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Chapter 14 - The Brain & Cranial Nerves

Human Anatomy and Physiology (University of Hawaii at Manoa)

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Anatomy & Physiology - Chapter 14

The Brain & Cranial Nerves
The brain contributes to homeostasis by receiving sensory input, integrating new & stored information,
making decisions & executing responses through motor activities
 Brain = control center for registering sensations, correlating them with one another & with stored
information, making decisions & taking actions
 Brain = center for intellect, emotions, behavior & memory
Brain Organization, Protection & Blood Supply
Major Parts of the Brain
Principal parts of the brain are: (1) brainstem, (2) cerebellum, (3) diencephalon, (4) cerebrum
(1) Brainstem – continuous with spinal cord
 Consists of medulla oblongata, pons & midbrain
(2) Cerebellum – posterior to brainstem
(3) Diencephalon – superior to brainstem
 Consists of thalamus, hypothalamus & epithalamus
(4) Cerebrum – largest part of brain; supported on diencephalon
& brainstem
Protective Coverings of the Brain
The brain is protected by cranial bones, cranial meninges & cerebrospinal fluid
(1) Cranial bones – completely surround brain
(2) Cranial meninges – continuous with spinal cord meninges
 Dura mater – most superficial meningeal layer; tough connective tissue that’s tightly
adhered to cranium bones
 Cranial dura mater composed of 2 layers (that are fused together except where
they separate to enclose dural venous sinuses—that drain venous blood from brain
& deliver it into internal jugular veins):
1) Periosteal layer (external)
2) Meningeal layer (internal)
 3 extensions (infoldings) of dura mater separate parts of brain:
1) Falx cerebri – separates 2 hemispheres (sides of) cerebrum
2) Falx cerebelli – separates 2 hemispheres (sides of) cerebellum
3) Tentorium cerebelli – separates cerebrum from cerebellum
 Arachnoid mater – middle meningeal layer
 Pia mater – deepest meningeal layer; directly adhered to brain
(3) Cerebrospinal fluid (CSF) – found in subarachnoid space (between arachnoid mater & pia mater)
 Also contains different areas of little spaces known as sinuses
o Arachnoid villus – extend out into sinus; help reabsorb CSF  keep pressure even
 Unlike spinal cord, no epidural space around brain
o Blood vessels that enter brain tissue pass along surface of brain  penetrate inward

Brain Blood Flow & Blood-Brain Barrier

Importance of Blood Flow to the Brain
Blood flows to the brain via the vertebral & carotid arteries
Blood flows back to the heart via draining of dural venous sinuses into internal jugular veins to return
blood from head to the heart
 Brain consumes 20% of oxygen & glucose used by body (even at rest)

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o Neurons synthesize ATP almost exclusively from glucose via reactions that use oxygen
o Any interruption of oxygen supply can result in weakening, permanent damage or death
or brain cells
 Blood flow interruption for 1-2 min  Impaired neuronal function
 Total deprivation of oxygen for 4 min  permanent brain damage
o Virtually no glucose stored in brain, so brain requires continuous supply of glucose
 Hypoglycemia can cause mental confusion, dizziness, convulsions & loss of
consciousness
Blood-Brain Barrier (BBB)
Blood-brain barrier (BBB) – consists of tight junctions that seal together endothelial cells of brain-blood
capillaries; thick basement membranes that surrounds capillaries
 Astrocytes (neuroglia) secrete chemicals to maintain “tightness” of tight junctions
 Allows certain substances in blood to enter brain tissue & prevents passage of others
 Lipid-soluble substances (including O2, CO2, steroid hormones, alcohol, barbiturates, nicotine &
caffeine) & water molecules easily cross BBB via diffusion across lipid bilayer
 Few water-soluble substances (e.g. glucose) cross BBB via facilitated transport
 Other substances (e.g. proteins, antibiotics) don’t pass BBB from blood into brain tissue
 Trauma, certain toxins & inflammation can cause BBB breakdown
Clinical Connection: Breaching the Blood-Brain Barrier
 BBB is so effective that it prevents passage of helpful substances & potentially harmful ones
 Researchers exploring ways to move drugs that could be therapeutic for brain cancer or other
CNS disorders past BBB
o Drug injected in concentrated sugar solution  high osmotic pressure of sugar solution
causes shrinkage of endothelial cells of capillaries  opens gaps between tight junctions
of BBB = “leaky BBB”  allows drug to enter brain tissue

Cerebrospinal Fluid
Cerebrospinal fluid (CSF) – clear, colorless liquid composed primarily of water that protects brain &
spinal cord from chemical & physical injuries
 Carries small amounts of oxygen, glucose & other important substances from blood to nervous
tissue cells (neurons & neuroglia) & carries waste products away from nervous system
 Continuously circulates through ventricles (cavities in brain) & central canal (spinal cord), and in
subarachnoid space (around brain & spinal cord)
o Ventricles – cavities within brain that are filled with CSF
Functions of Cerebrospinal Fluid
(1) Mechanical Protection
o CSF serves as shock-absorbing medium that protects delicate tissue of brain &
spinal cord from jolts that would cause them to hit bony walls of cranial cavity &
vertebral canal
o Fluid buoys the brain so that it “floats in cranial cavity”
(2) Chemical Protection (homeostatic function)
o CSF provides optimal chemical environment for accurate neuronal signaling
o Slight changes in ionic composition of CSF within brain can disrupt production of
action potentials & postsynaptic potentials
(3) Circulation
o CSF serves as medium for minor exchange of nutrients & wastes between blood &
adjacent nervous tissue

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Formation of CSF in Ventricles

