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Astrocytes:
Role
Physical support, repair, K+ metabolism

Removal of excess NT, maintain BBB

Reactive gliosis in response to injury

Marker: GFAP
Microglia:
Role
CNS phagocytes

Scavenger cells of CNS; respond to tissue damage by differentiating into large phagocytic cells

HIV-infected microglia fuse to form multinuc'd giant cells in CNS
Oligodendroglia:
Role
Each oligodendroglia myelinates multiple CNS axons

Destroyed in MS

Look like fried eggs

Predominant in white matter
Oligodendroglia
Schwann Cells:
Role
Each Schwann cell myelinates only 1 PNS axon

Promote axonal regeneration

Derived from Neural Crest

Destroyed in Guillain-Barre SYndrome
Acoustic neuroma = type of schwannoma
CNS/PNS embryologic origins
Neruoectoderm--CNS neurons, ependymal cells (line ventricles, make CSF), oligodendroglia, astrocytes

Neural Creast: Schwann cells, PNS neurons

Mesoderm--Microglia, like Macs, originate from Mesoderm
Free nerve endings:
Fiber type
Location
Role
C fibers--slow, unmyelinated

Adelta--fast, myelinated

Located in skin, some viscera

Sense pain and temp
Meissner's corpuscles:
Fiber type
Location
Role
Large, myelinated fibers

Located in glabrous (hairless) skin

Sense position, fine touch (manipulation), adapt quickly
Pacinian corpuscles:
Fiber type
Location
Role
Large, myelinated fibers

Deep skin layers, ligaments, joints

Sense vibration, pressure
Merkel's disks:
Fiber type
Location
Role
Large, myelinated fibers

Located in hair follicles

Sense position, static touch (shapes, edges, textures), adapt slowly
What is the difference between a slowly adapting and a rapidly adapting receptor?

Give examples of each.
Slow adapting--sends continuous signal throughout continuous stimulus

Ex: Merkel cells, Free nerve endings

Rapidly adapting--sends electrical signal only at beginning and end of a continuous stimulus

Ex: Meissner corpuscles, Pacinian corpuscles
Which sensory receptor:
Pricking pain (fast, myelinated)
A-delta fibers
Which sensory receptor:
Burning or dull pain and itch (slow, unmyelinated)
C fibers
Which sensory receptor:
Receptor for cold sensation
A-delta
Which sensory receptor:
Receptor for warm sensation
C fibers
Which sensory receptor:
Vibration and pressure
Pacinian corpuscle
Which sensory receptor:
Dynamic/changing light, discriminatory touch
Meissner corpuscle
Which sensory receptor:
Static/unchanging light touch
Merckel's disks
Which sensory receptor:
Proprioception information - muscle length monitoring
Muscle spindle
Which sensory receptor:
Proprioception information - muscle tension monitoring
Golgi tendon organ
Which sensory receptor:
Resembles an onion in cross section
Pacinian corpuscle
Which sensory receptor:
Robust spindle-shaped structures found particularly on the soles of the feet
Free nerve endings (Ruffini endings)
Which sensory receptor:
Found only in areas of skin without hair (fingertips, lips, eyelids, etc.)
Meissner Corpuscles
Which sensory receptor:
Simplest sensory receptor thought to be pain receptor or thermoreceptors
Free nerve endings
Which sensory receptor:
Touch receptor that is tough to distinguish from melanocytes
Merkel Cells
Which nervous system cell:
Look like fried eggs under histologic staining
Oligodendroglia
Which nervous system cell:
Form multinucleated giant cells in the CNS when infected with HIV
Microglia
Which nervous system cell:
Myelinates multiple CNS axons
Oligodendroglia
Which nervous system cell:
Myelinates one PNS axon
Schwann Cell
Which nervous system cell:
Damaged in Guillain-Barre syndrome
Schwann Cell
Which nervous system cell:
Damaged in multiple sclerosis
Oligodendroglia
Which nervous system cell:
Macrophages of the CNS
Microglia
Which nervous system cell:
Cells of the blood brain barrier
Astrocytes
NE:
Site of production
Relevant diseases
Made in locus ceruleus

