NEUROANATOMY

Alan P. Magpantay, PTRP

ORGANIZATION OF CELLS AND FIBERS
 Ganglia
 Nucleus

 Gray matter

 White matter

 Tracts or Fascicles – bundle of processes of neurons having the

same function located within the cerebrum
 Columns or Funiculi – located outside of the cerebrum
NEUROGLIA/ GLIAL CELLS
 Oligodendrocytes
 Astrocytes – movement of nutrients; structural
support; phagocytes; insulators
 Microglia - macrophages
 Ependymal – assist in circulation of CSF
AXON DIAMETER
 A fibers – myelinated; largest diameter (5-
20µm
 Conduction speed 12-130 m/sec
 Touch, pressure, position of joints and some thermal
sensation; motor neurons
 B fibers – diameter of 2-3µm; myelinated
 15 m/sec
 Sensory of viscera; autonomic motor
 C fibers – smallest diameter (0.5-1.5 µm);
unmyelinated
 Some sensory for pain, touch, pressure, heat and
cold; some pain from viscera
SPATIAL AND TEMPORAL
SUMMATION
 Spatial summation – when summation results from
buildup of neurotransmitter released simultaneously by
several presynaptic end bulbs
 Temporal summation – when summation results from
buildup of neurotransmitter released by a single
presynaptic end bulb two or more times in rapid
succesion
ORGANIZATION OF THE NERVOUS SYSTEM
 Central Nervous System
 Brain
 Cerebrum (forebrain or prosencephalon)
 Brainstem

 Cerebellum

 Spinal Cord
 Peripheral Nervous system
 Cranial Nerves – 12 pairs
 Spinal nerves – 31 pairs
 Autonomic Nervous System
 Parasympathetic (craniosacral)
 Sympathetic (thoracolumbar)
•18th gestational
age
•Neural plate
-thickening
•Neural folds -
fuse
•Neural tube
•Alar plate –
dorsal half
•Basal plate –
ventral half
EMBRYONIC DIVISIONS
Embryonic Divisions Adult Derivatives Ventricular
Cavities
Telencephalon Cerebral Cortex Lateral ventricles
Forebrain Basal Ganglia
(prosencephalon)
Diencephalon Thalamus Third ventricle
Hypothalamus
Subthalamus
Epithalamus

Midbrain Tectum Aqueduct

(mesencephalon) Cerebral Peduncles

Metencephalon Cerebellum Fourth ventricle

Hindbrain Pons
(rhombencephalon)
Myelencephalon Medulla

Spinal Cord (myelon) Spinal Cord No cavity

SULCI AND FISSURES
 Lateral or Sylvian Fissure – divides the temporal
lobe from the frontal and parietal lobe
 Central Sulcus or Sulcus of Rolando – separates
the frontal lobe from the parietal lobe
 Separates the precentral gyrus from the postcentral
gyrus
 Longitudinal Cerebral fissure – divides the
cerebral hemispheres into right and left halves
 Parieto-occipital fissure – separates the parietal
lobe from the occipital lobe
 Calcarine sulcus – surrounded by the Visual
Receptive Area
MENINGES OF THE CEREBRUM
 Dura Mater – Pachymeninx; outer membrane
 Tough fibrous tissue
 Extension of dura: falx cerebri and tentorium cerebelli

 Arachnoid mater – together with the pia mater is

called Leptomeninges
 Delicate thin cob-web like membrane
 Subarachnoid space – space between arachnoid and
pia; filled with cerebrospinal fluid
 Piamater – soft thin membrane which closely
lines brain and spinal cord
 Extends around blood vessels throughout the brain
WHITE MATTER
 Commissure – connects corresponding regions of two
hemisphere
 Corpus callosum
 Anterior commissure
 Posterior commissure
 Habenular commissure

 Association Fiber – connects various cortical regions within the

same hemisphere
 Uncinate fasciculus
 Cingulum
 Superior Longitudinal Fasciculus
 Inferior Longitudinal Fasciculus
 Fronto-Occipital Fasciculus

