Central Nervous System, Spinal

Nerves, and Cranial Nerves

Copyright 2014, John Wiley & Sons, Inc.

Spinal Cord Structure: Protection and
Coverings
n  Vertebrae
n  Spinal meninges
q  Three layers of connective tissue
n  Dura mater
n  Arachnoid mater
n  Pia mater
q  Continuous with cranial meninges
n  Cerebrospinal fluid (CSF)
q  Buoyant liquid that suspends the central nervous tissue in a
weightless environment while surrounding it with a shock-absorbing,
hydraulic cushion.
Copyright 2014, John Wiley & Sons, Inc.
Spinal Meninges and Spaces
n  Epidural space: between vertebrae and
dura mater
n  Dura mater: tough, dense irregular
connective tissue
q  Extends to vertebra S2 (well beyond spinal cord)
n  Arachnoid mater: resembles spider’s web
q  Extends into subarachnoid space
n  Subarachnoid space – between arachnoid
and pia matter
q  CSF circulates in this space
n  Pia mater: thin, delicate layer
q  Adheres to surface spinal cord (and brain)
q  Contains blood vessels
Spinal
Meninges
and Spaces
 Gross Anatomy of Spinal Cord
n  Extends from medulla of brain to L2 vertebra
n  Enlargements: cervical (C4-T1) and lumbar
enlargement (T9-T12)
q  Points of origins of nerves to upper and lower
limbs
n  Cauda equina (horse’s tail)
q  Extends inferior to end of spinal cord

q  Consists of roots of lumbar, sacral and coccygeal

spinal nerves
n  Left and right halves partially separated by
q  Anterior median fissure and posterior median
sulcus
q  Small central canal (filled with CSF) in middle
Gross
Anatomy of
Spinal Cord
Internal Structure of Spinal Cord
n  Gray matter forms “H” (or “butterfly”)
q  Three horns on each side; sites of cell bodies
n  Posterior gray horns: contain interneurons and
sensory neurons
n  Anterior gray horns: contain somatic motor nuclei

n  Lateral: contain autonomic motor nuclei

n  White matter (surrounds gray “H”)

q  Consists of white columns
n  Posterior, Anterior, and Lateral white columns
n  Contain tracts (bundles of axons)
q  Sensory tracts: ascending to brain
q  Motor tracts: descending from brain
Internal Structure of Spinal Cord
Spinal Nerves
n  31 pairs
q  Named according to level of vertebra

q  C1-C8, T1-T12, L1-L5, S1-S5, 1 coccygeal

q  Emerge from spinal cord through intervertebral

foramina
n  Nerves attached to spinal cord by 2 roots
q  Dorsal root: made of axons of sensory neurons

n  Dorsal root ganglion: swelling containing cell

bodies of sensory neurons
q  Ventral root: composed of axons of motor neurons

n  Both somatic motor and autonomic motor

Spinal Nerve Composition
n  Mixed:
q  Formed from dorsal root (sensory) and ventral
root (motor)

n  Connective tissue coverings

q  Individual axons wrapped in ENDONEURIUM
q  Axons grouped in fascicles wrapped in

PERINEURIUM
q  Outer covering = EPINEURIUM
Distribution of Spinal Nerves: Branches

