Book Review And Study Questions For Chapter 5
Questions and Answers
- 1.
A 47-year-old woman presents with signs of increased intracranial pressure (vomiting, headache, lethargy).MRI shows a large tumor invading the head of the caudate nucleus, the rostral portion of the putamen, and involving a fiber bundle located between these two structures. This fiber bundle is most likely the:
- A.
Anterior commissure
- B.
Anterior limb of the internal capsule
- C.
Column of the fornix
- D.
External capsule
- E.
Posterior limb of the internal capsule
Correct Answer
B. Anterior limb of the internal capsuleExplanation
The anterior limb of the internal capsule is insinuated between the head of the caudate nucleus and the rostral aspect of the lenticular nucleus, mostly the putamen. The posterior limb is between the lenticular nucleus and the thalamus; the column of the fornix is rostromedial to the interventricular foramen; and the anterior commissure traverses the midline at the level of the genu of the internal capsule. The external capsule is a thin sheet of white matter lateral to the lenticular nucleus and medial to the claustrum.(p.66–67,78Rate this question:
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- 2.
A 76-year-old woman is diagnosed as having “probable “Alzheimer disease based on a steady decline in cognitive function. It is likely that this woman has cell dropout in the nucleus accumbens. Which of the following most specifically describes the location of this cell group?
- A.
At the junction of the caudate head and putamen
- B.
At the junction of the pallidum and putamen
- C.
At the junction of the pallidum and substantia nigra
- D.
In the anterior wall of the temporal horn
- E.
Internal to the uncus
Correct Answer
A. At the junction of the caudate head and putamenExplanation
The nucleus accumbens is located in the rostral and basal forebrain at the point where the head of the caudate is continuous with the putamen. The amygdaloid nucleus is located internal to the uncus and in the anterior wall of the temporal horn. The pallidum (globus pallidus) and the substantia nigra do not have a continuum with the nucleus accumbens.(p.66,68,80)Rate this question:
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- 3.
Which of the following structures is located in the medial wall of the temporal horn of the lateral ventricle and, if severely damaged, or damaged bilaterally, may result in memory deficits?
- A.
Amygdaloid complex
- B.
Calcar avis
- C.
Hippocampus
- D.
Pulvinar
- E.
Tail of the caudate
Correct Answer
C. HippocampusExplanation
The hippocampal formation, commonly called the hippocampus, is located in the medial wall of the temporal(inferior) horn of the lateral ventricle. Damage to the hippocampus may result in memory problems. The amygdaloid complex is located in the rostral wall of the temporal horn, the tail of the caudate in its lateral wall, and the calcar avis (also called the calcarine spur, a ridge in the wall of the posterior horn indicating the depth of the calcarine sulcus) is in the medial wall of the posterior horn of the lateral ventricle. The pulvinar is part of the diencephalon.(p.69–72,80)Rate this question:
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- 4.
Which of the following represents the fibers that fan out from the internal capsule into the white matter of the hemisphere?
- A.
Cingulum
- B.
Corona radiate
- C.
Genu of the corpus callosum
- D.
Superior longitudinal fasciculus
- E.
Uncinate fasciculus
Correct Answer
B. Corona radiateExplanation
The corona radiata (radiating crown) are those fibers of the internal capsule that fan out in all directions from its superior edge. These fibers contain a variety of fibers traveling to and from the cerebral cortex. The superior longitudinal and uncinate fasciculi are organized bundles of corticocortical fibers on the ipsilateral side, and the cingulum is a fiber bundle located internal to the cingulate cortex. The fibers of the genu of the corpus callosum contain corticocortical fibers that pass between the cerebral hemispheres.(p.68–71,78)Rate this question:
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- 5.
The lamina of white matter located immediately internal to the cortex of the insula is the:
- A.
Arcuate fasciculus
- B.
External capsule
- C.
Extreme capsule
- D.
Internal capsule
- E.
Tapetum
Correct Answer
C. Extreme capsuleExplanation
The layer of white matter located internal to the insular cortex, and external to the claustrum, is the extreme capsule. The external capsule is found between the claustrum and the putamen, and the internal capsule is a large bundle of fibers located primarily between the lenticular nucleus on one side and the head of the caudate and the diencephalon on the other side. The tapetum is located in the lateral wall of the posterior horn of the lateral ventricle. Arcuate fasciculi are small bundles of fibers passing between gyri.(p.69–70,78–79)Rate this question:
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- 6.
A 48-year-old man presents with a movement disorder (chorea)and mental deterioration. MRI shows the loss of a prominent structure in the wall of the anterior horn of the lateral ventricle. Which of the following is most likely lost in this patient?
- A.
