OUTLINE

1. Hypothalamus

Neurology: ●
●
A. Hypothalamic Nuclei
B. Jet Lag Syndrome
● C. Kallman Syndrome

Diencephalon ●
●
D. Wernicke-Korsakoff Syndrome
E. Disorders of Temperature Regulation
2. Thalamus
● A. Thalamic Nuclei
● B. Thalamic Syndrome
● C. Lacunar Stroke
● D. Hydrocephalus Ex Vacuo
● E. Pseudotumor Cerebri
3. Pineal Gland
● A. Suprachiasmatic Nucleus
● B. Parinaud Syndrome
4. Limbic System
● A. Hippocampus
● B. Amygdala
● C. Kluver-Bucy Syndrome
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• Hypothalamus:
• Homeostasis à regulating appetite, temperature, circadian rhythm, and growth
• Thalamus:
• Ventral lateral thalamic nucleus: Inà Cerebellum, basal ganglia : Out à Primary motor cortex
• Ventral posterolateral nucleus (VPL): Inà Spinothalamic tract, DCML : Out à Somatosensory cortex
• Ventral posteromedial nucleus (VPM): In à Trigeminal nerve, taste sensation : Out à Somatosensory cortex
• Lateral geniculate nucleus (LGN): In à Optic pathway, superior colliculi : Out à Primary visual cortex
• Medial geniculate nucleus (MGN): In à Inferior colliculi : Out à Primary auditory cortex
• Dorsomedial nucleus: In à Substantia nigra, amygdala, temporal cortex : Out à Prefrontal cortex
• Pineal Gland:
• Receives input from suprachiasmatic nucleus
• Regulation of sleep wake cycle via circadian release of melatonin
• Limbic System:
• Hippocampus: Memory formation, affected in Alzheimer’s dementia and early in hypoxia
• Amygdala: Emotion, fear, aggression
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Hypothalamic Nuclei
Function Lesion Regulation
Anterior + Parasympathetics
Heat loss Hyperthermia
- Sympathetics

Posterior Heat retention Hypothermia + Sympathetics

Lateral + Ghrelin
Hunger Poor appetite
- Leptin

Ventromedial Satiety Hyperphagia + Leptin

Function Lesion
Arcuate Dopamine secretion ↑ prolactin

Preoptic Kallman syndrome

GnRH secretion
↓ GnRH

Paraventricular Oxytocin and ADH secretion

CRH, TRH release
Somatostatin release Central diabetes insipidus

Supraoptic Oxytocin and ADH secretion

Suprachiasmatic Circadian rhythm

Regulation of melatonin release Insomnia
(pineal gland)

Mamillary Body
Episodic memory Wernicke Encephalopathy
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• Jet Lag Disorder:

• Suprachiasmatic nucleus dyssynchrony
• Kallman Syndrome (Hypogonadotropic hypogonadism):
• Anosmia à impaired migration of GnRH-neurons
• ↓ GnRH à ↓ FSH, ↓ LH
• Males: cryptorchidism, females: primary amenorrhea
• Wernicke Encephalopathy:
• History of chronic alcohol use
• Vitamin B1 (thiamine) deficiency à Avoid dextrose without thiamine supplementation
• Acute and reversible
• Ataxia, oculomotor disease, and encephalopathy
• Mamillary body (atrophy or
• Korsakoff Syndrome:
• Chronic Vitamin B1 deficiency
• Vitamin B1 (thiamine deficiency)
• Chronic and irreversible
• Confabulation with poor insight, anterograde (and/or retrograde) amnesia, personality changes
• Attention, cognition, and long-term memory generally preserved
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• Heat exhaustion:
• T less than or equal to 104 F (40 C)
• No deficits in central neurologic functioning
• Nonexertional Heatstroke:
• T greater than 104 F (40 C)
• Bimodal distribution (children and elderly)
• Deficits in central neurologic functioning
• +/- absence of diaphoresis
• Exertional Heatstroke:
• T greater than 104 F (40 C).
• Healthy adults
• Deficits in central neurologic functioning
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https://commons.wikimedia.org/wiki/File:Osborn_wave.gif

