A To Z of The Brain Web Version

The A to Z of
The Brain
Dr A. L. Neill
BSc MSc MBBS PhD FACBS
Dr A. L. Neill
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
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
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
Aspenpharmacare Australia, Rob Koster, Richard Clements and Ante
Mihaljevic and everyone who provided valuable feedback.
DEDICATION
To those striving to understand.
HOW TO USE THIS BOOK
The structure of the A to Z books has by necessity changed slightly.
The principle of listing all the structures in an alphabetical manner and
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
SBN 978-0-9806840-2-5
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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
Guide to Anatomical Planes and Relations 24
Anatomical movements 26
The Nervous system overview 28
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
Fibrous tracts 44
Meninges coverings 46
Dura Mater 46
Meninges and the Brain 48
Meninges and the SC 50
Neurological assessment 52
Headache 52
History 52
Examination - conscious patient 56
unconscious patient 57
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
Brodmanns areas see Cerebrum
Circle of Willis = Cerebral arterial circle 72
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Topography
Macroscopic components of the Brain 74
Outer surfaces see also Gyri & Sulci
Inferior
Lateral
Posterior
Sagittal - Median = mid-sagittal
Superior see Cerebrum
Gyri + Sulci / Outer surfaces 78
Dissections Sectional Anatomy 84
Coronal sections
Sagittal sections see also Median section 90
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
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 also Cranial Ns
Brocas area see Language centres
Bulb = Medulla Oblongata see Brainstem , Midbrain
Cerebrum -
Arteries 104
Brodmanns areas and maps of the cerebral cortex 106
Examination of CH - cognitive skills 113
Lobes Cerebrum Major anatomy 114
Sections coronal / transverse
see Dissections/Coronal, Transverse
Caudate nucleus see Basal nuclei
Cerebellum 122
Choroid plexus see Basal Nuclei, CSF, Ventricles
Cingulate gyrus see Cerebrum/lobes
Claustrum see Anterior commissure
Colliculi - superior & inferior bodies see Brainstem
Corpus Callosum see also the Brain Dissections Sagittal 124
Corpus striatum = Caudate nucleus + Lentiform nucleus
see Macroscopic structure, Basal Nuclei
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Crus Cerebri see Brainstem Midbrain
Cuneus see Lobes - Occipital, Brain sagittal
Dentate nuclei see Brainstem, Cerebellum, Limbic system
Dermatomes (of the Face)
see Cranial Ns and Special senses / CN V Trigeminal N
Diencephalon = Epithalamus + Hypothalamus + Thalamus 126
Dura Mater see Meninges coverings
Ependyma see Ventricles
External Capsule see Brain/sections/coronal
Falx Cerebri see Meninges brain coverings
Fornix see also Septum Pellucidum 128
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
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
Language centres see also Pathology / Aphasia 130
Lateral Sulcus = Sylvian fissure see Cerebrum/lobes, Gyri + Sulci
Lentiform Nucleus = Globus Pallidus + Putamen
see Basal nuclei, Hypothalamus
Limbic system see also Fornix 132
Mammillary bodies (AKA Mammilary) see Fornix, Limbic system
Medulla Oblongata = Medulla see Brainstem , Midbrain
Midbrain = Mesencephalon see also Brainstem 134
Nucleus Accumbens = septal nuclei see Basal Nuclei, Fornix
Obex see Ventricles
Operculum see Cerebrum /lobes
Optic radiation see CN II
Paraterminal gyrus = Subcallosal gyrus
see Anterior commissure, Septum Pellucidum
Pineal body/gland see Brain- Outer surfaces - Median
Pons see Brainstem, Midbrain
Precuneus see Cerebrum/lobes, Brain sagittal
Pulvinar (part of the Thalamus) see Thalamus
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Putamen see Basal Nuclei
Red Nucleus see Brainstem, Midbrain, Rubrospinal tract
Rhinencephalon = the Olfactory region of the brain
see Septum Pellucidum, CN I
Septum Pellucidum 136
Striate body = Corpus Striatum
Substantia Nigra see Brainstem
Superior Colliculus see Brainstem
Sylvian fissure = Lateral Sulcus see Cerebrum
Tela Choroidea see, Hypothalamus, Ventricles
Thalamus see also Basal ganglia & Diencephalon 138
Uncinate Fasciculus see Anterior Commissure
Vallecula see Cerebellum
Ventricles 142
Vermis see Cerebellum
Wernickes area see Language centres
THE CRANIAL NERVES & SPECIAL SENSES
Overview and summary 148
BS to the CNs and Relations see also the Brain veins
CN I see also Special senses / Smell & Taste 152
Medications affecting Smell & Taste
Pathology of Smell & Taste
CN II see Brain outer surfaces /inferior; Special senses / Sight
CN III see also Special senses / Sight 153
CN IV see also Special senses / Sight 156
CN V 158
CN VI see also Special senses / Sight 172
CN VII see also Brainstem CN nuclei / Special senses / Taste 174
CN VIII see Special senses / Sound and Balance 182
CN IX see also Special senses / Taste 186
CN X see also Special senses / Taste 188
CN X special anatomy Larynx 192
CN X + ANS 194
CN XI see also CN IX X & XI 200
CN IX, X & XI neural pathways & interrelationships 202
CN XII 206
SPECIAL SENSES
Sight = Vision + Focus and eye movement -
Vision- CN II 210
Visual field defects 214
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Control of eye movement and focus - CN III, IV & VI 216
see also Venous sinuses/Cavernous sinus
Smell & Taste - 222
Smell - CN I see Rhinencephalon
Taste CN VII, IX & X
Sound + Balance 228
CN VIII
Examination of the CNs - 230
Reflexes of the CNs - 238
THE SPINAL CORD
Ascending = Sensory tracts 250
Anterolateral system = Spinothalamic +
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
Anterior corticospinal tracts = uncrossed pyramidal tracts
see Corticospinal tracts
Corticobulbar = Rubrospinal see Pyramidal tracts
Corticospinal = anterior + lateral corticospinal
Extrapyramidal tracts = Tectospinal + Vestibulospinal +
Spinocerebellar tracts see Tracts of the SC
Lateral corticospinal tracts = crossed pyramidal tracts
see Pyramidal tracts
Pyramidal = corticobulbar tracts + corticospinal tracts 256
Rubrospinal = Corticobulbar see Pyramidal tracts
Nociceptive information see Pain pathways
Pain pathways 258
Overview of tracts of the SC 260
Points of immobility 262
Relations with the ANS 264
Sensory modalities eg pressure, proprioception, temperature, touch,
vibration see Tracts of the SC for description of individual modalities
Structure overview see The Brain and SC - overview
Tracts of the SC
Examination of the SC, Spinal N roots and PNs
see the A to Z of the Bones, Joints & Ligaments and the Back &
The A to Z of the Peripheral Nerves
Overview of CNS disease
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Abbreviations
A = actions /movements
of a joint
A = anterior
ACF = anterior cranial fossa
aka = also known as
alt. = alternative
AM = arachnoid mater
ANS = autonomic nervous system
ant = anterior
art = articulation (joint w/o the
additional support structures)
AS = Alternative Spelling,
generally referring to the diff.
b/n British &
American spelling
assoc. = associated with
BBB = blood brain barrier
bc = because
BP = brachial plexus
BS = blood supply
BS = brain stem
b/n = between
C = cervical / carpal
CC = cerebral cortex
c.f. = compared to
CF = cranial fossa(e)
CH = cerebral hemispheres
CN = cranial nerve
CNS = central nervous system
CO =cardiac output
Co = coccygeal
CoP = coccygeal plexus
collat.= collateral
Cr = cranial
CSF = Cerebrospinal fluid
CT = connective tissue
DH = dorsal horn (of the spinal cord)
dist. = distal
DM = dura mater
e.g. = example
EC = extracellular (outside the cell)
Gk. = Greek
GM = grey matter
Hp = Hippocampus
IC = intracellular / intercostal
IC = intercarpal
IMC = intermetacarpal
jt(s) = joints = articulations
L = lateral
L = left / lumbar
LL = lower limb
Lt. = Latin
lig = ligament
M = mater
MB = midbrain
MC = metacarpal
MCF = middle cranial fossa
med = medial
MO = medulla oblongata (medulla)
MN = myelinated nerve
nMN = non-myelinated nerve
N = nerve
NS = nervous system/nerve
supply
NT = nervous tissue
NTr = nerve tract / trunk
P = posterior
PaNS = parasympathetic nervous
system
PCF = posterior cranial fossa
pl. = plural
PM = pia mater
PN = peripheral nerve
post. = posterior
proc. = process
prox. = proximal
R = Right
RC = radiocarpal
S = sacral
sing. = singular
Sc = spinal canal
SC = spinal cord
SN = spinal nerve
SP = spinous process
SyNS = sympathetic nervous system
T = thoracic
TP = transverse process
UL = upper limb, arm
V = vertebra
VB = vertebral body
VC = vertebral column
VH = ventral horn (of the spinal
cord)
Ven = ventricle (of the brain)
WM = white matter
w/n = within
w/o = without
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Neuro-anatomical and Neurological terms
Action potential the generation of a N impulse through stimulation and
depolarizing of the N cell membrane
Acusis hearing
Adiadochokinesia inability to rapidly perform rapidly alternating movements
Afferent incoming - as with sensory fibres see Sensory
Agnosia w/o knowledge inability to recognize sensory stimuli
(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
4
th
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
Ammons horn Ammonis = Egyption god with a rams head used for
the Hp which sagittally has a curl like a rams horn
Amygdala almond - almond shaped body in the Temporal lobe
involved in memory & emotion
Anasthesia w/o feeling - loss of sensation
Angular gyrus part of the Temporal lobe involved in language
processing, letter shape and word recognition,
connects occipital cortex with Wernickes area
Anopsia w/o sight - defect of vision
Ansa - loop - a loop like structure eg Ansa Cervicalis
Ant. Cingulate gyrus part of the limbic system - assoc. with cognitive processing
of pain perception and emotional response (see cingulum)
Antidromic N impulse running up the axon or down the dendrite
in the opposite direction
Aperture an opening or space b/n bones or w/n a bone.
Aphasia w/o speech - loss of speech or comprehension of the
written and spoken word
Apraxia w/o being able to do - inability to move purposefully
w/o paralysis
Arachnoid spidery weblike eg AM
Archeocortex AS Archiocortex part of the 3 layered Allocortex in the
Limbic system mainly in the Hp and Dentate gyrus
Archicerebellum AS Archeocerebellum old part of the little brain to do
with balance
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Area postrema caudal area on the floor of the 4
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Ven
Articulation joint, which is a point of contact b/n 2 bones / relating
to a joint. - hence articular branches of a N supply the
joint described.
Association fibres those N fibres which connect cortical areas of the
brain ipsilaterally (as opposed to commissural fibres)
Astereognosis w/o solid shape - inability to recognise basic shapes
by feeling them
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
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.
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
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
NUCLEUS + PUTAMEN + GLOBUS PALLIDUS +
SUBSTANTIA NIGRA
Basilar relating to the base or bottom of structures
Basiocranium bones of the base of the skull
Basis pedunculi (see crus cerebri)
Bipolar neurons with 1 dendrite + 1 axon (see unipolar, multipolar)
Blood brain barrier = BBB the barrier protecting the brain from certain
substances found in the BS
Brachium arm - large bundle of N fibres joining one region to another
Bradykinesia abnormally slow movements
Brainstem MO + Pons + Midbrain
Brocas area central region of the L frontal lobe of the CC - involved
in the production of speech: - word perception,
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production, sound and memory
Brodmanns areas areas of the CC which have been designated by their
histology cytoarchetecture - and later analysed and
found to have specific functions (after Korbinian
Brodmann 1909)
Bulb old term for MO / in the corticobulbar tract refers to
the that part of the brain stem containing the motor
nuclei of the CNs
Calamus Scriptorius reed / pen - caudal part on the floor of the 4
th
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
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
body see also CT scan
Cauda equina horses tail - lumbar and sacral N roots of the SC
resembling a horses 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
or formed by 2 or more bones (adj. cavernous), may
be used interchangeably with fossa. Cavity tends to
be more enclosed fossa a shallower bowl like space
(Orbital fossa-Orbital cavity).
Central sulcus major groove in the coronal plane dividing the frontal
and parietal lobes
Cephalic pertaining to the head
Cerebellum little brain the brain situtated in the PCF - to do with
motor coordination, balance and posture same
structure as the Cerebrum 2 hemispheres cortex
and medulla - only smaller
Cerebrospinal fluid = CSF fluid - fluid surrounding the brain and SC formed
by the ependymal cells from filtered blood. It is part of
the BBB, and contains sugar, urea and protein - approx
125mls and flows around the brain and SC at any time.
Cerebral cortex GM interconnection b/n the 2 sides via the
Corpus Callosum
Cerebral hemispheres = CH L mainly to do with: speech, writing, language
& calculation R mainly to do with spatial abilites, face
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recognition, music perception and production
- see Cerebrum
Cerebro-spinal fluid = CSF , fluid surrounding the Brain + SC providing
insulation, nutrition and pressure
Cerebrum Brain the major 2 hemispheres of the brain
consisting of an outer cortex of Ns = GREY MATTER
GM) + inner medulla of N fibres WHITE MATTER (WM)
Chiasma (Gk = ) used for the crossing of the Optic fibres
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
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
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
functions as in recognition and recall for use in
problem solving etc
Colliculus small elelvation / mound e.g. superior and inf.
colliculi forming the tectum of the MB Facial
colliculus on the floor of the 4
th
Ven
Commissural fibres those N fibres crossing the Median plane in the brain
or SC (e.g. anterior commisure)
Commissure joining together - a decussation or crossing of large
groups of fibres from one side of the median plane to
the other in the brain or SC
Cordotomy AS Chordotomy sectioning of spinothalamic tract for
intractable pain (also tractotomy)
Contra opposite (as opposed to ipsi the same)
Contralateral on the opposite side (as opposed to ipslateral on the
same side)
Corona crown fibres radiating from an inner point outwards
- as in the Corona Radiata fibres from the internal
capsule to the CC
Corpus Callosum hard body the main neocortical commissure of the
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CH connects the 2 CH via large mass of axons
crossing from one side to the other
Corpus Striatum striped body - mass of GM with motor functions at the
base of each CH
Cortex outer rind / bark outer GM of the cerebrum and
cerebellum
Cortical plasticity ability of connections b/n Ns of the CC to change
Cranial Nerve (CN) N coming directly from the brain not the SC
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.
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
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
the pyramids, medial leminisici and superior
cerebellar peduncles
Dendrite(s) tree - N process(es) bringing communication to the
cell body
Dentate toothed e.g. Dentate nucleus in cerebellum
Dentate gyrus in the Temporal lobe
Depolarization the loss of the potential across the cell membrane of a
N due to stimulation and formation of a N impulse
(see repolarization)
Dermatome the cutaneous innervation of a SN
Diencephalon through the brain = Epithalamus + Thalamus +
Subthalamus + Hypothalamus
Diplopia double vision
Distal further away from the axial skeleton
(opposite of Proximal)
Dura hard as in DM thick external layer of the meninges
Dyskinesis disordered movement abnormal motor function with
involuntary purposeless movements
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Dysmetria disordered measure abnormal reach or control of
muscle action
Efferent outgoing as in Motor nerves - see Motor
Emboliform plug e.g. emboliform nucleus of the cerebellum
Endocranium w/in the skull - refers to the interior of the braincase
adj. endocranial divided into the 3 major fossae
anterior (for the Frontal lobes) middle (containing
Temporal lobes) and posterior (for the containment of
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
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
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
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
Fasciculus small bundle used for a bundle of N fibres
Fastigial gabled roof top eg the Fastigial nucleus at the top of
the cerebellum
Fimbria fringe band of N fibres along the edge of Hp
continues as the fornix
Forceps paired tongs as in the U shaped fibres of the Corpus
Callosum - Forceps frontalis and Forceps occipitalis
Foramen a natural hole in a bone usually for the transmission of
BVs &/or nerves.(pl. foramina).
Fornix an arch as in the efferent N tract of the Hp which
arches over the Thalamus and teminates in the
Mammillary body
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Fovea pit as in the Fovea Centralis at the centre of the retina
Funiculus little cord as in the cords of WM in the SC which
consist of a number of different fasiculi all running
together in the Lateral Funiculus of the SC
Funis cord
Ganglion knot - collection of N cell bodies outside the SC (also
incorrectly used for isolated islands of N cells w/n in
the WM of the brain eg Basal Ganglia of the brain - see
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
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
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
(opposite to WM which contains mainly
myelinated axons)
Gracilis slender Fasiculus Gracilis of the SC; Nucleus Gracilis
of the of the Medulla
Groove long pit or furrow
Gyrus a circle, hence a coil of brain cortex generally the CC.
Hemiplegia half stroke paralysis down one side of the body
Hippocampus sea horse a neural gyrus in the Limbic system (in the
Temporal lobe) producing an elevation on the floor of the
temporal horn of the lateral Ven. - involved in the
conversion of short term memory to long term memory
Homunculus little human - any representation of a human being, in
this context - the homunculus maps of the motor and
somatosensory cortex show how many neurons are
devoted to various regions of the body
Horn projection of GM in the SC (ant. & post. horns are for
motor & sensory Ns respectively)
Hydrocephalus water in the head swelling in the cranium due to
CSF accumulation
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Hypothalamus under the inner chamber region in the Diencephalon
which controls the ANS and the Pituitary gland
Impulse a depolarization of the N membrane resulting in the
promulgation of a signal along the N process.
Inferotemporal cortex lower part of the Temporal lobe involved in number
and object recognition
Infundibulum funnel / stem stalk of the ant. pituitary =
neurohypophysis
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
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
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.
Lacrimal related to tears and tear drops. (noun lacrima)
Lateral sulcus groove running across the cerebrum in the coronal
plane separating the frontal & parietal lobes
Lambda from the Greek letter a capital 'L' and written as an
inverted V.(adj. lambdoid) and used to name the point
of connection between the 3 skull bones Occipital
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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Locus a place -c.f. location, locate, dislocate.
Longitudinal sulcus deep sulcus or groove along the mid-sagittal plane of
the brain separating the R & L CH
Macula spot as in the Macula Lutea of the retina = yellow spot
Magnetic Resonance Imaging = MRI used to see soft tissues other forms
are fMRI which allows for images of soft tissues as
they change see MRI
Magnum large pl magna
Mammillary -
AS Mamillary little nipple mammillary body in the ventral
surface of the Thalamus
Medulla marrow middle Medulla Oblongata the caudal
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.
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
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
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
INTRODUCTION
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muscle site general term meaning either the neuron(s),
process(es) or part of a bundle of neurons, either
cranial, spinal or peripheral
Neurilemma layers of Schwan cell membranes coating axon
processes
Neurium general term for the CT covering of a PN fibre
(see endoneurium, perineurium and epineurium)
Neurocranium refers only to the braincase of the skull.
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
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
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
Perineurium middle of the 3 CT coverings of a PN fibre
(see neurium, perineurium and epineurium)
Peripheral N (PN) coming from the SC, - often the combination of 1 or
more SNs or part thereof and not the brain directly
(cranial N) see Spinal N
Peroneal pertaining to the lower leg
Pia soft pia mater PM soft covering of the brain
Pineal pine cone shaped pineal body = pineal gland
Plexus plait / knot an interlaced network of Ns
brachial plexus
Polarization the maintenance of an unequal charge across the
membrane of the N, allowing the cell to be stimulated
- all excitable cells have a polarized membrane
Pons bridge part of the brainstem which lies b/n the
medull and the midbrain
Posterior - part of the CC which transforms visual information
Parietal cortex into motor commands
Precentral gyrus site of the primary motor cortex
Prefrontal cortex involved in complex decision making, behavioural
INTRODUCTION
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inhibition and judgement
Premotor cortex involved in sensory guidance of movement
Primary motor cortex area directly involved in producing muscle contraction
Primary visual cortex receives the first visual information = Brodmanns
area 17, V1 see Striate cortex
Procedural memory unconscious memory such as recall to catch a ball
Process A general term describing any marked projection or
prominence as in the mandibular process, in
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 sense of position of body parts
Prosencephalon = forebrain
Proximal closer to the axial skeleton (opposite of distal)
Ptosis drooping - describing a dropping upper eyelid
Pulvinar a cushioned seat posterior projection of the Thalamus
over the medial and lateral geniculate bodies
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
pyramid shape on the ventral surface of the MO
Pyramidal tract corticospinal tract only
Pyriform pear shaped pyriform area of the olfactory cortex
Quadriplegia = Tetraplegia, paralysis of all 4 limbs
Ramus branch pl. rami/branches - 2 main branches Ventral
supplying all structures in front of the SC and Dorsal
| supplying all structures behind the SC - the Rami are
mixed Ns
Raphe seam an anatomical seam in the midline raphe
nuclei of the reticular formation, in midline of the MO,
Pons & MB
Reflex referring to the Reflex arc of sensory impulse - going
to the SC and causing a motor or efferent response
w/o imput from the brain
Refractory period time b/n depolarization and repolarization, where the
N cannot be restimulated in part to stop the impulse
from traveling in both directions
Repolarization restoration of the resting potential after transmission
of a N impulse (see depolarization, polarization)
INTRODUCTION
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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
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
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
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
then brain &/or reflex
Short term memory that memory limited to several minutes of recall only
Soma body - the main part of the neuron
Somatic bodily denotes the viscera in neurology
Somatosensory relating to information perveived through sensory
receptors in the skin and muscles
Spinal Cord (SC) Extension of the brain protected by the VC, PN
come from here
Spinal Nerve (SN) N coming directly from the SC not the brain
Spine a thorn (adj. spinous) descriptive of a sharp,
slender process/protrusion.
Splanchocranium the splanchocranium refers to the facial bones of the skull
Splenium bandage thickened post. extremity of the
Corpus Callosum
Stimulation events which lead to the formation of a N impulse
Stimulus something in the environment which will cause a N
impulse to be generated from the receptor
Strabismus a squinting constant lack of parallelism in the visual
axes ie crossed eye(s)
INTRODUCTION
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Stratum layer as in stratum zonal on the dorsal surface of
the Thalamus
Striate striped
Striate cortex striped rind = Brodmanns area 17
= primary visual cortex
= V1;
CC on the Occipital lobe which receives 1
s
visual
information from the eyes via the Thalamus (has a
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
parahippocampal gyrus
Substantia gelatinosa a column of GM at the apex of the dorsal horn of the SC
Substantia nigra dark substance - large nucleus in the MB with a high
number of pigmented cells loss of cells in this area is
related to Parkinsons disease
Sulcus long wide groove often due to a BV indentation space
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
Supramarginal gyrus forms words form letters
Sural pertaining to the lower leg
Suture The saw-like edge of a cranial bone that serves as
joint between bones of the skull.
Synapse to join - the gap at the joining of N and nerve process,
N and N, process to process or N and muscle for trans-
mission or inhibition of an impulse via neurotransmitters
- presynaptic before the synapse (where the
neurotransmitter is released) / post synaptic after the
synapse (where the neurotransmitter is received).
Tapetum carpet fibres from the corpus callosum over the
lateral wall of the lat. Ven.
Tectum roof as in the roof of the MB
Tegmentum cover dorsal portion of the Pons
Tela choroidea web membrane vascular CT continuous with the PM
which continues to the Choroid plexus
Telodendria axon terminal branches
Temporal refers to time and the fact that grey hair (marking the
passage of time) often appears first at the site of the
temporal bone.
INTRODUCTION
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Tetraplegia see Quadriplegia
Thalamus inner chamber functions are sensory and integrative
2 egg-shaped masses of Ns key relay station and
filter of information to go to and not to go to the CC
Tract vertical columns of axons, generally myelinated in the
SC &/or brain
Tractotomy see Cordotomy
Trunk when SNs join together as large combined large Ns to
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 little valley as in the fold on the inferior aspect of
the cerebellum
Velate sail
Ventral chest - to the front, used interchangeably with
anterior, relating to the chest
Ventricle little belly as in ventricles of the brain filled with CSF
Vermis worm as in the vermis of the cerebellum
midline structure
Wernickes area located in the Temporal lobe crucial for language
and comprehension
White matter N tissue which consists mainly of myelinated axons
(see Grey matter)
INTRODUCTION
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Guide to Anatomical Planes and Relations
This is the anatomical position.
A= Anterior Aspect from the front Posterior Aspect from the back
used interchangeably with ventral and dorsal respectively
B= Lateral Aspect from either side
C= Transverse / Horizontal plane
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
The A to Z of the Brain
A. L. Neill 24
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D
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25 A. L. Neill

