Neurology

Introduction
Introduction is Latin: intro-
means in; -ducere means to lead
(introduction means to lead in)

Getting a strong start

Definition
Neurology is a branch of medicine
specialized with diseases of the
nervous system.
Neurology is Latin: neuro- is a
prefix means nerve; -logy is a
suffix means study of.
Nerve is Latin means strength;
nerve has a stronger structure
than artery, vein, and lymphatic
vessel.
 Human is Latin humanus means of
man; human body is composed of 11
systems
The nervous system is composed of
the central nervous system and the
peripheral nervous system.
The central nervous system is
composed of the brain, spinal cord,
olfactory nerve, optic nerve, and the
retina; while the peripheral nervous
system is composed of the cranial
nerves with their roots (except the
olfactory and the optic nerves) and
the spinal nerves with their roots (31
pairs of spinal nerves).
The word central means main, major,
which means of greatest importance;
the central nervous system is so named
because it is the center of processing
information from all parts of the body,
and influences the activity of all parts
of the body; (processing means
subjecting information to series of
actions to achieve a particular result;
series means group which is two or
more of related or similar things).
Peripheral is Latin: periferia which means
outer surface, peripheral nervous
system so named because its function
is to connect the central nervous
system to the limbs, organs, skin,...
1
Central nervous
system
2

Retina

3 4 5
 Peripheral nervous system

1. Cranial nerves except

the olfactory and the optic
nerves
………………………………………………………….................

2. Spinal nerves
The brain (Latin cerebrum) is composed
of two cerebral hemispheres,
diencephalon, brainstem and the
cerebellum.
The two cerebral hemispheres are the
largest component of the brain.
Diencephalon (di means inter,
between, cephalon means brain) as
it connects the cerebral
hemispheres with the midbrain.
Diencephalon means thalamic
structures (two thalami, two
subthalamic nuclei, a single
hypothalamus, and epithalamus).
 Diencephalon includes: two thalami,
two subthalamic nuclei, single
hypothalamus, and epithalamus
Cerebral hemisphere
Diencephalon (thalamic structures)
is rostral to the midbrain, caudal
and medial to the basal nuclei
 Diencephalon includes: two thalami, two
subthalamic nuclei, single hypothalamus, and
epithalamus
Subthalamic nuclei
Note the difference in location of
subthalamic nucleus and the
hypothalamus; (sub- means under;
hypo- means lower)
Hemiballism is a rare involuntary
irregular violent movement affecting
one side of the body, proximal
muscles more than the distal
muscles, the movements are
continuous and exhausting but cease
during sleep.
Hemiballism is caused by lesion of the
contralateral (opposite) subthalamic
nucleus usually infarction.
Hemiballism caused by disinhibition of
thalamus, and the motor cortex
which is located in the frontal lobe.
Ballism is Latin means to throw, jump.
A rare disorder or disease is defined by the world health
organization as a disorder or a disease with a
prevalence of ≤ 1 patient per 1000 of the general
population (in Europe rare disease or disorder affects
1 in 2000 or less; in America 1 in 1,500 or less or total
of 200,000 patients or less in whole America).
A very rare disorder or disease is defined as a disorder
or a disease with a prevalence of less than 2 patients
per 100,000 of the general population.
Rare comes from the Latin word rarus, meaning widely
spaced, having intervals (distance) in between.
Population means all the members of one species (class,
type) like humans that live in an area.
Population from Latin populus which means people.
People (people is the plural of person “persons” and it
means men, women, and children).
General population refers to all individuals (people)
without reference to any specific characteristic.
 Prevalence refers to number of patients
who have a condition at a particular time
(point prevalence), or during a particular
time period (time prevalence); prevalence
includes old and new cases.
Incidence refers to number of patients
who develop a condition during a
particular time period (usually one year
“annual incidence); i.e. incidence means
new cases); annual is Latin annus which
means year; -al is a suffix means related
Incidence means happening to

Prevalence means spread

Both prevalence and

incidence measure
frequency of the
condition in the
community.

Frequency means the

rate at which something
occurs
 Incidence (incident) means
how many fall ill

Prevalence (prevail) means

how many are ill
Note that prevalence is a
proportion and not a rate, so the
term (prevalence rate) is
incorrect (although commonly
used).

