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CNS

Q-1 What is the difference btw Basal ganglia and Cerebellum?

Ans:Basal Ganglia:
1-Oreintation
2-Emotions works in relationship with Limbic system
3-Recognition and performance (movements) "brake hypothesis"

Cerebellum:
1-The cerebellum is involved in the coordination of movement
2-The cerebellum is also partly responsible for motor learning, such as riding a bicycle.
3-Equlibrium

Q-2 Histological difference btw Cerebrum and Brain stem?

Ans:Cerebral cortex contain Non-spiny simple neurons (non-myelinated) 20% Sensory neurons 28% Motor neurons
Basal ganglia contain Spiny motor neurons (Myelinated) 80% Motor neurons 20% sensory neurons


Q-3 Neurological Disorders

Ans: Cerebrum: ALzheimer's disease(formation of plaques)(Dimentia)
Thalamus: Asphasia, lesions lead to loss of all sensation,astereognosis
Basal ganglia:Parkinsons disease,Huntingtons Cholera
Cerebellum:Deficit
Manifestation:——————————————————————————
Ataxia(lack of order)

Reeling, wide-based gait

Decomposition of movement

Inability to correctly sequence fine, coordinated acts

Dysarthria

Inability to articulate words correctly, with slurring and inappropriate phrasing

Dysdiadochokinesia

Inability to perform rapid alternating movements

Dysmetria(lack of measurement)

Inability to control range of movement

Hypotonia

Decreased muscle tone

Nystagmus

Involuntary, rapid oscillation of the eyeballs in a horizontal, vertical, or rotary direction, with the fast component maximal toward the side of the cerebellar lesion

Scanning speech

Slow enunciation with a tendency to hesitate at the beginning of a word or syllable

Tremor

Rhythmic, alternating, oscillatory movement of a limb as it approaches a target (intention tremor) or of proximal musculature when fixed posture or weight bearing is attempted (postural tremor)

BASAL GANGLIA AND CEREBELLUM

The basal ganglia and cerebellum are large collections of nuclei that modify movement on a minute-to-minute basis. Motor cortex sends information to both, and both structures send information right back to cortex via the thalamus. (Remember, to get to cortex you must go through thalamus.) The output of the cerebellum is excitatory, while the basal ganglia are inhibitory. The balance between these two systems allows for smooth, coordinated movement, and a disturbance in either system will show up as movement disorders.


A. The basal ganglia:

What are the basal ganglia? The name is confusing, as generally a ganglion is a collection of cell bodies outside the central nervous system. Blame the early anatomists. The basal ganglia are a collection of nuclei deep to the white matter of cerebral cortex. The name includes: caudate, putamen, nucleus accumbens, globus pallidus, substantia nigra, subthalamic nucleus, and historically the claustrum and the amygdala. However, the claustrum and the amygdala do not really deal with movement, nor are they interconnected with the rest of the basal ganglia, so they have been dropped from this section. Other groupings you may hear are the striatum (caudate + putamen + nucleus accumbens), the corpus striatum (striatum + globus pallidus), or the lenticular nucleus (putamen + globus pallidus), but these groupings obviously get confusing very quickly, so we will try to avoid them.

The anatomy of these structures should be a review from the "coronal and horizontal sections" lab. Here once again are the basal ganglia as they appear when stained for myelin:

rostral section:
middle section:


caudal section:


An alternate stain is the acetylcholinesterase (AChE) stain. This technique stains for the enzyme that degrades acetylcholine (ACh), a major neurotransmitter. Areas which use ACh generally stain darkly. Here is a section through monkey brain, stained for AChE.


You can see that the caudate and putamen are stained, while the globus pallidus remains fairly pale. This emphasizes their different functions and connections. And those are...?

B. Different functions and connections:

The relationships between the nuclei of the basal ganglia are by no means completely understood. When dealing with the brain, you may sometimes be tempted to think that everything is connected to everything else. Take heart, some fairly simple generalizations and schematics can be drawn.

The caudate and putamen receive most of the input from cerebral cortex; in this sense they are the doorway into the basal ganglia. There are some regional differences: for example, medial caudate and nucleus accumbens receive their input from frontal cortex and limbic areas, and are implicated more in thinking and schizophrenia than in moving and motion disorders. The caudate and putamen are reciprocally interconnected with the substantia nigra, but send most of their output to the globus pallidus (see diagram below).

