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A lesion of these fibers on the left side of the medulla will result in a loss of 41 discount 25mg sominex fast delivery sleep aid pillows. Answer E: The loss of most eye movement on one side (oculo- pain and thermal sensations on the left side of the face purchase sominex 25 mg online sleep aid exclusively at walgreens. Lesions of motor nerve root involvement) coupled with a paralysis of the ex- the right trigeminal ganglion, trigeminothalamic fibers on the left, tremities on the contralateral side is a superior alternating hemi- and the right spinal trigeminal nucleus would all result in pain and plegia (this is also Weber syndrome): superior because it is the most thermal losses on the right side of the face. The principal sensory rostral of three; alternating because it is a cranial nerve on one side nucleus conveys touch information. Answer A: Recognizing that this woman has a sensory loss on plegia involves the abducens (VI) nerve root and adjacent corti- the left side of her face, damage to fibers of the anterolateral sys- cospinal fibers, and an inferior alternating hemiplegia involves the tem on the left correlates with the loss of pain and thermal sensa- hypoglossal (XII) nerve root and corticospinal fibers in the pyra- tions on the right side of her body. Alternating hemianesthesia is a sensory loss, and a Brown- (ALS) fibers cross in the spinal cord within about two levels of Séquard syndrome is a spinal cord lesion with no cranial nerve where they enter. Damage to anterior trigeminothal- amic fibers on the left would produce a corresponding right-sided 42. Answer B: Taste fibers (special visceral afferent, SVA) that deficit on the face. The medial lemniscus conveys vibratory, dis- serve the anterior two-thirds of the tongue on the ipsilateral side criminative touch, and proprioceptive sensations. The trigeminal ganglion contains cell bodies that convey general sensation (general somatic affer- 48. Answer B: This patient has a lateral medullary syndrome (also ent, GSA), and the ciliary ganglion contains visceromotor cell commonly called a posterior inferior cerebellar artery, or PICA bodies (general visceral efferent GVE, postganglionic, parasym- syndrome) on the left; this correlates with the left-sided sensory pathetic). The superior ganglion of the glossopharyngeal contains loss on the face and right-sided sensory loss on the body. A lateral cell bodies for taste from the posterior one-third of the tongue, medullary lesion on the right would result in the same deficits, but and the superior ganglion of the vagus nerve contains cell bodies on the opposite sides. The Parinaud, Weber, and Benedikt syn- for taste from the root of the tongue. Answer B: Stimulation of the supraorbital nerve (Vth nerve, af- ferent limb of the supraorbital reflex) results in contraction of the 49. Answer B: Wilson disease (hepatolenticular degeneration) is an orbicularis oculi muscle (VIIth nerve, efferent limb of the supra- inherited error of copper metabolism. Changes in pupil size relate to the third nerve, the decreased; urinary levels are increased; and copper accumulates in pupillary light reflex, and the distribution of postganglionic fibers the liver, lenticular nuclei, and kidneys. Contraction of masticatory treated by reducing the level of dietary copper and administering muscles is seen in the jaw-jerk reflex, and nystagmus usually re- a copper-chelating agent. Maintenance can be achieved by taking sults from cerebellum or brainstem lesions or disease of the zinc, and treatment must be life-long. However, none of these is the causative agent in hepatolenticular degeneration. Answer A: Fibers in the postsynaptic posterior column and in 214–215) the spinocervicothalamic pathways are spared in an anterolateral cordotomy. Answer E: The dilator pupillae muscle of the iris is innervated posterior horn that also contribute to the anterolateral system. It by postganglionic sympathetic fibers whose cell bodies of origin is possible that these pathways remodel to transmit pain and ther- are located in the ipsilateral superior cervical ganglion. Pregan- mal sensations in the absence of the normal anterolateral system glionic sympathetic cell bodies are found in the intermediolateral (ALS) pathway. Preganglionic parasympathetic cell bodies are found Q & A’s: A Sampling of Study and Review Questions with Explained Answers 291 in the Edinger-Westphal nucleus; axons of these cells terminate in terminate in the lateral parts of the ventral posterolateral nu- the ciliary ganglion, which, in turn, innervates the sphincter pupil- cleus and, from there, be relayed to the posterior paracentral lae muscle of the iris. The hypothalamus is the origin of hypothal- gyrus (the lower extremity area of the primary somatomotor amospinal fibers that project to the intermediolateral cell column. Answer E: The deficits described for the man are consistent central gyrus is the somatomotor cortex for the lower extrem- with a tumor on the root of the vestibulocochlear (VIII) nerve; ity. Answer E: Syringomyelia is a cavitation in central areas of the of the VIIIth nerve. Acoustic neuroma is an earlier, and now in- spinal cord that results in damage to fibers conveying pain and correct, designation for this lesion.