 Projection Fiber – connects cerebral hemisphere with interior

structures
Brodmann’s Area
 4 – flaccid

 6 – spastic

8
 frontal eye gaze syndrome ( deviation of the eye away from the
hemiplegic side and towards the affected hemisphere)
 44
 Broca’s aphasia (dominant hemisphere)
 Expressive dysprosody (rhythm and pitch) (nondominant)

 9 -12
 Phineas gage syndrome (inappropriate behavior)
 3, 1, 2
 Tactile discrimination
 5 and 7 – Tactile agnosia (astereognosis)
 40
 ideomotor, ideational and facial apraxia, tactile agnosia and conduction
aphasia
 39
 R-L discrimination, finger agnosia, agraphia and acalculia (Gerstmann
syndrome)
 17
 contralateral hemianopsia/ homonymous hemianopsia
 18 and 19
 visual hallucination/ visual agnosia if both hemisphere
 22 – Wernicke’s aphasia
 41
 partial hearing loss
 42
 receptive dysprosody (inability to comprehend inflection or emotion in
speech)
 90% 0f cases the LEFT hemisphere is the DOMINANT
hemisphere
 Left hemisphere is primarily concerned with:
 Verbal, calculating and abstract thinking
 Interpretation of speech
 Stereognosis
 Motor function of the right extremities
 Right hemisphere is primarily concerned with:
 Non-verbal, spatial, temporal and synthetic function
 Appreciation of art and music
MOTOR
HOMONCUL
US
SENSORY
HOMONCULUS
 Approximately 18% of total blood volume are in the
brain
 Brain uses 20% of oxygen absorbed in the lungs

 Circle of Willis – formed by the PCA, ACA, anterior

communicating and posterior communicating arteries
CIRCL
E OF
WILLIS
TYPES OF APHASIA
Aphasia Expression Comprehension Repetition Naming

Transcortical Motor Poor Good Good Poor

Broca’s Poor Good Poor Poor
Global Poor Poor Poor Poor
Transcortical Mix Poor Poor Good Poor

Wernicke’s Good Poor Poor Poor

Transcortical Sensory Good Poor Good Poor

Conduction Good Good Poor Poor

Anomia Good Good Good Poor
CRANIAL NERVES
Number Name Function
CN 1 Olfactory Smell
CN 2 Optic Sight
CN 3 Oculomotor Constricts pupils, accomodates, moves eyes
CN 4 Trochlear Move eyes
CN 6 Abducens
CN 5 Trigeminal Chew, feels front of head
CN 7 Facial Moves face, taste, salivation, crying
CN 8 Vestibulocochlear Hearing, regulates balance
CN 9 Glossopharyngeal Taste, salivation, swallowing, monitors carotid
body and sinus
CN 10 Vagus Taste, swallowing, lifts palate; communication to
and from thoracoabdominal viscera to the splenic
flexure of the colon
CN 11 Accessory Turns head, lifts shoulders
CN 12 Hypoglossal Moves tongue
CRANIAL NERVE 5
 Branches
 Opththalmic
 Maxillary
 Mandibular

 Tic douloureux / trigeminal neuralgia

 Unbearable severe pain lasting for seconds over the
distribution of CN 5
BELL’S PALSY
 Lesion 1 – outside the stylomastoid foramen
 Lesion 2 – facial canal involving the chorda tympani
 Lossof taste in anterior 2/3 of tongue
 Reduced salivation

 Lesion 3 – higher in the facial canal involving stapedius

muscle
 Hyperacusis

 Lesion 4 – involving the geniculate ganglion

 Ramsay-Hunt Syndrome – Herpes Zoster of the geniculate
ganglion
 Deafness
 Lesion 5 – internal auditory meatus
 Lesion 6 – Pons
 CN 5 and 8
 May also involve CN 6, 11 and 12
DIENCEPHALON
 Thalamus
 Hypothalamus