n  Posterior (dorsal) ramus - serves the deep

muscles and skin of the posterior surface of the
trunk.
n  Anterior (ventral) ramus - serves the muscles
and structures of the upper and lower limbs and
the skin of the lateral and anterior surfaces of
the trunk.
n  Meningeal branch - supplies the vertebrae,
vertebral ligaments, blood vessels of the spinal
cord, and meninges.
Distribution of Spinal Nerves
n  Spinal nerves branch after pass through
intervertebral foramina
n  Some join with branches from neighboring
nerves to form Plexuses
n  Nerve names relate to region innervated
n  Spinal nerves T2-T12 do not form plexuses
q  Called Intercostal nerves
q  Supply abdominal muscles, skin of chest and
back, and muscles between ribs.
Plexuses
n  Cervical plexus
q  C1-C4
q  Supplies posterior head, neck, shoulders, and
diaphragm
q  Important nerves: Phrenic nerves to diaphragm
n  Brachial plexus
q  C5-C8 and T1
q  Supplies upper limbs + some neck and shoulder
muscles
q  Important nerves: Radial, Ulnar, Axillary,
Median, Musculocutaneous to arm, forearm,
hand
Plexuses
n  Lumbar plexus
q  L1-L4
q  Supplies abdominal wall, external genitalia, and part
of lower limbs
q  Important nerves: Femoral (to anterior thigh: quads)
n  Sacral plexus
q  L4-L5 and S1-S4
q  Supplies buttocks, perineum, and most of lower limbs
q  Important nerves: Gluteal, Sciatic (to posterior thigh
and all of leg and foot)
Dermatome

n  The area of the skin that provides sensory

input to the CNS via one pair of spinal
nerves or the trigeminal (V) nerve.
Spinal Cord Functions
The spinal cord has two principal functions in
maintaining homeostasis:
n  Nerve impulse propagation

n  Integration of information
Spinal Cord Functions
n  Pathways for nerve impulses within tracts
q  Ascending (sensory). Example: spinothalamic
q  Descending (motor). Example: corticospinal
n  Reflexes: fast, involuntary sequences of
actions in response to stimuli
q  Can be simple (withdrawal) or complex (learned
sequence such as driving car)
q  Levels
n  Spinal (reflex arc): simple
n  Cranial: more complex
Reflex Arc
•  pathway followed by nerve impulses that
produce a reflex
1.  Sensory receptor: responds to stimulus
2.  Sensory neuron: through dorsal root à
posterior horn
3.  Integrating center: single synapse
between sensory and motor neurons
4.  Motor neuron: from anterior horn à
ventral root à spinal nerve à
5.  Effector: muscle responds
Example of Reflex Arc: Patellar Reflex
1.  Sensory receptor is stimulated by tap on
patellar tendon
2.  Sensory neuron: through dorsal root à
spinal cord
3.  Integrating center: single synapse in
spinal cord
4.  Motor neuron: through ventral root à
spinal nerve à femoral nerve à
5.  Effector: quads contract, extend leg
Example of Reflex Arc: Patellar Reflex
 Reflexes and Diagnosis
n  Patellar reflex (knee jerk) - blocked by damage to the
sensory or motor nerves supplying the muscle or to the
integrating centers in the 2nd, 3rd, or 4th lumbar
segments of the spinal cord.
q  absent in people with chronic DM or neurosyphilis, both of
which cause degeneration of nerves.

n  Achilles reflex (ankle jerk) - involves plantar flexion of

the foot by contraction of the gastrocnemius and soleus
muscles in response to tapping the calcaneal (Achilles)
tendon.
q  absent indicates damage to the nerves supplying the posterior
leg muscles or to neurons in the lumbosacral region of the
spinal cord.
Reflexes and Diagnosis
n  Babinski sign - reflex results from gentle stroking of
the lateral outer margin of the sole.
q  positive Babinski sign after age 11/2 is abnormal and
indicates an interruption of the corticospinal tract as the
result of a lesion of the tract, usually in the upper
portion.
n  Abdominal reflex - involves contraction of the
muscles that compress the abdominal wall in
response to stroking the side of the abdomen.
q  absence of this reflex is associated with lesions of the
corticospinal tracts, lesions of the peripheral nerves,
lesions of integrating centers in the thoracic part of the
cord, or multiple sclerosis.
 BRAIN ORGANIZATION, PROTECTION,
AND BLOOD SUPPLY
n  Brain vesicles give rise to the following adult structures:
n  Telencephalon develops into the cerebrum and lateral
ventricles.
n  Diencephalon forms the thalamus, hypothalamus,
epithalamus, and third ventricle.
n  Metencephalon becomes the pons, cerebellum, and
upper part of the fourth ventricle.
n  Myelencephalon forms the medulla oblongata and
lower part of the fourth ventricle.
n  Mesencephalon or midbrain gives rise to the midbrain
and aqueduct of the midbrain (cerebral aqueduct).
Brain: Major Parts
n  Brain stem: continuous with spinal cord
q  Midbrain, Pons, Medulla oblongata
n  Diencephalon: superior to brain stem
q  Thalamus, hypothalamus, epithalamus, and
pineal gland
n  Cerebrum: largest part and most
superior
q  Surface covered with gray matter: cortex
q  Deep to cortex is cerebral white matter

