Post on 03-Feb-2022
AJ CastroEJ Neafsey
Loyola University of ChicagoStritch School of Medicine © 2007
About this Manual.This laboratorymanual isalsoprovidedonacompact
discthat containsseveralbuttonsthatprovideadditional informationnot included
intheprintedversion, e.g., labels tovarious figures,hints tovariousclinicalcasequestions,
links to websites thatprovideanswers toquestions, linkstotheRandAtlases,etc.
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Introduction
Neuroanatomy is easy.Learningneuroanatomyisdifficult.“Whyis thisso?”...youask.
First,because it isanewvocabulary.Second,becausenomatterwhereyoustart,youarealwaysreferring topartsof thebrainyouhaven’t studiedyet.Third,becausestudentsalmost invariably“fail tosee theforest forthetrees,” losingsightof the important relationsbyfocusingonunimportant, trivialdetails.
This laboratorymanualemphasizesimportantfactsyoushouldknow.Examplesof important facts includethemainsensoryandmotorpathwaysand
systems, suchas thedorsalcolumn/medial lemniscalpathway, thevisualpathway,andthecorticospinalpathway.Other important topics includeunderstandingtherelationof thecerebellumandbasalganglia to therestof themotorsystem.
Examplesofunimportant facts include thenamesofthe tenor twelvedifferent raphenuclei, theexact locationof thespino-olivaryfibers in thespinalcord,andthe locationof
thefrenulum.Ifyouspendaminutestudyingtheselast three items,youhavenotonly
wastedyour timebuthaveactuallyseriouslyhinderedyour learningof theessentialsby
fillingyourmind,whichhasafinitecapacity toabsorbnewinformation,with trivia.Do
notdothis.Ratheralwaysstrive tokeepthebigpictureandtheoverallpatternbeforeyou.
AnimportantnoteaboutSelf-StudyLab1.Lab1isaself-studylabsession...forseveralreasons.Muchof thematerial, suchasgeneralanatomical
nomenclature andthe gross topographyof thebrainandspinalcord isquitebasicandstraightforward.Also,muchof thismaterial,e.g., thegrossanatomyof thevertebralcol-umnandspinalcord,blood-supply to thebrain,etc., hasbeencovered inpreviouscoursework.Additionally,manyof thestructurescoveredsuchas themeningesandbloodves-selsaregenerallypoorlypreservedormissing in thespecimensavailableforstudy.Accordingly,youshouldreadandstudythis first labexerciseprior to thesecondlabses-sionwheninstructorswillbepresent toreviewthematerialandanswerquestions.
Learning Neuroanatomy
Thismanual includessevenlaboratorysessions.Eachsession includesseveralsectionsorcomponents.Workingingroupsof four, studentsareexpectedtowork
theirwaythroughthesecomponents.Laboratory instructorswillassist.Weacknowledgethatsomeofthematerial in the earlylabsessions ispresentedwellbeforeyouhave learnedsufficient informationtoanswerrelatedquestions.Don'tbediscouraged.Don't let thisalarm(unnerve?)you.Ourobjective is toshowyouwhereyouaregoing,whatyour finaldestina-tion is,howfundamentalknowledgeabout thebrainisactuallyusedclinically.Evenifyouarenot thereyet,somesenseofyourultimategoalisuseful.Gobackto thematerial inearlysessionsas thecourseprogressesandamazeyourselfwithall thatyouhave learned.Allwhohavegonebeforeyouagreethat thiswillhappen.
LesionLessons.Pathological imagesarepresentedatthebeginningofeachlaborat o-ryexercise.Studentsareexpected toanswerthreequestionsforeachlesion lesson:
(i) locationof lesion; (ii)signsorsymptomsassociatedwith thepathology;and(iii)causeofthepathology.TheseLesionLessonswill serve tofocusyourattentiononthesubsequentneuroanatomicalmaterialpresented in the labsessionaswellas inotheraspectsof thecourse,i.e., lectureandsmallgroupsessions. In thebeginningof thecourse, asyouslowlybecomefamiliarwith thesubjectofNeuroscience, theLesionLessonsare likely toappeardifficultanddaunting.That’s OKandtobeexpected.Besmart... gobackto theselesions timeandagain,perhapsbefore thenext labsession,andyouwill readilyseehowyourknowledge israpidly increasing.
