NEUROANATOMY CLASS ACTIVITY

INSTRUCTION: Label the component parts of the Circle of Willis

that form the arterial blood supply.
https://accessmedicine.mhmedical.com/content.aspx?bookid=673&sectionid=45395974

A 48-year-old attorney was told he was hypertensive but did not take his blood
pressure medications. He was apparently well until 4 days after his birthday, when
he had several episodes of blurred vision, “like a shade coming down,” involving
his left eye. These attacks each lasted less than an hour. He was referred for
neurologic evaluation but canceled the appointment because of a busy schedule.
Several weeks later, he complained to his wife of a left-sided headache. She found
him a half hour later slumped in a chair, apparently confused and paralyzed on the
right side. Neurologic examination in the hospital revealed total paralysis of the
right arm and severe weakness of the right face. The leg was only mildly affected.
Deep tendon reflexes were initially depressed on the right side but within several
days became hyperactive; there was a Babinski response on the right. The patient
was globally aphasic; he was unable to produce any intelligible speech and
appeared to understand only very simple phrases. A computed tomography (CT)
scan revealed an infarct in the territory of the middle cerebral artery of the left side
(see Fig 4–3). Angiography revealed occlusion of the internal carotid artery. The
patient recovered only minimally.

This tragic case illustrates several points. Although the carotid artery on the left was totally
occluded, the patient's cerebral infarct was limited to the territory of the middle cerebral
artery. Even though the anterior cerebral artery arises (together with the middle cerebral
artery) from the carotid, the anterior cerebral artery's territory was spared, probably as a
result of collateral flow from other vessels (e.g., via the anterior communicating artery). The
patient's functional deficit was nevertheless devastating because much of the motor cortex
and the speech areas in the left hemisphere were destroyed by the infarction.

This case reminds us that hypertension represents an important risk factor for stroke, and all
patients with hypertension should be carefully evaluated and treated if appropriate. It is not
enough to prescribe medication; the physician must follow up and make sure the patient
takes the medicine. This patient exhibited several episodes of amaurosis fugax, or transient
monocular blindness. These episodes, which are due to ischemia of the retina, often occur in
the context of atherosclerotic disease of the carotid artery. Indeed, angiography after this
patient's stroke revealed occlusion of the carotid artery. It has become clear that, in patients
with significant stenosis of the carotid artery, endarterectomy (removal of the atherosclerotic
material within the artery) may prevent stroke. The probability of a stroke appears to be
highest in the period after TIA onset. Any patient with TIAs of recent onset should be
evaluated on an urgent basis.
The recent advent of thrombolysis with TIA has made acute stroke a treatable entity if
therapy is begun early enough. Strokes, and suspected strokes, should be regarded as “brain
attacks,” and patients should be transported to the emergency room without delay.

A 44-year-old woman was admitted after a seizure. She was lethargic, with a right
facial droop, right hemiparesis, and right hyperreflexia. She complained of
headache and a painful neck. A few days later, she seemed slightly more alert and
made purposeful movements with her left hand but not her right hand. She was
still unresponsive to spoken commands and had a rigid neck. Other findings
included papilledema, a right pupil that was smaller than the left, incomplete
extraocular movements on the left side (nerve VI function was normal), decreased
right corneal reflex, and right nasolabial droop. The patient's right arm was
hypertonic and paretic, but the other extremities were normal. Reflexes appeared
normal. The right plantar extensor response was equivocal, but the left was
normal.

The blood pressure was 120/85; pulse rate, 60; and temperature, 38 °C (100.4 °F). The white
blood count was 11,200/μL, and the erythrocyte sedimentation rate was 30 mm/h.

Where is the lesion? What is the cause of the lesion? What is the differential diagnosis?

A CT scan showed a high-density area in the cisterns, especially on the right side. What is the
diagnosis now? Would you request a lumbar puncture with analysis of the cerebrospinal
fluid?

A 55-year-old salesman exhibiting signs of confusion was brought to the hospital.

The history elicited from his landlady indicated that he drank alcohol excessively.
His landlady had entered the apartment on the day of admission because he did
not respond to her calls. She found him lying on the floor, incontinent and
appearing bewildered; he had also bitten his lip. The landlady remembered that he
had been involved in a bar fight 2 months earlier, and 3 weeks previously he had
fractured his wrist falling down stairs.
On examination, the patient was unconcerned and disheveled. Bruises on his head and legs
were consistent with recent trauma. The liver was palpable 4 cm below the right costal
margin. The patient appeared to fall asleep when left alone. Neurologic examination showed
normal optic fundi, normal extraocular movements, and no abnormalities that would result
from dysfunction of other cranial nerves. When the left hand was extended, it showed a slow
downward drift. The reflexes were normal and symmetric, and there was a left-sided plantar
extensor response.