n  Cerebellum: posterior and inferior

q  Means “little brain”
Brain: Major Parts
Brain: Major Parts
 Protective Coverings of the Brain: Cranium &
Cranial Meninges
n  Cranial meninges - continuous with the spinal
meninges:
q  outer dura mater the middle arachnoid mater, and the inner
pia mater.
Brain Blood Supply and Blood-Brain
Barrier
n  Requires 20% of the body’s O2 supply
q  4 min lack à permanent damage
n  Requires continuous glucose supply
n  Protected by blood-brain barrier
q  Allows passage of lipid soluble materials: O2,
CO2, alcohol, anesthetic agents
q  But controls entry of most harmful materials
n  Created by tight capillaries and astrocytes
 Cerebrospinal Fluid (CSF)
Functions of CSF
n  Mechanical protection - shock-absorbing medium that
protects the delicate tissues of the brain and spinal cord.
The fluid also buoys the brain so that it “floats” in the
cranial cavity.
n  Homeostatic function - pH of the CSF affects pulmonary
ventilation and cerebral blood flow, which is important in
maintaining homeostatic controls for brain tissue.
n  Circulation - a medium for minor exchange of nutrients

and waste products between the blood and adjacent

nervous tissue
Cerebrospinal Fluid (CSF)
n  Formed in the 4 ventricles of brain
q  Lateral (#1 and 2) à 3rd à 4th ventricle
q  Formed in choroid plexuses
n  By filtration and secretion of blood plasma
n  In specialized capillary networks (covered by ependymal
cells) in walls of ventricles
n  Pathway
q  Through 4 ventricles à central canal of spinal cord
and within subarachnoid space à
q  Reabsorbed through arachnoid villi into blood in
superior sagittal sinus
n  Cushions brain and provides nutrients
CLINICAL CONNECTION | Hydrocephalus
n  excess CSF accumulates in the ventricles and the
CSF pressure rises.
n  Abnormalities in the brain—tumors, inflammation, or
developmental malformations, injury, meningitis, or
subarachnoid hemorrhage.
n  Hydrocephalus is relieved by draining the excess
CSF.
n  Endoscopic third ventriculostomy (ETV)-
neurosurgeon makes a hole in the floor of the third
ventricle and the CSF drains directly into the
subarachnoid space.
Endoscopic third ventriculostomy (ETV)
Cerebrospinal Fluid (CSF)
Brain Stem: Medulla Oblongata
n  Most inferior part of brainstem
q  White matter connects spinal cord and other parts
of brain
n  Contains vital nuclei
q  Cardiovascular center
n  Regulates heart rate, blood pressure, diameter of blood
vessels
q  Medullary rhythmicity area
n  Adjusts respiratory rhythm
n  Other sensory and reflex motor areas
n  Cranial nerves VIII-XII attached here
Brain Stem: Pons
n  Serves as a “bridge”
q  Connects medulla to midbrain and above
q  Contains ascending and descending tracts
q  Connects left and right sides of cerebellum
n  Contains nuclei
q  Motor relays from cerebrum to cerebellum
q  Helps control breathing
q  Cranial nerves V-VIII attached here
Brain
Stem
Brain Stem: Midbrain
n  Connects pons to diencephalon
q  Large tracts: cerebral peduncles
n  Nuclei:
q  Substantia nigra: related to Parkinson disease
q  Red nuclei: help coordinate movements
q  Origin of cranial nerves III and IV (control eye
movements)
q  Superior colliculi: nuclei involved in
n  Scanning eye movements
n  Responses to visual stimuli

