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Flashcards in INBR 7 - Neuroanatomy Deck (175):
1

1. Daerah-daerah otak yang tidak memiliki sawar darah-otak meliputi semua hal di bawah ini, kecuali:
A. Pineal body
B. Organ subfornikal
C. Organum vaskulosum dari lamina terminalis
D. Eminensi mediana dari hipotalamus
E. Nukleus habenulare

(E) The pineal body, subfornical organ, organum vasculosum of the lamina terminalis, median eminence of the hypothalamus, neurohypophysis, subcommissural organ, and the area postrema are devoid of a blood-brain barrier and are commonly referred to as circumventricular organs. The habenular nucleus is not a circumventricular organ (Carpenter, pp. 18-20; Kandel, p. 1293).

2

2. Manakah diantara hal-hal di bawah ini yang merupakan jaras keluar utama dari ganglia basalis
A. Fasikulus lentikularis (H2 dari Forel)
B. Ansa Lentikularis
C. Faskikulus talamikus (H1 dari Forel)
D. Ansa Retikularis
E. Traktus mammillotalamikus

(A) The major fibers projecting from the basal ganglia originate in the medial globus pallidus as a fiber tract known as the lenticular fasciculus, or Forel's field I-12 . Another tract, known as ansa lenticularis, loops around the internal capsule, merges with the lenticular fasciculus in Forel's field H, and continues with the dentatorubrothalamic tract as the thalamic fasciculus (Forel's field H 1 ) . These fibers then synapse in the centromedian (CM), ventrolateral (VL), and ventroanterior (VA) nuclei of the thalamus before being relayed to the cerebral cortex. Three other efferent tracts of the basal ganglia include the pallidosubthalamic, pallidohabenular (via the stria medullaris), and pallidotegmental, which terminate in the subthalamic nucleus, habenular nucleus, and midbrain tegmentum, respectively (Carpenter, pp. 341-344).

3

3. Cedera pada Segitiga GUILLAIN-MOLLARET dapat menyebabkan
A. Tremor pada lengan
B. Torsional nistagmus
C. Hipotonia
D. Tuli
E. Mioklonus

(E) Guillain-Mollaret's triangle is a physiologic connection between the red nucleus, inferior olives, and dentate nucleus of the cerebellum. Injury to this pathway has been !mown to result in palatal myoclonus. This occurs mainly from hypertrophic degeneration of the inferior olive secondary to either red or dentate nucleus damage. Other muscles of branchial origin (face, tongue, vocal cords, and diaphragm) may also be affected. Vascular lesions and multiple sclerosis are common causes of secondary palatal myoclonus that persists during sleep. The etiology of primary myoclonus is unclear and is often associated with bothersome clicking sounds i n the ear caused by contractions of the tensor veli palatini (CN V) muscles, which open the eustachian tubes. Primary myoclonus disappears during sleep (Merritt, pp. 666-667; Wilkins, p. 149 ) .

4

4. Melalui struktur manakah serabut dari olive inferior mencapai serebelum?
A. Pedunkulus serebelaris superior
B. Pedunkulus serebelaris inferior
C. Pedunkulus serebelaris medius
D. Nukleus vestibularis
E. Lobe flokulonodularis

(B) The fibers exiting the inferior olive are climbing fibers and reach the cerebellum through the inferior cerebellar peduncle. Climbing fibers are excitatory and synapse with Purkinje cells in a distinctive morphologic fashion. They wrap around the cell body and dendrites of Purkinje cells, where numerous synaptic contacts are made. Each climbing fiber contacts 1 to 10 Purkinje cells, and each Purkinje cell receives input from only a single climbing fiber. The response elicited by the interaction between climbing fibers and Purkinje cells is believed to be the most powerful in the CNS and results in a large action potential (complex spike) secondary to Ca2+ influx into the Purkinje cell. The other major afferent fibers reaching the cerebellum are mossy fibers, which influence Purkinje cells indirectly through synapses with granule cells (Carpenter, pp. 230-234) .

5

5. Semua di bawah ini adalah serabut asosiasi, KECUALI
A. Faskikulus longitudinal superior
B. Faskikulus arkuatus
C. Fascikulus unsinatus
D.Corona radiata
E.Singulum

(D) The corona radiata is made u p of projection fibers conveying impulses to subcortical structures including the thalamus, basal ganglia, brainstem, and spinal cord. The superior and inferior longitudinal fasciculus, arcuate fasciculus, uncinate fasciculus, external capsule, and cingulum are six of the more notable association fibers that connect different lobes within the same hemisphere. Commissural fibers connect corresponding regions of the two hemispheres, which include the corpus callosum, anterior commissure, and hippocampal commissure (Carpenter, pp. 33-3 7 ) .

6

6. Neuron ordo pertama untuk dilatasi pupil berasal dari struktur yang mana?
A. Thalamus
B. Hipothalamus
C. Kolukulus superior
D. Ganglion servikalis superior
E. Nukleus EDINGER-WESTPHAL

(B) First-order neurons involved with pupillary dilation originate in the hypothalamus and descend through the brainstem and cervical spinal cord to the T 1-T2 level of the spinal cord. They then synapse on ipsilateral preganglionic sympathetic fibers, exit the cord, travel with the sympathetic fibers as second-order neurons,. and synapse on postganglionic sympathetic fibers. The third-order neurons travel with the internal carotid artery to the orbit and innervate the radial smooth muscle of the iris ( Kandel, p. 905).

7

7. Nukleus basalis (dari MEYNERT) mengandung jenis neuron yang mana?
A. Kolinergik
B. Adrenergik
C. Serotonergik
D. Dopaminergik
E. Noradrenergik

(A) The basal nucleus (of Meynert) contains neurons with acetylcholine that project to the cingulate gyrus, septal nuclei, and the nucleus of the diagonal band of Broca. Dopaminergic fibers are located mainly in the substantia nigra and ventral tegmental area, w

8

8. Awal insisi untuk graf krista iliaka anterior pada sekitar 3 cm lateral dari spina iliaka anterior adalah upaya untuk mencegah kerusakan struktur berikut :
1. Muskulus Sartorius
2. Nervus kutaneus femoralis lateralis
3. Ligamen ilio-inguinal
4. Muskulus iliakus

(A) Beginning the incision for an anterior iliac crest graft approximately 3 em lateral to the anterior iliac spine av()ids the attachments of the sartorius muscle and ilioinguinal ligament. The lateral femoral cutaneous nerve courses through this region_ and is also vulnerable to injury with this approach, but it does not attach to or originate from the iliac crest (Connolly, pp. 818-819).

9

9. Serabut mossy yang berasal dari girus dentatus akan berakhir di sini.
A. CA1
B. CA2
C. CA3
D. CA4
E. Griseum indusium
F. Girus dentate
G. Bukan, A-F

(C) The hippocampal formation includes the hippocampus, dentate gyrus, and subiculum. The hippocampus and dentate gyrus form interlocking C-shaped structures when viewed in transverse section. Both structures also contain three cortical layers, which is characteristic of the archicortex. The hippocampus is found in the floor of the temporal horn and is composed of the molecular, pyramidal, and poly- morphic layers. The neurons of the hippocampus reside in the pyramidal layer and have extensive apical dendrites that project to the molecular layer. Terminal axons from several sources, including the dentate gyrus and entorhinal cortex, synapse with pyramidal cell dendrites in the molecular layer. The polymorphic layer contains basal dendrites and axons of pyramidal cells. The axons of hippocampal pyramidal cells have extensive collateral branching patterns. The hippocampus can be further subdivided into four regions, namely CAl , CA2, CA3, and CA4. CAl is the largest sector and is continuous with the subiculum, which is located in the parahippocampal gyrus and joins the hippocampal formation to the entorhinal cortex. CAl is also called Sommer's sector and is extremely vulnerable to hypoxia. The CA2 subfield is a short transitional region between the more extensive CA3 and CAl subfields. CA3 (harbors largest pyramidal cells of hippocampus) is located at the genu and enters the dentate gyrus and is relatively resistant to hypoxia. CA4 lies in the concavity of the dentate gyrus, and represents the transition zone into this structure. morphic layers. The neurons of the hippocampus reside in the pyramidal layer and have extensive apical dendrites that project to the molecular layer. Terminal axons from several sources, including the dentate gyrus and entorhinal cortex, synapse with pyramidal cell dendrites in the molecular layer. The polymorphic layer contains basal dendrites and axons of pyramidal cells. The axons of hippocampal pyramidal cells have extensive collateral branching patterns. The hippocampus can be further subdivided into four regions, namely CAl , CA2, CA3, and CA4. CAl is the largest sector and is continuous with the subiculum, which is located in the parahippocampal gyrus and joins the hippocampal formation to the entorhinal cortex. CAl is also called Sommer's sector and is extremely vulnerable to hypoxia. The CA2 subfield is a short transitional region between the more extensive CA3 and CAl subfields. CA3 (harbors largest pyramidal cells of hippocampus) is located at the genu and enters the dentate gyrus and is relatively resistant to hypoxia. CA4 lies in the concavity of the dentate gyrus, and represents the transition zone into this structure. The dentate gyrus also consists of three layers: the molecular, granular, and polymorphic. The granule cells (of the granular layer) have dendritic trees that extend into .the molecular layer and axons within the polymorphic layer. The subiculum is located in the superior part of the parahippocampal gyrus and is buried in the ventral bank of the hippocampal fissure. The subiculum forms the transition between the trilaminar hippocampus and the six layers of the entorhinal cortex (area 28); like the dentate gyrus and hippocampus, it also contains three cortical layers: a superficial molecular layer, a deeper polymorphic layer, and a pyramidal layer which lies in between them . The hippocampus contains three major intrinsic pathways, including the perforant pathway, Schaffer collateral pathway, and mossy fiber pathway. The serial flow of information begins in the entorhinal cortex, which is believed to be the first leg of a multisynaptic loop that flows through the hippocampal formation. Information from the entorhinal cortex (area 28) is first projected to the granule cells of the dentate gyrus via the perforant pathway. It is called the perforant pathway because the fibers perforate the hippocampal formation before reaching the granular cell dendrites of the dentate gyrus (located in the molecular layer). The granule cells of the dentate gyrus, in turn, send a dense projection of axons, or mossy fibers, to the molecular layer of the CAJ subfield, where they synapse on the apical dendrites of pyramidal neurons. Axons from CAJ then bifurcate into two pathways. One pathway enters the alveus to exit the hippocampus in the fibers of the fornix; the other includes Schaffer collaterals, which project to the pyramidal neurons of CAl, which, in turn, project back to the subiculum. Finally, neurons from the subiculum complete this multisynaptic loop through the hippocampal formation by sending axons back to the entorhinal cortex. These pathways form the intrinsic connections within the hippocampal formation that are involved in long-term potentiation. With long-term potentiation, small stimuli result in increased and prolonged postsynaptic potentials of target neurons (facilitation) , and this often involves the NMOA receptor. Long-term potentiation involves depolarization and activation of NMOA receptors and/or voltage dependent calcium channels as well as release of calcium from intracellular stores. This increase in intracellular calcium results in activation of specific intracellular transduction cascades, including gene transduction, resulting in long-lasting modifications of synaptic integrity. The fornix represents the primary efferent projections of the hippocampal formation (subiculum and hippocampus) . The fornix passes under the splenium of the corpus callosum (crura) , after which the crura join to form the body of the fornix, which curves around to the rostral thalamus. The body of the fornix then divides into the anterior columns of the fornix that curve ventrally to the foramina of 1vlonro. The fornix then divides into precommissural and postcommissural fibers at the anterior commissure. Precommissural CHAPTER 2 Neuroanatomy Answers 37 fibers project to the septal nuclei. Postcommissural fibers project to the mammillary body, hypothalamus, septal region, medial frontal cortex, and anterior thalamus. A small number of postcommissural fibers project to the midbrain tegmentum. Collateral projections also exit the fornix at various points along its course and project to neocortical association areas. The majority of fibers that enter the fornix originate in the subiculum, which in turn receives extensive input from the hippocampus and dentate gyrus. The anterior hippocampus also has direct efferent projections to the amygdala. Vestigial remnants of the hippocampal formation include the indusium griseum (supracallosal gyrus), which connects to the dentate gyrus via the fasciolar gyrus. The hippocampus is involved with recent memory and encoding of new memories into long-term storage. Bilateral hippocampal lesions result in marked deficits in short term memory, inability to acquire new information and skills, and mild behavioral changes, while memory for remote events is usually unaffected (Carpenter, pp. 369-3 76; Kandel, pp. 1259-1260; Pritchard , pp. 3 7 7-380 ) .

10

10. Sangat rentan terhadap hipoksia.
A. CA1
B. CA2
C. CA3
D. CA4
E. Griseum indusium
F. Girus dentate
G. Bukan, A-F

(A) The hippocampal formation includes the hippocampus, dentate gyrus, and subiculum. The hippocampus and dentate gyrus form interlocking C-shaped structures when viewed in transverse section. Both structures also contain three cortical layers, which is characteristic of the archicortex. The hippocampus is found in the floor of the temporal horn and is composed of the molecular, pyramidal, and poly- morphic layers. The neurons of the hippocampus reside in the pyramidal layer and have extensive apical dendrites that project to the molecular layer. Terminal axons from several sources, including the dentate gyrus and entorhinal cortex, synapse with pyramidal cell dendrites in the molecular layer. The polymorphic layer contains basal dendrites and axons of pyramidal cells. The axons of hippocampal pyramidal cells have extensive collateral branching patterns. The hippocampus can be further subdivided into four regions, namely CAl , CA2, CA3, and CA4. CAl is the largest sector and is continuous with the subiculum, which is located in the parahippocampal gyrus and joins the hippocampal formation to the entorhinal cortex. CAl is also called Sommer's sector and is extremely vulnerable to hypoxia. The CA2 subfield is a short transitional region between the more extensive CA3 and CAl subfields. CA3 (harbors largest pyramidal cells of hippocampus) is located at the genu and enters the dentate gyrus and is relatively resistant to hypoxia. CA4 lies in the concavity of the dentate gyrus, and represents the transition zone into this structure. morphic layers. The neurons of the hippocampus reside in the pyramidal layer and have extensive apical dendrites that project to the molecular layer. Terminal axons from several sources, including the dentate gyrus and entorhinal cortex, synapse with pyramidal cell dendrites in the molecular layer. The polymorphic layer contains basal dendrites and axons of pyramidal cells. The axons of hippocampal pyramidal cells have extensive collateral branching patterns. The hippocampus can be further subdivided into four regions, namely CAl , CA2, CA3, and CA4. CAl is the largest sector and is continuous with the subiculum, which is located in the parahippocampal gyrus and joins the hippocampal formation to the entorhinal cortex. CAl is also called Sommer's sector and is extremely vulnerable to hypoxia. The CA2 subfield is a short transitional region between the more extensive CA3 and CAl subfields. CA3 (harbors largest pyramidal cells of hippocampus) is located at the genu and enters the dentate gyrus and is relatively resistant to hypoxia. CA4 lies in the concavity of the dentate gyrus, and represents the transition zone into this structure. The dentate gyrus also consists of three layers: the molecular, granular, and polymorphic. The granule cells (of the granular layer) have dendritic trees that extend into .the molecular layer and axons within the polymorphic layer. The subiculum is located in the superior part of the parahippocampal gyrus and is buried in the ventral bank of the hippocampal fissure. The subiculum forms the transition between the trilaminar hippocampus and the six layers of the entorhinal cortex (area 28); like the dentate gyrus and hippocampus, it also contains three cortical layers: a superficial molecular layer, a deeper polymorphic layer, and a pyramidal layer which lies in between them . The hippocampus contains three major intrinsic pathways, including the perforant pathway, Schaffer collateral pathway, and mossy fiber pathway. The serial flow of information begins in the entorhinal cortex, which is believed to be the first leg of a multisynaptic loop that flows through the hippocampal formation. Information from the entorhinal cortex (area 28) is first projected to the granule cells of the dentate gyrus via the perforant pathway. It is called the perforant pathway because the fibers perforate the hippocampal formation before reaching the granular cell dendrites of the dentate gyrus (located in the molecular layer). The granule cells of the dentate gyrus, in turn, send a dense projection of axons, or mossy fibers, to the molecular layer of the CAJ subfield, where they synapse on the apical dendrites of pyramidal neurons. Axons from CAJ then bifurcate into two pathways. One pathway enters the alveus to exit the hippocampus in the fibers of the fornix; the other includes Schaffer collaterals, which project to the pyramidal neurons of CAl, which, in turn, project back to the subiculum. Finally, neurons from the subiculum complete this multisynaptic loop through the hippocampal formation by sending axons back to the entorhinal cortex. These pathways form the intrinsic connections within the hippocampal formation that are involved in long-term potentiation. With long-term potentiation, small stimuli result in increased and prolonged postsynaptic potentials of target neurons (facilitation) , and this often involves the NMOA receptor. Long-term potentiation involves depolarization and activation of NMOA receptors and/or voltage dependent calcium channels as well as release of calcium from intracellular stores. This increase in intracellular calcium results in activation of specific intracellular transduction cascades, including gene transduction, resulting in long-lasting modifications of synaptic integrity. The fornix represents the primary efferent projections of the hippocampal formation (subiculum and hippocampus) . The fornix passes under the splenium of the corpus callosum (crura) , after which the crura join to form the body of the fornix, which curves around to the rostral thalamus. The body of the fornix then divides into the anterior columns of the fornix that curve ventrally to the foramina of 1vlonro. The fornix then divides into precommissural and postcommissural fibers at the anterior commissure. Precommissural CHAPTER 2 Neuroanatomy Answers 37 fibers project to the septal nuclei. Postcommissural fibers project to the mammillary body, hypothalamus, septal region, medial frontal cortex, and anterior thalamus. A small number of postcommissural fibers project to the midbrain tegmentum. Collateral projections also exit the fornix at various points along its course and project to neocortical association areas. The majority of fibers that enter the fornix originate in the subiculum, which in turn receives extensive input from the hippocampus and dentate gyrus. The anterior hippocampus also has direct efferent projections to the amygdala. Vestigial remnants of the hippocampal formation include the indusium griseum (supracallosal gyrus), which connects to the dentate gyrus via the fasciolar gyrus. The hippocampus is involved with recent memory and encoding of new memories into long-term storage. Bilateral hippocampal lesions result in marked deficits in short term memory, inability to acquire new information and skills, and mild behavioral changes, while memory for remote events is usually unaffected (Carpenter, pp. 369-3 76; Kandel, pp. 1259-1260; Pritchard , pp. 3 7 7-380 ) .

11

11. Kolateral-kolateral SCHAFFER berproyeksi pada neuron piramidial dari sub-lapisan ini
A. CA1
B. CA2
C. CA3
D. CA4
E. Griseum indusium
F. Girus dentate
G. Bukan, A-F

(A) The hippocampal formation includes the hippocampus, dentate gyrus, and subiculum. The hippocampus and dentate gyrus form interlocking C-shaped structures when viewed in transverse section. Both structures also contain three cortical layers, which is characteristic of the archicortex. The hippocampus is found in the floor of the temporal horn and is composed of the molecular, pyramidal, and poly- morphic layers. The neurons of the hippocampus reside in the pyramidal layer and have extensive apical dendrites that project to the molecular layer. Terminal axons from several sources, including the dentate gyrus and entorhinal cortex, synapse with pyramidal cell dendrites in the molecular layer. The polymorphic layer contains basal dendrites and axons of pyramidal cells. The axons of hippocampal pyramidal cells have extensive collateral branching patterns. The hippocampus can be further subdivided into four regions, namely CAl , CA2, CA3, and CA4. CAl is the largest sector and is continuous with the subiculum, which is located in the parahippocampal gyrus and joins the hippocampal formation to the entorhinal cortex. CAl is also called Sommer's sector and is extremely vulnerable to hypoxia. The CA2 subfield is a short transitional region between the more extensive CA3 and CAl subfields. CA3 (harbors largest pyramidal cells of hippocampus) is located at the genu and enters the dentate gyrus and is relatively resistant to hypoxia. CA4 lies in the concavity of the dentate gyrus, and represents the transition zone into this structure. morphic layers. The neurons of the hippocampus reside in the pyramidal layer and have extensive apical dendrites that project to the molecular layer. Terminal axons from several sources, including the dentate gyrus and entorhinal cortex, synapse with pyramidal cell dendrites in the molecular layer. The polymorphic layer contains basal dendrites and axons of pyramidal cells. The axons of hippocampal pyramidal cells have extensive collateral branching patterns. The hippocampus can be further subdivided into four regions, namely CAl , CA2, CA3, and CA4. CAl is the largest sector and is continuous with the subiculum, which is located in the parahippocampal gyrus and joins the hippocampal formation to the entorhinal cortex. CAl is also called Sommer's sector and is extremely vulnerable to hypoxia. The CA2 subfield is a short transitional region between the more extensive CA3 and CAl subfields. CA3 (harbors largest pyramidal cells of hippocampus) is located at the genu and enters the dentate gyrus and is relatively resistant to hypoxia. CA4 lies in the concavity of the dentate gyrus, and represents the transition zone into this structure. The dentate gyrus also consists of three layers: the molecular, granular, and polymorphic. The granule cells (of the granular layer) have dendritic trees that extend into .the molecular layer and axons within the polymorphic layer. The subiculum is located in the superior part of the parahippocampal gyrus and is buried in the ventral bank of the hippocampal fissure. The subiculum forms the transition between the trilaminar hippocampus and the six layers of the entorhinal cortex (area 28); like the dentate gyrus and hippocampus, it also contains three cortical layers: a superficial molecular layer, a deeper polymorphic layer, and a pyramidal layer which lies in between them . The hippocampus contains three major intrinsic pathways, including the perforant pathway, Schaffer collateral pathway, and mossy fiber pathway. The serial flow of information begins in the entorhinal cortex, which is believed to be the first leg of a multisynaptic loop that flows through the hippocampal formation. Information from the entorhinal cortex (area 28) is first projected to the granule cells of the dentate gyrus via the perforant pathway. It is called the perforant pathway because the fibers perforate the hippocampal formation before reaching the granular cell dendrites of the dentate gyrus (located in the molecular layer). The granule cells of the dentate gyrus, in turn, send a dense projection of axons, or mossy fibers, to the molecular layer of the CAJ subfield, where they synapse on the apical dendrites of pyramidal neurons. Axons from CAJ then bifurcate into two pathways. One pathway enters the alveus to exit the hippocampus in the fibers of the fornix; the other includes Schaffer collaterals, which project to the pyramidal neurons of CAl, which, in turn, project back to the subiculum. Finally, neurons from the subiculum complete this multisynaptic loop through the hippocampal formation by sending axons back to the entorhinal cortex. These pathways form the intrinsic connections within the hippocampal formation that are involved in long-term potentiation. With long-term potentiation, small stimuli result in increased and prolonged postsynaptic potentials of target neurons (facilitation) , and this often involves the NMOA receptor. Long-term potentiation involves depolarization and activation of NMOA receptors and/or voltage dependent calcium channels as well as release of calcium from intracellular stores. This increase in intracellular calcium results in activation of specific intracellular transduction cascades, including gene transduction, resulting in long-lasting modifications of synaptic integrity. The fornix represents the primary efferent projections of the hippocampal formation (subiculum and hippocampus) . The fornix passes under the splenium of the corpus callosum (crura) , after which the crura join to form the body of the fornix, which curves around to the rostral thalamus. The body of the fornix then divides into the anterior columns of the fornix that curve ventrally to the foramina of 1vlonro. The fornix then divides into precommissural and postcommissural fibers at the anterior commissure. Precommissural CHAPTER 2 Neuroanatomy Answers 37 fibers project to the septal nuclei. Postcommissural fibers project to the mammillary body, hypothalamus, septal region, medial frontal cortex, and anterior thalamus. A small number of postcommissural fibers project to the midbrain tegmentum. Collateral projections also exit the fornix at various points along its course and project to neocortical association areas. The majority of fibers that enter the fornix originate in the subiculum, which in turn receives extensive input from the hippocampus and dentate gyrus. The anterior hippocampus also has direct efferent projections to the amygdala. Vestigial remnants of the hippocampal formation include the indusium griseum (supracallosal gyrus), which connects to the dentate gyrus via the fasciolar gyrus. The hippocampus is involved with recent memory and encoding of new memories into long-term storage. Bilateral hippocampal lesions result in marked deficits in short term memory, inability to acquire new information and skills, and mild behavioral changes, while memory for remote events is usually unaffected (Carpenter, pp. 369-3 76; Kandel, pp. 1259-1260; Pritchard , pp. 3 7 7-380 ) .

