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The A To Z of The Brain
The A To Z of The Brain
The A To Z of The Brain
The A to Z of
The Brain
Dr A. L. Neill
BSc MSc MBBS PhD FACBS
Front cover
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TABLE OF CONTENTS
INTRODUCTION
This is the 6th in the series of the A to Zs.
It continues on where the A to Z of the Head & Neck left off and
continues with some of the new features of the evolving series original.
It is the first book of an “organ” in that the Brain and CNs is a whole
with multiple parts. Clinical considerations are maintained. As usual
feedback plays an extremely important role in this, please feel free to
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comment and contribute to any and all aspects of these publications
after all they are for you – whoever you, the reader may be.
We have a website where you can view all images of the A to Zs and
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other material and from which you make comments:
http://www.aspenpharma.com.au/atlas/student.htm
ACKNOWLEDGEMENT
Thank you ASPENpharmacare Australia for your support and assistance
in this valuable project, particularly Mr. Greg Lan CEO of
. L.
Aspenpharmacare Australia, Rob Koster, Richard Clements and Ante
Mihaljevic and everyone who provided valuable feedback.
DEDICATION
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hence making the book its own index for easy retrieval has been
maintained, but because of the complexity of this material, it has been
necessary to do this after first dividing the material into a number of
main topics as was the case in the A to Z of the Head & Neck.
Thank you
Amanda Neill
BSc MSc MBBS PhD FACBS
SBN 978-0-9806840-2-5
3 © A. L. Neill
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TABLE OF CONTENTS
Table of contents
Introduction 3
Acknowledgement 3
Dedication 3
How to use this book 3
Table of contents 4
Abbreviations 9
Common Terms used in Neurology – Neuroanatomy 10
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Guide to Anatomical Planes and Relations 24
Anatomical movements 26
The Nervous system – overview 28
Ne
The Nerve Cells – overview 30
The Brain and SC – overview 32
Blood brain barrier 32
Blood supply 34
CSF 38
Development and Organization 40
Macroscopic structure 42
. L.
Fibrous tracts 44
Meninges – coverings 46
Dura Mater 46
Meninges and the Brain 48
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THE BRAIN
Blood supply – overview
Blood Vessels and Meningeal layers of the Brain 60
Brain Arteries - overview see also Cerebrum / arteries 64
Brain Veins - overview 66
Cranial Venous Sinuses 68
Cavernous sinus 68
Petrosal sinuses see Sagittal sinuses
Sagittal sinuses 70
Straight sinus see Veins overview & Sagittal sinuses
Transverse sinus see Veins overview & Sagittal sinuses
Brodmann’s areas see Cerebrum
Circle of Willis = Cerebral arterial circle 72
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TABLE OF CONTENTS
Topography
Macroscopic components of the Brain 74
Outer surfaces – see also Gyri & Sulci
Inferior
Lateral
Posterior
Sagittal - Median = mid-sagittal
Superior see Cerebrum
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Gyri + Sulci / Outer surfaces 78
Dissections – Sectional Anatomy 84
Coronal sections
Sagittal sections see also Median section 90
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Transverse sections see also Coronal sections 92
REGIONS
Amygdala / Amygdaloid bodies see Fornix
Angula gyrus see Cerebrum/lobes
Anterior Commissure 94
Anterior Perforating substance see Brain outer surfaces / inferior
. L.
Basal ganglion/nuclei see also Brainstem and Diencephalon 96
Basis Pedunculi = Crus cerebri see Brainstem Midbrain
Brainstem = Midbrain + Pons + Medulla Oblongata 98
Arteries 102
CN nuclei see Cranial Ns
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External Capsule see Brain/sections/coronal
Falx Cerebri see Meninges –brain coverings
Fornix see also Septum Pellucidum 128
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Frontal lobe see Brain - Outer surfaces / Cerebrum Lobes
Geniculate bodies – lateral / medial see Brainstem, Midbrain
Globus Pallidus see Anterior Commissure
Habenular nucleus see Basal nuclei, Hypothalamus
Hippocampus see Fornix, Limbic system
Hindbrain see Brainstem, Midbrain
. L.
Hypothalamus see Basal nuclei, Diencephalon
Inferior Colliculus see Brainstem
Infundibulum see Brain/outer surfaces/inferior
Insula see Cerebrum/lobes
Internal Capsule see Brain/sections/coronal
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TABLE OF CONTENTS
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Sylvian fissure = Lateral Sulcus see Cerebrum
Tela Choroidea see, Hypothalamus, Ventricles
Thalamus see also Basal ganglia & Diencephalon 138
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Uncinate Fasciculus see Anterior Commissure
Vallecula see Cerebellum
Ventricles 142
Vermis see Cerebellum
Wernicke’s area see Language centres
THE CRANIAL NERVES & SPECIAL SENSES
. L.
Overview and summary 148
BS to the CNs and Relations see the Brain veins
CN I see also Special senses / Smell & Taste 152
CN II see Brain outer surfaces /inferior; Special senses / Sight
CN III see also Special senses / Sight 153
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THE SPINAL CORD
Ascending = Sensory tracts 250
Anterolateral system = Spinothalamic +
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Spinoreticular tracts (pain & temperature) see Pain pathways
Dorsal columns = Fasciculi Cuneatus + Gracilis
(touch, proprioception & vibration)
Spinocerebellar tracts = anterior + posterior spinocerebellar
tracts see Dorsal Columns
Spinothalamic tracts = anterior + lateral spinothalamic tracts 252
see also Pain pathways
Descending = Motor tracts 254
. L.
Anterior corticospinal tracts = uncrossed pyramidal tracts
see Corticospinal tracts
Corticobulbar = Rubrospinal see Pyramidal tracts
Corticospinal = anterior + lateral corticospinal
Extrapyramidal tracts = Tectospinal + Vestibulospinal +
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INTRODUCTION
Abbreviations L
L
= lateral
= left / lumbar
A = actions /movements LL = lower limb
of a joint Lt. = Latin
A = anterior lig = ligament
ACF = anterior cranial fossa M = mater
aka = also known as MB = midbrain
alt. = alternative MC = metacarpal
AM = arachnoid mater MCF = middle cranial fossa
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ANS = autonomic nervous system med = medial
ant = anterior MO = medulla oblongata (medulla)
art = articulation (joint w/o the MN = myelinated nerve
additional support structures) nMN = non-myelinated nerve
AS = Alternative Spelling, N = nerve
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generally referring to the diff. NS = nervous system/nerve
b/n British & supply
American spelling NT = nervous tissue
assoc. = associated with NTr = nerve tract / trunk
BBB = blood brain barrier P = posterior
bc = because PaNS = parasympathetic nervous
BP = brachial plexus system
BS = blood supply PCF = posterior cranial fossa
. L.
BS = brain stem pl. = plural
b/n = between PM = pia mater
C = cervical / carpal PN = peripheral nerve
CC = cerebral cortex post. = posterior
c.f. = compared to proc. = process
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INTRODUCTION
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(auditory, tactile, visual)
Agraphia w/o writing - inability to write coherently – due to a
cerebral lesion
Ala cinerea ashen hued wing - triangular region on the floor of the
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4th Ven – one of the Vagal nuclei
Alexia w/o words - inability to grasp the meaning of words
Allocortex the older cerebral cortex = archicortex + paleocortex
Alveus trough – thin WM layer covering the ventricular
surface of the Hp
Amacrine long - the N cell type with long fibrous processes in
the retina
. L.
Ammon’s horn Ammonis = Egyption god with a ram’s head used for
the Hp which sagittally has a curl like a ram’s horn
Amygdala almond - almond shaped body in the Temporal lobe
involved in memory & emotion
Anasthesia w/o feeling - loss of sensation
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INTRODUCTION
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Astrocytes star - one of the supportive cell types in the CNS (see Glia)
Asynergy w/o work - disturbance in the muscle contraction
sequence in doing a coordinated act
Ataxia w/o order inability to contract muscles in order and
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hence weakness in contraction
Athetosis w/o position inability to keep fingers or toes in a still
position continually writhing of the extremities – due
to degeneration in the CC and Corpus Striatum
Autonomic automatic motor innervation of the viscera
Axial axis - refers to the head and trunk (vertebrae, ribs and
sternum) of the body.
. L.
Axolemma plasma membrane of the axon
Axon N process carrying material away from the cell body
to the target organ, each N has only one axon
Axon collaterals branches of the axon
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Axon hillock part of the N where the axon rises and has no Nissl bodies
Axoplasm cytoplasm of the axon
Baroreceptor weight receiver sensory N fibre which responds to
pressure changes as in the carotid canal
Basal ganglia incorrect term for cluster of Ns buried in the WM of the
brain and involved in movement includes: CAUDATE
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INTRODUCTION
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Calamus Scriptorius reed / pen - caudal part on the floor of the 4th Ven
which looks like a pen
Calcar spur as in the Calacarine sulcus of the Occipital lobe
Canal tunnel / extended foramen as in the carotid canal, at
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the base of the skull adj canular (canicular - small canal)
Caput relating to the skull
Carotid to put to sleep; compression of the common or
internal carotid artery causes coma. This refers to
bony points related to the carotid vessels
CAT scan = computerized axial tomography scan – computer
mediated Xray image depicting a crossection of the
. L.
body see also CT scan
Cauda equina horse’s tail - lumbar and sacral N roots of the SC
resembling a horse’s tail
Caudate nucleus tail nucleus in the Corpus Striatum, having a long tail
Cavity an open area hence an open area or sinus w/in a bone
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INTRODUCTION
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Chorea dance – irregular, involuntary, movements of the limbs
and face – due to degen. of the neostriatum
Choroid AS Chorioid delicate membrane – as in the choroid
plexus in the brain or the retina
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Cinerea ashes / ashen colour / grey – as in Tuber Cinereum -
ventral portion of the Hypothalamus
Cingulate gyrus part of the Limbic System, directly above the corpus
callosum on the medical surface of the CH –to do with
emotion and attention
Cingulum girdle as in a bundle of association fibres in the WM of
the Cingulate gyrus of the CH, medial surface
. L.
Claustrum barrier - thin sheet of GM b/n Lentiform nucleus and
the Insula
Cochlea a snail hence snail-like shape relating to the Organ of
Corti in the middle ear (adj. cochlear)
Cognition to know – a processing of knowledge for use in higher
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INTRODUCTION
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Cranium the cranium of the skull comprises all of the bones of
the skull except for the mandible.
Crest prominent sharp thin ridge of bone formed by the
attachment of muscles particularly powerful ones e.g.
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Temporalis/Sagittal crest
Crus leg – e.g. Crus Cerebri - the ventral part of the
Cerebral Peduncle of the MB
CT scan = computerized axial tomography scan – computer
mediated Xray image depicting a cross-section of the
body see also CAT scan
Cuneus wedge – e.g. gyrus on the medial surface of the CH –
. L.
Fasciculus Cuneatus of the MB & SC
Cutus skin - hence cutaneous branches refer to the Ns
supplying the skin & adnexae
Declarative memory memory of words which can be recalled
Decussation X - a crossing of paired N fibres inside the CNS e.g. in
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INTRODUCTION
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the Cerebellum).
Endoneurium w/in the N - innermost of the CT coverings of a PN
fibre (see neurium, perineurium and epineurium)
Engram mark – a lasting memory – memory picture from a
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past experience
Entorhinal w/in the nose – the entorhinal area lies in the ant. of
the parahippocampal gyrus – in the lateral olfactory area
Ependyma/
Ependymal cells line the ventricles and the central canal of the SC
(see Glia) form the CSF
Epineurium upon the N - outermost of the CT coverings of a PN
. L.
fibre (see neurium, perineurium and endoeurium)
Epithalamus upon the inner chamber – region of the diencephalons
above the thalamus includes the pineal body
Extradural space space external to the Dura mater but w/n the skull or
boney canal of the SC
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Extrapyramidal system all the motor parts of the CNS except the
pyramidal system
Extrastriate visual areas of the CC assoc with higher order visual
recognition eg face recognition
Falx sickle as in falx cerebri, falx cerebelli
Fascis bundle
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INTRODUCTION
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Basal Ganglion), pl ganglia an abnormal collection of
neural tissue found subcutaneously
Gemmule small bud – swellings on the ends of some dendrites
in the CNS
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Genu knee – anterior end of the Corpus Callosum = the
genu of the Corpus Callosum; geniculate ganglion of
the Facial N; geniculate nuclei of the Thalamus
Glia / Glial cells glue associated supporting cells of the CNS connective
tissue and immune functions, types: astrocytes,
oligodendrocytes, ependymal cells and microglia
Globus pallidus pale ball – medial part of the Lentiform nucleus of the
. L.
Corpus Striatum - part of the basal ganglia
Glomerulus small knot, tangle – synaptic glomeruli of the
olfactory bulb
Grey Matter (AS Gray) N tissue in the brain and SC which contains mainly N
cells, dendrites unmyleinated axons & glial cells
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INTRODUCTION
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Insula island – CC concealed from the surface at the bottom
of the Lateral Sulcus = Island of Reil
Inter between
Interneurons act b/n motor and sensory Ns in a reflex - transferring
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the signal from the sensory to the motor w/o higher imput
Intra within
Introitus an orifice or point of entry to a cavity or space.
Ipsi- same – as opposed to contra- opposite
Ipsilateral on the same side as opposed to contralateral
Isocortex equal bark – the CC which has 6 layers = neocortex
. L.
Kinesthesia movement sensation – the perception of moving
and movement
Lacerum something lacerated, mangled or torn - eg Foramen
Lacerum, small sharp hole at the base of the skull
often ripping tissue in trauma.
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and Temporals.
Lamina a plate - the lamina of the vertebra is a plate of bone
connecting the vertical and transverse spines (pl. laminae)
Leminiscus ribbon -ribbonlike, flat band of N fibres in the CNS -
e.g. Lateral & Medial Leminisci
Lentiform lenslike – Lentiform nucleus of the Corpus Striatum
Limbic System group of brain structures to regulate emotion
and memory
Limbus border – as in the Limbic System which has a border
of CC on the medical surface of the CH consisting of:
septal areas, cingulate and parahippocampl gyri,
mammillary bodies and ant. thalamic nuclei
Linea a line - as in the Nuchal lines of the Occitipum
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INTRODUCTION
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Mammillary -
AS Mamillary little nipple – mammillary body in the ventral
surface of the Thalamus
Medulla marrow middle – Medulla Oblongata – the caudal
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portion of the brain stem , spinal medulla
Meninges coverings of the brain and SC made up of 3 layers -
Dura (hard) mater on the outer to protect the NT;
Arachnoid (spidery) mater in the middle to support the
BS and Pia (soft) mater, the inner coating to coat the
NT and act as a barrier to foreign substances. CSF
flows b/n the inner 2 coverings.
. L.
Macroglia large supportive cells of the CNS (see Glia)
Microglia phagocytic cells of the CNS (see Glia)
Miosis excessive contraction of the pupil due to drugs or disease
Mixed N a N containing both sensory & motor components,
most peripheral Ns are mixed
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Mnemonic memory
Motor / motor N causes muscle contraction. these Ns are efferent or
moving away from the SC
Motor cortex part of the brain – cerebral motor cortex - responsible
for executing bodily movements
Motor program a sequence of muscle contractions needed for a
©D
complex movement
MRI technique to see images of soft tissues eg. the brain
using magnets
Multipolar referring to a N which has many dendrites + 1 axon
(see unipolar, bipolar)
Myelin marrow - the phospholipids produced by Schwann
cells to insulate the axons of PNs and allow impulses
to travel for longer and faster to the target organ
Myotome the muscular innervation of a SN
“Nerve” (N) N cell (neuron) capable of transmitting or firing off a
signal caused by ion transfer - excitable cell N process
- generally Axon carrying the impulse to the skeletal
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INTRODUCTION
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Neuroglia see Glia
Neuron Nerve cell
Neurotransmitter substances in vacuoles at the foot of the nerve
process which are released to induce a N impulses or
Ne
in response to a N impulse
Nociceptive injury – nociceptors respond to injurious stimuli
Nucha The nape or back of the neck adj.- nuchal
Nystagmus sleepy – involuntary oscillations of the eyes
Occiput The prominent convexity of the back of the head
Occipitum = Occipital bone adj. occipital
. L.
