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Easy and Interesting Approach to

HUMAN NEUROANATOMY
(Clinically Oriented)
Easy and Interesting Approach to
HUMAN NEUROANATOMY
(Clinically Oriented)

SAMAR DEB MS
Professor of Anatomy
Agartala Government Medical College
Agartala, Tripura
India

Formerly
Academic Director and Professor of Anatomy
Katihar Medical College, Katihar
Bihar, India

Principal and Professor of Anatomy


College of Medicine and JNM Hospital, Kalyani, Nadia,
West Bengal, India

Dean and Professor of Anatomy


North Bengal Medical College, Sushrutanagar, Darjeeling,
West Bengal, India

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Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)

First Edition: 2014

ISBN 9789350909409

Printed at ? ? ?
Dedicated to
My parents
who trained me to face and to overcome
all kinds of hardship in life

and

My teachers
who gave me the direction to achieve
the success in life.
PREFACE
Just to Justify the Birth of First Edition

During the long journey of my teaching experience for more than 40 years, I had the opportunity to notice the
metamorphosis of my subject, Anatomy. I still remember my memorable days as a student of 1st professional
MBBS (1st MBBS) course, when my esteemed and respected teachers, as stalwarts in the field of anatomy,
used to be satisfied only after getting answers of the questions like, what are the structures passing through
canaliculus innominatus (not foramen ovale!) or what are the structure punctured, in order from superficial
to deep, if a deep pin-prick is made at the apex of femoral triangle. I have experienced that while asked
in examination, marks were divided for enumeration of the structures related to lateral aspect of palatine
tonsil starting from paratonsillar vein (of great clinical significance) up to ramus of mandible(!). My learned
renowned teachers had been very caring to teach all these details to us. But it was the time when Anatomy
used be taught as only Anatomy.
Since the beginning of my teaching profession, as time rolled on, I observed revolution in the subject of
anatomy. Gradually, the subject became more and more delicious when we achieved the techniques to bite
through the dry and hard cortex to enjoy the taste of juicy marrow of the subject through its more horizontal as
well as vertical integration and clinical orientation, of course, with omission of unnecessary details. I believe,
all anatomists like me, are thankful and grateful to Medical Council of India and Anatomical Society of India
who have been pioneer to bring this revolution.
My present submission, Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented),
is an attempt to follow the revolutionary path. Avoiding further details, I can only say, the title of the book,
through its every word, of speaks of its aims and objectives.
About the subject Neuroanatomy, it is well-known to all that, this branch of anatomy is characterized
by various negative adjectives such as, rough and tough, difficult, less important, not much required at
undergraduate level, etc. Undergraduate students are usually in a habit of ignoring or being away from it
as very often they are scared of. But they must know that this branch of anatomy can never be avoided in
professional life. Because Neuroanatomy deals with the study of nervous system which, being the master
system, regulates bodily functions performed by all other systems of body.
An effort has been made to deliver this subject through this book to the doorstep of readers of all levels in
easiest, simplest, and most interesting form.
It is not only the appreciation, if any, but also comments and criticisms are expected from anybody, anytime,
anywhere, its next edition.

Samar Deb
ACKNOWLEGDMENTS

My Hats off to:


My beloved students, undergraduates as well as postgraduates, of all the times and all the places, for taking
keen interest for the classes for all the times in my life, which enabled me to present any topic in most
palatable and interesting way, even for one of them sitting in the backbench.
My honorable teachers, of all the times and all the places, from whom I gathered many stones to build an
approach road through which I have been able to reach the destination of art and quality of a good teacher.
My special tribute to Prof Shamer Singh, Prof GC Sen Sharma, Prof PR Roy, Prof NH Keshwani, Prof Samar
Mitra, Prof NG Das, and Prof SM Sen.
My cordial colleagues, senior and junior, and professional friends of all the times and all the places, including
those of my recent institutions, Agartala Government Medical College and Katihar Medical College. Special
mention is needed for those of my IMS, BHU days, namely Prof Shyamal Kumar Basu, Prof SN Samal, Prof.
Mandavi Singh, Prof JD Singh, Prof SK Pandey and Prof Gajender Singh.
Prof DN Choudhury, Prof. Swarup Kumar Dey, Prof KL Talukdar, Prof BK Khan, Prof Parthapratim
Pradhan, Prof. Kalyan Bhattacharya, Prof Hasi Das Gupta, Prof Karabi Baral and Prof Soumya Bhattacharya
from whom I have learnt something to flourish my creative ideology.
Prof CR Maity, Ex-director of Medical Education, Government of West Bengal, my inspiration in professional
life.
Prof Sibani Mazumdar and Dr Seikh Ali Amam, my colleagues and Dr Ansuman Ray, Dr Sudipa Biswas,
Dr Maitreyee Kar, Dr Hironmoy Roy, Dr Saif Omar and Dr Ananya Biswas, my bright postgraduate students
who constantly insisted me for writing this book.
All the eminent personalities in field of anatomy of the country whom I met sometime and somewhere
through which I have been able to enrich my knowledge.
All concerned authorities of Medical Council of India and Anatomical Society of India who brought the
revolution in teaching of anatomy to make it more interesting and integrated.
All the dignitaries, officials, and staff of M/s Jaypee Brothers Medical Publishers (P) Ltd., New Delhi, India
for giving the valuable opportunity to my creation to find the light of the earth.
Dr Malay Chakrabarty, famous neurosurgeon of Eastern India for giving necessary advanced information
on clinical relevance.
Shams Jamal Hashmi, for his untiring, meticulous and sincere work beyond his usual official job hours, in
connection with all computer works. Sri Ashok Sharma (Uprety), for his very caring technical assistance time
to time.
Paromita, for her heartful help to give final shape of the production.
Ghazi Danish Ahmad, System Engineer, Information and Technology Section, Katihar Medical College for
his technical assistance in connection with my work.
SZ Khan, Chief Librarian, Katihar Medical College and all his associates for all kinds of help from the
beautiful and very enriched library where I spent many hours for many days.
Madhubanti, my daughter, as she used to admire whenever she came close to my working table during
the late hours of the days, while at home. All my family members and all other near and dear, for their moral
support.
CONTENTS

Chapter 1.
Introduction to Human Neuroanatomy 1
Principles of Functions of Nervous System 1

Chapter 2.
Nervous System in Brief 20
Central Nervous System 20
Brainstem26
Cerebellum28
Peripheral Nervous System 35
Chapter 3.
Peripheral End Organs 44
Receptors44
Receptors Other Ways of Classification 51
Motor End Organs (Effectors) 51
Motor Unit 53
Nerve Ending Related to Exocrine Gland Acini 56
Chapter 4.
Spinal Cord 57
Definition and Situation 57
Role of Spinal Cord as a Part of Central Nervous System 57
Extent57
Important Notes in Connection with Termination 57
Parameters of Spinal Cord 57
Regional Classification of Spinal Cord Segments 58
Exit of Spinal Nerves from Vertebral Foramen 59
Correlation of Spinal Cord Segments with Vertebral Level 60
Enlargement60
Surface Features 60
Coverings (Meninges) and Spaces Around the Spinal Cord 61
Internal Structure of Spinal Cord 63
Formation of Different Zones of Spinal Cord 64
Formation of Different Functional Cell Groups 65
Peripheral Outflow of Spinal Cord 66
Internal Structure of Spinal Cord 66
Internal Structure of Spinal Gray Matter 69
Various Cell Groups of Spinal Gray Matter 69
Cell Groups in Posterior Gray Column 69
Cell Groups in Intermediate Area of Spinal Gray Matter 70
Cell Groups in Anterior Gray Column 70
Cell Groups Around Central Canal 71
Rexeds Lamination of Spinal Gray Matter 71
Internal Structure of Spinal White Matter 72
Rubrospinal Tract 80
Tectospinal Tract 81
Vestibulospinal Tracts 82
Reticulospinal Tract 83
Olivospinal Tract 83
Hypothalamospinal Tract 83
Solitariospinal Tract 83
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Chapter 5.
Brainstem 94
Medulla Oblongata 124
Pons125
Midbrain126
Traumatic Lesion 126
Chapter 6.
Cerebellum 128
Introduction128
Position and Relations 128
Principle of Functions 129
Gross Anatomy 129
Primary Fissure and Lobes of Cerebellum 130
Phylogenetic Classification of Cerebellum 131
Internal Structure of Cerebellum 132
Structural detail of Cerebellar Cortex 134
Mechanism of Cerebellar Cortical Circuit 134
White Matter of Cerebellum 135
Nuclei of Cerebellum 135
Relationship Between Cerebellar Nuclei and Mediolateral Subdivisions of Cerebellar Cortex 136
Cerebellar Peduncles 136
Impaired Function of Paleocerebellum 138
Impaired Function of Neocerebellum 138
Chapter 7.
Fourth Ventricle of Brain 139
Chapter 8.
CerebrumCortical Gray Matter 144
Introduction144
Cerebral Hemispheres 145
Medial Surface 153
Tentorial Surface 155
Orbital Surface 155
Some Important Points about Cerebral Cortex 155
Types of Neurons in Cerebral Cortex 155
Layer of Cerebral Cortex 156
Functional Areas of Cerebral Cortex 157
Functional Areas in Frontal Lobe 157
Functional Areas in Parietal Lobe 160
Functional Areas in Occipital Lobe 161
Functional Areas in Temporal Lobe 162
Chapter 9.
Cerebrum White Matter 163
Classification 163
Internal Capsule 172
Chapter 10.
Basal Ganglia 176
Chorea183
Ballismus183
Athetosis183
Parkinson Disease 183

xii
Contents
Chapter 11.
Lateral Ventricle of Brain 185
Chapter 12.
Diencephalon  192
Thalamus193
Metathalamus198
Epithalamus200
Paraventricular Nuclei of Epithalamus 202
Habenular Nucleus and Habenular Commissure
(Consult Figures of Commissure in Chapter of White Matter of Brain) 202
Subthalamus203
Chapter 13.
Third Ventricle of Brain  211
Tela Choroidea and Choroid Plexus 214

Chapter 14.
Meninges of Brain and Cerebrospinal Fluid  215
Dura Mater 215
Arachnoid Mater 221
Pia Mater 223
Cerebrospinal Fluid 224
Chapter 15.
Blood Supply of Brain and Spinal Cord 228
Blood Supply of Brain 228
Variations of Circle of Willis 232
Cortical Branches Supplying Different Surfaces of Cerebral Hemisphere 234
Venous Drainage of Brain 236
Blood Supply of Spinal Cord 237
Venous Drainage of Spinal Cord 239
Blood-brain Barrier 240
Chapter 16.
Reticular Formation 245
Chapter 17.
Limbic System 253
Chapter 18.
Autonomic Nervous System 260
A component Parallel to Somatic Nervous System 260
Autonomic Nervous System and Endocrine system Jointly Maintain Internal Environment of body 260
Composition of Autonomic Nervous System 260
Subdivision of Autonomic Nervous System Sympathetic and Parasympathetic 261
Sympathetic Part of Autonomic Nervous System 264
Parasympathetic Part of Autonomic Nervous System 274
Injuries to Autonomic Nervous System 282
Diseases Involving Autonomic Nervous System 283
Combined Sympathetic and Parasympathetic Lesion Causing Urinary Bladder Dysfunction in Spinal Cord Injury 284
Disrupted Motor Functions of Bladder 284
Visceral Pain 285
Stomach Pain 286
Appendicular Pain 286
Renal Pain 286
Ureteric Pain 287

xiii
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Chapter 19.
Cranial Nerves 288
Olfactory Nerve and Olfactory Pathway 288
Optic Nerve and Visual Pathway 291
Optic Nerve 293
Optic Chiasma 293
Optic Tract 293
Lateral Geniculate Body (Third of Neurons) 294
Macular Vision 294
Clinical Examination of Retina 296
Detachment of Retina 297
Various Kinds of Loss of Visual Field 297
Argyll Robertson Pupil 298
Cranial Nerves Arising From Brainstem 299
Oculomotor Nerve 299
Postganglionic Branches of Ciliary Ganglion 302
Roots of Communication to Ciliary Ganglion 303
Trochlear Nerve 304
Trigeminal Nerve 305
Ophthalmic Nerve 308
Maxillary Nerve 311
Sphenopalatine Ganglion 312
Mandibular Nerve 313
Lingual Nerve 315
Inferior Alveolar Nerve 315
Auriculotemporal Nerve 316
Abducent Nerve 317
Facial Nerve 319
Vestibulocochlear Nerve 326
Vestibular Pathways 326
Cochlear Component of Vestibulocochlear Nerve 330
Last Four Cranial Nerves 334
Glossopharyngeal Nerve 334
Vagus Nerve 337
Accessory Nerve 343
Hypoglossal Nerve 347
Index 349

xiv
Introduction to Human Neuroanatomy
1
Human Neuroanatomy is the division of Human Anat- The exocrine glands influenced by the activity of
omy which deals with of Human Nervous System. the nervous system may be single and solitary like
The Nervous System is defined as the Master of all any salivary gland or the lacrimal gland, or it may be
Systems or the Master System of the body, because multiple and minute, like the mucous glands of the
it controls or regulates all bodily functions performed wall of GI tract, or respiratory tract.
by other systems of the body, for example locomotor So result of functions of nervous system may be
summarized as follows
system, gastrointestinal system, respiratory system.
1. Contraction of voluntary muscle(s): Resulting
movement of a joint. It may result movement of
PRINCIPLES OF FUNCTIONS OF NERVOUS some organs, like tongue, eyeball.
SYSTEM (FIG. 1.1) 2. Contraction of involuntary muscle(s) present in:
a) Viscera: It is called visceral muscle.
When nervous system exerts its action over the other b) Wall of the cardiovascular system: Myocardium
systems of body, most simplified form of its action is of heart or smooth muscle in the wall of the
manifested basically as blood vessels.
1. Contraction of muscles. c) Dermis of skin called Arrectores pili: It is
2. Secretion of exocrine glands. attached to the root of hair follicle.
It may be noted here that the secretion of endocrine 3. Secretion of exocrine glands like:
glands is mostly under the hormonal control. a) Salivary glands or lacrimal gland: Large and
The muscles, whose contraction is regulated by solitary.
nervous system, may be voluntary (striated or skeletal) b) Mucous secreting glands: In the wall of GI tract
or involuntary (nonstriated or smooth). Contraction of or respiratory tractmany and minute.
the voluntary muscles results in movement of a joint. But it is to be noticed that the functions of nervous
The involuntary muscles may be in the wall or in the system do not mean only the effects as mentioned
substance of viscera, which are specifically called above, but, in gist it also performs the followings:
(Fig. 1.1).
Visceral muscle, e.g. in the wall of the gastrointestinal
1. It receives and carries different information from
tract, or tracheobronchial tree or in the substance of
its periphery to center, which are related to change
any solid viscera. Again, the involuntary muscle may in external and/or internal environment.
be in the wall of the cardiovascular channel, e.g. in the 2. It perceives or acknowledges the informations at
wall of the heart (myocardium) or in the wall of blood its center.
vessel (tunica media). It may be also in the dermis of 3. It analyzes, integrates and coordinates the infor-
the skin named the Arrectores pili. mations or inputs.
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
4. It commands for some effect after reception and, classified regionally as Cervical-8, Thoracic-12,
integration or coordination of informations. Lumbar-5,Sacral-5 and Coccygeal-1.
5. It stores the informations for the memory, intelli- 2. Peripheral: This is known as Peripheral Nervous
gence, learning and emotion of an individual. System. This is peripheral outflow or peripheral
extensions from Central Nervous System in the
form of peripheral nerves. The peripheral nerves
SUBDIVISIONS OF NERVOUS SYSTEM (FIGS 1.2 AND 1.3) are divided into two groups as
a) Proximal (Cranial): Cranial nerves, 12 pairs
A. Topographical Subdivision arising as outflow from brain.
1. Central: Part situated in the central axis of the b) Distal (Caudal): Spinal nerves, 31 pairs, each
body, known as Central Nervous System. These pair arising from each segment of spinal cord.
are Brain and Spinal cord. Brain is the proximal Central Nervous System may be compared as the
expanded part situated inside the cranial cavity. Director of an office, and Peripheral Nervous System
Distal, narrow, tubular and elongated part is the as the Field Staff. Like the Director, Central Nervous
spinal cord which is lodged in the upper two-third System gathers information from and gives direction
of the vertebral canal. Grossly brain is divided into to the Peripheral Nervous System, whose duty is to
three partsForebrain, Midbrain and Hindbrain. convey information and also to carry out the order from
Spinal cord is divided into 31 segments, which are its Director, i.e. Central Nervous System, for action.

Stored for
Memory
Intelligence
Learning
Emotions

Sensory information Analyzed Command


Received Integrated or
and and directions
Perceived Coordinated given

Sensory information
Carried from undermentioned
receptors Motor effect
Due to change in Produced in the
external/internal environment form of

Exteroceptor Proprioceptors Contraction of


Touch Sensation from Contraction of involuntary muscles
Pressure muscles and tendons voluntary muscles Secretion of
Pain Sensation from exocrine glands
Temperature joints
Outputs
Inputs

Fig. 1.1 Diagrammatic representation of principles of function of nervous system


2
Introduction to Human Neuroanatomy

Cerebrum

Brain

Midbrain
Brain Cerebellum

Brainstem Pons

Medulla oblongata

Spinal nerves

Spinal
cord

Lower spinal
nerve forming
cauda equina

Filum terminale

Fig. 1.2 Central nervous system

n Fundamental difference between the Cranial i. Contractions of voluntary muscles to move the
and Spinal nerves: joints or to move some organs like tongue, eyeball.
All the spinal nerves contain sensory (incoming) fibers ii. Contractions of involuntary muscles like
carrying impulse (information) towards the central a) Visceral muscles.
nervous system and motor fibers (outgoing) carrying b) Smooth muscles in the wall of cardiovascular
impulse (directions) away from the central nervous channel.
system to the effector organ, that is why all the spinal c) Smooth muscles in the root of hair follicle of
nerves are mixed nerves. But some cranial nerves are skin, known as Arrectores pili.
mixed like spinal nerves and some are either purely iii. Secretions of exocrine glands which may be either
motor or purely sensory. single, large, solitary, e.g. Salivary glands or
tiny innumerable, for examplemucous glands of
B. Functional Subdivision gastrointestinal and respiratory tract.
Out of these different functionsThe contractions
It is already understood that nervous system controls of voluntary muscles is controlled or regulated as per
various bodily functions. The simplified form of fun- ones own desire and is known as voluntary function,
ctions controlled by nervous system are the follow- whereas others are not under ones own control, called
ings: involuntary function.
3
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)

A cranial nerve among 12


pairs may be

Motor* Motor fibers of cranial nerves


carry out command or effects
BRAIN
Sensory*
Sensory fibers of cranial
or Mixed*
nerve carry sensory
information

S
P
I Sensory fibers of cranial
N nerve carry sensory
Each of the 31 pairs of spinal A information
nerves L
is
mixed*
C Motor fibers of spinal nerve
O carry out command or effects
R
D

Peripheral nervous system


Central nervous system

Acts as director Acts as field staff


Receives information Carries informations inwards
Analyze it Carries out directions or orders
Sends command outwards

Fig. 1.3 Central and peripheral part of nervous system

With the help of this background knowledge, it is Two parallel components of autonomic nervous
to be noted that functionally the nervous system is system:
classified as Somatic and Autonomic (Figs 1.4A They are called sympathetic and parasympathetic
and B). nervous system. These two systems have anta-gonistic
A. Somatic Nervous System: It is that division actions on the same target organ, e.g. Parasympathetic
of nervous system which controls or regulates the nervous system contracts the muscles in wall of
voluntary functions, i.e. functions which can be perfo-
hollow viscera like GI tract (peristaltic movements),
rmed as well as controlled as per ones own desire. It
but relaxes the sphincters; whereas the sympathetic
is contraction of voluntary or skeletal muscles.
B. Autonomic Nervous System: It is that division nervous system causes the opposite action on the same
of nervous system which controls or regulates invol- target organ. Again in some cases either of them has
untary functions, e.g. functions which can neither the influence, e.g. mucous glands of respiratory or
be preformed nor can be regulated as per ones own alimentary tract are under control of parasympathetic
desire. These are contraction of involuntary or smooth nervous system, whereas secretion of sweat glands are
muscles and secretion of exocrine glands. controlled by sympathetic system.
4
Introduction to Human Neuroanatomy

Somatic
peripheral
outflow

Central nervous system


Exteroceptive brain and spinal cord
sensory fibers Somatic nervous system
Pain Temperature
Pressure Touch
Centers:

Proprioceptive sensory fibers Brain


from muscles and tendons and
spinal cord
[31 segments]

Motor fibers
To the effector organ, i.e. the
voluntary muscles

Fig. 1.4A Schematic representation of somatic nervous system (centers and outflow)

Autonomic
peripheral
outflow

Central nervous system


brain and spinal cord

Autonomic nervous system Sensory fibers


From all viscera

Centers:

Sympathetic motor
Sympathetic
T1 L2 (L3) segments of spinal
cord
G
Parasympathetic
Nuclei of 3rd, 7th, 9th, 10th
cranial nerves
C Para-
sympathetic
S24 segments of spinal cord motor

1. Motor fibers to involuntary


muscles
2. Secretomotor fibers to
exocrine glands

Fig. 1.4B Schematic representation of autonomic nervous system (centers and outflow) [G Autonomic ganglia Synaptic junction
between preganglionic and postganglionic neurons]
5
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)

CENTERS OF NERVOUS SYSTEM may be maximum as in connective tissue. But every-


where it is noncellular.
Center for somatic nervous system extend throughout The structural and functional units of nervous
the whole length of brain and spinal cord, lying in system are cells, known as Neuron. It is noteworthy
central axis of body. that in the nervous system, the intercellular substance
Thats why it is called Central nervous system. is not noncellular, rather made up of cells called
Centers for sympathetic and parasympathetic co- Neuroglia. The neuroglia, proportionately more in
mponents of autonomic nervous system are situated number and primarily acting as supporting element
in some of the levels of brain and spinal cord. occupying the interstitial spaces between neurons.
a) Sympathetic center is located in first to twelfth
thoracic and first and second lumbar (T1L2) NEURONS
segments of spinal cord.
The structural as well as functional units of nervous
b) Center of parasympathetic system situated
system is Neuron.
partly in brain in the form of nuclei of some
It has two special properties
cranial nerves (3rd, 7th, 9th, 10th). Again 1. Irritability It is the power of a cell(neuron) by
part of its center is occupied in 2nd, 3rd, 4th which it is able to respond or react to change in
sacral segments of spinal cord (S24). These the environment (known as stimulus),which may
centers for sympathetic and parasympathetic be external or internal (outside or inside the body).
components of autonomic nervous system 2. Conductivity It is the power of a cell (neuron)
are of course, finally controlled by posterior by which the excited state (known as impulse) is
and anterior parts of hypothalamus of brain propagated from the site of stimulus for a distance
respectively. to get the desired effect through hand to hand
contact of threadlike protoplasmic processes of
COMPOSITION OF NERVOUS SYSTEM chain of neurons.
Nervous system is composed of very delicate and
sensitive tissue known as nervous tissue. In general, Structure of a Typical Neuron (Fig. 1.5)
it is known that a tissue is composed of cells and A typical neuron is composed of
intercellular substance. The intercellular substance i. Cell body: It is known as Soma or Perikaryon and
may be little or minimum as in epithelial tissue, or ii. Processes: Thread- like protoplasmic prolongations.

