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L. Ningal, M.A., Ph.D.

Medical Instructor, Saint Louis University School of Medicine

Synaptogenesis the developmental process by which the synapses and dendrites of the brain form. Tactile agnosia Also called astereognosis; a disorder in which there is an inability to recognize objects by touch. Tactile extinction/suppression/inattention Suppression of touch sensation on one side of body. Tardive dyskinesia A disorder with Parkinson-like symptoms, including writhing movements of the mouth, face, and tongue, often develops in schizophrenics after long-term medication use. Tegmentum "Covering"; a structure of the midbrain that surrounds the cerebral aqueduct. Telencephalon Also called the endbrain; one of the five principal divisions of the brain; consists of the two cerebral hemispheres, which are connected by a massive bundle of fibers, the corpus callosum. Temporal lobe One of the four cortical lobes, concerned with the reception and interpretation of auditory information; also plays a role in memory. Temporal lobe (psychomotor) epilepsy A form of seizure originating from the temporal lobe; emotional symptoms often present (such as changes in mood). Tensile strength the amount of physical, longitudinal stress that an axon can withstand before it ruptures. The site of interneuronal contact, where neurochemical information is transmitted from one neuron to another. Teuber, Hans-Lukas (American, 1916­1977) Credited for first using the term neuropsychology in a national 536 Glossary forum during a presentation to the American Psychological Association in 1948. Theory of mind the cognitive capacity to understand, attribute, and predict the mental state of others, and the relation of these mental states to behavior. Deficits in this capacity have been observed in autistic children and other developmental disorders. Therapeutic recreation An approach to treatment that emphasizes the importance of recreational and leisure time activities in brain injury rehabilitation, to help in the "transfer" of learning. Therapeutic recreation also allows patients to begin socializing with each other in a structured, but less formal, atmosphere than that afforded in other therapy settings. Thermoreceptors Receptors that serve as monitors to detect heat and cold throughout the body. Thrombosis A type of occlusion in which a clot or thrombus (Greek meaning "clot") forms in an artery and obstructs blood flow at the site of its formation. This is the most common form of stroke and accounts for approximately 65% of all cerebrovascular accidents. Tonotopic map Projected onto the auditory cortex in a manner similar to the retinopic mapping of the visual system. Because the cortical bands can respond to multiple frequencies, there is no strict one-to-one correspondence, but bands are more attuned to certain frequencies than others. Transtentorial herniation Associated with high intracranial pressure and generalized swelling of the brain. Tremor Involuntary shaking, usually of a limb, tremors may be resting or occur with intentional movement. Trephination An ancient procedure in which small holes were scraped or cut into the skull deliberately for either surgical or mystical reasons. Tumor the morbid enlargement or new growth of tissue in which the multiplication of cells is uncontrolled and progressive. The tumor growth is often arranged in nonorganized ways, does not serve any functional purpose, and often grows at the expense of surrounding intact tissue. Ultradian rhythm Ninety-minute cycles of heightened and lowered brain arousal observed throughout the wake/sleep cycle. Ultrasonography A procedure for imaging the internal structures of the body by introducing and recording the reflection of high-frequency sound waves. Utilization behavior A characteristic behavior of environmental dependency syndrome that involves the tendency to grasp and use objects that are within reach. The use of the object is in accordance with its function, but inappropriate for the situation.