Elevated in anxiety/mania
Dec'd in depression
DA:
Site of production
Relevant diseases
Ventral tegmentum and SNc

Inc'd in schizophrenia
Dec'd in PD
Dec'd in Depression
What are the 4 dopaminergic pathways and what is the result of blocking each pathway?
Mesocortical--inc'd negative syx of psychoses (social withdrawal, depression)

Mesolimbic: Relief of psychosis (positive syx)

Nigrostriatal: PD syx (stimulation would result in extrapyramidal side effects)

Tuberoinfundibular PW: Inc in release of PL from pituitary-->amenorrhea, gynecomastia, galactorrhea
What disorder is thought to arise from reduced NE activity?
Depression
What disorder is thought to arise from increased NE activity?
Anxiety, mania
5HT:
Site of production
Relevant diseases
Raphe nucleus

Dec'd in anxiety
Dec'd in depression
Acetylcholine:
SIte of production
Relevant diseases
Basal nucleus of Meyert

Dec'd in AD
Dec'd in HD
Dec'd in REM sleep
GABA:
Site of production
Relevant diseases
Nucleus accumbens

Dec'd in ANX
Dec'd in HD
What is required for the synthesis of GABA?
Pyridoxal phosphate (Vit B6)
Which nucleus of the hypothalamus:
Considered the "master clock" for most of our circadian rhythms
Suprachiasmic Nuc
Which nucleus of the hypothalamus:
Regulates the parasympathetic NS
Anterior and preoptic nuclei
Which nucleus of the hypothalamus:
Destruction results in hyperthermia
Anterior and preoptic nuclei
Which nucleus of the hypothalamus:
Regulates the sympathetic NS
Posterior and lateral nuc
Which nucleus of the hypothalamus:
Produces antidiuretic hormone (ADH) to regulate water balance
Supraoptic nucleus
Which nucleus of the hypothalamus:
Mediates oxytocin production
Paraventricular Nuc
Which nucleus of the hypothalamus:
Receives input from the retina
Suprachiasmic Nuc
Which nucleus of the hypothalamus:
Savage behavior and obesity result from stimulation
Dorsal medial nuc
Which nucleus of the hypothalamus:
Savage behavior and obesity result from destruction
Ventromedial nuc
Which nucleus of the hypothalamus:
Stimulation -->eating destruction -->starvation
Lateral nuc
Which nucleus of the hypothalamus:
Regulates the release of gonadotropic hormones (i.e,. LH and FSH)
Preoptic nuc
Which nucleus of the hypothalamus:
Responsible for sweating and cutaneous vasodilation in hot temperatures
Anterior and preoptic nuc (responsible for parasympathetic NS)
Which nucleus of the hypothalamus:
Responsible for shivering and decreased cutaneous blood flow in the cold
Posterior and lateral nuc (responsible for sympathetic NS)
Which nucleus of the hypothalamus:
Destruction results in neurogenic diabetes insipidus
Supraoptic nuc (produces ADH)
Which nucleus of the hypothalamus:
Destruction results in inability to stay warm
Posterior and lateral nuc
Which nucleus of the hypothalamus:
Releases hormones affecting the anterior pituitary
Arcuate nuc
Where in the hypothalamus does leptin act?

