Neuroanatomy through Clinical Cases

Hal Blumenfeld, M.D., Ph.D., Yale University School of Medicine

Publication Date: 2002
951 pages, 405 illustrations
paper

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Figures & Tables on the Instructor's Resource CD

Chapter 1

Figure 1.1 Arrowhead of Neurologic Differential Diagnosis

Chapter 2

Figure 2.1 Parts of the Human Nervous System
Figure 2.2 Embryological Development of the Central Nervous System
Figure 2.3 Orientation of the Central Nervous System in Reptiles
Figure 2.4 Orientation of the Central Nervous System in Humans
Figure 2.5 Anatomical Planes of Section
Figure 2.6 Typical Mammalian Neuron
Figure 2.7 Gray Matter and White Matter in the Central Nervous System
Figure 2.8 The Spinal Cord
Figure 2.9 Autonomic Nervous System
Figure 2.10 Cerebral Cortex: Frontal, Parietal, Temporal, and Occipital Lobes
Figure 2.11 Detailed Labeled Surface View of Cerebral Cortex
Figure 2.12 Primary Sensory and Motor Cortical Areas
Figure 2.13 Somatotopic Maps in the Cortex
Figure 2.14 Layers of the Neocortex
Figure 2.15 Brodmann’s Cytoarchitectonic Areas
Figure 2.16 Overview of Corticospinal Tract
Figure 2.17 Overview of Basal Ganglia and Cerebellar Circuits
Figure 2.18 Posterior Column Sensory Pathway: Vibration, and Joint Position Sense
Figure 2.19 Spinothalamic Sensory Pathway: Pain and Temperature
Figure 2.20 The Thalamus
Figure 2.21 Neural Circuit for Deep Tendon (Muscle Stretch) Reflex
Figure 2.22 Brainstem and Cranial Nerves
Figure 2.23 Simplification of Brainstem, Thalamic, and Cortical Circuits Important for Maintaining Consciousness
Figure 2.24 Limbic System Structures
Figure 2.25 Association Cortex
Figure 2.26 Blood Supply to the Brain
Table 2.1 Main Parts of the Human Nervous System
Table 2.2 Some Important Neurotransmitters
Table 2.3 Cell Layers of the Neocortex
Table 2.4 Brodmann’s Cytoarchitectonic Areas
Table 2.5 Overview of the Cranial Nerves

Chapter 3

Figure 3.1 Written Alternating Sequencing Task
Figure 3.2 Plantar Response
Figure 3.3 Reflex Stick Figure
Figure 3.4 Finger–Nose–Finger Test
Figure 3.5 Posturing and Triple Flexion
Table 3.1 Outline of the Neurologic Exam
Table 3.2 Parts of the General Physical Exam with Special Neurologic Significance
Table 3.3 Signs of Upper Motor Neuron (UMN) and Lower Motor Neuron (LMN) Lesions
Table 3.4 Upper Extremity Strength Testing
Table 3.5 Lower Extremity Strength Testing
Table 3.6 Deep Tendon Reflexes
Table 3.7 Additional Reflexes for Localizing Spinal Cord Lesions
Table 3.8 Outline of the Neurologic Exam in the Comatose Patient
Table 3.9 Important External Signs of Cranial Trauma
Table 3.10 Minimal Screening Neurologic Exam

Chapter 4

Figure 4.1 CT Scout (Localizer) Image
Figure 4.2 Schematic Diagram of CT Scanning Gantry
Figure 4.3 Typical CT Scan Image
Figure 4.4 CT Image with Intravenous Contrast
Figure 4.5 Physics of MRI Excitation Pulse
Figure 4.6 Typical MRI Images
Figure 4.7 Coronal MRI Image with Intravenous Gadolinium Contrast
Figure 4.8 Three-Dimensional Surface Reconstruction
Figure 4.9 Neuroangiography Setup
Figure 4.10 Ictal-Interictal SPECT Difference Imaging
Figure 4.11 BOLD fMRI Mapping of Sensorimotor Cortex and Language Cortex
Figure 4.12 CT Images
Figure 4.13 MRI: Axial T1-Weighted Images
Figure 4.14 MRI: Coronal T1-Weighted Images
Figure 4.15 MRI: Sagittal T1-Weighted Images
Figure 4.16 Angiographic Images: Anterior Circulation
Figure 4.17 Angiographic Images: Posterior Circulation
Figure 4.18 MRA Images: Intracranial Circulation
Figure 4.19 MRA Images: Neck Vessels
Figure 4.20 MRA Images: Origins of Carotid and Ver-tebral Arteries
Table 4.1 CT Hounsfield Units (HU) for Commonly Scanned Tissues
Table 4.2 CT versus MRI in Different Situations
Table 4.3 MRI Appearance of Commonly Scanned Tissues
Table 4.4 MRI Appearance of Intracranial Hemorrhage

