Last Minute Review
Anatomy — Last Minute Review
Rapid Review
A last-minute review of high-yield anatomy facts for the RITE and board exams. Tables, key associations, and must-know one-liners — designed for a quick pass the night before.
Cranial Nerves — Master Table
| CN | Name | Type | Foramen | Key Fact |
|---|---|---|---|---|
| I | Olfactory | S | Cribriform plate | Only CN to bypass thalamus |
| II | Optic | S | Optic canal | Afferent limb of pupillary reflex |
| III | Oculomotor | M | SOF | Pupil-involving = compressive (PComm aneurysm) |
| IV | Trochlear | M | SOF | Only dorsal exit + decussates; longest intradural/cisternal course |
| V | Trigeminal | B | V1: SOF, V2: rotundum, V3: ovale | Corneal reflex afferent (V1) |
| VI | Abducens | M | SOF | Longest subarachnoid course; classic false-localizing nerve with ↑ ICP (stretched over petrous apex) |
| VII | Facial | B | IAM → stylomastoid | UMN = forehead spared; LMN = entire face |
| VIII | Vestibulocochlear | S | IAM | CPA schwannoma most common tumor |
| IX | Glossopharyngeal | B | Jugular foramen | Afferent of gag reflex; glossopharyngeal neuralgia |
| X | Vagus | B | Jugular foramen | Efferent of gag reflex; recurrent laryngeal → hoarseness |
| XI | Spinal accessory | M | Jugular foramen | SCM (turn head contralateral) + trapezius |
| XII | Hypoglossal | M | Hypoglossal canal | LMN: tongue deviates toward lesion |
Key Foramina & Contents
| Foramen | Contents |
|---|---|
| Cribriform plate | CN I (olfactory) |
| Optic canal | CN II, ophthalmic artery |
| Superior orbital fissure | CN III, IV, V1, VI; ophthalmic veins |
| Foramen rotundum | CN V2 |
| Foramen ovale | CN V3 |
| Foramen spinosum | Middle meningeal artery |
| Internal acoustic meatus | CN VII, VIII; labyrinthine artery |
| Jugular foramen | CN IX, X, XI; jugular vein |
| Hypoglossal canal | CN XII |
| Foramen magnum | Spinal cord, vertebral arteries, CN XI (ascending) |
Brainstem Syndromes
| Syndrome | Level | Structure | Findings |
|---|---|---|---|
| Weber | Midbrain | Cerebral peduncle + CN III | Ipsi CN III palsy + contra hemiparesis |
| Benedikt | Midbrain | Red nucleus + CN III | Ipsi CN III + contra tremor/ataxia |
| Claude | Midbrain | Red nucleus + SCP + CN III | Ipsi CN III + contra ataxia |
| Parinaud | Dorsal midbrain | Pretectal area | Upgaze palsy, light-near dissociation, convergence-retraction nystagmus |
| Millard-Gubler | Pons | Base of pons + CN VI, VII | Ipsi CN VI + VII + contra hemiparesis |
| Foville | Pons | PPRF/CN VI + CN VII | Ipsi lateral gaze palsy + facial palsy + contra hemiparesis |
| Locked-in | Pons (ventral) | Bilateral basis pontis | Quadriplegia, anarthria; vertical eye movement preserved |
| Wallenberg | Lateral medulla | PICA territory | Ipsi: Horner, face pain/temp loss, ataxia, IX/X; Contra: body pain/temp loss |
| Dejerine | Medial medulla | ASA → pyramid, ML, CN XII | Ipsi tongue deviation + contra hemiparesis + contra proprioception loss |
Vascular Territories — Artery → Deficit
| Artery | Territory | Classic Deficit |
|---|---|---|
| ACA | Medial frontal/parietal | Contra leg > arm weakness; abulia; urinary incontinence |
| MCA superior | Lateral frontal | Contra face/arm > leg weakness; Broca aphasia (dominant) |
| MCA inferior | Lateral temporal/parietal | Wernicke aphasia (dominant); neglect (non-dominant) |
| MCA lenticulostriates | Basal ganglia, internal capsule | Pure motor hemiparesis; most common lacunar location |
| PCA | Occipital, medial temporal | Contra homonymous hemianopia with macular sparing |
| PICA | Lateral medulla, inf cerebellum | Wallenberg syndrome |
| AICA | Lateral pons, ant cerebellum | Ipsi hearing loss + facial palsy + ataxia + Horner |
| SCA | Superior cerebellum | Ipsi ataxia + contra pain/temp loss; dentate nucleus |
| Basilar tip | Midbrain, thalamus, PCA | "Top of the basilar": coma, visual, behavioral changes |
| Anterior choroidal | Posterior limb IC, optic tract, hippocampus | Contra hemiparesis + hemianopia + hemisensory loss |
| Heubner (recurrent) | Head of caudate, anterior IC | Contralateral face/arm weakness; behavioral changes |
| ACA–MCA watershed | Border zone (superior frontal) | "Man in a barrel" — bilateral proximal arm weakness |
| MCA–PCA watershed | Parieto-occipital border | Transcortical aphasia; visual processing deficits |
Cortical & Neurobehavioral Syndromes
| Syndrome | Key Features | Lesion Location |
|---|---|---|
| Aphasias | ||
| Broca | Non-fluent, impaired repetition, preserved comprehension | Dominant inferior frontal (area 44/45) |
| Wernicke | Fluent, impaired comprehension and repetition | Dominant superior temporal (area 22) |
| Conduction | Fluent, preserved comprehension, impaired repetition | Arcuate fasciculus |
