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DisordersoftheBasalGanglia L33bDr.Schetz
Disorder Defect Signs&Symptoms Treatment
1.muscarinicanticholinergics(usefulinearlystages)inhibitorydopaminergic
controlofcholinergicinterneuronsinstriatumislostinPDandblocking
muscarinicreceptorspreventstheoveractivityofthecholinergicinterneurons.
2.Levodopa(LDOPA)adopamineprecursorthatrestoresthelostdopamine.
lossofdarklypigmented Tremor,cogwheelrigidity,
dopaminergicneuronsinthe akinesia,abnormalposture, Givenincombinationwithcarbidopa(anperipheralAAADinhibitior)sothatL
substantianigraparscompactis(SNc, expressionlessface,slow DOPAisnotconverttodopamineintheperiphery.
Parkinsonss nigrostriatalpathway monotonousspeech, 3.Amantadineanantiviralagentthatalsoactsasaweakantiglutamatergic
micrographia (reducescorticalglutamatergicexcitation)
inhibitionofthalamuswhichcauses 4.selegilineanMAOBinhibitorthatprolongstheactionsofdopamine,by
underexcitementofmotorcortex Nomentaldeficit preventingisdegradation.
5.pallidotomylesioningoftheGPi(reducesexcessiveinhibitionofthethalamus
bythisnucleusinPD,whichresultsinenhancedstimulationofthecortex)
6.Lesioningofthesubthalamicnucleus.
lossofstriatalGABAergic(andsome choreaformmovements(rigidity
cholinergic)neuronsinthecaudate
ifearlyonset),cognitive
andputamen(striatonigral
Huntingtons dysfunction, None
pathwaySNr)
Autosomaldominant,CAGtriple psychiatricdysfunction(often
repeatsonChr4,onset3545yrs depression)
Contralateralinvoluntaryand
Hemiballism Lesionofsubthalamicnucleus Spontaneouslyresolvesafterseveralweeks
violentflailingmovements
BasalGangliaandExtrapyramidalStructures L33bDr.Schetz
Structures Inputsfrom Outputs to Image
GPe GABA,inhibitory
Cortexglutamate(+)
SNrGABA,inhibitory
Caudatenuclei SNcdopamine(D1)(+),direct
BasalGanglia
InterneuronsACh(muscarinic),(+)
Striatum
SNcdopamine(D2)(),indirect
InterneuronsGABA()(95&)
GPe GABA,inhibitory
Cortexglutamate(+)
Putamen SNrGABA,inhibitory
SNcdopamine(D1)(+),direct
(maininput) InterneuronsACh(muscarinic)(+)
SNcdopamine(D2)(),indirect
InterneuronsGABA()(95%)
Thalamus (VL&VA) GABA()
Globuspallidis
StriatumGABA,inhibitory STNGABA()
(GPimainoutput)
Rednucleus
Extrapyramidal
Cortex
Subthalamicnucleus SNrGlutamate(+)
Structures
GPiGABA,inhibitory
Compacta
Reticulata
StriatumDopamine(D1)(+),direct
StriatumGABA()
Substantianigra StriatumDopamine(D2)(),indirect
GPiGABA()
Reticulata
STNGlutamate(+)
ThalamusGABA()
Thalamocorticaltract
Anteriorlimb Frontopontinetract
Internal
Capsule
Caudateputameninterneurons
Anterior
Corticospinal,corticobulbar,corticorubraltracts;siteforpuremotorstroke
Posteriorlimb
Posterior
Sensoryfibers
MotorTracts L33cDr.Schetz
Tract Function Origins Course Termini
Posteriorinternalcapsule,
Corticobulbar Face,CNnuclei Facialpartofmotorhomunculus Brainstemnuclei
middlepartofcruscerebri
87%decussateinpyramids
55%Frontal(4,6),35%sensory(3,1,2), Thalamus(VL),brainstem,spinalcord
Corticospinal Voluntarymovementofbody 3%donotcrosstrunk
10%other,5%Betzcells Directpathwayonlyfordistalextremities
10%decussatelowerlevels
Cerebellumequilibrium,
Corticopontine
posture,gait
Interneuronsinspinalcordwhichproject
Rubrospinal Flexormuscletone Rednucleus
toflexormusclemotorneurons
Reticulospinal Biogenicamines Reticularformation Interneuronsandmotorneurons
/motorneurons,somedirectlyonto
Vestibulospinal Balance,extensormuscletone Vestibularnucleusinbrainstem
extensormusclemotorneurons
Tectospinal Sightandsoundcues
Cerebrovascularsystem L31Dr.Aschenbrenenr
Arteries Vessel Origin Supplies/Branches Veins
Medial surfacesofcerebral
Anteriorcerebrala. Internalcarotida.
