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ganglionic structures and the funneling of efferent projections to the ventrolateral thalamus and then to the motor cortex, current evidence indicates an organization into several parallel basal ganglionic cortical circuits Although these circuits run parallel to the premotor or prepyramidal pathway, they remain separate from it anatomically and physiologically At least ve such circuits have been described, each projecting to a different portion of the frontal lobe: (1) the prototypical motor circuit, converging on the premotor cortex; (2) the oculomotor circuit, on the frontal eye elds; two prefrontal circuits, (3) one on the dorsolateral prefrontal and (4) another on the lateral orbitofrontal cortex; and (5) a limbic circuit that projects to the anterior cingulate and medial orbitofrontal cortex An additional and essential feature of basal ganglionic structure, also relatively recently appreciated, is the nonequivalence of all parts of the striatum Particular cell types and zones of cells within this structure appear to mediate different aspects of motor control and to utilize speci c neurochemical transmitters, as detailed below under Pharmacologic Considerations (see Albin et al and DeLong) This specialization has taken on further importance with the observation that one or another cell type is found to be destroyed preferentially in degenerative diseases such as Huntington chorea The most important basal ganglionic connections and circuitry are indicated in Figs 4-1, 4-2, and 4-3 Conventionally it has been taught that the striatum, mainly the putamen, is the receptive part of the basal ganglia, receiving topographically organized bers from all parts of the cerebral cortex and from the pars compacta (pigmented neurons) of the substantia nigra, and that the output nuclei of the basal ganglia consist of the medial (internal) pallidum and the pars reticulata (nonpigmented portion) of the substantia nigra (Fig 4-3) It has been proposed on the basis of physiologic, lesional, and pharmacologic studies that there are two main efferent projections from the putamen; but these models, being quite incomplete, should be viewed as provisional Nonetheless, there are reasons to conceptualize a direct efferent system from the putamen onto the medial (internal) pallidum and then onto the substantia nigra again, particularly to the pars reticulata (nonpigmented) cells, and an indirect system that traverses the lateral (external) pallidum and continues on to the subthalamic nucleus, with which it has strong to-and-fro connections In most ways, the subthalamic nucleus and lateral pallidum operate as a single functional unit (at least in terms of the effects of lesions in those locations on parkinsonian symptoms and the neurotransmitters involved; see further on) The medial pallidum and reticular part of the nigra can be viewed in a similar unitary way, sharing the same input and output patterns Within the indirect pathway, an internal loop is created by projections from the subthalamic nucleus to the medial segment of the pallidum and pars reticulata A second offshoot of the indirect pathway, recently uncovered, consists of projections from the lateral pallidum to the medial pallidonigral output nuclei These anatomic and physiologic concepts are continuously being revised on the basis of clinical and neurochemical observations As already mentioned, a complete account of this intricate connectivity cannot be given; but the main themes outlined here seem to have been accepted The relative importance of the direct and indirect pathways is being altered by recent experience, as discussed below From the internal pallidum, two bundles of bers reach the thalamus the ansa lenticularis and the fasciculus lenticularis The.

thickened membranes of subdural hematomas The neovascular response and brosis of the dura and meninges that result from low CSF pressures and give the same appearance as pachymeningitis on enhanced CT scans and MRI have been discussed earlier in the chapter

As you can see, this program allows us to migrate selectively based on filters, including by specific items, libraries, and roles, or by the All Items option The bottom section of this program is important identifying the behavior of the roles that are possibly assigned to

Although the ependyma may be involved as part of any chronic meningeal reaction, it may also be the site of a relatively isolated process In experimental animals, Johnson and colleagues found that the mumps virus could localize in and destroy ependymal cells This results in activation of subependymal astrocytes, which may bury the remaining ependymal cells and, by overgrowth, narrow the aqueduct of Sylvius Ependymitis with similar consequences may be the dominant change in infantile toxoplasmosis and cytomegalic encephalitis Spinal uid and meningeal reactions to degradation products released from tumors that are in contact with the cerebrospinal spaces, particularly dermoid and craniopharyngioma, are discussed in Chap 32 Hemosiderosis (Super cial Siderosis) of the Meninges Sometimes mistaken by neuropathologists for hemochromatosis, which has entirely different effects on the nervous system, hemosiderosis is clearly the consequence of repeated contamination of the menin-

ges by blood (McDougal and Adams; Fishman) An oozing vascular malformation or tumor has been the usual cause in our experience, although there have been instances in which the source of the blood could not be found The red blood corpuscles are phagocytosed, with the formation of hemosiderin, and gradually both iron pigment and ferritin are released into the CSF As a result, the surface of the cerebellum, spinal cord, hippocampi, and olfactory bulbs are stained orange-brown Iron pigments and ferritin, which are toxic, gradually diffuse through the pia into super cial parts of the cerebellum, eighth cranial nerve, and spinal cord, destroying nerve cells and exciting a glial reaction In microscopic sections stained for iron, the histiocyte-microglial cells contain iron and ferritin, and particles of iron can be seen studding nerve and glial cells for a distance of several millimeters beneath the pia The clinical syndrome of siderosis of the meninges consists essentially of a progressive ataxia and nerve deafness; sometimes a spastic paraparesis is added and, rarely, mental impairment The hemosiderin and iron-stained meninges are readily visualized by MRI, since iron is strongly paramagnetic All the iron-impregnated tissues are hypointense in T2-weighted images Koeppen and associates attributed the vunerability of the acoustic nerves to their extended meningeal exposure before acquiring a broblastic perineurium and epineurium There is no treatment other than nding the source of the meningeal blood and preventing further hemorrhage and treating hydrocephalus if it is present

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