| Global | Non-fluent, impaired comprehension and repetition | Large dominant MCA territory |
| Transcortical motor | Non-fluent, intact repetition | Anterior/superior to Broca (ACA watershed) |
| Transcortical sensory | Fluent, intact repetition, impaired comprehension | Posterior to Wernicke (PCA watershed) |
| Mixed transcortical | Non-fluent, impaired comprehension, intact repetition (echolalia) | Bilateral watershed (isolation of perisylvian) |
| Parietal Syndromes | ||
| Gerstmann | Agraphia, acalculia, finger agnosia, left-right confusion | Dominant angular gyrus |
| Hemispatial neglect | Unaware of contralateral space; extinction on double simultaneous stimulation | Non-dominant (R) parietal — inferior parietal lobule |
| Anosognosia | Unaware of own deficit (e.g., denies hemiparesis) | Non-dominant (R) parietal |
| Asomatognosia | Unawareness or denial of body part ownership | Non-dominant (R) parietal |
| Ideomotor apraxia | Cannot pantomime on command; can imitate and use objects | Dominant parietal (supramarginal gyrus) or premotor |
| Ideational apraxia | Cannot sequence multi-step tasks (e.g., making tea) | Dominant parietal; also seen in diffuse disease |
| Constructional apraxia | Cannot copy or draw shapes/figures | Non-dominant (R) parietal |
| Dressing apraxia | Cannot orient clothing to body | Non-dominant (R) parietal |
| Visual & Occipital Syndromes | ||
| Anton | Cortical blindness with denial of visual loss | Bilateral occipital (PCA) |
| Balint | Simultagnosia, optic ataxia, ocular apraxia | Bilateral parieto-occipital |
| Prosopagnosia | Cannot recognize familiar faces; can identify by voice | Bilateral (or R) fusiform gyrus |
| Achromatopsia | Loss of color perception (cortical) | Bilateral ventral occipitotemporal (V4) |
| Visual agnosia | Cannot recognize objects by sight; can identify by touch | Bilateral occipitotemporal |
| Alexia without agraphia | Cannot read but can write; disconnection syndrome | L occipital + splenium of corpus callosum (PCA) |
| Frontal Syndromes | ||
| Abulia | Lack of will/initiative; reduced spontaneous behavior | Medial frontal / ACA territory |
| Akinetic mutism | Alert-appearing but no speech or movement; extreme abulia | Bilateral medial frontal (ACA) or bilateral thalamic |
| Alien hand | Involuntary purposeful hand movements; intermanual conflict | Corpus callosum (callosal type) or SMA / medial frontal (frontal type) |
| Utilization behavior | Compulsively uses objects placed in hand | Bilateral frontal (medial/orbitofrontal) |
| Witzelsucht | Inappropriate joking, disinhibition, poor social judgment | Orbitofrontal cortex (R > L) |
| Bruns ataxia | Gait apraxia — "magnetic gait," freezing | Bilateral frontal (NPH, frontal lobe lesions) |
| Temporal & Limbic Syndromes | ||
| Klüver-Bucy | Hyperphagia, hypersexuality, hyperorality, visual agnosia, placidity | Bilateral amygdala / anterior temporal tips |
| Pure word deafness | Cannot comprehend speech; can read, write, and hear non-verbal sounds | Bilateral superior temporal (auditory cortex) |
| Amnesia (anterograde) | Cannot form new memories; remote memory intact | Bilateral hippocampi or bilateral medial thalamus (Papez circuit) |
| Capgras | Believes familiar person replaced by identical imposter | R hemisphere (bifrontal, temporal disconnect) |
| Reduplicative paramnesia | Believes a place has been duplicated or relocated | R hemisphere (frontal + parietal) |
| Disconnection Syndromes | ||
| Callosal disconnection | Left hand agraphia, left hand anomia, alien hand | Corpus callosum |
| Alexia without agraphia | Cannot read; can write (see above) | L occipital + splenium |
| Conduction aphasia | Impaired repetition with fluent speech (see above) | Arcuate fasciculus disconnection |
Visual Pathway — Lesion → Field Deficit
| Lesion Site | Visual Field Defect | Key Feature |
|---|---|---|
| Optic nerve | Monocular blindness (ipsi) | Afferent pupillary defect (RAPD) |
| Optic chiasm | Bitemporal hemianopia | Pituitary adenoma classic |
| Optic tract | Contra homonymous hemianopia | Incongruent; RAPD contralateral to lesion |
| LGN | Contra homonymous hemianopia | Dual blood supply (PCA + anterior choroidal) |
| Temporal radiations (Meyer loop) | Contra superior quadrantanopia ("pie in the sky") | MCA territory |
| Parietal radiations | Contra inferior quadrantanopia ("pie on the floor") | MCA territory |
| Occipital cortex | Contra homonymous hemianopia | Macular sparing (bilateral cortical representation + large macular cortical magnification; classical dual PCA/MCA blood-supply teaching is not well supported); most congruent |
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