Dendrites

Axonhillock

Nissl bodies

Nucleus

Neurofibrils
Axon
terminal
Axon

Fig. 1.5 A typical neuron


6
Introduction to Human Neuroanatomy
Processes adjacent neurons (synapse) through those neuro-
transmitters. Nissl substances are absent not only
The processes are of two types known as Dendrites
in the axons but also in the base of axons known as
and Axons. Dendrites are the processes through
which impulse is transmitted towards the cell body. axon-hillock.
Axons transmit impulse away from the cell body. So, b) Neurofibrils: These are ultramicroscopic thre-
when an impulse passes through a chain of neurons, adlike or fibrillar structures homologous to micro-
it passes from axon of one neuron to the dendrite of filaments of other cells. Neurofibrils are concerned
the next neuron of the chain (Fig. 1.6). with maintenance of architecture of neuron and
Number of processes in a neuron A neuron acts as a storehouse of protein called Tubulin.
always posseses at least one process, which is axon, l Dendrites: They are fibrillar protoplasmic exten-
the number of which is always single. A neuron may sions of neuron with the following characteristics
or may not have the Dendrites. If it is present, it may 1. These are the processes through which impulse
be one or multiple (Fig. 1.7). travels towards the cell body.
2. Narrower in width.
Cell body 3. Highly branched.
It is the main expanded mass of cell with a centrally 4. Branching of the dendrites are short known as
placed nucleus containing a prominent nucleolus. Dendrite Tree.
Cytoplasm has following unique characteristics: 5. Terminal ends of dendrite tree are known as
a) Nissl bodies (Nissl granules/Nissl substance): Dendrite Spines.
These are nothing but large aggregations of pro- 6. Dendrites may be absent, if present it may be
minently stained rough endoplasmic reticulum. single or multiple.
These are concerned with synthesis of enzymes l Axon: It is the fibrillar protoplasmic extension of
which are required for productions of chemical neuron with following characteristics
substances known as neurotransmitters. Nerve 1. These are the processes through which impulse
impulse is transmitted over the junction of travels away from the cell body.
Dendrites Axons

Axodendritic
Junction
(Synapse)
Target organ
(Skeletal muscle)

Fig. 1.6 Chain of neurons transmitting impulse (excited state of neurons) to target organ (e.g. skeletal muscle)
7
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)

d d
d

C
d d d D

Figs 1.7 A to D Neurons showing variable number of processes


A One process Axon, B Two processes One axon and one dendrite,
C Three ProcessesOne axon and two dendrites, D Many processes One axon and many dendrites

2. Basal end is conicalknown as axon-hillock. transport (Fig. 1.8A). These chemical substances
3. Wider in breadth. are either concerned with the nerve conduction,
4. It has no terminal branching, but from the middle when these pass through the interneuronal junction
of the axon branching at right-angle may takes (synapse) or these may be concerned with desired
place known as Collaterals. function of nerve impulse when these reach the
5. Terminal end is expanded known as Telodendria effector organ. Sometimes chemical substances (may
showing knob-like or button-like endings called be neurotoxins) liberated at the tissue level, absorbed
axon terminals or Terminal buttons. by axon terminals, are carried back towards the cell
6. Number of axon in neuron is always constantly body of the neuron. This is known as Retrograde
one. transport (Fig. 1.8B).
It is important to notice that dendrites and axons
cannot be differentiated by their relative length. Some Classification of Neurons
neurons may have long axon. Again some may have long 1. According to number of processes (polarity)
dendrite. Fibers of median or ulnar nerve supplying (Figs 1.9A and B)
small muscles of hand are example of long axon. Wher-
It is to be noted that, at one initial phase of
eas fibers of saphenous nerve carrying sensation from
development, neurons used to have no process. How-
skin of foot are the example of very long dendrite. In
ever, this phase is followed by gradual appearance of
both the cases cell bodies are located in or very close to
number of processes which will classify the neurons
spinal cord.
as follows:
Neuronal (Axonal) Transport a. Unipolar neurons
Chemical substances synthesized in the neuronal These are developmentally primitive variety of neu-
cell body are required to be transported through the rons with single process which is the axon. It is devoid
axon at its distal end. This is known as Orthograde of any dendrites.
8
Introduction to Human Neuroanatomy

Dendrite
Axon

Neurotransmitter

Fig. 1.8A Orthograde transport


Neurotransmitter passing from cell body of neuron to axon to neuronal junction (Synapse) to dendrite of next neuron

Toxin

Cell body Axon Tissue

Fig. 1.8B Retrograde transport, toxins liberated in tissue pass in opposite direction through axon toward cell body

Flask-shaped
Pyramidal (cerebrum) Polygonal (spinal cord) (cerebellum)

Unipolar Bipolar Pseudounipolar Multipolar neurons

Fig. 1.9A Types of neurons Fig. 1.9B Types of neurons


9
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
b. Bipolar neurons of dendrites so also the polarity. For example, the
neurons of motor area of cerebral cortex are pyramidal
These are the fusiform or spindle-shaped neurons
or triangular whereas the motor neurons of spinal
with one dendrite and one axon arising from opposite cord are polygonal and neurons of cerebellum are
poles. These are specialized neurons found in the flask-shaped.
pathways of special senses, e.g. Retina (visual path-
way), nasal epithelium (olfactory pathway) and in 2. According to length of axon (Figs 1.10A and B)
the vestibulocochlear nerve (auditory pathway for
hearing and equilibrium). a. Golgi type I (Fig. 1.10A)
Axons of these neurons are long in comparison to their
c. Pseudounipolar neurons
multiple short dendrites, viz. Pyramidal Neurons of
These are neurons with round or oval shape with a motor area of cerebral cortex, Anterior horn cells of
common short stem of process dividing into peripheral spinal cord , Purkinje cells of cerebellum.
(dendrite) and central (axon) limbs. These neurons Axons of pyramidal cells of cerebral cortex form
are called pseudounipolar because apparently they long descending tracts passing through the spinal
seem to have two poles. Classical example of these are cord. Axons of anterior horn cells of spinal cord form
the dorsal root ganglion cells of spinal nerve lying just long peripheral nerves supplying voluntary muscles.
outside and close to the spinal cord carrying sensory Purkinje cells axons form efferent fibers from
impulse from periphery towards the spinal cord. cerebellar cortex to relay in cerebellar nuclei situated
in its white matter.
d. Multipolar neurons
These neurons present single axon with multiple b. Golgi type II (Fig. 1.10B)
dendrites. Their shape will vary from triangular or Axons of these neurons are short, similar to the
pyramidal to polygonal depending upon numbers length of the dendrites. Classical example of these

Brain

Upper motor
neuron
(Golgi type I)
with long
axon Long
axon

Interneurons
of spinal cord

Spinal cord

Lower motor
neuron (Golgi type I)
with long axon

Stellate (star-shaped) neuron of


A cerebellum (Golgi type II with short axon) B

Figs 1.10A and B A. Golgi type I neuron (with long axon), B. Golgi type II neuron (with short axon)
10
Introduction to Human Neuroanatomy

Cerebrum
(Brain)
Tertiary sensory neurons

Thalamus (Brain)

Secondary sensory neurons

Primary sensory neurons


(Posterior root ganglion cell)

Peripheral process from sensory end organ


Spinal cord

Fig. 1.11 Types of sensory neurons

neurons are stellate cells of cerebellar cortex, which the central nervous system. Their cell bodies are
have short axon and multiple short dendrites giving a situated outside the central nervous system. Only
star-shaped appearance. It forms synaptic connection exception is the cell group of mesencephalic nucleus of
with too many neurons. trigeminal nerve, whose cell bodies lie inside central
It is important to note that some of the neurons nervous system.
may have single long dendrite. For example, fibers
n Secondary sensory (Second order) neu-rons:
present in the sensory nerves carrying sensory imp-
ulse from the periphery are the long dendrites of They are situated at the level of spinal cord which
sensory neurons present in the posterior root ganglia receive impulse from 1st order of neurons.
of spinal nerve. n Tertiary sensory (Third order) neurons: They
relay the sensation from the secondary neurons to the
3. According to function of neuron final target, i.e. cerebral cortex. First group of these
neurons are situated in the thalamus. The second or
a. Sensory neuron (Fig. 1.11) final group is situated in the sensory area of cerebral
These neurons carry sensory impulse from a receptor cortex.
(sensory end organ) through the dendrite towards
the center of nervous system finally through axon. b. Motor neuron (Fig. 1.10A)
From the sensory end organ or receptor situated
These neurons carry outgoing motor impulse from
at the periphery of the body, the sensory nerve
impulse needs to pass through a chain of neurons central nervous system to the peripherally situated
as the relay system to reach the center of nervous effector organs which are either muscles or glands.
system. The participating neurons in this chain l Types of motor neuron:
are classified as primary, secondary and tertiary In somatic nervous systemUpper motor neuron and
neurons (Fig. 1.11). Lower motor neuron.
n Primary sensory (First order) neurons: They i. Upper motor neuron: These motor neurons are
start from the receptor or sensory end organ to enter situated in motor areas of brain above the level
11
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
of spinal cord and brainstem (Midbrain, Pons external or internal, impulse or action potential is
and Medulla). generated.But activity of nervous system depends on
ii. Lower motor neuron: These motor neurons are transmission or conduction of nerve impulse or action
situated in spinal cord. potential through a chain of neurons. In the chain
neurons are approximated or apposed closely to each
4. Classification of neurons in relation to neuronal other. This site of apposition or contact between two
junction(synapse) (Fig. 1.12) neurons is known as synapse. Though, it is simple to
Functions of a neuron depends upon the transmission understand, but in 1891, neuronal theory of Waldeyer
of impulse through a chain of successive neurons. The first established that at the synapse or neuronal
junction of neuronal chain is known as Synapse or junction of two successive neurons are contiguous, but
Ganglion (pl. Ganglia).When related to a particular not continuous to each other. It was then detected that
synapse, the neurons are classified as some chemical substances called Neurotransmitters
a) Presynaptic (Preganglionic) neuron: Proximal jump across the synaptic junction to carry the nerve
to a synapse impulse or action potential of the neuronal chain.
b) Postsynaptic (Postganglionic) neuron: Distal to Fundamental points to remember regarding the
the synapse. synapse:
In somatic nervous system, both the pre and post-
1. Two successive neurons are contiguous in the syn-
ganglionic neurons are situated inside the central
nervous system except the first order of sensory apse but not continuous.
neuron which lies outside of central nervous system, 2. Chemical substance released in the proximal
e.g. Posterior root ganglia cells of spinal nerve. But in neuron (presynaptic neuron) passes to distal or
autonomic nervous system the preganglionic neuron postsynaptic neuron, through which impulse is
is situated inside the central nervous system and transmitted.
postganglionic neuron is situated outside the central 3. Impulse under physiological condition travels thr-
nervous system. ough the synapse in one direction only.
4. Single end of an axon, known as axon terminal
NEURONAL JUNCTION (SYNAPSE) (FIG. 1.12) will form synapse with single dendritic spine.
5. Multiple end button of one presynaptic neuron
It has already been noticed that, when a neuron may form synapse with dendrites of multiple
is stimulated due to change in the environment, neurons or multiple dendrites of single neuron.
Presynaptic neuron Postsynaptic neuron

A. Axodendritic synapse

B. Axosomatic synapse

C. Axoaxonic synapse

Fig. 1.12 Common varities of synapses


12
Introduction to Human Neuroanatomy

Neurofibrils
Axoplasm

Mitochondria
Axon terminal
Presynaptic vesicle containing
Neurotransmitter
Presynaptic membrane

Exocytosis Synaptic cleft containing


fluid rich in polysaccharide
Receptor
Postsynaptic membrane
Synaptic web

Fig. 1.13 Structure of a typical synapse

Types of Synapse (Fig. 1.12) Beneath this membrane the axoplasm shows some
specialized features. The cytoplasm is condensed with
So far, it is already understood that axon of presy-
naptic neuron forms synapse with the dendrons of presence of number of mitochondria. It also contains
postsynaptic neuron. But truly speaking axon of a many membrane bound vesicles which contain ch-
neuron may form synapse with any component of emical substances known as neurotransmitter.
another neuron, e.g. dendrite, cell body, even the axon The vesicles are very tiny, 4050 nm (nanometer)
also. So, the synapses are grossly classified as in diameter. One mm (micrometer) is 1/1000 of a
1. Axodendritic: Synapse between axon of presynaptic millimeter and one nm (nanometer) is 1/1000 of a mm
and dendron of postsynaptic neuron. (micrometer). During transmission of nerve impulse,
2. Axosomatic: Synapse between axon of presynaptic neurotransmitter is released from presynaptic vesic-
and cell body or soma of postsynaptic neuron.
les into synaptic cleft by exocytosis to stimulate
3. Axoaxonic: It is considered as a lateral synapse.
In this type, axon of lateral neuron form synaptic postsynaptic membrane of the distal neuron.
connection with axon of another neuron which is
lying in the regular neuronal chain. Synaptic Cleft
Besides the above mentioned commoner types of It is the gap measuring 2030 nm between pre and
synapses, other types are somatodendritic, somato-
postsynaptic membranes. It contains interstitial
somatic and dendrodendritic.
fluid rich in polysaccharides. Through the process of
Structure of a typical axodendritic synapse exocytosis neurotransmitters are released across the
(Fig. 1.13) presynaptic membrane into synaptic cleft.
A typical axodendritic synapse is composed of follo-
wing three parts. These are Postsynaptic Membrane
i. Presynaptic membrane of axon of proximal neuron. This is the thickened plasma membrane of dendrite
ii. Synaptic cleft between axon and dendrite. spine at the site of synapse. This membrane sho-
iii. Postsynaptic membrane of dendrite of distal neu- ws specialization known as receptors which are to
ron. uptake neurotransmitters passing across the syn-
aptic cleft. The dense cytoplasm beneath postsy-
Presynaptic Membrane
naptic membrane is segmented and known as syn-
Thickened cell membrane of the axon terminal at aptic web which contains a network of filame-ntous
the site of synapse is called presynaptic membrane. structure.
13
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Impulse Transmitted Across the Synapse Size of neuroglia is much smaller than neurons,
but their number is far more proportionately, may be
Nerve impulse transmitted through presynaptic neu- as many as 50 times the number of neurons. When the
ron causes release of neurotransmitter from pres- number of neurons are fixed after birth, the neuroglia
ynaptic vesicles. Neurotransmitter passing across the can multiply throughout life. In case of injury or
synaptic cleft act as chemical impulse to stimulate disease of nervous tissue, area of damaged or dead
receptors of postsynaptics membrane. Chemical imp- neurons, are occupied by multiplying neuroglia. This
ulse reaching synaptic web beneath postsynaptic process is known as replacement gliosis.
membrane is again converted into nerve impulse to
stimulate postsynaptic neuron. Types of Neuroglia
In central nervous system
Neurotransmitters 1. Ependymal cell
There are varieties of chemical substances acting as 2. Macroglia a) Astrocytes b) Oligodendrocytes
neurotransmitter. Mostly found neurotransmitters 3. Microglia.
are Acetylcholine and Norepinephrine. Acetylcholine In peripheral nervous system
is liberated as neurotransmitter in many synapses of 1. Schwann cells.
central and peripheral nervous system including those 2. Satellite cells.
of parasympathetic nervous system. Norepinephrine
is released in most of the synapses of sympathetic Ependymal cell (Fig. 1.14A)
nervous system. Glycine is the neurotransmitter These are single-layered cubical or columnar cells
discharged in the synapses of spinal cord. Dopamine is lining the cavities (ventricles and central canal) of
the transmitter found in basal ganglia and substantia central nervous system (brain and spinal cord). They
nigra. Serotonin and Gumma-amino-butyric acid represent the original cells lining the neural tube of
(GABA) are other examples of commonly known embryonic life. The free surface of the cells present
neurotransmitters. ultramicroscopic finger-like prolongations which are
nonmotile in nature. These are known as stereocilia.
Deactivation or cessation of action of neurotransmitters n Functions:
After desired effect, influence of neurotransmitters 1. Stereocilia of free surface of ependymal cells
is withdrawn in either of two different ways. In case increase surface area, so help in absorption of
of Acetylcholine, it is broken down by the enzyme cerebrospinal fluid circulated in cavity of central
Acetylcholinesterase at synaptic cleft. But in case nervous system.
of transmitters like norepinephrine, its effect is 2. Specialized area of ependymal lining of ventricles
restricted by its reuptake back through presynaptic is also concerned with formation of cerebrospinal
membrane. fluid (CSF).

Neuromodulators Astrocytes

These are the chemical substances which enhance, These cells are so-called because they are star-shaped
prolong, restrict or inhibit the effect of the neuro- with radiating cytoplasmic processes. Astrocytes are
transmitter on postsynaptic membrane. They are of following two types.
stored in separate presynaptic vesicles.
Protoplasmic astrocytes (Fig. 1.14B)
NEUROGLIA The radiating processes of these types of astrocytes are
thicker containing more amount of cytoplasm inside.
Broadly, the neuroglia can be defined as group of
cells of nervous system which are other than the
neurons. So the cells of this family do not posses two
basic characteristics of neurons, i.e. irritability and
conductivity. That is why none of them can generate
and conduct the nerve impulse. Both in central as well
as peripheral nervous system fundamentally they act
Stereocilia
as intercellular (interneuronal) supportive material. (Nonmotile microvilli)
In addition, each type of neuroglia is characterized by
its independent specific function. Fig. 1.14A Ependymal cells
14
Introduction to Human Neuroanatomy

Neuron
Capillary Protoplasmic astrocyte
found in gray matter

Fig. 1.14B Protoplasmic astrocyte

They are related in relation to cell bodies of neuron 2. Astrocytes transport nutritive materials from blo-
(in gray matter of central nervous system). Terminal od capillaries to neurons.
ends of the processes present foot-like expansions 3. It forms the blood brain barrier.
known as end-feet. These types of astrocytes are
intermediate in position between cell bodies of neuron Oligodendrocytes (Fig. 1.15A)
and blood capillary. End-feet come in contact in one
side with neuronal cell body and in another side with These are smaller round or spherical cells with lesser
wall of capillary, thus helping in selective transport of number of processes. They are found in white matter
substance like nutritive substance or metabolites from of central nervous system where expanded end of their
blood capillary to neuron. This media may prevent processes wrap around the length of nerve fibers. This
transport of some unwanted or toxic materials, for
wrapping (ensheathment) or insulation of nerve fibers
which it is known as blood brain barrier, some drugs
having action on central nervous system posses the is known as Myelination. The myelination prevent the
ability to cross this blood brain barrier. nerve impulse to be dissociated to the surrounding
tissue and thus facilitate the full conduction of impulse
Fibrous astrocytes (Fig. 1.14C ) towards the destination.
The cell bodies of these types of astrocytes are n Functions:
smaller with thinner and more branching processes.
They are predominantly distributed inbetween 1. Oligodendrocytes primarily provide supportive
pro-cesses of nerve cells (in white matter of central functions around neurons of central nervous sys-
nervous system). tem.
n Functions: 2. They form myelin sheath around nerve fibers
1. Astrocytes posses supportive function acting as (processes of neurons) inside central nervous sys-
packing material of central nervous system. tem.

Fibrous astrocytes
Nerve fibers of CNS forming white matter

Fig. 1.14C Fibrous astrocytes


15
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)

Nerve
fiber

Cell body of
oligodendrocyte

Process of oligodendrocyte Myelin sheath

Fig. 1.15A Multiple processes of one oligodendrocyte form myelin sheath (for insulation) of many nerve fibers in central nervous system

Microglia (Fig. 1.15B) Schwann cells (Fig. 1.16)


Microglia are so-called because they are smaller These are the neuroglial cells found in peripheral
in size. The cells present finer tortuous processes. nervous system, related to peripheral nerve fibers.
Microglia are identified by following three characters The cells are flattened with adequate amount of cyto-
which are related to the letter M. plasm surrounding nucleus. The surface of the cell is
1. Microglia are Mesodermal in origin which develops invaginated by processes of neuron. The nerve fiber,
from circulating Monocytes of fetal blood. following invagination, undergoes spiral movement to
2. Microglia function as Macrophages of central ner- be finally wrapped by layers of Schwann cells which
vous system to engulf toxic substances, micro- finally acts as myelin sheath.
organism and damaged CNS tissue debris. n Function: Many Schwann cells in a row, take part
3. For phagocytic function, microglia are Migratory in in formation of myelin sheath of peripheral nerves
nature. Many microglia, acting as scavenger cells outside central nervous system.
are localized at the site of damaged or degenerated
nerve tissue and may fuse together to form a
Multinucleated giant cell of central nervous system.
n Function: Microglia, as already stated above,
Nerve fiber
are phagocytic in nature to act as scavenger cells or
macrophages of central nervous system. Schwann cells
A

Mesoaxon
Schwann cells

Nerve fiber

Nerve fiber
B

Figs 1.16A and B Schwann cells the glial (supporting) cells of


peripheral nervous system
A. A Schwann cell is invaginated by a single nerve fiber to
Fig. 1.15B Microglia Macrophage of CNS Surrounding form myelin sheath
damaged tissue for scavenging. Migrating in nature B. A Schwann cell is invaginated by many nerve fibers, so
Mesodermal in origin attempt for myelin sheath formation fails
16
Introduction to Human Neuroanatomy

Capsular (Satellite) cells

Posterior root ganglion cell

Fig. 1.17 Capsular or satellite cells surrounding cell body of posterior root ganglion neuron

Satellite cells (Fig. 1.17) 2. Macroglia (Astrocytes and oligodendrocytes):


from the spongioblasts of mantle zone of neural
These are another variety of glial cells related to tube (ectodermal).
peripheral nervous system. These cells are related to 3. Microglia: From the circulating monocytes of fetal
surface of cell body of the neurons which are present life (mesodermal).
outside the central nervous system, e.g. neurons of 4. Schwann cells and satellite cells: From cells of
posterior root ganglia of spinal nerves and neurons of neural crest (ectodermal).
sympathetic ganglia. The satellite cells are flattened
in shape and small in size. A good number of these MYELIN SHEATH (FIGS 1.15A, 1.16 AND 1.18)
cells form an encapsulation around the surface of the A nerve fiber, either in peripheral or in central nervous
above mentioned neurons present outside the central system carries nerve impulse towards destination.
nervous system. This impulse must reach the destination to the full
n Function: Satellite cells are also known as caps- extent with full velocity without being dissociated in
ular cells as they form a covering around the cell the surrounding tissue. For this, the nerve fiber needs
bodies of neurons of peripheral nervous system. insulation (nonconductive coating). This insulation is
formed by formation of sheath around the fiber, known
Developmental Source of Neuroglial Cells as myelin sheath. In the nervous system, only the supp-
orting cells are available to form this myelin sheath.
1. Ependymal cells: These represent the original In peripheral nervous system, the Schwann cells and
parent lining cells of primitive neural tube (ecto- in central nervous system, the oligodendrocytes take
dermal). part in formation of myelin sheath.
Nucleus of Schwann cell

