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The lateral and medial segments of the globus pallidus 78 Internal Morphology of the Brain in Slices and MRI Hypothalamus (HyTh) Anterior cerebral arteries (ACA) Head of Lamina terminalis caudate nucleus Third ventricle (ThrVen) Nucleus accumbens Optic tract (OpTr) Anterior perforated substance Uncus Crus cerebri (CC) Amygdaloid nuclear complex Inferior horn of lateral ventricle (IHLatVen) Mammillary body (MB) Interpeduncular Hippocampal fossa (IPF) formation Lateral geniculate Substantia nucleus nigra (SN) Tail of caudate nucleus Decussation of superior Hippocampal formation (Hip) cerebellar peduncle Choroid plexus in inferior horn Inferior colliculus (IC) Periaqueductal gray Cerebellum (Cbl) Cerebral Aqueduct (CA) ACA OpTr ThrVen HyTh ThrVen Un MB CC SN IPF IHLatVen Hip CA IC Posterior cerebral artery Posterior horn lateral ventricle Cbl 4-14 Ventral surface of an axial section of brain through the hypo- planes and show many of the structures identified in the brain slice 50mg dramamine with mastercard. The three MRI images (inverted inversion For details of the cerebellum see Figures 2-31 to 2-33 on pp. Axial Brain Slice—MRI Correlation 81 Basilar artery Basilar pons Anterior median fissure (AMF) Pyramid (Py) Preolivary sulcus (PreOIS) Olivary eminence (OlEm) Vestibulocochlear nerve Vagus and glossopharyngeal nerves Retroolivary sulcus (Postolivary sulcus) (PoOIS) Restiform body (RB) Medial lemniscus Tonsil of cerebellum (TCbl) Hemisphere of posterior lobe Fourth ventricle (ForVen) of cerebellum (HCbl) Vermis of posterior lobe of cerebellum (VCbl) AMF Py PreOlS OlEm PoOlS RB TCbl TCbl ForVen HCbl VCbl OlEm Lesion-Lateral medullary syndrome RB ForVen 4-17 Ventral surface of an axial section of brain through portions of show many of the structures identified in the brain slice. Note the lateral the medulla oblongata, just caudal to the pons–medulla junction and the medullary lesion (lower), also known as the posterior inferior artery posterior lobe of the cerebellum. The three MRI images (T1-weighted— syndrome or the lateral medullary syndrome (of Wallenberg). For de- upper left and right; T2-weighted—lower) are at the same plane and tails of the cerebellum see Figures 2-31 to 2-33 on pp. CHAPTER 5 Internal Morphology of the Spinal Cord and Brain in Stained Sections Basic concepts that are essential when one is initially learning how and the lateral corticospinal tract (grey). In the brainstem, these to diagnose the neurologically impaired patient include 1) an un- spinal tracts are joined by the spinal trigeminal tract and ventral derstanding of cranial nerve nuclei and 2) how these structures re- trigeminothalamic fibers (both are light green). The importance of these relationships is clearly color-coded on one side only, to emphasize 1) laterality of function seen in the combinations of deficits that generally characterize le- and dysfunction, 2) points at which fibers in these tracts may de- sions at different levels of the neuraxis. First, deficits of only the cussate, and 3) the relationship of these tracts to cranial nerves. This key identifies the var- the same, or opposite, sides are indicative of spinal cord lesions ious tracts and nuclei by their color and specifies the function of (e. This approach not only emphasizes istically have motor and sensory levels; these are the lowest functional anatomical and clinical concepts, but also lends itself to a variety levels remaining in the compromised patient. In these examples cranial nerve signs are better localizing and CT (myelogram/cisternogram) images are introduced into signs than are long tract signs. A localizing sign can be defined as an the spinal cord and brainstem sections of this chapter (see also objective neurologic abnormality that correlates with a lesion (or Chapter 1). To show the relationship between basic anatomy and lesions) at a specific neuroanatomical location (or locations). This continuum of visual information consists of (1) a small ver- Color Coded Cranial Nerve Nuclei and Long Tracts: sion of the colorized line drawing in an Anatomical Orientation, Cranial nerve nuclei are coded by their function: pink, sensory; (2) a top-to-bottom flip of this illustration that brings it into a red, motor.

The extent of the tions associated with spinal cord injury is risk is related to the level of injury generic 50 mg dramamine. In gen- pressure sores (decubitus ulcers), which eral, the higher the level of injury, the result from lack of blood supply to a body greater the risk of developing secondary pressure point, such as the buttocks, sac- disabling conditions. Pressure sores develop ative that individuals with spinal cord when continuous pressure is exerted to a injuries, family members, and profes- body part over time (Pires & Adkins, 1996; sionals working with them are aware of Woolsey & McGarry, 1991). Pressure on a the risk and use prevention strategies to body part interferes with blood supply, lessen the risk. Because individu- Altered Symptoms of Illness als with spinal cord injury are often immobile, areas of pressure on certain Because of the lack of sensation that bony prominences are more likely to accompanies most spinal cord injuries, as develop. Since these individuals usually well as the interruption to nerve path- have no sensation below the level of ways, symptoms of various conditions un- injury, they are unable to feel pressure, 82 CHAPTER 3 CONDITIONS OF THE NERVOUS SYSTEM: PART II and because of the paralysis they are urine and prevent incontinence. The unable to easily shift their weight to bladder and its contents normally contain relieve the pressure. Inadequate skin care, no pathologic organisms, but there is irritation, and nutritional deficiency can always the potential for the introduction further contribute to the development of of infectious organisms when a catheter is the problem. For individuals with spinal cord be small on the surface, but the depth of injury, urinary tract infections can be a the ulcer may be more extensive. Un- serious, debilitating, and, at times, life- treated pressure sores can progress from threatening problem. Untreated urinary redness to breakdown of the skin, infec- tract infection can lead to pyelonephri- tion, and eventually death (necrosis) of tis (infection of the kidney) and, in skin tissue, which could extend through severe cases, septicemia (infection in the the tissue all the way to the bone. As a consequence, the risk of de- must be aware of the risk of pressure sores veloping kidney stones (renal calculi) is and the importance of monitoring their increased.