The substantia nigra can be divided into two parts: the substantia nigra pars compacta (SNpc) and the substantia nigra pars reticulata (SNpr). The SNpc receives input from the caudate and putamen, and sends information right back. The SNpr also receives input from the caudate and putamen, but sends it outside the basal ganglia to control head and eye movements. The SNpc is the more famous of the two, as it produces dopamine, which is critical for normal movement. The SNpc degenerates in Parkinson's disease, but the condition can be treated by giving oral dopamine precursors.

The globus pallidus can also be divided into two parts: the globus pallidus externa (GPe) and the globus pallidus interna (GPi). Both receive input from the caudate and putamen, and both are in communication with the subthalamic nucleus. It is the GPi, however, that sends the major inhibitory output from the basal ganglia back to thalamus. The GPi also sends a few projections to an area of midbrain (the PPPA), presumably to assist in postural control.

This schematic summarizes the connections of the basal ganglia as described above.


Although there are many different neurotransmitters used within the basal ganglia (principally ACh, GABA, and dopamine), the overall effect on thalamus is inhibitory. The function of the basal ganglia is often described in terms of a "brake hypothesis". To sit still, you must put the brakes on all movements except those reflexes that maintain an upright posture. To move, you must apply a brake to some postural reflexes, and release the brake on voluntary movement. In such a complicated system, it is apparent that small disturbances can throw the whole system out of whack, often in unpredictable ways. The deficits tend to fall into one of two categories: the presence of extraneous unwanted movements or an absence or difficulty with intended movements.

C. Lesions of the basal ganglia:

Lesions in specific nuclei tend to produce characteristic deficits. One well-known disorder is Parkinson's disease, which is the slow and steady loss of dopaminergic neurons in SNpc. An instant Parkinson-like syndrome will result if these neurons are damaged. This happened several years ago to an unfortunate group of people who took some home-brewed Demerol in search of a high. It was contaminated by a very nasty byproduct, MPTP ,which selectively zapped the SNpc neurons. The three symptoms usually associated with Parkinson's are tremor, rigidity, and bradykinesia. The tremor is most apparent at rest. Rigidity is a result of simultaneous contraction of flexors and extensors, which tends to lock up the limbs. Bradykinesia, or "slow movement", is a difficulty initiating voluntary movement, as though the brake cannot be released.

Huntington's disease, or chorea, is a hereditary disease of unwanted movements. It results from degeneration of the caudate and putamen, and produces continuous dance-like movements of the face and limbs. A related disorder is hemiballismus, flailing movements of one arm and leg, which is caused by damage (i.e., stroke) of the subthalamic nucleus.

D. The cerebellum:

The cerebellum is involved in the coordination of movement. A simple way to look at its purpose is that it compares what you thought you were going to do (according to motor cortex) with what is actually happening down in the limbs (according to proprioceptive feedback), and corrects the movement if there is a problem. The cerebellum is also partly responsible for motor learning, such as riding a bicycle. Unlike the cerebrum, which works entirely on a contralateral basis, the cerebellum works ipsilaterally.

The cerebellum ("little brain") has convolutions similar to those of cerebral cortex, only the folds are much smaller. Like the cerebrum, the cerebellum has an outer cortex, an inner white matter, and deep nuclei below the white matter.




Cat cerebellum, sagittal section
Single folium, enlarged


If we enlarge a single fold of cerebellum, or a folium, we can begin to see the organization of cell types. The outermost layer of the cortex is called the molecular layer, and is nearly cell-free. Instead it is occupied mostly by axons and dendrites. The layer below that is a monolayer of large cells called Purkinje cells, central players in the circuitry of the cerebellum. Below the Purkinje cells is a dense layer of tiny neurons called granule cells. Finally, in the center of each folium is the white matter, all of the axons traveling into and out of the folia.

These cell types are hooked together in stereotypical ways throughout the cerebellum.


Mossy fibers are one of two main sources of input to the cerebellar cortex. A mossy fiber is an axon terminal that ends in a large, bulbous swelling. These mossy fibers enter the granule cell layer and synapse on the dendrites of granule cells (right); in fact the granule cells reach out with little "claws" to grasp the terminals. The granule cells then send their axons up to the molecular layer, where they end in a T and run parallel to the surface. For this reason these axons are called parallel fibers. The parallel fibers synapse on the huge dendritic arrays of the Purkinje cells.

However, the individual parallel fibers are not a strong drive to the Purkinje cells. The Purkinje cell dendrites fan out within a plane, like the splayed fingers of one hand. If you were to turn a Purkinje cell to the side, it would have almost no width at all. The parallel fibers run perpendicular to the Purkinje cells, so that they only make contact once as they pass through the dendrites.