What is its effect?
Leptin inhibits lateral area, inhibiting hunger

Leptin stimulates the ventromedial nucleus, inducing satiety.
Neurohypophysis:
Embryonic origin
Hormones
ADH, oxytocin

Neuroectoderm

Remember A-denohypophysis = A-nterior
What part of thalamus:
Somatosensory from body (via medial lemniscus and spinothalamic)
VPL nuc
What part of thalamus:
Communications with prefrontal cortex; memory loss results if destroyed
Medial dorsal nuc
What part of thalamus:
Cerebellum (dentate nucleus) and basal ganglia-->motor cortex
VL nuc
What part of thalamus:
Trigeminothalamic and taste pathways to somatosensory cortex
VPM nuc
What part of thalamus:
Retina --> occipital lobe
Lateral geniculate body
What part of thalamus:
Basal ganglia --> prefrontal, premotor, and orbital cortices
Ventral Anterior Nuc
What part of thalamus:
Mamillothalamic tract --> cingulate gyrus (part of Papez circuit)
Anterior Nuc
What part of thalamus:
Integration of visual, auditory, and somesthetic input
Pulvinar nuc
What part of thalamus:
Dentate nucleus and basal ganglia --> supplementary motor cortex
VL nuc
What part of thalamus:
(Auditory info) brachium of inferior colliculus --> primary auditory cortex
Medial geniculate body
What are the deep nuclei of the cerebellum? (In order)
Don't eat greasy foods:

Going from lateral to medial:
Dentate
Emboliform
Globose
Fastigial
What are the longitudinal zones of the cerebellum starting with the most medial?
Vermis
Intermediate (paravermal) zones
Lateral hemispheres (cerebrocerebellum)
Describe the general flow of information through the cerebellum.
Inputs (mossy and climbing fibers)
-->Cerebellar cortex
-->Purkinje fibers
-->Deep nuclei of cerebellum (Dentate, Emboliform, Globose, Fastigial)
-->Output targets
What structure provides the major output pathway from the cerebellum? Where does it go to?
Superior Cerebellar Peduncle-->Contralateral VL of thalamus
Based on the primary source of information brought into the cerebellar cortex, which cerebellar region is referred to as:
Vestibulocerebellum

To which deep nucleus does this region project?
Vestibulocerebellum-->Flocculonodular lobe and vermis-->Fastigial
Based on the primary source of information brought into the cerebellar cortex, which cerebellar region is referred to as:
Spinocerebellum

To which deep nucleus does this region project?
Spinocerebellum-->Vermis and paravermal regions-->Fastigial and interposed nuclei
Based on the primary source of information brought into the cerebellar cortex, which cerebellar region is referred to as:
Cerebrocerebellum

To which deep nucleus does this region project?
Cerebrocerebellum-->Lateral hemispheres-->dentate nucleus
Motor control on which side of the body would be affected with a lesion on one side of the cerebellar hemisphere?
Motor control ipsilateral to side of lesion would be affected because cerebellum-->contralateral thalamus-->cortex-->corticospinal tract-->body contralateral to cortex

i.e., decussate after cerebellum
What neurological abnormalities can be attributed to damage of the spinocerebellum?

What regions comprise the spinocerebellum?
Lesion spinocerebellum-->Postural instability, slurred/slow speech, hypotonia, pendular knee jerk reflexes

Spinocerebellum = vermis, paravermis
What symptoms are seen in anterior lobe (cerebellar) syndrome?

What is the most common cause of anterior lobe syndrome?
Anterior lobe = anterior vermis syndrome

Most anterior portion fo vermis belongs to legs.

Results in ataxia/dystacia of legs, even when trunk is supported-->broad-based, staggering gait

Causes:
Chronic EtOH-->Thiamine def-->degeneration of cerebellar cortex starting at anterior lobe
What neurological deficits can be attributed to damage of the cerebrocerebellum?

What region comprises that cerebrocerebellum?
Cerebrocerebellum = lateral hemisphere

Lesion results in:
Lack of coordination of vol mvmts (timing, and rate of mvmt)

Delays in initiating and trouble stopping mvmts

Dysmetria--impaired ability to control speed, power of a mvmt

Intention tremor
Essential tremor vs Resting tremor vs Intention tremor:
General
Essential tremor--family Hx tremor; occurs w/mvmt and at rest

Resting tremor--a/w PD, disappers w/voluntary mvmt

Intention tremor--a/w cerebellar damage, appears only with voluntary mvmts
What neurological deficits can be attributed to damage of the vestibulocerebellum?