Chapter 5

Figure 5.1 Layers of Protection for the Brain
Figure 5.2 Major Foramina at the Base of the Skull
Figure 5.3 CT Scan: Bone Windows Showing Major Foramina at the Base of the Skull
Figure 5.4 Anterior, Middle, and Posterior Fossae and Their Contents
Figure 5.5 Falx Cerebri and Tentorium Cerebelli
Figure 5.6 Tentorium Cerebelli and Structures Traversing the Tentorial Notch
Figure 5.7 Middle Meningeal Artery
Figure 5.8 Dural Venous Sinuses and Internal Jugular Veins
Figure 5.9 Dural Venous Sinuses
Figure 5.10 Cerebrospinal Fluid Circulation
Figure 5.11 Brain Ventricles
Figure 5.12 Principal CSF Cisterns in the Subarachnoid Space
Figure 5.13 Blood–Brain and Blood–CSF Barriers
Figure 5.14 Fluid Compartments of the Nervous System
Figure 5.15 Circumventricular Organs
Figure 5.16 Intracranial Pressure versus Intracranial Mass Volume
Figure 5.17 Papilledema
Figure 5.18 Herniation Syndromes
Figure 5.19 Types of Intracranial Hemorrhage Demonstrated by CT Scans
Figure 5.20 Common Sites of Intracranial Aneurysms
Figure 5.21 Common Sites of Cerebral Contusion
Figure 5.22 Lumbar Puncture
Figure 5.23 Head CT Showing Chronic Subdural Hematoma
Figure 5.24 Head CT Images Showing Acute Subdural Hematoma and Recovery
Figure 5.25 Head CT Showing Epidural Hematoma
Figure 5.26 Pathologic Specimens Showing Herniations and PCA Hemorrhagic Infarcts
Figure 5.27 CT Scan Images Showing Intracranial Hemorrhage
Figure 5.28 CT Scan Images Showing Subfalcine Herniation and Anterior Cerebral Artery Infarcts
Figure 5.29 MRI Scan Images Showing Pineal Tumor and Recovery
Figure 5.30 MRI Scan Images Showing Cysticercosis Obstructing Iter and Causing Noncommunicating Hydrocephalus
Figure 5.31 MRI Scan Images Showing Colloid Cyst Causing Obstructive Hydrocephalus
Figure 5.32 Head CT Showing Dilated Ventricles Typical of Normal-Pressure Hydrocephalus
Table 5.1 Brain Ventricles
Table 5.2 Differential Diagnosis of Headache
Table 5.3 Common Symptoms and Signs of Elevated Intracranial Pressure
Table 5.4 Treatment Measures for Elevated Intracranial Pressure
Table 5.5 Signs and Symptoms of Meningeal Irritation
Table 5.6 Intracranial Neoplasms in Adults
Table 5.7 Cerebrospinal Fluid Profiles in Normal Adults and in Those with Infectious Meningitis
Table 5.8 Bacterial Meningitis: Common Pathogens and Treatment Based on Age
Table 5.9 Differential Diagnosis of Lymphocyte-Predominant “Aseptic” Meningitis
Table 5.10 Locations of Hemorrhage Associated with Head Trauma

Chapter 6

Figure 6.1 Motor and Somatosensory Cortical Areas
Figure 6.2 Somatosensory and Motor Homunculi
Figure 6.3 Basic Spinal Cord Anatomy
Figure 6.4 Myelin Stained Sections through Different Levels of the Spinal Cord
Figure 6.5 Spinal Cord Arterial Supply
Figure 6.6 General Organization of the Motor Systems
Figure 6.7 Somatotopic Organization of Medial and Lateral Motor System Projections to Anterior Horn Cells
Figure 6.8 Lateral Corticospinal Tract
Figure 6.9 Internal Capsule
Figure 6.10 Somatotopic Organization of Corticobulbar and Corticospinal Tracts
Figure 6.11 Descending Motor Pathways
Figure 6.12 Somatic and Autonomic Efferents
Figure 6.13 Sympathetic and Parasympathetic Divisions of the Autonomic Nervous System
Figure 6.14 (A) Pure Hemiparesis
Figure 6.14 (B)Hemiparesis with Additional Deficits
Figure 6.14 (C) Hemiparesis Sparing the Face
Figure 6.14 (D) Unilateral Face and Arm Weakness
Figure 6.14 (E) Brachial Monoparesis
Figure 6.14 (F) Crural Monoparesis
Figure 6.14 (G) Facial Weakness (Lower Motor Neuron–Type)
Figure 6.14 (H) Facial Weakness (Upper Motor Neuron-Type)
Figure 6.14 (I) Brachial Diparesis
Figure 6.14 (J) Paraparesis
Figure 6.14 (K) Quadriparesis
Figure 6.15 Infarct in Left Precentral Gyrus Hand Area
Figure 6.16 Infarct in Left Precentral Gyrus Leg Area
Figure 6.17 Infarct in Left Precentral Gyrus Face Area
Figure 6.18 Lesion in Posterior Limb of Right Internal Capsule
Figure 6.19 Left Pontine Basis Infarct
Table 6.1 Main Long Tracts of the Nervous System
Table 6.2 Nuclei and Laminae of the Spinal Cord
Table 6.3 Lateral and Medial Descending Motor Systems
Table 6.4 Signs of Upper Motor Neuron and Lower Motor Neuron Lesions
Table 6.5 Terms Commonly Used to Describe Weakness
Table 6.6 Localization of Common Gait Disorders
Table 6.7 Common Symptoms and Signs in Chronic Multiple Sclerosis

Chapter 7

Figure 7.1 Posterior Column–Medial Lemniscal Pathway
Figure 7.2 Anterolateral Pathways
Figure 7.3 Somatotopic Organization of Posterior Column and Anterolateral Pathways in the Spinal Cord
Figure 7.4 Spinal Cord Sensory and Motor Spinal Cord Pathways
Figure 7.5 Central Pathways Involved in Pain Modulation
Figure 7.6 Main Nuclear Divisions of the Thalamus
Figure 7.7 Noncortical Inputs to the Thalamus
Figure 7.8 Reciprocal Connections between Thalamus and Cortex
Figure 7.9 Patterns of Sensory Loss in Lesions of the Brain or Peripheral Nerves
Figure 7.10 Spinal Cord Syndromes
Figure 7.11 Pathways for the Control of Urinary Function
Figure 7.12 Types of Incontinence Resulting from Flaccid and Hyperreflexic Bladder Disorders
Figure 7.13 Infarct in Left Postcentral Gyrus Somatosensory Cortex and Adjacent Parietal Lobe
Figure 7.14 Lacunar Infarct in Left Thalamus Region of VPL and VPM
Figure 7.15 Sensory Testing
Figure 7.16 T10 Vertebral Fracture with Obliteration of Spinal Canal
Figure 7.17 Pinprick Testing
Figure 7.18 Intradural Mass Compatible with Meningioma Compressing Left Spinal Cord at T9
Figure 7.19 Pinprick Testing
Figure 7.20 Fluid-Filled Syrinx in Cervical Spinal Cord at C3, C4 levels
Figure 7.21 Region of Hyperintensity in the Posterior (Dorsal) Cervical Spinal Cord at the C3, C4, C5 Levels Compatible with Demyelination
Figure 7.22 Pinprick Testing
Figure 7.23 Anterior Spinal Cord Lesion at C5–T1 Levels
Table 7.1 Main Long Tracts of the Nervous System
Table 7.2 Sensory Neuron Fiber Types
Table 7.3 Major Thalamic Nuclei
Table 7.4 Differential Diagnosis of Spinal Cord Dysfunction
Table 7.5 Nuclei and Nerve Roots for Bladder, Bowel, and Sexual Function

