Contents

I.ClassificationofANSReceptors..............................2 VIII.Sensory/Language/SpeechDisorders.......................4
II.CholinergicReceptorDrugs....................................2 IX.LearningandMemory..............................................4
III.AdrenergicReceptorDrugs....................................2 X.TheLimbicSystem....................................................4
IV.OrganizationoftheHypothalamus........................3 XI.LimbicSystemDisorders...........................................4
V.OrganizationandFunctionsofthePituitary..........3 XII.Arousal,Sleep,andAttention...................................5
VI.HypothalamicandPituitaryDisorders...................3 XIII.SleepandAttentionDisorders.................................5
VII.FrontalCorticalLesions..........................................3 XIV.NormalCNSAging.....................................................5
XV.CNSAgingDisorders.................................................5

Sawthedorsalhornsoff!
byDMFA NervousSystemWrittenExamIIITables Page2
TableI ClassificationofANSReceptors VariousLectures
ReceptorType Locations Action Notes
Preganglionicsynapses(NN) + +
Cholinergic

BindAChandopenchannel LigandgatedNa /K channels(nearest

Nicotinic Adrenalmedulla
Alwaysstimulatory nerve)
Motorendplateofskeletalmuscle(NM)
Allparasympathetictargetorgans 2+ GProtein regulatedinwardlyrectifying
Stimulatory(M1,3,5)Ca releaseviaPLC,IP3 +
Muscarinic Sympathetic:smoothmuscle(bloodvessels)
Inhibitory(M2,4)cAMPreleaseviaadenylcyclase
K channel(GIRK)
andglandularsecretion Ruleofthumbcontractsmoothmuscle
Bloodvessels Constrictsbloodvessels andvisceralorgansphincters
Allsympathetictargetsexceptheart (GI,urinary) Ruleofthumbconstrictssmooth
1 Eye Dilatespupilsviaradialm.ofiris nd
muscleviaIP3as2 messenger(Gq)
Prostate Contractsprostate(1A)
Mediatesinhibition ofNE andsympatheticoutflow
Membranesofadrenergicaxonterminals
2
nd
Promotescoagulation UsescAMPas2 messenger(Gi)
Bloodplatelets
Adrenergic

Relaxessmoothmuscle,inhibitsinsulinrelease
Increases heartrate (+chronotropic)andstrengthof
contraction(+inotropic)
Mostlyheartandcoronaryvessels
1
nd
Dilatescoronaryarterioles UsescAMPas2 messenger(Gs)
Kidneys,liver,adiposetissue
Stimulatesreninreleasefromkidneys
Aqueoushumorineyes
Stimulatesinsulinsecretionfrompancreas
Lungs Ruleofthumbrelaxessmoothmuscle
Dilatesbloodvesselsandbronchioles
2
+
Mostsympathetictargetorgans StimulatesK uptake(hyperpolarization)
Relaxessmoothmuscleofgut,bladder,uterus nd
Coronaryvessels,systemicarterioles UsescAMPas2 messenger(Gs)
Liverglycogenolysis,pancreaticinsulinrelease
3
nd
Adiposetissue Stimulateslipolysis UsescAMPas2 messenger(Gs)

