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

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Presentation on theme: "Blumenfeld – Chapter 18 Limbic System: Homeostasis, Olfaction, Memory, and Emotion Chenjie Xia (R2) Academic ½ Day Wednesday, April 7 th, 2010."— Presentation transcript:

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

2 Review of key structures

3 Overview of limbic structures

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6 Limbic structures Amygdala nuclei –Corticomedial, basolateral, central, bed nucleus of the stria terminalis Diencephalon –Hypothalamus, thalamus (anterior and mediodorsal nuclei), habenula Basal ganglia –Ventral striatum, ventral pallidum

7 Limbic structures Basal forebrain –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 SyndromesMiscellaneous 100 200 300 400 500

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

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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

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

19 Clinical Anatomy 300 1)Rupture of A-com aneurysm (disrupt basal forebrain, medial diencephalon, and frontal lobes) 2)Top of the basilar artery lesions (b/l medial temporal or medial diencephalic supplied by PCA) 3)Artery of Percheron lesion / single paramedian thalamoperforator artery (b/l medial thalami)

20 Clinical Anatomy 300 http://www.ajnr.org/cgi/content-nw/full/24/10/2005/F4

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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

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25 Clinical Anatomy 500 Which pattern of olfactory loss (left, right, bilateral) would be caused by lesions at the following sites? 1)Left olfactory mucosa 2)Left olfactory bulb 3)Left olfactory tract 4)Left primary olfactory cortex 5)Left thalamus

26 Clinical Anatomy 500

27 1)Left olfactory mucosa  left sided loss 2)Left olfactory bulb  left sided loss 3)Left olfactory tract  left sided loss 4)Left primary olfactory cortex  no loss 5)Left thalamus  no loss

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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 1)Perforant pathway Entorhinal cortex  Dentate gyrus  Hippocampus (CA1&3)  Subiculum  Entorhinal cortex 2) Alvear pathway Entorhinal cortex  Hippocampus (CA1&3)  Subiculum  Entorhinal cortex

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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 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

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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

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41 Book Anatomy 400 Pathway A.Uncinate fasciculus B.Stria terminalis and amygdalofugal pathway C.Medial forebrain bundle Structure 1.Orbital frontal cortex 2.Hypothalamus and the septal region 3.Brainstem Which pathway connects the following structure to the amygdala?

42 Book Anatomy 400

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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 http://upload.wikimedia.org/wikipedia/commons/thumb/ 9/95/Papez_Circuit.jpg/400px-Papez_Circuit.jpg

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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

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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

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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 1)Thiamine 2)Alcoholics and patients with malnutrition 3)Confusion, opthalmoplegia, ataxia

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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

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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

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63 Miscellaneous

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

65 Miscellaneous 100 Mnemonic: HOME

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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

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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

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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

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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

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