Nerve fiber Nerve fiber

A
Myelin sheath Layers of plasma membrane of
Nucleus of Schwann cell Internode Schwann cell made up of lipid-protein

Nerve fiber
Nerve fiber

B Node of Ranvier

Fig. 1.18 Myelin sheath of peripheral nerves


17
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
In peripheral nervous system, many Schwann cells So a tumor in nervous system cannot originate from
come in relation to the length of a single nerve fiber neuron. Tumors formed due to abnormal proliferation
in a row. These many Schwann cells are invaginated or multiplication of neuroglia and cells of connective
by a single nerve fiber. Due to invagination, Schwann tissue of meninges and cells of wall of blood vessels
cell give rise to formation of mesoaxon (Fig. 1.16A). are known as Glioma, Meningioma and Angioma
Now the Schwann cell rotates around axon in a spiral respectively.
fashion. The mesoaxon turn around several times
around the fiber, thus squeezing out the cytoplasm Neuronal Damage or Injury
at the periphery of Schwann cell. The turns of cell Injury may affect neuronal cell body and /or processes.
membrane of Schwann cell around nerve fiber form Initially it leads to loss of function. But ultimate effect
the myelin sheath (Fig. 1.18A). The multiple layered will depend upon serverity of the injury and duration
membranous sheath is white in color due to presence of action of injurious agents. It is important to note at
of white lipid protein. More peripherally rim of this stage that if neuronal death occurs quickly, within
cytoplasm of Schwann cell form an additional sheath a few minutes, no morphological changes are found.
which is known as Schwann cell sheath or neurilemmal But if the neuron manages to survive for 612 hours,
morphological changes are characterized by swelling
sheath. Intermittent gap between the segments of
of cell cytoplasm and nucleus, and displacement of
myelin sheath formed by adjacent Schwann cells is
Nissl granules to the periphery. This is followed by
known as nodes of Ranvier (Fig. 1.18B). An unit of recovery of the neuron.
sheath formed by a single Schwann cell, in between When a nerve cell process (axon) is a cut or injured,
nodes of Ranvier is known as internode. it will lead to change in nerve cell which is known as
Myelin sheath of central nervous system is formed axonal reaction or axonal degeneration. This change
by oligodendrocytes. But it is important to note follo- is noticed within 2448 hours. The change is more
wing important points at this stage (Fig. 1.15A). rapid if axon is injured close to cell body. Axonal
1. It is not the whole cell, but only the processes of injury in peripheral nervous system is followed by
oligodendrocyte take part in formation of myelin an attempt for repair in cell body. In central nervous
sheath. system, degeneration is not followed by regeneration.
2. Many processes of one oligodendrocyte take part
in the formation of myelin sheath of many nerve Activities of Neuroglia Following Neuronal
fibers. Damage
3. Again processes of many oligodendrocytes take Neurons show some stage of cell death. Initially they
part in formation of myelin sheath of single nerve are characterized by dark stained cytoplasm with ill-
fiber. defined nucleus. But the neurons finally get dissolved
n Functions: passing through a stage of appearance of vacuoles in
1. Myelin sheath helps in conduction of impulse cytoplasm and disintegration of cell organelles. By
through nerve fiber to the full extent and with full this time microglia, being migratory in nature, rush
velocity to the destination. to the site of lesion to act as scavenger with their
2. Thus myelin sheath prevents dissociation of impu- phagocytic activity. Monocytes from the neighboring
bloodstream also join with the microglia to help in
lse to the surrounding tissue.
scavenging activity. It is now the astrocytes which
3. It acts as a support to the nerve fiber.
undergo hyperplasia and hypertrophy to occupy the
4. It prevents ionic interchange between the cyto- space of disintegrated neurons. This procedure is
plasm of nerve fiber and the surrounding tissue. known as replacement gliosis.

CLINICAL ANATOMY Spread of Some Viral Infection Through


Neuronal Process
Tumors of Central Nervous System
Rabies is a viral disease which causes acute attack
A tumor is formed as a result of abnormal cell division on central nervous system. The virus is transmitted
(mitosis) of a tissue. It is important to note at this through the bite of rabied dog or some other wild
stage that nervous system is composed of neurons, animal. From the site of bite virus spread centrally
neuroglia as well as blood vessels and meninges towards central nervous system through retrograde
(covering of central nervous system made up of direction (retrograde axonal transport) via axoplasm.
connective tissue). Among these, only the neurons are Therefore, it is clear that onset of the disease will be
fixed in number as they do not multiply after birth. quicker if the site of the wound (due to bite) is more
18
Introduction to Human Neuroanatomy
close to central nervous system (i.e. in trunk or head scopolamine, are able to act on synapses of central
and neck) than if it is away (e.g. in distal part of nervous system. In myasthenia gravis there is a
limbs). profuse deficiency of synaptic transmission due to
Axonal transport also play important role in absence of Acetylcholine in synaptic cleft.
spread of some other viral diseases affecting nervous Caffeine present in tea or coffee act as neuro-
system, e.g. poliomyelitis, and herpes simplex and modulator which enhance the activity of neuro-
herpes zoster. transmitters stimulating central nervous system.

Chemical Agents Acting on Synaptic Multiple Sclerosis A Disease Causing


Transmission Demyelination
Neurotransmitters jumping through synaptic cleft
Multiple sclerosis is a degenerative disease of central
from presynaptic neuron to postsynaptic neuron are
nervous system. Exact cause of the disease is not
responsible for conduction of nerve impulse through
chain of neurons to the destination. Chemical agents known. Probable cause is the imbalance between some
acting on autonomic ganglia may interfare with viral infection and immune response of the individual.
neurotransmission is either of two ways. Some agents Young adults between the age of 2040 years are
like procaine, simply inhibit release of Acetylcholine most commonly affected. Fibers of optic nerve, spinal
(neurotransmitter) from presynaptic neuron. The cord and cerebellum are affected usually. The myelin
other group, like nicotine, hexamethonium do not sheath of nerve fibers are degenerated during active
give chance to Acetylcholine to act on postsynaptic phase of the disease. The myelins are scavenged by
membrane, because these drugs occupy the receptor microglia with subsequent formation of replacement
site of postsynaptic membrane. Some drugs which gliosis. The disease is sometimes typically charac-
can cross the blood brain barrier, like atropine, terized by exacerbations and remissions.

19
Nervous System in Brief*
2
*(This chapter should not be ignored but is to be read thoroughly. If the reader goes thoroughly, all the subsequent chapters will
be better understood)

CENTRAL NERVOUS SYSTEM onents which are further subdivided. Each of these
parts is having Latin names which are of clinical
Central Nervous System is made up of (Fig. 2.1) significance.
1. Brain: Proximal expanded part situated inside the
cranial cavity. Forebrain (prosencephalon)
2. Spinal cord: Distal, narrow, tubular and elongated
part situated in upper two-third of vertebral canal. It is most expanded part having
i. Diencephalon: Central midline part having rig-
Fundamental Subdivisions of Brain (Fig. 2.1) ht and left identical halvesIt forms different
Morphologically, the brain is composed of three comp- components of thalamus.

Cerebrum

Brain Midbrain
Pons Cerebellum
Brainstem
Medulla
oblongata

Spinal Spinal nerves


cord

Lower spinal nerve


forming cauda equina

Filum terminale

Fig. 2.1 Central nervous system


Nervous System in Brief
Brain

Tree

Stem
Brainstem

Fig. 2.2 Brainstem is like stem of a tree

ii. Telencephalon: Two (right and left) lateral exten- Brainstem


sions, each of which looks like half of a sphere,
known as cerebral hemisphere. Both the cerebral It is the component like stem of a tree on which lies
hemispheres are most expended parts of brain. the main mass of brain (Fig. 2.2). It is made up of
They overhang the diencephalon (thalamus) form following parts of brain.
both sides and together form a sphere known as 1. Midbrain

}
cerebrum. 2. Pons
3. Medulla Two ventral components of hindbrain
Midbrain (mesencephalon) oblongata
It is shortest and simplest out of the three comp- Long-axis of brainstem is oblique vertical directed
onents of brain. downwards and backwards (Fig. 2.3). 3 components
of brainstem namely midbrain, pons and medulla
Hindbrain (rhombencephalon) oblongata are connected to cerebellum by 3 pairs of
It is subdivided into as many as 3 parts. compact bundles of white matter known as cerebellar
l Proximal(Metencephalon): Which is further subd- peduncles (Fig. 2.4)
ivided into two parts: l Superior cerebellar peduncle: Connecting midb-
1. Ventral Pons 2. Dorsal Cerebellum rain.
l Distal (Myelencephalon) 3. Medulla oblongata: l Middle cerebellar peduncle: Connecting pons.
Which is distal most cylindrical part of brain. It is l Inferior cerebellar peduncle: Connecting medulla
continuous with the spinal cord below. oblongata.

Cerebral peduncle

Superior cerebellar peduncle

Middle cerebellar peduncle

Inferior cerebellar peduncle

Fig. 2.3 Long-axis of brainstem passes downwards and backwards


21
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
central nervous system starts very early at the stage of
tri-laminar embryonic disk (plate). Midline ectoderm
on the dorsal aspect of embryonic disk (neuroectoderm)
becomes thickened on 16th day of embryonic life
which is called neural plate (Fig. 2.5A). By 20th day,
a cephalocaudal linear depression appears on neural
plate. It is called neural groove (Fig. 2.5B). Right
Cerebral
Superior cerebellar and left lips of neural groove gradually become more
Peduncle
peduncle and more elevated and prominent which are called
Middle cerebellar neural crest. On 25th day fusion of two neural crests
peduncle
starts from the middle of neural groove and proceeds
Inferior cerebellar
simultaneously towards both ends. Closure is almost
peduncle complete leaving temporarily openings at the cephalic
and caudal ends (Fig. 2.5C) called anterior (cephalic)
Fig. 2.4 Peduncles of brain
One cerebral peduncle
and posterior (caudal) neuropores. As soon as the
Three cerebellar peduncles neuropores are closed, a closed tube so far lined by
Cerebral peduncle Compact ventral part of midbrain single layer of neuroectodermal cells is formed by 30th
connecting brainstem with cerebrum (Fig. 2.4). day of intraembryonic life. It is called neural tube.
Within the period of 35th day, proximal (cephalic)
Gray and White Matters of Central Nervous dilated part of tube, which will form the brain, is
System with Embryological Background differentiated from the distal, narrow, elongated
Central nervous system so also the whole nervous part, the future spinal cord (Fig. 2.5D). By 35th day of
system is developed from ectoderm with the exception intrauterine life, the proximal dilated part is divided
of its blood vessels and some neuroglial cells (microglia) into three sacculations known as Forebrain, Midbrain
which are mesodermal in origin. Development of and Hindbrain Vesicles (Fig. 2.5D).
Neural plate

Neural groove
Ectoderm

Mesoderm B

Endoderm A
Telencephalon

FB
Diencephalon
MB Mesen cephalon

HB Rhombencephalon

Anterior
neuropore Posterior
neuropore

C D

Figs 2.5A to D Embryological background showing central nervous system develops from neural tube. A. Formation of neural plate
on ectodermal surface of 3 germ layered embroyonic disk, B. Formation of neural groove, C. Anterior and posterior neuropores,
D. Formation 3 brain vesicles
22
Nervous System in Brief
Multiplication of Single Layered Cells of Neural Tube (Fig. 2.6)

A
A B

Single layered neuroectodermal Spongioblast


cells initially lining neural tube Neuroblast

Ependyma
Ependyma

Astrocytes

Neurons

C Neuroblast Spongioblast D Oligodendrocyte

Figs 2.6A to D Multiplication of single-layered neural tube cells. A. Single-layered neuroectodermal cells lining neural tube, B.
Following mitosis, newer cells pushed to the periphery are differentiated into neuroblast and spongioblast, C and D. Formation neuron
and neuroglia (astrocyte and oligodendrocyte) from neuroblast and spongioblast respectively

On 35th day, single layered neuroectoderm cells cells form a barrier between neuron and capillary
(Fig. 2.6A) lining the neural tube start mitotic cell allowing selective transport of substance and prev-
division. The newer cells (daughter cells) are pushed enting transport of unwanted substance (toxic
to the periphery (Fig. 2.6B). The original lining cells materials) from capillary to neuron. This is known
form the inner lining of the cavity of neural tube called as Blood Brain Barrier (Fig. 2.8). The processes of
Ependymal cells. The daughter cells pushed to the neurons situated in mantle layer are pushed outside
periphery, are differentiated into two types known as forming another peripheral zone known as Marginal
neuroblasts and spongioblasts (Fig. 2.6C) which will be Zone (Figs 2.7 and 2.8). Oligodendrocytes of neuroglial
transformed into Neurons and Neuroglia (Astrocytes cells are present in this zone which will ensheath
and oligodendrocytes) respectively (Fig. 2.6D). The (myelin sheath) the neuronal processes. Microglia of
microglia will be formed from the monocytes of blood neuroglial cells are present in both mantle as well as
squeezed out through pores of capillaries. Outside the marginal zones (Fig. 2.8).
ependymal cell lining, the cell bodies of neuron forms Initially relation of inner mantle zone and surro-
a zone called Mantle Zone (Figs 2.7 and 2.8). This unding it, outer marginal zone exists althrough the
zone also contains Astrocyte type of neuroglia. length of neural tube.
Foot processes (end-feet) of astrocytes come in
contact, on one side with neuronal cell bodies and Gray and White Matters (Fig. 2.8)
on other side with the fenestrated (pored) wall of Lipid material of myelin sheath of nerve cell process
capillaries. These astrocytes thus, help in nutritional (called nerve fiber) present in marginal zone of
transport from capillaries to neurons. Besides, these developing central nervous system gives a Whitish
23
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)

Ependyma

Mantle zone

Marginal zone

Fig. 2.7 Cell division of neural tube leads to formation of layer of ependymal cells, mantle zone and marginal zone

appearance. That is why this zone is called White of gray and white matters. Both components are
matter of central nervous system. Inner mantle zone intermingled.
made up of neuronal cell bodies presents grayish l In parts of brain (cerebrum and cerebellum)
appearance for which it is called Gray matter. relationship of gray and white matter is reversed.
Gray matter becomes peripheral forming the
Variations of relationship between gray matter and cortex and white matter forms the central core.
white matter This alteration is due to following reasons:
l In spinal cord, throughout the whole length, i. Due to elongation of neuronal processes the
gray matter presents its original central position nerve cell bodies forming the gray matter is
surrounding the central canal. White matter, pushed to the periphery (Fig. 2.9).
containing bundles of nerve fibers is peripherally ii. Peripheralization of gray matter (cortex) of
positioned. cerebrum and cerebellum is further caused
l In brainstem (midbrain, pons and medulla oblo- due to need for increase in surface area of gray
ngata) there is no separately demarcated zones matter through formation of foldings (gyrus).

Ependymal cell

Neuron
Astrocyte
Mantle zone Capillary
forming gray
matter Microglia

Marginal zone
M
forming white
matter
Oligodendrocyte
Forming
Myelin sheath

Fig. 2.8 Various cells of central nervous system with blood brain barrier (B) and formation of myelin sheath (M)
24
Nervous System in Brief
White matter Spinal cord is made up of 31 segments which
are regionally subdivided from above downwards as
follows
Gray matter Cervical 8
Thoracic 12
Lumbar 5
Sacral 5
Coccygeal 1
A pair of spinal nerve (right and left) comes out
from each of the segments of spinal cord which are
numbered and named accordingly (Fig. 2.10). All
the spinal nerves are mixed nerve formed by union
of ventral (motor) outgoing and dorsal (sensory),
incoming nerve roots which are attached separately
to anterolateral and posterolateral aspects of each
segment respectively.
Fig. 2.9 Peripheralization of neuronal cell bodies due to Interior of spinal cord shows centrally situated H-
elongation of neuronal process, for which gray matter becomes
shaped area of gray matter. The central connecting
superficial to white matter
limb (gray commissure) is traversed by central canal
l Diencephalon (thalamus), the central, midline lined by ependymal cells and extensive throughout
portion of forebrain is made up of only gray matter. the whole length. Each lateral half of gray matter
of spinal cord presents a broader anterior horn and
l Basal ganglia are submerged collection of gray
narrower posterior horn. All the thoracic and upper
matter in the central core of white matter of two lumbar (T1 L2) segments of spinal cord present
cerebrum. additional lateral horn. Along the length of spinal cord,
respective horns are called anterior, posterior and
Different Parts of Central Nervous System in lateral gray columns. Neurons of anterior (ventral)
Brief horn are motor (efferent) or effector in nature. Their
axons, coming out through ventral nerve root, pass
Spinal cord is the caudal (distal), elongated, narrow, via spinal nerves and end in effector organs, like
tubular part of central nervous system situated in upper voluntary muscles (Fig. 2.11).
two-third of vertebral canal. It starts as a continuation Again neurons of posterior (dorsal) horn are
of medulla oblongata at upper border of 1st cervical sensory (afferent) or receptor in nature. These
vertebra and ends at the level of lower border of 1st receive sensory informations (inputs) carried from
lumbar vertebra. Sometimes it may extend upto 2nd peripheral sensory end organs through peripheral
lumbar vertebra. It is 18 inches in length. processes of pseudounipolar nerve cells of posterior
root ganglion of posterior roots of spinal nerves. These
Posterior pseudounipolar neurons of posterior root ganglia
root are developed from neural crest cells aggregated on
Dorsal ganglion dorsolateral aspect of neural tube. The neurons of
nerve Gray matter posterior horns (tract neurons) give out axons which
root
are pushed out to the peripheral white matter in the
form of compact bundle (ascending or afferent tract)
which carry sensory informations from periphery, via
Spinal nerve posterior (dorsal) nerve root upwards to the higher
Ventral
nerve root White matter sensory centers of brain (Fig. 2.11). The neurons of
intermediate or lateral gray horn (T1 L2 segments
only) form centers for sympathetic component of
autonomic nervous system. Peripheral white matter
also contains descending (efferent) or motor tracts
coming down as long axons of neurons of motor area
of brain (upper motor neurons) to relay on motor
neuron of anterior horns of spinal cord (lower motor
Fig. 2.10 A pair of spinal nerve arises from each of the segments
neurons). Each half of peripheral white matter
of spinal cord of spinal cord is divided into anterior, lateral and
25
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Tract neuron Posterior root Sensory nerve endings
ganglia cells carry impulse from
receptors

Ascending Efferent (motor) Motor nerve endings supply


(sensory) tract neuron effector organ (skeletal muscle)

Fig. 2.11 Destination of ventral and dorsal roots of a spinal nerve

posterior white columns. They are known as anterior, BRAINSTEM (FIGS 2.12 TO 2.14)
lateral or posterior funiculus. (Pl- funiculi). Anterior
and lateral funiculi are composed of both ascending Brainstem is the short tubular stalk-like or pedu-
(afferent or sensory) as well as descending (efferent ncular component of brain which is composed of follo-
or motor) tracts. But posterior funiculus is made up
wing parts of brain from above downwards
of only ascending (sensory) tracts.
Again in 2nd, 3rd and 4th sacral (S2, S3 and S4) 1. Midbrain
segments of spinal cord, neurons of intermediate
area (no lateral horn present here) form center for
2. Pons
3. Medulla oblongata }Ventral parts of
hindbrain
parasympathetic component of antonomic nervous Cerebral peduncle is the ventral most part of mid-
system. brain composed of compact vertical bundle of nerve

Superior cut surface of midbrain

Cerebral peduncle of
midbrain
Midbrain

Pons

Cut surface of middle


cerebellar peduncle

Inferior cerebellar peduncle


Medulla oblongata

Fig. 2.12 Ventral (anterior) view of brainstem


26
Nervous System in Brief

Aqueduct (central canal) of midbrain

Cerebral peduncle

Midbrain
Superior cerebellar peduncle

Pons Middle cerebellar peduncle

Inferior cerebellar peduncle


Medulla oblongata

Fig. 2.13 Lateral view of brainstem

fibers by which brainstem is connected above to the sulcus which lodges the basilar artery. Basilar part
cerebrum (Figs 2.12 and 2.13). of pons is continuous laterally and horizontally with
Cerebellum is connected to the three components of middle cerebellar peduncle. Ventral part of midbrain
brainstem, i.e. midbrain, pons and medulla oblongata presents compact cerebral peduncle. Dorsally mid-
through 3 compact bundle of fibers called Superior, brain presents two pairs of round bulge, upper is
Middle and Inferior Cerebellar Peduncles. Superior known as superior colliculus and lower one is called
cerebellar peduncle is thinnest whereas middle is the inferior colliculus (pl-colliculi).
thickest. Again superior and inferior peduncles are Cavity of brainstem (Fig. 2.14) cavity of
composed of both afferent as well as efferent fibers midbrain is narrow and slit-like which is known as
of cerebellum, but middle is made up of only afferent aqueduct of Sylvius. Cavity of the central nervous
fibers to cerebellum (Fig. 2.13). system opposite pons and medulla oblongata is dilated
Medulla oblongata is narrower, cylindrical and which is known as 4th ventricle of brain. It is related
most caudal part of brainstem which is continuous ventrally to the dorsal surface of pons and medulla
below with the cylindrical spinal cord. Pons presents and dorsally to cerebellum. The 4th ventricle of brain,
ventrally bilateral bulge known as basilar part. In the cavity of hindbrain is continuous below with central
midline, it presents a vertical sulcus known as basilar canal of spinal cord.

Central canal (aqueduct)


of midbrain
Inner white matter

Fourth ventricle Outer gray matter of


cerebellum

Central canal of lower part


of medulla oblongata

Fig. 2.14 Cavity of brainstem through sagittal section


27
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)

Cerebral peduncle
Cerebellum

Midbrain Superior cerebellar peduncle

Middle cerebellar peduncle


Pons

Inferior cerebellar peduncle

Medulla oblongata

Fig. 2.15 Cerebellum related to three components of brainstem

Gray and White Matter of Brainstem from which it is separated by the cavity of hindbrain,
the 4th ventricle of brain. It is connected to 3 parts of
Brainstem is the part of central nervous system which brainstem by 3 pairs of cerebellar peduncles, superior,
shows intermingling of white and gray matter. There middle and inferior.
is no defined separate zones of white and gray matter Phylogenetically cerebellum is divided into follo-
as found in the other parts of central nervous system. wing 3 parts:
n White matter: i. Archicerebellum Oldest (Vestibulocerebellum)
1. Vertical fibers: These are present in the form of ii. Paleocerebellum Intermediate (spinocerebel-
ascending and descending bundles. Ascending lum)
bundles are afferent or sensory fibers connecting iii. Neocerebellum Latest (Pontocerebellum).
spinal cord or different centers of brainstem vert-
ically upwards to the higher centers of cerebellum Principle of Functions
or cerebrum. Descending bundles of fibers are
Various sensory inputs are carried to cerebellum to be
efferent or motor passing down from higher centers
analyzed and to be coordinated or integrated to give
to the spinal cord.
directions for:
2. Horizontal fibers: These are afferent to or efferent
i. Maintenance of equilibrium (by archicerebell-
form cerebellum passing through three cerebellar
um).
peduncles.
ii. Maintenance of muscle tone and postural adjust-
n Gray matter: ment of muscles (by paleocerebellum).
1. Specific collection of nerve cells in a different parts iii. Coordination of muscle movements (by neoce-
of brainstem forming nuclei, e.g. rebellum).
i. In midbrain: Substantia nigra, red nucleus,
tectum. Midbrain
ii. In pons: Pontine nucleus.
iii. In medulla oblongata: Olivary nuclei, nucleus Superior cerebellar
gracilis, nucleus cuneatus, arcuate nucleus. peduncle
2. Reticular nucleus extends throughout whole len- Vermis
gth of brainstem.
3. Nuclei of cranial nerves: Nuclei (motor and sen-
sory) of lower 10 (ten) cranial nerves (3rd12th)
are present at different levels of 3 components of
brainstem.

