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About half of the patients improve on individual treatment regimens and acquire different degrees of motor and psychosocial skills. In infants and children, continuous provision of carbohydrate by the nasogastric route may be required to maintain euglycaemia. Therefore, it is important to consider the application of a stroke assessment tool to 328 Stroke Risk Factors quantify risk and to trigger effective prevention measures at the individual patient level. Information about visceral pain ascends the spinal cord in two pathways: the well-established spinothalamic pathway located in the contralateral ventral quadrant of the spinal cord and a relatively recently discovered pathway that ascends the spinal cord in the ipsilateral dorsal columns to the brainstem, where after synapsing in nucleus gracilis or nucleus cuneatus, it crosses the contralateral side. Vagal afferents utilize L-glutamate as well as several neuropeptides including substance P and calcitonin gene related peptide. There are typically 31 pairs of spinal roots on each side of the spinal cord: 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal. A lesion involving the trochlear nucleus or its fascicles may result in contralateral paresis of the superior oblique muscle. Nerve fiber bundle defects occur most commonly with lesions in the optic nerve head, where the tip of the defect reaches the blind spot, but they may also occur with branch retinal artery or vein occlusion and with juxtapapillary inflammation. Orotic aciduria presents during infancy with severe megaloblastic hypochromatic anaemia, orotic acid crystalluria, and occasionally, Deficiency of dihydropyrimidinase Dihydropyrimidinase catalyses the second step of the pyrimidine degradation pathway. After adjustment for age and sex, blacks were significantly more likely than whites to report limitations on all twelve of the queried activities, and more likely to report using special equipment. Postnatal growth, which becomes more marked after the second year of life, is also subnormal. Neonatal screening that depends on tests for galactose in the blood will not detect galactokinase deficiency. Once a diagnosis of definite or probable vasculitic neuropathy is established, the specific type of vasculitis underlying the neuropathy must be determined. Other sources include illicit liquor, oral abortifacients, opium, traditional medicines, ocean fish, and marine crustacea (pomfret, plaice, haluan, and hilsa). Short periods of fasting, or other metabolic stressors such as infection, provoke hypoglycaemia and lactic acidosis. It may be related to an older term for visual disorientation, the inability to localize the spatial position and distance of objects, resulting in problems scanning the environment, walking around obstacles, and reaching for objects. In later life, due to failure to export lipid there is chronic fatty liver, often with raised transaminases, and there is increased fibrosis, progressing sometimes to cirrhosis. The afferent pathway of the reflex is via the 1a motor fibers in the mandibular division, and the efferent pathway constitutes fibers traveling from the motor nucleus of the trigeminal nerve via the same mandibular division. Large hemorrhages may produce vomiting or unconsciousness, but so may infarcts in the vertebrobasilar circulation. Tissues with significant iron storage show peroxidative injury in membrane lipid fractions. Data from such cases also support the concept that neurological outcome following fibrinolytic treatment is better when there are collateral vessels present that at least partially supply the ischemic territory while a clot occludes a major vessel. Atypical case presentations contribute to diagnostic confusion in patients with transient neurological attacks. The physiological effect of thyroid hormone is apparent in all metabolically active tissues, the manifestations of which become most apparent in disease states. Nevertheless, a metaanalysis dating from 2013 concluded that there was no evidence that febuxostat is superior to allopurinol for clinically relevant outcomes. Partially modelled on earlier Arabic trading in Africa, the use of slave labour in the sugar plantations in New World and other colonies has a haunting legacy. The extreme periphery of the visual field is represented anteriorly at the junction of the calcarine and parietooccipital fissures. Care and appropriate monitoring is needed in patients on anticoagulants and some diabetic blood glucose-reducing drugs as fibrates interact with these classes of drug. In the spinal cord, an astrocytoma may have a holocord cyst extending from the obex to the conus. They found three similar cases in the literature and were able to isolate Toxoplasma from another case. However, the involvement of genetic determinants, possibly of paternal origin, in an alloimmune response has not been excluded. Nalmefene has a reduced risk of producing liver toxicity, but large studies to support efficacy are lacking. The thermoregulatory sweat test (calorimetric method) is a simple and inexpensive test that allows the assessment of sweating over the anterior body surface.

