Contents

I.MusclesofMouth,Throat,andDeepNeck...........2 XII.CerebellarNeurons................................................6
II.GrossExternalAnatomyoftheBrainstem.............2 XIII.DivisionsofCerebellum.........................................6
III.InternalAnatomyoftheBrainstem........................3 XIV.RetinalCellTypes...................................................7
IV.BrainstemTracts.....................................................4 XV.Phototransduction.................................................7
V.EyeMovementLesions...........................................4 XVI.LesionsoftheVisualPathway...............................7
VI.BrainstemLesions...................................................4 XVII.EyeandVisualDisorders.......................................8
VII.AreasoftheCerebralCortex..................................5 XVIII.TheAuditoryProcess.............................................8
VIII.WhiteMatteroftheCerebrum..............................5 XIX.TheVestibularSystem...........................................9
IX.SensoryReceptors..................................................6 XX.AudiovestibularDisorders.....................................9
X.SensoryNeurons.....................................................6 XXI.ClassificationofANSReceptors.............................9
XI.CorticalSomatosensoryAreas................................6 XXII.ComparisonofAutonomicNervousSystem.......10

Exclusions:CerebrovascularSystem(L30,Aschebnrenner),ReticularFormation(DSA10,Forster),BasalGanglia(L33b,Schetz),MotorSystems(L33c,Schetz),TasteandOlfaction
(DSA9,Schetz).Allwillbecompletedbytomorrowafternoon.

fromthisdaytotheendingoftheworld,
Butweinitshallberememberd;
Wefew,wehappyfew,webandofbrothers;
Forhetodaythatshedshisbloodwithme
Shallbemybrother;behene'ersovile,
Thisdayshallgentlehiscondition:
AndgentlemeninEnglandnowabed
Shallthinkthemselvesaccursedtheywerenothere,
Andholdtheirmanhoodscheapwhilesanyspeaks
ThatfoughtwithusuponSaintCrispin'sday.
WilliamShakespeare,HenryV,ActIV,Sceneiii

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TableI MusclesofMouth,Throat,andDeepNeck Lecture21(Dr.Sheedlo)

Muscle Innervation Action
Palatoglossus PharyngealplexusofCNX Elevatestongue
Tongue

Styloglossus Hypoglossaln.(CNXII) Elevatesandretractstongue

Hyoglossus Hypoglossaln.(CNXII) Depressestongue
Genioglossus Hypoglossaln.(CNXII) Depressesandprotrudestongue
3
Tensorvelipalatini CNV viaoticganglion Tensessoftpalate
SoftPalate

Levatorvelipalatini PharyngealplexusofCNX Raisessoftpalate

Palatoglossus PharyngealplexusofCNX Elevatestongue (pullsrootoftongueupanddown)
Palatopharyngeus PharyngealplexusofCNX Elevateswallofpharynx
Uvulamuscle Vagusnerve(CNX) Elevatesuvula
Geniohyoid Firstcervicalnerve Pullshyoidanterior
Floor

Mylohyoid Inferioralveolarnerve Elevateshyoidandfloor,depressesmandible

Ant.bellyofdigastricm. Nervetomylohyoid Depressesmandible
Pharyngealconstrictors PharyngealplexusofCNX Propelsbolusdownwards
Pharynx

Salpingopharyngeus Elevatespharynx
Palatopharyngeus PharyngealplexusofCNX Elevateswallofpharynx
Stylopharyngeus Glossopharyngealn.(CNIX) Elevateslarynxduringswallowing
Obliquearytenoid Recurrentlaryngealn. Narrowslaryngealinlet
Thyroepiglottic Recurrentlaryngealn. Widenslaryngealinlet
Cricothyroid Externallaryngealn. Tensesvocalcord
Larynx

Posteriorcricoarytenoid Recurrentlaryngealn. Abductsvocalcord

Lateralcricoarytenoid Recurrentlaryngealn. Adductsvocalcord
Transversearytenoid Recurrentlaryngealn. Adductsvocalcord
Thyroarytenoid Recurrentlaryngealn. Relaxesvocalcord
Vocalis Recurrentlaryngealn. Relaxesvocalcord
Anteriorscalene AnteriorramiofC4C6 Laterallyflexes&rotatestheneck,elevatesfirstrib
Middlescalene Anteriorramiofcervicalnn. Laterallyflexes&rotatestheneck,elevatesfirstrib
DeepNeck

Laterallyflexesvertebralcolumn,elevatessecond
Posteriorscalene Anteriorramiofcervicalnn.
rib
Longuscapitis C1C3spinalnerves Flexesheadanteriorly
Longuscolli C2C7spinalnerves Flexesneckanteriorly,slightlyrotatesneck