TableII CholinergicReceptorDrugs L41Dr.Martin

Class
Agonists
NeuromuscularBlockers
(Anesthesia,paralysis)
Anticholinesterases
(Indirectactivation)
MuscarinicAgonists
MuscarinicAntagonists
CholinesteraseReactivators
Drug Action(s)
Acetylcholine,Nicotine,Muscarine Acetylcholineusedduringcataract surgeryasamioticagent
Curaredrugs Nondepolarizing,competitiveinhibitionofnicotinicreceptorsinmuscle (NM)
Hexamethonium Competetiveblockadeofnicotinic receptorsinnerves(NN)
Succinylcholine,ultrashortduration Depolarizing,plasmacholinesterasehydrolysis,flaccidparalysis
Botuliniumtoxin(C.botulinium) InhibitsAChreleaseviaSNAP25protein, rigidparalysis
Tetanustoxin(C.tetani) InhibitsreleaseofGABA,glycineatmotorneuron
Carbamates(neo,physopyridostigmine) Treatment ofmyastheniagravis,curarepoisoning
Alcoholsedrophonium(Tensilon) Shortacting,reversible,usedindiagnosisofmyastheniagravis
Organophosphatesmalathion,parathion Irreversible,inhibitplasmabutyrylcholinesterasebyaging(Insecticides)
NerveGasesSarin,Tabun,Soman,VX Inhibitacetylcholinesterasebyaging
Tacrine,donezepil,rivastigmine,galantamine GivenforAlzheimers todelayprogression
Bethanechol Increasessmoothmuscletone,postopatonicity/retention
Methacholine Diagnosisofsubclinicalasthma
Pilocarpine Fortreatmentofglaucoma bypromotingoutflowofaqueoushumorviaCanalofSchlemm
Cevimeline Fortreatmentofdrymouth (xerostomia) inSjgrenssyndrome,dryeye
Atropine,scopolamine Mydriasis,cycloplegia,lowersGItone,decreasessecretions;tertiary,enterCNS
Oxybutynin Mostcommonlygivenforurologic disorders,constrictssphincter,relaxesdetrusorandureter,3
Ipratropium(Ventolin) Inhaled,relaxesmusclesw/otachycardia,forCOPDbronchospasm,quaternary,cantenterCNS
Benztropine GivenforParkinsons diseasealongwithdopamineelevators
Pralidoxime(2PAM) Preventsaging(acetylationofserine)byorganophosphates

TableIII AdrenergicReceptorDrugs L423Dr.Oglesby

Class Drug Action(s)
Norepinephrine Actson1,2,1systolicBP,diastolicBP,HR(reflexbradycardia)
Actsonalladrenergicreceptors systolicBP,diastolicBP,HR
Epinephrine
Agonists Increasesaqueousfluidoutflowviauveoscleralpathway
Phenylephrine Noncatecholamine,notdegradedbyMAOandthereforelongerlasting;actson1;nasaldecongestant,inducesmydriasis
Tyramine Indirectactingsympathomimetic,entersnerveterminalatreuptakepumpandreleasesNE,doesnotcrossBBB
Nonselective,givenfor acutehypertensivecrisis,pheochromocytoma,necrosis;muscarine&histamine agonist
Phentolamine
Oftencausesorthostatichypotension,syncope,reflextachycardiaduetoblockadeof2forreuptake,allowingNEtouse1
Antagonists Prazosin 1selective,givenforhypertension(HTN),benignprostatichypertrophy(BPH);maycauseorthostatichypotension,syncope
Phenoxybenzamine Irreversible,usedspecificallyforpheochromocytoma
Isoproterenol Nonselective,systolicBP,diastolicBP,HR;usedforbronchialasthma(inhaled),heartblock
Agonists Albuterol 2selective,Inhaledbronchodilator,treatmentofasthma,causestachycardia,muscletremors
Nonselective,contraindicatedinasthma,givenforangina,HTN,pheochromocytoma,delaysrecoveryfromhypoglycemia
Propranolol(Inderal)
Antagonists Decreaseaqueoushumorproductionintheeyeinglaucoma
Metoprolol,Atenolol 1selective,givenforhypertension,tachycardia;losesselectivityathighdoses
ReuptakeInhibitors Cocaine Blocksdopamine,serotonin,andNEreuptake,prolongsandintensifieseffects