Vital signs, complete blood count, and urinalysis were within normal limits. A lumbar
puncture showed an opening pressure of 180 mm H2O, xanthochromia, a protein level of 80
mg/dL, and a glucose level of 70 mg/dL. Cell counts in all tubes showed red blood cells,
800/μL; lymphocytes, 20/μL; and polymorphonuclear neutrophils, 4/mL. A CT scan of the
head was obtained.

Over the next 36 hours, the patient became deeply obtunded, and a left-sided hemiparesis
seemed to develop.

What is the differential diagnosis? What is the most likely diagnosis?

Question 1 of 6

If the optic nerve (II) or olfactory tract is interrupted, will it regenerate?

A. No, will not
. regenerate.
B. Yes, will
. regenerate.
 Chapter 3: Multiple Choice Questions
Instructions
Answer the following questions and then press 'Submit' to get your score.

Question 1

Parasympathetic preganglionic axons leave the CNS with the

a) cervical spinal nerves.

b) thoracic spinal nerves.

c) lumbar spinal nerves.

 d) sacral spinal nerves.

Question 2

Where are the vital centres located in the brainstem?

a) midbrain

b) pons

c) medulla oblongata

d) cerebellum

Question 3

Noradrenaline is the neurotransmitter between which of the two structures below?

a) parasympathetic pre- and post-ganglionic neurons

b) sympathetic pre- and post-ganglionic neurons

c) parasympathetic post-ganglionic neurons and target organs

d) sympathetic post-ganglionic neurons and target organs

Question 4

A patient cuts a peripheral motor nerve in their wrist when they fall through a plate glass window. If
the nerve does not regenerate, after about 6 months the muscles it normally innervates will show
signs of which of the four options below?

a) spastic paralysis

b) flaccid paralysis

c) atrophy

d) contracture

Question 5

Which one of the following is brought about by activation of sympathetic nerves?

 a) Contraction of bronchial smooth muscle.

b) Dilation of the pupil of the eye.

c) Increase in intestinal secretion

d) Decrease in heart rate

Question 6

The dorsal roots of all spinal nerves contain

a) sensory neuronal processes.

b) sensory and autonomic neuronal processes.

c) motor neuronal processes.

d) motor and autonomic neuronal processes. his set of Human Physiology Multiple Choice
Questions & Answers (MCQs) focuses on “Mid Brain”.

1. The midbrain is also called as ______

a) Medulla
b) Diencephalon
c) Mesencephalon
d) Hypothalamus
View Answer
Answer: c
Explanation: Mesencephalon is known as midbrain, it is a part of brain stem. It is associated with
vision, hearing, motor control, temperature regulation and arousal.
2. Mid brain is formed of _______ parts.
a) 1
b) 2
c) 3
d) 4
View Answer
Answer: b
Explanation: Midbrain is made up of 2 parts. They are optic lobes and cerebral peduncles.
3. How many pairs of optic lobes are present?
a) 4
b) 3
c) 2
d) 1
View Answer
Answer: d
Explanation: Optic lobes are present on dorsal side. 1 pair of an optic lobe is present. Each divided
transversely into upper and larger superior coliculus and lower and smaller inferior colicus.
4. Optic lobes control visual reflexes.
a) True
b) False
View Answer
Answer: a
Explanation: Optic lobes control visual reflexes. It controls and coordinates the movement of head
and eyes. It controls auditory refluxes also.
5. The optic lobes in human are represented by the corpora ___
a) Bigemina
b) Arenacea
c) Striata
d) Quadrigemina
View Answer
Answer: d
Explanation: Corpora Quadrigemina are reflex centers involving vision and hearing. Corpora
Quadrigemina are the four colliculi- two inferior and two superior.
6. The 3rd ventricle of brain is situated in ___________
a) Roof of diencephalon
b) Base of telencephalon
c) Roof of metencephalon
d) Base of mylencephalon
View Answer
Answer: a
Explanation: Ventricles are filled with cerebrospinal fluid. It protects the brain from injury and
transport nutrients and waste. The third ventricle is a narrow cavity that is located between the two
halves of the brain.
7. Which foramen is paired in mammalian brain?
a) Foramen of Luschka
b) Foramen of Monro
c) Foramen of Magendie
d) Inter ventricular foramen
View Answer
Answer: a
Explanation: Foramen of Luschka is two of the foramen in ventricular system and link the fourth
ventricle to the cerebellopontine cistern.
8. Which of the following is the reduced part of the brain?
a) Fore brain
b) Mid brain
c) Hind brain
d) Cerebral cortex
View Answer
Answer: b
Explanation: Mid brain is a reduced part of the brain. It is composed of tectum and tegmentum.
9. Brain is situated in __________
a) Benign
b) Polonium
c) Meninges
d) Cranium
View Answer
Answer: d
Explanation: The skull is composed of 2 part.: The cranium and the mandible. Brain is situated in
cranium and it protects the brain.
10. How much does a normal brain weigh?
a) 1.4 kg
b) 85g
c) 3kg
d) 3 tons
View Answer
Answer: a
Explanation: a normal brain weighs1.4 kg. it is about 2% of the total body weight. It is 140mm wide
and 167mm long.
Human Physiology Questions and Answers – Human Brain
and its Functions
This set of Human Physiology Multiple Choice Questions & Answers (MCQs) focuses on
“Human Brain and its Functions”.

