10/29/200712:17AM NervousSystemWrittenExamITables byDMFA

GrossAnatomyofBrainstem Lecture1Dr.Machu
Division Subdivison Component Function Images
Raphenuclei Majorserotoninarea
Pyramidaldecussationat Corticospinaltract(motor),
Medulla Medullarypyramids
spinalmedullatransition caudalcontinuationofpeduncles
(myel Decussatesincaudalmedulla,
encephalon) Mediallemniscus Relaynucleiofdorsalcols
allowsfinetouchtransmission
Inf.CerebellarPeduncle Fibersprojecttocerebellum
Corticospinaltractfibers Voluntarymovement
Receiveinputfromcerebral
Basispontis Pontinenuclei
cortex(corticopontinepathway)
Pontocerebellarfibers Throughmid.cerebellarpeduncle
Pons Cranialnervenuclei
(met
encephalon) Centraltegmentaltract
Tegmentum
Tectospinaltract
Mediallongitudinalfasciculus
MiddleCerebellarPeduncle Largestof3pedunles
Identifies basis ontheventral
Cerebralpeduncles
surfaceofthebrainstem
Cruscerebrifiberbundle of Corticospinal,corticobulbar,
Basis(caudal)
cerebralpeduncles corticopontinepathways
Majordopaminergic nn.
Substantianigra
Partofmotorsystem
Oculomotor&trochlear
Nucleiforextraocularmm.
nuclei
Partofmotorsystem,rubrospinal
Tegmentum(ventralto Rednuclei
tract
cerebralaqueduct)
majordopaminergic nn.
Ventraltegmentalarea
Midbrain partofrewardsystem
(mes Lateraltegmentalarea Majornorepinephrinearea
encephalon) Cerebralaqueduct(of rd th
Connects3 and4 ventricles
Sylvius)
Formsroofofmidbrain
Quadrigeminalplate Rostralsuperiorcolliculi,vision

Caudalinferiorcolliculi,hearing
Tectum(rostral)
Locusceruleus Majornorepinephrinearea

Majoropioidcenterofbrain
Periaqueductalgreymatter
Haslimbicfunctions
Midbrainreticularformation Regulatesarousal,alertness

Function
Specialsensoryinput
Eyemovements,pupilconstruction
Puremotor
Mixedsensoryandmotor
Parasympatheticfibers
CranialNervesbyType Lecture1Dr.Machu
CranialNerves
olfactory(I),optic(II)&auditory/vestibulocochlear (VIII)
oculomotor(III),trochlear(IV)&abducens(VI)
spinalaccessory(XIsternocleidomastoid&trapezius)&hypoglossal(XII musclesofthetongue)
trigeminal(V),facial(VII),glossopharyngeal(IX) &vagus(X)
oculomotor(III),facial(VII),glossopharyngeal(IX)&vagus(X)

TheMeninges Lecture1Dr.Machu
Layer Adherence Thickness Function Subunits
Outerperiostiallayer formsperiosteumofinnersurfaceofskull
Innerfibrous,meningeallayer
Duramater Innersurfaceofskull Thick Stabilizebrainwithinskull Falxcerebripartitionbetweenthetwocerebellarhemispheres
Tentoriumcerebelliformsroofoverthecerebellum,partition
Arachnoid Brain Thin Bloodbrainbarrier

Piamater Brainfollowsgyri/sulci Thinnest

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TheCerebellum Lecture1Dr.Machu
Area Description Functions Image
Cortex Foliagyriofcerebellum

Dentatenucleus(lat,largest) Voluntarymovement
Whitematter
Emboliformnucleus

DontEatGreasy
Globosenucleus
Food
Fastigialnucleus(med) Standingandwalking
Toneoftrunk
Vermis Separateshemispheres
Gait,balance
Hemispheres Controlipsilateral(same)sideofbody