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Reoperative parathyroid surgery in the era of sestamibi scanning and intraoperative parathyroid hormone monitoring. The pain sites include temple, frontal, and retro-orbital headaches and pain in the maxillary anterior teeth. The risk of developing thyroid cancer is 5 to 10 times higher in patients with a first-degree relative who has thyroid cancer, when compared to the general population. In both cases, this hypermethylation silences the promoters, resulting in absent or decreased expression. Distal to the narrowed arterial lumen, the blood flow becomes turbulent, resulting in aneurysm formation. Meningitis develops from discharge of bacilli from a subjacent focus directly into the subarachnoid space. Manual laborers who use the same hand tools repetitively may cause pressure on the hypothenar eminence. In clinical practice venous malformations are most often encountered as incidental, asymptomatic lesions when patients undergo imaging for various complaints. This article is a revision of the previous edition article by Robert Daroff, volume 4, p 614, r 2003, Elsevier Inc. Juvenile haemochromatosis is inherited as a very rare recessive trait in which there is an increased frequency of consanguinity among the parents of affected subjects. Ocular, bulbar, neck flexor, axial (respiratory), and proximal limb muscles are affected. Paradoxically, both vitamin A deficiency and vitamin A intoxication have been implicated in the production of increased intracranial pressure. This likely extrapolates to women, who before menopause are less susceptible to damage from cerebrovascular stroke, ischemic brain injury, hypoxia, drug toxicity, and trauma to the nervous system than are men, but after menopause may actually have greater susceptibility. Dotan G, Goldstein M, Stolovitch C, and Kesler A (2013) Pediatric pseudotumor cerebri associated with low serum levels of vitamin A. Reduction of vitamin D intake to normal levels, as well as treatment of the electrolyte abnormalities, will improve symptoms and signs. In 1952, Spiegel and Wycis published the first human stereotactic map and were the first to perform stereotactic functional surgery. Nociceptive trigeminal inhibition reflex device is another appliance that is popular. However, since 2008, sucralose has become the most popular nonsugar sweetener, replacing aspartame to artificially sweeten foods and beverages. Destruction of the endothelium lining this endolymphatic sac or occlusion of the duct result in an increase in endolymphatic volume in experimental animals. Other epidemiological studies emphasize the importance of the environmental factors of purine, protein, and alcohol intake. This acute or subacute progression may be the only Vasculitic Neuropathy 613 clue that an otherwise cryptogenic polyneuropathy has an identifiable and treatable cause. In this syndrome caused by a lateral medullary infarct, the trigeminal signs include analgesia for pain and temperature of the same side of the face and head, with decreased corneal sensation. Uremic coma, now uncommon, is typically accompanied by Kussmaul breathing related to metabolic acidosis. Importantly, a change to a large, fat pen that requires different muscle activation for holding and writing or a switch to typing is often the most helpful of all therapies. As a rootlet merges with the dorsal columns, the small diameter axons tend to take a ventral lateral heading to constitute bundles of axons radially distributed on the ventral and lateral rootlet surfaces. Characteristic skeletal abnormalities include anterior rib cupping, scapular spurring, and are present at diagnosis in about half of individuals. At present, it is advisible stopping medication overuse based on the knowledge that medication can alter the clinical picture. Asterisked enzymes are: 1, cystathionine -synthase; 2, methylene tetrahydrofolate reductase, 3, methionine synthase; and 4, betaine methyltransferase. In warmthsensitive neurons, the prepotential depolarization is augmented by warming and increasing neuronal firing rate.

