Podcast
Questions and Answers
Which artery is primarily associated with the posterior limb of the internal capsule?
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?
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?
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?
The blood supply to the posterior pituitary gland is mainly through which artery?
Which structure is least likely to be associated with the splenium of the corpus callosum?
Which structure is least likely to be associated with the splenium of the corpus callosum?
Which artery is incorrectly matched with its typical neuralgia condition?
Which artery is incorrectly matched with its typical neuralgia condition?
The dorsal nucleus is closely associated with which functions?
The dorsal nucleus is closely associated with which functions?
Which cranial nerve is primarily associated with the pterygopalatine ganglion?
Which cranial nerve is primarily associated with the pterygopalatine ganglion?
Which structure is primarily responsible for proprioceptive and fine touch sensations in the upper limb?
Which structure is primarily responsible for proprioceptive and fine touch sensations in the upper limb?
Which nerve is commonly affected in conditions leading to wrist drop?
Which nerve is commonly affected in conditions leading to wrist drop?
What is a common result of median nerve injury at the wrist level?
What is a common result of median nerve injury at the wrist level?
Which of the following conditions can result from compression of the radial nerve?
Which of the following conditions can result from compression of the radial nerve?
What type of sensory loss is typically observed in a median nerve injury?
What type of sensory loss is typically observed in a median nerve injury?
Which of the following muscles is affected by radial nerve dysfunction?
Which of the following muscles is affected by radial nerve dysfunction?
What symptom is characteristic of median nerve entrapment?
What symptom is characteristic of median nerve entrapment?
Which condition is likely to cause damage to both the median and ulnar nerves at the elbow?
Which condition is likely to cause damage to both the median and ulnar nerves at the elbow?
Which structure is primarily associated with the involuntary movement characteristic of hemiballismus?
Which structure is primarily associated with the involuntary movement characteristic of hemiballismus?
What vascular abnormalities are linked with hemiballismus in approximately 25% of cases?
What vascular abnormalities are linked with hemiballismus in approximately 25% of cases?
Disconnection lesions involving which nucleus results in hyperreflexia and increased extensor tone?
Disconnection lesions involving which nucleus results in hyperreflexia and increased extensor tone?
What is the primary cause of hemiballismus that is commonly identified?
What is the primary cause of hemiballismus that is commonly identified?
Which tract may contribute to the flinging motion in hemiballismus due to its disruption?
Which tract may contribute to the flinging motion in hemiballismus due to its disruption?
What is the commonly noted characteristic sign of vascular issues in the cases of hemiballismus?
What is the commonly noted characteristic sign of vascular issues in the cases of hemiballismus?
In hemiballismus, what is the typical result of lesions above the red nucleus?
In hemiballismus, what is the typical result of lesions above the red nucleus?
What is the most significant factor inhibiting extensor action in the arms and legs?
What is the most significant factor inhibiting extensor action in the arms and legs?
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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