Crossman book summary

Chapter 1
Development of CNS
Ectoderm: skin and nervous system. Mesoderm: skeletal, muscles and connective tissue.
Endoderm: GI resp and GU tract
Process of development of embryonic nervous system is called NEURULATION
 3rd week thickening midline of ectoderm forming Neural plate. 2) Elevation of lateral
margins forming neural folds with a midline depression called neural groove. 3) later on
there will converging of the neural folds which will fuse together forming the neural tube.
Some cells from neural folds will start to separate and form groups dorsolaterally to tube,
this are known as neural crest.
 Maximal cell differentiation will occur in the rostral part leading to formation of the brain
and caudally the spinal cord.
 Central cavity in neural tube will develop in central canal and brain ventricles.
 The neural crest cells will form sensory ganglia and cranial nerves and autonomic ganglia.
 Longitudinally formation of Sulcus limitans inner surface of lateral walls of embryonic
spinal cord and caudal brain.
 Formation of alar plate (sensory) and basal plate (motor).
 Further development of grey (central) and white matter (outer)
 Development of discontinues longitudinal columns  special somatic afferent: develop
with inner ear and receive auditory and vestibular input  general somatic afferent: from
periphery
Special visceral afferent: taste  general visceral afferent: from viscera  general visceral
efferent: preganglionic autonomic Branchial efferent: motor neurons for, branchial (pharyngeal)
arches. – somatic efferent: motor neurons from somatic efferent.

Brain embryonic development

* the longitudinal axis of CNS (neuroaxis) doesn’t remain straight but is bent by midbrain
and cephalic flexure, occurring at junction of midbrain with forebrain. Cervical flexure
between brain and spinal cord
 *Pontine flexure (reckon exam question) is junction between metencephalon and
myelencephalon.
 The telencephalon will develop the 2 cerebral hemispheres. Outer gray matter layer and
inner white matter (nuclei buried forming corpus striatum)
Central cavity in neural tube will develop in central canal and brain ventricles, which will
contain CSF fluid.
 Phylogeny (genetics) has a big effect on the evolution of brain, leading to expansions and
outgrowths from dorsal aspect and simple tubular brain. Bilaterally paired centers develop
for smell vision and hearing. Midline for vestibular function and maintain equilibrium This
process is called Prosencephalisation. There will be the formation of 4 swellings in dorsal
surface of midbrain: corpora quadrigemina, superior and inferior colliculi. Motor centre
developed in cerebellum (maintain equilibrium and coordination of movement)

Developmental anomalies
Anencephaly: infant minute brain and skull
Spina bifida: low spinal cord and nerve roots undeveloped, uncovered skin and bone
(meningomyelocele) lead to paralysis of low limbs and bowel incontinence

Overview anatomy of CNS

Coverings and blood supply
 CNS is covered by 3 membranous layers called meninges. Outermost is dura mater, tough,
fibrous coat, surrounding like a loose-fitting bag, separated either in cranial and spinal by
periosteum. Though on some skull parts it is tightly adherent to interior of skull. Falx
cerebri in sagittal plane between 2 cerebral hemispheres, free border above corpus
callosum. Tentorium cerebelli horizontally, lying beneath occipital lobes and above
cerebellum. Dura mater can be 2 layers in some locations that are separated by Dural
venous sinuses. Important venous sinuses: on cranial cavity floor, along attachment falx
cerebri and tentorium cerebelli to interior skull and along line one another
 Beneath dura there will be arachnoid mater, separation by subdural space, arachnoid is
collagenous and loose. Innermost layer is pia mater that is delicate and thin and tightly
adherent. Separation from arachnoid mater by subarachnoid space full of CSF.
Blood supply from internal carotid and vertebral arteries, which anastomose to form
circulusum arteriosus (circle of willis).
 Spinal cord supplied by branches of vertebral arteries, with further reinforcement from
radicular arteries (from segmental arteries), will supply through subarachnoid space. The
meninges are mainly supported by Middle meningeal artery (pterion location).

Anatomy of spinal cord

 31 pairs of spinal nerves. Dorsolaterally attachment is sensory/afferent/ascending (to
brain). Presence if dorsal root ganglion as cell body.
 Ventralaterally are motor/efferent/descending (from brain), which leave vertebral canal
through intervertebral foramina. Spinal cord just till L1-L2 disc, down it will cauda equina
that will be the nerves trying to reach their exit foramina. Transverse section is butterfly
shaped, central grey matter and out white matter.
 In Tx and upper Lx there will be an addition lateral grey matter horn that contains
preganglionic neurons of sympathetic division.
 Main ascending tract are dorsal columns (fasciculus gracilis (arms) and cuneatus (legs))
carry touch and proprioception, Spinothalamic for temperature and pressure and
 spinocerebellar that carry from joints and muscles to cerebellum. Most important
descending is lateral corticospinal (skilled voluntary movements).

Anatomy of brain
 Out grey matter and inner white matte, with specific functions. Cerebral hemispheres are
separated by great longitudinal fissures that are occupied by falx cerebri and deeper
corpus callosum with commissural fibres between two hemispheres. Brainstem is origin of
10 cranial nerves (3-12). Dorsal/posterior to brainstem there is cerebellum. Tentorium
cerebelli lies between cerebellum and occipital lobes (posterior cerebral hemispheres).

Ventricular system
 Dorsal shallow depression of surface of pons and medulla is the 4 th ventricle, the walls
converge forming a narrow tube that is the cerebral aqueduct (dive substance from
brainstem).
 At junction between midbrain and forebrain, aqueduct opens forming 3 rd ventricle, which
the walks are formed by thalamus and hypothalamus. Near rostral end of 3 rd ventricle
there is an aperture called interventricular foramen (foramen of Monro), communicating
with extensive chamber of lateral ventricle of each hemisphere. It is contained CSF
produced by choroid plexus

Brainstem
 Is composed by medulla oblongata, pons and midbrain, coordinates brain and spinal cord.
Site of origin of many cranial nerves. Vital function of controlling cardiovascular, breathing
and consciousness.
 Medulla oblongata caudal continuation with spinal cord and extend rostrally to pons.

Cranial nerves
First 2 in forebrain. The rest in brainstem with their cranial nerve nuclei (termination and
origin motor fibres

Cerebellum
 attached to brainstem by large nerves on lateral side of 4 th ventricle. Divided into inferior,
middle and superior cerebellar peduncles.
 Outer layer grey matter called cerebellar cortex and central core white. Highly convoluted
cortical surface to form folds called folia. White matter has tree like arrangement.
Coordination and all unconscious level is controlled

Diencephalon and cerebral hemispheres

 2 sides of diencephalon are separated by lumen of 3rd ventricle and lateral walls.
 Diencephalon has 4 division: ((dorso to ventral):
o 1. epithalamus with pineal gland rostral to superior colliculus of midbrain.
o 2. thalamus, is the largest, forms lateral wall of 3 rd ventricle, important for sensory,
motor and cognitive.
o 3. subthalamus is small region on ventricular wall with subthalami nucleus close to
basal ganglia.
o 4. hypothalamus low part and floor 3 rd ventricle, important for ANS, limbs and
neuroendocrine, from midline raise of infundibulum attached to pituatory gland.
  Cerebral hemispheres, outer grey inner white matter (in subcortical white matter a lot of
basal ganglia and basal nuclei).
 Divided by great longitudinal fissures, with lying on it falx cerebri (dura mater sheet), with
deep lie of corpus callosum, two hemispheres linked by commissural fibres.
 Highly convulted, convolutions are called gyri and furrows are called sulci.
 On lateral surface there is a deep cleft called lateral fissure (landmark), with sulci it divides
hemispheres into 4 lobes.
 Most anterior is frontal lobe, posterior boundary of frontal lobe is central sulcus (from
great longitudinal fissures to lateral fissures), posteriorly there is the parietal lobe, which is
separated below lateral fissures from temporal lobe. Posterior lobe is the occipital
 Occipital and parietal are separated by parieto-occipital lobe.
 On medial aspect of cerebral hemisphere there is cingulate sulcus which runs parallel to
upper corpus callosum, with medial aspect of temporal lobe, it is referred as Limbic lobe.
 In frontal lobe, gyrus in front of central sulcus is precentral gyrus (primary motor cortex)
main controller of movement
 In parietal lobe posteriorly to postcentral gyrus or primary somatosensory cortex,
termination of pathways for temperature touch and pressure
 Occipital lobe has the visual cortex in calcarine sulcus
 In temporal lobe there is auditory cortex in superior temporal gyrus, beneath lateral
fissures
 In limbic lobe there are cingulate gyrus, hippocampal formation and amygdala (structures
related to memory and behaviour).
 Cortical afferent and efferent fibres between these structures have a radiating pattern,
they are called corona radiate.
 Inside hemisphere deep white matter sheet called internal capsule. Medial and lateral to
internal capsule grey matter basal ganglia are present. Biggest is corpus striatum that
consists of caudate nucleus (lie in lateral ventricle, C shaped), putamen and globus pallidus.
Basal ganglia related to muscles, posture and movement.

Major sensory pathways

 Special sense= from cranial nerves and other structures
 General senses= from exteroreceptos, proprioceptors and cranial nerve 5 trigeminal.
 3 neuron sequence. 1st order neuron ipsilateral to side of stimulus located in dorsal root
ganglion or trigeminal ganglion. Still ipsilaterally will synapse to 2 nd order neuron which will
be either in spinal cord or brainstem, afterwards it will decussate to other side of cns and
synapse with Thalamus (controlaterally), which will send the axons to somatosensory
cortex of parietal lobe.
 From dorsal root ganglion (fasciculus gracilis/cutaneous and spinothalamic tract) will
ascend to thalamus through medial lemniscus.
 Differently the trigeminal nerve will have the 2nd order neuron in trigeminal sensory
nucleus and go to thalamus through trigeminothalamic tract. This spatial segregation of the
projections of somatosensory system is called somatotopic organization. Quite evident in
area cerebral cortex where a strip of medial aspect of hemisphere (leg area) to
inferolateral aspect of parietal lobe (head area)
Major motor pathways
 Direct innervation is offered by lower motor neurons called as well final common pathway,
but they will be controlled by upper motor neurons.
 Descending tracts from brainstem and spinal cord. Most important are corticospinal and
cortibulbar or corticonuclear in a somatotpic fashion.
 Axons go through internal capsule, into brainstem to docusate (most of them) so
movement controlled in opposite cortex.
 Corticobulbar/corticonuclear control cranial nerves that innervate neck and head muscles.
Corticospinal will control trunk and limbs.
 Corticospinal will form a prominent ridge on ventral surface of medulla called pyramids
that is where decussation will happen.
 There is other structure involved in control skeletal muscles these are called
extrapyramidal including vestibular nuclei and reticular nuclei, important for tone and
posture.
 Basal ganglia exert their action on lower motor neurons, important to facilitate appropriate
motor behaviour and inhibit unwanted movement.
 Cerebellum is important to program the movement and coordination, it will receive
sensory information through spinocerebellar tracts, the information are ipsilateral to spinal
cord and contralateral to cerebral cortex. They will do decussation in midbrain to send to
contralateral thalamus.

Basic clinical DX principles

 Extrinsic disorder: from the outside affecting the CNS
Compression of brain, spinal cord or roots or peripheral nerves. Delay can lead to paralysis,
sensory loss or incontinency. These compressions can be caused by blood clots
(haematomas), abscesses or tumours.
 A brain compression can lead to blockage of CSF flow in ventricles leading to a rise in
pressure and expansion of ventricles (hydrocephalus).
 Compression of spinal cord can be due to arthritis (spondylosis), prolapsed disc or tumour,
or meningiomas. There can be compression of spinal cord nerve fibres (syringomelya).
 There can be compression of the cranial nerves from brainstem due to tumour or
aneurysm. Tumours and prolapsed discs can lead to radiculopathy.
Peripheral nerves can get trapped into vulnerable areas pressure areas in limbs or ribs
causing loss of sensory distribution and weakness, entrapment neuropathy.
Systemic disorder:
 Affects organs, patient will present with drug intoxication, dietary deficit, failure of systems
and endocrine problems
Vascular disorder
 Occlusion of vessels = thrombosis
Restriction of oxygen supply= infarction
Bleeding in nervous tissue= haemorrhage
Intrinsic disorder (focal)
 Uncommon and chronic and irreversible
Heredodegeneration
 Congenital (muscular dystrophy)
 Due to degeneration through life (Parkinson’s and Alzheimer’s)
 Neoplasia excessive growth of malignant tumour
  Inflammation of tissue from infection quite common in meninges
Immune disorders, common in CNS is Ms

Major sensory pathways

 Damaging of pathway due to lesion on spinal cord and brainstem, there will be dissociate
sensory loss, leading to a selective loss of modalities of touch and proprioception (most
commonly in dorsal columns) or temperature (most commonly spinothalamic tract).
 Differently a lesion on tx spine will lead to sensory loss and temperature problems either in
trunk and lower limbs ipsilaterally. For limbs is most commonly explained as Pyramidal
weakness (damage of corticospinal tract)/Brown sequard syndrome.
 Brainstem lesion of medial lemniscus will lead to problems with touch, lesion on
trigeminothalamic tract will affect temperature, contralateral.

Lower motor neuron lesion

 Weakness or paralysis of individual muscles
 Wasting muscles
 Fasciculation
 Hypotonia
 Lack of reflex

Upper motor neuron lesion

 Weakness of specific muscles (pyramidal weakness)
 No wasting
 Hyperreflexia
 Spastic
 Positive babinsky
 Absent abdominal reflex

Cerebellum
 There will be ipsilateral symptoms, the problems will be: Nystagmus (eye movement),
dysarthria, tremor and ataxia (gait). With ataxia patient as soon will close their eyes they
will lose equilibrium leading to a positive Rombergs sign.
Basal ganglia
 They will cause loss of voluntary control of muscles. It will be contralateral. This will cause
Akinesia and bradykinesia slow move
 Parkinson disease Resistant gait flexed posture, absence of arm swinging
Rigidity, more muscle tone (lead pipe, cog-wheel), spasticity, resistance to passive
movement
 Tremor
 Dyskenisia: problems speaking, problem in movement patterns
 Chorea: rapid, irregular not predictive move
 Dystonia abnormal postures
 Athetosis slow movement
 Tics involuntary movements

Neuropsychological functions (see image in page after)

Frontal lobe syndrome will cause problems in executive functions
Main language functions (language area) will be in opposite hemisphere to dominant hand
Visuospatial function in parietal lobe
Primary visual in occipital lobes
Memory and learning in temporal lobe (bilateral loss of medial temporal lobe lead to loss
of memory called amnesia)
 Chapter 2 Crossman
Cells of nervous system
Neuronal structure
 The cell body, known as soma can have variable size, eg interneurons soma size is 5nanom,
differently a motor neuron soma will be over 100 nanom. Larger the soma is, there will be
a bigger axon (so faster).
 Dendritic arborization there will be a big variation in sizes and numbers, there will an
organization of afferent inputs
o eg pyramidal cell in cerebral cortex have 1 or 2 apical dendrites towards pial
surface, or purkinje cells in cerebral cortex (tree like)
o The configuration depends on the number of dendrites that attach to the cell body
 Multipolar large numbers of dendrites (motor neurons)
 Bipolar, centrally placed soma, from which it extends just one axon (common in visual,
auditory and vestibular systems)
 Unipolar single process, in case of sensory it is, having dorsal root ganglia in sensory and
sensory ganglia in cranial nerves.
 It centers of the body there is chromosomal DNA, there will be clumps called Nissl granules
which will appear in basophilic dyes (blue), containing RER and ribosomes
 In neurons there will be structural protein strands called Neurofilaments, assembled
neurofibrils. For transport information there will be microtubules that will carry
anterograde and retrograde).
 Neuromelanin is a brown-black from the synthesis of catecholamines, using with
neurotransmitters, commonly pars compacta in substaintia nigra of midbrain and locus
coeruleus in pons
 Lipofuscin is a yellow-brown pigments that are accumulated in neurons with age.
 Different types of synapses are axodendritic, axosomatic, axoaxonal and dendrodentritic,
mechanisms of releasing neurotransmitters from presynaptic membrane to postsynaptic

Neurotransmitters
 Acetylcholine is used from motor neurons to striated muscles, or it is used in ANS in both
pregangnglionic neurons and just in postganglionic neurons from parasympathetic. The use
of ACH in a synapse is called cholinergic.
 In the CNS as excitatory and inhibitory neurotransmitters are used glutamic acid and GABA
Glycine is important in the spinal cord
 Noradrenaline is used in postsynaptic sympathetic.
 Dopamine and serotonin are used in brain and spinal cord
 In brainstem the neurotransmitters are located in locus coerulus (noradrenaline),
substantia nigra (dopamine) and raphe nuclei (5-HT).
 The neurotransmitters action is help the change in permeability of the membrane to
different ions, some others are slower as they act as a second messenger like cAMP.
 Some of the peptides (neuropeptides) are stored and released at the synapse, eg
encephalin, sub P, somatostatin, they are co-localized in the same neuron, called as co-
transmitters.
 Their main function is to modulate, release, re-uptake and postsynaptic effects of other
transmitters, that’s why they are called neuromodulators. To stop the action of a
 neurotransmitter are used enzymes (ach specific one is acetylcholinesterase ACHe).
Neuropeptides are degraded by peptidases.