TableII GrossExternalAnatomyoftheBrainstem L23Dr.Aschenbrenner

Area Boundaries(suplat)
Posterior:commissureof
diencephalonCNIV
Midbrain Anterior:mamillarybodiesof
hypothalamussup.
pontinesulcus
Posterior:CNIVstria Superior&inferiorsulci
th
medullaris(floorof4 v.)
Pons
Anterior:sup.pontinesulcus
inf.pontinesulcus
Posterior:striamedullaris
rootsofC1
Medulla
Anterior:inf.pontinesulcus
pyramidaldecussation
Rhomboid Pontineportion
Fossa Medullaryportion
Structures Images
Cerebralpeduncles
CNsIII,IV
Corticopontine,spinal,bulbartracts
Interpeduncularfossa
Superiorcolliculusopticreflex
Inferiorcolliculusauditoryreflex
Laterallemniscus(auditorypathway)
CNsV,VI,VII,VIII
Cerebellarpeduncles
Facialcolliculus
Pyramids&decussation
Postolivarysulcus(IXXI)
Preolivarysulcus(CNXII)
Fasciculuscuneatus&gracilis
Pontine:post.mediansulcus,sulcus
limitans,locusceruleus,facialcolliculus
Medullary:Vagal&hypoglossal
trigones,chemoreceptortriggerzone
(CTZ),lateralrecess

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TableIII InternalAnatomyoftheBrainstem L24Dr.Aschenbrenner
CrossSection StructuresMarked
MotorDecussation
CaudalMedulla

Corticospinaltractdecussations(a.k.a.,Decussationofthepyramids)(1),Lateralspinothalamictract(2),
Reticularformation(centralgraymatter)(3),Dorsalandventralspinocerebellartracts(4),Accessorynucleus(5),
Fasciculusgracilis(6A)Fasciculuscuneatus(6B),Nuc.gracilis(7),SpinalTractandunderlyingnucleusofCNV(8)

Fasciculusgracilis(1),Fasciculuscuneatus(2),Hypoglossalnuc.andn.(3),Dorsalmotornuc.ofvagusn.(4),
SensoryDecussn
CaudalMedulla

Nucleusambiguus(5),Spinaltractandnuc.ofCNV(6),Lateralspinothalamictract(7),
Internalarcuatefibers/mediallemniscus(8),Dorsalandventralspinocerebellartracts(9),Pyramids(10),
Mediallongitudinalfasciculus(MLF)(11)

Somatotopicarrangementofthefibersinthemediallemniscusisimportant!
Mostventralbankoffibersreceiveinputfromthefasc.gracilis(lowerlimb,foot/toessacralarea)
Mostdorsalbankoffibersreceiveinputfromthefasc.cuneatus(upperlimb,hand,fingers)
RostralMedulla@
Obex/Inf.Olive

ObexandIVVentricle(opens)(1),Hypoglossalnuc.(2),Dorsalmotornuc.ofCNX(3),Mediallemniscus(4),
Spinaltractandnuc.ofCNV(5),Lateralspinothalamictract(6),Inferiorcerebellarpeduncle(7),
Vestibularnuclearcomplex(8),Inferiorolivarynucleus(9),Nuc.ambiguus(SVE:CNIX,X,XI)(10),
Nucleusandtractussolitarius(11),Pyramids(12),Mediallongitudinalfasciculus(13)

CaudalPons

Abducensnuc.andnervefascicles(1),Facialnuc.andnerve(internalgenu)(2),Mediallemniscus(3),
Superiorolivarynucleus(4),Trapezoidbody/Laterallemniscus(5),Mediallongitudinalfasciculus(6),
Corticospinalandcorticobulbartracts(7),Spinalnuc.andtractofCNV(8),Lateralspinothalamictract(9),
Middlecerebellarpeduncle(brachiumpontis)(10)
Trigem.Complex
MidPons,

PrincipalsensorynucleusofCNV(1),MotornucleusofCNV(2),Mediallemniscus(3),
Lateralspinothalamictract(4),Mediallongitudinalfasciculus(5),Corticospinalandcorticobulbartracts(6),
Pontinenuclei(7)

RostralPons

Superiorcerebellarpeduncles(1),FasciclesofCNIVdecussatinginthesuperiormedullaryvelum(2),
Mediallemniscus(3),Laterallemniscus(4),Lateralspinothalamictract(5),Mediallongitudinalfasciculus(6),
Pontinenuclei(7),Corticospinalandcorticobulbartracts(8),Middlecerebellarpeduncle(9)

InferiorColliculus
CaudalMidbran,

Nuc.oftheinferiorcolliculus(1),Trochlearnuc.(2),Decussationofsup.cerebellarpeduncle(3),
Mediallongitudinalfasciculus(MLF)(4),Mediallemniscus(5),Laterallemniscus(6),Cerebralaqueduct(7),
Periaqueductalgray(8),Mesencephalicnuc.CNV(9),Cerebralpeduncle(10)

SuperiorColliculus
RostralMidbrain,

Nucleusofthesuperiorcolliculus(1),Cerebralaqueduct(2),Periaqueductalgray(3),Mesencephalicnuc.CNV(4),
Rednucleus(5),Oculomotornucleus(6),
EdingerWestphalnuc.(Accessoryoculomotornuc.)preganglionicparasymp.nuc.ofCNIII(7),Substantianigra(8)
Cerebralpeduncles(9),Oculomotornervefibers(10)