Oligodendrocytes in the CNS only, become Schwann cells in the PNS and
SC, act as a barrier and insulator of axons and neurons
Osmatic to do with the sense of smell
Pars a part of
Pathway general term indicating a path of defined N fibres
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INTRODUCTION
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neurology the nerve process either Dendrite or Axon
depending upon the direction of the NI.
Projection fibres axons which connect the Cerebral cortex with the
Brainstem or SC
Proprioception
Ptosis
Pulvinar
Ne
sense of position of body parts
Prosencephalon = forebrain
Proximal closer to the axial skeleton (opposite of distal)
drooping - describing a dropping upper eyelid
a cushioned seat – posterior projection of the Thalamus
over the medial and lateral geniculate bodies
. L.
Putamen shell – larger lateral part of the lentiform nucleus –
one of the basal ganglia
Pure N a N which is either only sensory or motor not both
(as in mixed N)
Pyramidal system corticospinal and corticobulbar tracts which form a
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INTRODUCTION
Resting potential the charge difference across the cell membrane of the
N created by ionic imbalance
Reticular a net – as in the reticular formation of the brainstem
Rhinal pertaining to the nose
Rhinencephalon part of the components of the olfactory system
Ridge Elevated bony growth often roughened.
Root the segment(s) of origin of the PN from the SN
Rostral towards the nose
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Rostrum beak – recurved process of the Corpus Callosum
Rubro red as in the red nucleus – rubrospinal tract
Saccadic to jerk – as in quick jerky movements of the eyes
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when changing focus
Sagittal an arrow, the sagittal suture is notched posteriorly,
making it look like an arrow by the lambdoid sutures;
the anatomical plane from anterior to posterior.
Satellite attendant – satellite cells form a capsule around Ns
in ganglia
Schwann cells cells supplying phospholipid coat - insulation to the
. L.
axons to preserve the N impulse in the PNS - role of
the oligodendrocytes in the CNS
Secondary -
visual cortex = V2 perceives colour and form
Sensory to feel pertaining to imput - which goes to the SC and
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INTRODUCTION
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white stripe w/in the cellular layer)
Subcortical anything deep to or beneath the CC
Subdural space space beneath the DM external to the AM
Subiculum little layer - as in the thin layer of GM b/n Hp and
Substantia nigra Ne
parahippocampal gyrus
Substantia gelatinosa a column of GM at the apex of the dorsal horn of the SC
dark substance - large nucleus in the MB with a high
number of pigmented cells loss of cells in this area is
related to Parkinson’s disease
Sulcus long wide groove often due to a BV indentation –space
. L.
b/n the gyri of the GM in the brain (pl – sulci)
Superior temporal gyrus refines language interpretation such as
recognizing “s” as a plural etc
Supplementary motor area = SMA involved in complex motor functions such
as 2 handed functions
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INTRODUCTION
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supply specific anatomical regions (e.g. BP) but again
must re-organize to become PNs
Uncus hook adj. Uncinate -
Uvula little grape – as in dorsal part of the cerebellum
Vallecula
Velate
Ventral
sail Ne
little valley – as in the fold on the inferior aspect of
the cerebellum
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D= Midsagittal plane = Median plane; trunk moving away from this
plane = lateral flexion or lateral movement moving into this plane
medial movement; limbs moving away from this direction =
abduction; limbs moving closer to this plane = adduction
E = Coronal plane
F = Median
Ne C
. L.
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D
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Ne
. L.
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Anatomical Movements
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Hip flexion Hip extension
Ne
. L.
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Foot inversion Foot eversion
Ne
Foot normal position
. L.
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around the Brain and SC, and boney coverings, the Skull around the
brain and the vertebral column (VC) around the SC.
In the PNS the Ns form 2 separate divisions the voluntary and the
Ne
autonomic (ANS). The ANS is made up of the Sympathetic exiting from
the thoracic region and Parasympathetic Ns, depending upon the
region of the SC, and these nerves may travel with the PNs.
CONNECTIVE
TISSUE
= MENINGES CRANIAL
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NERVES (1-12)
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BONEY = VC
SPINAL
CORD = SC SPINAL
CONNECTIVE
NERVES = SNs
TISSUE
= MENINGES
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B C
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D E
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This brain is stripped of its normal meningeal
coverings, showing cerebral cortex - grey matter.
A = superior view
. L.
B = L lateral view
C = R lateral view
D = inferior view
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E = sagittal view
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© A. L. Neill 29
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Nerve cells when grouped together have a grey appearance and when
seen in large collections are called GREY MATTER = GM, while their
processes are often myelinated and appear white – so neural tracts are
called WHITE MATTER = WM.
Ne
In the brain the Ns are on the surface or cortex, except for some areas
where collections of Ns may be seen deep in the brain tissue – nuclei (or
ganglia). In the SC, the Ns are placed deep in the tissue in long columns.
1 nucleus and nucleolus
2 dendrites
. L.
3 neurilemma - protective myelin sheath from Schwann cells
4 axon terminal branches / telodendria
5 nodes of Ranvier
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10 neurotransmitter
11 synaptic cleft
12 postsynaptic membrane on dendrite or N cell body
13 myofibril of skeletal muscle
14 sarcolemma - cell membrane
of the skeletal muscle cell
15 sarcoplasm - plasma of the
skeletal muscle cell
16 subneural clefts
17 mitochondria
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2
1 7
Ne
6
3
5
4
. L.
18
3 4 4
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13
14
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15 17
16
13, 14 4
8
9
10
11
7
12
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THE BRAIN
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number of factors: the glial foot processes on capillaries , the unique
properties of the endothelial lining and components of the basement
membrane. The filter also alters the components of the CSF fluid via
Ne
the vessels in the choroid plexus and the choroid epithelium.
Clinically this may prevent the neural tissue from the effects of oral and
iv medications and toxins, requiring intrathecal injections. In certain
pathologies particularly inflammatory ones the barrier can be
compromised, causing oedema and other complications.
1 Medium sized cerebral BV
. L.
2 Pia Mater layer
3 Glia limiting membrane
4 Perivascular space
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9 Basement membrane
10 Glial tissue
11 Choroid epithelium
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2
3 2 4 5
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7
1 6
Ne
9
. L.
8
7
rA
5
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8 8f 7
9
10
9
11
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5 Brain – nervous tissue
6 Choroid plexus
7 Deep cerebral vein
8
9
10
11
Extracranial vein
Extracranial artery
Meningeal artery
Superficial cerebral artery
Ne
Spinal Cord Schema of the SC – transverse
. L.
1 Posterior spinal artery
2 Radicular branches a = anterior / L = lateral / p = posterior
3 Arterial vasocorona
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4 Lateral artery
5 Anterior radicular artery
6 Branches of the superficial arterial network
7 Anterior spinal artery
8 Sucal artery = ant. spinal art. (lies in the sulcus of the SC)
©D
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12
Ne
6
11
. L.
10 7
9 8
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13 2p 1
12 14
2L
9
3
4
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11
10 6
9 8
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THE BRAIN
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1 Basilar artery
2 Vertebral artery
3
4
5
6
Radial artery of C5
Radial artery of C7
Anterior spinal artery
Lateral thoracic arteries
Ne
7 Artery of the lumbar enlargement
. L.
Expanded on the one side at the level of T10 –L2
Spinal Cord
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C 4
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5
T1
Ne
T 6
. L.
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T12
L
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A B
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THE BRAIN
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circulates through the ventricular system and subarachnoid space of the
brain and SC and then is removed by the Arachnoid granulations (20) to
the venous sinus systems around the brain. Blood in the perforating BVs
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(21) surrounding the neural tissue is also filtered via the BBB.
38 © A. L. Neill
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4
5 3
2
6
1
ill
7
8
Ne 15
16
17
18
14
9
. L.
10 13
11 12 20
21 30
19
rA
19
22 2
6 1
©D
27
23
24 18
9 16
25
8 14
10
27
25 26
© A. L. Neill 39
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THE BRAIN
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develop into the
CNS. Additional
cells excluded from
Ne
the tube become the
neural crest and form
the components of the
PNS.
The brain continues to
develop throughout
adolescence and may do
. L.
so throughout life,
although neural tissue
has a limited capacity to
repair.
rA
©D
foramen magnum
(exit from skull)
40 © A. L. Neill
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Cerebral Cortex
Telencephalon Basal Nuclei
ill
NeDiencephalon
Retina of the eye
Thalamus
Hypothalamus
Neurohypophysis
. L.
Midbrain
Superior colliculus
rA
Pons
Metencephalon Cerebellum
©D
© A. L. Neill 41
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THE BRAIN
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particular patterns which can be recognized and identified histologically
with the NISSL stain. Particular cytoarchitechtural patterns have thus
been identified and regionalized – the commonest scheme being the
BRODMANN mapping of the CC.
Ne
In many cases the structure has been found to relate to the function of
these areas and so as well as naming the structure, a Brodmann
number may also be listed. The “Brodmann area” is related to the
arrangement of the Ns in the region but this may not always be directly
related to the macroscopic appearance of the brain.
The SC has its nerve cells on the inside, which are in long columns 2 in
. L.
the front – ventral horns – and 2 in the back – dorsal horns.
Connecting processes b/n the SC and the brain run up and down the
SC outside the GM forming tracts of WM, and neurons are also found
posteriorly sitting outside the main mass of the SC in small groups at
rA
42 © A. L. Neill
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5S 14 2C
5i
4C 1C
6
7 13
ill
3C
Ne
. L.
4
1B
8
rA
1K
3K 2K
3S
9 1S
©D
1S
2S
4 12
11
10
© A. L. Neill 43
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THE BRAIN
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myelinated and hence white coloured fibre tracts – the white matter WM.
The fibrous tracts of the WM in the brain are of several types
Association fibres = N tracts connecting one area to another of the
Ne
same specialty of increasing complexity e.g. area primary visual cortex
V1 to the secondary visual area V2 e.g. the perpendicular and uncinate
fasciculi and the “short fibres”
Commissural fibres = N tracts which cross from one side to the other
in the cerebrum the largest of these is the Corpus Callosum (+ ant. &
post. commissures)
. L.
Projection fibres = N tracts which send fibres of one modality to an
area of an other i.e. from the visual areas to the frontal areas for
decision making processes to begin based on the visual information
e.g. superior & inf. longitudinal fasciculi.
rA
7
1
10
ill
5 8
Ne 9
. L.
4
rA
2
1 4S
1
3
©D
11
12 4i 5
10
© A. L. Neill 45
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THE BRAIN
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Space b/n Skull and DM = EXTRADURAL SPACE (hence extra-dural
haemorrhage)
Ne
Space b/n DM and Pia – Arachnoid maters = SUBDURAL SPACE
(hence sub-dural haemorrhage)
The DM is pain sensitive and may be the cause of local headache or
spinal pain or referred pain to structures associated with the exiting Ns.
1 Falx Cerebri – contains and prevents movement of the main
cerebral hemispheres supports the superior sagittal sinus
. L.
2 Tentorium Cerebelli – separates the Cerebrum and the
Cerebellum forming a roof over the cerebellum - supports
the straight and transverse sinuses
3 Dura Mater – covering the SC – lumbar region
rA
4 Zygapophyseal jt
5 Spinous process
6 Intervertebral disc
7 PLL (at the back of the VB)
©D
8 Sinuvertebral N
9 SN
10 Sinuvertebral artery
46 © A. L. Neill
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ill
2
Ne
. L.
rA
4
©D
3
9
10
8 7 6
© A. L. Neill 47
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THE BRAIN
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5 PM
6 SC
7 Dural sac of the SC (continuing on from the cranial cavity)
8
9
10
11
CC – GM
Corpus Callosum
WM of the brain
Ne
Subarachnoid space (b/n Cerebrum and Cerebellum)
48 © A. L. Neill
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10 1
9
2
ill
Ne 5
4
3
8
. L.
7 6
rA
14 12S 1
3
©D
9
13 12i 11
© A. L. Neill 49
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THE BRAIN
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d = dorsal root (pure sensory)
v = ventral root (pure motor)
3 Denticulate lig. (from the PM)
4 DM
5 Outer layer of the AM Ne
6 Subarachnoid space (b/n the intermediate layers of
the AM)
. L.
7 Dorsal lig (from the AM)
8 PM
9 SC – GM
d = dorsal horn
rA
v = ventral horn
10 Central canal
11 Filum terminale (PM)
12 Thoracic enlargement of the SC
©D
50 © A. L. Neill
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ill
12
9d
8
Ne
9v
10
3
4
7
. L.
8
6
rA
16
6 13
©D
5 6
4 2v
14
3
2d 11
1
15
© A. L. Neill 51
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THE BRAIN
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The mouth – teeth & gums also refers pain to C4 (4)
The nose - nasal mucosa, paranasal spaces also refers pain to C3 (3)
The scalp – BVs & muscles also refers pain to C1 (1)
Ne
Intracranial pain sensitive structures :
Basal arteries
Cortical veins & venous sinuses
DM of the ACF and MCF – innervated by CN V1 (5) pain also referred
to the forehead and temple & PCF - innervated by CN IX, X (6) – pain
also referred to the back of the head and neck (suboccipital and upper
cervical regions)
. L.
Note other structures e.g. the cervical VB and neck muscles may refer
pain to the head and cause a “headache”
HISTORY:
rA
1 2
ill
3
Ne 4
. L.
5
rA
5
©D
6
5
© A. L. Neill 53
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THE BRAIN
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throbbing
severe - - - - quick - -
dull
Ne
- + - - slow - -
intermittant
acute sharp - + - - varies - -
severe + + + - rapid ± ±
varies - - - - quick - -
recedes
. L.
severe + + ± - v quick + +
severe + + ± ++ rapid + +
rA
dull + + ± - slow + +
dull + + - - slow ± ±
constant
©D
dull + + - - slow ± ±
constant
severe - - - - slow - -
throbbing
increases
through - - - - varies - -
the day
dull - ± - - slow - ±
sharp - ± ± - varies + -
positional
54 © A. L. Neill
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ill
cluster
+ + + ± global
headaches
halos around
Ne
- + + - frontal glaucoma
objects
unilateral retrobulbar
- + - - orbital
vision loss neuritis
post-
± ± - + global
traumatic
drugs/toxins
- ± - - global
vasodilators
. L.
haemorr-
+ ± - ++ global
hage
meningitis
focal
encephalitis
+ ± - ++ global neurological
acute /
rA
signs
subacute
impaired hydroce-
± + - + global
upward gaze phalus
papilloe- intracranial
- ± - + global
dema Tm
benign
©D
papilloe-
- ± - + global intracranial
dema
hypertension
stiff tender
temporal
+ - + - temple scalp
arteritis
arteries
frontal situation
tension
- - ++ - band precipitates
headaches
pattern onset
need ocular impaired
- + - -
aids/glasses vision
back and upper limb cervical
+ - + -
neck pain spondylosis
© A. L. Neill 55
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NEUROLOGICAL ASSESSMENT
NEUROLOGICAL SYMPTOMS
changes in site of control
balance CN VIII / middle ear
conscious levels global brain/ metabolic
headache global brain / DM / neck / multiple sources
hearing CN VIII middle ear
ill
mental frontal lobe /
endocrine
motor SC / Brainstem / Cerebellum
sensory SC /
Ne
sensory CC
smell CN I
speech / swallowing CN IX-XII
upper cervical Ns
sphincters / continence Sacral Ns
lumbar SC
. L.
taste CN X, XII ``
visual CN II-VI
voice change CN X
NEUROLOGICAL EXAMINATION
rA
Upper limbs –
Trunk and lower limbs -
Sphincters -
Examine: power, tone, symmetry, reflexes, ROM
SENSORY
Upper limbs –
Trunk and lower limbs -
Examine – pain, touch, pressure, proprioception, temperature
56 © A. L. Neill
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ill
± Head injury ?
