Central and Peripheral nervous system

1. Spinal cord, structure, blood supply, coverings.

Structure
 2 swellings
o cervical intumescentia
o lumbar intumescentia

 At the lower end the spinal cord tapers into a medullary cone and ends as a terminal
filament
 From the medullary cone onwards the vertebral canal contains only a dense mass of fibres
known as the cauda equina (horses tail)

Spinal segments
 The spinal cord is divided into segments
 1 segment is the part of the spinal cord that gives rise to 1 pair of spinal nerves
 There are 31 segments in the spinal cord
o 8 cervical segments
o 12 thoracic segments
o 5 lumbar segments
o 5 sacral segments
o 1 pair of coccygeal nerves

The spinal cord is made up of white and grey matter

 White matter
o Form the funiculi
o Anterior, lateral and posterior funiculi are present in the spinal cord
o These funiculi contain nerve tracts (pathways)
o There are no nuclei in the white matter
 Grey matter
o The grey matter is organised into horns
o Anterior, lateral and posterior horns
o The grey matter is made up of neurons (nerve cells)
o It contains the nuclei of the nervous system

Blood supply
 Vertebral arteries (2)
o Before they unite they give off 2 small posterior spinal arteries which form a
network along the posterior surface of the spinal cord
o At the level of the pyramidal decussation the 2 additional branches of vertebral
arteries join to form the anterior spinal artery which runs along the entire length of
the spinal cord at the anterior sulcus
 Segmental arteries
 o Posterior branches and the vertebral arteries give spinal branches
o These branches enter through the intervertebral foramina to the spinal cord
 Anterior spinal artery
o It is widest at the intumescentiae
o It is narrow in the middle thoracic region
o It gives off sulcocommisural arteries which alternate to the left and right halves of
the spinal cord in the cervical and thoracic regions, but divides into 2 branches in
the lumbar and sacral regions
Veins
 1 anterior spinal vein and 2 posterior spinal veins (which form a network amongst
themselves) open into the epidural venous plexus

NB – there are anastomoses between the posterior and the anterior spinal arteries, forming a
vascular ring (vasocorona) around the spinal cord. Arteries from this ring radiate into the white
matter, the grey matter is even more highly vascularised.

Coverings (meninges)
 the spinal cord has 3 coverings
o Dura mater
o Arachnoidea
o Pia mater

Spinal dura mater

 Forms the outermost layer
 Separated from the vertebral column by the epidural space
 Filled with adipose tissue and internal venous plexus
 Caudally the dura mater forms the dural sac, which envelopes the cauda equina
 Extends with the terminal filament up to the periosteum of the coccyx
 Bending the head pulls the dural sac upwards (causing mechanical stress on the spinal
cord)
 Bending the head forwards causes the roots and vessels to be stretched.
 Bending the head backwards causes them to be compressed

Arachnoidea
 Borders closely to the inner surface of the dura mater
 Forms the boundary of the subarachnoid space (which is filled with CSF)
 Between the dura mater and the Arachnoidea lies a capillary cleft – the subdural space –
which widens into a real space only in pathological conditions – subdural bleeding
 The dura mater and the arachnoidea accompany the roots and cover ganglia
 The dura mater then becomes the epineurium while the arachnoidea becomes the
perineurium of spinal nerves.

Spinal Pia mater

 Borders directly on the marginal glial layer of the spinal cord
 It represents the boundary of mesodermal envelopes and ectodermal nerve tissue
  Contains numerous blood vessels which penetrate from the surface into the spinal cord
 The denticulate ligament extends on both sides from the pia mater to the dura mater
 Attached to the dura mater by individual pointed processes
 Extends from the cervical spinal cord to the mid lumbar spinal cord
 It keeps the spinal cord in position as it floats in the CSF

Function of the Spinal cord

 The spinal cord controls the sensory, motor and vegetative functions of the trunk and
extremities
 Reflexes – both motor and sensory

Reflexes
 They are a simple and quick answer to sensory irritation
 They work via reflex arches
 A reflex arch has 2 parts
o Afferent – this is the sensory part from the receptors
o Efferent – this is the motor part of the arch, it runs to the effectors (usually
muscle)

2. Transverse section of the spinal cord, white and grey matter.

In the spinal cord, the grey matter is organised in a rough “H” shape, with the white matter
around the outside.

White matter
 On the outside; around the grey matter
 Separated into funiculi (fasciculi) – these are only functional separations, there are no
septa dividing them
 There are 3 funiculi
o Posterior, anterior and lateral
 They contain the nerve pathways of the spinal cord (ascending and descending tracts)

Grey matter
 Organised in horns
 There are 3 horns
o Posterior, anterior and lateral horn
 The horns are composed of neurons (nuclei)
 The nuclei are divided into 4 groups
o Somatomotor nuclei (in the anterior horn)
o Somatosensory nuclei (in the posterior horn)
o Visceromotor and viscerosensory nuclei (in the lateral horn)

Posterior horn
 Contains the sensory centres
  Sensory nuclei are divided into 4 areas in the posterior horn
1. Substantia spongiosa (apex of the dorsal horn)
2. Substantia gelatinosa (just below the substantia spongiosa)
3. Nucleus proprius (protopathic sensation)
4. Nucleus dorsalis (of Clarke) (proprioception)

The nucleus proprius and the dorsal nucleus of Clarke are the most important nuclei for sensory
purposes (Somatosensory)

Protopathic sensation – sensation of pain, temperature, pressure etc (i.e. the basic sensations)
Proprioception – sensation of muscle tone

Lateral Horn
 Visceromotor and viscerosensory nuclei (for vegetative functions)
 There are 2 nuclei in the lateral horn
o Intermediomedial nucleus
o Intermediolateral nucleus

Anterior horn
 Motor centres (motoneurons)
 There are 2 types of motoneurons
o ά motoneurons, these are bigger and are for impulses to contract muscles
o γ motoneurons, these are smaller than the ά motoneurons and serve for control of
muscle tone
 Radicular fibres originate from the anterior horn

The white matter contains tracts

Ascending pathways

Anterolateral funiculus

 Lateral spinothalamic tract

 Anterior spinothalamic tract
 Spinotectal tract

Posterior funiculus

 Fasciculus gracilis
 Fasciculus cuneatus

Lateral funiculus

 Posterior spinocerebellar tract

 Anterior spinocerebellar tract
  Spino-olivary tract
 Vestibulospinal tract
Descending tracts
 Pyramidal tract
o Corticospinal tract
o corticonuclear
 Extrapyramidal tracts
o Vestibulospinal tract
o Anterior and lateral reticulospinal tract (from the pons)
o Lateral reticulospinal tract (from medulla oblongata)
o Tegmentospinal tract
o Rubrospinal and tectospinal tracts terminate in the cervical spinal cord and only
influence the motor system of the head and upper limb

3. Spinal nerve, roots and branches.

Spinal nerves contain several types of fibres, they are known as mixed nerves.

Somatomotor fibres (to striated muscles)

 Pass from the anterior horn through the anterior root

Somatosensory and viscerosensory fibres

 Originate from nerve cells of the spinal ganglia

Visceromotor fibres (smooth muscles)

 From the lateral horn cells
 The fibres pass through the anterior root

Roots
 A spinal nerve has 2 roots; 1 dorsal root and 1 ventral root.

Anterior (ventral) root

 Contains motor fibres (both somatomotor and visceromotor) from the anterior horn

Dorsal root
 Contains sensory fibres to the posterior horn
 The dorsal root extends from the dorsal root (spinal) ganglion to the dorsal horn

Ventral and dorsal roots join to form the spinal nerve

The spinal nerve is a short trunk which gives off branches

Branches of the spinal nerve

 Meningeal branch
o Recurrent sensory branch to the spinal meninges
  Posterior branch
o Supplies motor fibres to the deep muscles of the back and sensory fibres to the
skin areas on both sides of the vertebral column
 Anterior branch
o Motor fibres to the muscles of the anterior and lateral walls of the trunk and the
muscles of the limbs
o Also sends sensory fibres to the corresponding skin areas
 Communicating branch
o Connect with the sympathetic chain ganglion (autonomic nervous system)
o Usually forms 2 branches – a white (myelinated) and a grey (unmyelinated)
communicating branch
o Visceromotor fibres pass via the white communicating branch to the sympathetic
chain ganglion where they are relayed to neurons
 The axons of these neurons partly re-enter the spinal nerve as post
ganglionic fibres via the grey branch

4. Nuclei of the cranial nerves. Rhomboid fossa

See page 106 - 107, learn diagram

Also see page 100 for external bulges of the cranial nerve nuclei.

5. Brainstem, reticular formation.

Brain stem
 3 parts
 Medulla oblongata
 Pons of Varol
 Midbrain (mesencephalon)

Medulla oblongata
 Represent the transition from the spinal cord to the brain
 Has the anterior medial fissure and the Anterolateral sulcus on each side
 These extend to the pons
 The anterior medial fissure is interrupted by the pyramidal decussation
 Below the pons the anterior funiculi thicken to form the pyramids
 On either side of the pyramids, the olives are visible as a bulge
 The posterior medial sulcus and the posterolateral sulci are on the posterior side of the
medulla oblongata
 The posterior funiculi thicken to form the tubercle of the cuneate nucleus and the tubercle
of the gracile nucleus.

Pons of Varol
 Broad arching bulge with prominent transverse fibres
 Here the descending pathways from the brain are relayed to neurons in the cerebellum
Posterior surface of the brain stem is covered by the cerebellum, removal of which opens the 4 th
ventricle
The floor of the 4th ventricle is called the rhomboid fossa
Rhomboid fossa – see question 4
The medulla oblongata and the pons together form the rhombencephalon (named after this fossa)
The brain stem shows bulges corresponding to the nuclei of the cranial nerves

Reticular formation
 Formed by scattered neurons of the tegmentum
 Starts in the medulla oblongata and extends to the rostral part of the brain stem
 Occupies the central areas of the tegmentum
 In the medial part are magnocellular nuclei where the long ascending and descending
fibre tracts originate here
 Lateral are the parvocellular areas and this is regarded as an association area

Many neurons have long ascending or descending axons, or axons which bifurcate into a
descending and an ascending branch.
These neurons can reach both caudal cranial nerve nuclei and diencephalic nuclei at the same
time

Contains
 Afferent connections
o The reticular formation is reached by all sensory modalities (forms of sensory
perception)
o The sensory spinoreticular fibres, secondary fibres of the trigeminal and vestibular
nuclei all terminate in the medial field of the medulla oblongata
o Collaterals of the lateral lemniscus bring in acoustic impulses and fibres of
tectoreticular fasciculus bring in optic stimuli.

 Efferent connections
o Reticulospinal tract runs from medial field of medulla oblongata and pons to the
spinal cord
o Reticulothalamic fasciculus ascends to the intralaminar nuclei of the thalamus
o Fibre bundles from the midbrain terminate in the oral hypothalamus and in the
septum

 Respiratory and cardiovascular control centres

o Groups of neurons regulate respiration, heart rate and blood pressure
o The neurons for inspiration are localised in the central field of the lower portion of
the medulla oblongata
o Those for expiration are further dorsal and lateral
o Those for inhibition and stimulation of respiration are in the pons
o Autonomic nuclei of the Glossopharyngeal and vagus nerves regulate heart rate
and blood pressure
 o Caudal central field of medulla oblongata causes drop in blood pressure
o Remaining reticular formation in medulla oblongata causes increase of blood
pressure

 Effect on the motor system

o Reticular formation in the medial field of the medulla oblongata lies an inhibition
centre
o Stimulation of this causes muscle tone to drop, reflexes to fail and motor
stimulation of the brain cortex no longer triggers a reaction
o Reticular formation of the pons and midbrain has an enhancing effect on the motor
system

 Ascending activation systems

o Reticular formation has effect on consciousness via connections to the
intralaminar nuclei of thalamus
o When strongly stimulated the organism suddenly becomes fully alert (attention
and perception improves)
o Upon electrical stimulation of the reticular formation, this “wake-up function” can
be objectively assessed using electroencephalography (EEG)

6. Cerebellum, form and organization, nerve tracts, circuits.

Form
 Covers the brain stem
 Divided into the vermis and 2 hemispheres
 The vermis is unpaired while everything in the hemispheres is paired
 The tripartition is only visible at the inferior surface where the vermis forms the floor of a
fossa known as the vallecula of the cerebellum
 The cerebellum is divided into 3 sections
o Archicerebellum (consists of the flocculonodular lobe and the lingula)
o Paleocerebellum (the anterior lobe of the cerebellar body)
o Neocerebellum (the posterior lobe of the cerebellar body)
 The posterolateral fissure separates the flocculonodular lobe from the cerebellar body
 Most sections of the vermis are associated with a pair of hemisphere lobes
 Between the pairs of peduncles the roof of the 4th ventricle is formed by the superior and
inferior medullary velum

Section of vermis pair of lobes

Central lobule wing of the central lobule

Culmen quadrangular lobule
Declive simple lobule
Folium superior semilunar lobule
 Tuber inferior semilunar lobule and the upper part of gracile lobule
Pyramid lower part of gracile lobule and biventral lobule
Uvula tonsilla and paraflocculus
Nodulus flocculus

The lingula is the only part of the vermis not associated with any lateral lobe

Connections to the brain stem

 Connected by the cerebellar pedunculi – these are white matter containing nerve tracts
 3 pairs of peduncles
o Superior (brachium conjunctivum)
 Efferent fibres to the red nucleus and the thalamus
o Middle (brachium pontis)
 Fibres from the pontine nuclei – they are a continuation of the
corticopontocerebellar tract
o Inferior (restiform body)
 Contains spinocerebellar tracts and connections to the vestibular nuclei

Grey matter
 Round the outer surface of the cerebellar cortex
 Forms the cerebellar folia
 Nuclei
o Nucleus dentatus
o Nucleus fastigii
o Nucleus emboliformis
o Nuclei globosi
 The nuclei are only connected to the efferent cerebellar tracts
 They are found deep in the white matter

White matter
 Inside the grey matter
 Forms a tree like structure
 This is visible in a sagittal section and is known as the “arbor vitae” – the tree of life

Function of the cerebellum

 Archicerebellum
o For the maintenance of posture and balance
o Hence they it is connected to the vestibular nuclei
 Paleocerebellum
o Proprioceptive sensation from muscles
o Hence can control muscle tone
 Neocerebellum
o Connected to the cerebral cortex by the corticopontocerebellar tracts
o They control voluntary motor activity
Purkinje cells
 Largest, most characteristic cell of the cerebellum
 Has a pear shaped body with the basal portion of 2 or 3 dendrites at the upper pole of the
cell
 They are arranged in a strictly geometric fashion
 They are arranged at relatively regular intervals and form a row between the granular and
molecular layers
 Send dendritic trees into the molecular layer towards the surface of the folium

Neuronal circuits
 These are afferent fibres
 There are 2 types of fibres
o Climbing and mossy fibres

Climbing fibres
 Terminate at the Purkinje cells
 Attach like tendrils (slender climbing organ)
 Each fibre terminates at a single Purkinje cell
 Climbing fibres originate at the olive and its accessory nuclei