12

12. Terletak pada konkavitas girus dentatus.
A. CA1
B. CA2
C. CA3
D. CA4
E. Griseum indusium
F. Girus dentate
G. Bukan, A-F

(D) The hippocampal formation includes the hippocampus, dentate gyrus, and subiculum. The hippocampus and dentate gyrus form interlocking C-shaped structures when viewed in transverse section. Both structures also contain three cortical layers, which is characteristic of the archicortex. The hippocampus is found in the floor of the temporal horn and is composed of the molecular, pyramidal, and poly- morphic layers. The neurons of the hippocampus reside in the pyramidal layer and have extensive apical dendrites that project to the molecular layer. Terminal axons from several sources, including the dentate gyrus and entorhinal cortex, synapse with pyramidal cell dendrites in the molecular layer. The polymorphic layer contains basal dendrites and axons of pyramidal cells. The axons of hippocampal pyramidal cells have extensive collateral branching patterns. The hippocampus can be further subdivided into four regions, namely CAl , CA2, CA3, and CA4. CAl is the largest sector and is continuous with the subiculum, which is located in the parahippocampal gyrus and joins the hippocampal formation to the entorhinal cortex. CAl is also called Sommer's sector and is extremely vulnerable to hypoxia. The CA2 subfield is a short transitional region between the more extensive CA3 and CAl subfields. CA3 (harbors largest pyramidal cells of hippocampus) is located at the genu and enters the dentate gyrus and is relatively resistant to hypoxia. CA4 lies in the concavity of the dentate gyrus, and represents the transition zone into this structure. morphic layers. The neurons of the hippocampus reside in the pyramidal layer and have extensive apical dendrites that project to the molecular layer. Terminal axons from several sources, including the dentate gyrus and entorhinal cortex, synapse with pyramidal cell dendrites in the molecular layer. The polymorphic layer contains basal dendrites and axons of pyramidal cells. The axons of hippocampal pyramidal cells have extensive collateral branching patterns. The hippocampus can be further subdivided into four regions, namely CAl , CA2, CA3, and CA4. CAl is the largest sector and is continuous with the subiculum, which is located in the parahippocampal gyrus and joins the hippocampal formation to the entorhinal cortex. CAl is also called Sommer's sector and is extremely vulnerable to hypoxia. The CA2 subfield is a short transitional region between the more extensive CA3 and CAl subfields. CA3 (harbors largest pyramidal cells of hippocampus) is located at the genu and enters the dentate gyrus and is relatively resistant to hypoxia. CA4 lies in the concavity of the dentate gyrus, and represents the transition zone into this structure. The dentate gyrus also consists of three layers: the molecular, granular, and polymorphic. The granule cells (of the granular layer) have dendritic trees that extend into .the molecular layer and axons within the polymorphic layer. The subiculum is located in the superior part of the parahippocampal gyrus and is buried in the ventral bank of the hippocampal fissure. The subiculum forms the transition between the trilaminar hippocampus and the six layers of the entorhinal cortex (area 28); like the dentate gyrus and hippocampus, it also contains three cortical layers: a superficial molecular layer, a deeper polymorphic layer, and a pyramidal layer which lies in between them . The hippocampus contains three major intrinsic pathways, including the perforant pathway, Schaffer collateral pathway, and mossy fiber pathway. The serial flow of information begins in the entorhinal cortex, which is believed to be the first leg of a multisynaptic loop that flows through the hippocampal formation. Information from the entorhinal cortex (area 28) is first projected to the granule cells of the dentate gyrus via the perforant pathway. It is called the perforant pathway because the fibers perforate the hippocampal formation before reaching the granular cell dendrites of the dentate gyrus (located in the molecular layer). The granule cells of the dentate gyrus, in turn, send a dense projection of axons, or mossy fibers, to the molecular layer of the CAJ subfield, where they synapse on the apical dendrites of pyramidal neurons. Axons from CAJ then bifurcate into two pathways. One pathway enters the alveus to exit the hippocampus in the fibers of the fornix; the other includes Schaffer collaterals, which project to the pyramidal neurons of CAl, which, in turn, project back to the subiculum. Finally, neurons from the subiculum complete this multisynaptic loop through the hippocampal formation by sending axons back to the entorhinal cortex. These pathways form the intrinsic connections within the hippocampal formation that are involved in long-term potentiation. With long-term potentiation, small stimuli result in increased and prolonged postsynaptic potentials of target neurons (facilitation) , and this often involves the NMOA receptor. Long-term potentiation involves depolarization and activation of NMOA receptors and/or voltage dependent calcium channels as well as release of calcium from intracellular stores. This increase in intracellular calcium results in activation of specific intracellular transduction cascades, including gene transduction, resulting in long-lasting modifications of synaptic integrity. The fornix represents the primary efferent projections of the hippocampal formation (subiculum and hippocampus) . The fornix passes under the splenium of the corpus callosum (crura) , after which the crura join to form the body of the fornix, which curves around to the rostral thalamus. The body of the fornix then divides into the anterior columns of the fornix that curve ventrally to the foramina of 1vlonro. The fornix then divides into precommissural and postcommissural fibers at the anterior commissure. Precommissural CHAPTER 2 Neuroanatomy Answers 37 fibers project to the septal nuclei. Postcommissural fibers project to the mammillary body, hypothalamus, septal region, medial frontal cortex, and anterior thalamus. A small number of postcommissural fibers project to the midbrain tegmentum. Collateral projections also exit the fornix at various points along its course and project to neocortical association areas. The majority of fibers that enter the fornix originate in the subiculum, which in turn receives extensive input from the hippocampus and dentate gyrus. The anterior hippocampus also has direct efferent projections to the amygdala. Vestigial remnants of the hippocampal formation include the indusium griseum (supracallosal gyrus), which connects to the dentate gyrus via the fasciolar gyrus. The hippocampus is involved with recent memory and encoding of new memories into long-term storage. Bilateral hippocampal lesions result in marked deficits in short term memory, inability to acquire new information and skills, and mild behavioral changes, while memory for remote events is usually unaffected (Carpenter, pp. 369-3 76; Kandel, pp. 1259-1260; Pritchard , pp. 3 7 7-380 ) .

13

13. Sisa vestigial dari pembentukan hipokampus
A. CA1
B. CA2
C. CA3
D. CA4
E. Griseum indusium
F. Girus dentate
G. Bukan, A-F

(E) The hippocampal formation includes the hippocampus, dentate gyrus, and subiculum. The hippocampus and dentate gyrus form interlocking C-shaped structures when viewed in transverse section. Both structures also contain three cortical layers, which is characteristic of the archicortex. The hippocampus is found in the floor of the temporal horn and is composed of the molecular, pyramidal, and poly- morphic layers. The neurons of the hippocampus reside in the pyramidal layer and have extensive apical dendrites that project to the molecular layer. Terminal axons from several sources, including the dentate gyrus and entorhinal cortex, synapse with pyramidal cell dendrites in the molecular layer. The polymorphic layer contains basal dendrites and axons of pyramidal cells. The axons of hippocampal pyramidal cells have extensive collateral branching patterns. The hippocampus can be further subdivided into four regions, namely CAl , CA2, CA3, and CA4. CAl is the largest sector and is continuous with the subiculum, which is located in the parahippocampal gyrus and joins the hippocampal formation to the entorhinal cortex. CAl is also called Sommer's sector and is extremely vulnerable to hypoxia. The CA2 subfield is a short transitional region between the more extensive CA3 and CAl subfields. CA3 (harbors largest pyramidal cells of hippocampus) is located at the genu and enters the dentate gyrus and is relatively resistant to hypoxia. CA4 lies in the concavity of the dentate gyrus, and represents the transition zone into this structure. morphic layers. The neurons of the hippocampus reside in the pyramidal layer and have extensive apical dendrites that project to the molecular layer. Terminal axons from several sources, including the dentate gyrus and entorhinal cortex, synapse with pyramidal cell dendrites in the molecular layer. The polymorphic layer contains basal dendrites and axons of pyramidal cells. The axons of hippocampal pyramidal cells have extensive collateral branching patterns. The hippocampus can be further subdivided into four regions, namely CAl , CA2, CA3, and CA4. CAl is the largest sector and is continuous with the subiculum, which is located in the parahippocampal gyrus and joins the hippocampal formation to the entorhinal cortex. CAl is also called Sommer's sector and is extremely vulnerable to hypoxia. The CA2 subfield is a short transitional region between the more extensive CA3 and CAl subfields. CA3 (harbors largest pyramidal cells of hippocampus) is located at the genu and enters the dentate gyrus and is relatively resistant to hypoxia. CA4 lies in the concavity of the dentate gyrus, and represents the transition zone into this structure. The dentate gyrus also consists of three layers: the molecular, granular, and polymorphic. The granule cells (of the granular layer) have dendritic trees that extend into .the molecular layer and axons within the polymorphic layer. The subiculum is located in the superior part of the parahippocampal gyrus and is buried in the ventral bank of the hippocampal fissure. The subiculum forms the transition between the trilaminar hippocampus and the six layers of the entorhinal cortex (area 28); like the dentate gyrus and hippocampus, it also contains three cortical layers: a superficial molecular layer, a deeper polymorphic layer, and a pyramidal layer which lies in between them . The hippocampus contains three major intrinsic pathways, including the perforant pathway, Schaffer collateral pathway, and mossy fiber pathway. The serial flow of information begins in the entorhinal cortex, which is believed to be the first leg of a multisynaptic loop that flows through the hippocampal formation. Information from the entorhinal cortex (area 28) is first projected to the granule cells of the dentate gyrus via the perforant pathway. It is called the perforant pathway because the fibers perforate the hippocampal formation before reaching the granular cell dendrites of the dentate gyrus (located in the molecular layer). The granule cells of the dentate gyrus, in turn, send a dense projection of axons, or mossy fibers, to the molecular layer of the CAJ subfield, where they synapse on the apical dendrites of pyramidal neurons. Axons from CAJ then bifurcate into two pathways. One pathway enters the alveus to exit the hippocampus in the fibers of the fornix; the other includes Schaffer collaterals, which project to the pyramidal neurons of CAl, which, in turn, project back to the subiculum. Finally, neurons from the subiculum complete this multisynaptic loop through the hippocampal formation by sending axons back to the entorhinal cortex. These pathways form the intrinsic connections within the hippocampal formation that are involved in long-term potentiation. With long-term potentiation, small stimuli result in increased and prolonged postsynaptic potentials of target neurons (facilitation) , and this often involves the NMOA receptor. Long-term potentiation involves depolarization and activation of NMOA receptors and/or voltage dependent calcium channels as well as release of calcium from intracellular stores. This increase in intracellular calcium results in activation of specific intracellular transduction cascades, including gene transduction, resulting in long-lasting modifications of synaptic integrity. The fornix represents the primary efferent projections of the hippocampal formation (subiculum and hippocampus) . The fornix passes under the splenium of the corpus callosum (crura) , after which the crura join to form the body of the fornix, which curves around to the rostral thalamus. The body of the fornix then divides into the anterior columns of the fornix that curve ventrally to the foramina of 1vlonro. The fornix then divides into precommissural and postcommissural fibers at the anterior commissure. Precommissural CHAPTER 2 Neuroanatomy Answers 37 fibers project to the septal nuclei. Postcommissural fibers project to the mammillary body, hypothalamus, septal region, medial frontal cortex, and anterior thalamus. A small number of postcommissural fibers project to the midbrain tegmentum. Collateral projections also exit the fornix at various points along its course and project to neocortical association areas. The majority of fibers that enter the fornix originate in the subiculum, which in turn receives extensive input from the hippocampus and dentate gyrus. The anterior hippocampus also has direct efferent projections to the amygdala. Vestigial remnants of the hippocampal formation include the indusium griseum (supracallosal gyrus), which connects to the dentate gyrus via the fasciolar gyrus. The hippocampus is involved with recent memory and encoding of new memories into long-term storage. Bilateral hippocampal lesions result in marked deficits in short term memory, inability to acquire new information and skills, and mild behavioral changes, while memory for remote events is usually unaffected (Carpenter, pp. 369-3 76; Kandel, pp. 1259-1260; Pritchard , pp. 3 7 7-380 ) .

14

14. Cedera pada sektor ini bisa menyebabkan masalah memori yang lalu.
A. CA1
B. CA2
C. CA3
D. CA4
E. Griseum indusium
F. Girus dentate
G. Bukan, A-F

(G) The hippocampal formation includes the hippocampus, dentate gyrus, and subiculum. The hippocampus and dentate gyrus form interlocking C-shaped structures when viewed in transverse section. Both structures also contain three cortical layers, which is characteristic of the archicortex. The hippocampus is found in the floor of the temporal horn and is composed of the molecular, pyramidal, and poly- morphic layers. The neurons of the hippocampus reside in the pyramidal layer and have extensive apical dendrites that project to the molecular layer. Terminal axons from several sources, including the dentate gyrus and entorhinal cortex, synapse with pyramidal cell dendrites in the molecular layer. The polymorphic layer contains basal dendrites and axons of pyramidal cells. The axons of hippocampal pyramidal cells have extensive collateral branching patterns. The hippocampus can be further subdivided into four regions, namely CAl , CA2, CA3, and CA4. CAl is the largest sector and is continuous with the subiculum, which is located in the parahippocampal gyrus and joins the hippocampal formation to the entorhinal cortex. CAl is also called Sommer's sector and is extremely vulnerable to hypoxia. The CA2 subfield is a short transitional region between the more extensive CA3 and CAl subfields. CA3 (harbors largest pyramidal cells of hippocampus) is located at the genu and enters the dentate gyrus and is relatively resistant to hypoxia. CA4 lies in the concavity of the dentate gyrus, and represents the transition zone into this structure. morphic layers. The neurons of the hippocampus reside in the pyramidal layer and have extensive apical dendrites that project to the molecular layer. Terminal axons from several sources, including the dentate gyrus and entorhinal cortex, synapse with pyramidal cell dendrites in the molecular layer. The polymorphic layer contains basal dendrites and axons of pyramidal cells. The axons of hippocampal pyramidal cells have extensive collateral branching patterns. The hippocampus can be further subdivided into four regions, namely CAl , CA2, CA3, and CA4. CAl is the largest sector and is continuous with the subiculum, which is located in the parahippocampal gyrus and joins the hippocampal formation to the entorhinal cortex. CAl is also called Sommer's sector and is extremely vulnerable to hypoxia. The CA2 subfield is a short transitional region between the more extensive CA3 and CAl subfields. CA3 (harbors largest pyramidal cells of hippocampus) is located at the genu and enters the dentate gyrus and is relatively resistant to hypoxia. CA4 lies in the concavity of the dentate gyrus, and represents the transition zone into this structure. The dentate gyrus also consists of three layers: the molecular, granular, and polymorphic. The granule cells (of the granular layer) have dendritic trees that extend into .the molecular layer and axons within the polymorphic layer. The subiculum is located in the superior part of the parahippocampal gyrus and is buried in the ventral bank of the hippocampal fissure. The subiculum forms the transition between the trilaminar hippocampus and the six layers of the entorhinal cortex (area 28); like the dentate gyrus and hippocampus, it also contains three cortical layers: a superficial molecular layer, a deeper polymorphic layer, and a pyramidal layer which lies in between them . The hippocampus contains three major intrinsic pathways, including the perforant pathway, Schaffer collateral pathway, and mossy fiber pathway. The serial flow of information begins in the entorhinal cortex, which is believed to be the first leg of a multisynaptic loop that flows through the hippocampal formation. Information from the entorhinal cortex (area 28) is first projected to the granule cells of the dentate gyrus via the perforant pathway. It is called the perforant pathway because the fibers perforate the hippocampal formation before reaching the granular cell dendrites of the dentate gyrus (located in the molecular layer). The granule cells of the dentate gyrus, in turn, send a dense projection of axons, or mossy fibers, to the molecular layer of the CAJ subfield, where they synapse on the apical dendrites of pyramidal neurons. Axons from CAJ then bifurcate into two pathways. One pathway enters the alveus to exit the hippocampus in the fibers of the fornix; the other includes Schaffer collaterals, which project to the pyramidal neurons of CAl, which, in turn, project back to the subiculum. Finally, neurons from the subiculum complete this multisynaptic loop through the hippocampal formation by sending axons back to the entorhinal cortex. These pathways form the intrinsic connections within the hippocampal formation that are involved in long-term potentiation. With long-term potentiation, small stimuli result in increased and prolonged postsynaptic potentials of target neurons (facilitation) , and this often involves the NMOA receptor. Long-term potentiation involves depolarization and activation of NMOA receptors and/or voltage dependent calcium channels as well as release of calcium from intracellular stores. This increase in intracellular calcium results in activation of specific intracellular transduction cascades, including gene transduction, resulting in long-lasting modifications of synaptic integrity. The fornix represents the primary efferent projections of the hippocampal formation (subiculum and hippocampus) . The fornix passes under the splenium of the corpus callosum (crura) , after which the crura join to form the body of the fornix, which curves around to the rostral thalamus. The body of the fornix then divides into the anterior columns of the fornix that curve ventrally to the foramina of 1vlonro. The fornix then divides into precommissural and postcommissural fibers at the anterior commissure. Precommissural CHAPTER 2 Neuroanatomy Answers 37 fibers project to the septal nuclei. Postcommissural fibers project to the mammillary body, hypothalamus, septal region, medial frontal cortex, and anterior thalamus. A small number of postcommissural fibers project to the midbrain tegmentum. Collateral projections also exit the fornix at various points along its course and project to neocortical association areas. The majority of fibers that enter the fornix originate in the subiculum, which in turn receives extensive input from the hippocampus and dentate gyrus. The anterior hippocampus also has direct efferent projections to the amygdala. Vestigial remnants of the hippocampal formation include the indusium griseum (supracallosal gyrus), which connects to the dentate gyrus via the fasciolar gyrus. The hippocampus is involved with recent memory and encoding of new memories into long-term storage. Bilateral hippocampal lesions result in marked deficits in short term memory, inability to acquire new information and skills, and mild behavioral changes, while memory for remote events is usually unaffected (Carpenter, pp. 369-3 76; Kandel, pp. 1259-1260; Pritchard , pp. 3 7 7-380 ) .

15

15. Sektor yang paling besar
A. CA1
B. CA2
C. CA3
D. CA4
E. Griseum indusium
F. Girus dentate
G. Bukan, A-F

(A) The hippocampal formation includes the hippocampus, dentate gyrus, and subiculum. The hippocampus and dentate gyrus form interlocking C-shaped structures when viewed in transverse section. Both structures also contain three cortical layers, which is characteristic of the archicortex. The hippocampus is found in the floor of the temporal horn and is composed of the molecular, pyramidal, and poly- morphic layers. The neurons of the hippocampus reside in the pyramidal layer and have extensive apical dendrites that project to the molecular layer. Terminal axons from several sources, including the dentate gyrus and entorhinal cortex, synapse with pyramidal cell dendrites in the molecular layer. The polymorphic layer contains basal dendrites and axons of pyramidal cells. The axons of hippocampal pyramidal cells have extensive collateral branching patterns. The hippocampus can be further subdivided into four regions, namely CAl , CA2, CA3, and CA4. CAl is the largest sector and is continuous with the subiculum, which is located in the parahippocampal gyrus and joins the hippocampal formation to the entorhinal cortex. CAl is also called Sommer's sector and is extremely vulnerable to hypoxia. The CA2 subfield is a short transitional region between the more extensive CA3 and CAl subfields. CA3 (harbors largest pyramidal cells of hippocampus) is located at the genu and enters the dentate gyrus and is relatively resistant to hypoxia. CA4 lies in the concavity of the dentate gyrus, and represents the transition zone into this structure. morphic layers. The neurons of the hippocampus reside in the pyramidal layer and have extensive apical dendrites that project to the molecular layer. Terminal axons from several sources, including the dentate gyrus and entorhinal cortex, synapse with pyramidal cell dendrites in the molecular layer. The polymorphic layer contains basal dendrites and axons of pyramidal cells. The axons of hippocampal pyramidal cells have extensive collateral branching patterns. The hippocampus can be further subdivided into four regions, namely CAl , CA2, CA3, and CA4. CAl is the largest sector and is continuous with the subiculum, which is located in the parahippocampal gyrus and joins the hippocampal formation to the entorhinal cortex. CAl is also called Sommer's sector and is extremely vulnerable to hypoxia. The CA2 subfield is a short transitional region between the more extensive CA3 and CAl subfields. CA3 (harbors largest pyramidal cells of hippocampus) is located at the genu and enters the dentate gyrus and is relatively resistant to hypoxia. CA4 lies in the concavity of the dentate gyrus, and represents the transition zone into this structure. The dentate gyrus also consists of three layers: the molecular, granular, and polymorphic. The granule cells (of the granular layer) have dendritic trees that extend into .the molecular layer and axons within the polymorphic layer. The subiculum is located in the superior part of the parahippocampal gyrus and is buried in the ventral bank of the hippocampal fissure. The subiculum forms the transition between the trilaminar hippocampus and the six layers of the entorhinal cortex (area 28); like the dentate gyrus and hippocampus, it also contains three cortical layers: a superficial molecular layer, a deeper polymorphic layer, and a pyramidal layer which lies in between them . The hippocampus contains three major intrinsic pathways, including the perforant pathway, Schaffer collateral pathway, and mossy fiber pathway. The serial flow of information begins in the entorhinal cortex, which is believed to be the first leg of a multisynaptic loop that flows through the hippocampal formation. Information from the entorhinal cortex (area 28) is first projected to the granule cells of the dentate gyrus via the perforant pathway. It is called the perforant pathway because the fibers perforate the hippocampal formation before reaching the granular cell dendrites of the dentate gyrus (located in the molecular layer). The granule cells of the dentate gyrus, in turn, send a dense projection of axons, or mossy fibers, to the molecular layer of the CAJ subfield, where they synapse on the apical dendrites of pyramidal neurons. Axons from CAJ then bifurcate into two pathways. One pathway enters the alveus to exit the hippocampus in the fibers of the fornix; the other includes Schaffer collaterals, which project to the pyramidal neurons of CAl, which, in turn, project back to the subiculum. Finally, neurons from the subiculum complete this multisynaptic loop through the hippocampal formation by sending axons back to the entorhinal cortex. These pathways form the intrinsic connections within the hippocampal formation that are involved in long-term potentiation. With long-term potentiation, small stimuli result in increased and prolonged postsynaptic potentials of target neurons (facilitation) , and this often involves the NMOA receptor. Long-term potentiation involves depolarization and activation of NMOA receptors and/or voltage dependent calcium channels as well as release of calcium from intracellular stores. This increase in intracellular calcium results in activation of specific intracellular transduction cascades, including gene transduction, resulting in long-lasting modifications of synaptic integrity. The fornix represents the primary efferent projections of the hippocampal formation (subiculum and hippocampus) . The fornix passes under the splenium of the corpus callosum (crura) , after which the crura join to form the body of the fornix, which curves around to the rostral thalamus. The body of the fornix then divides into the anterior columns of the fornix that curve ventrally to the foramina of 1vlonro. The fornix then divides into precommissural and postcommissural fibers at the anterior commissure. Precommissural CHAPTER 2 Neuroanatomy Answers 37 fibers project to the septal nuclei. Postcommissural fibers project to the mammillary body, hypothalamus, septal region, medial frontal cortex, and anterior thalamus. A small number of postcommissural fibers project to the midbrain tegmentum. Collateral projections also exit the fornix at various points along its course and project to neocortical association areas. The majority of fibers that enter the fornix originate in the subiculum, which in turn receives extensive input from the hippocampus and dentate gyrus. The anterior hippocampus also has direct efferent projections to the amygdala. Vestigial remnants of the hippocampal formation include the indusium griseum (supracallosal gyrus), which connects to the dentate gyrus via the fasciolar gyrus. The hippocampus is involved with recent memory and encoding of new memories into long-term storage. Bilateral hippocampal lesions result in marked deficits in short term memory, inability to acquire new information and skills, and mild behavioral changes, while memory for remote events is usually unaffected (Carpenter, pp. 369-3 76; Kandel, pp. 1259-1260; Pritchard , pp. 3 7 7-380 ) .

16

16. Pada orang normal, sirkuit langsung dan tidak langsung dari ganglia basal diseimbangkan oleh
A. Aksi-aksi perlawanan dari proyeksi-proyeksi nigrostriatal dopaminergik pada sub-tipe-sub-tipe reseptor D1 dan D2 pada putamen
B. Aktivitas penghambatan dari nukleus subthalamik pada globus pallidus interna.
C. Meningkatnya aktivitas neuron-neuron GABAergik pada segmen bagian dalam dari globus pallidus ileh jalur langsung
D. Serat-serat dopaminergik yang semakin naik dab berasal dari tegmentum bagian
tengah otak dari substantia nigra ( yang mempengaruhi reseptor-reseptor D1 dan D2 dari globus pallidus).
E. A, B, C dan D semuanya benar

(A) . T h e dopaminergic projections o f t h e SNc t o t h e striatum facilitate movements by influencing the direct and indirect pathways. The nigrostriatal projections to the spiny neurons of the direct pathway ( 0 1 receptors) are excitatory, while the nigrostriatal projections to the spiny neurons of the indirect pathway (02 receptors) are inhibitory. In normal individuals, the direct and indirect circuits of the basal ganglia are balanced by the opposing actions of these projections on these receptors. The loss of SNc dopaminergic projections to the striatum results in increased activity of the indirect circuit (and decreased activity of the direct circuit), which accounts for the hypokinetic aspects of Parkinson's disease. It is important to realize, however, that the segregation of the 0 1 and 02 receptors between the direct and indirect pathways is probably not as strict as described above, but it still serves as a nice framework to explain the differential action of dopamine on striatal output. The subthalamic nucleus has an excitatory effect on the internal segment of the globus pallidus via the indirect pathway. In normal individuals, the activation of striatal GABAergic neurons inhibits GABAergic neurons within the internal segment of the globus pallidus instead of activating them. The ascending dopaminergic activating system originates in the brainstem reticular

17

17. Lesi visual yang menyebabkan defek sentral pada satu lapang pandang dengan defek temporo-superior sisi berlawanan, kemungkinan berasal dari lokasi yang mana?
A. Kiasm depan
B. Lobe okipital
C. Lobe temporal
D. Saraf optik
E. Lobe parietal inferior

(A) A visual lesion producing a central defect i n one field with a superior temporal defect in the opposite field s uggests 38 Intensive Neurosurgery Board Review a lesion near the anterior optic chiasm. This is likely the result of damage to the ipsilateral optic nerve and the fibers that loop forward from the inferonasal retina of the opposite eye (Wille brand'$ knee). (Brazis, p. 136, Kline, pp. 3 , 9).

18

18. Serat-serat dari medan-medan mata frontal lewat melalui genu dari kapsul bagian dalam, melakukan dekusasi di dalam pons, dan bersinapse di dalam struktur yang terlibat dengan sakkades yang mana?
A. Faskikulus longitudinal medial (MLF)
B. Kolikulus inferior
C. Nukleus Edinger-Westphal
D. Nukleus soliteris
E. Formasi retikular pontin paramedian (PPRF)

(E) Fibers controlling saccades originate in the contralateral frontal eye fields (Brodmann's area 8), pass through the internal capsule, decussate in the pons, and synapse in the paramedian pontine reticular formation (PPRF) . Efferent fibers from the PPRF project to the ipsilateral abducens nucleus (VI) and contralateral oculomotor nucleus (III) via the medial longitudinal fasciculus (MLF) , which results in saccadic eye movements. Saccades that are organized in the PPRF are usually under the control of the superior colliculus, although some saccadic eye movements occur independently, without collicular influence (Kandel, pp. 789-792 ) .

19

19. Oklusi dari pembuluh ini merupakan penyebab yang paling lazim dari sindroma medularis lateral (Wallenberg) .

(E) The vertebral artery (VA) is generally the l argest branch of the subclavian artery; as a variant, the left VA arises from the aortic arch about 4% of the time. There are four segments of the vertebral artery (E). The first courses superiorly and posteriorly to enter the transverse foramen of the sixth cer\'ical vertebral body. The second segment ascends vertically within the transverse foramina, accompanied by a network of sympathetic fibers from the stellate ganglion and a venous plexus. I t turns laterally within the transverse process of the axis. The third segment exits the foramen of the axis and curves posteriorly and medially in a groove on the upper surface of the atlas to enter the foramen magnum. The fourth and last segment pierces the dura and joins the opposite VA near the lower pontine border. Branches of the V-A include the anterior meningeal artery, which may occasionally feed meningiomas or clival chordomas; the posterior meningeal arfery; posterior spinal artery; posterior inferior cerebellar artery (PICA) (D), and the anterior spinal artery. Occlusion of PICA (D) or the vertebral artery (E) may produce the lateral medullary (Wallenberg) syndrome, which is characterized by ipsilateral facial numbness; contralateral trunk numbness; ipsilateral palatal, pharyngeal, and vocal cord paralysis (nucleus ambiguus ) ; ipsilateral Horner's syndrome; vertigo; nausea; vomiting; ipsilateral cerebellar signs; and occasionally hiccups. The most common cause of Wallenberg syndrome is VA occlusion ; however, it has classically been described in the literature after PICA occlusion. The PICA vessels are at risk for injury during a Chiari decompression, as they loop around the tonsils. The characteristic picture of anterior inferior cerebellar artery (AICA) (C)' occlusion includes vertigo, nystagmus, nausea and vomiting (vestibular nuclei involvement), ipsilateral facial numbness (trigeminal spinal nucleus and 'tract), ipsilateral Horner's syndrome (descending sympathetic fibers), contralateral limb numbness (lateral spinothalamic tract), ipsilateral ataxia (middle cerebellar peduncle) , and ipsilateral deafness and facial paralysis (lateral pontomedullary tegmentum). It supplies the middle and inferior lateral pontine regions and the anterolateral parts of the cerebellum, which includes the middle cerebellar peduncle, flocculus, pyramis, and tuber. It is the most common vessel compressing the seventh cranial nerve during hemifacial spasm, which occasionally requires surgical decompression. Occlusion of the SCA (B) is the least common cause of cerebellar infarction, which is characterized by nausea, vomiting, vertigo, nystagmus, ipsilateral Horner's syndrome, ataxia, ipsilateral intention tremor (superior cerebellar peduncle), contralateral limb numbness, contralateral hearing loss (crossed fibers of the lateral lemniscus), and possibly a fourth nerve palsy (pontine tectum) . The SCA is the most common nerve compressing the trigeminal nerve i n trigeminal neuralgia. The posterior cerebral arteries (A) are joined by the posterior communicating arteries (PComA) about 1 em from their origin . The PComA is the major origin of the PCA 15 to 20% of the time and is termed a "fetal" PCA. The PCA comprises the P1 (peduncular), P2 (ambient) , P3 (quadrigeminal) , and P4 (distal or cortical) segments and their respective branches . Major branches of the PCA include the medial and lateral posterior choroidal arteries; anterior, middle, and posterior temporal arteries; parieto-occipital artery; calcarine artery; as well as the smaller thalamoperforating and thalamogeniculate arteries. The origin of the PComA is the first or second most common location for aneurysm formation, along with the anterior communicating artery ( Brazis, p p . 37 4-3 7 7 ; Kaye and Black, pp. 1603, 1734; Osborn DCA, p p . 153-193; Greenberg, pp. 107-108) .