Neuroglia (cells of nervous system)

 Astrocytes= have a lot of processes (perivascular endfeet), they line the capillaries in the
brain and allow substance exchanges, they are called blood brain barrier
 Oligodendrocytes= myelin sheet producers of the CNS
 Schwann cells= myelin producing cells in PNS
 Nodes of Ranvier= unmyelinated area of the axon, that is what makes travel AP, by
applying changes in ionic permeability, this mode of propagation is called salutatory
conduction
 Microglia: few process and small cells, respond to damage to CNS, proliferate and move to
injury site. Similar to macrophages
 Ependyma= epithelial cells in ventricles and cover choroid plexus, in ventricles they are
ciliated and release CSF

Chapter 3 Crossman
PNS
 Nerve endingssensory receptors, detect changes in environment, control muscle
contraction and glands
 Peripheral nerves  spinal and cranial nerves and their branches
 Plexuses structures of spinal and cranial nerves distributed without synapse, forming
other peripheral nerves
 Peripheral ganglia outside CNS, where nerve and cell bodies are located (dorsal root
ganglia)

Muscles
2 types
1) Extrafusal= more numerous and for muscle strength, innervated by alpha motor neuron
(lie in ventral horn of gray matter and in motor cranial nuclei of brainstem). Its defined one
motor neuron innervating various fibers motor unit (small for precise movements and large
for postural control)
2) Intrafusal= highly specialized and work as sensory receptors, occur in groups known as
muscle spindles, signal muscle stretch and tension to CNS. Innervated by gamma motor
neuron (same origin of alpha). They control sensitivity of sensory endings and stretch reflex
and muscle tone

Myopathies
Myopathy weakness and wasting of muscles (facial, bulbar and proximal limb), preserve
reflex and sensation
Polymyositis immune disorder cause either pain or no pain myopathy, occurs in elderly due
to a primary neoplasm (paraneoplastic syndrome), in children causes a rush called
dermatomyositis
Duchenne muscular dystrophy  XP21.2, x linked. After 2-3 years child weak progressively on
arms and legs leading to a wheelchair and die around 10 years old

Nerve endings
 Afferent respond to various stimuli: touch temperature etc, carrying AP to CNS.
Efferent will involve muscle contraction and glands under CNS control called as well
secromotor
Afferent
Different receptors
 Exteroceptors: superficial to skin respond to noiciception and temperature
 Interoreceptors occur in viscera and respond to mechanical and chemical stimuli
 Proprioceptors: in muscles, joints and tendons and provide awareness of posture and
movement (kinaesthesia) (most common)
They are uncapsulated and work as ending branch of sensory fibres
They are innervated by A-delta and C fibres
 Merkel cells small and near epidermis border, detect touch and pressure, A beta
innervation, still noncapsulated

Encapsulated are:
Meisseners: in dermal papillae and in fingertips, sensitive to touch, rapid adapting.
Pacinian: in deep skin tissue in joints and mesentery. A alpha innervation, detect vibration
Ruffini: slow in dermis, detect stretch

Intrafusal fibers can be of 2 types, nuclear bag and nuclear chain

Annulospiral nerve endings are related to fast afferent, differently flowespray are related to slow
afferent

Golgi tendon organ: they are in tendons and respond to tension, 1 beta afferent

Efferent
Activated by action potential arriving at synapse complex, both alpha motor and gamma motor in
striated muscle arrive and neuromuscular junction or motor end plate releasing ach leading to
contraction

Myasthenia gravis is an immune disorder at NMJ, causing weakness and fatigue of cranial muscles
and limbs (proximal), no waisting, change reflex or sensation. Needed to inhibit acetylcholine to
treat.
Eaton lambert syndrome immune and paraneoplastic disorder, no response to anticholinesterase

Peripheral nerves
Endoneurium: individual muscle fibers in delicate connective tissue
Perineurim: bundles of fibers
Epineurium: whole nerve ensheated
Meninges are continuos with them (classify the maters basing on how they cover spinal cord to
match)

Degeneration and regeneration

When peripheral nerve fibers are damaged, usually far away from body will lead to anterograde or
Wallerian degeneration. The proximal part of axon still can survive and lead to regeneration. Farer
away more likely to survive. It can happen some reterogade degeneration causing loss of Nills
granules on cell body (chromatolysis) swelling of cell body and movement of nucles from central
to peripheral location. Regrowth can occur and 1 or 2 mm at day. Can oocur in CNS, but is harder
to regenerate.

Distribution spinal and peripheral nerves (important as well for diagnosis)

A tumour can lead to problems in the brachial plexus, so neurological symptoms (Pancoast
tumour)
 Chapter 4 crossman
ANS
Controls smooth muscles, visceral organs or glands. The main action is to maintain a stable
internal environment (homeostasis), by controlling the different body systems automatically and
with a very small volitional control.
Within spinal cord and brainstem there will be interconnections related to reflexes.
There will be afferent ascending neurons which will connect to other neurons about conscious
awareness towards brain, from hypothalamus there will be descending information to carry action
to the target. Between the CNS and the target there will be an autonomic ganglion (peripherally),
before there will be preganglionic neuron in spinal cord or brainstem and there will be afterwards
the postganglionic neuron located peripherally in an autonomic ganglion.
The efferent fibers can be either sympathetic (fight and flight) or parasympathetic (rest and digest)

remember erector pili in dermis just sympathetic (Pat question)

Sympathetic division
They will be located just in TX and L1 and L2, with an extra part of grey matter called Lateral horn.
They will leave through ventral horn and join spinal nerve
Postganglionic sympathetic neurons have cell bodies in 2 location: ganglia chain or plexus (coeliac,
superior or inferior mesenteric) surrounding abdominal aorta. The link between the ganglia of the
sympa chain and spinal nerves is in the rami communicantes, which are white due to myelin, in
preganglionic case. In postganglionic case will return to spinal nerve by grey ramus
communicantes.
Areas concerned of pelvis and abdominal wall will just go uninterruptedly through plexus
Preganglionic neuron releases ach, postganglionic neuron will release noradrenaline, though
innervation of sweat glands are cholinergic.
Adrenal medulla is directly innervated by preganglionic sympathetic neurons

Lesions
Primary autonomic failure is chronic degenerative disease of NS leading to failure to control heart
rate and blood pressure (postural syncope), incontinence of bladder
Horner’s syndrome, drop of eye lid (ptosis) and constriction of pupil (mioisis), damaging to sympa
innervation of levator palpebrae superioris muscle and the radial (puppilodilator fibers). The
dmamage can be caused by a tumour or a stroke in brainstem and spinal cord, affecting as well
carotid arteries causing migraine.

Parasympathetic division
In brainstem and spinal cord. Associated with cranial nerves, oculamotor, facial, glossopharyngeal
and vagus. In cord they lie from S2 to S4.
Contribute to Auberbach and meissner’s plexus in GI tract.
Both pre and post ganglionic will release acetylcholine
Chapter 5 crossman
Coverings of CNS
Skull
Brain lies in floor of cranial cavity, with bones of cranial vault offers support and protection. The
floor or cranial cavity consists into 3 Fossae, having different foramina to accommodate the cranial
nerves and blood vessels
Anterior cranial fossa
Is formed by frontal, ethmoid and sphenoid bones, containing frontal lobes of the brain. Greater
part consists in frontal lobe forming as well the roof of the orbit, in the anterior wall fossa is
contained the frontal air sinus. In the midline of the floor of the anterior canal there is ethmoid
bone. In midline a sharp ridge called “crista galli”, is the anterior point of attachment of Fal
cerebri. There will be an elongated depression in the ethmoid bone of the crista galli liying in the
cribiform plate, which has small perforations through the fascicles of olafactory nerve entering
cranial cavity from nasal cavity to attach to olafactory bulb.
Middle cranial fossa
Formed by sphenoid and temporal bone. In midline of sphenoid there is a deep fossa called
hypopheseal fossa, with anterior and posterior clinoid processes. There will in the hypopheseal
fossa hypophysis and pituatory gland
- Optic canal= medial to anterior clinoid processes, communicate with orbit and has Optic
nerve (II) and ophthalmic artery (branch internal carotid artery)
- Superior orbital fissures: between greater and lesser wings sphenoid and communicates
with orbit, carries oculamotor (III) throchlear (IV), Abducens (VI) and ophthalmic division of
trigeminal (V).
- Foramen rotundum: in pterygopalatine fossa and carries maxillary division of trigeminal
nerve (V)
- Foramen ovale carries large mandibular division of trigeminal nerve
- Foramen spinosum: entry point of middle meningeal artery (common injury point)
Posterior cranial fossa
Formed by occipital and petrous temporal bones. Anteriorly it forms clivus which is continuos to
sphenoid bone, just posterior to hypophyseal fossa. The brainstem is above the clivus, with
medulla going through foramen magnum forming spinal cord. the foramen magnum allows as well
vertebral arteries and accessory nerve (coming from spinal cord) (XI). Laterally to foramen
magnum there is the hypoglossal canal which contains hypoglossal nerve (XII). Between occipital
and petrous temporal bones ther will be a large Jugular foramen through which there will be
internal jugular vein, glossopharyngeal (IX), vagus (X) and accessory (XI). In vertical wall there will
be internal acustic meatus which has through vestibular (VIII) and facial (XII)
Raised intracranial pressure
Space occupying lesions is a focal lesion such as tumour or haematoma, where brain is displaced
downwards to foramen magnum and raise pressure, causing headache, vomit, blurry vision.
Swollen optic disc (papilloedema) sign of brainstem dysfunction required operation. Benign
intracranial hypertension is general brain swelling in absence of lesion.
Foraminal syndromes
can be caused by extrinsic compression such as bone deformity, tumour etc, most common
superior orbital fissures syndrome and foramen magnum syndromes.

Cranial meninges
Dura mater: tough, fibrous membrane that enclose brain, is some areas it is tightly adherent to
skull forming frontoparietal area that are just seprated by small extradural space. In midline
vertical sheet of dura is called falx cerebri from cranial roof into great longitudinal fissures
between cerebral hemispheres. Posteriorly there will horizontal dura called tentorium cerebelli,
extending from occipitotemporal region to transverse cerebral fissures, which free bord incircles
midbrain. In midline in becomes falx cerebri. 2 layers of dura mater, separated by dural venous
sinuses, which are attached mainly to falx cerebri and tentorium cerebelli. Veins drain mainly into
Internal jugular vein
Head trauma
Displace and torsion of brain, tearing white matter causing bleeding= intracerebral haematoma
Tear middle meningeal artery causing bleeding in extradural space= extradural haematoma
Tearing veins in subdural space= subdural haematoma

Arachnoid and Pia mater

Arachnoid is soft and translucent, loosely arranged, separated from dura by subdural space
(containing venous sinuses)
Pia mater is very thin and adherent to brain, separated from arachnoid by subarachnoid space,
which contains connective tissue strands (trabeculae) arteries and veins. Most importantly
contains CSF produced by choroid plexus cells within ventricles. Significant depressions and
fissures in brain due to arachnoid mater are called subarchnoid cisterns, 2 most important are:
Cisterna magna: between cerebellum and dorsal medulla, where CSF from 4 th ventricle flows
Interpenducular cistern: base of brain where arachnoid spans space between temporal lobes,
containing optic chiasm. Between cerebral peduncles of midbrain

Meningitis
Infection from virus or bacteria causing photophoia headache and vomiting, leads to cranial nerve
and brain injuries by increasing intracranial pressure

Chapter 6 crossman
Ventricular system
Topographic anatomy of ventricular system
in rostral opening of medulla, the spinal cord opens out into a wide and shallow depression known
as 4th ventricle , which lies on dorsal surface of brainstem benath cerebellum. On each lateral
margin of brainsteam, there is a recess through a small aperture (foramen of Luschka) with the
subarachnoidal space of cerebellopontine angle. Roof of 4 th ventricle is by cerebellum. Roof of
caudal part is is made of Pia and ependyme, with a central defect forming a median aperture
called foramen of magendie. This will allow communication between ventricle and cisterna magna.
Rostral part of 4th ventricle is relatively formed by superior cerebellar peduncles with a small space
called superior medullary velum.
The 4th ventricle expands till the pontomesencephalic junction where it becomes continuos with
the cerebral acqueduct (narrow channel) through midbrain length, benath inferior and superior
colliculi.
At rostral margin of midbrain, the cerebral acqueduct opens into 3 rd ventricle, narrow midline, slit
like cavity, where lateral walls are formed by thalamus and hypothalamus. Roof of 3 rd ventricle is
made of Pia and ependymal, with 2 nerve bundles, stria medullaris thalami, along dorsomedial
border of thalamus. In rostral part there will an aperture known as Interventricular foramen or
foramen of monro, between column of forninx and anterior pole of thalamus. This foramen will
offer communication bilaterally with extensive lateral ventricles, C-shaped, anterior frontal horn,
posterior occipital horn and inferior temporal horn, the lateral wall is formed by head of caudate
nucleus and roof is corpus callosum. The medial wall is formed by septum pellucidum, thin sheep
spans between corpus callosum and fornix, with the separating function of 2 anterior horns of
lateral ventricles.
CSF
Contained in cranial and spinal subarachnoid spaces. It Is produced by choroid plexus (located in
lateral, 3rd and 4th ventricles). Choroid plexus is formed by invaginations of vascular pia mater,
which is highly convoluted, forming a fissure in the ventricles along line of fornix. CSF is active
secretory process and partly by passive diffusios, colourless, approximately the volume is 150 mL,
continuously produced. Most of it is producend in lateral ventricles, which will move in 3 rd
ventricle by interventricular foramen, and following cerebral acqueduct in 4 th ventricle. Most of
CSF moves to subarachnoid space by the median aperture to enter in cisterna magna between
medulla and cerebellum. Smaller amount will move from lateral ventricle to subarachnoid space
by cerebellopontine angle, moving to cerebral hemispheres area to reabsorption site. The
reabsorption comes by venous system, with the sinuses located in the arachnoid villi. Will occur
reabsorption by hydrostatic pressure. With age there will hypertrophy of the villi, causing
arachnoid granulations.
Hydrocephalus
Is obstruction of flow of CSF in ventricular system or subarachnoid space, leading to rise in
pressure and swelling
Swelling of optic discs= papilloedema
Need to decompress dilated ventricles to jugular vein or abdominal peritoneum shunting
connection

