1. Chenjie Xia (R2) Academic ½ Day Wednesday, April 7th, 2010
Blumenfeld – Chapter 18 Limbic System: Homeostasis, Olfaction, Memory, and Emotion
Chenjie Xia (R2)
Academic ½ Day
Wednesday, April 7th, 2010

2. Review of key structures

3. Overview of limbic structures

4. Overview of limbic structures

5. Overview of limbic structures

6. Limbic structures Amygdala nuclei Diencephalon Basal ganglia
Corticomedial, basolateral, central, bed nucleus of the stria terminalis
Diencephalon
Hypothalamus, thalamus (anterior and mediodorsal nuclei), habenula
Basal ganglia
Ventral striatum, ventral pallidum
Habenula: small epithalamic structure located just lateral to the pineal gland.

7. Limbic structures Basal forebrain Septal Region Brainstem nuclei
Nucleus basalis of Meynert, olfactory tubercle, nucleus of diagonal band of Broca, preoptic area, portions of amygdala
Septal Region
Medial septal nucleus, lateral septal nucleus, nucleus accumbens
Brainstem nuclei
Interpeduncular, superior central, dorsal and ventral tegmental, parabrachial, periaqueductal gray, reticular formation, nucleus solitarius, dorsal motor nucleus of vagus

8. Overview of limbic circuitry

9. The Return of Neuro-Jeopardy!
(No more Meryl Streep questions…)

10. Neuro-Jeopardy
Clinical anatomy
Book anatomy
Syndromes
Miscellaneous
100
100
100
100
200
200
200
200
300
300
300
300
400
400
400
400
500
500
500
500

11. Clinical Anatomy

12. Clinical Anatomy 100
Where did Dr. Brenda Milner obtain her undergraduate degree and what did she major in?
A) Oxford, philosophy
B) Cambridge, psychology
C) McGill, physiology
D) University of Montreal, biology

13. Clinical Anatomy 100
Where did Dr. Brenda Milner obtain her undergraduate degree and what did she major in?
A) Oxford, philosophy
B) Cambridge, psychology
C) McGill, physiology
D) University of Montreal, biology

15. Clinical Anatomy 200
Bilateral lesions of medial temporal and diencephalic structures would impair which of the following?
A) Mediate working memory
B) Consolidate long-term explicit memory
C) Consolidate long-term implicit memory
D) Retrieve long-term explicit memory
E) Retrieve long-term implicit memory

16. Clinical Anatomy 200
Bilateral lesions of medial temporal and diencephalic structures would impair which of the following?
A) Mediate working memory
B) Consolidate long-term explicit memory
C) Consolidate long-term implicit memory
D) Retrieve long-term explicit memory
E) Retrieve long-term implicit memory
Think of what HM can and cannot do

18. Clinical Anatomy 300
Name 2 intracerebral vascular lesions which could lead to memory deficits

19. Clinical Anatomy 300
Rupture of A-com aneurysm (disrupt basal forebrain, medial diencephalon, and frontal lobes)
Top of the basilar artery lesions (b/l medial temporal or medial diencephalic supplied by PCA)
Artery of Percheron lesion / single paramedian thalamoperforator artery (b/l medial thalami)

20. Clinical Anatomy 300

22. Clinical Anatomy 400
Which function has Dr. Brenda Milner has discovered for each of the following structures?
1) Medial temporal lobes
2) Right temporal lobe
3) Left frontal lobe
4) Dorsolateral frontal lobes

23. Clinical Anatomy 400
Which function has Dr. Brenda Milner discovered for each of the following structures?
1) Medial temporal lobes  explicit memory
2) Right temporal lobe  visuospatial memory
3) Left frontal lobe  verbal fluency
4) Dorsolateral frontal lobes  reversal-learning / task switching

25. Clinical Anatomy 500
Which pattern of olfactory loss (left, right, bilateral) would be caused by lesions at the following sites?
Left olfactory mucosa
Left olfactory bulb
Left olfactory tract
Left primary olfactory cortex
Left thalamus
Primary olfactory cortex (piriform and periamygdaloid cortex)

26. Clinical Anatomy 500
Olfactory mucosa  cribriform plate  glomeruli of olfactory bulb  olfactory tract (anterior olfactory nucleus)  to ipsilateral olfactory areas and contralateral olfactory bulb (via medial olfactory stria and anterior commissure)
Primary olfactory cortex: piriform and periamygdaloid cortex

27. Clinical Anatomy 500 Left olfactory mucosa  left sided loss
Left olfactory bulb  left sided loss
Left olfactory tract  left sided loss
Left primary olfactory cortex  no loss
Left thalamus  no loss
Olfaction: only sensory modality which bypasses thalamus

29. Book Anatomy

30. Book Anatomy 100
What are the two main pathways connecting the hippocampal formation and the entorhinal cortex?

31. Book Anatomy 100

32. Book Anatomy 100 Perforant pathway Entorhinal cortex  Dentate gyrus
Hippocampus (CA1&3)
Subiculum
2) Alvear pathway
Entorhinal cortex 
Hippocampus (CA1&3)
Subiculum

34. Book Anatomy 200
What are the 3 main targets of axons travelling forward in the fornix?
Where do axons travelling backward in the fornix originate from?