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Other anticonvulsants affect mitochondrial metabolism, including carbamazepine, phenytoin, oxcarbazepine, ethosuximide, zonisamide, topiramate, gabapentin, and vigabatrin. Moreover, sumoylation of a polyglutamine-expanded huntingtin fragment has been shown to exacerbate neurodegeneration in a D. Characteristic findings are developmental delay and megaloblastic anaemia, but the onset may be in later in childhood with dementia and spasticity. Bilateral sympathectomies from the stellate ganglia to T7 may be required to treat refractory angina pectoris. Surgeons are increasingly relying on decompression as the initial approach, and it may be done endoscopically. The most important alternative diagnosis is chorea in the context of systemic lupus erythematosus. Sydenham was often indifferent or scornful toward his contemporaries, and criticized their often overzealous approach to blistering and purging. There is also little evidence that asymptomatic hyperuricaemia increases the risk of gouty arthritis. This includes epileptic encephalopathy, muscular hypotonia, respiratory insufficiency, extrapyramidal movement disorders, cortical visual failure, microcephaly, and severe developmental delay. Clinical presentation Clinical symptoms are indistinguishable from those of patients with tyrosine hydroxylase deficiency. Several infants have presented with benign intracranial hypertension (pseudotumour cerebri), possibly as a result of comparable osmotic effects of galactitol in the brain. Some viral life cycles have unique features that are attractive antiviral targets. The common neurovisceral symptoms of acute porphyric attacks are listed in Box 12. Hydrolysed lipids are solubilized in micelles and presented to the apical membranes of enterocytes. As a consequence of binding of a hormone to its receptor, there is activation of a series of cellular processes that affect functional outcomes. Temporal lobe damage, particularly in the right lobe, can impair at least some aspects of pitch processing. Usefulness of Ki-67 for predicting the metastastic potential of rectal carcinoids. Recent evidence suggests that only IgM, and not IgG, Kidd antibodies are able to bind complement. Finally, pancreatic cysts, pancreatic islet cell tumors, and papillary cystadenomas of the epididymis are other frequently encountered complications of the disease. This form of surgical intervention is typically an effective treatment for seizures of temporal lobe origin that are resistant to drug therapy: it has been demonstrated to produce a marked reduction in seizure frequency or even complete abolition of seizures. Wollaston saw that such cases could readily be accounted for on the assumption that afferent signals from the nasal Encyclopedia of the Neurological Sciences, Volume 4 doi:10. If electrolyte disturbances are present, usually found only in the first few days of treatment, these must be appropriately corrected. Thoracic Spine Stabilization Further Reading Balmaceda C (2000) Chemotherapy for intramedullary spinal cord tumors. The nuclear ensemble is encapsulated by myelinated fibers that appear to be an anterior extension of the intralaminar system. Upon endocytosis back into the follicular cells, T3 and T4 molecules are released from Tg molecules before being secreted into the systemic circulation. Neurovascular compression of the trochlear nerve at the root exit zone may be responsible for many cases of superior oblique myokymia. Early treatment with antibiotics and folic acid reverses the gastrointestinal syndrome and renders neurological manifestations uncommon. The organism was first identified as an infectious agent in 1932, after the recognition of congenital toxoplasmosis. The diagnosis is made by the laboratory finding of high blood levels of sitosterol and campesterol, and gene sequencing. Evidence from epidemiology, meta-analyses of cholesterol-lowering end-point clinical trials, human and animal genetics, and pathology overwhelmingly demonstrate the prominence of elevated levels of high blood cholesterol as a causal risk factor for atherosclerotic cardiovascular disease. In contrast, patients with lesions to the left temporal lobe are deficient in verbal memory tests such as remembering the details of a story read to them a short time before. In addition to this quantitative dichotomy, there is also a qualitative difference between A1 and A2.

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Sydenham ultimately returned to Oxford in 1647, graduating as bachelor of medicine in 1648, after having received at best a limited medical training. Eggs, organ and lean meats, fish, shellfish, cereal grains, and oilseeds are the main sources of phospholipids. These episodes typically occur within 30 min of meals that contain large quantities of fructose or sucrose. Thus, carotid ultrasonography provides an accurate, safe, reliable, and inexpensive method to study carotid and cerebrovascular disease. Such testing fits well into diagnostic algorithms that utilize noninvasive tests initially, reserving more costly, risky, or invasive methods for those who require them for treatment planning. Input to Sympathetic Ganglia the preganglionic sympathetic axons are, for the most part, small myelinated fibers which exit via the ventral roots, and pass via the white rami communicanti of the corresponding spinal nerve to reach the paravertebral sympathetic chain. As the disease progresses, affected children develop pyramidal signs, and finally decerebration. Studies in the United States showed that in children with cancer and kidney transplants, the vaccine was safe, although two doses were needed to guarantee optimal protection from chicken pox. Recent experiments have shown that steroids are also synthesized in the nervous system, and other