Mossy fibres
 Divide into widely divergent branches
 Give off numerous lateral branches with the small rosettes of spheroid terminals
 They fit the claw like terminals of the granule cell dendrites
 Terminate the spinocerebellar and pontocerebellar tracts and also fibres from the nuclei of
the medulla oblongata

The afferent fibre system termination pattern reveals a functional tripartition into the Vermis,
hemisphere and intermediate zone

Spinocerebellar (i.e. anterior and posterior spinocerebellar tract)

 Terminate as mossy fibres in the vermis of the anterior lobe, in the pyramid, uvula and the
intermediate zone laterally to them

Corticopontocerebellar tract
 Enter the cerebellum through the middle cerebellar peduncle
 Terminate as mossy fibres in the cerebellar hemisphere

Inferior cerebellar peduncle

Vestibulocerebellar tract
 Terminate in the flocculonodular lobe and the uvula
 Afferent pathways that synapse in the olive, its accessory nuclei and in the lateral reticular
nuclei terminate according to their origin
  Spinal fibres terminate in the vermis while cortical fibres terminate in the hemisphere
 Cerebellum receives both primary (originate from vestibular ganglion) and secondary
(synapse in vestibular nuclei) vestibular fibres
 Nearly all fibres terminate in the nodulus, flocculus and fastigial nucleus, but some
terminate in the uvula.
 Also present are cerebellofugal fibres (cerebellovestibular tracts – originate in the
terminal areas just mentioned + the vermis of anterior lobe)
 Some of them synapse in the lateral vestibular nuclei and extend in the Vestibulospinal
tract to the spinal cord

Olivocerebellar tract
 Olive sends all of its fibres to the cerebellum
 The olive and its accessory nuclei receive ascending fibres from the spinal cord (spino-
olivary tract), fibres from the cerebral cortex and from the Extrapyramidal nuclei (central
tegmental tract.)
 The fibres synapse in specific segments of the olive
 Fibres cross and pass to the contralateral half of the cerebellum
 Ends as mossy fibres in the cerebellar cortex

Reticulocerebellar, nucleocerebellar and arcuatocerebellar tracts

 Lateral reticular nucleus receives Exteroceptive sensory fibres
 These fibres ascend with the spinothalamic tracts
 Postsynaptic fibres run as Reticulocerebellar tract through the ipsilateral cerebellar
peduncle to the vermis and the hemisphere
 Nucleocerebellar tract transmits tactile impulses of the facial area primarily from the
trigeminal nuclei to the cerebellum
 Arcuatocerebellar tract originates in the arcuate nucleus and runs to the floor of the 4 th
ventricle where they form the medullary striae and run to the flocculus

Middle cerebellar peduncle

 Pathways from cerebral cortex of frontal and temporal lobes extend to the pons
 Together with the pyramidal tract they form the cerebral peduncles in which they occupy
the medial and lateral segments
 Laterally is the temporopontine and medially is the frontopontine tract
 Fibres of the 1st neuron terminate in the pons
 Fibres of the 2nd neuron cross and form the pontocerebellar tract (this is the middle
cerebellar peduncle)
 Terminate as mossy fibres in the contralateral hemisphere, but some also bilaterally in the
middle segment of the vermis

Superior cerebellar peduncle

 Most efferent fibres of cerebellar pathways run through the superior peduncle
 Only afferent bundle is the anterior spinocerebellar tract
 Fibres of the spinocerebellar tract enter the midbrain tegmentum at the level of the
inferior colliculi and cross in the decussation of the superior peduncle
  Here they divide into an ascending and a descending limb
 The descending fibres originate at the globosi nucleus and the fastigial nucleus
 They terminate in the medial nuclei of the reticular formation in the pons and the medulla
oblongata
 Here they synapse to form the reticulospinal tract and the Vestibulospinal tract
 Fibres of the ascending limb originate predominantly from the dentate nucleus but also
partly from the emboliform nucleus
 Terminate in 2 areas
o 1 – the red nucleus, its surroundings, and various nuclei of the midbrain
tegmentum that connect the cerebellum to the Extrapyramidal system
o 2 – in the dorsal thalamus from where impulses are passed on to the cerebral
cortex

These connecting tracts create a large neuronal circuit – cerebellar impulses affect cerebral cortex
via superior peduncle while cortex can affect cerebellum via the corticopontocerebellar and
cortico-olivocerebellar systems

Anterior spinocerebellar tract

 Fibres originate in the posterior horn
 Postsynaptic bundles do not enter inferior peduncle but instead extend up as far as the
upper margin of the pons where they then turn and enter the superior peduncle
 Terminate as mossy fibres in vermis and intermediate zone in the anterior lobe and uvula

7. Midbrain, form, organization, nerve tracts.

 3 parts – tectum, tegmentum and crura mesencphali

 The nuclei are in the tegmentum
 The tectum is posterior covering of the mesencephalon – the medulla oblongata and the
pons are covered by the cerebellum

The anterior surface is formed by the cerebral peduncles

 These are the descending cerebral pathways
 Between these is the interpeduncular fossa
 The floor of this is called the posterior perforated surface due to the perforating arteries

Posterior surface is formed by the tectal (quadrigeminal) plate

 The quadrigeminal plate has 2 pairs of elevations – the inferior and superior colliculi
 Superior colliculi – these are the subcortical optic centres (optico-motor reflexes)
 Inferior colliculi – subcortical auditory centres (acoustico-motor reflexes)

There is a considerable narrowing of the ventricular system in the midbrain, the CSF pathway is
reduced to a narrow “aqueduct of the mesencephalon” (the aqueduct of Sylvius)

Medially the nuclei are motor nuclei

 Nucleus of the oculomotor (III) nerve
  Nucleus of the trochlear (IV) nerve
 Edinger-Westphal nucleus (III – parasympathetic innervation of the smooth muscles in
the eye)

The tegmentum also contains

 Substantia nigra Subcortical centres of the
 Nucleus ruber (red nucleus) extrapyramidal motor system

White matter
 Ascending pathways – medial lemniscus
o Connect all sensory tracts from the spinal cord and cerebellum to the thalamus
 Descending pathways – run through the crura mesencephali
o Pyramidal (except corticonuclear) and Extrapyramidal pathways

Learn cross sections of mesencephalon

8. Diencephalon, parts, nuclei and tracts.

Function:

 Chewing
 Directs Sense Impulses Throughout the Body
 Equilibrium
 Eye Movement, Vision
 Facial Sensation
 Hearing
 Phonation
 Respiration
 Salivation, Swallowing
 Smell, Taste

Location:

 The diencephalon is located between the cerebral hemispheres and above the
midbrain.

Structures:

 Structures of the diencephalon include the thalamus, hypothalamus, the optic

tracts, optic chiasma, infundibulum, Ventricle III, mammillary bodies, posterior
pituitary gland and the pineal gland.

Thalamus:
The thalami are prominent bulb-shaped regions, typically slightly more than 1 cm in length,
located in the center of the brain. They form on each side of the paleopalliar diencephalon that
emerges from the mammalian prosencephalon. The thalamus is largely made of nuclear groups
that relate to specific functions in the cerebrum. Thalamic nuclei have subcortical projections,
and can be classified as either relay nuclei or association nuclei (see below). Thalamic nuclei also
have strong reciprocal connections with the cerebral cortex, forming cortico-thalamo-cortical
recurrent loops that are believed may be involved with consciousness.

Nuclear groups of the thalamus include:

 anterior nuclear group

o anteroventral nucleus
o anterodorsal nucleus
o anteromedial nucleus
 medial nuclear group
o dorsomedial nucleus
 parvocellular part
 magnocellular part
o midline nuclear group
 paratenial nucleus
 parventricular nucleus
 reuniens nucleus
 rhomboidal nucleus
o intralaminar nuclear group
 centromedian nucleus
 parafascicular nucleus
 paracentral nucleus
 central lateral nucleus
 central medial nucleus
 lateral nuclear group
o lateral dorsal nucleus
o lateral posterior nucleus
o pulvinar
 ventral nuclear group
o ventral anterior nucleus
o ventral lateral nucleus
o ventral posterior nucleus
 ventral posterolateral - receives sensory information from the body
 ventral posteromedial - receives sensory information from the face
 metathalamus
o medial geniculate body - receives auditory information (via brachium from
inferior colliculus of midbrain)
o lateral geniculate body - receives visual information from the optic tract
 thalamic reticular nucleus

Function
Most textbooks will tell you that the thalamus is a "relay" that simply relays signals from
auditory, somatic, visceral and visual regions of the peripheral nervous system to the cerebral
cortex. The real picture is more complicated, and the commonly accepted function of the
thalamus nowadays is that it modulates, in addition to relaying, sensory signals to and from
cortex.

It is common to classify thalamic nuclei as either "relay nuclei" or "association nuclei" on the
basis of the source of their driving inputs, whether they are subcortical or cortical. Relay nuclei
receive their driving inputs from subcortical sources including ascending afferents (medial
lemniscus for somatosensory information, optic tract for visual information, etc...) and project
predominantly to primary sensory cortical areas. On the other hand, association nuclei receive
their driving inputs from other cortical areas. (See Sherman and Guillery's "Exploring the
Thalamus", 2002)

Alternative ways for subdividing thalamus are also coming into vogue. For example, Ted Jones
has recently proposed a Matrix-Core model for the thalamus, which is not subdivided based on
nuclei, but rather on chemically-defined populations of neurons. Specifically, Jones proposes the
calbindin immunopositive neurons constitute a "matrix", whereas parvalbumin immunopositive
neurons form the "core". In Jones' scheme, the "matrix", which includes much of the intralaminar
nuclei, is involved in state functions (arousal, level of attention, mood), whereas the "core" is
involved in discriminative sensori-motor functions.

Hypothalamus

In the anatomy of mammals, the hypothalamus is a region of the brain located below the
thalamus, forming the major portion of the ventral region of the diencephalon and functioning to
regulate certain metabolic processes and other autonomic activities. The hypothalamus links the
nervous system to the endocrine system by synthesizing and secreting neurohormones often
called releasing hormones because they function by stimulating the secretion of hormones from
the anterior pituitary gland — among them, gonadotropin-releasing hormone (GnRH). The
neurons that secrete GnRH are linked to the limbic system, which is very involved in the control
of emotions and sexual activity. The hypothalamus is also the area of the brain that controls body
temperature, hunger and thirst, and circadian cycles.

Hypothalamic nuclei

Region Medial Area Lateral Area

Medial preoptic nucleus
Lateral preoptic nucleus
Supraoptic nucleus
Anterior Lateral nucleus
Paraventricular nucleus
Part of supraoptic
Anterior nucleus
nucleus
Suprachiasmatic nucleus
Tuberal Dorsomedial nucleus Lateral nucleus
 Ventromedial nucleus
Lateral tuberal nuclei
Arcuate nucleus
Mammillary nuclei (part of mammillary
bodies)
Posterior Lateral nucleus
Posterior nucleus

Epithalamus

The epithalamus is a dorsal posterior segment of the diencephalon (a segment in the middle of the
brain also containing the hypothalamus and the thalamus) which includes the habenula, the stria
medullaris and the pineal body. Its function is the connection between the limbic system to other
parts of the brain.

Some functions of its components include the secretion of melatonin by the pineal gland, and the
regulation of hunger and thirst by the habenula.

The Subthalamus

 The midbrain tegmentum continues into the diencephalon as the subthalamus.

 This area is completely surrounded by neural tissue.

 It is located:

1. Inferior

To the thalamus;
2. Lateral

To the hypothalamus;
3. And medial to the basis pedunculi and internal capsule.

 The subthalamus contains rostral potions of the red nucleus and substantia nigra.
 It is traversed by somatosensory pathways on their way to the thalamus, as well as several
pathways involving the cerebellum and basal ganglia.

 In addition, the subthalamus contains the subthalamic nuclei.

Subthalamic Nuclei

 This is a lens-shaped, bi-convex structure.

 It is located medial and superior to portions of the basis pedunculi and internal capsule.
  This nucleus is interconnected with the basal ganglia.

Zona Incerta

 This is a small mass of grey matter intervening between the subthalamic nuclei and the
thalamus.
 It appears to be a continuation of the midbrain reticular formation.
 It has widespread connections, including direct projections to the cerebral cortex.

 Its function is largely unknown.

9. Brain hemispheres: form, organization, development of gyri.

Each hemisphere is divided into 4 lobes

 Frontal lobe
 Parietal lobe
 Temporal lobe
 Occipital lobe

Frontal lobe
 From the frontal pole to the central sulcus

Parietal lobe
 From the frontal lobe to the occipital lobe

Temporal lobe
 Includes temporal pole

Occipital lobe
 Includes occipital pole
 Has calcarine sulcus

See Platzer page 212, learn Gyri.

Grey matter of the hemispheres

 Surface of the end brain
o Localisation of the most important special centres (motor, sensory, optic, auditory,
speech etc)
 Inner structures of the hemispheres
o Basal ganglia – subcortical centres of the Extrapyramidal system
o Limbic system
o Hippocampus
White matter of the hemispheres
 Internal, external and extreme capsules
 Corpus callosum
o Connects the 2 hemispheres – largest commissural pathway between the
hemispheres
 Semioval centre
 Fornix
 Septum Pellucidum

The Telencephalon consists of the Allocortex the Neocortex

Allocortex
 Oldest, smallest part of the brain cortex
 Found in the basic + medial surfaces of the hemispheres
 All these cortical centres form functional units with Subcortical areas + nuclei
 Divided into the Paleocortex + Archicortex

Paleocortex
 Together with Olfactory bulb + olfactory tract it forms olfactory brain/Rhinencephalon
 Formerly found on the outer side of the hemisphere, during phylogenesis (evolution) it
moved to the basal surface of the frontal lobe – the surface area decreases
 Larger Surface Area v’s Decreased SA = macrosmatic v’s microsmatic (greater sense of
smell v’s lessened)
 Components of Paleocortex
 Olfactory Bulb
 Olfactory Tract
 Olfactory Striae
 Olfactory Triangle
 Substantia Perforata Anterior
 Uncus Gyri Hippocampi (Parahippocampalis)

Archicortex
 Limbic system – Emotional Brain
Cortical Regions
 Outer Arc
 Parahippocampal Gyrus
 Cingulate Gyrus
 Subcallosal Area
 Indusium Griseum
 Inner Arc
 Hippocampus
 Fornix
 Septal Region
 Paraterminal Gyrus
Subcortical Regions
  Amagdaloid Nucleus
 Mamillary Body
 Ant Thalamic Nuc
 Habenular Nuclei
 Some nuclei of the Reticular Formation – Dorsal + Vent Tegmental,
Interpeduncular)
Tracts
1. Papez Circuit
2. Olfactory Centre – Septum, Subcallosal Area, Olfactory Centre – Amygdala
3. Limbic System – Hypothalamus through: Fornix, Stria Terminalis, Ventral
Amygdalofugal Fibres
4. Habenulo-Tegmental Tract
Mamillo-Tegmental Tract

Neocortex
 Contains all cortical areas – See Q32

10.Basal ganglia.