Chapter 8

Figure 8.1 Spinal Cord and Nerve Roots in Relation to the Vertebral Spinal Canal
Figure 8.2 Vertebral Bones, Meninges, and Other Tissues
Figure 8.3 Relation of Cervical and Lumbosacral Nerve Roots to Intervertebral Discs
Figure 8.4 Dermatomes
Figure 8.5 Straight Leg Raising and Spine Percussion Tests
Figure 8.6 Three Roots to Remember in the Arm
Figure 8.7 Three Roots to Remember in the Leg
Figure 8.8 Herniated C5–C6 Intervertebral Disc Obliterating Left C6 Neural (Intervertebral) Foramen
Figure 8.9 Metastatic Bladder Carcinoma Encasing Left C2 Nerve Root
Figure 8.10 Region of Skin Blistering and Decreased Pinprick Sensation
Figure 8.11 Region of Decreased Sensation
Figure 8.12 Region of Decreased Sensation
Figure 8.13 Region of Decreased Sensation
Figure 8.14 Region of Decreased Sensation
Figure 8.15 L5–S1 Posterolateral Disc Herniation Compressing Left S1 Nerve Root in the Lateral Recess
Figure 8.16 Axial Sections Showing Posterolateral Disc Herniation Compressing Left S1 Nerve Root in the Lateral Recess
Figure 8.17 Example of Myelogram Showing Bilateral L5 Nerve Root Compression at the Level of the L4–L5 Intervertebral Disc
Figure 8.18 Region of Decreased Sensation
Figure 8.19 Region of Decreased Sensation
Figure 8.20 Region of Decreased Sensation
Figure 8.21 Large Posterior L5–S1 Disc Herniation Compressing Cauda Equina
Table 8.1 Summary of Peripheral Nerves, Muscles, and Nerve Roots in the Upper and Lower Extremities
Table 8.2 Differential Diagnosis of Back Pain
Table 8.3 Clarifying Definitions for Degenerative Disorders of the Spine
Table 8.4 Common Causes of Radiculopathy
Table 8.5 Three Important Nerve Roots in the Arm
Table 8.6 Three Important Nerve Roots in the Leg

Chapter 9

Figure 9.1 Brachial Plexus
Figure 9.2 Brachial Plexus: Simplified Schematic
Figure 9.3 Lumbosacral Plexus
Figure 9.4 Lumbosacral Plexus: Simplified Schematic
Figure 9.5 Regions of Sensory Innervation Supplied by Cutaneous Nerve Branches
Figure 9.6 Three Nerves Acting on the Thumb
Figure 9.7 “Bellman’s” or “Waiter’s Tip” Pose Assumed in Upper-Plexus Lesions
Figure 9.8 Classic Hand Poses in Lesions of the Radial, Median, and Ulnar Nerves
Figure 9.9 Nerve Conduction Study
Figure 9.10 Region of Sensory Loss
Figure 9.11Right Apical Lung Cancer Extending into the Region of the Brachial Plexus
Figure 9.12 Region of Sensory Loss
Figure 9.13 Region of Sensory Loss
Figure 9.14 Region of Sensory Loss
Figure 9.15 Region of Sensory Loss
Figure 9.16 Region of Sensory Loss
Figure 9.17 Abnormal Bright Signal in the Right Sciatic Nerve, Compatible with Sciatic Neuropathy MRI of the lumbar plexus.
Figure 9.18 Region of Sensory Loss
Figure 9.19 Region of Sensory Loss
Figure 9.20 Decrement on Repetitive Stimulation
Table 9.1 Five Important Nerves in the Arm
Table 9.2 Muscles Contributing to Flexion and Extension at Finger Joints Other than the Thumb
Table 9.3 Important Nerves in the Leg

Chapter 10

Figure 10.1 Some Important Func-tional Areas of the Cerebral Cortex
Figure 10.2 Anterior and Posterior Circulations
Figure 10.3 Circle of Willis and Its Main Branches
Figure 10.4 Anterior Cerebral Artery (ACA) and Posterior Cerebral Artery (PCA)
Figure 10.5 Regions of Cortex Supplied by the Anterior Cerebral Artery (ACA), Middle Cerebral Artery (MCA), and Posterior Cerebral Arteries (PCA)
Figure 10.6 Superior and Inferior Divisions of the Middle Cerebral Artery (MCA)
Figure 10.7 Lenticulostriate Arteries
Figure 10.8 Blood Supply to Deep Cerebral Structures
Figure 10.9 Summary of Superficial and Deep Blood Supply to the Cerebral Hemispheres
Figure 10.10 Watershed Zones for the Major Cerebral Arteries
Figure 10.11 Venous Drainage of the Cerebral Hemispheres
Figure 10.12 Subarachnoid Hemorrhage Caused by Aneurysmal Bleeding
Figure 10.13 Right Anterior Cerebral Artery (ACA) Infarct
Figure 10.14 Automated Visual Field Mapping Showing Right Homonymous Hemianopia
Figure 10.15 Left Posterior Cerebral Artery (PCA) Infarct
Figure 10.16 Internal Carotid Artery Stenosis
Figure 10.17 Serial Pathologic Sections of Severe Internal Carotid Artery Stenosis Caused by Atherosclerosis
Figure 10.18 Left Middle Cerebral Artery (MCA) Superior Division Infarct
Figure 10.19 Left Middle Cerebral Artery (MCA) Inferior Division Infarct
Figure 10.20 Left Middle Cerebral Artery (MCA) Deep Territory Infarct
Figure 10.21 Left Middle Cerebral Artery (MCA) Stem Infarct, Causing Significant Mass Effect
Figure 10.22 Right Carotid Occlusion
Figure 10.23 Right Middle Cerebral Artery (MCA) Stem Infarct, Treated with Hemicraniectomy
Figure 10.24 Right ACA–MCA Watershed Infarct
Figure 10.25 Right Parietal Hemorrhage, and Empty Delta Sign
Figure 10.26 Superior Sagittal Sinus Thrombosis
Table 10.1 Major Clinical Syndromes of the MCA, ACA, and PCA Territories
Table 10.2 Differential Diagnosis of Transient Neurologic Episodes
Table 10.3 Common Lacunar Syndromes
Table 10.4 Common Stroke Risk Factors
Table 10.5 Medical Conditions Leading to Hypercoagulability