CSF is formed from blood plasma by ependymal cells in choroid plexuses of ventricles
 Ventricles of brain contain CSF
 Choroid plexuses – networks of blood capillaries in walls of ventricles of brain that make CSF
o Ependymal cells joined by tight junctions cover capillaries of choroid plexuses
o Selected substances (mostly water) from blood plasma filtered from capillaries secreted
by ependymal cells to produce CSF
 Blood-cerebrospinal fluid barrier – permits certain substances to enter CSF but excludes other,
protecting brain & spinal cord from potentially harmful blood-borne substances
o Formed by tight junctions of ependymal cells
Circulation of CSF
1) CSF formed in choroid plexuses of each lateral ventricle flows into
3rd ventricle through 2 interventricular foramina—narrow oval
openings
2) More CSF added by choroid plexus (in roof of 3 rd ventricle)
3) Fluid flows through aqueduct of midbrain (cerebral aqueduct)—
passes through midbrain into 4th ventricle (choroid plexus of 4th
ventricles contributes more fluid)
4) CSF enters subarachnoid space via 3 openings in roof of 4 th ventricle
(1) Median aperture
(2) Paired lateral aperture (one on each side)
5) CSF circulates in central canal of spinal cord & in subarachnoid
space around surface of brain & spinal cord
6) CSF gradually reabsorbed into blood through arachnoid villi—
fingerlike extensions of arachnoid mater that project into dural
venous sinuses especially superior sagittal sinus
o Arachnoid granulation—cluster of arachnoid villi
7) CSF reabsorbed as rapidly as it’s formed by choroid plexuses
**Because rates of formation & reabsorption are the same, pressure & volume of CSF normally constant
Clinical Connection: Hydrocephalus
Hydrocephalus – abnormal accumulation of CSF d/t obstruction to CSF flow or abnormal rate of CSF
production and/or reabsorption
 Caused by elevated CSF pressure  damage to nervous tissue
o When excess CSF accumulates in ventricles, CSF pressure rises
o If condition persists, fluid buildup compresses & damages delicate nervous tissue
o Brain abnormalities (tumor, inflammation) can interfere with CSF circulation
 In baby whose fontanels haven’t closed yet, head bulges d/t increased pressure
 Treated by draining excess CSF via endoscopic third ventriculostomy
 In adults, may occur after head injury, meningitis or subarachnoid hemorrhage

**Nuclei – collection of neuronal cell bodies that are coming together to carry out a specific function**

The Brainstem & Reticular Formation

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Brainstem – part of brain between spinal cord & diencephalon

 Consists of (1) medulla oblongata, (2) pons & (3) midbrain
Reticular formation – netlike region of interspersed gray & white matter; extending through brainstem
Medulla Oblongata
Medulla Oblongata – forms inferior part of brainstem; continuous with superior part of spinal cord
 Begins at foramen magnum & extends to inferior border of pons (most inferior portion of
brainstem)
 Medulla’s white matter contains all sensory (ascending) tracts & motor (descending) tracts that
extend between spinal cord & other parts of brain
o Pyramids – protrusions of white matter tracts (myelinated axons) on anterior aspect of
medulla
 Formed by large corticospinal tracts that pass from cerebrum to spinal cord
 Control voluntary movements of limbs & trunk
o Decussation of pyramids – crossing where 90% of axons in left pyramid cross to right side
& 90% axons in right pyramid cross to left side
 Located just superior to junction of medulla with spinal cord
 Explains why each side of brain controls voluntary movements on opposite side of
body
 Vestibulocochlear & hypoglossal cranial nerves originate on medulla oblongata
Functional Regions of Medulla Oblongata
Functions that medulla oblongata helps control—heartrate, respiratory rate, vasoconstriction,
swallowing, coughing, vomiting, sneezing, hiccupping
 Medulla contains several nuclei that control/regulate vital body functions
o Cardiovascular (CV) center – regulates rate & force of heartbeat, blood vessel diameter
o Medullary respiratory center – regulates normal breathing rhythm
 Medulla also controls reflexes for vomiting, swallowing, sneezing coughing & hiccupping
o Vomiting center of medulla – causes vomiting—forcible expulsion of contents of upper GI
tract through mouth
o Deglutition center of medulla – promotes deglutition—swallowing mass of food that’s
moved from oral cavity of mouth into pharynx (throat)
o Sneezing—spasmodic contraction of breathing muscles that forcefully expel air through
nose & mouth
o Coughing—long-drawn/deep inhalation & then strong exhalation that suddenly sends air
through upper respiratory passages
o Hiccupping—caused by spasmodic contractions of diaphragm, that ultimately results in
production of sharp sound on inhalation
Clinical Connection: Injury to the Medulla
 Given vital activities controlled by medulla, injury to the medulla d/t hard blow to back of
head/upper neck can be fatal
 Damage to medullary respiratory center can rapidly lead to death
 Symptoms of nonfatal injury may include: cranial nerve malfunctions on same side of body as
injury, paralysis & loss of sensation on opposite side of body, breathing & heart rhythm
irregularities
 Alcohol overdose suppresses medullar rhythmicity center  may result in death

Pons

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Pons – bridge of bundles of axons that connects parts of brain with one another located directly superior
to medulla & anterior to cerebellum
 Sits between midbrain & medulla oblongata  thus serves as a “bridge”
o Connections provided by bundles of axons
o Some axons connect right & left sides of cerebellum
o Includes ascending sensory tracts & descending motor tracts
 Trigeminal, abducens, facial & vestibular branch of vestibulocochlear originate on pons
Functional Regions of Pons
 Relays nerve impulses related to voluntary skeletal muscle movements from cerebrum to
cerebellum
 Includes pneumotaxic & apneustic areas (control respiration)
o Pontine respiratory group – helps control breathing with medullary respiratory center
 Pneumotaxic center – neural center that provides inhibitory impulses on
inspiration  prevents overdistension of lungs & helps maintain alternately
recurrent inspiration & expiration
 Apneustic center – excites inspiratory center  controls intensity of breathing
(involved with inhalation)
Midbrain
Midbrain (Mesencephalon) – most superior aspect of brainstem
 Located superior to medulla oblongata & extends from pons to diencephalon
 Cerebral aqueduct (aqueduct of midbrain) – passes through midbrain  connects 3rd ventricle to
4th ventricle
 Contains oculomotor & trochlear cranial nerves
 Includes cerebral peduncles, corpora quadrigemina, substantia nigra, red nuclei & medial
lemniscus
o Cerebral peduncles – paired bundles of axons of corticospinal, corticobulbar &
corticopontine tracts, which conduct nerve impulses from motor areas in cerebral cortex
to spinal cord, medulla & pons
o Corpora quadrigemina – made up of 4 colliculi (2 inferior, 2 superior)  reflex centers for
vision & hearing
o Substantia nigra –large, darkly pigmented paired (L/R) nuclei
 Extending from substantia nigra, dopamine-releasing neurons help control
subconscious muscle activities
o Red nuclei – paired (L/R) nuclei, reddish color comes from rich blood supply & iron-
containing pigment in neuronal cell bodies
 Axons from cerebellum & cerebral cortex form synapses  help control muscular
movements
o Medial lemniscus – band of white matter  posterior column-medial lemniscus pathway
Functional Regions of Midbrain
 Conveys motor impulses from cerebrum to cerebellum & spinal cord
 Sends sensory impulses from spinal cord to thalamus
 Regulates auditory & visual reflexes
Reticular Formation
Reticular formation – netlike arrangement of white matter (small bundles of myelinated axons) & gray
matter (small clusters of neuronal cell bodies)
 Extends from superior part of spinal cord, throughout brainstem & into inferior part of
diencephalon