Although each parallel fiber touches each Purkinje cell only once, the thousands of parallel fibers working together can drive the Purkinje cells to fire like mad.

The second main type of input to the folium is the climbing fiber. The climbing fibers go straight to the Purkinje cell layer and snake up the Purkinje dendrites, like ivy climbing a trellis. Each climbing fiber associates with only one Purkinje cell, but when the climbing fiber fires, it provokes a large response in the Purkinje cell.




The Purkinje cell (left) compares and processes the varying inputs it gets, and finally sends its own axons out through the white matter and down to the deep nuclei. Although the inhibitory Purkinje cells are the main output of the cerebellar cortex, the output from the cerebellum as a whole comes from the deep nuclei. The three deep nuclei are responsible for sending excitatory output back to the thalamus, as well as to postural and vestibular centers.
There are a few other cell types in cerebellar cortex, which can all be lumped into the category of inhibitory interneuron. The Golgi cell is found among the granule cells. The stellate and basket cells live in the molecular layer. The basket cell (right) drops axon branches down into the Purkinje cell layer where the branches wrap around the cell bodies like baskets.

E. Inputs and outputs of the cerebellum:

The cerebellum operates in 3's: there are 3 highways leading in and out of the cerebellum, there are 3 main inputs, and there are 3 main outputs from 3 deep nuclei. They are:

The 3 highways are the peduncles, or "stalks". There are 3 pairs: the inferior, middle, and superior peduncles.

The 3 inputs are: Mossy fibers from the spinocerebellar pathways, climbing fibers from the inferior olive, and more mossy fibers from the pons, which are carrying information from cerebral cortex. The mossy fibers from the spinal cord have come up ipsilaterally, so they do not need to cross. The fibers coming down from cerebral cortex, however, DO need to cross (remember the cerebrum is concerned with the opposite side of the body, unlike the cerebellum). These fibers synapse in the pons (hence the huge block of fibers in the cerebral peduncles labeled "corticopontine"), cross, and enter the cerebellum as mossy fibers.

The 3 deep nuclei are the fastigial, interposed, and dentate nuclei. The fastigial nucleus is primarily concerned with balance, and sends information mainly to vestibular and reticular nuclei. The dentate and interposed nuclei are concerned more with voluntary movement, and send axons mainly to thalamus and the red nucleus.

Neurohumoral mechanism

Neurohumoral mechanism maintaining normal cardiac output and blood pressure



Acute haemorrhage —>

1) Rapidly acting pressure control mechanisms; to return blood pressure to physiological levels. All are nervous mechanisms:
i) Baroreceptor
ii) Chemoreceptor
iii) CNS ischaemic response

2) Long term mechanisms for arterial pressure regulation; to return blood volume to normal levels. Essentially involves kidney control via several hormonal mechanisms:
i) Renin — Angiotensin
ii) Aldosterone



SHORT TERM REGULATION OF MEAN ARTERIAL BLOOD PRESSURE

RAPIDLY ACTING NERVOUS MECHANISMS


1) BARORECEPTOR REFLEXES

Anatomy
• Baroreceptors are especially abundant in the:
a) carotid sinuses [located in wall of ICA just above carotid bifurcation]
b) walls of the aortic arch
• Impulses are transmitted from:
a) carotid sinus via the glossopharangeal nerve (CN-IX) to the medulla
b) aortic arch via the vagal nerve (CN-X) to the medulla


response of baroreceptors to pressure



• < i =" impulses]">
i) vasodilation of peripheral vasculature
ii) decreased HR & contractility
—> reduced BP
[low BP has an opposite effect]
• baroreceptors play a major role in maintaining BP during postural changes



2) CHEMORECEPTOR REFLEXES

Anatomy
• Chemoreceptors are located in the:
a) carotid bodies [located in the carotid bifurcation]
b) aortic bodies in walls of the aortic arch
• Impulses are transmitted via the vagus [along with nerve fibres from baroreceptors] into the vasomotor centre
• Each body has its own blood supply —> each body is in close contact with arterial blood

chemoreceptor reflex
• 1° reduced arterial BP —> reduced O2; increased CO2 & H+ —> stimulate chemoreceptors —> excite vasomotor centre —> increase BP
[& increased resp stim]
• 1°reduced O2; increased CO2 & H+ —> stimulate chemoreceptors —> excite vasomotor centre —> increase BP
• Only works strongly with BP < style="font-weight:bold;">atrial reflexes
• stretched atria —>
1) slight reflex vasodilation of peripheral arterioles —>
i) reduced peripheral resistance —> reduced BP back down to normal
ii) increased blood flow into capillaries —> increased capillary pressure —> third space shifting —> reduced blood volume
2) reflex dilatation of afferent arterioles of kidney —> increased urine production
3) stimulate hypothalamus —> decreased ADH —> reduced resorption of H2O in kidney —> increased urine secretion
4) increased HR [Bainbridge reflex] —> offload fluid from heart