20

20. Memasok piramis, tuber, flokulus, dan bagian-bagian kaudal dari tegmentum pontin

(C) The vertebral artery (VA) is generally the l argest branch of the subclavian artery; as a variant, the left VA arises from the aortic arch about 4% of the time. There are four segments of the vertebral artery (E). The first courses superiorly and posteriorly to enter the transverse foramen of the sixth cer\'ical vertebral body. The second segment ascends vertically within the transverse foramina, accompanied by a network of sympathetic fibers from the stellate ganglion and a venous plexus. I t turns laterally within the transverse process of the axis. The third segment exits the foramen of the axis and curves posteriorly and medially in a groove on the upper surface of the atlas to enter the foramen magnum. The fourth and last segment pierces the dura and joins the opposite VA near the lower pontine border. Branches of the V-A include the anterior meningeal artery, which may occasionally feed meningiomas or clival chordomas; the posterior meningeal arfery; posterior spinal artery; posterior inferior cerebellar artery (PICA) (D), and the anterior spinal artery. Occlusion of PICA (D) or the vertebral artery (E) may produce the lateral medullary (Wallenberg) syndrome, which is characterized by ipsilateral facial numbness; contralateral trunk numbness; ipsilateral palatal, pharyngeal, and vocal cord paralysis (nucleus ambiguus ) ; ipsilateral Horner's syndrome; vertigo; nausea; vomiting; ipsilateral cerebellar signs; and occasionally hiccups. The most common cause of Wallenberg syndrome is VA occlusion ; however, it has classically been described in the literature after PICA occlusion. The PICA vessels are at risk for injury during a Chiari decompression, as they loop around the tonsils. The characteristic picture of anterior inferior cerebellar artery (AICA) (C)' occlusion includes vertigo, nystagmus, nausea and vomiting (vestibular nuclei involvement), ipsilateral facial numbness (trigeminal spinal nucleus and 'tract), ipsilateral Horner's syndrome (descending sympathetic fibers), contralateral limb numbness (lateral spinothalamic tract), ipsilateral ataxia (middle cerebellar peduncle) , and ipsilateral deafness and facial paralysis (lateral pontomedullary tegmentum). It supplies the middle and inferior lateral pontine regions and the anterolateral parts of the cerebellum, which includes the middle cerebellar peduncle, flocculus, pyramis, and tuber. It is the most common vessel compressing the seventh cranial nerve during hemifacial spasm, which occasionally requires surgical decompression. Occlusion of the SCA (B) is the least common cause of cerebellar infarction, which is characterized by nausea, vomiting, vertigo, nystagmus, ipsilateral Horner's syndrome, ataxia, ipsilateral intention tremor (superior cerebellar peduncle), contralateral limb numbness, contralateral hearing loss (crossed fibers of the lateral lemniscus), and possibly a fourth nerve palsy (pontine tectum) . The SCA is the most common nerve compressing the trigeminal nerve i n trigeminal neuralgia. The posterior cerebral arteries (A) are joined by the posterior communicating arteries (PComA) about 1 em from their origin . The PComA is the major origin of the PCA 15 to 20% of the time and is termed a "fetal" PCA. The PCA comprises the P1 (peduncular), P2 (ambient) , P3 (quadrigeminal) , and P4 (distal or cortical) segments and their respective branches . Major branches of the PCA include the medial and lateral posterior choroidal arteries; anterior, middle, and posterior temporal arteries; parieto-occipital artery; calcarine artery; as well as the smaller thalamoperforating and thalamogeniculate arteries. The origin of the PComA is the first or second most common location for aneurysm formation, along with the anterior communicating artery ( Brazis, p p . 37 4-3 7 7 ; Kaye and Black, pp. 1603, 1734; Osborn DCA, p p . 153-193; Greenberg, pp. 107-108) .

21

21. Oklusi dapat menyebabkan gangguan pendengaran kontra-lateral.

(B) The vertebral artery (VA) is generally the l argest branch of the subclavian artery; as a variant, the left VA arises from the aortic arch about 4% of the time. There are four segments of the vertebral artery (E). The first courses superiorly and posteriorly to enter the transverse foramen of the sixth cer\'ical vertebral body. The second segment ascends vertically within the transverse foramina, accompanied by a network of sympathetic fibers from the stellate ganglion and a venous plexus. I t turns laterally within the transverse process of the axis. The third segment exits the foramen of the axis and curves posteriorly and medially in a groove on the upper surface of the atlas to enter the foramen magnum. The fourth and last segment pierces the dura and joins the opposite VA near the lower pontine border. Branches of the V-A include the anterior meningeal artery, which may occasionally feed meningiomas or clival chordomas; the posterior meningeal arfery; posterior spinal artery; posterior inferior cerebellar artery (PICA) (D), and the anterior spinal artery. Occlusion of PICA (D) or the vertebral artery (E) may produce the lateral medullary (Wallenberg) syndrome, which is characterized by ipsilateral facial numbness; contralateral trunk numbness; ipsilateral palatal, pharyngeal, and vocal cord paralysis (nucleus ambiguus ) ; ipsilateral Horner's syndrome; vertigo; nausea; vomiting; ipsilateral cerebellar signs; and occasionally hiccups. The most common cause of Wallenberg syndrome is VA occlusion ; however, it has classically been described in the literature after PICA occlusion. The PICA vessels are at risk for injury during a Chiari decompression, as they loop around the tonsils. The characteristic picture of anterior inferior cerebellar artery (AICA) (C)' occlusion includes vertigo, nystagmus, nausea and vomiting (vestibular nuclei involvement), ipsilateral facial numbness (trigeminal spinal nucleus and 'tract), ipsilateral Horner's syndrome (descending sympathetic fibers), contralateral limb numbness (lateral spinothalamic tract), ipsilateral ataxia (middle cerebellar peduncle) , and ipsilateral deafness and facial paralysis (lateral pontomedullary tegmentum). It supplies the middle and inferior lateral pontine regions and the anterolateral parts of the cerebellum, which includes the middle cerebellar peduncle, flocculus, pyramis, and tuber. It is the most common vessel compressing the seventh cranial nerve during hemifacial spasm, which occasionally requires surgical decompression. Occlusion of the SCA (B) is the least common cause of cerebellar infarction, which is characterized by nausea, vomiting, vertigo, nystagmus, ipsilateral Horner's syndrome, ataxia, ipsilateral intention tremor (superior cerebellar peduncle), contralateral limb numbness, contralateral hearing loss (crossed fibers of the lateral lemniscus), and possibly a fourth nerve palsy (pontine tectum) . The SCA is the most common nerve compressing the trigeminal nerve i n trigeminal neuralgia. The posterior cerebral arteries (A) are joined by the posterior communicating arteries (PComA) about 1 em from their origin . The PComA is the major origin of the PCA 15 to 20% of the time and is termed a "fetal" PCA. The PCA comprises the P1 (peduncular), P2 (ambient) , P3 (quadrigeminal) , and P4 (distal or cortical) segments and their respective branches . Major branches of the PCA include the medial and lateral posterior choroidal arteries; anterior, middle, and posterior temporal arteries; parieto-occipital artery; calcarine artery; as well as the smaller thalamoperforating and thalamogeniculate arteries. The origin of the PComA is the first or second most common location for aneurysm formation, along with the anterior communicating artery ( Brazis, p p . 37 4-3 7 7 ; Kaye and Black, pp. 1603, 1734; Osborn DCA, p p . 153-193; Greenberg, pp. 107-108) .

22

22. Pembuluh yang lazim berasosiasi dengan neuralgia trigeminal .

(B) The vertebral artery (VA) is generally the l argest branch of the subclavian artery; as a variant, the left VA arises from the aortic arch about 4% of the time. There are four segments of the vertebral artery (E). The first courses superiorly and posteriorly to enter the transverse foramen of the sixth cer\'ical vertebral body. The second segment ascends vertically within the transverse foramina, accompanied by a network of sympathetic fibers from the stellate ganglion and a venous plexus. I t turns laterally within the transverse process of the axis. The third segment exits the foramen of the axis and curves posteriorly and medially in a groove on the upper surface of the atlas to enter the foramen magnum. The fourth and last segment pierces the dura and joins the opposite VA near the lower pontine border. Branches of the V-A include the anterior meningeal artery, which may occasionally feed meningiomas or clival chordomas; the posterior meningeal arfery; posterior spinal artery; posterior inferior cerebellar artery (PICA) (D), and the anterior spinal artery. Occlusion of PICA (D) or the vertebral artery (E) may produce the lateral medullary (Wallenberg) syndrome, which is characterized by ipsilateral facial numbness; contralateral trunk numbness; ipsilateral palatal, pharyngeal, and vocal cord paralysis (nucleus ambiguus ) ; ipsilateral Horner's syndrome; vertigo; nausea; vomiting; ipsilateral cerebellar signs; and occasionally hiccups. The most common cause of Wallenberg syndrome is VA occlusion ; however, it has classically been described in the literature after PICA occlusion. The PICA vessels are at risk for injury during a Chiari decompression, as they loop around the tonsils. The characteristic picture of anterior inferior cerebellar artery (AICA) (C)' occlusion includes vertigo, nystagmus, nausea and vomiting (vestibular nuclei involvement), ipsilateral facial numbness (trigeminal spinal nucleus and 'tract), ipsilateral Horner's syndrome (descending sympathetic fibers), contralateral limb numbness (lateral spinothalamic tract), ipsilateral ataxia (middle cerebellar peduncle) , and ipsilateral deafness and facial paralysis (lateral pontomedullary tegmentum). It supplies the middle and inferior lateral pontine regions and the anterolateral parts of the cerebellum, which includes the middle cerebellar peduncle, flocculus, pyramis, and tuber. It is the most common vessel compressing the seventh cranial nerve during hemifacial spasm, which occasionally requires surgical decompression. Occlusion of the SCA (B) is the least common cause of cerebellar infarction, which is characterized by nausea, vomiting, vertigo, nystagmus, ipsilateral Horner's syndrome, ataxia, ipsilateral intention tremor (superior cerebellar peduncle), contralateral limb numbness, contralateral hearing loss (crossed fibers of the lateral lemniscus), and possibly a fourth nerve palsy (pontine tectum) . The SCA is the most common nerve compressing the trigeminal nerve i n trigeminal neuralgia. The posterior cerebral arteries (A) are joined by the posterior communicating arteries (PComA) about 1 em from their origin . The PComA is the major origin of the PCA 15 to 20% of the time and is termed a "fetal" PCA. The PCA comprises the P1 (peduncular), P2 (ambient) , P3 (quadrigeminal) , and P4 (distal or cortical) segments and their respective branches . Major branches of the PCA include the medial and lateral posterior choroidal arteries; anterior, middle, and posterior temporal arteries; parieto-occipital artery; calcarine artery; as well as the smaller thalamoperforating and thalamogeniculate arteries. The origin of the PComA is the first or second most common location for aneurysm formation, along with the anterior communicating artery ( Brazis, p p . 37 4-3 7 7 ; Kaye and Black, pp. 1603, 1734; Osborn DCA, p p . 153-193; Greenberg, pp. 107-108) .

23

23. Pembuluh yang paling berisiko cedera selama dekompresi Chiari.

(D) The vertebral artery (VA) is generally the l argest branch of the subclavian artery; as a variant, the left VA arises from the aortic arch about 4% of the time. There are four segments of the vertebral artery (E). The first courses superiorly and posteriorly to enter the transverse foramen of the sixth cer\'ical vertebral body. The second segment ascends vertically within the transverse foramina, accompanied by a network of sympathetic fibers from the stellate ganglion and a venous plexus. I t turns laterally within the transverse process of the axis. The third segment exits the foramen of the axis and curves posteriorly and medially in a groove on the upper surface of the atlas to enter the foramen magnum. The fourth and last segment pierces the dura and joins the opposite VA near the lower pontine border. Branches of the V-A include the anterior meningeal artery, which may occasionally feed meningiomas or clival chordomas; the posterior meningeal arfery; posterior spinal artery; posterior inferior cerebellar artery (PICA) (D), and the anterior spinal artery. Occlusion of PICA (D) or the vertebral artery (E) may produce the lateral medullary (Wallenberg) syndrome, which is characterized by ipsilateral facial numbness; contralateral trunk numbness; ipsilateral palatal, pharyngeal, and vocal cord paralysis (nucleus ambiguus ) ; ipsilateral Horner's syndrome; vertigo; nausea; vomiting; ipsilateral cerebellar signs; and occasionally hiccups. The most common cause of Wallenberg syndrome is VA occlusion ; however, it has classically been described in the literature after PICA occlusion. The PICA vessels are at risk for injury during a Chiari decompression, as they loop around the tonsils. The characteristic picture of anterior inferior cerebellar artery (AICA) (C)' occlusion includes vertigo, nystagmus, nausea and vomiting (vestibular nuclei involvement), ipsilateral facial numbness (trigeminal spinal nucleus and 'tract), ipsilateral Horner's syndrome (descending sympathetic fibers), contralateral limb numbness (lateral spinothalamic tract), ipsilateral ataxia (middle cerebellar peduncle) , and ipsilateral deafness and facial paralysis (lateral pontomedullary tegmentum). It supplies the middle and inferior lateral pontine regions and the anterolateral parts of the cerebellum, which includes the middle cerebellar peduncle, flocculus, pyramis, and tuber. It is the most common vessel compressing the seventh cranial nerve during hemifacial spasm, which occasionally requires surgical decompression. Occlusion of the SCA (B) is the least common cause of cerebellar infarction, which is characterized by nausea, vomiting, vertigo, nystagmus, ipsilateral Horner's syndrome, ataxia, ipsilateral intention tremor (superior cerebellar peduncle), contralateral limb numbness, contralateral hearing loss (crossed fibers of the lateral lemniscus), and possibly a fourth nerve palsy (pontine tectum) . The SCA is the most common nerve compressing the trigeminal nerve i n trigeminal neuralgia. The posterior cerebral arteries (A) are joined by the posterior communicating arteries (PComA) about 1 em from their origin . The PComA is the major origin of the PCA 15 to 20% of the time and is termed a "fetal" PCA. The PCA comprises the P1 (peduncular), P2 (ambient) , P3 (quadrigeminal) , and P4 (distal or cortical) segments and their respective branches . Major branches of the PCA include the medial and lateral posterior choroidal arteries; anterior, middle, and posterior temporal arteries; parieto-occipital artery; calcarine artery; as well as the smaller thalamoperforating and thalamogeniculate arteries. The origin of the PComA is the first or second most common location for aneurysm formation, along with the anterior communicating artery ( Brazis, p p . 37 4-3 7 7 ; Kaye and Black, pp. 1603, 1734; Osborn DCA, p p . 153-193; Greenberg, pp. 107-108) .

24

24. Nukleus dentate biasanya dipasok oleh pembuluh ini.

(B) The vertebral artery (VA) is generally the l argest branch of the subclavian artery; as a variant, the left VA arises from the aortic arch about 4% of the time. There are four segments of the vertebral artery (E). The first courses superiorly and posteriorly to enter the transverse foramen of the sixth cer\'ical vertebral body. The second segment ascends vertically within the transverse foramina, accompanied by a network of sympathetic fibers from the stellate ganglion and a venous plexus. I t turns laterally within the transverse process of the axis. The third segment exits the foramen of the axis and curves posteriorly and medially in a groove on the upper surface of the atlas to enter the foramen magnum. The fourth and last segment pierces the dura and joins the opposite VA near the lower pontine border. Branches of the V-A include the anterior meningeal artery, which may occasionally feed meningiomas or clival chordomas; the posterior meningeal arfery; posterior spinal artery; posterior inferior cerebellar artery (PICA) (D), and the anterior spinal artery. Occlusion of PICA (D) or the vertebral artery (E) may produce the lateral medullary (Wallenberg) syndrome, which is characterized by ipsilateral facial numbness; contralateral trunk numbness; ipsilateral palatal, pharyngeal, and vocal cord paralysis (nucleus ambiguus ) ; ipsilateral Horner's syndrome; vertigo; nausea; vomiting; ipsilateral cerebellar signs; and occasionally hiccups. The most common cause of Wallenberg syndrome is VA occlusion ; however, it has classically been described in the literature after PICA occlusion. The PICA vessels are at risk for injury during a Chiari decompression, as they loop around the tonsils. The characteristic picture of anterior inferior cerebellar artery (AICA) (C)' occlusion includes vertigo, nystagmus, nausea and vomiting (vestibular nuclei involvement), ipsilateral facial numbness (trigeminal spinal nucleus and 'tract), ipsilateral Horner's syndrome (descending sympathetic fibers), contralateral limb numbness (lateral spinothalamic tract), ipsilateral ataxia (middle cerebellar peduncle) , and ipsilateral deafness and facial paralysis (lateral pontomedullary tegmentum). It supplies the middle and inferior lateral pontine regions and the anterolateral parts of the cerebellum, which includes the middle cerebellar peduncle, flocculus, pyramis, and tuber. It is the most common vessel compressing the seventh cranial nerve during hemifacial spasm, which occasionally requires surgical decompression. Occlusion of the SCA (B) is the least common cause of cerebellar infarction, which is characterized by nausea, vomiting, vertigo, nystagmus, ipsilateral Horner's syndrome, ataxia, ipsilateral intention tremor (superior cerebellar peduncle), contralateral limb numbness, contralateral hearing loss (crossed fibers of the lateral lemniscus), and possibly a fourth nerve palsy (pontine tectum) . The SCA is the most common nerve compressing the trigeminal nerve i n trigeminal neuralgia. The posterior cerebral arteries (A) are joined by the posterior communicating arteries (PComA) about 1 em from their origin . The PComA is the major origin of the PCA 15 to 20% of the time and is termed a "fetal" PCA. The PCA comprises the P1 (peduncular), P2 (ambient) , P3 (quadrigeminal) , and P4 (distal or cortical) segments and their respective branches . Major branches of the PCA include the medial and lateral posterior choroidal arteries; anterior, middle, and posterior temporal arteries; parieto-occipital artery; calcarine artery; as well as the smaller thalamoperforating and thalamogeniculate arteries. The origin of the PComA is the first or second most common location for aneurysm formation, along with the anterior communicating artery ( Brazis, p p . 37 4-3 7 7 ; Kaye and Black, pp. 1603, 1734; Osborn DCA, p p . 153-193; Greenberg, pp. 107-108) .

25

25. Memasok pedunkel serebelar tengah.

(C) The vertebral artery (VA) is generally the l argest branch of the subclavian artery; as a variant, the left VA arises from the aortic arch about 4% of the time. There are four segments of the vertebral artery (E). The first courses superiorly and posteriorly to enter the transverse foramen of the sixth cer\'ical vertebral body. The second segment ascends vertically within the transverse foramina, accompanied by a network of sympathetic fibers from the stellate ganglion and a venous plexus. I t turns laterally within the transverse process of the axis. The third segment exits the foramen of the axis and curves posteriorly and medially in a groove on the upper surface of the atlas to enter the foramen magnum. The fourth and last segment pierces the dura and joins the opposite VA near the lower pontine border. Branches of the V-A include the anterior meningeal artery, which may occasionally feed meningiomas or clival chordomas; the posterior meningeal arfery; posterior spinal artery; posterior inferior cerebellar artery (PICA) (D), and the anterior spinal artery. Occlusion of PICA (D) or the vertebral artery (E) may produce the lateral medullary (Wallenberg) syndrome, which is characterized by ipsilateral facial numbness; contralateral trunk numbness; ipsilateral palatal, pharyngeal, and vocal cord paralysis (nucleus ambiguus ) ; ipsilateral Horner's syndrome; vertigo; nausea; vomiting; ipsilateral cerebellar signs; and occasionally hiccups. The most common cause of Wallenberg syndrome is VA occlusion ; however, it has classically been described in the literature after PICA occlusion. The PICA vessels are at risk for injury during a Chiari decompression, as they loop around the tonsils. The characteristic picture of anterior inferior cerebellar artery (AICA) (C)' occlusion includes vertigo, nystagmus, nausea and vomiting (vestibular nuclei involvement), ipsilateral facial numbness (trigeminal spinal nucleus and 'tract), ipsilateral Horner's syndrome (descending sympathetic fibers), contralateral limb numbness (lateral spinothalamic tract), ipsilateral ataxia (middle cerebellar peduncle) , and ipsilateral deafness and facial paralysis (lateral pontomedullary tegmentum). It supplies the middle and inferior lateral pontine regions and the anterolateral parts of the cerebellum, which includes the middle cerebellar peduncle, flocculus, pyramis, and tuber. It is the most common vessel compressing the seventh cranial nerve during hemifacial spasm, which occasionally requires surgical decompression. Occlusion of the SCA (B) is the least common cause of cerebellar infarction, which is characterized by nausea, vomiting, vertigo, nystagmus, ipsilateral Horner's syndrome, ataxia, ipsilateral intention tremor (superior cerebellar peduncle), contralateral limb numbness, contralateral hearing loss (crossed fibers of the lateral lemniscus), and possibly a fourth nerve palsy (pontine tectum) . The SCA is the most common nerve compressing the trigeminal nerve i n trigeminal neuralgia. The posterior cerebral arteries (A) are joined by the posterior communicating arteries (PComA) about 1 em from their origin . The PComA is the major origin of the PCA 15 to 20% of the time and is termed a "fetal" PCA. The PCA comprises the P1 (peduncular), P2 (ambient) , P3 (quadrigeminal) , and P4 (distal or cortical) segments and their respective branches . Major branches of the PCA include the medial and lateral posterior choroidal arteries; anterior, middle, and posterior temporal arteries; parieto-occipital artery; calcarine artery; as well as the smaller thalamoperforating and thalamogeniculate arteries. The origin of the PComA is the first or second most common location for aneurysm formation, along with the anterior communicating artery ( Brazis, p p . 37 4-3 7 7 ; Kaye and Black, pp. 1603, 1734; Osborn DCA, p p . 153-193; Greenberg, pp. 107-108) .

26

26. Serat-serat yang lewat dari amigdala ke hypothalamus bisa berjalan pada bundel serat yang mana?
A. Stria medullaris
B. Forniks
C. Terminal-terminal stria
D. Bundel otak depan tengah
E. Singulum

(C) Afferent connections into the hypothalamus are umerous and complex. Seven of the main pathways are described below. 1. Amygdalohypothalamic fibers pass from the amygdala to the hypothalamus by two pathways: the stria terminalis and a pathway under the lentiform nucleus (ventral amygdalofugal fibers). The stria terminalis arises mainly from the corticomedial part of the amygdala and distributes fibers to the medial preoptic nucleus, anterior hypothalamic nucleus , and ventromedial and arcuate nuclei. Ventral amygdalofugal fibers arise from the basolateral amygdala and pyriform cortex and spread medially and rostrally under the lentiform nucleus to reach the lateral hypothalamus and medial forebrain bundle. 2. Visceral and somatic fibers reach the hypothalamus through collateral branches of the lemniscal tracts and reticular formation. 3. Basal olfactory, septal nuclei, periamygdaloid, and subiculum fibers reach the lateral and preoptic hypothalamic regions via the medial forebrain bundle . 4. Cortical fibers to the hypothalamus arise mainly from the frontal lobe. 5. Hippocampohypothalamic fibers travel through the fornix to the mammillary body. 6. Thalamohypothalamic fibers arise from the dorsomedial and midline thalamic nuclei. 7. Brainstem fibers to the hypothalamus arise from the raphe nuclei of the midbrain, the lateral parabrachial nuclei of the pons, and the locus ceruleus. Brainstem reticular fibers also ascend to the hypothalamus by the mammillary pedicle and dorsal longitudinal fasciculus (Carpenter, pp. 304-307 ; Kandel, pp. 972-981 , 992-993 ) .

27

27. Sebuah glomerulus serebelar terdiri dari semua hal di bawah ini, KECUALI
A. Serat-serat mendaki
B. Kapsul glial
C. Dendrit neuron-neuron granula
D. Akson & dendrite dari neuron-neuron Golgi Tipe-II
E. Serat-serat Mossy

(A) The cerebellar glomeruli have synaptic connections consisting of mossy fiber rosettes, axons of Golgi type II neurons, and dendrites of granule cells. A glial capsule surrounds this conglomeration. The axons of the granule neurons, which enter the molecular layer, provide the output from the glomerulus. Climbing fibers bypass the glomeruli to synapse directly on Purkinje cells (Carpenter, pp. 224-234). 2 8 .

28

28. Situs utama proliferasi neuroblas pada Sistem Saraf Pusat adalah
A. Lapisan III dari korteks serebral
B. Daerah ependimal periventrikular
C. Zat putih
D. Spinal cord
E. Lapisan araknoid

(B) The major site of neuroblast proliferation in the CNS is the periventricular ependymal surface. After undergoing mitosis, these young neural cells migrate away from the ependyma ( El liso n , p. 7 1 ) .