Anterior thalamic nucleus
- B.
Body of the caudate nucleus
- C.
Column of the fornix
- D.
Dorsomedial nucleus
- E.
Head of the caudate nucleus
Correct Answer
E. Head of the caudate nucleusExplanation
The large bulge in the lateral wall of the anterior horn of the lateral ventricle is the head of the caudate nucleus. The position of the interventricular foramen represents the point at which the head of the caudate becomes the body of the caudate. The dorsomedial nucleus borders on the third ventricle; the anterior thalamic nucleus is located at the rostral end of the diencephalon and is caudomedial to the interventricularforamen; and the column of the fornix is rostromedial to thisforamen.(p.66–69,78)Rate this question:
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- 7.
A 76-year-old man presents with a resting tremor, bradykinesia, and stooped posture. These observations suggest loss of a prominent population of cells in the brain. Which of the following structures is most likely affected in this patient?
- A.
Lateral cerebellar nucleus
- B.
Locus ceruleus
- C.
Red nucleus
- D.
Substantia nigra
- E.
Subthalamic nucleus
Correct Answer
D. Substantia nigraExplanation
These deficits are characteristic of Parkinson’s dis-ease and are directly correlated with loss of the dopamine (and melanin)-containing cells of the substantia nigra of the mid-brain. The locus (nucleus) ceruleus, also called the nucleus pigmentosus pontis, also contains cells with melanin, but loss of these cells does not cause motor deficits. The other choices do not contain pigmented cells, but damage to these structures does cause a different series of motor deficits.(p.70–71,80)Rate this question:
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- 8.
Which of the following represents the larger, more laterally located portion, of the basal nuclei (sometimes called the basal ganglia)?
- A.
Caudate nucleus
- B.
Globus pallidus
- C.
Putamen
- D.
Subthalamic nucleus
- E.
Substantia nigra
Correct Answer
C. PutamenExplanation
The putamen is the most lateral part of the basal nuclei; taken together, the putamen and globus pallidus comprise the lenticular nucleus. The caudate nucleus, specifically its head and body portions, is located medial to the internal capsule. Although the subthalamic nucleus and the substantianigra function in concert with the basal nuclei, these structures are medially located and are not part of the basal nuclei.(p.69–70,78–79)Rate this question:
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- 9.
The MRI of a 59-year-old woman shows a large arteriovenous malformation (AVM) located between the lenticular nucleus and the dorsal thalamus. Based on its location, this AVM most likely involves which of the following structures?
- A.
Anterior limb of the internal capsule
- B.
Crus cerebri
- C.
External capsule
- D.
Posterior limb of the internal capsule
- E.
Retrolenticular limb of the internal capsule
Correct Answer
D. Posterior limb of the internal capsuleExplanation
The posterior limb of the internal capsule, containing important cortical afferent and efferent fibers, is located between the lenticular nucleus and dorsal thalamus. Damage to this structure may result in sensory and/or motor deficits on the opposite side of the body. The anterior limb is located between the head of the caudate and putamen, while the retro-lenticular limb is found caudal to the lenticular nucleus. The crus cerebri is on the inferolateral aspect of the midbrain. The external capsule is lateral to the putamen.(p.67,70,79,80)Rate this question:
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- 10.
A 29-year-old man is brought to the emergency department with a severe and persistent headache. MRI shows a large tumor of the pineal gland. Based on its location, as this lesion enlarges it may impinge on which of the following structures?
- A.
Anterior thalamic nucleus
- B.
Body of the caudate nucleus
- C.
Globus pallidus
- D.
Pulvinar nucleus(i)
- E.
Ventral posteromedial nucleus
Correct Answer
D. Pulvinar nucleus(i)Explanation
The pineal gland is located in the quadrigeminal cistern, superior to the colliculi, and between the pulvinar nuclei of the thalamus. At this location, the lesion would potentially impinge the colliculi and pulvinar. The other thalamic nuclei are not adjacent to the pineal, the globus pallidus is lateral to the posterior limb of the internal capsule, and the body of the caudate is located in the lateral wall of the body of the lateral ventricle.(p.73,79)Rate this question:
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- 11.
The hippocampal commissure contains fibers from one hippocampal formation that cross the midline to distribute to tar-gets on the opposite side of the hemisphere. Which of the following structures is directly adjacent to this commissure?
- A.
Body of the corpus callosum
- B.
Genu of the corpus callosum
- C.
Splenium of the corpus callosum
- D.
Spiral fibers of the hippocampus
- E.
