1. Incidental findings on brain MRI. Arrows indicate abnormalities.
Vernooij MW et al. (2007) NEJM 357:
Aneurysm of anterior communicating artery (6 mm diameter; proton-density–weighted axial image).
Tonsillar herniation (type I Chiari malformation) more than 5 mm below level of foramen magnum (T1-weighted sagittal image).
Typical vestibular schwannoma with extension into right internal auditory canal (proton-density–weighted axial image).
Large meningioma (T1-weighted axial image).
Large, chronic subdural hematoma (proton-density–weighted axial image).
Trigeminal schwannoma of the left fifth cranial nerve, with cystic degeneration(T1-weighted axial image).

2. Cranial Nerve and Reflex Testing
Cranial Nerve Exams
Notice:
3,4,6 versions, normal & abnormal1
3,4,6 ductions, abnormal2
Vestibulo-ocular normal (tests 3, 8)
12 normal, abnormal
Reflexes
Normal Babinski:
Normal Babinski (infant):
Positive Babinski (adult):
1. Versions: binocular tests, part of a regular exam. Pt. 1 can’t abduct L, i.e. n.6 (L) palsy. Pt.2 limited adduct, elevate, depress L eye, also shows ptosis & dilated pupil, i.e. n.3 (L) palsy.
2. Duction (monocular) tests done iff version results abnormal. Pt can’t medially rotate either eye.
Movies from the Neurologic Exam and PediNeurologic Exam websites by Paul D. Larsen, M.D., University of Nebraska Medical Center and Suzanne S. Stensaas, Ph.D., University of Utah School of Medicine. Additional materials for Neurologic Exam are drawn from resources provided by Alejandro Stern, Stern Foundation, Buenos Aires, Argentina; Kathleen Digre, M.D., University of Utah; and Daniel Jacobson, M.D., Marshfield Clinic, Wisconsin.

3. Anatomical basis of the ear-cough reflex
Posterior view of temporal bone
1 vagus nerve, 2 glossopharyngeal nerve, 3 facial nerve, 4 chorda tympani, 5 auricular branch of the vagus (Arnold's nerve), 6 anastomosis with auricular branch of the facial 7, 8 jugular vein, 9 internal carotid artery (reproduced from Tiedemans Z Schr Physiol, 1832)
F. Jegoux et al. (2002) Lancet 360: 618

4. Diagrammatic representation of Arnold's (ear-cough) reflex
D. Gupta et al. (1986) Surg Radiol Anat 8 :

5. Spontaneous Otogenic Pneumocephalus Healthy 54-year-old woman presented with abnormal acoustic sensations, aphasia, visual-field disturbances. She reported no head trauma. See notes.
healthy 54-year-old woman presented with progressive abnormal acoustic sensations, aphasia, and visual-field disturbances. She reported no head trauma or recent infection, such as otitis media. An initial cranial radiograph revealed air in the left temporal region without evidence of a fracture (Panel A, arrow). A computed tomographic scan of the head showed a large amount of air in the left temporal lobe; the involved area was approximately 4 cm by 3 cm by 5 cm (Panel B, arrow). This abnormality led to significant compression of the left lateral ventricle and the adjacent sulci and gyri; there was a midline shift, with signs of uncal herniation and slight brain-stem rotation. A left temporal craniotomy was performed, and a defect in the anterolateral surface of the mastoid was found and repaired. No specific underlying pathologic lesion — such as a tumor or infection — was identified. Pneumocephalus can occur after neurosurgical procedures, head and facial trauma, or ear infection and can even occur spontaneously, as in this patient. Although small amounts of air are usually reabsorbed without complications, in patients with increasing air entrapment, significant clinical sequelae may occur, as seen in this case. After surgical decompression, this patient's symptoms resolved immediately. Her postoperative course was uneventful, and she remains asymptomatic at 1 year.
Villa R.A., Capdevila A. N Engl J Med 2008;358:e13, March 20, 2008

6. The Brain on the Sistine Chapel Ceiling:
Does Michelangelo’s fresco include images of the human brain?
Meshberger, JAMA 264 (14): , 1990.
Suk & Tamargo, Neurosurgery 66: , 2010.

7. The Creation of Adam. Michelangelo, c. 1512.
Meshberger, JAMA 264 (14): , 1990.

8. Separation of Light From Darkness. Michelangelo, c. 1512.

9. Suk & Tamargo, Neurosurgery 66: 851-861, 2010.