It’s situated in the anterior & middle cranial fossae Cerebrum is divided into 2 parts Diencephalon : Forms the central core Telencephalon : Forms cerebral hemispheres The diencephalon It’s a midline structure with symmetrical right & left halves It can be divided into 4 major parts : Thalamus, Subthalamus, Epithalamus & Hypothalamus Thalamus It’s a large ovoid mass of grey matter (No axons) Serve as a cell station to all the main sensory system, except the olfactory pathway It’s situated on each side of the 3rd ventricle Subthalamus Lies inferior to the thalamus (Situated between the thalamus & the Tegmentum of the midbrain) It’s involved in the control of muscle activity Epithalamus It’s consist of Habenular nucleus & Pineal gland (Endocrine gland) Pineal gland secretions can influence (Mainly inhibitory) the endocrine activities of : Pituitary (Directly or indirectly), Pancreas, Parathyroids, Adrenals & Gonads Hypothalamus It’s involved in almost all the body activities Relations of the hypothalamus from anterior to posterior Optic chiasma Tuber cinereum & the infundibulum Mammillary bodies 3rd ventricle Situated between the 2 thalami Communicates anteriorly with the lateral ventricles through the inter ventricular foramina (Foramen of Monro) Communicates posteriorly with the 4th ventricle trough the cerebral aqueduct It’s walls are lined by ependyma Cerebral hemispheres (Telencephalon) Largest part of the brain 2 hemispheres are separated by a deep midline fissure : The longitudinal cerebral fissure Corpus callosum connects the hemispheres across the midline Tentorium cerebelli separates the cerebral hemispheres from the cerebellum To increase the surface area of the cerebral cortex, each hemisphere has formed folds (Gyri) & gyri are separated by sulci (Fissures) Each hemisphere is divided into 4 lobes : Frontal, parietal, temporal & occipital (Named according to the cranial bones under which they lie) The main sulci & Gyri Lateral view of the left cerebral hemisphere Medial view of the right cerebral hemisphere The structures situated interior to the cerebral hemispheres: Lateral ventricles Basal nuclei White matter & nerve fibers Basal ganglia It’s a collection of grey masses in the white matter of the hemispheres There are 3 main parts Corpus striatum : Divided by the internal capsule into Caudate & Lentiform nucleus Amygdaloid nucleus : Situated in the temporal lobe Claustrum White matter of the cerebral hemispheres It’s composed of myelinated nerve fibers The nerve fibers are classified into 3 groups Commissural fibers Association fibers Projection fibers Commissural fibers Connect corresponding regions of the 2 hemispheres They are as follows Corpus callosum Anterior & posterior commissures Fornix Habenular commissure Association fibers Connect various cortical regions within the same hemisphere Projection fibers Afferent & efferent nerve fibers passing to & from the brainstem to the cerebral cortex Examples Internal capsule (Anterior, posterior limbs & genu) Corona radiata Optic radiation Internal capsule & its nerve fiber arrangement Relationships between internal capsule, basal ganglia, and thalamus in horizontal section. Notice that descending motor fibers for the face, arm, and leg (F, A, L) run in front of ascending sensory fibers (f, a, l) in the posterior limb of the internal capsule
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The cerebellum
The position of the cerebellum Situated in the posterior cranial fossa Covered superiorly by the tentorium cerebelli Lies posterior to the 4th ventricle, pons & medulla oblongata Cerebellum has 2 hemispheres & they are joined by the vermis It’s connected to the brainstem by the superior, middle & inferior cerebellar peduncles Cerebellum has 3 lobes : Anterior, Middle (Largest) & Flocculonodular lobe Cerebellum has an outer covering of grey matter (Cortex) & inner white matter Cortex (The grey matter) The white matter White matter is made up of 3 groups of fibers Intrinsic fibers : Don’t leave the cerebellum, but connect different parts of the organ Afferent fibers : Proceed to the cerebellar cortex Efferent fibers : Constitute the output of the cerebellum 4 masses of grey matter are embedded in the white matter forming intra cerebellar nuclei (Lateral to medial) Dentate nucleus : Axons form the superior cerebellar peduncle Emboliform nucleus : Axons form the superior cerebellar peduncle Globose nucleus : Axons form the superior cerebellar peduncle Fastigial nucleus : Axons form the inferior cerebellar The cerebellum (Superior view) The lobes of the cerebellum Positions of the intra cerebellar nuclei