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Anatomical Movements
A. L. Neill 26
Hip flexion Hip extension
Hip abduction Hip adduction
Hip lateral and
medial rotation Hip circumduction
Knee flexion Knee extension

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27 A. L. Neill
Foot dorsiflexion
Foot plantar flexion
Foot inversion
Fingers extension
Forearm pronation
Fingers abduction Thumb opposition
Fingers flexion
Forearm supination
Fingers adduction
Foot eversion
Foot normal position
Hand deviation
radial/laterally
ulna/medially

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The Nervous system
The nervous system is made up of: the CNS = Brain + SC, the PNS =
Ns exiting from the CNS - CRANIAL directly from the brain (12 PAIRS)
and from the SC (31 PAIRS), the protective coverings of the tissue are
made up of - connective tissue - the MENINGES of which there are 3
layers, the outer or DURA MATER and the inner often fused 2 layers
THE ARACHNOID & PIA MATERS for the diffusions of CSF and blood
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
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.
THE NERVOUS SYSTEM
A. L. Neill 28
SPINAL
CORD = SC
CENTRAL NERVOUS
SYSTEM = CNS
PERIPHERAL NERVOUS
SYSTEM = PNS
BRAIN
BONEY = SKULL
CONNECTIVE
TISSUE
= MENINGES
PROTECTIVE
COVERINGS
BONEY = VC
CONNECTIVE
TISSUE
= MENINGES
CRANIAL
NERVES (1-12)
SPINAL
NERVES = SNs
ANS

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29 A. L. Neill
This brain is stripped of its normal meningeal
coverings, showing cerebral cortex - grey matter.
A = superior view
B = L lateral view
C = R lateral view
D = inferior view
E = sagittal view
A
B
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The Nerve Cells
The basic functioning cell of the NS is the NEURON = NERVE CELL =
N. Most are multipolar meaning that they have multiple dendritic (2)
processes, which feed impulses into the nerve cell body (7). All Ns only
have one axon (6), taking an impulse away from the cell body.
There are 2 basic types of Ns: - MOTOR Ns, which stimulate target organs
and SENSORY Ns, which provide feedback about the target organs.
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.
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
3 neurilemma - protective myelin sheath from Schwann cells
4 axon terminal branches / telodendria
5 nodes of Ranvier
6 axon and base of axon - axon hillock
7 N cell body plasma with neurofibrils, Nissl bodies,
mitochondria, Golgi & ribosomes
8 presynaptic membrane
9 synaptic vesicles
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
THE NERVOUS SYSTEM
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31 A. L. Neill
15
16
4
13
14
3
17
4
18
5
6
7
1
2
4
8
9
11
7
12
10
13, 14
3
4
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Blood Brain Barrier BBB
Schema of Blood Vessel
BBB in the neuroaxis of capillary
BBB in the choroid plexus in ventricle
The Blood Brain Barrier BBB prevents brain tissue from being
exposed to various blood borne substances. This is achieved by a
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
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
2 Pia Mater layer
3 Glia limiting membrane
4 Perivascular space
5 Foot processes of astroglia on capillaries
6 Neural tissue
7 BV lumen
8 Endothelial cell f = fenestration
9 Basement membrane
10 Glial tissue
11 Choroid epithelium
THE BRAIN
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33 A. L. Neill
2
1
3
2 4
5
7
6
5
9
8
7
7
8 8f
9
10
9
11

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Blood Supply overview
Brain Schema of the brain coronal
1 Skull = boney covering
2 Meningeal vein
3 DM around the venous sinuses + communicating vessel
4 External cerebral vein
5 Brain nervous tissue
6 Choroid plexus
7 Deep cerebral vein
8 Extracranial vein
9 Extracranial artery
10 Meningeal artery
11 Superficial cerebral artery
Spinal Cord Schema of the SC transverse
1 Posterior spinal artery
2 Radicular branches a = anterior / L = lateral / p = posterior
3 Arterial vasocorona
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)
9 Marginal zone (of Lissauer) - ALM tracts before synapse
10 Anterior horn = ventral motor horn
11 Deep spinal artery
12 Substantia gelatinosa - ALM Ns synapse point
13 Mediobasal column (of Clarke) - for sensory interneurons
14 Posterior horn = dorsal sensory horn
15 Skull = boney covering
16 Meningeal vein
THE BRAIN
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35 A. L. Neill
1
2
3
4
5
6
7
8
9
10
11
12
9
12
13
14
2p
1
2L
4
3
5
6
2a
9
10
11
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Blood Supply overview
Spinal Cord
Schema of the SC anterior surface
C = cerebral region
T= thoracic region
L= lumbar region
1 Basilar artery
2 Vertebral artery
3 Radial artery of C5
4 Radial artery of C7
6 Lateral thoracic arteries
7 Artery of the lumbar enlargement
Expanded on the one side at the level of T10 L2
Spinal Cord
Schema of the SC deep and superficial arterial networks
Note there are minimal anastomoses b/n these 2 different circulations
This circulation as with the brain has end arteries and distally the
tissue may be compromised.
A deep arterial network neural tissue supplied by anterior spinal artery
B superficial arterial network

THE BRAIN
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37 A. L. Neill
T1
T
T12
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5
4
3
2
1
6
L
C
A B

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CEREBROSPINAL FLUID = CSF - circulation of
fluid in and around the Brain & SC
Lateral overview of ventricles
Sagittal view of CSF circulation
Definition CSF bathes the Brain and SC, filtered from arterial blood by the
Choroid plexus (27). Removing the blood proteins and cellular elements, it
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
(21) surrounding the neural tissue is also filtered via the BBB.
THE BRAIN
A. L. Neill 38
1 Frontal lobe
2 Anterior horn of lateral
ventricles
3 Body of the lateral
ventricles -
4 Cerebral cortex
5 Parietal lobe
6 Posterior horn of the
lateral ventricles
7 Occipital lobe
8 Cerebellum
9 Cerebral aqueduct
(aqueduct of Sylvius)
10 4th ventricle with
lateral aperture
11 Median aperture
(foramen of Magendie)
12 SC
13 Lateral recess of
4th ventricle
(foramen of Lushka)
14 Pons
15 Temporal lobe
16 3rd ventricle
17 Lateral fissure
(Sylvian fissure)
18 Interventricular foramen
19 Subarachnoid space
20 Arachnoid granulations
21 Perforating veins
22 Pia/arachnoid mater
23 Transverse sinus
24 Cistern of the great
cerebral vein*
25 Cerebral artery
26 Cerebral vein
27 Choroid plexus
28 Pituitary gland + stalk
29 Dura mater
30 Superior sagittal sinus
*may sample CSF here

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39 A. L. Neill
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3
2
1
18
17
16
15
14
13
12
11
10
9
8
7
6
5
20
19
30
19
2
1
27
18
16
25
14
27
26
25
10
8
9
24
23
6
22
21

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The Brain develops from
ectoderm the top
germinal layer cells
form a tube the neural
tube which develops 3
bulges as shown and
develop into the
CNS. Additional
cells excluded from
the tube become the
neural crest and form
the components of the
PNS.
The brain continues to
develop throughout
adolescence and may do
so throughout life,
although neural tissue
has a limited capacity to
repair.
THE BRAIN
A. L. Neill 40
Brain Development and Organization
foramen magnum
(exit from skull)

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41 A. L. Neill
PRIMARY SECONDARY DERIVATIVES
BRAIN VESICLES BRAIN VESICLES
Cerebral Cortex
Basal Nuclei
Telencephalon
Diencephalon
Metencephalon
Myelencephalon
Spinal cord
Midbrain
Superior colliculus
Pons
Cerebellum
Medulla Oblongata
dorsal horn = sensory
ventral horn = motor
Retina of the eye
Thalamus
Hypothalamus
Neurohypophysis

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The Brain and SC macroscopic structure
The Brain places most of its neurons on the outer surface cortex -
which gives the brain surface a grey colour hence it is the grey matter
GM. The Ns are connected by their processes underneath mostly
myelinated and hence white coloured fibre tracts the white matter WM.
The Ns of the brain are layed down in multiple laminae/layers in
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.
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
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
each outlet dorsal root ganglia.
1 GM b = basal ganglia- deep GM - part of the Corpus
Striatum / c = cerebrum / k = cerebellum / s = SC
2 WM c = cerebrum / k = cerebellum / s = SC
3 Space in the CNS filled with CSF in the c = cerebrum
k = cerebellum s = SC (spinal canal)
4 Subarachnoid space
5 Sagittal sinus s = superior / i = inferior
6 Lateral ventricle
7 Third ventricle
8 Cerebral aqueduct
9 Fourth ventricle
10 DM
THE BRAIN
A. L. Neill 42
11 AM
12 PM
13 Choroid plexus

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43 A. L. Neill
2C
14
5S
5i
4C
6
7
8
3K
4
9
4
10
11
12
2S
1S
1S
2K
3S
1K
1B
13
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1C