Chapter 11

Figure 11.1 Formation of Images on the Retina
Figure 11.2 Normal Visual Fields
Figure 11.3 Demonstration of the Blind Spot for the Left Eye
Figure 11.4 The Retina
Figure 11.5 Retinal Ganglion Cells with Center–Surround (Concentric) Receptive Fields
Figure 11.6 Geniculate and Extrageniculate Visual Pathways
Figure 11.7 Layers of the Lateral Geniculate Nucleus
Figure 11.8 Optic Radiations
Figure 11.9 Retinotopic Map
Figure 11.10 Primary Visual Cortex (Striate Cortex)
Figure 11.11 Visual Processing Pathways
Figure 11.12 Intrinsic Optical Signals Demonstrating Ocular Dominance Columns, and Orientation Columns
Figure 11.13 Receptive Fields of Cortical Simple Cells Derived from Integration of Center–Surround Cell Inputs
Figure 11.14 Hypercolumn
Figure 11.15 Effects of Lesions in the Primary Visual Pathways
Figure 11.16 Examples of Macular Sparing
Figure 11.17 Altitudinal Scotomas
Figure 11.18 Visual Fields
Figure 11.19 Visual Fields
Figure 11.20 Visual Fields
Figure 11.21 Brain MRI Showing a Meningioma of the Suprasellar Region Compressing the Optic Chiasm
Figure 11.22 Visual Fields
Figure 11.23 Brain MRI Showing a Tumor Involving the Right Optic Tract
Figure 11.24 Visual Fields
Figure 11.25 Brain MRI Showing an Arteriovenous Malformation (AVM) in the Superior Bank of the Right Calcarine Cortex
Figure 11.26 Arteriovenous Malformation (AVM) in the Right Superior Occipital Cortex
Table 11.1 Some Terms to Describe Visual Disturbances

Chapter 12

Figure 12.1 Midsagittal View of the Brainstem In Situ
Figure 12.2 Surface Anatomy of the Brainstem and Cranial Nerves
Figure 12.3 Skull Foramina Serving as Cranial Nerve Exit Points
Figure 12.4 Development of Cranial Nerve Nuclei Sensory and Motor Longitudinal Columns
Figure 12.5 Functional Columns of Brainstem Sensory and Motor Cranial Nerve Nuclei
Figure 12.6 Summary of Cranial Nerve Parasympathetic Pathways
Figure 12.7 Trigeminal Nerve (CN V)
Figure 12.8 Trigeminal Sensory System Nuclei and Pathways
Figure 12.9 Somatotopic Maps of the Spinal Trigeminal Nucleus
Figure 12.10 Facial Nerve (CN VII)
Figure 12.11 Axial Section of the Mid-to-Lower Pons, Showing the Facial Colliculus
Figure 12.12 Central Taste Pathways
Figure 12.13 Upper Motor Neuron versus Lower Motor Neuron Facial Weakness
Figure 12.14 Superior View of Internal Auditory Canal and Inner Ear Structures
Figure 12.15 Summary of Vestibular and Cochlear Structures
Figure 12.16 Central Auditory Pathways
Figure 12.17 Brainstem Sections of Auditory Pathways
Figure 12.18 Vestibular Nuclei and Vestibular Tracts
Figure 12.19 Glossopharyngeal Nerve (CN IX)
Figure 12.20 Vagus (CN X)
Figure 12.21 Mass in Orbital Frontal Region
Figure 12.22 Menigioma in Region of Left Foramen Rotundum
Figure 12.23 Region of Decreased Sensationigure
Figure 12.24 Trigeminal Schwannoma Eroding through Left Foramen Ovale
Figure 12.25 Left Temporal Bone Fracture in Region of Facial Canal
Figure 12.26 Left Acoustic Neuroma (Vestibular Schwannoma)
Figure 12.27 Left Vocal Cord Paralysis
Figure 12.28 Left Glomus Jugulare Tumor
Figure 12.29 Meningioma Compressing the Pons
Table 12.1 Cranial Nerve Names and Main Functions
Table 12.2 Cranial Nerve Exit Foramina
Table 12.3 Classification of Cranial Nerve Nuclei into Motor and Sensory Columns
Table 12.4 Cranial Nerves: Sensory and Motor Functions
Table 12.5 Cranial Nerves: Peripheral Sensory and Parasympathetic Ganglia
Table 12.6 Analagous Trigeminal and Spinal Somatosensory Systems
Table 12.7 Positional Testing to Distinguish Peripheral from Central Causes of Vertigo and Nystagmus

Chapter 13

Figure 13.1 Extraocular Muscles and Actions
Figure 13.2 Oculomotor Nerves (CN III) in Situ
Figure 13.3 Oculomotor Nuclear Complex
Figure 13.4 Trochlear Nerves (CN IV) and Abducens Nerves (CN VI) in Situ
Figure 13.5 Oculomotor Nerve (CN III) Palsy
Figure 13.6 Trochlear Nerve (CN IV) Palsy
Figure 13.7 Abducens Nerve (CN VI) Palsy
Figure 13.8 Parasympathetic Pathways Causing Pupillary Constriction
Figure 13.9 Actions of the Ciliary Muscle and the Pupillary Muscles
Figure 13.10 Sympathetic Pathways Causing Pupillary Dilation
Figure 13.11 Cavernous Sinus
Figure 13.12 Brainstem Pathways for Control of Horizontal Eye Movements
Figure 13.13 Effects of Lesions in Brainstem Pathways for Horizontal Eye Movements
Figure 13.14 Cortical Regions Important in Eye Movement Control
Figure 13.15 Right-Way and Wrong-Way Eyes
Figure 13.16 Left Posterior Communicating Artery (Pcomm) Aneurysm
Figure 13.17 Results of Red Glass Testing
Figure 13.18 Orbital Pseudotumor Involving Left Lateral Rectus Muscle
Figure 13.19 Region of Decreased Sensation
Figure 13.20 MRI Scan from Case 13.5
Figure 13.21 Location of Entry Wound
Figure 13.22 Steel Pellet in Region of the Sympathetic Trunk
Figure 13.23 Right Carotid Dissection
Figure 13.24 Infarct in Left Medial Pontine Basis and Tegmentum
Figure 13.25 Plaque in the Left MLF
Figure 13.26 Pineal Region Tumor Compressing the Tectum
Table 13.1 Actions and Innervation of the Extraocular Muscles
Table 13.2 Subnuclei of the Oculomotor Nucleus (CN III) and Their Functions
Table 13.3 Common Pupil Abnormalities

