <p>Red nucleus (C)</p> Signup and view all the answers

    What is the primary cause of hemiballismus that is commonly identified?

    <p>Vascular issues, particularly in the PCA territory (D)</p> Signup and view all the answers

    Which tract may contribute to the flinging motion in hemiballismus due to its disruption?

    <p>Rubrospinal tract (D)</p> Signup and view all the answers

    What is the commonly noted characteristic sign of vascular issues in the cases of hemiballismus?

    <p>Tau sign (flow void) (D)</p> Signup and view all the answers

    In hemiballismus, what is the typical result of lesions above the red nucleus?

    <p>Extension in arms and flexion in legs (B)</p> Signup and view all the answers

    What is the most significant factor inhibiting extensor action in the arms and legs?

    <p>Cortical inhibition (A)</p> Signup and view all the answers

    Study Notes

    Hemiballismus

    • Unilateral, involuntary, violent flinging of the limbs
    • Lesion in the contralateral subthalamic nucleus or its connections
    • Often due to vascular causes (PCA territory)
    • Can occur in Multiple Sclerosis
    • Often resolves spontaneously
    • Drug treatment ineffective

    Factors Inhibiting Extensor Action

    • Cortical inhibition of lateral vestibular nucleus (vestibulospinal tract) and pontine reticular formation
    • Red nucleus projections to spinal cord (rubrospinal tract; possibly arms only)
    • Medullary reticular formation

    Disconnection Lesions

    • Lesions involving the red nucleus result in loss of normal inhibition of extension and loss of cortical inhibition of extensor action of LVN and pontine RF.
    • This produces hyperreflexia and increased extensor tone (decerebrate rigidity)
    • Disconnection lesions above the red nucleus result in extension in legs, but flexion in arms (decorticate rigidity)

    Posterior Communicating Artery (PCOMM)

    • Found between 0.1-0.6% of cerebral angiograms
    • Connects the cavernous ICA (just proximal to the meningohypophyseal trunk) to the basilar artery between superior cerebellar and anterior inferior cerebellar arteries
    • Persistence is usually associated with hypoplastic basilar and vertebral arteries proximal to the anastomosis, as well as a hypoplastic PCOMM.
    • Frequency explained by order of regression during embryogenesis: otic/acoustic artery first, followed by hypoglossal, and then trigeminal.
    • Vascular abnormalities (AVM, aneurysm) occur in 25%
    • Characterized by the tau sign (flow void) on sagittal MRI

    Location of Structures

    • Posterior limb of the internal capsule: C
    • Medial and lateral geniculate nuclei: D
    • Anterior limb of the internal capsule and head of caudate: A
    • Posterior pituitary gland: E
    • Splenium of corpus callosum: F

    Cerebral Veins

    • A: Superior sagittal sinus
    • B: Straight sinus
    • C: Transverse sinus
    • D: Sigmoid sinus
    • E: Internal jugular vein
    • F: Cavernous sinus
    • G: Inferior petrosal sinus
    • L: Left lateral ventricle
    • M: Right lateral ventricle
    • R: Right
    • Z: Left

    Autonomic Nervous System

    • a. Erdinger-Westphal nucleus: Dorsal nucleus of vagus
    • b. Superior salivatory nucleus: Facial nerve
    • c. Inferior salivatory nucleus: Glossopharyngeal nerve
    • d. Dorsal nucleus: Vagus nerve
    • e. Ciliary ganglion: Oculomotor nerve
    • f. Pterygopalatine ganglion: Facial nerve
    • g. Otic ganglion: Glossopharyngeal nerve
    • h. Submandibular ganglion: Facial nerve
    • i. CNII: Optic nerve
    • j. CNV: Trigeminal nerve
    • k. Y: Unknown

    Rostral Pons

    • A: Motor tract of trigeminal nerve
    • B: Spinal trigeminal tract
    • C: Trapezoid body
    • D: Middle cerebellar peduncle
    • E: Superior cerebellar peduncle
    • F: Inferior cerebellar peduncle
    • G: Facial nerve
    • H: Abducens nerve
    • I: Lateral lemniscus
    • J: Medial lemniscus
    • K: Medial longitudinal fasciculus
    • L: Fourth ventricle
    • M: Superior olive
    • N: Tegmentum
    • O: Pontine nuclei
    • P: Basilar artery
    • Q: Reticular formation
    • R: Trigeminal nerve
    • S: Brachium pontis

    Additional Questions

    • 1. Glossopharyngeal neuralgia: C, g
    • 2. Trigeminal neuralgia: R
    • 3. Hemifacial spasm: G
    • 4. Horner’s syndrome: E
    • 5. CN III palsy: E
    • 1. Medial lemniscus: J
    • 2. Medial longitudinal fasciculus: K
    • 3. Trochlear nerve: N
    • 4. Central tegmental tract: Q
    • 5. Tectobulbospinal tract: N

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