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The Brain fibrous tracts
coronal- view looking at the face
sagittal view looking from the side
The Brain places most of its neurons on the outer surface cortex -
which gives the brain surface a grey colour hence it is the grey matter
GM. The Ns are connected by their processes underneath mostly
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
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)
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.
1 GM of the cerebrum = cerebral cortex
2 Association fibres of the cerebrum WM short fibres
3 Commissural fibres of the cerebrum - WM (Corpus Callosum)
4 Projection fibres of the cerebrum - WM
4i inferior longitudinal fasciculus /
4s superior longitudinal fasciculus
5 Gyrus
6 Sulcus
7 Longitudinal fissure
8 Lateral fissure / sulcus
9 Insula GM of cerebrum deep to the lateral fissure
10 Thalamus
11 uncinate fasciculus
12 perpendicular fasciculus
THE BRAIN
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45 A. L. Neill
1
10
10
7
3
6
5
4
9
8
2
1
3
12
4i
5
11
1
4S

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Dura Mater - DM = Hard Mother
Outer layer of the Meninges
Fixes the brain and limits movements supports the 2 inner coverings
which contain the BS of the Brain.
Continues down the SC to protect the neural tissue in this region as well.
Composed of thick connective tissue
Space b/n Skull and DM = EXTRADURAL SPACE (hence extra-dural
haemorrhage)
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
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
4 Zygapophyseal jt
5 Spinous process
6 Intervertebral disc
7 PLL (at the back of the VB)
8 Sinuvertebral N
9 SN
10 Sinuvertebral artery
THE BRAIN
A. L. Neill 46

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47 A. L. Neill
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2
1
4
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10
6 7
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The Meninges and the Brain
1 Bone - Skull
2 Frontal sinus
3 DM
4 AM + Subarachnoid space
5 PM
6 SC
7 Dural sac of the SC (continuing on from the cranial cavity)
8 Subarachnoid space (b/n Cerebrum and Cerebellum)
9 CC GM
10 Corpus Callosum
11 WM of the brain
12 Sagittal sinus i = inferior / s = superior
13 Falx cerebri
THE BRAIN
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49 A. L. Neill
10
9
1
12S
14
9
13
12i 11
5
4
3
1
2
3
4
5
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7
8

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The Meninges and the Spinal Cord (SC)
Transverse view of the SC and coverings cross-section
Coronal view cutting down the VC showing the SC and
coverings.
1 SN
2 Nerve root (mixed N)
d = dorsal root (pure sensory)
v = ventral root (pure motor)
3 Denticulate lig. (from the PM)
4 DM
5 Outer layer of the AM
6 Subarachnoid space (b/n the intermediate layers of
the AM)
7 Dorsal lig (from the AM)
8 PM
9 SC GM
d = dorsal horn
v = ventral horn
10 Central canal
11 Filum terminale (PM)
12 Thoracic enlargement of the SC
13 Lumbar enlargement of the SC
14 SC termination at L1/2 in adults
15 Spinal canal termination at S2
THE BRAIN
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51 A. L. Neill
12
9v
16
10
6
2v
1
2d
3
4
5
6
7
8
9d
3
4
8
6
13
14
11
15

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Neurological Assessment HEADACHE
DEFINITION: pain or discomfort b/n the orbits and Occiput
arising from pain sensitive structures via
Extracranial pain sensitive structures:
The ear inner & middle - also refers pain to C2 (2)
The eye orbit - also refers pain to C2/3 (3)
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)
Intracranial pain sensitive structures :
Basal arteries
Cortical veins & venous sinuses
DM of the ACF and MCF innervated by CN V
1
(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)
Note other structures e.g. the cervical VB and neck muscles may refer
pain to the head and cause a headache
HISTORY:
Associated features visual disturbances, vomiting + other
Character aching dull / sharp, throbbing stabbing
Duration & timing hours / days / morning / evening
Frequency acute single, chronic daily / wkly / mnthly
intermittent - seasonal
Mode of onset gradual, rapid
Precipitating factors coughing / exercising, hunger,
medications / foods, menstruation / menopause
noise / stress, posture changes / stooping
Relieving factors analgesics, lying down / sleeping
Severity scale 1-5, bearable able to read / unbearable
unable to do anything
Site front / band around the head / back
specific region above the eye / around the
temple
THE BRAIN
A. L. Neill 52

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53 A. L. Neill
5
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HEADACHE diagnoses ! = changes in
THE BRAIN
A. L. Neill 54
pain type
!
consci-
ousness
progressive
deterior-
ation
Head
injury
infect-
ion
onset
limb
weak-
ness
! eye
move-
ments
throbbing - - - quick - -
severe
throbbing
- - - quick - +
severe - - - - quick - -
dull
intermittant
- + - - slow - -
acute sharp - + - - varies - -
severe + + + - rapid
varies
recedes
- - - - quick - -
severe + + - v quick + +
severe + + ++ rapid + +
dull + + - slow + +
dull
constant
+ + - - slow
dull
constant
+ + - - slow
severe
throbbing
- - - - slow - -
increases
through
the day
- - - - varies - -
dull - - - slow -
sharp
positional
- - varies + -

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55 A. L. Neill
neck
stiffness
!
vision
recurr-
ence
nausea
vomitting
headache
location
other DX
++ -
face
forehead
sinusitis
+ + + ++ global migraine
+ + + global
cluster
headaches
- + + - frontal
halos around
objects
glaucoma
- + - - orbital
unilateral
vision loss
retrobulbar
neuritis
- + global
post-
traumatic
- - - global
drugs/toxins
vasodilators
+ - ++ global
haemorr-
hage
+ - ++ global
focal
neurological
signs
meningitis
encephalitis
acute /
subacute
+ - + global
impaired
upward gaze
hydroce-
phalus
- - + global
papilloe-
dema
intracranial
Tm
- - + global
papilloe-
dema
benign
intracranial
hypertension
+ - + - temple
stiff tender
scalp
arteries
temporal
arteritis
- - ++ -
frontal
band
pattern
situation
precipitates
onset
tension
headaches
- + - -
need ocular
aids/glasses
impaired
vision
+ - + -
back and
neck
upper limb
pain
cervical
spondylosis

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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
mental frontal lobe /
endocrine
motor SC / Brainstem / Cerebellum
sensory SC /
sensory CC
smell CN I
speech / swallowing CN IX-XII
upper cervical Ns
sphincters / continence Sacral Ns
lumbar SC
taste CN X, XII ``
visual CN II-VI
voice change CN X
NEUROLOGICAL EXAMINATION
From head to toe
CNs see CN section
Conscious level & higher functions emotional state, memory, reasoning
MOTOR
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
see the A to Z of Peripheral Nerves for details
NEUROLOGICAL ASSESSMENT
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The UNCONSCIOUS PATIENT
HISTORY
Ask those around: Alcohol or drugs preceding the event ? medications ?
Illness preceding the event
Epilepsy
Sudden collapse
Head injury ?
Limb twitching
Assessment of conscious level (Glasgow coma scale)
Assess EYE OPENING
NON-RESPONSIVE
Assess VERBAL RESPONSE
ORIENTATED knows where they are
CONFUSED talks in sentences
WORDS cannot form sentences but
can form words
SOUNDS can only make sounds
NONE no response to questions
57 A. L. Neill
SPONTANEOUS TO SPEECH TO PAIN via pressure
to the supraorbital N

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A. L. Neill 58
LOCALISING
MOVEMENT TOWARDS
PAIN directional
response to pain
OBEYS COMMANDS
EXTENDING TO PAIN
extension of the elbow &
spastic flexion of the
wrist non-directional
Record assessments as 1-5 for each modality
Always record the best result if there is variation
Always record the upper limb result as this is more consistent
FLEXING TO PAIN
elbow flexing but no movement
towards pain

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59 A. L. Neill
type
area
affected
ability to
repeat
speech
auditory
comprehension
fluency
Brocas =
expressive
aphasia
frontal
cortex
++++ +++++ nonfluent laboured
speech, slow disjointed
sentences agrammatism
Wernickes*
= sensory
aphasia =
receptive
aphasia
sup. temporal
gyrus of the
dominant CH
+ - but can learn
and sing songs
correctly (from
the non. dom.
CH)
fluent - nonsensical
jargon paraphasic
(substituting words
which sounds the same)
poor self correction
Conduction =
associative
dysphasia
arcuate
fasciculus
connecting
Brocas to
Wernickes
area
+ ++++ often the result of a
stroke, fluent paraphasic
but with self correction
mixed
transcortical
++ + non-fluent
transcortical
motor
++ ++++ non-fluent
transcortical
sensory
supramargin
al + angular
gyri
+++++ + fluent self correction of
grammar + syntax only
global + + non-fluent
anomic =
amnesic
dysphasia
global -
parietal +
temporal
lobes & their
connections
++ +++++ often the result of head
injury or tumour, fluent
circumlocution because
cannot recall the names of
things
APHASIA
acquired deficiency in language processing incorporating
both production and comprehension, due to brain damage.
* note is not Wernickes encephalopathy

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Blood Vessels and the Meningeal layers
of the Brain
1 scalp vein
2 scalp skin covering
the skull
3 middle meningeal vessels
a=anterior / m=middle /
p=posterior branches
4 Frontal bone
5 dura mater e= endostial /
m= meningeal layers
6 Parietal bone
7 transverse sinus (R/L)
8 Occipital bone
9 superior sagittal sinus /
v= venous lacuna
10 arachnoid granulations
11 emmisary veins
12 cerebral veins s=superior
/sp=superficial branches
13 arachnoid mater p with
pia mater (often fused)
14 cerebellum
15 diploic vein
16 frontal sinus
THE BRAIN
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61 A. L. Neill
9v
10
11
1
2
3p
4
5e
5m
3a
3
6
7R
8
12sp
3m
10
9v
11
15
5m
5e
7R
5m
14
12sp
3
6
13
16
9
12s

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Venous sinuses the Meningeal layers
of the Brain
THE BRAIN
A. L. Neill 62
1 scalp vein
2 scalp skin covering
the skull
3 middle meningeal vessels
a=anterior /m=middle
/ p = posterior branches
4 Frontal bone
5 DM e = endostial /
m = meningeal layers
6 Parietal bone
7 transverse sinus (R/L)
8 Occipital bone
9 superior sagittal sinus /
v = venous lacuna
10 arachnoid granulations
11 emmisary veins
12 cerebral veins s=superior
/sp=superficial branches
13 arachnoid mater with pia
mater (often fused)
14 cerebellum
15 diploic vein
16 frontal sinus
17 cerebrum
postcentral gyrus
18 falx cerebri
19 olfactory bulb and tract
20 optic chiasma
21 carotid artery
22 sphenoparietal sinus
23 hypophysis and stalk
(infundibulum)
24 CNs 24-3 CN III /
24-6CN VI / 24-4 CN IV/
24-5 CN V
25 petrosal sinus
s=superior/ i=inferior
26 straight sinus
27 tentorum cerebelli
e=edge inserted b/n
cerebrum & cerebellum
28 great cerebral vein
29 basilar plexus
30 dorsum sella
(DM removed)
31 cavernous sinus
32 orbital plate
(of the frontal bone) ACF
33 crista galli

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63 A. L. Neill
9
18
19
20
21
22
23
24-3
24-6
24-4
24-5
25s
25i
7R
27
9
26
28
27e
7L
29
30
31
5e
9
9v
17
13
13
5m
5e
16
5e
4
3a
5m
13
6
3p
10
2
16
33
32

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Brain arteries - Overview
The brain is an end organ in that once past a central anastomotic ring
of vessels, the circle of Willis all supply to the distal tissue is a single
supply. Any blockage of the BV distal to that arterial circle will die,
making the Brain a great energy consumer sensitive to any regional
deprivation of blood. Overall the brain as a whole cannot be deprived of
arterial blood for longer than 10 sec to any partic. area - 20% of the
CO goes to the brain brain is 2.5kg or <2% of the body weight.
1 Anterior spinal art.
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
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)
11 Cerebellar arteries
THE BRAIN
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65 A. L. Neill
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9
7
8
6
5
4
3
2
1
11
7
9

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The Veins and Venous drainage of the
BRAIN Overview
On the surface of the brain there are many BVs which drain into a
series of sinuses endothelial lined channels b/n the 2 layers of the
DM. They anastomose extensively and have no valves relying on
gravity, cranial pressure and head movements for drainage. Superficial
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.
1 Sagittal sinus i=inferior / s = superior
2 Connecting anastomosing veins
3 Deep posterior cerebral veins
4 Straight sinus
5 Transverse sinus
6 Sigmoid sinus (s-shaped)
7 Petrosal sinus i =inferior / s = superior
8 Cavernous sinus
9 Internal jugular vein
THE BRAIN
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67 A. L. Neill
8
7s
7i
9
6
5
2
4
3
1i
2
1s

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Cranial Venous Sinuses
The venous supply of the brain consists of a number of sinuses - or
lakes of blood protected from the brain tissue by the DM. Unlike other
veins in the body, they have no muscle or valves in their walls.
Arachnoid granulations feed CSF into this system, which then drains to
the jugular veins. Flow is determined by pressure w/in the cranial cavity
a closed box. CSF, gravity and arterial pressure affect this and flow
may be very slow and on occasions is bidirectional.
Cavernous Sinus
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.
THE BRAIN
A. L. Neill 68
1 pituitary gland =
hypophysis
1a anterior lobe
1i infundibulum = stalk
1p posterior lobe
2 third ventricle
3 Optic N = CNII
3c chiasma
3n nerve
4 cerebral arteries
branches
4a anterior
4mmiddle
4p posterior
5 internal carotid artery
6 communicating arteries
6a anterior
6p posterior
7 Occulomotor N = CN III
8 Trochlear N = CN IV
9 Trigeminal N =CN V
9-1CN V1
9-2CN V2
10 foramen ovale
11 Abducens N = CN VI
13 carotid sympathetic
nerve plexus
14 opening to nasal cavity
15 sphenoidal air sinuses
16 body of the sphenoid
17 DM dura mater
e = endostial layer
m = meningeal layer
18 cavernous sinus =
filled with venous blood
19 cerebral cortex
20 AM -arachnoid mater
21 subarachnoid space
22 PM = pia mater
23 diaphragma sella

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69 A. L. Neill
1
8
1
7
M
2
0
2
1
2
2
1
a
1
p
2
3
3
n
1
2
4
a
5
4
m
9
3 4
5
i
9
-
2
6
1
0
1
2
1
1
1
4
1
5
1
6
1
3
1
7
e
1
7
m

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Sagittal venous sinuses
Superior and Inferior
Superio-lateral
looking into the head from above and laterally
1 CNs 1-3 CN III /1-6CNVI / 1-4 CNIV/ 1-5 CNV
2 emmisary vein
3 scalp skin covering the skull
4 DM e= endostial / m = meningeal layers
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
10 tentorum cerebelli e=edge
11 transverse sinus
12 straight sinus
13 great cerebral vein
14 cerebral artery a=anterior /m= middle /
p= posterior branches
15 communicating artery a = anterior /
p = posterior branches
17 frontal air sinus
18 trigeminal ganglion (from CNV)
19 middle meningeal vessels a = anterior /m = middle /
p = posterior branches
20 greater superficial petrosal N
21 cerebral aqueduct (aqueduct of Sylvius)
22 midbrain
THE BRAIN
A. L. Neill 70
See the website for more details on the Blood Vs and
CNs relationships.