CEREBELLUM (FIGS 2.14 TO 2.16) Cerebellar


hemisphere
Cerebellum, the Little Brain is dorsal part of Hind-
brain situated behind pons and medulla oblongata Fig. 2.16 Cerebellum viewed from above
28
Nervous System in Brief
Superior
vermis
Fastigial
nucleus

Globose

Cerebellar
hemisphere
nucleus

nucleus
} Nucleus
Emboliform interpositus

Dentate nucleus

Inferior vermis

Fig. 2.17 Coronal section of cerebellum strowing cerebellar nuclei

Gross Anatomy the white matter of cerebellum. Central core of white


matter contains collections of gray matter called
Cerebellum presents superior and inferior surfaces.
cerebellar nuclei which are following from lateral to
Anteriorly, a notch is related forwards to the brain-
medial (Fig. 2.17).
stem. Cerebellum is divided grossly into i. Dentate nucleus
a) A midline part: Vermis, so called because it

}
ii. Emboliform nucleus
looks like worm.
Nucleus Interpositions
b) Two lateral extensions: Cerebellar hemisphe-
iii. Globose nucleus
res. iv. Fastigial nucleus
Surface of both vermis as well as cerebellar hemi-
spheres show parallel fissures. Primary fissures Forebrain (prosencephalon) (Fig. 2.18)
divide cerebellum into lobes. Secondary fissures divide
It is the largest component of brain and subdivided into:
lobes into smaller units called lobules. Almost all the
1. Telencephalon: It is right and left lateral exte-
lobules have vermis as well as corresponding lateral nsion. Both jointly giving the appearance of a
extensions. Tertiary fissures in each lobule demarcate sphere called cerebrum. Each half, right or left
adjacent narrow linear leaf-like components known as half of sphere (cerebrum) is hemispherical called
Folia. cerebral hemisphere.
2. Diencephalon: It is the central component of fore-
Fundamental Structure
brain which forms 5 components of thalamus.
Outer or peripheral portion of cerebellum is made up Components of diencephalon is not visible in int-
of gray matter known as cerebellar cortex. Cortical act brain as it is overhung from either side by
gray matter is thrown into narrow, linear leaf-like cerebral hemispheres (Fig. 2.18). Diencephalon is
parallel pleats called folia. Inner central portion is the inferomedial portion of forebrain.

Cerebral hemisphere Cerebral hemisphere

Thalamus

Diencephalon
{ Hypothalamus

Two cerebral hemispheres form


cerebrum (Telencephalon)

Fig. 2.18 Forebrain seen through coronal section


29
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)

A B
Superolateral surface Medial surface

Inferior surface C

Figs 2.19A to C Three primary surfaces of cerebral hemisphere of left side

Cerebral hemisphere 2. Parietal lobe: Between central sulcus and parieto


Both the cerebral hemispheres present large number occipital sulcus.
of convolutions (foldings) on the surfaces. These 3. Occipital lobe: Behind parietooccipital sulcus.
convolutions are known as gyri (singular = gyrus), 4. Temporal lobe: Below lateral sulcus.
one gyrus is separated from adjacent gyrus by linear 5. Central lobe (Insula): At the bottom of lateral
depression called sulcus (Plural = sulci). Gyri on the sulcus (Fig. 2.20B).
surfaces of cerebral cortex (superficial layer of gray Poles of cerebral hemisphere are 3 in number
matter) increase the surface area of cortical gray 1. Frontal pole (anterior).
matter. In life, both the cerebral hemispheres are 2. Occipital pole (posterior).
inseperable from each other, as both are interconnected
3. Temporal pole (anterior and inferior).
by thick, compact, transversely passing band of white
matter called corpus callosum. Structural components
l Surfaces of cerebral hemispheres: Grossly, cerebral
Fundamentally cerebral hemisphere is made up of
hemisphere presents three surfaces (Figs 2.19A to C):
i. Superolateral A. Outer gray matter: This is known as cerebral
ii. Medial cortex. Gray matter presents foldings called gyri
iii. Inferior. (gyrus singular) which increase the surface area
Superolateral surface is convex, but medial and of cortex, so number of neurons within limited
inferior surfaces are flat. capacity of cranial cavity (cavity of skull). Almost
Lobes and Poles (Fig. 2.20A): Three (3) sulci called all the gyri are named and separated from each
primary sulci divide the cerebral hemispheres into other by furrows named sulci. Different gyri or
five lobes. cortical areas have different functions. Grossly
The sulci are (Fig. 2.20) the different lobes of cerebral hemisphere posses
1. Lateral sulcus. 2. Central sulcus. different functions as follows:
3. Parietooccipital sulcus. 1. Frontal lobe:
Five lobes are the following: i. Voluntary movements of skeletal muscles of
1. Frontal lobe: Infront of central sulcus. opposite half of body.
30
Nervous System in Brief

Central sulcus
Parietal lobe

Frontal lobe
Parietooccipital sulcus
Frontal pole
Occipital lobe

Occipital pole
Temporal pole
Lateral sulcus
Temporal lobe
A

Insula

Inferomedial border Inferolateral border


B

Figs 2.20A and B Lobes, poles, surfaces and borders of cerebral hemisphere A. Lobes and poles of cerebral hemisphere, B. Surfaces and
borders of cerebral hemisphere

ii. Emotional activities substance. It is white in appearance as it is made


iii. Awareness of individual up of nerve fibers (processes of nerve cells) which
iv. Motivation for any activity are myelinated. The white matter or medullary
v. Aggression or anger. substance of cerebral hemisphere contain follow-
2. Parietal lobe: Reception, recognition (perception) ing
and evaluation of all superficial and deep (from
i. Bundle of nerve fibers.
muscles, tendons, joints) sensations except vision,
ii. Basal ganglia: Deep-seated masses of gray
hearing and smell.
3. Occipital lobe: Reception, perception and inter- matter within the core of white matter.
action of visual sensation. iii. Lateral ventricle: Cavity of telencephalon.
4. Temporal lobe: Nerve fibers in the white matter are compact
i. Reception, perception and evaluation of sense bundles of fibers of following types
of hearing. 1. Association fibers (Fig. 2.21A): These fibers may
ii. Reception, perception and evaluation of sense be shorter to interconnect areas of adjacent gyrus.
of smell. Again they may be long enough to interconnect
iii. Memory and intellect of an individual. areas of two different lobes. Association fibers lie
5. Limbic lobe: It is not a separate anatomical lobe. in the same hemisphere.
But it is a ring-shaped component of cerebral 2. Commissural fibers (Fig. 2.21B): These fibers
cortex situated in the border line (limbus means
connect identical areas of two hemispheres, so
border) between central cortex and diencephalons.
cross the midline.
Limbic lobe is concerned with following functions.
i. Control on the activity for acquisition of food, Both association fibers and commissure fibers do
water and reproductive activity. not project to any center beyond cerebral hemisphere.
ii. Storage of short-term memory. 3. Projection fibers (Fig. 2.21C): These types
B. Inner white matter: It forms central core of of fibers projects beyond cerebral cortex to the
cerebral hemisphere. It is also known as medullary subcortical centers of same side or opposite side.
31
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)

A Association fibers

B Commissural fibers

C Projection fibers

Figs 2.21A to C Fibers of white matter of cerebrum A. Association fibers, B. Commissural fibers, C. Projection fibers

l Basal Ganglia (Fig. 2.22): These are collections ii. Claustrum Medial part: Globus pallidus
of gray matter deeply-seated inside white core of iii. Lentiform nucleus
cerebrum. These masses of gray matter are traversed iv. Caudate nucleus Lateral part: Putamen
by fine myelinated nerve fibers which give a striated Phylogenetically, corpus striatum (basal ganglia)
appearance. That is why they are known as Corpus are divided into
Striatum. i. Archistriatum: Amygdaloid nucleus and clau-
Basal ganglia are composed of followings: strum
i. Amygdaloid nucleus ii. Paleostriatum: Globus pallidus

Cortical gray matter


Corpus callosum Corona radiata in central white matter

Lateral ventricle
Caudate nucleus
Stria terminalis Caudate nucleus
Thalamostriate vein Claustrum
Third ventricle
Insula (central lobe)
Thalamus
Lentiform nucleus
Hypothalamus

Amygdaloid body

Fig. 2.22 Coronal section of cerebral hemisphere showing Telencephalon composed of cortical gray matter central white matter,
basal ganglia and ventricles, with diencephalon
32
Nervous System in Brief

Corpus callosum

Lateral ventricle Lateral ventricle

Fornix
Caudate nucleus
Stria terminalis
Thalamostriate vein

Thalamus
Third ventricle

Hypothalamus

Fig. 2.23 Cavities of cerebral hemisphere

iii. Neostriatum: Putamen and caudate nucleus. 1. Forebrain: 2. Telencephalon 1st and 2nd
Different components of basal ganglia form a spe- (cavity dilated) ventricles
cific functioning system in brain called extrapyramidal (Both called
system which has following functions: lateral ventricle)
1. It has regulatory effect on tone of voluntary mu- Diencephalon 3rd ventricle
scles. (cavity: Narrow
2. During a desired voluntary movements, extrapy- midline cleft)
ramidal system inhibits unwanted movements of 2. Midbrain: Cavity is a narrow Aqueduct of
voluntary muscles and improves quality of motor linear slit Sylvius
functions.
Cavity of cerebral hemisphere (Figs 2.23 and 2.24): 3. Hindbrain: Cavity dilated 4th ventricle
Cavity of cerebral hemisphere (telencephalon) are 4. Spinal cord: Narrow slit
wide and usually bilaterally symmetrical. They are throughout whole
named lateral ventricle of brain. Right and left lateral length of
ventricles being the most proximal are considered as
spinal cord Central Canal
1st and 2nd ventricles. Both these ventricles comm-
unicate through aperture (interventricular foramen) Diencephalon
with the midline cavity of diencephalon called third
ventricle of brain. Diencephalon is the central or midline component of
It is the time now to notice that cavity of central forebrain. On both sides, from superolateral aspect,
nervous system is of different nature and different diencephalon is overlapped and hidden by cerebral
name in different levels as follows (Fig. 2.24): hemispheres (telencephalon).

}
Anterior horn
Central part
Interventricular foramen Posterior horn of Lateral ventricle
Third ventricle
Aqueduct of midbrain Inferior horn

Fourth ventricle

Central canal of spinal cord

Fig. 2.24 Cavities of central nervous system


33
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)

Thalamus

Metathalamus

Epithalamus
} Dorsal
diencephalon

Hypothalamic
sulcus
Midbrain

Subthalamus

Hypothalamus } Ventral
diencephalon

Fig. 2.25 Components of diencephalon

On either side of midline diencephalon presents Functions of thalamus


right and left identical halves separated by a narrow
midline cleft, cavity of third ventricle of brain 1. Thalamus is an important sensory relay station
(Fig. 2.23). Two halves of diencephalon merge with where all sensory inputs converge (except sense of
each other below 3rd ventricle of brain. This part of smell) before they finally end in respective sensory
diencephalon (hypothalamus) is only visible when areas of cerebral cortex.
seen from inferior surface (base) of the brain. 2. Thalamus is the center where sense of pain and
Subdivisions of Diencephalon (Fig. 2.25): temperature can be perceived, even before they
reach cerebral cortex.
l Dorsal Diencephalon: 3. Thalamus is the center, where inputs are received
1. The thalamus. from cerebellum and basal ganglia. These inputs are
2. Metathalamus (meta: beyond) composed of then integrated to send message to cerebral cortex
i. Lateral geniculate body through efferent pathway for motor functions.
ii. Medial geniculate body. 4. Efferent pathway from thalamus to limbic system
3. Epithalamus: composed of of forebrain regulates mood, behavior and inte-
i. Pineal gland llect of an individual.
ii. Habenular nucleus.
l Ventral Diencephalon: Metathalamus (Fig. 2.25)
4. Hypothalamus. Metathalamus is made up of two small ovoid bulge
5. Subthalamus. which protrude from posteroinferior aspect of thal-
amus. These are called lateral and medial geniculate
Thalamus bodies.
Thalami (pl) are two in number, right and left. These Lateral geniculate body is the diencephalic relay
are ovoid mass of gray matter which is made up of station of visual pathway.
different cell groups called thalamic nuclei. These Medial geniculate body is the diencephalic relay
nuclei of thalamus are the relay stations below station of pathway for hearing (auditory pathway).
cerebral cortex where all kinds of sensory pathway
(except that for smell) relay before their final relay in Epithalamus (Fig. 2.25)
respective sensory areas of cerebral cortex.
3rd ventricle of brain is the cavity of diencephalon Epithalamus is a small sessile projection from poste-
between medial surfaces of both thalami. It comm- rosuperior aspect of thalamus.
unicates on either side with respective (right and left) It is composed of
lateral ventricles which are cavities of telencephalon i. Pineal gland (pineal body).
(cerebral hemisphere) (Fig. 2.23). ii. Habenular nuclei.
34
Nervous System in Brief
Functions of epithalamus 1. Dura mater: It is outermost and thickest. It is
made up of tough fibrous tissue containing plenty
i. Pineal gland of epithalamus secretes a hormo-
ne, called melatonin. Melatonin regulates onset of collagen fibers. This thick fibrous layer is opa-
of puberty. Early onset of puberty is found to que. Its main function is protective.
be related to reduced synthesis of melatonin. 2. Arachnoid mater: It is thin, delicate and trans-
In general, pineal gland has inhibitory effect parent layer. It is related more close to the surface
on gonads. of brain and spinal cord but does not dip into the
ii. Habenular nucleus of epithalamus, through wall or bottom of sulci of brain.
its connections with limbic system regulates 3. Pia mater: It is thinnest and most delicate layer
emotional and visceral activities on perception made up of thin layer of fibroareolar tissue in
of specific odors. which lies fine network of blood vessels. This layer
is closely adherent to surface of brain and spinal
Hypothalamus (Fig. 2.25) cord. It dips into the walls and bottom of sulci and
It is the anterior part of ventral diencephalon lying fissures.
below thalamus and infront of subthalamus. Hypotha- Dura mater is known as Pachymeninges which
lamus is the part of diencephalon which forms the develops from mesoderm surrounding the developing
lower part of lateral wall as well as the floor of 3rd neural tube. Arachnoid mater and pia mater are
ventricle of brain. Its lowermost part is the only part known as Leptomeninges which are ectodermal in
of diencephalon which is visible from inferior surface origin.
or base of the brain. Space beneath arachnoid mater, i.e. between
Hypothalamus is a very small area of brain which arachnoid and pia mater of brain and spinal cord is
contain various nuclei. prominent. This space is called subarachnoid space.
Subarachnoid space contains thin watery fluid which
Functions is called Cerebrospinal fluid (CSF). This fluid is also
present inside the cavity of whole central nervous
1. Autonomic: Anterior part of hypothalamus pro-
system. Cerebrospinal fluid is liberated from tufts of
duces influence on parasympathetic part and
capillaries related to wall of ventricles of brain, called
posterior part influences on sympathetic part of
Tela Choroidea. CSF of ventricular system (cavity of
autonomic nervous system. Through this influence,
CNS) and subarachnoid space freely communicate
hypothalamus controls visceral activities.
with each other through apertures on the roof of
2. Hormonal: Pituitary gland (hypophysis cerebri),
4th ventricle. In normal individual a balance is
being the bandmaster of endocrine symphony (fun-
maintained between secretion and absorption of CSF.
ctions), is influenced by hypothalamus through hy-
In case of imbalance, that means either oversecretion
pothalamo hypophyseal tract. Through influence
or less absorption, accumulations of excess CSF leads
on pituitary, hypothalamus controls activities of
to a clinical condition called hydrocephalus.
various other endocrine glands.

Subthalamus (Fig. 2.25) PERIPHERAL NERVOUS SYSTEM


It is the posterior part of ventral diencephalon lying Peripheral nervous system is the outflow from central
ventral to thalamus, posterior to hypothalamus and nervous system (brain and spinal cord). It is mainly
above midbrain. It contains small compact mass of composed of peripheral nerves. It means that apart
gray matter called subthalamic nucleus. from peripheral nerves, there are other constituents
Subthalamic nucleus is one of the centers of extra- of peripheral nervous system.
pyramidal system. It controls unwanted voluntary
movements and thus makes movements of voluntary Composition of Peripheral Nervous System
muscles smooth.
1. Peripheral nerves: Outflow from brain and spinal
Coverings (Meninges) of Central Nervous cord in the form of
a) 12 pairs of cranial nerves from brain.
System and Cerebrospinal Fluid (CSF)
b) 31 pairs of spinal nerves from spinal cord.
Both brain and spinal cord posses coverings which 2. Collections of neurons outside the central nervous
are called meninges. The meninges are of following 3 system: These are named Ganglia (singular gan-
layers from outside inwards glion).
35
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Cortical sensory
neuron
Sensory cortex

Lemniscus

Thalamic nucleus

Thalamus

Skin
Ascending (afferent)
tract

Spinal cord

Sensory (tract) neuron

Spinal (lower) motor


neuron

Pseudounipolar primary
sensory neuron
A (mixed) spinal nerve

Efferent (motor) component


of spinal nerve

Effector organ (muscle)

Fig. 2.26A Destination of motor and sensory components of spinal nerve

Functional Components of Peripheral Nerves Functional Types of Peripheral Nerve


(Figs 2.26A and B) A peripheral nerve (cranial or spinal) may be either of
the following three functional types:
Peripheral nerves are made up of axons of groups of i. Motor nerve: When it contains only motor
neurons situated inside the central nervous system component.
and/or dendrites of 1st order of neurons in the sensory ii. Sensory nerve: When it contains only sensory
pathway. Axons carry impulse (direction) from the component.
central nervous system to the target organ (e.g. iii. Mixed nerve: When it contains both motor and
sensory components.
muscles) and form motor or efferent component of
a peripheral nerve. Dendrites carry impulse (infor- Fundamental comparison between cranial and spinal
mations) from peripheral end organs (receptors) tow- nerve
ards the central nervous system and form sensory or 12 pairs of cranial nerves come out through the
afferent component of a peripheral nerve. surface of brain.
36
Nervous System in Brief
Cell body of sensory root
of cranial nerve is not
Receptor pseudounipolar, unlike posterior
root ganglia of spinal nerve

Sensory nucleus of
cranial nerve

Motor nucleus of
cranial nerve

BRAIN

A cranial nerve may be


1. A motor nerve

Effector 2. A sensory nerve


or

3. A mixed nerve

Fig. 2.26B A cranial nerve may be motor, sensory or mixed unlike spinal nerve which is always mixed in composition

A pair of spinal nerve comes out through surface Cranial nerves V, VII, IX, X Mixed
of each of 31 segments of spinal cord. So number of Again, Ist (olfactory) and IInd (optic) cranial nerves,
spinal nerves are 31 pairs. carrying special sense of smell and vision respectively,
All spinal nerves are mixed nerve but not all the are attached to the forebrain, but other 10 pairs of cranial
cranial nerves: nerves come out from the surface of brainstem. Unlike
All the spinal nerves are mixed nerves as they are the spinal nerves, separate motor and sensory roots of
made up of both motor as well as sensory roots. Motor some of mixed cranial nerves (V, VII) are attached close
and sensory roots of spinal nerve are attached to different to each other at the surface of brainstem.
sites of surface of spinal cord called anterolateral sulcus
and posterolateral sulcus respectively. Peripheral Nerve Forming Plexus (Networks)
Out of 12 pair of cranial nerves some are sensory,
(Fig. 2.27)
some are motor whereas some of these are mixed
nerves as follows: Adjacent spinal nerves in different regions, except
Cranial Nerves I, II, VIII Sensory 3rd thoracic to 11th thoracic intercommunicate with
Cranial Nerves III, IV, VI, XI, XII Motor each other in different regions (upper cervical, lower

Cords Divisions Trunks Nv. roots

C5
Anterior division U
Lateral cord
C6

M
Posterior cord C7

Posterior
divisions C8
L
Medial cord
Anterior division T1

Fig. 2.27 Peripheral spinal nerves forming plexus. C5 C8 and T1 spinal nerves, through formation of brachial plexus, supply upper limb
(through various nerves derived from lateral, posterior and medial cords)
37
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)

Umbilicus

T10 Dermatome
Overlapping of T11 T11 Dermatome
dermatome in the area
of T10 dermatome

Fig. 2.28 Belt of skin (Dermatome) supplied by sensory component of peripheral nerve

cervical, lumbar, sacrococcygeal) and finally give Contd...


named branches which are distributed peripherally. Ventral rami of Name of the Distribution area
spinal nerve plexus formed
Reasons for formation of nerve plexuses 3. T12 to L4 nerves Lumbar plexus Motor fibers to
Muscles of front of
1. A muscle developed by union of multiple meso- Lower limb.
dermal units (segments), will get supply of multiple Sensory fibers to
Skin of front of
segmental motor nerve fibers by union of adjacent lower limb.
spinal nerve roots through plexus formation. 4. L4 to S5 nerves Sacral plexus Motor fibers to
2. A belt of skin of body is innervated (supplied) Muscles of back of
by sensory fibers of one peripheral nerve. This Lower limb.
is called dermatome. There may be overlapping Sensory fibers to
Skin of back of lower
of nerve supply by adjacent peripheral nerve to limb.
adjacent dermatome (Fig. 2.28).
Spinal nerves which do not form plexuses
Different nerve plexuses (T2 T11) but supply the body wall or trunk (thorax
and abdomen) are distributed as follows:
Each of the spinal nerves divides into ventral and
T2 T11 nerves Distributed in thorax.
dorsal rami. Nerve plexuses at different regions of
T7 T11 nerves Distributed in abdomen. T12
body are formed by ventral rami. Ventral rami of 3rd
nerve also supplies wall of abdomen.
thoracic (T3) to 11th thoracic (T11) spinal nerves are
distributed to the body wall. Ventral rami of other Constituents of a Peripheral Nerve (Fig. 2.29)
spinal nerves are distributed to following regions
of body through formation of different nerve plexus A peripheral nerve is covered by connective tissue
named below. sheath in different planes which are as follows:
1. Epineurium: It is the outermost connective tissue
Ventral rami of Name of the Distribution area
spinal nerve plexus formed sheath of a peripheral nerve. Structurally, it is
1 C1 to C4 nerves Cervical plexus Motor fibers to
made up of dense connective tissue which posseses
Muscles of neck and protective function. On the surface of epineurium
to diaphragm. lies very fine network of blood vessels.
Sensory fibers to 2. Perineurium: A peripheral nerve is composed of
Skin of neck bundles of nerve fibers. Many group of nerve fibers
2. C5 to T1(T2) nerves Brachial plexus Motor fibers to which are called fasciculi (singular fasciculus)
Muscles of upper
are present in a nerve. Each fasciculus is enclosed
limb
Sensory fibers to by a sheath of connective tissue which is smooth in
Skin of upper limb nature but made up of finer collagen fibers. This is
Contd... called perineurium.
38
Nervous System in Brief
Epineurium