DiencephalonJct.
Midbrain/

Posteriorcommissure(1),Pretectalnucleus(region)(2),Medialgeniculatenucleus(3),
Lateralgeniculatenucleus(4),Oculomotornucleus(5),Rednucleus(6),Substantianigra(7),Cerebralpeduncle(8),
Medial&trigeminallemniscus(9)

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TableIV BrainstemTracts L26Dr.Shi
Images Tract Functions

Vestibulospinal Paraveterbralextensorsandproximallimbextensors(postureandbalance)

Reticulospinal ThroughgammaMNs,maintainingpostureandmodulatingmuscletone

Tectospinal Headmovementsfororientingreactions

onMNs(through interneurons)indorsolateralgraythatcontroldistallimbmuscles
Rubrospinal toMNsinnervatingproximallimbflexors(upperextremity)
(lateral) Specieslackcorticospinaltractandfinecontrolofdistalmusclesisthroughrubrospinaltract
Humansw/corticospinallesions,itprovidesremainingfunction

TableV EyeMovementLesions L26Dr.Shi

LocationofLesion Defect Image

Inabilitytolookconjugatetothecontralateralside

FrontalEyeFields(Area8)
Eyes(atrest)deviateipsilaterallybecausethecontralateral
frontaleyefieldisunopposed

Inabilitytomakeconjugateshifttoipsilateralside
CenterforLateralGaze(Paramedian
PontineReticularFormation,PPRF) Eyesperformverticalandcontralateralgazesproperly,but
cannotprogressbeyondthemidline

MedianLongitudinalFasciculus(MLF) Seeinternuclearopthalmoplegia

TableVI BrainstemLesions L29Dr.Aschenbrenner

Lesion Location(s) Structures Type CN SignsandSymptoms
Midbrain Vascular,Compression Paralysisofupwardgaze,advancedsexualmaturityatyoungage
Parinauds Pinealgland
tectum (pinealoma,hydrocephalus) duetopinealinvolvement
Midbrain Rednucleus Vascular Contralateraltremorsandhemiparesis(rednucleus)
Benedikts III
tegmentum Brachiumconjunctivum (basilara.) Abolishedlightreflex,externalstrabismus,ptosis(CNIII)
Cerebralpeduncle Contralateralfacialmusclepalsy,hypoglossalpalsy,paralysisof
Vascular(posterior
ClaudeWeber Midbrainbase Corticospinaltract III upperandlowerlimbs(CS/CBtracts,peduncle)
communicatinga.)
Corticobulbartract Abolishedlightreflex,externalstrabismus,ptosis(CNIII)
Alternatingabducensn.palsy(lat.rotationofeye)
MillardGubler Medialpons Corticospinaltract Vascular(basilara.) VI
Contralateralvoluntarymovementparalysis(CStract)
Alternatingfacialn.palsy(facialexpression)
Fovilles Lateralpons Corticospinaltract Vascular(basilara.) VII
Contralateralvoluntarymovementparalysis(CStract)
Impairmentofadductionduringvoluntarylateralgaze
Internuclear Tegmentumof Mediallongitudinal Autoimmune(MS)
Horizontalnystagmusinabductingeye
ophthalmoplegia pons fasciculus(MLF) Vascular
Adductionduringconvergenceremainsintact
Alternatinghypoglossaln.palsy(deviationoftongue)
Dejerines Medialmedulla Corticospinaltract Vascular(ant.spinala.) XII
Contralateralvoluntarymovementparalysis(CStract)
Difficultyswallowingandspeaking(nucleusambiguus,CNsIXXI)
Nucleusambiguus
Post/lat V,IX, Contralateralpain/tempsensation(latspinothalamictract)
Wallenbergs Lat.spinothalamictract Vascular(PICA)
medulla X,XI Ipsilateralfacialpain/tempsensation(spinalCNVnucleus)
Spinaltrigeminalnucleus
Ipsilateraldescendingsympathetics(Horners)
Post/lat Superiorcervicalganglion
Horners Sympathetic III Ptosis,miosis,Ipsilateralanhydrosis,enophthalmos,vasodilation
medulla Preganglionicfibers