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71 A. L. Neill
10 6
5i
9
9s
1-4
1-3
3
4
1-2
1-1
7
5i
6
5s
4m
4e
3
2
1-5
1-6
1-7,8
1-9,10
13
12
11
10e
10
1-11 1-12
14p
15p
16
7i
1-2
5s
17
8
1-L
1-2
1-3
1-4
1-6
18
19
20 4m
9s
1-5
16
1-4
13
21
22

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Circle of Willis = Cerebral arterial circle
Arterial vessels to supply the cerebrum arise from the inferior surface
of the brain via the internal carotid arteries which enter the cranium via
the carotid canal and the anterior surface of the SC via the Basilar
artery from the fusion of the 2 Vertebral arteries. These 3 BVs form an
anastomotic arterial ring the circle of Willis - from which branches
arise to supply the cerebrum. Because of its structure, supply can be
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 Anterior cerebral
2 Anterior communicating
3 Ophthalmic
4 Internal carotid
5 Medial striate (branches)
6 Midfdle cerebral
7 Lateral striate (branches)
8 Anterior choroid
9 Posterior communicating
10 Posterior cerebral
11 Superior cerebellar
12 Posterior choroid
13 Basilar
THE BRAIN
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73 A. L. Neill
1
2
3
4
5
6
7
8
9
10
11
12
13
12

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The Brain Macroscopic Components
The brain lies in the cranial cavity the skull - consists of the CEREBRUM,
CEREBELLUM, MIDBRAIN, and HIND BRAIN which leads to the SC.
The CEREBRUM overlies most of the brain and consists of 5 lobes
named according to the bones which they underly, see the A to Z of
the Head & Neck, and the hidden grey matter the INSULA.
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
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.
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
II PARIETAL LOBE for somatosensory perception - integration of visual,
proprioceptive and spatial information.
III TEMPORAL LOBE for language, auditory perception, memory & emotion
IV OCCIPITAL LOBE for vision 1 CN V
1
opthalmic division
Inferior
Lateral
Posterior
THE BRAIN
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75 A. L. Neill
10
9
17
16
7
6
2
1

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The Brain Macroscopic Components cont
1 Frontal lobe
2 Central Sulcus = Rolandic fissure
3 Parietal lobe
4 Parietal occipital sulcus
5 Occipital lobe
6 Cerebellum
7 SC coming from the Brainstem
8 Temporal lobe
9 Lateral fissure = Sylvian fissure
10 Central Sulcus = Central fissure
11 Cerebral hemisphere = CH
12 Cerebellar hemisphere
13 Posterior lobe of the cerebellum
14 Vermis
15 Folia = small gyri and sulci of the cerebellum
16 Pons
17 Infundibulum (of the pituitary removed)
THE BRAIN
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10
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lateral
posterior

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Cerebral gyri and sulci
Inferior view looking up at the cerebrum
Lateral looking at the side of the cerebrum
Median = Midsagittal - looking at the middle plane
The labeling of the fissures, gyri and sulci are often duplicated. The
most common duplications are listed here. Gyri can also be labeled
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
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
gyrus F4
2g medial orbital gyrus F5
3g anterior orbital gyrus F3
4g posterior orbital gyrus F3
5g lateral orbital gyrus F3
1s medial orbital sulcus f4
2s H-shaped orbital sulcus f3
3s lateral orbital sulcus f3
6f rhinal fissure (b/n
frontal & temporal lobes)
7g gyrus ambiens T5
7s collateral sulcus t4
8g lunate gyrus = uncus T5
8s sulcus semilunaris t5
9g medial occipitotemporal gyrus
= parahippocampal
gyrus O5/T5
10g lingual gyrus 05
10l hippocampal lobule T5
10s hippocampal sulcus t5
11g occipitotemporal gyrus
inferiotemporal gyrus T3
12g lateral occipitotemporal
gyrus fusiform gyrus
occipitotemporal gyrus T4
13g inferior-occipital gyrus O3
14g cingulate gyrus F5/P5
15f Sylvian fissure =
lateral sulcus
16g precentral gyrus 1
o
motor area F3
16s central sulcus
17g postcentral sulcus 1
o
sensory area P1
18g paramarginal gyrus P3
19g angular gyrus
THE BRAIN
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79 A. L. Neill
1g=F4
3g
4g
6f
5g
7g
8s
8g
12g
10s
9g
10g
13g
14g
11g
7s
10L
11s
3s
2s
1s=f4
2g

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Cerebral gyri and sulci cont
20g superior temporal gyrus T1
21g middle temporal gyrus T2
22s Occipitotemporal sulcus b/n Occipital &
Temporal lobes
23s Calacarine sulcus (meets 22s)
24g Hippocampal gyrus T5
25 Cuneus O1
26 Precuneus O2
27g Cingulate gyrus
27s Cingulate sulcus
28 Corpus callosum
28s Corpus callosum sulcus
superior-anterior projection of the CC = frontal pole
posterior part of the CC = occipital pole
inferior anterior projection of CC temporal pole
cingular gyrus = small GM just above corpus callosum
dentate gyrus = posterior layered part of the hippocampal gyrus
undergoes neogenesis in the adult for new memories ?
fornicate gyrus = cingulate + parahippocampal gyri (fornix)
note there are also 5 gyri in the Insula I1-5
i = pars operculus
ii = pars triangularus
iii = pars orbicularis all parts of F3 = inferior frontal gyrus
THE BRAIN
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81 A. L. Neill
16g
i
ii
iii
15f
11g
13g
20g
19g
18g
17g
27g
28
15f
15g
12g
24g
23s
10g
25
26
22s
28s
27s

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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.
The pons, cerebellum, thalamus, optic chiasma and midbrain are
bisected. The pituitary is not, although it is midline.
1 Gyrus rectus straight
gyrus (of the frontal pole)
2 Optic structures = CN II
c = chiasma / n = nerve
r = radiation
3 Pituitary gland
4 IVth ventricle
5 Tuber cinereum
6 Mammillary body
7 Pons
8 Olive
9 Hindbrain
10 Spinal canal
(from aqueduct)
11 Temporal lobe
(contralateral)
12 Cerebellum vermis
13 Pinal body + Great
cerebral vein
14 Lingual gyrus
(Occipital lobe)
15 Calcarine sulcus
16 Cuneus (Occipital lobe)
17 Parieto-occipital sulcus
18 Precuneus (parietal lobe)
19 Post-central gyrus
(parietal lobe)
20 Central sulcus
21 Paracentral gyrus =
Precentral gyrus
22 Medical frontal =
marginal gyrus
23 Thalamus and
intermediate body
(connecting the 2 sides)
24 Fornix
25 Septum pellucidum
26 Cingulum
27 Minor gyri and sulci in
the frontal lobe
28 Corpus callosum s =
splenium / r = rostrum /
g= genu
29 Lamina terminalis
THE BRAIN
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83 A. L. Neill
22
23
24
25
26
28g
27
28r
27
29
2
3
11
5
6
7
8
9
10
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12
13
14
15
16
17
18
19
20
21
28s

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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
iv = through the thalamus
1 Longitudinal fissure dividing the 2 cerebral hemispheres
2 Corpus callosum g = genu s = splenium
3 Lateral ventricle ah = ant. horn / ph = post horn
4 Putamen (part of basal nuclei)
5 Globus pallidus
6 Capsules - i = internal / e = external
7 Thalamus - s = subthalamic nuclei / n = nuclear groups
8 Tela choroidea + choroid plexus
9 Fornix c = columns / x = crura
10 Claustrum
11 Septum pellucida c = cavity / l = lamina / v = vein
12 Caudate nucleus
THE BRAIN
A. L. Neill 84
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85 A. L. Neill
1
2g
3ah
4
5
6i
7
3ph
2s
1
9x
8
10
8
9c
11L
12
11c

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Cerebrum sections
coronal
i = at the level of the anterior commissure
ii = behind the anterior commissure
dividing the 2 CH
2 Corpus callosum
g = genu s = splenium
3 Lateral ventricle ah =ant.
horn / ph = post horn
4 Putamen (part of
basal nuclei)
5 Globus pallidus
6 Capsules i =internal /
e = external
7 Thalamus -
s = subthalamic nuclei /
n = nuclear groups
8 Tela choroidea +
choroid plexus
9 Fornix c = columns /
x = crura
10 Claustrum
11 Septum pellucida c = cavity
l = lamina / v = vein
12 Caudate nucleus
13 Cingulate sulcus
14 Longitudinal fasciculus
s = superior
15 Operculum
16 Lateral sulcus
17 Insula
18 Uncinate fasciculus
19 Collateral sulcus
20 Optic tract
21 Anterior commissure
22 Corona radiata
23 Third ventricle
24 Precentral gyrus
25 Temporal gyri
s = superior / m = medial
i = inferior
26 Amygdaloid complex
27 Hippocampus
28 Fusiform gyrus
29 Parahippocampus (gyrus)
30 Mammillary body
31 Base of hypothalamus
32 Substantia nigra
33 Gyrus occitpitotemporalis
medialis
THE BRAIN
A. L. Neill 86
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87 A. L. Neill
i
ii
1
22
2
14s
3
11i,v
19
20
10
3ph
6e
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2
14s
6i
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16
17
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20
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3
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6e
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4
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Cerebrum sections
coronal
iii = through the mammillary bodies
iv = through the thalamus
dividing the 2 CH
2 Corpus callosum
g = genu s = splenium
3 Lateral ventricle ah =
ant. horn / ph = post horn
4 Putamen (part of
basal nuclei)
5 Globus pallidus
6 Capsules i = internal /
e = external
7 Thalamus -
s = subthalamic nuclei /
n = nuclear groups
8 Tela choroidea +
choroid plexus
9 Fornix c = columns /
x = crura
10 Claustrum
11 Septum pellucida c = cavity
l = lamina / v = vein
12 Caudate nucleus
13 Cingulate sulcus
14 Longitudinal fasciculus
s = superior
15 Operculum
16 Lateral sulcus
17 Insula
18 Uncinate fasciculus
19 Collateral sulcus
20 Optic tract
22 Corona radiata
23 Third ventricle
24 Precentral gyrus
25 Temporal gyri s = superior
m = medial / i = inferior
26 Amygdaloid complex
27 Hippocampus
28 Fusiform gyrus
29 Parahippocampus (gyrus)
30 Mammillary body
31 Base of hypothalamus
32 Substantia nigra
33 Gyrus occitpitotemporalis
medialis
THE BRAIN
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89 A. L. Neill
iii
iv
1
24
12
14s
6i
15
25s
25m
25i
26
28
29
27
20
30
23
9c
7s
5
10
16
2
3
12
4
8
27
17
31
32
7s
6i
7n
22
9
3ph
3
9
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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
3 Crus Cerebri
4 Striae terminalis
5 pyramidal bundles in the Pons
6 Pyramid
7 Olive
8 Hindbrain / SC
9 Hippocampus w/in the Dentate gyrus
10 Cerebellum
11 Optic radiation in the Corona Radiata
12 Superfical longitudinal fasciculus (of Corpus Callosum)
13 Corona Radiata
14 Central sulcus
15 Internal capsule + medial wall of putamen
(part of the corpus striatum)
17 Orbital surface of the frontal lobe
18 Gyrus rectus / straight gyrus
THE BRAIN
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91 A. L. Neill
15
14
13
12
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7
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4
3
2
1a
18
1t
17
16

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Brain superior to Globus Pallidus
transverse section - viewing it from above
see also Cerebrum Sections transverse section (deeper
level at the mammillary bodies)
This slice through the brain shows the development of the internal GM
of the cerebrum: head of the caudate nucleus (16), the thalamus (13),
the pulvinar (13p), striate body and its contents (5,6,7,9 & 14) and
projection fibres - the optic radiation (10) and tapetum (11).
2 Middle frontal gyrus
3 Corpus callosum g = genu / s= splenium
4 lateral ventricle a = anterior horn / p = posterior horn
5 Septum Pellucidum cavity
6 External Capsule
7 Claustrum
8 Insula
9 Internal Capsule g = genu / p = posterior limb
10 Optic radiation
11 Tapetum
12 junc of Posterio-occipital and Calcarine sulci
13 Thalamus (p= pulvinar)
14 Lentiform nucleus p = putamen
15 fornix columns
16 Caudate nucleus
17 Cingulum
18 Middle Cerebral artery
19 Calcarine Sulcus
20 Fimbria
THE BRAIN
A. L. Neill 92

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93 A. L. Neill
1
2
3g
4a
5
6
7
18
8
9p
10
11
19
1
12
3s
20
4p
13p
9p
13
9g
14
15
16
17

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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
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
4 internal capsule
5 lentiform nucleus
p = putamen
6 external capsule
7 anterior commissure
8 uncinate fasciculus last
WM to mature in the human
(part of the limbic system)
9 inferior longitudinal fasciculus
= occipitotemporal fasciculus
10 insula
11 corona radiata base of
12 habenular nuclei
(part of the diencephalon)
13 pineal body /gland
14 thalamus
15 claustrum (connecting basal
nuclei suspected receptors
of hallucogens LSD)
16 fornix columns of
17 septum pellucidum
18 globus pallidus
19 striae arteries
20 amygdaloid bodies
21 infundibulum
22 root of the Optic N CN II
23 lateral ventricle
i =inferior horn
24 Anterior perforating
substance
25 pons
26 crus cerebri
27 lamina terminalis
(continuous with 2g)
28 subcallosal gyrus =
paraterminal gyrus
(continuous with 27)
THE BRAIN
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95 A. L. Neill
28
3
27
5
19,24
10
15
23
8
25
21
22
26
20
19
5p
37
15
4
18
2g
1
1
17
16
15
10
14
13 12
11
10
9
8
7
6
5
4
3
28, 2r
2g

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Basal Ganglia = Basal Nuclei
Coronal plane - looking in from the anterior
Sagittal - looking in from the side
The Basal ganglia are connected groups of GM deep nuclei - in the brain
in the diencephalic region - around the thalamus and hypothalamus.
Named primarily because of their relationship to the lateral and 3rd
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
C = Hypothalamus (rostral) + Subthalamus (caudal)
1 Corpus callosum
2 Caudate nucleus
3 Lateral ventricle
4 Choroid plexus
5 Thalamus
6 Putamen
7 Globus pallidus
8 Zona incerta
6+ 7+ 8 = Lentiform nucleus
9 Supraorbital nucleus
10 Optic tract + chiasma
11 Subthalamic nuclei =
nucleus of Luys
12 Ventromedial nuclei of
the hypothalamus
13 Nucleus tuberus
14 Pituitary gland=Hypophysis
a = anterior lobe adenohy-
pophysis p = posterior lobe
neurohypophysis
15 Infundibulum (of the
pituitary gland)
16 Third ventricle
17 Interthalamic adhesion
18 Paraventricular nucei
19 Septum pellicidum
20 Fornix
21 Transverse cerebral
fissure
22 Periventricular nuclei
23 Mammillary nuclei
24 Hypothalamic nuclei
25 Dorsomedial nuclei
26 Pineal body
THE BRAIN
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97 A. L. Neill
20
21
26
25
24
22
23
12
14p
14a
15
10
22
9
18
19
1
A
A
B
B
C
1
21 20
19
2
3
4
5
6
7
8
10
11
12
13
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15
16
17
18
16
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Brain Stem = Midbrain + Pons +
Medulla Oblongata
Anterior surface
Lateral view
All CNs except CN I, IV & XI arise from the anterior surface of the brainstem.
The SC begins at the inferior end of the Brainstem, and cerebrum
arises superiorly.
1-12 labels the CNs - subcategories indicate the parts thereof
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
4 CN I
5 CN V
6 CN VI
7 CN VII + nervus intermedius
of Facial N
8 CN VIII both parts
9 CN IX travels with CN X
10 CN X
11 CN XI arises from the SC
12 CN XII arises superior to CN XI but leaves the
cranium inferiorly
13 Crus cerebri part of the midbrain
14 Geniculate body l = lateral / m = medial
15 Pulvinar (posterior nuclei in the Thalamus)
16 Middle cerebellar peduncle
17 Inferior cerebellar peduncle
18 C1 ventral roots
???
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99 A. L. Neill
30
31 32
1b
1t
2n
1L
2t
2c
13
14
3
15
4
5
16
7
8
17
12
18
19
20
21
11
9,10
22
23
24
25
26
27
28
29

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Brain Stem = Midbrain + Pons +
Medulla Oblongata Cont
Anterior surface
Lateral view
19 Pyramid
20 Decussation of pyramids
21 SC
22 Cerebellar flocculus
23 Olive crossed by ant. ext. arc fibres
24 Pons
25 Perforating substances a= anterior / p= posterior
26 Mammillary body
27 Tuber cinerum
28 Infundibulum (of pituitary gland)
29 Ant. Perforating substance
30 Inf. surface of frontal lobe
31 Frontal pole
33 Caudate nucleus
34 Corona radiata (base of)
35 Lateral leminiscus
36 Superior cerebellar peduncle
37 Arbor vitae (of the cerebellum)
38 Cuneate tubercle
39 Gracile tubercle
40 Spinocerebellar fasciculus a= anterior / p = posterior
41 Olive tract = circumolivary fasiculus
42 Gyrus rectus = straight gyrus
44 Striate anastomoses
THE BRAIN
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101 A. L. Neill
34
33
44
43
29
1!
42
2
28
26
3
5
24
7,8
19
23
41
2
40p
40a
5t
39
38
37
17
16
36
4
35
14m
15
14L
13

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Brainstem - arterial supply
Lateral view
1 pontine cerebral art.
2 inferior colliculus
3 cerebral aqueduct
4 inferior quadrigeminal art.
5 superior vermis of cerebellum
6 superior cerebellar art.
7 dentate gyrus
8 anterior inferior cerebellar art.
9 cerebellar flocculus and nodulus
10 4th ventricle
11 posterior inferior cerebellar art.
12 central canal
13 posterior spinal art.
14 veretbral art. (paired vessels)
15 anterior spinal art.
16 paramedian art.
17 cuneate and gracile nuclei
18 inferior olivary nuclei
19 pons
20 basilar art (unpaired fusion of the vertebrals)
21 posterior communicating art. (part of the circle of Willis)
THE BRAIN
A. L. Neill 102

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103 A. L. Neill
1
2
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21
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16
20
20
19
16
18
17
16
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14
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12
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9
8
7
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5
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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
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.
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.
A = cerebral tissue supplied by the anterior cerebral artery
and its branches
M = cerebral tissue supplied by the middle cerebral artery
and its branches
P = cerebral tissue supplied by the posterior cerebral artery
and its branches
1 Anterior cerebral artery b = branches
2 Anterior communicating artery
3 Middle cerebral artery b = branches
4 Posterior cerebral artery b = branches /
c = calcarine branch / o = occipital branch
5 Brainstem
6 Corpus callosum g = genu / s = splenium
7 Anterior perforating substance
8 Thalamus
THE BRAIN
A. L. Neill 104