Basal Ganglia are part of Extrapyramidal System (See Q25 for more information)

Caudate Nucleus
Putamen
Globus Pallidus
Subthalamic Nucleus
Substantia Nigra
Nucleus Ruber
Nucleus Amygdalae
Nucleus Basalis Meynepti
Claustrum

 Caudate Nucleus and Putamen together = Striatum

 Putamen and Globus Pallidus together = Lentiform Nucleus

11.Internal, external, and extreme capsule.

Internal Capsule
 Located in the Telencephalon
 Formed by ascending and descending projection fibres
 Anterior Limb – Bordered by Head of Caudate Nucleus, Globus Pallidus + Putamen
 Posterior Limb – Bordered by Thalamus, Globus Pallidus + Putamen
 Between both – Genu
 Tracts of the Internal Capsule
 Anterior Limb – Frontopontine Tract, Anterior Thalamic Radiation
 Genu – Corticonuclear Fibres (supply cranial nerve nuclei)
  Posterior Limb – Corticospinal Tract, Thalamocortical Fibres (to Area 4),
Corticorubral + Corticotegmental Fibres (From Area 6)
 Caudal Posterior Limb - Central Thalamic Radiation (to Post-Central Area),
Posterior Thalamic Radiation* + Temporopontine Tract*
*Both pass through obliquely
External Capsule
 Separates the Claustrum from the Putamen
Extreme Capsule
 Separates the Claustrum from the Cortex of the Insula

12.Cerebrospinal fluid system, ventricles, CSF circulation.

CSF –
 Surrounds CNS – Internal Cerebrospinal Fluid Space
 Fills inner cavities of brain - External Cerebrospinal Fluid Space
 Connected by Fourth Ventricle
Internal Cerebrospinal Fluid Spaces
 Lateral Ventricle (1+2)
o In Telencephalon
o Anterior Horn – In Frontal Lobe
Bordered laterally by head of caudate nucleus, medially by
Septum Pellucidum + dorsally by Corpus Callosum
o Central Part – Narrow
Above the Thalamus
o Inferior Horn – In Temporal Lobe
o Posterior Horn – In Occipital Lobe
 Lateral Ventricle is connected to 3rd ventricle by Interventricular Foramen (of Monro)
 3rd Ventricle
o In Diencephalon
o Lateral Wall formed by Thalamus and Hypothalamus
o Optic, Infundibular (rostrally), suprapineal + pineal (caudally) recesses project
into ventricle
 3 Ventricle communicated with 4th ventricle by Cerebral Aqueduct (of Sylvius)
rd

 4th Ventricle
o Creates tent-like space above rhomboid fossa between cerebellum and medulla
oblongata
o Lateral Aperture of 4th Ventricle - Foramen of Luschka
Median Aperture – Foramen of Magendie
External Cerebrospinal Fluid Spaces
 External cerebrospinal fluid space lies between pia mater (inside) and arachnoid mater
(outside) – Subarachnoid Space
 Indentations in the arachnoid mater create cisterns
o Cerebellomedullary Cistern
 Largest
 Between Cerebellum and Medulla Oblongata
 o Interpeduncular Cistern
 Formed by diencephalons floor, cerebellar peduncles, and pons
o Chiasmatic Cistern
 Lies in front of interpeduncular cistern near optic chiasma
o Cisterna Ambiens
 Formed by cerebellar surface, quadrigeminal plate and pineal gland
Circulation of CSF
 Produced by Choroid Plexus
 Flows form Lateral Ven → 3rd Ven → Aqueduct → 4th Ven
 Drainage to venous system takes place partly in arachnoid granulations (of Pacchioni) +
partly at exits of spinal nerves

13.Coverings of the brain (meninges).

Brain is surrounded by mesodermal coverings – Meninges

 Dura Mater – Outer layer
 Arachnoid Mater
 Pia Mater Leptomeninx

Dura Mater
 Lines inner surface of skull – forms periosteum
 Falx Cerebri
 Fold of dura
 Situated between the 2 cerebral hemispheres in vertical position
 Attached to the Crista Galli, extends over frontal crest to internal occipital
protuberance where it turns into Tentorium of the Cerebellum
 Tentorium of the Cerebellum
 Lies in posterior cranial fossa
 Attached to transverse sulcus of occipital bone, upper margin of petrous bone
 At lower surface of Tentorium and along occipital crest, falx of cerebellum
projects into posterior cranial fossa
 There are 4 folds of the Dura mater
 Falx cerebri
 Falx cerebelli
 Tentorium cerebelli
 Sellar diaphragm
 Sinuses of Dura Mater (See Q.15)
 Structures encapsulated by dura mater
 Sellar Diaphragm – Extends over sella turcica and separates hypophysis from the
brain
 Trigeminal Cave (of Meckel) – Covers trigeminal ganglion – situated on anterior
surface of petrous bone

 No Epidural Space, however epidural bleeding may occur upon damage to the Middle
Meningeal Artery
 Arachnoid Mater
 Adheres closely to Dura Mater
 Separated by Subdural Space which is only seen in the case of Subdural bleeding
 Arachnoid Mater encloses Subarachnoid space
 Contains CSF
 Dura mater enclosed arachnoid granulations protrude into sinuses (Most abundant around
superior sagittal sinus)

Pia Mater
 Contains the Blood Vessels
 Closely covers the surface of brain gyri and sulci

14.Arteries of the brain and their supply areas.

Brain is supplied by 2 Internal Carotid Arteries and 2 Vertebral Arteries

Internal Carotid Artery (see also Q.3 Vascular System)

Branches
 Superior Hypophysial Artery - Hypophysis
 Posterior Communicating Artery
 Anterior Choroidal A – Optic Tract, Hippocampus, Tail of CN, Thalamus
 Anterior Cerebellar Artery – Medial Surface
o Anterior Communicating Artery
o Recurrent Artery of Heubner – Anterior limb of IC, Head of NC, Putamen
 Middle Cerebral Artery – Lateral Surface of Hemisphere
o Striate Branches - Globus Pallidus, Thalamus, Genu of IC

Vertebral Arteries
Branch
 Posterior Inferior Cerebellar Arteries
Basilar Artery
 Anterior Inferior Cerebellar Artery (Cerebellum, Medulla, Pons)
 Labyrinthine Artery (Internal Ear)
 Superior Cerebellar Artery
 Posterior Cerebellar Arteries – Occipital Lobe, Base of Temporal Lobe, Cerebral Peduncles
and Tectum, Geniculate Bodies
15.Venous sinuses of the dura mater.

Sinuses of the dura mater

 Walls are formed by duplication of the dura mater
 Each sinus is lined by endothelium but lacks the muscle layer of vein walls

Superior sagittal sinus

 Runs along the attachment of the falx cerebri to the cranium (falx cerebri is formed by the
dura mater, it juts out and runs between the 2 hemispheres of the brain)

Inferior sagittal sinus

 Lies at the lower border of the falx cerebri

Straight sinus
 Takes blood from the inferior sagittal sinus and the great cerebral vein to the confluence
with the superior sagittal sinus (this confluence is the origin of the transverse sinus)

Sigmoid sinus
 Continuation of the transverse sinus
 Runs along the posterior lower margin of the petrous bone to the pyramidal part of the
petrous bone to the posterior circumference of the jugular foramen
 Occipital sinus
 Connection from the confluence of the sinuses to the foramen magnum
 Forms anastomoses with the sigmoid sinus – this is the “marginal sinus”

Cavernous sinus
 Paired
 Lie on either side of the sella turcica above the sphenoidal air sinus
 Incompletely divided by connective tissue septa
 Internal carotid artery and the abducens nerve pass through it
 Oculomotor, trochlear, and the ophthalmic nerves all run in the lateral wall of the sinus
 It has the following connections
o Intercavernous sinus (connect the cavernous sinuses in front of and behind the
hypophysis)
o Sphenoparietal sinus – runs along the crest of the lesser wing of the sphenoid bone
o Superior petrosal sinus - superior margin of each side of the petrous bone to the
sigmoid sinus
o Inferior petrosal sinus – runs along the posterior aspect of the petrous bone to
reach the anterior part of the jugular foramen
o Basilar plexus
 Venous network of the spinal canal, through the foramen magnum
o Superior ophthalmic vein
 Connects cavernous sinus to the facial veins via the angular vein (in the
medial part of the corner of the eye).
 This is a pathway by which infections of the upper lip area can cause
thrombosis of the cavernous sinus

Venous pathways also go via the foramen ovale from the orbits to the pterygoid plexus
o Transverse sinus
 Originates on each side of the confluence of the sinuses
 Runs initially in the attachment of the tentorium cerebelli
 Continues as the sigmoid sinus

16.Veins of the brain and spinal cord.

Veins of the Brain – Superficial and Deep

Superficial Veins
 Superior Cerebral Veins –
 10-15 veins
 Collects blood from Frontal + Parietal Lobes
 Drain to Superior Sagittal Sinus
 Veins open into sinus against the flow of its blood
 Inferior Cerebral Veins
 Largest is Superficial Middle Cerebral Vein
  Carry blood from Temporal + Occipital Lobes
 Drain to Transverse and Superior Petrosal Sinus
 Anastomosis occurs between Sup and Inf due to Superior, Central and Inferior
Anstomotic Veins (of Trolard, Roland and Labbe)

Deep Veins
 Drain Diencephalon and Deep structures of Hemispheres
 Basal Vein (of Rosenthal) –
 Drains ventral parts of Thalamus and BG
 Internal Cerebral Vein –
 Drains dorsal parts of the Thalamus, Pallidum

17.Hypothalamus and hypophysis.

Hypothalamus

In the anatomy of mammals, the hypothalamus is a region of the brain located below the
thalamus, forming the major portion of the ventral region of the diencephalon and functioning to
regulate certain metabolic processes and other autonomic activities. The hypothalamus links the
nervous system to the endocrine system by synthesizing and secreting neurohormones often
called releasing hormones because they function by stimulating the secretion of hormones from
the anterior pituitary gland — among them, gonadotropin-releasing hormone (GnRH). The
neurons that secrete GnRH are linked to the limbic system, which is very involved in the control
of emotions and sexual activity. The hypothalamus is also the area of the brain that controls body
temperature, hunger and thirst, and circadian cycles.

Hypothalamic nuclei

Region Medial Area Lateral Area

Medial preoptic nucleus
Lateral preoptic nucleus
Supraoptic nucleus
Anterior Lateral nucleus
Paraventricular nucleus
Part of supraoptic
Anterior nucleus
nucleus
Suprachiasmatic nucleus
Dorsomedial nucleus
Lateral nucleus
Tuberal
Ventromedial nucleus
Lateral tuberal nuclei
Arcuate nucleus
Mammillary nuclei (part of mammillary
Posterior Lateral nucleus
bodies)
 Posterior nucleus
Hypophysis

 Separated into 2 parts – adenohypophysis and neurohypophysis

 Adenohypophysis develops from an evagination of the roof of the primitive foregut
 Neurohypophysis develops from an evagination of the floor of the diencephalon
 Adenohypophysis is and endocrine gland, neurohypophysis is a part of the brain
composed of nerve fibres, a capillary bed and a special type of glial cells (pituicytes)
 The two parts of the hypophysis adjoin together bringing together the nervous system and
the endocrine system in association with each other
 Hypophysis is held up by the Hypophysial stalk (infundibulum)
 Hypophysis sits in the sella turcica
 Adenohypophysis secretes somatotropin (growth hormone), prolactin, FSH, LH,
thyrotropin, ACTH,
 Neurohypophysis secretes ADH, oxytocin


18.Organ of smell, olfactory pathway.

 Olfactory epithelium occupies a small region in both nasal cavities

 This is at the upper margin of the superior nasal conchae and on the opposite surface of
the nasal septum
 Epithelium consists of 2 types of cells – supporting and receptor cells
 Region also contains small mucous glands – Bowman’s (olfactory) glands
 Sensory cell tapers into a thin shaft that extends slightly beyond the supporting cells
 Olfactory nerves are bundles of processes covered by schwann cells
 They extend through the cribriform plate to the olfactory
 How the sensory cells receive the smell is not known however it is possible that the
receptors are very specific to molecules of only 1 size
 The idea is that there are a few basic qualities of smell and that each individual sensory
cell registers via specific receptors
 It is possible that this is related to the size of the molecules as those molecules belonging
to the same group of odours have roughly the same size
 Apart from olfactory nerves there are also 2 other nerves present in the nasal cavity
running to the brain
 These are the terminal nerve and the vomeronasal nerve
 The terminal nerve contains a bundle of delicate nerve fibres through the cribriform plate
 This nerve is regarded as an autonomic nerve
 The vomeronasal nerve is only demonstrated in humans during embryonic development
 This nerve is well developed in lower reptiles – runs from vomeronasal organ to the
accessory olfactory bulb
 It is thought to play an important role in tracking down prey
 The principle centre for smell in the brain cortex is Brodman’s area 51

19.Organ of taste, gustatory pathways.

 Taste sensations are sensed by the taste buds

 These together with the olfactory epithelium form the chemoreceptors
 Taste buds (gustatory receptors) are found in large numbers in the vallate papillae of the
tongue, in moderate numbers in the fungiform papillae and in the foliate papillae with
isolated taste buds in the soft palate, posterior pharyngeal wall and in the epiglottis.
 The four basic taste sensations are not equally well perceived by all taste buds
 Bitter is perceived by the base of the tongue especially
 Salty at the lateral margins and the tip
 Sour at the lateral margins
 Sweet at the tip

Taste fibres
 From 3 cranial nerves
o Facial nerve
o Glossopharyngeal nerve
o Vagus nerve
 3 sensory ganglion
o Geniculate ganglion (facial nerve)
o Petrosal ganglion (inferior ganglion of the Glossopharyngeal ganglion)
o Nodose ganglion (inferior ganglion of the vagus nerve)
 Those of the facial nerve run in the chorda tympani to the lingual nerve and supply the
receptors of the anterior 2/3 of the tongue
 Those of the Glossopharyngeal nerve run in the lingual nerve and supply the vallate
papillae in the posterior 1/3 of the tongue
 In the tonsillar branch of the Glossopharyngeal nerve are taste fibres for the soft palate
 The vagus nerve supplies taste buds in the pharynx and the epiglottis
 Neurons enter the medulla obloFngata and form the solitary tract
 The primary taste fibres terminate in the solitary nuclear complex
 Secondary taste fibres start at the solitary nucleus and it is assumed that the majority of
the fibres cross as arcuate fibres and join the medial lemniscus
 They terminate in the medial part of the ventral posterior nucleus of the thalamus
 From here the tertiary taste fibres project to the cortical area of the brain cortex
 Primary taste centre in the brain - 43

20.Optic reflexes (pupillary).