 Epithalamus

 Subthalamus
 Thalamus – integration of certain types of sensation and
the relay of these sensations to areas of the brain
 Hypothalamus – function of hormonal release from the
pituitary gland
 The therapist suspects a patient recovering from a middle
cerebral artery stroke is exhibiting a pure hemianopsia.
This can be examined using a:
a. Distance acuity chart placed on a well-lighted wall at
patient’s eye level 20 feet away
b. Penlight held approximately 12 inches from the eyes
and moved to the extremes of gaze right and left
c. Penlight held 6 inches from the eyes and moved
inward toward the face
d. Visual confrontation test with a moving finger
 The therapist is called to the traumatic brain injury unit to
examine a new patient. Among the findings, are ptosis and
meiosis of the right eye with loss of facial sweating. The
therapist suspects:
a. Sympathetic nerve damage consistent with Argyll-
Robertson pupil
b. Sympathetic nerve damage consistent with Horner’s
syndrome
c. Sympathetic nerve damage consistent with autonomic
dysreflexia
d. Loss of parasympathetic function of the oculomotor
nerve
 A 76 year-old patient suffered a cerebral thrombosis four
days ago. She presents with the following symptoms:
decreased pain and temperature sensation of the ipsilateral
face, nystagmus, vertigo, and nausea, dysphagia, ipsilateral
Horner’s syndrome, and contralateral loss of pain and
temperature sensation of the body. The MOST LIKELY site
of the thrombosis is the:
a. Posterior cerebral artery
b. Midbasilar artery
c. Posterior inferior cerebellar artery
d. Internal carotid artery
 A patient suffers a CVA resulting in right hemisphere
damage. This patient will MOT LIKELY exhibit:
a. Negative, self-deprecating comments and frequent
depression
b. Slow, cautious behaviors
c. Hesitancy, requiring more feedback and support
d. Poor judgment with increased safety issues
RETICULAR FORMATION
 Control of skeletal muscle
 Control of somatic and visceral sensations

 Control of the autonomic nervous system

 Control of the endocrine nervous system

 Influence on the biological clocks

 Reticular activating system

LIMBIC SYSTEM
 Include
 Subcallosal gyrus
 Cingulate gyrus
 Parahippocampal gyrus
 Hippocampal formation (hippocampus, dentate gyrus,
parahippocampal gyrus)
 Amygdaloid nucleus
 Mammillary bodies
 Anterior thalamic nucleus
LIMBIC SYSTEM
 Control of emotion, behavior and drive
 Important in memory
 Hippocampus – recent memory

 Kluver-Bucy syndrome – destruction of amygdaloid

nucleus
 Decrease in aggresivenes
 Emotional instability
 Restlessness
 Increased interest in food (inc appetite)
 hypersexuality
CEREBROSPINAL FLUID
 135 cc – total quantity
 400 – 500 cc – constantly renewed daily

 Contains small amount of protein, sugar, chloride and

lymphocytes
 150 mmH2O – normal pressure in recumbent pos’n

 300 mmH2O – in sitting

VENTRICULAR SYSTEM
 Components:
 Lateralventricles
 Interventricular foramen or foramen of Monro
 Third ventricle – narrow vertical cleft between the
diencephalon
 Fourth ventricle – on dorsal aspect of pons and medulla
 2 Foramen of Lushka
 Foramen of Magendie
 Communicating hydrocephalus
 Non-communicating hydrocephalus
BLOOD-BRAIN BARRIER
 The barrier to passage of molecules from the blood into
the brain
 Small molecules enter the CNS more rapidly than large
molecules
 Larger proteins do not enter the CNS at all
 Ordinarily, substances bound to serum protein cannot
penetrate the CNS
 Substances that are highly soluble in lipid enter the CNS
more readily than those that are poorly soluble in lipid
 Carrier-mediated mechanisms transport some substances,
such as glucose and some amino acids, into the brain
BASAL GANGLIA
BASAL GANGLIA
 Composed of:
 Corpus striatum
 Amygdaloid nucleus
 Claustrum