She was not wearing a seat belt and was thrown from the car and suffered severe head injuries. On being examined by the emergency medical technicians, she was found to be unconscious and was admitted to the emergency department. After 5 hours, she recovered consciousness, and over the next 2 weeks, she made a remarkable recovery. She left the hospital 1 month after the accident, with very slight weakness of her right leg. Four months later, she was seen by a neurologist because she was experiencing sudden attacks of jerking movements of her right leg and foot. One week later,the patient had a very severe attack,which involved her right leg and then spread to her right arm. The neurologist diagnosed jacksonian epileptic seizures, caused by cerebral scarring secondary to the automobile injury. The weakness of the right leg immediately after the accident was due to damage to the superior part of the left precentral gyrus. Her initial attacks of epilepsy were of the partial variety and were caused by irritation of the area of the left precentral gyrus corresponding to the leg. In her last attack, the epileptiform seizure spread to other areas of the left precentral gyrus,thus involving most of the right side of her body,and she lost consciousness. Knowledge of the functional localization of the cerebral cortex enabled the physician to make an accurate diagnosis and advise suitable treatment. The cerebral scar tissue was cleanly excised by a neurosurgeon,and apart from a small residual weakness of the right leg, the patient had no further epileptiform seizures. The cerebral cortex receives vast amounts of information and responds in a precise manner by bringing about appropriate changes. The physician can use this information to locate hemispheric lesions based on clinical symptoms and signs. It is composed of gray matter and has been estimated to contain approximately 10 billion neurons. The surface area of the cortex has been increased by throwing it into convolutions, or gyri, which are separated by fissures or sulci. The cortex is thickest over the crest of a gyrus and thinnest in the depth of a sulcus. The cerebral cortex, like gray matter elsewhere in the central nervous system, consists of a mixture of nerve cells, nerve fibers, neuroglia, and blood vessels. The following types of nerve cells are present in the cerebral cortex: (1) pyramidal cells,(2) stellate cells,(3) fusiform cells,(4) horizontal cells of Cajal, and (5) cells of Martinotti (Fig. The fusiform cells have their long axis vertical to the surface and are concentrated mainly in the deepest cortical layers (Fig. The inferior dendrite branches within the same cellular layer, while the superficial dendrite ascends toward the surface of the cortex and branches in the superficial layers. The axon arises from the inferior part of the cell body and enters the white matter as a projection, association, or commissural fiber. The horizontal cells of Cajal are small, fusiform, horizontally oriented cells found in the most superficial layers of the cortex (Fig. A dendrite emerges from each end of the cell, and an axon runs parallel to the surface of the cortex, making contact with the dendrites of pyramidal cells. The cells of Martinotti are small, multipolar cells that are present throughout the levels of the cortex (Fig. The cell has short dendrites, but the axon is directed toward the pial surface of the cortex, where it ends in a more superficial layer, commonly the most superficial layer. Nerve Fibers of the Cerebral Cortex the nerve fibers of the cerebral cortex are arranged both radially and tangentially. They include the afferent entering projection, association, and commissural fibers, which terminate within the cortex, and the axons of pyramidal, stellate, and fusiform cells, which leave the cortex to become projection,association,and commissural fibers of the white matter of the cerebral hemisphere. The tangential fibers run parallel to the cortical surface and are, for the most part, collateral and terminal branches of afferent fibers. They also include the axons of horizontal and stellate cells and collateral branches of pyramidal and fusiform cells. The tangential fibers are most concentrated in layers 4 and 5, where they are referred to as the outer and inner bands of Baillarger, respectively. The bands of Baillarger are particularly well developed in the sensory areas due to the high concentration of the terminal parts of the thalamocortical fibers.

Area of frontal cortex activated in Wisconsin Card Sorting Test during shifting of cognitive sets? What neurodevelopmental process predominately occurs during adolescence and young adulthood? Wear in the brain are circadian rhythms related to sleep behavior set and maintained? Region of the brain most closely associated with cortical processing of faces this hypothalamic nuclei is key to integration of neural and nutrient signals with hormonal signals from the small intestine, pancreas, liver, adipose tissue and brainstem Region of brain connected with the anterior medial frontal cortex during recognition of affective behavior by mirror neuron system. The rapid learning demonstrated by children during the school-age years is paralleled neurodevelopmentally by which of the following brain processes? The cortical synaptic remodeling characteristic of normal adolescence is also believed to be associated with what neurobiological change? The most important feature of post natal brain development is an increase in what? Potent neuroprotective factor preventing neuronal cell death (apoptosis) What type of receptor is a glucocorticoid receptor? Positive allosteric modulators of neurotransmitter-gated, multimeric ion channels do what? Principal mechanism of termination of synaptic activity of dopamine in prefrontal cortex? Opiates inhibit Camp dependent protein phosphorylation in: Neurotransmitter maintains consistent levels with age: Which neurotransmitters are reduced in quantity, uptake and turnover is spasticity? Neurotransmitter assoc w/ reward & reinforcement in nicotine dependence Prostaglandin D2 increases extracellular levels of. What neurotransmitter is thought to play a key role in fine-tuning working memory function in the dorsolateral prefrontal cortex? What neurotransmitter present in the periaqueductal gray matter is involved in the mediation of pain? Lumbar puncture elevated opening pressure with no cells, 62 mg/dl glucose, and 22mg/dl protein. Most likely dx: (7x) 79 y/o pt with a deteriorating mental state over a 3-week period has an exaggerated startle response with violent myoclonus that is elicited by turning on the room lights, speaking loudly, or touching the pt. Likely to develop later: (3x) 9 y/o F has 3 month h/o seemingly unprovoked bouts of laughter. Likely dx: (2x) Young adult gained 70 lbs in last year c/o daily severe headaches sometimes associated with graying out of vision. Goal of treatment in this case: (2x) Superior homonymous quadrantic defects in the visual fields result from lesions to which of the following structures? What is the transmissible element that causes progressive decline and myoclonic jerks. Kluver-Bucy syndrome: placisity, hyperorality, hypersexuality and hyperphagia, can be induced in animals with bilateral resection of which structure? Gait is somewhat slow, with short steps, and the pt is slow when arising from a chair. This is most likely a complication of excessively rapid correction of which metabolic problem? Dx: Inability to carry out motor activites on verbal command despite intact comprehension & motor function indicates? Most common cause of aseptic meningitis: 25 y/o M w 7 months depression, forgetfulness, weight loss, insomnia, painful tingling in both feet+incoordination. Physical exam reveals mild disorientation, nuchal rigidity, and mild spasticity in the lower extremities. Spinal tap reveals opening pressure 200mm H20, 84%neutrophils (7,000 nucleated cells), glucose level of 128mg/dl, and protein level of 33mg/dl. Romberg test: negative, but very unsteady while walking and walks with a broad-based, lurching gait. Essential criterion for declaration of brain death prior to organ donation requires?

