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These fibers for coordinat- ing the eye movements are carried in the MLF buy generic grifulvin v 125mg on line. There is a “gaze center” within the pontine reticular VESTIBULAR NUCLEI AND EYE formation for saccadic eye movements order 125 mg grifulvin v with amex. These are MOVEMENTS extremely rapid (ballistic) movements of both eyes, yoked together, usually in the horizontal plane so that we can The vestibular system carries information about our posi- shift our focus extremely rapidly from one object to tion in relation to gravity and changes in that position. The fibers controlling this movement originate The sensory system is located in the inner ear and consists from the cortex, from the frontal eye field (see Figure of three semicircular canals and other sensory organs in 14A), and also likely course in the MLF. There is a peripheral ganglion (the spiral ganglion), and the central processes CLINICAL ASPECT of these cells, CN VIII, enter the brainstem at the cere- bellar-pontine angle, just above the cerebellar flocculus A not uncommon tumor, called an acoustic neuroma, can (see Figure 6, Figure 7, and Figure 8B). This is a slow-growing benign lar nuclei, which are located in the upper part of the tumor, composed of Schwann cells, the cell responsible medulla and lower pons: superior, lateral, medial, and for myelin in the peripheral nervous system. Initially, there inferior (see Figure 8B; also Figure 66C, Figure 67A, and will be a complaint of loss of hearing, or perhaps a ringing Figure 67B). The lateral vestibular nucleus gives rise to noise in the ear (called tinnitus). Because of its location, the lateral vestibulo-spinal tract (as described in the pre- as it grows it will begin to compress the adjacent nerves vious illustration; see also the following illustration). Eventually, if left unattended, there is the pathway that serves to adjust the postural muscula- would be additional symptoms due to further compression ture to changes in relation to gravity. The medial and inferior vestibular nuclei give rise Modern imaging techniques allow early detection of this to both ascending and descending fibers, which join a tumor. Surgical removal, though, still requires consider- conglomerate bundle called the medial longitudinal fas- able skill so as not to damage CN VIII itself (which would ciculus (MLF) (described more fully with the next illus- produce a loss of hearing), or CN VII (which would pro- tration). The descending fibers from the medial vestibular duce a paralysis of facial muscles) and adjacent neural nucleus, if considered separately, could be named the structures. This sys- tem is involved with postural adjustments to positional ADDITIONAL DETAIL changes, using the axial musculature. The ascending fibers adjust the position of the eyes There is a small nucleus in the periaqueductal gray region and coordinate eye movements of the two eyes by inter- of the midbrain that is associated with the visual system connecting the three cranial nerve nuclei involved in the and is involved in the coordination of eye and neck move- control of eye movements — CN III (oculomotor) in the ments. This nucleus is called the interstitial nucleus (of upper midbrain, CN IV (trochlear) in the lower midbrain, Cajal). This and CN VI (abducens) in the lower pons (see Figure 8A, nucleus (see also the next illustration) receives input from Figure 48, and also Figure 51B). If one considers lateral various sources and contributes fibers to the MLF. Some gaze, a movement of the eyes to the side (in the horizontal have named this pathway the interstitio-spinal “tract. Medial vestibulo-spinal tract (within MLF) Lateral vestibulo-spinal tract FIGURE 51A: Vestibular Nuclei and Eye Movements © 2006 by Taylor & Francis Group, LLC 140 Atlas of Functional Neutoanatomy FIGURE 51B tecto-spinal tract, are closely associated with the MLF and can be considered part of MEDIAL LONGITUDINAL this system (although in most books it is discussed separately). As shown in the upper FASCICULUS (MLF) inset, these fibers cross in the midbrain. Note the orien- • The small interstitial nucleus and its contri- tation of the spinal cord (with the ventral horn away from bution have already been noted and dis- the viewer). The MLF is a tract within the brainstem and upper spinal cord that links the visual world and vestibular events The lower inset shows the MLF in the ventral funic- with the movements of the eyes and the neck, as well as ulus (white matter) of the spinal cord, at the cervical level linking up the nuclei that are responsible for eye move- (see Figure 68 and Figure 69).