 Corpus striatum – caudate nucleus and lentiform

nucleus
 Lentiform nucleus – globus pallidus and
putamen
 Neostriatum (Striatum) – caudate nucleus and
putamen
 Paleostriatum – globus pallidus or pallidum
NOMENCLATURE
TERM COMPONENTS
Dorsal Striatum Caudate nucleus and putamen
Dorsal pallidum Globus pallidus, pars externa, and pars
interna
Lenticular (lentiform) nucleus Putamen and globus pallidus
Ventral striatum Nucleus accumbens and anterior
perforated substance
Ventral pallidum
Substantia nigra Pars compacta and pars reticulata
Ventral tegmental area
Subthalamic nucleus
FUNCTION/ DYSFUNCTION
 Control of motor activity
 Chorea – quick, jerky, irregular movts; nonrepetitive
 Huntington’s chorea – degeneration of GABA-secreting, P
substance-secreting, and the acetylcholine-secreting neurons
of the nigrostriatal pathway (overactivity of dopamine-
secreting neurons)
 Athetosis – slow, sinuous, writhing movts of distal
extremity
 Degeneration of globus pallidus
 Hemiballismus – involuntary movt confined to one side
of the body; proximal mm
 Opposite subthalamic nucleus
 Parkinson’s dse – degeneration of substantia nigra;
decrease dopamine; hypersensitivity of receptors
CEREBELLUM
LOBES
 Flocculonodular lobe
 Archicerebellum – oldest part phylogenetically
 Anterior lobe
 Paleocerebellum – second oldest part
 Posterior lobe
 Neocerebellum – newest part
Functional Division
Flocculonodular
(vestibulocerebellum)
Vermis (spinocerebellum)
Intermediate zone (spinocerebellum)
Lateral zone (cerbrocerebellum)
Function
Equilibrium (axial), eye movements,
vestibular reflexes
Axial and proximal muscle control
and execution, progressive movement
Distal muscle control and execution,
progressive movement
Motor planning, initiation and timing
HANDS TREMOR
 H – hypotonia (loss of muscle tone)
 A – Asynergy (lack of coordination)

 N – Nystagmus (ocular oscillation)

 D – Dysarthria (speech abnormalities)

 S – Station and gait (imbalance, gait ataxia)