TheDiencephalon L1Dr.Machu
Image Area Description Subunits Function
Thalamus Majorrelaycenter
Autonomic Opticchiasm Opticn.fiberscrossmidline
neuroendocrine Pituitarystalk regulationofpituitary
Midlineinfindibulum
Hypothalamus emotion function
Appetitive Fornixinputfromthehippocampus,
Mammillarybodies
(motivated)behavior outputviathemammillothalamictract
Pinealgland Melatonin circadianrhythm
Epithalamus Posterior Eyemovement,lightresponse
commissure Betweenmidbrainandthalamus
Ventraltothalamus Arousal,attention
Subthalamicn.
Subthalamus Posterolateralto
(hemiballisimus)
Controlofmovement(subthal.nucleus)
hypothalamus Oculomotorcontrol

CerebralCortices L1Dr.Machu
Lobe Subunits Image
Primarymotorcortex
Premotor&supplementarymotorareas
Frontal Frontaleyefields(eyemovement)
(motor)
Brocasarealanguageproduction
Prefrontalcortexgoals&plans

Parietal Primarysomatosensorycortexsomatosensoryandvisualassociation
(somatosensory) Supramodalassociationcortices

Occipital Primaryvisualcortexreceivesinputfromthalamus
(visual) Somatosensoryassociation

Primaryauditorycortexreceivesinputfromthalamus
Temporal Wernickesareainhemispheredominantforlanguage(usuallyleft)
(auditory) comprehensionandproductionoflanguage
Temporalvisualassociationareas

SubcorticalGreyMatter&LimbicSystem L1Dr.Machu
Image Area(*=limbicsystem) Subunit Functions
Hippocampus Formationofnewmemories,becomescontinuous
(Ammonshorn) withfornix
HippocampalFormation*
Dentategyrus Inputstation
Subiculum Mainoutput
Inputs
Amygdala* Motivationalbehavior,emotionalfunction
Outputs
Caudatenucleus Learning,memory
Basalganglia Putamen Reinforcement
Globuspallidis
Medialseptalnuclei Linkedviafornixtohippocampus,memory
Lateralseptalnuclei*
Basalforebrain
Nucleusaccumbens* Reinforcement
Nucleusbasalis(ofMeynert) Memoryformation,wideprojectionstocortex
Parahippocampal,cingulated,
Limbiclobe*(cortical) Olfaction,emotion
andsubcallosalgyri

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BranchialArches Lecture2Dr.Aschenbrenner
Arch OriginofCore Muscles Bones Otherstructures Innervation
Mm.ofmastication temporalis, Maxilla(maxillaryprocess)
2
masseter,pterygoids Mandible(mandibularprocess) CNV (s)
IMandibular Neuralcrest
Mylohyoid,ant.bellyofdigastric, Incus(maxillarycartilage)
3
CNV (m,s)
tensortympani,tensorvelipalatini Malleus(mandibular/Meckelsc.)
Stapes(Reichertscartilage)
IIHyoid Neuralcrest Mm.offacialexpression Styloidprocessoftemporalbone Stylohyoidlig. CNVII(m,s)
Lessercornua&superiorhyoid
III Neuralcrest Stylopharyngeusm. Greatercornua&inferiorhyoid CNIX(m,s)
Laryngealcc.thyroid,
Pharyngealconstrictormm., cuneiform,corniculate, Superiorlaryngeal
IV Lat.platemesoderm
levatorvelipalatini,cricothyroid

arytenoids,cricoids branchofCNX(m,s)
Epiglottisviamigration
st nd Recurrent(inf.)
Intrinsicmm.oflarynx(1 and2
VI Lat.platemesoderm
occipitalsomites)
laryngealbranchof
CNX(m,s)
Abranchialarchconsistsof:1)acartilaginouscore,2)striatedskeletalmusclederivedfromparaxialmesoderm,3)innervationviaacranialn.,4)bloodvesselfromext.carotida.
DevelopmentofFace Lecture2Dr.Aschenbrenner
Structure Origin
Nasolabialfold,nasolacrimalgroove&duct Fusionoflat.nasalprocesseswithmaxillaryswelling
Bridgeofnose,medialnasalseptum Fusionofmed.nasalprocesses
Intermaxillaryprocess,philtrumoflip Fusionoftipsofmed.nasalprocesses
Primarypalate Posteriorextensionofmaxillaryprocess
Partitionofnasalcavity,choanae Fusionofnasalseptumandhardpalate
Secondarypalate Palatineshelves(processes)ofmaxilla(med.aspectofmandibularswellings)
Hardandsoftpalates Fusionofbothsecondarypalates,endochondralossificationofanteriorpartofsecondarypalate
Lowerlip Fusionofdistalextentofthemandibularswellings
Embryonicstomatodeum(mouth) Ruptureofbuccopharyngealmembrane