Chapter 7
Vasculature of CNS
Vasculature spinal cord
3 longitudinal arteries, single anterior spinal artery and paired double posterior spinal arteries.
Anterior spinal arteries, Y shaped from 2 vertebral arteries at medulla oblongata level and descend
in midline ventral surface. Posterior spinal arteries, arise from vertebral arteries or posterior
inferior cerebellar arteries and run caudally in posterior surface of cord. They don’t offer sufficient
blood so they will be supported by anastomosis segmentally of radicular arteries (cervical,
intercostal and lumbar), they will pass through IVF and divide in posterior and anterior branches. A
particular one is the artery of Adamkiewicz/ great radicular that is between T8 or L3.
Occlusion of anterior spinal artery leads to acute Tx syndrome with paraplegia and incontinence,
with lost of spinothalamic parts.
About veins, we got 6 longitudinal venous channels. Consists firstly of anterior and posterior spinal
veins. There are more irregular anterolateral and posterolateral veins in ventral and dorsal roots,
they will all drain via anterior and posterior radicular arteries into intervertebral venous plexus
(epidural) between dura and vertebral periosteum. The internal venous plexus and external
venous plexus communicate and thence ascending lumbar, azygos and hemiazygos.
Vasculature of brain
Brain supplied by 2 pairs of vessels Internal carotid arteries and vertebral arteries. Internal carotid
arteries arise from common carotid and enter in middle fossa of cranial cavity through carotid
canal.
On the course there will be a series of bends called carotid syphon, through cavernous sinus on
medial aspect anterior clinoid process to reach lateral optic chiasm, and give rise to ore-terminal
branches
Hypophyseal artery= from intra-cavernous section to supply neurohyphysis, form also pituatory
portal by which releasing factors are carried from hypothalamus and adenohypophysis.
Ophthalmic artery= orbit through optic foramen, supply orbit, frontal and ethmoidal sinuses, front
part of scalp and nose dorsum
Anterior choroidal artery= supply optic tract, choroid plexus of lateral ventricle, hippocampus and
internal capsule and globus pallidus
Posterior communicating artery= backwards joining posterior cerebral artery forming circle of
Willis

Lateral to optic chiasm the internal carotid artery divides into terminal anterior and middle
cerebral arteries. Anterior goes into great longitudinal fissure and joins on opposite side by short
anterior communicating artery, following dorsal curvature of corpus callosum, supplying frontal
and parietal lobes. Includes in the supplying the motor and sensory cortices of lower limb.
Middle cerebral artery is the largest (most affected by stroke), goes to lateral fissures and supply
lateral surface frontal, parietal and temporal, including primary motor and sensory cortices of all
body, apart from low limbs, auditory cortex and insula.
Often all this complex is known as internal carotid system.
Vertebral artery arise from subclavian artery, goes through Cx tvp and enter in cranial cavity, at
junction of medulla and pons unify forming basilar artery and give rise to anterior and posterior
spinal arteries (supply medulla and spinal cord), largest branch posterior inferior cerebellar artery,
supply inferior cerebellum. Basilar artery in pons supply small pontine and gives rise as well to
Laberynthine artery supplying the middle ear. At junction of pons and midbrain it gives rise to
superior cerebellar (superior cerebellum) and posterior cerebellar artery (midbrain and visual
cortex of occipital lobe and inferomedial aspect temporal lobe). All this complex is known as
vertebrobasilar system. Internal carotid and vertebrobasilar are joined by two small posterior
vessels known as posterior communicating arteries. All this anastomosis is known as the circle of
willis or circulus arteriosus. Encircling optic chiasm and floor of hypothalamus and midbrain. A
small insufficiency will be supplied by communicating arteries. From circle of Willis there are small
vessels that penetrate brain surface known as perforating arteries
2 groups division:
anterior perforating arteries: arise from anterior cerebellar arteries, anterior communicating and
region of middle cerebral arteries, enter through optic chiasm and termination at olfactory know
as anterior perforated substance, supply basal ganglia, optic chiasm, internal capsule and
hypothalamus.
Posterior perforating arteries, enter in brain through 2 crura in cerebri of midbrain, known as
posterior perforated substance, to supply midbrain, subthalamus and hypothalamus
Brain supply disorders are: stroke, cerebral haemorrhage, aneurysm, subarachnoid and
intracerebral haemorrhage and angioma/arteriovenous malformation: congenital swollen vessels
Venous drainage of brain
Deep cerebral vein, drain internal structures of forebrain, importantly thalamostriate and
choroidal vein which drain from basal ganglia, thalamus, internal capsule, choroid plexus and
cerebral hemispheres. Within each cerebral hemispheres, these vessels merge from internal
cerebral vein. Two internal cerebral veins unite to form great cerebral vein (galen) lie beneath
splenium of corpus callosum, lie in middle of tentorium cerebelli
Superficial veins lie in subarachnoid space.
Superior cerebral veins drain the lateral surface of cerebral hemisphere and empty into superior
sagittal sinus.
Superior middle cerebral vein along lateral fissure and empty into cavernous sinus
Two major anastomotic channels exists, superior (great) that drains in sagittal sinus and inferior
that drains into transverse sinus.
Deep and superficial cerebral veins that drain into dural venous sinuses, formed between 2 layers
of dura mater. Major is attached to borders of falx cerebri and tentorium cerebelli on floor of
cranial cavity.
On line where falx cerebri attaches to interior of cranium there is the superior sagittal sinus (vein
drain).
Free border of falx encloses inferior sagittal sinus
In tentorium cerebelli along falx attachment there is large straight sinus
Superior sagittal and straight sinus converge in confluence of sinus adjacently to internal occipital
protuberance. From here blood flows laterally either side in transverse sinus with lie in tentorium
attachment to occipital bone. Transverse sinus is continuos with sigmoid sinus, which joins internal
jugular vein at jugular foramen.
Cavernous sinus, lie laterally to sphenoid bone body, receives vlood frim middle cerebral vein and
drain into internal jugular vein (inferior petrosal sinus) and into transverse sinus (superior petrosal
sinus), 2 cavernous sinuses are connected by intercavernous sinuses to hypophysis forming a
venous circle (circular sinus). The dural venous sinuses are connected to extracranial veins via
emissary veins
 Chapter 8 crossman
Spinal cord
Topographical anatomy
Vertebral column offers protection and support, it is rostrally continuos with medulla oblongata.
Segmentally spinal cord consists 8 cervical, 12 thoracic, 5 lumbar, 5 sacral and 1 coccygeal. Varies
shapes through levels. In cx and lx there will be enlargments. In cx will be between C4-T1
innervating the brachial plexus. The lx enlargement will be between L1-S3, associated lumbosacral
plexus, caudally to lumbar enlargement there will be conical termination, called conus medulllaris,
the tip of the conus will be a strand of connective tissue that will attach to dorsal surface of first
coccygeal vertebrae, called filum terminale.
In fetus, spinal cord is equally long as vertebral column, afterwards as fetus grows spinal cord will
just achieve the disc between L1-L2, downwards it will be called cauda equine. The rule for the
segment is in Cx the segment will be one up vertebrae, in TX 2 higher, in Lx will be 4 higher
Spinal nerve
31 bilaterally pairs of spinal nerves, originating from fascicles or rootlets attached to dorsolateral
and ventrolateral, that will pass through corresponding Intervertebral foramen, close to proper
spinal nerve.
There will be either afferent and efferent, dorsal are primary afferent neurons (from PNS to Spinal
cord or brainstem), cell body in dorsal root ganglia. Ventral roots will carry efferent, cell body will
be in grey matter, innervating muscles or preganglionic neurons of ANS. C8 nerve will be between
C7 and T1, caudally the nerve root to achieve proper IVF will have an oblique downwards route
(especially in Lx and Sx). After leaving IVF the spinal nerve will split into a thin dorsal (posterior)
ramus to supply back and larger ventral (anterior) ramus for body front and limbs
An injury to spinal nerves can be caused by either spondylosis or prolapsed intervertebral disc
Spinal meninges
3 Concentric layers of covering, pia, arachnoid and dura
innermost is pia mater, delicate, vascular membrane closely applied to surface of cord and nerve
roots, attached to roots by denticulate ligaments, which has free lateral margins, but
intermittently it attaches to spinal cord and arachnoid mater, through dura
Arachnoid in the middle, loose fitting bag, containing CSF
Tough outer covering separated by subdural space from arachnoid and by epidural space from
vertebral column. The arachnoid and dura sheat continue further the end of spinal cord till S2
level, the nerves passing through the IVF will invaginate forming meningeal root sleeve. They
become continuos with epineurium
Internal structure of spinal cord
two symmetrical halves, dorsal median sulcus and ventral median fissure, with a small central
canal, surrounded by grey matter, outer part is white matter (myelin) containing ascending and
descending axons, many of these have same origin and sam function, grouped together are called
fascicles, forming long tract of spinal cord. Different levels of spine contain different amounts of
grey and white matter.
Grey matter of spinal cord
is H shaped, with 4 protrusions, dorsal (posterior) and ventral (anterior) horns. The Cx and Lx levels
are strongly linked to limbs innvercation. Tx and upper Lx got lateral horn due to preganglonic
sympathetic neurons. Grey matter can be divided into 10 zones, known as Rexed’s laminae.
Dorsal horn
Afferent fibres run into dorsolateral tract ot lissauer’s tract (tip of horn). Cutaneous end in
superficial laminae, muscular in deeper laminae.
Rexed’s laminae 1-3 are the tip, known as well as substantia gelatinosa, receives Adelta or C-fibers
(nociception), excitatory neurons using substance P and glutamic acid. In substantia gelatinosa
there will be interneourons controlling the pain pathway of spinothalamic and spinoreticular,
distributed in dorsal horn. Mechanism of gate control theraphy. Input from larger alpha and beta
inhibit transmission of nociception impulses, eg. Use rubbing, the neurotransmitter released is
endogenous opioid peptide encephalin, process of synaptic inhibition. Descending pathways from
the brain can influence nociception transmission. This serotenergic fibers originated in nucleus
raphe magnus of medulla and noradrenergic fibers of locus coeruleus of upper pons exciting
enkephalinergic dorsal horn interneurons, by inhibiting nociceptive input.
Deeper in horn, lamina VII (C8-L3) cells of Clarke’s column (tx nucleus, nucleus dorsalis), origin in
dorsal spinocerebellar tract affecting muscles spindles and golgi tendon organ. And will contain
lateral horn, while at S2-S4 contain preganglionic parasympathetic.
Ventral horn
Contain Alpha motor neurons (innervate extrafusal)
Gamma motor neurons (innervate intrafusal)
More medially innvervate trunk and neck, more laterally limbs
In C3-C5 ventral horn, there is phrenic nucleus, related to innervate the diaphragm , they can as
well receive direct dorsal afferent roots (from muscle spindles, stretch reflex).
Spinal reflexes
Involuntary, stereotyped response from sensory stimulus, important to evaluate qualitative and
quantitative (big variations due to intersegmental and supraspinal). There will be an involvement
of an interneuron in CNS, and the organization of spinal cord and breainstem will affect reflex.
Stretch reflex
Muscle stretch in response to contraction, activating stretch and myotatic reflex, afferent anf
efferent connected by monosynaptic reflex arc. The stretch receptos are attached to central non-
contractile intrafusal muscle fibers, encapsulated in muscle spindles. The impulse is carried to the
CNS where it makes contact with alpha motor neurons of extrafusal fibers.
2 types of intrafusal muscles:
1 Primary or annulospiral: nuclear bag with group of Ia afferent, relative to dynamic endings
(velocity and stretch)
2 Secondary or flower-spray: nuclear chain fibers and give rise to group II afferents. Relative
to static endings (change in muscle length)
Important to evaluate muscle tone and evaluated by compliance of muscle in palpation and
resistance to passive stretch
Differently gamma motor neurons control sensitivity of the stretch, by the contraction of the
intrafusal fibers by tension on sensory nerve endings, causing the lowering of threshold to
increase sensitivity, this is called gamma reflex loop.
Affected by upper and lower motor neuron lesions.
Tendons of skeletal muscle fibers contain mechanoreceptors in golgi tendon organs with 1b
afferent and interneuron and inhibition of alpha motor neuron. Important to evaluate initial
contraction on rapid passive muscle stretch (clasp-knife reaction).
In stretch reflex there will be inhibition of antagonist muscles, this process is called reciprocal
innervation.
Flexor reflex
Noxius cutaneous stimulation of limbs causes flexion withdraw from offending stimulus, by
polysynaptic reflex by activing more than one interneuron, by activating alpha motor neuron, at
collaterally activated afferent and interneurons. Descending pathways of brain prevents to happen
always, unless cutaneous stimulus is painful. Eg Babinski. In infants due to not full myelination in
corticospinal tract is absent, due do not suppression.
In weight bearing limb, activating this reflex causes extension of contralateral limb; crossed
extensor reflex due to excitation of contralateral alpha motor neurons