 Tremor – intention tremor

BRAIN STEM
 Midbrain
 Pons

 Medulla Oblongata
 Vestibulospinal and Reticulospinal tracts – postural biasing of
muscles and anticipatory postural adjustment
 Excitatory to extensor motor neurons of arms and legs (inhibited by
cortex)
 Rubrospinal and Corticospinal tracts
 Facilitates flexor muscles
 Rubrospinal tract – arms only
SPINAL CORD
REXED
LAMINAE
 Lamina I – conveys pain and temperature
 Lamina II & III – substantia gelatinosa
 Responds to noxious stimuli
 Lamina IV – nucleus proprius
 Conveys light touch
 Lamina V – noxious and visceral afferent stimuli
 Lamina VI – deepest layer of dorsal horn
 Mechanical signals from joints and skin
 Lamina VII – aka zona intermedia
 Contains dorsal nucleus (Clark’s column); uncrossed fibers of
the spinocerebellar tract (unconscious proprioception) and
intermediolateral nucleus
 Lamina VIII – sends commissural axons to the opposite
side of the cord
 Lamina IX – peripheral group innervates the extensor
muscle group; centrally located innervates the flexor
muscles
 Lamina X – small neurons surrounding the central canal
ARTERY OF
ADAMKIEWI
CZ – T10 AND
L3
CORTICOSPINAL/
CORTICOBULBAR
TRACT
DERMATOME
Root level Cutaneous Area
C2 Occipital Protuberance
C3 Supraclavicular fossa
C4 Top of acromioclavicular joint
C5 Lateral antecubital fossa
C6 Thumb
C7 Middle finger
C8 Little finger
T1 Medial antecubital fossa
T2 Apex of axilla
T3 3rd intercostals space (IS)
T4 4th IS (nipple level)
T5 5th IS
T6 6th IS (Xiphisternum)
Root level Cutaneous area
T7 Continuation of 7th IS to midline
T8 Continuation of 8th IS to midline
T9 Continuation of 9th IS to midline
T10 Continuation of 10th IS to midline
T11 Continuation of 11th IS to midline
T12 Inguinal ligament in the region of femoral artery
L1 1/3 distance of T12 and L2
L2 Mid anterior thigh
L3 Medial femoral condyle
L4 Medial malleolus
L5 Dorsum of foot at big toe
S1 Dorsum of foot at 3rd MTP
S2 Lateral heel
S3 Popliteal fossa in midline
S4-S5 Ischial tuberosity and perianal area
MYOTOME
Root level Key Muscles
C5 Elbow flexors
C6 Wrist extensors
C7 Elbow extensors
C8 Finger flexors
T1 Hand intrinsics
T1-T12 Chest wall and abdominal muscles
L2 Hip flexors
L3 Knee extensors
L4 Ankle dorsiflexors
L5 Toe extensors
S1 Ankle plantarflexors
S3-S5 Bladder, bower, sex organ, anal and pelvic muscles
 A patient is recovering from a complete spinal cord injury, at
the level of L2. The expected outcome in this case would
MOST likely include:
a. A spastic or reflex bladder
b. Some recovery of function since damage is to peripheral
nerve roots
c. Loss of motor function and pain and temperature
sensation below the level of the lesion with light touch,
proprioception and position sense preserved
d. Greater loss of arm function than leg function with early
loss of pain and temperature sensation
 During a sensory exam a patient complains of a dull,
aching pain and is not able to discriminate a stimulus as
sharp or dull. Two-point discrimination is absent. Based
on these findings, the pathway that is intact is the:
a. Lateral spinothalamic tract
b. Dorsal columns/neospinothalamic systems
c. Fasciculus gracilis/ medial lemniscus
d. Anterior spinothalamic tract
 A therapist is treating a patient with Brown-Sequard
syndrome that resulted from a gun shot wound. The
therapist’s examination should reveal:
a. Loss of motor function and pain and temperature
sensation with preservation of light touch and position
sense below the level of the lesion
b. Loss of upper extremity function, (cervical tract
involvement) with preservation of lower extremity
function (lumbosacral tract involvement)
c. Sparing of tracts to sacral segments with preservation of
perianal sensation, and active toe flexion
d. Ipsilateral weakness and loss of position sense and
vibration below the lesion level with contralateral loss of
pain and temperature sensation
 A 92 year-old patient is being examined for signs of
stroke. When tested for two-point discrimination on the
right hand, the patient is unable to tell whether the
therapist is touching with one or two points. The
therapist determines that there is impaired function in
the:
a. Dorsal column/lemniscal pathways or
somatosensory cortex
b. Anterior spinothalamic tract or thalamus
c. Lateral spinothalamic tract or somatosensory cortex
d. Spinal lemniscus or ventral posterolateral nucleus of
the thalamus
MUSCLE
SPINDLE
MUSCLE SPINDLE – LENGTH AND RATE
OF CHANGE IN LENGTH  Intrafusal fibers –
connected to tendon
 Parallelwith
extrafusal fibers
 Types:
 Nuclear bag – longest
and largest
 Nuclear chain –

shorter and thinner

with nuclei
INNERVATION OF
MM SPINDLE
Types of Efferent
Endings:
•Plates – nuclear bag
•Trails – nuclear
chain
Innervated
by
gamma or beta
motorneurons
Types of Afferent
Endings:
•Primary (Group IA
fiber)– central region of
both bag and chain
• Monosynaptic with
alpha motorneurons
(homonymous and
heteronymous mm)
•Secondary (Group II
fibers) – nuclear chain
• Monosynaptic with
alpha (homonymous)
Alpha motoneurons
– innervates
extrafusal fibers

Renshaw cells
• Excited by
collaterals of
alpha
motoneurons
• inhibit alpha
motoneurons
GOLGI TENDON ORGAN
 In series with the tendons at the insertion
 Ib afferent fibers – polysynaptically inhibit alpha
motoneurons of agonist muscle and facilitate
antagonist muscle
 Provides info on muscle force
SPASTICITY
 Clasp-knife phenomenon
 Theories
 Disinhibition
 Collateralsprouting
 Denervation supersensitivity
AUTONOMIC NERVOUS SYSTEM
Structure Sympathetic function Parasympathetic function
Eye Dilates pupil (mydriasis) Contracts pupil (miosis)
No significant effect on Contracts ciliary muscle
ciliary muscle (accomodation)
Lacrimal gland No significant effect Stimulates secretion
Salivary gland No significant effect Stimulates secretion
Sweat glands Stimulates secretion No significant effect
(cholinergic fibers)
Heart
rate Increases Decreases
force of contrxn Increases Decreases
Blood vessels Dilates or constricts cardiac No significant effect
& skeletal muscle vessels

