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The lateral cord derived the hand is on the hip. Staal, 17; Brazis, 29 from the upper and middle trunk of the brachial plexus provides innervations to the A The upper trunk of the brachial plexus is pronator teres without any contribution from formed by the anterior primary rami of the fifth the posterior cord. Brazis, and sixth cervical roots. They course down- ward between the scalenus medius and ante- D The sciatic nerve is a mixed nerve that car- rior muscles and unite to form the upper trunk.

The nerve then curves laterally and Lateral to the first rib and behind the axillary downward beneath the gluteus maximus artery, the three trunks split into three anterior muscle and runs on the dorsal side of the and three posterior divisions. The anterior divi- femoral bone to terminate at the proximal part sions of the upper and middle trunks unite to of the popliteal fossa, where it divides into the form the lateral cord.

McGraw-Hill Specialty Board Review Neurology, Second Edition

The posterior divisions of tibial nerve medially and the peroneal nerve the three trunks unite to form the posterior laterally. Within the sciatic nerve, as proximal cord. Two branches arise from the proximal as the gluteal region, the fibers of the tibial and aspect of the upper trunk, the suprascapular peroneal nerves are arranged into two sepa- nerve innervating the suprasinatus and infra- rate divisions: the medial and the lateral trunks. Answers: The medial part of the nerve innervates the medulla between the pyramid and inferior adductor magnus and the hamstring muscles olive.

Afifi, except for the short head of the biceps femoris it is the only thigh muscle supplied by the lat- D Vertical saccades are controlled by cortical eral peroneal division. The hamstring muscles pathways descending to the rostral interstitial are flexors of the knee joint and include the nucleus of the medial longitudinal fasciculus at semimembranosus muscle, the semitendinosus the junction between the midbrain and the thal- muscle, and the short and long heads of the amus.

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Kline and Bajandas, 50 biceps femoris. Staal, E The abducens nucleus is the site of horizon- A The point of entrapment of the median tal versional control. The nucleus of the abducens nerve in carpal tunnel syndrome lies under the nerve contains two types of neurons: those that flexor retinaculum, which forms the roof of the innervate the ipsilateral lateral rectus and those carpal tunnel, whereas the carpal bones and that project via the contralateral medial longi- their connective tissue components form the tudinal fasciculus to the contralateral oculo- floor of the carpal tunnel.

In Guyons canal, motor nucleus. The parapontine reticular the hamate and pisiform bones are sites of com- formation contains cells that project to the pression of the ulnar nerve at the wrist. Rarely, abducens nucleus and activate it. The para- radial nerve compression occurs at the level of pontine reticular formation contains excitatory the styloid process, just proximal to the wrist. Once the eye reaches a new B The femoral nerve supplies the sartorius eccentric position at the end of the saccade, muscle a flexor and everter of the thigh and the stimulation of the abducens nucleus by the quadriceps an extensor of the leg.

The obturator parapontine reticular formation burst neurons nerve supplies the adductor muscles of the thigh. This sensory nerve. It divides near the inguinal lig- requires a neuronal network that integrates a ament into the external genital branch respon- velocity-coded signal into a position-coded sible for the innervation of the cremaster signal. This is referred to as the neural integra- muscle and the medial femoral branch respon- tor, which includes the horizontal gaze center, sible for the innervation of the skin of the upper the medial vestibular nucleus, and the nucleus thigh over the femoral triangle.

The superior prepositus hypoglossi. Kline and Bajandas, 55 gluteal nerve innervates the gluteus medius and gluteus minimus. The inferior gluteal nerve A The rostral interstitial nucleus of the innervates the gluteus maximus. Brazis, medial longitudinal fasciculus contains excita- tory burst neurons for vertical and torsional A This is a brainstem section at the level of saccade. It projects bilaterally to the oculomo- the medulla. The structure indicated by the tor nuclei in the case of upward gaze and arrow is the hypoglossal nucleus.

The section mainly ipsilaterally in the case of downward shows a schematic diagram of the origin and gaze.

McGraw Hill Specialty Board Review Neurology, Second Edition

The gaze-holding neural integrator for intramedullary course of rootlets of the vertical gaze is located in the interstitial nucleus hypoglossal nerve. Except for its most rostral of Cajal. Kline and Bajandas, 52 and caudal levels, the nucleus of the hypoglos- sal nerve extends throughout the medulla E The trochlear nerve is purely a motor nerve oblongata. It is divided into cell groups that and is the only cranial nerve to exit the brain correspond to the tongue muscles they supply. The trochlear nerve supplies one The root fibers of the nerve course in the muscle: the superior oblique.

