CLINICAL NEUROANATOMY NOTES

Chapter 1: Fundamentals of the Nervous System

2 main divisions that are based on Structure and Function

1. Structure (Anatomy): 2 subdivisions

- Central Nervous System (CNS) – brain and spinal cord
- Peripheral Nervous System (PNS) – cranial and spinal nerves that innervate
the body

2. Function (Physiology) (PNS): 2 systems

- Somantic NS – controls body structures (voluntary movements)
- Autonomic NS – controls smooth muscles, glands, blood vessels (you’re not
actively pumping blood, or digesting food, these happen on their own,
involuntary moments)
o Sympathetic NS – arouses body to expend energy (fight or flight)
(keeping you awake)
o Parasympathetic NS – calms body to conserve and maintain energy
(calms you) (puts you to sleep)

How these systems communicate with each other:

- The nervous system communicates with the peripheral nervous system

- Sends signals
- The PNS receives information through your sensory nerves, that information
goes to the brain, brain processes it, and then sends it to the motor nerves
CNS Orientation, Structural Units and Organization

Axes of orientation – use spatial reasoning to determine structure position

Talking about the brain:

1. Dorsal (superior)
2. Caudal (posterior)
3. Ventral (inferior)
4. Rostral (anterior)

When we are talking about the whole nervous system, up is superior, right is posterior,
bottom is inferior, and left is anterior.

Most inferior part of the brain: hypothalamus

Most inferior part of the CNS: spinal cord

Back side of the spina cord is Dorsal, front is ventral, up is rostral and bottom is caudal.

If the person is looking upwards, or sideways, the directions would change accordingly.
Planes of section (coronal, horizontal, sagittal, transverse) – frequently used in the
description of the brain and spinal cord
 Coronal plane – front to back (frontal section)
- Bilateral symmetry (one side is the mirror image of the other side)
 Horizontal plane (top to bottom)
- bilateral symmetry

 Mid-Sagittal (Sagittal) view – (side to side)

 Transverse section – section through the spinal cord

MID – SAGITTAL VIEW

Why are we bilaterally symmetrical?

 Bilateral symmetry is adaptive in perceiving and acting in a natural world without
systematic left-right bias

CNS
Positionality
 Compromised of the brain (encephalon) and spinal cord
 Brain has a tiered structure – 3 main subdivisions of the brain
 - Cerebrum (forebrain) – most rostral
- Cerebellum
- Brain Stem – most caudal
 Each division is further divided into discrete regions

Cerebrum (Forebrain)
- Most phylogenically advanced b rain region
- Responsible for complex functions (eg. Cognition)
o Telencephalon
 Cerebral cortex gray matter (neuronal cell bodies)
 Subcortical white matter (myelinated axons) (collection of
axons)
 Basal ganglia (subcortical collections of cell bodies)
o Diencephalon
 Thalamus (up)
 Hypothalamus (front)
 Epithalamus (back)
 Subthalamus (bottom)
Cerebellum
Collections of gray matter and white matter tracts
- Vermis – central position of the cerebellum
- Lateral lobes (2)

Brain Stem
Collections of gray matter and white matter tracts
- Midbrain (mesencephalon)
- Pons
- Medulla oblongata
- Has the most important parts of your brain for survival
Ventricles
 Hollow spaces within the brain and spinal cord filled by cerebral spinal fluid (CSF)

SPINAL CORD – NEURONAL SOMATA (cell bodies) and Axon Tracts

 Neuron cell bodies lie in center of the spinal cord in an area called the Central
Gray (gray matter) connections (or pathways) between neurons in CNS exist as
fiber bundles or tracts (white matter)
- Aggregates of tracts in the SC are called Columns
Tracts and Commissures in Brain and Spinal Cord
Connections (pathways) between neurons inn CNS exist as fiber bundles or tracts
called Fasciculli
- Vertical pathways may remain on the same side (ipsilateral) or cross
(decussate) to the opposite side (contralateral)
- The right brain controls the left side of your body, and vice versa
- Neurons that control motor veins in the right side of your brain send their
axons down a specific path and then cross over to the other side of the spinal
cord to go to the other side and elevate neurons that control the left side of
your body – devastation