• Mild hypothermia:
• T 90-95 F (32-35 C)
• Tachycardia, tachypnea, possibly altered mental status
• Moderate hypothermia:
• T 82-90 F (28-32 C)
• Bradycardia, irregular breathing, possibly lethargy and general nervous system
depression
• Severe hypothermia:
• T less than 82 F (28 C)
• Hypotension, pulmonary edema, apnea, ventricular fibrillation
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• Thalamic Syndrome:
• Severe contralateral burning, sharp pain affecting regions involved by previous stroke
• Lacunar Stroke Affecting the Thalamus:
• Pure Sensory à Ventroposterolateral and/or ventroposteriomedial thalamus (common)
• Contralateral sensory loss of face, upper and lower extremities (affecting multiple pathways)
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https://commons.wikimedia.org/wiki/File:Tumor_Pineocytoma1.JPG

• Kluver-Bucy Syndrome:
• Hyperorality, hyperphagia, and hypersexuality +/- HSV encephalitis
• Parinaud Syndrome:
• Vertical gaze palsy, pseudo-Argyll Robertson pupils, convergence-retraction nystagmus
• Pinealoma may cause compression of cerebral aqueduct (obstructive hydrocephalus)
• Precocious puberty may be observed in setting of pinealoma
≣ ⟽ ⟾
Item 1 of 1 Test Your Knowledge
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Question ID: 0023 Previous Next

A 55-year-old male with no known past medical history presents to the emergency department by paramedics after being found
unconscious for an undetermined length of time. His initial glucose in the field was 28 mg/dL. The patient is managed acutely and
admitted to the hospital. The following day a more formal history is attempted, however the patient repeatedly interrupts the
physician stating, “everything looks blurry”. He appears to be generally disinterested in the conversation and displays
inattentiveness throughout the interview. No tremors are noted. His BMI is approximately 15 kg/m2 with otherwise normal vital
signs. Physical exam reveals horizontal nystagmus and significant postural ataxia. MRI of the brain and EEG are performed. EEG
is unremarkable. Previous medical records reveal that he was admitted one month prior for an episode of acute pancreatitis and
had previously reported living in a homeless shelter for the past year. During his last admission, there is no mention of
disorientation or confusion.

Which of the following findings on MRI would be most consistent with this patient’s presentation?

⚪ A. Diffuse atrophy of the frontal and temporal lobes bilaterally

⚪ B. Prominent cerebral sulci and ventriculomegaly
⚪ C. Pronounced atrophy of the caudate nucleus and ventriculomegaly
⚪ D. Pronounced atrophy of the mammillary bodies
⚪ E. Hyperintensity throughout the basal ganglia, temporal, and frontal cortices
≣ ⟽ ⟾
Item 1 of 1 Test Your Knowledge
◽" Mark Difficulty: ✪✪ Bootcamp.com
Question ID: 0023 Previous Next

A 55-year-old male with no known past medical history presents to the emergency department by paramedics after being found
unconscious for an undetermined length of time. His initial glucose in the field was 28 mg/dL. The patient is managed acutely and
admitted to the hospital. The following day a more formal history is attempted, however the patient repeatedly interrupts the
physician stating, “everything looks blurry”. He appears to be generally disinterested in the conversation and displays
inattentiveness throughout the interview. No tremors are noted. His BMI is approximately 15 kg/m2 with otherwise normal vital
signs. Physical exam reveals horizontal nystagmus and significant postural ataxia. MRI of the brain and EEG are performed. EEG
is unremarkable. Previous medical records reveal that he was admitted one month prior for an episode of acute pancreatitis and
had previously reported living in a homeless shelter for the past year. During his last admission, there is no mention of
disorientation or confusion.

Which of the following findings on MRI would be most consistent with this patient’s presentation?

⚪ A. Diffuse atrophy of the frontal and temporal lobes bilaterally

⚪ B. Prominent cerebral sulci and ventriculomegaly
⚪ C. Pronounced atrophy of the caudate nucleus and ventriculomegaly
" D. Pronounced atrophy of the mammillary bodies
⚪ E. Hyperintensity throughout the basal ganglia, temporal, and frontal cortices