The cerebellum
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Descending tracts have 3 neurons 1st order neurons (UMN) : Cell bodies are in the cerebral cortex & other supra spinal areas 2nd order neurons : Short & situated in the anterior grey column of the spinal cord 3rd order neuron (LMN) : Situated in the anterior grey column & innervate the skeletal muscles through anterior roots of the spinal nerves Cortico-spinal tract : Rapid, skilled & voluntary movements image 1st order neuron Axons arise from the pyramidal cells of the cerebral cortex (Situated in the 5th layer), 2/3 from the pre central gyrus & 1/3 from the post central gyrus 1/3 of fibers arise from the 1stry motor cortex (Area 4) 1/3 of fibers arise from the 2ndry motor cortex (Area 6) 1/3 of fibers arise from the parietal lobe (Area 1, 2 & 3) Descending fibers converge in the corona radiata & pass though the posterior limb of the internal capsule; Organization of fibers within the internal capsule: Close to genu (Medial) : Concerned with the cervical parts of the body Away from the genu (lateral) : Concerned with the lower extremity The tract then passes through the middle 3/5 of the basis pedunculi of the midbrain; Organization of fibers in the midbrain: Medially : Cervical parts of the body Laterally : Lower limbs When the tract enters the pons, it’s broken into many bundles by the transverse pontocerebellar fibers In the medulla oblongata, the bundles group together to form the pyramids At the junction of the MO & the spinal cord, most fibers cross the midline at the decussation of the pyramids & enter the lateral white column of the spinal cord to form the lateral corticospinal tract (LCST) LCST descends length of the spinal cord; terminate in the anterior grey column of all the spinal segments The fibers which didn’t cross, descend in the anterior white column of the spinal cord as the anterior corticospinal tract (ACST) Fibers of the ACST eventually cross & terminate in the anterior grey column of the spinal cord segments in the cervical & upper thoracic regions 2nd order neuron : it’s an internuncial neuron 3rd order neuron : it’s a alpha or gamma motor neuron
Related lecturesDescending tract 1
Descending tract 2
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Features Ipsilateral LMN paralysis & muscular atrophy in the corresponding part of the body to the damaged segment of the spinal cord Ipsilateral spastic paralysis below the of the level lesion (γ motor neuron inhibition is lost) Ipsilateral loss of cutaneous sensation below the of the level lesion Ipsilateral loss of dorsal column sensation below the of the level lesion Contralateral pain, temperature, touch & pressure sensations are lost below the of the level lesion Tracts which are affected Dorsal column : Ipsilateral Lateral Spinothalamic tract : Contralateral Anterior Spinothalamic tract : Contralateral Anterior Spino cerebellar tract : Contralateral Posterior Spino cerebellar tract : Ipsilateral Anterior corticospinal tract : Ipsilateral Posterior corticospinal tract : Ipsilateral Autonomic nervous system : Ipsilateral
Related lecturesDescending tract 1
Descending tract 2
Discriminative touch, vibratory sense & conscious muscle joint sense : Posterior white column (Fasciculus gracilis & fasciculus cuneatus)
1st order neuron
The axons enter the spinal cord from the posterior root ganglion & pass directly to the posterior white column of the same side
The ascending fibers travel upward in the white column as the fasciculus gracilis & cuneatus
Fasciculus gracilis is present throughout the spinal cord (Contain ascending fibers from the sacral, lumbar & lower 6 thoracic spinal nerves)
Fasciculus cuneatus is situated lateral to the FG in the upper thoracic & cervical segments (Contain ascending fibers from upper 6 thoracic & cervical spinal nerves)
FG & FC ascends ipsilaterally & synapses with the 2nd order neurons at medulla oblongata
2nd order neuron
The axons are called internal arcuate fibers
They decussate with the corresponding fibers from the opposite side in the sensory decussation
The fibers then ascend as a compact bundle called the medial lemniscus through medulla, pons & midbrain
The fibers synapse with the 3rd order neuron in the ventral posterolateral nucleus of the thalamus
Some fibers from the FC enter the cerebellum through the inferior cerebellar peduncle of the same side (Cuneocerebellar tract)
3rd order neuron
Axons pass through the posterior limb of the internal capsule & corona radiata to reach the somesthetic area in the post central gyrus of the cerebral cortex