Constricts skin and

digestive system blood
vessels
 Structure Sympathetic Function Parasympathetic
Function
Lungs Dilates bronchial tubes Constricts bronchial tubes
Stimulates bronchial gland
secretion

Gastrointestinal tract Inhibits motility and Stimulates motility and

secretion secretion
GI sphincters Contracts Relaxes
Adrenal Medulla Stimulates secretion of No significant effect
adrenaline (cholinergic
fibers)

Urinary bladder ? Contracts

Sex organ Ejaculation erection
SYMPATHETI
C
PARASYMPATHE
TIC
PARASYMPATHETIC CN
 Edinger-Westphal nucleus – CN 3
 Terminates in ciliary ganglion → pupil
 Superior salivatory nucleus – CN 7
 Pterygopalatineand submandibular ganglion → lacrimal
gland, and submandibular and sublingual glands
 Inferior salivatory nucleus – CN 9
 Otic ganglion → parotid gland
 Dorsal Motor nucleus – CN 10
 Abdominal viscera
BRACHIAL PLEXUS
 Formed by the union of the anterior rami of C5, C6, C7,
C8 and T1 spinal nerves
 Roots (ventral rami) of brachial plexus lie between
scalenus anterior and medius
 Trunks:
 Ventral rami of C5 and C6 join to form the UPPER trunk
 C7 ventral rami forms the MIDDLE trunk
 Ventral rami of C8 and T1 join to form the LOWER trunk
 Branches from the Ventral Rami (roots)
 Dorsal scapular n. arises from the post. aspect of ventral
ramus of C5 and supplies the rhomboid muscles and levator
scapulae
 Long thoracic n. arises from the post. aspect of ventral rami
of C5, C6 and C7 and supplies the serratus anterior muscles

 Branches from the Upper Trunk

 The nerve to subclavius arises from the anterior aspect of the
upper trunk and supplies the subclavius muscles
 The suprascapular nerve arises from the posterior aspect of
the upper trunk and supplies the supra and infraspinatus
muscles.
DIVISIONS AND CORDS OF THE
BRACHIAL PLEXUS
 Behind the clavicle, each of the trunks divide into
anterior and posterior divisions.
 They join to form the cords below the clavicle and
behind the pectoralis minor
 The anterior divisions of the upper and middle trunks form
the LATERAL CORD
 The posterior divisions of all 3 trunks form the POSTERIOR
CORD.
 The anterior division of the lower trunk forms the MEDIAL
CORD
TERMINAL BRANCHES OF THE
BRACHIAL PLEXUS
 3 branches of the lateral cord
 Lateral pectoral nerve
 Lateral root of median nerve
 Musculocutaneous nerve

 5 branches of the medial cord

 Medial pectoral nerve
 Medial cutaneous nerve of the arm
 Medial cutaneous nerve of the forearm
 Ulnar nerve
 Medial root of median nerve
TERMINAL BRANCHES OF THE
BRACHIAL PLEXUS
 5 branches of the posterior cord
 Upper subscapular nerve
 Thoracodorsal nerve
 Lower subscapular nerve
 Axillary nerve
 Radial nerve
LUMBAR
PLEXUS
LUMBAR PLEXUS
 Iliohypogastric nerve
 From the upper branch of L1
 Supply the lateral aspect of the skin of the buttocks

 Ilioinguinal nerve
 From the upper branch of L1
 Passes through the superficial inguinal ring
 Supply the groin or superomedial aspect of the thigh and
scrotum or labia majora
 Genitofemoral nerve
 From the lower branch of L1 and upper branch of L2
 Divides into 2 branches
 Genital branch – cremasteric muscle
 Femoral branch – skin just inferior middle part of inguinal ligament
 Lateral femoral cutaneous nerve
 Anterior division of L3 and posterior division of lower branch of
L2
 Passes under lateral end of inguinal ligament near ASIS
 Supply the anterolateral aspect of the skin of the thigh

 Femoral nerve
 From the posterior division of lower branch of L2, L3 and upper
branch of L4
 Passes over iliacus and supplies it, supplies the anterior thigh and
pectineus
 Gives cutaneous branches:
 Anterior femoral cutaneous nerve
 Medial femoral cutaneous nerve

