4.

BRAIN–NEUROANATOMY

Contents

Preface to the Seventh Edition vii

Preface to the First Edition (Excerpts) viii
Index of Competencies xvi
Glossary xvii

1. Introduction 3 2. Meninges of the Brain and Cerebrospinal

Fluid 25
Divisions of Nervous System 3
Anatomical 3 Introduction 25
Functional 3 The Meninges 25
Cellular Architecture 4 Dura Mater 25
Neuron 4 Dissection 25
Arachnoid Mater 26
Synapse 6
Pia Mater 27
Neuroglial Cells 6
Extradural (Epidural) and Subdural Spaces 28
Grey Matter and White Matter 7
Subarachnoid Space 29
Reflex Arc 7 Cisterns 29
Parts of the Nervous System 8 Clinical Anatomy 30
Central Nervous System 8 Cerebrospinal Fluid (CSF) 31
Components of Central Nervous System 8 Clinical Anatomy 31
Peripheral Nervous System 9 Mnemonics 32
Clinical Anatomy 10 Facts to Remember 32
Receptors 10 Clinicoanatomical Problem 32
Sensory Afferent Receptors 10 Further Reading 32
Motor Efferent Endings 12 Frequently Asked Questions 33
Functional Classification 13 Multiple Choice Questions 33
Viva Voce 33
Clinical Anatomy 13
Development of Brain 13
3. Spinal Cord 34
Neural Tube 13
Parts of Brain 18 Introduction 34
Dissection 34
Molecular Regulation of Development of
Spinal Cord and Brain 19 Meningeal Coverings 35
Cauda Equina 36
Spinal Cord 19
External Features of Spinal Cord 36
Clinical Anatomy 19
Internal Structure 36
Gross Study of Brain 20
Clinical Anatomy 36
Facts to Remember 21 Spinal Nerves 38
Clinicoanatomical Problem 21 Spinal Segment 38
Further Reading 23 Nuclei of Spinal Cord 38
Frequently Asked Questions 23 Nuclei in Anterior Grey Column or Horn 39
Multiple Choice Questions 24 Nuclei in Lateral Grey Column or Horn 40
Viva Voce 24 Nuclei in Posterior Grey Column or Horn 40
xii HUMAN ANATOMY—BRAIN–NEUROANATOMY

Laminar Organisation in Spinal Cord 40 Abducent Nerve 73

Sensory Receptors 41 Functional Components 73
Tracts of the Spinal Cord 41 Nucleus 73
Descending Tracts 41 Course and Distribution 73
Pyramidal or Corticospinal Tracts 41 Clinical Anatomy 73
Extrapyramidal Tracts 42 Fifth Cranial Nerve 74
Ascending Tracts 45 Trigeminal Nerve 74
Intersegmental Tracts 49 Nuclear Columns 74
Clinical Anatomy 49 Sensory Components of V Nerve 74
Facts to Remember 52 Motor Components for Muscles 75
Clinicoanatomical Problems 53 Branches of Trigeminal Nerve 75
Further Reading 53 Ophthalmic Nerve Division (Sensory) 76
Frequently Asked Questions 54 Maxillary Nerve Division (Sensory) 76
Multiple Choice Questions 54 Mandibular Nerve Division (Sensory and
Viva Voce 55 Motor) 77
Clinical Anatomy 77
4. Cranial Nerves 56 Seventh Cranial Nerve 78
Introduction 56 Facial Nerve 78
Features 56 Functional Components 78
Embryology 56 Nuclei 78
Functional Components of Cranial Nerves 56 Course and Relations 78
Nuclei 57 Branches and Distribution 79
General Somatic Efferent (GSE) Nuclei 57 Ganglia 81
Special Visceral Efferent/Branchial Efferent Clinical Anatomy 81
Nuclei 57 Eighth Cranial Nerve 82
General Visceral Efferent Nuclei 58 Vestibulocochlear Nerve 82
General Visceral Afferent Nucleus and Pathway of Hearing 82
Special Visceral Afferent Nucleus 59 Vestibular Pathway 85
General Somatic Afferent Nuclei 61 Clinical Anatomy 85
Special Somatic Afferent Nuclei 61 Ninth Cranial Nerve 85
First Cranial Nerve 63 Glossopharyngeal Nerve 85
Olfactory (Smell) Pathway 63 Functional Components 86
Clinical Anatomy 63 Nuclei 87
Second Cranial Nerve 64 Course and Relations 87
Human Vision 64 Branches and Distribution 88
Optic Pathways 64 Clinical Anatomy 89
Reflexes 65 Tenth Cranial Nerve 89
Clinical Anatomy 68 Vagus Nerve 89
Third Cranial Nerve 69 Functional Components 89
Oculomotor Nerve 69 Nuclei 89
Functional Components 69 Course and Relations in Head and Neck 89
Nucleus 69 Branches in Head and Neck 90
Course and Distribution 69 Clinical Anatomy 91
Clinical Anatomy 71 Eleventh Cranial Nerve 92
Fourth Cranial Nerve 71 Accessory Nerve 92
Trochlear Nerve 71 Functional Components 92
Functional Components 71 Nuclei 92
Nucleus 71 Course and Distribution of the Cranial
Course and Distribution 72 Root 92
Clinical Anatomy 73 Course and Distribution of the Spinal Root 92
Sixth Cranial Nerve 73 Clinical Anatomy 93
 CONTENTS xiii