Chapter 14

Figure 14.1 Main Components of the Brainstem
Figure 14.2 Brainstem Basis, Tegmetum, and Tectum
Figure 14.3 Myelin-Stained Sections of the Midbrain
Figure 14.4 Myelin-Stained Sections of the Pons
Figure 14.5 Myelin-Stained Sections of the Medulla and Cervical Spine
Figure 14.6 Brainstem Reticular Formation
Figure 14.7 Ascending Reticular Activating Systems
Figure 14.8 Major Inputs to the Pontomesencephalic Reticular Formation
Figure 14.9 Cholinergic Projection Systems
Figure 14.10 Dopaminergic Projection Systems
Figure 14.11 Noradrenergic Projection Systems
Figure 14.12 Serotonergic Projection Systems
Figure 14.13 Histaminergic Projection Systems
Figure 14.14 Sleep Stages
Figure 14.15 Brainstem Circuits Important for Sleep Regulation
Figure 14.16 Brainstem Regions Involved in Respiratory Control
Figure 14.17 Brainstem Blood Supply
Figure 14.18 Penetrating Vessels Supplying the Internal Brainstem Structures
Figure 14.19 Brainstem Vascular Territories, Surface View
Figure 14.20 Brainstem Vascular Territories Shown in Axial Sections
Figure 14.21 Sensory Testing
Figure 14.22 Left Laterally Medullary Infarct Caused by Vertebral Dissection
Figure 14.23 Left Medial Medullary Infarct
Figure 14.24 Left Basis Pontis Infarct
Figure 14.25 Right AICA Infarct and Basilar Insufficiency
Figure 14.26 Bilateral Pontine Basis Infarcts Causing Locked-in Syndrome
Figure 14.27 Bilateral Midbrain Basis Infarcts Causing Locked-in Syndrome
Figure 14.28 Basilar Artery Stenosis_
Figure 14.29 Basilar Artery Thrombosis Treated with Intra-arterial Thrombolysis
Figure 14.30 Eye Movement Findings
Figure 14.31 Left Midbrain Infarct in Region of Third Nerve Fascicles and Superior Cerebellar Peduncle
Figure 14.32 Right Midbrain Infarct in Region of Cerebral Peduncle, Superior Cerebellar Peduncle, Red Nucleus, and Third-Nerve Fascicles
Figure 14.33 Infarcts Caused by Top-of-the-Basilar Syndrome
Figure 14.34 Top-of-the-Basilar Syndrome
Figure 14.35 Cavernous Angioma in the Rostral Medulla, in Region of the Obex
Table 14.1 Summary of Brainstem Structures
Table 14.2 Widespread Projection Systems in the Nervous System
Table 14.3 Definitions of Coma and Related States
Table 14.4 Some Important Causes of Coma
Table 14.5 Typical Pupil Abnormalities in Coma
Table 14.6 Common Warning Signs of Vertebrobasilar Ischemia
Table 14.7 Focal Vascular Syndromes of the Medulla
Table 14.8 Focal Vascular Syndromes of the Pons
Table 14.9 Focal Vascular Syndromes of the Midbrain

Chapter 15

Figure 15.1 Cerebellum and Posterior Fossa, Sagittal View in Situ
Figure 15.2 Lateral View of the Cerebellum Attached to the Brainstem
Figure 15.3 Subregions of the Cerebellum, and Attachments of the Cerebellar Peduncles to the Brainstem
Figure 15.4 Deep Cerebellar Nuclei and Related Structures
Figure 15.5 Schematic Diagram of Cerebellar Input and Output Pathways
Figure 15.6 Photomicrographs Showing Cell Layers of Cerebellar Cortex
Figure 15.7 Summary of Microscopic Circuitry of the Cerebellar Cortex
Figure 15.8 Enlarged View of Cerebellar Circuit Showing Cerebellar Glomerulus
Figure 15.9 Cerebellar Output Pathways
Figure 15.10 Somatotopic Organization of Multimodal Inputs to the Cerebellum
Figure 15.11 Spinocerebellar Pathways
Figure 15.12 Vascular Territories of Cerebellum
Figure 15.13 Vascular Territories of the Cerebellar Arteries Reviewed in Axial Sections
Figure 15.14 Finger–Nose–Finger Test
Figure 15.15 Left Superior Cerebellar Artery (SCA) Infarct
Figure 15.16 Superior Cerebellar Artery (SCA) and Posterior Inferior Cerebellar Artery (PICA) Infarcts
Figure 15.17 Lung Metastasis in the Cerebellar Vermis
Figure 15.18 Cerebellar Astrocytoma in the Vermis and Left Cerebellar Hemisphere
Figure 15.19 Metastasis of Lung Adenocarcinoma to the Right Middle Cerebellar Peduncle
Table 15.1 Functional Regions of the Cerebellum
Table 15.2 Main Cerebellar Output Pathways
Table 15.3 Main Cerebellar Input Pathways
Table 15.4A Differential Diagnosis of Ataxia in Adults
Table 15.4B Differential Diagnosis of Ataxia in Infants and Children