29

29. Diantara sel-sel di bawah ini, sel manakah yang hanya mewakili keluaran dari korteks serebelar?
A. Sel granula
B. Sel Golgi
C. Sel Stellate
D. Sel Purkinje
E. Sel horisontal

(D) The cerebellar cortex consists of a molecular layer, Purkinje cell layer, and granular layer. The granular layer is deepest and lies just above the central medullary white matter. This layer contains the granule cells, which utilize glutamate as their neurotransmitter and are the only excitatory cells of the cerebellar cortex. Granule cell dendrites terminate in glomeruli, and their axons ascend to the molecular layer of the cerebellum as parallel fibers, which synapse with Purkinje cell dendrites. Golgi type II cells also reside in the granular layer of the cerebellar cortex. These cells are inhibitory (GABA) interneurons; their dendrites contact parallel fibers while their axons terminate in glomeruli. Each glomerulus consists of granule cell dendrites, Golgi cell axons , and a mossy fiber rosette. The Purkinje cells reside in the middle layer of the cerebellar cortex; they are large cells that project inhibitory fibers (GABA) to the deep cerebellar nuclei and the vestibular nuclei. The Purkinje cell represents the only output of the cerebellar cortex, which is inhibitory. Purkinje cells have extensive dendritic arborizations that extend into the molecular layer and are stimulated by parallel fibers and climbing fibers. Specialized astrocytes, called Bergman cells (Golgi epithelial cells) , surround Purkinje cells within the Purkinje cell layer and provide supportive functions. The molecular layer is the most superficial layer of the cerebellar cortex; it contains stellate cells, basket cell . Purkinje dendrites, and pqrallel fibers (from granule cells). Stellate cells make synaptic contacts with Purkinje cell dendrites, while basket cells form synapses on Purkinje cell bodies. Both stellate and basket cells are inhibitory and utilize GABA as their neurotransmitter. Cerebellar cortical input occurs via climbing fibers an • mossy fibers. Climbing fibers originate in the inferior oli,•e (olivocerebellars) ; they ascend to the molecular layer. "'•h;:re they directly stimulate the dendrites of small numb rs u

30

30. Struktur-struktur manakah yang melewati annulus tendineus ( dari Zinn)?
1. Ophthalmic vein
2. Muskulus rektus lateral
3. Cabang lakrimal dari saraf optalmik
4. Pencabangan inferior saraf okulomotor

(C) The annulus tendineus (of Zinn) lies at the apes the periorbita and gives rise to four rectus muscles. The o

31

31. Saraf-saraf memasok otot yang bersifat antagonis bagi seratus anterior.

(K) The brachial plexus is formed from the anterior primary rami of segments CS, C6, C7, C8, and T l . It is about 15 em long in adults and e,xtends from the spinal cord to the axilla. It is divided into five major components, as follows : roots, trunks, divisions, cords, and branches. The fifth and sixth cervical roots unite to form the upper trunk of the plexus, and the eighth cervical and first thoracic spinal roots unite to form the lower trunk. The seventh cervical root emerges as the middle trunk of the plexus. The three trunks then traverse the supraclavicular fossa, behind the axillary artery, and .s.e.parate into three anterior and three posterior divi

32

32. Cedera pada saraf ini dapat menyebabkan winged scapula .

(A) The brachial plexus is formed from the anterior primary rami of segments CS, C6, C7, C8, and T l . It is about 15 em long in adults and e,xtends from the spinal cord to the axilla. It is divided into five major components, as follows : roots, trunks, divisions, cords, and branches. The fifth and sixth cervical roots unite to form the upper trunk of the plexus, and the eighth cervical and first thoracic spinal roots unite to form the lower trunk. The seventh cervical root emerges as the middle trunk of the plexus. The three trunks then traverse the supraclavicular fossa, behind the axillary artery, and .s.e.parate into three anterior and three posterior divi

33

33. Menginervasi otot halus teres .

(I) The brachial plexus is formed from the anterior primary rami of segments CS, C6, C7, C8, and T l . It is about 15 em long in adults and e,xtends from the spinal cord to the axilla. It is divided into five major components, as follows : roots, trunks, divisions, cords, and branches. The fifth and sixth cervical roots unite to form the upper trunk of the plexus, and the eighth cervical and first thoracic spinal roots unite to form the lower trunk. The seventh cervical root emerges as the middle trunk of the plexus. The three trunks then traverse the supraclavicular fossa, behind the axillary artery, and .s.e.parate into three anterior and three posterior divi

34

34. Cedera pada saraf ini dapat menyebabkan kelemahan fleksi, khususnya jika lengan bagian depan yang terkena.

(J) The brachial plexus is formed from the anterior primary rami of segments CS, C6, C7, C8, and T l . It is about 15 em long in adults and e,xtends from the spinal cord to the axilla. It is divided into five major components, as follows : roots, trunks, divisions, cords, and branches. The fifth and sixth cervical roots unite to form the upper trunk of the plexus, and the eighth cervical and first thoracic spinal roots unite to form the lower trunk. The seventh cervical root emerges as the middle trunk of the plexus. The three trunks then traverse the supraclavicular fossa, behind the axillary artery, and .s.e.parate into three anterior and three posterior divi

35

35. Menginervasi otot supinator

(G) The brachial plexus is formed from the anterior primary rami of segments CS, C6, C7, C8, and T l . It is about 15 em long in adults and e,xtends from the spinal cord to the axilla. It is divided into five major components, as follows : roots, trunks, divisions, cords, and branches. The fifth and sixth cervical roots unite to form the upper trunk of the plexus, and the eighth cervical and first thoracic spinal roots unite to form the lower trunk. The seventh cervical root emerges as the middle trunk of the plexus. The three trunks then traverse the supraclavicular fossa, behind the axillary artery, and .s.e.parate into three anterior and three posterior divi

36

36. Saraf yang paling sering terpengaruh oleh neuropati entrapmen

(H) The brachial plexus is formed from the anterior primary rami of segments CS, C6, C7, C8, and T l . It is about 15 em long in adults and e,xtends from the spinal cord to the axilla. It is divided into five major components, as follows : roots, trunks, divisions, cords, and branches. The fifth and sixth cervical roots unite to form the upper trunk of the plexus, and the eighth cervical and first thoracic spinal roots unite to form the lower trunk. The seventh cervical root emerges as the middle trunk of the plexus. The three trunks then traverse the supraclavicular fossa, behind the axillary artery, and .s.e.parate into three anterior and three posterior divi

37

37. Luka murni pada cabang saraf ini dapat menyebabkan kelemahan pada flekstor-flekstor panjang dari ibu jari dan kelingking ( yang menimbulkan tanda jepitan) dan pronator quadratus.

(H) The brachial plexus is formed from the anterior primary rami of segments CS, C6, C7, C8, and T l . It is about 15 em long in adults and e,xtends from the spinal cord to the axilla. It is divided into five major components, as follows : roots, trunks, divisions, cords, and branches. The fifth and sixth cervical roots unite to form the upper trunk of the plexus, and the eighth cervical and first thoracic spinal roots unite to form the lower trunk. The seventh cervical root emerges as the middle trunk of the plexus. The three trunks then traverse the supraclavicular fossa, behind the axillary artery, and .s.e.parate into three anterior and three posterior divi

38

38. Cedera pada saraf ini dapat terjadi pada saluran Guyan.

(F) The brachial plexus is formed from the anterior primary rami of segments CS, C6, C7, C8, and T l . It is about 15 em long in adults and e,xtends from the spinal cord to the axilla. It is divided into five major components, as follows : roots, trunks, divisions, cords, and branches. The fifth and sixth cervical roots unite to form the upper trunk of the plexus, and the eighth cervical and first thoracic spinal roots unite to form the lower trunk. The seventh cervical root emerges as the middle trunk of the plexus. The three trunks then traverse the supraclavicular fossa, behind the axillary artery, and .s.e.parate into three anterior and three posterior divi

39

39. Jika saraf ini ditekan, bisa menyebabkan ligamen yang menjembatani proses suprakondilar ke epikondile medial.

(H) The brachial plexus is formed from the anterior primary rami of segments CS, C6, C7, C8, and T l . It is about 15 em long in adults and e,xtends from the spinal cord to the axilla. It is divided into five major components, as follows : roots, trunks, divisions, cords, and branches. The fifth and sixth cervical roots unite to form the upper trunk of the plexus, and the eighth cervical and first thoracic spinal roots unite to form the lower trunk. The seventh cervical root emerges as the middle trunk of the plexus. The three trunks then traverse the supraclavicular fossa, behind the axillary artery, and .s.e.parate into three anterior and three posterior divi

40

40. Menginervasi otot-otot interosei

(F) The brachial plexus is formed from the anterior primary rami of segments CS, C6, C7, C8, and T l . It is about 15 em long in adults and e,xtends from the spinal cord to the axilla. It is divided into five major components, as follows : roots, trunks, divisions, cords, and branches. The fifth and sixth cervical roots unite to form the upper trunk of the plexus, and the eighth cervical and first thoracic spinal roots unite to form the lower trunk. The seventh cervical root emerges as the middle trunk of the plexus. The three trunks then traverse the supraclavicular fossa, behind the axillary artery, and .s.e.parate into three anterior and three posterior divi

41

41. Memasok sensasi kepada lengan bagian depan anteromedial dan posteromedial ke arah siku.

(E) The brachial plexus is formed from the anterior primary rami of segments CS, C6, C7, C8, and T l . It is about 15 em long in adults and e,xtends from the spinal cord to the axilla. It is divided into five major components, as follows : roots, trunks, divisions, cords, and branches. The fifth and sixth cervical roots unite to form the upper trunk of the plexus, and the eighth cervical and first thoracic spinal roots unite to form the lower trunk. The seventh cervical root emerges as the middle trunk of the plexus. The three trunks then traverse the supraclavicular fossa, behind the axillary artery, and .s.e.parate into three anterior and three posterior divi

42

42. Entrapmen pada rongga kuadrilateral.

(I) The brachial plexus is formed from the anterior primary rami of segments CS, C6, C7, C8, and T l . It is about 15 em long in adults and e,xtends from the spinal cord to the axilla. It is divided into five major components, as follows : roots, trunks, divisions, cords, and branches. The fifth and sixth cervical roots unite to form the upper trunk of the plexus, and the eighth cervical and first thoracic spinal roots unite to form the lower trunk. The seventh cervical root emerges as the middle trunk of the plexus. The three trunks then traverse the supraclavicular fossa, behind the axillary artery, and .s.e.parate into three anterior and three posterior divi

43

43. Semua fitur di bawah ini adalah fitur dari korteks serebral, KECUALI
A. Batas-batas sitoarsitektural kabur
B. Susunan laminar dari neuron-neuron yang ada
C. Garis-garis rapat pada serat tak termielinasi
D. Susunan neuron radial atau kolom
E. Banyak sel piramidal pada lapisan V dari korteks visual tang mengirimkan serat ke pusat otak untuk pergerakanpergerakan mata refleksif yang diarahkan secara visual.

(C) The cells of the cerebral cortex show both a laminar and radial or columnar arrangement. Several areas of cortex have grossly visible stripes of myelinated fibers, most notably the band of Gennari in layer IV of the occipital cortex. Most cytoarchitectural boundaries are vague rather than sharp. The large pyramidal neurons located in layer V of the visual receptive cortex send axons to the brainstem that mediate visually directed ret1ex eye movements (Carpenter, pp. 390- 433 ) .

44

44. Arcuate fasciculus terdiri dari serat-serat asosiasi yang saling menghubungkan
struktur yang mana?
A. Lobule parietal superior dan lobe okipital
B. Girus frontal atas dan tengah dan lobe temporal
C. Girus frontal atas dan bawah dan lobelimbik
D. Thalamus dan amigdala
E. Giri frontal orbital dan lobe temporal

(B) The arcuate fasciculus projects from the superior temporal gyrus (STG) to the superior and middle frontal gyri. More commonly, it is known as the tract that links the receptive area of speech in the superior temporal gyrus (Wernicke's area) with the inferior frontal gyrus (Broca's area) . Lesions in this tract often produce conduction aphasia, in which patients have t1uent speech with poor repetition of spoken language. \Vernicke's aphasia (WA) is a receptive aphasia characterized by poor comprehension of spoken language, neologisms, literal and verbal paraphasias, poor repetition, and a lack of concern regarding the speech problem. Injury to Broca's area results in an executive aphasia characterized by slow and effortful speech, agrammatic sounds, and telegraphic speech. The uncinate fasciculus connects the orbital frontal gyri with the anterior portions of the temporal lobe, while the cingulum connects the medial regions of the frontal and parietal lobes with the parahippocampal and temporal regions. The fibers of the superior and inferior longitudinal fasciculus lie close to the arcuate fasciculus and connect the parietal and occipital lobes with the frontal and temporal lobes, respectively. The anterior commissure (association tract) crosses the midline rostral to the fornix and has two parts: the smaller anterior portion interconnects the olfactory bulbs, and the larger posterior portion interconnects the middle and inferior temporal gyri (Carpenter, pp. 33-3 7 ) .

45

45. Seorang laki-laki berumur 27 tahun dibawa ke ruang gawat darurat dengan ptosis pada alis mata kanan dan konstriksi pupilaris pada mata yang sama, tapi tidak terdapat tanda gaze palsy atau diplopia. Penjelasan yang paling mungkin dari hal ini adalah adanya luka pada lokasi:
A. CN II
B. CN III
C. CN V
D. CN VII
E. Saraf simpatetik carotid

(E) The combination o f pupillary constriction and ptosis suggests a Horner's syndrome. Two muscles ele\'ate the eyelid: the levator palpebrae (CN III) and the superior tarsal muscle of •Muller (carotid sympathetic nerve). The key to further differentiation is the size of the pupil. A lesion of cranial .nerve I I I may likely result in pupillodilation (due to pupilloconstrictor muscle paralysis), whereas injury to the sympathetic nerve would result in pupil constriction , as seen in this patient. In addition, the ptosis of sympathetic paralysis may improve when the patient volitionally looks up , because the levator palpebrae is the muscle that mediates voluntary upward gaze. The lesion causing injury to the sym- CHAPTER 2 Neuroanatomy Answers 41 pathetics may originate i n any location along the descending pathways from the hypothalamus through the spinal cord and out through the peripheral pathways along the sympathetic chain and carotid artery (see discussion for question 6) (Brazis, pp. 181-182; Greenberg, p. 578).

46

mengandung kolom-kolom dominansi ocular?
1. Daerah kortikal yang mencerminkan blind spot dari retina
2. Daerah kortikal yang mencerminkan
paruh nasal dari retina ipsilateral
3. Daerah kortikal yang mencerminkan bulan sabit temporal monocular dari medan visual
4. Sistem kolom, yang terutama berhubungan dengan orientasi garis dan posisi retinal

(B) The striate cortex is organized in both vertical and horizontal systems. The vertical or columnar system is mainly concerned with line orientation, retinal position, detection of movements, and ocular dominance. Ihe two regions of the striate cortex that do not contain ocular dominance columns include the region representing the blind spot of the eye and the cortical regimi representing the monocular temporal crescent of the visual fields (Carpenter, pp. 411-414) .

47

47. Rentan terhadap cedera selama prosedur obsetrik dan ginekologi.

(D) The first clinically relevant branch of the lumbar plexus is the lateral femoral cutaneous nerve of the thigh (A, L2-3), which reaches the thigh by passing under the lateral aspect of the inguinal ligament. Entrapment of this nerve as it enters the thigh can produce a numb, tingling, or burning hypersensitivity over the lateral thigh known as meralgia paresthetica. It is often encountered in obese patients of either sex who have lost a significant amount of weight, or, conversely, can be seen in late pregnancy due to a sagging anterior abdominal wall. This condition often remits on its own, but surgical decompression is sometimes warranted. The femoral nerve (B, E, L2-4) passes down along the lateral aspect of the psoas muscle and emerges under the inguinal ligament into the femoral triangle. It innervates the iliopsoas (hip t1exion), sartorius (hip t1exion, thigh eversion), and quadriceps femoris muscles (knee extension). I n the abdomen and pelvis, a primary or secondary neoplasm, psoas abscess, or pelvic hematoma may damage the upper portion of this nerve (B). In the femoral ring (E), this nerve is particularly vulnerable to local compression and possibly pressure palsy from diabetes mellitus. Although diabetes can also affect the L2-4 roots of this nerve, diabetic neuropathy of the femoral nerve is most often encountered in the femoral triangle. The patient usually presents with pain that resolves, only to be followed by rapid wasting and weakness of the quadriceps, which makes walking very difficult. Fortunately, the condition eventually improves, although it may take up to 2 years. The obturator nerve (D, L2-4) lies, on the medial side of the iliopsoas muscle and comes into close relationship with the uterus before reaching the obturator foramen. In the pelvis, it is particularly vulnerable to injury during obstetric and gynecologic procedt1res. This nerve supplies the adductor muscles of the thigh, which includes the pectineus; adductor longus, brevis, and magnus; and gracili.t; muscles. I ts integrity is tested by having the patient hold the legs together against resistance. The sciatic nerve (C, F) consists of two discrete components invested by the same fascia called the peroneal and 42 Intensive Neurosurgery Board Review tibial nerves. This major nerve may also be damaged in the pelvis by direct spread of neoplasms (along with the femoral nerve), particularly from the rectum or genitourinary tract. In the buttock, misplaced deep intramuscular injections, complicated hip ' fractures, and penetrating trauma are the most frequent causes of sciatic nerve damage. Misplaced injections can be especially problematic, because they can produce not only significant weakness but also severe causalgic pain over the leg and foot that is often refractory to medications. The superior gluteal neurovascular bundle lies in the superomedial gluteal quadrant. The sciatic nerve and inferior gluteal neurovascular bundle lie in the inferolateral and inferomedial quadrants, respectively. The safest location for intramuscular injection is the superolateral gluteal quadrant. The peroneal nerve is particularly vulnerable to injury as it crosses near the fibular neck, although this nerve is more resilient to injury than the tibial nerve after sciatic nerve injury. The reason for this is not entirely clear ( Patten, pp. 299-310; Brazis, pp. 62-65, 73-7 7; April , p. 584).

48

48. Saraf yang berasosiasi dengan “neuralgia paresthetica” .

(A) The first clinically relevant branch of the lumbar plexus is the lateral femoral cutaneous nerve of the thigh (A, L2-3), which reaches the thigh by passing under the lateral aspect of the inguinal ligament. Entrapment of this nerve as it enters the thigh can produce a numb, tingling, or burning hypersensitivity over the lateral thigh known as meralgia paresthetica. It is often encountered in obese patients of either sex who have lost a significant amount of weight, or, conversely, can be seen in late pregnancy due to a sagging anterior abdominal wall. This condition often remits on its own, but surgical decompression is sometimes warranted. The femoral nerve (B, E, L2-4) passes down along the lateral aspect of the psoas muscle and emerges under the inguinal ligament into the femoral triangle. It innervates the iliopsoas (hip t1exion), sartorius (hip t1exion, thigh eversion), and quadriceps femoris muscles (knee extension). I n the abdomen and pelvis, a primary or secondary neoplasm, psoas abscess, or pelvic hematoma may damage the upper portion of this nerve (B). In the femoral ring (E), this nerve is particularly vulnerable to local compression and possibly pressure palsy from diabetes mellitus. Although diabetes can also affect the L2-4 roots of this nerve, diabetic neuropathy of the femoral nerve is most often encountered in the femoral triangle. The patient usually presents with pain that resolves, only to be followed by rapid wasting and weakness of the quadriceps, which makes walking very difficult. Fortunately, the condition eventually improves, although it may take up to 2 years. The obturator nerve (D, L2-4) lies, on the medial side of the iliopsoas muscle and comes into close relationship with the uterus before reaching the obturator foramen. In the pelvis, it is particularly vulnerable to injury during obstetric and gynecologic procedt1res. This nerve supplies the adductor muscles of the thigh, which includes the pectineus; adductor longus, brevis, and magnus; and gracili.t; muscles. I ts integrity is tested by having the patient hold the legs together against resistance. The sciatic nerve (C, F) consists of two discrete components invested by the same fascia called the peroneal and 42 Intensive Neurosurgery Board Review tibial nerves. This major nerve may also be damaged in the pelvis by direct spread of neoplasms (along with the femoral nerve), particularly from the rectum or genitourinary tract. In the buttock, misplaced deep intramuscular injections, complicated hip ' fractures, and penetrating trauma are the most frequent causes of sciatic nerve damage. Misplaced injections can be especially problematic, because they can produce not only significant weakness but also severe causalgic pain over the leg and foot that is often refractory to medications. The superior gluteal neurovascular bundle lies in the superomedial gluteal quadrant. The sciatic nerve and inferior gluteal neurovascular bundle lie in the inferolateral and inferomedial quadrants, respectively. The safest location for intramuscular injection is the superolateral gluteal quadrant. The peroneal nerve is particularly vulnerable to injury as it crosses near the fibular neck, although this nerve is more resilient to injury than the tibial nerve after sciatic nerve injury. The reason for this is not entirely clear ( Patten, pp. 299-310; Brazis, pp. 62-65, 73-7 7; April , p. 584).

49

49. Saraf yang kemungkinan rusak oleh hematoma pada pelvis.

(B) The first clinically relevant branch of the lumbar plexus is the lateral femoral cutaneous nerve of the thigh (A, L2-3), which reaches the thigh by passing under the lateral aspect of the inguinal ligament. Entrapment of this nerve as it enters the thigh can produce a numb, tingling, or burning hypersensitivity over the lateral thigh known as meralgia paresthetica. It is often encountered in obese patients of either sex who have lost a significant amount of weight, or, conversely, can be seen in late pregnancy due to a sagging anterior abdominal wall. This condition often remits on its own, but surgical decompression is sometimes warranted. The femoral nerve (B, E, L2-4) passes down along the lateral aspect of the psoas muscle and emerges under the inguinal ligament into the femoral triangle. It innervates the iliopsoas (hip t1exion), sartorius (hip t1exion, thigh eversion), and quadriceps femoris muscles (knee extension). I n the abdomen and pelvis, a primary or secondary neoplasm, psoas abscess, or pelvic hematoma may damage the upper portion of this nerve (B). In the femoral ring (E), this nerve is particularly vulnerable to local compression and possibly pressure palsy from diabetes mellitus. Although diabetes can also affect the L2-4 roots of this nerve, diabetic neuropathy of the femoral nerve is most often encountered in the femoral triangle. The patient usually presents with pain that resolves, only to be followed by rapid wasting and weakness of the quadriceps, which makes walking very difficult. Fortunately, the condition eventually improves, although it may take up to 2 years. The obturator nerve (D, L2-4) lies, on the medial side of the iliopsoas muscle and comes into close relationship with the uterus before reaching the obturator foramen. In the pelvis, it is particularly vulnerable to injury during obstetric and gynecologic procedt1res. This nerve supplies the adductor muscles of the thigh, which includes the pectineus; adductor longus, brevis, and magnus; and gracili.t; muscles. I ts integrity is tested by having the patient hold the legs together against resistance. The sciatic nerve (C, F) consists of two discrete components invested by the same fascia called the peroneal and 42 Intensive Neurosurgery Board Review tibial nerves. This major nerve may also be damaged in the pelvis by direct spread of neoplasms (along with the femoral nerve), particularly from the rectum or genitourinary tract. In the buttock, misplaced deep intramuscular injections, complicated hip ' fractures, and penetrating trauma are the most frequent causes of sciatic nerve damage. Misplaced injections can be especially problematic, because they can produce not only significant weakness but also severe causalgic pain over the leg and foot that is often refractory to medications. The superior gluteal neurovascular bundle lies in the superomedial gluteal quadrant. The sciatic nerve and inferior gluteal neurovascular bundle lie in the inferolateral and inferomedial quadrants, respectively. The safest location for intramuscular injection is the superolateral gluteal quadrant. The peroneal nerve is particularly vulnerable to injury as it crosses near the fibular neck, although this nerve is more resilient to injury than the tibial nerve after sciatic nerve injury. The reason for this is not entirely clear ( Patten, pp. 299-310; Brazis, pp. 62-65, 73-7 7; April , p. 584).

50

50. Amiotropi diabetik paling mungkin mempengaruhi situs ini.

(E) The first clinically relevant branch of the lumbar plexus is the lateral femoral cutaneous nerve of the thigh (A, L2-3), which reaches the thigh by passing under the lateral aspect of the inguinal ligament. Entrapment of this nerve as it enters the thigh can produce a numb, tingling, or burning hypersensitivity over the lateral thigh known as meralgia paresthetica. It is often encountered in obese patients of either sex who have lost a significant amount of weight, or, conversely, can be seen in late pregnancy due to a sagging anterior abdominal wall. This condition often remits on its own, but surgical decompression is sometimes warranted. The femoral nerve (B, E, L2-4) passes down along the lateral aspect of the psoas muscle and emerges under the inguinal ligament into the femoral triangle. It innervates the iliopsoas (hip t1exion), sartorius (hip t1exion, thigh eversion), and quadriceps femoris muscles (knee extension). I n the abdomen and pelvis, a primary or secondary neoplasm, psoas abscess, or pelvic hematoma may damage the upper portion of this nerve (B). In the femoral ring (E), this nerve is particularly vulnerable to local compression and possibly pressure palsy from diabetes mellitus. Although diabetes can also affect the L2-4 roots of this nerve, diabetic neuropathy of the femoral nerve is most often encountered in the femoral triangle. The patient usually presents with pain that resolves, only to be followed by rapid wasting and weakness of the quadriceps, which makes walking very difficult. Fortunately, the condition eventually improves, although it may take up to 2 years. The obturator nerve (D, L2-4) lies, on the medial side of the iliopsoas muscle and comes into close relationship with the uterus before reaching the obturator foramen. In the pelvis, it is particularly vulnerable to injury during obstetric and gynecologic procedt1res. This nerve supplies the adductor muscles of the thigh, which includes the pectineus; adductor longus, brevis, and magnus; and gracili.t; muscles. I ts integrity is tested by having the patient hold the legs together against resistance. The sciatic nerve (C, F) consists of two discrete components invested by the same fascia called the peroneal and 42 Intensive Neurosurgery Board Review tibial nerves. This major nerve may also be damaged in the pelvis by direct spread of neoplasms (along with the femoral nerve), particularly from the rectum or genitourinary tract. In the buttock, misplaced deep intramuscular injections, complicated hip ' fractures, and penetrating trauma are the most frequent causes of sciatic nerve damage. Misplaced injections can be especially problematic, because they can produce not only significant weakness but also severe causalgic pain over the leg and foot that is often refractory to medications. The superior gluteal neurovascular bundle lies in the superomedial gluteal quadrant. The sciatic nerve and inferior gluteal neurovascular bundle lie in the inferolateral and inferomedial quadrants, respectively. The safest location for intramuscular injection is the superolateral gluteal quadrant. The peroneal nerve is particularly vulnerable to injury as it crosses near the fibular neck, although this nerve is more resilient to injury than the tibial nerve after sciatic nerve injury. The reason for this is not entirely clear ( Patten, pp. 299-310; Brazis, pp. 62-65, 73-7 7; April , p. 584).

51

51. Memasok otot pektineus dan grasilis.

(D) The first clinically relevant branch of the lumbar plexus is the lateral femoral cutaneous nerve of the thigh (A, L2-3), which reaches the thigh by passing under the lateral aspect of the inguinal ligament. Entrapment of this nerve as it enters the thigh can produce a numb, tingling, or burning hypersensitivity over the lateral thigh known as meralgia paresthetica. It is often encountered in obese patients of either sex who have lost a significant amount of weight, or, conversely, can be seen in late pregnancy due to a sagging anterior abdominal wall. This condition often remits on its own, but surgical decompression is sometimes warranted. The femoral nerve (B, E, L2-4) passes down along the lateral aspect of the psoas muscle and emerges under the inguinal ligament into the femoral triangle. It innervates the iliopsoas (hip t1exion), sartorius (hip t1exion, thigh eversion), and quadriceps femoris muscles (knee extension). I n the abdomen and pelvis, a primary or secondary neoplasm, psoas abscess, or pelvic hematoma may damage the upper portion of this nerve (B). In the femoral ring (E), this nerve is particularly vulnerable to local compression and possibly pressure palsy from diabetes mellitus. Although diabetes can also affect the L2-4 roots of this nerve, diabetic neuropathy of the femoral nerve is most often encountered in the femoral triangle. The patient usually presents with pain that resolves, only to be followed by rapid wasting and weakness of the quadriceps, which makes walking very difficult. Fortunately, the condition eventually improves, although it may take up to 2 years. The obturator nerve (D, L2-4) lies, on the medial side of the iliopsoas muscle and comes into close relationship with the uterus before reaching the obturator foramen. In the pelvis, it is particularly vulnerable to injury during obstetric and gynecologic procedt1res. This nerve supplies the adductor muscles of the thigh, which includes the pectineus; adductor longus, brevis, and magnus; and gracili.t; muscles. I ts integrity is tested by having the patient hold the legs together against resistance. The sciatic nerve (C, F) consists of two discrete components invested by the same fascia called the peroneal and 42 Intensive Neurosurgery Board Review tibial nerves. This major nerve may also be damaged in the pelvis by direct spread of neoplasms (along with the femoral nerve), particularly from the rectum or genitourinary tract. In the buttock, misplaced deep intramuscular injections, complicated hip ' fractures, and penetrating trauma are the most frequent causes of sciatic nerve damage. Misplaced injections can be especially problematic, because they can produce not only significant weakness but also severe causalgic pain over the leg and foot that is often refractory to medications. The superior gluteal neurovascular bundle lies in the superomedial gluteal quadrant. The sciatic nerve and inferior gluteal neurovascular bundle lie in the inferolateral and inferomedial quadrants, respectively. The safest location for intramuscular injection is the superolateral gluteal quadrant. The peroneal nerve is particularly vulnerable to injury as it crosses near the fibular neck, although this nerve is more resilient to injury than the tibial nerve after sciatic nerve injury. The reason for this is not entirely clear ( Patten, pp. 299-310; Brazis, pp. 62-65, 73-7 7; April , p. 584).