Prevalence usually means point

prevalence
 Prevalence

Prevalence is a measure of the proportion of

the population that has the disease
 Disorder versus disease
Disorder is defined as a disturbance of
function of body or mind.
Disturbance of function of body such
as an eating disorder like anorexia,
disorder of bowel motion;
disturbance of function of mind like
anxiety; (disorder is Latin: dis-
means away, lack; order means
regular, arrangement; anorexia is
Greek: an- means without, -orexis
means appetite, desire).
Disease is defined as an abnormal,
harmful deviation from the normal
structure or function of the body,
manifested with certain (particular)
symptoms and signs.
So both disorders and diseases are
deviations from normal function, but
diseases have characteristic features
(symptoms and signs) that occur
together to be diagnostic; while
disorders have less characteristic
features; this means that all diseases
are disorders but not all disorders
are diseases.
 Infarction

Infarction

Infarction is a localized area of dead tissue (necrosis) due to

inadequate blood supply to the affected area; infarction is Latin: in-
and -farctus means fill (stuffed into, packed into); necrosis is Greek
nekrōsis, from nekroun to kill, becoming dead
 Midbrain is the smallest part of the
brainstem, pons is the largest part of the
brainstem

Midbrain

Pons

Medulla oblongata
 Nucleus versus ganglion
Nucleus is defined as aggregation of
neuronal cell bodies inside the central
nervous system, nucleus could be motor,
sensory, or autonomic (sympathetic or
parasympathetic).
Nucleus is Latin means core, kernel.
Ganglion is defined as aggregation of
neuronal cell bodies outside the central
nervous system; ganglion could be
sensory or autonomic (sympathetic or
parasympathetic); ganglion is Latin means
swelling.
 Basal nuclei
These are masses of grey matter embedded in
the white matter of the base of each
cerebral hemisphere, lateral to the
thalamus; they include caudate nucleus,
globus pallidus, and putamen.
Lentiform nucleus = globus pallidus +
putamen.
Striatum = caudate nucleus + putamen.
Corpus striatum = caudate nucleus + globus
pallidus + putamen.
Basal nuclei = corpus striatum + claustrum +
amygdala (amygdaloid nucleus)
Globus is Latin means sphere, rounded; pallidus
means pale; (so named because it is rounded
and because of its pale appearance in
comparison to the darker grey color of the
caudate nucleus and the putamen).
Putamen is the outer portion of the lentiform
nucleus located beneath the insula; putamen is
Latin means shell, husk
Caudate is Latin: cauda which means tail, it looks
like a tail, so named because it has a head,
body and an extended tail (extend means
makes longer or wider); extend is Latin: ex-
means out; -tendere means to stretch.
Lentiform is Latin means form like a lenti which
means a lens (lens shaped; has a shape like
lens of the eye which is biconvex which means
arched on both sides, curved on both sides; bi-
means two; convex: con- means together with,
-vexus means to carry).
 Globus pallidus +
putamen

Claustrum

Claustrum is a vertical thin

irregular curved nucleus (thin
vertical sheet of grey matter);
claustrum is Latin means hidden
away; it’s function is unknown
The Amygdale are The amygdala is
a pair of almond responsible about
shaped emotions, behaviors
nuclei located and memories
deep and medially associated with fear
one within each
temporal lobe

Amygdala is
Latin means
almond
(tonsil)

Location of the amygdalae

Extinct = obsolete = no longer in use
 Imaging planes (imaging
levels), types of sections:
There are three imaging
planes (three imaging
sections): one transverse
plane called axial plane;
and two vertical planes
which are sagittal plane and
coronal plane.
 Axial plane
It is a horizontal plane that divides the
body into upper and lower parts.
Axial = central (axis = center, middle).