± Limb twitching
Assessment of conscious level (Glasgow coma scale)
Ne
Assess EYE OPENING
NON-RESPONSIVE
©D
© A. L. Neill 57
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NEUROLOGICAL ASSESSMENT
OBEYS COMMANDS
ill
LOCALISING
MOVEMENT TOWARDS
PAIN directional
response to pain
Ne
. L.
FLEXING TO PAIN
elbow flexing but no movement
rA
towards pain
©D
EXTENDING TO PAIN
extension of the elbow &
spastic flexion of the
wrist non-directional
58 © A. L. Neill
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APHASIA
– acquired deficiency in language processing incorporating
both production and comprehension, due to brain damage.
ability to
type area repeat
auditory
fluency
affected speech
comprehension
ill
Broca’s = frontal ++++ +++++ nonfluent laboured
expressive cortex speech, slow disjointed
aphasia sentences agrammatism
transcortical
transcortical ++ ++++ non-fluent
motor
transcortical supramargin +++++ + fluent self correction of
sensory al + angular grammar + syntax only
gyri
©D
global + + non-fluent
anomic = global - ++ +++++ often the result of head
amnesic parietal + injury or tumour, fluent –
dysphasia temporal circumlocution because
lobes & their cannot recall the names of
connections things
© A. L. Neill 59
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THE BRAIN
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a=anterior / m=middle /
p=posterior branches
4 Frontal bone
5 dura mater e= endostial /
m= meningeal layers
6 Parietal bone
Ne
7 transverse sinus (R/L)
. L.
8 Occipital bone
9 superior sagittal sinus /
v= venous lacuna
10 arachnoid granulations
rA
11 emmisary veins
12 cerebral veins s=superior
/sp=superficial branches
13 arachnoid mater p with
pia mater (often fused)
©D
14 cerebellum
15 diploic vein
16 frontal sinus
60 © A. L. Neill
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10 11 1 2
9v 3p
3m 4
12sp 5e
5m
8
ill
3a
3
Ne 6
7R
. L.
10 12s
9v
rA
9
11
13
15
5m 16
©D
5e
3
7R
12sp
5m
14
© A. L. Neill 61
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THE BRAIN
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23 hypophysis and stalk
a=anterior /m=middle (infundibulum)
/ p = posterior branches
24 CNs – 24-3 CN III /
4 Frontal bone
Ne
24-6CN VI / 24-4 CN IV/
5 DM e = endostial / 24-5 CN V
m = meningeal layers 25 petrosal sinus
6 Parietal bone s=superior/ i=inferior
7 transverse sinus (R/L) 26 straight sinus
. L.
8 Occipital bone 27 tentorum cerebelli
9 superior sagittal sinus / e=edge inserted b/n
v = venous lacuna cerebrum & cerebellum
10 arachnoid granulations 28 great cerebral vein
rA
62 © A. L. Neill
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ill
13
6
17
13
3p Ne
10 9v
. L.
9
2
33 16 9 18
rA
32 19
20
5e
21
31
©D
22
23
30 24-3
24-6
24-4
29
24-5
25s
27e
25i
7L 28 7R
27
26 9
© A. L. Neill 63
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THE BRAIN
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CO goes to the brain – brain is 2.5kg or <2% of the body weight.
1 Anterior spinal art.
Ne
2 Vertebral art. – paired
3 Post. Inf. Cerebellar art.
4 Ant. Inf. Cerebellar art.
5 Basilar artery – from the fusion of the paired vertebrals
6 Pontine branches
. L.
7 Post. Cerebral art. (branch pierced by CN III)
8 Circle of Willis = arterial circle ,
9 Middle cerebral art (branch b/n. frontal & temporal lobe)
10 Ant. Cerebral art. (branch under optic chiasma)
rA
11 Cerebellar arteries
©D
64 © A. L. Neill
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10
ill
9
Ne
. L.
rA
©D
6 9
5 7
4
3
2 1 11
© A. L. Neill 65
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THE BRAIN
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vessels drain to the superior sagittal sinus (1s) and deeper vessels
drain to the straight sinus (4). The eyeball and facial areas drain to the
cavernous sinus (8) and may bring infection into the cranial cavity.
Ne
1 Sagittal sinus i=inferior / s = superior
2 Connecting anastomosing veins
3 Deep posterior cerebral veins
4 Straight sinus
5 Transverse sinus
. L.
6 Sigmoid sinus (s-shaped)
7 Petrosal sinus i =inferior / s = superior
8 Cavernous sinus
9 Internal jugular vein
rA
©D
66 © A. L. Neill
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ill
1i 3
4 2 1s
Ne
2 . L.
rA
5
7s 8
©D
7i
6
© A. L. Neill 67
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THE BRAIN
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may be very slow and on occasions is bidirectional.
Cavernous Sinus
Ne
Coronal section, Looking into the sinus posteriorly
One of the most complex sinuses is the Cavernous sinus. Through this
lake of slow moving venous blood, air, arteries, brain and glandular
tissue and CNs traverse, making this site particularly dangerous for
infection and/or neoplastic spread.
1 pituitary gland = 9 Trigeminal N =CN V
. L.
hypophysis 9-1 CN V1
1a anterior lobe 9-2 CN V2
1i infundibulum = stalk 10 foramen ovale
1p posterior lobe 11 Abducens N = CN VI
rA
17M
20
18
21
22
17m 17e
ill 1a
Ne
13
1p
16
. L.
23 1 2 3n
15
14
rA
11 12
4a
5
©D
6
4m
10
9-2
5i
3
4
© A. L. Neill 69
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THE BRAIN
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3 scalp – skin covering the skull
4 DM e= endostial / m = meningeal layers
Ne
5 sagittal sinus / s = superior / i = inferior
6 falx cerebri
7 hypophysis i = infundibulum (stalk)
8 crista galli
9 petrosal sinus s = superior/ i = inferior
. L.
10 tentorum cerebelli e=edge
11 transverse sinus
12 straight sinus
13 great cerebral vein
rA
1-6 1-5 2 3 4e
1-7,8
4m
1-9,10 5s
6
5i
13
ill
7
12
11
10e
Ne 4
1-2
1-1
10 3
1-11 1-12 9s 1-4 1-3
. L.
22 10 6 5i
21 9
rA
14p
15p
16
7i
13 1-2
©D
5s
17
1-4
8
1-L
16
1-2
1-3
1-4
1-5
18 1-6
9s 4m 20 19
© A. L. Neill 71
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THE BRAIN
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continued despite the blockage of any 1 or 2 of the individual
contributors, provided it is not acute. However distal to the ring this is
not the case.
1
2
3
4
Anterior cerebral
Anterior communicating
Ophthalmic
Internal carotid
Ne
5 Medial striate (branches)
. L.
6 Midfdle cerebral
7 Lateral striate (branches)
8 Anterior choroid
rA
9 Posterior communicating
10 Posterior cerebral
11 Superior cerebellar
12 Posterior choroid
©D
13 Basilar
72 © A. L. Neill
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ill
1
2
3
Ne 4
5
6
. L.
8 7
9
rA
10
12 11
12
©D
13
© A. L. Neill 73
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THE BRAIN
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B/n the brain and the skull are the meninges which act as protective
coverings, limit the movement of the brain w/n the skull, support the
BS and CSF and filter material to and from the brain. The outer GM is
arranged as a series of folds to maximize the surface area: the GYRI
Ne
the convex folds and grooves SULCI (may also be called fissures),
named according to their anatomical position on the brain.
Brodmann numbers have also been assigned to these areas, particularly
on the CC which relate the grey matter to brain functions, they often span
gyri and do not directly correlate to the anatomical divisions of the brain.
. L.
Generally information flows from the back of the brain– primarily the
sensory areas – via a series of tracts of WM – nerve processes - to the
front where it is integrated and processed, resulting in decisions,
planning or other higher functions.
FRONTAL LOBE for thinking, planning, decision making & motor execution
rA
Inferior
Lateral
Posterior
74 © A. L. Neill
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10
ill
1
Ne
9
17
. L.
rA
16
©D
© A. L. Neill 75
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THE BRAIN
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5 Occipital lobe
6 Cerebellum
7 SC coming from the Brainstem
8
9
10
Temporal lobe
Ne
Lateral fissure = Sylvian fissure
Central Sulcus = Central fissure
11 Cerebral hemisphere = CH
. L.
12 Cerebellar hemisphere
13 Posterior lobe of the cerebellum
14 Vermis
15 Folia = small gyri and sulci of the cerebellum
rA
16 Pons
17 Infundibulum (of the pituitary removed)
©D
76 © A. L. Neill
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ill
6
Ne 8 9
7
. L.
10
posterior 11
rA
5
©D
12
15
13
14
7
© A. L. Neill 77
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THE BRAIN
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using a Capital letter to designate the lobe and a number to show its
position in the lobe. Sulci are labeled the same way only with a small
letter –e.g. T1 = first or superior temporal gyrus –the corresponding
Ne
sulcus = t1. However several of these large folds may cross the lobe or
may have different names along their length.
The commonest names and duplications are listed below.
1g-5g = orbital gyri 1s-3s = orbital sulci
1g gyrus rectus, straight 10g lingual gyrus 05
. L.
gyrus F4 10l hippocampal lobule T5
2g medial orbital gyrus F5 10s hippocampal sulcus t5
3g anterior orbital gyrus F3 11g occipitotemporal gyrus
4g posterior orbital gyrus F3 inferiotemporal gyrus T3
rA
1g= F4
1s=f4
2g
ill
3g
2s 4g
6f
3s
Ne
5g
. L.
rA
©D
7g
11s
10L 8s
7s 8g
10s
11g 9g
14g 13g 12g
10g
© A. L. Neill 79
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THE BRAIN
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24g Hippocampal gyrus T5
25 Cuneus O1
Ne
26 Precuneus O2
27g Cingulate gyrus
27s Cingulate sulcus
28 Corpus callosum
28s Corpus callosum sulcus
. L.
superior-anterior projection of the CC = frontal pole
posterior part of the CC = occipital pole
inferior – anterior projection of CC temporal pole
rA
i = pars operculus
ii = pars triangularus
iii = pars orbicularis all parts of F3 = inferior frontal gyrus
80 © A. L. Neill
A-Z The Brain55:Layout 1 14/12/09 12:43 AM Page 81
17g 16g
18g
19g
i
ill
20g
ii
Ne iii
15f
. L.
13g 11g
rA
27s
27g
26
22s
©D
28s
28
15f
25
24g
10g 23s 12g 15g
© A. L. Neill 81
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THE BRAIN
Brain
Median view – midsagittal
This dissection halves the brain through the longitudinal sulcus
Moving rostrally from the most caudal gyrus – the lingual, cuneus,
precuneus, postcentral, paracentral, marginal (medial frontal gyrus) and
straight gyri (gyrus rectus) face into this sulcus from each CH.
ill
The pons, cerebellum, thalamus, optic chiasma and midbrain are
bisected. The pituitary is not, although it is midline.
1 Gyrus rectus – straight 17 Parieto-occipital sulcus
gyrus (of the frontal pole)
2 Optic structures = CN II
c = chiasma / n = nerve
r = radiation
Ne
18 Precuneus (parietal lobe)
19 Post-central gyrus
(parietal lobe)
20 Central sulcus
3 Pituitary gland
21 Paracentral gyrus =
. L.
4 IVth ventricle Precentral gyrus
5 Tuber cinereum 22 Medical frontal =
6 Mammillary body marginal gyrus
rA
ill
21 22 23
20 28s 24 25
18
17
19
Ne 26
28g
27
16
. L.
28r
rA
29
2
15 27
14 11 3
7 5
13
12 6
©D
8
4
10 9
© A. L. Neill 83
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THE BRAIN
Cerebrum – sections
Transverse section (guide) – coronal sections i-iv
i = at the level of the anterior commissure
ii = behind the anterior commissure
iii = through the mammillary bodies
ill
iv = through the thalamus
i
ii
iii
iv
84 © A. L. Neill
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1
2g
ill
3ah
11c
11L
12
9c
Ne 4
8 5
. L.
10
6i
rA
3ph
©D
9x 2s
© A. L. Neill 85
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THE BRAIN
Cerebrum – sections
coronal
i = at the level of the anterior commissure
ii = behind the anterior commissure
1 Longitudinal fissure 20 Optic tract
dividing the 2 CH 21 Anterior commissure
ill
2 Corpus callosum 22 Corona radiata
g = genu s = splenium
23 Third ventricle
3 Lateral ventricle ah =ant.
Ne
24 Precentral gyrus
horn / ph = post horn
25 Temporal gyri
4 Putamen (part of
s = superior / m = medial
basal nuclei)
i = inferior
5 Globus pallidus
26 Amygdaloid complex
6 Capsules – i =internal /
27 Hippocampus
e = external
. L.
28 Fusiform gyrus
7 Thalamus -
s = subthalamic nuclei / 29 Parahippocampus (gyrus)
n = nuclear groups 30 Mammillary body
8 Tela choroidea + 31 Base of hypothalamus
rA
l = lamina / v = vein
12 Caudate nucleus
13 Cingulate sulcus i
ii
14 Longitudinal fasciculus iii
s = superior iv
15 Operculum
16 Lateral sulcus
17 Insula
18 Uncinate fasciculus
19 Collateral sulcus
86 © A. L. Neill
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4
Ne 9c
3 20
21
16
6e
. L.
17
10 19 18 5
ii 2
22
rA
14s
5
3
6i
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6e
20
10
23
3ph 11i,v
19
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THE BRAIN
Cerebrum – sections
coronal
iii = through the mammillary bodies
iv = through the thalamus
1 Longitudinal fissure 20 Optic tract
dividing the 2 CH 21 Anterior commissure
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2 Corpus callosum 22 Corona radiata
g = genu s = splenium
23 Third ventricle
3 Lateral ventricle ah =
Ne
24 Precentral gyrus
ant. horn / ph = post horn
25 Temporal gyri s = superior
4 Putamen (part of
m = medial / i = inferior
basal nuclei)
26 Amygdaloid complex
5 Globus pallidus
27 Hippocampus
6 Capsules – i = internal /
e = external 28 Fusiform gyrus
. L.
7 Thalamus - 29 Parahippocampus (gyrus)
s = subthalamic nuclei / 30 Mammillary body
n = nuclear groups 31 Base of hypothalamus
8 Tela choroidea +
rA
32 Substantia nigra
choroid plexus
33 Gyrus occitpitotemporalis
9 Fornix c = columns / medialis
x = crura
10 Claustrum
11 Septum pellucida c = cavity
©D
l = lamina / v = vein
12 Caudate nucleus
13 Cingulate sulcus
14 Longitudinal fasciculus ii i
iii
s = superior
iv
15 Operculum
16 Lateral sulcus
17 Insula
18 Uncinate fasciculus
19 Collateral sulcus
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1
3 24
iii 12
14s
6i
9 15
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4
Ne 23
20
25s
9c 30
. L.
7s 27 25m
10 5 26
29
25i
28
9
rA
22 2
iv 3
12
4
©D
7n
16
6i
8
32 31
7s
3ph 27 17
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THE BRAIN
Brain
sagittal section - off centre
This section shows the Corona Radiata with the fibres from the related
GM and N tracts projecting into it.