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 Neurons within reticular formation have both ascending (sensory) & descending (motor)
functions
o Reticular activating system (RAS) – sensory axons that project to cerebral cortex
 Ascending portion of RAS activated by sensory stimuli (visual & auditory stimuli,
mental activities, stimuli from pain, touch & pressure receptors, receptors in
limbs/head that keep us aware of positions of body parts)
 Consciousness – state of wakefulness in which individual is fully alert, aware &
oriented
 Arousal – awakening from sleep
 Attention – concentrating on single object or thought
 Damage to RAS  coma—state of unconsciousness from which individual cannot
be aroused
 Descending portion of RAS has connections to cerebellum & helps regulate muscle
tone, heart rate, BP & respiratory rate
Functions of Reticular Formation
 Helps regulate muscle tone—slight involuntary contraction in normal resting skeletal muscles
 Alerts cortex to incoming sensory signals
 Responsible for maintaining consciousness & awakening from sleep
o Inactivation of RAD  sleep—state of partial consciousness from which invidual can be
aroused
 Prevents sensory overload (excessive visual and/or auditory stimulation) by filtering out
insignificant information so it doesn’t reach consciousness

The Cerebellum
Cerebellum – “mini brain” that occupies inferior & posterior aspects of cranial cavity
 Consists of anterior & posterior lobes, two cerebellar hemispheres & central vermis
 Makes up ~1/10 of brain mass, yet contains nearly 50% of all neurons in brain
 Shape of cerebellum resembles butterfly
 Arbor vitae—tracts of white matter on the inside, completely surrounded by cerebellar cortex—
folds of gray matter on the outside
o Deep within white matter = cerebellar nuclei—regions of gray matter that give rise to
axons carrying impulses from cerebellum to other brain centers
 Transverse fissure – deep groove & tentorium cerebelli—supports posterior part of cerebrum 
separates cerebellum from cerebrum
Function of Cerebellum
The cerebellum coordinates skilled movements & regulates posture/balance
 Coordination of skeletal muscle contractions
 Maintenance of normal muscle tone, posture & balance
 Important in refining motor skills
Clinical Connection: Ataxia
Ataxia – loss of ability to coordinate muscular movements caused by damage to cerebellum
 Cannot coordinate movement with their sense of where body part is located
o Ex: blindfolded people with ataxia cannot touch tip of their nose with finger
 Changed speech pattern d/t uncoordinated speech muscles
The  Diencephalon
Too much alcohol  ataxia b/c alcohol inhibits cerebellum activity
 Caused –bycentral
Diencephalon degenerative
core of disease (MS,just
brain tissue Parkinson’s
superior disease), trauma, brain tumors, genetic factors, side
to midbrain
 effects of medications
Diencephalon composed of (1) thalamus, (2) hypothalamus, (3) epithalamus

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Thalamus
Thalamus – paired oval masses of gray matter organized into nuclei with interspersed tracts of white
matter; makes up ~80% of diencephalon
 Located superior to midbrain
 Contains nuclei that serve as relay stations for all sensory impulses (except smell) to cerebral
cortex
o **Functions as primary relay station for information**
o Major relay stations for most sensory impulses that reach primary sensory areas of
cerebral cortex are from brain stem & spinal cord
o Information from cerebellum & basal nuclei transmitted to primary motor area of cerebral
cortex
Hypothalamus
Hypothalamus – small part of diencephalon located inferior to thalamus
 Located directly inferior to thalamus
 Controls many bodily activities—**main regulator of homeostasis**
 Composed of dozen nuclei in 4 major regions:
(1) Mamillary region – most posterior part of hypothalamus
o Mamillary bodies – serves as relay stations for reflexes related to sense of smell
(2) Tuberal region – widest part of hypothalamus
(3) Supraoptic region – superior to optic chiasm—point of crossing of optic nerves
(4) Preoptic region – anterior to supraoptic region
o Regulates certain autonomic activities
Epithalamus
Epithalamus – small region that contains pineal gland & habenular nuclei—involved in olfaction
 Located superior & posterior to the thalamus
 Pineal gland – pea-sized gland (part of endocrine system) that secretes hormone melatonin
o Melatonin – hormone that regulates circadian rhythms & thus promotes rhythmic
changes in sleep, wakefulness, hormone secretion & body temperature
 Habenular nuclei – involved in olfaction; especially emotional responses to odors (e.g., loved
one’s cologne, mom’s chocolate chip cookies baking in oven)
Circumventricular Organs
Circumventricular organs (CVOs) – parts of diencephalon that can monitor chemical changes in blood
b/c they lack a blood-brain barrier
 Includes portion of hypothalamus, pineal gland, pituitary gland
 CVOs coordinate homeostatic activities of endocrine & nervous systems
o Ex: blood pressure regulation, fluid balance, hunger, thirst

The Cerebrum
Cerebrum – “seat of intelligence”—provides us with ability to read, write & speak; to make calculations
& compose music; to remember the past & plan for the future; and to create
 Consists of (1) outer cerebral cortex, (2) internal region of cerebral white matter, (3) gray matter
nuclei deep within white matter

Cerebral Cortex
Cerebral Cortex – region of gray matter (contains billions of neurons arranged in distinct layers) that
forms the outer rim of the cerebrum