tissues, such as lung, heart, skin, kidney, and thymus, may also synthesize steroids. When the boy was later inoculated with fully virulent material from a smallpox lesion, no disease resulted. Veterinarians and laboratory workers who may be exposed to rabies will be vaccinated against it. In donors, a D variant (weak D or partial D) phenotype should mean that the unit is labelled as RhD positive. Treatment is likely to affect only the Toxoplasma tachyzoite, therefore posttreatment anti-Toxoplasma prophylaxis is maintained for several months. V2 V1 Foramen ovale V3 Percutaneous Procedures In 1965, the first modern percutaneous modality for the treatment of trigeminal neuralgia was developed. Although it was previously thought that neurons and glia might differentiate from different types of stem cells, research has shown that stem cells in the nervous system can give rise to both neurons and glia under appropriate conditions. Treatment is generally supportive and anti-inflammatory therapy may be useful for symptomatic relief. In reality, only sources extended over multiple layers of several square centimeters of cortical tissue have sufficient energy to generate detectable scalp discharges. It is very probable that specifically designed low-phenylalanine and lowtyrosine diets would lower the production still further. Posttranslational Modification (Phosphorylation, Acetylation, and Sumoylation) A striking feature of most polyglutamine diseases is that they are highly cell specific. The third stage of tuberculous meningitis is characterized by coma, irregular pulse, rising fever, and, eventually, death. Thus, perception must shift at least partly from a viewer-based perspective to an object-centered code. Severe and paroxysmal pain is the most common feature and may involve all three or only selected divisions of the trigeminal nerve, mainly the maxillary and mandibular. This property is used to good effect in acid elution procedures in the laboratory, where it is desirable to dissociate the antibody from its antigen. Inadequate supply of oxygen: Interference with blood supply to tissues is called ischemia. Even accounting for these two factors, there was still heterogeneity among neurons and, additionally, gray matter and white matter were different. However, in some patients, the symptoms are not controlled without long-term orthopedic dental support. Multiple biopsy specimens can be obtained along a single trajectory to ensure as representative a sampling of the pathological lesion as possible. It blocks the channel only when applied to the external surface of the nerve membrane, with no effect when applied intracellularly even at concentration as high as 1000 nM. In utero, bilirubin released from the breakdown of haemoglobin is partly cleared by the placenta, and so it may not be until the infant is born that serious problems develop, when exchange transfusion may be indicated.

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The indomethacin test can be performed in two different ways: the oral trial or a placebo-controlled indotest test. Treatment and outcome Pyridoxal 5-phosphate given by nasogastric tube is dramatically effective in stopping seizures and improving the appearances of the electroencephalogram. For example, Diseases of the sensory visual system often leave their mark as a visual field defect. Although approximately a quarter of incidentalomas increase in size with time, the risk of malignant change is thought to be low. Another evolving use of the Valsalva maneuver involves the use of the relationship between the phases of the Valsalva maneuver and corresponding changes in cerebral blood flow velocity recorded using transcranial Doppler to evaluate cerebral autoregulation. Stabilization appliances are made out of hard cured acrylic and should cover the entire maxillary or mandibular teeth. Monocular visual field defects are almost always due to disease of the choroid, retinal pigment epithelium, retina, optic disk, or optic nerve. Low cerebral blood flow, combined with increased glucose generation (for healing processes), causes an energy crisis, leaving the brain more vulnerable to secondary damage (swelling). The hair cells are innervated by nerve fibers and are embedded within a gelatinous mass called the cupula. Lamotrigine abolished the attacks but they briefly returned, with associated olfactory hallucinations, during a period of noncompliance, and ceased again when he restarted the medication. It is important to establish the diagnosis and evaluate the liver as cirrhosis may occur. Homozygotes develop atherosclerotic cardiovascular disease in childhood or adolescence. Aspartoacylase is localized in oligodendrocytes catalysing the deacetylation of N-acetylaspartic acid to produce acetate, a substrate for the synthesis of myelin lipids including cholesterol. Small-fiber neuropathies, especially those caused by diabetes mellitus, a-galactosidase A deficiency, and acrylamide, thallium, and arsenic poisoning, may produce an excitatory phase of distal hyperhidrosis. These differences may reflect alternative pathophysiological mechanisms between the two subpopulations as well as a predilection for more distal vasculature within the histologically defined group. The lateral geniculate nucleus is composed primarily of a dorsal lateral component that is the major thalamic processing center for visual inputs. Regular oral carbohydrate during the day and continuous overnight pump feeding with glucose, delivered either by nasogastric or gastrostomy tube, clearly improves clinical and biochemical parameters. For example, a lesion of the left vestibular nerve evokes vertigo by simulating a head rotation to the right (the vertical components essentially cancel). It is performed by placing the transducer on the surface of the pancreas, which is covered in