White matter
Surrounds grey matter, is divided in dorsal, ventral and lateral columns/funiculi, separating the
horns, where we find fibers sharing same function (fascicles). The inersegmental or propriospinal
occupy a narrow band immediately in peripheral to grey matter. This is known as fasciculus
proprius
Ascending spinal tracts
Some reach conscious level (cerebral cortex, other unconscious (cerebellum)
1st order neuron in dorsal root of spinal nerve, central process may collateralize extensively and
make synaptic conneetion that mediate spinal reflex and intersegmental connection. Fibre stays
ipsilateral and synapses in 2nd order neuron in spinal grey matter or medulla oblongata
2nd in body in the cord or medulla oblongata and decussates in CNS and goes to thalamus 3 rd
3rd is n the thalamus and axon goes to somatosensory cortex in parietal lobe of ipsilateral cerebral
hemispheres.
The main tracts from dorsal posterior columns or spinothalamic tracts
Dorsal columns
In dorsal median sulcus and dorsal horn. 2 tracts medial fasciculus gracilis (low tx, lx and sx and
lower limbs) and fasciculus cuneatus (upper Tx, Cx and upper limbs), in ipsilateral side of body and
carry to nucleus gracilis and cuneatus that are the 2nd order neuron.
The axons decussate in in medulla as internal arcuate fibres and ascend to brainstem as medial
lemniscus and terminate in ventral posterior nucleus in thalamus and project after in
somatosensory cortex in postcentral gyrus of parietal lobe
Spinothalamic tract
Lies lateral and ventral to ventral horn of grey matter, carries information about pain and
temperature, touch and pressure. It contains the 2 nd order neuron in contralateral dorsal horn and
receive primary afferent input that terminate in that region, after leaving parent cell body
decussate through ventral white commissure ventrally to central canal and enter contralateral to
spinothalamic tract. Pain and temperature decussate promptly, touch and pressure can ascend
some segments. In brainstem run in spinal lemniscus terminating in ventral posterior nucleus of
thalamus (thalamocortical neurons project in somatosensory cortex)
Important for sharp and soft detection.
Spinoreticulothalamic system is additional, by which nociception sensory impulses ascend to
higher centres, where some 2nd order neuron arise from dorsal horn ascend in ventrolateral region
and terminate in brainstem particularly in medulla. This fibers go to intralaminar nuclei in cerebral
cortex, is poorly organized, carries slow pain, conscious level. Body one easy to detect, visceral one
hard to detect (referred pain) due to share same segment as area of body.
Spinocerebellar tract
Principal subconscial ones. From spindles and mechanoreceptors (golgi tendon organ) to
cerebellum to control posture. 2 from upper limbs and 2 from lower limbs. Just 2 neurons. The 2 nd
order neuron lies in dorsal horn, can ascend either controlaterally or ipsilaterally. Specifically, in
dorsolateral and ventrolateral spinocerebellar relay from legs. Origin of dorsolateral from lamina
VII between T1-L2 in clarke’s column, axons ascending ipsilaterally through inferior cerebellar
peduncle. Differently from ventrolateral surface there will originate from lumbosacral cord levels
and decussate to enter in cerebellum via superior cerebellar peduncle. Upper limb of dorsal tract
equivalent is cuneocerebellar fibers, ascend ipsilaterally in fasciculus cuneatus and terminate in
medulla in lateral cuneate nucleus. Upper limb equivalent of ventral tract is rostral
spinocerebellar, origin laterally to lateral funinculus and enter in cerebellum by inferior peduncle.
Spinocerebellar tract terminate in cerebellar cortex within vermis and paravermal area.
Degeneration of spinocerebellar tract leads to Friedreich’s ataxia.
Descending spinal tracts
Origin in cerebral cortex or brainstem, control move, tone, reflexes, spinal autonomic function and
modulation of sensory transmission
Corticospinal tracts
Concerned with voluntary, discrete, skill movements, especcialy in distal limbs (fractioned
movement). Widely distributed in motor and sensory cortices, especcialy precentral gyrus and
primary motor cortex of frontal lobe, where there are Betz cells (origin), leave cerebral
hemispheres through subcortical fibre system, corona radiate and internal capsule to enter crus
cerebri of midbrain, to reach medulla oblongata to form 2 prominent columns on ventral surface
(pyramids), in caudal medulla there is decussation. Most decussate and enter in lateral
corticospinal tract in lateral part of white matter, deep in spinocerebellar tract, the rest stays
ipsilateral and enter in ventral corticospinal tract in ventral median fissure
Rubrospinal tract
Origin in red nucleus of midbrain tegmentum. Exerts in control overt tone of limb flexor. Axons
leave red nucleus and cross ventral tegmental decussation and descend ventrolaterally and slightly
intermingled to lateral corticospinal tract. Red nucleus receive afferent from motor cortex and
cerebellum, is a non pyramidal tract.
Tectospinal tract
From superior colliculus of midbrain, axons goes ventrolaterally around periacqueductal grey
matter and cross in dorsal tegmental decussation. Descend in spinal cord close to ventral medial
fissures in Cx segments. Visual stimuli
Vestibuspinal tract
From vestibular nuclei in pons and medulla, near floor 4th ventricle, input from labyrinthine system
by vestibular nerve and from cerebellum. Axons from lateral vestibular nucleus (deiters nucleus)
are ipsilateral as lateral vestibuspinal tract, in ventral funiculus. They mediate to extensor motor
neuron
Medial vestibular nucleus descends ipsilateral medial longitudinal fasciculus/medial
vestibulospinal tract adjacent to ventral median fissure.
Reticulospinal tract
Origin in pons and medulla, arise from pontine reticular formation and descend ipsilaterally as
medial (pontine) reticulospinal tract, from medulla descend bilaterally in lateral reticulospinal tract
in ventral funiculus. Control voluntary muscles and tone, controls either alpha and gamma motor
neuron. Mediate pressor and depressor effects in circulatory system and breathing

Chapter 9 crossman
Brainstem
Consists in medulla oblongata, pons and midbrain. Old term was bulb. Bulbar palsy describe
syndromes of medulla. Brainstem lies on basal portion of occipital bone (clivus) and connects to
cerebellum. Continuos with spinal cord below foramen magnum. Rostrally midbrain is continuos
with diencephalon of forebrain. Some nuclei receive fibres or sent to cranial nerves (3-12), called
cranial nerve nuclei. Contains complex and heterogenous matrix known as reticular formation
(consciousness, pain perception and regulate CV and respiratory tract). Extensive connections with
cranial nerve nuclei (motor mechanisms and tone). Brainstem contains cells of monaminergic
origin.
External features of brainstem
Dorsal surface of brainstem
3 pairs of nerve fibre bundles/peduncles. On dorsum of medulla the midline is marked by dorsal
median sulcus, in caudal part of medulla there are dorsal columns (fasciculus gracilis, cuneatus,
contain 1st order neurone), continuing rostrally into the graciclis and cuneatus nuclei, marked by 2
small elevations (tubercles). Caudal 2/3 of medulla is continuation of central canal spinal cord, is
called close portion, the rostral 1/3 opens in 4th ventricle, is called open medulla.
Caudal 1/3 of 4th ventricle is made up by rostral medulla, the rostral 2/3 are made up by the pons.
The 4th ventricle is widest at pontomedullary junction where lateral recess extends in brainstem
lateral margins, with a small aperture (luschka foramen) to pass CSF to subarachnoid space. The
lateral walls are made up by superior and inferior cerebellar peduncles connecting brainstem to
cerebellum. In rostral pons, the walls converge at pontomesencephalic junction where 4 th
ventricles becomes continuos with cerebral acqueduct, through midbrain length. Dorsal aspect of
midbrain, contains superior and inferior colliculi related respectively to visual and auditory
systems. The throchlear nerve emerges caudally to inferior colliculus.
Ventral surface of brainstem
There are prominent longitudinal columns, called pyramids, either side ventral median fissure,
giving rise to corticospinal tract. Laterally to pyramids there will be inferior olivary nucleus,
primary connection with cerebellum and movement control.
Ventral part of pons is dominated by transverse pontine fibres or pontocerebellar fibres that
originate from ventral pons (pontine nucleus) and go controlaterally by middle cerebellar peduncle
to enter cerebral hemisphere. This nuclei receive corticopontine fibres from cerebral cortex,
important for coordination of movement.
Ventral surface of midbrain, large column of descending fibres, crus cerebri or basis pedunculi. In
midline two crura of crus cerebri are separated by interpeduncular fossa. Crus cerebri continuos
with internal capsule and contains corticobulbar and corticospinal tracts.
Internal structure of brainstem
Caudal medulla
Rearrangement of white and grey matter. Ventral horn more attenuated, dorsal horn replace by
caudal part of trigeminal sensory nucleus (receives primary afferent from head general sensation.
The caudal part of trigeminal nucleus is more related to pain and temperature. The trigeminal
nerve attaches to pons and trigeminal tract is superficial to nucleus. Most fibers in medulla
decussate forming lateral corticospinal tract
Mid-medulla
Ventral surface is mainly pyramids. Dorsal surface is mainly ascending fibres reaching gracile and
cuneate nuclei (1st order sensory neuron in DRG and ipsilaterally to medulla), axons from second
order neuron, run as internal arcuate fibres decussating and forming rostrally medial lemniscus to
terminate in posterior nucleus in thalamus as 3rd order neuron
Rostral medulla
Ventricular and cerebellar connections.
In midline there will be raphe nuclear complex, most commonly by nucleus raphe magnus major
origin of serotonergic neurons. Dorsolaterally to pyramids and laterally to medial lemniscus there
are inferior olivary nucleus (crenelated bag shape eith a hilum for afferent and efferent fibres.
Concerned to control movement and receive fibres from red nucleus. Main efferent connection is
with inferior cerebellar peduncle. Examples or originating fibers are climbing fibers as purkinje
fibres. Dorsal to inferior olivary nucleus and lateral to medial leminiscus lie 2 nd order neuron fibers
ascending ventral posterior thalamus from trigeminal nucleus (trigeminothalamic tract) and from
spinal cord (spinothalamic tract). Beneath ventricular floor there is hypoglossal nucleus, for
muscles of tongue, laterally to it there is dorsal motor nucleus of vagus with preganglionic
parasympathetic. Most caudal area of ventricular floor is area postrema, related to blood brain
barrier (substances abnormality can cause vomit). In lateral part of floor there iare vestibular
nuclei. Medially to hypoglossal nucleus there is medial longitudinal fasciculus, containing
vestibular nuclei that link with other nuclei supplying extraocular muscles and a coordination of
head and eye movements. Dorsolateral part of rostral medulla dominated by inferior cerebellar
peduncle or restiform body (fibres between medulla and cerebellum. Common here are
olivocerebellar fibers between vestibular nuclei and cerebellum and dorsal spinocerbellar tract for
proprioception of legs. On dorsal and lateral aspects of inferior cerebellar peduncle there are
cochlear nuclei, receiving afferent from cochlear nerve. Inferior there is the nucleus solitaries
receiving visceral afferent from facial, glossopharyngeal and vagus. Ventrally to nucleus solitaries
there is nucleus ambiguous with motor fibres of vagus and glossopharyngeal and cranial roots of
accessory for pharynx and larynx.
Pons
Divided in ventral and dorsal (tegmentum). Ventral has pontocerebellar fibres from pontine nuclei
and pass controlaterally to middle cerebellar peduncle (brachium pontis). There is an additional
group of transverasaly running fibers located close to ascending lemniscal fibres but dorsal to
pontocerebellar fibres, known as trapezoid body, having acoustic fibres from cochlear nuclei.
Ascending laterally into midbrain as lateral lemniscus and terminate in inferior colliculus. In flor of
tegmentum there are abducnes nucleus (lateral rectus), facial motor nucleus (muscles of facial
expression) and trigeminal motor (mastication). Superior cerebellar peduncle contains ventral
spinocerebellar afferent for leg proprioception and ascending cerebellar efferents that go in red
nucleus of midbrain or ventral lateral nucleus. Where it joins to mid brain is called
pontomesencephalic junction (isthmus).
Midbrain
At level of cerebral acqueduct, dorsal is known as tectum and is made of superior (corpora
quadrigemina) and inferior colliculus. Ventral is tegmentum. Bounded ventrally by crus cerebri.
In caudal part afferently the inferior colliculus makes an ascending acoustic (auditory) projection,
which efferently will go to thalamus to auditory cortex in temporal lobe. Superior colliculus will be
visual system with corticotectal fibres fro, visual cortex occiput and front eye lid frontal cortex,
inputs to control eye movement (smooth pursuit and saccadic), involved with accommodation
reflex. From optic tract from superior colliculus end in pretectal nucleus that has connection with
preganglionic parasympathetic neurons (edinger-westphal nucleus) controlling smooth muscle of
eye through pupillary light reflex. Surrounding the acqueduct there is periacqueductal grey matter
containing throchlear and oculamotor nuclei for extraocular muscles and eye movement and link
to abducens in pons and vestibular in medulla by medial fasciculus. At level of inferior colliculus
the tegmentum is dominated by superior cerebellar peduncles (brachium conjuctivum) fibres from
cerebellum to midbrain. Decussation beneath peduncles. At level of superior peduncles there is in
tegmentum the red nucleus for motor control, afferent motor cortex of frontal lobe and efferent
into rubrospinal tract and projects into inferior olivary nucleus of medulla via central tegmental
tract. Most ventral part of tegmentum of midbrain there is substantia nigra: made of pars
compacta (secrete dopamine, which project in forebrain by nigrostriatal pathway) and pars
reticulate (non pigmented and contains globus pallidus, functional homologue). Important for
voluntary movement, degeneration of pars compact leads to parkinsons. Tegmental area origin of
ascending mesolimbic dopaminergic pathway to innervate forebrain. Ventral to substantia nigra
there is crus cerebri with descending cortical efferent (corticobulbar and corticospinal) for
movement coordination
Reticular formation
Complex matrix of neurons, widespread afferent and efferent, various functions. Very focused on
CV and respiratory movements.
Descending reticulospinal tracts from medullary and pontine reticular formation for muscle tone
and movement, with cells like nucleus reticularis gigantocellularis. Some ascending are reticular
activating system, which are cholinergic receiving either direct and undirect input, through
intermediary of thalamic nuclei causing activation cerebral cortex
Raphe nuclei midline nuclei that extend through brainstem length using serotonin, important
ascending to forebrain involved in mood, cognition and sleeping neural mechanism. Differently
nucleus raphe magnus from medulla involve descending nociception modulation, containing
encephalin.
Locus coeruleus pigmented neurons in rostral pontine tegmentum, principal noradrenergic cell
group. Projects in cerebellum and forebrain areas such as diencephalon, limbs and cerebral cortex,
important to regulate sleep and rapid eye movements in sleep. Important as well for mood and
cognition.
Chapter 10 crossman
Cranial nerves and nuclei
12 bilateral pairs, mainly for head and neck structures.
1 olofactory in forebrain
2 optic in forebrain
3 oculamotor midbrain
4 throchlear midbrain
5 trigeminal pons
6 abducens pons
7 facial pons
8 vestibulocochlear medulla
9 glossopharyngeal medulla
10 vagus medulla
11 accessory medulla
12 hypoglossal medulla
first 2 in forebrain, others are in brainstem
cranial nerve nuclei
afferent nuclei
carry general sensory information, that enter through trigeminal nerve at pons level and terminate
at trigeminal sensory nucleus
special senses are conveyed by vestibulocochlear nerve, which terminate at vestibular and
cochlear nuclei in medulla laterally to 4th ventricle
viscera afferent terminate in nucleus solitarious of medulla
efferent nuclei
3 different groups
somatic efferent
nuclei 3,4,6 and 7
oculamotor terminates in ventral apex of periaqcueductal grey of midbrain at superior colliculus,
innervating levator palpebrae superior and all extraocular muscles, except superior oblique and
lateral rectus.
Trochlear nucleus in midbrain, ventral border periacqueductal grey, level of inferior colliculus,
innervate superior oblique of eye.
Abducens nucleus in caudal pons of floor of 4th ventricle innervate lateral rectus
Hypoglossal nucleus in intrinsic and extrinsic of tongue.
Brachiomotor cell
Striated muscles from branchial arches. In tegmentum of mid pons in trigeminal motor nucleus,
innervate mastication and other muscles. Facial motor nucleus, facial expression and stapedius
muscles
In medulla there is nucleus ambiguous, 9, 10 and 11 cranial nerves, 11 for pharynx and larynx.
Parasympathetic
Preganglionic neurons from 3,7,9 and 10. Located rostrally in Edinger-Westphal nucleus in
midbrain in periaqueductal mater.
Oculamotor innervate ciliary ganglion of orbit, from which postganglionic go sphincter pupillae
and ciliary muscles in eye.
In tegmentum pontine, we find superior and inferior salivatory nuclei. Superior by facial nerve to
pterygopalatine (lacrimal gland and nasal and oral mucous membrane) and submandibular ganglia
(glossopharyngeal, which terminate in otic ganglion to parotid salivary gland.
Benath floor of 4th ventricle there are dorsal motor nucleus of vagus that go in Tx and abdominal
viscera area.
 Chapter 11 Crossman
Cerebellum
Largest part of hindbrain. Origin from dorsal aspect of brainstem and overlie 4 th ventricle.
Connected to brainstem by 3 stouts pairs of fibers called inferior, middle and superior peduncles,
these joins medulla, pons and midbrain. Function are motor and unconscious, to maintain
equilibrium, posture, tone and coordination move.
External features of cerebellum
2 laterally located hemispheres, joined in midline by vermis. Superior surface is beneath dural
tentorium cerebelli and superior vermis raised, forming midline ridge. Inferior vermis lies in deep
groove, highly convoluted, folds and folia and orientated transversely. Between folia lie fissures of
various depths. Fissures divide cerebellum in 3 lobes, superior surface deep primary surface,
separating anterior lobe, on underside, conspicuous posterolateral fissures which demarcates
small regions (floccolus) and vermis (nodule) forming flocculonodular lobe.
Internal structure of cerebellum
Outer layer of grey matter, called cerebellar cortex and inner core white matter (afferent and
efferent fibers) that run from cortex to irregular branch like projections (tree of life/ arbor vitae).
Buried deep within white matter 4 bilaterally cerebellar nuclei output of cerebellum in other levels
of neruoaxis, connected to cerebellar cortex.
Cerebellar cortex
Highly convoluted forming transverse folia. Large collection of neurons in cortex, same
organization in all regions
3 layers
1) Outer, fiber rich, molecular layer
2) Intermediate, purkinje cell layer
3) Inner granular layer, dominated by granule cell