Fine touch, localization, 2 point discrimination & vibratory sense can be recognized consciously
The main sensory pathways to consciousness
The main sensory pathways to consciousness
Unconscious muscle joint sense pathways to the cerebellum
Unconscious muscle joint sense pathways to the cerebellum Unconscious muscle joint sense pathways to the cerebellum
Lecture as Text
They are located in the white matter Conduct afferent information (May or may not reach consciousness) There are 2 types of information Exteroceptive : Originates from outside the body (Pain, temperature & touch) Proprioceptive : Originates from inside the body (From muscles & joints) Normally there are 3 neurons in an ascending pathway 1st order neuron : Cell body is in the posterior root ganglion 2nd order neuron : Decussates (Crosses to the opposite side) & ascends to a higher level of the CNS 3rd neuron : Located in the thalamus & passes to a sensory region of the cortex Pain & temperature pathway :Lateral spinothalmic tract Pain & temperature pathway :Lateral spinothalmic tract 1st order neuron Peripheral process extends to skin or other tissues & ends as free nerve endings (Receptors) Cell body is situated in the posterior root ganglion Central process extends into the posterior grey column & synapses with the 2nd order neuron 2nd order neuron The axon crosses obliquely to the opposite side in the anterior grey & white commissures within one spinal segment of the cord It ascends in the contra – lateral white column as the lateral spinothalamic tract (LSTT) As the LSTT ascends through the spinal cord new fibers are added to the antero – medial aspect of the tract (Sacral fibers are lateral & cervical fibers are medial) The fibers carrying pain are situated anterior to those conducting temperature As the LSTT ascends through the medulla oblongata, it’s joined by the anterior spinothalamic tract & the spinotectal tract and forms the spinal lemniscus Spinal lemniscus ascends through the pons & the mid brain Fibers of the LSTT end by synapsing with the 3rd order neurons in the ventral posterolateral nucleus of the thalamus (Here crude pain & temperature sensations are appreciated) 3rd order neuron Axons pass through the posterior limb of the internal capsule & corona radiata to reach the somesthetic area in the post central gyrus of the cerebral cortex From here information is transmitted to other regions of the cerebral cortex to be used by motor areas The role of the cerebral cortex is interpreting the quality of the sensory information at the level of the consciousness Light (Crude) touch & pressure pathway : Anterior spinothalamic tract (ASTT) 1st order neuron : It is similar to the pain & temperature pathway 2nd order neuron The axon crosses obliquely to the opposite side in the anterior grey & white commissures within several spinal segments It ascends in the contra – lateral white column as the anterior spinothalamic tract (ASTT) As the ASTT ascends through the spinal cord new fibers are added to the antero – medial aspect of the tract (Sacral fibers are lateral & cervical fibers are medial) As the ASTT ascends through the medulla oblongata, it’s joined by the lateral spinothalamic tract & the spinotectal tract and forms the spinal lemniscus Spinal lemniscus ascends through the pons & the mid brain Fibers of the ASTT end by synapsing with the 3rd order neurons in the ventral posterolateral nucleus of the thalamus (Here crude awareness of touch & pressure sensations are appreciated) 3rd order neuron Axons pass through the posterior limb of the internal capsule & corona radiata to reach the somesthetic area in the post central gyrus of the cerebral cortex The sensations can be crudely localized Very little discrimination is possible
They are located in the white matter Conduct afferent information (May or may not reach consciousness) There are 2 types of information Exteroceptive : Originates from outside the body (Pain, temperature & touch) Proprioceptive : Originates from inside the body (From muscles & joints) Normally there are 3 neurons in an ascending pathway 1st order neuron : Cell body is in the posterior root ganglion 2nd order neuron : Decussates (Crosses to the opposite side) & ascends to a higher level of the CNS 3rd neuron : Located in the thalamus & passes to a sensory region of the cortex Pain & temperature pathway :Lateral spinothalmic tract Pain & temperature pathway :Lateral spinothalmic tract 1st order neuron Peripheral process extends to skin or other tissues & ends as free nerve endings (Receptors) Cell body is situated in the posterior root ganglion Central process extends into the