Symmetry of the nervous system

- The central gray of the spinal cord sends information (axons) to the periphery
Functional Maps exist within the Brain
- The sensory cortex lies right behind the motor cortex

Topographically faithful map

- Body relationships preserved
- Size of part reflects. Disproportional sensitivity
Peripheral Nervous System (PNS)
- Spinal nerves, cranial nerves, and ganglia (collections of cell bodies) outside
of the CNS
- PNS fibers that conduct information to the CNS are called afferent fibers
- PNS fibers that conduct information from the CNS are called efferent fibers
- Peripheral nerves connect to spinal cord by dorsal (sensory) and ventral
(motor) roots

Spinal nerves branch off from the spinal cord

 Each nerve is split into DORSAL and VENTRAL nerve roots
 Dorsal roots are sensory, ventral roots are motor
- Dorsal, sensory, afferent
- Ventral, motor, efferent
CHAPTER 3: SIGNALLING IN THE NERVOUS SYSTEM

BASICS OF NEUROPHYSIOLOGY
Nerve cells are unique in that they are electrically excitable
 Neurons respond to stimuli from other neurons by generating electrical Impulses
 Impulses may be:
- Local (restricted to the area that received the stimulus like post-synaptic
membrane) or
- Propagated (may travel through the neuron and axon)
 Propagated electrical impulses travel down the axon and are termed action
potentials

MEMBRANE POTENTIAL
 Most brain function can be explained by understanding the influence that the
movement of two (2) charged salt atoms (ions) across the neuronal membrane has
on the electrical charge of the inside of the neuron – those ions are:
- Potassium (K+) ions = positive potassium force
- Sodium (Na+) ions = positive sodium force
 Chemical composition of intracellular (inside) and extracellular (outside) areas of
neurons differs
- Intracellular environment is rich in potassium (K+) ions
- Extracellular environment is rich in sodium (Na+) ions
 High calcium outside the cell
Difference in ion concentrations inside and outside of the cell is actively maintained by
ion pumps embedded in the cell membrane
 Na+/K+ Pump – maintains a nearly constant concentration of ions in the cell
 Energy-consuming process
 Moves three Na+ ions out of the cell and two K+ ions IN to cell
- 3 (+)

Chapter 5:
THE SPINAL CORD
The cross-sectional external anatomy of the spinal cord
 The spinal cord is a package of highways of axons going from your body to your
brain and from brain to body.

Spinal nerves in the lumbar region and sacred region, they come down and exit the
spinal column after gangling down below the end of the spinal cord
- Called the Cauda Equina (horse’s tail) (lowest column of the spinal tract)
- All the nerves emanating from the lower region of the spinal cord, lumbar
region, upper and lower thoracic
- These nerves dangle down and descend, and exit the spinal column through
the lumbar region in the sacred region

Spinal cord is surrounded by a protective covering just like the brain and it’s called the
fecal sack.
- End of the spinal cord is right around the Conus Medullaris
- Some nerves exit in the lumbar zones, and some exit through the pelvis

Whenever you get a spinal tap to look for an infection in your nervous system, it is done
in a very low level in the lumbar zone where little nerves come down so you’re less
likely to do any nervous system damage because you’re not putting down a needle
where there are cells and large fiber tracts.