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TableVII AreasoftheCerebralCortex L28Dr.Routh
BrodmannsAreas Lobe Area Function
Axonalfibersfromlargepyramidalneurons(Betzscells)and
smallneuronsdescendtoformthecorticospinaltract.
PrimaryMotorArea(4)
Correspondtoamotorhomonculus.
Frontal involvedwithvoluntarymotoractivity
(memory, Premotor(Cortex)Area(6) Storageofmotorpatternsandvoluntaryactivities
behavior,
emotion) FrontalEyeField (8) Eyemovements.Sendsprojectionstolat gazecenter(PPRF)
Anteriortothemotorcortexcontrollingthelipsandtongue.
BrocasArea(4445) Involvedinthemotorproductionofspeech.Projectsto
Wernickesareaviaarcuatefasciculus
Somatotopicallyrepresented,inasensoryhomonculus,in
Parietal PrimarySomatosensoryArea
thepostcentralgyrus.Somatosensoryinterpretation.
(sensory) (3,1,2)
ReceivessomatosensoryinputfromtheVPLandVPMnuclei
Processofvisualstimuli.Inputfromlateralgeniculate,and
PrimaryVisualCortex(17) projectstoareas18&19.Damageresultsinlossofvisionin
thecontralateralvisualfield.
Occipital
Damagetotheassociationcortexresultsinalossofthe
VisualAssociationCortex
abilitytorecognizeobjectsseeninthecontralateralfieldof
(18,19)
vision,mayexperienceflashoflights,stars.
PrimaryAudtioryCortex(41) Processofauditorystimuli.Inputfrommedialgeniculate
Temporal AssociativeAuditoryCortex
(expressed Assistintheprocessingofauditorystimuli
(42)
behavior,
memory Receptivespeech,languagecomprehension.Inputfrom
retrieval) WernickesArea(22,39.40) auditoryassociationcortex,visualassociationcortex,Brocas
area(viaarcuatefasciculus).
Sunkenportionofthecerebralcortex.Itliesdeepwithinthe lateralcerebralfissure and
Insular canbeexposedbyseparatingtheupperandlowerlips(opercula)ofthelateralfissure.The
insulaisboundbythecircularsulcus.
Amygdaloid(almond)body,LimbicLobe(madeupof3gyri): cingulate (girdleorbelt)gyrus,
Limbic parahippocampalgyrus,anddentategyrus.Thesegyriconcealthehippocampus(sea
(emotion) horse).Thesecomponentsformaringofcortexthatformsaborder(limbus)betweenthe
diencephalonandmorelateralcerebralhemisphere.

TableVIII WhiteMatteroftheCerebrum L28Dr.Routh

Type Fiber AreasConnected
Shortfibersliebeneaththecortexandarcharoundthebottomofthe
UFibers
sulcitoconnectadjacentgyri
Superiorlongitudinal Coursesbackwardsfromthefrontal lobetotheoccipital lobe, and
fasciculus thistractsendsfiberstotheposteriorpartofthetemporallobe.
Atthebottomofthesuperiorlongitudinalfasciculus, sweeps around
Arcuatefasciculus theregionoftheinsulaconnectingthesuperiorandmiddlefrontal
gyriwithpartsofthetemporallobe.Importantinaphasia
Associationfibers Inferiorlongitudinal
(samehemisphere) Runsfromtheoccipitaltothetemporalpoles
fasciculus
Connectstheanterior andtheinferior partsofthefrontal lobewith
Uncinatefasciculus partsofthetemporallobebyafanshapedbundleateitherendand
drawntogetherasitarchesaroundthestemofthelateralsulcus.
Principalassociationtractofthemedialaspect.Itlieswithinthe
Cingulum cingulategyrusandrunsanarchedcourseoverthecorpuscallosum
beginningbelowtherostrumandterminatingintheuncus.
Fibersfanouttoallpartsofthecortexdorsally,intersectingthe
commissuralfibersofthecorpuscallosum.Ventrally,theyconverge
uponthestriatum(caudateandputamen)andoncetheybeginto
Coronaradiate funneldownbetweenthesenuclei,thefibersarereferredtoasthe
internalcapsule.Manyfibersoftheinternalcapsulecontinuedown
Projectionfibers tothebrainsteminthecruscerebriandonintothespinalcord;some
(cortextodeeper terminateinthethalamusandbasalganglia
structures) Visualpathway canbefollowedfromthestumpoftheopticnerves
throughthechiasmandoptictracttothelateralgeniculatenucleus
Thalamicradiations andthenthroughtheopticradiationstotheprimaryvisualcortexin
theoccipitallobe.Thalamicradiationsalsocontainreciprocal
connectionsfromthecortextothethalamus.
Largestconnectingfibers.Itjoinscorrespondingareasinthe
Corpuscallosum
neocortexoftwohemispheres.Somenonhomologousfibers.
Commissural Rounded,compactbundleoffibers,whichcrossesthemidlinejust
anteriortotheanteriorcolumnofthefornixandjustbelowthe
fibers
Anteriorcommissure interventricularforamen.Itsmainpartconnectsregionsofthe
(homologousareasin
inferiorandmiddletemporalgyriwhileasmallerportion
eachhemisphere)
interconnectsolfactoryregionsonthetwosides.
Hippocampalcommissure Transversefiberswhichjointheposteriorcolumnsofthefornix
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TableIX SensoryReceptors L32Dr.Routh