q  Inferior colliculi: responses to auditory input

Reticular Formation
n  Netlike arrangement of gray and white matter
n  Contains ascending and descending tracts
n  Ascending part is called the Reticular
Activating System (RAS)
q  Carries sensory pathways to cerebral cortex
q  Helps maintain consciousness

q  Maintain attention and alertness

q  Prevent sensory overload

n  Inactivation of the RAS produces sleep

n  Damage to the RAS, results in coma
Reticular Formation
 Diencephalon
n  Thalamus: major sensory relay center
q  Also motor, autonomic, and consciousness functions

n  Hypothalamus: lies inferior to thalamus

q  Control of pituitary and hormone production

q  controls and integrates activities of ANS

q  Involved with feelings and behavior patterns

q  Regulation of eating, drinking, fluid levels

q  Control of body temperature

q  Regulation of circadian rhythms, sleep, waking

n  Epithalamus: superior and posterior to the thalamus.

q  Pineal gland: secretes melatonin, controls sleep, biological
clock
q  Habenular nuclei: involved in olfaction
Diencephalon
Cerebellum
n  Location: posterior to medulla and pons,
inferior to cerebrum
q  Attached to brain stem by cerebellar peduncles
n  Structure:
q  Two cerebellar hemispheres
q  Cerebellar cortex: gray matter
q  Arbor vitae: Tree-like appearance (seen in sagittal
section) of white matter and gray nuclei
Cerebellum
n  Functions
q  Receives wide range of sensory input from
muscles, joints, tendons, eyes, inner ears
q  Compares actual movements with intended ones

q  Helps produce smooth, coordinated movements

q  Helps execute skilled motor activities

q  Regulates posture and balance

Cerebrum: Structure
n  “seat of intelligence”
Consists:
n  Cerebral cortex

n  Internal white mater

n  Deep gray nuclei

n  Surface folds of cerebral cortex: gyri

n  Deepest grooves between gyri: Fissures;

shallow grooves: sulci
n  Longitudinal fissure: divides cerebrum into left
and right hemispheres
n  Hemispheres connected by corpus collosum
Cerebrum: Structure
n  Each hemisphere has 4 lobes
q  Frontal, Parietal, Temporal, Occipital
q  Central sulcus separates frontal, parietal
q  Precentral gyrus anterior to sulcus: primary
motor area
q  Postcentral gyrus: primary somatosensory area
n  Deep gray nuclei: basal nuclei/basal
ganglia
q  Globus pallidus, Putamen, Caudate nucleus
Cerebrum
Cerebrum
Cerebrum
Limbic System
n  Ring of structures on inner border of
cerebrum and floor of diencephalon
n  Called “emotional brain”: plays primary role
in pain, pleasure, anger, affection and in
behavior
n  Involuntary activity related to survival
n  Important in memory development
Limbic System
Functional Areas of Cerebral Cortex
n  Specialized areas in specific regions of
cerebral cortex
n  Sensory areas receive input à perception
n  Motor areas à initiate movements
n  Associative areas à complex integration:
memory, emotion, reasoning, judgment
Sensory Areas
n  Primary somatosensory area: postcentral
gyrus
q  Input includes: touch, proprioception, pain, itching, tickle,
temperature
n  Primary visual area: occipital lobe
n  Primary auditory area: temporal lobe
n  Primary gustatory (taste) area: base of
postcentral gyrus
n  Primary olfactory (smell) area: medial
aspect of temporal lobe
Motor Areas
n  Located anterior to central sulcus
n  Primary motor area: precentral gyrus
n  Broca’s speech area
q  Interacts with premotor area and primary motor
area to regulate breathing and speech muscles
q  Is in left hemisphere in 97% of persons
Association Areas
n  Adjacent to sensory and motor areas and
connected via association tracts
n  Integrate and interpret information
n  Examples
q  Somatosensory association area
n  Posterior to primary somatosensory area
n  Integrates sensation: exact shape and texture of object
compared with stored memories
q  Wernicke’s area: left temporal, parietal lobes
n  Interprets meaning of speech: words à thoughts
n  Right hemisphere adds emotional content
Cerebrum: Functional Areas
Somatic Sensory Pathways
n  Relay sensory information from periphery to
cerebral cortex
n  3 neurons in each pathway
q  Cell body #1 in dorsal root ganglion
q  Cell body #2 in spinal cord or brain stem
q  Cell body #3 in thalamus; axon extends to
cerebral cortex (somatosensory area in
postcentral gyrus)
n  Most sensory input to right side of body
reaches left side of brain (and vice versa)
Somatic Sensory Pathways
n  Posterior column - medial lemniscus pathway
senses
q  Fine touch: body location, texture, size
q  Proprioception: position and motion of body parts