 Saphenous nerve

 Supplies the medial aspect of knee, leg and foot (saphenous

nerve)
 Obturator nerve
 From the anterior division of lower branch of L2, L3 and
upper branch of L4
 Supplies middle part of the medial aspect of thigh and
adductor muscles except pectineus and hamstring part of
adductor magnus
NOTES ON LUMBAR PLEXUS
 Only the anterior rami of L1, L2 and L4 divides into
upper and lower branch
 Only the lower branch of L2, L3 and the upper branch of
L4 divides into anterior and posterior division
SACRAL
PLEXUS
SACRAL PLEXUS
 Superior gluteal nerve
 From posterior division of L4, L5 and S1
 Divides into:
 Superior branch
 Inferior branch

 Inferior gluteal nerve

 From posterior division of L5, S1 and S2
 Supplies gluteus maximus

 Nerve to the obturator internus

 From anterior division of L5, S1
 Supplies superior gemellus and obturator internus
 Nerve to the quadratus femoris
 From anterior division of L4, L5, S1
 Supplies hip joint, quadratus femoris and inferior gemellus

 Nerve to the piriformis

 Directfrom S1 and S2
 Supplies the piriformis

 Posterior femoral cutaneous nerve

 From posterior division of S1-S2 and anterior division of S2-
S3
 Supplies skin of inferior aspect of buttocks, posterior thigh
and posterior aspect of proximal part of leg, skin of perineum
 Pudendal nerve
 From anterior division of S2, S3 and S4
 Supplies perineal structures

 Sciatic nerve
 Main branch of the sacral plexus and largest nerve in the
body
 From L4-S3
 Common peroneal part: posterior division of L5-S2 and Lower
branch of L4
 Tibial part: anterior division of L5-S3 and lower branch of L4)
 Tibial nerve
 Gives off:
 Branches to gastrocnemius, plantaris, popliteus and soleus
 3 articular branches to the knee jt.

 Medial sural cutaneous nerve

 Branches to the tibialis posterior, flexor digitorum longus and flexor hallucis

longus
 Passes the tarsal tunnel
 Medial plantar nerve (supplies abductor hallucis, flexor digitorum brevis,
flexor hallucis brevis and 1st lubrical)
 Medial aspect of sole of the foot up to the medial 3 ½ digits

 Lateral plantar nerve (supplies all other muscles of the soles not innervated

by the medial plantar nerve)

 Lateral aspect of sole upto the lateral 1 ½ digit
 Common Peroneal nerve
 Gives off:
 Articular branches to the knee and proximal tibiofibular jts
 Lateral sural cutaneous nerve – together with the medial sural cutaneous

nerve form the SURAL NERVE

 Passesover the posterior aspect of the head of the fibula winding
around the lateral surface of the neck of fibula then dividing into:
 Deep Peroneal nerve
 Supplies all muscles of the anterior compartment, extensor digitorum

brevis, distal tibiofibular and ankle jts.

 Dorsal skin between the 1st and 2nd digits

 Superficial Peroneal nerve

 Supplies both muscles of the lateral compartment

 Skin over distal part of anterior surface of the leg, dorsum of the foot

and most of the digits

 Sural nerve
 Supplies the lateral aspect of the leg, ankle and foot
 Used for nerve grafts
NOTES ON SACRAL PLEXUS
 All the contributors (lower branch of L4, L5-S3) divides
into anterior and posterior division.
 The anterior and posterior division of lower branch of
L4, L5-S3 contributes to form the tibial and common
peroneal parts of the sciatic nerve respectively, except
for the posterior division of S3.
 A patient presents with severe, frequent seizures
originating in the medial temporal lobes. Following
bilateral surgical removal of these areas, the patient is
unable to remember any new information just prior to
the surgery to the present. The patient cannot recall text
read minutes ago or remember people previously met.
These outcomes are indicative of:
 Loss of hippocampus and declarative memory
function
 Loss of procedural memory and integration with
frontal cortex
 A primary deficit from the loss of the amygdale
 Loss of integration of the temporal lobe with the basal
ganglia and frontal cortex