52

52. Komunikan-komunikan ramus abu-abu, yang membentang antara ganglion tanduk. simpatetik dengan ramus primer depan dari saraf spinal, mengandung:
A. Serat aferen somatik umum
B. Serat-serat termielinasi
C. Neuron-neuron simpatetik pra-ganglionik
D. Serat-serat yang menjadi sistem saraf enteric
E. Serat-serat adrenergic

(E) Sympathetic preganglionic fibers originate from the T1 through L2 (thoracolumbar) levels of the spinal cord and pass successively through the ventral roots, anterior primary rami of the spinal nerves, and myelinated white rami communicans before synapsing in the sympathetic chain (composed of paravertebral ganglia and interconnecting fiber bundles) . Sympathetic postganglionic fibers from the paravertebral ganglia then may take one of several routes. They may pass back to a spinal nerve along an unmyelinated gray ramus communicans to innervate dermal sweat glands, smooth muscle cells of arterioles, and/or arrector pili muscles of the body and extremities. They may exit the sympathetic ganglia through splanchnic nerves to innervate the abdominal or pelvic viscera or may course up or down the sympathetic chain to synapse with postganglionic neurons located several spinal levels away. Every spinal nerve receives a gray ramus from the sympathetic chain, whereas only spinal levels T1-L2 have white rami communicans (myelinated). Preganglionic sympathetic neurons are cholinergic, whereas the sympathetic postganglionic fibers (some tra\'eling through gray ramus communicans) are adrenergic. Because the paravertebral and preVertebral ganglia are located some distance away from the organ innervated, the sympathetic preganglionic fibers are shorter, whereas postganglionic fibers are longer as compared to the parasympathetic division (Apri l , pp. 28-30).

53

53. Saraf-saraf yang terinervasi oleh ansa servikalis meliputi sebagai berikut, KECUALI
A. Omohioid
B. Geniohioid
C. Tirohioid
D. Geniohioid
E. Stilohioid

(E) The superior ramus of the ansa cervicalis, which arises from C1 and the •hypoglossal nerve, innervates the geniohyoid (protracts hyoid) and thyrohyoid (raises larynx) muscles, whereas the inferior ramus, arising from C 1-C3, inner\'ates the omohyoid (lowers hyoid) and sternothyroid (lowers larynx) muscles. Since the muscles supplied by the ansa cervicalis often have collateral innervation, sectioning or mobilization of this structure during various surgical procedures (such as carotid endarterectomy) rarely has clinical consequences. The stylohyoid (elevates and retracts hyoid) muscle is innervated by CN VII (Apri l , p. 5 12).

54

54. Seorang laki-laki berumur 46 tahun dengan riwayat lama luka tembak di wajah dan penyalahgunaan obat-obatan intravenus dibawa ke ruang gawat darurat dalam keadaan demam dan luka pada sisi kiri leher dan wajahnya. CT scan mengungkapkan adanya abses di dekat fossa pterigopalatin. Infeksi ini mungkin langsung dapat dilacak ke seluruh kompartemen dibawah ini, KECUALI,
A. Rongga orbital
B. Rongga nasal
C. Fossa kranial tengah
D. Telinga bagian dalam
E. Rongga oral

(D) . The pterygopalatine fossa harbors many nerves and blood vessels, which directly communicate with various compartments of the face and skull. The pterygopalatine fossa communicates directly with the middle cranial fossa through the foramen rotundum and vidian canal, with the orbital cavity through the inferior orbital fissure, with the nasal cavity via the sphenopalatine foramen, and with the oral cavity by way of the palatine canal. It does not directly communicate with the inner ear (Apri l , pp. 490- 491).

55

55. Saraf siliaris pendek
A. Pupil Marcuss-Gunn
B. Pupil Horner
C. Pupil Adie (Pupil Tonik)
D. Pupil Argyll-Robertson
E. Bukan, A-D

(C) Adie's pupil (dilated pupil) is thought to be due to impaired postganglionic parasympathetics from a viral infection of the ciliary ganglion. Adie's pupil often constricts with dilute (0. 1 to 0. 1 25%) pilocarpine, a parasympathomimetic, because of denervation hypersensitivity (normal pupils react to 1% pilocarpine). The ArgyllRobertson pupils are believed to result from disruption of pathways leading to the Edinger-Westphal nucleus, which produces light-near dissociation (pupillary constriction with convergence and absent light response). The Marcus-Gunn pupil is best detected by the swinging flashlight test, as the consensual reflex is stronger than the direct reflex (afferent pupillary defect). It is caused by lesions anterior to the optic chiasm, such as retinal detachment or infarct, optic or retrobulbar neuritis, or trauma to the optic nerve. The presence of the consensual reflex is evidence of a preserved third nerve (with parasympathetics) on the side of the direct reflex. Horner's syndrome (HS) results from interruption of the sympathetic pupillomotor pathways anywhere between the primary motor neuron in the hypothalamus, the second motor neuron i n the cervicothoracic junction, and thirdorder neuron i n the superior cervical ganglion. Findings may include miosis, ptosis, enophthalmos, eye hyperemia, or anhidrosis of the face. Cocaine can be used if the diagnosis is i n doubt; however, this has no localizing value. Cocaine blocks norepinephrine (NE) reuptake by postganglionic sympathetic fibers at the neuroeffector junction. In HS, no NE is released, so cocaine cannot dilate the eye. If the pupil dilates normally, there is no HS. To differentiate a secondfrom a third-order neuron injury, administer 1% hydroxyamphetamine, which releases NE from nerve terminals at the neuroeffector junction. This causes pupillary dilation with second-order neuron lesions but not with third-order neuron damage (since third-order neurons do not release NE) (Greenberg, p. 578).

56

56. Ganglion servikal superior
A. Pupil Marcuss-Gunn
B. Pupil Horner
C. Pupil Adie (Pupil Tonik)
D. Pupil Argyll-Robertson
E. Bukan, A-D

(B) Adie's pupil (dilated pupil) is thought to be due to impaired postganglionic parasympathetics from a viral infection of the ciliary ganglion. Adie's pupil often constricts with dilute (0. 1 to 0. 1 25%) pilocarpine, a parasympathomimetic, because of denervation hypersensitivity (normal pupils react to 1% pilocarpine). The ArgyllRobertson pupils are believed to result from disruption of pathways leading to the Edinger-Westphal nucleus, which produces light-near dissociation (pupillary constriction with convergence and absent light response). The Marcus-Gunn pupil is best detected by the swinging flashlight test, as the consensual reflex is stronger than the direct reflex (afferent pupillary defect). It is caused by lesions anterior to the optic chiasm, such as retinal detachment or infarct, optic or retrobulbar neuritis, or trauma to the optic nerve. The presence of the consensual reflex is evidence of a preserved third nerve (with parasympathetics) on the side of the direct reflex. Horner's syndrome (HS) results from interruption of the sympathetic pupillomotor pathways anywhere between the primary motor neuron in the hypothalamus, the second motor neuron i n the cervicothoracic junction, and thirdorder neuron i n the superior cervical ganglion. Findings may include miosis, ptosis, enophthalmos, eye hyperemia, or anhidrosis of the face. Cocaine can be used if the diagnosis is i n doubt; however, this has no localizing value. Cocaine blocks norepinephrine (NE) reuptake by postganglionic sympathetic fibers at the neuroeffector junction. In HS, no NE is released, so cocaine cannot dilate the eye. If the pupil dilates normally, there is no HS. To differentiate a secondfrom a third-order neuron injury, administer 1% hydroxyamphetamine, which releases NE from nerve terminals at the neuroeffector junction. This causes pupillary dilation with second-order neuron lesions but not with third-order neuron damage (since third-order neurons do not release NE) (Greenberg, p. 578).

57

57. Midbrain dorsal
A. Pupil Marcuss-Gunn
B. Pupil Horner
C. Pupil Adie (Pupil Tonik)
D. Pupil Argyll-Robertson
E. Bukan, A-D

(D) Adie's pupil (dilated pupil) is thought to be due to impaired postganglionic parasympathetics from a viral infection of the ciliary ganglion. Adie's pupil often constricts with dilute (0. 1 to 0. 1 25%) pilocarpine, a parasympathomimetic, because of denervation hypersensitivity (normal pupils react to 1% pilocarpine). The ArgyllRobertson pupils are believed to result from disruption of pathways leading to the Edinger-Westphal nucleus, which produces light-near dissociation (pupillary constriction with convergence and absent light response). The Marcus-Gunn pupil is best detected by the swinging flashlight test, as the consensual reflex is stronger than the direct reflex (afferent pupillary defect). It is caused by lesions anterior to the optic chiasm, such as retinal detachment or infarct, optic or retrobulbar neuritis, or trauma to the optic nerve. The presence of the consensual reflex is evidence of a preserved third nerve (with parasympathetics) on the side of the direct reflex. Horner's syndrome (HS) results from interruption of the sympathetic pupillomotor pathways anywhere between the primary motor neuron in the hypothalamus, the second motor neuron i n the cervicothoracic junction, and thirdorder neuron i n the superior cervical ganglion. Findings may include miosis, ptosis, enophthalmos, eye hyperemia, or anhidrosis of the face. Cocaine can be used if the diagnosis is i n doubt; however, this has no localizing value. Cocaine blocks norepinephrine (NE) reuptake by postganglionic sympathetic fibers at the neuroeffector junction. In HS, no NE is released, so cocaine cannot dilate the eye. If the pupil dilates normally, there is no HS. To differentiate a secondfrom a third-order neuron injury, administer 1% hydroxyamphetamine, which releases NE from nerve terminals at the neuroeffector junction. This causes pupillary dilation with second-order neuron lesions but not with third-order neuron damage (since third-order neurons do not release NE) (Greenberg, p. 578).

58

58. Retina
A. Pupil Marcuss-Gunn
B. Pupil Horner
C. Pupil Adie (Pupil Tonik)
D. Pupil Argyll-Robertson
E. Bukan, A-D

(A) Adie's pupil (dilated pupil) is thought to be due to impaired postganglionic parasympathetics from a viral infection of the ciliary ganglion. Adie's pupil often constricts with dilute (0. 1 to 0. 1 25%) pilocarpine, a parasympathomimetic, because of denervation hypersensitivity (normal pupils react to 1% pilocarpine). The ArgyllRobertson pupils are believed to result from disruption of pathways leading to the Edinger-Westphal nucleus, which produces light-near dissociation (pupillary constriction with convergence and absent light response). The Marcus-Gunn pupil is best detected by the swinging flashlight test, as the consensual reflex is stronger than the direct reflex (afferent pupillary defect). It is caused by lesions anterior to the optic chiasm, such as retinal detachment or infarct, optic or retrobulbar neuritis, or trauma to the optic nerve. The presence of the consensual reflex is evidence of a preserved third nerve (with parasympathetics) on the side of the direct reflex. Horner's syndrome (HS) results from interruption of the sympathetic pupillomotor pathways anywhere between the primary motor neuron in the hypothalamus, the second motor neuron i n the cervicothoracic junction, and thirdorder neuron i n the superior cervical ganglion. Findings may include miosis, ptosis, enophthalmos, eye hyperemia, or anhidrosis of the face. Cocaine can be used if the diagnosis is i n doubt; however, this has no localizing value. Cocaine blocks norepinephrine (NE) reuptake by postganglionic sympathetic fibers at the neuroeffector junction. In HS, no NE is released, so cocaine cannot dilate the eye. If the pupil dilates normally, there is no HS. To differentiate a secondfrom a third-order neuron injury, administer 1% hydroxyamphetamine, which releases NE from nerve terminals at the neuroeffector junction. This causes pupillary dilation with second-order neuron lesions but not with third-order neuron damage (since third-order neurons do not release NE) (Greenberg, p. 578).

59

59. Istilah lentiform nuclei merujuk kepada struktur atau struktur-struktur yang mana?
A. Nukleus kaudata dan globus pallidum
B. Putamen dan amygdale
C. Putamen dan globus pallidum
D. Nukleus kaudata, globus pallidum dan putamen
E. Globus pallidus

C. The term corpus striatum refers to the caudate, putamen, and pallidum, whereas the term striatum typically includes only the caudate nucleus and putamen. The lentiform nuclei consist of the globus pallidus and putamen, which lie between the internal and extreme capsules and are separated by a curved vertical lamina of white matter called the lateral medullary lamina. Other terms commonly used to refer to the basal ganglia include neostriatum (caudate nucleus and putamen), paleostriatum (globus pallidus), and archistriatum (amygdaloid complex). All the structures mentioned above except for the globus pallid us (and subthalamic nucleus) are believed to have originated from the telencephalon, which is a diencephalic structure (Carpenter, p. 325).

60

60. Nukleus subtalamik (STN) menerima asupannya yang dominan dari struktur yang mana?
A. Nukleus ventral-lateral (VL) dari thalamus
B. Nukleus sentromedian (CM) dari Thalamus
C. Globus pallidus lateral
D. Globus pallidus medial
E. Korteks serebral

C. The largest number of afferent fibers into the STN originate in the lateral pallidal segment. Afferents to the STN from the motor, premotor, and prefrontal cortex are mainly collaterals from other tracts, while a relatively small number of afferents originate from the Clvl nucleus of the thalamus. Mferents to the STN from the lateral pallidal segment are mainly GABAergic, while most cells of the STN are believed to release glutamate and exert excitatory effects on their targets. The medial globus pallidus is the major outflow site of the basal ganglia, as described in the discussion for question 2 (Carpenter, pp. 347-351) .

61

61. Semua saluran di bawah ini merupakan saluran-saluran aferen melalui pedunkel serebelar bawah, KECUALI
A. Vestibuloserebelar
B. Olivoserebelar
C. Spinoserebelar Dorsal
D. Reticuloserebelar
E. Kortikopontoserebelar

E. The corticopontocerebellar tract consists almost entirely of crossed fibers from the pontine nuclei that transmit impulses from the cerebral cortex to the intermediate and lateral zones of the cerebellum through the middle cerebellar peduncle (brachium pontis). The inferior cerebellar peduncle connects the medulla to the cerebellum and consists of two divisions: the restiform body contains afferent fibers from the olivocerebellar, dorsal spinocerebellar, reticulocerebellar, and cuneocerebellar tracts, while the juxtarestiform body contains both afferent (vestibulocerebellar) and efferent ( cerebellovestibular) fibers. The superior cerebellar peduncle (brachium conjuctivum) consists principally of efferents from the cerebellum. Rubral , thalamic, and reticular projections arise from the dentate and interposed nuclei, which exit the cerebellum via the superior cerebellar peduncle. Mferent tracts into the superior cerebellar peduncle include the ventral spinocerebellar, trigeminocerebellar, and tectocerebellar tracts ( Kandel, pp. 626-646; Fix, pp. 196-197 ) .

62

62. Akson dari sel-sel yang manakah yang meninggalkan lapisan V dari neokorteks yang terutama sebagai serat-serat proyeksi?
A. Sel-sel Stellata
B. Sel-sel fusiform
C. Sel-sel piramidal
D. Sel-sel horisontal
E. Sel-sel fusiform

(C) T h e following layers are distinguished in the neocortex in passing from the pial surface toward the white matter: Layer I (molecular layer): contains cells with horizontal axons and Golgi type II cells. Layer II (external granular layer): consists mostly of closely packed granule cells. Layer I I I (external pyramidal layer) : consists of two sublayers of pyramidal neurons. Layer IV (internal granular layer) : comprises closely packed stellate cells with either short aJwns ramifying within the layer or larger axons projecting to deeper layers. Myelinated fibers of the external band of Baillarger form a prominem horizontal plexus in this layer. Layer V (internal pyramidal layer) : consists mainly of medium and large pyramidal cells (Betz cells). Apical dendrites of large pyramidal cells project to the molecular layer. while axons mainly leave the cortex as projection fibers. Layer VI (multiform layer): contains spindle-shaped cells whose long axes are perpendicular to the cortical suriace

63

63. Bagian tubuh yang manakah diantara bagian tubuh di bawah ini yang memiliki
representasi terbesar dalam korteks sensorimotor?
A. Genitalia
B. Jari Tengah
C. Putting Susu
D. Ibu Jari
E. Jari Kelingking

D. Some areas o f the body have a greater sensori representation than others. -The largest areas in, tongue, thumb, little finger, and corresponding digirs or foot, as well as the hands and feet in general. The complexi - of motor actions of the thumb requires a larger circuitry than the trunk, index finger, nipple, geniralia middle finger (Carpenter, p p . 401-404). I 44 Intensive Neurosurgery Board Review

64

64. Perbedaan utama antara arkikorteks dan neokorteks meliputi?
A. Tidak adanya laminasi pada arkikorteks
B. Susunan lapis-enam dari arkikorteks
C. Adanya sebuah lapisan semu dan materi putih pada arkikorteks
D. Kurangnya sel-sel Betz pada arkikorteks
E. Arkikorteks memiliki hubungan-hubungan utama hanya dengan sistem limbik

C. Both the archicortex and neocortex are laminated, contain pyramidal neurons, and have connections with the limbic system. One major difference is that the archicortex has a distinct sup

65

65. Nukleus hypothalamus yang manakah yang terlibat di dalam produksi faktor-faktor
yang pelepasan-hipothalamik dan menyebabkan tumbuhnya saluran tuberohipofisial?
A. Dorsomedial
B. Suprakiasmatik
C. Arkuate
D. Belakang
E. Praoptik

C. The nuclei of the hypothalamus are divided by an imaginary plane formed by the columns of the fornix and mammillothalamic tract into medial and lateral groups. The medial hypothalamic area is again divided into four regions from anterior to posterior: preoptic, supraoptic, tuberal, and mammillary regions. Each of these regions contains a separate subgroup of nuclei . Medial group 1. Preoptic region: contains the medial preoptic nucleus involved with the release of gonadotropic hormones. This nucleus is sexually dimorphic and requires testosterone for development. 2. Supraoptic region: contains the supraoptic nucleus (synthesizes ADH and oxytocin), paraventricular nucleus (makes and releases ADH, oxytocin, and CRH) , anterior nucleus (plays a role in temperature regulation) , and suprachiasmatic nucleus (controls circadian rhythms), which lie dorsal to the optic chiasm. 3 . Tuberal region: the arcuate nucleus is located in the tuber cinereum; it contains neurons that produce hypothalamic releasing factors and gives rise to the tuberohypophysial tract, which terminates in the hypophyseal portal system of the infundibulum. This nucleus regulates the release of adenohypophyseal hormones into the systemic circulation. The arcuate nucleus, along with the dorsomedial and ventromedial nuclei, lies dorsal to the tuber cinereum and makes up the nuclei adjacent to this structure. 4. Mammillary region: this contains the mammillary and posterior nuclei, which lie dorsal to the mammillary bodies. The lateral hypothalamic area is traversed by the medial forebrain bundle and includes two major nuclei: the lateral preoptic and lateral hypothalamic nuclei (Carpenter, pp. 297-303).

66

66. Diantara konstelasi-konstelasi mengenai fungsi hipothalamik di bawah ini, konstelasi atau konstelasi-konstelasi yang manakah yang paling benar?
1. Daerah-daerah hipothalamik lateral dan belakang berhubungan dengan respons-respons simpatetik
2. Daerah-daerah hipothalamik depan dan tengah mengendalikan respons-respons parasimpatetik
3. Luka setempat dua arah dari nukleus hipothalamik pada daerah tuberal dapat
menyebabkan hiperphagia
4. Luka-luka hipothalamik belakang dua arah dapat menyebabkan poikilotermia

E. The supraoptic and paraventricular nuclei of the hypothalamus synthesize and secrete vasopressin and oxytocin, respectively. The anterior portion of the hypothalamus controls mechanisms that dissipate heat. Stimulation of this area causes dilaticm of blood vessels and sweating, which lowers body temperature. Stimulation of the posterior hypothalamus results in vasoconstriction of blood vessels, inhibition of sweating, and possibly shivering, which may increase body temperature. The posterior (mainly) and lateral hypothalamic nuclei are also involved with the sympathetic nervous system control. The lateral region of the hypothalamus is sometimes referred to as either the hunger and thirst center, as stimulation can result in increased food and water intake. Stimulation of the medial region of the hypothalamus results in decreased food intake; it is often referred to as the satiety center. The suprachiasmatic nucleus controls circadian rhythms, and the anterior and preoptic nuclei help to control parasympathetic responses as well as gonadotropin secretion (Carpenter, pp. 3 1 7 -324).

67

67. Saraf peroneal dalam menginervasi otot-otot yang mana?
1. Ekstensor halusis longus
2. Digitorum longus ekstensor
3. Tibialis depan
4. Peroneos longus

A. The sciatic nerve (L4-S3) is the major branch of the sacral plexus and is also the largest nerve in the body. The sciatic nerve consists of the tibial and common peroneal nerves. The tibial nerve (L4-S3) innervates the flexors of the leg, including the semitendinosus, semimembranosus, biceps femoris, gastrocnemius, soleus, flexor hallucis longus, flexor digitorum longus, popliteus, tibialis posterior, and plantaris. The tibial nerve gives rise to the lateral sural cutaneous nerve, which unites with the communicating branch of the peroneal nerve to form the sural nerve. This nerve supplies cutaneous innervation to the lateral inferior leg and lateral foot. The tibial nerve may become entrapped in the tarsal tunnel posterior and inferior to the medial malleolus, which results in pain and paresthesias in the toes and sole of the foot (often sparing the heel because these sensory branches often originate proximal to the tarsal tunnel) and wealmess on plantarflexion . The common peroneal nerve (L4-S2) innervates extensors and adductors of the leg (and part of the biceps femoris) and gives rise to the lateral sural cutaneous nerve (to the inferolateral leg), the deep peroneal nerve, and the superficial peroneal nerve. The deep peroneal nerve innervates the foot and toe extensors (tibialis anterior, extensor hallucis longus, extensor digitorum longus) and provides sensation to a small area between the great and second toes. The superficial peroneal nerve i nnervates the peroneus longus/brevis (foot eversion) and the skin of the distal anterior leg, the dorsum of the foot, and the digits. Lesions of the common peroneal nerve (most common) result in paralysis of dorsiflexion (foot-drop) and foot eversion. The posterior femoral cutaneous nerve (Sl-S3) innervates the skin of the inferior buttocks, perineum, posterior thigh, and proximal leg (Greenberg, pp. 522, 544-546).

68

68. Anggota bagian belakang kapsul intern mengandung semua saluran di bawah ini,
KECUALI
A. Kortikopontin prefrontal
B. Kortikospinal
C. Kortikotektal
D. Kortikorubral
E. Radiasi talamik atas

A. Refer to Figure 2.68A. The corticospinal, frontopontine, superior thalamic radiations, and a relatively smaller number of corticotectal and corticorubral fibers run in the posterior limb of the internal capsule. The prefrontal corticopontine tract and anterior thalamic radiations run in the anterior limb of the internal capsule, while the corticobulbar and corticoreticular tracts are contained within the genu of the internal capsule (Carpenter, p. 282).

69

69. Karakteristik mana yang paling lazim ditemukan pada thalamus?
A. Glutamat
B. Apartat
C. GABA
D. Asetilkolin
E. Senyawa P

C . Although glutamate appears to be the main neurotransmitter of the corticothalamic tracts, the thalamus itself is rich in GABA. Virtually all cells of the thalamus are rich in this neurotransmitter; in primates, the major projections of the medial pallidum to the VA and VL nuclei of the thalamus are GABAergic. Moreover, the projections from the pars reticulata of the substantia nigra to the VA and MD nuclei of the thalamus are also rich in GABA (Carpenter, pp. 278- 2 79).

70

70. Serat-serat silang pada saluran optik berhenti pada lapisan-lapisan tubuh genikulat lateral yang mana?
A. 2. 4. dan 6 D. 1, 3 dan 5
B. 1, 4, dan 6 E. 2, 5 dan 6
C. 2, 3 dan 5

B. The LGN contains six layers, numbered 1 through 6. The ventralmost layers contain large cells and are known as "magnocellular"; they receive their input from M ganglion cells. The dorsal four layers are known as "parvocellular" and receive their input from P ganglion cells. An individual layer receives input from only one eye. Fibers from the contralateral nasal hemiretina synapse in layers 1, 4, and 6, and fibers from the ipsilateral temporal hemiretina synapse in layers 2, 3 , and 5 ( Ka ndel, pp. 528-532) .

71

71. Yang manakah diantara nukleus di bawah ini yang BUKAN merupakan nukleus dalam
dari serebelum?
A. Fastigial
B. Fusiform
C. Emboliform
D. Globose
E. Dentate

B. The cerebellum comprises the fastigial, globose, emboliform, and dentate nuclei. The globose and emboliform nuclei together are known as the interposed nuclei. These nuclei correspond to the three functional dh•isions of the cerebellum: the vestibulocerebellum, spinocerebellum, and cerebrocerebellum. The vermis projects via the fastigial nucleus to the cortex and brainstem giving rise to the medial CHAPTER 2 Neuroanatomy Answers 45 descending systems controlling proximal musculature. The intermediate zone of the cerebellum projects via the interposed nuclei to cortical and brainstem regions, which giye rise to the lateral descending pathways controlling distal limb muscles. The lateral zone projects to the dentate nucleus, which forms connections with the motor and premotor areas of the cerebral cortex for the planning of voluntary movements (Carpenter, pp. 234-236) .

72

72. Sampai seberapa jauh di belakang sutur
koronal letak garis motorik yang lazim?
A. 1 – 2 cm
B. 2 – 3 cm
C. 4 – 5 cm
D. 7 – 8 cm
E. 9 – 10 cm

C. The motor strip generally lies 4 to 5.4 em behind the coronal suture (Greenberg, pp. 97 -98) .

73

73. Cedera saraf kranial yang menimpa foramen ini akan menyebabkan diplopia dan pusing jika melihat ke bawah dan mendongak.