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105 A. L. Neill
8
1
4b
4b
3b
3
2
1b
2
1
5
4
46s
9
1b
6g
1
2
4t
4b
4
4c
4o
6s

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Brodmanns Maps of the Cerebral Cortex
Lateral
Mid-Sagittal median
Inferior of the frontal lobe
Brodmann areas were originally defined and numbered by
Korbinian Brodmann in 1909 based on the organization
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
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.
FRONTAL LOBE
OCCIPITAL LOBE
PARIETAL LOBE
TEMPORAL LOBE
THE BRAIN
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107 A. L. Neill

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a
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a
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s
u
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m
a
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BRAIN IMAGES
A. L. Neill 108
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a
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l
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a
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N
a
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F
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A. L. Neill 111
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A. L. Neill 112
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.
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A. L. Neill 113
COGNITIVE SKILLS tested
Dominant CH Disorders
Note L hemisphere is
Dominant in R-handed
People
language pattern
hesitant
fluent
dysphasia receptive /
expressive
can simple orders be followed
hold up your arms!
receptive dysphasia
can simple objects be named
what is this? (a ball)
nominal dysphasia
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
objects?
agnosia
can the patient find their way around their
surroundings ?
geographia agnosia
can the patient dress them selves ? dressing apraxia
can the patient draw shapes ?
please draw a square / circle / clockface
constructional apraxia
MEMORY TESTED
can the patient copy a beat with their fingers? immediate memory loss
can the patient describe their illness and last
meal ?
recent memory loss
can the patient remember their recent past
before the illness ?
remote memory loss
can the patient remember the items on a tray
after it is removed ?
visual memory loss
REASONING & PROBLEM SOLVING
set small problems / ask
about ability to receive the
right change
EMOTIONAL STATE
anxious / depressed
flat / apathetic /
inappropriate
disinhibited / slow in
speech or movement c
HIGHER CEREBRAL FUNCTION assessment

D
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N
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l
Cerebrum - Major Anatomy
Lateral and Superior
CEREBRUM covered in GM with 4 major lobes, 4 major lobes of the
Brain and a covered area of GM - the Insula or 5th lobe
1 FRONTAL LOBE
2 PARIETAL LOBE
3 OCCIPITAL LOBE
4 TEMPORAL LOBE
5 INSULA
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
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
h transverse occipital sulcus
i inferior temporal sulcus
l intra parietal sulcus
k associated rami of the lateral sulcus
GM either side of the lateral fissure = Opercula, overlies the covered
GM of the brain = Insula = Island of Reil
g = gyrus bulge in the brain
s = sulcus / fissure if large = infolded section b/n the gyri
1Ag pre-central gyrus MOTOR
2Ag post central gyrus SENSORY
2Ig inferior parietal gyrus (lobule)
2Sg superior parietal gyrus (lobule)
1Sg superior frontal gyrus
1Fg mid frontal gyrus
1Ig inferior frontal gyrus
4Dg superior temporal gyrus
THE BRAIN
A. L. Neill 114
4Ig inferior temporal gyrus
4Mg mid temporal gyrus

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115 A. L. Neill
L
A
1Ig
1Fg
1Sg
k
E
D
4Dg
4Ds
C
j
h
B
l
2Ig
2Sg
1Sg
1Mg
1Ig
1Ig
1As
1Ag
A
2Ag
2As
2Ig
D
2Dg
2Sg
j
B
h
3
4Mg
4Dg
D
A
1Ss
1Ms

D
r

A
.
L
.

N
e
i
l
l
Cerebrum Insula and Operculum
Lateral
Most of the GM of the cerebrum is superficial and divided into 4 lobes
named according to the bones which overlie them - but a 5th lobe is
buried deep to the Lateral fissure - the Insula (island) the GM overlying
this Insula GM is the Operculum
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
radiate going to the GM on the surface
See website for more details on the Cerebrum and Cerebellum.
THE BRAIN
A. L. Neill 116

D
r

A
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L
.

N
e
i
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l
117 A. L. Neill
Operculum
Insula

D
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L
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N
e
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l
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.
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.
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
6 Occipito-temporal sulcus
7 Lunate sulcus
8 Occiptial pole
9 Branches of the occipital sulcus
10 Frontal pole (of frontal lobe)
11 Gyrus rectus = straight gyrus
12 Orbital sulci
13 Parahippocampus
14 Gyrus occipitotemporalis medialis
15 Lingual gyrus
16 Cingulum
17 Longitudinal Sulcus
18 Cerebral aqueduct + periductal GM
19 Crus cerebris
20 Mammillary body
21 Infundibulum ( of the pituitary)
22 Uncus
THE BRAIN
A. L. Neill 118

D
r

A
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N
e
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l
119 A. L. Neill
17
10
11
12
1
3
2
4
5
14
6
7
9
17
15
16
23
18
19
20
22
21

D
r

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L
.

N
e
i
l
l
Cerebellum Little Brain
views from the back and side posterio-lateral
in the middle through the 4th ventricle mid-sagittal
median plane
(see also Cerebrum outer surfaces posterior)
Responsible for most unconscious motor movements: coordination,
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,
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.
THE BRAIN
A. L. Neill 120
1 Vermis superior, middle
and inferior sections
2 Anterior lobe (small)
3 Primary fissure
4 Posterior lobe (largest
lobe)
5 Folia - fine folds of the
cerebellum
6 SC
7 Flocculonodular lobe
(= 21 + 24)
8 Medulla oblongata
9 Pons
10 Arbor vitae of the
cerebellum
11 Cerebellar cortex
12 Dentate nuclei
13 Choroid plexus
14 Inferior cerebellar
peduncles
15 Middle cerebellar
peduncles
16 Superio cerebellar
peduncles
17 Fourth ventricle
18 Crus cerebri
19 Cerebral aqueduct
20 CN V
21 Flocculus
22 Secondary fissure
23 Posterior notch
24 Central nodule
25 Folds of the vermis
(cut through)
26 Uvula inferior process
of the vermis
27 Cerebellar tonsil
28 Vallecular cerebella
29 Posterior median Sulcus
of the SC

D
r

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e
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l
121 A. L. Neill
1
2
3
4
9
8
7
17
18
9
16
15
14
8
13
7
12
5
11
10
2
6
5

D
r

A
.
L
.

N
e
i
l
l
Cerebellum Little Brain
views from the back and side posterio-lateral
in the middle through the 4th ventricle mid-sagittal
median plane (see also Cerebrum outer surfaces posterior)
Responsible for most unconscious motor movements: coordination,
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, 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.
THE BRAIN
A. L. Neill 122
1 Vermis superior, middle
and inferior sections
2 Anterior lobe (small)
3 Primary fissure
4 Posterior lobe
(largest lobe)
5 Folia - fine folds of
the cerebellum
6 SC
7 Flocculonodular lobe
(= 21 + 24)
8 Medulla oblongata
9 Pons
10 Arbor vitae of the
cerebellum
11 Cerebellar cortex
12 Dentate nuclei
13 Choroid plexus
14 Inferior cerebellar
peduncles
15 Middle cerebellar
peduncles
16 Superio cerebellar
peduncles
17 Fourth ventricle
18 Crus cerebri
19 Cerebral aqueduct
20 CN V
21 Flocculus
22 Secondary fissure
23 Posterior notch
24 Central nodule
25 Folds of the vermis
(cut through)
26 Uvula inferior process
of the vermis
27 Cerebellar tonsil
28 Vallecular cerebella
29 Posterior median
Sulcus of the SC

D
r

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L
.

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e
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123 A. L. Neill
1
25
26
29
6
28
3
27
12
24
1
3
4
23
5
2
21
22
20
19
18

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l
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
with this structure.
A = genu or knee
B = body or trunk
C = splenium or tail
A + B + C = corpus callosum = 11
THE BRAIN
A. L. Neill 124
1 Thalamus i =
intermediate body /
m = medullary striae
2 Optic structures = CN II
c = chiasma / n = nerve /
r = radiation
3 CN III
4 IVth ventricle
5 Pons
6 Midbrain
7 Pineal body
8 Commissures a = anterior
p = posterior
9 Fornix c = column /
X = crus
11 Corpus callosum
L = longitudinal striae /
r = rostrum
12 Interventricular foramen
13 Lamina terminalis
14 Pituitary i = infundibulum
a= anterior / p= posterior
15 Cingulum f = floor of
the cingulum suclus
16 Forceps M = major /
m = minor
17 Superior longitudinal
fascicles o = occipital
part / t = temporal part
18 Short association fibres
19 Central sulcus
20 Tapetum
21 Floor of Calcaneal sulcus
22 Inferior longitudinal
fascicles
23 Roof of the inferior horn
of the lateral ventricles
24 Insula
25 Lentiform nucleus
26 Corona radiata
b = base of

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125 A. L. Neill
1im
12
10
9c
11r
8a
2c,n
14i
14a
14p 8,9 3
4
5
6
8p
7
8p
9x
C
B
A
11+26
15
21
16m
20
22
23
17
24
25
26
15f
11a
11L
15m
17
18
19
17t
17o
2r
2o
11c
16m

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l
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),
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
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
B Epithalamus
C Hypothalamus
D Pituitary gland = Hypophysis
D1 posterior pituitary = neurohypophysis
D2 anterior pituitary = adenohypophysis
D3 infundibulum = stalk of pituitary
THE BRAIN
A. L. Neill 126
1 Anterior thalamic
nuclei
2 Medial thalamic nuclei
with Intermediate
Mass in b/n
3 Lateral thalamic nuclei
4 Internal medullary laminae
5 Geniculate bodies
lateral and medial
6 Corpus Callosum
7 Frontal lobe of the CC
8 Optic N = CN II
9 Optic Chaisma
10 Brain stem and cerebral
canal b/n the 3rd and
4th ventricles
11 Supraoptic nuclei
12 Arcuate nuclei
13 Ventromedical nuclei
14 Mammillary bodies
15 Dorsomedial nuclei
16 Posterior hypothalamic
nuclei
17 Paraventricular nuclei
18 Lateral preoptic nuclei
19 Pineal gland

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127 A. L. Neill
1
6
2
18
17
7
8
9
D3
D2
D1
11
12
13
14
19
15
16
C
A
D
B
2
5
3
4
3

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N
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l
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
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 Cingluate gyrus
2 Corpus callosum
3 Suprcallosal gyrus
4 Fornix
b = body, c = columns,
f = fimbria, l = crura,
x = commissure
5 Amygdala & amygdaloid bodies
6 Lateral sulcus
7 Hippocampus f = fimbria
8 Mammillary bodies
9 Nucleus accumbens + septal nuclei
THE BRAIN
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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
understanding reading. Traditionally 2 areas are described Brocas
and Wernickes 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
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 Brocas area ~ inferior-frontal gyrus (pars triangularis + pars
opercularis) - for speech + writing
W Wernickes area ~ superior temporal gyrus + auditory cortex -
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:
4 hand and finger movements, tone and sound formation
7 calculation
18 recognition of objects
19 recognition of colours
21 auditory attention, understanding of sounds with respect to music
22 understanding of sound sequences
37 understanding of numbers
39 recognition of numbers
40 writing
41/42 understanding sequences of sounds + speech
44 formation of phrases and sentences
45 articulation of sentences
46 articulation of names
APHASIA acquired deficiency in language processing incorporating
both production and comprehension, due to brain damage.
THE BRAIN
A. L. Neill 130

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131 A. L. Neill
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7
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44
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22
42
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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
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 Cerebral Cortex = CC higher thinking centres
2 Limbic system -
3 Brainstem -
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
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
10 Olfactory bulb and tract (CNI)
THE BRAIN
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133 A. L. Neill
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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
2 Corpus callosum
3 Caudate nucleus
4 Globus pallidus
5 Thalamus
6 Putamen
7 Amygdala
8 Hippocampus
9 SC
10 Medulla oblongata
11 Pons
12 Fornix
13 Crus cerebri
14 Mammillary bodies
15 CC
16 Lateral ventricle
THE BRAIN
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135 A. L. Neill
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2
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Septum Pellucidum = Septum lucidum
Median view midsagittal
This thin triangular 2 layered vertical membrane of GM and WM
separates the lateral ventricles of the brain and the CH. It lies beneath
the corpus callosum and attaches to the superior surface of the fornix.
Absence of this membrane results in hypothalamic, visual and IQ
disorders as well as hypopituitarism.
1 Olfactory b = bulb t = tract
2 Medial root 2+ 3 = olfactory striae
3 Lateral root
4 Paraolfactory area
5 Subcallosal gyrus and sulcus
7 Hippocampal complex
8 Band of Giacomini = tail of the Dentate gyrus
9 Uncus = Parahippocampal gyrus
11 Corpus callosum
12 Supracallosal gyrus = Indusium griseum contains the
medial and lateral longitudinal fibres (of the corpus
callosum) continuous superiorly with cingulate gyrus
13 Fornix b = body / c = columns
14 Fimbriae of the hippocampal complex
15 Dentate gyrus of the hippocampus
16 Amygdaloid bodies
17 Mammilary bodies
18 Hippocampal complex
19 Anterior commissures
THE BRAIN
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137 A. L. Neill
13b 13c
19
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The Thalamus - Part of the Diencephalon
Superior view- looking from above
Major relay station of the brain bilobed oval body made up of diverse
number of interconnecting nuclei grouped together.
Each thalamus is about 3X4X3cm.
All sensory imput via THALAMOFUGAL fibres pass into the thalamus
before going to the cerebral cortex via THALAMOPETAL fibres, except
the olfactory imput; further refinement of corticocortical
communication is also via the thalamus. Nuclei (ganglia) of GM in the
region also communicate extensively with the thalamic nuclei.
THE BRAIN
A. L. Neill 138
nuclear group abbrev. / alt name
1 anterior nuclear gp AN
2 ventral anterior gp VA
3 ventral lateral gp VL
4 ventral intermediate gp VI
5L ventral posterio-lateral gp VPL
5m ventral posterior-medial gp VPM
6 5 + 4 + accessory semilunar gp
= ventral posterior gp
VP
7L lateral geniculate body LGB
7m medial geniculate body MGB
8 pulvinar
9 internal medullary lamina (band of
myelinated fibres)
contains several nuclei w/in these 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 Kosikoffs syndrome, excessive alcohol consumption- no short
term memory and confabulation

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139 A. L. Neill
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5L
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The Thalamus - Destinations
Relations to the CC functional description
A1= 1o auditory area / A2 = 2o auditory area / B = Brocas area
E = frontal visual fields / G = gustatory area / M1 = 1o motor cortex /
PM = premotor cortex / S1 = 1o sensory cortex / S2 = sensory
association area / V1 = 10 visual cortex / V2 = 2o visual cortex / V3 30
visual cortex (visual association cortex)
THE BRAIN
A. L. Neill 140
nuclear group destination of.. / output
1 anterior nuclear gp cingulate gyrus - emotion, limbic system
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 -
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
gp= ventral posterior gp
+ gustatory cortex taste.
7L lateral geniculate body visual cortex vision
7m medial geniculate body auditory cortex hearing
8 pulvinar posterior association cortex sensory information
integration partic audition & vision
9 internal medullary lamina
(band of myelinated fibres)
concerned with emotional arousal and control diffuse
cortical projection
10 dorsomedial gp prefrontal cortex* - executive function, social skills
affection, memory
11 lateral posterior gp parietal lobe, cingulate gyri, - sensory information integration
12 medial gp hypothalamus , frontal cortex ANS integration
13 lateral dorsal gp cingulate gyrus - emotional expression
14 intrathalamic adhesion communicates with other thalamus
15 intralaminar gp w/in the
lamina
frontal cortex + basal nuclei - arousal
largest motor control
*damaged in Kosikoffs syndrome, excessive alcohol consumption- no short
term memory and confabulation