Marchiafava-Bignami disease: magnetic resonance imaging findings in corpus callosum and subcortical white matter. Inflammatory reaction in progressive multifocal leukoencephalopathy: harmful or beneficial? Erythropoietin prevents the increase in blood-brain barrier permeability during pentylentetrazol induced seizures. Prolonged postictal stupor: nonconvulsive status epilepticus, medication effect, or postictal state? The difficulty arises in part because many patients are very accurate in mimicking neurologic signs (actors are often used to train medical students in the diagnosis of neurologic illnesses) and, in part, because many patients with psychogenic neurologic disorders (conversion reactions) also have somatic disease, the somatic illness representing a stressor that causes psychologic problems. Examples abound: approximately one-half of patients with psychogenic seizures also have epilepsy. With most psychogenic illnesses that mimic structural neurologic disease, the physician pursues a twopronged diagnostic attack. Because in psychogenic unresponsiveness no history or mental status examination from the patient is possible (a history should be obtained from relatives or friends), the physician is left with only the first portion of his diagnostic armamentarium. Thus, the diagnosis of psychogenic unresponsiveness must be approached with the greatest care. However, if after such a meticulous examination of a patient with suspected psychogenic unresponsiveness any question remains about the diagnosis, a careful search for other causes of coma is obligatory. Psychogenic unresponsiveness is uncommon; it was the final diagnosis in only eight of our original 500 patients (Table 1­1). We have, however, encountered the condition as a challenging diagnostic problem in several further patients at a rate of about one every other year since that time. In one study of conversion symptoms in 500 psychiatric outpatients, ``unconsciousness' occurred in 17. More recently, Lempert and colleagues found that 405 (9%) of 4,470 consecutive neurologic inpatients were found to have psychogenic rather than neurologic disorders8 (Table 6­1). Among these only Table 6­1 Signs and Symptoms (N = 717) of 405 Patients With Psychogenic Dysfunction of the Nervous System* Pain Trunk and extremities Headache Atypical facial pain Motor Symptoms Astasia/abasia Monoparesis Hemiparesis Tetraparesis Paraparesis Paresis of both arms Recurrent head drop Tremor Localized jerking Stereotyped motor behavior Hypokinesia Akinesia Foot contracture Isolated ataxia of the upper extremities Sensory Symptoms Hypesthesia/anesthesia Paresthesia/dysesthesia Sensation of generalized vibration Sensation of fever Pressure in the ears Seizures With motor phenomena Other (amnestic episodes, mental and emotional alterations) Vertigo/Sizziness Attacks of phobic postural vertigo Continuous dizziness From Lempert et al. Another study conducted in the 566-bed tertiary care hospital identified a conversion disorder in 42 patients over 10 years. Because the diagnosis of psychogenic neurologic symptoms is often difficult, mistakes are sometimes made. Sometimes a structural disorder is initially diagnosed as psychogenic,10,11 but sometimes the opposite occurs. The latter is typically true when psychogenic coma complicates a physical illness. These include (1) conversion reaction, which may in turn be secondary to a personality disorder, severe depression, anxiety, or an acute situational reaction15; (2) catatonic stupor, often a manifestation of schizophrenia; (3) a dissociative or ``fugue' state; and (4) factitious disorder or malingering. The two major categories of psychogenic unresponsiveness are those that result from a conversion disorder (often called conversion hysteria) and those that are part of the syndrome of catatonia (often thought to be a manifestation of schizophrenia). The two clinical pictures differ somewhat, but both may closely simulate delirium, stupor, or coma caused by structural or metabolic brain disease. The diagnosis of psychogenic unresponsiveness of either variety is made by demonstrating that both the cerebral hemispheres and the brainstem-activating pathways can be made to function in a physiologically normal way, even though the patient will seemingly not respond to his or her environment. The physician must recognize that with the exception of factitious disorders and malingering, psychologically produced neurologic symptoms are not ``imaginary. Interestingly, those feigning paralysis exhibited hypofunction of the right anterior prefrontal cortex when compared with controls. A patient studied during catatonic stupor showed hypometabolism in a large area of the prefrontal cortex including anterior cingulate, medial prefrontal, and dorsolateral cortices when compared with controls. Many physicians associate conversion reactions with a hysterical personality (conversion hysteria) but, in fact, conversion reactions may occur as a psychologic defense against a wide range of psychiatric syndromes, including depressive states and neuroses. The respiratory rate and depth are usually normal, but in some instances the patient may be overbreathing as another manifestation of the psychologic dysfunction (hyperventilation syndrome).