The results presented in this section clearly establish the fact that classical impact theory gives the limiting solution to the model equations as the impact time approaches zero buy 125 mg grifulvin v fast delivery. Moreover discount 125mg grifulvin v with amex, the results indicate inapplicability of the classical impact theory to practical situations where the impact time can range from 15 to 30 ms. Another problem associated with the application of the classical impact theory © 2001 by CRC Press LLC FIGURE 3. The result of the approximate solution (classical impact solution) is indicated by (·). It is shown here that impulse magnitude alone is not sufficient to assess the loading condition at the joint. In fact, such an indication can be quite misleading in that a higher impulse does not necessarily mean higher forces. Finally, the fact that ligament response is not instantaneous entails its exclusion from the classical impact theory, whereas real-time simulations have shown that the liga- ments are affected by the impact in comparable magnitudes with contact forces. In most situa- tions, the problem of determining forces, especially their distribution as contact forces between the tibia and femur (tibio-femoral forces), and between the femur and patella (patello-femoral forces) as well as related ligament and muscle forces, is extremely complex. In an Applied Mechanics Review article, Hefzy and Grood20 discussed both phenomenological and anatomically based models of the knee joint and stated, “To date, all anatomically based models consider only the tibio-femoral joint and neglect the patello-femoral joint, although it is an important part of the knee. Hirokawa’s three-dimensional model21 of the patello-femoral joint has some advanced features over the models of Van Eijden et al. In this section, patello-femoral and tibia-femoral contact forces exerted during kicking types of activities are presented by means of a dynamic model of the knee joint which includes tibio-femoral and patello-femoral articulations and the major ligaments of the joint. Major features of the model include two contact surfaces for each articulation, three muscle groups (quadriceps femoris, ham- strings, and gastrocnemius), and the primary ligaments (anterior cruciate, posterior cruciate, medial collateral, lateral collateral, and patellar ligaments). For a quantitative description of the model, as well as its mathematical formulation, three coordinate systems as shown in Fig. An inertial coordinate system (x, y) is attached to the fixed femur with the x axis directed along the anterior-posterior direction and the y axis coinciding with the femoral longitudinal axis. The moving coordinate system (u, v) is attached to the center of mass of the tibia in a similar fashion. The second moving coordinate system (p, q) is connected to the attachment of the quadriceps tendon, with its p axis directed toward the patella’s apex. Since we are dealing here with an anatomically based model of the knee joint, the femoral and tibial articulating surfaces as well as posterior aspect of the patella and intercondylar groove must be represented realistically. This is achieved by utilizing previously obtained polynomial functions. Equations of motion of the tibia can be written in terms of these three variables, along with the mass of the lower leg (m), its centroidal moment of inertia (I), the patellar ligament force (FP), the tibio-femoral contact force (N2), the hamstrings and gastrocnemius muscle forces (FH, FG), the weight of the lower leg (W), and any externally applied force on the lower leg (FE). The contact conditions at the tibio-femoral articulation and at the patello-femoral articulation are expressed as geometric compatibility and colinearity of the normals of the contact surfaces. The force coupling between the tibia and patella is accomplished by the patella ligament force FP. The model has three nonlinear differential equations of motion and eight nonlinear algebraic equations of constraint. The major task in the solution algorithm involves solution of the three nonlinear differential equations of the tibia motion along with three coupled nonlinear algebraic equations of constraint associated with the tibio-femoral articulation.

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The A closed head injury that affects the brain is one of the function of this cortical area has been somewhat in doubt most serious forms of accidents buy 125mg grifulvin v mastercard. It seems that this is the area responsible is a concussion buy grifulvin v 250mg free shipping, a bruising of the brain. There are various for receiving taste sensations, relayed from the brain- degrees of concussion depending upon the severity of the stem (see Figure 8B and Figure 67A). The effects vary from mild headache to uncon- our internal organs may reach the cortical level in this sciousness and may include some memory loss, usually area. Everything possible should be done to avoid a The specialized cortical gyri for hearing (audition) are brain injury, particularly when participating in sport activ- also to be found within the lateral fissure, but they are part ities. Proper headgear in the form of a helmet should be of the upper surface of the superior temporal gyrus (as worn by children and adults while cycling, skiing, snow- shown in Figure 38 and Figure 39). Closed head It should be noted that the lateral fissure has within it injuries occur most frequently with motor vehicle acci- a large number of blood vessels, which have been removed dents, and the use of seatbelts and proper seats for children —branches of the middle