PharyngealPouches Lecture2Aschenbrenner
Pouch Derivatives
Pouch1 Tubotympanicrecessandtympaniccavity

Pouch2 Palatinetonsils

Pouch3 Thymusgland,inferiorparathyroidglands

Pouch4 Superiorparathyroidglands

Pouch5 UltimobranchialbodyParafollicular(Ccells)ofthethyroid
Pharyngealpouchesareformedbyinvaginationoftheendodermalepitheliallining.

CervicalCystsandFistulas Lecture2Dr.Aschenbrenner
Lateral
Typesof Cervicalw/externalfistula
cervicalcysts Cervicalw/internalfistula
Cervicalw/bothinternalandexternalfistulas

Clinical Develop justmedialtotheanteriorborderofthesternocleidomastoid

considerations Auralcystsformanteriorandinferioroftheauricle

ThyroidDevelopment Lecture2Dr.Aschenbrenner
Invaginationoftheepitheliumattheforamencecumofthetongue
producestheanlagenofthethyroidgland.
Thethyroidmigratesinferiorlyandmidsagittallytoitslocationin
Steps theneckanteriorandinferiortothethyroidcartilageofthelarynx.
Thyroglossalductwhichformsduringthismigrationusually
disappears.
Ifthethyroglossalductpersists,cystsmayformduetorestsofcells
becomingmetabolicallyactiveunderhormonalinfluence.
Abnormalities Thyroglossalductcystsoccupypositionsalongthemidsagittal
plane.

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TongueDevelopment Lecture2Dr.Aschenbrenner
BranchialArch EmbryonicComponent AdultStructure CranialNerve
I Mediantonguebud Mucosaanterior2/3oftongue V(sensation)

II Laterallingualswellings Mucosaanterior2/3oftongue VII(tastechordatympanin.)

III Hypopharyngealeminence Mucosaposterior1/3oftongue IX

IV Hypopharyngealeminence Mucosabaseofthetongue X
OccipitalSomites Myoblasts Intrinsicmm.,palatoglossal m. X,XII

FacialDevelopmentAbnormalities Lecture2Dr.Aschenbrenner
Abnormality Cause StructuresAffected
Acrocephaly Prematureclosureofcoronalsuture Tallandnarrowskull;hypertelorism,cleftnose&lipsoftenassociated
Trigonocephaly Prematureclosureofmetopicsuture Triangularskull
st
CrouzonSyndrome Failureof1 branchialarch Skullandfacialbonesfuseearly;withoutsurgery,blindnessandretardationoccur
st
ApertSyndrome Failureof1 branchialarchandapoptosis Syndactyly,skullandfacialbonesfuseearly
Holoprosencephaly forebrainandlimbicstructures,majorcauseofretardation
Philtrumcleftnoseandlips,archedpalate
Retrognathiashort,retractedmandible
FetalAlcoholSyndrome ETOHuseduringpregnancy
Microcephalysmallskull
Cebocephalysinglenostril
Cyclopiasingleeye
Failureofthemaxillaryswellingtofusewiththemedial
nasalprocessandintermaxillaryprocessduetodefective
Lips,hardpalate,softpalate
CleftNose/Palate migrationofneuralcrestcellsorabnormalapoptosis
Maybeuniorbilateral
Inducedby:phenytoin/dilantin,vitaminAandits
analogues:isoretinoin/accutan
nd LateralfacialcleftdefectofTMJ,mandible,mm.ofmastication,outerandmiddle
GoldenharsSyndrome Hematomaofstapediala.of2 branchialarch
earstructures
Deficiencyinneuralcrestcellmigrationpatternor
TreacherCollinsSyndrome st nd Downwardslantingeyes,smallmandible,malformedorabsentears
excessiveapoptosisor1 and2 branchialarches
Craniofacial micrognathia,lowsetears,auricularabnormalities,cleftpalateand
Abnormalneuralcrestcellmigrationpatternsdueto
hypertelorism
DiGeorgeSyndrome partialmonosomyofchromosome22andpossiblyalcohol
rd th Agenesisorhypoplasiaofthethymusorparathyroidglands
ingestion;3 and4 branchialarches
Cardiovascularpatentductusarteriosisandinterruptionoftheaorta