4) CNS ISCHEMIC RESPONSE

• reduced blood flow to vasomotor centre in brain stem —> ischaemia of medulla —> increased local[CO2] —> excite vasomotor centre —> increased BP
• has a tremendous magnitude in increasing BP: is one of the most powerful activators of the sympathetic vasoconstrictor system
• Only becomes active at arterial BP <> compression of arteries in brain —> CNS ischaemic response —> increased BP


note that in all the above reflexes, the increased sympathetic output not only stimulates the arteries & arterioles but also constricts the veins —> increased mean systemic pressure —> increased cardiac output —> increased BP



RAPIDLY ACTING HORMONAL MECHANISMS

1) NORADRENALIN—ADRENALIN VASOCONSTRICTOR MECHANISM

• Sympathetic stimulation —> stimulate adrenal medulla —> release of Ad & NAd —> excite heart; vasoconstrict most blood vessels
• May act on metarterioles which are not innervated


2) VASOPRESSIN VASOCONSTRICTOR MECHANISM

• Reduced BP —> hypothalamus secretes vasopressin via post pituitary —> direct vasoconstriction —> increased peripheral resistance/MSFP —> increased BP
• Very potent; plays an important role in correcting BP when is acutely dangerously low —> important short term role
• Important long term role as ADH (same substance)


3) RENIN—ANGIOTENSIN VASOCONSTRICTOR MECHANISM
Decreased-BP -- RENIN


• at least 20 minutes are required before this system can become fully active
• it has a relatively long duration of action


Types of Cancer

Cancer is a group of many related diseases that begin in cells, the body's basic unit of life. Normally, cells grow and divide to produce more cells only when the body needs them. Sometimes, however, cells become abnormal and keep dividing to form more cells without control or order, creating a mass of excess tissue called a tumor. Tumors can be malignant (cancerous) or benign (not cancerous).

The cells in malignant tumors can invade and damage nearby tissue and organs. Cancer cells can also break away from a malignant tumor and travel through the bloodstream or lymphatic system to form new tumors in other parts of the body.

Most cancers are named for the organ or type of cell in which they begin. For example, cancer that begins in the lung is lung cancer, and cancer that begins in cells in the skin known as melanocytes is called melanoma.

When cancer cells spread (metastasize) from their original location to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if lung cancer spreads to the brain, the cancer cells in the brain are actually lung cancer cells. The disease is called metastatic lung cancer (it is not brain cancer).

Use the links below to find information on specific types of cancer, including treatment options, expertise at The James, clinical trials, and frequently asked questions.

Common Cancers

Bone Cancer
Brain Cancer
Breast Cancer
Endocrine Cancer
Gastrointestinal Cancer
Gynecologic Cancer
Head & Neck Cancer
Leukemia
Lung Cancer
Lymphoma
Multiple Myeloma
Prostate Cancer
Skin Cancer
Soft Tissue Sarcoma

Erectile dysfunction

Definition

Erectile dysfunction is the inability to develop and maintain an erection for satisfactory sexual intercourse or activity in the absence of an ejaculatory disorder such as premature ejaculation). Erectile dysfunction is the preferred term rather than the more commonly used term of impotence. There are no universally agreed on criteria for how consistent the problem has to be and for what duration it needs to be present to fulfill the definition. A period of persistence for longer than 3 months has been suggested as a reasonable clinical guideline.

Signs and Symptoms

Although erectile dysfunction is a common problem, many patients are reluctant to discuss it. Certainly, some patients who present with issues relating to depression or anxiety disorders may actually have a significant problem with erectile dysfunction. Additionally, patients who are poorly compliant with medication prescribed for hypertension may be experiencing significant erectile dysfunction. The best way to elicit whether the problem is present is to ask questions about sexual function as a routine part of the examination.
Some health questionnaires help screen for and evaluate erectile dysfunction and may help in the primary care setting. It is important, however, to recognize that abbreviated questionnaires may not evaluate specific areas of the sexual cycle, such as sexual desire, ejaculation, and orgasm. Nonetheless, they can be useful in helping patients discuss the problem and in signaling the need for an evaluation