Receptor
Meissnerscorpuscle
Merkelscorpuscle
Haircells
Paciniancorpuscle
Krousesendbulb
Ruffiniscorpuscle
Mech/thermnociceptors
Polymodalnociceptors
Visceralpainsystem
Type Speed Sensation Notes
Mechanical Fast Movementalongskin
Mechanical Slow Form,texture,localizestouch
Mechanical Singlehaircanbedetected
Mechanical Fast Touch,proprioception,vibration
Thermal Fast Cold(040C)
Mechanical,Thermal Slow(mech),Fast(therm) Stretch,proprioception,warmth (3050C)
Mechanical,Thermal Fast Pain(highlylocalized) ViamyelinatedAfibers
ViaunmyelinatedCfibers,inhibitedby
Mech,Chem.,Therm. Slow Pain(poorlylocalized)
enkephalinergicinterneurons
Mechanical,Chemical Stretch(e.g.distention),chemical(e.g.angina) Viadorsalrootganglionandvagusn.(X)

TableX SensoryNeurons L32Dr.Routh

Neuron Celltype CellBodyLocation Synapse Notes
Firstorder Pseudobipolar,nodendrites Dorsalrootganglia,CNganglia Spinalcord(centralprocess) Peripheralprocesstosensoryreceptor
Spinalcord,decussateinbrainstem VPLnucleus ofthalamus Trigeminals synapseinVPM nucleus
Secondorder Crossedaxons
Ascendingspinalcordtracts (*dullburningsensation) Spinothalamicdecussatesinspinalcord
Somatosensoryregionsof
Thirdorder Thalamus Viaposteriorlimbofinternalcapsule
cerebralcortex(postcentral)

TableXI CorticalSomatosensoryAreas L32Dr.Routh

Area Function Images
positionandedgedetection,size&3Dshape
Brodmanns1 perception,paincutaneousinputfromarea3band
nociceptiveandmuscleinputfromarea3a
textureperceptionslowly&rapidlyadapting
Brodmanns2
cutaneousinputfromarea3b
proprioceptionmuscleandnociceptiveafferentsvia
Brodmanns3a
thethalamus
tactileperception(shape,size,texture),vibratory
sensation,thermalsensationslowly&rapidly
Brodmanns3b
adaptingcutaneousinputviathethalamusand
nociceptiveafferentsviathethalamus
Inputfromthalamus
Secondary
ExtensivereciprocalconnectionswithSI
somatosensory
LotsoftranscallosalconnectionswithcontralateralSII

TableXII CerebellarNeurons L33aDr.Schetz

Image Neuron Activity Neurotransmitter

Purkinje Inhibitsdeepnuclei GABA

Granule ExcitesPurkinjecells Glutamate

InhibitsPurkinjecells
Basket (interneuron)
GABA

InhibitsPurkinjecells
Stellate (interneuron)

Inhibitsgranulecells
Golgi (interneuron)

TableXIII DivisionsofCerebellum L33aDr.Schetz

Division CortexArea DeepNuclei AssociatedFunctions DamageResultsin: Image
Archicerebellum Flocculi Equilibrium,coordinated Falling(ipsilateral),
Fastigial
(Vestibulocerebellular) Nodulus movementofhead/eyes Nystagmus
Stereotypedand
Paleocerebellum Vermis Fastigial(Vermis) TruncalAtaxia,
propulsivemovement
(Spinocerebellular) Int.Zones Globose,Emboliform(IZ) Drunkengait
(walking)
Dysdiadochokinesia,
Neocerebellum Lateral Coordinationoffine
Dentate Dysmetria,Ataxiaof
(Corticocerebellular) hemispheres movement
extremities,Asynergy

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TableXIV RetinalCellTypes L36Dr.Sheedlo
CellType Location Components Functions
Tightandadherentjunctions Pigmentabsorbsstraylight
Betweensensoryretinaand
RPECells Apicalprocessesenvelopoutersegmentof Development&maintenanceofretina,esp.photoreceptors
choroid
photoreceptors Phagocytizeshedoutersegments,recycleretinoids
Ciliumconnectssegments (rods&cones) SeveralrodssynapseondendritesofonebipolarneuroninINL
Throughoutretinaexceptfovea
Rod Membranousdiscsshedevery10days Releaseglutamatetonicallyindark;respondtolightby
Bodyouternuclearlayer
photoreceptors Rhodopsin11cisretinalandopsin conformationalchangeinrhodopsin,resultingin
Axonouterplexiformlayer
Mitochondriaininnersegment(rods&cones) hyperpolarizationanddecreasedglutamaterelease
Outersegmentopentosubretinalspace
Foveacentralis,fewinperiphery 1:1or2:1ratioofsynapsesonbipolarneuronsinINL
Cone Membranousdiscsshedevery30days
Bodyouternuclearlayer Opsinsrespondtolightbyconformationalchange,resultingin
photoreceptors ConepediclesynapticendinginONL
Axonouterplexiformlayer hyperpolarization
1OpsinLong(red)Med(Green),orShort(blue)
Bodyinnernuclearlayer Interneuronbetweenphotoreceptorsandganglioncells
Bipolarcells
Axoninnerplexiformlayer Canreceiveinputfromasmanyas2050photoreceptors
Bodyinnernuclearlayer Receiveglutamatergicinputfromphotoreceptors
Horizontalcells
Axoninnerplexiformlayer Sharpenedgeofvisualfieldinhibitsurroundingphotoreceptors
Amacrinecells Bodyinnernuclearlayer Noobviousaxon,highlybrancheddendrite Appeartomodulatesignalsfromphotoreceptors
Bodyganglioncelllayer Unmyelinatedaxoninretina,becomes
Ganglioncells Outputcellsofretina,2:1ratiotoconesinfoveacentralis
Axonsexitretinaatopticn. myelinatedbyoligodendrocytesinopticn.
Mullerglial Processesspanfrominnertoouterlimiting
Bodyinnernuclearlayer Structureandtrophyoftheretinalcells
cells membraneoftheretina
Astrocytes Surroundingbloodvessels Formsbloodeyebarrier