1 Olfactory CN I t = tract / a = trigone
2 Optic tract Corpus callosum g = genu / r = rostrum
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3 Crus Cerebri
4 Striae terminalis
Ne
5 pyramidal bundles in the Pons
6 Pyramid
7 Olive
8 Hindbrain / SC
9 Hippocampus w/in the Dentate gyrus
. L.
10 Cerebellum
11 Optic radiation –in the Corona Radiata
12 Superfical longitudinal fasciculus (of Corpus Callosum)
rA
13 Corona Radiata
14 Central sulcus
15 Internal capsule + medial wall of putamen –
(part of the corpus striatum)
16 Anterior commissure
©D
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14 15
13 16
11
12
Ne 17
. L.
rA
3 2 1t
18
4
1a
5
6
©D
10 9 7
8
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THE BRAIN
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the pulvinar (13p), striate body and its contents (5,6,7,9 & 14) and
projection fibres - the optic radiation (10) and tapetum (11).
1 Longitudinal fissure
2
3
4
Middle frontal gyrus
Ne
Corpus callosum g = genu / s= splenium
lateral ventricle a = anterior horn / p = posterior horn
5 Septum Pellucidum – cavity
6 External Capsule
. L.
7 Claustrum
8 Insula
9 Internal Capsule g = genu / p = posterior limb
rA
10 Optic radiation
11 Tapetum
12 junc of Posterio-occipital and Calcarine sulci
13 Thalamus (p= pulvinar)
©D
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17 1 2
16 3g
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15 4a
14 5
Ne
9g
6
13 7
9p 18
. L.
rA
13p
©D
8
4p
9p
10
20
11
3s 1
12 19
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THE BRAIN
Anterior Commissure
coronal section – viewing it from the front
transverse section - viewing it from above
This is a major communication pathway b/n the 2 CH - anterior to the
columns of the fornix and connecting the 2 temporal lobes, olfactory
tracts and amygdaloid bodies. It is part of the neospinothalamic tract
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for pain, and is inferior to and smaller than the Corpus Callosum - 10X
larger. It has been implicated in gender studies because of its
increased size in homosexual men compared to heterosexual men
(34%) and heterosexual women (20%).
1 longitudinal fissure
2 Corpus callosum
g = genu / r = rostrum
3 caudate nucleus
Ne
17
18
19
septum pellucidum
globus pallidus
striae arteries
20 amygdaloid bodies
4 internal capsule 21 infundibulum
. L.
5 lentiform nucleus 22 root of the Optic N CN II
p = putamen
23 lateral ventricle
6 external capsule i =inferior horn
7 anterior commissure
rA
24 Anterior perforating
8 uncinate fasciculus – last substance
WM to mature in the human 25 pons
(part of the limbic system)
26 crus cerebri
9 inferior longitudinal fasciculus
27 lamina terminalis
= occipitotemporal fasciculus
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2g
4 1
18 28
15 3
27
37 5
5p
19,24
19
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10
20
Ne
26 15
22 23
. L.
21 8
25
2g 1
rA
28, 2r
17
3
16
5 4
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6 15
7
10
8
9 10 12 13 14
11
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THE BRAIN
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ventricles they act as further modifiers b/n the thalamus and the CC.
They are the beginning of the change of the GM from an outer rim in
the CC to the central core it becomes in the SC. They lie in the 3
divisions of the thalamic regions.
A = Epithalamus
C = Thalamus Ne
C = Hypothalamus (rostral) + Subthalamus (caudal)
1 Corpus callosum 15 Infundibulum (of the
pituitary gland)
. L.
2 Caudate nucleus
3 Lateral ventricle 16 Third ventricle
4 Choroid plexus 17 Interthalamic adhesion
5 Thalamus 18 Paraventricular nucei
rA
9 Supraorbital nucleus
23 Mammillary nuclei
10 Optic tract + chiasma
24 Hypothalamic nuclei
11 Subthalamic nuclei =
nucleus of Luys 25 Dorsomedial nuclei
12 Ventromedial nuclei of 26 Pineal body
the hypothalamus
13 Nucleus tuberus
14 Pituitary gland=Hypophysis
a = anterior lobe adenohy-
pophysis p = posterior lobe
neurohypophysis
96 © A. L. Neill
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1 19
21 20
2
A
3
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B
4 16
6
5
18
7
8 10 11
12
Ne 16
17
15
13
. L.
14
A
21 1
rA
B
20
19
26
©D
25
18
9
C
22
10
24
22 13 15
23 12 14a
14p
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???
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arises superiorly.
1-12 labels the CNs - subcategories indicate the parts thereof
Ne
1 CN I - b= bulb / f = fibres dropping through the sup.
concha of the nose
/ l = lateral striae / t = tract / = trigone
2 CN II - c= chiasma or crossing (50%of fibres cross to the
other CH) / n = nerve / t = tract .
3 CN III
. L.
4 CN I
5 CN V
6 CN VI
7 CN VII + nervus intermedius
rA
of Facial N
8 CN VIII –both parts
9 CN IX travels with CN X
10 CN X
©D
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31 32
1b
30
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1t
28
29
Ne 2n
1L
2c
27
2t
. L.
26 13
25 14
rA
3
4 15
24
5
23
©D
16
7
8
22
17
9,10 12
18
19
11
20
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THE BRAIN
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21 SC
22 Cerebellar flocculus
Ne
23 Olive crossed by ant. ext. arc fibres
24 Pons
25 Perforating substances a= anterior / p= posterior
26 Mammillary body
27 Tuber cinerum
. L.
28 Infundibulum (of pituitary gland)
29 Ant. Perforating substance
30 Inf. surface of frontal lobe
31 Frontal pole
rA
32 Longitudinal fissure
33 Caudate nucleus
34 Corona radiata (base of)
35 Lateral leminiscus
36 Superior cerebellar peduncle
©D
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33 34
13
44
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43
Ne
14L
15
29
14m
1 35
. L.
4
42
2 26 36
28 3
rA
5 16
24
7,8
19
17
©D
23
41 37
2
39 38
40p 5t
40a
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THE BRAIN
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4 inferior quadrigeminal art.
5 superior vermis of cerebellum
6 superior cerebellar art.
7 dentate gyrus
Ne
8 anterior inferior cerebellar art.
9 cerebellar flocculus and nodulus
10 4th ventricle
11 posterior inferior cerebellar art.
. L.
12 central canal
13 posterior spinal art.
14 veretbral art. (paired vessels)
rA
19 pons
20 basilar art (unpaired – fusion of the vertebrals)
21 posterior communicating art. (part of the circle of Willis)
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4 2
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5 3
21
Ne 16
20
. L.
16
6
rA
20
7
9 8 19
10
16
11
©D
18
17
12
16
13
14 15
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THE BRAIN
Cerebral arteries
The arteries supplying the cerebrum consist of 3 paired branches
arising from the arterial circle or Circle of Willis: the anterior, middle
and posterior cerebral arteries.
Their supply corresponds roughly although not absolutely with the
cerebral lobes. There are no branches between these arteries, in
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contrast to the extensive anastomising in the venous system and if
blocked, the distal tissue generally dies.
The brain is very sensitive to any deprivation of oxygen and will die of
deprived for oxygen completely for longer than 1 min in normal
circumstances.
Ne
Lowering the temperature, releasing intracerebral pressure, rapid
dissolving of the intravascular blockage (usually a clot) all help to
reduce the permanent damage of such an event. Brain tissue has
limited capacity to repair or regenerate its tissue.
. L.
A = cerebral tissue supplied by the anterior cerebral artery
and its branches
M = cerebral tissue supplied by the middle cerebral artery
and its branches
rA
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4b
3b
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2
46s 4 1 1b
4b
Ne
5
9
. L.
rA
8
1
1b
©D
6s
6g
4o
1
4c 4b 4t 2
4
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THE BRAIN
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cytoarchitecture and histology of Ns in the CC. The numbers
start from the central sulcus and move outwards. Many of the
areas Brodmann defined based solely on their neuronal
Ne
organization have been correlated closely to diverse cortical
functions, but they donot always correlate with the macroscopic
anantomy of the cerebral cortex nor do all the areas have a
functional correlation as seen in the following table. There has
been much discussion about the boundaries and their
correlations. This is the most widely accepted mapping.
. L.
FRONTAL LOBE
OCCIPITAL LOBE
PARIETAL LOBE
rA
TEMPORAL LOBE
©D
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Ne
. L.
rA
©D
© A. L. Neill 107
108
Brodmann’s areas – summary
Area Anatomical location Name Function Pathology
BRAIN IMAGES
312 postcentral gyrus Primary Somatosensory Cortex (rostral to caudal Primary body sensation TOUCH Agraphthesisa Astereognosia
3, 1, 2) – sensory Homunculus representation: Homunculus pattern Proprioception Light touch
legs + trunk fold over midline; arms + hands
(most tissue) are along the middle; face (most
tissue to the lips) near bottom
4 precentral gyrus mainly Primary Motor Cortex - motor homunculus 10 motor cortex = guenon MOVEMENT Paralysis Aphasia
©D
5 Superior parietal lobe Somatosensory Association Cortex Somatosensory processing cortex
6 Superior frontal gyrus Pre-Motor and Supplementary Motor Cortex 20motor cortex / supplementary motor
rA
= 20 motor cortex cortex may contribute to planning of
complex coordinated movements
7 Somatosensory association Somatosensory Association Cortex involved in locating objects in space; vision
. L.
cortex + proprioception, visuo-motor coordination
e.g. reaching to grasp an object
8 Anterior to premotor cortex Frontal eye fields Dorsolateral prefrontal Conscious control of eye movements Tonic deviation to the side of the
Ne
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© A. L. Neill
109
Brodmann’s areas – summary
Area Anatomical location Name Function Pathology
10 postcentral gyrus Most rostral Anterior prefrontal, cortex Frontopolar area Executive functions planning and Agraphthesisa Astereognosia
part of superior and middle insertion of old plans into new ones Proprioception Light touch
frontal gyri
©D
11 orbital and rectus gyri, plus Orbitofrontal area involved in planning, reasoning, and Inability to change original learnt
part of the rostral part of the decision making. Perhaps the only patterns or behaviours
superior frontal gyrus cortical constraint of the hypothalamus.
rA
12 Area b/n superior frontal gyrus Orbitofrontal area (used to be part of BA 11)
and inferior rostral gyrus
13,14 Insular cortex
. L.
15 Anterior Temporal Lobe
16
Ne
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© A. L. Neill
BRAIN IMAGES
110
Brodmann’s areas – summary
Area Anatomical location Name Function Pathology
CT IMAGING
0
20 Inferior Temporal gyrus 3 Visual cortex (V3) high-level visual processes and recognition
0
21 Middle Temporal gyrus 3 Visual cortex (V3) Language recognition and visual
+20 auditory cortex association with sounds mainly L side
22 Superior Temporal Gyrus 20 auditory cortex L side in generation and understanding
30 sensory cortex of words. R side, melody, pitch, and
©D
-includes Wernicke's area in its posterior sound intensity. Feedback with
movement of body in music
23 Ventral posterior cingulate cortex
rA
24 Ventral anterior cingulate cortex motivation, will
25 Subgenual cortex
. L.
26 Ectosplenial area
Ne
27 Piriform cortex
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© A. L. Neill
111
Brodmann’s areas – summary
Area Anatomical location Name Function Pathology
30 Part of cingulate cortex
31 Dorsal Posterior cingulate cortex
©D
32 Dorsal Anterior cingulate cortex
33 Part of anteriorcingulate cortex
34 part of parahippocampal gyrus Anterior Entorhinal Cortex
rA
35 part of parahippocampal gyrus Perirhinal cortex
36 part of parahippocampal gyrus Parahippocampal cortex
. L.
37 Fusiform gyrus 20 visual cortex
38 Most of the rostral part of Temporopolar area important area in self representation,
Ne
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© A. L. Neill
CT IMAGING
112
Brodmann’s areas – summary
Area Anatomical location Name Function Pathology
CT IMAGING
0 0
41,42 1 2 Auditory association Cortex conscious awareness of sound
43 b/n Insula and post/precentral gyrus Subcentral area
44 pars opercularis part of Broca's area on L hemisphere Formation of speech
0
45 pars triangularis 3 motor cortex
©D
part of Broca's area on L hemisphere
46 30 motor cortex Dorsolateral prefrontal cortex
47 Inferior prefrontal gyrus 30 motor cortex involved in syntactical processing
rA
48 small part of the medial surface Retrosubicular area
of the temporal lobe
. L.
49
50
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51
52 at the junction of the temporal Parainsular area
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lobe and the insula
© A. L. Neill
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NEUROLOGICAL ASSESSMENT
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hesitant expressive
fluent
can simple orders be followed receptive dysphasia
hold up your arms!
Ne
can simple objects be named – nominal dysphasia
what is this? (a ball)
can the patient read words correctly ? dyslexia
can the patient write words correctly ? dysgraphia
can the patient calculate simple tests ? dyscalculia
can the patient pick the object asked in agroup of agnosia
objects?
. L.
can the patient find their way around their geographia agnosia
surroundings ?
can the patient dress them selves ? dressing apraxia
can the patient draw shapes ? constructional apraxia
please draw a square / circle / clockface
rA
MEMORY TESTED
can the patient copy a beat with their fingers? immediate memory loss
can the patient describe their illness and last recent memory loss
meal ?
can the patient remember their recent past remote memory loss
before the illness ?
©D
can the patient remember the items on a tray visual memory loss
after it is removed ?
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THE BRAIN
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3 OCCIPITAL LOBE
4 TEMPORAL LOBE
5 INSULA
Ne
Separated by major fissures or sulci
A central sulcus = Rolandic fissure b/n the frontal and parietal lobes
B parieto-occipital sulcus
C preoccipital notch
D lateral sulcus = Sylvian fissure b/n the temporal and the frontal
+parietal lobes
. L.
E stem of the lateral sulcus
L longitudinal suclus = longitudinal fissure b/n the R and L CH
further subdivided w/n the lobes by minor sulci
j lunate sulcus
rA
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A 1Ig 1Fg
2Sg
2Ig 1Sg
l
B
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h
Ne E
k
j C 4Ds 4Dg D
. L.
L
1Sg
1Mg
1Ss 1Ig
rA
1Ms 1Ig
1As
A 1Ag
©D
A
2Ag
D
2As
2Ig
4Dg D
4Mg 2Dg
2Sg
3
h j
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THE BRAIN
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1 Operculum -(insula lying deep to this GM) – partially in
the frontal, parietal and temporal lobes
2 Insula (operculum cutaway) showing fibres of the corona
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radiate going to the GM on the surface
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Operculum
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Ne
. L.
rA
Insula
©D
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THE BRAIN
Cerebrum
Inferior view - Cerebellum removed
CEREBRUM – a highly folded cap of neural tissue with the outer N cells
(GM), sitting in the anterior and middle cranial fossae. Arranged into 4
major lobes on the surface, the cerebrum is responsible for most of the
“executive” decisions of the body and mind.
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Many of the CNs can be seen emerging from the brainstem inserted
into the undersurface concavity of the cerebrum, and continuing on to
become the SC.
Ne
1 Olfactory bulb and tract – CN I
2 Optic nerve, chiasma and tract CN II
3 Stem of the lateral sulcus
4 Collateral sulci
5 Preoccipital notch
. L.
6 Occipito-temporal sulcus
7 Lunate sulcus
8 Occiptial pole
9 Branches of the occipital sulcus
rA
17 10
11
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21 12
22 1
19
20
Ne 3
2
4
. L.
rA
18 5
©D
23 14
6
16 7
15 9
17
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THE BRAIN
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posture and balancing of the motor system, affected by sedatives and
alcohol. Lying under the Occipital lobes the cerebellum is made up of 2
small hemispheres separated by a small wormlike bridge the Vermis,
Ne
with small transverse folds = folia as opposed to the large folds =
sulci + gyri of the cerebrum, and 3 lobes as opposed to the 5 (4+1) of
the cerebrum.