Descending Pathways purchase sominex 25mg without a prescription insomnia 33rd st, Visualization of Pathways 59 6 7 10 8 1 9 4 5 2 3 B Descending pathways 11 12 C Autonomic pathways A Anterior and lateral corticospinal tract (pyramidal tract) 13 2 D Unmyelinated pyramidal tract E Degeneration of the fasciculus gracilis in the newborn after injury to the spinal cord Kahle order 25mg sominex amex sleep aid in turkey, Color Atlas of Human Anatomy, Vol. Injection of tracers segmental arteries (intercostal arteries and revealed that the gray matter is much more lumbar arteries). The anterior spi- they give off two thin posterior spinal arter- nal artery supplies the anterior horns, the ies that form a network of small arteries bases of the posterior horns, and the largest along the posterior surface of the spinal part of the anterior lateral funiculi (E9). At the level of the pyramidal decussa- posterior funiculi and the remaining parts tion, two additional branches of the verte- of the posterior horns are supplied by the bral arteries join to form the anterior spinal posterior spinal arteries (E10). The marginal artery (AD2) which runs along the anterior zone of the anterior lateral funiculus is sup- surface of the spinal cord at the entrance to plied by the plexus of the vasocorona (E11). Their posterior which one anterior spinal vein and two pos- branches(C4)andthevertebralarteriesgive terior spinal veins stand out. The efferent off spinal branches (C5) which enter through veins run along the spinal roots and open the intervertebral foramina and divide at into the epidural venous plexus (see vol. Of the 31 spinal arteries, only 8 to 10 extend to the spinal cord and C12 Aorta. The levels at which the radicular arteries approach the spinal cord vary, and so do the sizes of the vessels. The largest vessel approaches the spinal cord at the level of the lumbar en- largement between T12 and L3 (large radicu- lar artery) (A6). The anteriorspinalartery is widest at the level of the cervical and lumbar enlargements. Its diameter is much reduced in the mid- thoracic region of the spinal cord. As this re- gion is also the border area between two supplyingradiculararteries,thissegmentof the spinal cord is especially at risk in case of circulatory problems (A, arrow). Depending on the variation of the radicular arteries, this may also apply to other segments of the spinal cord. The anterior spinal artery gives off numer- ous small arteries into the anterior sulcus, the sulcocommissuralarteries (D7). In the cer- vical and thoracic spinal cords, they turn al- ternately to the left and right halves of the spinal cord; in the lumbar and sacral spinal cords, they divide into two branches. Spinal Blood Vessels 61 1 C 1 2 5 C 3 C 5 3 4 T 1 12 T 3 C Afferent blood vessels T 5 T 8 8 T10 7 2 D Vascularization of the spinal cord 6 L 2 10 L 5 11 9 A B Arteries and veins E Areas supplied by the spinal cord of the spinal cord arteries (according to Gillilan) Kahle, Color Atlas of Human Anatomy, Vol. It contains fibers of various cali- bers, two-thirds of them being poorly my- The posterior spinal root contains a spindle- elinated or unmyelinated fibers. The thin shaped bulge, the spinal ganglion (A), an poorly myelinated and unmyelinated fibers, accumulation of cell bodies of sensory neu- which transmit impulses of the protopathic rons; their bifurcated processes send one sensibility (p. They lie thick myelinated fibers transmit impulses as cell clusters or as cell rows between the of the epicritic sensibility and enter through bundles of nerve fibers. This zone is regarded as the boundary Hence, the spinal ganglia can be regarded as between the central and the peripheral gray matter of the spinal cord that became nervous systems (Redlich–Obersteiner zone) translocated to the periphery. In the electron-microscopic image (H), tives of the neural crest are the cells of the however, this boundary does not exactly autonomic ganglia, the paraganglia, and the coincide with the Redlich–Obersteiner adrenal medulla. Foreachaxon,theboundaryismarked by the last node of Ranvier prior to the en- From the capsule (A3) of the spinal gan- trance into the spinal cord. Up to this point, glion,whichmergesintotheperineuriumof the peripheral myelin sheath is surrounded the spinal nerve, connective tissue extends by a basal membrane (blue in H). The next to the interior and forms a sheath around internode no longer has a basal membrane. The innermost sheath, however, also marked by the basal membrane of the is formed by ectodermal satellite cells (BE5) enveloping Schwann cell. Thus, the basal and is surrounded by a basal membrane membranes around the spinal cord form a comparable to that around the Schwann boundary that is only penetrated by the cellsoftheperipheralnerve. The remainder consists of medium-sized and small ganglion cells with poorly myeli- nated or unmyelinated nerve fibers which arethoughttoconduct pain signals and sen- sations from the intestine.