posterior grey column & synapses with the 2nd order neuron 2nd order neuron The axon crosses obliquely to the opposite side in the anterior grey & white commissures within one spinal segment of the cord It ascends in the contra – lateral white column as the lateral spinothalamic tract (LSTT) As the LSTT ascends through the spinal cord new fibers are added to the antero – medial aspect of the tract (Sacral fibers are lateral & cervical fibers are medial) The fibers carrying pain are situated anterior to those conducting temperature As the LSTT ascends through the medulla oblongata, it’s joined by the anterior spinothalamic tract & the spinotectal tract and forms the spinal lemniscus Spinal lemniscus ascends through the pons & the mid brain Fibers of the LSTT end by synapsing with the 3rd order neurons in the ventral posterolateral nucleus of the thalamus (Here crude pain & temperature sensations are appreciated) 3rd order neuron Axons pass through the posterior limb of the internal capsule & corona radiata to reach the somesthetic area in the post central gyrus of the cerebral cortex From here information is transmitted to other regions of the cerebral cortex to be used by motor areas The role of the cerebral cortex is interpreting the quality of the sensory information at the level of the consciousness Light (Crude) touch & pressure pathway : Anterior spinothalamic tract (ASTT) 1st order neuron : It is similar to the pain & temperature pathway 2nd order neuron The axon crosses obliquely to the opposite side in the anterior grey & white commissures within several spinal segments It ascends in the contra – lateral white column as the anterior spinothalamic tract (ASTT) As the ASTT ascends through the spinal cord new fibers are added to the antero – medial aspect of the tract (Sacral fibers are lateral & cervical fibers are medial) As the ASTT ascends through the medulla oblongata, it’s joined by the lateral spinothalamic tract & the spinotectal tract and forms the spinal lemniscus Spinal lemniscus ascends through the pons & the mid brain Fibers of the ASTT end by synapsing with the 3rd order neurons in the ventral posterolateral nucleus of the thalamus (Here crude awareness of touch & pressure sensations are appreciated) 3rd order neuron Axons pass through the posterior limb of the internal capsule & corona radiata to reach the somesthetic area in the post central gyrus of the cerebral cortex The sensations can be crudely localized Very little discrimination is possible
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efinitions Infertility: failure to conceive after one year of regular unprotected intercourse primary infertility: no prior pregnancies secondary infertility: previous conception Incidence 10-15% of couples 60% of couples achieve pregnancy within 6 months of trying 80% of couples achieve pregnancy within 1 year of trying Etiology Female factors (50%) male factors (40%) multiple factors (30%) unknown factors (10-15%) note: even when fertilization occurs, > 50-70% of resulting embryos are non-viable Male Factors Inadequate or abnormal production of sperm congenital trauma, e.g. sports injury varicocele infection - usually mumps orchitis smoking, stress, heat, alcohol rare: malignant disease, endocrine disease Delivery problems bilateral obstruction of epididymis or ducts ejaculatory dysfunction, e.g. retrograde ejaculation erectile dysfunction abnormal position of urethral orifice Diagnosis semen analysis after 2-3 days of abstinence (2 specimens several weeks apart) normal ejaculate volume: 2-5 mL count: > 20 million sperm/mL ïmotility: > 50% morphology: > 60% normal forms liquefaction: complete in 20 minutes pH: 7.2-7.8 WBC: < 10 per high power field oligospermia: count < 20 million/mL azoospermia: absence of living spermatozoa in the semen endocrine evaluation required if abnormal sperm Female Factors Ovulatory dysfunction (15-20%) Etiology hyperprolactinemia (e.g. pituitary microadenoma) olycystic ovarian disease drugs (e.g. cimetidine, psychotropic) systemic diseases e.g. thyroid, hepato-renal disease, Cushing syndrome congenital - Turner syndrome, testicular feminization, gonadal dysgenesis, and gonadotropin deficiency luteal phase defect excessive exercise (even in absence of amenorrhea) premature ovarian failure - autoimmune disease Diagnosis history of cycle patterns basal body temperature (biphasic) mucous quality (mid-cycle) endometrial biopsy for luteal phase defect (day 24-26) serum progesterone level (day 20-22) serum prolactin, TSH, LH, FSH If hirsute: serum free testosterone, DHEAS ovulation predictor kits Tubal factors (20-30%) Etiology PID adhesions (previous surgery, peritonitis, endometriosis) tubal ligation Diagnosis hysterosalpingogram, day 8-10 = diagnostic and therapeutic (i.e. may open tube just prior to ovulation) laparoscopy with dye injection of tubes Cervical factors (5%) Etiology hostile, acidic cervical mucous, glands unresponsive to estrogen (e.g. chlamydial infection) anti-sperm antibodies structural defects (cone biopsies, laser, or cryotherapy) Diagnosis post-coital test (day 12-14, sperm motility in cervical mucous 2-6 hours after intercourse) Uterine factors (< 5%) Etiology congenital anomalies intrauterine adhesions (e.g. Asherman syndrome) infection leiomyomata polyps Investigation hysterosalpingogram hysterosonogram hysteroscopy Treatment education : timing of intercourse (temperature charting) medical : bromocriptine if increased prolactin ovulation induction clomiphene citrate (Clomid) human menopausal gonadotropin (Pergonal) urofollitropin (FSH) (Metrodin) followed by flhCG for stimulation of ovum release surgical tuboplasty artificial insemination - donor or husband sperm washing in vitro fertilization GIFT (gamete intrafallopian transfer) CSI (intrecellular sperm injection)
efinitions Infertility: failure to conceive after one year of regular unprotected intercourse primary infertility: no prior pregnancies secondary infertility: previous conception Incidence 10-15% of couples 60% of couples achieve pregnancy within 6 months of trying 80% of couples achieve pregnancy within 1 year of trying Etiology Female factors (50%) male factors (40%) multiple factors (30%) unknown factors (10-15%) note: even when fertilization occurs, > 50-70% of resulting embryos are non-viable Male Factors Inadequate or abnormal production of sperm congenital trauma, e.g. sports injury varicocele infection - usually mumps orchitis smoking, stress, heat, alcohol rare: malignant disease, endocrine disease Delivery problems bilateral obstruction of epididymis or ducts ejaculatory dysfunction, e.g. retrograde ejaculation erectile dysfunction abnormal position of urethral orifice Diagnosis semen analysis after 2-3 days of abstinence (2 specimens several weeks apart) normal ejaculate volume: 2-5 mL count: > 20 million sperm/mL ïmotility: > 50% morphology: > 60% normal forms liquefaction: complete in 20 minutes pH: 7.2-7.8 WBC: < 10 per high power field oligospermia: count < 20 million/mL azoospermia: absence of living spermatozoa in the semen endocrine evaluation required if abnormal sperm Female Factors Ovulatory dysfunction (15-20%) Etiology hyperprolactinemia (e.g. pituitary microadenoma) olycystic ovarian disease drugs (e.g. cimetidine, psychotropic) systemic diseases e.g. thyroid, hepato-renal disease, Cushing syndrome congenital - Turner syndrome, testicular feminization, gonadal dysgenesis, and gonadotropin deficiency luteal phase defect excessive exercise (even in absence of amenorrhea) premature ovarian failure - autoimmune disease Diagnosis history of cycle patterns basal body temperature (biphasic) mucous quality (mid-cycle) endometrial biopsy for luteal phase defect (day 24-26) serum progesterone level (day 20-22) serum prolactin, TSH, LH, FSH If hirsute: serum free testosterone, DHEAS ovulation predictor kits Tubal factors (20-30%) Etiology PID adhesions (previous surgery, peritonitis, endometriosis) tubal ligation Diagnosis hysterosalpingogram, day 8-10 = diagnostic and therapeutic (i.e. may open tube just prior to ovulation) laparoscopy with dye injection of tubes Cervical factors (5%) Etiology hostile, acidic cervical mucous, glands unresponsive to estrogen (e.g. chlamydial infection) anti-sperm antibodies structural defects (cone biopsies, laser, or cryotherapy) Diagnosis post-coital test (day 12-14, sperm motility in cervical mucous 2-6 hours after intercourse) Uterine factors (< 5%) Etiology congenital anomalies intrauterine adhesions (e.g. Asherman syndrome) infection leiomyomata polyps Investigation hysterosalpingogram hysterosonogram hysteroscopy Treatment education : timing of intercourse (temperature charting) medical : bromocriptine if increased prolactin ovulation induction clomiphene citrate (Clomid) human menopausal gonadotropin (Pergonal) urofollitropin (FSH) (Metrodin) followed by flhCG for stimulation of ovum release surgical tuboplasty artificial insemination - donor or husband sperm washing in vitro fertilization GIFT (gamete intrafallopian transfer) CSI (intrecellular sperm injection)