byDMFA NervousSystemWrittenExamIIITables Page3

TableIV OrganizationoftheHypothalamus L44Dr.Singh
Image Division Nucleus Functions
Lateralnucleus Relaysystembetweenautonomicnuclei,hunger
Med.forebrainbundle Mediatesconnectionsbetweenbrainstem,hypothalamus,cortex
Lateral
Separateslateralandmedialhypothalamus,lesionsaffectbothcognitiveand
Fornix
neuroendocrinefunctions
Dorsomedial (DMN) Dorsal noradrenergicbundlefromlocusceruleus
Satiety,appetitivebehavior,relatedtohypogonadism,ventral noradrenergicbundlefrom
Ventromedial(VMN)
nucleussolitarius(CNsIX,X)
Medial
Anteriorpituitaryfunction aminergicinputs
Arcuatenucleus(Arc) Releasesgonadotrophinreleasinghormone(GnRH),endorphin,dopamineviatubero
infundibularsystem(TIDA),growthhormomereleasinghormone(GHRH)
Receivesinputfromnucleussolitarius(IXX),locusceruleus,periaqueductalgrey(pain)
Communicateswithposteriorpituitary(hypothalamohypophysealtract),autonomicnuclei
Paraventricular(PVN)
Regulatesproductionofoxytocin,vasopressin(ADH)
Periventricular
Releasescorticotrophinreleasinghormone(CRH),somatostatin
Releasesthyrotrophinreleasinghormone(TRH)
Periventricular
Affectedbycytokineswhichstimulatesprostaglandinsynthesis
Majorareaofthermoregulation,housesestrogenreceptors
Medialpreopticarea
Releasesgonadotrophinreleasinghormone(GnRH)
Circadianrhythm viazeitgebers(timekeepers)suchaslight(retinohypothalamicpathway),
Anterior Suprachiasmatic(SCN)
pinealmelatonin(jetlag)
Communicateswithposteriorpituitary(hypothalamohypophysealtract)
Supraoptic(SON)
Regulatesproductionofoxytocin,vasopressin(ADH)
Posterior Mammillary nuclei Thermoregulation(minor),autonomicnuclei

TableV OrganizationandFunctionofthePituitaryGland L44Dr.Singh

Division Origin System Circulation Pathways Image

Neurotransmitters,peptides

Parvocellular
Pituitaryportal Adrenal(HPA):CRH(PVN)ACTHcorticosteroids

Anterior Ectoderm
(small
Thyroid(HPT):TRH(PeriVN)TSHT3,T4
(Adenohypophysis) (Rathkespouch) diameter
(extracapillary Gonads(HPG,F):GnRH(mPOA,Arc)FSH,LHEstrogen
bed) Gonads(HPG,M):GnRH(Arc)FSH,LHTestosterone
neurons)
Growthhormone:byGHRH(Arc),bysomatostatin(PVN)
Prolactin:byTIDAsystem(Arc)

Magnocellular Peptides
Posterior Neurectoderm
Systemic

(Neurohypophysis) (Diencephalon) (largediameter Oxytocin,vasopressin(ADH)projectfromSONandPVN
neurons) throughinfundibulum(lesion=diabetesinsipidus)

TableVI HypothalamicandPituitaryDisorders L44Dr.Singh

Disorder Lesion Signs/Symptoms
+
AddisonsDisease Hypocortisolism,duetointerruptionofHPAaxis Hypotension,lowNa
CushingsDisease Hypercortisolism,duetopituitaryoradrenaltumor Weightgain,fatdepositsatneckandupperback(hunchback)
GravesDisease T3&T4,TSHduetooveractivethyroid(hyperthyroidism) Tachycardia,weightloss,sweating,exophthalmos(bulgingeyes)
Anyoneofthefollowing:lossofambition,fatigue,periorbitalpuffiness,cold
Hypothyroidism T3&T4,TSHduetounderactivethyroid intolerance,weightgain,slowmovements,drowsiness,memoryimpairment,
constipation,hoarseness
Hyperprolactinemia Dysfunctionoftuberoinfundibulardopaminesystem(TIDA) Highprolactinlevels,excessivemilkletdownanduterinecontractility
Acromegaly Excessgrowthhormoneaftersealingofepiphyses Largeheadandlimbs
Dwarfism Deficiencyofgrowthhormone
PituitaryTumor Bitemporalhemianopsia,excesshormonelevels
+
DiabetesInsipidus Lackofvasopression(ADH)duetodysfunctionofSON,PVN,orfornix Excretionoflargeamountsofdiluteurine,highNa ,excessivethirst