Spinal cord is a bilateral structure, nerves coming out of each column

The spinal cord looks different at different levels

- There’s a central H gray region in the spinal cord that is surrounded by white
matter
 - Lots of white matter in the neck region of the spinal cord because that’s
where the nerves begin, but they keep going out of the nerve endings/nerve
holes called Foramina as we go down the spinal cord, hence, lesser white
matter in the lower regions
- Spinal cord enlargements: the spinal cord varies in width along its length
- SC is wider in the Cervical and lumbrosacral regions
- More lower motor neurons in these areas of cord (arms/legs)
- The nerves that go out to the thoracic region don’t have a lot of motor
neurons because we don’t need a lot of control or movement in our chest,
stomach zone

Segments of the Spinal Cord

30 spinal cord segments giving rise to 30 bilateral spinal nerves originating from the
spinal cord
 8 cervical, 12 thoracic, 5 lumber and a few coccygeal nerves
Coccyx – tiny bone at the end of your back/pelvis, used to be the tail, tail bone

30 spinal cord segments giving rise to 30 bilateral spinal nerves emanating from the
spinal cord
 Spinal vertebral segments correspond to the peripheral nerve groups
 In the cervical region, the nerve exits above the corresponding vertebra
 C1 nerve will go above the C1 vertebra
 In the other regions, it is the opposite
 T1 nerve exits below the T1 vertebra

Longitudinal (up & down) features of the SC

2 main fissures:
 Anterior (Ventral) Median fissure (wide anterior fissure)
- Abuts the Anterior (Ventral) white commissure
 Posterior (Dorsal) Median fissure (deep shallow fissure)
 Anterolateral sulcus
- Where ventral nerve roots (motor nerves) exit the cord
 Posterolateral sulcus
- Where dorsal nerve roots (sensory nerves) enter the cord

Visible features of the white matter:

GRAY MATTER AND WHITE MATTER OF THE SPINAL CORD
Some CNS tissue is translucent and appears GRAY, other areas are opaque and
appears WHITE

 White matter – bundles of myelinated axons running up and down the spinal cord
 in the CNS these bundles are called a tract, a fasciculus, a column, or a pathway
  in the spinal cord they consist of the sensory (afferent) fibers and motor (efferent)
fibers
- sensory (going from part to brain), motor (going from brain to part)
- Gray matter - unmyelinated area in the spinal cord - collections of cell bodies
(neuropil)

 Occupies the central region of the spinal cord = Central Gray Region
 4 lobed structure home to spinal Sensory and Motor Function
 Dorsal horn of Central Gray is home to spinal sensory function
 Ventral horn of Central Gray is home to spinal motor function

The H Gray Matter

- 4 lobed structure, responsible for both sensory and motor function
- Dorsal sensory afferent (upper motor neurons)
o The 2 posterior lobes is where information comes into the spinal cord
through dorsal roots
- Ventral efferent motor (ventral horn of spinal cord)
o Home to cell bodies that send information out to make your move
(motor behavior)

When you want to move, an axon from your brain is sent down to the spinal cord into
the white matter, the neuron from the brain is interacting with a neuron in the ventral
horn of the spinal cord. That neuron then communicates out to the muscle (lower motor
neurons)
- ALS is a disease in this part

SPINAL ROOTS AND SPINAL NERVES

 Each segment of the spinal cord gives rise to 4 spinal roots (Left & Right Ventral &
Dorsal Roots) which join together as they exit the spinal cord to form a spinal nerve
 So, a spinal nerve is a mixed nerve, which carries motor and sensory signals
between the spinal cord and the body.
SPINAL ROOTS AND SPINAL NERVES
 Each segment of the spinal cord gives rise to 4 nerve roots (Left & Right Ventral &
Dorsal Roots)

Ventral Spinal Roots

 Motor output from the CNS to the body
 Axons from motor neurons in the anterior horn of the spinal cord that innervate
the body’s muscles, organs, and circulatory system
 Information flows out of the CNS to PNS
SPINAL ROOTS AND SPINAL NERVES
 Each segment of the spinal cord gives rise to 4 nerve roots (Left & Right Ventral &
Dorsal Roots)

Dorsal Spinal Roots

 Sensory input into the CNS from sensory receptors in the body Carry information
about pressure, temperature, pain
 Cell bodies of the body’s sensory neurons lie outside the CNS in the Dorsal Root
Ganglia (DRG) (collection of cell bodies)
- DRG neurons send axons into CNS