Axis
 Axial plane
Horizontal plane
Transverse plane

Axial plane is also called horizontal

plane, and transverse plane
Sagittal plane
It is a vertical plane that divides the
body into right and left halves
through the nose.
Sagittal means arrow.
 Sagittal plane
Midsagittal plane
Median plane
Longitudinal plane

Sagittal plane is also called midsagittal

plane, or median plane, or longitudinal
plane
Coronal plane
It is a vertical plane that passes
through the ears and divides the
body into anterior (front) and
posterior (back) portions.
Coronal means crown
 Coronal plane
Frontal plane

Coronal plane is also called frontal plane

Imaging planes (levels)
Imaging planes (levels)
Basal nuclei are located in the base of
each cerebral hemisphere
 Base of cerebral hemisphere
Base of cerebral hemisphere is the inferomedial
portion of the cerebral hemisphere

Basal nuclei
The most highly pigmented cells in the
brain are the dopaminergic neurons
of the substantia nigra pars
compacta and the noradrenergic
neurons of the locus coeruleus, they
are pigmented because these
neurons contain a dark brown-black
pigment called neuromelanin
granules in their cytoplasm; these
neuromelanin containing neurons,
degenerate in Parkinson disease and
there will be loss of the
neuromelanin granules
Substantia nigra pars compacta neurons secrete dopamine
(dihdroxyphenethylamine), while the less densely packed pars
reticulata neurons secrete gamma-aminobutyric acid (GABA)
The midbrain is divided by the cerebral aqueduct
into two unequal parts: a larger anterior part
composed of two equal cerebral peduncles
"right and left" (cerebral means brain, peduncle
means foot; each cerebral peduncle is
composed of three parts: a posterior part called
tegmentum, an anterior part called crus cerebri
"crus in Latin means leg" and in between them
is the substantia nigra "Latin: substantia means
substance, nigra means black"; the crus cerebri
with the substantia nigra together are called
base of the midbrain or basis pedunculi); and a
smaller posterior part called the tectum
(tectum in Latin means roof) and formed of four
colliculi (two superior colliculi "one on each
side" responsible about reflex movements of
the body in response to visual stimuli, and two
inferior colliculi "one on each side" responsible
about reflex movements of the body in
response to auditory stimuli.
cerebri
Base of the brain
The base of the brain is the inferior
surface of the brain (lower part of
the brain), the following structures
are located at the base of the brain:
diencephalon, pituitary gland,
brainstem, cranial nerves,
cerebellum , and the circle of willis
(where the two internal carotid
arteries join the basilar artery to
form anastomosis).
Base of the brain
Circle of Willis:
The Circle of Willis is an anastomotic
ring of arteries situated at the base
of the brain.
It is named after Thomas Willis , a
British physician.
The circle of Willis encircles the stalk
of the pituitary gland (infundibular
stalk = infundibulum) and provides
important communications between
the internal carotid and
vertebrobasilar circulations.
Thomas Willis (1621–1675)
was a British physician
The circle of Willis is composed of the
following arteries:
Two anterior cerebral arteries (right
and left).
A single anterior communicating
artery.
Two internal carotid arteries (right
and left).
Two posterior cerebral arteries (right
and left).
Two posterior communicating
arteries (right and left).
Tip of basilar artery.
Circle of Willis

Circle of Willis
ACA anterior
cerebral artery
ANCA anterior
communicating
artery
OA ophthalmic Circle
artery of
IC internal Willis
carotid artery
MCA middle
cerebral artery
PCA posterior
cerebral artery
B basilar artery
VA vertebral
artery
The two cerebral hemispheres are
identical in shape but not in function;
only one cerebral hemisphere carries
the function of language because it
contains the language centers, that
cerebral hemisphere is called the
dominant cerebral hemisphere.
Each cerebral hemisphere is composed
of six lobes: four anatomical lobes:
frontal lobe , parietal lobe, temporal
lobe, and occipital lobe and two
physiological lobes: limbic lobe and
the insula.
Insula
Limbic lobe so called because it forms
a rim surrounding the corpus callosum

Corpus callosum is
Latin means the
tough body

Limbic is Latin: limbus, limb which means border; -ic is a suffix used
to form adjectives from nouns (with the meaning related to)
Insula
Cells of the nervous system
The cells of the nervous system include
neurons and glial cells.
Neurons (nerve cells) are the functional
unit and the structural unit of the
nervous system.
Neurons are the functional unit of the
nervous system because they have the
ability to generate, conduct (transmit),
and receive electrical signals called
nerve impulses, so that neurons can
control and coordinate body functions
Neurons are electrically excitable cells.
 A multipolar neuron in the
peripheral nervous system

..…………………..