Perineurium

Endoneurium (interstitial
connective tissue between
nerve fibers)
Fasciculi

Fig. 2.29 Connective tissue elements of a peripheral nerve

3. Endoneurium: It is not present in the form of she- 2. Somatic efferent (motor): These fibers carry
ath. A nerve fasciculus enclosed by perineurium impulse (command) from central nervous system
is composed of number of nerve fibers. Interstitial (brain and spinal cord) to the skeletal muscles
tissue inbetween nerve fibers inside a fasciculus is (effector organs).
called endoneurium. It is made up of very delicate 3. Visceral afferent (sensory): These fibers carry
loose connective tissue. impulse (sensory inputs or information) from viscera,
Apart from the connective tissue related to a peri- like sense of pain, pressure, distension, stretch.
pheral nerve classified as above individual nerve fibers 4. Visceral efferent (motor): These fibers carry
which are myelinated are covered by myelin sheath. impulse (command) from central nervous system
(brain and spinal cord) to
Types of Nerve Fibers in a Peripheral Nerve i. Smooth (involuntary) muscles of viscera.
ii. Smooth (involuntary) muscles of cardiovascular
I. According to thickness so also velocity of conduction: channels.
Thickness Velocity of iii. Arrectores pili muscles (involuntary) of skin.
Type Example iv. Exocrine glands.
(diameter) conduction
Out of the above mentioned fibers visceral afferent
1. Type A 1.5 22 4 120 i. Motor neurons
(thickest, microns meters/sec supplying skeletal and visceral efferent fibers are fibers of autonomic
fastest and (voluntary) nervous system which are made up of sympathetic
myelinated) muscles and parasympathetic components.
ii. Most of the Somatic afferent and visceral afferent fibers enter
sensory neurons. through the same route of sensory nerve (cranial as
2. Type B 1.5 3 3 15 Preganglionic well as spinal), but relay in different groups of neurons
(medium in microns meters/sec autonomic nerve
thickness fibers
in central nervous system (brain and spinal cord).
and as well Again somatic efferent and visceral efferent fibers
as conduction come out through the same route of motor nerve
speed and (cranial and spinal). But somatic efferent fibers end
myelinated) directly to the target organs (effector organs) which
3. Type C 0.1 2 0.5 4 i. Postganglionic are voluntary muscles, and visceral efferent fibers
(thinnest with microns meters/sec automonic nerve reach the target organs (involuntary muscles or
minimum fibers
conduction ii. Autonomic exocrine glands) after a relay in postganglionic neu-
speed and afferent (sensory) rons thus forming autonomic ganglion (singular
non- fibers from viscera ganglia) (Fig. 2.30B).
myelinated) iii. Somatic Additional functional components of fibers in
afferent (sensory)
cranial nerves: During intrauterine life, six pairs of
fibers from
skin and muscles mesodermal bars develop winding primitive phar-
ynx from its dorsolateral aspect. These are called
Type AFibers are further classified as follows: pharyngeal (branchial) arches. 5th branchial arch gets
Type AMotor fiber Alpha, Beta and Gamma degenerated finally. Some muscles in the region of head
Type ASensory fibers Types I, II, III. and neck are developed from mesoderm of 5 (1st4th
II. According to area distribution (Figs 2.30A and B) and 6th) branchial arches. These muscles are voluntary
1. Somatic afferent (sensory): These fibers carry muscles but not somatic muscles. Some of cranial
impulse (sensory inputs or informations) from nerves contain fibers which supply these branchial
skin, muscles, tendons and joints. arch muscle called branchial efferent component. These
39
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Posterior root
Somatic receptor ganglion
Somatic
afferent fiber

Somatic
efferent fiber

Somatic effector

Posterior root
Autonomic receptor ganglion
Visceral
afferent fiber

Autonomic
ganglion

Visceral
efferent fiber

Autonomic effector
B

Figs 2.30A and B Types of nerve fibers in peripheral nerve. A. Somatic fibers, B. Autonomic fibers

fibers of cranial nerves are also called special visceral 5. Special visceral afferent: Fibers carrying taste
efferent component. In this connection, it is to be noted sensation.
here that, some special senses like taste (gustatory 6. Special visceral efferent (branchial efferent):
sensation) is carried from viscera like tongue, part of
Fibers supplying (voluntary) muscles developed
pharyngeal wall and soft palate. Sensory fibers of some
from branchial arch mesoderm of 1st to 4th and
cranial nerves carrying this (taste) sensation are called
special visceral afferent component. 6th arches.
So, in addition to the previously mentioned four For more clear concept about functional components
components of a peripheral spinal nerve, some of of peripheral nerve, reader is suggested to go through
cranial nerves may contain following types of fibers. the chapters of spinal cord and brainstem.
40
Nervous System in Brief
Peripheral Nerve Injury (Figs 2.31A and B) of nerve fiber towards the cell body which also
shows degenerative changes. This is known as
When a peripheral nerve is injured and cut, nerve
Retrograde or Wallerian degeneration. This so
fiber (neuronal process) may be divided into two
called after the name of Waller who first noticed
segments. The two segments are as follows:
the degenerative changes of nerve fiber.
1. Proximal: This is connected to cell body of neuron,
This degeneration process starts within 48 hours
known as proximal stump.
of nerve injury.
2. Distal: This is known as distal stump.
Following nerve injury, both the proximal as well Degenerative changes of fibers of proximal stump
as distal stump of nerve fibers undergo degeneration.
The cell body also gets degenerated along with Disintegrated myelin sheath is converted into lipid
proximal stump. droplets.

Degenerative changes of nerve fibers Degenerative changes in cell body


1. Degeneration of proximal stump From the site i. Cell body is swollen and rounded.
of lesion (injury) degenerative process start in ii. Nucleus becomes eccentric (peripheral) in
retrograde direction through the proximal stump position.
Influx of macrophages

Nucleus Chromatolysis with Cell body is Endoneurium Schwann cells disintegrate


becomes disappearance of rounded is torn into lipid droplets
eccentric Nissl granules
A

Axonal process
regrows
All axonal sprouts Schwann cells
B except one disappear proliferate

Figs 2.31A and B Degeneration and regeneration of neuron. A. Process of degeneration, B. Process of regeneration
41
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
iii. Fragmentation of Nissl bodies This is called Cellular Components of Peripheral Nervous
chromatolysis. System (Figs 2.30A and B)
iv. Neurofilaments are broken down.
In the pathway of peripheral nervous system, apart
Degenerative changes of distal stump from the peripheral nerves, there are groups or
clusters of neurons, which are called ganglia (singular
This is called anterograde degeneration. This occurs ganglion).
immediately after injury. The degenerative process is There are two different types of ganglia. Though
same as that of proximal stump fibers. both are commonly termed Ganglia structurally they
are different.
Regeneration of nerve fiber
During degeneration process of a nerve fiber, follo-
Sensory Root Ganglia
wing peripheral nerve injury, myelin sheath gets In peripheral nervous system, outside the central
disintegrated. But the endoneurium and neurolem- nervous system, these are collections of cell bodies of
mal sheath of proximal stump remain intact. That first order of sensory neurons in the afferent (sensory)
is why chance of regeneration of proximal stump pathway which form sensory component of peripheral
of nerve fiber with cell body remains alive. But in nerves (cranial and spinal nerves).
no case distal stump gets regenerated, unless and
until it is surgically connected with the proximal Sensory root ganglia of sensory components of
stump. In central nervous system, nerve fibers do not some cranial nerves
regenerate, because they are devoid of endoneurium.
These are cell bodies of 1st order of neurons present
Steps of regeneration in sensory components of cranial nerves (Fig. 2.26B)
which may be either purely sensory nerves or sensory
1. Many Schwann cells undergo proliferation at the component of a mixed nerves.
site of injury. The ganglia are as follows:
2. Some of the Schwann cells undergo changes to
macrophages which take out the tissue debris as No. and name of Type of nerve Name of the ganglia
well as lipid droplets formed by disintegration of cranial nerves (mixed or sensory)
myelin sheath. Vth Trigeminal Mixed Semilunar ganglia
3. Neuronal body return to its original nature and VIIth Facial Mixed Geniculate ganglia
shape. Its nucleus again come back to the central VIIIth Vestibu- Sensory Spiral ganglia and
position. locochlear vestibular ganglia
4. Terminal end of proximal stump presents knob- IXth Glosso- Mixed Superior and inferior
pharyngeal ganglia
like appearance from where number of sprouts
Xth Vagus Mixed Superior and inferior
come out. ganglia
5. One of the sprouts is elongated and others dis-
appear. Cells of these ganglia are mostly bipolar. Peripheral
process carries impulse from peripherally situated
6. The elongated sprouts it ensheathed by many of
sensory end organs towards the cell body. The central
the proliferating Schwann cells which thus form
process carries impulse from the cell body towards
new myelin sheath.
the central nervous system (brainstem).
Regeneration of nerve fiber occur at a speed of
1mm per day. Complete regeneration may need a
Posterior root ganglia of spinal nerves (Figs 2.26A
period of 36 months.
and 2.30)
Regeneration of a nerve fiber is arrested due to
following reasons: These are cell bodies of 1st order of neurons carrying
1. If endoneurium is not intact. sensory impulse towards the spinal cord. The ganglia
2. If the distance between the two cut segments of are attached to the dorsal (posterior) root of spinal
nerve fibers is more than 3 cm. nerve close to spinal cord. The neurons are pseudo-
3. If nerve growth factor does not act. unipolar in nature whose single process bifurcates
4. If the site of injury is infected. It is important to in Tshaped manner into peripheral and central
note here that leprosy bacillus travels beneath the process. The peripheral limb acting as dendrite carr-
endoneurium in retrogate direction and damage ies impulse from peripherally situated sensory end
the Schwann cells, thus disintegrating myelin organs (receptors). The central limb of Tshaped proc-
sheath causes infective nerve injury. ess carries impulse towards central nervous system.
42
Nervous System in Brief
It is important to note that these sensory neurons system end in a relay stations, from where another
of both cranial as well as spinal nerves are of two neuron (postganglionic) starts to reach the target
types. Some carry somatic sensations from skin, organs (involuntary muscles or exocrine glands).
muscles, tendons, joints. Some of them carry visceral These synaptic junctions with postganglionic cell
sensation forming sensory component of autonomic bodies are called autonomic ganglia. These ganglia
nervous system.
may be large and enclosed by connective tissue
The sensory ganglia are covered by connective tis-
sue capsule. Inside the ganglia, cell body of each of capsule. Again it may be small and situated in the
the neurons is enclosed by capsular or satellite cells network of autonomic nerves.
all around. These cells protect the neurons and also These autonomic ganglia lying in the peripheral
provide nutrition to them lying between neurons and nervous system are, therefore, relay stations as well
blood capillaries. as collections of cell bodies of second order (post-
ganglionic) of autonomic neurons.
Autonomic Ganglia (Fig. 2.30B) Between central nervous system and target organs,
In case of somatic neurons (cranial as well as spinal), relative position of sympathetic and parasympathetic
motor fibers coming out of central nervous system end autonomic ganglia vary. Sympathetic ganglia are more
directly to the target organs (voluntary muscles). In close to the central nervous system. Parasympathetic
case of both sympathetic as well as parasympathetic ganglia are away from central nervous system, so
components of autonomic nervous system, motor more close to the target organs (involuntary muscles
(efferent) fibers, after coming out of central nervous or exocrine glands).

43
Peripheral End Organs
3
By this time it is well-understood that a peripheral End organs at the terminal ends of sensory nerve
nerve is composed of nerve fibers. These nerve fibers fibers which receive sensory informations or inputs
may be motor or sensory in nature. Sensory fibers, are called receptors.
forming a sensory nerve, carry informations (input) End organs at terminal ends of motor nerve fibers
through its peripheral or terminal endings from which are to produce effect in the form of contraction
the periphery of body. The peripheral ends of these of muscles or secretion of exocrine glands, are called
sensory nerve fibers present specialized structure effectors.
to receive sensory inputs due to change in the
environment. Again a motor nerve is made up of nerve RECEPTORS
fibers which carry impulse (directions or command)
from central nervous system to the peripheral target Receptors are specialized structures at the terminal
organs (muscles or exocrine glands) for an effect. So, ends of sensory nerve fibers which are distributed
peripheral or terminal ends of motor nerve fibers peripherally to receive sensory informations (inputs)
come in close contact with target organs (muscles due to change in the environment (stimulus).
or exocrine glands). These sites of contact present
specialized structures. Anatomical Classification of Receptors
These specialized terminal endings of both sensory Fundamentally, receptors are classified as
as well as motor nerve fibers are called end organs l Exteroceptors.
(Fig. 3.1). l Proprioceptors.
l Interoceptors.

Exteroceptors
These receptors are distributed superficially in the
Receptor Sensory nerve Central nervous system
layers of skin and subcutaneous tissue. Exteroceptors
are stimulated by external stimulus liketouch, pres-
Effector Motor nerve Central nervous system sure, pain by mechanical or chemical trauma and
alteration of temperature. These receptors are more
accurately called general exteroceptors.
Exteroceptors for perception of sense of smell
(olfactory), vision (visual), hearing (acoustic) and
Fig. 3.1 Peripheral end organs (receptor and effector) taste (gustatory) are called special exteroceptors.
Peripheral End Organs
Proprioceptors distension, compression, etc. These sensations are
carried through autonomic sensory nerves. The
When a joint moves due to contraction of a muscle or a
sensory end organs in the wall of viscera from where
group of muscles, we can feel it. This is called sense of
these sensations are carried, are called interoceptors.
movements. Again, due to contraction of muscle, when
So, receptors are classified through following
a part of body is stretched or adjusted, we can also
table:
feel it. This is called sense of position. These feelings
In this chapter, general receptors (general exter-
or perceptions are because of impulse that are carried
oceptors and general proprioceptors) are described.
through chain of sensory neurons from concerned part
of periphery of body to central nervous system. The For special receptors, the reader is to consult the
informations are carried from peripheral end organs chapters of respective sensory pathways.
located in muscles, tendons and joints. These sensory General exteroceptors
end organs are called general proprioceptors.
Specialized receptors are located in specialized These receptors located in skin and subcutaneous
site of internal (innermost) ear, whose function is tissue are subdivided into two groups
related to perception and maintenance of balance 1. Nonencapsulated.
or equilibrium of body. These are called special 2. Encapsulated.
proprioceptors. Impulse is carried through vestibular Nonencapsulated receptors (Fig. 3.2)
component of vestibulocochlear nerve (eighth cranial
These receptors do not present any specialized struc-
nerve).
tures made up of modified cells of the tissue. These
are free endings of sensory nerve fibers in different
Interoceptors
forms which directly come in contact with tissue-cell
Both exteroceptors as well as proprioceptors, defined or intercellular spaces.
above, are related to endings of somatic sensory nerves, Types of nonencapsulated receptors:
thus carry sensations called somatic sensations. 1. Free nerve endings: These nerve fibers may be
There are various sensations carried from viscera. myelinated or nonmyelinated. But finally ends
These are sense of pain (due to ischemia), stretch, of the fibers loose myelin sheath. Apart from the

Type of sensory nerve


Name of receptor
Location Type of sensations carried
through which carried
1. General exteroceptor Skin and subcutaneous Touch, pressure, pain, Somatic sensory
tissue temperature
2. Special exteroceptor Nose, eye, ear, tongue Smell, vision, hearing, taste Somatic sensory. Special
Visceral sensoryfor taste
3. General proprioceptor Muscles, tendons, joints Sense of movement and Somatic sensory
position of body
4. Special proprioceptor Ear Sense of body balance or equilibrium Somatic sensory
5. Interoceptor Viscera Sense of pain, stretch, distension, Autonomic sensory (both symp-
compression athetic and parasympathetic)

Epidermis
{
Dermis

{ Free nerve endings


Hair follicle receptor Merkel disk

Fig. 3.2 Nonencapsulated sensory end organ


45
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)

End bulb of
krause

End bulb of
Meissners corpuscle Pacinian corpuscle Ruffini

Fig. 3.3 Encapsulated sensory end organ

skin, these receptors are also located in cornea, for example palm of hand, sole of foot, external
periosteum of bone and root of teeth. In skin, these genitalia, nipple and eyelids.
free nerve endings come in contact with basal cells Meissners corpuscles are oval in shape and pre-
of epidermis or with collagen fibers of dermis. sent a capsule surrounding a central core made up of
Mostly, they carry pain sensation. But they may be modified Schwann cells. At the center of the corpuscle
stimulated by touch, pressure as well as temperature. schwann cells are intermingled with free nerve
2. Hair follicle receptors: These are also free endings.
nerve endings, but in different forms. Terminal These receptors gives a special tactile power to the
unmyelinated ends of nerve fibers form a spiral skin. Because of their function, a person is able to feel
two points of skin touched close to each other. This is
arrangement around the root of hair follicles below
called power of two point discrimination.
the position of sebaceous gland.
2. Pacinian corpuscles: Pacinian corpuscles are
These receptors are stimulated initially when largest in size, widely distributed in the body, oval
the hair is bent. But so long hair remains bent, the in shape being about 2mm in measurement.
receptors remain silent. When hair is released, a They lie in dermis of skin and subcutaneous tissue,
second burst of stimulation occurs. being most abundant in palm, sole, breast. Apart from
3. Merkel disks: These are also called Tactile Dis- the skin, these are also found in the structures related
ks of Merkel. In this cases free nerve endings to joints, e.g. capsules, ligaments, synovial membrane.
present small disk-shaped endings which come in Firm pressure stimulates these receptors.
contact with specialized dark cells in the basal or The oval corpuscles are 2mm in length and 0.5mm
deeper part of epidermis of skin. These cells are in diameter. Structurally it is made up of:
called Merkel cells. i. Outermost capsule.
These receptors are located in nonhairy skin. ii. Inside the capsule, the central core is formed
Stimulation of these receptors makes a person aw- by concentric layers of flattened cells.
are of degree of pressure exerted while touching an iii. A large myelinated sensory nerve fiber pierces
object. one pole of the corpuscle, looses its myelin
sheath. The naked nerve fiber traverses the
Encapsulated receptors (Fig. 3.3) center of central core of flattened cells and end
These receptors present outer connective tissue cap- in a small swollen terminal.
sule surrounding a central core inside which lies the Though pacinian corpuscle is known as pressure
free nerve ending. They are found in different size receptor, it is also sensitive to vibration.
and shape. 3. End bulbs: These are so called because they are
1. Meissners corpuscles: These are the receptors bulbous and, spherical or fusiform in appearance
for touch and that is why called Tactile Corpuscles at the end of nerve terminal. They are of following
of Meissner. They are present in dermal papillae types:
of skin and are mostly found in the skin of those a) End Bulb of Ruffini: They are fusiform in outline
parts of body which are very sensitive to touch, and present in the dermis of skin. Capsule of
46
Peripheral End Organs

Sensory nerve

Neuromuscular spindle
(Intrafusal fiber)

Neurotendinous spindle
(Golgi tendon organ)

Fig. 3.4 Proprioceptive sensory end organs in skeletal muscle and its tendon

these receptors is cellular in nature and central and position of voluntary muscles. Central nervous
core is made up of fine collagen fibers. Each system uses this information for control of activity of
corpuscle presents multiple large unmyelinated voluntary muscles.
nerve fibers ending within the center of colla- Neuromuscular spindle is a fusiform or spindle-
gen fibers. They are stretch receptors and stim- shaped organ whose long-axis is parallel to the length
ulated when skin is stretched. of a muscle. Length of this end organ varies from
b) End Bulb of Krause: These are spherical in 14 mm. It is enclosed by a connective tissue capsule.
outline. The capsule is made up of cells as well Inside the capsule of this fusiform organ, units of this
as fibers. The nerve fiber, after piercing the sensory receptors are situated. These are specialized
capsule, presents a club-shaped appearance at muscle fibers called intrafusal fibers. In contrast to
the central core of the bulb. these intrafusal fibers (inside the spindle), usual
Though these end organs are enlisted here, these muscle fibers (myocytes) of voluntary muscle, outside
are not universally accepted as receptors. These are the spindle, are called extrafusal fibers which are
considered by many as degenerating or regenerating effector in nature (Fig. 3.5).
nerve terminal rather than a receptor. The intrafusal fibers of neuromuscular spindle are
of following two types
General proprioceptors 1. Nuclear bag fibers.
These are deep-seated receptors present in the mus- 2. Nuclear chain fibers.
cles, tendons and joints. These receptors are Both these types of fibers are specialized muscle
1. Muscle Spindle or Neuromuscular Spindle: These fibers. Their long-axis are parallel to the length of the
sensory end organs are present in muscles. spindle. Their number in a spindle varies from 614.
2. Golgi Tendon Organ or Neurotendinous Spindle: Each of them presents a central part (equatorial
The receptors are present in tendons. part) and two terminal ends. Fundamentally term-
3. Proprioception sensation is also carried from inal ends of both these fibers present transverse
joint structures like: Capsule, ligaments and striations of voluntary muscles and are contractile
synovial membrane. These receptors are Pacinian in nature. Central or equatorial part lacks striation
corpuscles which have been already discussed. property and present accumulation of many nuclei
(Figs 3.6 and 3.7).
Neuromuscular spindle (Fig. 3.4)
n Nuclear bag fibers: Equatorial part of these
Neuromuscular spindles are also known as muscle fibers presents spherical sac which is filled up with
spindles. These are sensory end organs present in nuclei. Length of nuclear bag fiber is more. Their ends
voluntary muscles. They are more abundant in number project beyond the capsule and are fixed through their
in the muscle close to its junction with tendons. These attachment to connective tissue of extrafusal fibers.
receptors, on stimulation, send information to the n Nuclear chain fibers: Structurally these differ
central nervous system regarding state of contraction from nuclear bag fibers. These are shorter in length
47
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)

Nuclear bag fiber

Intrafusal fibers
{ Nuclear chain fiber

Central equatorial
parts containing
nuclei
Extrafusal fibers
Terminal striated
contractile parts
Capsule of neuromascular
spindle

Fig. 3.5 Neuromuscular spindle composed of intrafusal fibers, and its relation with extrafusal fibers

and uniform in breath althrough. But the equatorial proprioceptive sensory end organs, intrafusal fibers
part presents collection of nuclei in the form of rows inside the spindle act as both receptor as well as
or chains. effector. Equatorial or central noncontractile part acts
Both intrafusal fibers are receptor as well as as receptors and terminal cross striated, contractile
effector organs It is important to notice at this parts act as effectors, which receive sensory and
stage that, though the neuromuscular spindle are motor nerve fibers respectively.
Higher centers
Basal ganglia
Reticular formation
Cerebellum