TableXV Phototransduction L36Dr.Sheedlo

Step
Conformationalchange
Activationoftransducin(T)
Activationofphosphodiesterase
DecreasedintracellularcGMP
+ +
ClosureofNa channels
Hyperpolarization
Decreasedglutamateemission
Regenerationof11cisretinalby
RPE
+ Guanylatecyclase(GC)reformscGMPfromGMP,causingchannelstoreopen
ReopeningofNa channels
Description Image
Isomerizationof11cisretinalintoalltransretinal inOSyieldsphotoexcited
rhodopsin(R*)
R*diffusesontodiskmembranewithT,catalyzesexchangeofGTPforGDP on
Tsubunit,releasingactivatedT*
T*diffusesacrossmembraneactivatingasinglecGMPPDEsubunit
HydrolyzedbyT*activatedPDE*decreasescGMPneededtokeepchannels
open
cGMPhydrolysispreventsNa channelsfromstayingopen
+
LackofNa ionflowintocellcreatesrelativenegativecharge,making
membranepotentialmorenegative
Normallyemitshighlevelsofglutamateindark,thereforeemissionisinversely
proportionaltophotonabsorption
Alltransretinal(lecithinretinolacyltransfersae)alltransretinylester
(RPE65)11cisretinol(11cisretinoldehydrogenase)11cisretinal
CarriedfromRPEtoOSofphotoreceptorsbyIRBP
andreversinghyperpolarization

TableXVI LesionsoftheVisualPathway L36Dr.Sheedlo

GrossSchema LesionSite Fibersaffected Visualdefect Image

1Opticn.anteriortoopticchiasm Allfibersfromoneeye Completeblindnessinaffectedeye

Bothnasalretinas,canbe
2Opticchiasm Bitemporalhemianopsia
causedbypituitarytumor
Ipsilateraltemporalretinaand
3Optictractpost.toopticchiasm Homonymoushemianopsia(R)
contralateralnasalretina
4Temporalportionsofoptic
Contralateralinferiorretina Superiorquadrantanopsia(R)
radiation(MeyersLoop)
5Parietalportionsofoptic
Contralateralsuperiorretina Inferiorquadrantanopsia(R)
radiation(geniculocalcarinetract)
Allfibersfromoneeyeexcept Homonymoushemianopsiawith
6VisualCortex(Area17)
frommacula(macularsparing) macularnotch

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TableXVII EyeandVisualDisorders L36Dr.Sheedlo
Disease/Lesion Cause Description VisualDefect Treatment
ColorBlindness Xlinkedrecessive 812%ofmales,99%redgreen Lackofsensitivitytocertaincolors None
nearsightedness imagefocusesinfrontof
Myopia Refractingsystemistoopowerful Concavelenses
retina
Hyperopia Refractingsystemistooweak farsightedness imageappearsbeforefocusing Convexlenses
Occurswith Curvatureoflens/corneaisgreaterinone Pointsappearmorelikeovals Correctivelenses
Astigmatism
near/farsightedness axisfootballshapedeye Lightfocusesatmorethanonepointonretina Refractivesurgery
LossofRPEpigmentgranules,detachment
AgerelatedMacular Therapiestoslow
Age fromBruchsmembrane Lossofcentralandfinevision(cones)
Degeneration(ARMD) progression
Appearspatchywhiteonfundus
Mostcommonformofjuvenilemacular
Autosomalrecessive
StargardtsDisease degeneration;yellowflecksaround Lossofcolor,central,andfinevision(cones) None
(1/20,000)
maculacalledfundusflavimaculatus
Defectivephotoreceptorsduetomutation
RetinitisPigmentosa Lossofperipheralandnightvision(rods,most)
Unknown inopsin,peripherin,orrds/peripherin None
(RP) Lossofcolorandsharpcentralvision(cones)
Oftenperipheralroddegeneration
Increasedintraocularpressure
Excessaqueoushumor
Glaucoma Lossofaxonsofretinalganglionneurons Cuppingofopticdiskleadstoblindness None
(blockage,overproduction)
Secondleadingcauseofblindnessinworld
Proliferationofvessels leakingontoretina
DiabeticRetinopathy Diabetesmellitus,VEGF Sporadic,progressivevisionlossoverbotheyes
irregularcorkscrewappearance
Tears/holesorfluid
DetachedRetina RPEpullsawayfromphotoreceptors Completevisionlossindetachedareas Vitrectomy
accumulation
Lossofmacularvisionasinoptic/retrobulbar
Scotoma Unknown Blindsportsinvisualfields None
neuritis,colorvision,reading,highacuityfunctions
Increasedintracranial Chokeddisk,swellingofopticn.head Enlargesblindspot,noinitialaffectonvisual Reductionin
Papilledema
pressure,braintumor Usuallybilateralwithnopupildefect acuity;chronicmaycauseatrophyandvisualloss pressure
Developmental,
Blurredvision,abnormalperipheralvision,
inflammation,tumor,
OpticAtrophy Opticdiskappearspink,white,orgray abnormalcolorvision,poorpupilconstriction, Irreversible
glaucoma,toxins,vitamin
decreasedbrightnessinaffectedeyethanother
deficiency,MS,syphilis