1 Vermis superior, middle 15 Middle cerebellar
and inferior sections peduncles
2 Anterior lobe (small) 16 Superio cerebellar
. L.
3 Primary fissure peduncles
4 Posterior lobe (largest 17 Fourth ventricle
lobe) 18 Crus cerebri
rA
23 Posterior notch
8 Medulla oblongata
24 Central nodule
9 Pons
25 Folds of the vermis
10 Arbor vitae of the (cut through)
cerebellum
26 Uvula – inferior process
11 Cerebellar cortex of the vermis
12 Dentate nuclei 27 Cerebellar tonsil
13 Choroid plexus 28 Vallecular cerebella
14 Inferior cerebellar 29 Posterior median Sulcus
peduncles of the SC
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1
2
3
4
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Ne 8
9
5
. L.
6
7
rA
17
2
18
10
9
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11
16
15
5
14
12
7 8
13
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THE BRAIN
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alcohol. Lying under the Occipital lobes the cerebellum is made up of 2
small hemispheres separated by a small wormlike bridge the Vermis, with
small transverse folds = folia as opposed to the large folds = |sulci + gyri
of the cerebrum, and 3 lobes as opposed to the 5 (4+1) of the cerebrum.
1 Vermis superior, middle
and inferior sections
2 Anterior lobe (small)
3 Primary fissure
Ne
17
18
19
20
Fourth ventricle
Crus cerebri
Cerebral aqueduct
CN V
4 Posterior lobe 21 Flocculus
. L.
(largest lobe)
22 Secondary fissure
5 Folia - fine folds of
23 Posterior notch
the cerebellum
24 Central nodule
6 SC
rA
28 Vallecular cerebella
cerebellum
29 Posterior median
11 Cerebellar cortex
Sulcus of the SC
12 Dentate nuclei
13 Choroid plexus
14 Inferior cerebellar
peduncles
15 Middle cerebellar
peduncles
16 Superio cerebellar
peduncles
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18
19 24
20
1
21
ill
3
2
Ne
. L.
4
22 23
5
1
rA
12 25
27 26
3
©D
29
28
6
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THE BRAIN
Corpus Callosum
Median view - midsagittal
Superior views - Upper image deep transverse - level of insula
- Lower image supf. transverse - level of central sulcus
This decussation of fibres is the main form of communication b/n the 2
CH and has 3 parts, other fibres linking parts of the CC are associated
ill
with this structure.
A = genu or knee
B = body or trunk
Ne
C = splenium or tail
A + B + C = corpus callosum = 11
8 Commissures a = anterior
p = posterior 21 Floor of Calcaneal sulcus
9 Fornix c = column / 22 Inferior longitudinal
X = crus fascicles
10 Septum pellucidum 23 Roof of the inferior horn
11 Corpus callosum of the lateral ventricles
L = longitudinal striae / 24 Insula
r = rostrum 25 Lentiform nucleus
12 Interventricular foramen 26 Corona radiata
13 Lamina terminalis b = base of
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B 10
1im 12
9x 9c
8p
C
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A
8p
8a 11r
6
4
Ne 2c,n
14i
14a
. L.
3 8,9 14p
19 17t
18 17o
17
rA
11L 2r
15m
2o
11a 16m
15f 11c
©D
23 17 24 25
22
26
20
11+26
16m
21 15
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THE BRAIN
Diencephalon
Thalamus + Epithalamus + Hypothalamus = Diencephalon
Superolateral, Mid sagittal
The Thalamus (A) is a bilobed oval mass of GM ~ 3cm long - the major
sensory relay station - coordinating sensory imput to the CC. The
Hypothalamus (C) is the major control of the ANS. The Epithalamus (B),
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which includes the pineal gland (19) has a role in the body clock and
awareness of location. These 3 structures develop from the
Diencephalon in the embryonic brain. The Thalamus lies immediately
inferior to the Corpus Callosum (6) and CC (7) in the 3rd ventricle
Ne
coordinating information. It has a number of nuclei (1-5) which relate
to the CC lobes that are immediately adjacent and feeds information to
the Hypothalamus (C) where, via the hypothalamic nuclei, (12-18)
information has direct effects on the ANS, pituitary gland actions and
the sense of smell.
A Thalamus
. L.
B Epithalamus
C Hypothalamus
D Pituitary gland = Hypophysis
D1 posterior pituitary = neurohypophysis
rA
1
3
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A 2
4
5 Ne 6
2
. L.
18
17
rA
19
16 C
15
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7
14 13 12
11 8
B D3
9
D1 D2
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THE BRAIN
Fornix = arch
Lateral view – in situ
Lateral view isolated
The Fornix is an arch of fibres carrying signals from the Hippocampus
to the mammillary bodies and anterior nuclei of the thalamus and
septal nuclei. Beginning in the hippocampus the fimbria converge as
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the crura of the fornix joining in the midline with fibres crossing from
one side of the fornix body to the other via the fornix commissure.
Running along the inferior edge of the Septum Pellucidum, the fornix
redivides just before the anterior commissure, forming the columns of
the fornix.
1
2
Cingluate gyrus
Corpus callosum
Ne
3 Suprcallosal gyrus
. L.
4 Fornix
b = body, c = columns,
f = fimbria, l = crura,
x = commissure
rA
10 Anterior commissure
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1
2
3
8
Ne 9
7 5
. L.
9
10
rA
4b 4x
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4l 4c
7f 8
7 5
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THE BRAIN
Language centres
cortical centres of verbal expression
The frontal lobe contains zones for expressive language, hence motor
aphasia results when damaged, difficulty speaking ± writing. The
temporo-parieto-occipital regions contain zones for receptive language
interpretation, hence sensory aphasia results with damage, difficulty
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understanding ± reading. Traditionally 2 areas are described Broca’s
and Wernicke’s both lying in the peri-Sylvian area, around the lateral
sulcus, and more highly developed in the dominant CH. This is the
LEFT CH (for R handed people). However the 2 functions are not
Ne
exclusive to these areas. Brodmann areas 22, 41, 42, 44 & 45 are all
involved in language production and comprehension. The exact
boundaries of these areas vary, and their precise roles are interrelated.
B – Broca’s area ~ inferior-frontal gyrus (pars triangularis + pars
opercularis) - for speech + writing
W – Wernicke’s area ~ superior temporal gyrus + auditory cortex -
. L.
for comprehension and reading
Language processing is a global brain activity and apart form the listed
areas other Brodmann areas associated with aspects of language
activities are:
rA
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Ne
W B
3 4 6
2
8
5 1
7
46
44
. L.
19 40
39 45
43 47
42 41
18
rA
22
21
38
37
19
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THE BRAIN
Limbic System
Lateral
Sagittal
Definition – Limbus Gk = limb -It is the 2nd layer of “Brain structures”
evolution overlaying the Brainstem – the 1st layer – and underlying the
CC and providing substantial interconnections b/n them. Allowing for
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bodily/physiological response to emotional imput and visa versa
overriding of the autonomic response by the CC. It contains several
interconnected structures, and connects extensively with the
Rhinencephalon or “Smelling brain” and the Diencephalon which
contains the Thalamic structures.
1
2
Ne
Cerebral Cortex = CC– higher thinking centres
Limbic system -
3 Brainstem -
. L.
4 Amygdala – associated with fear and aggression
connecting mainly to Rhinencephalon
5 Hippocampus – associated with memory and learning
6 Hypothalamus – associated with body temp regulation
rA
and ANS
7 Cingulate gyrus – main connection with the superior CC
8 Corpus Callosum – major decussation joining the
R and L CH
9 Anterior thalamic nuclei
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1
2
3
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Ne
. L.
6
rA
8
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10
9
5 4
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THE BRAIN
Midbrain + Hindbrain
Anterior view – looking at the front of the midbrain –
inferior surface of the brain
b/n the forebrain cerebrum and the SC
1 Septum pellucidum
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2 Corpus callosum
3 Caudate nucleus
4 Globus pallidus
5
6
7
8
Thalamus
Putamen
Amygdala
Hippocampus
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9 SC
. L.
10 Medulla oblongata
11 Pons
12 Fornix
rA
13 Crus cerebri
14 Mammillary bodies
15 CC
16 Lateral ventricle
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16 2
Ne
15
3
12 4
5
6
. L.
14
13
7
rA
11
12 8
©D
10
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THE BRAIN
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disorders as well as hypopituitarism.
1 Olfactory b = bulb t = tract
2 Medial root 2+ 3 = olfactory striae
3
4
5
Lateral root
Paraolfactory area
Subcallosal gyrus and sulcus
Ne
6 Anterior perforating substance
. L.
7 Hippocampal complex
8 Band of Giacomini = tail of the Dentate gyrus
9 Uncus = Parahippocampal gyrus
10 Septum pellucidum
rA
11 Corpus callosum
12 Supracallosal gyrus = Indusium griseum contains the
medial and lateral longitudinal fibres (of the corpus
callosum) continuous superiorly with cingulate gyrus
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13b 13c 19
Ne
14 12
11
10
. L.
5
15 4
2 1t
16
rA
17
9 3
18
8 6 1b
7
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THE BRAIN
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before going to the cerebral cortex via THALAMOPETAL fibres, except
the olfactory imput; further refinement of cortico–cortical
communication is also via the thalamus. Nuclei (ganglia) of GM in the
Ne
region also communicate extensively with the thalamic nuclei.
6 5 + 4 + accessory semilunar gp VP
= ventral posterior gp
7L lateral geniculate body LGB
7m medial geniculate body MGB
8 pulvinar
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9 internal medullary lamina (band of contains several nuclei w/in these fibres
myelinated fibres)
10 dorsomedial gp = mediodorsal gp
11 lateral posterior gp LP
12 medial gp
13 lateral dorsal gp LD
14 intrathalamic adhesion central thalamic body
15 intralaminar gp – w/in the lamina centromedian nuc. CM is the largest
*damaged in Kosikoff’s syndrome, excessive alcohol consumption- no short
term memory and confabulation
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13 15
11
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10
8
12
9 Ne 14 1
. L.
rA
7m
7c 2
5L 5m 3
4
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THE BRAIN
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visual cortex (visual association cortex)
nuclear group destination of.. / output
1 anterior nuclear gp cingulate gyrus - emotion, limbic system
Ne
2 ventral anterior gp motor cortex initiate actions, resting muscle tone +
insula cortex, globus pallidus
3 ventral lateral gp motor + premotor cortex motor activity coordination
4 ventral intermediate gp cerebral cortex areas 4,6 from cerebellum motor
activity coordination
5L ventral posterio-lateral gp somatosensory cortex somatic sensation of body -
. L.
pain and temp
5m ventral posterior-medial gp somatosensory cortex (post central gyrus areas 3,1,2)
somatic sensation of face and jaw – pain and temp + taste.
6 5 + 4 + accessory semilunar + gustatory cortex taste.
gp= ventral posterior gp
rA
9 2
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10
11
12
13
14 Ne 15
1
5ml 11 2,3,4,9
9,11 M1 3
S1
. L.
S2 PM 2
E
71, 8
V3
9,10,
V2
rA
12,13,
71, 8 15
B
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V1
71 9,4,2
G
A2 A1 6
7m 8 7m 8
9
9,10
1,9,11,13
2
7L,8 12,15
12
4
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THE BRAIN
Ventricles
Lateral view – looking in at the side of the brain
Coronal view schema – looking at the front of the ventricles
The brain and SC sit in a closed cavity the Skull and Vertebral cavity
surrounded by CSF – a filtered form of blood plasma from the BBB -
which connects with 4 internal cavities and the spinal canal. The 4
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cavities or VENTRICLES produce the CSF which circulates around the
brain and SC, cushioning and nourishing the neural tissue.
3 ventricles lie in the cerebrum and the 4th is in the brainstem
Ne
continuous with the SC inferiorly and the subarachnoid space via 3
openings in the roof of the 4th ventricle, 2 lateral and 1 posterior.
1 frontal lobe
2a anterior horn of the lateral ventricle(s)
2b body of the lateral ventricle(s)
. L.
2i inferior horn of the lateral ventricle(s)
2p posterior horn of the lateral ventricle(s)
3 3rd ventricle
4 4th ventricle
rA
5 cerebral aqueduct
6 lateral recess(es) – foramen of Luschka
7 median aperture and foramen of Magendie
8 SC
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9 hindbrain
10 brainstem / pons
11 interventricular foramen
12 parietal lobe
13 occipital lobe
14 cerebellum
15 spinal canal
2a
1
2p
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13
2i
5
4
14
6
Ne 10
3
11
7 9
. L.
8
1
2a
2b
rA
2a
2
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3
11
2i
5
2i
4 14
7
7
15 9 10
8
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THE BRAIN
Ventricles – relations
Superior view - looking down from above
The ventricles have intimate relations with the Choroid plexus and its
parts: Tela Choroidea and Glomus Choroideum. CSF produced by
these tissues flows through the ventricles, the spinal canal and out
around the brain and spinal cord. Any blockage results in swelling and
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crushing of the tissues nearby, hence they are most vulnerable to
cerebral oedema.
Relations
Ne
1 Corpus callosum g = genu / s = splenium
2 Caudate nucleus h = head / b = body / t = tail
3 Septum pellucidum c = cavity
4 Fornix h = hippocampus
5 Amygdaloid body
. L.
6 Optic radiation
7 Tapetum
Ventricle components
10 Lateral ventricle
rA
12 suprapineal recess
13 cerebral aqueduct
14c choroid plexus
14g glomus choroideum
15 4th ventricle
15l lateral recess(es) – foramen of Luschka
15m median aperture and foramen of Magendie
15p posterior recess
16 spinal canal
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1g
3c 10a
2b
4h
Ne 10b
11
12
5
. L.
10i
2t 14c
4h
13
rA
1s
14g
6
7 15L 15i
©D
15
15p 10p
16 15m
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THE BRAIN
Ventricles – relations
Ventricles opened for internal view
The ventricles are spaces and this view emphasizes this fact.
The top view is pf one of the lateral ventricles and the lower view of the
transposed 3rd and 4th ventricles which sit higher in b/n the large
lateral ventricles
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Ventricles make up 3-4% of the weight of the brain.
Ne
1 Lateral ventricle 12 pineal body
1a anterior horn of the 13 pineal recess
lateral ventricle(s) 14 cerebral aqueduct
1b body of the lateral 15c inferior vermis
ventricle(s)
16 median foramen of
. L.
1i inferior horn of the posterior recess
lateral ventricle(s)
17 posterior recess =
1p posterior horn of the median recess
lateral ventricle(s)
18 ependymal pocket –
rA
1b
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1a
1c Ne
1p
. L.
2 11
5
12
6
rA
13
7 10
23 14
3 4
8
9 4r
©D
22
15
?? 16
17
19
18
20
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CRANIAL NERVES
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brain. Their names are an attempt
to reflect their function.
Below is a summary of the Cranial
Ne
Nerves and their functions.
They are listed in the order they leave
the Cranium/Skull.
. L.
rA
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Ne
. L.
rA
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CRANIAL NERVES
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and related structures except 3
CNs - CN 1 and II which act as
extension of brain tissue rostral to
the brainstem and CN IV which
Ne
exits from the dorsal brainstem
surface and crosses to the
contralateral side immediately.