Twelfth Cranial Nerve 94 Medial Longitudinal Bundle 113

Hypoglossal Nerve 94 Clinical Anatomy 113
Functional Components/Nuclear Columns 94 Development 114
Nucleus 94 Mnemonics 114
Course and Relations 94 Facts to Remember 114
Extracranial Course 94 Clinicoanatomical Problem 115
Branches and Distribution 95 Further Reading 115
Clinical Anatomy 95 Frequently Asked Questions 116
Foramina for Cranial Nerves and their Branches 96 Multiple Choice Questions 116
Mnemonics 96 Viva Voce 116
Facts to Remember 96
Clinicoanatomical Problem 97 6. Cerebellum 117
Further Reading 97 Introduction 117
Frequently Asked Questions 98 Location 117
Multiple Choice Questions 98 External Features 117
Viva Voce 99 Parts of Cerebellum 117
Morphological Divisions of Cerebellum 117
5. Brainstem 100 Functional Divisions of Cerebellum 118
Introduction 100 Connections of Cerebellum 121
Medulla Oblongata 100 Grey Matter of Cerebellum 121
External Features 100 Blood Supply 121
Internal Structure 102 Functions of Cerebellum 123
Transverse Section through the Lower Part of Clinical Anatomy 124
the Medulla Passing through the Histological Structure 124
Pyramidal Decussation 102 Development 125
Transverse Section through the Middle of Facts to Remember 125
Medulla Passing throught the Sensory Clinicoanatomical Problem 125
Decussation 103 Further Reading 126
Transverse Section through the Upper Part of Frequently Asked Questions 127
Medulla Passing through the Floor of Multiple Choice Questions 127
Fourth Ventricle/Open Part 103 Viva Voce 127
Blood Supply 106
Clinical Anatomy 106 7. Fourth Ventricle 128
Development 107
Introduction 128
Pons 107
Lateral Boundaries 128
External Features 107
Floor 128
Internal Structure 107
Roof 129
Tegmentum in the Lower Part of Pons 108
Cavity and Recesses of Fourth Ventricle 131
Tegmentum in the Upper Part of Pons 108
Clinical Anatomy 131
Blood Supply 109
Facts to Remember 131
Clinical Anatomy 109
Clinicoanatomical Problem 131
Development 110
Further Reading 132
Midbrain 110
Frequently Asked Questions 133
Subdivisions 110
Multiple Choice Questions 133
External Features 111
Viva Voce 133
Internal Structure 111
Transverse Section of Midbrain at the
8. Cerebrum, Diencephalon, Basal Nuclei
Level of Inferior Colliculi 111
and White Matter 134
Transverse Section of Midbrain at the
Level of Superior Colliculi 112 Cerebrum 134
Blood Supply 113 Dissection 134
xiv HUMAN ANATOMY—BRAIN–NEUROANATOMY