(B) The oculomotor (CN III), trochlear (CN IV) , and abducens nerves (VI) innervate the extraocular muscles and, along with the V1 and V2 divisions of CN V, exit the skull base through the superior orbital fissure (B). The trochlear (see question 84 for complete discussion) and abducens nerves provide GSE fibers to the superior oblique and lateral rectus muscles, respectively, while CN Ill innervates the levator palpebrae superioris, superior rectus, medial rectus, inferior rectus, and inferior oblique muscles. Lesions of CN III will produce lateral strabismus ("wall eyes") with nearly complete ophthalmoplegia of the eye as well as ptosis. The Edinger-Westphal nucleus is the most rostral parasympathetic nucleus, which gives rise to the GVE component of the oculomotor nerve (CN III) . The facial nerve is both a sensory and motor nerve. The main motor nucleus of the facial nerve lies i n the reticular formation of the lower pons. Fibers leaving this nucleus course dorsally toward the floor of the fourth ventricle, loop around the abducens nucleus, and slightly indent the floor of the fourth ventricle, forming the facial colliculus. This loop is the internal genu of the facial nerve, which then turns ventrally to emerge on the ventrolateral part of the brainstem at the caudal border of the pons. This nerve then accompanies cranial nerve VIII through the internal auditory canal (G) and petrous temporal bone and exits the skull at the stylomastoid foramen. The nerve to the stapedius muscle is given off prior to exiting the skull, and injury to this small branch can result in hyperacusis. The remaining fibers exit the skull and innervate the frontalis (temporal nerve), orbicularis oculi (zygomatic nerve) , buccinator and orbicularis oris (buccal nerve ) , orbicularis oris (mandibular nerve), platysma (cervical nerve), and occipitalis muscles (posterior auricular nerve). The superior salh:_atory nucleus (SSN), which supplies the submandibular, salivary, and lacrimal glands, lies posterolaterally to the motor nucleus. The efferents from this nucleus travel via the nervus intermedius and divide i n the facial canal into two nerves called the greater petrosal (lacrimal and nasal glands) and the chorda tympani (submandibular gland) nerves. The greater petros.al nerve exits the petrous portion of the temporal bone via the greater superficial petrosal foramen (F) to enter the middle cranial fossa, passes deep to the trigeminal ganglion, traverses the lateral wall of the foramen lacerum, joins with the deep . . . 46 I ntensive Neurosurgery Hoard Review petrosal nerve carrying sympathetic fibers, and becomes the nerve of the pterygoid canal. It then synapses in the pterygopalatine ganglion prior to continuing forward to the lacrimal glan

74

74. Saraf yang menembus foramen ini kemudian akan bergabung dengan saraf petrosal dalam sehingga membentuk saraf bagi saluran pterigoid.

(F) The oculomotor (CN III), trochlear (CN IV) , and abducens nerves (VI) innervate the extraocular muscles and, along with the V1 and V2 divisions of CN V, exit the skull base through the superior orbital fissure (B). The trochlear (see question 84 for complete discussion) and abducens nerves provide GSE fibers to the superior oblique and lateral rectus muscles, respectively, while CN Ill innervates the levator palpebrae superioris, superior rectus, medial rectus, inferior rectus, and inferior oblique muscles. Lesions of CN III will produce lateral strabismus ("wall eyes") with nearly complete ophthalmoplegia of the eye as well as ptosis. The Edinger-Westphal nucleus is the most rostral parasympathetic nucleus, which gives rise to the GVE component of the oculomotor nerve (CN III) . The facial nerve is both a sensory and motor nerve. The main motor nucleus of the facial nerve lies i n the reticular formation of the lower pons. Fibers leaving this nucleus course dorsally toward the floor of the fourth ventricle, loop around the abducens nucleus, and slightly indent the floor of the fourth ventricle, forming the facial colliculus. This loop is the internal genu of the facial nerve, which then turns ventrally to emerge on the ventrolateral part of the brainstem at the caudal border of the pons. This nerve then accompanies cranial nerve VIII through the internal auditory canal (G) and petrous temporal bone and exits the skull at the stylomastoid foramen. The nerve to the stapedius muscle is given off prior to exiting the skull, and injury to this small branch can result in hyperacusis. The remaining fibers exit the skull and innervate the frontalis (temporal nerve), orbicularis oculi (zygomatic nerve) , buccinator and orbicularis oris (buccal nerve ) , orbicularis oris (mandibular nerve), platysma (cervical nerve), and occipitalis muscles (posterior auricular nerve). The superior salh:_atory nucleus (SSN), which supplies the submandibular, salivary, and lacrimal glands, lies posterolaterally to the motor nucleus. The efferents from this nucleus travel via the nervus intermedius and divide i n the facial canal into two nerves called the greater petrosal (lacrimal and nasal glands) and the chorda tympani (submandibular gland) nerves. The greater petros.al nerve exits the petrous portion of the temporal bone via the greater superficial petrosal foramen (F) to enter the middle cranial fossa, passes deep to the trigeminal ganglion, traverses the lateral wall of the foramen lacerum, joins with the deep . . . 46 I ntensive Neurosurgery Hoard Review petrosal nerve carrying sympathetic fibers, and becomes the nerve of the pterygoid canal. It then synapses in the pterygopalatine ganglion prior to continuing forward to the lacrimal glan

75

75. Cedera pada sebuah cabang kecil dari saraf ini, yang melewati kanal ini akan mengakibatkan hiperakusis

(G) The oculomotor (CN III), trochlear (CN IV) , and abducens nerves (VI) innervate the extraocular muscles and, along with the V1 and V2 divisions of CN V, exit the skull base through the superior orbital fissure (B). The trochlear (see question 84 for complete discussion) and abducens nerves provide GSE fibers to the superior oblique and lateral rectus muscles, respectively, while CN Ill innervates the levator palpebrae superioris, superior rectus, medial rectus, inferior rectus, and inferior oblique muscles. Lesions of CN III will produce lateral strabismus ("wall eyes") with nearly complete ophthalmoplegia of the eye as well as ptosis. The Edinger-Westphal nucleus is the most rostral parasympathetic nucleus, which gives rise to the GVE component of the oculomotor nerve (CN III) . The facial nerve is both a sensory and motor nerve. The main motor nucleus of the facial nerve lies i n the reticular formation of the lower pons. Fibers leaving this nucleus course dorsally toward the floor of the fourth ventricle, loop around the abducens nucleus, and slightly indent the floor of the fourth ventricle, forming the facial colliculus. This loop is the internal genu of the facial nerve, which then turns ventrally to emerge on the ventrolateral part of the brainstem at the caudal border of the pons. This nerve then accompanies cranial nerve VIII through the internal auditory canal (G) and petrous temporal bone and exits the skull at the stylomastoid foramen. The nerve to the stapedius muscle is given off prior to exiting the skull, and injury to this small branch can result in hyperacusis. The remaining fibers exit the skull and innervate the frontalis (temporal nerve), orbicularis oculi (zygomatic nerve) , buccinator and orbicularis oris (buccal nerve ) , orbicularis oris (mandibular nerve), platysma (cervical nerve), and occipitalis muscles (posterior auricular nerve). The superior salh:_atory nucleus (SSN), which supplies the submandibular, salivary, and lacrimal glands, lies posterolaterally to the motor nucleus. The efferents from this nucleus travel via the nervus intermedius and divide i n the facial canal into two nerves called the greater petrosal (lacrimal and nasal glands) and the chorda tympani (submandibular gland) nerves. The greater petros.al nerve exits the petrous portion of the temporal bone via the greater superficial petrosal foramen (F) to enter the middle cranial fossa, passes deep to the trigeminal ganglion, traverses the lateral wall of the foramen lacerum, joins with the deep . . . 46 I ntensive Neurosurgery Hoard Review petrosal nerve carrying sympathetic fibers, and becomes the nerve of the pterygoid canal. It then synapses in the pterygopalatine ganglion prior to continuing forward to the lacrimal glan

76

76. Saraf yang melewati foramen ini akan menginervasi otot tensor veli palatine

(D) The oculomotor (CN III), trochlear (CN IV) , and abducens nerves (VI) innervate the extraocular muscles and, along with the V1 and V2 divisions of CN V, exit the skull base through the superior orbital fissure (B). The trochlear (see question 84 for complete discussion) and abducens nerves provide GSE fibers to the superior oblique and lateral rectus muscles, respectively, while CN Ill innervates the levator palpebrae superioris, superior rectus, medial rectus, inferior rectus, and inferior oblique muscles. Lesions of CN III will produce lateral strabismus ("wall eyes") with nearly complete ophthalmoplegia of the eye as well as ptosis. The Edinger-Westphal nucleus is the most rostral parasympathetic nucleus, which gives rise to the GVE component of the oculomotor nerve (CN III) . The facial nerve is both a sensory and motor nerve. The main motor nucleus of the facial nerve lies i n the reticular formation of the lower pons. Fibers leaving this nucleus course dorsally toward the floor of the fourth ventricle, loop around the abducens nucleus, and slightly indent the floor of the fourth ventricle, forming the facial colliculus. This loop is the internal genu of the facial nerve, which then turns ventrally to emerge on the ventrolateral part of the brainstem at the caudal border of the pons. This nerve then accompanies cranial nerve VIII through the internal auditory canal (G) and petrous temporal bone and exits the skull at the stylomastoid foramen. The nerve to the stapedius muscle is given off prior to exiting the skull, and injury to this small branch can result in hyperacusis. The remaining fibers exit the skull and innervate the frontalis (temporal nerve), orbicularis oculi (zygomatic nerve) , buccinator and orbicularis oris (buccal nerve ) , orbicularis oris (mandibular nerve), platysma (cervical nerve), and occipitalis muscles (posterior auricular nerve). The superior salh:_atory nucleus (SSN), which supplies the submandibular, salivary, and lacrimal glands, lies posterolaterally to the motor nucleus. The efferents from this nucleus travel via the nervus intermedius and divide i n the facial canal into two nerves called the greater petrosal (lacrimal and nasal glands) and the chorda tympani (submandibular gland) nerves. The greater petros.al nerve exits the petrous portion of the temporal bone via the greater superficial petrosal foramen (F) to enter the middle cranial fossa, passes deep to the trigeminal ganglion, traverses the lateral wall of the foramen lacerum, joins with the deep . . . 46 I ntensive Neurosurgery Hoard Review petrosal nerve carrying sympathetic fibers, and becomes the nerve of the pterygoid canal. It then synapses in the pterygopalatine ganglion prior to continuing forward to the lacrimal glan

77

77. Saraf kranial yang melewati foramen ini akan diinervasi oleh nukleus salivatoris atas untuk menghasilkan ludah.

(G) The oculomotor (CN III), trochlear (CN IV) , and abducens nerves (VI) innervate the extraocular muscles and, along with the V1 and V2 divisions of CN V, exit the skull base through the superior orbital fissure (B). The trochlear (see question 84 for complete discussion) and abducens nerves provide GSE fibers to the superior oblique and lateral rectus muscles, respectively, while CN Ill innervates the levator palpebrae superioris, superior rectus, medial rectus, inferior rectus, and inferior oblique muscles. Lesions of CN III will produce lateral strabismus ("wall eyes") with nearly complete ophthalmoplegia of the eye as well as ptosis. The Edinger-Westphal nucleus is the most rostral parasympathetic nucleus, which gives rise to the GVE component of the oculomotor nerve (CN III) . The facial nerve is both a sensory and motor nerve. The main motor nucleus of the facial nerve lies i n the reticular formation of the lower pons. Fibers leaving this nucleus course dorsally toward the floor of the fourth ventricle, loop around the abducens nucleus, and slightly indent the floor of the fourth ventricle, forming the facial colliculus. This loop is the internal genu of the facial nerve, which then turns ventrally to emerge on the ventrolateral part of the brainstem at the caudal border of the pons. This nerve then accompanies cranial nerve VIII through the internal auditory canal (G) and petrous temporal bone and exits the skull at the stylomastoid foramen. The nerve to the stapedius muscle is given off prior to exiting the skull, and injury to this small branch can result in hyperacusis. The remaining fibers exit the skull and innervate the frontalis (temporal nerve), orbicularis oculi (zygomatic nerve) , buccinator and orbicularis oris (buccal nerve ) , orbicularis oris (mandibular nerve), platysma (cervical nerve), and occipitalis muscles (posterior auricular nerve). The superior salh:_atory nucleus (SSN), which supplies the submandibular, salivary, and lacrimal glands, lies posterolaterally to the motor nucleus. The efferents from this nucleus travel via the nervus intermedius and divide i n the facial canal into two nerves called the greater petrosal (lacrimal and nasal glands) and the chorda tympani (submandibular gland) nerves. The greater petros.al nerve exits the petrous portion of the temporal bone via the greater superficial petrosal foramen (F) to enter the middle cranial fossa, passes deep to the trigeminal ganglion, traverses the lateral wall of the foramen lacerum, joins with the deep . . . 46 I ntensive Neurosurgery Hoard Review petrosal nerve carrying sympathetic fibers, and becomes the nerve of the pterygoid canal. It then synapses in the pterygopalatine ganglion prior to continuing forward to the lacrimal glan

78

78. Saraf yang melewati foramen ini menumbuhkan serat-serat eferen visceral umum (GVE) yang memasok kelenjar parotid

(H) The oculomotor (CN III), trochlear (CN IV) , and abducens nerves (VI) innervate the extraocular muscles and, along with the V1 and V2 divisions of CN V, exit the skull base through the superior orbital fissure (B). The trochlear (see question 84 for complete discussion) and abducens nerves provide GSE fibers to the superior oblique and lateral rectus muscles, respectively, while CN Ill innervates the levator palpebrae superioris, superior rectus, medial rectus, inferior rectus, and inferior oblique muscles. Lesions of CN III will produce lateral strabismus ("wall eyes") with nearly complete ophthalmoplegia of the eye as well as ptosis. The Edinger-Westphal nucleus is the most rostral parasympathetic nucleus, which gives rise to the GVE component of the oculomotor nerve (CN III) . The facial nerve is both a sensory and motor nerve. The main motor nucleus of the facial nerve lies i n the reticular formation of the lower pons. Fibers leaving this nucleus course dorsally toward the floor of the fourth ventricle, loop around the abducens nucleus, and slightly indent the floor of the fourth ventricle, forming the facial colliculus. This loop is the internal genu of the facial nerve, which then turns ventrally to emerge on the ventrolateral part of the brainstem at the caudal border of the pons. This nerve then accompanies cranial nerve VIII through the internal auditory canal (G) and petrous temporal bone and exits the skull at the stylomastoid foramen. The nerve to the stapedius muscle is given off prior to exiting the skull, and injury to this small branch can result in hyperacusis. The remaining fibers exit the skull and innervate the frontalis (temporal nerve), orbicularis oculi (zygomatic nerve) , buccinator and orbicularis oris (buccal nerve ) , orbicularis oris (mandibular nerve), platysma (cervical nerve), and occipitalis muscles (posterior auricular nerve). The superior salh:_atory nucleus (SSN), which supplies the submandibular, salivary, and lacrimal glands, lies posterolaterally to the motor nucleus. The efferents from this nucleus travel via the nervus intermedius and divide i n the facial canal into two nerves called the greater petrosal (lacrimal and nasal glands) and the chorda tympani (submandibular gland) nerves. The greater petros.al nerve exits the petrous portion of the temporal bone via the greater superficial petrosal foramen (F) to enter the middle cranial fossa, passes deep to the trigeminal ganglion, traverses the lateral wall of the foramen lacerum, joins with the deep . . . 46 I ntensive Neurosurgery Hoard Review petrosal nerve carrying sympathetic fibers, and becomes the nerve of the pterygoid canal. It then synapses in the pterygopalatine ganglion prior to continuing forward to the lacrimal glan

79

79. Batang-batang sel dari serat-serat aferen ini terletak pada ganglion nodosal dan memasuki tengkorak melalui foramen ini

(H) The oculomotor (CN III), trochlear (CN IV) , and abducens nerves (VI) innervate the extraocular muscles and, along with the V1 and V2 divisions of CN V, exit the skull base through the superior orbital fissure (B). The trochlear (see question 84 for complete discussion) and abducens nerves provide GSE fibers to the superior oblique and lateral rectus muscles, respectively, while CN Ill innervates the levator palpebrae superioris, superior rectus, medial rectus, inferior rectus, and inferior oblique muscles. Lesions of CN III will produce lateral strabismus ("wall eyes") with nearly complete ophthalmoplegia of the eye as well as ptosis. The Edinger-Westphal nucleus is the most rostral parasympathetic nucleus, which gives rise to the GVE component of the oculomotor nerve (CN III) . The facial nerve is both a sensory and motor nerve. The main motor nucleus of the facial nerve lies i n the reticular formation of the lower pons. Fibers leaving this nucleus course dorsally toward the floor of the fourth ventricle, loop around the abducens nucleus, and slightly indent the floor of the fourth ventricle, forming the facial colliculus. This loop is the internal genu of the facial nerve, which then turns ventrally to emerge on the ventrolateral part of the brainstem at the caudal border of the pons. This nerve then accompanies cranial nerve VIII through the internal auditory canal (G) and petrous temporal bone and exits the skull at the stylomastoid foramen. The nerve to the stapedius muscle is given off prior to exiting the skull, and injury to this small branch can result in hyperacusis. The remaining fibers exit the skull and innervate the frontalis (temporal nerve), orbicularis oculi (zygomatic nerve) , buccinator and orbicularis oris (buccal nerve ) , orbicularis oris (mandibular nerve), platysma (cervical nerve), and occipitalis muscles (posterior auricular nerve). The superior salh:_atory nucleus (SSN), which supplies the submandibular, salivary, and lacrimal glands, lies posterolaterally to the motor nucleus. The efferents from this nucleus travel via the nervus intermedius and divide i n the facial canal into two nerves called the greater petrosal (lacrimal and nasal glands) and the chorda tympani (submandibular gland) nerves. The greater petros.al nerve exits the petrous portion of the temporal bone via the greater superficial petrosal foramen (F) to enter the middle cranial fossa, passes deep to the trigeminal ganglion, traverses the lateral wall of the foramen lacerum, joins with the deep . . . 46 I ntensive Neurosurgery Hoard Review petrosal nerve carrying sympathetic fibers, and becomes the nerve of the pterygoid canal. It then synapses in the pterygopalatine ganglion prior to continuing forward to the lacrimal glan

80

80. Saraf petrosal yang lebih halus menembus foramen ini

(E) The oculomotor (CN III), trochlear (CN IV) , and abducens nerves (VI) innervate the extraocular muscles and, along with the V1 and V2 divisions of CN V, exit the skull base through the superior orbital fissure (B). The trochlear (see question 84 for complete discussion) and abducens nerves provide GSE fibers to the superior oblique and lateral rectus muscles, respectively, while CN Ill innervates the levator palpebrae superioris, superior rectus, medial rectus, inferior rectus, and inferior oblique muscles. Lesions of CN III will produce lateral strabismus ("wall eyes") with nearly complete ophthalmoplegia of the eye as well as ptosis. The Edinger-Westphal nucleus is the most rostral parasympathetic nucleus, which gives rise to the GVE component of the oculomotor nerve (CN III) . The facial nerve is both a sensory and motor nerve. The main motor nucleus of the facial nerve lies i n the reticular formation of the lower pons. Fibers leaving this nucleus course dorsally toward the floor of the fourth ventricle, loop around the abducens nucleus, and slightly indent the floor of the fourth ventricle, forming the facial colliculus. This loop is the internal genu of the facial nerve, which then turns ventrally to emerge on the ventrolateral part of the brainstem at the caudal border of the pons. This nerve then accompanies cranial nerve VIII through the internal auditory canal (G) and petrous temporal bone and exits the skull at the stylomastoid foramen. The nerve to the stapedius muscle is given off prior to exiting the skull, and injury to this small branch can result in hyperacusis. The remaining fibers exit the skull and innervate the frontalis (temporal nerve), orbicularis oculi (zygomatic nerve) , buccinator and orbicularis oris (buccal nerve ) , orbicularis oris (mandibular nerve), platysma (cervical nerve), and occipitalis muscles (posterior auricular nerve). The superior salh:_atory nucleus (SSN), which supplies the submandibular, salivary, and lacrimal glands, lies posterolaterally to the motor nucleus. The efferents from this nucleus travel via the nervus intermedius and divide i n the facial canal into two nerves called the greater petrosal (lacrimal and nasal glands) and the chorda tympani (submandibular gland) nerves. The greater petros.al nerve exits the petrous portion of the temporal bone via the greater superficial petrosal foramen (F) to enter the middle cranial fossa, passes deep to the trigeminal ganglion, traverses the lateral wall of the foramen lacerum, joins with the deep . . . 46 I ntensive Neurosurgery Hoard Review petrosal nerve carrying sympathetic fibers, and becomes the nerve of the pterygoid canal. It then synapses in the pterygopalatine ganglion prior to continuing forward to the lacrimal glan

81

81. Foramen ini ditembus oleh sebuah saraf yang menghabiskan serat-serat timpani korda.

(G) The oculomotor (CN III), trochlear (CN IV) , and abducens nerves (VI) innervate the extraocular muscles and, along with the V1 and V2 divisions of CN V, exit the skull base through the superior orbital fissure (B). The trochlear (see question 84 for complete discussion) and abducens nerves provide GSE fibers to the superior oblique and lateral rectus muscles, respectively, while CN Ill innervates the levator palpebrae superioris, superior rectus, medial rectus, inferior rectus, and inferior oblique muscles. Lesions of CN III will produce lateral strabismus ("wall eyes") with nearly complete ophthalmoplegia of the eye as well as ptosis. The Edinger-Westphal nucleus is the most rostral parasympathetic nucleus, which gives rise to the GVE component of the oculomotor nerve (CN III) . The facial nerve is both a sensory and motor nerve. The main motor nucleus of the facial nerve lies i n the reticular formation of the lower pons. Fibers leaving this nucleus course dorsally toward the floor of the fourth ventricle, loop around the abducens nucleus, and slightly indent the floor of the fourth ventricle, forming the facial colliculus. This loop is the internal genu of the facial nerve, which then turns ventrally to emerge on the ventrolateral part of the brainstem at the caudal border of the pons. This nerve then accompanies cranial nerve VIII through the internal auditory canal (G) and petrous temporal bone and exits the skull at the stylomastoid foramen. The nerve to the stapedius muscle is given off prior to exiting the skull, and injury to this small branch can result in hyperacusis. The remaining fibers exit the skull and innervate the frontalis (temporal nerve), orbicularis oculi (zygomatic nerve) , buccinator and orbicularis oris (buccal nerve ) , orbicularis oris (mandibular nerve), platysma (cervical nerve), and occipitalis muscles (posterior auricular nerve). The superior salh:_atory nucleus (SSN), which supplies the submandibular, salivary, and lacrimal glands, lies posterolaterally to the motor nucleus. The efferents from this nucleus travel via the nervus intermedius and divide i n the facial canal into two nerves called the greater petrosal (lacrimal and nasal glands) and the chorda tympani (submandibular gland) nerves. The greater petros.al nerve exits the petrous portion of the temporal bone via the greater superficial petrosal foramen (F) to enter the middle cranial fossa, passes deep to the trigeminal ganglion, traverses the lateral wall of the foramen lacerum, joins with the deep . . . 46 I ntensive Neurosurgery Hoard Review petrosal nerve carrying sympathetic fibers, and becomes the nerve of the pterygoid canal. It then synapses in the pterygopalatine ganglion prior to continuing forward to the lacrimal glan

82

82. Memindahkan ophthalmic vein.

(B) The oculomotor (CN III), trochlear (CN IV) , and abducens nerves (VI) innervate the extraocular muscles and, along with the V1 and V2 divisions of CN V, exit the skull base through the superior orbital fissure (B). The trochlear (see question 84 for complete discussion) and abducens nerves provide GSE fibers to the superior oblique and lateral rectus muscles, respectively, while CN Ill innervates the levator palpebrae superioris, superior rectus, medial rectus, inferior rectus, and inferior oblique muscles. Lesions of CN III will produce lateral strabismus ("wall eyes") with nearly complete ophthalmoplegia of the eye as well as ptosis. The Edinger-Westphal nucleus is the most rostral parasympathetic nucleus, which gives rise to the GVE component of the oculomotor nerve (CN III) . The facial nerve is both a sensory and motor nerve. The main motor nucleus of the facial nerve lies i n the reticular formation of the lower pons. Fibers leaving this nucleus course dorsally toward the floor of the fourth ventricle, loop around the abducens nucleus, and slightly indent the floor of the fourth ventricle, forming the facial colliculus. This loop is the internal genu of the facial nerve, which then turns ventrally to emerge on the ventrolateral part of the brainstem at the caudal border of the pons. This nerve then accompanies cranial nerve VIII through the internal auditory canal (G) and petrous temporal bone and exits the skull at the stylomastoid foramen. The nerve to the stapedius muscle is given off prior to exiting the skull, and injury to this small branch can result in hyperacusis. The remaining fibers exit the skull and innervate the frontalis (temporal nerve), orbicularis oculi (zygomatic nerve) , buccinator and orbicularis oris (buccal nerve ) , orbicularis oris (mandibular nerve), platysma (cervical nerve), and occipitalis muscles (posterior auricular nerve). The superior salh:_atory nucleus (SSN), which supplies the submandibular, salivary, and lacrimal glands, lies posterolaterally to the motor nucleus. The efferents from this nucleus travel via the nervus intermedius and divide i n the facial canal into two nerves called the greater petrosal (lacrimal and nasal glands) and the chorda tympani (submandibular gland) nerves. The greater petros.al nerve exits the petrous portion of the temporal bone via the greater superficial petrosal foramen (F) to enter the middle cranial fossa, passes deep to the trigeminal ganglion, traverses the lateral wall of the foramen lacerum, joins with the deep . . . 46 I ntensive Neurosurgery Hoard Review petrosal nerve carrying sympathetic fibers, and becomes the nerve of the pterygoid canal. It then synapses in the pterygopalatine ganglion prior to continuing forward to the lacrimal glan

83

83. Seorang laki-laki berumur 45 tahun ditemukan menderita diplopia dengan kelemahan pada lirikan ke bawah dan tengah pada mata kanannya. Laki-laki ini juga merasa sangat kesulitan setiap kali menuruni tangga tanpa harus mengangkat kepalanya agar penglihatannya menjadi
lebih jelas. Saraf kranial manakah yang paling mungkin terserang?
A. Saraf okulomotor kanan
B. Saraf okulomotor kiri
C. Saraf troklear kiri
D. Saraf troklear kanan
E. Saraf abdusens kanan

C. The trochlear nucleus is located in the tegmentum of the mesencephalon at the level of the inferior colliculus, ventral to the cerebral aqueduct. Axons leaving this nucleus course dorsally around the aqueduct, decussate \Yithin the superior medullary velum, and exit the brainstem on the dorsal surface (only cranial nerve to exit the brain stem dorsally and decussate after exiting the brainstem). Since the trochlear nerve crosses to the other side, it innervates the contralateral superior oblique muscle. Of note, the trochlear nerve passes through the cavernous sinus along with cranial nerves III, V1, sometimes V2, and VI. Cranial nerves III, V1, V 2, and IV run along the lateral wall of the sinus, while cranial nerve VI runs more medially and adjacent to the internal carotid artery. Injury to the superior oblique muscle or trochlear nerve results in diplopia, with weakness of downward and medial gaze. Patients have most difficulty walking down stairs, and because of the tendency to tilt the head to compensate for the affected superior oblique muscle, fourth nerve palsies should be included in the differential for torticollis (Wilson-Pauwels, pp. 70-7 7 ) .

84

84. Semua pernyataan mengenai saluran kortikospinal di bawah ini adalah benar, KECUALI
A. Sekitar 3% dari serat-serat kortikospinal berasal dari sel-sel piramidal Betz/
B. Sel-sel kortikospinal terdekusasi di dalam medulla sehingga membentuk sebuah saluran kortikospinal besar dan saluran kortikospinal depan kecil.
C. Mayoritas serat-serat kortikospinal servikal ditemukan secara medial dan serat-serat sakral ditemukan secara lateral.
D. Luka-luka kortikospinal menyebabkan refleks-refleks jerk tendon, respons jari kaki ekstensor, dan spastisitas setelah periode hipotonia.
E. Berhenti terutama pada neuron-neuron motorik α di dalam lamina IX dari urat spinal.