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 Gyri (cortical folds), fissures (deepest grooves between folds) & sulci (shallower grooves between
folds) can be identified on the cortex
o Longitudinal fissure – most prominent fissure that separates cerebrum into right & left
hemispheres
o Folds of brain  increased SA  more neurons
 Deep to the cortex, white matter (myelinated axons) composed of tracts of neurons that connect
parts of brain to one another & spinal cord
o Corpus callosum – broad band of white matter tracts that connects the right & left
hemispheres of the cerebrum
o Association tracts, commissural tracts & projection tracts form white matter tracts in
cerebral hemispheres
Lobes of the Cerebrum
Each cerebral hemisphere further subdivided into several lobes:
(1) Frontal lobe
(2) Parietal Lobe
(3) Temporal Lobe
(4) Occipital Lobe
(5) Insula – region of brain deep to parietal, frontal & temporal lobes
 Cannot be seen at surface of brain b/c lies within lateral cerebral sulcus
Gyri of Cerebrum
1) Central sulcus – separates frontal lobe from parietal lobe
2) Precentral gyrus – contains primary motor area of cerebral cortex
3) Postcentral gyrus – contains primary somatosensory area of cerebral cortex
4) Lateral cerebral sulcus – separates frontal lobe from temporal lobe
5) Parieto-occipital sulcus – separates parietal lobe from occipital lobe
Cerebral White Matter
Cerebral white matter – consists of myelinated axons
 Made up of 3different types of white matter tracts:
(1) Association tracts – axons that conduct nerve impulses between gyri in same hemisphere
(2) Commissural tracts – axons that conduct nerve impulses from gyri in one cerebral
hemisphere to corresponding gyri in other cerebral hemisphere
o Includes corpus callosum, anterior commissure & posterior commissure
(3) Projection tracts – axons that conduct nerve impulses from cerebrum to lower parts of
CNS (thalamus, brainstem, spinal cord) or from lower parts of CNS to cerebrum
o Includes internal capsule—thick band of white matter that contains both
ascending & descending axons
Basal Nuclei
Basal nuclei – 3 nuclei (paired masses of gray matter) found deep within each cerebral hemisphere
 Also called basal ganglia (although anatomically not correct term)
 Important in motor function
o Basal nuclei receive input from cerebral cortex & provide output to motor parts of cortex
via medial & ventral group nuclei of thalamus
o Functions to help regulate initiation & termination of movements

The Limbic System

Limbic System – composed of different structures located in cerebral hemispheres & diencephalon
 “Emotional brain”—governs emotional aspects of behavior

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o Ex: removal of amygdala  lack of fear & aggression

 Also involved in olfaction & memory
o Associating certain smells with feeling specific emotions

Functional Organization of the Cerebral Cortex

Specific types of sensory, motor & integrative signals are processed in certain regions of cerebral cortex
(1) Sensory Areas – processing sensory information from body
(2) Motor Areas – processing motor output
(3) Association Areas – interpreting/integrate information  what it all means
Sensory Areas
Primary sensory areas receive sensory information relayed from peripheral sensory receptors
 Integrate sensory experiences to generate meaningful patterns of recognition & awareness
 Primary Somatosensory area – receives nerve impulses for sensory information from the body—
touch, pressure, vibration, itch, tickle, temperature, pain, proprioception (joint & muscle position,
involved in perception of these somatic sensations
o Located in postcentral gyrus of parietal lobe
o Sensory homunculus – somatic sensory map of the body
 Larger cortical area (e.g. lips, fingertips) = more sensory receptors in that body part
 larger features on model
 Also includes primary visual area, primary auditory area, primary gustatory area, primary
olfactory area
Motor Areas
Motor output from cerebral cortex flows from anterior part of hemispheres
 Primary motor area – each region controls voluntary contractions of specific muscles or groups of
muscles
o Electrical stimulation cause contraction of specific skeletal muscle fibers on opposite sides
of body
o Located in precentral gyrus of frontal robe
o Motor homunculus – distorted muscle map of the body
 Larger cortical region (e.g. fingers, hands, face, tongue) = muscles involved in
skilled, complex, movements
Association Areas
 Association areas of cerebrum consist of large areas of occipital, parietal & temporal lobes, and
frontal lobes anterior to motor areas
 Connected with one another by association tracts
(Some) Functional Areas of the Cerebrum
 Broca’s Speech Area – motor area associated with speaking & understanding language
o Involves several sensory, association & motor areas of cortex
o Located in frontal lobe; typically localized in left hemisphere
o Coordinated contractions of speech & breathing muscles enable speech
o People who suffer a CVA or stroke in this area can cause nonfluent aphasia—condition of
still having clear thoughts but are unable to form words
 Wernicke’s Language Area – sensory area associated with understanding language &
interpretation of meaning of speech by recognizing spoken words
o Active as your translate words into thoughts
o Broad region located in left temporal & parietal lobes

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o People who suffer a CVA or stroke in this area can cause fluent aphasia/“word salad”—
condition where they can still speak, but cannot arrange words in coherent fashion
Hemispheric Lateralization
Although brain is almost symmetrical on right & left sides, subtle anatomical & physiological differences
between the two hemispheres exists
 Although two hemispheres share performance of many functions, each
hemisphere also specializes in performing certain unique functions
 This functional asymmetry = hemispheric lateralization
 Where terminology “right-brained” vs. “left-brained” comes from
Functional Differences Between Right & Left Hemispheres
Right Hemisphere Functions – “Right-Brained” Left Hemisphere Functions – “Left-Brained”
 Receives somatic sensory signals from, and  Receives somatic sensory signals from, and
controls muscles on, left side of body controls muscles on, right side of body
 Musical and artistic awareness  Reasoning
 Space and pattern perception  Numerical and scientific skills
 Recognition of faces and emotional content of  Ability to use and understand sign language
facial expressions  Spoken and written language
 Generating emotional content of language  Persons with damage in the left hemisphere
 Generating mental images to compare spatial often exhibit aphasia
relationships
 Identifying and discriminating among odors
 Patients with damage in right hemisphere
regions that correspond to Broca's and
Wernicke's areas in the left hemisphere speak
in a monotonous voice, having lost the ability
to impart emotional inflection to what they
say
Brain Waves
Brain waves – indicate electrical activity of cerebral cortex
 Generated by neurons close to brain surface, mainly neurons in cerebral cortex
 Electroencephalogram (EEG) – record of brain waves
o Useful in studying normal brain functions (e.g. changes that occur during sleep)
o Useful in diagnosing brain disorders (e.g. epilepsy, tumors, trauma, hematomas, metabolic
abnormalities, sites of trauma, degenerative diseases)
o Utilized to establish or confirm that brain death has occurred
 Patterns of activation of brain neurons produce 4 types of brain waves:
(1) Alpha waves – present in EEGs of nearly all normal individuals when they’re
awake & resting with their eyes closed; disappear entirely during sleep
(2) Beta waves – appear when nervous system is active (during periods
of sensory input & mental activity)
(3) Theta waves – normally occur in children & adults experiencing
emotional stress
(4) Delta waves – occur during deep sleep in adults, but normal in
awake infants
 When produced by awake adult, they indicate brain damage
Clinical Connection: Brain Injuries
Brain injuries – commonly associated with head trauma & result in part from displacement/distortion of
neural tissue at moment of impact