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UTERINE PROLAPSE Symptoms mass or bulge at introitus back pain due to stretching of uterosacral ligaments feeling of heaviness in the pelvis worse with standing, lifting relieved by lying down Classification 0 = No descent 1 = Descent between normal position and ischial spines 2 = Descent between ischial spines and hymen 3 = Descent with hymen 4 = Descent through hymen Procidentia: failure of genital supports and complete prolapse of uterus Treatment conservative vaginal pessary estrogen therapy pelvic muscle exercises (Kegels) surgical prosthetic slings in cases associated with urinary incontinence vaginal hysterectomy ±anterior + posterior repair VAULT PROLAPSE follows hysterectomy, vagina turns inside out Treatment conservative vaginal pessary estrogen therapy surgical vaginal vault suspension (can be very complicated) CYSTOCELE CYSTOCELE prolapse of bladder into the upper anterior vaginal wall Symptoms frequency, urgency, nocturia stress incontinence incomplete emptying bladder increased incidence of UTIs Treatment conservative vaginal pessary, Kegels exercises surgical anterior colporrhaphy (ìanterior repairî) plication of pubocervical fascia to support bladder and urethra RECTOCELE RECTOCELE prolapse of large bowel in lower posterior vaginal wall Symptoms constipation constant straining may increase rectocele Treatment conservative laxatives and stool softeners vaginal pessary usually not helpful surgical posterior colporrhaphy (ìposterior repairî) plication of endopelvic fascsia and perineal muscles approximated in midline to support rectum/perineum ENTEROCELE ENTEROCELE prolapse of small bowel in upper posterior vaginal wall usually associated with rectocele image Some types of vaginal pessaries used for prolapse. (A) Gellhorn, (B) Shaatz, (C) Ring, (D) ring with support, (E) Cube, (F) Smith, (G) Hodge, (H) Hodge with support for cystocele, (I) Inflatoball, (J) Gehrung, and (K) Donut.
It’s cylindrical shape Starts : At the foramen magnum in the skull Ends Adult : Lower border of the 1st lumbar vertebra (L 1) Young child : upper border of the 3rd lumbar vertebra (L 3) Inferiorly Tapers off into the conus medullaris (It’s a prolongation of the pia mater) Filum terminale descends & attach to the posterior surface of the coccyx Anteriorly : Anterior median fissure (Deep longitudinal fissure) Posteriorly : Posterior median sulcus Coverings 3 meninges (Dura, Arachnoid & Pia mater) CSF in the sub arachnoid space It has 2 fusiform enlargements Cervical enlargement : Gives origin to brachial plexus Lumbar enlargement : Gives rise to lumbosacral plexus There are 31 pairs of spinal nerves attached by the: Motor roots (Anterior) Sensory roots (Posterior) Each posterior nerve root has a posterior root ganglion (Gives rise to peripheral & central nerve fibers) Spinal cord – Nerve supply image Body landmark Dermatome Back of head C-2 Shoulder C-4 Thumb C-6 Middle finger C-7 Small finger C-8 Nipple T-4, T-5 Umbilicus T-10 Inguinal region L-1 Big toe L-4, L-5 Small toe S-1 Genitalia and perianal region S-4, S-5 Structure of the spinal cord : (Grey matter: Inner core & White matter: Outer covering) Transverse section of the spinal cord Gray matter image White Matter image profile editor"It will take only 2 sec to say thanks and will take only 10 sec to write a comment it will be a nice encouragement for uploaders "
Lecture Content
The 1stry divisions of the developing brain
Development of the medulla oblongata
There are basal & alar plates in the hind brain, separated by the sulcus limitans
As the 4th ventricle enlarges, the alar plate comes lateral to the basal plate
Basal plate forms the motor nuclei of IX, X, XI & XII cranial nerves (They are situated medial to the sulcus limitans)
Alar plate forms the sensory nuclei of the V, VIII, IX & X cranial nerves, gracile & cuneate nuclei and Olivary nuclei
As the roof plate becomes stretched into a thin layer, tela choroidea projects into the cavity of the 4th ventricle to form the choroid plexus
During the 4th & 5th months, foramina of Luschka & foramen of Magendie are formed
Descending motor fibers from the cortex produce a prominent swelling in the anterior aspect of MO called the pyramids
Development of the pons
Transverse section through the caudal part of the metencephalon. Note the differentiation of the various motor and sensory nuclear areas in the basal and alar plates, respectively
It’s formed from the anterior part of the Metencephalon
It has also cellular contributions from the alar part of the Myelencephalon
Basal plate forms the motor nuclei of V, VI & VII cranial nerves
Alar plate forms
Sensory nucleus of V & VII
Vestibular cochlear nuclei of VIII
Pontine nuclei