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141 A. L. Neill
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5L
5m
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9
S2
S1
M1
PM
E
9,10,
12,13,
15
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5ml 11
9,11
71, 8
71, 8
71
7m 8
7m 8
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9,4,2
B
A1
G
A2
V1
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V2
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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
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
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)
2i inferior horn of the lateral ventricle(s)
2p posterior horn of the lateral ventricle(s)
3 3rd ventricle
4 4th ventricle
5 cerebral aqueduct
6 lateral recess(es) foramen of Luschka
7 median aperture and foramen of Magendie
8 SC
9 hindbrain
10 brainstem / pons
11 interventricular foramen
12 parietal lobe
13 occipital lobe
14 cerebellum
15 spinal canal
See website for more details on the Ventricles Superior view
THE BRAIN
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143 A. L. Neill
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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
crushing of the tissues nearby, hence they are most vulnerable to
cerebral oedema.
Relations
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
6 Optic radiation
7 Tapetum
Ventricle components
10 Lateral ventricle
10a anterior horn of the lateral ventricle(s)
10b body of the lateral ventricle(s)
10i inferior horn of the lateral ventricle(s)
10p posterior horn of the lateral ventricle(s)
11 3rd ventricle
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
THE BRAIN
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145 A. L. Neill
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3c
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15m
15p
15
15L
10p
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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
Ventricles make up 3-4% of the weight of the brain.
Ventricle components
1 Lateral ventricle
1a anterior horn of the
lateral ventricle(s)
1b body of the lateral
ventricle(s)
1i inferior horn of the
1p posterior horn of the
2 interventricular foramen-
joining the laterals with
the 3rd ventricle
3 3rd ventricle
4 4th ventricle
4r roof of the 4th ventricle
5 triangular recess
6 anterior commissure
7 optic recess
8 optic chiasma
9 infundibular recess
10 interthalamic recess
for the joining of the 2
thalamic bodies
11 suprapineal recess
12 pineal body
13 pineal recess
14 cerebral aqueduct
15c inferior vermis
16 median foramen of
posterior recess
17 posterior recess =
median recess
18 ependymal pocket
lower ends of the
4th ventricle
19 obex = border b/n the
4th ventricle and the
spinal canal
20 spinal canal
21 lateral recess
22 foramen of Luschka
23 Calamus scriptorus =
floor of the 4th ventricle
THE BRAIN
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147 A. L. Neill
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The Cranial Nerves
CN are defined as Ns which leave
from the skull (cranium) rather than
the SC. There are 12 pairs, and
they are numbered in the order
they leave the skull not necessarily
the same order that they leave the
brain. Their names are an attempt
to reflect their function.
Below is a summary of the Cranial
Nerves and their functions.
They are listed in the order they leave
the Cranium/Skull.
CRANIAL NERVES
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The Cranial Nerves
summary
5 are purely motor III, IV, VI, XI, XII; 3
purely sensory I, II, VIII and the rest
4 are mixed. All exit from the
ventral surface of the Brainstem
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
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
that UMN lesions (eg. stroke) do not
usually result in complete loss of
function, whereas LMN lesions (eg.
trauma) generally do so.
Nucleus Solitarius is SENSORY -
the site of neuron origin for CNs
VII, IX & X.
Nucleus Ambiguus is MOTOR -
the site of neuron origin for CNs
IX & X
CRANIAL NERVES
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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)
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
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
1 Olfactory bulb
2 Olfactory tract
3 Mitral cell
4 Fibrous processes of receptor cells
3,4 = Glomerulus of fibres b/n the receptor cells and the
Mitral cells to transmit and amplify the sensory material
5 Ethmoid bone with olfactory holes in the Cribiform
plate to allow passage of olfactory receptor N cell axons
6 Mucosa and CT for BVs and support to the Ns
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
CRANIAL NERVES
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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.
1 pretectal nucleus
2 superior colliculus
3f fibres of CN III - a combination of the motor fibres from
the main nucleus and the PNS motor fibres from the
accessory nucleus
3m main oculomotor motor nucleus
3mf fibres from the motor nucleus
3p accessory oculomotor nucleus =
Edinger-Westphal nucleus
3pf PNS fibres
4 tectobulbar fibres
5 medial longitudinal fasciculus
6 red nucleus
7 substantia nigra
8 central canal
9 cerebral cortex motor
Exit of the CN III from the base of the skull
CRANIAL NERVES
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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
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 mesencephalic nucleus of CN V
2f fibres form the superior colliculus - tectobulbar fibres
4f trochlear N fibres
4n trochlear N nucleus
6 crus cerebri
7 substantia nigra
8 central canal
9 cerebral cortex motor
Pathway of the CN IV from the brainstem dorsal surface and exit from skull
10 midbrain
11 superior cerebellar peduncle
12 cavity of 4th ventricle
13 MO
14 superior medullary velum
15 pons
CRANIAL NERVES
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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
Motor : NR from masticator motor nucleus in the Pons
Course The Trigeminal N has 3 large branches.
Ophthalmic (V
1
sensory),
Maxillary (V
2
, sensory) and
Mandibular (V
3
, motor and sensory).
The sensory branches join the trigeminal ganglion in the MCF
Cranial Exits: foramen ovale, superior and inferior orbital fissures.
BRANCHES in detail
The Mandibular N = V
3
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
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.
The 2 other sensory branches of CN V also converge on the trigeminal
ganglion via the cavernous sinus.
The Ophthalmic N has 7 branches and enters the cranium through the
superior orbital fissure from the orbit and the skin of the forehead and head.
The Maxillary N has 8 branches and enters the cranium through the
inferior orbital fissure, and the pterygopalatine canal via the
Pterygopalatine fossa and Foramen Rotundum, carrying information
from the face, cheek and upper teeth and soft and hard palate, nasal
cavity and pharynx. Meningeal sensory branches enter the trigeminal
ganglion w/n the cranium.
CRANIAL NERVES
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V
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CN V Cont
Ophthalmic N branches V
1
1 Infratrochlear
2 Anterior Ethmoid
3 Posterior Ethmoid
4 Lacrimal
5 Supraorbital
6 Supratrochlear
7 Nasociliary
Maxillary N branches V
2
1 Zygomaticotemporal
2 Zygomaticofacial
3 Post. Superior Alveolar
4 Nasopalantine
5 Greater Palatine
6 Lesser Palatine
7 Middle & Anterior Alveolar branches
8 Infraorbital
CRANIAL NERVES
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161 A. L. Neill
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2
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7
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Palatine branches from V
2
in greater detail
1 incisive fossa
2 nasopalatine N
3 greater palatine N
4 Lesser palatine N
5 Posterior nasal spine
6 palatine bone -horizontal plate
7 hard palate (Maxilla)
CRANIAL NERVES
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163 A. L. Neill
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2
3
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6

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Mandibular N branches V
3
1 Auriculotemporal
2 Lingual
3 Inferior Alveolar
4 N to Mylohyoid
5 Mental
6 Buccal
for innervation to the face see the Dermatomes
CRANIAL NERVES
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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
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
4 main sensory nucleus continuous with 5s
5g Trigeminal ganglion
5i Ophthalmic N = CN V
1
5ii Maxillary N = CN V
2
5iii Mandibular N = CN V
3
5l Trigeminal leminiscus
5n Trigeminal N
5s spinal nucleus of the Trigeminal N
6 thalamus
7 midbrain
8 proprioceptive fibres from the face and eye synapse in 2
9 substantia gelatinosa
10 C2
11 MO
CRANIAL NERVES
A. L. Neill 166

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167 A. L. Neill
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5s
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5g
5iii
5ii
5i
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5L
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Neural pathways for CN V = Trigeminal N
and interrelationships with CN III,VII & IX (Oculomotor, Facial
& Glossopharyngeal)
This schema demonstrates their interactions and the sites where they
occur. The name of the N may change at points along its pathway e.g.
Nervus intermedius (1) and Chorda tympani (2)
CRANIAL NERVES
A. L. Neill 168
A Intracerebral from the Bs to C2
B Intracranial
C Emergence from the skull
D Branches & N pathways
E Ganglia
F Ns & end organs
1 Nervus Intermedius
2 Chorda Tympani N
1!2 via petrotympanic fissure
3 submandibular + sublingual
ganglia
4 N to sublingual gland
5 N to submandibular gland
6 N supplying taste for the
ant. 2/3 of the tongue +
7 Lingual N (CN V
3
)
8 pterygopalatine ganglion
9 N to mucous glands
10 Zygomatic N
11 Lacrimal gland
12 greater petrosal N
12!13 via foramen lacerum
13 N of Pterygoid canal
14 N to Mucous glands
15 ciliary ganglion
16 short ciliary Ns
17 eye
18 Nasociliary N branch of V1
19 Lacrimal N branch of V1
20 Frontal N branch of V1
21 Auriculotemporal N
22 lesser petrosal N
23 otic ganglion
24 N to Parotid gland
25 N to Labial gland
26 Mental N (to the chin)
27 Inf. alveolar N
(to the chin & jaw)
28 Ns to Tensor Typmani &
Tensor Veli Palatini
CN IIIa fibres from the Accessory
nucleus (ParS)
CN V Trigeminal N
CN Vg Trigeminal ganglion
CN Vm motor nucleus
CN Vs sensory nucleus
CN VII Facial N
CN VIIa superior salivary nucleus
CN IXa inf. salivary nucleus
CN VII
l
lacrimopalatonasal
ganglion
CN IX Glossopharyngeal N exit
jugular foramen
V1 Ophthalmic N - pure sensory
exit foramen rotundum
V2 Maxillary N - pure sensory exit
foramen lacerum
V3 Mandibular N - motor +
sensory exit foramen ovale

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169 A. L. Neill
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F
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2
1
!
2
1
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-
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2
?
?
2
2
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7
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N

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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 (V
1
)
2 Supratrochlear N (V
1
)
3 Lacrimal N (V
1
)
4 Infratrochlear N (V
1
)
5 External nasal N(V
1
)
6 Zygomaticofacial N (V
2
)
7 Infra-orbital N (V
2
)
8 Mental N(V
3
)
9 Buccal N (V
3
)
10 Great Auricular N (C2,3)
11 Anterior cutaneous N of the Neck (C2-3)
12 dorsal branches of C6
16 Auriculotemporal N (V
2
)
17 Lesser Occipital N (C1,2)
18 Greater Occipital N (C2)
19 Zygomaticotemporal N (V
2
)
note if the Onion skin pattern shown
in the lower image is present this
indicates a lesion compressing the Bs
and so the nuclei of CN V.
CRANIAL NERVES
A. L. Neill 170

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171 A. L. Neill
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2
6
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8
9
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11
12
13
14
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16
17
18
19

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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
enters the cavernous sinus lateral to the carotid artery
Cranial Exit superior orbital fissure
1 cerebral cortex
2f fibres form the superior colliculus - tectobulbar fibres
3 pons
4 cavity of 4th ventricle
6f fibres of Abducent N
6 abducent motor nucleus
7 MO
CRANIAL NERVES
A. L. Neill 172

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173 A. L. Neill
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4
5
6n
2f
6f
3

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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
Origin ventral surface of the Brainstem Pontomedullary junction
Course enters the IAM, travels with CN VIII branch Greater
Petrosal N (Para Ns)
facial canal (petrosal canal) branch Chorda Tympani
(Para Ns + SSNs)
Cranial Exit stylomastoid foramen
Longest intracranial pathway of any CN
1 cortical input to facial motor nucleus corticobulbar tract
2 motor nucleus of the Facial N
3 motor branches of the Facial N
4 IAM
5 stylomastoid foramen
CRANIAL NERVES
A. L. Neill 174

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175 A. L. Neill
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Facial CN VII cont
Main Motor branches of the Facial Nerve - lateral view of
the skull
The main motor fibres of the Facial N supply the muscles of facial
expression, via 5 branches and travel in the superficial fascia of the face.
1 Temporal N to Auricularis, & Epicranius
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
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
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
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
inferior Alveolar branches (8).
The Para Ns of Chorda Tympani exit the brainstem via Nervus Intermedius,
which lies b/n CNVIII and the somatic motor fibres of the Facial N (VII).
The fibres of taste (Special Sensory) of the anterior 2/3 of the tongue, and
the general sensory fibres travel with the Chorda Tympani also via Nervus
Intermedius and enter the skull through the petrotympanic fissure.
6 Chorda Tympani
7 N to Mylohyoid
8 Inferior Alveolar N
9 Lingual N
CRANIAL NERVES
A. L. Neill 176

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177 A. L. Neill
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Lesions of the Facial N
The motor nucleus of CN VII is in the caudal portion of the ventrolateral
pontine tegmentum. Axons from the LMN travel dorsally, loop around
the CN VI nucleus (motor) & exit the ventral pons medial to the CN V
spinal nucleus. Along with the motor fibres of CN VII are the ParaNs &
the sensory components which branch off and form the Nervus
Intermedius.
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
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
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
innervated by CN V and CN XI motor nuclei, these areas have multiple
innervation, there is great potential for rehabilitation of this area eg
swallowing after CVAs / strokes.
Image of facial palsies Bells / Central seven
Bells on the ipsilateral side LMN
Central facial Palsy on the contralateral side UMN
1 drooping eyelid dry eye excessive tears
2 facial paralysis/weakness twitching
3 drooping mouth dry mouth impaired taste
cannot blow / whistle /close lips firmly
4 forehead muscles generally spared
5 difficulties in swallowing, talking
CRANIAL NERVES
A. L. Neill 178

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Neural pathways for CN VII = Facial N
and interrelationships with CN V, IX & X (Facial,
Glossopharyngeal & Vagus).
CN VII travels with both CN V & CN IX to reach its destination. It also
interacts with the Vagus N (CN X) and has a second component, the
Chorda Tympani.
This schema demonstrates these interactions and the sites where they
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.
A Intracerebral
B Intracranial
C Intrapetrosal path = facial canal (also intracranial)
D Extrapetrosal ganglia, pathways, Ns & endorgans
1 greater petrosal N
3 auriculotemporal N (sensory branch to EAM)
4 infraorbital N
5 buccal N
6 mental N
7 inferior alveolar N
8 Ns to Stylohyoid & Digastric post. belly
9 chorda tympani + motor facial N
9c chorda tympani branching just before cranial exit part of
taste sensation, supplies ant. 2/3 of the taste & pain of
the tongue - inhibits other sensory input
10 lingual N (from CN V3)
11 submandibular + sublingual ganglia
12 auricular br. of CN X
13 N to Stapedius
14 Geniculate ganglion
CN VIIm Facial N motor nucleus
CN VIIa superior salivary nucleus of the Facial N
CN IXg gustatory nucleus of the Glossopharyngeal N
CN VIIl lacrimopalatonasal ganglion of the Facial N
CN IX Glossopharyngeal N exit jugular foramen
CN X Vagus N
CP Ns from the cervical plexus proprioceptive
CRANIAL NERVES
A. L. Neill 180

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181 A. L. Neill
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B
C
D
C
N

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1
1
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1
2
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3
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9
9
c
1
0
1
1
C
P
8
7 6 5 4
2
3
C
N

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m
C
N

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a

C
N

V
I
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g
C
N
X

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CN VIII in the ear
Coronal section of the ear
exit and relationship with CN VII
Auditory N = Vestibulocochlear N
1 cochlea
2 eustachian tube = auditory tube
3 round window
4 stapes
5 incus
6 malleus
7 CN VII = Facial N
8c Cochlear N part of CN VIII
8v Vestibular N part of CN VIII
9 Tympanic membrane
10 IAM
11 EAM
12 Pinna
CRANIAL NERVES
A. L. Neill 182

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Auditory N = Vestibulocochlear N CN VIII
Diagram of the intracranial pathway and entrance of the CN
VIII coronal section of the skull.
The Vestibulocochlear N pure special sensory with 2 parts =
vestibular + audition = BALANCE & HEARING
Origin sensory cells attached to specialized organs in the
membranous labyrinth (AKA boney labyrinth) in the petrous
part of the Temporal bone
Cochlear duct connected to the boney ossicles for
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
cochlear nucleus and the vestibular nuclear complex.
Cranial Exit remains in the cranium in the internal auditory meatus
1 crus cerebri
2 red nucleus
3 3rd Ventricle
4 vertebral artery
5 sigmoid sinus
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
CRANIAL NERVES
A. L. Neill 184

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185 A. L. Neill
1
2
3
5
7,8
9
10,11
11s
6
4
12
C3
C2
C1
4
5

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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
Course branch intracranial the Tympanic N (Para Ns + sensory
fibres) exits via Foramen Ovale as the Lesser Petrosal N
supplies parotid gland
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
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
posterior 1/3 of the tongue - converge and synapse in the inferior
glossopharngeal ganglion, then enter the Bs and terminate in the upper
part of the Nucleus Solitarius. (also known as the Gustatory nucleus).
CRANIAL NERVES
A. L. Neill 186