Neurulation Lecture6Dr.Aschenbrenner
ComponentofNeurectoderm Subunits Structuresformed
Sensorygangliaofcranial&spinalnn.,autonomicmotorganglia,
Neuralcrest Neuralcrestcells postganglionicmotorneurons,chromaffincellsofadrenalmedulla,some
skeletalmuscleofheadregion
Telencephalon Cerebrum,lateralventricles,basalganglia,CNI
Proencephalon
Diencephalon Thalamus,hypothalamus,epithalamus,opticchiasm,CNII
Neuraltube Mesencephalon Mesencephalon Midbrain,CNIII&IV
Brain Metencephalon
th
Pons,cerebellum,CNVVIII,mostof4 ventricle
Rhombencephalon th
Myelencephalon Medulla,CNVIIIXII,restof4 ventricle
Ependymalzone Surroundscentralcanal Developmentofneuroblasts,glioblasts,andependymalcells
Basalplate Formsventralhorns amotorneurons(LMNs)
Neuraltube Mantlezone(grey)
Alarplate Formsdorsalhorns sensory
SpinalCord Marginalzone(white) Atmarginofspinalcord Formsascending/descendingtracts
Sulcuslimitans Betweenalarandbasalplates Formslat.boundaryofmedialeminenceinfourthventricle
th
Neurulationoccursat2223days(startof4 week).Cervicalflexure(90betweenspinalcordandbrainstem)occursaroundday26,causingmidbraintoappearlargeIt
straightensoutinthefinalstagesofCNSdevelopment.Pontineflexureappearslaterandbendsconcaveposteriorly,reducingthesizeofthemidbrain,creatingspaceforthe
cerebellum.

IonConcentrationsandPotentials Lecture9Dr.Machu
Ion ExtracellularConcentration(mM) IntracellularConcentration(mM) EquilibriumPotential(mV)
+
Na 145 12 +66
K+ 4 155 97
Cl 120 4 90
Eion>Em:Enters;Eion=Em:noflow;Eion<Em:Exits

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SpinalCordTractsandWhiteMatterOrganization Lecture7Dr.Aschenbrenner
Tract Direction Function Location Image

Pain Lateral,anterior
Spinothalamic Ascending
TemperatureCrudetouch Onlytracttocrossinspinalcord

Unconsciousproprioception
Spinocerebellar Ascending
Coordination
Posterior,anterior

Finetouch,Vibration,Pressure
Consciousproprioception
Dorsalcolumns Ascending
CuneatusUpperlimbs(T6)
Dorsal
GracilisLowerlimbs(T6)

Corticospinal Descending Voluntarymovement Lateral,anterior

Posteriormediansulcus
Posteriorintermediatesulcus
SurfaceFeatures
Posteriorlateralsulcus
Anterolateralsulcus
Anteriormediamfissure
Separatesrightandleftdorsal
columns
OnlyaboveT6,separatescuneatus
&gracilis
Dorsalrootentryzone
Ventralrootexitzone
Sulcalbranchofanteriorspinala.

SpinalCordGreyMatterOrganization
Image RexedsLaminae
LaminaeIV(dorsalhorn)
LaminaeVIVII
(intermediolateralcellcolumn,IMLCC)
LaminaeVIIIIX(ventralhorn)
Lecture7Dr.Aschenbrenner
Function
Sensory (afferent);pain,temperature,touch
Inucleusposteriomarginalis
IInucleussubstantiagelatinosa,modulationofpaininput
IIIVnucleusproprius,intersegmentalreflexactivity
Autonomicnervoussystem(T1L2)
Thinnergreymatter
VIInucleusdorsalis(Clarke),originofspinocerebellarpathways
Motor (efferent)
VIIIlowermotorneuronstoproximalmm.
IXlowermotorneuronstodistalmm.
Renshawcellsinterneuronsinvolvedinnegativefeedback,switching
betweenagonist/antagonistmuscles

LaminaX Centralgreymatter

CervicalEnlargement(C4T1) Brachialplexus,largergreyhorns

Lumbarenlargement(L1S2) Lumbarplexus,largergreyhorns

SpinalCordBloodSupply
Section Arteries Images
Spinalbranchesfromvertebrala.radicularaa.
Ascendingcervicala.
Cervical Externalcarotidbranches
Deepcervicala.

