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Visual Cortex Primary Visual corTex the primary visual or striate cortex (Brodmann area 17) is the principal cortical area for visual perception diabetes and erectile dysfunction health effective kamagra 50 mg, integration erectile dysfunction statin drugs buy kamagra 100 mg with amex, and formation of a binocular image. It is mainly confined medially to the banks of the calcarine fissure, although part of this cortex also extends slightly around the occipital pole to the lateral surface. The six-layer organization of the visual cortex is discussed in detail in Chapter 8. Due to this precise connection, a small lesion in the visual cortex may result in scotoma Visual System 337 (focal blindness). Area 17 includes portions of the lingual and cuneate gyri, extending to the lateral surface of the occipital lobe. It consists of a very thin granular cortex, in which layer lV is divided into densely packed upper and lower sublayers and a lighter middle layer with fewer small cells between the giant stellate cells. The light middle layer has a thickened outer myelin-rich band, is visible to the naked eye in sections of the fresh brain, and is known as the band of Gennari. The interconnection between area 17 of both cerebral hemispheres is not well developed. Bilateral destruction of the occipital poles, on the other hand, markedly impairs the ability to clearly and accurately observe visual fields. Occlusion of one eye during postnatal development may permanently hinder growth of the associated column. The orientation columns are smaller than the dominance columns and extend from the white matter to the pial surface of the cerebral cortex. They contain cells that possess the same receptive field axis of orientation and have "on" and "off" centers. The visual cortex is primarily supplied by the calcarine branch of the posterior cerebral artery, although the middle cerebral artery also contributes through its anastomotic connections. Macular sparing a phenomenon in which a lesion involving the occipital lobe or occipital pole results a visual defect that spares central vision. Macular sparing is seen with cortical blindness, accompanied by contralateral incongruous homonymous hemianopsia. Dark bars against a light background, and straight edges separating areas of different degrees of brightness effectively stimulate the visual cortex. The primary visual cortex consists of functional units that are arranged in columns of cells exhibiting different receptive fields. These functional units include the ocular dominance and orientation columns that are arranged perpendicular to the cortical surface. The ocular dominance columns, partially formed at birth, which run at a right angle to the cortical surface, receive visual input from both eyes. However, they are arranged in such a manner that the visual input to a cortical column is only derived from one eye (dominant). The close proximity of the ocular dominance columns of the right and left eyes renders selective disruption of the input from a single eye very difficult. However, no ocular dominance columns exist in the parts Amblyopia (lazy eye) is a disorder that develops from a prolonged suppression of an image in one eye between the second and fourth years of life. It may be the result of congenital strabismus and the inadequate stimulation of one eye by visual image. It occurs in children who exhibit diplopia as a sequel to functional imbalance between the extraocular muscles and subsequent attempts to eliminate the image in one eye by constantly utilizing the other eye. As the cross-eyed child favors one eye over another, the unused eye eventually loses visual acuity and may permanently be blind. In this condition, no deficits are recorded in the refractive media or ocular apparatus. This condition may be associated with damage to the optic nerves and bilateral scotoma. Transient occlusion of the vertebral arteries on both sides, which may occur as a result of cervical spondylosis and subsequent narrowing of the transverse foramina, may dramatically reduce the blood flow in the labyrinthine and posterior cerebral arteries. A patient with this condition may experience vertigo and transient blindness, which last for few seconds, without remembering that these disorders ever have happened. Patients have normal and reactive pupils but may show indifference or pay no attention to half of 338 Neuroanatomical Basis of Clinical Neurology the visual field of the affected side.