Axons of the pontine nuclei go to the developing cerebellum of the opposite side (Rhombic lip) & form
Transverse pontine fibers
Middle cerebellar peduncle
Development of the cerebellum
Dorsal view of the mesencephalon and rhombencephalon in an 8-week embryo
Similar view in a 4-month embryo
It’s formed from the posterior part of the alar plate of the Metencephalon
On each side, alar plates bend medially to form the rhombic lip
As the lips enlarges, they project over the roof plate of the 4th ventricle & unite with each other to form the cerebellum
At 12th week, vermis & 2 cerebellar hemispheres can be recognized
Matrix cells situated close to the ventricle form neuroblasts & migrate to the cerebellum to form the cerebellar cortex
Neuroblasts that remained close to the ventricles differentiate into dentate & other cerebellar nuclei
Development of the midbrain
Mid brain develops from the midbrain vesicle
Cavity becomes much small to form the cerebral aqueduct
Basal plate forms
Motor nuclei of the 3rd & 4th cranial nerves
Red nuclei
Substantia nigra
Reticular formation
The marginal zone of basal plates on each side enlarges to form basis pedunculi (The descending motor tracts are situated in that region – Cortico pontine, corticobulbar & corticospinal tracts)
The 2 alar plates & the roof plate forms the Tectum
The alar plate forms the sensory neurons of the superior & inferior colliculi
Development of the medulla oblongata
There are basal & alar plates in the hind brain, separated by the sulcus limitans
As the 4th ventricle enlarges, the alar plate comes lateral to the basal plate
Basal plate forms the motor nuclei of IX, X, XI & XII cranial nerves (They are situated medial to the sulcus limitans)
Alar plate forms the sensory nuclei of the V, VIII, IX & X cranial nerves, gracile & cuneate nuclei and Olivary nuclei
As the roof plate becomes stretched into a thin layer, tela choroidea projects into the cavity of the 4th ventricle to form the choroid plexus
During the 4th & 5th months, foramina of Luschka & foramen of Magendie are formed
Descending motor fibers from the cortex produce a prominent swelling in the anterior aspect of MO called the pyramids
Development of the pons
Transverse section through the caudal part of the metencephalon. Note the differentiation of the various motor and sensory nuclear areas in the basal and alar plates, respectively
It’s formed from the anterior part of the Metencephalon
It has also cellular contributions from the alar part of the Myelencephalon
Basal plate forms the motor nuclei of V, VI & VII cranial nerves
Alar plate forms
Sensory nucleus of V & VII
Vestibular cochlear nuclei of VIII
Pontine nuclei
Axons of the pontine nuclei go to the developing cerebellum of the opposite side (Rhombic lip) & form
Transverse pontine fibers
Middle cerebellar peduncle
Development of the cerebellum
Dorsal view of the mesencephalon and rhombencephalon in an 8-week embryo
Similar view in a 4-month embryo
It’s formed from the posterior part of the alar plate of the Metencephalon
On each side, alar plates bend medially to form the rhombic lip
As the lips enlarges, they project over the roof plate of the 4th ventricle & unite with each other to form the cerebellum
At 12th week, vermis & 2 cerebellar hemispheres can be recognized
Matrix cells situated close to the ventricle form neuroblasts & migrate to the cerebellum to form the cerebellar cortex
Neuroblasts that remained close to the ventricles differentiate into dentate & other cerebellar nuclei
Development of the midbrain
Mid brain develops from the midbrain vesicle
Cavity becomes much small to form the cerebral aqueduct
Basal plate forms
Motor nuclei of the 3rd & 4th cranial nerves
Red nuclei
Substantia nigra
Reticular formation
The marginal zone of basal plates on each side enlarges to form basis pedunculi (The descending motor tracts are situated in that region – Cortico pontine, corticobulbar & corticospinal tracts)
The 2 alar plates & the roof plate forms the Tectum
The alar plate forms the sensory neurons of the superior & inferior colliculi
DSM-IV-TR Criteria for Manic Episode- A. a distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting >1 week (or any duration if hospitalization is necessary)
- B. during the period of mood disturbance, >3 of the following symptoms have persisted (4 if the mood is only irritable) and have been present to a significant degree:
- inflated self-esteem or grandiosity
- decreased need for sleep (e.g. feels rested after only 3 hours of sleep)
- more talkative than usual or pressure to keep talking
- flight of ideas or subjective experience that thoughts are racing