TableXVIII TheAuditoryProcess L38Dr.Routh

Structure/Area
Cochlea
Cochlearnerve&nuclei
SuperiorOlivaryComplex
Function Images
Basetransductionofhighnotes
Apextransductionoflownotes
Basilarmembranestimulatedbyfluidmovement,transmitterisglutamate
Tonotopicorganization,intensitydiscriminationviarateofafferentfiring,speech
sounds
Localizationbasedonintensityandtimeofarrivalineitherear
Descendingaffectscochlearmechanicsstiffnessofstereocilia,heightofcells

InferiorColliculus Auditoryreflexes,multisensoryintegration

Complexfeaturedetection,movingstimuli,auditoryattention,multisensory
MedialGeniculateNucleus
integration
PrimaryAuditoryCortex
Frequencycolumnslowsoundsbylateralportion,highsoundsbymedial
(Area41)
SecondaryAuditoryCortex
Partofplanumtemporale,largeronleft
(Area42)

Partofplanumtemporale,posteriorportionofsuperiortemporalgyrus
Area22

WernickesArea
Speechcomprehension
(Areas39,40)

BrocasArea(44,45) Speechexpression

Arcuatefasciculus Connectsauditoryandspeechareas

Page9of10 NervousSystemWrittenExamIITables byDMFA
TableXIX TheVestibularSystem L38Dr.Routh
Structure Function Subunits Images
Detectstiltin Macula:containshaircells,depolarizewithtilttowards striola,
Utricle
lateralplane entryofvestibularn.
Detectstiltin Macula:containshaircells,depolarizewithtiltawayfrom striola,
Saccule
vertical(AP)plane entryofvestibularn.
Ampulla:enlargementatendofduct,entryofvestibularn.
Crista:neuroepithelialridgewithhaircells,movementof
Horizontal Detectsrotation
endolymphtowardsutricledepolarizes
SemicircularCanal inlateralplane
Atrest:firingonbothsidesissame,leftorrightheadturncauses
increaseinfiringtowardsideofturn&decreaseonoppositeside
Vertical Ampulla:enlargementatendofduct,entryofvestibularn.
Detectsrotationin
Semicircular Crista:neuroepithelialridgewithhaircells,movementof
vertical(AP)plane
Canals(A&P) endolymphawayfromutricledepolarizes
Vestibulocerebella
Reflexes Eye,neck,andheadmovements
rpath

Directionofnystagmusnamedforfastphase
Vestibuloocular Reflexes(e.g.
COWS:cold=opposite,warm=same;relationshipbetweentemp
path nystagmus)
andnystagmus(coldinLear,nystagmusonR)

VPL,VPM,andposteriorthalamicnuclei
Vestibulocortical Conscious
Area3a:integratesmotorcontrolofheadandbody
path integration
Area2v:stimulationinducessensationofspinning,moving

TableXX AudiovestibularDisorders L38Dr.Routh

Disorder
Conductionlosses
Sensorineurallosses
Tinnitus
Mniresdisease
Benignpositionalvertigo
Toxicvestibulopathy
VestibularSchwannoma
(acousticneuroma)
Symptoms
Reductionofnormalconversationtoawhisper
Soundsarelouderinaffectedear,betterboneconductionthanair
Soundsaresofterinaffectedear,betterairconductionthanbone
Ringingintheears;usuallyasymptomofgreaterpathology
Severevertigo,positionalnystagmus&nausea
Dizziness,feelingoffalsemovementtriggeredbyturningoverinbed,
bendingover,orgettingupfrombentposition
Hearingloss,usuallybilateral
Dizziness,tinnitus,fullnessinoccipitalregion,progressivehearingloss,
abnormalauditoryreflexes
Cause
Otitismedia(commoninchildren)
Otosclerosis(lossofmovement)
Lossofhaircells,CNVIIIdamage,acousiticneuromas
Cochlearn.degeneration,inflammation,drugs
Increasedendolymphdistendsmembranouslabyrinth
Stimulationofsemicircularcanalbydebrisfloatinginendolymph
ETOH,aminoglycosidedrugs(gentamicin,streptomycin),salicylates
(aspirin),quinine
BenignovergrowthofmyelinatingcallsofCNVIII,commonlyat
cerebellarpontineangle