Multipolar neuron has a single axon and multiple

dendrites; multipolar neurons are the commonest
type of neurons in the nervous system; (multi
means multiple “more than one”, pole is the place
on the cell body at which a cell process begins).
 …………………

A multipolar neuron in the

central nervous system
Unipolar Bipolar Pseudounipolar Multipolar
Glial cells are larger in number but
smaller in size than neurons, they are
electrically non excitable cells that
support the neurons, they have no
axons.
Glial cells can not generate and conduct
nerve impulses.
Glial cells in the central nervous system
are of four types: astrocytes,
oligodendrocytes, microglia, and
ependymocytes (in the ependyma).
Glial cells in the peripheral nervous
system are of two types: Schwann cells,
and, satellite cells.
Glia is Latin: means glue, so named
because of their function to hold the
neurons together.
Ependymocytes
Astrocytes are the most abundant type
of cells in the central nervous
system; there are two types of
astrocytes: fibrous astrocytes and
protoplasmic astrocytes; fibrous
astrocytes are more prevalent in the
white matter supporting the nerve
fibers (axons), and blood vessels,
while protoplasmic astrocytes are
more prevalent in the gray (grey)
matter supporting the neuronal cell
bodies, nerve fibers (axons), and the
blood vessels.
Astrocytes are of two types fibrous
astrocytes and protoplasmic astrocytes
Astrocytes support neurons
by providing energy
(astrocytes are the only
cells in the central nervous
system capable of storing
glycogen) also they share
in blood brain barrier by
the way of their foot
processes.
Capillary and venule
Oligodendrocytes (cells with few
branches):
Oligodendrocytes are divided into two
types:
Interfascicular oligodendrocytes, and
satellite (perineuronal = perineural)
oligodendrocytes.
They have different functions.
Interfascicular oligodendrocytes are the
myelin’s and the axon's maintenance
cells (maintain means preserve and
protect), their function is to synthesize,
maintain and repair myelin, and to
maintain the axon (they are axon
maintenance cells).
………………..
In the central nervous system one
interfascicular oligodendrocyte forms
about 20-70 internodal myelin
segments around different axons,
thus death of a single
oligodendrocyte leads to loss
of myelin segments (demyelination)
on several different axons.
While in the peripheral nervous
system one Schwann cell forms only
one internodal myelin segment.
One interfascicular
oligodendrocyte
forms about 20-70
internodal myelin
segments around
different axons
One Schwann cell forms only
one internodal myelin segment
Multiple sclerosis is regarded as a disease of
interfascicular oligodendrocytes

Interfascicualr ligodendrocytes are the

targets of autoimmune inflammatory
attacks in multiple sclerosis
Brain parenchyma
The nervous system is composed of three
elements: neurons (nerve cells), glia (glial
cells which are supportive cells), and blood
vessels.
The neurons and the glia form the
parenchyma while the blood vessels form
the stroma (parenchyma is the essential
functional part of an organ in contrast to
the stroma which is the connective tissue).
Parenchyma is Latin: para- means beside +
enchyma = infusion from en = in + khein =
to pour; so parenchyma is beside the blood
vessel (infusion, to pour) stroma in Latin
means layer, bed.
 Parenchyma of the nervous
system composed of neurons and
glia.