1. Descending fiber tracts relay to


gamma motor neuron

2.
Axon of gamma neuron innervates
terminal contractile parts of intrafusal
fibers


3. Stretching of both ends of nuclear bag
type of intrafusal fiber stimulates central
noncontractile part

4. Annulospiral endings of afferent nerve fiber carry impulse to


spinal cord to stimulate alpha motor neuron through synapse

5. Axon terminal of alpha neuron innervates


extrafusal fiber

Fig. 3.6 Illustration to explain mode of function of neuromuscular spindle (nuclear bag fiber)
48
Peripheral End Organs
n Mode of function of neuromuscular spindle Even when a muscle is in a resting stage, in
(Figs 3.6 and 3.7): It is understood that central unnoticed (subconscious) state of an individual, motor
(equatorial) nonstriated as well as noncontractile part impulse is carried from higher centers (Figs 3.6 and
of both nuclear bag and nuclear chain type intrafusal 3.7) of brain, e.g. basal ganglion, cerebellum, reticular
fibers are receptor of voluntary muscle. From receptors formations to the gamma motor neurons of spinal cord
proprioceptive sensations are carried by sensory root through descending motor fiber tracts (Figs 3.6 and
of spinal nerves to the spinal cord. The terminal 3.7). Impulse pass via axons of gamma neurons to both
contractile parts of both type of intrafusal fibers receive the contractile ends of intrafusal fibers. When both the
efferent (motor) nerves which are axons of small-sized ends are contracted, central noncontractile receptor
(less than 25 microns) gamma motor neurons of gray part (proprioceptor) gets stretched and so stimulated.
mattter of spinal cord. Again extrafusal fibers, lying Sensory impulse is carried from here through afferent
outside neuromuscular spindle, are supplied by axons (sensory) roots of spinal nerve to the gray matter of
of large sized (more than 25 microns) alpha motor spinal cord where it forms synapse with alpha motor
neurons of spinal cord gray matter. neurons. Stimulation of alpha neurons helps to keep
It is very important as well as interesting to note the extrafusal fibers so the whole voluntary muscle
at this stage that functions of the neuromuscular in a partially contracted stage (in resting condition)
spindle proprioceptors is interrelated to the function which maintains thus the tone of the muscle.
of contractile terminal parts of intrafusal fibers supp- n Neuromuscular spindle acting for stretch
lied by gamma motor neurons as well as function of reflex: In reference to the above stages of functions,
extrafusal fibers supplied by alpha motor neurons. even if the influence of higher centers of brain, e.g.
Higher centers
Basal ganglia
Reticular formation
Cerebellum

1. Descending fiber tracts relay to


gamma motor neuron

2. Axon of gamma neuron innervates terminal


contractile parts of intrafusal fibers

3. Stretching of both ends of nuclear chain


type of intrafusal fiber stimulates central
noncontractile part

4. Flower-spray endings of afferent nerve


fiber carry impulse to spinal cord to
stimulate alpha motor neuron through
synapse

5. Axon terminal of alpha neuron innervates


extrafusal fiber

Fig. 3.7 Illustration to explain mode of function of neuromuscular spindle (nuclear chain fiber)
49
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
basal ganglia, cerebellum or reticular formation is not muscle presents neuromuscular spindle (intrafusal
there to stimulate gamma neuron so the intrafusal fibers) and also extrafusal fibers. A tendon contains
fibers, stretching of the voluntary muscle, causing Golgi tendon organs or neurotendinous spindles.
elongation of intrafusal fibers at their ends will These are receptors present in tendon. Increase in
stimulate the central receptor part. Sensory impulse tension of a muscle also causes increase in tension of
will be carried to the spinal cord via afferent nerve tendon which stimulates the neurotendinous spindles.
which will synapse with motor neurons supplying
Afferent (sensory) impulse is carried through sensory
extrafusal fibers at the spinal cord segement level.
nerve root of spinal nerve to reach the spinal cord.
This is called stretch reflex.
Afferent nerve form synaptic reflex arc with alpha
Neurotendinous spindles (Golgi tendon organ) Fig. 3.4 neuron through an intermediate (internuncial) neur-
on. Alpha neuron ends in extrafusal fibers which
These are fusiform or spindle-shaped proprioceptive remain in a contracted state through stimulation
receptors present in the tendons of voluntary muscle.
of alpha neurons. But when impulse is carried
They are situated in the muscle-tendon close to its
through internuncial neurons to alpha neuron, these
junction with fleshy belly. These receptors send
information to the central nervous system to make an internuncial neuron produces inhibitory effect to
individual aware of the state of tension of a muscle- alpha neuron, being inhibitory in nature. Result is
tendon. the release of tension of the muscle.
Like neuromuscular spindle, neurotendinous spin-
dles are also fusiform in outline and covered by a General proprioceptors in relation to joints
connective tissue capsule. But it is filled with parallel These sensory end organs are situated in the substance
bundles of collagen fibers along long axis of the spindle.
of capsule, ligaments and synovial membranes of
Fibroblasts are larger and more in number in between
joints. Sense of position of joints and sense of their
the bundles of collagen fibers. The myelinated nerve
pierces the capsule, looses its myelin sheath and movements are detected when these receptors are
divides into finer branches which end in knob-like stimulated. Moreover sense of stretch, pressure and
endings in between the collagen fibers. When these pain are also carried due to stimulation of these
fibers are stretched due to tension of a tendon, these receptors.
knob-like endings are squeezed and thus carry the n Types: These are of following four types
impulse. l Type I: These are nothing but Ruffini endings
n Mode of Function of Neurotendinous Spindle structurally. They carry sense of position and
(Fig. 3.8): A tendon is continuation of a muscle. A movement of the joint.

Afferent fibers carried from


Golgi tendon organ Internuncial neuron

Golgi tendon organ

Axon of alpha motor neuron supplies


extrafusal muscle fibers

Fig. 3.8 Illustration explaining mode of action of neurotendinous spindle (Golgi tendon organ)
50
Peripheral End Organs
l Type II: Structurally these are Pacinian corpu- 6. Osmoreceptors: They are stimulated by change
scles. They carry the sense of pressure. of osmotic pressure in the tissue.
l Type III: These are neurotendinous organ or
Golgi tendon organ. As found in tendons, these Structural Classification (Fig. 3.9)
are present in ligaments. Due to stretching of
In general we know that receptors are specialized
ligament these carry inhibitory impulse through
cells present in the peripheral tissue from where start
internuncial neurons of spinal cord, these prevents the sensory neurons to carry the impulse.
excessive movements of voluntary muscle. These afferent (sensory) neurons carry impulse to
l Type IV: These are free nerve endings which carry the central nervous system. Variation in this usual
pain sensations from synovial membrane. structural pattern divides receptors in three different
types. In first variety the specialized cells are
RECEPTORS OTHER WAYS OF CLASSIFICATION epithelial cell. So the receptors are called epithelial
receptors (1). Majority of the receptors are examples of
this type. Sometimes, these specialized cells forming
According to Nature of Stimulation receptors are modified neurons which are present in
1. Mechanoreceptors: These are stimulated by mec- the epithelial lining, as are the bipolar neurons in the
hanical deformation, i.e. Receptors which carry epithelial linings of nose, carrying sensation of smell
(olfactory sensation). These are called neuroepithelial
sense of
receptors (2). In third variety, no specialized cells are
i. Touch, pressure and stretch
present to be defined as receptors. In this case, free
ii. Sense of hearing Through sound waves nerve endings of peripheral dendritic processes of first
iii. Sense of body balance (equilibrium). order of sensory neurons themselves act as receptors.
2. Thermoreceptors: These are stimulated by cha- Examples are nonencapsulated exteroceptors (cutan-
nge of temperature in the environment surround- eous receptors). These are named as neuronal rece-
ing them. ptors (3).
i. Rise of temperature Heat
ii. Fall of temperature Cold. MOTOR END ORGANS (EFFECTORS)
3. Chemoreceptors: These are stimulated by chem-
ical change in their environment. Effectors are the specialized junctional areas where
i. Receptors for taste terminal ends of motor nerve fibers come in contact
ii. Receptors for smell. with effector organs. These effector organs are of
4. Nociceptors: These receptors are stimulated due following three types
to injury or damage in the tissue. Due to stimulation 1. Somatic effectors: These are skeletal muscle
of these receptor, unpleasant sensations are felt fibers (myocytes) which receive terminal ends of
like-pain, irritation or discomfort. somatic motor nerve fibers. These specialized sites
5. Photoreceptors: They are stimulated only by are known as somatic neuromuscular or myon-
light causing perception of vision. Example eural junctions.
Receptors in retina of eyeball called rods and cones 2. Visceral effectors: These are smooth muscle
cells. fibers (myocytes) which receive terminal ends of

1. Epithelial receptor 2. Neuroepithelial receptor (Bipolar 3. Neuronal receptor (Free nerve


(Pacinian corpuscles) cells of nasal mucosa) endings)

Fig. 3.9 Structural classification of receptors


51
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
autonomic motor nerve fibers (sympathetic or pa- that both terminal contractile ends of intrafusal
rasympathetic). These specialized junctional sites fibers receive gamma motor nerve endings.
are known as visceral neuromuscular or myo- Myoneural junctions, in relation to above two
neural junctions. types of muscle fibers, may show following variations.
3. Secretomotor effectors: These are specialized n A. Motor end plates or en plaque endings
junctional areas between secretomotor autonomic (Fig. 3.10): Most of the myoneural junctions are of
nerve endings and specialized contractile cells this variety. In these types, the axon terminal of a
in the walls of alveoli (acini) of exocrine glands. motor nerve comes to an oval specialized area of a
These contractile cells are known as myoepithelial muscle fiber at its center. This specialized oval area
cells. at the surface of muscle fiber is called sole plate. The
junctional area between sole plate and axon terminal
Somatic Neuromuscular Junction (Myoneural is known as motor end plates.
Junction) n B. En Grappe endings (Fig. 3.11A): In this

Each of the somatic (skeletal) muscle fibers gets variety, axon terminal runs along the length of muscle
direct contact with endings of motor nerve fibers fiber. While running along, it divides, into series of
for innervation. This site of contact is called neuro- short branches which end into knob-like endings on
muscular junction or myoneural junction. the surface of muscle fiber.
These muscle fibers are of two types n C. Trail endings (Fig. 3.11B): In this type, axon
i. Extrafusal fibers: Which receive endings of terminal run along the length of muscle fibers and
alpha neuron end in multiple finer endings.
ii. Intrafusal fibers: Which receive endings of En Grappe and trail endings are found in
gamma neuron. It has already been studied intrafusal fibers of muscle spindles.

Motor nerve fiber


Axon terminal

Skeletal muscle fiber Motor end plate (en-


(myocyte) plaque ending)

Fig. 3.10 Motor end plate


52
Peripheral End Organs
Axon terminal Axon of a motor neuron

Noncontractile Striated contractile part of


En-grappe equatorial part muscle fiber
ending containing nuclei

Axon of a motor
Axon terminal neuron
Noncontractile equatorial
part containing nuclei
Striated
contractile part

Figs 3.11A and B Neuromuscular junction of intrafusal fibers. A. En-grappe endings, B. Trail endings

MOTOR UNIT (FIGS 3.12A AND B) 2. Small: When one axonal process supplies less
number of muscle fibers (10 in number), as found
A motor unit is defined as a single alpha motor neuron in small muscles of hand for finer movements.
and number of skeletal muscle fibers (extrafusal
fibers) innervated by it. So composition of a motor Neuromuscular Junction or Myoneural
unit is as follows: Junction
i. A motor neuron cell body in central nervous It is called motor end plate which is defined as
system (alpha neuron). specialized junction between terminal end of one of the
ii. Its axonal process coming out as motor nerve divisions of axon of a motor neuron (neural element)
fiber. and a skeletal muscle fiber (muscular element).
iii. Number of muscle fibers (myocytes) innervated A motor nerve enters inside a skeletal muscle
by a single axon. along with its blood vessels for innervation through a
Depending upon the number of muscle fibers supp- point called neurovascular hilum. Inside the muscle,
lied by a single motor neuron, a motor unit may be of the nerve divides further into number of axons. One
two types axonal process divides into number of branches. Each
1. Large: When one axonal process supplies more of these branches of axon presents a terminal knob-
number of muscle fibers, as many as(!) 500, as like endings (telodendria). This terminal swelling
found in coarse muscle for gross movements, like comes in contact with a gutter or depression on mi-
Gluteus maximus (muscle of buttock). ddle of surface of a single muscle fiber (myocyte).
53
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)

Axon of a motor neuron


Axon terminal
Skeletal Motor end plate
muscle fiber

Skeletal Motor end plate Axon of a


muscle fiber Axon terminal motor neuron

Figs 3.12A and B Motor unit. A. Large motor unit, B. Small motor unit

This junctional area is called motor end plate Synaptic knob at the terminal end of division of axonal
(neuromuscular junction or myoneural junction). process is swollen because axoplasm is crowded here
with
Structure of motor end plate (Fig. 3.13) i. Many mitochondria.
ii. Large number of electron-dense, membrane
Motor end plate presents structural characteristics bound vesicles called presynaptic vesicles.
similar to that of a typical synaptic junction between These vesicles are filled with Acetylcholine
two neurons. Structure of motor end plate shows follo- which acts as neurotransmitters.
wing 3 components. At the site of motor end plate, sole plate is
1. Neural element: It is the terminal, nonmyel- characterized by a surface elevation which is at the
inated, swollen end of the division of axon of middle of the muscle fiber. This elevation is due to
motor neuron (Telodendria). It is called synaptic condensation of sarcoplasm (cytoplasm of muscle
knob. fiber) which shows granular appearance beneath the
2. Muscular element: It is the central, raised sur- sarcolemma (cell membrane of muscle fiber). This area
face of a muscle fiber with a gutter which comes also presents accumulation of more number of nuclei,
in contact with synaptic knob. This is called sole mitochondria, Golgi apparatus and endoplasmic
plate. reticulum.
3. Synaptic cleft: It is the gap between neural and The raised surface of sole plate presents a
muscular element measuring 3040 mili micron or depression called primary cleft which is related to
nanometer. axon terminal. But, as already mentioned, axolemma
54
Peripheral End Organs

Axolemma

Myelin sheath

Presynaptic vesicle
Synaptic cleft Synaptic knob

Sarcoplasm Sole plate


Sarcolemma

Receptor
Mitochondria
Nucleus

Myofilaments

Fig. 3.13 Structure of motor end plate

(cell membrane of axon) at the site of axon terminal muscle spasm, function of this drug can be utilized.
is separated by synaptic cleft from primary cleft of It becomes possible because the drug binds with
sole plate covered by sarcolemma. Surface of primary the receptors at postsynaptic membrane, thus not
cleft is thrown into number of foldings to increase the allowing acetylcholine to come in contact with the
surface area. These are called secondary cleft. Bottom receptors to result depolarization for generation of
(floor) of the secondary cleft presents specialized action potential.
features called receptors.
Myasthenia Gravis an Autoimmune Disease
Mechanism of neuromuscular transmission
Myasthenia gravis is an autoimmune disease which is
When the nerve impulse reaches axon terminal at characterized by generalized muscular weakness and
the site of neuromuscular junction, Acetylcholine muscular fatigue. Muscles of eye, face, respiration
is released from presynaptic vesicles into the syn- and swallowing are mostly affected. This disorder
aptic cleft through a process called exocytosis. Rele-
is due to formation of an antibody. This antibody
ased Acetylcholine diffuses at a high speed through
binds with many (not all) of the receptors which are
synaptic cleft and binds with the receptors at the
thereby destroyed. So acetylcholine finds less number
secondary cleft of postsynaptic membrane of sole
plate. The receptors get activated. Activation of of receptors at postsynaptic membrane to bind for
receptors causes depolarization of postsynaptic mem- generation of action potential. This disorder can be
brane which results in muscular contraction due to compensated by administration of a drug named neo-
generation of action potential. stigmine which posseses anticholinesterase activity
Contraction of a muscle fiber (so also the whole which prevents breakdown of acetylcholine at the
muscle) is to be followed by relaxation. This becomes synaptic cleft.
possible because, as soon as depolarization occurs
to cause contraction of muscle fiber, Acetylcholine Myoneural junction of smooth muscle
is broken down (hydrolyzed) by the enzyme cholin- This does not show classical structure of neuro-
esterase into choline and acetic acid. This enzyme is muscular junction or motor end plate. Axon terminal
bound to both pre as well as postsynaptic membrane. does not come in contact with surface of muscle fiber.
Choline is reutilized back into the axoplasm for re- Rather, there is considerable gap between the two.
synthesis of acetylcholine. Terminal segment of axon is nonmyelinated and may
be covered by cytoplasm of Schwann cells. At the
Neuromuscular Blocking Agent terminal end axoplasm presents vesicles containing
Tubocurarine is a drug which blocks neuromuscular neurotransmitter. In case of parasympathetic nerve
transmission. In clinical conditions causing violent ending neurotransmitter is acetylcholine, but in
55
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)

Epithelium
lining acini of
exocrine gland

Myoepithelial
cell

Axon terminal
Secretomotor
nerve axon

Fig. 3.14 Secretomotor nerve endings supplying myoepithelial cells related to acini of exocrine gland

case of sympathetic it is catecholamine (usually glandular acini or alveoli, there is no specialized


noradrenaline). In sympathetic system, monoamine junctional area. Glandular alveoli are lined by single
oxidase is the enzyme which destroys catecholamine. layer of cells resting on basement membrane. Close
In relation to muscle fibers of gastrointestinal and to the basement membrane in the substance of loose
urinary tract, some autonomic nerve endings release fibroconnective tissue there are some specialized cells
another variety of neurotransmitter called adenosine which are contractile in nature. These are called
triphosphate which is inhibitory in nature. myoepithelial cells. Autonomic secretomotor axon
terminals come in relation to these myoepithelial
NERVE ENDING RELATED TO EXOCRINE GLAND cells close to the basal surface of acinar cells.
ACINI (FIG. 3.14) Following release of neurotransmitter (acetylcholine),
myoepithelial cells contract and squeeze the acinar
Same as myoneural junction of smooth muscle, wall leading to discharge of glandular content through
in case of nerve endings of secretomotor fibers to the duct.

56
Spinal Cord
4
DEFINITION AND SITUATION n Termination: Spinal cord terminates as a coni-
cal end known as conus medullaris at the level of
Spinal cord is the distal, narrow, cylindrical and intervertebral disk between first and second lumbar
elongated part of central nervous system which is vertebrae. A connective tissue filaments known as Fil-
situated in upper two-thirds of vertebral canal as a um terminale extends from conus medullaris down-
continuation of medulla oblongata of hindbrain (Fig. wards to be attached to the back of first piece of coccyx.
4.1).
IMPORTANT NOTES IN CONNECTION WITH
ROLE OF SPINAL CORD AS A PART OF CENTRAL TERMINATION
NERVOUS SYSTEM
Upto third month of intrauterine life, rate of growth of
1. It provides innervation (nerve impulse) to the
body wall so also the vertebral column is coextensive
trunk and limbs through its peripheral outflow
known as spinal nerves. with that of spinal cord. Subsequently vertebral
2. It receives sensory information from the receptors column with the trunk grows at a rapid rate than
distributed peripherally in the trunk and limbs spinal cord, when appears the disparity in length of
and transmits to the brain. the two. At birth spinal cord is found to extend upto
3. It contains cell groups at some levels (not thro- lower border of body of third lumbar vertebra.
ughout whole length of spinal cord) which form In 40% cases of adult, spinal cord extends upto the
spinal autonomic centers (sympathetic and para- level of lower border of second lumbar vertebra or the
sympathetic) to send impulses to the autonomic disk between second and third lumbar vertebra. On
effector organs (smooth muscles and exocrine
rare occasions, spinal cord terminates at the level of
glands) and to receive sensory information from
the visceral wall. lower border of twelfth thoracic vertebra.
4. It forms local circuit (at its segmental level) kno- The knowledge of termination of spinal cord is
wn as reflex arc which regulates some bodily important for the clinicians to avoid injury to the spinal
functions at unconscious level. cord during lumbar puncture to take out cerebro-
spinal fluid.
EXTENT
PARAMETERS OF SPINAL CORD
n Beginning: Spinal cord begins as continuation of
medulla oblongata beyond foramen magnum at the l Length: 45 cm
level of upper border of 1st cervical vertebra (atlas). l Weight: 30 gm
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)

Medulla oblongata

Spinomedullary junction

Cervical part

Spinal nerve of left side seen from lateral view

Thoracic part
Spinal cord

Lumbar part

Cauda equina
Sacral part

1 Coccygeal
segment
Conus medullaris

Filum terminale

Fig. 4.1 Spinal cord (lateral view)the distal, narrow, elongated and tubular part of central nervous system

l Segments: Spinal cord is made up of 31 numbers


REGIONAL CLASSIFICATION OF SPINAL CORD
of units known as segments of spinal cord. Adjacent
SEGMENTS (FIG. 4.1)
segments cannot be demarcated on the surface. Each
of the segments gives rise to one pair of spinal nerves 31 segments of spinal cord are regionally classified as
(right and left). Each of the spinal nerves shows follows:
surface attachment of one ventral (motor or efferent) Cervical 8
and one dorsal (sensory or afferent) nerve root. The Thoracic 12
two roots unite within the vertebral canal to form a Lumbar 5
mixed spinal nerve which finally comes out through Sacral 5
intervertebral foramen. Coccygeal 1
Therefore, an universal truth is learnt that ventral It is to be noted here that number of cervical
root of a spinal nerve is made up motor fibers and its vertebrae are 7 and coccygeal pieces are 4. But the
dorsal root is composed of sensory fibers only. This is numbers of thoracic (12), lumbar (5) and sacral (5)
known as Bell-Magendies law. cord segments correspond with the same number of
It is important to note at this stage that all the respective regional vertebrae.
spinal nerve (31 pairs) are mixed in nature, composed Each of the spinal cord segments gives rise to a pair
of motor as well as sensory components. But a cranial of spinal nerve of corresponding name and number.
nerve (out of total 12 pairs) may be mixed, purely Each spinal nerve, as already mentioned is formed
motor or purely sensory. by a ventral motor (efferent) and a dorsal sensory
58
Spinal Cord

Posterior root ganglion


Anterolateral sulcus Posterolateral sulcus

Dorsal nerve root coming out


Ventral root of spinal nerve coming
through posterolateral sulcus
out through anterolateral sulcus

A spinal nerve

Fig. 4.2 Segments of spinal cord (left lateral view) showing ventral and dorsal roots of spinal nerves coming out through corresponding
sulcus

(afferent) root. Attachment of ventral roots forms a come out through sacral hiatus. To adjust the disparity
fine and shallow anterolateral sulcus and similarly of numbers of cervical spinal cord segments (8) and
posterolateral sulcus is defined along the line of atta- cervical vertebra (7), cervical spinal nerves (1st to 7th)
chment of dorsal nerve roots. Dorsal nerve roots, come out above the pedicles of corresponding vertebra
close to the site of surface attachment present a small and 8th cervical nerve comes out below the pedicle of 7th
enlargement known as posterior root ganglion which cervical vertebra, through the intervertebral foramen
contains the cell bodies of first order of sensory neurons between 7th cervical and 1st thoracic vertebra.
located outside the central nervous systems (Fig. 4.2). As the spinal cord is shorter in length than the
vertebral column, lower spinal nerves (lumbar, sacral
EXIT OF SPINAL NERVES FROM VERTEBRAL FORAMEN and coccygeal) are to descend through the vertebral
canal in the form of a bunch to reach corresponding
All the spinal nerves come out of vertebral canal intervertebral foramen. These bunch of nerves are
through the corresponding intervertebral foramina known as cauda equina as they look like a horses
except fifth sacral nerve and coccygeal nerve which tail (Fig. 4.3).