- distractibility (i.e. attention too easily drawn to unimportant or irrelevant external stimuli)
- increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
- excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g. engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
- C. the symptoms do not meet criteria for a Mixed Episode
- D. the mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features
- E. the symptoms are not due to the direct physiological effects of a substance (e.g. drug of abuse, medication, or other treatment) or a general medical condition (e.g. hyperthyroidism). Note: Manic-like episodes that are clearly caused by somatic antidepressant treatment (e.g. medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder
Mnemonic
Criteria for Mania (>3): GST PAID
Grandiosity
Sleep (decreased need)
Talkative
Pleasurable activities, Painful consequences
Activity
Ideas (flight of)
Distractable
![image_thumb[10]](http://lh3.ggpht.com/_oj6TkG186pI/TaKVmXNTEgI/AAAAAAAAGak/QcrIjvjxpt4/s1600-h/image_thumb%5B10%5D%5B3%5D.png "image_thumb[10]")
DSM-IV-TR Criteria for Major Depressive Episode
- A. >5 of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either 1) depressed mood, or 2) loss of interest or pleasure (anhedonia) Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations
- depressed mood most of the day, nearly every day, as indicated by either subjective report or observation made by others
- markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
- significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day
- insomnia or hypersomnia nearly every day
- psychomotor agitation or retardation nearly every day
- fatigue or loss of energy nearly every day
- feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
- diminished ability to think or concentrate, or indecisiveness, nearly every day
- recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
- B. the symptoms do not meet criteria for a Mixed Episode
- C. the symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
- D. the symptoms are not due to the direct physiological effects of a substance or a GMC
- E. the symptoms are not better accounted for by bereavement, i.e. after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation
Mnemonic
Criteria for Depression (>5): MSIGECAPS
M - Depressed Mood
S - Increased/decreased Sleep
I - Decreased Interest
G - Guilt
E - Decreased Energy
C - Decreased Concentration
A - Increased/decreased Appetite
P - Psychomotor agitation/retardation
S - Suicidal ideation
Definitions
- mood disorders are defined by the presence of mood episodes
- mood episodes represent a combination of symptoms comprising a predominant mood state that is abnormal in quality or duration; examples include: major depressive, manic, mixed, hypomanic
- types of mood disorders include:
- depressive (major depressive disorder, dysthymia)
- bipolar (bipolar I/II disorder, cyclothymia)
- secondary to GMC, substances, medications
Secondary Causes of Mood Disorders
- infectious: encephalitis/meningitis, hepatitis, pneumonia, TB, syphilis
- endocrine: hypothyroidism, hyperthyroidism, hypopituitarism, SIADH
- metabolic: porphyria, Wilson’s disease, diabetes
- vitamin disorders: Wernicke’s, beriberi, pellagra, pernicious anemia
- collagen vascular diseases: SLE, polyarteritis nodosa
- neoplastic: pancreatic cancer, carcinoid, pheochromocytoma
- cardiovascular: cardiomyopathy, CHF, MI, CVA
- neurologic: Huntington’s disease, multiple sclerosis, tuberous sclerosis, degenerative (vascular, Alzheimer’s)
- drugs: antihypertensives, antiparkinsonian, hormones, steroids, antituberculous, interferon, antineoplastic medications
Medical Workup of Mood Disorder
- routine screening:
- physical examination
- complete blood count
- thyroid function test
- electrolytes
- urinalysis, urine drug screen
- addtional screening:
- neurological consultation
- chest x-ray
- electrocardiogram
- CT scan
- diagnosis: delusion that develops in an individual who is in a close relationship with another person who already has a psychotic disorder with prominent delusions; the delusion is similar in content to that of the other person
- treatment: separation of the two people results in the disappearance of the delusion in the healthier member; antipsychotics may play a role
- prognosis: good
Table 1. Differentiating Psychotic Disorders
Psychotic Disorders >> Links :
Definition
Differential Diagnosis of Psychosis
Schizophrenia
Schizophreniform Disorder
Brief Psychotic Disorder
Postpartum Mood Disorders
Schizoaffective Disorder
Delusional Disorder
Shared Psychotic Disorder (Folie à Deux)
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