cerebral artery (discussed with reduces the risk. Branches to the interior of the brain, the striate © 2006 by Taylor & Francis Group, LLC Orientation 45 Central fissure Auditory gyri (transverse gyri Insula of Heschl) Lateral fissure (opened) FIGURE 14B: Cerebral Hemispheres 3 — The Insula (photograph) © 2006 by Taylor & Francis Group, LLC 46 Atlas of Functional Neutoanatomy FIGURE 15A CN I (see Figure 79). Olfactory information is then carried in the olfactory tract to various cortical and subcortical CEREBRAL HEMISPHERES 4 areas of the temporal lobe (discussed with Figure 79). The optic nerves (CN II) exit from the orbit and continue to the optic chiasm, where there is a partial crossing of visual CEREBRAL CORTEX: INFERIOR fibers, which then continue as the optic tract (see Figure (PHOTOGRAPHIC) VIEW WITH 41A). Posterior to the chiasm is the area of the hypothal- BRAINSTEM amus, part of the diencephalon, including the pituitary stalk and the mammillary bodies, which will be seen more This is a photographic view of the same brain seen from clearly in the next illustration. The medulla and pons, parts of the part of this brain from this inferior perspective. These brainstem can be identified (see Figure 6 and Figure 7), structures occupy the posterior cranial fossa of the skull. The cranial In fact, the cerebellum obscures the visualization of the nerves are still attached to the brainstem, and some of the occipital lobe (which is shown in the next photograph, arteries to the brain are also present. The frontal lobe occupies the anterior cranial fossa of Various cranial nerves can be identified as seen previously the skull. The inferior surface of the frontal lobe extends (see Figure 7). The oculomotor nerve, CN III, should be from the frontal pole to the anterior tip of the temporal noted as it exits from the midbrain; the slender trochlear lobe (and the beginning of the lateral fissure). This is association cortex and these specimen (the arterial supply is discussed with Figure gyri have strong connections with the limbic system (dis- 58–Figure 62). The initial part, vertebral arteries and the cussed in Section D). This lobe occupies the middle cranial fossa of the situated in front of the pons, ends by dividing into the skull. The temporal lobe extends medially toward the mid- posterior cerebral arteries to supply the occipital regions brain and ends in a blunt knob of tissue known as the of the brain. The cut end of the internal carotid artery is uncus. Moving laterally from the uncus, the first sulcus seen, but the remainder of the arterial circle of Willis is visible is the collateral sulcus/fissure (seen clearly on the not dissected on this specimen (see Figure 58); the arterial left side of this photograph). The parahippocampal supply to the cerebral hemispheres will be fully described gyrus is the gyurus medial to this sulcus; it is an extremely in Section C (see Figure 60 and Figure 61). It should be noted that the uncus is the most and diencephalon shown in Figure 7 was created by medial protrusion of this gyrus.

The scalene muscles are attached to the transverse processes 250mg grifulvin v overnight delivery. Two important structures are the longitudinal ligaments and the intervertebral discs cheap grifulvin v 125mg fast delivery. The laminae of the vertebral arches are connected by the ligamentum flavum. Rootlets of ventral and dorsal origin form roots (fusing in the intervertebral foramen). The dorsal root ganglia (DRG) lie just dorsal to the fusion. Dura and arachnoid extend around nerve roots into the intervertebral foramina as root pouches or sleeves. In the cervical spine, the nerve roots exit over the vertebral body and are numbered by the vertebral body beneath the root (e. C6 exits between C5–C6, the C8 root exits between C7 and T1). While the cervical roots exit horizontally, there is about a one segment difference (see Fig. Symptoms Classically, the patient with cervical disc rupture complains of neck, shoulder, and arm pain, with or without distally radiating paresthesias. Pain is described as radiating into the shoulder, periscapular, or pectoral regions, or the “whole” arm. C5/6 lesions tend to cause more shoulder pain than C7/8 lesions. Upper medial arm pain is characteristic of C7/8 lesions. Pain radiating into the scapula or interscapular regions points to C7/8. Sensory symptoms (paresthesia, dysesthesia or numbness) may occur in the nerve root distribution. Thumb and index finger are associated with C6; index and middle finger with C7; ring and little finger with C8. Pain quality: Lancinating, shooting, or radiating into an extremity, with a narrow spatial distribution (2 inches). Dull aching pain is constantly felt in surrounding structures. Signs Weakness, and later atrophy occurs in a myotomal distribution (caveat: pain may impede examination of muscle power). Correspondingly diminished or absent tendon reflexes. Reproduction of the patient’s pain on extension and ipsilateral rotation of the head (Spurling’s maneuver) is pathognomic for cervical root irritation and analogous to sciatica produced by straight leg raising with herniated lumbar discs. Neck movement may also produce paresthesias or radiating pain. Percussion or pressure on the spinous process of the affected vertebral body may induce segmental, shock like radiating pain (resembling Tinel’s phenome- non). Patients sit with head tilted away from the affected side and support the head with one hand. This position opens the foramen and alleviates the additional stretch to a compressed root by supporting the arm’s weight.

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