Pupillary light reflex

 When light falls on to the retina, the pupil constricts
 Afferent loop of this loop is the optic nerve fibres extending to the pretectal nucleus
  Latter is connected with the rostral part of the Edinger-Westphal nucleus
 The fibres of this extend as the efferent limb of the reflex arch
 It runs to the ciliary ganglion, the postganglionic fibres innervate the sphincter pupillae
 The 2 pretectal nuclei are connected by the epithalamic fissure
 Also the optic nerve fibres of each side terminate in the 2 pretectal nuclei – this explains
the bilaterality of the pupillary reflex (i.e. when light falls onto only 1 eye the pupil of the
other eye constricts as well)

Accommodation
 Apparatus consists of the lens, ciliary zone, ciliary body and choroidea
 These parts form a tense elastic system spanning the entire eyeball and maintains the flat,
slightly curved shape of the lens (this is negative accommodation)
 During positive accommodation the Ciliaris muscle contracts and the lens rounds off
 Afferent limb is optic nerve (as fixation of an object is necessary for accommodation)
 Efferent limb is oculomotor nerve
 Reflex arch probably runs via the visual cortex to the pretectal nuclei and also the superior
colliculi
 Efferent loop begins at the Edinger-Westphal nucleus

21.Optic pathway.

Optic pathway is a special sensory pathway

 4 neurons
 1st – rods and cones (photoreceptors)
 2nd – retinal ganglion – bipolar nerve cells
o Transmit impulses from photoreceptors to ganglion opticum
 3 – optic ganglion – multipolar cells
rd

o axons combine to form the optic nerve

 4 – lateral geniculate body
th

o axons project as optic radiation

Optic nerve
 enters skull via optic canal
 At base of the diencephalon it joins with the contralateral optic nerve to form the
chiasm
 From here on it is known as the optic tract (see qu. 29)

The optic pathway ends when the optic radiation enters the brain cortex (principal areas 17, 18,
19)

22.Auditory pathway.
See Q53 Vestibulocochlear Nerve
Special Sensory Pathway
Information from Organ of Corti
 1st Neuron – Spiral Cochlear Ganglion – Bipolar Cells
2nd Neuron – Ventral Cochlear Nucleus – Cross as Trapezoid Body
Lateral Cochlear Nucleus – Cross as Dorsal Acoustic Striae
Lateral (Acoustic) Lemniscus
3rd Neuron – Inferior Colliculi (midbrain)
4th Neuron – Mediale Geniculatum
Auditory Radiation
o From Medial Geniculate → Lateral Geniculate → Internal Capsule (@ Inferior margin of
Putamen) → Temporal Lobe (in Anterior Transverse Gyrus)
o Tonotopic organisation of Pathway – According to tone frequencies

23.Organ of balance, vestibular pathways.

See Q53 Vestibulocochlear Nerve
Vestibular Pathway
Special Sensory pathway – 3 Neurons

1st Neuron – Vestibular Ganglion –

Bipolar Cells – Dendrites extend to sensory areas in semicircular ducts
Axons – Vestibular part of N. VIII
2 Neuron – Vestibular Nuclei
nd

 Superior (Bechterev)
 Inferior (Roller)
 Medial (Schwalbe)
 Lateral (Deiters)
Cross in the Medial Lemniscus (Cortralateral)
3rd Neuron – Thalamus – Ventral Nuclei -

In your ears

Your ears aren't only your organs of hearing. They also help you keep your balance. In your inner
ear is a maze of bony chambers called the bony labyrinth that can be divided into three parts. One
section, known as your cochlea, is responsible for your sense of hearing. The other two, however,
contain your organs of balance.

Position of your head

Your first organ of balance detects the position of your head. It consists of two sacs called the
utricle and saccule. Within these sacs are receptors called maculae. They are made of sensory hair
cells covered by a gel-like cap with tiny crystals inside. Whenever you tilt your head, gravity
causes the crystals to slide to one side, creating a pull on the gel and the sensory hairs. This
triggers your hair cells to fire nerve impulses along your vestibular nerve to your brain.

Rotation of your head

 Your second organ of balance detects rotational movements of your head. It consists of three
fluid-filled loops that are arranged at right angles to each other. Within each of these 'semicircular
canals' is a receptor region called crista ampullaris. It is made of hair cells covered by a gel-like
cap. When you begin to rotate your head, the fluid in the canals lags behind and moves in the
opposite direction, thereby bending the gel-like cap. This stimulates your hair cells, which, in
turn, send nerve impulses along your vestibulocochlear nerve to your brain.

Other balance sensors

To keep your balance, you don't only rely on the two sensory organs in your inner ear. Your eyes
also deliver important information about your body's position, as do receptors in your muscles
and tendons. Called 'proprioreceptors', they detect how stretched your muscles, tendons and joints
are.

24.Corticospinal and corticonuclear tracts. (pyramidal tract)

Descending motor tracts

Control Voluntary Movements (Quick and Rapid)
Tracts take 4-6 years after birth to fully mature
About 60% of fibres are myelinated
Pyramidal tracts activate flexors and inhibit extensors

1st Neuron – Upper Motor Neuron (UMN)

Pyramidal cells of the cortex in motor area of frontal lobe – Broadman’s area 4 + 6 Precentral
Gyrus
2nd Neuron – Lower Motor Neuron (LMN)
Corticospinal tract – α-motor neurons in ventral horn of spinal cord
Corticonuclear tract – Motor nuclei of cranial nerves

Course of Corticospinal Tract

Brain cortex → Internal Capsule → Crura Mesencephali → Pyramids of Medulla Oblongata →
Pyramidal Decussation (60-80% cross to form lateral tract) → Lateral and Ventral Corticospinal
Tract → α-motor neurons in ventral horn → Ventral root, Spinal Nerve, Ventral + dorsal
branches, Muscles)

Course of Corticonuclear Tract

Brain cortex → Internal Capsule → Motor Nuclei (All except 1, 2 + 8) → Muscles of Head and
Neck
Damage to the UMN – Spastic Paralysis – Uncontrollable Reflexes
Damage to the LMN – Flaccid Paralysis – No Reflexes

25.Extrapyramidal motor system.

Nuclei of the extrapyramidal motor system
 Putamen + Caudate Nucleus (Neostraitum)
 Pallidum
 Subthalamic Nucleus
 Red Nucleus
 Substantia Nigra

Other connected centres

 Cerebellum
 Thalamic Nuclei
 Reticular Formation
 Vestibular Nuclei

Pathways of the Extrapyramidal motor system

 They connect many cortical and subcortical centres
 All tracts are multi-synaptic (more than 2 neurons)
 Functions –
 Maintain posture and balance during movements, associated movements,
involuntary support of voluntary movements, co-ordination of movements, and
control of muscle tone
Afferent Pathways
Cerebellorubral tract
 From cerebellum to red nucleus
Cortical Fibres
 Run to Striatum, red nucleus and substantia nigra
Vestibular Fibres
 Terminate in interstitial nucleus of Cajal

Efferent Pathways
These are descending motor pathways

Tegmentospinal Tract
 From the Mid-Brain
 Consists of
 Pallido-Olivary Fibres
 Rubro-Olivary Fibres
 Reticulo-Olivary Fibres
Vestibulospinal Tract
 Balance, Muscle Tone – Against the effect of Gravity
Reticulospinal Tract (Ant + Lat)
 Activation of Extensors
 From the Pons
Rubrospinal Tract
 Activation of Flexors
  Precise movements
Tectospinal Tract
 Optic control of Movement

26.Pathways of epicritic sensibility.

These pathways are concerned with gentle touch, vibration, discrimination and joint sensation
There are 2
 Spino-bulbar tract
 Bulbo-thalamic tract

These are direct ascending pathways (go straight to the brain nuclei without going through the
cerebellum)
They have 3 neurons
 1st order neuron – dorsal root ganglion
o the fibres then enter the posterior funiculi of the spinal cord
o they are the fasciculus gracilis and the fasciculus cuneatus
 2 order neuron – medulla oblongata
nd

o the nucleus gracilis and the nucleus cuneatus

o this is unusual as the 2nd order neuron of ascending pathways is normally in the
spinal cord
o the fibres form the medial lemniscus and cross at the level of the midbrain (this is
the decussatio lemniscorum and enter the thalamus
 3rd order neuron – thalamus
o Ventral posterolateral nucleus (VPL)

NB – in the brain stem all sensory paths form the medial lemniscus

The axons then continue as the thalamo-cortical tract to the postcentral gyrus, Brodman’s area 1,
2, and 3

27.Pathways of protopathic sensibility.

Again there are 2

 Ventral spinothalamic tract
 Lateral spinothalamic tract

Again these are direct ascending pathways.

These pathways are concerned with crude touch, pressure, pain and temperature etc.

Again there are 3 neurons

 1st order neuron – dorsal root ganglion
 2nd order neuron – proper nucleus (nucleus proprius)
o the fibres cross to the opposite side of the white matter and form the spinothalamic
tracts
 o in the brain stem they join the medial lemniscus and ascend to the thalamus
 3 order neuron – thalamus
rd

o Ventral posterolateral nucleus (VPL)

o Axons continue as thalamo cortical tract
o They also go to the postcentral gyrus, Brodman’s area 1, 2 and 3

Lateral spino-thalamic tract → pain and temperature

Anterior spino-thalamic tract → touch and pressure

28.Afferent (sensory) tracts of cranial nerves.

Trigemino-thalamic tract

All sensory (proprioception, protopathic epicritic sensation) from head

1st neuron – Gasserian ganglion or Ganglias of nerves VII, IX, X

2nd neuron – Sensory nucleus of Trigeminal nerve (Rhomboid Fossa)
Trigeminal Lemniscus to Thalamus
3rd Neuron – Thalamus – Ventral Posteromedial Nucleus (VPM)
Fibres continue as Thalamo-Cortical Tract to primary sensory area (3, 2, 1)

29.Optic tract, conjugated eye movements.

 Optic tract stretches from the optic chiasma to lateral geniculate body of the thalamus
 Runs around the cerebral peduncles
 Before entering the lateral geniculate body the optic tract divides into 2 roots
o Lateral root
 Most fibres run through this root to the lateral geniculate body of the
thalamus
o Medial root
 Continue below the medial geniculate body to the superior colliculi
 Contain visual reflex pathways
 Runs to the pretectal nucleus in the midbrain
 Also runs to the interstitial nucleus (of cajal)
 This is the contact with the optic reflexes and other pathways
 Optic radiation (fanlike fibre system passing from the lateral geniculate body of the
thalamus to the visual cortex) begins at lateral geniculate body and runs to the
calcarine sulcus at the medial aspect of the occipital lobe and while doing so it forms
the outward arching temporal genu
 The nerve fibres originating from the nasal halves of the retina cross in the optic
chiasm
 Fibres from temporal halves do not cross
 In cross section uncrossed fibres are dorsomedially with the crossed fibres
ventrolaterally
 Conjugated eye movements
 Adduction of the eyes (both eyes – makes you cross eyed) to a fixed object as it moves
toward to body is called convergence
 Coordination of the extraocular muscles, movements of the eyeballs, eyelids, head and
neck – makes them all move together
 5 neurons control it
o 3 neurons of the optic pathway (see qu. 21)
o 4th neurons – interstitial nucleus (of cajal)
o 5th – motor nuclei of the oculomotor nerves (III, IV, VI)

Medial longitudinal fasciculus is the common course of reflexes

30.Ascending and descending tracts of anterolateral funiculi of the spinal cord.

Ascending Tracts

 Ventral spinothalamic tract

 Lateral spinothalamic tract
See Question 27

Descending
 Anterior and lateral corticospinal tracts
 Also the Extrapyramidal pathways also run through here
See Question 24

31.Commissural, associating and projection fibre tracts.

 A broad layer of white matter lies between the cerebral cortex and the deep grey nuclei
 Consists of fibre bundles from neurons of cortex or fibre bundles extending to cortex and
ending on cortical neurons
 3 types of fibres – Projection, Association + Commissural

Projection Fibres
 Connect Cerebral Cortex + Subcortical Areas (at all levels of CNS)
 Ascending + Descending Pathways
 Form Internal Capsule
 Radiate out from internal capsule to form Corona Radiata on either side
 Internal Capsule
 Anterior Limb – Bordered by Head of Caudate Nucleus, Globus Pallidus + Putamen
 Posterior Limb – Bordered by Thalamus, Globus Pallidus + Putamen
 Between both – Genu
 Tracts of the Internal Capsule
 Anterior Limb – Frontopontine Tract, Anterior Thalamic Radiation
  Genu – Corticonuclear Fibres (supply cranial nerve nuclei)
 Posterior Limb – Corticospinal Tract, Thalamocortical Fibres (to Area 4),
Corticorubral + Corticotegmental Fibres (From Area 6)
 Caudal Posterior Limb - Central Thalamic Radiation (to Post-Central Area),
Posterior Thalamic Radiation* + Temporopontine Tract*
*Both pass through obliquely
 Most Important Projection Pathways – Acoustic and Optic Radiation
Acoustic Radiation
o From Medial Geniculate → Lateral Geniculate → Internal Capsule (@ Inferior
margin of Putamen) → Temporal Lobe (in Anterior Transverse Gyrus)
Optic Radiation
o From Lateral Geniculate (where they fan out to form a wide medullary lamina) →
Temporal Lobe (Temporal Genu of Visual Pathway) → Passes around lateral horn
of Lateral Ventricle → Through Occipital Lobe to Calcarine Sulcus

Association Fibres
 Connect centres of the brain cortex in 1 hemisphere
 Short/Arcuate Fibres
 Connections within 1 cerebral lobe or 1 convolution to the next
 Arcuate fibres lie immediately beneath cortex
 Long Fibres
 Connect different cerebral lobes
 Cingulum – Follows course of cingulated gyrus
From Parolfactory Area → Rostrum of Corpus Callosum →
Entorhinal Area
 Subcallosal Fasciculus (Superior Occipitofrontal Fasciculus)
Situated dorsolateral to caudate nucleus, below radiation of Corpus Callosum
Connects Frontal Lobe → Temporal + Occipital Lobes
Branching fibres extend to Insula and Caudate Nucleus
 Superior Longitudinal Fasciculus –
Situated dorsolateral to Putamen
Connects Frontal lobe to Occipital Lobe
Branches extend to Parietal + Temporal Lobes
 Inferior Occipitofrontal Fasciculus -
Frontal Lobe → Ventral Portion of Extreme Capsule → Occipital Lobe
 Inferior Longitudinal Fasciculus -
Occipital Lobe → Temporal Lobe
 Uncinate Fasciculus –
Temporal Cortex → Frontal Cortex
Ventral part connects entorhinal area and orbital area of frontal lobe
 Other Bundles
Vertical Occipital Fasciculus
Orbitofrontal Fasciculus

Commissural Fibres
 Connects centres of 2 Hemispheres
  Pass through Corpus Callosum, Anterior Commissure and Commissure of Fornix
 Corpus Callosum
 Starts with pointed rostrum
 Anterior – Curved rostral part – Genu
 Trunk
 Posterior – Splenium of Corpus Callosum
 Fibres through Genu – Connect Frontal Lobes to Minor Forceps
 Fibres through Splenium – Connect Occipital Lobes to Major Forceps
 Mainly Homotopic
 Homotopic Fibres – Connect same cortical areas in each hemisphere’s
 Heterotopic Fibres – Connect different areas
 Not all areas are connected – Somatosensory areas pertaining to hand and foot aren’t
connected
Area 18 (Optic integration area) however is very strongly connected

32.Principal regions and areas of the brain cortex.