TableXXI ClassificationofANSReceptors ReviewfromMSS&L39Dr.Machu

ReceptorType Locations Action Examples
Ganglionicneurons&preganglionicsynapses + +
Cholinergic

BindAChandopenchannel LigandgatedNa /K channels(nearest

Nicotinic Adrenalmedulla
Alwaysstimulatory nerve)
Motorendplateofskeletalmuscle
Allparasympathetictargetorgans 2+ GProtein regulatedinwardlyrectifying
Stimulatory(M1,3,5)Ca releaseviaPLC,IP3 +
Muscarinic Sympathetic:smoothmuscle(bloodvessels)
Inhibitory(M2,4)cAMPreleaseviaadenylcyclase
K channel(GIRK)
andglandularsecretion Ruleofthumbcontractsmoothmuscle
Constrictsbloodvessels andvisceralorgan
Bloodvessels Ruleofthumbconstrictssmooth
1 Allsympathetictargetsexceptheart
sphincters nd
muscleviaIP3as2 messenger
Dilatespupils
Membranesofadrenergicaxonterminals Mediatesinhibitionofnorepinephrinerelease
2
nd
UsescAMPas2 messenger
Bloodplatelets Promotescoagulation
Adrenergic

Increases heartrate (+chronotropic)andstrengthof

Mostlyheartandcoronaryvessels contraction(+inotropic)
1
nd
UsescAMPas2 messenger
Kidneys,liver,adiposetissue Dilatescoronaryarterioles
Stimulatesreninreleasefromkidneys
Stimulatesinsulinsecretionfrompancreas
Lungs Ruleofthumbrelaxessmoothmuscle
Dilatesbloodvesselsandbronchioles
2
+
Mostsympathetictargetorgans StimulatesK uptake(hyperpolarization)
Relaxessmoothmusclewallsofviscera,uterus nd
Coronaryvessels UsescAMPas2 messenger
Liverglycogenolysis,pancreaticinsulinrelease
3
nd
Adiposetissue Stimulateslipolysis UsescAMPas2 messenger

Page10of10 NervousSystemWrittenExamIITables byDMFA
TableXXII ComparisonofAutonomicNervousSystem L39Dr.Machu
Parasympathetic Attribute Sympathetic
Craniosacral SpinalLevel Thoracolumbar
Digestion,defecation, Exercise,excitement,
OutflowsandGanglia Roles OutflowsandGanglia
dieresis emergency,embarrass
BP,HR,andRR HR,skincold&sweaty
Appearance
warmskin,smallpupils Largepupils
LongpreG,shortpostG FiberLength ShortpreG,longpostG
Locationof
Wallsofeffectororgans Closetospinalcord
Ganglia
Effects
Constrictspupil Irisofeye Dilatespupil
Bulgeslens
Ciliarym.ofeye
(accommodation)
Eye,visceral Inhibitssecretion,
Stimulatessecretion
glands vasoconstrictionofglands
Stimulatessweating
Sweatglands
(muscarinic)
Stimulatesepinephrine,
Adrenalmedulla
norepinephrinesecretion
Stimulatescontraction
Erectorpilimm.
(goosebumps)
Decreasesrateandforce Cardiacmuscle Increasesrateandforce
Coronaryvessels Constricts(1),dilates(2)
Contractsbladderwall, Relaxesbladderwall,
relaxessphincter Bladder,urethra constrictssphincter
(urination) (urination)
Dilatesbronchioles,mildly
Constrictsbronchioles Lungs
constrictsbloodvessels
Increasesmotilityand Decreasesmotilityand
secretion,relaxes Digestivetract secretion,constricts
VisceralReflexes(Para&Symp) sphincters(digestion) sphincters(e.g.anus) SympatheticTrunks&Pathways
Liver Stimulatesglycogenolysis
Stimulatesbilesecretion Gallbladder Inhibitsbilesecretion
Vasoconstriction,urine
Kidney
output,reninformation
Erection(vasodilation) Penis Ejaculation
Reverseperistalsis
Erection(vasodilation) Vagina/clitoris (contraction),mucus
secretion
Vasoconstriction,BP,
Little/noeffect
diversionofbloodto
Dilationviamuscarinic Bloodvessels
muscle,brain,andheart,
NOpathway
vasodilationinskeletalm.
Bloodcoagulation Stimulates
Cellmetabolism Stimulates
Adiposetissue Stimulateslipolysis
Mentalactivity Increasesalertness