Chapter 16

Figure 16.1 Spatial Relationships of Basal Ganglia, Thalamus, and Amygdala
Figure 16.2 Basal Ganglia and Thalamus in Relation to the Internal Capsule and Lateral Ventricle
Figure 16.3 Horizontal Brain Sections through Basal Ganglia and Thalamus
Figure 16.4 Coronal Brain Sections through Basal Ganglia and Thalamus
Figure 16.5 Basal Ganglia Inputs Arrive at the Striatum_
Figure 16.6 Basal Ganglia Outputs Arise from the Internal Globus Pallidus, and the Substantia Nigra Pars Reticulata
Figure 16.7 Basal Ganglia Internal Connections, Showing the Direct and Indirect Pathways
Figure 16.8 Frontal Lobe Outputs of the Four Parallel Channels through the Basal Ganglia
Figure 16.9 Terminology of Basal Ganglia Output Pathways, and Fields of Forel
Figure 16.10 Pathologic Changes of Parkinson’s Disease
Figure 16.11 Ring-enhancing Toxoplasmosis Lesion in Left Subthalamic Nucleus
Figure 16.12 Atrophy of Caudate Head Associated with Huntington’s Disease
Figure 16.13 Gross Pathologic Changes of Huntington’s Disease
Figure 16.14 Left Pallidotomy Performed for Advanced Parkinson’s Disease
Figure 16.15 Gross Pathological Changes in a Patient with Striatonigral Degeneration
Figure 16.16 Microscopic Pathologic Changes in a Patient with Striatonigral Degeneration
Table 16.1 Basal Ganglia
Table 16.2 Four Parallel Channels through the Basal Ganglia
Table 16.3 Ranking of Common Movement Disorders by Movement Speed
Table 16.4 Classification of Tremors
Table 16.5 Differential Diagnosis of Parkinsonism

Chapter 17

Figure 17.1 Embryological Development of the Anterior and Posterior Pituitary
Figure 17.2 Anatomical Relations of Hypothalamus and Pituitary
Figure 17.3 Important Medial Hypothalamic Nuclei
Figure 17.4 Coronal Sections through the Hypothalamus
Figure 17.5 Regulation of Anterior and Posterior Pituitary Hormones by the Hypothalamus
Figure 17.6 Summary of Pituitary Hormone Actions
Figure 17.7 Feedback Control of CRH and ACTH Production in the Hypothalamic–Pituitary Axis
Figure 17.8 Venous Angiogram for Petrosal Sinus Sampling
Figure 17.9 Enhancing Mass in the Hypothalamus Extending into the Optic Tracts
Table 17.1 Some Important Hypothalamic Nuclei
Table 17.2 Anterior Pituitary Hormones and Hypothalamic Releasing and Inhibitory Factors
Table 17.3 Laboratory Test Results in Case 17.2

Chapter 18

Figure 18.1 Overview of Limbic Circuitry
Figure 18.2 Limbic Cortex
Figure 18.3 Herpes Encephalitis Affecting the Limbic Cortex Bilaterally
Figure 18.4 Coronal Brain Sections through Basal Forebrain and Septal Region
Figure 18.5 Principal Neurons and Pathways of Olfactory Nerves and Olfactory Bulbs
Figure 18.6 Central Olfactory Structures, and Other Components of the Parahippocampal Gyrus
Figure 18.7 Embryological Development of the Hippocampal Formation
Figure 18.8 Hippocampal Formation
Figure 18.9 Circuit of Papez, and Related Structures
Figure 18.10 Sagittal Section through the Hippocampal Formation and Amygdala
Figure 18.11 Summary of Hippocampal Input and Output Connections
Figure 18.12 Long-Term Potentiation (LTP) in the CA1 Sector of the Hippocampus
Figure 18.13 Three-Dimensional Structure of the Fornix and Anterior Commissure
Figure 18.14 MRI from Patient H.M
Figure 18.15 Classification of Memory
Figure 18.16 Diagram of Anterograde and Retrograde Amnesia in Patient H.M.
Figure 18.17 Input and Output Connections of the Amygdala
Figure 18.18 Bilateral Medial Temporal Lymphoma
Figure 18.19 Bilateral Medial Thalamic Infarcts_
Figure 18.20 Left Anterior Temporal Glioblastoma Multiforme
Figure 18.21 Right Hippocampal Sclerosis
Figure 18.22 Right Temporal Hypometabolism
Table 18.1 Main Components of the Limbic System
Table 18.2 Simplification of Limbic Functions and Corresponding Key Structures
Table 18.3 Terminology for Classifying Cerebral Cortex
Table 18.4 Summary of Major Limbic Pathways
Table 18.5 Components of the Parahippocampal Gyrus
Table 18.6 Memory Mechanisms in the Time Domain and in the Spatial Domain
Table 18.7 Causes of Memory Loss
Table 18.8 International Classification of Epileptic Seizures
Table 18.9 Clinical Manifestations of Partial Seizures in Different Brain Regions
Table 18.10 Staring Spells: Complex Partial Seizures versus Absence Seizures
Table 18.11 Causes of Seizures
Table 18.12 Results of the Wechsler Memory Scale Test in Case 18.3