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 Additional tissue damage may occur when normal blood flow restored after ischemia (reduced
blood flow)  sudden increase in oxygen level  oxygen free radicals
 Can also result from hypoxia (cellular oxygen deficiency)
Concussion – injury characterized by an abrupt, but temporary, loss of consciousness, disturbances of
vision & problems with equilibrium
 Caused by blow to the head or sudden stopping of moving head (e.g. automobile accident)
 Most common brain injury
 Produces no obvious bruising of brain
 Signs include: headache, drowsiness, nausea and/or vomiting, lack of concentration, confusion,
post-traumatic amnesia (memory loss)
Chronic traumatic encephalopathy (CTE) – progressive, degenerative brain disorder caused by
concussions & other repeated head injuries
 Occurs primarily among athletes who participate in contact sports (e.g. football, ice hockey,
boxing), combat veterans & individuals with history of repetitive brain trauma
 Assembly of microtubules (support axon) into structural & functional units in axons promoted by
brain protein tau
o Repeated brain injuries causes buildup of tau  clumps together  clumps kill affected
brain cells & spread to nearby cell
 Changes in brain can begin months, years or decades after last brain trauma
 Possible symptoms include memory loss, confusion, impulsive/erratic behavior, impaired
judgment, depression, paranoia, aggression, difficulty with balance & motor skills, dementia
 No treatment or cure for CTE
o Definitive diagnosis can only be made after death by brain tissue analysis
Brain contusion – bruising d/t trauma and includes leakage of blood from microscopic vessels
 Usually associated with concussion
 Pia mater may be torn, allowing blood to enter subarachnoid space
 Usually results in immediate loss of consciousness (typically no longer than 5 min), loss of
reflexes, transient cessation of respiration, decreased blood pressure
o Vital signs typically stabilize in few seconds
Brain laceration – tear of brain, usually from skull fracture or gunshot wound
 Results in rupture of large blood vessels with bleeding into brain & subarachnoid space
 Consequences include cerebral hematoma (localized pool of blood), edema, increased
intracranial pressure
o If blood clot is small enough  pose no major threat, may be absorbed
o If blood clot is large, may require surgical removal
 Swelling infringes on limited space that brain occupies in cranial cavity
o Causes excruciating headaches
o Can cause necrosis d/t swelling or herniation through foramen magnum  death

Cranial Nerves: An Overview

12 cranial nerves part of peripheral nervous system (PNS)
 Cranial nerves identified by name & by roman numeral
o Name indicates nerve’s distribution or function
o Numbered in order from anterior to posterior, in which nerves arise from brain
Types of cranial nerves—(1) sensory, (2) motor, (3) mixed
(1) Special sensory nerves – cranial nerves that carry axons of sensory neurons; unique to head
o Includes cranial nerve I, II & VIII

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o Associated with special senses of smelling, seeing & hearing

o Cell bodies of most sensory neurons located in ganglia outside brain
(2) Motor nerves – cranial nerves that only contain axons of motor neurons as they leave brainstem
o Includes 5 cranial nerves (CN III, IV, VI, XI & XII)
o Cell bodies of motor neurons lie in nuclei within brain
o 2 types of motor axons that innervate skeletal muscles:
1) Brachial motor axons – innervate skeletal muscles that develop from pharyngeal
(branchial) arches; neurons leave brain via mixed cranial nerves & accessory nerve
2) Somatic motor axons – innervate skeletal muscles that develop from head somite
(eye muscles & tongue muscles); neurons exit brain via 5 motor cranial nerves
» Autonomic motor axons - motor axons that innervate smooth muscle,
cardiac muscle & glands; part of parasympathetic division
(3) Mixed nerves – contain axons of both sensory neurons entering brainstem & motor neurons
leaving brainstem
o Includes remaining 4 cranial nerves (CN V, VII, IX & X)
Summary of Cranial Nerves
Cranial Nerve Components Principal Functions
Olfactory (CN I) Special sensory Olfaction (smell)
Optic (CN II) Special sensory Vision (sight)
Oculomotor (CN III) Motor - Somatic Movement of eyeballs & upper eyelid
Motor - Autonomic Adjusts lens for near vision (accommodation)
Constriction of pupil
Trochlear (CN IV) Motor – Somatic Movement of eyeballs
Trigeminal (CN V) Mixed - Sensory Touch, pain & thermal sensations from scalp,
face & oral cavity (including teeth & anterior
2/3 of tongue)
Mixed – Motor Chewing & controls middle ear muscle
(Branchial)
Abducens (CN VI) Motor -Somatic Movement of eyeballs
Facial (CN VII) Mixed - Sensory Taste from anterior 2/3 of tongue
Touch, pain, thermal sensations from skin in
external ear anal
Mixed – Motor Control of muscles of facial expression & middle
(Branchial) ear muscle
Mixed – Motor Secretions of tears & saliva
(Autonomic)
Vestibulocochlear (CN VIII) Special sensory Hearing & equilibrium
Glossopharyngeal (CN IX) Mixed - Sensory Taste from posterior third of tongue
Proprioception in some swallowing muscles
Monitors BP and O2 & CO2 levels in blood
Touch, pain & thermal sensations from skin of
external ear & upper pharynx
Mixed – Motor Assists in swallowing
(Branchial)
Mixed – Motor Secretion of saliva
(Autonomic)
Vagus (CN X) Mixed - Sensory Taste from epiglottis

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Proprioception from throat & voice box muscles

Monitors BP and O2 & CO2 levels in blood
Touch, pain & thermal sensations from skin of
external ear
Sensations from thoracic & abdominal organs
Mixed – Motor Swallowing, vocalization & coughing
(Branchial)
Mixed – Motor Motility & secretion of gastrointestinal organs
(Autonomic) Constriction of respiratory passageways
Decreases heart rate
Accessory (CN XI) Motor (Branchial) Movement of head & pectoral girdle
Hypoglossal (CN XII) Motor (Somatic) Speech, manipulation of food & swallowing