Afferent usually from spine (spinocerebellar fibres), inferior olivary nucleus (olivocerebellar) and
pons (pontocerebellar), terminating in cerebellar cortex, excitatory to cortical neurons. Fibres
enter to cerebellum through one of cerebellar peduncles and proceed to cortex as mossy fibres or
climbing fibres. A part from inferior olivary nucleus , they are all mossy fibres. They supply granule
cell towards cortex and molecular layer. They will bifurcate forming two parallel fibres and
orientated by long axis of folium. The purkinje fibres consist of unicellular of somata of purkinje
neurons. The profuse dendritic arborisation of these cells extend towards the surface of cortex,
into molecular layer. Arborisation are at 90° to folium, receiving excitatory synaptic input.
Inhibitory modulation of intracortical circuitory from stellate and golgi cells. Axons of purkinje are
the only axons leaving the cerebellar cortex, though they don’t fully leave, but end in deep
cerebellar nuclei.
Climbing fibers (originating from inferior olivary nucleus of medulla, providing discrete excitatory
input to purkinje cells, there are axon collaterals of climbing which excite neurons in deep
cerebellar nuclei. Purkinje use GABA as neurotransmitter which is inhibitory.
Cerebellar nuclei
4 bilaterally paired nuclei, from medial to lateral
fastigial, globose, emboliform and dentate
dentate is the largest, only one to be discerned at naked eye, thin layer of nerve cell, reminiscent
of a crinkled bag, receives afferent from inferior olivary nucleus, vestibular nuclei, reticular,
pontine nuclei and spinocerebellar tracts, predominantly by means collateral of mossy fibres.
Cerebellar nuclei constitute primary source of efferent fibres from cerebellum to other brain parts.
Principal destinations are reticular and vestibular nuclei of medulla and pons, red nucleus of
midbrain and ventral lateral nucleus of thalamus.
Functional anatomy cerebellum
3 functional divisions
1) Archibellum= oldest portion with flocculonodular lobe and associated fastigial nuclei
2) Paleocerebellum, to midline of vermis surround paravermis together with globose and
emboliform
3) Neocerebellum vast majority remainder, of cerebellar hemisphere and dentate nuclei

Archicerebellum
Primarly concerned with mantainance (equilibrium). Extensive connection with vestibular and
reticular nuclei of brainstem through inferior cerebellar peduncles. Vestibular tract is carried
ipsilaterally flocculonodular lobe.
Cortical efferent (Purkinje cells) project to fastigial nucleus, which turns back to vestibular
nuclei and reticular formation. A lot of fastigial decussate of brainstem. There is bilateral
influence and principally mediated y descending vestibulospinal and reticulospina projections
Paleocerebellum
For muscle tone and posture
 Afferent from dorsal and ventral spinocerebellar tracts, from joints and cutaneous receptors,
going to cerebellum through superior and inferior cerebellar peduncles. Terminating in
ipsilateral vermis and paravermis
Efferents will go to globose, emboliform and fastigial nucleus
Globose and emboliform will be via superior cerebellar peduncle, to contralateral red nucleus
of midbrain, with influencing activity to descending rubrospinal tract.
Neocerebellum
Muscle coordination, trajectory, speed and force movements. Afferent is through
pontocerebellar fibres from pontine nuclei, in basal portion of pons. Decussate in opposite side
of brainstem and enter in middle cerebellar peduncle, terminating in lateral cerebellar
hemispheres. Output is to dentate nucleus, which will project laterally to contralateral red
nucleus and ventral lateral nucleus of thalamus. These efferent fibres form major part of
superior cerebellar peduncle or brachium conjuctivum. Some fibres realy in red nucleus via
rubro thalamic tract, but most bypass directly to ventral lateral thalamus.

Chapter 12
Thalamus
Lies in forebrain (prosencephalon). Forebrain consists of bilaterally paired diencephalon and
cerebral hemispheres on each side and largest derivative of 3 embryological divisions.
Diencephalon is continuous with rostral midbrain and lies between brainstem and cerebral
hemispheres. From dorsal to ventral diencephalon is compromised of the epithalamus, thalamus
(largest), subtahalamus and hypothalamus. Thalamus consists on numerous nuclei, which have
extensive reciprocal connections with cerebral cortex.
� Nuclei of general and special sensory information correspond to sensory cortices
� Impulses from cerebellum and basal ganglia and interface motor region of frontal lobe
� Connections with associative and limbic areas of cerebral cortex
Diencephalon almost entirely surrounded by cerebral hemispheres, base of brain you can see
hypothalamus.
Caudal to optic chiasm is a small midline elevation, tuber cinereum, from the apex there is an
extension called infundibulum, which attaches to pituatory gland. Caudally there are the
mammillary bodies (contain mammillary nuclei of hypothalamus). Hypothalamus lies below to
thalamus, has important connection to limbic system and influence on ANS and neuroendocrine
functions (pituatory gland).
Epithalamus, is in most caudal and ventral part, immediately rostrally to superior colliculus,
consisting principally to pineal gland (release melatonin and cyrcandian rythim so cycle and sleep
and puberty onset) and habenula (habenular nuclei).
Subthalamus , contains subthalamic nucleus (connections with substantia nigra and control
movement) and zona incerta (connections to thalamus, specifically ascending sensory projections
(medial lemniscis, spinothalamic tracts and trigeminothalamic tract). Cerebellothalamic from
dentate nucleus and pallidothalamic tract from globus pallidus. The latter group of zona incerta as
lenticular and thalamic fasciculus.
Topographical anatomy of thalamux
External features
With hypothalamus, forms lateral wall of third ventricle, transition between 2 is marked by
hypothalamic sulcus, usually they are joind by a thin slit of the 3 rd ventricle called interthalamic
adhesion or massa intermedia. Fascicles of nerve fibres, stria medullaris, for limbic connections,
along this line there is epyndimal lining of third ventricle forming the roof.
Anterior pole of thalamus extends to interventricular foramen. Lateral to thalamus there is
internal capsule, and anterolateral lies head of caudate nucleus. Another fascicle of stria
terminalis, marked boundary between thalamus and caudate.
Internal organization
Contains afferent and efferent, y shaped with 3 nuclear masses: anterior, medial. Lateral to main
nuclei mass lies another sheet of nerve, there is anterior sheet called lateral medullary lamina
(thalamocortical and corticothalamic fibres), the internal lamina consists of intralaminar nuclei.
Between this and internal capsule we can find reticular nucleus of thalamus.
Functional organization of thalamic nuclei
All nuclei, except reticular nucleus, project ipsilaterally. All thalamic nuclei receive corticofugal
fibres. The general and special senses and motor regions receive cerebellar and basal ganglia
nuclei, they are called specific nuclei and lie in the ventral part of lateral nuclei group. The other
afferent fibres are non specific nuclei, which lie in dorsal tier of lateral nucleus complex as whole
of anterior and medial complexes.
Lateral nuclear groups
Contains specific. Ventral part, include ventral anterior, ventral lateral, ventral posterior, lateral
and medial geniculate nuclei.
Ventral posterior nuclei
Lies between ventrolateral nucleus and pulvinar. In ventroposterior nuclei there are the ascending
pathways from spinal cord carrying general sensory nucleus from contralateral of body at
conscious level. The pathways wull include spinothalamic, medial leminiscus and
trigeminothalamic. An extensive lateral portion receive all information from trunk and limbs via
spinothalamic and medial lemniscus, this is referred as ventral posterolateral tract (VPL). Smaller
medial portion of ventral posterior nucleus receive from head, via trigeminothalamic tract, this is
ventral posteromedial nucleus (VPM). This area will receive also information from nucleus
solitaries of medulla and vestibular nuclei. Sends everything to somatosensory cortex in
postcentral gyrus of parietal lobe
Lateral geniculate nucleus
Located in posterior pole of thalamus, ventral to pulvinar, forming small eminences, known as
geniculate body. The lateral geniculate body is related to visual system, due to termination of optic
tract, carrying axons from retinal ganglion cells, due to hemidecussation of optic chiasm the fibres
will be ipsilateral for temporal hemiretina and controlateral nasal retina, it will send this fibres to
visual cortex of occipital lobe
Medial geniculate nucleus
Related auditory system, receives ascending fibres from inferior colliculus, via inferior brachium.
Send fibres to primary auditory cortex of temporal lobe
Ventral anterior nucleus
Located in rostral part of lateral nucleus mass. Will be subdivided in larger, principal part and
smaller magnocellular part. Principal will involve subcortical afferents from ipsilateral basal
ganglia, originating from internal segment of globus pallidus and pars reticulate of substantia nigra
will be for magnocellular
Ventral lateral nucleus
Lies in ventral tier of lateral nuclear complex, 3 subdivisions, pars oralis, pars medialis and pars
caudalis. Subcortical afferens to ventral lateral nucleus originate from ipsilateral globus pallidus
and substantia nigra and from contralateral dentate nucleus of cerebellum.
Pallidal and nigral afferents end in pars oralis and medialis, from cerebellum will end in caudalis.
Will be connected as well with primary motor cortex of precentral gyrus.
In dorsal tier of lateral nuclear complex there are non specific nuclei, among these there will be
lateral dorsal nucleus in limbic system part, receiving afferent from hippocampus and send
efferents to cingulate gyrus. Lateral posterior nucleus has connections with sensory association
cortex of parietal lobe. Pulvinar most posterior part of thalamus, is associated with parietal,
temporal and occipital lobes.
Anterior nuclear group
Most anterior part of thalamus, 3 subdivisons: anteroventral (limbic), anteromedial and
anterodorsal nuclei. Anteroventral will receive large afferents from mammillary body of
hypothalamus via mammillothalamic tract. Bringing instinctive drives, emotional aspects and
memory.
Medial nuclear group
Mainly mediodorsal nucleus (dorsomedial nucleus), has afferents subcortical from hypothalamus,
amygdala and other thalamic nuclei (intralaminar nuclei). Controls mood and emotion
Intralminar nuclei
Embedded within internal medullary lamina of thalamus. Including centromedian and
parafascicular nuclei. Receive afferent from brainstem reticular formation and from spinothalamic
and trigeminothalamic systems. Project widespread into cortex and caudate and putamen
nucleus. They are stimulated by alphe rythim activity, related to repose and sleep. Lesions will lead
to loss of pain perception and level of consciousness.
Reticular nucleus
Thin layer of cells on lateral aspect of thalamus, between external medullary lamina and internal
capsule. Will receive fibres from thalamocortical and corticothalamic fibres, from thalamic nuclei
and cerebral cortex