Chapter 19

Figure 19.1 Classification of Different Types of Cortex
Figure 19.2 Anatomy of Language Areas
Figure 19.3 Vascular Territories of Language Areas
Figure 19.4 Classification of Language Disorders
Figure 19.5 Schematic Circuit Diagram of Alexia without Agraphia
Figure 19.6 Disconnection Syndrome in which a Left Middle-Cerebral Artery (MCA) Superior Division Infarct Causes Left-Hand Apraxia
Figure 19.7 Hemispheric Asymmetry in Attention Demonstrated through Attentional Rays
Figure 19.8 Lesions Causing Left Hemineglect
Figure 19.9 Cancellation Tasks in a Patient with Left Hemineglect
Figure 19.10 Pen-and-Paper Tasks from Another Patient with Left Hemineglect
Figure 19.11 Main Functional Areas of Frontal Cortex
Figure 19.12 “What?” and “Where?” Streams of Visual Processing
Figure 19.13 Color, Face, Letter, and Number Recognition Areas of the Inferior Occipitotemporal Cortex
Figure 19.14 Typical Distribution of Pathologic Changes in Alzheimer’s Disease
Figure 19.15 Left MCA Superior Division Infarct
Figure 19.16 Left MCA Inferior Division Infarct
Figure 19.17 Left Frontal Hemorrhage
Figure 19.18 Left Peri-Sylvian Intraparenchymal Hemorrhage in Region of Arcuate Fasciculus
Figure 19.19 Metastasis of Colon Adenocarcinoma to the Left Medial Occipital and Posterior Callosal Region
Figure 19.20 Complex Picture Used for Visual Neglect Testing in Case 19.6
Figure 19.21 Right MCA Inferior Division Infarct
Figure 19.22 Head CT Scans from a Patient with Left Hemispherectomy and Hydrocephalus
Figure 19.23 Clock Drawings by a Patient with Left Hemispherectomy and Hydrocephalus
Figure 19.24 “Butterfly” Astrocytoma of the Bilateral Frontal Lobes
Figure 19.25 Large Falcine Meningioma Compressing the Frontal Lobes
Figure 19.26 Written Alternating Sequencing Task
Figure 19.27 Bilateral Infarcts of the Visual Cortex
Figure 19.28 Bilateral Inferior Occipitotemporal Infarts
Figure 19.29 Cysticercosis Lesion in the Right Superior Temporal Gyrus
Figure 19.30 Plaque and Tangles
Table 19.1 Overview of the Mental Status Exam
Table 19.2 Terminology Used for Classifying Neocortex
Table 19.3 Functions of the Dominant and Nondominant Hemispheres
Table 19.4 Disorders Commonly Mistaken for Aphasia
Table 19.5 Causes of Aphasia
Table 19.6 Bedside Language Exam
Table 19.7 Types of Neglect Tested on Patient Examination
Table 19.8 Some Functions of the Frontal Lobes
Table 19.9 Apparently Contradictory Behavior Seen in Frontal Lobe Syndromes
Table 19.10 Evaluating Frontal Lobe Function
Table 19.11 Examples of Proverbs and Similarities Used for Testing Abstraction
Table 19.12 Differential Diagnosis of Frontal Lobe Disorders
Table 19.13 Common Causes of Impaired General Attention
Table 19.14 Causes of Acute or Subacute Mental Status Changes
Table 19.15 Causes of Chronic Mental Status Changes
Table 19.16 Blessed Dementia Scale

Clinical Cases

Chapter 5

5.1 An Elderly Man with Headaches and Unsteady Gait
5.2 Altered Mental Status Following Head Injury
5.3 Delayed Unresponsiveness after Head Injury
5.4 Headache and Progressive Left-Sided Weakness
5.5 Sudden Coma and Bilateral Posturing during Intravenous Anticoagulation
5.6 Severe Head Injury
5.7 A Child with Headaches, Nausea, and Diplopia
5.8 Headaches and Progressive Visual Loss
5.9 An Elderly Man with Progressive Gait Difficulty, Cognitive Impairment, and Incontinence
5.10 A Young Man with Headache, Fever, Confusion, and Stiff Neck

Chapter 6

6.1 Sudden Onset of Right Hand Weakness
6.2 Sudden Onset of Left Foot Weakness
6.3 Sudden Onset of Right Face Weakness
6.4 Pure Motor Hemiparesis I
6.5 Pure Motor Hemiparesis II
6.6 Progressive Weakness, Muscle Twitching, and Cramps
Additional Cases

Chapter 7

7.1 Sudden Onset of Right Arm Numbness
7.2 Sudden Onset of Right Face, Arm, and Leg Numbness
7.3 A Fall Causing Paraplegia and a T10 Sensory Level
7.4 Left Leg Weakness and Right Leg Numbness
7.5 Sensory Loss over Both Shoulders
7.6 Body Tingling and Unsteady Gait
7.7 Hand Weakness, Pinprick Sensory Level, and Urinary Retention

Chapter 8

8.1 Unilateral Neck Pain and Tingling Numbness in the Thumb and Index Finger
8.2 Unilateral Occipital and Neck Pain
8.3 Unilateral Shoulder Pain and Weakness
8.4 Blisters, Pain, and Weakness in the Left Arm
8.5 Unilateral Shoulder Pain and Numbness in the Index and Middle Fingers
8.6 Unilateral Neck Pain, Hand Weakness, and Numbness in the Ring and Little Fingers
8.7 Pain and Numbness in the Medial Arm
8.8 Low Back Pain Radiating to the Sole of the Foot and the Small Toe
8.9 Unilateral Thigh Weakness with Pain Radiating to the Anterior Shin
8.10 Low Back Pain Radiating to the Big Toe
8.11 Saddle Anesthesia with Loss of Sphincteric and Erectile Function
Additional Cases

Chapter 9

9.1 Complete Paralysis and Loss of Sensation in One Arm
9.2 A Newborn with Weakness in One Arm
9.3 A Blow to the Medial Arm Causing Hand Weakness and Numbness
9.4 Nocturnal Pain and Tingling in the Thumb, Pointer, and Middle Finger
9.5 Hand and Wrist Weakness after a Fall
9.6 Numbness and Tingling in the Pinky and Ring Finger
9.7 Unilateral Thigh Pain, Weakness, and Numbness in a Diabetic
9.8 Tingling and Paralysis of the Foot after a Fall
9.9 A Leg Injury Resulting in Foot Drop
9.10 Lateral Thigh Pain and Numbness after Pregnancy
9.11 Dysarthria, Ptosis, and Decreased Exercise Tolerance

Chapter 10

10.1 Sudden-Onset Worst Headache of Life
10.2 Left Leg Weakness and Left Alien Hand Syndrome
10.3 Decreased Vision on One Side
10.4 Transient Episodes of Left Eye Blurriness or Right Hand Weakness
10.5 Nonfluent Aphasia with Right Face and Arm Weakness
10.6 Talking Ragtime
10.7 Dysarthria and Hemiparesis
10.8 Global Aphasia, Right Hemiplegia, and Hemianopia
10.9 Left Face and Arm Weakness
10.10 Left Hemineglect
10.11 Left Hemineglect, Hemiplegia, and Hemianopia
10.12 Unilateral Proximal Arm and Leg Weakness
10.13 Right Frontal Headache and Left Arm Numbness in a Woman with Gastric Carcinoma

Chapter 11

11.1 A Dark Spot Seen with One Eye
11.2 Vision Loss in One Eye
11.3 Menstrual Irregularity and Bitemporal Hemianopia
11.4 Hemianopia after Treatment for a Temporal Lobe Tumor
11.5 Visual Changes Caused by Migraine Headaches?
Additional Cases