Lower end of spinal cord

Conus medullaris

Filum terminale

Bunch of lower spinal nerves forming


cauda equina before their exit through
respective intervertebral foramina

Exit of vth sacral and coccygeal nerves


through sacral hiatus

Fig. 4.3 Lower spinal nerves form cauda equina before they come out through corresponding intervertebral foramina at a lower level
59
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Key to remember level of
2 enlargement
3

Cervical enlargement
(C3T2 Segments)

Lumbosacral enlargement
(L1S3 Segments)

1 3
Key to remember level of
enlargement

Fig. 4.4 Enlargements of spinal cord

CORRELATION OF SPINAL CORD SEGMENTS WITH ENLARGEMENT (FIG. 4.4)


VERTEBRAL LEVEL The spinal cord is almost cylindrical althrough its length.
More lower is the segment of spinal cord, its distance However, it presents two expansions as enlargements.
from corresponding intervertebral foramen so also These are at the cervicothoracic (C3 T2 segments) and
the corresponding vertebra is more. Interrelations of lumbosacral (L1S3 segments) levels (Fig. 4.4). These
their levels are as follows: enlargements appear in fetal life with the formation
Spinal cord segments Vertebral level
of upper and lower limb buds, because of more amount
of motor neurons in these segments to supply limb
Upper cervical C 3 same level = C3
musculature and stretching of nerve fibers arising from
Lower carnival C 7 - 1 = C6
the plexuses for upper and lower limbs.
Upper thoracic T5 - 2 = T3
Lower thoracic T8 - 3 = T5
Lumbar (upper) L3 - 4/5 = T11 SURFACE FEATURES (FIG. 4.5)
Lumbar (lower) L5 - 4/5 = T12
Sacral /coccygeal S 1 - 6/10 = T12 Linear depression along the anterior and posterior
S 5 - 6/10 = L1 median line of spinal cord are known as anterior
median fissure and posterior median sulcus respe-
Clinical Importance of Correlation of Levels ctively. Anterior (ventral) median fissure is 3mm
In case of spinal injury, fracture dislocation of deep, but posterior (dorsal) median sulcus is comp-
vertebra may cause lesion of spinal cord segment of aratively shallower. Besides, linear depressions
the same level. A clinician will be able to judge of along the lines of attachment of ventral (motor) and
level of spinal segment affected in spinal injury from dorsal (sensory) nerve roots are respectively known
the above mentioned guidelines. Level of fracture as anterolateral and posterolateral sulcus. Spinal
dislocation of vertebra is counted through identi- arteries and venous tributaries run along the sulci
fication of vertebral landmark. and fissure. Single unpaired anterior spinal artery
60
Spinal Cord
Midline posterior Posterior median sulcus
spinal vein in posterior
median sulcus
Posterior root ganglion
Posterolateral sulcus with entry
of posterior root of spinal nerve
and presence of posterior spinal
artery and vein

Spinal nerve

Lateral anterior
spinal vein
Anterolateral sulcus with exit of
anterior root of spinal nerve and
presence of anterior spinal vein
Anterior spinal artery
with corresponding
vein in anterior median
fissure

Fig. 4.5 Surface features of spinal cord

runs down along anterior median fissure, whereas 2. Arachnoid mater


paired bilateral posterior spinal arteries descend 3. Pia mater.
along posterolateral sulci. Each of the fissure and These superimposed coverings are either in close
sulci are occupied by one of six (3 anterior and 3 post- contact to each other (dura and arachnoid) or separated
erior) spinal veins. by a space (arachnoid and pia).

COVERINGS (MENINGES) AND SPACES AROUND Dura Mater


THE SPINAL CORD (FIG. 4.6) This is tough and dense fibrous membrane made up of
Coverings (meninges) of spinal cord are the following connective tissue which contains abundant collagen
from outside inwards. fibers. It encloses spinal cord as well as cauda equina.
1. Dura mater Proximally dura mater of spinal cord extends upto

Subarachnoid space Subarachnoid septum


containing CSF
Wall of vertebral canal

Subarachnoid sheath

Spinal nerve
Dura

Meninges
of spinal
cord
{ mater

Arachnoid
mater
Pia mater
Intervertebral foramen

Epidural space Ligamentum


denticulatum
Epidural (internal
vertebral) venous plexus Linea splendens
in epidural space

Fig. 4.6 Coverings (meninges) and spaces around spinal cord


61
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
foramen magnum of cranium above which it is Arachnoid Mater
continuous with inner (meningeal) layer of dura mater
of brain. Below, dura mater extends upto lower border Arachnoid mater is a thin transparent membrane
of body of second sacral vertebra beyond lower end of covering the spinal cord. It extends upwards beyond
spinal cord to enclose cauda equina and upper larger foramen magnum to be continuous with arachnoid of
part of filum terminale. Beyond that level, dura mater brain and below extends like dura mater up to second
is continued downward enwrapping external part of sacral vertebra. Unlike dura mater, arachnoid is
filum terminale to blend with periosteum of first piece prolonged for a short distance around spinal nerves
of coccyx. At the level of each segment of spinal cord beyond intervertebral foramen. Arachnoid is sepa-
dura mater is prolonged outwards around the spinal
nerve to be attached to the margin of intervertebral rated from pia mater with spinal cord by a space
foramen. Inner surface of spinal dura is in close known as subarachnoid space, which is continuous
contact with arachnoid mater. But outer surface of above with the same space around brain. The subara-
dura is separated from vertebral canal by a space chnoid space (of spinal cord as well as brain) contains
known as epidural space. This space contains loose a thin watery fluid known as cerebrospinal fluid.
areolar tissue containing fat in semiliquid state. The Subarachnoid space containing cerebrospinal fluid
epidural space also contains plexus of veins known as is more prominent below lower end of spinal cord
epidural venous plexus or internal vertebral venous (L2S2).
plexus.
Spinal Subarachnoid Space and Clinical
Clinical Importance of Epidural (Internal- Anatomy of Lumbar Puncture (Fig. 4.7)
vertebral) Venous Plexus
Spinal subarachnoid space is the space beneath
This venous plexus extends throughout whole length the arachnoid mater covering the spinal cord. It
of vertebral canal and it is proximally connected to is continuous with the subarachnoid space over
the veins of skull. In the vertebral canal it receives the brain and contains cerebrospinal fluid. The
basivertebral veins and also veins from the viscera subarachnoid space around the spinal cord becomes
(e.g. prostate). These communications may be hazar- more spacious below the termination of spinal
dous to cause spread of cancer cells (metastasis) from cord (L2) upto its lower limit (S2), which contains
viscera like prostate to vertebral bodies and even cerebrospinal fluid of considerable amount and is
cranial bones. known as lumbar cistern.

L1
Conus medullaris of
spinal cord
L2
Subarachnoid space
L3
Lumbar vertebrae
Lumbar puncture needle inserted
L4 between L3 and L4 spine

L5
Interspinous and
supraspinous ligaments
S1

S2

Sacrum
S3
Dura and arachnoid ending at the
S4 level of lower border of S2 vertebra

S5

Filum terminale attached to back of


Coccyx 1st piece of coccyx

Fig. 4.7 Distal part of vertebral canal in sagittal section and prominent spinal subarachnoid space with illustration for site of lumbar puncture
62
Spinal Cord
Lumbar Puncture (Spinal Tap) layer of fibroreticular tissue into which is embedded
network of fine blood vessels. Spinal pia mater
Various diseases of spinal cord so also whole central
presents following special features.
nervous system may cause abnormal increase in
n Filum terminale: It is a thin, white, delicate and
normally freely flowing quantity of cerebrospinal
fluid or may cause change of physical, biochemical or shining thread-like structure which extends vertically
microscopical characteristics of cerebrospinal fluid. In downwards from conus medullaris of spinal cord. Its
these cases for diagnosis and treatment of the disease, lower end is attached to the dorsal aspect of first piece
cerebrospinal fluid (CSF) may be required to be drawn of coccyx.
out from lumbar cistern below the termination of Length 20cm
spinal cord. Again some drugs may be required to be Structural composition: It is mainly composed
injected into the spinal subarachnoid space (lumbar of nonnervous pial connective tissue. But its upper
cistern) for treatment of some neurological disease or end also contains nervous element. It is supposed to
for induction of (spinal) anesthesia. This procedure is be rudiments of 2nd, 3rd and 4th coccygeal nerve.
known as lumbar puncture (spinal tap). Central canal of spinal cord extends beyond conus
medullaris for about 5mm in the upper end of filum
Anatomical Guidelines for Lumbar Puncture terminale, which is called terminal ventricle.
(Fig. 4.7) Parts: Spinal dura and arachnoid end at the level
l Site: Puncture (introduction of needle cannula to of 2nd sacral vertebra. But filum terminale extends
draw fluid) is done through the interspinous space from L1/L2 vertebra to 1st piece of coccyx. That is why
of vertebral column. it is divided into following two parts.
l Level: Spinal cord normally extends upto the level 1. Filum terminale internum: It is proximal 15cm
of intervertebral disk between 1st and 2nd lumbar lying inside subarachnoid space.
vertebrae. On rare occasion it may extend lower 2. Filum terminale externum: It is distal 5mm which
down upto 2nd lumbar vertebra. Ideal level for is beyond S2 vertebra.
puncture is the space between 3rd and 4th lumbar n Linea splendens: It is condensation of pia mater
spines. along the anterior median line of spinal cord, where it
l How to locate the levels of lumbar spines: Trans- dips into anterior median fissure.
cristal line is the line passing through the level of n Subarachnoid septum: It is a thin fenestrated
highest point of both iliac crests. It passes through pial septum along the posterior median line of spinal
the level of 4th lumbar spine which will help to cord extending from posterior median sulcus to deep
locate the interspinous space between 3rd and 4th surface of arachnoid mater.
lumbar spines. n Ligamentum denticulatum: This is a bilateral
l Position of body: Trunk of the body so also the
pial septum extending throughout whole length of
vertebral column must be ventrally flexed either
in lateral lying down position in bed or in sitting spinal cord in between lines of attachment of ventral
position to achieve two advantages. and dorsal nerve roots. Lateral margin of ligamentum
i. Interspinous space becomes wider. denticulatum is ragged and presents 21 tooth like
ii. Lower end of spinal cord is raised slightly pointed projections. First pair is situated above the
upwards. margin of foramen magnum of skull. Last pair is
longer and oblique. It is attached at the level of conus
Knowledge of Planes of Puncture medullaris and descends obliquerly downwards and
laterally between twelfth thoracic and first lumbar
During introduction of the needle-cannula, gentle nerves.
and uniform (sustained) pressure is to be applied.
After supraspinous and interspinous ligaments, and
tough layer of dura mater are penetrated, suddenly a INTERNAL STRUCTURE OF SPINAL CORD
loss of resistance is felt. It confirms that needle has n Embryological background: Knowledge of internal
reached the subarachnoid space. At this stage patient
structure of spinal cord is based on fundamental
may feel tingling root pain as nerve of cauda equina is
concept of its embryological background. Spinal cord
touched by the tip of needle. But it is just for a while
is developed from caudal elongated narrow tubular
as it floats away in the cerebrospinal fluid.
portion of neural tube which is ectodermal in origin.
Pia Mater At 4th week of intrauterine life surface ectoderm
along the midline gets condensed anteroposteriorly
Pia mater is a thin delicate membrane which closely known as neural plate (Fig. 4.8). Neural plate lies
invests the surface of spinal cord. It is made up of fine dorsal to notocord which is related on either side to
63
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Neural plate
Ectoderm
Notochord
Mesoderm

Endoderm
A

Neural groove
Neural crest

Ependyma
Surface
ectoderm Neural tube
Neural crest cells

Proliferating cells

E F

Figs 4.8A to F Illustrating development of spinal cord. A. Embryonic disk (Sectional view), B. Formation of neural plate, C. Formation of
neural groove, D. Formation of neural crest, E. Neural tube lined by single layer neuroectodermal cells, F. Proliferation of neural tube cells

secondary mesoderm. The neural plate gradually


FORMATION OF DIFFERENT ZONES OF SPINAL CORD
becomes grooved or folded cephalocaudally along its
long axis to form neural groove. This causes elevation
(FIG. 4.9A)
of two parallel ridges known as neural crests. It is The whole neural tube is initially lined by single layer
followed by two changes. Some cells of neural crest of ectodermal cells known as neuroectoderm. Part of
get detached and migrate ventrally on either side of the tube giving rise to spinal cord, shows proliferation
midline beneath surface ectoderm. These are named of cells same as proximal part. The canal of neural tube
neural crest cells. Secondly, the neural groove grad- becomes a narrow cleft and shows thickening of lateral
ually deepens more and more with prominence of both wall. Its thin dorsal and ventral walls are known as
sided neural crests which finally fuse to form neural roof plate and floor plate. The original inner lining is
tube. Fusion starts from the middle and proceed known as ependymal layer or matrix cell layer. This
toward both cephalic and caudal ends. Just before 6th layer of cells ultimately forms columnar epithelium
week of intrauterine life, when closed neural tube is lining the central canal of spinal cord known as
formed, cephalic and caudal ends present openings ependymal cells. Free surface of these cells shows
known as anterior and posterior neuropores. Cephalic presence of ultramicroscopic finger-like, nonmotile
end of neural tube shows three dilatations known as processes known as stereocillia. Proliferated daughter
forebrain, midbrain and hindbrain vesicles which will cells, pushed to the periphery, form mantle layer. Cells
from brain. Caudal narrow, elongated tubular part of of this layer shows differentiation into two types which
neural tube forms spinal cord. are called neuroblasts and spongioblasts. Neuroblasts
64
Spinal Cord

Neural crest cells

Alar lamina Ependyma

Mantle
layer
(zone)
{ Basal lamina
Mantle zone

Marginal zone

Fig. 4.9A Differentiation of mantle and marginal zones

Sensory neurons
developed in alar
lamina

Posterior root
ganglion cells

Spinal nerve

Motor neurons
developed in
basal lamina

Fig. 4.9B Formation of different fundamental cells of spinal cord

will form neurons of spinal cord whose processes will divided into dorsal and ventral groups by two
be elongated to be pushed to the periphery to form parallel cephalocaudal linear grooves on lateral
more peripheral marginal zone. Spongioblasts will wall of ependymal lining called sulcus limitans.
form supporting cells (neuroglia) of larger size known Ventral and dorsal groups of neurons are known
as macroglia (astrocytes and oligodendrocytes). The as Basal and Alar lamina respectively. Neurons
most of the glial cells are pushed to the peripheral of basal lamina will be motor neurons and
marginal zone. Cells bodies of neurons present in
those of alar lamina will form sensory neurons.
the mantle zone showing grayish appearance will
Alar laminae of both sides are apposed towards
form central gray matter of spinal cord. Processes of
neurons (nerve fibers) located in peripheral marginal each other so obliterating dorsal part of central
zone will be myelinated by oligodendrocyte group of canal of spinal cord. Two basal laminae diverge
cells of macroglia. This myelination will give whitish ventrolaterally forming future ventral median
appearance of marginal zone of spinal cord for which fissure of spinal cord.
it is called white matter. The neurons of basal lamina from two different
cell columns as
FORMATION OF DIFFERENT FUNCTIONAL CELL i. Somatic efferent (motor): Medial and close to
GROUPS (FIG. 4.9B) floor plate. The processes of these neurons
will supply voluntary (skeletal) muscles after
1. Cells of ependymal (matrix) layer: As already leaving the spinal cord through ventral root of
stated, these are original cell layer lining central spinal nerve.
canal of spinal cord called ependymal cells. ii. Visceral efferent (motor): Lateral to and away
The cells lined by stereocilia posses absorptive from floor plate. Their processes leave spinal
function. cord also through ventral root of spinal nerve
2. Cells of mantle zone: On either side of midline as preganglionic fibers for involuntary (smo-
the neurons developed from neuroblasts are oth) muscles and exocrine glands.
65
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
The neurons of alar lamina form the following the segments of spinal cord by two roots known as
cell columns. anterior (ventral) and posterior (dorsal) roots. Along
i. Somatic afferent (Sensory): This cell column is the length of spinal cord anterior and posterior roots
medial and close to roof plate. Neurons of this are attached along the lines of anterolateral sulcus
column receive connections from the sensory and posterolateral sulcus respectively. Anterior or
cells outside central nervous system (posterior ventral roots of spinal nerve are outgoing (efferent)
root ganglia cells) carrying somatic sensation fibers of spinal nerve which go to the peripheral target
from peripheral receptors. organs, e.g. muscles or glands. They are called motor
ii. Visceral afferent (Sensory): These neurons or efferent fibers. Posterior or dorsal roots of spinal
form cell column which is lateral to somatic nerve are the incoming (afferent) fibers of spinal nerve
afferent column and away from roof plate. which carry informations from peripheral sensory end
They receive sensory impulse from the wall of organs known as receptors. They are called sensory
viscera via posterior root ganglia cells. or afferent fibers.
Somatic efferent and somatic afferent cell columns All spinal nerves are mixed nerve: It is very clear
of gray matter of spinal cord extend throughout from the above that each of the spinal nerves, either
whole length of spinal cord to be present in all 31 right or left, is composed of outgoing or efferent
segments of spinal cord. Visceral efferent and visceral (motor) and incoming or afferent (sensory) fibers. So
afferent cell columns being close to each other in the all of them are considered as mixed nerve.
intermediate and lateral area of gray matter form It is to be remembered at this stage that, out of
spinal center of autonomic nervous system. 12 pair of cranial nerve, some are mixed like spinal
But these cell groups, unlike somatic centers do not nerve, whereas others are either motor or sensory.
extend throughout all the segments of spinal cord.
Neuronal groups of these columns extending from 1st INTERNAL STRUCTURE OF SPINAL CORD
thoracic (T1) to 2nd lumbar (L2) segments of spinal
cord form sympathetic center and those of second, Internal structure of spinal cord can be understood
third and fourth sacral (S2, S3 and S4) segments through the study of its cross section (Fig. 4.10).
form parasympathetic center of spinal autonomic Cross section of spinal cord shows fundamentally
nervous system. following two components.
Beside the above four groups of neurons developed 1. Central gray matter: This is so called due to
in the mantle zone (gray matter) of spinal cord, some grayish color of cell bodies of neurons. Central
cells are known as interneurons or internuncial zones of gray matter looks like butterfly on cross
neurons which are functionally connecting neurons. section. Roughly it resembles the capital letter
3. Cell of marginal zone(Marcoglia): They are H. Intermediate bar of H represents the body,
supporting cells called marcoglia group of neuroglia whereas wings of butterfly are represented by two
which are astrocytes and oligodendrocytes. Some limbs of the letter.
glial cells are also present in mantle zone. Astro- Basic components of spinal gray matter: Inter-
cytes form connecting link between neurons and mediate part of spinal gray matter is traversed
capillaries for selective transport of nutritive centrally be central canal of spinal cord throughout
substances from capillaries to neurons and prev- its whole length.
enting entry of toxic materials (blood neuron Central canal of spinal cord is lined by ependymal
barrier). cells. The gray matter anterior and posterior to
4. Migrated cells from bloodstream (Microglia): central canal are known as anterior and posterior
Microglia are characterized by letter M. It is gray commissures respectively.
mesodermal in origin, derived from, monocytes Each side of spinal cord gray matter is composed
and migratory in nature to act as macrophages. of following components:
a) Anterior known as anterior horn
b) Intermediate area
PERIPHERAL OUTFLOW OF SPINAL CORD
c) Posterior known as posterior horn.
When considered the whole length of spinal cord,
Spinal Nerves anterior gray horn forms the anterior gray column and
Spinal cord is made up of 31 segments. These segments posterior gray horn forms the posterior gray column.
are numbered regionally as Cervical-8, Thoracic-12, In addition to the above mentioned three comp-
Lumbar-5, Sacral-5 and Coccygeal-1. A pair of nerve onents, first thoracic to second lumbar segments
(right and left) is attached to the surface of each of (T1 L2) of spinal cord gray matter show a lateral
66
Spinal Cord
Posterior median
septum
Posterior funiculus
Posterior gray
commissure

Posterior gray horn

Intermediolateral
gray horn
Lateral funiculus

Anterior gray horn

Anterior white
commissure Anterior gray
commissure
Anterior
funiculus
Anterior median
fissure

Fig. 4.10 Fundamental components of internal structure of spinal cord

projection of intermediate area, which is known as of white matter known as anterior white
intermediolateral cell column. Neurons of this area commissure.
constitute sympathetic center of autonomic nervous b) Lateral funiculus: It is the part of white mat-
system. It is important to note at this stage that spinal ter demarcated between outgoing fibers of
center of parasympathetic nervous system is formed ventral root and incoming fibers of dorsal root
by neurons of intermediate area of second, third and of spinal nerve.
fourth (S2, S3 and S4) sacral segments of spinal cord. c) Posterior funiculus: It is the part of white matter
The different components so also the entire gray between posterior median sulcus and incoming
matter of spinal cord show variations in appearance fibers of dorsal root of spinal nerve attached to
in different regions of spinal cord, because it depends the posterolateral sulcus. Posterior funiculi of
upon the relative amount of nerve cells. Basically gray both sides are separated incompletely or even
matter is proportionately broader in lower cervical completely by posterior median septum.
and lumbosacral regions of spinal cord. The bundles of fibers either ascending (sensory or
2. Peripheral white matter: This is mainly made afferent) or descending (motor or efferent) are called
up of compact bundles of nerve fibers running tracts or fasciculi (Singular-Fasciculus).
vertically either in ascending or in descending It is interesting to note at this stage that posterior
direction.
funiculus is composed of only ascending tracts wher-
These fibers in the bundles are myelinated. The
eas anterior and lateral funiculi are composed of both
lipid-protein substance of myelin sheath of nerve
ascending as well as descending tracts.
fibers is white in color for which this peripheral zone
n Fundamental cell groups of spinal gray matter:
of spinal cord is called white matter.
All neurons of spinal cord are multipolar.
The bundles of ascending fibers carry sensory
Fundamentally the three different zones of spinal
informations to the centers of brain above the level
of spinal cord. The descending bundles carry impulse gray matter are made up of following four different
from higher motor centers of brain (above spinal cord) neuronal groups.
to the motor neurons situated in anterior horn of 1. Posterior horn: Sensory (afferent ) or tract neurons
spinal cord. 2. Anterior horn: Motor (efferent) neurons.
On either side of midline, the white matter is 3. Intermediate area:
composed of following three components called i. Interconnecting neurons (interneurons), and
Funiculi (Singular Funiculus). ii. Parasympathetic neurons at S2, S3 and S4
a) Anterior funiculus: It is the part of white segments only.
matter between anterior median fissure and 4. Intermediolateral area: Sympathetic neurons
anterolateral sulcus presenting outgoing fibe- (only T1 L2 segmetns).
rs of ventral nerve root. Anterior funiculi of Both the sympathetic as well as parasympathetic
two sides are bridged by a thin midline strip areas are composed of motor and sensory neurons.
67
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Somatic afferent neuron
Internuncial neuron
Tract neurons
Visceral afferent neuron
Sensory neuron Primary sensory
neurons