Chapter 13 Crossman
Cerebral hemispheres
Cerebral hemisphere is derived from telencephalon. It consists on a layer of grey matter (cortex),
highly convoluted to form a complex pattern of ridges (gyri) and furrows (sulcus). Axons run
through white matter mass beneath surface, in between cerebral cortex and subcortical
structures, into broad sheet called internal capsule. Between internal capsule and cortical surface,
fibres radiate in and out (corona radiata), that is buried in white matter with various nuclear
masses (caudate nucleus, putamen and globus pallidus, known as basal ganglia and corpus
striatum). 2 cerebral hemispheres are separated by a deep cleft, great longitudinal fissure, which
accommodates meningeal falx cerebri. The depth of this fissure is united by corpus callosum,
containing various commissural fibres, which run between cortices.
Gyri, sulci and lobes
Form basis to divide hemisphere into 4 lobes, frontal, parietal, temporal and occipital. Most
conspicuous and deepest cleft in lateral surface is called lateral fissure (separates temporal lobe,
from frontal and parietal), they are depths in the cortical area of it called insula. The area of the
lobes that overlie insula are called opercula. From lateral surface of hemisphere to separate
frontal and parietal lobes there is the central sulcus, which will extend for a short distance onto
medial surface of hemisphere, within great longitudinal fissure.
Frontal lobe is the entire region in front of central sulcus. In front of the sulcus and run parallel to
it, precentral gyrus, which is primary motor region of cerebral cortex. In front of it, the rest of
frontal lobe is variable convoluted patters, superior, middle and inferior frontal gyri.
Parietal lobe, most anterior part is postcentral gyrus, where is located the 1° somatosensory
cortex. Behind it the intraparietal sulcus divides the lobe into superior and inferior lobules. The
boundary between parietal and occipital lobe is marked by parieto-occipital sulcus on medial
surface. The occipital lobe on medial surface contains the calcarine sulcus, location of 1° visual
cortex.
The temporal lobe is divided into 3 areas: superior (1° auditory cortex, mostly in superior part,
delined by transverse temporal gyru or Heschl’s convolutions), middle and inferior temporal gyri.
All the lobes together constitute the limbic system. Curving around the corpus callosum and run
parallel to it, lies the cingulate gyrus, separate by the cingulate sulcus. The cingulate gyrus passes
posteriorly and inferiorly round the posterior portio, or splenium, of corpus callosum till become
continuos with parahippocampal gyrus of temporal lobe, within the temporal lobe, it lies the
hippocampus. Cingulate gyrus, parahippocampal gyrus and hippocampus are called Limbic lobe.
Focal cerebral lesions
Focal epileptic seizures
Sensory/motor deficits
Psychological deficits
Raised intracranial pressure
Unilateral cerebral hemisphere lesion (upper motor neuron lesion)
Stroke
Cerebral cortex
Histological
A layer of nerve cell bodies, dendritic arborisation and synaptic interconnections. Divided into
brodmann’s areas. Old cortex parts (archiocortex and paleocortex), hippocampus and temporal
lobes. Very importan with emotional aspects of behavior and memory. Still part of limbic system.
New area of cerebral cortex is called neocortex
Layer 1: most superficial, few cells but many dendrites and axons
Layer 2: many small neurons, establish intracortical connections
Layer 3: medium size, give rise to association and comminsural
Layer 4: termination of afferent fibres from specific thalamic nuclei
Layer 5: origin of projection fibers to extracortical targets, basal ganglia, thalamus, brainstem and
spinal cord. In primary motor cortex of frontal lobe, containing giant Betz cells, which project fibre
in pyramidal tract
Layer 6: association and projection neuron.
Functional organization
Necessary for conscious awareness, thought, memory and intellect. Is region where all sensory
modalities ascend and they are consciously perceived
- Posterior part of cerebrum, receives sensory from outside world into 1° sensory areas of
parietal lobe (somatosensory), occipital (vision) and temporal (hearing)
- In the adjacent cortical zones, the information are elaborated to permit object
identification in a modality specific act of perception. Areas of cortex at junction of 3
cerebral lobes are called association cortex (multimodal and spatial recognition).
- Medial portion work on storage and retrival information processed in posterior
hemispheric regions.
- Anterior part cerebrum is concerned with organization of movement (primary motor area)
and strategic guidance of motor behavior (prefrontal area)
- In majority of individuals, association cortex in frontal, parietal and temporal of the Left
hemispheres are responsible for comprehension and language expression (dominant
hemisphere). Usually contralateral to dominant hand.
Frontal lobe
Anterior to central sulcus, first part is precentral gyrus. Functionally known as primary motor
cortex (broadmann area 4) representation of the body is inverted, head at bottom and all going
up, till at corpus callosum, that above is lower limb. The area of cortex is devoted to the degree of
movement precision, so larynx, tongue, face and fingers are large regions. Stimulation will lead to
contralateral contraction for voluntary and skilled/fractioned movements coming from
corticospinal tract and corticobulbar fibres, where 3% of fibres originate from Betz cells. Afferent
come from ventral lateral nucleus of thalamus, which mainly receives from dentate nucleus of
cerebellum or globus pallidus of basal ganglia. Anterior to motor cortex, is the premotor cortex
(broadmann 6), where on lateral surface includes superior, middle and inferior gyri, medially to it
there is a supplementary motor cortex. Differently from primary motor cortex, it appears
bilaterally on the hemispheres. Stimulation premotor cortical areas, concerned with less focused
movements, such as posture and programming. Programming is connected by short corticospinal
and cortibulbar association fibres to primary motor cortex. The principal input comes from
anterior nucleus of thalamus, receiving fibres from globus pallidus and substantia nigra. In the
middle frontal gyrus lies frontal eye field (broadmann area 8), conjugate deviation of eyes.
Unilateral damage movement towards side of lesion of eye. Inferior frontal gyrus od dominant
there is the motor speech area, called Broca’s area (brodmann area 44 & 45), interconnections
with ipsilateral other lobes for language
Dominant frontal lobe lesion: jacksonians seizures, contralateral hemiplegia, broca’s aphasia
Anterior to premotor areas is referred as prefrontal cortex, having rich connections with other
lobes through fibres in subcortical white matter. Subcortical afferent from anterior nuclei of
thalamus. High cognitive functions, including intellectual, judgmental and predictive faculties and
planning behave.
Parietal lobe
Anterior part is postcentral gyrus, parallel to central sulcus, this region is called primary
somatosensory cortex (Broadmann’s area 1,2,3). Where thalamocortical neurons terminate,
constituting general sensation at conscious level. The thalamic origin is in the ventral posterior
nuvleus of the thalamus, receiving fibres from medial lemniscus ( touch and proprioception),
spinal lemniscus (coarse touch and pressure), spinothalamic tract (pain and temperature and
trigeminothalamic tracts (general sensation from the head). Somatosensory cortex contralateral to
body. Not proportionate sizes of body, depends on receptors, so once again large areas for
pharynx, tongue and face and digits. Posterior to primary somatosensory cortex is located the
association cortex. The superior lobule is responsible for general sensory information and
conscious awareness of contralateral body. The inferior lobule interfaces between primary
somatosensory cortex and visual and auditory association cortices of occipital and temporal lobes,
in dominant hemispheres
Parietal lobe lesions cause, focal seizures, sensory/motor deficits, psychological deficits (anomia,
alexia, agraphia and acalculia)
Temporal lobe
Temporal lobe is divided into superior, middle and inferior temporal gyri, running parallel to
lateral fissures. In superior temporal gyrus there is primary auditory cortex (broodman’s area 41-
42). Its precise location is marked by transverse temporal gyri or Heschl’s convolutions
Primary auditory cortex is related to sound perception tonotopical representation of cochlear
duct. Receive input from medial geniculate nucleus of thalamus. Ascending pathway has a small
decussation in brainstem on its way to medial geniculate nucleus. Unilateral lesions of primary
auditory cortex cause partial deafness in both ears. Auditory information is processed and
interpreted in auditory association cortex, posterior to primary cortex. In dominant hemispheres
we got Wernicke’s area (understanding the words and connect with other language areas).
Vestibular system is located in superior temporal gyrus anterior to primary auditory cortex.
Inferomedial part of lobe is hippocampus, which lies on floor of inferior horn of lateral ventricle,
deep to parahippocampal gyrus. Close to anterior end there is a subcortical mass of grey matter
called amygdala, receiving fibres from olfactory tract (smell)
Dominant hemisphere temporal lobe lesions: seizures (absences and automatism, déjà vu) sensory
motor deficit and psychological deficit.
Occipital lobe
Calcarine sulcus marks primary visual cortex (brodmann area 17) for visual perception. Receiving
fibres from lateral geniculate nucleus of thalamus by optic radiation of internal capsule.
Contralateral transmission. Rest is visual association cortex (interpretate images). Lesion of
primary visual cortex can lead to blindness, damage to association cortex will lead to problems
with visual interpretation and recognitions
Occipital lobe lesions
Focal seizures
Sensory motor deficit (contralateral homonymous hemianopia)
Bilateral lesion leads to cortical blindness/anton’s syndrome or apperceptive visual agnosia (not
recognize things).
Language areas of cerebral hemispheres
Cognitive functions, dominant hemispheres has language and mathematical ability, the non
dominant is more related to spatial perception and musical proficiency. Start to establish during
first years of birth, initially they are pretty much the same, then they start to differentiate, with
the non dominant losing abilities. Eg in dominant hemisphere the formation of Brocas area in
frontal lobe (talk) and in temporal lobe wernicke’s area (logic in talking)
White matter of cerebral hemisphere
Association fibres= interconnect cortical sites lying within one cerebral hemispherez
Commissural fibres= from one hemisphere to the other
Projection fibres= between cerebral corte and subcortical structures (thalamus etc)
Association fibres
Some are short and link nearby areas of cortex by arching beneath adjacent cerebral sulci (u
fibres) and travel through white matter to cerebral cortex. Primary sensory areas in parietal,
temporal and occipital lobes are linked by long association fibres to association areas of cerebral
cortex
Superior longitudinal fasciculus interconnects frontal and occipital lobes. A subsidiary bundle,
known as arcuate filaments, links frontal and temporal lobe (language)
Inferior longitudinal fasciculus from occipital to temporal lobes and contribute to visual
recognition
Uncinated fasciculus connects anterior and inferior parts of frontal lobe with temporal gyri, to
regulate behavior. Cingulul in cingulate gyrus, connects frontal and parietal lobes with the
parahippocampal and adjacent temporal gyri.
Associative agnosia: cerebral damage from CO, can destroy inferior longitudinal fasciculus
bilaterally leading to object agnosia and prosopagnosia.
Commissural fibres
The major fibres are corpus callosum, anterior commisures and hippocampal commisures. Corpus
callosum connects regions of neocortex a part from temporal fields (anterior commisures).
Splenium interconnects occipital cortices and contributes to visual functions.
Anterior commisures run transversely in front of anterior column of fornix to inferior and middle
temporal gyru and olofactory regions
Hippocampal commisures consists in transverse fibres linking the posterior columns of fornix on
each side.
Projection fibres
Either afferent and efferent. Afferent are known as corona radiata, concentrated in internal
capsule. Internal capsule in angulated to form anterior limb, genu and posterior limb and
retrolenticular part.
Anterior limb fibres between mediodorsal nucleus of thalamus and prefrontal cortex, and
frontopontine fibres from pontine nuclei to pons.
Posterior limb contains corticobulbar and coricospinal and as well thalamocortical from ventral
posterior nucleus to primary somatosensory cortex. And from ventroal anterior and ventral lateral
nuclei to motor regions of frontal lobe.
Behind posterior limb we find retrolenticular part of internal capsule. With fibres arising from
medial and lateral geniculate nuclei of thalamus to auditory and visual cortices.
Upper visual area is parietal lobe
Lower visual area (meyer’s loop) is temporal
Important to consider for lesions

Main part from this chapter homunculus

Chapter 14 crossman
 Basal ganglia
Within cerebral hemispheres there are various nuclear masses, most prominent are caudate
nucleus, putamen and globulus pallidus, which lie close to internal capsule, collectively called basal
ganglia, basal nuclei or corpus striatum. The amygdala is in the temporal lobe.
The most rostral and ventral part of corpus striatum includes nucleus accumbens, which will have
connections with amygdala and provides important link with basal ganglia and limbic system. Basal
ganglia are concerned to control movement. Disorders of basal ganglia manifest abnormalities of
motor control, posture and muscle tone. With the limbic system provides role of physical
expression of behavior driven by affective and motivational states. Nucleus accumbens is
associated with reward and gratification and is part of mechanism of base of control (addiction).
Caudate, putamen and globus pallidus is important in motor control. Basal ganglia has strong
connections eith other brain parts like cerebral cortex, thalamus and subthalamic nucleus.
Sometimes the putamen and globolus pallidus are called together lentiform nucleus, with a convex
lateral surface which lies against genu of internal capsule.
Globus pallidus is the oldest part, so is referred as paleostriatum, containing subthalamopallidal or
pallidothalamic. The caudate nucleus and putamen are called neostriatum, they are separated
from the anterior limb thanks to internal capsule, together they are referred as striatum.
Topography anatomy of basal ganglia
Striatum
Caudate nucleus and putamen
Putamen:
Lateral to internal capsule and globus pallidus. Separation from globus pallidus by lateral
medullary lamina. Lateral to putamen a lot of white matter and a thin grey matter sheet called
claustrum. This separates white matter into 2 layers, external capsule and extreme capsule. Lateral
to extreme capsule lies the cortex of insula, deep within lateral fissure hemisphere
Caudate:
Large head, almost fully separated by internal capsule. Most ventral and medial part is the nuvleus
accumbens, forming a prominent bulge in lateral wall of anterior horn of lateral ventricle.
Globus pallidus
Lies medial to putamen, separated by lateral medullary lamina. Divide into external (lateral) and
internal (medial), separated by medial medullary lamina. Connected to pars reticulate of
substantia nigra in midbrain.
Substantia innominate
Basal part of forebrain beneath corpus striatum. This complex region with several groups called
nucleus basalis (meynert) that projects in cerebral cortex and use Ach as neurotransmitter,
affected by Alzheimer’s
Functional anatomy of basal ganglia
Connects to striatum
input portions of basal ganglia
striatal afferents
come from cerebral cortex, thalamus and substantia nigra
corticostriatal fibres widespread region of cerebral cortex origin, usually ipsilaterally. Usually come
from frontal and parietal lobes.
Motor regions from frontal go to putamen, differently more anterior and association go to caudate
nucleus. Corticostriatal fibres are excitatory using glutamic acid as transmitter
Thalamostriatal projection comes from intralaminar nuclei (centromedian and parafascicular
nuclei), ipsilateral to thalamus
Nigrostriatal projection from pars compacta of ipsilateral substantia nigra of midbrain tegmentum,
use of either excitatory and inhibitory transmitter dopamine. Neurons in pars compacta are dark
pigment neuromelanin, produced as by product of dopamine synthesis. Nucleus accumbens,
receives dopaminergic input from ventral tegmental area, medial to substantia nigra, this
projection is called mesolimbic pathway providing innervation of amygdala.
Afferent from brainstem comes from raphe nuclei, using serotonin as transmitter
Striatal efferents
Usually directed to two segments of globus pallidus and to pars reticulate of substantia nigra
(striatopallidal and striatonigral fibres). The origin is from spiny neuons. These projections are
inhibitory using GABA. There are a number of neuropeptides co-localized projecting in internal
segments of globus pallidus and substantia nigra containing substance P and dynorphin. The
projection to external segment of globus pallidus contains met-enkephalin
Connection to globus pallidus
Similar afferent, but different efferents
Pallidal afferents
Arise from striatum and from subthalamic nucleus. These projections are inhibitory using GABA.
There are a number of neuropeptides co-localized projecting in internal segments to external
pallidal using encephalin and projecting to interal pallidum using substance P and dynorphin
Subthalamopappidal projection, origin is in subthalamic nucleus of caudal diencephalon. Located
beneath thalamus and lie on medial border of internal capsule, appear as biconvex lens.
Subthalamopappidal fibres pass laterally through internal capsule contributing to subthalamc
fasciculus and terminate in globus pallidus.
The subthalamopallidal pathway is excitatory to pallidal neurons, using glutamic acid as
neurotransmitter. The subthalamic nucleus sends similar fibres to pars reticulate of substantia
nigra. Subthalamopallidal and subthalamonigral have pivotal role.
Pallidal efferents
Main projection is to subthalamic nucleus. Pallidosubthalamic fibres pass medially to internal
capsule in subthalamic fasciculus. Will use GABA neurotransmitters. The internal segment of
globus pallidus, together with pars reticulate of substantia nigra, projecting to thalamus (ventral
lateral, ventral anterior and centromedian nuclei) and small projection in tegmentum. Inhibitory
stimuli.
Pallidothalamic fibres may pass anteriorly in ansa lenticularis, while others into internal capsule as
lenticular fasciculus. The fibres continue medially and then loop dorsally and laterally as thalamic
fasciculus to enter in thalamus in ventral aspect. Following to this the pallidothalamic fibres
circumnavigate subthalamus cellular region (zona incerta). Pallidothalamic main outflow is from
basal ganglia. Their thalamic target nuclei (Ventral anterior and ventral lateral) in turn, project
excitatory, glutamatergic fibres to motor and supplementary motor cortices. Smaller contigent of
medial pallidal efferent fibres passes caudally to terminate in brainstem tegmentum in nucleus
tegmenti pedunculopontinus, which lies between midbrain and pons, on lateral edge of superior
cerebellar peduncle. This region is mesencephalic locomotor region.
Pallidal nucleus are associated with limb movements
Nigral cells control axial musculature, including extraocular muscles.
Efferents of pars reticulate of substantia nigra pass to subregion of ventral thalamus to superior
colliculus and brainstem to superior colliculus and brainstem reticular formation
(pedunculopontine nucleus).