a pool of saline to maximise image quality. Functions and formation of haem Haem serves as a key prosthetic group in haem proteins, including cytochromes, myoglobin, and haemoglobin, by which it fulfils its essential biological roles as a transporter of oxygen and electrons in the respiratory chain. An important use involves the evaluation of patients presenting with an extrapyramidal syndrome. For patients with primary hyperhidrosis, the available treatment modalities target peripheral sympathetic pathways, although scientific evidence favors a central sudomotor dysfunction. Pathological examination of previously affected siblings shows shrinkage of gyri, with involvement of the medulla shown by loss or hypoplasia of the pyramids. The primary manifestation of vitamin D deficiency is rickets, a metabolic disease primarily affecting bone. The same neural system that enables and coordinates the timing of ovulation also coordinates reproductive behaviors with physiology. Weekly or fortnightly removal of 500 ml of blood will usually correct the abnormal urine and plasma porphyrin profile within a few months, but maintenance phlebotomy will be required, usually amounting to the removal of 2 to 4 units of blood at intervals each year. Weakness following exposure to tri-ortho-cresyl phosphate, an organophosphate contaminant of cooking oil, has accounted for outbreaks in Morocco, southern Asia, and the Caribbean.

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Myokymia of the superior oblique muscle, a uniocular rotatory microtremor, may cause episodes of vertical oscillopsia, shimmering, or transient diplopia. Localization of parathyroid tumors using endoscopic ultrasonography in primary hyperparathyroidism. Heterozygous Men1 mutant mice develop a range of endocrine tumours mimicking multiple endocrine neoplasia type 1. His work marked a transition between medieval and modern notions of brain function. Hyperhidrosis Generalized hyperhidrosis can be primary (some cases of essential hyperhidrosis, Shapiro syndrome) or secondary and due to medical disorders such as pheochromocytoma, thyrotoxicosis, acromegaly, chronic infection, and malignancy. The rounded apex end is adopted (sic) to reach the biceps tendon at the bend of the arm (and, according to S. In 1986, it was recognized that N-acetylaspartic aciduria was caused by deficient aspartoacylase in a child with a similar clinical presentation. Anaplastic carcinomas are composed of an admixture of spindle cells (not shown in this figure), pleomorphic giant cells and epithelioid cells. Preoperative portal embolisation may help induce regeneration of a hepatic lobe (without metastases) that is planned to remain after hepatic lobectomy for removal of metastatic tumour. Homonymous hemianopias affecting the tract and lateral geniculate body tend to be incongruous, but the more posteriorly the lesion is located in the optic pathways, the greater the congruity of the defect in either field. Orotic aciduria has been found in urea cycle defects, lysinuric protein intolerance, purine nucleoside phosphorylase deficiency, normal pregnancy, and during allopurinol administration. Thus, the interplay between regulated 1-hydroxylase and 24-hydroxylase determines the steady-state level of 1,25-dihydroxyvitamin D3. This can lead to quadriparesis with cervical cord lesions or paraparesis with thoracic cord lesions. E3 (dihydrolipoamide dehydrogenase) deficiency E3 (dihydrolipoamide dehydrogenase) deficiency is an autosomal recessive condition due to mutations in E3 dihydrolipoyl dehydrogenase, common to the action of the pyruvate dehydrogenase complex and the -ketodehydrogenase complex and the branchedchain -ketoacid dehydrogenase complexes. Preoperative staging studies are important to exclude patients from surgery who would not benefit from resection. Protein sorting, target motifs, and membrane diffusion barriers are involved in sorting macromolecules to specific subcellular regions, but cytoskeletal and motor proteins are also important in trafficking vesicles and organelles into appropriate regions of the neuron. Vitamin D Deficiency Vitamin D deficiency states may arise from inadequate dietary intake, malabsorption, or interference with the effects of the vitamin, which may be produced by antiepileptic drugs. The infection is actually within the periglandular lymph nodes and any of the cervical lymph nodes can be affected. Sudden audiovestibular loss in older patients at the risk of vascular disease may be due to inner ear stroke. Recommendations for parathyroidectomy in asymptomatic patients were updated in 2008, as surgical intervention decreases the long-term risks of hypercalcaemia on bone health and nephrolithiasis in broad patient populations. Treatment of dyslipidaemia the major treatment objectives are primary and secondary prevention of atherosclerotic cardiovascular disease and its complications, and prevention of hypertriglyceridaemic, acute pancreatitis. The probability of this process happening more than once in an individual is low, so the development of second primary endocrine tumours is rare. These neurosteroids are the reduced derivatives of progesterone, 11-deoxycorticosterone, and testosterone. Axon collaterals then sprout at appropriate points to innervate other targets along the pathway. Advantages of microvascular decompression include higher long-term success rates and significantly lower rates of facial dysesthesias. The identification of the main facial nerve trunk, two main divisions and branches is the cornerstone of nerve-sparing parotid surgery. After endovascular embolization or surgical resection, the normal branches reappear as the connection to the low-resistance system is severed. Numerous markers and special stains have been proposed to aid in differentiation, but none has gained wide acceptance.