Learn Brodmann’s Picture!!!

Motoric Cortical Areas –

4, 6 and 8
 Pre-Central Gyrus
 Area 8 controls voluntary conjugated eye movement through Fasciculatis Longitudinal
Medialis

Speech –
44, 45 – Broca’s Motor Centre
22 – Wernicke’s Sensory Centre
 Both centres are unpaired
 Both centres are interconnected by Fasciculus Arcuatus
 Speech Centres are usually localised in the left hemisphere

Primary Somatosensoric
3, 2, 1
 Post Central, Parietal Lobe

Primary Visual Area

17

Primary Acoustic Area

41 and sometimes 42
 Heschl’s Gyri, Temporal Lobe

Gustatory Cortical Area

43
 Parietal Lobe
 Olfactory Cortical Area
51
 Paleocortex, Base of Hemisphere

Secondary General + Special Sensoric Areas

General Sensoric – 5 + 7
Visual – 18 + 19
Acoustic – 22 (its post. part is Wernicke’s centre)

33.Indirect sensory pathways (proprioception).

These pathways are concerned with information from muscle spindles, tendons and joints about
muscle tone, position of limbs and body posture
There are 2 pathways
 Ventral and Dorsal Spino-Cerebellar Tract
 Spino-bulbo-celebellar Tract
They are indirect pathways i.e. Pass through Cerebellum
Ventral and Dorsal Spino-Cerebellar Tract
 1st order neuron – dorsal root ganglion
 2nd order neuron – Clarke’s nucleus
o Dorsal Spino-Cerebellar Tract → Inferior Cerebellar Peduncle → Synapses of
Purkynje cells in Cerebellar Cortex
o Ventral Spino-Cerebellar Tract → Superior Cerebellar Peduncle → Synapses of
Purkynje cells in Cerebellar Cortex
 Information from lower limbs and lower trunk
 Ventral and Dorsal Spino-Cerebellar Tract is NOT CONTRALATERAL
It crosses in 1st/2nd order neuron but crosses back before entering its peduncle

Spino-bulbo-celebellar Tract
 1st order neuron – dorsal root ganglion
o Fibres enter the spinobulbar tract of the fasciculus cuneatus (dorsal funiculi)
 2 order neuron – lateral cuneate nucleus (medulla oblongata)
nd

o Fibres from the Cuneocerebellar tract enter Inferior Cerebellar Peduncle →

Synapses of Purkynje cells in Cerebellar Cortex
 Information from upper limbs and upper trunk

34.Accessory organs of the eye.

The accessory structures of the eye are

 Eye muscles
o Internal smooth muscles
 Sphincter pupillae
 Dilatator pupillae
 o The radial muscular fibres extending from the sphincter pupillae to
the ciliary margin; some anatomists regard them as elastic, not
muscular, in humans.
 Ciliaris
o External striated muscles
 Oculomotor muscles
 Fasciae of the orbit
o Corpus adiposum orbitae
 Fatty tissue capsule
o Eyeball, optic nerve and eye muscles all embedded in this fat

o Vagina bulbi
 Connective tissue capsule
o Separates fatty capsule from the eyeball
o Covers sclera
 Eyelids
o Upper and lower eyelids demarcate the palpebral fissure
o Palpebral fissure runs to the medial corner of the eye with a recess enclosing the
Lacrimal caruncle
o Eyelids reinforced by firm plates of connective tissue know as the tarsus superior
(upper eyelid) and tarsus inferior (lower eyelid)
o Tarsal plates contain the tarsal (meibomian) glands
o They spread over the entire length of the eyelids
o Their secretions create a lipid barrier along the margin of the eyelids which
contains the normal secretions in the conjunctival sac by preventing the watery
fluid from spilling over the barrier when the eye is open
o Superior and inferior tarsal muscles attach to the tarsal plate and control the size of
the palpebral fissure
o Eyelids closed by orbicularis oris and upper eyelid is raised by the levator
palpebrae superioris

 Tunica conjunctiva
o Extends to anterior aspect of the eyeball at conjunctival fornix

 Lacrimal apparatus
o Lacrimal gland
o Lies above lateral corner of eye
o Tendon of levator palpebrae superioris divides it into orbital and palpebral part
o Excretory ducts at the conjunctival Fornix secrete Lacrimal fluid which keeps the
anterior surface of the eyeball moist
o At the inner surface of each eyelid is the Lacrimal point which leads to the
Lacrimal canaliculus
o The canaliculi ascend and descend to the Lacrimal (tear) sac
o From here the nasolacrimal duct arises which leads to the inferior nasal meatus
 o Blinking therefore ensures the eyeball is uniformly moist and also creates a
sucking effect on the flow of tears by expanding and contracting the nasolacrimal
duct

Exophthalmus – eyeball outside orbit (too much fatty tissue)

Endophthalmus – eyeball depper inside orbit (too little fatty tissue)

35.The eyeball and its layers.

Composed of 3 layers, 3 spaces

Layers
Fibrous Tunic, Vascular Tunic and Nervous layer

Fibrous Tunic – Cornea, Sclera

Cornea –
 Transparent, dome-shaped window covering the front of the eye
 Powerful refracting surface
 No blood vessels
 Extremely sensitive - more nerve endings here than anywhere else in the body.  
Sclera –
 Tough, opaque tissue
 Serves as the eye's protective outer coat
 Optic nerve is attached to the sclera at the very back of the eye

Vascular Tunic – Iris, Ciliary Body, Choroid

Iris –
 Colored part of the eye
 Controls light levels inside the eye
 Round opening in the center of the iris is called the pupil
  Sphincter muscle lie around the very edge of the pupil - dilate and constrict the pupil
size.  
Ciliary Body
 Lies just behind the iris
 Production of aqueous humor,
 Controls accommodation by changing the shape of the crystalline lens
Choroid
 Lies between the retina and sclera
 Composed of layers of blood vessels that nourish the back of the eye
 Connects with the ciliary body toward the front of the eye and is attached to edges of the
optic nerve at the back of the eye

Nervous Layer
Retina – Optic + Blind Part
Posterior Optic Part – Contains Photoreceptors – Rods and Cones
Anteror Part – Blind Part/Optic Disk – No Photorecceptors – no images can be seen in this part
Has a Ciliary and an iridial part
Borders between both parts – Ora Serrata
The retina contains 2 layers
 Pigmented stratum – the “dark chamber”
 Cerebral stratum – contains 3 layers of nerve cells – the 3 neurons of the optic pathway
Rods and cones, ganglionic layer of the retina, ganglionic layer of the optic nerve
The ganglionic cells of the retina are bipolar
Those of the optic nerve are multipolar and form the optic nerve

Regional structures
 The pars optica retina – macula lutea (yellow spot), fovea centralis
 Also the macula coeca (blind spot)
 The pars coeca retinae – this is the iris and ciliary body (blind part)

36.Anterior and posterior segments of the eye.

Anterior segment
 Transparent
 Anterior 1/6 of eyeball

Contains
 Cornea
See previous question
 Iris
 Lens
o Biconvex
 Anterior chamber
o Contains aqueous humor generated by the blood vessels of the iris
 Pupil
 Posterior chamber
 o space, filled with aqueous humor, between the iris/pupil anteriorly and the lens
and ciliary body posteriorly

Posterior segment
 Posterior 5/6 of eyeball

Contains
 Sclera
 Posterior wall – i.e. optic part of retina
 Vitreous body

37.Vascular supply and innervation of the eye.

Two different vascular systems

 Ciliary arteries
 Central retinal artery

All of these vessels arise from the ophthalmic artery

 Posterior ciliary arteries supply the vascular tunic of the eyeball, or uvea, which forms the
iris, the ciliary body and the choroidea
 This vascular tunic does not only supply blood but is also important for the maintaining
the intraocular pressure and tension of the eyeball

Long posterior ciliary arteries

 Penetrate sclera near exit of the optic nerve
 One runs in temporal wall of the eyeball
 Other in the nasal wall of the eyeball
 Both run to the ciliary body
 At the iris they form the greater arterial circle of the iris
 From here vessels radiate to the lesser arterial circle of the iris (near the pupil

Short posterior ciliary arteries

 Form the vascular plexus of the choroidea which extends from the posterior wall of the
eyeball to the ora serrata
 Inner choroid layer consists of especially wide capillaries – the choriocapillary layer and
borders on the pigmented epithelium of the retina

Anterior ciliary arteries

 Run from the rectus muscles to the sclera
 Here they branch in the episcleral tissue and in the conjunctiva
 In the conjunctiva they form the marginal loops around the margin of the cornea

Central retinal artery

 Enters optic nerve about 1cm behind eyeball
 Extends in middle of nerve to the papilla of the optic nerve
  Then divides into branches that run along the retina within the layer of nerve fibres
 The venules (take same course as arteries) combine to form the central vein of the retina
which takes a similar path to the central artery

Veins
 Central vein of the retina – see above
 4 posterior ciliary veins which obliquely penetrate sclera at the posterior surface of the
eyeball
 Posterior ciliary veins = Vorticose veins
 They drain into the superior and inferior ophthalmic veins which subsequently drain into
the cavernous sinus and pterygoid plexus respectively

Innervation
 Motor
 Oculomotor nerve
 Abducens
 Trochlear
 Sensory
 Trigeminal
 Special sensory
 Optic

Sympathetic innervation is given by the spinal cord (Intermediomedial nucleus – C8-T1 known
as the ciliospinal centre) – runs through the sympathetic trunk. Runs via the superior cervical
ganglion to the dilatator pupillae and causes mydriasis

Parasympathetic innervation is given by the oculomotor nerve from the Edinger-Westphal

nucleus via the ciliary ganglion. Innervates the Ciliaris (accommodation of the lens) and the
sphincter pupillae – controls miosis)

38.External ear.

 Consists of the auricle and the external acoustic meatus

 Auricle (use page 363)
o Also called the pinna
o Contains a scaffold of elastic cartilage (except in the lobule)
o Shapes of the auricular projections differ from person to person and are
genetically determined
o Following structures inherited:
 Helix
 Antihelix
 Scapha
  Concha
 Tragus
 Antitragus
 Triangular fossa

In the past features of the auricle were of special importance for establishing paternity

External acoustic meatus

 Outer ear canal
 Formed by a groove like continuation of the auricular cartilage
 Completed with connective tissue to form a uniform passage
 Passage is lined with epidermis and there are large ceruminous (release wax) glands
beneath
 Ends with the eardrum (tympanic membrane)
 This is obliquely placed in the meatus
 When viewed from the outside the mallear stria can be recognised, it is caused by
attachment of the manubrium of the malleus
 The malleus reaches the umbo of the tympanic membrane – the innermost point of the
funnel shaped eardrum
 Above the upper end of the mallear stria lies a lax, thin part of the eardrum (the pars
flaccida)
 The pars flaccida is separated from the firm grey and shiny pars tensa by 2 mallear folds.
 Outside of eardrum covered by skin, inside by mucosa

39.Middle ear.

Consists of the tympanic cavity, the mastoid cells and the auditory tube

Tympanic cavity
 Narrow, vertical space with the eardrum obliquely placed in its lateral wall
 The medial wall has 2 openings
o Cochlear (oval) window
o Vestibular (round) window
 Roof (tegmental wall) is relatively thin and borders on the surface of the petrous pyramid
 Floor is formed by a thin layer of bone beneath which runs the jugular vein
 Continues in the anterior direction as the auditory tube
 Its superior part opens into the mastoid antrum, a round space into which numerous small
cavities open
 These are the mastoid air cells
 They are air containing cavities lined with mucosa that form a system of chambers that
penetrates the entire mastoid bone, and they may even extend into the petrous bone

Auditory ossicles
  The 3 auditory ossicles or ear bones together with the eardrum form the sound conducting
apparatus
 They are
o The hammer (malleus)
 Manubrium is firmly attached to the eardrum and connected by its neck to
the head of the malleus
 Malleus has a saddle shaped articular surface that connects to the body of
the incus
o The anvil (incus)
 Its lenticular process which is attached to the long limb of the incus and
projects at a right angle, has the articular surface for the head of the stapes
o The stirrup (stapes)
 Footplate closes vestibular window
 Attached at margin by annular ligament of the stapes
 Several ligaments attached to the wall of the tympanic cavity retain the
ossicles in position.
 The ossicles transfer vibrations of the tympanic membrane produced by
sound waves
 This causes the hammer and incus to act as an angular lever and the stapes
undergoes a tilting movement
 Foot of the stapes transmits the waves to the fluid in the internal ear
 The mucous membrane lining the tympanic cavity forms a number of folds
 Amongst these folds are the posterior and anterior malleolar folds which
cover the chorda tympani
 Also a membranous pocket – the superior recess of the tympanic
membrane (Prussak’s cavity)
 Lies between the pars flaccida of tympanic membrane and the neck
of the malleus
 Of clinical importance as it is a site of infections
Medial wall of the tympanic cavity
 Divides tympanic cavity from the inner ear
 Promontory in the middle is formed by the basal convolution of the cochlea
 In the sulcus of the promontory lies the tympanic plexus
o This is formed by the tympanic nerve (from Glossopharyngeal nerve), and the
sympathetic fibres of the carotid plexus
 Promontory is lined by tympanic air cells
 Oval and round windows open into the inner ear
 Stapes rests on oval window and closes it with its foot plate
 Round window is closed by the secondary tympanic membrane
 Posterior wall opens into mastoid antrum
 Behind the posterior wall is the 2 canals run in an arched manner
o Facial canal
o Semilunar canal
 These form swellings in the tympanic cavity (the promontory of the facial canal and that
of the Semilunar canal)
  The medial wall at the level of the openings separates the tympanic cavity from the
carotid canal
 The floor divides it from the jugular fossa

NB – the floor and the roof the tympanic cavity (both bone) may be very thin and so an infection
of the middle ear can penetrate through them. Through the roof this can progress to the meninges
and brain (causing meningitis or a cerebral abscess in the temporal lobe), through the floor to the
jugular vein (causing jugular thrombosis)

Muscles of the tympanic cavity

 Tensor tympani muscle
o Arises from the cartilaginous wall of the tube and from the bony wall of the canal
o Narrow tendon bends away from the cochlear process and is attached to the handle
of the malleus
o Innervated by the nerve to the tensor tympani from the mandibular nerve
o Function – pulls the eardrum inward and pushes foot of stapes into the vestibular
window
o This increases the sensitivity of the transmission
 Stapedius muscle
o Arises in a small bony canal which usually communicates with the facial canal
o Fine tendon passes through the opening in the pyramidal eminence to attach to the
head of the stapes
o Innervated by the facial nerve
o Function – levers the foot plate of the stapes out of the oval window and thus
dampens transmission

These muscles are therefore antagonists

Paralysis of the facial nerve therefore causes a loss of the dampening of sound and the patient
will have “hyperacusis” which is n increased sensitivity to sound

40.Internal ear.