Stroma of nervous system

composed of blood vessels.
Blood brain barrier

Blood brain barrier

(Keep out)
 Blood brain barrier
The blood brain barrier is defined as
an anatomical highly selective
semipermeable border of brain
capillary endothelial cells that
prevents substances in the blood
from non-selectively (freely)
crossing into the extracellular fluid
of the brain where the brain cells
(neurons and glial cells) reside.
Endothelium =
Endothelial cells
Highly selective means it only allows certain
substances to pass from the blood into the
brain for instance gases like, oxygen, and
carbon dioxide can pass freely through the
blood brain barrier, water can pass easily
but not freely (to a limited rate), glucose
can pass with more difficulty, while proteins
cannot pass.
A similar barrier is present between the blood
and the spinal cord (blood spinal cord
barrier), between the blood and the
peripheral nerves (blood nerve barrier), and
between the blood and the cerebrospinal
fluid (blood cerebrospinal fluid barrier).
These barriers are unique properties of
capillaries of the nervous system (unique
means being the only one of its kind; unlike
anything else).
Components of blood brain barrier
The blood brain barrier is located at the level of the
brain capillaries; it is formed by the following four
structures:
1. Endothelial cells which are highly specialized
polarized monolayer tightly connected cells with each
other that line brain capillaries, this is the most
important component of the blood brain barrier
2. Basement membrane, 3. Pericytes, and
4. Perivascular end feet of astrocytes.
Polarized means divide into two opposing
poles i.e. distinct separation into two different
environments (one surface facing blood the other
surface facing brain tissue).
Pericytes are cells present in the walls of capillaries
(and venules).
Tight junction proteins: in the blood brain barrier there are
three type of proteins that tightly connect the capillary
endothelial cells with each other, they are: occludin, claudin,
and junctional adhesion molecule (JAM); these tight junction
proteins are the most important component of the blood brain
barrier.
Circumventricular organs
Circumventricular organs are highly vascularized structures
located mainly around the third cerebral ventricle (one of
them around the fourth cerebral ventricle) characterized by
lack of blood brain barrier; (circum- is a Latin prefix means
surrounding, around); the capillaries in these organs are
not continuous type (as in rest of the central nervous
system) but they are of the fenestrated type i.e. they lack
the tight junction proteins in between the endothelial cells
of the capillaries in addition to that the astrocyte foot
processes with the pericytes does not form a complete
circle around the endothelial cells of the capillaries.
Lack of the blood brain barrier in the circumventricular organs
is very important as they are able to sample the contents of
the blood (so that the brain can respond properly e.g. when
there is hypoglycemia there will be feeling of hunger, when
there is high serum osmolality there will be feeling of thirst.
Lateral cerebral ventricle

Third cerebral ventricle

Fourth cerebral ventricle

Neuronal cell bodies in both the central
nervous system and the peripheral
nervous system cannot divide and cannot
be repaired (renewed) when injured (no
neuronal cell body regeneration).
Axons (nerve fibers) as well as glial cells in
the central nervous system cannot
regenerate; however the glial cells in the
central nervous system can undergo
reactive hypertrophy which means
increase in size of the cell body and
increase in number and in size of the
dendrites but there is no new glial cell
formation or division of the cell to form
new cells.
Axons (nerve fibers) as well as the glial
cells in the peripheral nervous system are
capable of regeneration, repair, and
replication.
It should be noted that there is no new astrocyte is
formed but only increase in size of the cell body
and in the number and size of the cell processes
(this is also true for the other types of glial cells).
Regeneration to grow again after injury, re:
again, generate: born, produce;
regeneration = repair “renew” = replication

Central Regeneration Peripheral Regeneration

nervous nervous
system system

Neuronal No Neuronal No
cell cell bodies
bodies

Axons No Axons Yes

Oligoden- No Schwann Yes
drocytes cells
Myelin Yes Myelin Yes
sheath sheath
 Neuronal cell bodies in both
Axons (nerve fibers) the central nervous system
as well as glial cells and the peripheral nervous
in the peripheral system, axons (nerve
nervous system fibers) and glial cells in the
central nervous system
 Language versus speech
Language is comprehension and expression
of ideas, grammar, sentence formation,
communication, awareness (alertness),
reading and written expression as well as
signing and gestures.
Speech is the ability of communication and
expression of thoughts in spoken words it
involves breathing, phonation (sound
production), movement and coordination
of muscles of articulation of speech.
So speech is the verbal expression of
language; speech therefore is part of
language.
 Language centers
There are two language centers present in
one cerebral hemisphere (dominant cerebral
hemisphere):
1. Sensory language center: (old name
Wernicke's area) is situated in the temporal
lobe in the posterior part of the superior
temporal gyrus; the sensory language
center is responsible about comprehension
(understanding) of spoken and written
words; the sensory language center is
regarded as association auditory cortex
(secondary auditory cortex).
2. Motor language center: (old name
Broca's area) is situated in the frontal
lobe in the posterior part of the inferior
frontal gyrus; the motor language
center is responsible about fluency
which is the ability to make ideas into
spoken and written words easily and
quickly, (to express oneself easily and
quickly); fluency is Latin: fluentem
which means to flow.
The sensory and the motor language
centers are bidirectionally connected
with each other by a bundle of white
matter axons called the arcuate
fasciculus (means the curved bundle).
Angular gyrus is located in the lower part of the parietal lobe near its
junction with the temporal and the occipital lobes; the angular gyrus
of the dominant cerebral hemisphere carries the function of reading
and writing; angular is Latin: angulare means corner, angle.