Precommissural fornix
Correct Answer
C. Splenium of the corpus callosumExplanation
The hippocampal commissure is located immediately inferior to the splenium of the corpus callosum; the crossing of these fibers takes place at this point. Other parts of the corpus callosum are not related to the hippocampal commissure, and the spiral fibers of the hippocampus are bundles within the
hippocampal formation in the temporal lobe. Some of the fibers in the hippocampal commissure enter the precommissural fornix, but by no means all.(p.74)Rate this question:
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- 12.
An 85-year-old woman is brought to the emergency department by her family because she suddenly became confused and lethargic. CT shows a hemorrhage into the medial and lateral geniculate bodies. Which of the following structures would also likely be involved in this vascular lesion?
- A.
Anterior thalamic nucleus
- B.
Rostral dorsomedial nucleus
- C.
Globus pallidus
- D.
Pulvinar nucleus(i)
- E.
Subthalamic nucleus
Correct Answer
D. Pulvinar nucleus(i)Explanation
The geniculate bodies are tucked-up under the caudal and inferior aspect of the pulvinar. The groove between the medial geniculate body and pulvinar contains the brachium of the superior colliculus. The geniculate bodies and the pulvinar have a common blood supply from the thalamogeniculate artery, a branch of P2 . None of the other choices have a close apposition with the geniculate bodies. The anterior thalamic, rostral dorsomedial, and subthalamic nuclei do not share a common blood supply with the pulvinar.(p.72,79)Rate this question:
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- 13.
A 29-year-old woman presents with neurological deficits that wax and wane over time suggestive of multiple sclerosis. MRI (especially T2-weighted) shows small, demyelinated areas at several locations in her brain, one of these being the mammillothalamic tract. Which of the following structures is most intimately associated with this tract?
- A.
Anterior thalamic nucleus
- B.
Centromedian nucleus
- C.
Dorsomedial nucleus
- D.
Ventral anterior thalamic nucleus
- E.
Ventral lateral thalamic nucleus
Correct Answer
A. Anterior thalamic nucleusExplanation
The mammillothalamic tract extends from the mammillary bodies to the anterior nucleus of the thalamus; the cells of origin are in the mammillary nuclei and the axons terminate in the anterior nucleus. This tract is frequently visible in axial T2-weighted MRI. The ventral anterior nucleus is laterally adjacent to the mammillothalamic tract, but does not receive input from it. The other choices are nuclei located more caudally in the diencephalon.(p.69,78–88)Rate this question:
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- 14.
Which of the following structures is a primary target of the optic tract as it passes caudally from the optic chiasm?
- A.
Lateral geniculate nucleus
- B.
Mammillary body
- C.
Medial geniculate nucleus
- D.
Pulvinar
- E.
Ventral posterolateral nucleus
Correct Answer
A. Lateral geniculate nucleusExplanation
Many of the fibers contained in the optic tract terminate in the lateral geniculate nucleus. Some of these fibers bypass this nucleus to traverse the brachium of the superior colliculus and a few enter the suprachiasmatic nucleus. The medial geniculate nucleus receives input via the brachium of the inferior colliculus (auditory); the pulvinar has interconnections with the visual cortex and superior colliculus; and the ventral posterolateral nucleus receives input from the anterolateral system and the medical lemniscus. The mammillary body is located rostral to the interpeduncular fossa and medial to the optic tract.(p.72,79,137,142)Rate this question:
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- 15.
An 82-year-old man presents with a severe motor deficit (resting tremor) and dementia. The former correlates with degenerative changes in the putamen and Globus pallidus and the latter with degenerative changes in the ventral striatum and ventral pallidum. Which of the following structures separates these two areas in the basal forebrain?
- A.
Anterior commissure
- B.
Lamina terminalis
- C.
Massa intermedia
- D.
Posterior commissure
- E.
Septum pellucidum
Correct Answer
A. Anterior commissureExplanation
The anterior commissure, as it passes laterally from the midline, separates the dorsal basal nuclei (putamen and Globus pallidus) from the ventral striatum and ventral pallidum. The posterior commissure is located at the caudal aspect of the third ventricle just above the opening of the cerebral aqueduct, and the Massa intermedia bridges the third ventricle in about 80% of individuals; in about 20% it is absent. The rostral wall of the third ventricle is formed by the lamina terminals and the septum pellucidum forms the medial wall of the anterior horn of the lateral ventricle.(p.67,79)Rate this question:
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- 16.
A 23-year-old man is brought to the emergency department by emergency medical personnel after an automobile collision. CT shows bilateral damage to the temporal pole and the uncus. Which of the following structures is also most likely damaged in this patient?
- A.
Amygdaloid complex
- B.
Anterior thalamic nucleus
- C.
Cingulum
- D.
Gracile nucleus
- E.