The trochlear nucleus gives They receive direct projections from the senso- rise to fibers that cross to the other side of the rimotor cortex. The cortical input to these brainstem just prior to exiting the pons. Thus nuclei provides the basis for cortical influences each superior oblique muscle is supplied by on the baroreceptor reflex and sympathetic nerve fibers from the trochlear nucleus of the vasomotor mechanisms for the control of blood opposite side. The nerve travels in the lateral pressure.

Afifi and Bergman, 92 wall of the cavernous sinus and then enters the orbit via the superior orbital fissure.

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It passes C The rostral and lateral zone of the nucleus medially and diagonally across the levator solitarius is concerned with taste sensation. It palpebral superioris and superior rectus muscles receives gustatory sensations via three cranial to innervate the superior oblique. Parent, nerves: the facial nerve conveys taste sensation from the anterior two thirds of the tongue; the A The perihypoglossal nuclei are nuclear glossopharyngeal nerve conveys taste sensa- masses in close proximity to the hypoglossal tion from the posterior third of the tongue; and nerve. They receive input from the cerebral the vagus nerve conveys taste sensation from cortex, vestibular nuclei, accessory oculomotor the epiglottis.

Afifi and Bergman, 92 nuclei, and paramedian pontine reticular for- mation. The output of these nuclei terminates in B The structure indicated by the arrow in the cranial nuclei involved in extraocular move- Figure is the pontine reticular nucleus. The output of the perihy- tegmentum and corticospinal fibers in the basis poglossal nuclei also terminates in the thalamus pontis is associated with anosognosia for hemi- and the cerebellum.

Afifi and Bergman, 88 plegia, in which patients are unware of their motor deficit. A similar syndrome occurs in C The nucleus ambiguus is the ventral motor damage to the nondominant parietal lobe. Afifi nucleus of the vagus.

Axons of neurons in this and Bergman, nucleus convey special visceral efferent impulses to the branchiomeric muscles of the B The afferent roots of the trigeminal nerve pharynx and larynx. It also contributes efferent contains general somatic sensory fibers that fibers to the glossopharyngeal and accessory convey pain, temperature, and touch sensation nerves.

The dorsal motor nucleus of the vagus from the face and anterior aspect of the head. It receives afferent fibers in the semilunar ganglion gasserian ganglion. The proprioceptive fibers cera in the thorax and abdomen.

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The nucleus of from the deep structures of the face are periph- the spinal tract of the trigeminal nerve receives eral processes of unipolar neurons in the mes- general somatic afferent fibers from the external encephalic nucleus of the trigeminal nerve that ear. The nucleus solitarius receives special vis- travel via afferent and efferent roots of the ceral afferent fibers that convey taste sensation trigeminal nerve.

The proprioceptive fibers in from the region of the epiglottis. It also receives the mesencephalic nucleus convey pressure and general visceral afferent fibers that convey pain and kinesthesia from the teeth, periodontium, sensation from the mucosa of the posterior third hard palate, and joint capsules as well as of the tongue.

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Afifi and Bergman, impulses from stretch receptors in the muscles of mastication. The mesencephalic nucleus of the B The nucleus solitarius, the dorsal motor trigeminal nerve is involved in control of the nucleus of the vagus, and the caudal and ros- bite force. The facial nerve conveys taste sensa- tral ventrolateral medulla comprise the brain- tion from the anterior two third of the tongue.

The facial is a synaptic station in neural systems con- motor nuclei are involved in eliciting the corneal cerned with movement, linking the cerebral reflex. Collaterals from the secondary ascending cortex, cerebellum, and spinal cord.


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The ventral trigeminal tracts establish synapses with the tegmental nucleus is a part of a circuit con- facial motor nuclei on both sides, resulting in the cerned with emotion and behavior. Afifi and bilateral blink reflex and the corneal reflex in Bergman, , response to unilateral corneal stimulation. Afifi and Bergman, E Figure is a schematic diagram of the midbrain at the level of the superior colliculus.

D Figure is a schematic diagram of the The structure indicated by the arrow in Figure ventral surface of the midbrain and pons. It is a prominent part of The structure indicated by the arrow is the the tegmentum at the level of the superior col- trochlear nerve.

The nerve fascicles course pos- liculus, comprising a caudal magnocellular teroinferiorly around the aqueduct to decus- and a rostral parvocellular part. It is involved sate in the dorsal midbrain in the anterior in motor coordination. Afifi and Bergman, medullary velum. After traveling on the under- surface of the tentorial edge, it pierces the dura C Pupillary size is under the dual control of and travels to the cavernous sinus to reach the sympathetic and parasympathetic systems that superior orbital fissure and innervate the supe- innervate rings of radially arranged dilator and rior oblique muscle.