Tongue, lips
and face
areas

Motor
language
Sensory
center language
center
Motor
language
center
Sensory language
center is association
(secondary) auditory
cortex (area)

Sensory
language
center

Note that there is difference between

language and speech; language
involves speech plus reading and
writing.
 There are two Language
centers in the cerebral cortex:
1. Sensory language center
2. Motor language center
These two language centers
are bidirectionally connected
with each other by the arcuate
fasciculus and they have
reciprocal connections with
the dominant (left) thalamic
sensory
Motor nuclei; these thalamic nuclei
language
language integrate the motor language
center
center center with the sensory
language center and control
the interaction between them.
Reciprocal connection means a connection present on both sides, each to the
other, shared by both sides, back and forth; which means moving first in one direction
and then in the opposite one; give-and-take; integrate means combine with another so
that they become a whole
 Motor language
center

Superior
division

Main stem
of middle
cerebral
artery Sensory language
center

Inferior division
The middle cerebral artery is the direct continuation and the
largest branch of the internal carotid artery and it is the most
common pathologically affected artery in the brain, it
bifurcates into two branches superior branch which supplies
the motor language center, motor and sensory cortices and
inferior branch which supplies the sensory language center.
 Body parts are somatotopically organized but
disproportionally; somatotopically means different
parts of the motor cortex are associated with
distinct parts of the body

Somatotopically is Greek: soma-

means body, -topy means place
(specific relation between
particular body regions and
corresponding motor and sensory
areas of the brain)
Handedness and cerebral
dominance
Handedness means a better (faster and
more precise) performance and
individual preference for use of a hand.
About 88%-90% of people are right
handed (right hander) while about
10%-12% are left handed (left
hander), left handedness is more
common among males than among
females; handedness also involves foot
and eye, a right handed person prefers
right hand, right foot, and right eye.
In right-handed individuals always
the left cerebral hemisphere is
dominant i.e. contains the
language centers, in about 75%
of left-handed individuals still
the left cerebral hemisphere is
dominant, 15% has bilateral
cerebral representation, and
10% has right side cerebral
dominance; so in about 96% of
the general population the left
cerebral hemisphere is
dominant.
Dysphasia
 Dysphasia
Abnormality of language is called dysphasia.
Dysphasia is defined as a disorder of
language in which there is impairment of
the ability of comprehension of spoken and
written language and/or impairment of the
ability of expression by speech, writing, or
signs, caused by diseases of the language
centers in the brain or their connection
(arcuate fasciculus)
Dys-means bad, difficult, -phasia means to
speak.
Aphasia is severe dysphasia.
 Types of dysphasia
1. Motor dysphasia:
Motor dysphasia is characterized by normal
comprehension (both spoken and written commands),
impaired fluency, writing, naming objects, and
repetition.
There might be paraphasias. Paraphasia means
involuntary substitution of letters or words, if the
patient substitutes a letter within a word with another
letter it is called literal paraphasia (related to
letters), while if a word in a sentence is substituted
with another word it is called verbal paraphasia
(related to words); para- means abnormal, incorrect,
beside.
The patient is unable to produce speech normally (non
fluent), but the patient retains the ability to think the
words he wishes to say, and can understand their
meaning when he sees or hears them.
The lesion is in the motor language center.
2. Sensory dysphasia:
Sensory dysphasia is characterized by loss of ability to
understand the spoken and written words, the patient
can produce fluent speech (fluency is normal), there is
paraphasia (might be neologism) as the speech is
devoid of meaning, there is impaired reading, writing,
naming and repetition.
The patient is unaware of the meaning of the words he
uses, and uses incorrect words or even nonexistent
words and the patient is unaware about his mistakes
and about his deficit, so the patient has no insight
(insight is the accurate understanding of a situation).
The lesion is in the sensory language center.
3. Global dysphasia:
Global dysphasia characterized by combination of
features of both
motor and sensory dysphasia, the lesion involves both
sensory and motor language centers.
4. Thalamic dysphasia: the lesion is in the dominant
thalamus (left thalamus) which results from disconnection
between motor and sensory language centers and dominant
thalamic nuclei.
 Muscles of articulation of speech