 Consists of the bony labyrinth which contains

o The membranous labyrinth
o The internal acoustic meatus

Membranous labyrinth
 System of membranous vesicles and canals which are surrounded on all sides by a very
hard bony capsule
 A bony and a membranous labyrinth are differentiated
 Bony labyrinth contains a clear aqueous fluid – the perilymph - in which the membranous
labyrinth is suspended
 Perilymphatic space connects with the subarachnoid space via the perilymphatic duct at
the posterior margin of the petrous bone
 Membranous labyrinth contains a viscous fluid – the endolymph
Oval (vestibular) window
 Closed by the stapes
 Leads to the vestibule
 The vestibule is the midpart of the bony labyrinth
 Anteriorly the vestibule merges into the bony cochlea
 Posteriorly it opens onto the 3 semicircular canals
 The vestibule itself contains 2 membranous structures – the sacculus and the utriculus
 In these regions, a circumscribed area contains sensory epithelium known as the macula
sacculi and the macula utriculi
 These communicate via the utriculosaccular tract

Cochlea
 Has about two and half convolutions
 Bony structure
 Its canal is the spiral cochlear canal containing the membranous cochlear duct
 Cochlear duct goes to a blind end called the vestibular caecum and terminates in the
cupula as the caecum cupulare
 Above and below the duct are the perilymphatic spaces
o Above is the scala vestibule which opens into the vestibule
o Below is the scala tympani which terminates at the oval window

Semicircular canals
 Emanate from the vestibule
 Contain the membranous semicircular ducts
o These communicate with the utriculus
o Surrounded by perilymph
o Attached to the walls of the perilymphatic space by connective tissue fibres
o Arranged at right angles to each other

Superior semicircular duct

 Convexity directed towards the superior surface of the pyramid of the petrous bone
Posterior semicircular duct
 Is parallel to the posterior surface of the petrous bone

Lateral duct
 Horizontal

Each duct has an enlargement – the membranous ampulla at one of its connections to the
utriculus
Anterior and posterior canals join to form a common limb – the common crus
Each ampulla contains sensory epithelium – the crista ampullaris
 NB – the courses taken by the semicircular ducts do not match the axes of the body. Superior and
posterior ducts diverge at an angle of 45% from the medial and frontal planes. The lateral canal is
tilted 30% posterolaterally from the horizontal plane.

41.Cervical plexus.

 Anterior branches of C1-C4

 Following nerves originate here
o Lesser occipital nerve
o Greater auricular nerve
o Transverse nerve of the neck
o Supraclvicular nerves
o Phrenic nerve
o Roots of the cervical ansa

Anterior branches
 Innervation of muscles
o Short nerves run from the anterior branches to the deep muscles of the neck, i.e.
the anterior and lateral rectus, the rectus capitis and the long muscle of the head
and the long muscle of the neck
o From the anterior branch of C4 nerves run to the upper part of the anterior scalene
muscle and the medial scalene muscle
o Anterior branches of C1-C3 form the deep cervical ansa
 Fibres from C1 and C2 temporarily appose the hypoglossal nerve
 They then leave it as the superior root (of the deep cervical ansa)
 The fibres for the Thyrohyoid and the geniohyoid muscles continue with
the hypoglossal nerve
 The superior root then merges with the inferior root (from C2 and C3) to
form the cervical ansa, which supplies the Infrahyoid muscles
 These are
 Omohyoid, sternothyroid and Sternohyoid muscles.

Innervation of the skin

 Sensory nerves of the plexus pass behind the Sternocleidomastoid muscle
 Through the fascia where they form the punctum nervosum
 From here the nerves spread out over the head and neck
 Branches of the anterior branches
o Lesser occipital nerve
 C2, C3
 Runs to occiput
o Greater auricular nerve
 C3
 To area surrounding ear (auricula, mastoid process and the region of the
mandibular angle)
 o Transverse nerve of the neck
 C3
 Supplies upper neck region up to chin
o Supraclvicular nerves
 C3, C4
 Supply the subclavicular fossa and shoulder region

Area innervated by the phrenic nerve

o C3, C4
o Crosses anterior scalene muscle and enters to superior thoracic aperture in front of
subclavian artery
o Extends through mediastinum to diaphragm
o Gives off fine branches for sensory supply to the pericardium (the pericardiac branches)
o At surface of the diaphragm it branches out and supplies all the muscles of the diaphragm
o It also gives off fine fibres for sensory innervation of the membranes bordering on the
diaphragm (i.e. cranially – pleura, caudally – peritoneum)

NB – injury to the spinal roots C3 – C5 or injury to the cervical spinal cord, cause paralysis of the
diaphragm and hence in reduced respiration. Paralysis of the thoracic muscles however
respiration can still be maintained as the phrenic nerve from the cervical spinal cord

Posterior branches
o Supply motor fibres to the neck muscles belonging to the autochthonous muscles of the
back
o Also sensory fibres to the skin of the neck
o Posterior branch of C1 is exclusively motor and runs as the suboccipital nerve to small
muscles in the region of the occiput, atlas and axis.
o Greater occipital nerve runs from C2 to the occiput and supplies the skin up to the vertex
o Posterior branch of C3 runs as 3 rd occipital nerve and supplies sensory fibres to the neck
region
o Remaining posterior branches of the cervical spinal nerves supply sensory fibres to the
skin area bordering caudally and motor fibres to the autochthonous muscles of this region.

42. Brachial plexus and its ramification. Supra- and infraclavicular branches of
Brachial plexus

 Begins from 5 segments of the spinal cord

 C5-T1
 Anterior branches pass through scalene gap
 These 5 roots form 3 trunks
o Superior
o Middle
o inferior
 3 trunks branch and eventually form 3 cords
 o Lateral
o Medial
o posterior
 The cords then branch off into the nerves
 The trunks form the supraclavicular part
 The cords form the infraclavicular part

Supraclavicular part
o Gives rise to motor nerve for the muscles of the shoulder girdle
o Following nerves run to the posterior and lateral surfaces of the thoracic
o Dorsal scapular nerve
 C5
 To scapular muscle and rhomboid major and minor muscles
o Long thoracic nerve
 C5-C7
 Branches terminate at the lateral thoracic wall on the peaks of the serratus
anterior
o Thoracodorsal nerve
 C7, C8
 Supplies the latissimus dorsi
o Suprascapular nerve
 C5, C6
 Posterior surface of the supra- and infraspinatus
o Subscapular nerve
 C5-C7
 Anterior surface of the above muscles
o Subclavius
 C4-C6
 Supplies the Subclavius muscle
o Lateral (C5-C7) and medial (C7-T1) pectoral nerves
 Supply pectoralis major and minor

Infraclavicular part
 Gives rise to the cords
43.Branches of the posterior cord of the brachial plexus.

The posterior cord divides into 4 branches

 Radial nerve
o Supplies extensor muscles of the upper arm and the forearm
o Trunk extends from axilla into proximal 1/3 of the medial bicipital sulcus
o Passes to flexor side between brachial muscle and Brachioradialis muscle
o Can be easily injured by bone fractures due to its proximity to the bone
o Divides at head of radius into its terminal branches – deep and superficial
o Superficial branch continues on medial surface of Brachioradialis muscle
o Deep branch goes to the back of the hand
o Gives off posterior cutaneous nerve of the arm which supplies the skin area on the
extensor side of the upper arm
o Also gives inferior lateral cutaneous nerve of the arm
o Injury to the min nerve trunk results in paralysis of the extensor muscles
o This mainly affects the hand causing wrist drop
o

 Axillary nerve
o Runs deep inside the axilla and across capsule of shoulder joint
o Passes through lateral axillary gap and extends beneath the deltoid muscle to its
anterior margin
o Before passing through axillary gap it gives off motor fibres to teres minor muscle
o This muscle also passes through the lateral axillary gap
 o Lateral cutaneous nerve of the arm branches off at this level and supplies the skin
at the posterior margin of deltoid muscle
o As a result of the location on the capsule of the shoulder joint, this nerve can be
injured by dislocation of the humerus or humeral neck fracture.
o This causes anaesthesia in the skin covering the deltoid

44.Branches of the medial cord of the brachial plexus.

 Ulnar nerve
o Initially runs in the medial bicipital sulcus without giving off any branches in the
upper arm
o Crosses elbow joint on the extensor side of the arm
o Lies in sulcus for the ulnar nerve in the medial epicondyle of the humerus
o Then pass between the 2 heads of the flexor carpi ulnaris to the flexor side of the arm
o Does not pass through the carpal canal but passes over the flexor retinaculum to the
palm of the hand
o In forearm gives off nerves to the flexor carpi ulnaris and the ulnar half of the deep
flexors
o A sensory branch, the dorsal branch of the ulnar nerve branches off in the middle of
the forearm and runs to the ulnar side of the back of the hand where it supplies the
skin
o Also the palmar branch of the ulnar nerve extends to the palm where it supplies the
skin of the hypothenar eminence
o Damage causes formation of a claw hand where fingers are extended in the
metacarpophalangeal joints but flexed in the proximal and distal interphalangeal joints
 Medial brachial cutaneous nerve
o Approaches anterior surface of the arm below axillary fossa
o Here it supplies the skin of the medial aspect between the axilla and the elbow joint
o Reaches both sides of the forearm via posterior and anterior branches
o Frequently anastomosis with the intercostobrachial nerve
 Medial antebrachial cutaneous nerve
o Runs below fascia on the ulnar side of the forearm and passes in the lower 1/3 through
fascia with 2 branches
o Anterior branch
 Supplies the medial flexor side of the forearm almost upto the midline
o Ulnar branch
 Supplies upper region of the medial extensor side almost up to the midline

45.Branches of the lateral cord of the brachial plexus.

Lateral cord has 2 branches

 Musculocutaneous nerve
o Runs through coracobrachialis muscle
 o Between the biceps and the Brachialis muscles as far as the elbow
o Gives off branches to the flexor muscles of the upper arm
 Coracobrachialis
 both heads of the biceps muscle
 Brachialis muscle
o Sensory fibres of the nerve t the elbow pas through the fascia onto the surface
o As the lateral antebrachial cutaneous nerve supplies the skin in the lateral part of the
forearm
o Damage causes sensory loss in a small region of the elbow
o Diminished sensibility extends as far as the middle of the forearm
 Median nerve
o Median loop formed on anterior surface of axillary artery by parts of the lateral and
medial cords
o These two parts join to form the median nerve
o Runs to elbow in medial bicipital sulcus
o Reaches forearm between the 2 heads of the pronator teres muscle
o Extends to wrist between the flexor digitorum superficialis and profundus
o Before entering carpal canal it lies superficially between the tendons of the palmaris
longus and the flexor carpi radialis
o In carpal canal it divides into its terminal branches
o Supplies
 Pronators and most of the flexors of the forearm
 Pronator teres
 Flexor carpi radialis
 Palmaris longus
 Radial and humeroulnar head of the flexor digitorum superficialis
o Anterior antebrachial interosseus nerve branches off at the elbow and runs on interosseus
membrane to the pronator quadratus
o Gives off branches pollicis longus and the radial part of the flexor digitorum profundus
o In lower 1/3 of the forearm the sensory palmar branch of the median nerve passes to the
skin of the ball of the thumb, radial side of the wrist and the palm of the hand
o At the head of the wrist joint there is always an anastomosis with the ulnar nerve
o Damage of this nerve makes pronation of the forearm impossible
o Also flexion is very restricted
o In the hand the middle phalanges of the thumb, index and middle fingers cannot be flexed
o This is a characteristic indication of median nerve paralysis – the so called hand of
benediction
o When the nerve enters the carpal canal pressure damage can occur in elderly patients (this
is known as carpal tunnel syndrome)

46.Intercostal nerves.

Each thoracic spinal nerve divides into a posterior and an anterior branch
 Anterior branches run as the intercostal nerves
 Run initially on the inner surface of the thorax
 Later within the intercostal muscles
 Distinguish 2 groups – upper and lower
 Upper group (T1-T6)
o Run to the sternum and supply intercostal muscles
o Also supply the serratus posterior (both the superior and inferior) and the thoracis
transversus
o Give sensory branches to the skin of the thorax
o Lateral cutaneous branches
 At anterior margin of the serratus anterior

o Anterior cutaneous branches
 Close to the sternum

 Lower group
o T7-T12
o Nerves no longer end at the sternum
o Extend across the costal cartilages up to the white line
o Take an increasingly oblique downward path
o Eventually supply some of the abdominal muscles, namely
 Transversus abdominis
 Internal and external oblique
 Rectus abdominis
 Pyramidalis

NB – intercostal nerve participates in the brachial plexus. It sends only a thin branch to the
intercostal space. IC nerve 2 (and often 3) gives off lateral cutaneous branches to the upper arm
(intercostobrachial nerves) where it connects with the medial cutaneous nerve of the arm. Also
the last nerve is often known as the subcostal nerve (12 th nerve – below 12th rib) and runs
obliquely downwards across the iliac crest

47.Lumbar and sacral plexus.

 Formed by the anterior branches of the lumbar and sacral spinal nerves
 Branches provide sensory and motor innervation to the lower limb
 L1-L3 and part of L4 form lumbar plexus
 Remainder of L4, and L5 join to form lumbosacral trunk which joins S1-S3 to form sacral
plexus