Cranial Nerve I – Olfactory Nerve

Olfactory Nerve (CN I) – entirely sensory nerve; contains axons that conduct nerve impulses for olfaction
—sense of smell
 Located on inferior surface of cribriform plate & superior nasal conchae
 Odor-sensitive olfactory receptors
Sensory Pathway of Olfactory Nerve
1) When we breathe in, we breathe in particles in the air, “odorants” that get caught in mucous
membrane—olfactory epithelium
2) Bundles of axons of olfactory receptors that come down through cribriform plate receive
odorants
3) Send messages up via olfactory nerves to the olfactory bulb (on other side of cribriform plate)
4) Olfactory bulbs continues on as olfactory tract—bundle of myelinated axons in the CNS—into the
brain itself
5) From olfactory tract  primary olfactory area of brain in temporal lobe
**Sense of smell does NOT travel through thalamus—major relay station for everything else**
Clinical Connection: Anosmia
Anosmia – loss of sense of smell
 May be caused by infections of nasal mucosa, head injuries in which cribriform plate of ethmoid
bone is fractured, lesions along olfactory pathway or in brain, meningitis, smoking, or cocaine use
 Test: blinded odor test
 Loss of sense of smell also early indicator of Alzheimer’s disease

Cranial Nerve II – Optic Nerve

Optic Nerve (CN II) – entirely sensory nerve; contains axons that conduct nerve impulses for vision—
sense of sight
 Technically a tract of brain & not a nerve
Sensory Pathway of Optic Nerve
1) Light enters pupil & hits rods & cones (in retina)  initiate visual signals
2) Information is relayed to bipolar cells
3) Which transmit signals to ganglion cells
4) Axons of all ganglion cells in retina of each eye join to form optic nerve (exits back of eye via optic
foramen)
5) 2 Optic nerves (from both eyes) crisscross & merge to form optic chiasm

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 Within chiasm, axons from medial half of eye cross to opposite side
6) Regrouped axons (some from each eye) form optic tracts
7) Sensory information relays through thalamus
8) Primary visual area in occipital lobe
Clinical Connection: Anopia
Anopia – blindness due to defect in or loss of one or both eyes
 May be caused by fractures in orbit (bone), brain lesions, damage along visual pathway, diseases
of nervous system (e.g. MS), pituitary gland tumors, cerebral aneurysms
 May result in defects in visual field & loss of visual acuity
 Test: Snellen eye chart, Confrontation test (looks at whole visual field)
Diplopia – double vision

Cranial Nerve III – Oculomotor (III) Nerve

**Oculomotor, trochlear & abducens nerves are motor cranial nerves that control muscles that move
eyeballs**
Oculomotor Nerve (CN III) – entirely motor nerve; contains motor axons responsible for movement of
eyeball, adjust lens & constriction of pupil (extrinsic & intrinsic eye muscles)
 Oculomotor (III) nerve has widest distribution among extrinsic eye muscles
 Because it’s a motor pathway (not sensory), pathway is flip & thus originating in brain
o Motor nucleus located in anterior part of brain
 Branches into superior & inferior branches
o Superior branch  superior rectus (sits atop eye to lift it up) & levator palpebrae (elevates
eye lid) muscles
o Inferior branch  medial rectus, inferior rectus, inferior oblique & intrinsic eye muscles
Clinical Connection: Dysfunction of Oculomotor Nerve
 Strabismus – both eyes do not fix on same eye lid  one or both eyes may turn inward/outward
 Ptosis – drooping of upper eyelid (b/c levator palpebrae muscle doesn’t work
 Also includes dilation of pupil (normal reaction is a constricted pupil in reaction to light),
movement of eyeball downward & outward on damaged side, loss of accommodation for near
vision
 Diplopia – double vision
 Caused by trauma to skull/brain, compression d/t aneurysm, lesions of superior orbital fissure
 Test: pupil reflex, H pattern, accommodation

Cranial Nerve IV – Trochlear Nerve

Trochlear Nerve (CN IV) - entirely motor nerve; contains motor axons responsible for movement of eye
 Smallest of the 12 cranial nerves
 Only cranial nerve that arises from posterior aspect of brainstem
 Motor nucleus located in midbrain
 Contributes to movement of eye  innervates superior oblique muscle (extrinsic eye muscle)
 Damage to trochlear nerve can also result in strabismus & diplopia

Cranial Nerve V – Trigeminal Nerve

Trigeminal (CN V) – mixed (both sensory & motor) cranial nerve; largest of cranial nerves
 Responsible for sensations from scalp, face & oral cavity; chewing (muscles of mastication);
controls inner ear muscle

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 Emerges from 2 roots on anterolateral pons

 Has 3 branches: (1) ophthalmic, (2) maxillary, (3) mandibular
(1) Ophthalmic nerve – smallest branch (sensory)
(2) Maxillary nerve – intermediate sized branch (sensory)
(3) Mandibular nerve – largest branch (sensory & motor)
Clinical Connection: Dysfunction of Cranial Nerve V
Trigeminal neuralgia – neuralgia (pain) relayed via one of more branches of trigeminal (V) nerve
 Caused by inflammation or lesions
 Shar cutting or tearing pain that lasts few second to minute caused by anything pressing on
trigeminal nerve or its branches
 Occurs almost exclusively in those over 60 years of age
 Can be first sign of disease (e.g. MS, diabetes) or lack of vitamin B12 (causes nerve damage)
Paralysis of muscle of mastication – Injury to mandibular nerve may cause chewing muscle paralysis
& loss of sensations (touch, temperature, proprioception) in lower part of face
 Sensory test – test for sensation on forehead, cheek, jaw (like dermatomes)
 Motor test – test whether or not they can clench teeth

Cranial Nerve VI – Abducens Nerve

Abducens Nerve (CN VI) – entirely motor nerve; contains motor axons responsible for eye movement
 Somatic motor axons extend from nucleus  innervates lateral rectus muscle (extrinsic eye
muscle)
o Causes abduction (lateral rotation) of eyeball
 Motor nucleus located in pons
 Damage to abducens (VI) nerve  affected eyeball cannot move laterally beyond midpoint &
eyeball usually directed medially  strabismus or diplopia