Fewsegmentalbranchesfromthoracicaorta
Thoracic vulnerabletoinfarction

Greatradiculara.(A.ofAdamkiewicz)
Lumbar vulnerabletoinfaction,involvedfollowingabd.
aorticaneurysm(AAA)repair
Anterior&posteriorspinalvv.andplexi
Intervertebralvv.azygous,hemiazygous,or
Venous deepvv.ofneck
Batesonsplexus:prostaticvv.cancause
neoplasticinvastionofspinalcord

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ComparisonofMotorNeuronLesions
Variable Lowermotorneuronlesion Uppermotorneuronlesion
Weakness flaccidparalysis spasticparalysis
Deeptendonreflexes decreasedorabsent increased
Pathologicreflexes(Babinskisign) absent presentorhyperactive
Atrophy significant ifpresentitisdotodisuse
Fasciculations/fibrillations maybepresent absent

MuscleReceptors InvolvedinReflexControl
Type Group Subgroup Diameter Con.Vel. Tissue Function
A I Ia 1220 72120 Muscle primarymusclespindle
Ib Muscle Golgitendonorgan
II 612 3672 Muscle secondarymusclespindle
Beta Skin touchreceptors
III 16 636 Muscle pressurepainendings
Delta Skin touch,pain,temperature
C IV 1 0.52 Muscle pain
C Skin touch,pain,temperature

TypesofNeuronsintheSpinalCord
Neuron Type Description
Skinafferents Sensory AdeltaandCfibersterminatemostlyindorsalhornnucleiandaretheafferentlimboftheflexorreflex
Ruffiniendingsinjointcapsulesthatsignaldirectionandvelocityofmotion
Jointreceptors Sensory Primarilyenterthedorsalcolumnsandterminateinhigherbraincenters
Contributetoconsciousproprioception,primaryinfluenceisonpostureandlocomotionthroughhighercenters(cerebralcortex)
somedirectmonosynapticcontactwithmotorneuronsinventralhorn, basisfor stretchreflex(DTR)
Musclespindles Sensory
Alsocontributetoconsciousproprioception(inputtocortex)andunconsciousproprioception(inputtocerebellum)
Receptorsforthetendonorganreflex;GroupIbafferents terminateoninterneurons.
Tendonorgans Sensory
Contributetounconsciousproprioception(inputtocerebellum),feedbackcontrolfortension
Alphamotorneurons Motor a.k.a.lowermotorneurons,locatedinventralhorn,supplyskeletalmuscle;directsizetensionrelationship
Gammamotorneurons Motor Innervatemusclespindle receptor,involvedinreflexcontrol
Uppermotorneurons Motor Cellbodyinmotorcortex,axonsformcorticospinaltract,synapsesonlower/alphamotorneuron
TractInterneurons Interneuron Giverisetospinalcordtracts
CommissuralInterneurons Interneuron Axonscrossandmakeconnections with othersideofcord
IntrinsicInterneurons Interneuron Involvedinlocalreflexcontrolofmotorneurons,e.g.Renshawcell

TheVentricles
Ventricle Components Outlet Image
Anteriorandposteriorhornslackchoroidplexus
Intraventricularforamen(of
LateralVentricles Trigonjunctionofbodyandhorns
Monro)toThirdVentricle
Glomusattrigon,largeclumpofchoroidplexus
Narrowslitbetweenhalvesofdiencephalon Cerebralaqueduct(ofSylvius)
Smallamountofchoroidplexus Blockagescausedbypinealoma,
ThirdVentricle Suprapotic,infindibular,pineal,suprapineal hemorrhage,infectionto4
th

recesses vent.
Centralcanaltospinalcord
Choroidplexusinroof
FourthVentricle Pyramidshapedwithapex,lateralrecesses
ForamenofLuschka(lat.)
ForamenofMagdenie(med.)