Spinal Nerves branch off from the spinal cord

 each nerve is split into dorsal and ventral roots
 DORSAL ROOT FIBERS ARE SENSORY, VENTRAL ROOT FIBERS ARE
MOTOR
  Dorsal, sensory, afferent
 Ventral, motor, efferent

Different Types of Spinal Nerve Fibers Exiting and Entering the Spinal Cord
 Somatic Efferents (SE) - Motor fibers (axons) to skeletal muscle
 Axons from lower motor neurons in anterior horn of the spinal cord to the
muscles
 Control voluntary motor movement
 Somatic Afferents (SA) - Sensory fibers (axons) conveying info from skin, joints,
muscles
 Axons of unipolar neurons in the dorsal root ganglion (DRG) – convey stretch
and touch info
 Visceral Efferents (VE) - Autonomic motor fibers to smooth muscle in viscera &
glands
 Control involuntary smooth muscle motor movement and secretion
 Visceral Afferents (VA) - Sensory fibers conveying info from smooth muscle in
viscera & glands

Spinal Nerves
 Each spinal nerve is distributed to a defined part of the body
 Each spinal nerve has its own defined space
 So, neurally - you are a segmented organism

 Cervical Spinal Nerves (C1-C8)

 exit cervical spine
 to/from upper back, shoulders, arm, neck, face
 Thoracic Spinal Nerves (T1-T12)
 exit thoracic spine
 to/from chest, abdomen, back
 Lumbar Spinal Nerves (L1-L5)
 exit lumbar spine
 to/from hips, low back, legs, feet
 Sacral Spinal Nerves (S1-S5)
 exit sacrum
 to/from buttock, crotch, back of leg, feet
Some spinal nerves overlap in their distribution pattern

Dermatomes and Myotomes

 Sensory and motor component of each spinal nerve is distributed to a defined
portion of the body termed a dermatome (sensory component) or myotome (motor
component)
 There is no C1 dermatome and some dermatomes overlap (eg, C5-8, T1 for arm)
Spinal nerves & corresponding myotomes (motor)
INTERNAL DIVISIONS OF THE SPINAL CORD
Gray Matter
 H-shaped column of gray matter (CENTRAL GRAY)
 Bilaterally symmetric
 Extends entire length of cord
Ventral Horns
 Where lower motor neurons exist – origin of ventral roots
Dorsal Horns
 Where secondary sensory neurons involved in pain exist
 Input zone of sensory pathways for mechanoreception
(touch, vibration, pressure) and nociception (pain)

INTERNAL DIVISIONS OF THE SPINAL CORD

White Matter
 Columns (funiculi and fasciculi)
 Dorsal, lateral, ventral columns surround central gray
 Columns of axons leading to- and from- brain
 Tracts – fiber columns (bundles of axons) with common functions
- “Columns” contain multiple “Tracts”

Ascending tracts:
- Dorsal white column
- Posterior spinocerebellar tract
- Anterior spinocerebellar tract
 - Lateral spinothalamic tract
- Anterior spinothalamic tract
Descending tracts:
- Lateral reticulospinal tract
- Lateral corticospinal tract
- Rubrospinal tract
- Medial reticulospinal tract
- Anterior corticospinal tract
- Vestibulospinal tract
- Tectospinal tract

Descending Fiber Systems

 Corticospinal tract – Cerebral cortex to spinal cord
- Axons from upper motor neurons (in brain) to lower motor neurons (in spinal
cord)
 egs, lateral (decussates) and anterior (does not decussate) corticospinal tracts
Vestibulospinal tract - Brain stem vestibular nuclei to spinal cord
- Activate quick movements to sudden changes in body position
Reticulospinal tract - Reticular formation (in brain stem) to spinal cord
- Modify pain perception – important for pain control
Rubrospinal tract – Red nucleus (in midbrain) to spinal cord
- large muscle movement (particularly of the upper extremities)
Tectospinal tract – Superior colliculus (in midbrain) to spinal cord
- coordinates head and eye movements