Function of basal ganglia

Called as well extrapyramidal motor systems. Their functions is to facilitate behavior and
movements that are required and appropriate and to inhibit inappropriate or unwanted
movemtns. The movement is initiated by corticospinal, corticobulbar and by corticostriatal
(projects in neostratium. These glutamatergic fibres cause excitation of striatal medium spiny
neurons. 2 routes for striatum to control activity of basal ganglia. 1 st is the direct pathway,
striatopallidal and striatonigral which directly inhibit internal pallidal or pars reticulate neurons,
this will happen by affecting the action potential discharge during movement in that region.
Shown in internal pallidum for limbs and substantia nigra, pars reticulate for eye. Due to this
inhibition pathway will lead to disinhibition of target neurons, including motor neuron in
thalamus. This will cause an increase in thalamic neurons activity to excite cells in cerebral cortex,
to support ongoing movements by positive feedback to cortex.
2nd pathway is called undirect pathway and goes through subthalamic nucleus. Efferent from
striatum terminate in external pallidal segment and activation induces inhibition of external
pallidal neurons. Main pathway goes to subthalamic nucleus which will become disinhibition.
The resultant to increase discharge of subthalamic neurons causes activation of internal pallidal
and nigral neurons and inhibition of thalamic and cortical cells. This is for inhibit of unwanted
movements.
Pathophysiology of basal ganglia disorder
A dysfunction will lead to abnormal motor control, alterations in posture and muscle tone and
emerge of involuntary movements and dyskenisia.
Most common disease Is parkinsons disease, involve degeneration of dopaminergic fibres in pars
compacta of substantia nigra. Loss of striatal dopamine causes abnormal underactivity of direct
pathway and disinhibition of internal pallidal neurons. Simultaneously overactivity of undirected
projection leads to inhibition of external pallidal nucleus, disinhibition of subthalamic nuclei and
excessive drive of internal pallidal nuclei.
Huntingtons disease is a neurodegenerative disease, it leads to a disinhibition of external pallidal
neurons and inhibition of subthalamic nucleus. Therefore, internal pallidal nucleus are abnormally
underactive and this will lead to involuntary movements.
Unilateral lesions lead to symptoms and signs on contralateral side of body (distinguish from
cerebellar disorders)
Chapter 15 crossman
Visual system (phils favorite topic)
The optic nerve and retina develop from prosencephalic primary brain vesicles. Vision starts with
the formation of an image of the external world on photoreceptive retina. The retina encodes
visual information in discharge of the optic nerve. The fibres will undergo hemidecussation in optic
chiasm and project to lateral geniculate nucleus of thalamus. Thalamocortical neurons in turn
project into 1° visual cortex of occipital lobe (perception area)
The eye
Near posterior pole emerges in optic nerve. Eyeball consists of 3 concentric layers, outermost is
tough, fibrous and protective. Over globe it forms an opaque white coat, sclera to which
extraocular muscles attach (eyeball movement), over anterior part it forms a transparent cornea,
where light enters.
Near anterior margin of sclera, there are 2 rings of smooth muscles, that extend in eyeball. Most
anterior is iris (central aperture) and the pupil (Light admitted in posterior part of eye. Circular and
radial arrangement of muscles. ANS control. Circular fibres are innvervated by postganglionic
parasympathetic, which will constrict the pupil and reduce light falling. The radial by
postganglionic sympathetic fibres, for pupil dilation. Behind iris there is ciliary body with ciliary
muscles (innervated by parasympathetic nervous system). In central aperture within the annulus
there are biconvex lens, which focuses light upon retina. Lens are held in place by suspensory
ligament that is attached to posterior margins of lens and ciliary body. Contraction of this muscle
alters the focal length (accommodation process).
The lens and suspensory divide the lumen of eyeball in anterior and posterior part.
Anterior part is thin watery, aqueous humour, continuously secreted from ciliary body, and will
reabsorb it through the canal of Schlemm, which will sent it back through nervous system.
Posterior part of the glove contains gelatinous material, known as vitreous humour. Behind ciliary
body, the inner surface of sclera is lined by choroid, cells with dark pigment to absorb light and
reduce eye reflection. Light passes from objectios in the visual field, through a narrow aperture of
pupil to subtend an image to retina. On an object that attention is focused on, the image will be
more centered on posterior pole along line of visual axis into fovea centralis, which is surrounded
for 1 cm by macula lutea, involved into resolving power. Basal optic property are related to
pinhole camera, so image is dictated in both lateral an vertical dimensions, eg: objects in left half
visual field form image upon nasal right half of left retina and in temporal right half of half right
retina. Medial to macula there is an accumulation area of optic nerve, called optic discs. In this
area there aren’t photoreceptors, is referred the blind spot.
Retina
Either neural and non neural portions. Non-neural is represented by pigmented epithelium, single
absorbing light layer, lying adjacent to choroid. Neural part contains photoreceptors and neurons
with rich blood supply. Light entering the eye, is refracted ad partially absorbed by elements
reaching photoreceptors. 2 types of receptors rods and cones. Rods are 20 time more than cones.
Rods are light sensitive and cones are colour sensitive (due to their arrangement). Rods are mainly
distributed in peripheral parts of retina, cones more abundant in macula. At fovea just cones are
present. At fovea distribution of neurons, makes have the rods have direct access to light. This
combination helps for maximal visual acuity.
The retina contains the 1st order neuron of central visual pathway in a bipolar cells, entirely within
retina; and 2nd order neuron in a ganglion cell of optic nerve. Faster transport of information for
rods than cones. Retina contains also contains interneurons as horizontal cells and amacrine cells,
these will help modulate transmission between bipolar ells and ganglio cells.
Central visual pathway
axons from retinal ganglion assemble at optic disc and pass into optic nerve. The two optic nerve
will converge to form optic chiasm on brain base. Chiasm lies rostrally to tuber cinereum of
hypothalamus and between internal carotid arteries. In chiasm, axons derived from nasal halves of
2 retinae decussate and pass into contralateral optic tract, while temporal ones remain ipsilateral.
Optic tracts from chiasm and pass around cerebral peduncle to lateral geniculate nucleus of
thalamus. A relatively small number of fibres before thalamus, will terminate in pretectal area and
superior colliculus. These fibres are involved in pupillary light reflex. From lateral geniculate
nucleus, 3rd order thalamocortical neurons will project into retrolenticular part of internal capsule
and form optic radiation, terminating in primary visual cortex of occipital lobe (visual images,
recognition, depth perception and color vision)
each optic nerve carries information concerning both halves of visual field. Because of decussation
from nasal hemiretinae at optic chiasm, however, each optic tract, lateral geniculate and visual
cortex will be in contralateral half of visual field. Combination of both eyes will give depth
perception. Thalamocortical leave the lateral geniculate nucleus and pass around lateral ventricle,
low part of visual field will end above calcarine sulcus in visual cortex. Those representing upper
part of visual field sweep in temporal lobe (meyer’s loop), before terminating below calcarine
sulcus.
4 quadrants to 4 specific corresponding area of visual cortex., with lateral and vertical inversion so
eg. Up left goes in low right
visual deficits
disease of eyeball (cataract, intraocular haemorrhage, retinal detachment) and optic nerve (MS
and optic nerve tumours) leads to loss of vision on affected eye. Compression of optic chiasm by
adjacent pituatory tumour leads to bitemporal hemianopia. Vascular and neoplastic lesion lead to
contralateral homonymous hemianopia
retinitis pigmentosa, metabolic disorder of photoreceptors and retinal pigment epithelial cells,
progressive night blindnessm peripheral visual field constriction and pigmentation of retina visible
senile macular degeneration is degenerative disorder in elderly leading to loss of central and
coloured vision
a lot of questions on eye
Chapter 16 crossman
Hypothalamus, limbic system and olfactory
Related to homeostasis, interoceptors, will detect changes in organs and glands and will work to
maintain balance and stable.
Exteroceptive information dictates behavioural responses, to achieve homeostasis within physical
and social environment. The limbic system is strongly connected to the hypothalamus, essential
for adaptive behave and memory. The association cortex of the neocortex are capable of analyzing
exteroceptive information. Hypothalamus, limbic system and association neocortices act as
interface.
Olfactory system vital for sensing environment, overwhelmed by visuospatial in limbic system.
Hypothalamus
Most ventral of diencephalon. Forms floor and lower part of lateral wall of 3 rd ventricle, below
hypothalamus sulcus. Some parts of hypothalamus circumscribed by the crura cerebri, optic
chiasm and optic tracts. Into two crura cerebri, there are mammillary bodies, containing
hypothalamic mammillary nuclei, elevation of tuber circeneum, from apex extends the thin
infundibulum or pituatory stalk. This is attached to pituatory gland (hypophysis), which lies in sella
turcica of sphenoid bone. Pituatory gland is divided into 2 parts: posterior part neurohypophysis
(neural part) and anterior adenohypophysis (not neural). They are closely linked by pituatory
(hypophoseal) portal system of vessels, derived from superior hypophoseal artery. Releasing
factors from hypothalamus are released from anterior pituatory system. Neural signals come as
largest input from hippocampus and amygdala. Fibres of hippocampal origin constitute the fornix,
which terminates in medial mammillary nucleus within body. From amygdala to hypothalamus run
in stria medullaris. Nucleus solitarious of medulla projects to hypothalamus conveying information
from ANS, generating responses in either circulatory and neural. Eg of descending fibres are
reticular formation affecting wakefulness and sleep, control sympathetic and parasympathetic.
Ascending pass to limbic system by thalamus to orbit frontal of cerebral cortex.
Hypothalamic nuclei
Region lying medial and ventral to subthalamus is called lateral hypothalamus (food and water
intake). Anterior nuclei are supraoptic (vasopressin antidiuretic hormone) and paraventricular
(oxytocin) both release in posterior pituatory, their axons pass to neurohypophysis in the
hypothalmohypophysis. The hypothalamus also release factors inhibitory controlling hormones
from adenohypophysis, like ACTH, LH; FSH and TSH. To inhibit the release of these hormones is
used the released of dopamine from neurons of hypothalamic arcuate nucleus, travelling by the
hypothalamohypopheseal tract.
Suprachiasmatic nucleus is concerned with control diurnal rhythms and sleep/wake cycle, receives
afferent from retina. Ventromedial nucleus, lies lateral hypothalamus concerned with food control
and fluid intake. Posterior to nucleus and medial mammillary nucleus is part of limbic system
receiving afferents from hippocampus and projecting anterior nuclei to thalamus and brainstem.
Posterior hypothalamus is related to sympathetic, anterior is parasympathetic.
Limbic system
Instinct, emotion and memory. Rich interconnections with hypothalamus for emotional states,
affecting biochemistry of body. Focused on goal direct behavior and refined in parieto-occipital
association areas (perceptuospatial function). Information to frontal association areas and inferior
temporal association cortex is in planned behavior, where information can reach supramodal
status and meaning. Entry information is direct to amygdala or indirect to hippocampal formation,
via entorhinal line. Information flow to hippocampus is related to memory. The limbic system can
affect motor responses through the nucleus accumbens and projection to hypothalamus
Amygdala
Lies near temporal lobe, between inferior lobe of lateral ventricle and lentiform complex. Receives
afferent from inferior temporal association cortex, thalamus, septum and olfactory tract. Receives
as well catecholamine and serotonin projection from brainstem in medial forebrain bundle. The
principal efferent is stria medullaris folloing curvatures of caudate nucleus and terminate in
hypothalamus. The ventral amygdalofugal path project to hypothalamus. Efferent to nucleus
accumbens, permit motor behavioral responses
Septum
Beneath rostral part corpus callosum. Interconnects amygdala and project to hypothalamus via
medial forebrain bundle. Septum also connects to monoaminergic nuclei in brainstem. Projects
fibres to habenular nuclei of diencephalon and constitutes stria medullaris thalami. Habenular
nuclei in turn project via fasciculus retroflexus to interpeduncular nuclei, to brainstem. Two major
pathways are hypothalamus and monaminergic nuclei of brainstem
Orbital frontal cortex
receives afferent from posterior association cortex to inferior temporal neocortex and permits
entry of this information in limbic system (amygdala and hippocampal formation). From orbital
frontal to inferior temporal neocortex via massive uncinated fasciculus, and directly to
hypothalamus. Frontal convexity related to cognitive executive functions and planning behavior.
Orbital frontal cortex is related to motivation.
Memory of limbic system
Episodic: hippocampal formation
Semantic: middle and inferior temporal gyri of neocortex
Implicit: sensory motor skills, in hippocampal formation or temporal neocortex
Hippocampal formation
Consists on hippocampus, dentate gyrus and parahippocampal gyrus. Hippocampus an infolding
inferomedial of temporal love into lateral ventricle, in line of choroid fissure. Dentate gyrus
between parahyppocampal gyrus and hippocampus, receives afferent via from inferior temporal
cortex via entorhinal area of temporal lobe, receives as well contralateral entorhinal fibres vua
fornix system and hippocampal commissure. Principal efferent is fornix (c-shape fasclie of fibres
with the mammillary body and septum). Efferent converge in ventricular surface of hippocampus
as fimbria, which becomes continuos with crus of fornix. Two crura unite in midline, beneath
corpus callosum to form body of fornix, some fibres cross the opposite side through small
hippocampal commissure. The anterior nuclear group of thalamus via mammillothalamic tract and
to brainstem via mammillotegmental tract. The anterior tract have connections with cingulate
gyrus, hippocampal efferents and also projects to nucleus accumbens, enabling motor responses
Cingulate gyrus
With the parahippocampal gyrus are continuity around splenium of corpus callosum. The cingulate
fibres project to parahippocampal via fibres of cingulum. The principal structures of limbic system
have a series of connection, which constitute Papez circuit.
Olfactory system
Specialised, ciliated nerve cells that lie in olfactory epithelium in nasal cavity. Axons assemble in
number of fascicles which will go through cribiform plate of ethmoid bone and attach to olfactory
bulb on inferior surface of frontal lobe. Preliminary process in bulb contain may interneurons and
mitral cells. The olfactory tract passes backwards onto basal surface of frontal surface, for the
deflect laterally in lateral olfactory stria. The fibres depths of lateral fissure which cross temporal
lobe, terminating in primary olfactory cortex of uncus in inferomedial aspect of temporal lobe. The
primary and association cortices are referred as pyriform cortex and responsible to appreciate
olfacotory stimuli. Unique sensory pathway: only 2 neurons between sensory receptors and
cerebral cortex and not project to thalamus