TableVII FrontalCorticalLesions L49Dr.Forster

Lesion Deficits Tests
Abulia:Decisionmaking,sensorylinkedplanning impairment
Dorsolateral Stillhasvalues,longtermgoals
PoorperformanceonTrail&Wisconsincardsortingtests
Unabletolinkplansforbehaviortomotivationandvalues
Orbitofrontal Impulsive,personalitychanges AboveaverageperformanceTrail&Wisconsincardsortingtests
Internal,limbiclinkedplanning
Akinesia,motorimpersistence
Dorsomedial Inabilitytoinitiateandsustaingoalorientedbehavior
Shortsentences/letters
Improperexecutionofnormalbehavioralroutines
Utilizationbehavior Behaviorofdorsomedialisuninhibitedbyorbitofrontal

byDMFA NervousSystemWrittenExamIIITables Page4

TableVIII Sensory/Language/SpeechDisorders L46Dr.Forster
Defecit Signs/Symptoms LocationofLesion
Inabilitytonameobjectsbyseeingthem
Aperceptivevisualagnosia Normalvisualacuity
Unimodalvisualassociationcortex(occipitotemporal)

Lossofcolorvision Visualassociationcortexmediatingcolor
Aperceptivevisualagnosiawith Inabilitytonameobjectsbyseeingthem Unimodalvisualassociationcortex
motionbasedassocation Normalvisualacuity Dorsalaspect(motion)spared
Labored,dysarthricspeech
Brocasaphasia Comprehensionintact,Repetitionimpaired
Brocasarea
Fluentspeech,phonemicsubstitutions
Conductionaphasia Comprehensionintact,Repetitionimpaired
Arcuatefasciculus
Fluentspeech,useswrongwords Temporoparietalcortex
Transcorticalsensoryaphasia Comprehensionimpaired,repetitionintact Perisylvianregionspared
Fluentspeech,phonemicsubstitutionsandwrongwords
Wernickesaphasia Comprehensionandrepetitionimpaired
Wernickesarea
Ventralvisualassociationcortex(what)
Inabilitytocarryoutfunctionsoncommand
Perisylviancortex(namingthefunction)
Ideomotorapraxia Bodypartastoolerrorrecognizescorrectuseoftoolbutcannot
Dorsalvisualassociationcortex(where)
doit
Premotorcortex(carryingouttheaction)

TableIX LearningandMemory L47Dr.Forster

Learning/MemoryType
AssociativeLearning
InstrumentalLearning
SensoryRegister
ShortTermMemory
Declarative(Explicit)LTM
Nondeclarative(Implicit)LTM
LongtermPotentiation
RemoteMemory
RecentMemory
Description LocationinCNS
Medialdentateandinterpositusnuclei(E&G)ofcerebellum Superior
Classic/Pavlovianconditioningtostimuli
cerebellarpeduncle
Smooth/cardiac/glandularresponseorskeletalreflex
Hippocampusandcortexarecorrelatedwithresponse,butnotcritical
Medialforebrainbundle(hypothalamus)
Voluntaryskeletalmuscleresponse
Mesolimbicdopaminesystemventraltegmentalarea,nucleus
Requiresreinforcement
accumbens,prefrontalcortex
Immediaterecallofstimuli,lessthanhalfasecond
Secondstominutes,instantlyaccessible,maintainedbyrehearsal
Dysfunctiondemonstratedbyabnormaldigitspantest
Facts(semantic),events(episodic),capableofbeingverbalized Medialtemporallobe (encoding),cortex(storage),hippocampus
Procedural(skillsandhabits) Striatum
Classicalconditioning(emotionalormotor) Amygdala,cerebellum
Priming(subconsciousmemory) Neocortex
NMDAtypeglutamatereceptorsviaperforant,mossy,andSchaffer
Increaseofsynapticresponsefollowingstimulation
collateralpathwaysofthehippocampus
OftenintactinLTMlesionswhileSTMisintact
CanbeeitherLTMorSTMbasedonpermanence,rehearsal
OftenimpairedinLTMlesionswhileSTMisintact