What regions comprise the vestibulocerebellum?
Vestibulocerebellum = vermis and flocculonodular

Lesion results in disequilibrium, abnl eye mvmts (cerebellar nystagmus more pronounced when pt looks to side of lzn)
What is the most common cause of damage to the flocculonodular lobe?
Medulloblastoma in childhood
Draw the basal ganglia circuit.

Include indirect and direct pathways.
What disease is associated with degeneration of the basal nucleus of Meynert?
Dec'd ACh-->AD
Chorea:
Patphoys
Basal ganglia lesion-->sudden, jerky, purposeless mvmts
Athetosis:
Pathophys
Presentation
Slow, writhing movements, esp of fingers

Char of basal ganglia lesion (HD for ex)
What arteries supply the basal ganglia?
Lenticulostriate arteries ("arteries of stroke") from MCA
Parkinson's Disease:
Histologic Hallmarks
Pathophys
Presentation
Degenerative disorder associated with LEWY BODIES and depigmentation of SN pars compacta; loss of DA neurons

Presentation: TRAP
Tremor at rest (pill-rolling)
Cogwheel rigidity
Akinesia
Postural instability
L-dopa:
MOA
Use
AE
Inc'd DA in brain, unlike DA, l-dopa crosses BBB and is converted by dopa decarboxylase in CNS to dopamine

Use in PD

AE: arrhythmia from peripheral conversion to DA
How can AE of L-dops be avoided?
Administer carbidopa, a peripheral decarboxylase inhibitor, to inc biovailability of L-dope in brain and to limit peripheral side effects (arrhythmias)
What strategy is employed in the treatment of Parkinson's?

How are essential tremors treated?
BALSA

Agonize DA receptors (Bromocriptine)
Increase DA: Amantadine (may inc DA release)
Prevent DA breakdown: Selegiline
Curb excess ACh activity: Benztropine (Park your Benz)

For essential tremors, use beta-blocker (e.g., propranolol)
Selegiline:
MOA
Use
Selectively inhibits MAO-B which preferentially metabolizes DA over NE, and 5-HT, thereby increasing availability of DA.

Use: adjunctive agent to L-dopa in tx of PD.
Hemiballisumus:
Pathophys
Presentation
Sudden, wild flailing of 1 arm ±leg

Characteristic of contralateral subthalamic nucleus lesion (lacunar stroke from HTN)
Huntington's Disease:
Pathophys
Presentation
Expansion of CAG repeats (anticipation)

Caudate loses ACh and GABA

Presents with chorea, aggression, depression, and dementia (sometimes mistaken for substance abuse)
Sensory/motor effects of ACA lesion.
ACA supplies leg/foot of homunculus. Will lose sensation and motor innervation to leg/foot of CONTRALATERAL SIDE
Sensory/motor effects of MCA lesion.
Mouth/Hand

Hand of opposite side obvs
Broca's Aphasia:
Presentation
Cause
Nonfluent aphasia with intact comprehension
Lesion to MCA

Broca's Broken Boca
Wernicke's Aphasia:
Presentation
Cause
Fluent aphasia with impaired comprehension--word salad

Wernicke's = What?