E . T h e corticospinal tracts originate in layer V o f the cerebral cortex, pass through the corona radiata and posterior limb of the internal capsule, form the middle third of the cerebral peduncles and the pyramids of the medulla, and terminate primarily on interneurons of lamina VII in the spinal cord. Approximately 40% of corticospinal fibers originate in the parietal lobe, 30% are from the motor cortex (area 4 ) , 30% from the supplementary motor area (area 6), and only 3% originate from the giant Betz pyramidal cells of the motor cortex. Around two-thirds of the corticospinal fibers are myelinated, and there are approximately 1 million corticospinal fibers in each pyramid of the medulla. Corticospinal fibers incompletely decussate in the medulla and form the large crossed lateral corticospinal tract (90% of fibers ) , the smaller uncrossed anterior corticospinal tract, and the very small uncrossed anterolateral corticospinal tract. The lateral corticospinal tracts descend in the lateral funiculus to all levels of the spinal cord and synapse in laminae IV, V, VI, and VII of the spinal gray. The anterior corticospinal tracts descend adjacent to the anterior median fissure of the spinal cord and terminate primarily in cervical segments. The majority of these fibers (90%) decussate at upper cervical levels of the spinal cord in the anterior white commissure before synapsing in lamina VII of the spinal gray. The uncrossed anterolateral corticospinal tracts (1 0%) descend ventral to the lateral corticospinal tracts to terminate in the intermediate gray and base of the posterior horns of the spinal cord. A relatively small number of corticospinal fibers synapse directly on motor neurons in the anterior horn of the spinal cord. Within the spinal cord, cervical corticospinal fibers are located medially, and sacral fibers are found laterally. The corticospinal tracts are responsible for voluntary skilled movements of the extremities . Significant corticospinal tract lesions may cause hypotonia followed by hyperactive deep tendon reflexes, extensor toe response (Babinski sign), and loss of superficial abdominal and cremasteric reflexes (Carpenter, pp. 94-97 ; Martin , pp. 144-145) .

85

85. Sirkuit Papez meliputi seluruh hal di bawah ini, KECUALI
A. Amigdala
B. Forniks
C. Batang-batang mamillaris
D. Girus singulate
E. Hippokampus

A. The limbic lobe is not a true lobe of the brain but rather a functional collection of structures that regulates CHAPTER 2 Neuroanatomy Answers 4 7 higher activities such as memory and emotion. I t does not include the amygdala. Papez's circuit runs from the hippocampus to the fornix to the mammillary body. Fibers are then relayed to the anterior nucleus of the thalamus. (through the mammillothalamic tract) to the cingulate gyrus and back to the hippocampus through the cingulate bundle. The term limbic system includes the limbic lobe and its associated subcortical nuclei, including the amygdala, hypothalamus, septal, and certain hypothalamic nuclei (Kandel, pp. 986-987; Carpenter, pp. 376, 384-386).

86

86. Tipe pradominan dari synapse pada retina:
A. Elektrik
B. Dependen-koneksin
C. Kimiawi
D. Dependen-kalsium
E. dependen-cAMP

C, The retina contains both electrical and chemical synapses. Photoreceptors and horizontal cells are connected to each other via gap junctions, but, as in the rest of the brain, chemical synapses predominate in the retina. Most are calcium-independent and appear to work by cGMP. (See discussion for question 27 in Chapter 1, Neurobiology Answers, for further discussion of phototransduction.) (Kandel , pp. 492-506).

87

87. Lapisan nuklir dalam dari retina mengandung sel atau sel-sel jenis yang mana?
1. Sel-sel kutub ganda (bipolar)
2. Sel-sel horisontal
3. Sel-sel Amakrin
4. Sel-sel Ganglion

A. The innermost retinal cell layer (ganglion cell layer) is named after the retinal output cells. The axons of ganglion cells are unmyelinated, whict1 facilitates light transmission to the photoreceptor layer of the outer retina. The layers superficial to the ganglion cell layer include the inner synaptic (plexiform) layer, inner nuclear layer, outer synaptic (plexiform) layer, and outer nuclear layer. The outer nuclear layer contains the cell bodies of the rods (night vision) and cones (daylight vision). The inner nuclear layer contains the cell bodies of the retinal interneurons, which include the bipolar cells., horizontal cells, and amacrine cells. Bipolar cells link photoreceptors directly with the ganglion cells, while the _actions of horizontal and amacrine cells enhance visual contrast through interactions between laterally located photoreceptor cells and bipolar cells. Horizontal cells are located. on the outer part of the inner nuclear layer, while amacrine cells are located on the inner portion. Amacrine cells contain dopamine. Muller cells are the principal retinal neuroglial cells ( Marti n , p p . 164-171; Kandel, p. 515).

88

88. Area 5

(M) (Fix, p. 208; Carpenter, p. 262).

89

89. Kolikulus atas

(E) (Fix, p. 208; Carpenter, p. 262).

90

90. Lemniskus medial

(F) (Fix, p. 208; Carpenter, p. 262).

91

91. Saluran mammillotalamik; forniks

(I) (Fix, p. 208; Carpenter, p. 262).

92

92. Kolikulus bawah; lemniskus lateral

(K) (Fix, p. 208; Carpenter, p. 262).

93

93. Saluran optik

(J) (Fix, p. 208; Carpenter, p. 262).

94

94. Saluran trigeminotalamik

(L) (Fix, p. 208; Carpenter, p. 262).

95

95. Nuklei serebelar

(D)(Fix, p. 208; Carpenter, p. 262).

96

96. Semua pernyataan mengenai medulla oblongata di bawah ini adalah benar, KECUALI
A. Memanjang dari dekusasi piramidal ke sulkus spinal belakang
B. Menerima sebagian pasokan darahnya dari arteri spinal belakang
C. Menumbuhan serat-serat GVE yang bersinapsis di dalam ganglia optik
D. Menumbuhkan nukleus vestibular lateral
E. Adalah asal mula serat-serat GVE yang bersinapsis dengan nodus sinoatrial dan atrioventrikular dari jantung.

(D) Refer to Figure 2 . 96A. The medulla oblongata contains GVE fibers that originate in the inferior salivatory nucleus and gives rise to the fibers that synapse in the otic ganglia to control parotid gland secretion. It also contains the nucleus ambiguus, which gives rise to the vagal preganglionic p;uasympathetic GVE fibers that syqapse in the sinoatrial and atrioventricular nodes of the heart. The medulla extend from the pyramidal decussation to the inferior pontine sulcus and also contains the corticospinal tracts, medial lemniscus, medial longitudinal fasciculus, hypoglossal nuclei. oli\•ary nuclei, spinal lemniscus, spinocerebellar tracts, spinal trigeminal tract and nucleus, inferior cerebellar peduncle, dorsal motor nucleus of CN X, solitary tract, CN nuclei of IX to XI" (although it also houses portions of CN V and CN VIII ) , as well as the inferior and medial vestibular nuclei. The lateral vestibular nuclei are mainly in the pons. The medulla receives its blood supply from the posterior spinal artery, anterior spinal artery, PICA, and branches originating from the vertebral arteries (Carpenter, pp. 1 15-150) .

97

97. Seorang laki-laki berumur 54 tahun dibawa dalam keadaan menderita ptosis, milosis dan hemianhidrosis pada sisi kiri, kehilangan sensasi getar pada kaki kanan, kehilangan rasa nyeri dan peraba suhu pada wajah, tangkai dan tremor intensif pada sisi kiri. Luka yang menyebabkan konstelasi masalah ini paling mungkin berada pada lokasi mana?
A. Tegmentum midbrain kaudal, sisi kiri
B. Medulla rostral, zona medial, sisi kanan
C. Zona lateral medulla kaudal, sisi kiri
D. Ismus pontin. daerah lateral dorsal, sisi kiri
E. Anggota bagian belakang dari kapsul intern

D. The most likely cause of the constellation of signs/symptoms reported in this patient is a lesion in the dorsolateral zone of the pontine isthmus on the left side (lateral superior pontine syndrome). Interruption of the descending sympathetic tract resulted in the ipsilateral Horner's syndrome. I nvolvement of the lateral aspect (includes leg fibers) of the medial lemniscus resulted in loss of vibratory sensation and other dorsal column deficits on the contralateral side. Damage to the trigeminothalamic tract and spinothalamic tracts in this location would account for the contralateral hemianesthesia of the face and body. Disruption of the superior cerebellar peduncle can lead to the severe ataxia and tremor on the ipsilateral side (Carpenter, pp. 151-191; Fix, pp. 184-186). 98. A. Refer to Figure 2.

98

98. Infarct yang melibatkan bagian paramedian dari otak tengah paling mungkin akan mempengaruhi struktur yang mana?
1. Akar saraf okulomotorik (CN III)
2. Nukleus merah
3. Saluran dentatorubrothalamik
4. Lemniskus Lateral

A. Paramedian midbrain (Benedikt's) syndrome results from occlusion of the paramedian midbrain branches of the PCA and/or basilar artery. Structures affected include the CN III nerve roots (eye abduction and depression due to unopposed action of lateral rectus and superior oblique muscles) as well as the red nucleus and dentatorubrothalamic tract (intention tremor and ataxia). Medial midbrain (Weber's) syndrome results from occlusion of medial midbrain branches, which can result in CN III palsy, corticobulbar tract injury (contralateral facial weakness) , and corticospinal tract injury (contralateral hemiparesis or hemiplegia) (Fix, pp. 187-188; Carpenter, pp. 192-223) . FIGURE 2.98A Mesencephalon. This transverse section illustrates the midbrain at the level of the superior colliculus. CN, cranial nerve; MLF, medial longitudinal fasciculus. (Reprinted with permission from Moore SP. The Definitive Neurological Surgery Board Review. Malden, 1\•L

99

99. Semua struktur di bawah ini terlibat dalam sensasi rasa, KECUALI
A. Saraf kranikal VII, IX dan X
B. Nukleus solitaries
C. Nukleus parabrakial
D. Hipothalamus
E. Nucleus para bigeminal

E. The gustatory system innervates the special visceral afferent (SVA) modality of taste. Taste buds located on the tongue, epiglottis, and palate are innervated by the SVA fibers of CN VII, IX, and X. First-order neurons are pseudounipolar ganglion cells located in the geniculate ganglion of CNV II, the petrosal ganglion of IX, and the nodose ganglion of X. These fibers project centrally to the solitary nucleus, which then projects, via the central tegmental tract, to the parabrachial nucleus of the pons and VPM nucleus of the thalamus. The parabrachial nucleus then projects to the hypothalamus and amygdala, whereas the VPM projects to gustatory area 43 (parietal operculum) and parainsular cortex. Area 43 then projects via way of the en to rhinal cortex to the hippocampal formation. The parabigeminal nucleus functions with the superior colliculus in processina visual information ( Fix, pp. 254-256, Carpenter, pp. 137, 140, 143, 171, 2 7 1 , 418 ) .

100

100. Untuk fungsi motorik yang tepat, korteks motorik menerima asupan dari semua struktur di bawah ini. KECUALI
A. Korteks parietal
B. Ganglia basal
C. Nukleus dentate
D. Daerah somestetik primer (S I)
E. Nukleus Sentromedium (CM) dari thalamus

E . T h e parafascicular, centromedian, and rostral intralaminar nuclei of the thalamus lie within the internal medullary lamina and are known as the intralaminar nuclei of the thalamus. The parafascicular nucleus of the thalamus lies medial to the centromedian nucleus and ventral to the dorsomedial nuclei of the thalamus. While the projections of the parafascicular and centromedian nuclei of the thalamus CHAPTER 2 Neuroanatomy Answers 49 remain ill-defined, the majority are believed to terminate in the striatum. Cells of the centromedian nucleus project principally to the putamen, where they terminate i n a mosaic-type pattern, and cells from the parafascicular• nucleus project to the caudate nucleus. Few tracts project to both regions of the striatum. The majority of motor activities are influenced by the thalamus, cerebellum, basal ganglia, peripheral receptors, and other cortical areas. The basal ganglia and cerebellum provide priming and feedback functions for smoothly executed movements. Sensory feedback concerning position sense are provided by the dorsal columnmedial lemniscus (via the ventral posterior lateral [VPL] nucleus of the thalamus) , which is necessary to make both accurate and sequential movements. Complex voluntary motor activity is aided by the premotor region of the posterior parietal region (area 5 ) , which helps with goal-directed movements that require transformation of sensory representations of the environment into limb and hand movements, a process termed sensorimotor transformation (Carpenter, pp. 424-425; Kandel, pp. 756-7 79).

101

101. Oksida nitrik, salah satu pembawa kedua poten, tersintesis dari :
A. Lisin
B. Arginin
C. Tirosin
D. Dopamin
E. Beta lipoprotein

B. Nitric oxide is synthesized from the amino acid arginine by the enzyme nitric oxide synthase (NOS). Nitric oxide easily diffuses across the plasma membrane of target cells. Within target cell

102

102. Diantara serat-serat di bawah ini, serat-serat manakah yang melanggar hukum Bell-Magendie?
A. Serat-serat proprioseptif peripheral
B. Serat-serat C tak-termielinasi dari visera pelvik
C. Serat-serat motorik ujung bawah untuk muskulatur appendikular
D. Serat-serat eferen visceral umum untuk saluran GI proksimal
E. Bukan salah satu dari A sampai dengan D

B. The Bell-1viagendie law states that all motor fibers exit the spinal cord via the ventral roots and all sensory fibers enter the spinal cord via the dorsal roots. Unmyelinated C fibers that transmit pain and temperature information from the pelvic viscera reside in the ventral roots from L5 to S3, thus violating the Bell-Magendie law. The-cell bodies of these neurons reside in the dorsal root ganglia, like other sensory neurons (DeMyer, p. 55).

103

103. Diantara saluran-saluran menurun berikut ini, saluran-saluran manakah yangmenggunakan serotonin sebagai neurotransmitter-nya?
A. Tektospinal
B. Faskikulus longitudinal Medial (MLF)
C. Retikulospinal
D. Vestibulospinal
E. Rubrospinal

C. The reticulospinal tracts originate largely i n the brainstem reticular formation (pons and medulla) and project to all spinal• levels. The raphe nuclei of the reticular formation contain serotonergic projections that compose a portion of the reticulospinal tracts. These serotonergic projections synapse in laminae I, II, and V of the spinal cord (especially cervical levels) to influence afferent nociceptive impulses from the periphery (Carp

104

104. Apa yang menjadi target dari serat efferent substantia nigra?
A. Thalamus
B. Segmen dalam dari globus pallidus
C. Striatum
D. A & C
E. A, B & C

D. Efferent fibers from the substantia nigra proJect to the striatum (pars compac.ta efferents) and thalamus (pars reticulata efferents). Nigrothalamic fibers terminate primarily in the VA and MD thalamic nuclei. A small component of efferent fibers from the pars reticulata also project to the pedunculopontine nucleus (Carpenter, pp. 2 18-220) .

105

105. Diantara struktur-struktur di bawah ini, struktur manakah yang mengandung
proyeksi-proyeksi olfaktioris terhadap hipotalamus?
A. Stria olfaktioris lateral
B. Bundel forebrain medial
C. Thalami stria medularis
D.Pita diagonal dari Broca
E.Lemniskus lateral

B. The medial forebrain bundle sends fibers from the basal olfactory regfons, the septal nuclei, the periamygdaloid region, and the subiculum to the lateral preoptic and hypothalamic regions (Carpenter, p. 304) .

106

106. Vena labbé

(I) . (Osborn DCA, pp. 2 1 7-223)

107

107. Sinus kavernosus

(L) . (Osborn DCA, pp. 2 1 7-223)

108

108. Sinus rektus

(G) . (Osborn DCA, pp. 2 1 7-223)

109

109. Sinus sagital superior

(H) . (Osborn DCA, pp. 2 1 7-223)

110

110. vena caudate anterior

(C) . (Osborn DCA, pp. 2 1 7-223)

111

111. vena Galen

(E) . (Osborn DCA, pp. 2 1 7-223)

112

112. vena serebral interna

(D) . (Osborn DCA, pp. 2 1 7-223)

113

113. Pleksus pterigoid

(J) . (Osborn DCA, pp. 2 1 7-223)

114

114. vena talamistriata

(B) . (Osborn DCA, pp. 2 1 7-223)

115

115. vena septal anterior

(A) . (Osborn DCA, pp. 2 1 7-223)

116

116. vena terminal

(F) . (Osborn DCA, pp. 2 1 7-223)

117

117. Sinus sigmoid

(M) . (Osborn DCA, pp. 2 1 7-223)

118

118. vena superficial serebral medial

(K) . (Osborn DCA, pp. 2 1 7-223)

119

119. Di antara akar-akar dorsal di bawah ini, akar-akar manakah yang seringkali tidak ada atau hilang?
A. C1
B. C8
C. T1
D. T12
E. S2

A . The first dorsal root frequently undergoes regression and disappears. The front part of the scalp (forehead) is innervated by CN V: supraorbital and supratrochlear nerves (V1), zygomaticotemporal nerve (V2), and the auriculotemporal nerve (V3) . The occipital region is innervated by the greater occipital nerve (C2), the lesser occipital nerve (C2- 3), the least occipital nerve (C3), and the great auricular nerve (C2-3) (April , p. 427).

120

120. Perpotongan sistem saraf sentral dengan sistem saraf peripheral terjadi di lokasi mana?
A. Ganglia akar dorsal
B. Perpotongan antara akar dorsal dengan akar ventral
C. Tandyk ventral dari spinal cord dengan saraf kranial
D. Situs perlekatan akar-akar saraf masing-masing kepada spinal cord dan brainstem
E. Rami communicantes abu-abu

D. The Schwann cells and fibrous connective tissue stop abruptly at a site where the nerve roots meet the spinal cord and/or brainstem. Central to this junction, glial connective tissue is composed of oligodendrocytes, whereas in the peripheral nervous system, Schwann cells replace oligodendrocytes. This junction is called the Obersteiner-Redlich zone ( DeMyer, p. 59).

121

121. Seorang laki-laki berumur 45 tahun dibawa dalam keadaan nyeri dan mati rasa pada digit kelima dari tangan kanannya Gejala-gejala ini bisa terjadi sebagai gejala sekunder dari luka pada lokasi? (A)
1. Urat medial dari pleksus brakial
2. Saraf ulnar
3. akar saraf C8
4. akar saraf C7

A. The nerve that innervates the fifth digit, C8, travels through the medial cord of the brachial plexus and down the arm in the ulnar nerve. Therefore, a lesion anywhere along this course may produce pain and numbness in the little fingeL The precise localization in this patient would likely require the presence of other concomitant neurologic abnormalities and obtaining nerve conduction or perhaps neuroimaging studies. C 7 nerve root abnormalities often cause problem.s with the third and fourth digits ( B razis, pp. 16-21, 59:60, 72).

122

122. Pendekatan apa yang paling memungkinkan untuk digunakan dalam rangka memperoleh paparan bedah ini?
A. Trans-sylvian pterional
B. Subtemporal
C. Subokipital garis tengah
D.Fossa infratemporal
E.Transpetrous prasigmoid

The majority of posterior circulation aneurysms may be adequately exposed for surgical treatment through either a modification of the transsylvian approach or the far lateral suboccipital approach, which has also been referred to as the Extreme Lateral Inferior Transcondylar Exposure (ELITE) . With extensive opening of the posterior lateral portion of the cavernous sinus through a• transsylvian approach and by working through the space lateral to the oculomotor nerve, the upper and mid-basilar trunk can be successfully exposed to the level of the anterior inferior cerebellar artery (AICA). The ELITE exposure most often provides satisfactory exposure of the vertebral arteries bilaterally and the lower basilar trunk. The portion of the basilar trunk rostral to AICA origin assumes a distinctly midline location in the- majority of circumstances; it becomes increasingly difficult to control and visualize during rostral dissection due to the prominence of the ventral pons and the envelopment of the basilar artery by the brainstem as it enters the interpeduncular cistern. In select cases (giant aneurysms, cavernomas, or tumors of the dorsolateral pons) , • additional exposure may be obtained by a presigmoid corridor by removal of a portion of the petrous temporal bone, which may lessen the amount of brainstem or cerebellar retraction, as depicted here. The trochlear nerve (IV) is particularly vulnerable to injury while dividing the tentorium, and the superior petrosal sinus is often cauterized and divided during this exposure in order to mobilize the transverse and sigmoid sinuses (and quadrangular lobe of the cerebellum) as a single unit ( Kopitn i k, pp. 24-2 7)

123

123. Saraf kranial apakah yang sangat rentan terhadap cedera selama paparan awalnya?
A. IV B. V
C. VI D. VII
E. X

The majority of posterior circulation aneurysms may be adequately exposed for surgical treatment through either a modification of the transsylvian approach or the far lateral suboccipital approach, which has also been referred to as the Extreme Lateral Inferior Transcondylar Exposure (ELITE) . With extensive opening of the posterior lateral portion of the cavernous sinus through a• transsylvian approach and by working through the space lateral to the oculomotor nerve, the upper and mid-basilar trunk can be successfully exposed to the level of the anterior inferior cerebellar artery (AICA). The ELITE exposure most often provides satisfactory exposure of the vertebral arteries bilaterally and the lower basilar trunk. The portion of the basilar trunk rostral to AICA origin assumes a distinctly midline location in the- majority of circumstances; it becomes increasingly difficult to control and visualize during rostral dissection due to the prominence of the ventral pons and the envelopment of the basilar artery by the brainstem as it enters the interpeduncular cistern. In select cases (giant aneurysms, cavernomas, or tumors of the dorsolateral pons) , • additional exposure may be obtained by a presigmoid corridor by removal of a portion of the petrous temporal bone, which may lessen the amount of brainstem or cerebellar retraction, as depicted here. The trochlear nerve (IV) is particularly vulnerable to injury while dividing the tentorium, and the superior petrosal sinus is often cauterized and divided during this exposure in order to mobilize the transverse and sigmoid sinuses (and quadrangular lobe of the cerebellum) as a single unit ( Kopitn i k, pp. 24-2 7)

124

124. Struktur vaskular manakah yang paling sering dikauterisasi dan dibagi untuk meningkatkan paparan selama pendekatan ini?
A. Sinus petrosal bawah
B. Sinus sigmoid
C. Sinus oksipital
D.Sinus petrosal superior
E.Tabir serebelar prasentral

The majority of posterior circulation aneurysms may be adequately exposed for surgical treatment through either a modification of the transsylvian approach or the far lateral suboccipital approach, which has also been referred to as the Extreme Lateral Inferior Transcondylar Exposure (ELITE) . With extensive opening of the posterior lateral portion of the cavernous sinus through a• transsylvian approach and by working through the space lateral to the oculomotor nerve, the upper and mid-basilar trunk can be successfully exposed to the level of the anterior inferior cerebellar artery (AICA). The ELITE exposure most often provides satisfactory exposure of the vertebral arteries bilaterally and the lower basilar trunk. The portion of the basilar trunk rostral to AICA origin assumes a distinctly midline location in the- majority of circumstances; it becomes increasingly difficult to control and visualize during rostral dissection due to the prominence of the ventral pons and the envelopment of the basilar artery by the brainstem as it enters the interpeduncular cistern. In select cases (giant aneurysms, cavernomas, or tumors of the dorsolateral pons) , • additional exposure may be obtained by a presigmoid corridor by removal of a portion of the petrous temporal bone, which may lessen the amount of brainstem or cerebellar retraction, as depicted here. The trochlear nerve (IV) is particularly vulnerable to injury while dividing the tentorium, and the superior petrosal sinus is often cauterized and divided during this exposure in order to mobilize the transverse and sigmoid sinuses (and quadrangular lobe of the cerebellum) as a single unit ( Kopitn i k, pp. 24-2 7)

125

125. Pubertas prekokius
A. Hipotalamus belakang
B. Hipotalamus depan
C. Hipotalamus lateral
D. Bukan salah satu dari A, B atau C

(A) Bilateral lesions of the lateral hypothalamus abolishes the desire to eat, while lesions in the posterior hypothalamus can result in precocious puberty and excessive sleepiness, lethargy, and hypothermia. Lesions of the anterior hypothalamus can result in hyperthermia, while lesions in the arcuate nuclei and paraventricular region can result in decreased dopamine synthesis (Carpenter, pp. 125-129).

126

126. Lapar
A. Hipotalamus belakang
B. Hipotalamus depan
C. Hipotalamus lateral
D. Bukan salah satu dari A, B atau C

(C) Bilateral lesions of the lateral hypothalamus abolishes the desire to eat, while lesions in the posterior hypothalamus can result in precocious puberty and excessive sleepiness, lethargy, and hypothermia. Lesions of the anterior hypothalamus can result in hyperthermia, while lesions in the arcuate nuclei and paraventricular region can result in decreased dopamine synthesis (Carpenter, pp. 125-129).

127

127. Hipertermia
A. Hipotalamus belakang
B. Hipotalamus depan
C. Hipotalamus lateral
D. Bukan salah satu dari A, B atau C

(B) Bilateral lesions of the lateral hypothalamus abolishes the desire to eat, while lesions in the posterior hypothalamus can result in precocious puberty and excessive sleepiness, lethargy, and hypothermia. Lesions of the anterior hypothalamus can result in hyperthermia, while lesions in the arcuate nuclei and paraventricular region can result in decreased dopamine synthesis (Carpenter, pp. 125-129).

128

128. Letargi emosi, mengantuk yang amat sangat, hipotermia
A. Hipotalamus belakang
B. Hipotalamus depan
C. Hipotalamus lateral
D. Bukan salah satu dari A, B atau C

(A) Bilateral lesions of the lateral hypothalamus abolishes the desire to eat, while lesions in the posterior hypothalamus can result in precocious puberty and excessive sleepiness, lethargy, and hypothermia. Lesions of the anterior hypothalamus can result in hyperthermia, while lesions in the arcuate nuclei and paraventricular region can result in decreased dopamine synthesis (Carpenter, pp. 125-129).

129

129. Penurunan sintesis dopamin
A. Hipotalamus belakang
B. Hipotalamus depan
C. Hipotalamus lateral
D. Bukan salah satu dari A, B atau C

(D) Bilateral lesions of the lateral hypothalamus abolishes the desire to eat, while lesions in the posterior hypothalamus can result in precocious puberty and excessive sleepiness, lethargy, and hypothermia. Lesions of the anterior hypothalamus can result in hyperthermia, while lesions in the arcuate nuclei and paraventricular region can result in decreased dopamine synthesis (Carpenter, pp. 125-129).

130

130. Lobule parietal bawah terdiri dari giri yang mana?
1. Lingual
2. Angular
3. girus okipital lateral
4. Supramarginal

C. The inferior parietal lobule is composed of two gyri: the angular and supramarginal. The inferior parietal lobule represents a cortical association area, where multisensory signals from adjacent parietal, temporal, and occipital regions converge. The interparietal sulcus divides the parietal lobe into the superior and inferior parietal lobules (Carpenter, p. 2 7 ) .

131

131. Kontraksi-kontraksi dari otot-otot stapedius dan timpani tensor dipicu oleh asupan-asupan struktur yang mana?
A. Kolikulus bawah
B. Girus temporal atas (Girus Heschl)
C. Nukleus olivaris atas
D. sel-sel rambut dalam dari koklea
E. nukleus koklear

C . Acoustic reflex mechanisms involve t h e middle ear muscles, such as the stapedius and tensor tympani. The stapedius muscle (CN VII) serves to dampen the oscillations of the middle ear ossicles in response to loud sounds, while contraction of the tensor tympani muscle (CN V) diminishes the sensitivity of sound by tensing the tympanic membrane. These acoustic reflex mechanisms are initiated by fibers originating in the superior olivary nucleus (Carpenter, p. 159).