Lumbar plexus

 Roots lie within the psoas muscle
 Gives direct short muscular branches to the hip muscles – greater and lesser psoas,
quadratus lumborum, and also the lumbar intercostal muscles
 Upper nerves of the plexus are arranged roughly in the same way as the intercostal nerves
 Branches
o Iliohypogastric nerve
 Runs inside quadratus lumborum
 Arises from the first lumbar nerve.
 emerges from the upper part of the lateral border of the Psoas major, and
 Crosses obliquely in front of the Quadratus lumborum to the iliac crest. It
 then perforates the posterior part of the Transversus abdominis, near the
crest of the ilium, and
 divides between that muscle and the Obliquus internus abdominis into a
lateral and an anterior cutaneous branch.
o Genitofemoral nerve
 . arises from the first and second lumbar nerves. It
 passes obliquely through the substance of the Psoas major, and emerges
from its medial border, close to the vertebral column, opposite the
fibrocartilage between the third and fourth lumbar vertebræ;
 it then descends on the surface of the Psoas major, under cover of the
peritoneum, and
 divides into the external spermatic and lumboinguinal nerves.
 Occasionally these two nerves emerge separately through the substance of
the Psoas.
o Lateral cutaneous nerve of the thigh
 pierces the Obliqui internus and externus immediately above the iliac crest,
and is
 distributed to the skin of the gluteal region, behind the lateral cutaneous
branch of the last thoracic nerve
 the size of this branch bears an inverse proportion to that of the lateral
cutaneous branch of the last thoracic nerve
o Femoral nerve
 largest branch of the lumbar plexus,
 arises from the dorsal divisions of the second, third, and fourth lumbar
nerves. It
 descends through the fibers of the Psoas major, emerging from the muscle
at the lower part of its lateral border, and
 passes down between it and the Iliacus, behind the iliac fascia; it
 then runs beneath the inguinal ligament, into the thigh, and splits into an
anterior and a posterior division.
 Under the inguinal ligament, it is separated from the femoral artery by a
portion of the Psoas major.
 Within the abdomen the femoral nerve gives off small branches to the
Iliacus, and a branch which is distributed upon the upper part of the
femoral artery; the latter branch may arise in the thigh
  In the thigh the anterior division of the femoral nerve gives off anterior
cutaneous and muscular branches. The anterior cutaneous branches
comprise the intermediate and medial cutaneous nerves
 The intermediate cutaneous nerve
 pierces the fascia lata (and generally the Sartorius) about 7.5 cm.
below the inguinal ligament, and
 divides into two branches which descend in immediate proximity
along the forepart of the thigh, to supply the skin as low as the front
of the knee.
 Here they communicate with the medial cutaneous nerve and the
infrapatellar branch of the saphenous, to form the patellar plexus.
 In the upper part of the thigh the lateral branch of the intermediate
cutaneous communicates with the lumboinguinal branch of the
genitofemoral nerve
 The medial cutaneous nerve (
 passes obliquely across the upper part of the sheath of the femoral
artery, and divides in front, or at the medial side of that vessel, into
two branches, an anterior and a posterior.
 The anterior branch
 runs downward on the Sartorius,
 perforates the fascia lata at the lower third of the thigh, and
 divides into two branches: one supplies the integument as low
down as the medial side of the knee;
 the other crosses to the lateral side of the patella, communicating
in its course with the infrapatellar branch of the saphenous nerve.
 The posterior branch
 descends along the medial border of the Sartorius muscle to the
knee, where it pierces the fascia lata,
 communicates with the saphenous nerve, and gives off several
cutaneous branches. It then
  passes down to supply the integument of the medial side of the leg.
Beneath the fascia lata, at the lower border of the Adductor longus,
it joins to form a plexiform net-work (subsartorial plexus) with
branches of the saphenous and obturator nerves.
 When the communicating branch from the obturator nerve is large
and continued to the integument of the leg, the posterior branch of
the medial cutaneous is small, and terminates in the plexus,
occasionally giving off a few cutaneous filaments.
 The medial cutaneous nerve, before dividing, gives off a few
filaments, which pierce the fascia lata, to supply the integument of
the medial side of the thigh, accompanying the long saphenous
vein. One of these filaments passes through the saphenous opening;
a second becomes subcutaneous about the middle of the thigh; a
third pierces the fascia at its lower third
o Obturator nerve
 arises from the ventral divisions of the second, third, and fourth lumbar
nerves;
 the branch from the third is the largest, while that from the second is often
very small.
 It descends through the fibers of the Psoas major, and emerges from its
medial border near the brim of the pelvis; it then
 passes behind the common iliac vessels, and on the lateral side of the
hypogastric vessels and ureter, which separate it from the ureter, and runs
along the lateral wall of the lesser pelvis, above and in front of the
obturator vessels, to the upper part of the obturator foramen.
 Here it enters the thigh, and divides into an anterior and a posterior branch,
which are separated at first by some of the fibers of the Obturator externus,
and lower down by the Adductor brevis.
 anterior branch
 leaves the pelvis in front of the Obturator externus and
 descends in front of the Adductor brevis, and behind the Pectineus
and Adductor longus;
 at the lower border of the latter muscle it communicates with the
anterior cutaneous and saphenous branches of the femoral nerve,
forming a kind of plexus.
 It then descends upon the femoral artery, to which it is finally
distributed.
 Near the obturator foramen the nerve gives off an articular branch
to the hip joint.
 Behind the Pectineus, it distributes branches to the Adductor longus
and Gracilis, and usually to the Adductor brevis, and in rare cases
to the Pectineus; it
 receives a communicating branch from the accessory obturator
nerve when that nerve is present
 posterior branch
  pierces the anterior part of the Obturator externus, and supplies this
muscle; it
 then passes behind the Adductor brevis on the front of the Adductor
magnus, where it divides into numerous muscular branches which
are distributed to the Adductor magnus and the Adductor brevis
when the latter does not receive a branch from the anterior division
of the nerve.
 It usually gives off an articular filament to the knee-joint.

48.Cranial nerves.
49.I. and II. CN.

I. Olfactory nerves (not true peripheral nerve)

 Leaves brain – olfactory bulb
 Leaves skull – cribriform plate
 Function – smell
 Fibres – all special sensory

 Short fibres from the upper 1/3 of the nasal cavity

 In the roof, superior concha and the upper part of the nasal septum
 The axons of the bipolar neurons in the olfactory epithelium enter the foramina of the
cribriform plate (ethmoid bone) to the olfactory bulb.

Olfactory tract
 1st neuron – bipolar sensory cells in the nasal mucosa
 2nd neuron – mitral (multipolar) cells of the olfactory bulb – olfactory tract
o There is a projection to many areas of the brain (amygdale and limbic system)
o For smell, emotional responses and also the evocation of reflexes such as
salivation and secretion of digestive juices.

II. Optic nerve

 Leaves brain – Diencephalon
 Leaves skull – optic canal
 Function – use your imagination
 Fibres – all special sensory

 Not a true peripheral nerve

 It develops from the diencephalon
 Runs from the dorsal surface of the eyeball to the optic chiasma (where it becomes the
optic tract) through the optic canal
 The optic nerve consists of axons from multipolar cells in the retina
  It is covered by derivatives of the meninges
 The central retinal vessels enter the optic nerve about 1 cm from the eyeball

Optic pathway

The fibres begin from the retina, enter the optic nerve and continue from the optic chiasma as
the optic tract to the diencephalon and to the visual cortical centres
 1st neuron – rods and cones (photoreceptors in retina)
 2nd neuron – bipolar cells (also in retina)
 3rd neuron – multipolar cells (also in the retina)
 4th neuron – lateral geniculate body in the metathalamus

These fibres run to Brodman’s area 17, 18 and 19

The optic tract contacts with the superior colliculi (the tectum of the midbrain) – here are the
controls of the oculomotor reflexes
The Oculomotor reflexes are vegetative (i.e. miosis (contraction of the pupil) and mydriasis
(dilation))

50.III., IV, and VI. CN.

III. Oculomotor nerve

 Leaves brain – Midbrain

 Leaves skull – superior orbital fissure
 Function – movement of medial, superior and lateral recti and also the inferior oblique
muscle and the levator palpebrae superioris
 Fibres – Motor (both kinds)

 Contains both somatomotor and visceromotor fibres

 The motor nucleus in the midbrain – at the level of the superior colliculi – controls
innervation of the external (striated) oculomotor muscles
 This controls movement of the eyeball
 It innervates the rectus medialis, superior and inferior
 Also the obliquus inferior and the levator palpebrae superioris
 The Edinger-Westphal nucleus
o Visceromotor nucleus- parasympathetic innervation
o For smooth muscles inside the eye (intraocular)
o Sphincter pupillae (constriction of the pupil)
o Ciliaris (accommodation of the lens)
o The 2nd neuron in this pathway is in the ciliary ganglion in the orbit

IV. Trochlear nerve

  Leaves brain – Midbrain
 Leaves skull – superior orbital fissure
 Function – innervation of superior oblique muscle
 Fibres – somatomotor

 Exclusively somatomotor fibres

 Nucleus in the midbrain at the level of the inferior colliculi
 It is only for the innervation of the superior oblique muscle
 It is the only nerve to leave the midbrain from the dorsal side
 It turns ventrally and enters the cavernous sinus and the orbit via the superior orbital
fissure

VI. Abducens nerve

 Leaves brain – pons

 Leaves skull – superior orbital fissure
 Function – innervation of lateral rectus (abduction of eyeball)
 Fibres – somatomotor

 Somatomotor nerve
 Nucleus in the pons
 Innervates the lateral rectus muscle (for abduction of the eyeball)
 It emerges from the pons and enters the cavernous sinus and the superior orbital fissure

51.V CN.

V. Trigeminal nerve

 Leaves brain – pons

 Leaves skull – see individual branches
 Function – sensory innervation of face and motor innervation of masticatory muscles
 Fibres – all

 It is a somatomotor and a Somatosensory nerve (it has 2 nuclei – 1 motor and 1 sensory)
 It leaves the pons, enters the sensory ganglion (the Gasserian ganglion) and divides into 3
branches

V/1 – the ophthalmic nerve (sensory)

V/2 – the maxillary nerve (sensory)
V/3 – the mandibular nerve (motor and sensory)
The sensory fibres

Pseudounipolar cells in the Gasserian ganglion

 Peripheral processes take sensory information from the facial region
 The central processes end in the sensory trigeminal nucleus
 These fibres are for protopathic sensation (go to the spinal part of the nucleus)
 But also for epicritic sensation (go to the pontine part of the nucleus)

Proprioception from the masticatory muscles – the fibres directly enter the pseudounipolar cells
of the mesencephalic nucleus

Motor fibres come from the motor nucleus of the trigeminal nerve.

V/1 Ophthalmic nerve

 Leaves skull – superior orbital fissure

 Function - innervation of the orbit, frontal and sphenoidal sinuses, the nasal septum and
also the skin of the forehead

Branches
 Lacrimal nerve
o Runs to the Lacrimal gland
o Also innervates the skin of the lateral corner of the eye
 Frontal nerve
o Divides into the supratrochlear nerve (for the medial corner of the eye) and the
supraorbital nerve (goes through the supraorbital notch – innervates the upper
eyelid and the skin of the forehead)

 Nasociliary nerves
o Runs to medial corner of the eye, which it supplies with its terminal branch The
infratrochlear nerve
o It also gives off the following branches
 Long ciliary nerves to the eyeball
 Posterior ethmoidal nerve to the sphenoidal and ethmoidal sinuses
 Anterior ethmoidal nerve – runs through the anterior ethmoidal foramen to
the nasal cavity to supply the skin of the dorsum and the tip of the nose

V/2 maxillary nerve

 Leaves skull - foramen rotundum (enters the pterygopalatine fossa)
 Branches
o Zygomatic nerve
 Runs through the inferior orbital fissure to the lateral wall of the orbit.
Contains fibres from the pterygopalatine ganglion to the Lacrimal gland
  Also gives off zygomaticotemporal branch (to the temple) and the
zygomaticofacial branch (to the skin over the Zygomatic arch
o Infraorbital nerve
 Reaches through the inferior orbital fissure into the orbit
 Then through the infraorbital canal to the cheek
 Supplies skin between the lower eyelid and the upper lip
 Gives off posterior superior alveolar nerves (for the molar teeth), middle
superior alveolar nerves (for the premolar teeth) and the anterior superior
alveolar nerves (for the incisors)
 The superior alveolar nerves form the superior dental plexus
o There are also ganglionic branches, these are 2 or 3 fine filaments running to the
pterygopalatine ganglion
o They provide sensory innervation to the upper pharynx, nasal cavity and the hard
and soft palate

V/3 Mandibular nerve

 Leaves skull - foramen ovale
 Gives off a meningeal branch in the infratemporal fossa
 Then divides into the
o Auriculotemporal nerve
 Supplies the temporal skin, external acoustic meatus and the tympanic
membrane
 Usually originates from 2 roots which embrace the middle meningeal
artery and then unite to form the nerve
o Lingual nerve
 Descends in an arch to the base of the tongue
 Supplies sensory fibres to the anterior 2/3 of the tongue
 Receives taste fibres from the chorda tympani (facial nerve)

o Inferior alveolar nerve

 Contains motor fibres for the mylohyoid muscle and the anterior belly of
the digastric muscle
 Also contains sensory fibres which enter the mandibular canal and give off
numerous inferior dental branches for the teeth of the lower jaw
 Main branch – the mental nerve
 Runs through the mental foramen
 Supplies sensory fibres to the chin, lower lip and the skin over the body of
the mandible
o Buccal nerve
 Passes through the buccinator muscle to supply the mucosa of the cheek
o Pure motor branches
 Leave mandibular nerve shortly after its passage through the foramen
 Masseteric nerve – for the masseter muscle
 The deep temporal nerve – for temporal muscle
 Pterygoid nerves – for the pterygoid muscles
Run to otic ganglion  Motor fibres for tensor tympani muscle
  Motor fibres for the tensor muscle of the velum palatinum

52.VII CN.

VII. Facial nerve

 Leaves brain – pons
 Leaves skull – internal acoustic meatus
 Function – motor innervation of mimetic muscles (muscles of facial expression), taste
fibres for tongue, motor innervation of Lacrimal, Submandibular and sublingual glands
 Fibres – sensory and motor

 Supplies motor fibres to the muscles of facial expression (mimetic muscles)

 Also carries nerve fibres for taste and parasympathetic fibres

Motor fibres
 Originate from the nucleus of the facial nerve (multipolar neurons)
 Fibres arch around nucleus of Abducens (forming internal genu of the facial nerve)
 They emerge on lateral aspect of the medulla oblongata at the lower border of the pons
(bulbopontine)

Cells of the preganglionic fibres form the superior salivatory nucleus

Taste fibres originate from pseudounipolar cells in the geniculate ganglion and terminate in the
solitary nucleus

 The visceromotor fibres and the taste fibres do not arch around the abducens nucleus
 They join the ascending limb of the nerve
 They emerge as the intermediate nerve between the facial nerve (VII) and the
vestibulocochlear nerve (VIII)

Both parts of the facial nerve pass through the internal acoustic meatus and enter the facial canal
as a trunk

 At the bend of the facial nerve (external genu of the facial nerve) in the petrous bone, in
the facial canal there is a ganglion (the geniculate ganglion)
 The facial canal lies above the tympanic cavity
 It turns caudally towards the stylomastoid foramen
 The nerve leaves via the stylomastoid foramen and ramifies in the parotid gland (parotid
plexus)
 The facial nerve does not innervate the parotid gland

Branches
 Inside the facial canal the facial nerve gives off 3 branches
 Greater petrosal nerve
o Contains preganglionic fibres Lacrimal, palatine and nasal glands
 o Extends from the geniculate ganglion to the pterygopalatine ganglion via the
hiatus for the lesser petrosal nerve, across the petrous bone, through the foramen
lacerum.
 Stapedius nerve
o Supplies the Stapedius muscle in the middle ear
 Chorda tympani
o Branches off above stylomastoid foramen
o Runs through the tympanic cavity and then to the petrotympanic fissure and joins
the lingual nerve to supply taste fibres to the anterior 2/3 of the tongue.
o Also contains preganglionic fibres for the Submandibular and sublingual glands.

Before entering the parotid gland it gives off the posterior auricular nerve as well as branches to
the anterior belly of the digastric muscle and also the stylohyoid muscle.

53.VIII CN.

VIII. Vestibulocochlear nerve

 Leaves brain – pons
 Leaves skull – internal acoustic meatus
 Function - hearing and information from the organ of balance
 Fibres – sensory

 Afferent nerve consisting of 2 components

 Cochlear root (for organ of hearing) and the vestibular root (for the organ of balance)
 Leaves midbrain through the cerebellopontine angle

Cochlear root
 Nerves originate from the bipolar cells in the spiral ganglion in the cochlea
 Peripheral processes terminate at the hair cells of corti’s organ
 The central processes form small bundles that organise into the foraminous spinal tract
and combine in the floor of the inner auditory canal (internal acoustic meatus) to form the
cochlear root
 This extends with the vestibular root through internal acoustic meatus into the cranial
cavity
 At the entrance to the medulla oblongata at the cerebellopontine angle the cochlear
component lies dorsally with the vestibular component ventrally
 Cochlear fibres terminate in the anterior and posterior cochlear nucleus
 From the anterior nucleus the fibres cross over to the opposite side (the trapezoid body)
 After synapsing in the trapezoid nucleus they ascend in the lateral lemniscus
 The fibres from the posterior cochlear nucleus also cross as medullary striae just below
the rhomboid fossa and also ascend in the lateral lemniscus (the central auditory tract.)