Cranial Nerve VII – Facial Nerve

Facial Nerve (CN VII) – mixed (sensory & motor) nerve
 Sensory axons pass to geniculate ganglion—cluster of cell bodies of sensory neurons of facial
nerve within temporal bone & end in pons
 Sensory axons responsible for taste from anterior 2/3 of tongue, sensations from skin in external
ear canal, scalp & face
 Branchial motor neurons: control of muscles of facial expression & middle ear, scalp, neck
muscles
 Autonomic motor neurons: secretion of tears & saliva
Clinical Connection: Bell’s Palsy
Bell’s palsy – paralysis of the facial muscles
 Causes loss of taste, decreased salivation, loss of ability to close eyes (even during sleep)
 Caused by damage to facial (VII) nerve d/t conditions such as viral infection (e.g. shingles) or
bacterial infections (e.g. Lyme disease)
o Nerve can be damaged by trauma to skull or brain, tumors, stroke
 Test: smile, close eyes, taste

Cranial Nerve VIII – Vestibulocochlear Nerve

Vestibulocochlear Nerve (CN VIII) – sensory cranial nerve; formerly known as acoustic or auditory nerve
 Has 2 branches: (1) vestibular branch & (2) cochlear branch
(1) Vestibular branch – carries impulses for equilibrium

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(2) Cochlear branch – carries impulses for hearing


Clinical Connection: Dysfunction of Cranial Nerve VIII
Vestibulocochlear nerve may be injured as result of trauma, lesions or middle ear infections
 Vertigo – subjective feeling that one’s own body or environment is rotating
 Ataxia – muscular incoordination
 Nystagmus – involuntary rapid movement of eyeball
o Vertigo, Ataxia & Nystagmus—caused by injury to vestibular branch of vestibulocochlear
nerve (CN VIII)
 Tinnitus – ringing in ears
o Caused by injury to cochlear branch
o Or deafness
 Test: hearing test or balance test

Cranial Nerve IX – Glossopharyngeal Nerve

Glossopharyngeal Nerve (CN IX) – mixed (sensory & motor) nerve; responsible for taste, assists in
swallowing, secretion of saliva, sensation from skin of external ear/upper pharynx, monitors BP, O 2 & CO2
levels in blood
 Sensory axons of glossopharyngeal nerve arises from:
(1) Taste buds on posterior 1/3 of tongue
(2) Proprioceptors from swallowing muscles
(3) Baroreceptors (pressure-monitoring receptors) in carotid sinus  monitor blood pressure
(4) Chemoreceptors (receptors that monitor blood levels of oxygen & carbon dioxide) in
carotid bodies
(5) External ears
 Motor axons arise from medulla, includes:
o Stylopharyngeus (swallowing) muscle
o Parotid gland  release of saliva
Clinical Connection: Dysfunction of Cranial Nerve IX
Glossopharyngeal nerve may be injured as result of trauma or lesions
 Dysphagia – difficulty swallowing
 Aptyalia – reduced secretion of saliva; loss of sensation in throat
 Ageusia – loss of taste sensation
 Test: taste sensation (in posterior 1/3 of tongue), gag reflex
o Pharyngeal (gag) reflex – rapid & intense contraction of pharyngeal muscles
o Except for normal swallowing, pharyngeal reflex designed to prevent choking by not
allowing objects to enter throat

Cranial Nerve X – Vagus Nerve

Vagus Nerve (CN X) – mixed (sensory & motor) nerve; responsible for swallowing, vocalization &
coughing; motility & secretion of GI organs; constriction of respiratory passageways; decreases HR
 Widely distributed in head, neck, thorax & abdomen
 Sensory neurons deal with variety of sensations (e.g. proprioception, stretching)

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 Parasympathetic axons  gland of GI tract & smooth muscle of respiratory passageways &
digestive organs
 Motor neurons arise from medulla  muscle of pharynx, larynx & soft palate involved in
swallowing & vocalization
Clinical Connection: Dysfunction of Cranial Nerve X
Injury to vagus nerve d/t trauma or lesions, can cause:
 Vagal neuropathy/paralysis – interruptions of sensations from many organs in thoracic &
abdominal cavities
 Dysphagia – difficulty in swallowing
 Tachycardia – increased heart rate
 Tests: say “ahhh” or cannot pronounce words “egg” or “rub”
Cranial Nerve XI – Accessory Nerve
Accessory Nerve (CN XI) – branchial motor cranial nerve; responsible for movement of head & pectoral
girdle
 Motor neurons innervates sternocleidomastoid muscle & trapezius muscles to coordinate head
movements
 Motor axons in anterior gray horn in spinal cord
 Divided into (1) cranial accessory nerve & (2) spinal accessory nerve  exit spinal cord & join
together into 1 nerve
Clinical Connection: Dysfunction of Cranial Nerve XI
If accessory (XI) nerve is damaged d/t trauma, lesions or stroke
 Paralysis of sternocleidomastoid & trapezius muscles – person unable to raise shoulders & has
difficult in turning head
 Test: ask to shrug shoulders or ask to turn head

Cranial Nerve XII – Hypoglossal Nerve

Hypoglossal Nerve – motor cranial nerve; important for speech, manipulation of food & swallowing
 Motor axon nucleus in medulla oblongata
 Innervates muscles of tongue  speech & swallowing
Clinical Connection: Dysfunction of Cranial Nerve XII
Injury to hypoglossal (XII) nerve can be d/t trauma, lesions, stroke, ALS (Lou Gehrig’s), infections in
brainstem
 Difficulty in chewing
 Dysarthria – difficulty in speaking
 Dysphagia – difficulty in swallowing
 When protruded, tongue curls toward affected side  affected side atrophies
 Test: ask to protrude tongue & move it around

Aging and the Nervous System

From early adulthood onward, brain mass declines
 Although number of neurons present doesn’t decrease much, number of synaptic contacts
declines
 Decreased brain mass  decreased capacity for sending nerve impulses to/from brain
diminished ability to process information
Aging can also result in:

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 Loss of neurons
 Diminished capacity for sending nerve impulses to/from brain
 Diminished ability to process information
 Decreased conduction velocity
 Slowing of voluntary motor movements
 Increased reflex time
 Degenerative changes in vision, hearing, sight, taste, smell, touch & balance