TableX TheLimbicSystem L48Dr.Singh

Structure Subunit Functions Image
Limbic Cingulategyrus Inputfromthalamusandassociationcortices,outputtoparahippocampal
association Parahippocampalgyrus Entorhinalcortex:memoriesassociatedw/odors,mainhippocampalinput
cortex Medialorbitofrontalgyri Dilationofpupils,salivation,arousal,behavior
Hippocampus Fornix Projectstomammillarybodies
Emotionalsignificancetoastimulus,arousal,learnedemotionalresponses
Amygdala
Basolateral(largest) Connectscorticalassoc.areasviathalamicDMN,uncinatefasciculus
(coordinates
Receivessensoryinputandrelaysittocentralnucleus
activityof
Corticomedial Endocrinefunctions,appetitive behavior
hypothalamus
ANStobrainstemviaamygdalofugalpathwayanddorsalmotornucleusof
withcortex) Centralnucleus
CNX,regulatesvisceralandCVfunction
PathwayfromamygdalatoVMNofhypothalamusallowing
Striaterminalis(Dorsal
neuroendocrinologicalchangesinresponsetoemotionsandimmune
amygdalofugalpathway)
Amygdala influencebydepression
Pathways Ventralamygdalofugal Toforebrain/nucleusbasalis:cognition,motivation
pathway(inmedial Tohypothalamus:homeostaticfunction,behavioralarousal
forebrainbundle) Tobrainstem:periacqueductalgray(pain),CNX,reticularformation

TableXI LimbicSystemDisorders L48Dr.Singh

Disorder Lesion Signs/Symptoms
KluverBucySyndrome Bilateraltemporallobelesionsaffectingamygdala Flattenedemotions,nofear,hyperorality,hypersexuality
TemporalLobeSeizures Electricaldisruptionsintemporallobe Dreamystate,olfactory/auditoryhallucinations,memoryloss
UncinateSeizures Electricaldisruptionsinuncus Dreamystate

byDMFA NervousSystemWrittenExamIIITables Page5

TableXII Arousal,Sleep,andAttention L50Dr.Forster
Activity CNSLocation Subunits Neurotransmitter Pathway Actions
Pedunculopontine&laterodorsaltegmentalnucleivia
IndirectSystem AcetylcholineviaGABA Wakefulness,forwardmotion
nucleusreticularis(NR)ofthalamus
Midbrainreticular
Arousal formation(MRF) DirectSystem
Histamine,NE,5HT Tuberomammillarynuc. (H1),locusceruleus(NE),raphe
Wakefulness,forwardmotion
(serotonin),ACh,Orexin nuclei(5HT),nucleusbasalis(ACh),lat.hypothal.(Orex.)
Enablingcircuit Orexin Lateralhypothalamicneurons Lesioncausesnarcolepsy
Hyperpol.thalamocortical tract
Inhibitsdirect(ACh)andindirect(aminergic)arousal
Ventrolateralpre HR,RR,BP,temp,
Direct&indirect H1antagonists(antihistamines)whichcrossBBBproduce
NREMSleep opticnucleus
arousalsystems
GABA,Histamine
sedation
metabolism,cortisol,thyroid
(VLPO) GH,testosterone,prolactin,
Tuberomammillarynucleus
insulin,glucose
Ventrolateralpre Coresubnucleus Histamine Tuberomammillarynucleus Switch betweenNREM/REM
REMSleep opticnucleus Extendedsubnuc. NE,5HT,ACh Locusceruleus(NE),raphenuc. (5HT),PPN&LDTN(ACh) InitiationofREM
(VLPO) Descending Glutamate Descendingspinalpathways Lossofmuscletone
Intentional Dorsolateralprefrontalcortex Conscious,deliberatefocusing
Cortex,superior
Attention colliculi
Reactive Parietalpolymodalassociationcortex(7) Shiftinattentionduetostimulus
Orientingresponse Frontaleyefields(8),superiorcolliculi Responsetoashiftinattention