The olfactory nerves divide in OlfactOry Nerve the olfactory nerve or olfactory filaments represent the central processes of the bipolar neurons located in the olfactory mucosa of the superior nasal concha and the corresponding part of the nasal septum impotence of organic origin 60784 order genuine kamagra on line. They are enclosed by glial cells erectile dysfunction treatment medications generic 100mg kamagra mastercard, form medial and lateral fasciculi, and enter the olfactory bulb in the anterior cranial fossa by traversing the cribriform plate of the ethmoid bone. Tufted cells with few granule cell bodies and axons as well as collaterals of the mitral cells constitute a separate layer known as the internal plexiform layer. The olfactory synaptic glomeruli are formed by the dendrites of the mitral, internal tufted, and periglomerular cells as well as axons of the mitral cells. The olfactory bulb acts as a relay, integration, and feedback center for complex pathways. These neurons receive axonal collaterals of mitral and tufted cells and provide recurrent collaterals to synapse with the dendrites of the ipsilateral tufted and granule cells. Efferents of the olfactory bulb are formed mainly by the axons of the mitral and tufted cells. Axons of the mitral cells form the bulk of the olfactory tract, giving rise to recurrent collaterals that diffuse in the granule cell and internal plexiform layers. Through this arrangement, the mitral cells can influence olfactory input through the glomeruli in the superficial layer and modulate output in the deep layers. It is presumed that glutamate and aspartate are utilized as neurotransmitters in the connections of the dendrites and axons of the mitral and tufted cells. Despite the morphological similarities of the mitral and tufted cells, the presence of certain characteristics enabled the categorization of the tufted cells into the external, middle, and internal groups of cells. Those cells that are located in close proximity to and Olfactory System 381 Left cerebral hemisphere Right cerebral hemisphere Temporal cortex Anterior commissure Nucleus accumbens septi Enthorhinal cortex Anterior perforated substance Anterior olfactory nucleus Prepyriform cortex Olfactory bulb Olfactory tubercle Diagonal band of Broca O. Observe the identical structures in both hemispheres connected by this resemble the mitral cells form the internal tufted cells. In view of their number and axonal contribution to olfactory tract, the middle tufted cells are considered the main group of tufted cells that provide axons to the olfactory tract, with collaterals to the internal plexiform layer and dendritic branches that join the olfactory glomeruli. This selectivity of connection extends to the granule cells, which differentially influence the output of the mitral and tufted cells. Through their extensive connections with the mitral and tufted cells and terminals of afferents, the spines of the granule cell dendrites are considered important sites where olfactory input is regulated. Those granule cells that are positioned between the superficial and deep groups remain within the confines of the same layer, unable to project dendritic processes to the adjacent parts of the olfactory bulb. Within the olfactory glomeruli, their dendrites connect with the dendrites of the mitral and tufted cells as well as with the terminals of the olfactory filaments, whereas their short axons extend outside the glomerulus and establish interglomerular connection, enabling activities within one glomerulus to affect the output of neighboring glomeruli. The olfactory glomerulus is a site of excitatory and inhibitory axodendritic synaptic connection of the olfactory nerve axon with the dendrite of the mitral, tufted, and periglomerular cells as well as dendrodendritic synapses 382 Neuroanatomical Basis of Clinical Neurology involving the mitral, tufted, and periglomerular cells. The synaptic linkage between the granule cell on one hand and the mitral/tufted cell on the other hand is thought to be inhibitory, a fact that may account for the inhibitory control of this connection on the olfactory bulb output. In contrast, the synapse between the mitral/tufted cell and the granule cell appears to be excitatory. The synaptic connectivity within these glomeruli continues to maintain specificity despite the continued production of new receptor cells and elimination of the degenerated cells. Serotonergic fibers that emanate from the mesencephalic raphe nuclei enhance the centrifugal influence of the glomeruli on the processing of olfactory information. It crosses the lamina terminalis and divides the fornix into precommissural and postcommissural columns. The granule and tufted cells activate other parts of the olfactory system through this connection. These axons act as a feedback loop, representing an efferent system that regulates the incoming olfactory pathways. The larger, posterior bundle courses inferior to the lenticular nucleus, running through the external capsule and terminating in the anterior temporal and parahippocampal gyri. It is a trilaminar structure that receives afferents from the dorsomedial nucleus of the thalamus and establishes reciprocal connection with the amygdala, while efferents project to the entorhinal area, hippocampal formation, and septal area via the medial forebrain bundle and stria medullaris thalami. As the lateral olfactory stria continues with the semilunar gyrus at the rostral end of the uncus, it is covered by the lateral olfactory gyrus that blends with the gyrus ambiens of the limen insulae, forming the prepiriform cortex that further continues caudally with the entorhinal areas (Brodmann area 28). The entorhinal area and prepiriform and periamygdaloid cortices form the piriform lobe, which lies medial to the rhinal sulcus. The medial olfactory stria runs anterior to the lamina terminalis, accompanied by the diagonal band of Broca, terminating ipsilaterally in the paraterminal (septal area) and subcallosal (parolfactory) gyri.