Disorders: Homeostatic Imbalances

Cerebrovascular Accident (CVA)
Cerebrovascular Accident – stroke, brain attack characterized by abrupt onset of persisting neurological
symptoms (e.g. paralysis, loss of sensation) that arise from destruction of brain tissue
 3rd leading cause of death in the US
 Common causes of CVAs are intracerebral hemorrhage, emboli & atherosclerosis of cerebral
arteries
 Risk factors for CVAs include: high BP, high blood cholesterol, heart disease, narrow carotid
arteries, TIAs, diabetes, smoking, obesity & excessive alcohol intake
 Tissue plasminogen activator (tPA) – clot-dissolving blood used to open up blocked blood vessels
in brain in cases of ischemic CVAs (due to blood clot)
o Most effective when administered within 3 hours of CVA onset
o Should not be administered to individuals with hemorrhagic stroke
 New studies show “cold therapy” might be successful in limiting residual damage from CVA
Transient Ischemic Attacks (TIA)
Transient Ischemic Attacks – episode of temporary cerebral dysfunction caused by impaired blood flow
to part of brain
 Symptoms include dizziness, weakness, numbness or paralysis in limb or on one side of body;
drooping on one side of face, headache, slurred speech or difficulty understanding speech and/or
partial loss of vision or double vision, sometimes nausea/vomiting
 Sudden onset of symptoms, typically persists for 5 -10 minutes
 Leaves no permanent neurological deficits
 Causes of TIAs include blood clots, atherosclerosis, certain blood disorders
 ~1/3 of patients who experience TIA will eventually have CVA
 Therapy for TIAs includes: drugs (e.g. aspirin) blocks aggregation of blood platelets &
anticoagulants, cerebral artery bypass grafting, carotid endarterectomy—removal of cholesterol-
containing plaques & inner lining of an artery
Alzheimer’s Disease
Alzheimer’s Disease – most common form of senile dementia—age-related loss of intellectual
capabilities (including impaired memory, judgment, abstract thinking & changes in personality)
 Unknown cause of Alzheimer’s, but likely d/t combination of genetic, environmental/lifestyle
factors & aging process
 Individuals with AD initially have trouble remembering recent events, become confused &
forgetful  disorientation grows, memories disappear  episodes of paranoia, hallucination or
violent changes in mood may occur
 As minds deteriorate, lose ability to read, write, talk, eat, walk
 Usually die of complication that afflicts bedridden patients (e.g. pneumonia)
 4 distinct structural abnormalities:
1) Loss of neurons that liberate acetylcholine

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2) Deterioration of hippocampus
3) Beta-amyloid plaques
4) Neurofibrillary tangles
 Drugs that inhibit acetylcholinesterase (AChE) improve alertness & behavior in some AD patients
Brain Tumors
Brain Tumor – abnormal growth of tissue in brain that may be malignant or benign
 Malignant & benign brain tumors equally serious  compresses adjacent tissues  causes
pressure in skull
 Most common malignant tumors = secondary tumors that metastasize rom other cancers in body
(e.g. lungs, breasts, skin—malignant melanoma, blood—leukemia, lymphatic organs—lymphoma)
 Most primary brain tumors (originate within brain) = gliomas (develop in neuroglia)
 Brain tumor symptoms dependent on size, location, growth rate
o Symptoms include headache, poor balance & coordination, dizziness, double vision,
slurred speech, nausea & vomiting, fever, abnormal pulse/respiration rate, personality
changes, numbness, weakness of limbs, seizures
 Treatment options include surgery, radiation, therapy and/or chemotherapy
o BUT chemotherapeutic agents don’t readily cross blood-brain barrier
Attention Deficit Hyperactivity Disorder (ADHD)
Attention Deficit Hyperactivity Disorder – learning disorder characterized by poor/short attention span,
consistent level of hyperactivity & level of impulsiveness inappropriate for child’s age
 Condition typically begins in childhood, continues into adolescence & adulthood
 Symptoms include: difficulty organizing & finishing tasks, lack of attention to details, short
attention span, inability to concentrate, difficulty following instructions, talking excessively,
frequently interrupting others, frequent running or excessive climbing, inability to play quietly
alone, difficulty waiting/taking turns
 Treatment options includes remedial education, behavioral modification techniques,
restructuring routines, drugs to calm child & help focus attention
Medical Terminology
Agnosia – inability to recognize significance of sensory stimuli such as sounds, sights, smells, tastes &
touch
Apraxia – inability to carry out purposeful movements in absence of paralysis
Consciousness – state of wakefulness in which individual is fully alert, aware & oriented, partly result of
feedback between cerebral cortex & reticular activating system
Delirium – transient disorder of abnormal cognition & disordered attention accompanied by
disturbances of sleep-wake cycle & psychomotor behavior (hyperactivity or hypoactivity of movements &
speech)
 Also called acute confusional state (ACS)
Dementia – permanent or progressive general loss of intellectual abilities, including impairment of
memory, judgment & abstract thinking & changes in personality
Encephalitis – acute inflammation of brain caused by either direct attack by any of several viruses or an
allergic reaction to viruses that are normally harmless to CNS
 If virus affects spinal cord, condition called encephalomyelitis
Encephalopathy – any disorder/disease of brain
Lethargy – condition of functional sluggishness
Microcephaly – congenital condition that involves development of small brain & skill and frequently
results in mental retardation

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Prosopagnosia – inability to recognize faces usually caused by damage to facial recognition area in
inferior temporal lobe of both cerebral hemispheres
Reye’s Syndrome – occurs after viral infection, particularly chickenpox or influenza
 Most often in children or teens who have taken aspirin
 Characterized by vomiting & brain dysfunction (disorientation, lethargy, personality changes) that
may progress to coma & death
Stupor – unresponsiveness from which patient can be aroused only briefly & only by vigorous &
repeated stimulation

An elderly relative suffered a CVA (stroke) and now has difficulty moving her right arm, and she also has
speech problems. What areas of the brain were damaged by the stroke? The left hemisphere & frontal
lobe
Nicky has recently had a viral infection and now she cannot move the muscles on the right side of her
face. In addition, she is experiencing a loss of taste and a dry mouth, and she cannot close her right eye.
What cranial nerve has been affected by the viral infection? Facial (VII) nerve

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