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Beginning in the 1990s, studies of functional neuroimaging focused on the recovery of aphasia after brain damage. The relationship between low-density lipoprotein cholesterol levels and change in per cent atheroma volume for several intravascular ultrasonography trials. Although the assimilation of fructose by the specialized pathway is blocked, only a small fraction of the fructose load is recovered in the urine. The primary diagnosis is the disorder that is directly responsible for the chief complaints in an individual patient. Thus, the possibility of vasculitis needs to be considered in almost any patient with a progressive axonal neuropathy. Dysfunction in cortical areas of higher level visual processing may produce selective deficits in the perception of form, color, motion, or spatial features. Impairments in cerebral autoregulation can be corrected in patients with occlusive disease by increasing the blood pressure or by revascularization surgery, including carotid endarterectomy or bypass surgery, to provide increased blood flow to affected areas. In those who report spontaneous episodes, usually symptoms cannot be reproduced at the bedside, so evaluation relies almost entirely on history rather than examination. Efficacy of preoperative diagnostic imaging localization of technetium 99m-sestamibi scintigraphy in hyperparathyroidism. The time required for performance of cognitive tasks with limited motor requirements does not appear to change over a wide age range. The burst of activity present in saccade-related cells may be generated, in part, by the reciprocal circuits interconnecting cortex and the deep layers. As part of the uncus has olfactory functions, the uncus can be included within the rhinencephalon, a functional concept. Glory Lily Gloriosa superba (climbing lily or glory lily) is a poisonous plant of the lily family. Other cancers that are less frequently involved are lung, kidney, testes, or ovarian cancer. If the transferase is markedly deficient or absent, galactose, galactose 1-phosphate, galactitol, and gluconate accumulate in the tissues. However, another P450 with 21 hydroxylase activity, P450 2D6, has recently been found in the rodent brain. Neurofibromas typically involve diffuse enlargement of the affected nerve, making surgical separation of the lesion and nerve more difficult. However, its disadvantage is the relatively high dose of ionising radiation involved. The biochemical defect in dihydrolipoyl dehydrogenase deficiency interferes with the Krebs cycle as well as the decarboxylation of pyruvate. Large vessels tend to be involved, but medium and small vessels can also become involved. Single tests, for example, in an emergency situation, require that controls are included at the same time. Toxoplasmosis, amebiasis, trypanosomiasis, schistosomiasis, hydatid disease, paragonimiasis, and sparganosis are parasitic diseases consistently reported in association with epilepsy. Lens dislocation usually occurs in preschool years, but later dislocation is well recognized in pyridoxine-responsive patients, and a few have not developed it even in adult life. His religious calling caused him to lose interest in his other writings, which lay in the archives of the Swedish Royal Academy of Sciences for 140 years until they were rescued in the 1880s. Paralysis of the serratus anterior muscle has also been associated with C7 radiculopathy, emphasizing the substantial contribution of this nerve root to its innervation. Greyish discoloration of cartilage is seen in the pinna, and pigment is deposited in the sclera. The first neuronal elements in the visual system are located deep in the retina, separated from the choroid by the retinal pigment epithelium. Ventriculopetal thin-walled channels (bottom) supply a vascular web within the mantle layer, near the ependyma and ventricle (top). In this article, the two terms are used interchangeably unless otherwise specifically noted.