Wetlabs. In thepertinent"wet" labsessions,youwillusegrossbrainspeci-mens,MRIfilmsandmodelsaswellasvariousimages inyourlabguide to
studysuperficialanatomy.Thesetopicswillalsobecoveredinmanylecturepresentationsaswellas insmallgroupsessions.Links to theRandAtlas inyourCD-basedlabguidewillbeveryuseful.
Manual layout
InternalAnatomy.Three"dry" labsessionsfocusontheinternalanatomyof theCNS.Athoroughstudyisessential todevelopinganunderstandingofmuchofneuro-science.Histologicalimagesareprovidedinyour labguide.Studiesof these imagesarefacilitatedbyuseof theRandAtlas,yourcourse textbookaswellasthemanybrainatlasesthathavebeenpublished.Student labelingof thecross-sectional figures isconsideredessential tosuccessonlaboratoryexaminations.
CaseBreaks.Clinicalcasebreaksare interspersed in the labsessions.Theseareintendedtoemphasizetheclinicalrelevanceof neuroanatomy.Fromthebriefclini-
calvignettespresented,youaretoreasonto theunderlyingcauseorclinicalcondition.Thisapproachstands incontrast to theLesionLessonswhereyoudeducefromtheneuropatholo-gytotheclinicalcondition.The“intercoursequestions”are intendedtoprovide integrationacrossdisciplinesofstudy.
ReviewQuestions.Asimplied thesequestionsare intendedtoreviewyourlaborato-ryknowledge,butalsoandveryimportantly they shouldhelp integrate thisknowl-
edge intoallaspectsof thecourse. In thiswaytheyserve toreviewmore thanthelabmateri-al.Returningbacktothesequestionsfromtimetotimewill serveasagaugeofyourprogressinunderstandingneuroscience.
MRICorrelations.Animportantaspectofneurology,andperhaps ofallclinical fields, isa familiarityofMRIimages.Theidentificationofbrainstruc-
ture fromMRIimages,asderivedfromyourstudyof thegrossbrainandinternalanatomy,isconsideredespecially relevantclinically.Links to theRandAtlaswillbemostuseful.
PatientPuzzles.Presentedat theendof the labsessions,mostof thesearebeststudiedfromtheCDastheycontainmovieclipsof patients.Generally, theseclips
areselected todemonstratephysician-patient interactions indemonstratingclinical signs.Like theCaseBreaks, thesecases testyourknowledge indiagnosing clinicalconditionsfromthesignsandsymptomspresented.
Manual layout (cont'd)
ContentsIntroduction
Lab I. Gross Brain & Spinal Cordand Blood Vessels
Lab II. Spinal Cord and Brain Stem
Lab III. Medulla
Lab IV. Pons and Midbrain
Lab V. Cerebral Hemispheresand Cerebellum
Lab VI. Diencephalon and Basal Ganglia
Lab VII. Limbic System and Ventricles
Additional Exercises
Lab 1. Spinal cord & Gross BrainLesion Lessons1.1. Malcom Tent1.2. Vito Powers1.3. Neal Sporin
IntroductionGeneral Topography of the BrainBrain StemCase BreakHead-On Crash
External Anatomy of the Spinal CordVertebral ColumnSpinal Cord
Review of Major Blood VesselsBlood Supply of the BrainInternal Carotid Artery (Anterior Circulation)Vertebral Arteries (Posterior Circulation)Basilar Artery
Blood Supply to the Spinal CordCase BreakDoris Locht – Secretary Headache
Meninges of the BrainDural Septae
Other Meninges-Related DescriptionsVenous SinusesSpinal Cord MeningesBrain Stem and CerebellumMidbrainPonsMedulla (oblongata)Spinal Cord