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Vagus CN X - wandering nerve
The Vagus N mixed : sensory, somatic motor fibres, & parasympathetic
fibres. ParaNs have input to the CVS, respiratory system from the larynx
to the bronchioles & the GIT to the splenic flexure (23).
Origin Motor : Nucleus Ambiguus, Dorsal Motor nucleus of the
Vagus (ParaNs)
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)
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
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 -
descends lateral to the pharynx. It divides into an int. (sensory &
autonomic) (10i) and ext. branch (10e). The ext. branch innervates the
Cricothyroid muscle.
3 the Recurrent Laryngeal N is different on the R and L sides.
R leaves the Vagus anterior to the subclavian, loops around the artery
and ascends b/n the trachea and the oesophagus (19).
L leaves the Vagus anterior to the aortic arch and loops around it to
ascend through the superior mediastinum. Hence the L Recurrent N is
sensitive to changes in the diameter of the aortic arch as in an
aneurysm. It ascends b/n the oesophagus (18) & trachea. Both Ns
enter supply intrinsic muscles of larynx.
The Para Ns of the Vagus N synapse in ganglia close to their target
organs, and forma networks or plexi around these organs.
Feedback comes from receptors in these organs. Sensation from the
mucous membranes of the epiglottis, base of the tongue, aryepiglottic
folds and the upper larynx travel via the Internal Laryngeal N.
Sensation below the vocal folds of the larynx is carried by the
Recurrent Laryngeal Ns.
CRANIAL NERVES
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189 A. L. Neill
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1
10s
22
10g
11
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21
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Vagus CN X - wandering nerve cont
pathway of the wandering nerve in the neck, thorax and
abdomen
1 EAM
3 external carotid artery
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
10a anterior vagal trunk
10e external vagal N
10g vagal ganglia
10i internal laryngeal N
10p Pharyngeal N branch of CN X to pharyngeal plexus
10s superior vagal ganglion
11 CN XI = Accessory N
12 CN XII = Hypoglossal N
13 oesophageal plexus
14 upper R pulmonary vein
15 R pulmonary artery
16 R main bronchus
17 deep oesophageal plexus + cardiac plexus
18 oesophagus
19 R recurrent laryngeal N - looping around the subclavian artery
20 jugular vein
21 phrenic N (C3,4,5)
22 jugular foramen
23 gastric plexus
CRANIAL NERVES
A. L. Neill 190

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22
11
20
8
10
2 10g
9
12
10p
10i
10e
3
4
5
21
19
18
17
16
15
14
13
10a
7
23
6

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Vagal innervation of the Larynx
Sagittal view of the Larynx showing CN X laryngeal
branches
Note the differences in R and L recurrent laryngeal Ns. Clinically this is
significant as an enlarged Aortic arch may present as a dry hacking cough.
1 Vagus N (CN X)
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
4 Posterior Cricoarytenoid
5 Epiglottis
6 Thyroid cartilage
7 Cricoid cartilage
8 Aryenoid cartilages
9 Oesophagus (removed posteroir to Trachea)
CRANIAL NERVES
A. L. Neill 192

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8
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7
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1B
1C
3
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5
1A

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1 ciliary ganglion
2 sympathetic chain
3 CN III
4 MO
5 Solar plexus
6 sacral Parasympathetic
outflow
7 SC
8 vesical plexus
9 splanchnic Ns
10 CN X cranial
Parasympathetic outflow
Overview - Vagus & the ANS
10p parasympathetic plexi located
near target organs with CN X
3
1
4
10p
10p
10p
6 8
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PUPIL SIZE
SALIVARY
SECRETIONS
HEART RATE
BRONCHIAL SIZE
GASTRIC
MOVEMENT
PANCREATIC &
BILE SECRETIONS
ADRENAL
SECRETIONS
BLADDER
CONTRACTION
LIBIDO
2
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Vagus CN X
autonomic input to the heart + BP
1 hypothalamic autonomic centre
2 sensory input from 3+5+6
3 carotid sinus
4 aortic sinus
5 arterial baroreceptors
6 sinoatrial node
7 arteries
8 sympathetic motor fibres "tone of arteries
9 sympathetic outflow
10 CN X = Vagus N
10n Bs containing solitary tract and nucleus
10p ganglion of the Cardiac plexus
CRANIAL NERVES
A. L. Neill 196

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2
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10
10p
10n
9
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Vagus CN X
Input to the tongue, oesophagus and upper GIT
1 input from the CC
2 pons
3 solitary tract and nucleus
4 nucleus ambiguous
5 dorsal vagal nucleus
6 SC
7g phrenic N nucleus
7n phrenic N
8 diaphragm
9 stomach
10n CN X = Vagus N
10p oesophageal plexus
11 physiological sphincter of oesophagus smooth muscle
12 crura of diaphragm skeletal muscle
13 oesophagus
14 tongue
15 pharynx
CRANIAL NERVES
A. L. Neill 198

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199 A. L. Neill
14
15
1
2
3
4
5
6
7g
7n
10n
8
9
11
12
13
10p

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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)
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
CRANIAL NERVES
A. L. Neill 200

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Neural pathways for CN IX, X & XI =
Glossopharyngeal, Vagus & Accessory Ns
and their interrelationships
CN IX, X and XI travel together and share innervation at for least part of
their pathways. This schema demonstrates their interactions and the
sites where they occur.
A Intracerebral
B Intracranial
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
4 Pharyngeal plexus
5 Laryngeal plexus
6 Coeliac plexus = Solar Plexus ie part of the abdominal
plexi
7 Cardiac and Bronchi plexi
8 Ns to Sternocleidomastoid
9 Ns to Trapezius
CN VIIb inferior salivatory nucleus
CN VII, IX, Xs Nucleus Solitarius -sensory with imput from
the indicated CNs
CN IX X m Nucleus Ambiguus -motor Ns from CN IX & X
CN Xs dorsal Sensory nucleus of the Vagus N
CN Xm dorsal Motor nucleus of the Vagus N
CN XI sc spinal nucleus of the Accessory N (motor)
C1, C2, C3 cervical spinal Ns
CRANIAL NERVES
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203 A. L. Neill
A
B
C
D
C
N

V
I
I

b
C
N

I
X

X

m
C
N

X
s
C
N

V
I
I
,

I
X
,

X
,

s
C
N

X

m
C
N

X
I

s
c
9
8
7
5
6 4
1
2
3
I
X
X
X
I
C
1
C
2
C
3

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Nuclei for CN IX, X & XI = Glossopharyngeal,
Vagus & Accessory Ns & their interrelationships
CN IX, X and XI are intimately related they emerge from the skull together, travel
together and share innervation at for least part of their pathways. This diagram
lists their main nuclei of these Cranial Nerves and the interrelationships with the
other CN nuclei. In some cases the same nuclei have several names, if
significant each one has been listed with their equivalents.
3 Oculomotor nucleus
3a Autonomic accessory nucleus of CN III
4 Trochlear nucleus
5m motor nucleus of Trigeminal N
- 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
7i Inferior salivatory nucleus
7l Lacrimopalatonasal nucleus = autonomic nucleus of the
Facial N
7m Motor nucleus of the Facial N
7s Superior salivatory nucleus
8b Superior vestibular nucleus = nucleus of Betcherew
8c dorsal & ventral Cochlear nuclei
8d Lateral vestibular nucleus = Deiters nucleus
8i inferior vestibular nucleus
8l Superior vestibular nucleus = Lewardanowsky nucleus
8s Medial vestibular nucleus = Schwalbe nucleus
9a Nucleus ambiguus upper part - leads to CN IX fibres
9g Gustatory nucleus - upper part of the Nucleus Solitarius =
Solitary tract
9s Nucleus of the solitary tract with CN IX fibres
10a Nucleus ambiguus middle part -leads to CN X fibres
10mDorsal motor nucleus of the Vagus N
10s Nucleus of the solitary tract with CN IX fibres
11a Nucleus ambiguus lower part -leads to CN XI fibres =
Laryngeal nucleus
11s Spinal nucleus of the Accessory N
12 Hypoglossal nucleus
SPECIAL SENSES
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205 A. L. Neill
3a
3
5me
8b
8L
5m
8d
8c
9s
8s
8i
9s + 10s
5s
10m
12
11s
11a
10a
7i
7s
9a
6
7m
7L
5ma
4

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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
Oblingata running with fibres from C1-3 in the
Ansa Cervicalis
Course passes b/n internal carotid artery and jugular vein loops
above the Hyoid bone and runs on the edge of the
Hypoglossus muscle.
joining the Vagus N (CN X)
Cranial Exit hypoglossal canal
SPECIAL SENSES
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207 A. L. Neill

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Neural pathway for CN XII = Hypoglossal N &
the relationship with the upper Cervical SNs
CN XII hypoglossal = under the tongue interacts with CN IX and V in
supplying the muscles of the tongue and with the upper Spinal Nerves
in the throat hyoid and thyroid muscles. This schema demonstrates
their interactions and the sites where they occur.
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
2 Ns to Muscles of the Tongue
3 Lingual N = from CN V3
4 N to Geniohyoid Muscle
5 N to Thyrohyoid muscle
6 Ansa Cervicalis
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
C1, C2, C3 cervical spinal Ns
SPECIAL SENSES
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209 A. L. Neill
A
B
C
D
C
1
m
C
2

-
3
s
C
N
X
I
I
m
X
I
I
C
1
C
2
C
3
1
2
4
5
3
6
2
&
7

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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
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
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
Lesions blindness
Aetiology injury to the eyeball &/or retina
1 Retina
2 Optic N
3 Optic chiasma
4 Optic Tract
5 Lateral Geniculate body
6 Optic radiation
7 Visual Cortex 1o and 2o in b/n pareito-occipital &
calcarine sulci
8 Corona Radiata
9 Brainstem
10 Superior colliculus
11 Pulvinar (Thalamus)
12 Medical geniculate body
13 Mammillary body
SPECIAL SENSES
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211 A. L. Neill
5
6
7
8
9
1
3
2
1
4
5
6
7
7
10
11
9
12
13
2
3
4

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Blood Vessels of the Eye
Horizontal
1 Central vessels of the retina a= artery v=vein
2 ophthalmic artery
4 cerebral arteries a=anterior /m= middle /
p= posterior branches
5 lateral striate artery
6 optic radiation
7 visceral cortex
8 lateral geniculate body
9 optic tract
10 basilar artery
11 anterior choroidal artery
12 communicating artery a=anterior / p= posterior
13 superior hypophysial artery
14 retina
15 choroid
16 sclera
17 short posterior ciliary arteries
18 DM
19 AM
20 PM
22 plial plexus
23 central collateral artery
24 circle of Zinn
25 lamina cribosa
SPECIAL SENSES
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213 A. L. Neill
1
14
15
16
17
18
19
20
21
22
9n
23
2
1a
21
1v
24
25
2
3
4m
5
4m
6
7
4p
8
9
10
11
12p
13
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12a

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Visual field defects
Lesions complete or partial along the visual pathway result in different
visual field defects.
This diagram represents the views seen in the R and L eyes when
these lesions occur.
L column represents the view from the L eye
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
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
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)
8 visual cortex
9 Optic radiation
10 lateral geniculate body
11 Optic chiasma
12 Optic N = CN II
13 nasal bridge
SPECIAL SENSES
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12 1
2
4
3
11
10
5
6
7
8
9
L
1
2
3
4
5,6,7
1
2
3
4
5,6,7
R

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CN III, IV, V, VI origins
lateral view of the ACF with lateral wall of the cavernous
sinus removed - showing commencement neural pathways
of CN II, III IV V and VI
1 ACF
2c Optic Chiasma
2n CN II = Optic N
3g ciliary ganglion
3n CN III = Oculomotor N
4n CN IV = Trochlear N
5i Ophthalmic N = CN V
1
5ii Maxillary N = CN V
2
5iii Mandibular N = CN V
3
5n Trigeminal N
6 Abducens N = CN VI
6m lateral rectus (muscle of CN VI)
7a anterior cerebral artery
7p posterior cerebral artery
8 superior cerebellar artery
10 maxillary sinus
11 infraorbital N
12a anterior communicating artery
12p posterior communicating artery
13 short ciliary Ns
14 falx cerebri
SPECIAL SENSES
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217 A. L. Neill
1
7p
8
4
3
6
5iii
5g
5i
5ii
12a
14
2c
7a 15 12p
7p
16
3n
9
10
11
13
6m
3g
2n

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Neural pathways to and from the EYE CN III ,
IV & VI motor and CN V sensory
Motor Nerves to the extra ocular muscles of the eye come from nuclei
of CN III, IV & VI;
Sensory feedback is received from the Ophthalmic division of the
Trigeminal N = CNV
1
The Light reflex comes for the parasympathetic imput from the
accessory nucleus of CN III = EdingerWestphal nucleus (IIIm)
1 intracerebral origins
3 pathway through the cavernous sinus
4 cranial exit through the superior orbital fissure
5 extracranial pathway - orbital fossa
6 ciliary ganglion site of synapse of the preganglionic
parasympathetic fibres
7 level of the superior colliculus
8 level of the inferior colliculus
9 inferior border of pons and medulla oblongata
10 N to sphinter papillae CN III
11 Ns to levator palpbrae superioris & superior oblique CN III
12 Ns to inferior & medial recti + inferior oblique muscles CN III
13 Ophthalmic N = CN V1 and the 3 branches just before
entrance into orbit
Lacrimal
Frontal
-Nasociliary
14 N to superior oblique - CN IV = Trochlear N
15 N to Lateral rectus - CN VI = Abducens N
SPECIAL SENSES
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219 A. L. Neill
1
2
3
4
5
89 7
I
I
I
I
I
I
m
I
V
V
I
1
3
1
2
1
0
1
1
6
1
5
1
4
V
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CN exits II, III, IV & VI
Coronal section muscular base of eye socket with
enucleation - eyeball removed
Coronal section muscles sectioned showing BV, ligament
support & N relations and boney cavity
CNs III, IV & VI control the movement of the eyeball - mainly CN III,
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
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
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
6 Abducent N = CN VI
7 Frontal N branch of CN V
1
8 Nasociliary N branch of CN V
1
9 Optic canal
10 Ophthalmic artery
11 Tendinous ring around the CN II and the artery
12 Lacrimal N branch of CN V
1
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
SPECIAL SENSES
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15
1s
14
13s
12
7
5s
4
3s
1l
8
6
3i 5i
17
1i
10
10
11
2
1m
9
1i
13i
3g
6
1L
15
1s
14
18
13s
16
13s
4
2
10
1m

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Neural pathways from the TONGUE CN VII, IX
& X special sensory TASTE CN V
3
sensory
The special sensation of Taste is supplied by 3 CNs on the ispilateral
side with overlap b/n these Ns.
Other sensory feedback such as pressure and pain is supplied by the
Mandibular N (CN V
3
), on the contralateral side.
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
5n Spinal nucleus of CN V
5s Sensory fibres of the Mandibular N
7g Geniculate ganglion
7n Sensory nucleus of Nervus intermedius =
upper portion of Nucleus solitarius
7ss Chorda Tympani fibres = special sense Taste fibres
8 Vallate papillae
9g inferior petrosal ganglion of CN IX
9s Gustatory nucleus (part of the Nucleus Solitarius
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
SPECIAL SENSES
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223 A. L. Neill
5s
1
5
7g
8
7ss
10ss
9ss
9g
10g
5n
10s
9s
4
3
2
7n
40
43
38
1

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Taste areas on the TONGUE
Tongue macroscopic view of the dorsal surface
Taste bud histological section through the structure
The special sensation of Taste is supplied by 3 CNs on the ispilateral
side with overlap b/n these Ns. Within these areas supplied are
subareas which recognize specific taste types. However there is
considerable variation and overlap of these areas.
The taste is detected via taste buds inserted into the stratified
squamous epithelium of the tongue.
1 taste pore
2 microvilli
3 supporting cells = sustenacular cells
4 basal cell
5 sensory N
6 sensory N fibres inot the cells
7 sensory hair on cell surface
Areas on the tongue detect certain tastes more sensitively
they do not reflect the innervation
A SWEET area
B SOUR area
C SALTY area
D BITTER area
CN VII area innervated by the Chorda tympani -
ant. tip of tongue
CN IX area innervated by the Hypoglossal N -
ant. 2/3 of tongue
CN X area innervated by the Vagus N post. - 1/3 of tongue
SPECIAL SENSES
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225 A. L. Neill
7
6
5f
5
4
3
2
1
A
B
C
D
CN IX
CN X
CN VII

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CN VIII Auditory / Balance Pathways
in situ
Schema
CN VIII the vestibulocochlear CN - conducts sensory information to the brain
on sound, body position and balance. It is a special sensory CN. There is a
crossover of the information as in most CNs, and extensive spread of the
imput to many areas of the brain for interpretation and subsequent response.
A = CEREBRUM
B = PARIETAL + TEMPORAL LOBES
C = MIDBRAIN
D = CN VIII pathway
E = COCHLEA apparatus
1 transverse temporal gyrus
2 auditory radiation
3 medial geniculate body
5 superior olive
6 cochlear nuclei anterior + posterior
7 Pons
8 CN VIII fibres
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
14 tectoral membrane
SPECIAL SENSES
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1
2
3
4
5
6
7
8
14
13
10
12
11
9
A
B
C
D
E

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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
(Menieres disease).
Input from the vestibular apparatus in the middle ear goes to the 4
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.
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
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
apparatus of the middle ear = ampullae, saccule &
semicircular canals
8n vestibular nuclei 4 inferior lateral medial & superior
9 fibres to cerebellum via inf. peduncle
10 lateral vestibulospinal tract
SPECIAL SENSES
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229 A. L. Neill
1
2
5
7a
7d
6
9
8n
4
3
8g
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
/speech and swallowing difficulties
TONE CHANGES - hyer-reflexia / spasticity / resistance to passive
movement / hypo-tonia / flaccidity / involuntary movements (also
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
the following capabilities are lost -
ABDUCENS = CN VI
Patient cannot abduct their eye - cannot look laterally on the affected
side (Lateral Rectus) rarely seen in isolation generally associated with
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
CRANIAL NERVE EXAMINATION
A. L. Neill 230