 If you have a cortical stroke on the left side, if 85% of the axons that lead the upper
neurons go through the lateral track and decussate to the other side, you’ll lose
motor movement
 If 15% don’t decussate, there won’t be complete paralysis on the other side
 Only Lateral decussate, anterior don’t decussate
Stroke therapy:
 The affected hand is strapped at the back so that the neurons are signal and operate
through the other hand

Spatial Orientation within Ascending and Descending Fiber Systems

 Ascending and Descending pathways have a specific medial -> lateral orientation
- particularly noteworthy in dorsal column, spinothalamic, and corticospinal
tracts

Ascending Fiber Systems

 Axons entering spinal cord via dorsal roots from cell bodies in Dorsal Root Ganglion
(DRG) Dorsal Column Tracts (Medial Lemniscal System)
 - Mechanoreception - carry info about touch, vibration, proprioception (position
sense)
 Spinothalamic tracts – Spinal Cord to thalamus (Ventrolateral Anterior System)
- Nociception – carry info about sharp (noxious) pain, temperature
 Spinocerebellar Tracts – - Spinal Cord to cerebellum
- Dorsal and Ventral tracts – motor control, state and position sense

A FUNCTIONAL SEGREGATION IN THE SPINAL CORD

Sensory and Motor function are separated in the spinal cord

Ascending Sensory Pathways In The Spinal Cord

In the first stages of sensory processing, synaptic connections are systematic and
hierarchical
 the first cell in the sensory system is the first-order neuron (primary or 1 st order) (lie
outside in the PNS)
 the cell body of all 1st order neurons lie outside the CNS in the PNS in the DRG
 the first-order neuron synapses onto a second-order neuron (secondary or 2 nd order)
in the CNS
 the second-order neuron synapses onto a third-order neuron (tertiary or 3 rd order) in
CNS, etc.
Nerve fibers often cross midline (decuss) and contact neurons on the other side of the
CNS.

 Decussation
- the left brain therefore controls the right side of the body and vice versa
 contralateral when nerve fibers cross the midline,
 ipsilateral when nerve fibers stay on the same side

Sensory Function
Sensation from the body surface is of several types and is carried by different fiber
systems
1. Large, quick fibers (mechanoreceptors)
- all other somatosensory systems
- sensing of pressure, touch, vibration
- fibers coming in from the PNS are large, fast-conducting fibers
2. Small, slow conducting fibers (nociceptors)
- activated by noxious stimuli (tissue damage)
- sensation of pain
- carried through relatively slow-conducting smaller fibers

1. Large Mechanoreceptors
 First-order mechanoreceptor cell bodies in the dorsal root ganglia DRG in PNS
 Axons of first order mechanoreceptor cells enter the spinal cord directly in the
CNS
o Axons ascend ipsilaterally (same side of cord) without synapsing in
spinal cord
 ascend in dorsal white matter columns
o Synapse with second order cell in brainstem
 Axons of second order cell decussate and synapse with third-order neurons in the
thalamus
 Secondary neuron sends a fiber and axon across to the other side of the brain, so it
decusses and it sends the contralateral projection up to the thalamus
 Third order neuron sends its information out to a part of the cortex that is appropriate
for the sensation (if it was for the hand, it would signal in the cortex where the hand
is)
 Note The Level Of DECUSSATION in the mechanoreceptors is that the level of the
brain that the second order neuron crosses at the level of the brain
 Mechanoreception: large activation of mechanoreceptors

2. Small Nociceptors

Nociceptors - small diameter, unmyelinated fibers that convey info about tissue damage

Projection of Nociceptors
 First-order nociceptor cell bodies are in the DRG
- Axons of first order nociceptor cells enter the spinal cord directly and
o Synapse immediately with a second-order cell in the dorsal horn of the
spinal cord
o Secondary neuron of the pain system is in the spinal cord
 - Axons of the second-order cell decussate and then project up to brainstem
and synapse with third-order cells in thalamus and reticular formation
o ascend in lateral white matter columns

Note The Level Of DECUSSATION

What is the benefit of a system like this?