Features 134 Facts to Remember 165

Cerebral Hemisphere 135 Clinicoanatomical Problems 165
Lobes of Cerebral Hemisphere 137 Further Reading 165
Insula 138 Frequently Asked Questions 166
Sulci and Gyri on Superolateral Surface 138 Multiple Choice Questions 167
Functional or Cortical Areas of Viva Voce 167
Cerebral Cortex 141
Motor Areas 141 9. Third Ventricle, Lateral Ventricle and
Clinical Anatomy 144 Limbic System 168
Sensory Areas 144 Introduction 168
Clinical Anatomy 145 Third Ventricle 168
Areas of Special Sensations 145 Dissection 168
Clinical Anatomy 146 Clinical Anatomy 169
Functions of Cerebral Cortex 146 Lateral Ventricle 169
Human Speech 147 Dissection 170
Clinical Anatomy 147 Central Part 170
Histology of Cerebrum 147 Anterior Horn 172
Diencephalon 149 Posterior Horn 172
Dorsal Part of Diencephalon 149 Inferior Horn 173
Thalamus 149 Limbic System 173
Metathalamus (Part of Thalamus) 150 Clinical Anatomy 176
Clinical Anatomy 153 Facts to Remember 177
Epithalamus 153 Clinicoanatomical Problem 177
Pineal Body/Pineal Gland 153 Further Reading 177
Ventral Part of Diencephalon 154 Frequently Asked Questions 178
Hypothalamus 154 Multiple Choice Questions 178
Functions of Hypothalamus 155
Viva Voce 178
Clinical Anatomy 155
Subthalamus 155 10. Some Neural Pathways and Reticular
Clinical Anatomy 156 Formation 179
Basal Nuclei 156
Introduction 179
Corpus Striatum 156
Pyramidal Tract (Corticospinal and
Dissection 157
Corticonuclear Tracts) 179
Connections of Corpus Striatum 158
Clinical Anatomy 180
Amygdaloid Body 158
Pathway of Pain and Temperature 180
Claustrum 158
Clinical Anatomy 159 Pathway of Touch 180
White Matter of Cerebrum 159 Pathway of Proprioceptive (Kinaesthetic)
Impulses—Position, Movement, Vibration 181
Subdivisions 159
Association (Arcuate) Fibres 159 Taste Pathway 181
Commissural Fibres 159 Reticular Formation 182
Dissection 160 Action of Drugs 183
Corpus Callosum 160 Facts to Remember 183
Projection Fibres 161 Frequently Asked Questions 184
Corona Radiata 161 Multiple Choice Questions 184
Internal Capsule 162 Viva Voce 184
Gross Anatomy 162
Fibres of Internal Capsule 162 11. Blood Supply of Spinal Cord and Brain 185
Blood Supply 164 Introduction 185
Clinical Anatomy 164 Blood Supply of Spinal Cord 185
Development 164 Clinical Anatomy 185
 CONTENTS xv

Blood Supply of Brain 186 Parasympathetic Nervous System 208

Arteries of Brain 186 Nerve Supply of the Viscera 209
Vertebral Arteries 186 Afferent Autonomic Fibres 211
Basilar Artery 187 Clinical Anatomy 211
Clinical Anatomy 188 Comparison of Parasympathetic and
Internal Carotid Artery 189 Sympathetic Nervous Systems 212
Circulus Arteriosus or Circle of Willis 190 Development 213
Arterial Supply of Different Areas 192 Viva Voce 214
Blood–Brain Barrier 193
Perivascular Spaces 194 Appendix: Ventricles, Cranial Nerves,
Clinical Anatomy 194 Arteries and Clinical Terms 215
Veins of the Brain 195 Summary of the Ventricles of the Brain 215
Blood Supply of the Brainstem 196 Lateral Ventricle 215
Clinical Anatomy 196
Third Ventricle 215
Mnemonics 197
Fourth Ventricle 215
Facts to Remember 197
Nuclear Components of Cranial Nerves 216
Clinicoanatomical Problems 197
CN I: Olfactory 216
Further Reading 198
Frequently Asked Questions 198 CN II: Optic 216
Multiple Choice Questions 198 CN III: Oculomotor 216
Viva Voce 199 CN IV: Trochlear 216
CN V: Trigeminal 216
12. Investigations of a Neurological Case, CN VI: Abducent 216
Surface and Radiological Anatomy and CN VII: Facial 216
Evolution of Head 200 CN VIII: Vestibulocochlear 216
Introduction 200 CN IX: Glossopharyngeal 216
Investigations Required in a Neurological CN X + CN XI: Vagus and Cranial Part of CN
Case 200 XI 216
Surface Anatomy 201 CN XI: Spinal Part of Accessory Nerve 216
Radiological Anatomy of the Brain 202 CN XII: Hypoglossal 216
Evolution of the Head 202 Arteries of Brain 217
Further Reading 204 Clinical Terms 217
Frequently Asked Questions 204 Multiple Choice Questions 220
Viva Voce 220
13. Autonomic Nervous System 205
Spots 221
Introduction 205 Answers of Spots 222
Sympathetic Nervous System:
Thoracolumbar Outflow 205 Index 223