All CNs cross partially to the
contralateral side hence most
structures have dual innervation so
. L.
that UMN lesions (eg. stroke) do not
usually result in complete loss of
function, whereas LMN lesions (eg.
trauma) generally do so.
rA
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Ne
. L.
rA
©D
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CRANIAL NERVES
CN I
Inferior view – looking up from below to the base of the brain
Superior view – looking down into the ACF – cranial exit
Magnified Sagittal view through Olfactory bulb
The Olfactory N-pure special sensory SMELL- functions as a brain extension
Origin the olfactory bulb (1)
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Course rootlets from receptor cells in the nasal lining (6) near
the superior concha pass up through the Cribiform plate of the Ethmoid
bone (5) synapse in the bulb (1) and sensory information then moves to
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the main brain tissue via the olfactory tracts (2) projecting to the
olfactory areas of the CC, see Rhiencephalon.
Cranial Exit cribiform plate
Branches none
Lesions amnosia inability to smell (and often taste is affected)
Aetiology injury to the ACF
. L.
1 Olfactory bulb
2 Olfactory tract
3 Mitral cell
4 Fibrous processes of receptor cells
rA
7 Receptor cells
8 Basal cells of the nasal epithelium
9 Columnar epithelial cells
8,9 = nasal epithelium = pseudocolumnar epithelium present
in most of the respiratory system
10 Glycocalyx on apical surface of the epithelial cells –sticky
11 Mucous secreted from the nasal glands
12 Nasal glands
13 Long microvilli and knob – specialized endings of the
receptor cells
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2
Ne 1
3
. L.
4
rA
6
©D
13 12 11 10
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CRANIAL NERVES
CN III
Schema of Oculomotor nuclei and their CNS and ANS
connections
Most of the muscles of the eye are supplied by CN III which has
connection with the ANS via the parasympathetic fibres from the
Accessory nucleus responsible for the light reflex.
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1 pretectal nucleus
2 superior colliculus
3f fibres of CN III - a combination of the motor fibres from
accessory nucleus
3m main oculomotor motor nucleus
3mf fibres from the motor nucleus
Ne
the main nucleus and the PNS motor fibres from the
154 © A. L. Neill
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Ne
9
. L.
1
8 2
rA
4
3p
3m
©D
3pf
7 3f
3mf
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CRANIAL NERVES
CN IV
Schema of Trochlear nuclei and their CNS connections
Only the Superior Oblique muscle in the eye is supplied by the
Trochlear N -= so called because of its external association with the
trochlea or pulley in the eye socket (see the A to Z of the Head and
Neck for further details). It is the only CN to exit the Brainstem from
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the dorsal surface, after complete decussation in the superior
medullary velum. It courses around to the anterior surface, through the
cavernous sinus and leaves via the optic canal as do the other eye
related CNs.
1
2
2f
mesencephalic nucleus of CN V
superior colliculus Ne
fibres form the superior colliculus - tectobulbar fibres
3 inferior colliculus
4f trochlear N fibres
. L.
4n trochlear N nucleus
5 medial longitudinal fasciculus
6 crus cerebri
rA
7 substantia nigra
8 central canal
9 cerebral cortex – motor
Pathway of the CN IV from the brainstem dorsal surface and exit from skull
©D
10 midbrain
11 superior cerebellar peduncle
12 cavity of 4th ventricle
13 MO
14 superior medullary velum
15 pons
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8 4f
3
1
2f
4n
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5
Ne 7
6
. L.
rA
10 2 3
14 4f
©D
11
12
13
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CRANIAL NERVES
CN V
The Trigeminal N – mixed : sensory, special sensory, somatic motor
fibres, and parasympathetic fibres, which relate to the muscles and
skin of the face.
Origin Sensory : NR terminates in the sensory nuclei extending from the Pons
to C2 Nu – the rootlets enter from midlateral surface of the Pons
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Motor : NR from masticator motor nucleus in the Pons
Course The Trigeminal N has 3 large branches.
Ophthalmic (V1 sensory),
Maxillary (V2, sensory) and
Ne
Mandibular (V3, motor and sensory).
The sensory branches join the trigeminal ganglion in the MCF
Cranial Exits: foramen ovale, superior and inferior orbital fissures.
. L.
BRANCHES in detail
The Mandibular N = V3 motor root + mandibular branch of the
sensory root of the Trigeminal N and has 6 branches.
The Mandibular N innervates the muscles of mastication: Mylohyoid
rA
and the anterior belly of Digastric; Tensor Veli Palatini and Tensor
Tympani. The sensory part of the Mandibular N carries general sensory
information from the mucous membranes of the mouth, cheek, anterior
2/3 of the tongue, the lower teeth, skin of the lower jaw, side of the
head and the meninges of the anterior and middle cranial fossae.
©D
158 © A. L. Neill
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V1
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V2
Ne V3
. L.
6
rA
4
©D
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CRANIAL NERVES
CN V Cont
Ophthalmic N branches V1
1 Infratrochlear
2 Anterior Ethmoid
3 Posterior Ethmoid
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4 Lacrimal
5 Supraorbital
6 Supratrochlear
7 Nasociliary
Maxillary N branches V2
1 Zygomaticotemporal
Ne
2 Zygomaticofacial
. L.
3 Post. Superior Alveolar
4 Nasopalantine
5 Greater Palatine
6 Lesser Palatine
rA
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8
Ne 2
3
. L.
1
rA
8
©D
7
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CRANIAL NERVES
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6 palatine bone -horizontal plate
7 hard palate (Maxilla)
Ne
. L.
rA
©D
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Ne
. L.
rA
1
2
©D
6
5 4
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CRANIAL NERVES
Mandibular N branches V3
1 Auriculotemporal
2 Lingual
3 Inferior Alveolar
4 N to Mylohyoid
5 Mental
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6 Buccal
for innervation to the face see the Dermatomes
Ne
. L.
rA
©D
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Ne 1
. L.
rA
6
©D
3
5
4
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CRANIAL NERVES
CN V
Schema of Trigeminal nuclei and their CNS and ANS
connections
coronal section through the brainstem
transverse section through the mid pons
Most of the sensory supply to the face and the motor supply to the
ill
muscles of mastication come from the Trigeminal N. Hence it travels
with the CNs supplying the eye and has ANS imput. It has an extensive
SC extension of its main sensory nucleus present until C2.
1 CC
2 mesencephalic nucleus
3 motor nucleus
Ne
4 main sensory nucleus – continuous with 5s
5g Trigeminal ganglion
. L.
5i Ophthalmic N = CN V1
5ii Maxillary N = CN V2
5iii Mandibular N = CN V3
rA
5l Trigeminal leminiscus
5n Trigeminal N
5s spinal nucleus of the Trigeminal N
6 thalamus
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7 midbrain
8 proprioceptive fibres from the face and eye synapse in 2
9 substantia gelatinosa
10 C2
11 MO
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2
6 5ii
5i
5L 5iii
5g
7
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3
5n
8
11
5L
Ne 4
5s
. L.
10 9
rA
2
©D
3
4
5g
5n
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CRANIAL NERVES
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A Intracerebral from the Bs to C2 20 Frontal N branch of V1
B Intracranial 21 Auriculotemporal N
C Emergence from the skull 22 lesser petrosal N
Ne
D Branches & N pathways 23 otic ganglion
E Ganglia 24 N to Parotid gland
F Ns & end organs 25 N to Labial gland
1 Nervus Intermedius 26 Mental N (to the chin)
2 Chorda Tympani N 27 Inf. alveolar N
12 via petrotympanic fissure (to the chin & jaw)
. L.
3 submandibular + sublingual 28 Ns to Tensor Typmani &
ganglia Tensor Veli Palatini
4 N to sublingual gland CN IIIa fibres from the Accessory
5 N to submandibular gland nucleus (ParS)
CN V Trigeminal N
rA
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F
Ne
E
. L.
D
rA
C
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B
A
© A. L. Neill 169
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CRANIAL NERVES
Facial Dermatomes
The Face is innervated by the Trigeminal N = CN V and its
branches.
The top of the head and neck by the upper cervical spinal Ns
1 Supra-orbital N (V1)
2 Supratrochlear N (V1)
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3 Lacrimal N (V1)
4 Infratrochlear N (V1)
Ne
5 External nasal N(V1)
6 Zygomaticofacial N (V2)
7 Infra-orbital N (V2)
8 Mental N(V3)
9 Buccal N (V3)
. L.
10 Great Auricular N (C2,3)
11 Anterior cutaneous N of the Neck (C2-3)
12 dorsal branches of C6
13 dorsal branches of C5
rA
14 dorsal branches of C4
15 dorsal branches of C3
16 Auriculotemporal N (V2)
17 Lesser Occipital N (C1,2)
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18 19 1
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17
2
17
Ne
3
4
5
. L.
6
16 8
rA
15
14
13
8
12 9
©D
10
11
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CRANIAL NERVES
CN VI
Schema of Abducens N nuclei and their CNS connections
Pathway of the CN VI from the brainstem and exit from skull
The Abducens N – pure motor, supplies the Lateral Rectus
Origin ventral surface of the Pons
Courses ventrally/anteriorly exits the DM lateral to Dorsum Sellae
ill
enters the cavernous sinus lateral to the carotid artery
Cranial Exit superior orbital fissure
1
2
2f
3
cerebral cortex
superior colliculus
Ne
fibres form the superior colliculus - tectobulbar fibres
pons
4 cavity of 4th ventricle
. L.
5 medial longitudinal fasciculus
6f fibres of Abducent N
6 abducent motor nucleus
rA
7 MO
©D
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Ne
. L.
rA
©D
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CRANIAL NERVES
CN VII
Diagram of the pathway from CC primary motor cortex
(UMN) CN VII motor nucleus(LMN) through facial canal
(longest intracranial pathway of any CN) exit.
The Facial N – mixed : sensory, special sensory, somatic motor fibres,
& Para Ns
ill
Origin ventral surface of the Brainstem – Pontomedullary junction
Course enters the IAM, travels with CN VIII – branch Greater
Petrosal N (Para Ns)
(Para Ns + SSNs)
Cranial Exit stylomastoid foramen
Ne
facial canal (petrosal canal) – branch Chorda Tympani
5 stylomastoid foramen
©D
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ill
Ne
. L.
1
rA
©D
3
4
5
© A. L. Neill 175
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CRANIAL NERVES
ill
2 Zygomatic N to Zygomaticus muscles & muscles around the eye
3 Buccal N to muscles of the cheek & upper lip
4 Mandibular N to muscles of the lower jaw (eg N to Mylohyoid-7)
5 Cervical N to Platysma
Other branches of the Facial N Ne
The Greater Petrosal N leaves the IAM, on the ant. surface of the
petrous part of the Temporal bone, in the MCF. It passes forward across
the foramen lacerum and joins the Deep Petrosal N (sym. fibres from
. L.
the superior cervical ganglion). These 2 Ns enter the pterygoid canal as
the Nerve of the Pterygoid canal.
The N of the Pterygoid canal exits the canal - synapses in the
Pterygopalatine ganglion in the Pterygopalatine fossa. It supplies
rA
branches to the lacrimal gland and the mucous secreting glands of the
nasal & oral cavities.
The Chorda Tympani (6) joins the Lingual N (9) from CN V3 in the
infratemporal fossa prior to synapsing in the submandibular ganglion in
the lateral floor of the oral cavity. Fibres from this ganglion innervate
the submandibular & sublingual glands, – not the parotid gland. via the
©D
ill
2
Ne
5
. L.
3 4
rA
©D
6
9
7 8
© A. L. Neill 177
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CRANIAL NERVES
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LMNs from the dorsal CN VII motor nucleus receive bilateral UMN input
(from both sides of the CC) and innervate the muscles of the upper face.
LMNs from the ventral CN VII motor nucleus receive contralateral UMN
Ne
inputs and innervate the lower muscles of the face
Hence both sides of the brain control the muscles of the upper face,
while only the contralateral side of the brain controls the muscles of the
lower side of the face.
Hence lesions in the corticobulbar tract, UMN lesions, result in central
. L.
facial palsy = central seven, spastic paralysis on the contralateral lower
face, while LMN lesions result in paralysis of the lower muscles on the
ipsilateral side = Bells Palsy. In both cases there may be difficulty in
sucking, swallowing, and talking. In both cases the forehead muscles
tend to be spared, and as the upper larynx and pharynx are also
rA
178 © A. L. Neill
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ill
4
Ne 1
. L.
rA
2
©D
© A. L. Neill 179
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CRANIAL NERVES
ill
occur. CN VII travels intracranially extensively through the Petrosal
canal (facial canal). At the endorgans often the motor branches are
from CN VII & the sensory from CN V.
Ne
A Intracerebral
B Intracranial
C Intrapetrosal path = facial canal (also intracranial)
D Extrapetrosal ganglia, pathways, Ns & endorgans
1 greater petrosal N
2 pterygopalatine ganglion
. L.
3 auriculotemporal N (sensory branch to EAM)
4 infraorbital N
5 buccal N
6 mental N
7 inferior alveolar N
rA
4
5
6
7
ill
3
11
2
D
Ne CP
10
CNX
8
9c
. L. 9
13
12
C
14
rA
1
©D
B
A
CN VII m
CN VII 1
CN VII g
CN VII a
© A. L. Neill 181
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CRANIAL NERVES
ill
3 round window
4 stapes
5
6
7
8c
incus
malleus
CN VII = Facial N
Cochlear N – part of CN VIII
Ne
8v Vestibular N part of CN VIII
. L.
9 Tympanic membrane
10 IAM
11 EAM
rA
12 Pinna
©D
182 © A. L. Neill
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8c
10
8v
1
ill
7
Ne
2
3
4
5
. L.
9 6
rA
©D
11
12
© A. L. Neill 183
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CRANIAL NERVES
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membranous labyrinth (AKA boney labyrinth) in the petrous
part of the Temporal bone
Cochlear duct – connected to the boney ossicles for
Ne
sound transmission
Vestibular apparatus – fluid filled tubes to detect changes
in body movement
Course cells travel to and then through the internal auditory
meatus with CN VII and Nervus intermedius entering the
brain at the pontomedullary junction lateral to VII in the
. L.
cochlear nucleus and the vestibular nuclear complex.
Cranial Exit remains in the cranium in the internal auditory meatus
1 crus cerebri
rA
2 red nucleus
3 3rd Ventricle
4 vertebral artery
5 sigmoid sinus
©D
6 MO
7 CN VII & Nervus intermedius exiting with …
8 CN VIII
9 CN IX exit
10 CN X exiting with ..
11 CN XI
11s Spinal root of CN XI
12 SC
184 © A. L. Neill
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2 3
ill
1
Ne 5
7,8
9
. L.
10,11
11s
rA
5 6
4
4
C1
©D
C2
C3
12
© A. L. Neill 185
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CRANIAL NERVES
CN IX
The Glossopharyngeal N – mixed : sensory, special sensory,
somatic motor fibres, and parasympathetic fibres, which
relate to the tongue and pharynx.
Origin ventral surface of the Brainstem –a series of rootlets b/n
olive and inferior cerebellar peduncle
ill
Course branch intracranial – the Tympanic N (Para Ns + sensory
fibres) exits via Foramen Ovale as the Lesser Petrosal N
supplies parotid gland
Ne
Cranial Exit jugular foramen travels and exits with CN X.
Motor fibres supply the Stylopharyngeus muscle.
General sensory fibres synapse in the superior glossopharyngeal
ganglia, go to the Bs and terminate in the Trigeminal nucleus. These
fibres supply the skin of the external ear, the inner surface of the
tympanic membrane, posterior one-third of the tongue and the upper
. L.
pharynx.
Sensory nerve fibers for the autonomic system - originate from the
carotid body (oxygen tension measurement) and carotid sinus (blood
pressure changes) and Special sensory fibres - detect taste from the
rA
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Ne
. L.
rA
©D
© A. L. Neill 187
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CRANIAL NERVES
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Sensory : terminate in the superior (10s) and inferior (also
containing ParaNs) vagal ganglia (10g).