CNSlocationsofarousalcenters CNSlocationsofsleepcenters EEGtracingsofsleep Humansleepcycle(7hof25hcycle)

TableXIII SleepandAttentionDisorders L50Dr.Forster

Disorder Signs/Symptoms Lesion
Fallsasleepatinappropriatetimes
Cataplexy(weaknessduringemotionalarousal) ComponentsofREMoccurinwrongcontextdueto
Narcolepsy Sleepparalysis,hypnopompic(endofsleep)hallucinations impairedfunctionoforexin
Vividdreamsathypnogogicstage(beginningofsleep)
Bodypain,irritability
Causedbysleepapneaandperiodiclimb
NonREMSleepDeprivation Memorydeficit,dizziness,clumsiness
movementsofsleep
Frequentawakening,difficultyfallingasleep
Hemianopsia,hemibodysensoryloss,hemiakinesia
HemispatialNeglect Severeimpairmentofintentional,reactive,andorientingresponse Largecontralateralhemisphericstroke
Normalfunctionofaffectedsideifbroughtintonormallyfunctioninghemispace

TableXIV NormalCNSAging L51Dr.Forster

Type Changes
15%lossofmass,wideningsulci,enlargementofventricles,arterialdisease
Cortical,hippocampalneuronnumberNOTreduced(exceptinsubiculumofhippocampus,50%)
Anatomical DendriticextentreducedinpyramidalandPurkinjecells(pictured)
Lipofuscinaccumulation(oxidativedamage,esp.inforebrain)
CerebellarPurkinjeneuronyoung(L)andaged(R)
protein,lipid(minimal),H2O(minimal),bloodflow,O2 consumption,neurotransmittersynthesis&release,signaltransduction
Physiological DNA(gliosis),Iron
Nochangeinreceptornumberorsensitivity
Mildtomoderatedeclineofrecentmemory,problemsolving,reactiontime,sensorimotorskills
Functional Normallyalleviatedbypractice,reductionoftimerequirements

TableXV CNSAgingDisorders L51Dr.Forster

Disorder Cause Signs/Symptoms
Dementia Various Lossofintellectualfunctionwithoutlossofconsciousness
WernickeKorsekoff VitaminB12deficiency Sensorydisturbancesduetodemyelination,numbness/tingling,disturbedcoordination
Progressivesubcorticaldementiaofwhitematterofcerebralhemispheres
SchildersDisease Demyelination
Cognitivedeficitsoftenimprovewithtime
Pickbodiesinfrontaland
PicksDisease Personalitydefectsearlyindisease;memoryandvisuospatialdeficitsoccurlater
temporallobes
Neuronalandsynapticloss:50%oflayerIIIcorticocorticalneurons,especiallyinentorhinal
cortex,hippocampus;occipitallobesspared
Possiblegeneticfactors:
Neurofibrillarytangles(NFTs):hyperphosphorylatedtaumicrotubuleprotein,destabilization
APPprocessing(Chr21) Neurofibrillarytangles
AlzheimersDisease Neuriticplaques(amyloidpeptide):accumulateinvessels,abnormalcleavageofAPP,a
ApolipoproteinE4(Chr19)
normallyfoundAtrophyofolfactorybulbandtracts
Presenilins1(Chr14)and2(Chr1)
Corticalatrophypronouncedinearlyonset,limbicatrophypronouncedmembraneproteinin
lateonset Neuriticplaque