- It separates information in the two systems
- If they weren’t different, pressure would be perceived as pain

Descending Motor Pathways in the Spinal Cord

 Motor pathways are divided into upper motor and lower motor neuron regions
 The origin for motor commands is from upper motor neurons in the cerebral cortex
(motor cortex)
 Final path for motor commands is from lower motor neurons in the ventral horn of
the spinal cord

 Upper motor neurons in the motor cortex project axons down spinal cord tracts and
activate lower motor neurons in the ventral horn of the spinal cord
 Lower motor neurons in the ventral horn of the spinal cord send axons that exit the
CNS via the ventral roots and innervate skeletal muscles in the body
Upper Motor Neuron projections through the Spinal Cord

Upper motor neurons send two fiber bundles (axon bundles) as part of corticospinal
tracts down either side of the cord (Pyramidal and Extrapyramidal tracts) - activate
lower motor neurons

The Pyramidal System

 Upper motor neurons lie in the motor cortex of brain

- Pyramidal Cells - largest neurons in mammalian brain

- Pyramidal Tracts – axons leave upper motor neurons - the majority cross the
midline of the spinal cord at the Decussation of the Pyramids (in the lower
medulla), thus are contralateral

• After that the tracts descend in white matter and insert into ventral horn of spinal cord
and innervate lower motor neurons
CLOSER LOOK AT THE SOMATOSENSORY SYSTEMS

Feelings from the body (Somatic Sensation) come from many sensory systems
• pressure from the body surface, vibration of the skin, and deflection of hair on the body

surface – all these contribute to bodily awareness in space

Somatic Sensation – Two Principal Organs of Touch •Mechanoreceptors

- Nerve endings that change physical energy in the form of pressure, stretch, or
vibration into neural energy = Transduction

• associated sensory organs accomplish this property for the nerve endings • eg.,
stretch organ (Pacinian Corpuscle) for pressure reception

•Nociceptors
- Nerve endings of small, myelinated and unmyelinated fibers that transport information
regarding noxious stimuli (tissue damage) to the CNS
• tissue damage depolarizes these free nerve endings directly

Mechanoreceptors for Pressure, Stretch, Vibration

  Primary unipolar sensory neurons in the DRG have very specialized neurites that
project to the body that produce and conduct electrical signals in response to
pressure, vibration, and stretch
 These neurites tranduce (or transform) physical energy (in the form of pressure,
stretch, or vibration) into neural energy (electrical signals) by directly depolarizing
the peripheral membrane à producing what is called a Generator Potential

Generator potentials

 are graded in amplitude according to the strength of the stimulus (amount of

pressure)
 the greater the pressureàthe greater the amplitude of the generator potential
 generator potential amplitude is converted into action potential frequency by DRG
neurons potentials
 So, signal Intensity is represented by Frequency of action potential firing

Projections of the Mechanoreceptor System

- Sensory information is carried to DRG sensory neurons by large myelinated fibers (A-
alpha fibers)

- The MAJORITY of axons from the DRG sensory neurons synapse with neurons in the
brainstem

- Brainstem neurons then project contralaterally onto neurons in the thalamus (sensory
waystation)

- Thalamic neurons then project to the Somatosensory cortex

- onto neurons in an area known as the Sensory Homunculus

• Topographically faithful cortical map of body surface

 body relationships preserved

 size of structure reflects sensitivity
Nociceptors for Pain

 Sensory neurons located in the DRG have very specialized neurites that project
to the body
 These neurites respond to noxious stimuli (tissue damage)

ASCENDING NOCICEPTOR SYSTEMS

Nociceptor cells in DRG

 neurites project into the periphery

 cell bodies in DRG
 axons project and insert into the dorsal horn of spinal cord

Mechanical tissue damage releases K+ from the tissue - depolarizing

peripheral neurites – send a depolarizing signal to nociceptor cells in the
DRG
ASCENDING NOCICEPTOR SYSTEMS (con’t)
Pain information is sent to DRG pain neurons by small unmyelinated (C-fibers) and
myelinated (A- delta fibers) fibers
- The axons from the DRG pain neurons synapse immediately onto neurons in the
dorsal horn of the spinal cord
- Spinal cord neurons then project contralaterally onto neurons in the thalamus
(sensory waystation)