Course rootlets exit via the MO, the motor division forming 3
major branches
Cranial Exit jugular foramen (22)
Ne
The Vagus N is the longest CN. The motor fibres travel with CN XI (11).
The sensory fibres travel with CN IX (9).
Test: Gag reflex
3 MOTOR BRANCHES in detail
. L.
1 the Pharyngeal N, (10p) travels b/n the int. (2) & ext. (3) carotid
arteries - enters the pharynx at the upper border of the middle
constrictor muscle and supplies the all the muscles of the pharynx and
soft palate (except the Stylopharyngeus & Tensor Veli Palatini).
2 the Superior Laryngeal N branches distal to the pharyngeal branch -
rA
9
1
10s
ill
22
10g
11
21
20
Ne 12
3
2
. L.
4
10
rA
©D
© A. L. Neill 189
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CRANIAL NERVES
ill
4 common carotid artery
5 pulmonary trunk (venous)
6 inf. Phrenic artery
7 L lobe of the liver
8 Trapezius
9 CN IX = Glossopharyngeal N
10 CN X = vagus N
Ne
10a anterior vagal trunk
. L.
10e external vagal N
10g vagal ganglia
10i internal laryngeal N
10p Pharyngeal N branch of CN X to pharyngeal plexus
rA
22
1 10g 2 9
11
ill
12
20
10
Ne 10i
10p
3 10e
19
. L.
18
4
17
16
rA
15 5
14
21
13
10a
©D
7
23
6
© A. L. Neill 191
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CRANIAL NERVES
1 Vagus N (CN X)
ill
1A Superior Laryngeal N
1B Recurrent Laryngeal N (L) – note the R branch curls
around the Aortic arch - removed
1C cardiac branches of Vagus
2 Thyroarytenoid muscle
3 Lateral Cricoarytenoid
Ne
4 Posterior Cricoarytenoid
. L.
5 Epiglottis
6 Thyroid cartilage
7 Cricoid cartilage
8 Aryenoid cartilages
rA
192 © A. L. Neill
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ill
Ne 1A
. L.
5
8
6
4
rA
7 2
3
©D
9 1B
1C
© A. L. Neill 193
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ill
outflow
7 SC
Ne
3
1
. L.
10p 4
7
rA
10p
©D
10p
8 6
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ill
PUPIL SIZE
2
Ne SALIVARY
SECRETIONS
. L.
HEART RATE
rA
BRONCHIAL SIZE
5
GASTRIC
©D
MOVEMENT
PANCREATIC &
BILE SECRETIONS
9
ADRENAL
SECRETIONS
8 BLADDER
CONTRACTION
© A. L. Neill LIBIDO 195
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CRANIAL NERVES
Vagus – CN X
autonomic input to the heart + BP
1 hypothalamic autonomic centre
2 sensory input from … 3+5+6
3 carotid sinus
ill
4 aortic sinus
5 arterial baroreceptors
6 sinoatrial node
7 arteries
Ne
8 sympathetic motor fibres tone of arteries
9 sympathetic outflow
10 CN X = Vagus N
10n Bs containing solitary tract and nucleus
. L.
10p ganglion of the Cardiac plexus
rA
©D
196 © A. L. Neill
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3
1
ill
2
4
Ne 5
10n 10
. L.
10p
6
rA
9
©D
© A. L. Neill 197
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CRANIAL NERVES
Vagus – CN X
Input to the tongue, oesophagus and upper GIT
1 input from the CC
2 pons
3 solitary tract and nucleus
ill
4 nucleus ambiguous
5 dorsal vagal nucleus
6 SC
7g phrenic N nucleus
7n phrenic N
8 diaphragm
9 stomach
Ne
10n CN X = Vagus N
. L.
10p oesophageal plexus
11 physiological sphincter of oesophagus smooth muscle
12 crura of diaphragm – skeletal muscle
rA
13 oesophagus
14 tongue
15 pharynx
©D
198 © A. L. Neill
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ill
1
14
15
Ne
2
3
4
. L.
5
6
rA
10p 10n 7g
7n
13
8
©D
12
11
© A. L. Neill 199
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CRANIAL NERVES
Accesssory – CN XI
lateral view of the Bs
superior view of the base of the skull
CN XI crossing in the neck and supplying the 2 muscles
The Accessory N – pure motor supplies cervical parts of Trapezius (1)
+ Sternocleidomastiod (2)
ill
Origin ventral surface of the MO + cervical SC
Course ascends rostrally through the Foramen Magnum
joining and traveling with the Vagus N (CN X)
Cranial Exit jugular foramen
Ne
. L.
rA
©D
200 © A. L. Neill
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ill
Ne
. L.
rA
©D
© A. L. Neill 201
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CRANIAL NERVES
ill
A Intracerebral
B Intracranial
Ne
C Jugular Foramen + VC exits for cervical Ns
D Peripheral distribution
1 otic ganglion
2 to the parotid gland
3 to the tympanic membrane / Tympanic N
. L.
4 Pharyngeal plexus
5 Laryngeal plexus
6 Coeliac plexus = Solar Plexus ie part of the abdominal
plexi
rA
202 © A. L. Neill
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6
4
ill 8
9
5
7
Ne
2
1
. L.
D
C1
C2
C3
C
rA
IX
XI
X
B
©D
A
CN XI sc
CN VII b
CN IX X m
CN Xs
CN VII, IX, X, s
CN X m
© A. L. Neill 203
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SPECIAL SENSES
ill
3 Oculomotor nucleus
3a Autonomic accessory nucleus of CN III
4 Trochlear nucleus
5m motor nucleus of Trigeminal N
Ne
- part of the Spinal nuclear complex of the Trigeminal N
5ma motor nucleus of Trigeminal N = Masticatory nucleus
5me Mesencephalic nucleus of Trigeminal N
5s Spinal nucleus of the Trigeminal N
6 Abducens nucleus
. L.
7i Inferior salivatory nucleus
7l Lacrimopalatonasal nucleus = autonomic nucleus of the
Facial N
7m Motor nucleus of the Facial N
7s Superior salivatory nucleus
rA
3
3a
ill
5ma 5me
7L
Ne 8b
8L
. L.
5m
rA
8d
7m
8c
9s
6
8s
9a
©D
8i
7s
9s + 10s
7i
5s
10a
10m
11a 12
11s
© A. L. Neill 205
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SPECIAL SENSES
Hypoglossal – CN XII
lateral view of the Bs
superior view of the base of the skull
The Hypoglossal N – pure motor –supplying tongue muscles (except
Palatoglossus)
Origin hypoglossal nucleus –ventrolateral sulcus of Medulla
ill
Oblingata running with fibres from C1-3 in the
Ansa Cervicalis
Course passes b/n internal carotid artery and jugular vein loops
Hypoglossus muscle.
Ne
above the Hyoid bone and runs on the edge of the
206 © A. L. Neill
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ill
Ne
. L.
rA
©D
© A. L. Neill 207
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SPECIAL SENSES
ill
A Intracerebral for CN XII & SC for C1-3
B Intracranial for CN XII & Vertebral canal for C1-3
C Hypoglossal canal for CN XII & Intervertebral
foraminae for the SNs
D Peripheral distribution
1 N to Styloglossus
Ne
2 Ns to Muscles of the Tongue
3 Lingual N = from CN V3
. L.
4 N to Geniohyoid Muscle
5 N to Thyrohyoid muscle
6 Ansa Cervicalis
rA
7 Ns to Infrahyoid muscles
CN XIIn Nucleus of CN XII – motor
C1m motor nuclei of the C1 -ventral horn
C2-3s sensory nuclei of C2, C3 – dorsal horns
©D
208 © A. L. Neill
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ill
4
5
Ne
2
D
2&7
3
1
. L.
6
rA C1
C2
C3
C
©D XII
B
CNXIIm
A
C2 -3s
C1m
© A. L. Neill 209
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SPECIAL SENSES
Optic - CN II
Sagittal view showing CN II pathway
Transverse view - looking down from above
The Optic N - pure special sensory VISION - functions as a
brain extension
Origin the retinal bipolar cells synapsing on specialized light
ill
receptors – rods & cones (1)
Course cells coalesce at the back of the eye as the Optic N (2) –
moves down the Optic canal, 50% cross at the Optic chiasma (3), and
Ne
proceed as the Optic tract on the contralateral side (4) to the Lateral
Geniculate body (5). A further synapse here forms the Optic radiation
(6) which travels to the Visual cortex – Brodmann areas 17,18, 19.
Cranial Exit orbital fissure /optic canal
Branches none
. L.
Lesions blindness
Aetiology injury to the eyeball &/or retina
1 Retina
2 Optic N
rA
3 Optic chiasma
4 Optic Tract
5 Lateral Geniculate body
6 Optic radiation
©D
210 © A. L. Neill
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5 4
3
6
2
ill
Ne
7 9
8
. L.
1
2
rA
3
13
4
12
©D
6 9
11
10
7
7
© A. L. Neill 211
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SPECIAL SENSES
ill
4 cerebral arteries a=anterior /m= middle /
p= posterior branches
5 lateral striate artery
Ne
6 optic radiation
7 visceral cortex
8 lateral geniculate body
9 optic tract
10 basilar artery
. L.
11 anterior choroidal artery
12 communicating artery a=anterior / p= posterior
13 superior hypophysial artery
rA
14 retina
15 choroid
16 sclera
17 short posterior ciliary arteries
©D
18 DM
19 AM
20 PM
21 subarachnoid space
22 plial plexus
23 central collateral artery
24 circle of Zinn
25 lamina cribosa
212 © A. L. Neill
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1
12a
2
4a 3
13
12p 4m
ill
11
10
9 5
8
4p
Ne 4m
7 6
. L.
25
14 15
rA
16
24 17
©D
18
1v 19
20
1a 21
2 22
9n
23 21
© A. L. Neill 213
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SPECIAL SENSES
ill
R column represents the view from the R eye
1 Pressure on the L Optic N causes circumferential
blindness on L side - the ipsilateral side
Ne
2 Total blindness on the affected side of the cut CN II
3 Pressure on the L optic tract results in R sided
nasal hemianopia
4 Pressure / Lesions on the Optic chiasma (as in pituitary
tumors) result in bilateral Temporal hemianopia –
. L.
no side vision
5, L temporal hemianopia + R nasal hemianopia is the
6, result from lesions in the optic tract (5), Optic radiation
7 (6,9) and or in the Visual cortex (7,8)
rA
8 visual cortex
9 Optic radiation
10 lateral geniculate body
11 Optic chiasma
©D
12 Optic N = CN II
13 nasal bridge
214 © A. L. Neill
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ill
L 13 R
12
Ne 4 1
1
2 2 2
. L.
11
3
3 3
10 5
rA
4 4
©D
6
5,6,7 9
5,6,7
8 7
© A. L. Neill 215
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SPECIAL SENSES
ill
2n CN II = Optic N
3g ciliary ganglion
Ne
3n CN III = Oculomotor N
4n CN IV = Trochlear N
5g Trigeminal ganglion
5i Ophthalmic N = CN V1
5ii Maxillary N = CN V2
. L.
5iii Mandibular N = CN V3
5n Trigeminal N
6 Abducens N = CN VI
rA
10 maxillary sinus
11 infraorbital N
12a anterior communicating artery
12p posterior communicating artery
13 short ciliary Ns
14 falx cerebri
15 internal carotid artery
216 © A. L. Neill
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12p 15 7a
ill
2c 12a
7p
16 2n
3n 14
Ne
. L.
3g
6m
1
13
rA
7p
3 4 11
8 6 10
9
5iii 5g 5i 5ii
©D
© A. L. Neill 217
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SPECIAL SENSES
ill
The Light reflex comes for the parasympathetic imput from the
accessory nucleus of CN III = Edinger–Westphal nucleus (IIIm)
1 intracerebral origins
2
3
4
subarachnoid space
Ne
pathway through the cavernous sinus
cranial exit through the superior orbital fissure
5 extracranial pathway - orbital fossa
. L.
6 ciliary ganglion – site of synapse of the preganglionic
parasympathetic fibres
7 level of the superior colliculus
8 level of the inferior colliculus
rA
218 © A. L. Neill
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6
10
11
12
5
Ne
14
15
13
4
. L.
rA
3
2
©D
VI
1
IIIm
IV
VI
III
7
© A. L. Neill 219
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SPECIAL SENSES
ill
except for Superior Oblique CN IV and Lateral Rectus CN VI, for more
details see the A to Z of the Head & Neck.
CN II – is a special sensory N which reports the stimulation from the
Ne
receptor cells in the retinas to the visual cortex.
These diagrams demonstrate the exits of these Nerves and their interplay
with other CNs such as CN V1 which is the sensory N for this area.
1 Recti muscles 4 in the eye i = inferior/ l = lateral /
m = medial /s = superior
. L.
2 Optic N = CN II
3 Oculomotor N = CN III s = superior div. i = inferior div.
4 Trochlear N = CN IV
5 Ophthalmic vein i = inferior /s = superior
rA
6 Abducent N = CN VI
7 Frontal N – branch of CN V1
8 Nasociliary N – branch of CN V1
9 Optic canal
©D
10 Ophthalmic artery
11 Tendinous ring around the CN II and the artery
12 Lacrimal N – branch of CN V1
13 Oblique muscles i = inferior /s = superior
14 Levator palpabrae superioris
15 Superior orbital fissure – exit in the orbital cavity for the
CNs & BVs
16 Trochea – ligamentous ring for superior oblique
17 Orbital cavity
18 Supraorbital notch
220 © A. L. Neill
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14 18
1s 13s
15 16
13s
1L
ill
4
2
Ne
10
1m
6
3g
. L.
9
13i
1i
rA
14
15 13s
1s
12 1m
©D
7
2
5s
4 11
10
3s
10
1l
8
6 1i
17
3i 5i
© A. L. Neill 221
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SPECIAL SENSES
ill
1 ventroposteriomedical nuc of the Thalamus =
arcuate and accessory arcuate nuclei of the Thalamus
2 solitariothalamic tract in the medical leminiscus
3 Bs
4 4th ventricle
5g Trigeminal ganglion
Ne
5n Spinal nucleus of CN V
. L.
5s Sensory fibres of the Mandibular N
7g Geniculate ganglion
7n Sensory nucleus of Nervus intermedius =
upper portion of Nucleus solitarius
rA
solitary tract)
9ss Special sensory fibres of CN IX - taste
10g nodose ganglion of CN X = inferior vagal ganglion
10s Solitary nucleus = Solitary tract = Solitary fasciculus
10ss Special sensory fibres of CN X - taste
38 Brodmann area for normal tongue sensation = uncus
40, 43 Brodmann areas for TASTE = Opercular Insular
region in the CC
222 © A. L. Neill
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43
ill
40
Ne 7n
2
1
38
3
. L.
1
5
rA
4
7g
5s 9s
10s
©D
8
7ss 5n
10g
9g
9ss
10ss
© A. L. Neill 223
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SPECIAL SENSES
ill
considerable variation and overlap of these areas.
The taste is detected via “taste buds” inserted into the stratified
squamous epithelium of the tongue.
Ne
1 taste pore
2 microvilli
3 supporting cells = sustenacular cells
4 basal cell
5 sensory N
. L.
6 sensory N fibres inot the cells
7 sensory hair on cell surface
Areas on the tongue detect certain tastes more sensitively
rA
224 © A. L. Neill
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CN X D
CN IX
Ne C
B
. L.
CN VII A
1
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SPECIAL SENSES
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imput to many areas of the brain for interpretation and subsequent response.
A = CEREBRUM
B = PARIETAL + TEMPORAL LOBES
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C = MIDBRAIN
D = CN VIII pathway
E = COCHLEA apparatus
1 transverse temporal gyrus
2 auditory radiation
3 medial geniculate body
. L.