132

132. Serat-serat akar yang memasuki saluran trigeminal spinal memiliki susunan topografis yang pasti. Semua pernyataan di bawah ini adalah benar, KECUALI
A. Serat-serat divisi optalmik adalah ventral
B. Serat-serat divisi mandibular adalah dorsal
C. Serat-serat divisi maksilaris terletak pada lokasi di tengah-tengah serat mandibular dengan serat optalmik
D. Saluran ini membentang dari zona masuk akar trigeminal ke segmen-segmen spinal servikal tang teratas
E. Saluran ini secara rostral melebar menjadi nukleus soliteris.

E. The spinal trigeminal tract merges with the principal sensory nucleus rostrally (not the solitary nucleus), while caudally it blends into the substantia gelatinosa of the first two cervical spinal segments. Fibers of the ophthalmic division are most ventral, fibers of the mandibular division are most dorsal, and fibers from the maxillary division are intermediate (Carpenter, p. 1 7 7 ) .

133

133. Manakah diantara hal-hak di bawah ini yang disekresi oleh kelenjar pineal?
1. Serotinin
2. Melatonin
3. Norepineprin
4. Senyawa P

. A . The best-known pineal secretions are the biogenic amines (serotonin, melatonin, and norepinephrine), but the gland also contains significant concentrations of hypothalamic peptides, such as thyrotropin-releasing hormone, leuteinizing hormone-releasing hormone, and somatostatin. Substance P is not known to be present in high concentrations in the pineal gland (Carpenter, pp. 253-254).

134

134. Di antara lokasi-lokasi CNS di bawah ini, lokasi manakah yang mengandung melanosit?
1. Medulla ventral
2. Velum medularis bawah
3. Spinal cord atas
4. Nukleus habenular

B. Melanocytes are located in the leptomeninges are most often located in the ventral medulla and upper levels of the cervical spinal cord (Ellison, pp. 734-737).

135

135. Diantara struktur-struktur di bawah ini, struktur manakah yang terbentuk secara langsung dari notokord embriologis
A. Pulposus nukleus dari piringan intervertebral
B. Batang vertebral
C. saluran spinal
D. Pleksus koroid
E. Ganglia akar dorsal

A. The intervertebral disc is a fibrocartilaginous remnant of the embryologic notochord (Youmans, p. 4327 ) .

136

136. Pasokan darah ke anggota bagian depan dari kapsul dalam berasal dari
A. Arteri koroidal depan
B. Arteri inferolateral
C. Arteri Heubner rekuren
D. Arteri tuberoinfundibular
E. Arteri Pervheron yang mengkomunikasikan basilar

A. The internal capsule is supplied primarily by the lateral lenticulostriate branches from the middle cerebral artery. Additionally, the medial striate artery (of Heubner) supplies the rostromedial parts of the anterior limb of the internal capsule, the genu receives direct branches from the internal carotid artery, while parts of the posterior limb and the entire retrolenticular capsule are supplied by the anterior choroidal artery (Carpenter, p. 448 ) .

137

137. Pasokan darah ke anggota bagian belakang dari kapsul dalam berasal dari
A. Arteri koroidal anterior
B. Arteri inferolateral
C. Arteri Heubner rekuren
D. Arteri tuberoinfundibular
E. Arteri Pervheron yang mengkomunikasikan basilar

A. The internal capsule is supplied primarily by the lateral lenticulostriate branches from the middle cerebral artery. Additionally, the medial striate artery (of Heubner) supplies the rostromedial parts of the anterior limb of the internal capsule, the genu receives direct branches from the internal carotid artery, while parts of the posterior limb and the entire retrolenticular capsule are supplied by the anterior choroidal artery (Carpenter, p. 448 ) .

138

138. Aferen-aferen gustatoris dari CN VII berakhir pada nukleus yang mana?
A. Nukleus salivatorius
B. Nukleus sendoris Mesensepalik
C. Nukleus Solitarius
D. Nukleus dari Roller
E. Nukleus fasial Pontine

C . Taste sensation is carried by t h e facial (VII), glossopharyngeal (IX), and vagus nerves (X) . The gustatory afferents end primarily in the nucleus of the tractus solitarius in the medulla (Brazis, p. 273).

139

139. Semua hal di bawah ini mengandung serat-serat parasimpatetik, KECUALI
A. CN VII
B. CN IX
C. CN X
D. CN XI
E. CN III

D . The spinal accessory nerve (XI) does not carry parasympathetic fibers but instead carries branchial motor fibers to the sternocleidomastoid and trapezius muscles (Wilson-Pauwels, p. 205) .

140

140. Pollicis brevis abductor
A. Terutama C5
B. Saraf thorakdorsal
C. Saraf Aksilaris
D. Saraf interoseus depan
E. Saraf ulnar
F. Saraf median
G. Saraf Radial
H. Saraf Supraskapular
I. Saraf Muskulokutanus

(F) (Greenberg, pp. 520-521).

141

141. Infraspinatus
A. Terutama C5
B. Saraf thorakdorsal
C. Saraf Aksilaris
D. Saraf interoseus depan
E. Saraf ulnar
F. Saraf median
G. Saraf Radial
H. Saraf Supraskapular
I. Saraf Muskulokutanus

(H) (Greenberg, pp. 520-521).

142

142. Deltois
A. Terutama C5
B. Saraf thorakdorsal
C. Saraf Aksilaris
D. Saraf interoseus depan
E. Saraf ulnar
F. Saraf median
G. Saraf Radial
H. Saraf Supraskapular
I. Saraf Muskulokutanus

(C) (Greenberg, pp. 520-521).

143

142. Deltois
A. Terutama C5
B. Saraf thorakdorsal
C. Saraf Aksilaris
D. Saraf interoseus depan
E. Saraf ulnar
F. Saraf median
G. Saraf Radial
H. Saraf Supraskapular
I. Saraf Muskulokutanus

(G) (Greenberg, pp. 520-521).

144

144. Bisep
A. Terutama C5
B. Saraf thorakdorsal
C. Saraf Aksilaris
D. Saraf interoseus depan
E. Saraf ulnar
F. Saraf median
G. Saraf Radial
H. Saraf Supraskapular
I. Saraf Muskulokutanus

(I) (Greenberg, pp. 520-521).

145

145. Pollicis abductor
A. Terutama C5
B. Saraf thorakdorsal
C. Saraf Aksilaris
D. Saraf interoseus depan
E. Saraf ulnar
F. Saraf median
G. Saraf Radial
H. Saraf Supraskapular
I. Saraf Muskulokutanus

(E) (Greenberg, pp. 520-521).

146

146. Kuadratus pronator
A. Terutama C5
B. Saraf thorakdorsal
C. Saraf Aksilaris
D. Saraf interoseus depan
E. Saraf ulnar
F. Saraf median
G. Saraf Radial
H. Saraf Supraskapular
I. Saraf Muskulokutanus

(D) (Greenberg, pp. 520-521).

147

147. Romboid
A. Terutama C5
B. Saraf thorakdorsal
C. Saraf Aksilaris
D. Saraf interoseus depan
E. Saraf ulnar
F. Saraf median
G. Saraf Radial
H. Saraf Supraskapular
I. Saraf Muskulokutanus

(A) (Greenberg, pp. 520-521).

148

148. Latissimus dorsi
A. Terutama C5
B. Saraf thorakdorsal
C. Saraf Aksilaris
D. Saraf interoseus depan
E. Saraf ulnar
F. Saraf median
G. Saraf Radial
H. Saraf Supraskapular
I. Saraf Muskulokutanus

(B) (Greenberg, pp. 520-521).

149

149. Mutisme, gangguan berjalan kaki, dan inkontinensi
A. Sindroma orbitofrontal (kutub frontal)
B. Sindroma Konveksitas Frontal
C. Sindroma frontal medial
D. Bukan salah satu dari A, B atau C

(C) The orbitofrontal cortex is linked to the limbic and reticular areas; therefore lesions of this area can lead to behavioral abnormalities. Il•1ost commonly, orbitofrontal (frontal pole) lesions can result in euphoria, emotional lability, poor judgment and insight, explosiveness, and distractibility. The lateral frontal cortex is linked to motor structures, therefore damage to this area can lead to disturbances of action with apathy, indifference, psychomotor retardation, motor preservation and impersistence, and poor abstraction. The medial frontal syndrome is associated with mutism, gait disturbances, incontinence, "salutatory seizures," "alien hand syndrome," and apraxia of gait or "magnetic gait" (paracentral lobule) . Exploring objects orally i s a feature o f temporal lobe dysfunction (Brazis, pp. 4 73-4 7 4, 509, 522-524) .

150

150. Tidak pedulian, apatis, preservasi motorik, dan tidak ulet
A. Sindroma orbitofrontal (kutub frontal)
B. Sindroma Konveksitas Frontal
C. Sindroma frontal medial
D. Bukan salah satu dari A, B atau C

(B) The orbitofrontal cortex is linked to the limbic and reticular areas; therefore lesions of this area can lead to behavioral abnormalities. Il•1ost commonly, orbitofrontal (frontal pole) lesions can result in euphoria, emotional lability, poor judgment and insight, explosiveness, and distractibility. The lateral frontal cortex is linked to motor structures, therefore damage to this area can lead to disturbances of action with apathy, indifference, psychomotor retardation, motor preservation and impersistence, and poor abstraction. The medial frontal syndrome is associated with mutism, gait disturbances, incontinence, "salutatory seizures," "alien hand syndrome," and apraxia of gait or "magnetic gait" (paracentral lobule) . Exploring objects orally i s a feature o f temporal lobe dysfunction (Brazis, pp. 4 73-4 7 4, 509, 522-524) .

151

151. Impulsif, euphoria, judgement yang buruk
A. Sindroma orbitofrontal (kutub frontal)
B. Sindroma Konveksitas Frontal
C. Sindroma frontal medial
D. Bukan salah satu dari A, B atau C

(A) The orbitofrontal cortex is linked to the limbic and reticular areas; therefore lesions of this area can lead to behavioral abnormalities. Il•1ost commonly, orbitofrontal (frontal pole) lesions can result in euphoria, emotional lability, poor judgment and insight, explosiveness, and distractibility. The lateral frontal cortex is linked to motor structures, therefore damage to this area can lead to disturbances of action with apathy, indifference, psychomotor retardation, motor preservation and impersistence, and poor abstraction. The medial frontal syndrome is associated with mutism, gait disturbances, incontinence, "salutatory seizures," "alien hand syndrome," and apraxia of gait or "magnetic gait" (paracentral lobule) . Exploring objects orally i s a feature o f temporal lobe dysfunction (Brazis, pp. 4 73-4 7 4, 509, 522-524) .

152

152. Cenderung menjelajah benda secara oral
A. Sindroma orbitofrontal (kutub frontal)
B. Sindroma Konveksitas Frontal
C. Sindroma frontal medial
D. Bukan salah satu dari A, B atau C

(D) The orbitofrontal cortex is linked to the limbic and reticular areas; therefore lesions of this area can lead to behavioral abnormalities. Il•1ost commonly, orbitofrontal (frontal pole) lesions can result in euphoria, emotional lability, poor judgment and insight, explosiveness, and distractibility. The lateral frontal cortex is linked to motor structures, therefore damage to this area can lead to disturbances of action with apathy, indifference, psychomotor retardation, motor preservation and impersistence, and poor abstraction. The medial frontal syndrome is associated with mutism, gait disturbances, incontinence, "salutatory seizures," "alien hand syndrome," and apraxia of gait or "magnetic gait" (paracentral lobule) . Exploring objects orally i s a feature o f temporal lobe dysfunction (Brazis, pp. 4 73-4 7 4, 509, 522-524) .

153

153. Apraksia berjalan atau “cara berjalan magnetis”
A. Sindroma orbitofrontal (kutub frontal)
B. Sindroma Konveksitas Frontal
C. Sindroma frontal medial
D. Bukan salah satu dari A, B atau C

(C) The orbitofrontal cortex is linked to the limbic and reticular areas; therefore lesions of this area can lead to behavioral abnormalities. Il•1ost commonly, orbitofrontal (frontal pole) lesions can result in euphoria, emotional lability, poor judgment and insight, explosiveness, and distractibility. The lateral frontal cortex is linked to motor structures, therefore damage to this area can lead to disturbances of action with apathy, indifference, psychomotor retardation, motor preservation and impersistence, and poor abstraction. The medial frontal syndrome is associated with mutism, gait disturbances, incontinence, "salutatory seizures," "alien hand syndrome," and apraxia of gait or "magnetic gait" (paracentral lobule) . Exploring objects orally i s a feature o f temporal lobe dysfunction (Brazis, pp. 4 73-4 7 4, 509, 522-524) .

154

154. “Kejang salutatoris”
A. Sindroma orbitofrontal (kutub frontal)
B. Sindroma Konveksitas Frontal
C. Sindroma frontal medial
D. Bukan salah satu dari A, B atau C

(C) The orbitofrontal cortex is linked to the limbic and reticular areas; therefore lesions of this area can lead to behavioral abnormalities. Il•1ost commonly, orbitofrontal (frontal pole) lesions can result in euphoria, emotional lability, poor judgment and insight, explosiveness, and distractibility. The lateral frontal cortex is linked to motor structures, therefore damage to this area can lead to disturbances of action with apathy, indifference, psychomotor retardation, motor preservation and impersistence, and poor abstraction. The medial frontal syndrome is associated with mutism, gait disturbances, incontinence, "salutatory seizures," "alien hand syndrome," and apraxia of gait or "magnetic gait" (paracentral lobule) . Exploring objects orally i s a feature o f temporal lobe dysfunction (Brazis, pp. 4 73-4 7 4, 509, 522-524) .

155

155. Arteri-arteri vertebral berjalan pada foramina transverse dari
A. C6 menuju C2 D. C7 menuju C2
B. C4 menuju C2 E. C8 menuju C1
C. C7 menuju C1

A. The vertebral artery usually travels through the transverse foramina of C6 through C2 prior to exiting the transverse foramen of the axis and curving posteriorly and superiorly in a groove on the upper surface of the atlas (Greenberg, p. 107).

156

156. Suatu cacad pupilaris afferent relatif TIDAK tampak dengan luka yang melibatkan
A. Retina
B. Batang genikulat lateral
C. Nukleus pratektak
D. Saraf optik
E. Kiasme optik

B. An afferent pupillary defect (Marcus Gunn pupil) can be diagnosed by the "swinging flashlight test." This pupillary sign is characterized by normal bilateral pupillary responses when the normal eye is illuminated, CHAPTER 2 Neuroanatomy Answers 51 but pupillary dilation occurs when the flashlight is quickly switched to the affected eye. This abnormality may be seen with lesions involving the macula, retina, optic nerve, optic tract, brachium of the superior colliculus, or pretectal nucleus ( Kline, pp. 1 2 7-128, Brazis, pp. 144-145).

157

157. Jika mata kiri menunjukkan suatu cacad pupilaris afferent relatif, pupil kanan akan
A. Serta merta mengecil ketika cahaya diayun ke sebelah kiri
B. Serta merta membesar ketika cahaya diayun ke sebelah kanan
C. Membesar ketika cahaya diayun dari mata kanan ke kiri
D. Tetap tidak berubah ketika cahaya diayun ke kiri
E. Tetap membesar seterusnya

C. An afferent pupillary defect (Marcus Gunn pupil) can be diagnosed by the "swinging flashlight test." This pupillary sign is characterized by normal bilateral pupillary responses when the normal eye is illuminated, CHAPTER 2 Neuroanatomy Answers 51 but pupillary dilation occurs when the flashlight is quickly switched to the affected eye. This abnormality may be seen with lesions involving the macula, retina, optic nerve, optic tract, brachium of the superior colliculus, or pretectal nucleus ( Kline, pp. 1 2 7-128, Brazis, pp. 144-145).

158

158. Diantara otot-otot mata di bawah ini, otot mata manakah yang menerima Inervasi nuklir kontralateral?
1. Oblik bawah
2. Rektus atas
3. Rektus bawah
4. Oblik atas

C. The superior rectus (medial subnucleus of the oculomotor nucleus, CN III) and superior oblique (trochlear nucleus, CN IV) muscles receive contralateral nuclear innervation (Wilson-Pauwels, pp. 53, 70).

159

159. “Periodic alternating gaze” biasanya tampak dengan
A. Foci kejang frontal
B. lesi fossa posterior
C. Kejang otot persisten pada wajah dan Rahang
D. Luka formasi retikular pontin paramedian bilateral
E. Luka faskikulus longitudinal medial bilateral (MLF)

B . "Periodic alternating gaze" (PAG) consists of cyclic conjugate lateral deviation of the eyes with compensatory head turning towards the opposite side (1 to 2 minutes), a midline changeover period ( 1 0 to 15 seconds), which is followed by conjugate deviation of the eyes toward the other side (with compensatory head turning). It is most common with diseases of the posterior fossa (pontine damage, posterior fossa ischemia, medulloblastoma, and Chiari malformations) (Brazis, pp. 212-2 13)

160

160. Refleks mengendus
A. CV V1
B. CN V2
C. CN V3
D. CN IX
E. CN X
F. Bukan, A-E

(B) The trigeminal nerve afferents mediate the tearing and corneal reflex (V1), sneeze reflex (V2) , and jaw-jerk reflex (V3) . The vagus nerve (X) mediates the afferent limb of the cough reflex, while the glossopharyngeal nerve (IX) mediates the afferent limb of the carotid sinus and gag reflexes. The optic nerve innervates the afferent limb of the pupillary reflex via the Edinger-Westphal nucleus (DeMyer, pp. 1 7 1 , 176-1 7 7 ) .

161

161. Refleks batuk
A. CV V1
B. CN V2
C. CN V3
D. CN IX
E. CN X
F. Bukan, A-E

(E) The trigeminal nerve afferents mediate the tearing and corneal reflex (V1), sneeze reflex (V2) , and jaw-jerk reflex (V3) . The vagus nerve (X) mediates the afferent limb of the cough reflex, while the glossopharyngeal nerve (IX) mediates the afferent limb of the carotid sinus and gag reflexes. The optic nerve innervates the afferent limb of the pupillary reflex via the Edinger-Westphal nucleus (DeMyer, pp. 1 7 1 , 176-1 7 7 ) .

162

162. Refleks tersedak
A. CV V1
B. CN V2
C. CN V3
D. CN IX
E. CN X
F. Bukan, A-E

(D) The trigeminal nerve afferents mediate the tearing and corneal reflex (V1), sneeze reflex (V2) , and jaw-jerk reflex (V3) . The vagus nerve (X) mediates the afferent limb of the cough reflex, while the glossopharyngeal nerve (IX) mediates the afferent limb of the carotid sinus and gag reflexes. The optic nerve innervates the afferent limb of the pupillary reflex via the Edinger-Westphal nucleus (DeMyer, pp. 1 7 1 , 176-1 7 7 ) .

163

163. Sinus karotid
A. CV V1
B. CN V2
C. CN V3
D. CN IX
E. CN X
F. Bukan, A-E

(D) The trigeminal nerve afferents mediate the tearing and corneal reflex (V1), sneeze reflex (V2) , and jaw-jerk reflex (V3) . The vagus nerve (X) mediates the afferent limb of the cough reflex, while the glossopharyngeal nerve (IX) mediates the afferent limb of the carotid sinus and gag reflexes. The optic nerve innervates the afferent limb of the pupillary reflex via the Edinger-Westphal nucleus (DeMyer, pp. 1 7 1 , 176-1 7 7 ) .

164

164. Refleks kedip kornea
A. CV V1
B. CN V2
C. CN V3
D. CN IX
E. CN X
F. Bukan, A-E

(A) The trigeminal nerve afferents mediate the tearing and corneal reflex (V1), sneeze reflex (V2) , and jaw-jerk reflex (V3) . The vagus nerve (X) mediates the afferent limb of the cough reflex, while the glossopharyngeal nerve (IX) mediates the afferent limb of the carotid sinus and gag reflexes. The optic nerve innervates the afferent limb of the pupillary reflex via the Edinger-Westphal nucleus (DeMyer, pp. 1 7 1 , 176-1 7 7 ) .

165

165. Refleks gemeretuk rahang
A. CV V1
B. CN V2
C. CN V3
D. CN IX
E. CN X
F. Bukan, A-E

(C) The trigeminal nerve afferents mediate the tearing and corneal reflex (V1), sneeze reflex (V2) , and jaw-jerk reflex (V3) . The vagus nerve (X) mediates the afferent limb of the cough reflex, while the glossopharyngeal nerve (IX) mediates the afferent limb of the carotid sinus and gag reflexes. The optic nerve innervates the afferent limb of the pupillary reflex via the Edinger-Westphal nucleus (DeMyer, pp. 1 7 1 , 176-1 7 7 ) .

166

166. Refleks menyobek
A. CV V1
B. CN V2
C. CN V3
D. CN IX
E. CN X
F. Bukan, A-E

(A) The trigeminal nerve afferents mediate the tearing and corneal reflex (V1), sneeze reflex (V2) , and jaw-jerk reflex (V3) . The vagus nerve (X) mediates the afferent limb of the cough reflex, while the glossopharyngeal nerve (IX) mediates the afferent limb of the carotid sinus and gag reflexes. The optic nerve innervates the afferent limb of the pupillary reflex via the Edinger-Westphal nucleus (DeMyer, pp. 1 7 1 , 176-1 7 7 ) .

167

167. Reflek cahaya pupilaris
A. CV V1
B. CN V2
C. CN V3
D. CN IX
E. CN X
F. Bukan, A-E

(F) The trigeminal nerve afferents mediate the tearing and corneal reflex (V1), sneeze reflex (V2) , and jaw-jerk reflex (V3) . The vagus nerve (X) mediates the afferent limb of the cough reflex, while the glossopharyngeal nerve (IX) mediates the afferent limb of the carotid sinus and gag reflexes. The optic nerve innervates the afferent limb of the pupillary reflex via the Edinger-Westphal nucleus (DeMyer, pp. 1 7 1 , 176-1 7 7 ) .

168

168. Refleks optikokinetik
A. CV V1
B. CN V2
C. CN V3
D. CN IX
E. CN X
F. Bukan, A-E

(F) The trigeminal nerve afferents mediate the tearing and corneal reflex (V1), sneeze reflex (V2) , and jaw-jerk reflex (V3) . The vagus nerve (X) mediates the afferent limb of the cough reflex, while the glossopharyngeal nerve (IX) mediates the afferent limb of the carotid sinus and gag reflexes. The optic nerve innervates the afferent limb of the pupillary reflex via the Edinger-Westphal nucleus (DeMyer, pp. 1 7 1 , 176-1 7 7 ) .

169

169. Dari neuron-neuron di bawah ini, neuron manakah yang sifatnya kolinergik
A. Neuron-neuron Purkinje dari serebelum
B. Substantia unniminata
C. Interneuron dari substantia ngira
D. Neuron-neuron pada lapisan ganglionik dari retina
E. Interneuron dari lempeng kolikuler.

D. The ganglionic cells o f the retina are considered to be cholinergic, while some of the neurons of the striatum, dorsal horn, cerebellum, collicular plate, substantia nigra, hypothalamus, pallidum, and anterior perforated substance (substantia innominata) are considered to be GABAergic (DeMyer, pp. 384-385).

170

170. Sebuah luka pada lokasi manakah yang dapat menyebabkan ketulian bilateral parsial
A. Nukleus koklear ventral
B. Nukleus koklear dorsal
C. Sel-sel rambut dalam dari retina
D. Lemniskus lateral
E. Saraf Koklear

D. Since the secondary cochlear pathways are both crossed and uncrossed, lesions of one lateral lemniscus can result in partial bilateral deafness. I njury to the inner hair cells of the cochlea, cochlear nerve, or ventral and dorsal cochlear nuclei produces unilateral hearing loss (Brazis, pp. 293-295)

171

171. Interneuron Golgi Tipe II
A. Norepieprin
B. Serotinin
C. Dopamin
D. Asetilkolin
E. Glisin
F. GABA
G. Bukan, A-F.

(F) Majo'r sites of origin of the various neurotransmitters are as follows: acetylcholinegigantocellular complex of the basal forebrain including the basal nucleus (of Meynert) ; GABA-golgi type II interneurons as well as various areas of the hypothalamus, substantia nigra, cerebellum, dorsal horns, collicular plate, and substantia innominata; dopamine-ventral tegmental region/ substantia nigra of • midbrain, serotonin-raphe nuclei of midbrain; norepinephrine-locus ceruleus (DeMyer, p. 385; Carpenter, pp. 128, 131) .

172

172. Nukleus raphe dorsal
A. Norepieprin
B. Serotinin
C. Dopamin
D. Asetilkolin
E. Glisin
F. GABA
G. Bukan, A-F.

(B) Majo'r sites of origin of the various neurotransmitters are as follows: acetylcholinegigantocellular complex of the basal forebrain including the basal nucleus (of Meynert) ; GABA-golgi type II interneurons as well as various areas of the hypothalamus, substantia nigra, cerebellum, dorsal horns, collicular plate, and substantia innominata; dopamine-ventral tegmental region/ substantia nigra of • midbrain, serotonin-raphe nuclei of midbrain; norepinephrine-locus ceruleus (DeMyer, p. 385; Carpenter, pp. 128, 131) .

173

173. Locus ceruleus
A. Norepieprin
B. Serotinin
C. Dopamin
D. Asetilkolin
E. Glisin
F. GABA
G. Bukan, A-F.

(A) Majo'r sites of origin of the various neurotransmitters are as follows: acetylcholinegigantocellular complex of the basal forebrain including the basal nucleus (of Meynert) ; GABA-golgi type II interneurons as well as various areas of the hypothalamus, substantia nigra, cerebellum, dorsal horns, collicular plate, and substantia innominata; dopamine-ventral tegmental region/ substantia nigra of • midbrain, serotonin-raphe nuclei of midbrain; norepinephrine-locus ceruleus (DeMyer, p. 385; Carpenter, pp. 128, 131) .

174

174. Nucleus raphe medial
A. Norepieprin
B. Serotinin
C. Dopamin
D. Asetilkolin
E. Glisin
F. GABA
G. Bukan, A-F.

(B) Majo'r sites of origin of the various neurotransmitters are as follows: acetylcholinegigantocellular complex of the basal forebrain including the basal nucleus (of Meynert) ; GABA-golgi type II interneurons as well as various areas of the hypothalamus, substantia nigra, cerebellum, dorsal horns, collicular plate, and substantia innominata; dopamine-ventral tegmental region/ substantia nigra of • midbrain, serotonin-raphe nuclei of midbrain; norepinephrine-locus ceruleus (DeMyer, p. 385; Carpenter, pp. 128, 131) .

175

175. Substantia ngira
A. Norepieprin
B. Serotinin
C. Dopamin
D. Asetilkolin
E. Glisin
F. GABA
G. Bukan, A-F.

(C) Majo'r sites of origin of the various neurotransmitters are as follows: acetylcholinegigantocellular complex of the basal forebrain including the basal nucleus (of Meynert) ; GABA-golgi type II interneurons as well as various areas of the hypothalamus, substantia nigra, cerebellum, dorsal horns, collicular plate, and substantia innominata; dopamine-ventral tegmental region/ substantia nigra of • midbrain, serotonin-raphe nuclei of midbrain; norepinephrine-locus ceruleus (DeMyer, p. 385; Carpenter, pp. 128, 131) .