Correlating Neuroanatomy with Patient Presentation

Supratentoria Infratentorial Support Structures Pathways

above tentorium cerebelli - which contains the cerebrum

below - which contains the cerebellum

Overview of the Nervous System

Supratentorial Cortical Subcortical Infratentorial Brainstem Cerebellum

Tentorium Cerebelli

Supratentorial

Cortical
Outer gray matter Location of cell bodies (neurons, glia) Subcortical White matter (includes the internal capsule) Highways that connect cell bodies (axons) Deep nuclei: gray matter Basal Ganglia motor control Thalamus sensory, motor, consciousness Hypothalamus homeostasis

**GOOD QUIZ QUESTION **

Cerebral Cortex: 5 lobes: function 1. Frontal: 2. Parietal: 3. Occipital: 4. Temporal: 5. Insula:

sensory

movement, decision making, higher lvl of thinking, motion and personality

vision

auditory, speech, language, memory, emotion

limbic response

Neuroanatomy: Infratentorial
Brainstem: 3 areas Midbrain Pons Medulla
relay station
autonomic: respiratory, HR, BP
vision, hearing, motor control, sleep/wake, arousal/alertness, temp control

Neuroanatomy: Infratentorial Cranial nerves Centers for eye movement Cardiac, respiratory centers

Neuroanatomy: Infratentorial
Cerebellum: Lobes, Hemispheres, Tonsils
most important for motor control
ant, post, and occulonodular lobe

Functional divisions Midline (vermis) - axial coordination Lateral hemispheres - coordination and balance
(of gait)

(limb coordination)

Conduit for motor and sensory pathways

Lateral corticospinal tract (LCST) Dorsal columns (DC)

SENSORY PATHWAY

contralateral limbs

coming from cerebral Upper motor neuron axonssignals cortex to brainstem

Proprioception, discriminative touch and vibration Antero-lateral system (ALS) Pain/temperature

Anterior horn cells ( motor neuron)

Lower motor neuron cell bodies

LE

DC LCST ALS
Alpha

UE

Ends at

conus medullaris (L1-L2)

Cauda equina-.. (L2-L5) Nerve roots continue to exit respective intervertebral foramen C2-7: above respective vertebra C8: between C7-T1 T, L, S roots below

Neuroanatomy: Support structures

Meninges Spaces Ventricles Cerebrospinal Fluid Blood Arterial Venous

Neuroanatomy: Support structures

Meninges (outside-in) EPIDURAL 1. Dura Mater SUBDURAL 2. Arachnoid Mater SUBARACHNOID 3. Pia Mater
(outer most)

Arterial blood: torn meningeal artery Venous blood: torn bridging vein Normally contains cerebrospinal fluid When patient has hydrocephalus: monitor CSF (CSF) Arterial blood: aneurysm rupture

Epidural space A potential space in the cranium A real space in the vertebral canal

Neuroanatomy: Support structures Ventricular system

Cerebrospinal fluid (CSF) direction of flow in ventricular system: Lateral ventricles (2)

Interventricular foramen of Monro (2)

Third ventricle (1)

Cerebral aqueduct (1)

Fourth ventricle (1)

3 foramen

Subarachnoid space (SAS)

Intraventricular hemorrhage vs. subarachnoid hemorrhage

Neuroanatomy: Support structures

Ventricular system: CSF resorption Arachnoid villi/granulations Project from the SAS into the sinuses Cerebral venous sinuses
important for drainage

Neuroanatomy: Support structures

Anterior Circulation 2 Carotid Arteries Posterior Circulation 2 Vertebral Arteries

Vascular Supply

ACA

MCA - MOST common CVA location

PCA

Neuroanatomy: Support structures Blood Supply

Anterior Circulation Carotid Arteries (2) Ophthalmic artery Posterior communicating artery Pcomm

Anterior choroidal artery

Anterior cerebral artery (ACA) Middle cerebral artery (MCA

Neuroanatomy: Support structures Blood Supply

Posterior Circulation
Vertebral Arteries (2) Posterior Inferior Cerebellar (2 - PICA) Anterior Spinal Artery (1 - ASA) Basilar Artery (BA) Anterior Inferior Cerebellar (2 -AICA) Superior Cerebellar (2 - SCA) Posterior Cerebral (2 - PCA)

Neuroanatomy: Support structures

Blood supply
Arterial The Cerebral arteries (anterior, middle, posterior) are terminal branches Numbered segments (first, second, third order branches) i.e. A1, A2, A3, or M1, M2, M3, or P1, P2, P3 The internal carotid also has segments Cervical, carotid siphon, supraclinoid (intracranial)

Neuroanatomy: Support structures Venous

Sinuses Vein of Galen

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What are the differences in: pathways? modalities?

Three that are important to our patients! 1. Lateral Corticospinal Tract Volitional movement, the upper motor neuron 2. Dorsal Column Medial Lemniscus System AKA large fiber Proprioception/kinesthesia, discriminative touch, vibration
crosses over at spinal segment
crosses over at cervico-medullary junction

DESCENDING

ASCENDING

3. Spinothalamic Tract / Antero-lateral system AKA small fiber Pain, temperature, crude touch, itch, tickle
crosses over at spinal segment

originates in spinal cord and travels up and transmits info to thalamus

ASCENDING

Spinal Cord

What What What What

is the name of the 1o efferent track in the SC? lateral corticospinal tract cells in the CNS give rise to this efferent track? pyramidal cells is the other name for these cells / track? cross-pyramidal (OR lateral cerebrospinal tract) is the name for the analogous track for the CN? subcortical bulbar tract

Somatosensory / Proprioceptive Input

crosses over at the level of spinal segment

Somatosensory / Proprioceptive Input

Hemi-cord pathology affects touch and volitional movement on

Medial brainstem pathology often affects. Internal Capsule Infarcts affect Pain, Touch, Volitional movement is perceived/contr olled by.

Anterior horn cell / lower motor neuron pathology: LMN

Lateral brainstem pathology often affects.
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Thalamus Infarcts usually affect Only.

Distribution of Sensory Impairment

1. 2. 3. 4.

dermatomal

polyneuropathy

hempispheric

a. b. c. d.

Dermatomal Hemispheric Polyneuropathy Segmental

involves many nerves at a time - both motor and sensory