Review Questions – Meninges Gross Brain and Blood VesselsReview Questions – Brain Stem and Spinal CordMRI CorrelationPatient PuzzleOllie Hoop – The case of fluttering muscles and foot drop
Lab 2. Spinal Cord & Brain StemLesion Lessons2.1. Holli Penya2.2. Pete Zapasta2.3. Harla Quinn2.4 Justin Tyme
Detailed Contents
Internal Anatomy of Spinal CordGray MatterWhite Matter
Cervical CordThoracic CordLumbar CordSacral and Coccygeal Cord
Spinal Cord Review ExerciseCranial NervesGross Anatomy of Brain StemDiencephalonMidbrain (Mesencephalon)PonsCerebellumMedulla (Myelencephalon)Floor of the Fourth Ventricle
Case BreakAllyn Rench – Window Washer Fall
Case BreakPhil N. Troepik – Aorta Surgery
Review ExerciseMRI CorrelationReview QuestionsReview ExercisePatient PuzzleSara Bellum – The case of tingling feet
Lab 3. MedullaLesion Lessons3.1. Mike Rowmeter3.2. Anne Chovee
Spinomedullary JunctionMedullary Level of the Pyramidal (Motor) DecussationMedullary Level of the Sensory DecussationMedullary Level of the Vagus NerveMedullary Level of the Glossopharyngeal NerveCase BreakDewey Dessmul – An old man is spinning
Medullary Level Showing Deep Cerebellar NucleiReview QuestionsMRI CorrelationPatient PuzzleRusty Bell – An unsteady young boy
Detailed Contents (cont’d)
Detailed Contents (cont’d)Lab 4. Pons & MidbrainLesion Lessons4.1. Anne T. Pasta4.2. Colin S. Terase
Pontine level of the Facial GenuBasilar PonsPontine Tegmentum
Case BreakWillie Maykitt – Double vision
Pontine Level of the Trigeminal Motor Nucleus
Case BreakPenny Pinscher – Cheek pain
Level of the Isthmus and Trochlear NerveMidbrain Level of the Inferior ColliclusMidbrain Level of the Superior ColliculusMidbrain Level of the Red NucleusMidbrain-Diencephalon TransitionReview QuestionsMRI CorrelationPatient Puzzle4.1. Al Fresco is seeing double
Lab 5. Cerebral Hemispheres & CerebellumLesion Lessons5.1. Manny Festo5.2. Phil Abuster
Cerebral HemisphereFrontal LobeParietal LobeTemporal LobeInsulaOccipital LobeMedial Aspect of the Half BrainBroadmann NomenclatureCerebellumCerebellar PedunclesCase breakLiz Tureen – Drops and sways
Study Questions – Cerebral CortexStudy Questions – CerebellumMRI ReviewPatient PuzzleSam Anella is a clumsy guy
Detailed Contents (cont’d)Lab 6. Diencephalon & Basal GangliaLesion Lessons6.1. Lou Zur6.2 Jean Poole6.3. Ann Jyna
Midbrain-Diencephalon TransitionCase BreakBilly Club – Headache and falling
Caudal ThalamusLevel of the Centromedian NucleusCaudal Mid-Thalamic LevelMid-Thalamic LevelCase BreakAustin Tayshis – Right-sided numbness
Level of the Lenticular FasciculusLevel of the Ventral Anterior and Anterior Thalamic NucleiRostral Thalamic LevelBasal Ganglia and Ventral StriatumSeptum PellucidumGenu and Rostrum of Corpus CallosumReview questionsMRI CorrelationPatient Puzzle6.1. Anna Conda bumped her head
Lab 7. Limbic System & VentriclesLesion lessons7.1. Moe Bedder7.2 Happy Teecher
Rhinencephalon and Ring of Limbic CortexCoronal (Frontal) Gross Brain SectionsCoronal MRI (T2) SeriesHorizontal (Axial) SectionsHorizontal (Axial) MRI (T1) SeriesVentriclesReview QuestionsPatient Puzzle7.1. Ray Gunn, a real pain in the neck
Additional Exercises