Cranial nerves
3: oculomotor
carries somatic motor axons to innervate extraocular muscles. Contains preganglionic
parasympathetic, via intermediary ciliary ganglion, controlling smooth muscles of eye. Cell bodies
of motor neuron in oculomotor nucleus, which lies in periacqueductal grey matter of midbrain at
superior colliculus level. Preganglionic parasympathetic neurons arise close to edingerwestphal
nucleus. Fibres course ventrally through tegmentum and exit via medial aspect of crus cerebri in
interpendicular fossa. Pass between posterior and superior cerebral arteries, and leave through
superior orbital fissure. Supplies all extraocular muscles except superior oblique and lateral rectus
(elevate, depress and adduct eyeball). It also innervates striated levator palpaebrae superioris,
serving to elevate upper eyelid. Postganglionic neurons run in short ciliary nerves to innervate
pupillae muscle of iris and ciliary muscle in ciliary body
Pupillary light reflex
amount of light is regulated by size of pupil. Illumination leads to constriction due to contraction
of sphincter pupillae muscle of iris (direct light reflex)
one retina illuminated, both constrict, constriction in non illuminated eye (consensual light reflex).
Fibres that pass directly from eye to pretectal area.
Accommodation reflex
Converge optic axes, involves concomitant contraction of ciliary muscles to increase convexity of
lens, focusing on image. Pupillary constriction. Corticobulbar fibres activating parasympathetic
neurons of edinger-westphal nuclei bilaterally
4: trochlear
only somatic neurons. Trochlear nucleus lies in ventral part periaqueductal grey matter, at inferior
colliculus level. Efferent axons pass dorsally and decussate. Is the only cranial nerve that arises
from dorsal aspect of brainstem. Will go round cerebral punducle to get in the ventral area of
brainstem, passing between posterior cerebral and superior cerebellar arteries. Enters in orbit of
superior orbital fissure, supplying just superior oblique muscle (Depress, abduct and intort eye),
when eye is adducted it depresses visual axis.
6 abducens
only somatic motor neurons. Cell bodies in abducens nuclei, which lie beneath floor of 4 th ventricle
in caudal pons. Efferent axons go ventrally through pons and merge from ventral surface of
brainstem at junction of pons with pyramids. The nerve will leave by superior orbital fissure,
supplying lateral rectus (eye abductor)
5: trigeminal
both sensory and motor. Main sensory from head (teeth and gums included) and innervates
mastication muscles. Attaches to brainstem by 2 adjacent roots (large sensory and small motor) on
ventrolateral aspect of pons with middle cerebellar peduncle. The sensory fibres are primary
sensory neurons with peripheral process distributed in opthalmic, maxillary and mandibular. It
innvervates as well intracranial dura mater and intracranial arteries. It has proprioceptive fibres
from mastication muscles and TMJ. The afferents cell bodies except proprioceptive ones are
located into trigeminal ganglion. The central process of these cells is trigeminal sensory nucleus. It
extends through brainstem and upper Cx spinal cord. Contains 3 subnuclei, chief/principal sensory
which lies in pontine tegmentum. Mesencephalic nucleus in midbrain. Spinal nucleus through
medulla and into cord, is continuos with substantia gelatinosa (brainstem homologue). Fibres
conveying touch and pressure go into principal nucleus. Those carrying pain and temperature end
in spinal nucleus reaching spinal tract of trigeminal, fascicle superficial to nucleus. In upper Cx cord
becomes continuos with Lissauer’s tract, carrying afferents of spinal nerves in dorsal horn.
Proprioceptive afferents differently terminate in mesencephalic nucleus. Axons from 2 nd Order
neuron in trigeminal nucleus, decussate to form contralateral trigeminothalamic tract (trigeminal
lemniscus), terminating in contralateral ventral posterior nucleus of thalamus, sending to sensory
cortex of parietal lobe.
It will send fibres to cerebellum conveying a lot of reflexes, eg mediate facial grimacing and eye
closure (corneal reflex), sneeze and cough are trigeminal (coming from nasal mucosa) or vagus
(pharynx and larynx by the nucleus ambiguous). In raw and jerk, downward percussion of
mandible stimulate percussion of proprioceptors in temporalis and masseter. Monosynaptic
contact with alpha motor neurons.
Motor axons arise from cells in trigeminal motor nucleus in pontine tegmentum medial to
principal sensory nucleus. Axons leave pons in motor root of trigeminal to join mandibular
division. Innervates masseter and temporalis (jaw closure), lateral and medial pterygois (open
jaw). It will innervate tensor tympani within middle ear, tensor veli palatine, mylohyoid and
anterior belly digastric
7 facial
contains sensory, motor and parasympathetic. Joins brainstem at ventrolateral aspect of caudal
pons, near pontomedullary junction (cerebllopontine angle). 2 roots, more lateral (nervus
intermedius, with sensory and parasympathetic and medial root composed by motor). Sensory will
supply taste sensation from anterior 2/3 of tongue, floor of mouth and palate and cutaneous of
external ear. Cell bodies of primary afferent are located in geniculate ganglion within facial canal
of petrous temporal bone. From nucleus solitaries fibres will project to ventral posterior nucleus of
thalamus, which will send to sensory cortex of parietal lobe. Motor fibres will originate in caudal
pontine tegmentum, innervating muscles of facial expression, platysma, stylhyoid, posterior belly
gastric muscle and stapedius of middle ear. The afferents will involve certain reflexes, eye closure
to visual stimuli and tactile stimulation of cornea (corneal reflex). Corticobulbar fibres will
innvervate facial motor nucleus, by supply muscle of upper face (frontalis, orbicularis oculi)
bilaterally. Those controlling lower face muscles are crossed entirely.
Preganglionic parasympathetic fibres of facial nerve originat in superior salivatory nucleus of pons.
Fibres leave the brainstem in sensory root of facial nerve (nervus intermediu) passing to
parasympathetic ganglia (submandibular and pterygopalatine, synapsing with postganglionic
neurons. Submandibular will innervate submandibular and sublingual salivary glands.
Pterygopalatine will innvervate lacrimal gland and nasal and oral mucous membrane
8 vestibulocochlear
sensory nerve conveying impulses from inner ear, 2 parts, vestibular nerve (related to position and
head movement) and cochlear (auditory information). Both contain 1 st order neurons, dendrites of
which makes contact with hair cells. Both divisions go through internal auditory meatus (also facial
nerve) and attach to brainstem at junction of medulla and pons at cerebellopontine angle
- vestibular nerve: make dendritic contact with hair cells of the membranous labyrinth, cell
bodies are located in vestibular ganglion within internal auditory meaturs. Terminates in
vestibular nuclei in medulla. 4 nuclei (superior, inferior, medial and lateral) beneath lateral
part of floor of 4th ventricle. Important for posture, maintain equilibrium, coordination of
head and eye movements and conscious awareness. Lateral vestibular/deiters nucleus
descend ipsilaterally in lateral vestibulospinal tract, contributing to medial longitudinal
fasciculus. Medial longitudinal fasciculus makes connections with nuclei of abducens,
trochlear and oculomotor to coordinate head and eye movement. Some efferent from
vestibular nuclei pass through inferior cerebellar peduncle to flocculonodular lobe of
cerebellum, concerned with equilibrium
- cochlear nerve: dendritic contact with organ of corti hair, joins brainstem at medulla. It will
bifurcate and end in dorsal and ventral cochlear nuclei, close to inferior cerebellar
peduncle. Their 2nd order neuron will ascend in pons, some will decussate at pontine
tegmentum as trapezoid body, terminating in superior olivary nucleus. They have inhibitory
function and serve to modulate transmission of auditory information to cochlear nerve.
The superior olivary nucleus and lateral meninscus establish reflexes with motor neurons
of facial and trigeminal contracting tensor tympany and stapedius muscles to loud noise.
The inferior colliculus can send axons to medial geniculate nucleus, which will send axons
through capsule of 1° auditory cortex of temporal lobe, mainly located in Heschl’s gyri.
9 glossopharyngeal
mainly sensory, but contains a preganglionic parasympathetic and few motor fibres. Attaches
to brainstem through small rootlets, lateral to the olive in medulla
afferent of glossopharyngeal:
� receptors of general sensation in pharynx, posterior third of tongue, Eustachian tube and
middle ear
� taste buds of pharynx and posterior third of tongue
� chemoreceptors in carotid body and baroreceptors in carotid sinus

visceral and taste fibres of glossopharyngeal nerve terminate in nucleus solitarius. Fibres carrying
touch information from pharynx and back of tongue, tast fibres, are important in swallowing and
gag reflexes, through connections with nucleus ambiguous and hypoglossal nucleus
.motor component will start in nucleus ambiguous and innervate just stylopharyngeous muscle
(swallowing). Preganglionic parasympathetic originate in inferior salivatory nucleus synapsing with
postganglionic neurons in otic ganglion, innervating parotid salivary gland.
10 vagus
rootlets from lateral aspect of medulla. Contains afferent, motor and parasympathetic
afferent: receptors from general sensation in pharynx, larynx, oesophagus, tympanic membrane,
external auditory meatus and part of concha of external ear. From chemoreceptors in aortic
bodies and baroreceptors in aortic arch. Widely distributed receptors in abdominal viscera and Tx.
Afferent sensation will end in trigeminal sensory nucleus, visceral will end in nucleus solitarious.
Motor fibres arise from medulla and will innervate muscles of soft palate, pharynx, larynx and
upper part of oesophagus. Nucleus ambiguous is crucial for speech control and swallow. They are
leaving the brainstem as roots of the accessory nerve but will transfer to vagus nerve at jugular
foramen
Parasympathetic fibre originate from dorsal motor nucleus of vagus, immediately beneath floor of
4th ventricle, work on CV, respiratory and GI tract
11 accessory
purely motor. 2 parts: cranial and spinal. Cranial part emerges from lateral aspect of medulla, with
rootlets very close caudally to vagus rootlets, their origin is in nucleus ambiguous of medulla. At
jugular foramen these rootlets join vagus nerve ones to innervate muscles of pharynx, larynx and
soft palate. The spinal root origins is in C1-C5 in ventral horn of grey matter. These roots will enter
in skull through foramen magnum. At the side of medulla will join briefly to cranial roots but will
separate again in jugular foramen. The spinal fibres will innervate SCM and trapezius muscle
12 hypoglossal nerve
purely motor. Innervates both extrinsic and intrinsic muscles of tongue (move and change shape).
Axons origin in hypoglossal canal, beneath floor of 4 th ventricle. Axons will course ventrally
through medulla and emerge in ventrolateral aspect in linear rootlets between pyramids and
olives. Hypoglossal nucleus will receive afferent from nucleus solitarius and trigeminal sensory
nucleus. Involved in controlling reflex movements of chew, sucking and swallow. Will receive also
corticobulbar fibres from contralateral motor cortex, which subserve voluntary movements of
tongue and speech

Neuroanatomy conditions
Patterns of sensory loss disease: unilateral spinal cord lesions or lower brainstem lead to
dissociated sensory loss,
Lesions of upper brainstem and cerebral hemispheres lead to loss of all sensation on contralateral
body side
Lower motor neuron syndrome:
- weakness or paralysis of individual muscles
- waisting of muscles
- fasciculation
- reduced resistance to passive stretching (hypotonia)
- hyporeflexia
Upper motor neuron syndrome:
Weakness of specific muscles (pyramidal weakness)
No waisting (clasp-knife)
Hyppereflexia
Spasticity
Positive babinsky
No abdominal reflexes
Cerebellum disorder
- Nystagmus
- Dysarthria
- Intention tremor
- Ataxia
Basal ganglia disorder:
- slow initiation and execution of movements
- increase tone
- abnormal involuntary movements and posture
- on contralateral side
neuronal and glial disorders:
individual neurons, no longer replicate, but maintain integrity. They are prone to
neurodegenerative diseases, which in childhood is genetically determined. Glial can replicate,
but can be associated to neoplasm (astrocytomas,oligodendrogliomas and lymphomas).
Multiple sclerosis: demyelination in CNS
Myopathy= weakness and muscle waisting (facial. Bulbar and proximal limb muscles),
preservation of sensations and reflexes
Polymyositis= immune disorder causing painful or painless myopathy. In elderly can be caused
by neopslasm (paraneoplastic). In children presents with a rush, referred as dermatomyositis
Duchenne muscular dystrophy: inherited degenerative conditions in male childer (X linked).
After 2-3 years, child progressive weakness in arms and legs, and wheelchair by 10 years old
and death later.
Disorder of neuromuscular junction:
- myasthenia gravis: immune disorder. Causes weakness and fatigue of cranial muscles
(extraocular, facial and bulb) and proximal limb muscles
- eaton-lambert syndrome: similar fatigue and is an immune paraneoplastic syndrome
peripheral sensorimotor neuropathies:
muscle weakness and wasting, distal areflexia and glove and stocke syndrome distribution of
sensory loss
2 pathological types : demyelinating neuropathies and axonal neuropathies
Brachial plexus lesions: from trauma it can caused an avulsion of the brachial plexus leading to
immediate weakness and loss of feeling on one upper limb, later arm is painful.
a tumout example can be Pancoast tumour, causing severe pain, weakness and paresthesia
down arm
Lumbosacral plexus lesions: have similar symptoms to brachial plexus lesions, plus bladder
and bowel incontinence.
Compression and entrapment of neuropathies:
Can oocur in radial, ulnar, median nerve in arm
Can occur in lateral cutaneous nerve and common peroneal nerve in leg
Lesions of the sympathetic nervous system:
Primary autonomic failure is chronic degenerative and leads to faint, not control heart rate and
blood pressure (postural syncope), and bowel/bladder incontince
Horner’s syndrome: dropping of eyelid (Ptosis) and constrictionof pupil (miosis) caused by
sympathetic damage of levator palpabrae muscle and radial (pupillodilator) of iris. Can be
caused by strke and tumour.
Raised intracranial pressure: a space occupying lesions is expanding focal lesion such as
tumour, haematoma or abscess, brain is distorted and displaced downwards towards foramen
magnum. Patient complain of headache, vomit, blurry vision and drowsiness. Swollen optic
disc (papilloedema) is a sign of brainstem dysfunction
Benign intracranial hypertension: brain swelling
Head trauma: displacement and torsion due to contusion, tear white matte and bleed in brain
(Intracerebral haematoma). Tear of middle meningeal artery and bleeding in extradural space
(extradural haematoma). Tear of veins in subdural space (subdural haematoma).
Meningitis: inflammation from virus infection or bacteria. Patient presents with photophobia,
headache and vomit. The infection can lead to damage cranial nerves and brain by raising
intracranial pressure
Hydrocephalus: obstruction of the flow of CSF withing ventricular system or subarachnoid
space, causing swelling of ventricles.
Occlusion of anterior spinal artery: leads to acute thoracic syndrome with paraplegia and
incontinence. Lost of spinothalamic modalities, but kept dorsal columns.
Disorders of blood supply to brain:
Stroke
Infarction
Cerebral haemorrhage
Aneurysm
Subarachnoid/intracerebral haemorrhage
Angio,e: congenital swollen vessels casuing cerebral haemorrhage
Cavernous sinus thrombosis: acute pain and swelling of orbit with opthalmoplegia, ptosis and
face numbness
Spinal nerve injury: compression or degenerative changes (spondylosis or proplapsion of discs)
Cause radicular symtpoms (eg sciatica)
Lumbar puncture and epidural anaesthesia
Motor neuropathies (come up last year): poliomyelitis: acute viral infection of neurons,
leading to rapid paralysis of limb and respiratory muscles. Assymetrical, affects legs as well.
Motor neuron disease (lower motor neuron symptoms). Amyotrophical lateral sclerosis:
degeneration descending pathways leads to weakness and spasticity of limb muscles
Lesion of dorsal columns (last year exam): tabes dorsalis: syphilitic infection of cns. Affects
lumbosacral dorsal spinal roots. Loss of proprioception leading to sensory ataxia, exarcebated
when eyes close (romberg’s sign). Subacute combined degeneration: deficiency of B12,
leading to degeneration lateral colummns, causing sensory ataxia and weakness and spasticity
of limbs. MS: immune disease, specific damage to fasciculus cuneatus of CX spine leading to
loss of proprioception and loss of dexterity and inability to identify shape and obejcts by touch
(astereognosis)
Spinothalamic tract lesions (last years exam): damaged in stringomyelia, where central canal
enlarged to form cavity compressing adjacent nerve fibres. Damage to 2 nd order neuron
causing loss of pain and temperature awareness in upper limbs (dissociated sensory loss). The
patient injuries and burns hand painlessly and joints disorganization without discomfort is
Charcot joint
Friedreich’s ataxia: degenerative disease, in spinocerebellar tract leading to uncoordination
and wide based, reeling gait
Lesions of spinal cord. Occlusion spinal artery and trauma causing fractures of spine and
emerging nerve roots is caused by infection, tumour, ms or prolapsed disc, can be two types of
focal vision: 1) lesion destroys function at segmental level 2) lesion interrupts descending
motor and ascending sensory tracts
Brainstem lesion: unilateral lesion is caused by stroke, tumour or MS causes ipsilateral cranial
nerve dysfunction and uncoordination, contralateral spastic hemiparesis, hyoerreflexia and
extensor plantar response, hemisensory loss. Bilateral destroys the vital centres (breath and
circulatory) leading to come and death.
Lesions cranial nerves
Bell’s palsy (question last year)
Acute unilateral inflammatory lesion of facial nerve. Pain experienced around ear and paralysis
of facial muscles unilaterally. Failure to close the eye, absent corneal reflex, hyperacusis on
affected side and loss of taste on anterior 2/3 of tongue
Thalamic lesions: from stroke and tumours destroying thalamus leads to loss of sensarion in
the contralateral face and limbs, accompanied by destrissing in paradoxical anesthetic areas
(thalamic pain)
Parkinsons and huntingtom (exam)
Pharyngeal arches.