1. The supporting and nutritive cells found in brains are _______

a) Oligodendrocytes
b) Astrocytes
c) Microglia
d) Ependymal cells
View Answer
Answer: b
Explanation: Astrocytes are star shaped glial cells of the central nervous system. They are
supporting and nutritive cells found in brains.

2. Which of the following does not act as a neurotransmitter?

a) Acetylcholine
b) Epinephrine
c) Norepinephrine
d) Cortisone
View Answer
Answer: d
Explanation: Cortisone is a pregnane steroid hormone. It is released by the adrenal gland in
response to the stress. Cortisone is not a neurotransmitter.

3. ________ is a quick response to the stimuli that passes the brain.

a) Reflex action
b) Voluntary action
c) Knee jerk
d) Receptors
View Answer
Answer: a
Explanation: Reflex action is an involuntary and instantaneous movement in response to the
stimulus. A reflex is made possible by neural pathways called reflex arcs which can act on an
impulse before that impulse reaches the brain.

4. The cerebellum is located between the cerebrum and the brain stem in the back of the
head. It helps in __________
a) Breathing and controlling blood pressure
b) Balance and coordination
c) Voluntary movement
d) Speech and hearing
View Answer
Answer: b
Explanation: Cerebellum receives information from the sensory systems. It helps in balance and
coordination.

5. The outer covering of the brain is covered with __________

a) Axons
b) Nerve cells
c) Pons
d) Dendrites
View Answer
Answer: b
Explanation: The outer covering of the brain is called the cerebral cortex. It is covered with nerve
cells.

6. The brain stem is composed of _________

a) Brain buds and flowers
b) Spinal cord
c) Axon and vertebra
d) Medulla pons and middle brain tissue
View Answer
Answer: d
Explanation: The brainstem is the posterior part of the brain, adjoin and structurally continuous with
the spinal cord. It consists of medulla oblongata pons and midbrain.

7. What connects two hemispheres of the brain?

a) Pons
b) Pia matter
c) Corpus callosum
d) Diencephalon
View Answer
Answer: c
Explanation: The Corpus callosum is a thick band of nerve fibers that divides the cerebral cortex
lobes into left and right hemisphere. It connects the left and right sides of the brain for
communication between both hemispheres.
8. Fluid filled cavity in the brain is called as ___________
a) Matter
b) Cavity
c) Meninges
d) Ventricles
View Answer
Answer: d
Explanation: Fluid filled cavity in the brain is called as ventricles. It contains cerebrospinal fluid.
Within each ventricle is a region of choroid plexus.

9. Which part of the brain controls higher mental activities like reasoning?
a) Temporal lobe
b) Frontal lobe
c) Medulla oblongata
d) Cerebellum
View Answer
Answer: b
Explanation: Frontal lobe is a part of the brain that controls important cognitive skills in humans. It is
the largest of four major lobes and is located at the front of the brain.

10. Which part of the brain controls emotion experiences?

a) Pia matter
b) Hypothalamus
c) Limbic system
d) Medulla oblongata
View Answer
Answer: c
Explanation: Limbic system includes amygdale, hippocampus, thalamus, hypothalamus, basal
ganglia and cingulated gyrus. The amygdale is the emotion centre of the brain.