Chapter 12

12.1 Anosmia and Visual Impairment
12.2 Cheek Numbness and a Bulging Eye
12.3 Jaw Numbness and Episodes of Loss of Consciousness
12.4 Isolated Facial Weakness
12.5 Hearing Loss and Dizziness
12.6 Hoarse Voice Following Cervical Disc Surgery
12.7 Hoarseness, with Unilateral Wasting of the Neck and Tongue Muscles
12.8 Uncontrollable Laughter, Dysarthria, Dysphagia, and Left-Sided Weakness
Additional Cases

Chapter 13

13.1 Double Vision and Unilateral Eye Pain
13.2 A Diabetic with Horizontal Diplopia
13.3 Vertical Diplopia
13.4 Left Eye Pain and Horizontal Diplopia
13.5 Unilateral Headache, Ophthalmoplegia, and Forehead Numbness
13.6 Ptosis, Miosis, and Anhidrosis
13.7 Wrong-Way Eyes
13.8 Horizontal Diplopia in a Patient with Multiple Sclerosis
13.9 Headaches and Impaired Upgaze
Additional Cases

Chapter 14

14.1 Face and Contralateral Body Numbness, Hoarseness, Horner’s syndrome, and Ataxia
14.2 Hemiparesis Sparing the Face
14.3 Dysarthria and Hemiparesis
14.4 Unilateral Face Numbness, Hearing Loss, and Ataxia
14.5 Locked In
14.6 Wrong-Way Eyes, Limited Upgaze, Decreased Responsiveness, and Hemiparesis with an Amazing Recovery
14.7 Diplopia and Unilateral Ataxia
14.8 Intermittent Memory Loss, Diplopia, Sparkling Lights, and Somnolence
14.9 Intractable Hiccups

Chapter 15

15.1 Sudden Onset of Unilateral Ataxia
15.2 Walking like a Drunkard
15.3 A Boy with Headaches, Nausea, Slurred Speech, and Ataxia
15.4 Nausea, Progressive Unilateral Ataxia, and Right Face Numbness
Additional Cases

Chapter 16

16.1 Unilateral Flapping and Flinging
16.2 Irregular Jerking Movements and Marital Problems
16.3 Asymmetrical Resting Tremor, Rigidity, Bradykinesia, and Gait Difficulties
16.4 Bilateral Bradykinesia, Rigidity, and Gait Instability with No Tremor
Additional Cases

Chapter 17

17.1 Moon Facies, Acne, Amenorrhea, and Hypertension
17.2 Impotence, Anorexia, Polyuria, Blurred Vision, Headaches, and Hearing Loss
Additional Cases

Chapter 18

18.1 Sudden Memory Loss after a Mild Head Injury
18.2 Progressive Severe Memory Loss, with Mild Confabulation
18.3 Transient Diplopia, Lethargy, and Hemiparesis, Followed by a Sustained Memory Deficit
18.4 Episodes of Panic, Olfactory Hallucinations, and Loss of Awareness
18.5 Episodes of Staring, Lip Smacking, and Unilateral Semipurposeful Movements
Additional Cases

Chapter 19

19.1 Acute Severe Aphasia, with Improvement
19.2 Nonsensical Speech
19.3 Aphasia with Preserved Repetition
19.4 Impaired Repetition
19.5 Inability to Read, with Preserved Writing Skills
19.6 Left Hemineglect
19.7 Abulia
19.8 Blindness without Awareness of Deficit
19.9 Sudden Inability to Recognize Faces
19.10 Musical Hallucinations
19.11 Progressive Dementia, Beginning with Memory Problems
Additional Cases

Neuroexam Video Segments

Introduction
General Exam
Mental Status Introduction
Attention
Orientation
Recent Memory
Remote Memory
Spontaneous Speech
Comprehension
Naming
Repetition
Reading and Writing
Calculations
Right Ear, Left Thumb
Praxis
Neglect Drawing Tests
Copy Drawing
Grasp Reflex
Manual Alternating Sequence Test
Written Alternating Sequence Test
Auditory Go-No-Go
Analogies, Logic
Psychiatry
Olfaction
Ophthalmoscopic Exam
Red Desaturation
Visual Fields
Blink to Threat
Pupil Light Refelx
Accomodation
Swinging Flashlight
Smooth Pursuit
Saccades
Optokinetic Nystagmus
Oculocephalic Testing
Facial Sensation
Corneal Reflex
Masseter
Jaw Jerk Reflex
Facial Muscles
Taste
Hearing
Positional Vertigo Test
Palate Elevation
Articulation
Cranial Nerve XI Testing
Tongue Protrusion
Fasciculations
Upper Extremities Tone
Lower Extremities Tone
Drift
Rapid Hand Movements
Rapid Foot Tapping
Upper Extremities Strength
Detailed Hand Test
Lower Extremities Strength
Foot Eversion, Inversion
Deep Tendon Reflexes
Plantar Response
Finger Flexors
Special Reflexes
Rapid Alternating Movements
Precision Finger Tap
Finger-Nose-Finger
Heel-Shin
Overshoot
Romberg Test
Ordinary Gait, Tandem
Forced Gait
Pin Prick
Temperature
Vibration Sense
Joint Position Sense
2-Point Discrimination
Graphesthesia
Stereognosis
Tactile Extinction

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Catalog

Neuroanatomy through Clinical Cases

Hal Blumenfeld, M.D., Ph.D., Yale University School of Medicine

Figures & Tables on the Instructor's Resource CD

Chapter 1

Chapter 2

Chapter 3

Chapter 4

Chapter 5

Chapter 6

Chapter 7

Chapter 8

Chapter 9

Chapter 10

Chapter 11

Chapter 12

Chapter 13

Chapter 14

Chapter 15

Chapter 16

Chapter 17

Chapter 18

Chapter 19

Clinical Cases

Chapter 5

Chapter 6

Chapter 7

Chapter 8

Chapter 9

Chapter 10

Chapter 11

Chapter 12

Chapter 13

Chapter 14

Chapter 15

Chapter 16

Chapter 17

Chapter 18

Chapter 19

Neuroexam Video Segments