Hippocampal formation
Correct Answer
A. Amygdaloid complexExplanation
The amygdaloid complex is located immediately internal to the uncus. Bilateral damage to rostral portions of the temporal lobe may include the amygdala and result in a constellation of deficits known as the Klüver-Bucy syndrome. The hippocampal formation is internal to the cortex of the parahippocampal gyrus, and the anterior thalamic nucleus is internal to the anterior thalamic tubercle. The cingulate gyrusoverlies the longitudinally oriented fibers of the cingulum and the grackle tubercle is the external elevation formed by the gracile nucleus.(p.67–68,80)Rate this question:
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- 17.
The optic radiations are closely associated with which of the following spaces?
- A.
Anterior horn of the lateral ventricle
- B.
Body of the lateral ventricle
- C.
Cisterns adjacent to the midbrain
- D.
Posterior horn of the lateral ventricle
- E.
Third ventricle
Correct Answer
D. Posterior horn of the lateral ventricleExplanation
The optic radiations are located in the lateral wall of the posterior horn of the lateral ventricle as they pass through the retro lenticular limb of the internal capsule from the lateral geniculate nucleus to the primary visual cortex. A thin layer of white matter, the tapetum, separates the optic radiations from the wall of the ventricle. The cisterns at the midbrain on the basal aspect of the hemisphere contain the optic tract. The other ventricular spaces listed have no direct relationship to the optic radiations.(p.74,78–79)Rate this question:
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- 18.
A 31-year-old man presents with ill-defined neurological com-plaints (persistently tired, headache, confusion).CT shows an arteriovenous malformation occupying most of the dorsomedial nucleus (DM) of the thalamus. This lesion is located immediately medial to which of the following?
- A.
Ansa lenticularis
- B.
External medullary lamina
- C.
Internal medullary lamina
- D.
Lamina terminalis
- E.
Stria medullaris thalami
Correct Answer
C. Internal medullary laminaExplanation
The internal medullary lamina is a vertically oriented sheet of fibers that extends from the rostral portion of the thalamus caudally to surround the centromedian nucleus; this nucleus is frequently referred to as “in “the internal medullary lamina due to its position. This lamina separates the dorsomedial nucleus from the laterally adjacent ventral anterior, ventral lateral, and ventral posterolateral nuclei. The external medullary lamina is located between the thalamus and the posterior limb of the internal capsule, and the lamina terminalis is the rostral wall of the third ventricle. The stria medullaris is a small bundle of fibers passing rostrocaudally along the upper medial edge of the thalamus from the general location of the interventricular foramen to the habenula, and the ansa lenticularis contains pallidothalamic fibers.(p.69–71,78)Rate this question:
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- 19.
A 48-year-old woman presents with violent, flailing movements of her left upper extremity. CT shows a small hemorrhage in the subthalamic nucleus. Which of the following structures, due to its position, may also be affected by this lesion?
- A.
Centromedian nucleus
- B.
Globus pallidus
- C.
Medial geniculate nucleus
- D.
Putamen
- E.
Substantia nigra
Correct Answer
E. Substantia nigraExplanation
The subthalamic nucleus is separated from the substantia nigra by only a thin layer of myelinated fibers; these two structures are directly adjacent to each other. Damage to the subthalamic nucleus gives rise to hemiballistic movements(described in this question) while loss of cells in the substantianigra results in the motor deficits seen in Parkinson’s disease. The putamen, globus pallidus, and the medial geniculate nucleus are all lateral to the internal capsule; the subthalamic nucleus is medial. The centromedial nucleus is separated from the subthalamic nucleus by other thalamic nuclei.(p.70,71,80)Rate this question:
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- 20.
Which of the following structures is located immediately caudal to the anterior commissure and appears as a distinct black spot in a T2-weighted axial MRI?
- A.
Anterior limb of internal capsule
- B.
Column of the fornix
- C.
Crus of the fornix
- D.
Lenticular fasciculus
- E.
Mammillothalamic tract
Correct Answer
B. Column of the fornixExplanation
The column of the fornix is that portion of this fiber bundle that arches around the rostromedial end of the thalamus. As it does so, the column joins its counterpart on the opposite side and “leans against “the anterior commissure. The column of the fornix also signifies, in cross section or axial planes, the laterally adjacent interventricular foramen andgenu of the internal capsule. The mammillothalamic tract is located caudal to the fornix, and the crus of the fornix is found along the midline superior to the thalamus. The anterior limb of the internal capsule is found between the head of the caudate nucleus and the lenticular nucleus (mainly the putamen).The lenticular fasciculus contains pallidothalamic fibers and traverses the posterior limb of the internal capsule en route to the dorsal thalamus.(p.67–68,70,78–79)Rate this question:
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