hemisphere
Lenticulostriateaa. Ruptureisleadingcauseof
A1branch
(medialstriateaa.) intracerebralhemorrhage
Recurrenta.ofHubner A2branch
Frontopolarbranch A2branch
Callosomarginalbr. A2branch
Pericallosal A2branch
Anteriorcommunicating HighincidenceofBerry
Ant.cerebralaa.
a. aneurysmformation
Superiolateral surfaceof
Middlecerebrala. Internalcarotida. hemispheres,deepbrain
*Cerebrovasculardisease*
Lenticulostriateaa. Ruptureisleadingcauseof
M1branch
(lateralstriateaa.) intracerebralhemorrhage
Temporopolara. M2branch
Precentral(Rolandic) M2branch
Postcentral(Rolandic) M2branch
Angularbranch M2branch
Post.temporalbranch M2branch
Posterior Optictract,choroidplexus,
Ant.choroidala.
communicatinga. thalamicnuclei
Anastomosisbetweenantand
Int.carotida.and
Post.communicatinga. postcirculations
basilara.
Hypothalamus,brainbase
Vertebralaa. Subclavianaa. Upper6vertebrae
Posteriorspinala. Vertebrala. Spinalcord
th
Post/latmedulla,4 ventricle,
Post.inf.cerebellara. Vertebrala.
choroidplexus
Medullarypyramids,medial
Anteriorspinala. Vertebrala. lemniscus,MLF,2/3ofspinal
cord
Basilara. Vertebralaa. Allbrainstemstructures
Ant.inf.cerebellara. Basilara. Cerebellum
Superiorcerebellara. Basilara. Deepcerebellarnuclei
Basilara.through Temporal l.,occipital l.,
Posteriorcerebrala.
tentoriumcerebelli midbraintectum,peduncles
Thalamogeniculatebr. Post.cerebrala. Hypothalamus,thalamus
Calcarinebr. Post.cerebrala. Visual cortex
Deepcerebralvv. Thalamostriate,caudate,septalvv.
GreatveinofGalen Deepcerebralvv.
Greatv.ofGalen,Basalv.ofRosenthal,inf.&sup.
Straight(dural)sinus
sagittalsinuses
Confluenceofsinuses Sup.sagittal,straight,occipitalsinuses
Transverse(lat)sinus Straight,superiorsagittalsinuses
Sigmoidsinus Superiorpetrosalsinus
Spenoparietal,intercavernous,circularsinuses,sup&
Cavernoussinus
infophthalmicvv.,pterygoidplexus
Inferiorpetrosalsinus Cavernoussinus
Page3of3 NervousSystemWrittenExamIITables byDMFA
ReticularFormationFunctions DSA10Dr.Forster
Nuclei Function
Raphemagnusinhibitspaintransmissioninmedullaoblongata,descendinbrainstemtoterminateonspinaltrigeminalnucleusandsubstantia
Median(Raphe) gelatinosa
Paramedian Paramedianpontinereticularformation(PPRF)horizontaleyemovementsw/CNsIII,VI,MLF
Medial Visceralmotorinspiratoryresponse,depressoreffectonthecirculatorysystem
Lateral Visceralmotorexpiratoryresponse,pressorcirculatoryeffect
NeurotransmittersinReticularFormation DSA10Dr.Forster
Peduncolopontinereticularnucleus,lateraldorsaltegmentalnucleus arousal,movement;implicatedwithprogressivesupranuclearpalsy
Cholinergic Locomotorcentercoordinatedwalkingmovements
NucleusbasalisofMeynertbasalforebrain,implicatedinAlzheimers
Dopamine Nigrostriatal(Parkinsons),mesolimbic(Schizophrenia),Mesocortical(cognitiveeffectsofParkinsons)
Norepinephrine Locusceruleus,lateraltegmentalNE
Ascending:attention,sleepwakestate,mood,e.g.ADD,narcolepsy
Epinephrine Descending:sympatheticfunctions,e.g.BP
Mostlywithinraphenuclei;discretetopography,restrictedareaofterminaldistribution
Serotonin Rostral:psychdisorders
Medulla:inhibitsdorsalhornneurons
Comas DSA10Dr.Forster
Lesionsthatcausecoma Upperbrainstem,midbrain/hypothalamus,diencephalon,bilateralcerebralcortex
Intracranialcauses Headtrauma,CVA,CNSinfections,tumors,intracranialpressure
Extracranialcauses Vasculardisorders,metabolicdisorders,intoxication,hyperthermia,systemicinfections
GlasgowComaScale Scalewhichincorporatesspontaneouseyeopening,Speech,Pain,Commands(verbalandmotor)
Noncomadeficits
Syncope:brief,suddenlossofconsciousness;stupor/obtundation:impairedreactivity