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Aaron Rutman, MD Profile picture
@aaronrutman
Oct 30, 2020 • 5 tweets • 2 min read • Read on X
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Neuroanatomy TOTD #10🧵 
1/5 Small gray matter structure at the junction of the thalamus and midbrain is the subthalamic nucleus (STN).

#meded #FOAMed #FOAMrad #medtwitter #medstudents #radiology #neurorad #radres #neurology #neurosurgery #neuroanatomy #neuroanatomyTOTD Image
2/5...The STN is functionally a node within the basal ganglia (BG) INDIRECT LOOP. STN contains excitatory glutaminergic neuronsâžžoutput to the GABA neurons of GPi, which in turn have inhibitory effect on thalamic outputs to the motor cortex.
3/5...Loss of nigrostriatal input in Parkinsons Dzâžžincreased inhibitory output from GPiâžždecreased thalamic stimulation of the motor cortex (through both direct and indirect loop circuits). Makes sense that DBS treatments were initially directed at disrupting activity in GPi.
4/5...DBS treatments for PD are now more commonly directed at the STN, with similar resultsâžždecreased excitatory output to the GPi, and thus decreased inhibitory output to thalamusâžžincreased movement.
5/5...DBS tx for PD now more commonly directed at disruption of STN w/ similar resultsâžždecreased excitatory output to GPiâžždecreased inhibitory output to thalamusâžžincreased movement. DBS to the STN can also treat essential termor. Lesion/stroke involving STNâžž hemiballismus.

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More from @aaronrutman

Aaron Rutman, MD Profile picture
Dec 8, 2022
HYPOTHALAMUS (HT)🧵-the control center of circadian rhythm, fatigue/wakefulness, hunger/satiety, sex drive, thirst/BP—and the command post for endocrine control via the HT-pituitary axis.
#meded #neuroradiology #neuroscience #radiology #neurology #neurosurgery #neuroanatomy
1/28
Quiz A: Histamine activity in the brain/brainstem contributes to alertness/wakefulness–hence: sleepy effects of benadryl. Histaminergic neurosecretory cell bodies are exclusively in the tuberomammillary nucleus of the TUBER CINEREUM (HT floor), with widespread projections.
2/28
The HT is a mysterious and complex—I get confused sighs from medical students when the topic arises—the small almond-sized morsel is the control center for endocrine/hormone regulation, and homeostasis of food/water consumption, sleep, BP, sex/attachment. The HT is boss!
3/28
Read 29 tweets
Aaron Rutman, MD Profile picture
May 24, 2022
Pterygopalatine fossa🧵- inspired by ?s from med students in neuroanatomy lab & a resident w/ case of perineural tumor spread on same day! #meded #FOAMrad #medtwitter #medstudents #radiology #neurorad #HNrad #radres #neurology #ENT #temporalbone #neurosurgery #neuroanatomy
1/22
The PTERYGOPALATINE FOSSA (PPF) is a space deep in the face/skull base, bordered anteriorly by the maxilla (max sinus), posteriorly by the pterygoid base of the sphenoid, and medially by the perpendicular plate of the palatine bone. 2/22
It’s best to think of the PPF as a crossroads/intersection. Think about the roads that lead to and from it, and the cast of characters that pass through.

Some like to simplify/visualize the PPF as a cube or inverted pyramid.

3/22
Read 22 tweets
Aaron Rutman, MD Profile picture
Mar 6, 2021
Neuroanatomy TOTD #15🧵
The inner ear #tweetorial--it packs a large functional punch for its small size-strap in!
#meded #FOAMed #FOAMrad #medtwitter #medstudents #radiology #neurorad #HNrad #radres #neurology #ENT #temporalbone #neurosurgery #neuroanatomy #neuroanatomyTOTD
1/24
To evaluate the t-bone, best to compartmentalize--external/middle/inner ear (IE). See previous #tweetorial of the ME. The IE is difficult as most structures are obliquely oriented (at different obliquities!)-and can be hard to see on standard views. 2/24
IE communicates with ME via oval&round windows (which allow for transmission&dissipation of sonic vibrations). IE houses sensory organs for hearing/balance/sensing motion. The cochlear&vestibular nerves (CNVIII) transmit signals to the brain via the int auditory canal (IAC). 3/24
Read 25 tweets
Aaron Rutman, MD Profile picture
Jan 11, 2021
Neuroanatomy TOTD #14🧵
Got some requests to do one of the trickiest areas of human anatomy, the #temporalbone. So many named structures! #meded #FOAMed #FOAMrad #medtwitter #medstudents #radiology #neurorad #radres #neurosurgery #neuroanatomy #ENT #otolaryngology

1/21 Image
Whether learning t-bone anatomy as a medical student or evaluating a CT of the t-bone as a radres, it’s best to compartmentalize into external, middle, and inner ear. This thread🧵is on the middle ear: Inner ear to follow, some day:)

2/21 Image
The external ear extends from the external meatus to the TM. The TM should be thin and *almost* imperceptible on CT. Thickened and retracted TM suggests prior pathology (usually otitis media) and scarring.

3/21 Image
Read 22 tweets
Aaron Rutman, MD Profile picture
Dec 2, 2020
Neuroanatomy TOTD #12

The green structure is the amygdala (amygdaloid body) and the yellow structure is the stria terminalis (ST).

1/18

#meded #FOAMed #FOAMrad #medtwitter #medstudents #radiology #neurorad #radres #neurology #neurosurgery #neuroanatomy #neuroanatomyTOTD Image
Time for a deep dive into limbic networks. Bear with me—this is a fun subject. I got carried away preparing slides—it’s hard to know when to stop!

2/18
The amygdala is an almond-shaped collection of gray nuclei/subnuclei deep to the uncus and ant to hippocampus in the med temporal lobe. Involved in multiple functions: memory modulation, emotional learning and responses, +important connections w/ the olfactory bulb/cortex.

3/18 Image
Read 18 tweets
Aaron Rutman, MD Profile picture
Nov 15, 2020
Neuroanatomy TOTD #11🧵
➡️intracanalicular facial nerve. IAC cross section➡️4 nerves; ant-sup➡️facial, ant-inf➡️cochlear (7-up/coke-down). Post nerves➡️sup&inf vestibular #medtwitter #meded #FOAMed #FOAMrad #neurorad #radiology #radres #neurology #neurosurgery #neuroanatomy
1/11
Facial motor nucleus is in the pontine tegmentum; axons loop dorsally around the abducens nucleus, then course anterolaterally, exiting the brainstem at the CPA.
2/11
The nervus intermedius (NI) is composed of preganglionic parasympathetic fibers w/cell bodies in the sup salivatory nucleus, taste fibers w/cell bodies in the nucleus solitarius, and somatic sensory input from EAC/external ear, w/cell bodies in the spinal nucleus of CNV.

3/11
Read 11 tweets

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