The basolateral complex is considered a cortical structure that maintains connections with the temporal lobe and other neocortical areas such as the precentral and postcentral gyri but lacks the laminar organization erectile dysfunction treatment in tampa cheap kamagra 100mg otc. It consists of the lateral erectile dysfunction medicine in pakistan order 100mg kamagra with visa, basal, and accessory basal nuclei, whereas the corticomedial subdivision is regarded to have central, medial, and cortical nuclei. The lateral nucleus is the largest component that lies ventrolateral to the basal nucleus. The basal nucleus is composed of the dorsal magnocellular, intermediate parvicellular, and paralaminar nuclei. The accessory basal nucleus lies medial to the basal nucleus and is divided into ventral, parvicellular, and dorsal magnocellular parts. The basolateral nuclear complex is a polymodal cortical structure that maintains direct and often reciprocal connections with areas of the cerebral cortex and thalamus, as well as unidirectional projections to the motor and premotor cortices. Excitatory amino acid neurotransmitters such as aspartate and glutamate are also used by this nuclear subdivision. The lateral nucleus, the largest subdivision, lies ventrolateral to the basal nucleus. The basal nucleus consists of dorsal magnocellular, intermediate parvicellular, and paralaminar subnuclei. The accessory basal nucleus located medial to the basal nucleus consists of similar subdivisions to that of the basal nucleus. Dopaminergic projections from the midbrain ventral tegmental area (A10) are mainly received by the lateral and central nuclei and the parvicellular part of the basal nucleus. Dense cholinergic projections from the magnocellular division of nucleus basalis of Mynert reach the basal and parvicellular accessory basal nuclei. This subdivision contains the highest concentration of opiate receptors in the entire brain, which may be activated under stressful situation. The corticomedial nuclear complex consists of the central, medial, and cortical nuclei as well as the associated subnuclei including the periamygdaloid nucleus. The central nucleus, which divides into medial and lateral parts, is located dorsomedial to the basal nucleus, adjacent to the putamen, occupying the caudal portion of the amygdaloid nuclear complex. Extension of the central and medial nucleus with the bed nucleus of the stria terminalis, component of the substantia innominate inferior to the lentiform nucleus and basal forebrain, constitutes the "extended amygdala. The central and medial nuclei are considered by some as an extension of the basal nuclei. The central nucleus lies dorsal and medial to the basal nucleus, and together with the medial nucleus, it merges with the bed nucleus of stria terminalis and periamygdaloid cortex, forming the centromedial amygdaloid nuclear complex. It retains chemical and cellular continuity with the bed nucleus via the stria terminalis and the sublenticular basal forebrain. The central nucleus projects to the periaqueductal gray matter, substantia nigra, ventral tegmental area, parabrachial nuclei, dorsal motor nucleus of vagus, and solitary nucleus. Projections to the central nucleus arise directly from the parabrachial, and many other nuclei convey their impulses to the central nucleus via the parabrachial nucleus. These connections account for the important role that amygdala plays in the regulation of cardiovascular, respiratory, and gustatory systems. The lateral, basal, and accessory basal nuclei project (not reciprocated) mainly to the magnocellular part of the dorsomedial thalamic nucleus that conveys impulses Limbic System 401 to the prefrontal cortex, enabling the amygdala to influence the activities of this part of the cerebral cortex. On the other hand, the central and medial amygdaloid nuclei maintain reciprocal connections with the midline thalamic nuclei. Some experimental data also suggest projections from the ventral posteromedial nucleus to the lateral nucleus of the amygdala. The paraventricular nucleus of hypothalamus sends oxytocin and vasopressin-immunoreactive terminals to the central amygdaloid nucleus. Vasopressin-immunoreactive neurons are also found in the medial nucleus, which also receives projections from the suprachiasmatic nucleus of hypothalamus. The medial and central nuclei contain -endorphin and enkephalin immunoreactive neurons.

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