Vestibular root
 Nerve fibres originate from bipolar neurons of the vestibular ganglion
  This lies in the internal acoustic meatus
 Peripheral processes end in the sensory epithelia of the semicircular ducts, the saccule and
the utricle.
 Central processes unite to form the vestibular root
 Terminate, after dividing into ascending and descending branches, in the vestibular nuclei
of the medulla oblongata
 A small portion reaches the cerebellum via the inferior cerebellar peduncle
 Vestibular nuclei lie on the floor of the 4th ventricle (rhomboid fossa)
 Superior, medial, lateral and inferior nuclei
 Primary fibres terminate mainly in the medial nucleus
 Secondary fibres run from the vestibular nuclei to the cerebellum and spinal cord
(Vestibulospinal tract)
 Function of vestibular apparatus
o Plays important role in balance and upright posture
o Vestibulospinal tract has an effect on the muscular tension in various parts of the
body
o Vestibular apparatus especially controls movements of the head and fixation of
vision during movement (via tracts to the eye muscle nuclei)

54.IX, X CN.

IX. Glossopharyngeal nerve

 Leaves brain – medulla oblongata

 Leaves skull – jugular foramen
 Function – sensory innervation of tongue and middle ear, motor innervation of pharynx
 Fibres – motor and sensory

 Supplies sensory fibres to the middle ear, areas of the tongue and the pharynx
 Also contains motor fibres for the muscles of the pharynx
 Emerges from the medulla oblongata behind the olive, right above the vagus
 Leaves skull via jugular foramen
 Forms superior ganglion in foramen and after passing through it, it then forms the larger
inferior (petrosal) ganglion
 The motor fibres originate from the cranial part of the ambiguous nucleus
 Visceromotor fibres originate from the inferior salivatory nucleus
 Cells of the viscerosensory and taste fibres lie in the inferior ganglion and descend in
solitary tract to the solitary nucleus

Branches
 Tympanic nerve
o Originates from the inferior ganglion with viscerosensory and preganglionic
secretory fibres in the petrosal fossula
 o Runs through the tympanic canaliculus into the tympanic cavity
o Here it receives fibres from the plexus of the internal carotid artery via the
caroticotympanic nerve and forms tympanic plexus
o Supplies sensory fibres to the mucosa of the tympanic cavity and the auditory
(Eustachian) tube
 Branch of the carotid sinus
o Viscerosensory from the inferior ganglion
o Descends to the bifurcation of the common carotid artery and terminates in the
carotid sinus and in the carotid glomerulus
o Transmits impulses of mechanoreceptors of the sinus and chemoreceptors of the
glomus to the medulla oblongata
 Pharyngeal branches
o Together with part of the vagus nerve they form the pharyngeal plexus participate
in sensory and motor supply of the pharynx
 Stylopharyngeal branch
o Motor branch to the Stylopharyngeal muscle
 Tonsillar branches
o Sensory branches to tonsils and soft palate
 Lingual branches
o Supply posterior 1/3 of the tongue including vallate papillae with both sensory and
taste fibres

X. Vagus nerve

 Leaves brain – medulla oblongata

 Leaves skull – jugular foramen
 Function – see below
 Fibres – sensory and motor

 Strongest parasympathetic nerve in the autonomic system

 Hence most important antagonist of the sympathetic system

Has following components

 Motor fibres (branchial arch fibres)
 Exteroceptive (sensation from outside body) sensory fibres
 Visceromotor fibres
 Viscerosensory fibres
 Taste fibres

Fibres emerge directly behind olive, unite to form nerve and leave skull through the jugular
foramen
Like the Glossopharyngeal nerve it forms a ganglion in the foramen, the superior ganglion of the
vagus nerve. (Jugular ganglion)
After passing through it it then forms the inferior ganglion of the vagus nerve (larger and also
known as nodose ganglion)

Motor fibres for branchial arch muscles originate from multipolar neurons in the ambiguous
nucleus

Visceromotor fibres originate ion the posterior nucleus of the vagus nerve, which lies laterally to
the nucleus of the hypoglossal nerve on the floor of the rhomboid fossa.

Exteroceptive sensory fibres originate from the superior ganglion, descend with the terminal
trigeminal root and terminate in the spinal nucleus of the trigeminal nerve

Cells of the viscerosensory fibres lie in the inferior ganglion; the fibres run as part of the solitary
tract and terminate at the solitary nucleus

Taste fibres also originate from the inferior ganglion and end in the solitary nucleus.

Head region
 In addition to a meningeal branch which supplies sensory fibres to the dura mater the
vagus nerve gives off the auricular branch
 This branches off at the superior ganglion, passes through the mastoid canaliculus and
reaches through the external meatus to the tympanomastoid fissure
 Supplies skin of the meatus in the dorsal and caudal region and a small area of the auricle

Cervical region
 Nerve descends in the neck together with the internal carotid artery, common carotid
artery and the internal jugular vein, it emerges with them through the upper thoracic
aperture
 Gives off 4 branches
o Pharyngeal branches
 At level of the inferior ganglion
 Combine in the pharynx with fibres of the Glossopharyngeal nerve and the
sympathetic nervous system to form the pharyngeal plexus
 Vagal fibres provide sensory innervation of the mucosa of the trachea and
the oesophagus
 Taste buds on the epiglottis also supplied by the vagus nerve
 Motor fibres of the vagus nerve innervate the muscles of the soft palate and
the pharynx – these are the muscles of the tonsillar sinus, the levator
muscle of the velum palatinum and the constrictor muscles of the pharynx
o Superior laryngeal nerve
 Originates below the inferior ganglion and divides at the level of the hyoid
bone (C4) into an external branch (motor innervation for cricothyroid
muscle) and an internal branch (sensory innervation for mucosa of larynx
as far as the vocal cords)
o Recurrent laryngeal nerve
  Branches off in thorax after the vagus nerve has extended on the left over
the arch of the aorta, and over the subclavian artery on the right
 Passes around behind these vessels (on the left also behind ligamentum
arteriosum) and ascends to the larynx as the inferior laryngeal nerve
 In its course it gives off branches to the trachea and oesophagus
 Supplies motor fibres to all laryngeal muscles apart from the cricothyroid
muscle and sensory fibres to mucosa below vocal cords
o Cervical cardiac branches
 Preganglionic parasympathetic fibres
 Superior branches run with large vessels to the heart where they terminate
in the parasympathetic ganglia of the cardiac plexus
 One of these branches carries viscerosensory fibres that transmit
information about aortic wall tension
 Stimulation of these fibres causes a fall in pressure (depressor nerve)
 The inferior cervical cardiac branches depart from the recurrent pharyngeal
nerve or from main trunk and terminate in ganglia of the cardiac plexus

Thoracic and abdominal part

 Vagus nerve loses identity as single nerve
 It spreads out as a visceral nerve like a network
 Forms pulmonary plexus at the hilum of the lung
 Also forms the oesophageal plexus from which the anterior and posterior vagal trunks
arise and go to the anterior and posterior aspects of the stomach forming anterior and
posterior gastric branches
 Hepatic branches run to hepatic plexus
 Celiac branches to the celiac plexus
 Renal branches to the renal plexus

Parasympathetic (visceromotor) fibres originate from the posterior nucleus of the vagus nerve

Motor fibres – from ambiguous nucleus

Visceromotor fibres – from posterior nucleus of the vagus nerve
Somatosensory – fibres enter sensory spinal nucleus of the trigeminal nerve
Taste and viscerosensory fibres – from solitary nucleus

55.XI, XII CN

XI. Accessory nerve

 Leaves brain – medulla oblongata

 Leaves skull – jugular foramen
 Function – innervation of sternocleidomastoid muscle and trapezius muscle
 Fibres – motor
  Exclusively motor nerve
 Nucleus is in the cervical spinal cord – in the lateral aspect of the ventral horn
 Fibres leave the lateral cervical spinal cord between the anterior and posterior roots and
join to form the spinal root as they enter the skull
 The spinal root enters the skull via the foramen magnum
 Fibres from the caudal part of the ambiguous nucleus join as the cranial roots
 Both components pass through jugular foramen
 Fibres from ambiguous nucleus then change to internal branches to the vagus nerve
 Branches from cervical root form external branch, these supply as the accessory nerve
 Supplies the sternocleidomastoid muscle and the trapezius muscle

NB – injury to the accessory nerve causes the head to tilt (called plagiocephaly) and the arm can
no longer be lifted above the horizontal

XII. Hypoglossal

 Leaves brain – medulla oblongata

 Leaves skull – hypoglossal canal
 Function – motor innervation of the tongue
 Fibres – motor

 Exclusively somatomotor nerve for the tongue muscles

 Nucleus is in the medulla oblongata
 Fibres emerge from between the pyramid and the olive and form two bundles and then
combine to form a nerve trunk
 Leaves skull through hypoglossal canal
 Descends laterally to vagus nerve and internal carotid artery
 Forms a loop (arch of the hypoglossal nerve) and reaches root of tongue slightly above the
hyoid bone
 Ramifies into terminal branches between the hypoglossal and the mylohyoid muscles
 Innervates the intrinsic (horizontal, vertical and longitudinal)and extrinsic (styloglossus,
hyoglossus and genioglossus) muscles of the tongue
 Fibres from the cervical nerves join the hypoglossal nerve at the ansa cervicalis

56.Ganglia of the peripheral nerves

Ganglia of the cranial nerves

Parasympathetic
 Ciliary ganglion (in the orbit)
 Otic ganglion
 Pterygopalatine ganglion
 Submandibular ganglion
 The ciliary ganglion is for the smooth muscle of the eyes, the remaining 3 ganglia are for the
lacrimal glands, salivary glands and smooth muscles of the ear.

Sensory
 Geniculate ganglion (facial nerve)
 Gasserian (trigeminal) ganglion (trigeminal)
 Superior (jugular) and inferior (nodose) ganglia of the vagus nerve
 Superior and inferior (petrosal) ganglia of the Glossopharyngeal nerve

Sympathetic
 None, all sympathetic fibres of the head synapse in the superior cervical ganglion of the
sympathetic trunk

Sympathetic ganglia of the spinal nerves

 Linked together to form the sympathetic trunk (see qu. 58)

Parasympathetic
 No ganglia named
 The nerve fibres come from the sacral spinal cord

Sensory
 Dorsal root ganglia of the spinal cord

57.Vegetative (autonomic) nervous system, classification, principles

 Supply all internal organs and their coverings

 Has both Afferent and Efferent fibres
 Efferent Fibres arise from Vegetative Ganglia
 Main Function –
 To keep internal state of organism constant
 Achieved using 2 antagonistic parts of the autonomic system
Sympathetic and Parasympathetic Systems
 Sympathetic increases while parasympathetic decreases
 The division of the vegetative system is only concerned with motor and secretory fibres –
sensory fibres cannot be divided and are described as Viscerosensory fibres
 A peripheral and central vegetative system can be distinguished
 The central parasympathetic nerve cells form
 Edinger-Westphal nucleus
 Salivatory nuclei
 Dorsal nucleus of the Vagus
 The central sympathetic nerve cells occupy
 Lateral horn of thoracic cord
 Lateral horn of upper lumbar cord
  Within CNS the localisation of Parasympathetic nuclei is Craniosacral and Sympathetic is
Thoracolumbar

58.Sympathetic trunk: cervical and thoracic ganglia; prevertebral ganglia.

Consists of a chain of sympathetic ganglia - lie on each side in front of the transverse processes
of the vertebrae
Chain extends from base of skull to the coccyx
Ends in the ganglion impar
They are interconnected by interganglionic branches
Cervical and Upper Thoracic Ganglia
Superior, Middle and Stellate
Superior –
 Lies below base of skull near inferior ganglion of vagus nerve
 It receives fibres from upper thoracic segment
 Its postganglionic fibres form plexuses around Int and Ext Carotid Artery
 Branches extend to meninges, eyes, glands in head region, sup tarsal muscle of upper
eyelid and ophthalmic muscles at post wall of orbit
Middle –
 May be absent
Stellate –
 If middle is missing Inf will fuse with 1st Thoracic ganglion to form stellate ganglion
 Postganglionic fibres form plexuses around subclavian and vertebral artery
 Nerves from the cervical and upper thoracic ganglia extend to heart and hila of lungs
Participate with Para fibres of Vagus to form Cardiac Plexus and Pulmonary Plexus

Lower Thoracic Ganglia

 Nerves from the thoracic and lumbar sympathetic trunk pass to ganglia which lie within
dense nerve plexuses on each side of the abdominal aorta
 The upper group of ganglia are the celiac ganglia
 The greater splachnic nerve runs from the 5th to the 9th sympathetic trunk ganglia to this
ganglion
 Below this lies the superior and inferior mesenteric and the superior and inferior
hypogastric plexuses expand in the abdomen
 Nerves from the lower thoracic run to the prevertebral ganglia of the abdominal aortic
plexus

Prevertebral Ganglia

 The sympathetic ganglia (coeliac, aorticorenal, superior and inferior mesenteric) lying in
front of the vertebral column, as distinguished from the ganglia of the sympathetic trunk
(paravertebral ganglia); these ganglia occur mostly around the origin of the major
 branches of the abdominal aorta; all are in the abdomino-pelvic cavity, concerned with
innervation of abdomino-pelvic viscera.
 The connections to the prevertebral ganglia come from the sympathetic trunk, the
connections to the celiac ganglia are the greater and the lesser splachnic nerve
 Celiac ganglia
o Postganglionic fibres extend with branches of the aorta to the stomach, duodenum,
liver, pancreas, spleen and adrenal gland
o Preganglionic fibres run to the adrenal medulla
 Superior mesenteric ganglion
o Together with branches of the celiac plexus, runs to the small intestine, ascending
and transverse colon
 Inferior mesenteric ganglion
o Descending colon, sigmoid colon and rectum


59.Parasympathetic (craniosacral) system

The fibres of the central parasympathetic neurons run within various cranial nerves to the
parasympathetic ganglia of the head (question 56)
The principle sympathetic nerve is the vagus nerve
 After passing through the superior thoracic aperture it divides into plexuses to supply the
organs of the abdomen and the thorax
 Vagus innervation continues to the transverse colon (stops about 2/3 of the way across
transverse colon – cannon-bohms point)

Cells in the Intermediomedial nucleus of the sacral spinal cord send axons through the 3 rd and 4th
sacral root to the pudendal nerve. From here fibres pass as pelvic nerves to the inferior
hypogastric plexus and to the pelvic organs.
The same as in the sympathetic system, there are 2 orders of neurons in the parasympathetic
system, 1st in spinal cord, 2nd in ganglion.