- onto neurons in an area known as the Sensory Homunculus

• Topographically faithful cortical map of body surface

 body relationships preserved

 size of structure reflects sensitivity
Nociception and the Spinothalamic Tract

The nociceptor cells in the dorsal horn of spinal cord are of two types

 Nociceptive specific cells – located superficial aspects of the dorsal horn

• receive synaptic contacts from both A-delta and C-fiber cells

• only respond to noxious stimuli (tissue damage)

 Wide dynamic range cells – located deeper in the dorsal horn of the spinal cord

• receive contacts from A-delta cells and mechanoreceptor cells

The nociceptor cells in the dorsal horn of the spinal cord project axons that cross the
midline (decussation) at the spinal cord level and ascend to the brainstem in the
Spinothalamic and Neospinothalamic tracts
• Each tract carries different information about the painful stimulus

INTEGRATIVE SENSORY/MOTOR FUNCTIONAL CIRCUITS IN THE SPINAL CORD

The spinal cord has the capacity to integrate afferent (sensory) input and direct the
appropriate efferent (motor) output

The Monosynaptic Reflex

Each muscle has: (1) sensory structures and is (2) innervated by lower motor neurons
Eg, Muscle Spindle Organ

 Extrafusal muscle fibers (bulk of muscle) do the majority of the work moving
muscle
 Intrafusal muscle fibers contain a sensory stretch receptor

• When intrafusal fibers are stretched, its sensory afferents activate synapses on a
lower motor neuron which activates extrafusal fibers of the same muscle, causing
muscular contraction
Inhibition of Antagonist Muscles

Every muscle in the body has a monosynaptic reflex. But what has to happen for a
reflex to occur? •muscles exist in antagonistic pairs of flexors (muscle flexsion) and
extensors (muscle extension)

LESIONS IN THE MOTOR PATHWAYS

• Two main types of motor neuron lesions (Upper and Lower)

1. Lower Motor Neuron Lesions

- Cells of the ventral gray column (or brain stem) which constitute the ventral roots of
spinal and cranial nerves

- Result of toxins, trauma, infections

- Signs included flaccid paralysis of involved muscles, muscular atrophy, diminished or
absent deep tendon reflexes

2. Upper Motor Neuron Lesions

- Cells of cerebral cortex or lateral white columns of the spinal cord (axons from cells in
the cortex)
- Results from strokes, infections, tumors
- Signs include spastic paralysis, little/no muscle atrophy, hyperactive deep tendon
reflexes (hyperreflexia)

TABLE 5-6 Lower- Versus Upper-Motor-Neuron Lesions.

Spinal Cord Lesions

A. Small Central Lesion – pain and sensation abnormalities

B. Large Central Lesion – pain, sensation, and LMN and UMN dysfunction
C. Dorsal Column Lesion – sensation abnormalities
D. Irregular Peripheral – sensation/motor disruption below level of lesion (often seen
w/ penetrating injury)
E. Complete Hemisection – ipsilateral motor paralysis and sensation loss
DONTGONB263B

CHAPTER 8
CRANIAL NERVES AND PATHWAYS

Origin of Cranial Nerves

12 pairs of cranial nerves located bilaterally on ventral surface of brain
 Cranial nerves with motor (efferent) functions arise from cells (motor nuclei) in
brainstem
 Cranial nerves with sensory (afferent) functions have cells of origin (first order
nuclei) outside the brainstem in ganglia (DRG)

Cranial no.: (Positioning/Sequence)

