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Many of the receptor mecha- There is another circuit whereby septal inﬂuences are nisms for these functions are now known to be located in conveyed to the midbrain cheap clomid 100 mg on line. The ﬁrst part of the pathway is highly specialized hypothalamic neurons cheap clomid 50 mg on-line. The hypothala- the stria medullaris (note the possible confusion of termi- mus responds in two ways — as a neuroendocrine struc- nology), which connects the septal nuclei (region) with ture controlling the activities of the pituitary gland and as the habenular nuclei. The stria medullaris is found on the a neural structure linked to the limbic system. From the habenular nuclei, In its neural role there are small areas of the hypo- the habenulo-interpeduncular tract descends to the mid- thalamus that act as the “head ganglion” of the autonomic brain reticular formation, mainly to the interpeduncular nervous system, inﬂuencing both sympathetic and para- nucleus located between the cerebral peduncles (see mid- sympathetic activities. The response to hunger or thirst or brain cross-section, Figure 65B). FIGURE 78A: Hypothalamus © 2006 by Taylor & Francis Group, LLC 230 Atlas of Functional Neutoanatomy effect is not seen in all parts of the brain, and in some FIGURE 78B areas an opposite (negative) reaction may be seen. MEDIAL FOREBRAIN BUNDLE THE LIMBIC MIDBRAIN SEPTAL REGION AND LIMBIC MIDBRAIN A number of limbic pathways terminate within the retic- ular formation of the midbrain, including the periaqueduc- This illustration provides detailed information about other tal gray, leading to the notion that these areas are to be important parts of the limbic system, the septal region and incorporated in the structures that comprise the extended the limbic midbrain. The pathway that interconnects the limbic system (discussed in the Introduction to this sec- hypothalamus and these areas is the medial forebrain tion). This has led to the use of the term limbic midbrain. The two major limbic pathways, the medial forebrain bundle and a descending tract from the mammillary nuclei THE SEPTAL REGION (the mammillo-tegmental tract), terminate in the midbrain The septal region includes both cortical and subcortical reticular formation. From here, there are apparently descending pathways that convey the “commands” to the areas that belong to the forebrain. The cortical areas, parasympathetic and other nuclei of the pons and medulla named the septal cortex, are found under the rostrum of the corpus callosum (the thin “inferior” portion of the (e. Nuclei reticular formation of the medulla concerned with cardio- lying deep to this region are called the septal nuclei and vascular and respiratory control mechanisms (discussed in some species (not humans) are located within the sep- with Figure 42A and Figure 42B). Other connections are tum pellucidum (the septum that separates the anterior certainly made with autonomic neurons in the spinal cord horns of the lateral ventricles, see Figure 17 and Figure (i. In this atlas, both areas are included in the term septal region. The septal region receives input from the hippocampal MEDIAL FOREBRAIN BUNDLE formation (via the precommissural ﬁbers of the fornix, see Figure 72B) and from the amygdala (via the stria termi- Knowledge of this bundle of ﬁbers is necessary if one is nalis, see Figure 75B). The major connection of the septal to understand the circuitry of the limbic system and how region with the hypothalamus and the limbic midbrain the limbic system inﬂuences the activity of the nervous occurs via the medial forebrain bundle. Part of its course pressing of the bar completed an electrical circuit that is through the lateral part of the hypothalamus where the resulted in a tiny (harmless) electric current going through ﬁbers become somewhat dispersed (as illustrated). It was shown that rats will quickly are further connections to nuclei in the medulla. It is learn to press a bar to deliver a small electric current to relatively easy to understand how the septal region and the septal region. In fact, the animals will continue press- the hypothalamus can inﬂuence autonomic activity and ing the bar virtually nonstop, even in preference to food. From this result it has been inferred that the animals derive some type of “pleasant sensation” from stimulation of this ADDITIONAL DETAIL region, and it was named the “pleasure center”; it has since There are other pathways from the hypothalamus to the been shown that there are other areas where a similar limbic midbrain, such as the dorsal longitudinal bundle. However, this type of positive © 2006 by Taylor & Francis Group, LLC The Limbic System 231 Dorsal longitudinal bundle Fornix Stria terminalis Mammillo-tegmental tract 3rd ventricle "Limbic" midbrain Septal nn. Medial forebrain bundle Anterior commissure Descending autonomic ﬁbers Temporal lobe Midbrain Medulla Parasympathetic nn. OLFACTORY SYSTEM OLFACTORY CONNECTIONS SENSE OF SMELL The connections of the olfactory system involve the limbic The olfactory system, our sense of smell, is a sensory cortex, called the secondary olfactory areas.