35. Book Anatomy 200

36. Book Anatomy 200 Axons travelling forward in the fornix:
1) subiculum  postcommissural fornix  mammillary nuclei
2) subiculum & hippocampus  precommissural fornix  lateral septal nucleus
3) Fornix  anterior thalamic nucleus
Axons travelling backward in the fornix:
Medial septal nucleus  hippocampal formation
Lateral septal nucleus project richly to medial septal nucleus. Thus, the loop completes itself!

38. Book Anatomy 300
True or False: HM’s bilateral medial temporal lobectomy was performed by Dr. Wilder Penfield at the Montreal Neurological Institute.

39. Book Anatomy 300
False. It was done by Dr. William Scoville in Hartford, Connecticut

41. Book Anatomy 400
Which pathway connects the following structure to the amygdala?
Structure
Orbital frontal cortex
Hypothalamus and the septal region
Brainstem
Pathway
Uncinate fasciculus
Stria terminalis and amygdalofugal pathway
Medial forebrain bundle

42. Book Anatomy 400

44. Book Anatomy 500 Name all the structures involved in the Papez circuit
BONUS: Describe the connections between these structures in the Papez circuit…

45. Book Anatomy 500

47. Syndromes

48. Syndromes 100
Which syndrome is caused by bilateral lesions of the amygdala and adjacent temporal structures?
What are its main characteristics?

49. Syndromes 100 Kluver-Bucy syndrome:
Placid, tame, non-aggressive behaviour
Hyperorality
Hypersexuality
Visual agnosia

51. Syndromes 200 Who was Dr. Milner’s PhD thesis supervisor?
A) Dr. Donald Hebb
B) Dr. Wilder Penfield
C) Dr. Herbert Jasper
D) Dr. Henry Gustave Molaison
E) Dr. William Osler

52. Syndromes 200 Who was Dr. Milner’s PhD thesis supervisor?
A) Dr. Donald Hebb
B) Dr. Wilder Penfield
C) Dr. Herbert Jasper
D) Dr. Henry Gustave Molaison
E) Dr. William Osler

54. Syndromes 300 Regarding the Wernicke Korsakoff syndrome:
1) Which substance is deficient?
2) Who are at risk for developing it?
3) What is the typical clinical triad?

55. Syndromes 300 Thiamine Alcoholics and patients with malnutrition
Confusion, opthalmoplegia, ataxia

57. Syndromes 400
A previously healthy 64 yo man presents with an episode of 4 hours during which the wife witnessed him as repeatedly asking the same questions. He then returned to normal, but with complete amnesia of the episode.
What is the most likely diagnosis?
What are the main DDx?

58. Syndromes 400
TGA
DDx:
TIA
Seizure
Migraine

60. Syndromes 500
Which of the following tasks completed by HM provided Dr. Milner the insight for the theory of multi-system memory?
A) Learning a maze path through trial and error
B) Learning to trace a star shape through a mirror reflection
C) Successfully completing the Wisconsin Card Sorting Test

61. Syndromes 500
Which of the following tasks completed by HM provided Dr. Milner the insight for the theory of multi-system memory?
A) Learning a maze path through trial and error
B) Learning to trace a star shape through a mirror reflection
C) Successfully completing the Wisconsin Card Sorting Test

63. Miscellaneous

64. Miscellaneous 100
What are the 4 main functions of limbic system and their corresponding key structure?

65. Miscellaneous 100
Mnemonic: HOME

67. Miscellaneous 200
Which type of memory is invoked in the following situations (explicit vs implicit)?
1) A medical student impressing the attending by listing a full list of DDx for HA at neurology rounds
2) A neurology resident successfully retrieving CSF on first attempt in a agitated encephalopathic patient with a BMI of 35
3) An IM resident breaking into cold sweats every time a Code Blue is called

68. Miscellaneous 200
1) A medical student impressing the attending by listing a full list of DDx for HA at neurology rounds  Explicit
2) A neurology resident successfully retrieving CSF on first attempt in a agitated encephalopathic patient with a BMI of 35  Implicit (skills)
3) An IM resident breaking into cold sweats every time a Code Blue is called  Implicit memory (classical conditioning)

69. Miscellaneous 200

71. Miscellaneous 300
Which region of the parahippocampal gyrus serves as the most important relay between the hippocampal formation and association cortices?
A) Piriform and periamygdaloid cortex
B) Entorhinal cortex
C) Parahippocampal cortex
D) Perirhinal cortex
E) Orbital frontal cortex

72. Miscellaneous 300

74. Miscellaneous 400
Name the 3 components of the hippocampal formation?

75. Miscellaneous 400 3 components of the hippocampal formation:
1) Subiculum
2) Hippocampus (proper)
3) Dentate gyrus

76. Miscellaneous 400

77. Miscellaneous 400

79. Miscellaneous 500
Who were PB and FC?

80. Miscellaneous 500 Who were PB and FC?
PB: civil engineer; FC: glove-cutter
Patients with anterograde amnesia following left medial temporal lobectomy (1941) performed by Dr. Penfield for refractory epilepsy
Hypothesized to have baseline right medial temporal atrophy, thus functional bilateral medial temporal lesions following Sx