q  Vibrations: fluctuating touch stimuli

n  Spinothalamic pathways
q  Anterior and lateral spinothalamic tracts
q  Relay impulses for pain, tickle, itch, hot, and cold

sensations
Somatic
Sensory
Pathways
Somatic Motor Pathways
n  Signals come from
q  Upper motor neurons: via corticospinal tracts
q  Basal ganglia: help with muscle tone
q  Cerebellum: coordination
q  Sensory neurons or interneurons via reflexes
n  Impulses activate lower motor neurons
q  Cell bodies in anterior gray of spinal cord
q  Axons à ventral root à spinal nerve à muscle à
voluntary movements
Somatic Motor
Pathways
Lateralization
n  Brain controls opposite side of the body: all
sensory and motor pathways cross in CNS
q  Left side of the brain controls right side of body
q  Right side of brain controls left side of body

n  Left hemisphere important for spoken and

written language, numerical and scientific
skills, and reasoning
n  Right side more involved with spatial and
pattern recognition and emotional content
 Memory
n  Process for storing and retrieving information
n  Involves structural and functional changes
n  Involves association areas, parts of limbic
system, and diencephalon
n  Skill memory also involves cerebellum and
basal ganglia
Cranial Nerves
I.  Olfactory: special sensory—smell
II.  Optic: special sensory—vision
III.  Oculomotor: motor—control of eye
movements
IV.  Trochlear: motor—control of eye movements
V.  Trigeminal: mixed
q  General sensory: touch, pain, pressure, hot, cold
in face
q  Motor: to muscles used for chewing
Cranial Nerves
VI.  Abducens: motor—control of eye
movements
VII. Facial: mixed
q  Special sensory (taste) from anterior of tongue
q  Motor to muscles of facial expression, tear
glands, and some salivary glands
VIII. Vestibulocochlear: special sensory—ear
Cranial Nerves
IX.  Glossopharyngeal: mixed
q  Sensory for posterior of tongue, pharynx, and
palate; blood pressure
q  Motor to pharyngeal muscles (swallowing),
salivary gland (parotid
Cranial Nerves
X.  Vagus: mixed (the major parasympathetic nerve)
q  Sensory from pharynx, ear, diaphragm, visceral
organs in thoracic and abdominal cavities
q  Motor to palatal and pharyngeal muscles
(swallowing and voice); to viscera in thoracic and
abdominal cavities
XII.  Accessory: motor to voluntary muscles including
sternocleidomastoid and trapezius (move head,
shoulders)
XIII. Hypoglossal: motor to tongue (swallowing and speech)
Aging
n  Rapid brain growth during first few years of
life
q  Due to increase in size of neurons and
proliferation of neuroglia
q  Increase in development of dendritic branches

and synaptic contacts

n  From early adulthood through old age:
q  Decline in brain mass
q  Fewer synaptic contacts brain function

q  Some decrease in brain function

References
n  Tortora, D. (2014). Principles of Anatomy and Physiology. 15thed U.S.:
Wiley Higher Education.
n  Marieb, E. & Keller, S. (2017), Essentials of Human Anatomy and
Physiology. 12th ed. U.K.