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Electrophysiology NCV EMG Differential diagnosis Local arthritis cheap 50mg clomid visa, osseous changes purchase clomid 25 mg amex. References Borges LF, Hallet M, Selkoe DJ (1981) The anterior tarsal tunnel syndrome; report of two cases. J Neurosurgery 54: 89 Dawson DM, Hallet M, Millender LH (1990) Tarsal tunnel syndrome. Little Brown, Boston, pp 291–299 Kanbe K, Kubota H, Shirakura K, et al (1995) Entrapment neuropathy of the deep branch of the peroneal nerve associated with the extensor hallucis brevis muscle. J Foot and Ankle Surgery 34: 560–562 Kohno M, Takahashi H, Segawa H, Sano K (2000) Neurovascular decompression for idiopathic tarsal tunnel syndrome: technical note. J Neurol Neurosurg Psychiatry 69: 87– 90 Staal A, van Gijn J, Spaans F (2000) The tibial nerve. In: Staal A, van Gijn J, Spaans F (eds) Mononeuropathies: examination, diagnosis and treatment. Saunders, London, pp 125–132 Yamamoto T, Mizuno K (2001) Tarsal tunnel syndrome caused by synovial sarcoma. J Neurol 248: 433–434 237 Sural nerve Genetic testing NCV/EMG Laboratory Imaging Biopsy + + used The sural nerve is formed from two branches: the medial cutaneous nerve of the Anatomy calf (tibial nerve) and the lateral cutaneous nerve of the calf (common peroneal nerve). In general, the sural nerve contains only sensory fibers. It runs along the middle of the calf region, lateral to the Achilles tendon and lateral malleolus. The nerve innervates the lateral ankle and lateral aspect of the sole, to the base of the 5th toe. The sural nerve gives rise to the lateral calcaneal nerves posterior and proximal to the tip of the lateral malleolus. At the proximal fifth metatarsal tuberosity the nerve divides into a lateral branch (the dorsolateral cutaneous nerve of the fifth toe) and a medial branch, providing sensation to the dorsome- dial fifth toe and dorsolateral fourth toe. Numbness, pain, and paresthesias at the lateral side of the foot. Symptoms Symptoms after excision: Dysesthesias occur in 40–50% of cases. There is no difference in outcome between whole nerve biopsy or fascicular biopsy. Signs Pathogenesis Baker’s Cyst Popliteal fossa Arthroscopy, operation for varicose veins Calf muscle biopsies Calf Elastic socks Footwear Tight lacing Acute or chronic ankle sprain Ankle Avulsion fracture of base of 5th metatarsal bone Adhesion after soft tissue injury Fractured sesamoid bone in peroneus longus tendon Ganglion Idiopathic neuroma Osteochondroma Sitting with crossed ankles Shoes 238 Surgery: Ankle fractures, talus, calcaneus, base of fifth metatarsal, Achilles tendon rupture Diagnosis Laboratory (include genetics), electrophysiology, imaging, biopsy, sensory NCV Diagnosis of neuroma: Tinel‘s sign, pain and paresthesias below distal fibula or along the lateral or dorsolateral border of the foot. Differential diagnosis Asymmetric neuropathy Herpes zoster (rare) S1 irritation Therapy Padding of shoewear, steroids, excision and transposition of the nerve stump Prognosis Depends upon the etiology References Dawson DM, Hallet M, Wilbourn AJ (1999) Entrapment neuropathies of the foot and ankle. In: Dawson DM, Hallet M, Wilbourn AJ (eds) Entrapment neuropathies. Lippincott Raven, Philadelphia, pp 297–334 Gabriel CM, Howard R, Kinsella N, et al (2000) Prospective study of the usefulness of sural nerve biopsy. J Neurol Neurosurg Psychiatry 69: 442–446 Killian JM, Foreman PJ (2001) Clinical utility of dorsal sural nerve conduction studies. Muscle Nerve 24: 817–820 Pollock M, Nukada N, Taylor P, et al (1983) Comparison between fascicular and whole nerve biopsy. Ann Neurol 13: 65–68 Staal A, van Gijn J, Spaans F (1999) The sural nerve.