1. Olfactory – smell (most rostral)
 Lines up against the bottom of the frontal lobes of the brain
 Pretty close to the frontal cortex
 On top of your palette and your nasal cavity, so those nerves/neurons
periphery through your nasal cavity to give you a sense of smell
2. Optic – vision
 Big nerve
 On the basal surface of the brain
  Crosses at the optic chiasm (each part of your left retina goes to the left part
of your brain and same for right) the fibers from the retina cross at the chiasm
 Appears as an ‘X’
3. Oculomotor
 First thin nerve – medial nerve
 Comes almost at the top of the pons
4. Trochlear
 Tiny nerve that comes out more lateral than ocu
5. Trigeminal (biggest one that comes out of the brain)
 Big nerve, has three separate branches
o Sensory – face
o Sinuses – teeth
o Jaw muscles
6. Abducens
 First medial nerve on the medulla
o Eye movement
7. Facial
 Often looks like a double nerve coming up because it is attached for the most
part
o Face muscles
o Taste
8. Vestibulocochlear (also called the auditory nerve, they are interchangeable)
 Smaller than the facial nerve
o Hearing
o balance
9. Glossopharyngeal
 Small nerve
o Muscle of throat and larynx
o Taste
10. Vagus (big nerve, easy to locate, fan appearance to it)
o Internal organs
11. Accessory (also called the spinal accessory)
 Attached and runs down to the beginning of the spinal cord
 It goes up and tucks behind the hypoglossal
o Muscles of the neck and upper back
12. Hypoglossal
o Tongue movements

3 – 6 – 12 – 1 – 2 (Medial nerves)
Bottom to top in ventral view:
 Cerebellum – spinal cord – medulla – pons – midbrain – lateral lobes – temporal
lobes – frontal lobes
Das – dorsal, afferent, sensory
Vem – ventral, efferent, motor

Medulla is on top of the spinal cord, so it is the direct connecting point, that’s why it has
the ascending and descending tracts

Pontine tegmentum is lateral to pons

Pons – middle cerebellar

Medulla – inferior

Midbrain – most superior aspect of the brain

CHAPTER 9
DIENCEPHALON

Thalamus
Large centrally located sensory waystation in the brain
 Thalamic white matter
- Thalamic Radiations
- Medullary Lamina
o External medullary lamina – lateral white matter fiber tract between
thalamus and the reticular nucleus
 Major thalamic nuclei – 5 groups
1. Anterior nuclei
2. Midline and medial nuclei
 3. Lateral nuclei
4. Posterior nuclei

Midline nuclei – centrally located

Everything you hear, it gets in through your auditory nerve and goes through the lateral
geniculate nucleus (LGN)

Pulvinar nucleus
- Largest posterior group – connects with the parietal and temporal cortices (posterior
association cortices) and the Superior colliculus

Psychedelics work on the thalamus

Schizophrenia - Thalamic issues with sensory area, altered thalamic signaling

Autism – problem with sensory overload processing

When you see something, LGN activates

Hypothalamus (most ventral portion)

Bilateral centrally located brain area beneath the thalamus
 Involved in autonomic, appetitive, and regulatory functions
 Landmarks – lies just below and rostral to thalamus
- Sends signals to pituitary glands
- It’s underneath the thalamus
- Pre-optic nuclei

Hypothalamic nuclei goes from front to back

Pituitary is surrounded by blood vessels
- Dangling gland sur by blood vessels interact directly with axon terminal with neurons
that live in the hypothalamus – neuron to blood vessel connection
Anterior Pituitary – Neuroendoconstruction
Blood’s coming in through the posterior pituitary

Cells in hypothalamus release CRH and tell cells in the anterior pituitary to release ACTH. That
further signals to the Adrenal cortex to release CORT. CORT provides negative feedback to
hypothalamus and anterior pituitary to tell them to stop releasing CRH and ACTH when the
action is not required anymore. In cases of depression and PTSD, their negative feedback
loop system doesn’t work. They constantly feel stressed, in a flight-or-fight state.

Subthalamus
- Sits underneath the thalamus
- Modulates motor function

Epithalamus
Most caudal in the Diencephalon