The process of sensation is a portion of pleasure apart from the primary sensation of sominex 25 mg low price sleep aid music youtube, for example generic sominex 25mg with mastercard insomnia vitamin d, the more complex process of perception, in which sen- cold or touch. Previous experience and learning play a role sory information is integrated with previously learned in- in determining the affect of a sensory perception. Chemoreceptors detect chemi- cal signals and serve the senses of taste and smell, as well as The Nature of Environmental Stimuli. A factor in the detecting the presence of specific substances in the body. Stimuli involve ex- senses of touch and hearing, and can detect the amount of changes of energy between the environment and the re- stress in a tendon or muscle; and thermal receptors detect ceptors. Other sensory receptors are classi- quantities, such as radiant heat or light; mechanical quan- fied by their “vantage point” in the body. Among these, ex- tities, such as pressure, sound waves, and other vibrations; teroceptors detect stimuli from outside the body; entero- and chemical qualities, such as acidity and molecular shape ceptors detect internal stimuli; proprioceptors (receptors of and size. Common to all these types of stimuli is the prop- “one’s own”) provide information about the positions of erty of intensity, a measure of the energy content (or con- joints and about muscle activity and the orientation of the centration, in the case of chemical stimuli) available to in- body in space. Nociceptors (pain receptors) detect noxious teract with the sensory receptor. Most sensory re- The central nervous pathway over which sensory infor- ceptors respond preferentially to a single kind of environ- mation travels is also important in determining the nature mental stimulus. The usual stimulus for the eye is light; that of the perception; information arriving by way of the optic for the ear is sound. This specificity is due to several features nerve, for example, is always perceived as light and never as that match a receptor to its preferred stimulus. Stimuli Into Biological Information Often these accessory structures are a control system that adjusts their sensitivity according to the information being This section focuses on the actual function of the sensory received (Fig. The usual and appropriate stimulus for a receptor in translating environmental energy into action receptor is called its adequate stimulus. For the adequate potentials, the fundamental units of information in the stimulus, the receptor has the lowest threshold, the lowest nervous system. A device that performs such a translation is stimulus intensity that can be reliably detected. A threshold called a transducer; sensory receptors are biological trans- is often difficult to measure because it can vary over time ducers. The sequence of electrical events in the sensory and with the presence of interfering stimuli or the action of transduction process is shown in Figure 4. Although most receptors will respond to stimuli other than the adequate stimulus, the threshold The Generator Potential. Deformation or deflection tly pressing the outer corner of the eye will produce a visual of the tip of the receptor gives rise to a series of action po- sensation caused by pressure, not light; extremes of temper- tentials in the sensory nerve fiber leading to the central ature may be perceived as pain. The stimulus (1) is applied at the stimulated electrically to produce sensations that mimic the tip of the receptor, and the deflection (2) is held constant one usually associated with that receptor. This deformation of the receptor causes a 1 Stimulus Stimulator 2 20 Deflection of receptor Generator potential 40 mV 3 60 Recording electrodes Action potentials 4 0 Impulse Seconds initiation region Local Sensory neuron excitatory currents To central nervous system FIGURE 4. The increased permeability of the membrane leads to a lo- These, in turn, determine the amount of depolarization calized depolarization, called the generator potential. At produced in the impulse initiation region (4) of the recep- the depolarized region, sodium ions enter the cell down tor, and events in this region constitute the next important their electrochemical gradient, causing a current to flow in link in the process. Because current is flowing into the cell at one place, it must flow out of the cell in another The Initiation of Nerve Impulses place. It does this at a region of the receptor membrane (4) called the impulse initiation region (or coding region) be- Figure 4. The threshold (colored line) is a critical produce action potentials at a frequency related to the level of depolarization; membrane potential changes be- strength of the current caused by the stimulus. These cur- low this level are caused by the local excitatory currents rents, called local excitatory currents, provide the link be- and vary in proportion to them, while the membrane ac- tween the formation of the generator potential and the ex- tivity above the threshold level consists of locally pro- citation of the nerve fiber membrane. The lower trace shows a series of In complex sensory organs that contain a great many in- different stimuli applied to the receptor, and the upper dividual receptors, the generator potential may be called a trace shows the resulting electrical events in the impulse receptor potential, and it may arise from several sources initiation region. Often the receptor potential is given a No stimulus is given at A, and the membrane voltage is at special name related to the function of the receptor; for ex- the resting potential. At B, a small stimulus is applied, pro- ample, in the ear it is called the cochlear microphonic, ducing a generator potential too small to bring the impulse while an electroretinogram may be recorded from the eye.