Lesion to MCA
Global Aphasia:
Presentation
Cause
Nonfluent aphasia with impaired comprehension; both Broca's and Wernicke's areas affected

Lesion to MCA
Conduction Aphasia:
Presentation
Cause
poor repetition but fluent speech, intact comprehention

Lesion to arcuate fasciculus--connects Broca's, Wernicke's areas

Can't repeat phrases such as "No ifs, ands, or buts."
Lesion to what brain area:
Contralateral hemiballismus
Subthalamic Nuc
Lesion to what brain area:
Eyes look away from the side of the lesion
PPRF
Lesion to what brain area:
Paralysis of upward gaze
Superior Colliculi
Lesion to what brain area:
Hemispatial neglect syndrome
Non-dom parietal lobe (most commonly Right)
Lesion to what brain area:
Coma
Reticular activating system (involved in arousal, wakefulness)
Lesion to what brain area:
Poor repetition
Arcuate fasciculus--conduction aphasia
Lesion to what brain area:
Poor comprehension
Wernicke's
Lesion to what brain area:
Poor vocal expression
Broca's
Lesion to what brain area:
Resting tremor
SN pars compacta
Lesion to what brain area:
Intention tremor
Cerebeller hemisphere
Lesion to what brain area:
Hyperorality, hypersexuality, disinhibited behavior
b/l amygdala
Lesion to what brain area:
Personality changes
Frontal Lobe
Lesion to what brain area:
Dysarthria
Cerebellar vermis
Lesion to what brain area:
Agraphia and acalculia
Dominant parietal lobe (commonly left)
A patient with a cortical lesion is unaware of his neurologic deficiency.

Where is the lesion?
Hemispatial neglect:

Non-dominant parietal lobe (most commonly left)
Lesion to what brain area:
Eyes look toward the side of the lesion
Frontal Eye Fields
What are the most common causes of brain tumors?
MGM Studios
Mets
Glioblastoma Multiforme
Meningioma
Schwannoma
Glioblastoma Multiforme:
Characteristics
Most common primary tumor
Grave prognosis

Stains for GFAP
Pseudopalisading appearance on histology--border central areas of necrosis and hemorrhage (waterfall appearance)
Glioblastoma multiforme--pseudopalisading malignant tumor cells (waterfall-like) surrounding necrosis

most common primary tumor
Meningioma:
Characteristics
2nd most common primary brain tumor. Arises from arachnoid cells.

Contain psammoma bodies (laminated calcifications--rings on a tree appearance)
Schwannoma:
Characteristics
Schwann cell origin; often lozalized to CN VIII-->acoustic schwannoma. Resectable.

B/l Schwannoma?-->NF2

S100 positive
What does Rathke's pouch give rise to?
Anterior pituitary
What is the most common primary brain tumor of children?
Astrocytoma
Craniopharyngioma:
Characteristics
Benign childhood tumor, confused w/pituitary adenoma (can also cause b/l hemianopia)

Most common childhood supratentorial tumor

Derived from Rathke's pouch

CALCIFICATION is common (tooth enamel-like)
What are the most common brain tumors in adults?

In children?
Adults: MGM Studios
(Mets)
Glioblastoma multiforme
Meningioma
Schwannoma

Kids:
Pilocytic astrocytoma
Medulloblastoma
Ependymoma
Which primary brain tumor:
Pseudopalisading necrosis
Glioblastoma multiforme
Which primary brain tumor:
Polycythemia
Hemangioblastoma
Which primary brain tumor:
Neurofibromatosis II
Schwannoma
Which primary brain tumor:
a/w von Hipple-Lindau syndrome
Hemangioblastoma
Which primary brain tumor:
Foamy cells, high vascularity
Hemangioblastoma
Which primary brain tumor:
Prolactinemia ~ galactorrhea, amenorrhea, anovulation
Pituitary adenoma
Which primary brain tumor:
Psammoma bodies
Mengioma
Which primary brain tumor:
Fried-egg appearance
Oligodendrioglioma
Which primary brain tumor:
Perivascular pseudorosettes
Ependymoma
Which primary brain tumor:
Bitemporal hemianopia
Pituitary Adenoma
Craniopharyngioma
Which primary brain tumor:
Worst prognosis of any primary brain tumor
Glioblastoma multiforme
Which primary brain tumor:
Child with hydrocephalus
Medulloblastoma
Ependymoma
Which primary brain tumor:
Homer-Wright pseudorosettes
Medulloblastoma