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231 A. L. Neill
ACCESSORY = CN XI
Patient cannot turn head or raise shoulders against resistance
(Sternocleidomastoid + Trapezius)
FACIAL = CN VII
Inspect the face - look for: asymmetry, blinking, lacrimation, salivation
and evenness of facial creases and lip movement on speaking.
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).
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 = Bells 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
HYPOGLOSSAL = CN XII
Inspect the tongue - look for: atrophy, asymmetry, fasciculation and
involuntary movements - Patient cannot move the tongue in and out
evenly - will deviate to the side of the paralysis - nor push against the
cheek and examiners finger strongly
(Genioglossus and Linguali muscles)
seen in isolation and associated with lesions of CN IX, X and XI
DD drugs, chorea associated with psychiatric or mental illnesses, motor
neurone disease.
A. L. Neill 232

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233 A. L. Neill
OCULOMOTOR = CN III
test eye movements - Patient cannot move eyes around follow an
examiners 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
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
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.
A. L. Neill 234

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235 A. L. Neill
TRIGEMINAL = CN V
V
1
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
DD diseases of the skin
V
2
absent sensation over the mid and lower portions of the face
V
3
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
leave permanent residual affects), tumours in the nasopharynx.
V
1
V
2
V
3
Compression of Bs results in
onion skin pattern Parasthesia

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VAGUS = CN X
inability to cough with pressure - long bovine cough
asymmetry seen when examinig the larynx say AHHH observe uneven
uvula (paralysis on the ipsilateral side) and presence of an husky voice
seen in isolation and associated with CN IX and XII
DD hysteria and lesions in the CNs IX or XII
A. L. Neill 236
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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237 A. L. Neill
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
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
A fork placed on the head midway should be heard evenly if this is not
the case there may be unilateral hearing loss.
DD diseases w/in the ear eg. wax blockage growth in the auditory tube

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Accommodation & Light reflexes
(CN II, III, sympathetic fibres from T1 and 2 (Dilator Pupillae)
Parasympathetic fibres from the ciliary ganglion (Sphincter
Pupillae)
Shine a light into one eye while shielding the other and pupils
from both eyes should constrict, if only the stimulated pupil
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
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
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)
7 ciliary ganglion
8 Oculomotor N, CN III
9 postganglionic parasympathetic Ns = short ciliary Ns -
10 object for focus
11 visual cortex
12 Optic radiation for interpretation
13 Lateral geniculate nucleus
14 Ciliaris -adjustment of lens and iris
15 Medial Rectus - one of the muscles moving the eyeball for
better focus
CRANIAL NERVE REFLEXES
A. L. Neill 238

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239 A. L. Neill
14
15
1
2
3
8
9
7
5
6
4
13
12
11
?

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Blink reflex (CN V
1
, VII)
Tap the Glabella* region repeatedly and elicit blinking which will
diminish after several taps (Orbicularis Oculi)
Corneal reflex (CN V
1
, VII)
Approach the cornea from the side (out of sight by the patient)
and touch lightly causing a blink (Orbicularis Oculi)
1 bright light
2 stimulus touching the cornea
3 Ophthalmic N - CN V
1
4 Optic N tract - CN II
5 Emotional imput / or response to sensation from
higher centres
6 Visual reflex centres in the Midbrain
7 Facial N efferent fibres (CN VII)
8 Orbicularis Oculi + Levator Palpabrae Superioris
* Forehead b/n the eyes.
A. L. Neill 240

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241 A. L. Neill
3
2
4
7
6
5
8
1

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Crying/Lacrimation reflex (CN V
1
, VII)
(Orbicularis Oculi)
Irritation to the eye directly - smell (eg. onion) or touch or indirectly via
higher emotional centres will cause a reflex crying response.
1 stimulation of the cornea conjunctiva
2 stimulation from higher emotional centres
3a sympathetic chain
3b superior sympathetic ganglion
3c postganglionic fibres to the lacrimal gland
4 Ophthalmic N = CN V
1
5 sensory nucleus of CN V
6 parasympathetic nucleus of CN VII (in the Pons)
7 Facial N = CN VII and pterygopalatine ganglion
8 Lacrimal gland
Sneezing reflex
(CN V
2
, X, C3,4,5 =Phrenic N + Intercostals T1-12)
(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
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)
A. L. Neill 242

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243 A. L. Neill
4
6
7
1
2
8
5
4
3
7
6
1
3L
3b
3a
6
5
2

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Stapedial reflex (CN VIII, V
3
higher centres)
When a person is about to speak and a sudden loud noise will cause
the reflex contraction of Tensor Tympani
1 imput from higher centres - about to speak
2 loud irritating noise - afferent from CN VIII
3 somatic motor nuclei of CN V and VII
4 CN VII to Stapedius
5 Tympanic membrane
Salivation reflex (CN I, II, VII, IX higher emotional
centres, sympathetic and parasympathetic fibres)
The thought, smell, sight or taste of food causing reflex secretion from
the salivary glands
1 imput from higher centres - thinking of food
2 imput from seeing food Optic N = CN II - looking at food
3 imput from smelling food Olfactory N = CN I - smelling food
4a imput from tasting food Lingual N, Chorda Tympani (CN VII)
4b & Glossopharyngeal Ns (CN IX) - tasting food*
5 Solitary nucleus of Medulla = Nucleus Solitarius
6a Salivatory centres of the Facial
6b & Glossopharyngeal nuclei
7 Preganglionic sympathetic cells
(in the lateral horn of the SC) and fibres
8 Sympathetic chain
9 Postganglionic sympathetic fibres ("salivation)
10a Parasympathetic efferent fibres of CN IX and the
Otic ganglion ("salivation)
10b Parasympathetic efferent fibres of CN VII and the
Submandibular ganglion ("salivation)
11 Salivary gland
*note trained reflexes of timing and signals such as aural input can also
influence the afferent stimulus to salivate - also both parasympathetic and
sympathetic fibres increase salivation
A. L. Neill 244

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245 A. L. Neill
1
1
6a
6b
3
11
10b
10a
9
8
7
5
4b
4a
3
1
2
3
2
4 5

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Swallowing reflex (CN IX, X, XII V
3
)
a bolus of food or liquid - including saliva, placed at the back of the
throat will cause the reflex initiation of swallowing
1 oropharynx
2 afferent fibres of Glossopharyngeal N (CN IX)
3 Solitary nucleus = Nucleus Solitarius
4 Nucleus Ambiguus (motor nucleus of CN IX X & XII)..
5 Vagus N (CN X)
6 Hypoglossal N (CN XII)
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
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
coughing and muscle spasm
(Pharyngeal Constrictors)
diminished in 20% of people unless severely irritated - important to
stop particles from going into the trachea
Jaw Jerk (CN V
3
)
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 V
3
)
4 Trigeminal ganglion
5 Proprioceptive nucleus
6 Motornucleus of Trigeminal N (CN V
3
)
7 Efferents from Trigeminal N to muscles of mastication (CN V
3
)
A. L. Neill 246

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247 A. L. Neill
1
2
3
4
7
5
6
8
10
11
1
3
4
5
6
7
2

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Carotid reflex (CN IX, X)
Changes in the stretch receptors of the carotid sinus (BP) alter the level
of the CO to regulate the blood volume passing through this area hence
artificially stretching this body will cause a marked reduction in BF and
fainting - VASOVAGAL reflex.
Yawning reflex (higher centres, CN V, VII, IX, X, XII
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
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)
1 higher centres
2 Motor nuclei of several CNs including Trigeminal and
Facial Ns (CN V
3
, VII)
3 Interneurons to Phrenic N (C3,4,5)
4 Interneurons to Intercostal Ns (T1-12)
5 Diaphragm (innervated by the Phrenic)
6 Intercostal muscles
7 Mandible - opened by muscle stimulation (CN X, XII)
8 Pharynx and Larynx opened (CN IX, X)
A. L. Neill 248

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249 A. L. Neill
1
2
8
1
4
6
5
7

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Fasciculus Cuneatus + Fasciculus Gracilis &
Spinocerebellar tracts.
Fasciculus Cuneatus (neck to mid Thorax=T6) + Fasciculus Gracilis
(lower thorax =T7 - lower limb) = the Dorsal columns of the SC.
Ascending sensory tracts for pressure, proprioception and touch to the
sensory cortex of the CC or the cerebellum, the Dorsal columns. The
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)
1 axons of the 1st order neurones
1c fasciculus cuneatus
1g fasciculus gracilis
2 axons of the 2
nd
order neurones
M = medial leminiscal tracts contralateral
P= posterior spinocerebellar tracts ipsilateral
2c fasciculus cuneatis
3 axons of the 3
rd
order neurones
4 thalamus
5 CC
6 midbrain
7 cerebellum
8 pons
9 nucleus gracilis
10 nucleus cuneatus
11 MO
12 cell bodies of the 1
0
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
THE SPINAL CORD
A. L. Neill 250

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THE SPINAL CORD
251 A. L. Neill
19
20
4
5
8
2m
9
10
11
1g+1c
14
1g
12
14
15
18
17
13
16
2p
7
6
3

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Lateral Spinothalamic tract
Ascending sensory tracts for crude touch, deep pressure, pain &
temperature to the sensory cortex of the CC.
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)
1 axons of the 1st order neurones
2 axons of the 2nd order neurones
= lateral spinothalamic tract
3 axons of the 3rd order neurones
4 thalamus
5 CC
6 midbrain
7 cerebellum
8 pons
9 nucleus gracilis
10 nucleus cuneatus
11 MO
13 pain receptors
14 temperature receptors
15 lumbar SC
16 lateral spinothalamic tract
note crosses immediately to contralateral side
17 cervical SC
19 post central gyrus
THE SPINAL CORD
A. L. Neill 252

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THE SPINAL CORD
253 A. L. Neill
1
14
13
12
11
10
9
8
7
6
5
4
19
3
2
18
17
16
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.
1 motor CC
2 internal capsule
3 geniculate fibres
4 decussation of the pyramidal fibres
5a anterior cerebrospinal tracts
5L lateral corticospinal tracts
6 anterior N roots from the ventral / anterior horn
7 corona radiata
THE SPINAL CORD
A. L. Neill 254

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THE SPINAL CORD
255 A. L. Neill
7
1
2
3
4
5a
5L
6

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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
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.
1 upper motor neurones
2 primary motor area of the CC
3 internal capsule
4 red nucleus
5 midbrain
6 cerebellum
7 pons
8 MO
9 decussation (crossing over) of lat. corticospinal fibres
10 SC cervical region
11 skeletal muscle
12 lumbar / thoracic SC
13 lower motor neurones Spinal Nerves
14 anterior corticospinal tracts
15 lateral corticospinal tracts
16 rubrospinal tracts
note extrapyramidal tracts are all the others ie which donot pass through the
pyramids
THE SPINAL CORD
A. L. Neill 256

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THE SPINAL CORD
257 A. L. Neill
13
12
14
15
9
10
11
16
8
7
6
5
4
3
2
1

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Pain Pathways Nociceptor information
Spinomesencephalic
Spinoreticular &
Spinothalamic tracts
Ascending sensory tracts for pain or information from the nociceptors
may include any sensory pathway these are the main 3. Note they
cross in the SC dorsal horns segments immediately upon entering.
1 axons of the 1
st
order neurones
2 axons of the 2
nd
order neurones
3 axons of the 3
rd
order neurones
4 thalamus
5 CC
6 midbrain
6g periaqueduct GM (in Midbrain)
6r reticular formation of the midbrain
7 cerebellum
8 pons
8r reticular formation of the pons
9 nociceptors or pain receptors
10 tracts in the SC for the pathways described
11 MO
11r reticular formation of the medulla
12 sensory N fibre entering ganglion where the N cell
bodies are located
synapse in SC dorsal horn - changes from
1
o
to 2
o
neurones
13 SC segments cervical, lumbar and/or thoracic
THE SPINAL CORD
A. L. Neill 258

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THE SPINAL CORD
259 A. L. Neill
1
9
12
1
13
9
10
14
10
11
11r
2
8r
8
6
7
6r
6g
5
4
3
9
1

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Tracts of the SC*
Transverse thoracic
Motor = Descending - carries messages to the body / muscles from
the brain - efferent tracts = M = pure motor N
1 Corticospinal tracts a = anterior / l = lateral = PYRAMIDAL TACTS
motor CC !skeletal muscles
2 Reticulospinal tracts a = anterior / l = lateral
reticular formation in the Bs !muscles for tone + visceral function
3 Rubrospinal tracts*
Red nucleus in MB !distal flexor limb muscles for balance,
posture & tone
4 Olivospinal tracts
5 Tectospinal
MB !coordination of Head & Eye movements - looking
6 Vestibulospinal*
MO !muscles for posture & balance
Sensory = Ascending - carries sensory input from the body to the
brain / afferent tracts = S = pure sensory N
7 Fasciculus gracilis dorsal column from the lower thorax to LL
8 Fasciculus cuneatus dorsal column from the neck to the mid-
thorax + UL
Dorsal columns carry information regarding: - light touch, position,
pressure & vibration to the sensory CC
9 Spinocerebellar tracts a = anterior / p = posterior
neuromuscular + neurotendinous information to the Cerebellum &
Reflex arcs, to detect over stretching of muscle &/or tendons +
feedback on balance & coordination
10 Spinothalamic tracts a = anterior / L = lateral
crude touch, pain, pressure & temperature via the Thalamus to the CC
M + S = PN = peripheral N generally a mixture of motor & sensory fibres.
For more detail on SC structure see the A to Z of Peripheral Nerves.
THE SPINAL CORD
A. L. Neill 260

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THE SPINAL CORD
261 A. L. Neill
7
8
9
p
9
a
1
0
L
1
0
a
1
a
6
2
a
5
4
3
P
N
S
M
2
L
1
L

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Points of Immobility in the SC
The Brain is connected to the SC and together they are a relatively
immobile inelastic sensitive branched cord. Hence with changes in
posture any tethered points place tension and so pain on this structure.
As demonstrated this can be accentuated by various postures and so
allow the clinician to locate and evaluate the areas of sensitivity
for treatment.
Green arrows ! demonstrate the direction of the pain when stretched
and red arrows the direction of movement !
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
5 CN V Trigeminal N
6 midbrain
7 Femoral N
8 Saphenous N
9 Sciatic N
THE SPINAL CORD
A. L. Neill 262

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THE SPINAL CORD
263 A. L. Neill
9
9
4
3
6
5
2
1
C6
7c
L4

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Relation of the ANS / sympathetic chain to
the SC and VC
The sympathetic chain of the ANS flanks the thoracic region of the VC
forming ganglion opposite each thoracic outlet and feeding fibres into
the visceral region.
In the cervical region these coalesce into 3 major ganglia and in the
lumbar region they lie across the VB of the VC.
1 superior cervical ganglion
2 middle cervical ganglion
3 lower cervical ganglion
4 sympathetic chain
5 visceral branches
6 VB of L2
THE SPINAL CORD
A. L. Neill 264

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THE SPINAL CORD
265 A. L. Neill
1
2
3
4
5
6

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Relations of the Cervical Sympathetic Trunk
& Ganglia
Note Horners syndrome is due to an interruption of the cervical
ganglia = miosis + ptosis + enophthalmus + vasodilatation +
anhydrous
1 Vertebral artery
2 internal carotid N
3 Superior cervical ganglion
4 Middle cervical ganglion
5 Inferior thyroid artery
6 Thyrocervical trunk
7 Subclavian artery
8 Stellate ganglion (C4-T1 fusion)
9 2
nd
thoracic ganglion
10 vertebral N
11 communicans b/n cervical Ns
12 loop of Atlas
13 fibres to CN XII
14 fibres to CN X
15 fibres to CN XII in the descending loop ansa cervicalis
THE SPINAL CORD
A. L. Neill 266

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THE SPINAL CORD
267 A. L. Neill
1
2
3
13
14
15
16
5
4
6
7
8
9
T2
T1
C8
C7
C6
C5
C4
C3
C2
C1
12
11
10
10

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Dr. A. L. NEILL BSc MSc MBBS PhD FACBS
medicalamanda@gmail.com or www.amandasatoz.com
mobile 0410 018 681
Contact www.aspenpharma.com.au for login and passwords for
the complete A to Z and the AspenAtlas online.
Aspen Pharmacare Australia Pty Ltd 34-36 Chandos Street, St Leonards NSW 2065
ABN 51 096 236 985
Dr. A. L. NEILL BSc MSc MBBS PhD FACBS
medicalamanda@gmail.com or www.amandasatoz.com
mobile 0410 018 681
Contact www.aspenpharma.com.au for login and passwords for
the complete A to Z and the AspenAtlas online.
Aspen Pharmacare Australia Pty Ltd 34-36 Chandos Street, St Leonards NSW 2065
ABN 51 096 236 985
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