Muscles of articulation of speech are

skeletal muscles used for speech
production, these muscles include:
1. Tongue muscles: the tongue is the
most important articulator of speech
2. Soft palate muscles:
3. Pharyngeal muscles:
4. Layngeal muscles:
5. Lips muscles:
Muscles of articulation of speech

5
1
1. Tongue
2. Soft palate
3. Pharyngeal muscles.
4. Laryngeal muscles.
5. Lips muscles.
3

4
 Dysarthria
(dys = bad, arthria = joint).
Dysarthria means difficulty in speech
articulation due to abnormality in muscles
of articulation resulting from weakness of
the muscles (due to defect in the muscles or
in their neuromuscular junctions, or in their
cranial nerve innervations, or in their
cranial nerve nuclei, or in the corticonuclear
= corticobulbar fibers), or dysarthria might
be due to incoordination of muscle of
articulation (as occurs in diseases of the
cerebellum) or due to rigidity of muscles of
articulation (as occurs in Parkinson
disease).
 Anarthria
Anarthria is defined as an inability to
articulate by speech, it is a severe form
of dysarthria in which the patient
cannot produce any word, it is seen in
patients with paseudobulbar palsy and
in advanced cases of motor neuron
disease, advanced cases of Parkinson
disease, and in locked-in syndrome
Anarthria is differentiated from aphasia
by normal comprehension, normal
reading and normal writing
 Dysphonia
Dysphonia means difficulty in phonation (sound production),
dysphonic patient has hoarseness of voice with normal language
function and articulation.
Dysphonia commonly is caused by local disease of the vocal folds
such as laryngitis, carcinoma of the larynx,.... or disease of the
intrinsic laryngeal muscles as in polymyositis, myotonic dystrophy,
or in the neuromuscular junction as in myasthenia gravis,
botulism; dysphonia might be caused by lesions in the nerve
supply of the intrinsic laryngeal muscles (recurrent laryngeal
nerve a branch of the vagus nerve) or lesion of the the vagus
nerve itself, or its somatic motor nucleus (nucleus ambiguus) as
occurs in infarction of the lateral part of the medulla oblongata
(lateral medullary syndrome); dysphonia also might be seen in
other neurological diseases such as motor neuron disease,
Parkinson disease.
If dysphonia occurs in combination with other neurological
diseases usually it will be combined with dysarthria.
Nucleus ambiguus
The nucleus ambiguus is an elongated
aggregation of somatic motor neurons and
preganglionic parasympathetic motor neurons
located in the reticular formation of the medulla
oblongata that innervate the ipsilateral muscles
of the soft palate, pharynx, larynx, upper part
of the esophagus, as well as the heart;
(aggregation means collection, gathering).
Ambiguus is Latin means ambiguous which
means vague, mysterious, unclear.
The nucleus ambiguus is so named because it is
not clearly defined in sections of the medulla
oblongata and its borders are difficult to
discern in sections prepared with most stains;
(discern means recognize, distinguish).
The nucleus ambiguus is so named because it is not clearly defined in sections of the
medulla oblongata and its borders are difficult to discern in sections prepared with most
stains; (discern means recognize, distinguish).

ambiguus

literally = exactly

to wander means move in aimless way

The nucleus ambiguus is responsible
for swallowing, phonation, speaking,
and preganglionic parasympathetic
control of the heart (together with
the dorsal motor nucleus of the
vagus nerve).