When disease or disability results in altered bowel control dramamine 50 mg online, incontinence may become as devastating a problem as the disease itself. Control of incontinence and prevention of constipation and diarrhea are possible through an effective bowel program, which requires a knowledge of normal and altered bowel physiology as well as an in-depth assessment of bowel function. The lower bowel acts under voluntary control to store and eliminate feces. Inability to store fecal matter causes problems with involuntary bowel or incontinence. The bowel consists of three separate parts: the ileum, the cecum, and the colon. It is approximately 12 feet long and extends from the jejunum to the ileocecal opening. Almost all absorption and digestion is accomplished in the small intestine. The small intestine absorbs water and sodium and secretes mucus, potassium, and bicarbonate for stool formation. The cecum is 6 cm in length and lies below the terminal ileum, forming the first part of the large intestine. The colon is the division of the large intestine that extends from the cecum to the rectum. In the colon, fluids and electrolytes are reabsorbed and feces are stored so that defecation can occur at an acceptable time. Defecation is affected by peristalsis, anorectal sensory aware- ness, anal sphincter function, and abdominal muscle func- tion and strength.

Radiology 193:441-446 imaging study Radiology 177:83-88 Moulopoulos LA buy cheap dramamine 50 mg, Dimopoulos MA, Weber D, Fuller L, Libshitz Baur A, Stabler A, Bartl R, Lamerz R, Scheidler J, Reiser MF HI, Alexanian R (1993) Magnetic resonance imaging in the (1997) MRI gadolinium enhancement of bone marrow: age-re- staging of solitary plasmacytoma of bone. J Clin Oncol lated changes in normals and in diffuse neoplastic infiltration. Radiology sis in MR imaging of multiple myeloma: assessment of fo- 183:47-51 cal and diffuse growth patterns in marrow correlated with Moore SG, Bisset GS, 3d, Siegel MJ, Donaldson JS (1991) Pediatric biopsies and survival rates. Radiology 179:345-360 1036 Hajek PC, Baker LL, Goobar JE, Sartoris DJ, Hesselink JR, Vande Berg BC, Lecouvet FE, Michaux L et al (1996) Stage I mul- Haghighi P, Resnick D (1987) Focal fat deposition in axial tiple myeloma: value of MR imaging of the bone marrow in bone marrow: MR characteristics. Radiology 201:243-246 Abnormal Bone Marrow Lymphoma Steiner RM, Mitchell DG, Rao VM, Murphy S, Rifkin MD, Burk Parker BR, Marglin S, Castellino RA (1980) Skeletal manifesta- DL Jr. Magn Reson Q 6:17-34 Hoane BR, Shields AF, Porter BA Shulman HM (1991) Steiner RM, Mitchell DG, Rao VM, Schweitzer ME (1993) Detection of lymphomatous bone marrow involvement with Magnetic resonance imaging of diffuse bone marrow disease. Blood 78:728- Radiol Clin North Am 31:383-409 738 Vande Berg BC, Malghem J, Lecouvet FE Maldague BE (1998) Rodriguez M (1998) Computed tomography, magnetic resonance Classification and detection of bone marrow lesions with mag- imaging and positron emission tomography in non-Hodgkin’s netic resonance imaging. Stäbler Department of Radiology, Orthopaedic Clinic München Harlaching, München, Germany Introduction Bone marrow imaging is part of various muskuloskeletal diagnosic tasks including detection and staging of diseases originating in the bone marrow like multiple myeloma, lymphoma, leukaemia and myeloproliferative disorders, imaging of secondary bone marrow involvement (metasta- sis) in malignant diseases and reactive bone marrow changes due to stress or trauma of bones and joints. Non- neoplastic reasons for changes of bone marrow cellularity are marrow reconversion, which can be caused by various diseases including haemolytic anemias, chronic infection, smoking, and menstruation. These reactive changes must be differentiated from diffuse malignant bone marrow in- filtration. Adult pattern of red and marrow is related to pathologic load to bone and joints. Of all the imaging methods used to image bone mar- Cellular (red) marrow in the row, such as projection radiography, computed tomogra- adult is confined to the spine, the ribs, proximal femurs and phy (CT), magnetic resonance (MR) imaging, bone humeri, and the skull (dark). Both, celluarity and interposition of water is visu- The primary biochemical difference between red and alized in demonstration of differencies in the fat-water ra- yellow marrow is the water content or the fat/water ratio tio, as hematopoetic and malignant cells consist mainly (Table 1). Following the skin, the spongious and compact of water whereas fat cells contain mainly fat.