4 inferior colliculus
5 superior olive
6 cochlear nuclei anterior + posterior
7 Pons
8 CN VIII fibres
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9 spiral ganglion
10 middle ear = semicircular canals, ossicles, cochlea
11 basilar membrane of cochlea
12 parenchymal cells of cochlea
13 hair cells of cochlea
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14 tectoral membrane
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3
4
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6
7
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SPECIAL SENSES
Vestibulocochlear N – CN VIII
vestibular pathways = balance
Balance is part of the special function of the Vestibulococchlear N.
Hearing disorders are often accompanied by disturbance of balance
(Meniere’s disease).
Input from the vestibular apparatus in the middle ear goes to the 4
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vestibular nuclei then to the thalamus & CC. It also goes directly to the
cerebellum. The ocular Ns change the position of the eyeball to
compensate for changes of head and body position.
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1 to higher centres in CC
2 Thalamus VPM nucleus
3 CN III nucleus = oculomotor nucleus
4 CN IV nucleus = trochlear nucleus
5 medial leminicus
. L.
6 CN VI nucleus – abducens nucleus
7 medical longitudinal fasciculus a = ascending fibres /
d = descending fibres
8g vestibular ganglia (CN VIII) – sensory input from vestibular
rA
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1
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3
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7a
8n
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7d
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10
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Neurological examination
General Considerations - in the Head & Neck
When examining the neurological patient - look for:
ASYMMETRY- muscle atrophy &/or hypertrophy, fasciculation,
uneven facial features
DEFORMITY - head held in a strained position / uneven posture
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/speech and swallowing difficulties
TONE CHANGES - hyer-reflexia / spasticity / resistance to passive
movement / hypo-tonia / flaccidity / involuntary movements (also
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see the A to Z of Peripheral Nerves and the A to Z of the Head &
Neck for full consideration of this area upper and lower motor
syndromes and cerebellar dysfunction )
Cranial Nerve examination General
When there is a lesion in the CN described –
. L.
the following capabilities are lost -
ABDUCENS = CN V
Patient cannot abduct their eye - cannot look laterally on the affected
side (Lateral Rectus) rarely seen in isolation generally associated with
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lesions of CN III, IV and V1. DD lesion of the Lateral Rectus muscle itself
as in myopathies/muscle diseases
note the eye which cannot move to look medially has the CN lesion – top image
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ACCESSORY = CN XI
Patient cannot turn head or raise shoulders against resistance
(Sternocleidomastoid + Trapezius)
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FACIAL = CN VII
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Inspect the face - look for: asymmetry, blinking, lacrimation, salivation
and evenness of facial creases and lip movement on speaking.
. L.
Patient has difficulty in using muscles of facial expression cannot
whistle or blow through their cheeks, frown, raise their eyebrows, show
their teeth, blink or close their eyes against R (muscles of facial
expression).
rA
Taste is lost in the front of the tongue. Test by trying to open the tightly
shut eye against R. DD Botx and other cosmetic procedures, myopathies
Note : commonly seen unilaterally = Bell’s Palsy, associated with parotid gland
pathology, idiopathic, commonly resolves spontaneously after 2-3 weeks with
children, but not with adults
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GLOSSOPHARYNGEAL = CN IX
No feeling or reaction to touch on the soft palate and back of the throat
absent Gag reflex - note 20% of normal people have a weak or absent
GAG (Stylopharyngeus cannot be tested in isolation) very rarely seen in
isolation generally associated with lesions of CN X particularly in
eliciting the Gag reflex
DD CN X lesions
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HYPOGLOSSAL = CN XII
Inspect the tongue - look for: atrophy, asymmetry, fasciculation and
involuntary movements - Patient cannot move the tongue in and out
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OCULOMOTOR = CN III
test eye movements - Patient cannot move eyes around follow an
examiner’s finger with movements and sees double - eyelid may fall
over the pupil and not be able to be elevated
Range of eye movement possible is shown and all affected with CN III
lesions even though 2 other CNs are involved in eye movements.
(extrinsic and intrinsic eye muscles and Levator Palpabrae - not Lateral
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Rectus or Superior Oblique) seen in isolation and associated with
lesions of CN IV, V1 and VI
DD diseases of the eye muscles and myopathies
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. L.
rA
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OLFACTORY CN I
impaired or absent sense of smell - difficult to
test - need a strong stimulus cloves / peppermint
DD diseases of the upper respiratory tract
note this is important to test when there are
suspicions of lesions in the Anterior Cranial Fossa
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OPTIC = CN II
inability to see / difficulty in seeing /inability
to focus - test reaction to light - see light and accommodation reflexes
DD diseases w/in the eyeball - cataracts, macula degeneration etc.
if pathology is suspected go on to do evaluation of visual fields examination of
the eye with the dilated pupil etc.
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rA
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TRIGEMINAL = CN V
V1
absent sensation over the top half of the face - depending upon the
lesion - may demonstrate onionskin pattern.
absence of the corneal reflex
seen in isolation and associated with lesions of CN III, IV and VI
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DD diseases of the skin
V2
absent sensation over the mid and lower portions of the face
V3
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cannot open jaw or move it side to side against resistance
absent jaw jerk - note this is often absent in the young
DD multiple sclerosis, pathology in the TMJ, dental abscesses and
cavities, Herpes Zoster infections (this does infect V1 pathway and may
. L.
leave permanent residual affects), tumours in the nasopharynx.
V1
rA
V2
V3
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Compression of Bs results in
onion skin pattern Parasthesia
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TROCHLEAR = CN IV
impaired eye movement - particularly cannot look up and out
seen in isolation and associated with lesions of CN III, V1 and VI
DD diseases of the eye muscles and myopathies
note the eye which cannot move to look up and out has the CN lesion –
top image
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VAGUS = CN X
rA
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VESTIBULOCOCHLEAR = CN VIII
ACOUSTIC component
loss of hearing – to test the frequencies impaired use tuning forks of
different frequencies
If there is better conduction through the bone than in the air – ie hold
the fork against the mastoid – the hearing loss is CONDUCTIVE ie a
block in the canal and not NEUROLOGICAL ie the N is intact
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A fork placed on the head midway should be heard evenly if this is not
the case there may be unilateral hearing loss.
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DD diseases w/in the ear eg. wax blockage growth in the auditory tube
. L.
rA
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VESTIBULAR component
nystagmus persisting after rapid change in the position of the head
DD cerebellar diseases, viral infections of the brain or head region,
pathology of the cervical region
seen in isolation and associated with CN VII
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constricts - interruption in the Brainstem has occurred.
Ask the patient to shift their gaze rapidly from one object to
another at different distances in the room, closer objects cause
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pupillary constriction - presbiopia and cataracts may complicate
interpretation of this reflex
1 Light stimulus
2 Sphincter Pupillae/Dilator Pupillae
3 Optic N tract, CN II
. L.
4 Edinger-Westphal part of oculomotor nucleus (CN III)
5 Pretectal nucleus (before the Thalamus)
6 pathway to Sympathetic chain T1, T2 (for Dilator Pupillae)
rA
7 ciliary ganglion
8 Oculomotor N, CN III
9 postganglionic parasympathetic Ns = short ciliary Ns -
10 object for focus
11 visual cortex
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14
1 2
15
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9
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4
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6
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12
? 11
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1 bright light
2 stimulus touching the cornea
3
4
5
Ophthalmic N - CN V1
Optic N tract - CN II
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Emotional imput / or response to sensation from
higher centres
6 Visual reflex centres in the Midbrain
. L.
7 Facial N efferent fibres (CN VII)
8 Orbicularis Oculi + Levator Palpabrae Superioris
* Forehead b/n the eyes.
rA
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8
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3
4
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6
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3a sympathetic chain
3b superior sympathetic ganglion
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3c postganglionic fibres to the lacrimal gland
4 Ophthalmic N = CN V1
5 sensory nucleus of CN V
6 parasympathetic nucleus of CN VII (in the Pons)
7 Facial N = CN VII and pterygopalatine ganglion
. L.
8 Lacrimal gland
Sneezing reflex
(CN V2 , X, C3,4,5 =Phrenic N + Intercostals T1-12)
rA
(Palatoglossus)
Irritant to the nasal mucosa stimulates a response to expel the air in
the region under pressure of a closed Glottis - similar to the cough
reflex but directed to go through to the nasopharynx by closing the
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oropharyngeal isthmus
1 CN V
2 Sensory nucleus of CN V in the brain stem
3 Motor nucleus of CN IX, X & XI
4 Respiratory centre
5 Phrenic N = C3,4,5
6 intercostal Ns
7 Ns to abdominal muscles
8 Vagus, Hypoglossal & Glosspharyngeal Ns (CN IX, X, XII)
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2 7 1
6
4
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5
3L
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6
3b
3a
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2 1
8
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5
3
4
6
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4 CN VII to Stapedius
5 Tympanic membrane
Salivation reflex (CN I, II, VII, IX higher emotional
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2
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5
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1
1
2 6a 3
3
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6b
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9
10a 10b
8
7
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4 Nucleus Ambiguus (motor nucleus of CN IX X & XII)..
5 Vagus N (CN X)
6 Hypoglossal N (CN XII)
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7 Preganglionic sympathetic cells (in the lateral horn of
the SC) and fibres
8 Sympathetic chain
9 Postganglionic sympathetic fibres
10 interneuron connections stimulating peristalsis to the stomach
11 stomach
. L.
Gag reflex (CN X)
irritation of the oropharynx / larynx w/o swallowing imput will cause
coughing and gaging and if severe vomiting
CN IX / X afferents will loop and efferent Ns will cause reflex reaction of
rA
the mouth is opened slightly - strike the chin with a reflex hammer -
jaw will close and then open rapidly -monosynaptic stretch reflex -
(Masseter, Medial Pterygoid and Temporalis)
1 Temporalis
2 Masseter
3 Mandibular afferents (CN V3)
4 Trigeminal ganglion
5 Proprioceptive nucleus
6 Motornucleus of Trigeminal N (CN V3)
7 Efferents from Trigeminal N to muscles of mastication (CN V3)
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2
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3
4 5
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6
7
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8 11
10
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1
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7 2
6
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Phrenic N and Intercostal Ns)
Observation - Mimicry, Boredom, Tiredness, Low O2 levels and/or High
CO2 levels, will cause a reflex from the respiratory centre in the
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Medulla to increase the air intake rapidly by opening the mouth and
pharynx very widely, contracting the diaphragm and increasing the rib
cage -rapid relaxation follows - long expiration
(Diaphragm, Platysma, Thyroid and Hyoid muscles, Pharyngeal
muscles)
. L.
1 higher centres
2 Motor nuclei of several CNs including Trigeminal and
Facial Ns (CN V3, VII)
3 Interneurons to Phrenic N (C3,4,5)
rA
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1
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6
5
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ALS = anterolateral system.
Note as with all sensory tracts there are 3 neurones needed to complete the
pathway to the CC. (this also is present in the CNs)
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1 axons of the 1st order neurones
1c fasciculus cuneatus
1g fasciculus gracilis
2 axons of the 2nd order neurones
M = medial leminiscal tracts – contralateral
P= posterior spinocerebellar tracts – ipsilateral
. L.
2c fasciculus cuneatis
3 axons of the 3rd order neurones
4 thalamus
5 CC
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6 midbrain
7 cerebellum
8 pons
9 nucleus gracilis
10 nucleus cuneatus
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11 MO
12 cell bodies of the 10 N located in the dorsal root ganglion
13 proprioreceptors receptors in muscle
14 touch – light touch receptors
15 lumbar SC
16 spinocerebellar tract note ipsilateral tract
17 cervical SC
18 dorsal root ganglion
19 post central gyrus
20 central sulcus
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3
4
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5
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6
7
. L.
8
2p 2m
rA
9
10
16 11
1g+1c
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17 14
13 18
1g
12
14
15
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2 axons of the 2nd order neurones
= lateral spinothalamic tract
3 axons of the 3rd order neurones
4 thalamus
5 CC
6 midbrain
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7 cerebellum
. L.
8 pons
9 nucleus gracilis
10 nucleus cuneatus
11 MO
rA
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3 4
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6
Ne 7
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8
2 9
rA
10
11
12
18
©D
17 13
16 1
14
15
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Corticospinal tracts
Descending motor tracts = anterior + lateral corticospinal
tracts forming the main bulk of the Pyramidal tracts
A collection of Axons b/n the motor CC and the SC, which travel
through the internal capsule to the SC forming tracts in the anterior &
lateral columns of WM in the SC.
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1 motor CC
2 internal capsule
3 geniculate fibres
4
5a
5L
anterior cerebrospinal tracts
lateral corticospinal tracts
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decussation of the pyramidal fibres
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7 1
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Ne 3
2
. L.
rA
5a
5L
©D
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Pyramidal tracts
Descending motor tracts passing through the pyramid
formation of the MO = ant. & lat. corticospinal tracts +
rubrospinal tract
The smaller ant. tracts supply the skeletal muscles on the ipsilateral side.
The larger lat. tracts and the rubrospinal tracts supply muscle on the
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contralateral side, crossing in the pyramids of the MO. The rubrospinal
tracts are involved in maintaining muscle tone, coordination and balance.
They do not have input from the CC, beginning at the red nucleus.
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1 upper motor neurones
2 primary motor area of the CC
3 internal capsule
4 red nucleus
5 midbrain
. L.
6 cerebellum
7 pons
8 MO
9 decussation (crossing over) of lat. corticospinal fibres
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10 SC cervical region
11 skeletal muscle
12 lumbar / thoracic SC
13 lower motor neurones – Spinal Nerves
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3
Ne 4
5
6
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7
rA
16
9
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15 10
14 11
12
13
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cross in the SC dorsal horns segments immediately upon entering.
1 axons of the 1st order neurones
2 axons of the 2nd order neurones
3 axons of the 3rd order neurones
4 thalamus
5 CC
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6 midbrain
6g periaqueduct GM (in Midbrain)
. L.
6r reticular formation of the midbrain
7 cerebellum
8 pons
rA
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5
6g
Ne
6r
6
7
. L.
8
8r
rA
11r
10 11
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9
1
9
13 10
14
12
9
1
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2 Reticulospinal tracts a = anterior / l = lateral
reticular formation in the Bs muscles for tone + visceral function
3 Rubrospinal tracts*
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PN
3
2L
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1L
4
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5
2a
6
1a
. L.
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7
10a
8
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10L
S
9a
M
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Green arrows demonstrate the direction of the pain when stretched
and red arrows the direction of movement
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1 CN VII Facial N
2 boney canals in the mandible
h = hypoglossal m = mandibular canal
3 commencement of the SC hindbrain / SC junction
4 SC
. L.
5 CN V Trigeminal N
6 midbrain
7 Femoral N
8 Saphenous N
rA
9 Sciatic N
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5
6
2
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3
1
4
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9
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C6
7c
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L4
9
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lumbar region they lie across the VB of the VC.
1 superior cervical ganglion
2 middle cervical ganglion
3
4
5
lower cervical ganglion
sympathetic chain
visceral branches
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6 VB of L2
. L.
rA
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4
5 Ne
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6
rA
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2 internal carotid N
3 Superior cervical ganglion
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4 Middle cervical ganglion
5 Inferior thyroid artery
6 Thyrocervical trunk
7 Subclavian artery
8 Stellate ganglion (C4-T1 fusion)
. L.
9 2nd thoracic ganglion
10 vertebral N
11 communicans b/n cervical Ns
12 loop of Atlas
rA
13 fibres to CN XII
14 fibres to CN X
15 fibres to CN XII in the descending loop ansa cervicalis
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1 2
C1 13
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12
C2 14
11
C3
C4
10 Ne 15
16
5
10 4
. L.
C5
C6
rA
C7
6
C8
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7
T1
T2 8
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The A to Z of
The Brain
Back cover