Carrying
somatic
Skin sensation
Carrying
visceral
sensation

Supplying
smooth muscles,
exocrine glands

Supplying
voluntary
muscles

Visceral efferent neuron


Voluntary muscle

Motor neuron Somatic efferent neuron

Fig. 4.11 Fundamental types of neurons of spinal gray matter

Functional classification of neurons of spinal terminate in extrafusal fibers of voluntary


gray matter (Fig. 4.11): muscles, stimulation of which results in musc-
A. Tract neurons: These are sensory or afferent ular contraction.
neurons present in posterior horn. ii. Gamma motor neurons: Cell bodies of these
They are so called because their axons form neurons are less than 25 microns in size and
compact bundles of ascending (sensory) tracts to relay their axons terminate in intrafusal fibers of
in higher centers in brain. voluntary muscles, stimulation of which is
They receive synaptic connections from central concerned with increase in muscle tone.
process of pseudounipolar neurons of posterior root C. Interneurons (internuncial neurons): These
ganglion which collect sensory informations from are example of short axoned Golgi type II neurons.
peripheral sensory end organs (receptors). Their axon as well as dendrite are shorter being
confined in the gray matter of spinal cord.
It is important to note at this stage that axons of
Functionally they are interconnecting in nature
tract cells may ascend in the same side or may cross
forming synaptic link between sensory and motor
the midline and then ascend along opposite side of
neuron which together form a local reflex arc (Fig.
spinal cord to form uncrossed (ipsilateral) or crossed
4.11).
(contralateral) tracts respectively. Internuncial neuron also leads to an advantage
B. Motor neurons (efferent neurons): The neu- by connecting one first order of neuron, through its
rons of anterior horn are motor neurons. Their axons, multiple axon collateral, to the multiple third order of
leaving spinal cord through ventral root, end in neurons.
voluntary muscles via spinal nerve. Further classification of motor and sensory neurons
These motor neurons of spinal cord are called lower (Fig. 4.11):
motor neurons on which relay the axons of nerve cells It is already understood from the knowledge of
situated at higher centers (brain) which are called embryological background that, mantle zone of
upper motor neurons. developing spinal cord forming gray matter forms
Motor neurons of anterior horn of spinal cord four column of cells which are as follows from ventral
sending axons to voluntary muscles are of two types: to dorsal aspect.
i. Alpha motor neurons: Their cell bodies are 1. Somatic motor (efferent)
more than 25 microns in size and their axon 2. Visceral motor (efferent)
68
Spinal Cord
3. Visceral sensory (afferent)
VARIOUS CELL GROUPS OF SPINAL GRAY
4. Somatic sensory (afferent).
Among above four cell groups somatic efferent
MATTER (FIG. 4.12A)
and somatic afferent cell groups extend over all the Throughout the length of spinal cord, different neu-
31 segments of spinal cord in anterior and posterior ronal groups are present in the form of linear columns.
gray columns (horns) respectively. Somatic efferent Following two fundamental points are to be noted
neurons of anterior horn send axons to voluntary or before individual cell groups are studied.
skeletal (somatic) muscles. Somatic afferent neurons 1. Some of the cell columns extend throughout whole
of posterior horn from tract neurons whose axons length of spinal cord, but some cover part of its
form ascending tracts. length.
Visceral efferent and visceral afferent neurons do 2. Cell groups are primarily subdivided into following
not extend throughout whole length of spinal cord, areas.
but are present in two levels as follows: l Posterior gray column: Tract (sensory) neurons.
a) T1 L2 segments of spinal cord: Here both the l Intermediate area: Autonomic neurons and inte-
motor and sensory cell groups form additional rneurons.
horns called intermediolateral horn, where l Anterior gray column: Motor neurons.
visceral efferent and visceral afferent cell
groups form motor and sensory centers of symp- CELL GROUPS IN POSTERIOR GRAY COLUMN
athetic part of autonomic nervous system res- (FIG. 4.12A)
pectively.
b) S2, S3 and S4 segments of spinal cord: Here the From apex towards the base they are as follows:
cell groups are present in intermediate area of 1. Nucleus marginalis: It is ill-defined, thin strip
gray matter without forming any additional of gray matter extending throughout whole length
lateral horn. Visceral efferent and visceral of spinal cord. It contains neurons of varying size
afferent neurons in these cell groups form with intermingling reticulum of fibers.
motor and sensory centers of parasympathetic 2. Substantia gelatinosa of Rolando: It is a
part of autonomic nervous system respectively. narrow area extending throughout the whole
length of spinal cord. Afferent fibers, entering
INTERNAL STRUCTURE OF SPINAL GRAY MATTER through posterior nerve root which carry pain and
temperature sensations from synaptic connection
Gray matter of spinal cord, as mentioned earlier, is with these neurons. Axons of these neurons
so called because of grayish coloration of cell bodies cross midline and ascend through contralateral
of neurons. But apart from the neuronal cell bodies, lateral white column of spinal cord to form lateral
spinal gray matter is composed of neuronal processes, spinothalamic tract.
neuronal junctions (synapses), neuroglia and blood 3. Nucleus proprius: It is the main bulk of neurons
vessels. in posterior horn and extend throughout whole
Nucleus marginalis

Substantia gelatinosa
of Rolando
Nucleus proprius
Clarkes column (nucl. dorsalis)
Visceral afferent column
Intermediomedial cell column
Intermediolateral cell
(spinal parasympathetic center)
column
(Spinal symp center) Substantia gelatinosa centralis
Retrodorsolateral group
Dorsolateral group Central group

Dorsomedial group
Ventrolateral group
Ventromedial group

Fig. 4.12A Cell groups spinal cord gray matter


69
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
length of spinal cord. Nucleus proprius consists of i. Intermediolateral: These cell groups extend
following neurons. from C8/T1 to L2/L3 segments of spinal cord and
i. Some of these cells receive incoming posterior form an outward projection called intermedio-
nerve root fibers which carry sensations of lateral cell column. These cells form motor
crude touch and pressure. However it is told center for sympathetic part of autonomic
these days that crude touch and pressure nervous system and send out axons which leave
fibers end in many cell group of posterior horn. the spinal cord through ventral nerve root.
ii. Axons of some of cells of nucleus proprius link ii. Intermediomedial: These functional cell groups
adjacent segments of spinal cord for intraspinal are present only in S2, S3 and S4 segments
coordination. of spinal cord. But their existance does not
4. Nucleus dorsalis (Clarkes column): It is also show any outward projection in intermediate
called nucleus thoracis. It extends from eighth gray column of spinal cord. These cells form
cervical to third or fourth lumbar segments of spinal center for parasympathetic component
spinal cord. Nucleus dorsalis or Clarkes column of of autonomic nervous system. Their axons
cells are situated on medial side of base of dorsal also pass out through ventral nerve root of
gray horn and show a projection on posterior white corresponding sacral nerve.
column of spinal cord. Neurons of this column
of varying size and shape are of following two CELL GROUPS IN ANTERIOR GRAY COLUMN (FIG.
varieties. 4.12A)
i. Neurons which receive incoming afferent fibe-
rs via nerve root carrying unconscious propr- Cells of these groups are variable in size and are
ioceptive sensation from muscle spindle and either motor neurons or interneurons.
Golgi tendon organs. These neurons send axo- Neurons, whose cell body size is more than 25
ns which ascend through marginal strip of microns, are known as alpha motor neurons. Their
lateral white column forming dorsal as well as axons leave spinal cord via ventral nerve root
anterior spinocerebellar tract. and supply extrafusal fibers of voluntary muscle,
ii. Interneurons of Golgi type II characterized by stimulation of which is responsible for initiation of
short dendrites as well as short axons. movements of voluntary muscle.
5. Visceral afferent cell column: These cell Neurons, whose cell body size in between 15 to
groups are situated lateral to Clarkes column of 25 microns are either interneurons or gamma motor
cells at the base of dorsal gray horn. But it exists neurons. Gamma motor neurons, through their out-
in following two levels of spinal cord. going axons passing through the ventral root of spinal
i. T1 to L1/L2 segments of spinal cord: The cell nerve, supply intrafusal fibers of muscle spindle
stimulation of which is responsible for maintenance
groups receive sympathetic afferent fibers
of muscle tone.
which enter the spinal cord through posterior
Motor neurons of anterior gray column of spinal
root of spinal nerve. It receives sensations
cord are divided into three groups Medial, lateral
from wall of viscera.
and central. These groups extend for varying level in
ii. S2, S3 and S4 segments of spinal cord: These
spinal cord.
cell groups receive parasympathetic afferent Medial group extends throughout whole length of
fibers which also enter the spinal cord through spinal cord. It may be deficient in fifth lumbar and
posterior root of spinal nerve. It receives first sacral segment. In thoracic and upper lumbar
parasympathetic sensation from the wall level medial group of anterior horn cells is divided
of the viscera wherefrom carried via pelvic into ventromedial and dorsomedial parts. Neurons
splanchnic nerve. of medial column are concerned with innervation of
axial musculature, i.e. muscles of trunk.
CELL GROUPS IN INTERMEDIATE AREA OF SPI- Lateral group exists only in the segments of lower
NAL GRAY MATTER (FIG. 4.12A) cervical and lumbosacral enlargements of spinal cord,
as cells of this group innervate musculature of upper
Cells are fundamentally classified in two groups. and lower limb respectively.
n Interneurons: These interneurons link between Cell group of lateral column is divided into vent-
sensory neuron of dorsal horn and motor neuron rolateral, dorsolateral and retrodorsolateral compon-
of ventral horn, so form a local circuit of reflex arc. ents.
n Autonomic motor neurons: Having following Nucleus of Onuf: These are cells of ventrolateral
two components, which are not coexistant in a group at first and second sacral segments which
spinal segment. supply perineal striated muscles.
70
Spinal Cord
Central group of neurons form independent colu- laminae are ten in number, which are sequentially
mn in cervical and lumbosacral segments only. numbered from the dorsal horn side towards ventral
In cervical segments central group forms following horn, as per Roman numerals.
two nuclei. The cells of these laminae are classified according
l Phrenic nerve nucleus: It extends from C3C5 to shape, size, density and cytological characteristics.
segments of spinal cord. Their axons, forming These laminae corresponds more or less to the
independent phrenic nerve, supply musculature different cell-groups stated earlier.
of diaphragm which is very important respiratory n Lamina I: It is also called lamina marginalis. It is
muscles. Recent study shows phrenic nerve nuc- a very thin layer on the tip of dorsal horn. This lamina
leus extends up to C7 segments. is composed of cells of different size and shape with
l Nucleus of spinal accessory nerve: It is formed by intermingling fibers giving a reticular appearance.
central group of anterior horn cells from C1C5 n Lamina II: It is made up of densely packed and
segment of spinal cord. Axons of these cells form darkly stained cells with nonmyelinated fibers. It is a
spinal root of accessory nerve which supplies part of substantia gelatinosa.
sternomastoid and trapezius muscles. n Lamina III: It is made up of loosely packed and
Though existance of lumbosacral segments of large sized cells with myelinated fibers. This lamina
central group is established, their function is not is made up of cells of nucleus proprius and some cells
yet clear. of substantia gelatinosa.
n Lamina IV: It is thick and homogeneous lamina
CELL GROUPS AROUND CENTRAL CANAL (FIG. forming nucleus proprius.
4.12A) n Lamina V and VI: These two laminae constitute
base of posterior horn. Cells of this laminae receive,
This is the area which forms anterior and posterior i. Afferent fibers carrying proprioceptive sens-
gray commissures. It extends throughout whole ations and sensation from viscera.
length of spinal cord. This area is populated by neur- ii. Projections from corticospinal tracts which
oglia and nonspecific neurons. This area is called suggests that they are concerned with regu-
substantia gelatinosa centralis. lation of movement.
n Lamina VII: It contains following cell group
REXEDS LAMINATION OF SPINAL GRAY MATTER i. Intermediolateral cell group: Cells of sympat-
(FIG. 4.12B) hetic center of autonomic nervous system.
ii. Intermediomedial cell group: Cell forming
On cross-section of spinal cord, cells of various spinal parasympathetic center of autonomic
columns of spinal gray matter represent a strip-like nervous system.
appearance which is called Rexed lamination. These iii. Clarkes column of cells.

Lamina I

Lamina II

Lamina III

Lamina IV
Lamina V

Lamina VI
Lamina VII
Lamina X
Lamina VIII

Lamina IX Lamina IX (medial)


(lateral)

Fig. 4.12B Rexed lamination of spinal cord gray matter


71
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
n Lamina VIII: It is made up of interneurons which which are motor area of cerebral cortex or other sub-
receive terminals from cortical centers. Fibers of the descending tracts relay
i. Cells of adjacent laminae of same side in lower motor neurons (LMN) located in anterior
ii. Cells of lamina VIII of opposite side through horn of spinal gray matter to give command for motor
gray commissures. activities.
n Lamina IX: This lamina presents lateral and Some fibers of spinal white matter ascend or
medial strips which are made up of descend for a few segments and localized entirely in
i. Alpha and gamma motor neurons spinal cord for intersegmental coordination. These
ii. Interneurons. are called propriospinal tract.
n Lamina X: These are the nonspecific cells of
anterior and posterior gray commissures encircling Ascending Tracts
central canal. Ascending tract is a part of sensory pathway. Sensory
pathway transmits sensory inputs (impulse) from
INTERNAL STRUCTURE OF SPINAL WHITE MATTER peripheral receptors to concerned sensory areas of
brain through chain of neurons. Mostly the chain
Each of the funiculi (Singularfuniculus) of white
is made up of three neurons called neurons of first,
matter of spinal cord is mostly made up of vertically
second and third orders (Fig. 4.13).
running fibers, parallel to the length of spinal cord.
First order neuron is called primary sensory
These fibers posses following characteristics.
neuron. Its cell body is situated in posterior root
1. The fibers vary in caliber having the range from ganglion of spinal nerve. Peripheral process of this
110 mm. neuron carries sensory impulse from receptors or
2. They are either myelinated or nonmyelinated. sensory end organs. Its central process or axon, ent-
3. The fibers are grouped in bundles. Those of ering the spinal cord, will have either of the follo-wing
one particular bundle have common origin and two fates:
common destination. These bundles are tracts i. It terminates in different laminae of posterior
which are mostly of following two types. gray horn of spinal cord to relay in the tract
n Ascending Tracts: They carry sensory infor- neuron. These are short primary sensory neu-
mation from the level of spinal cord to the higher rons.
sensory areas of central nervous system ultimately to ii. Axons of some primary sensory neuron (called
reach sensory area of cerebral cortex. long primary sensory neurons) run vertically
n Descending Tracts: These are axons of upper upwards through white matter of spinal cord
motor neurons (UMN) located in supraspinal centers to relay in some cell groups or nuclei above the

Third order neuron


(thalamic nuclei)

Second order neuron


above spinal cord

Ascending tract

Long primary Second order neuron in spinal


sensory neuron cord (Tract cell)

Short primary
sensory neuron

Fig. 4.13 Principle of formation of ascending tract as a part of sensory pathway made up of three orders of neuron
72
Spinal Cord
level of spinal cord, e.g. nucleus gracilis and Before further study of ascending tracts, it is impor-
nucleus cuneatus of medulla oblongata. tant to note following points.
Axons of tract neurons of spinal cord and axons 1. Only major ascending tracts from above table are
of long primary sensory neuron, as compact bundles, described below.
carrying one specific type of sensation (exteroceptive 2. All ascending tracts (so also descending tract) are
or proprioceptive), ascend through different funiculi bilateral, and symmetrical in position in both side.
of spinal cord to form ascending tracts. 3. Fibers of adjacent tracts may present overlapping.
Second order neurons are therefore tract neurons 4. Some of the tracts are uncrossed (ipsilateral) and
of spinal cord, or some nuclei above spinal cord, where some are crossed (contralateral). Decussation (cro-
long primary sensory neurons relay. ssing) occurs mostly at the level of spinal cord.
Third order neuron is present in the thalamus Some cross in supraspinal level. For example,
in the form of different nuclei receiving inputs for ventral (anterior) spinocerebellar tract crosses at
the level of midbrain.
different sensations. Axons of third order of neurons
5. Ascending tracts are described below only upto the
finally send projection fibers to sensory areas of
level of their primary destination beyond spinal
cerebral cortex.
cord. Their further course has been mentioned
At this stage, it is important to repeat that ascending
while studied cross section (internal structure) of
tract and sensory pathways are not synonymous different levels of brainstem and forebrain.
term. It is already understood that ascending tract is
a part of sensory pathway. It is further important to Dorsal column (Fig. 4.14)
note that, some of sensory pathway is made up of less
than three neuronal chain, e.g. pathway for spino- Note: Reader must consult the figure while reading.
This is the ascending tract passing through dorsal
cerebellar tract. Again, some are composed of more
white column of spinal cord for which it is so called.
than three orders of neurons, e.g. visual pathway.
Dorsal white column or posterior funiculus is made up
l Classification of ascending tracts on functional
of this ascending tract which is ipsilateral in nature.
basis:
Dorsal column transmits following sensory infor-
A tract, as classified below, may carry either mations.
exteroceptive or proprioceptive sensation. Again one 1. Exteroceptive: Discrimination touch with the
may transmit sensations of both these kinds. help of ability to localize two points touched very
Type of sensation Name of tract closely on the body surface.
2. Proprioceptive: Sense of position and movements
Discriminative touch, i.e. ability Tracts of posterior funiculus,
to localize two points touched very called dorsal column (fasc-
from muscles and joints, and vibration sense.
close to each other on skin, fine iculus gracilis and fascic- Discriminative touch (and pressure also) sensation
touch or light touch, sense of vibr- ulus cuneatus). is carried from peripheral receptors to the spinal cord
ation, sense of position and move- through its posterior nerve root. Primary sensory
-ments carried from muscles and
joints.
neurons carrying this exteroceptive sensation are
called long primary sensory neurons because their
Pain and thermal sensation Lateral spinothalamic tract. axons, i.e. central process of the posterior root ganglia
(heat or cold).
cells, do not form synaptic connection with spinal
Crude touch and pressure. Anterior spinothalamic tract. sensory neurons. They pass vertically upwards
Unconscious information (unconsc- Dorsal (posterior) and ven- through the posterior funiculus to form the dorsal
ious proprioceptive) from muscles, tral (anterior) spinocere- column tract.
tendons, joints and even from sub- bellar tract. Short primary sensory neurons carrying vibration
cutaneous tissue for automatic,
stereotyped postural adjustment sense and sense of position and movements from
of body. muscles and joints relay in tract cell in Clerkes
Pain, thermal and tactile informa- Spinotectal tract to superior
column and other cell group of laminae IV to VI.
tion to the midbrain level for reflex colliculus of tectum of Axons of these second order neuron ascend through
visual response through pathway midbrain. posterior column to take part in formation of dorsal
for spinovisual reflex. column tract along with axons of long primary
Impulse from skin, muscles and Spinoreticular tract sensory neurons carrying discriminative touch (and
joints to reticular nuclei of brain- also pressure to some extent).
stem for awakefulness. So, it is clear from above description that, dorsal
An alternative and indirect Spinoolivary tract (part of column tract is formed by axons of two different kinds
pathway of spinocerebellar tract. spinoolivocerebellar tract). as follows.
73
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Nucleus gracilis

Nucleus cuneatus
Central canal
Fasciculus cuneatus Fasciculus gracilis

Cross section of lower half of


medulla oblongata

Fasciculus cuneatus

Fasciculus gracilis
} = Dorsal column

Posterointermediate
septum demarcating
fasciculus gracilis from
Short primary afferent neuron carrying fasciculus cuneatus
sense of position, movement and
vibration from upper half of body

Long primary afferent neuron carrying


cutaneous sensation of discriminative
touch from upper half of body

Fasciculus gracilis

Midthoracic level Midthoracic level

Tract neuron in lamina


IV to VI

Short primary afferent neuron carrying


sense of position, movement and
vibration from lower half of body

Long primary afferent neuron carrying


cutaneous sensation of discriminative
touch from lower half of body

Fig. 4.14 Dorsal column (fasciculus gracilis and fasciculus cuneatus)

1. Axons of long primary sensory neurons carrying Both kinds of fibers of fasciculus gracilis and fasciculus
sensory impulse for discriminative touch and cuneatus, i.e. axons of long primary sensory neurons as
pressure. well as those of tract neurons of lamina IV to VI, relay
2. Axons of tract neurons from Clarkes column and in nucleus gracilis and nucleus cuneatus in posterior
other sensory neurons of lamina IV to VI carrying part of lower half of medulla oblongata. Posterior
impulse for sense of position and movements and surface of lower half of medulla oblongata presents
also vibration sense. two round bulge known as gracile tubercle and cuneate
Fiber tracts of dorsal column carrying sensory tubercle beneath which lies corresponding nucleus.
impulse from lower half of body (below midthoracic
level), entering through lower group of spinal nerves, Spinocerebellar tracts
are placed in the medial part of posterior funiculus.
It is called fasciculus gracilis. It is superadded by n General consideration: These tracts are two in
similar kind of fiber bundle which enter the spinal number, called ventral (anterior) and dorsal (post-
cord carrying similar sensation from upper half of erior) spinocerebellar tracts.
body (above midthoracic level). These fiber bundles of Instead of going upto sensory area of cerebral
dorsal column ascend through lateral part of posterior cortex via thalamus, they terminate in cerebellar
funiculus lateral to medially placed fasciculus gracilis. cortex.
It is called fasciculus cuneatus. It is demarcated Functions of spinocerebellar tracts are concerned
from fasciculus gracilis by intermediolateral septum. wih coordination of movements.
74
Spinal Cord
Impulse is carried from neuromuscular spindle segment to T1 segment. It receives therefore input
(muscle spindle), neurotendinous spindle (Golgi ten- from the trunk through T1L2 / L3 segmental spinal
don organ) and joint receptors. nerve. It is interesting to note that it also receives
End organs are stimulated due to stretching of inputs from lower limb. Proprioceptive impulse from
muscles and tendons, and movements of the joints. neuromuscular spindle, neurotendinous spindle and
Both the spinocerebellar tracts are situated in joints of lower limbs are carried by dorsal column
the form of narrow strip covering the peripheral (fasciculus gracilis). Reaching upto L2 / L3 segments,
part of lateral funiculus, being anteroposteriorly collaterals are given from dorsal column to relay in
related. Clarkes column of cells of L2/L3 segments.
Both the tracts are ipsilateral. But it is important These collateral are given by the fibers of dorsal
to note that fibers for ventral spinocerebellar tract column carrying impulse from the lower limb
cross at the level of corresponding spinal cord through spinal segment, as they reach the level of
segments. But for the second time the tract crosses as L2/L3 segments. Again above T1 segment, propri-
a whole at the level of midbrain. oceptive sensations from neuromuscular spindle,
Both the tracts are made of myelinated fibers of
large diameter. Ventral spinocerebellar tract also neurotendinous spindle and joint receptors ascends
contains some thin calibered fibers. through fasciculus cuneatus to relay also in accessory
Individual characteristics of either of the tracts cuneate nucleus which is a smaller oval bulge
will be clear from their description below. superolateral to nucleus cuneates. Fibers from this
nucleus reach the cerebellum via cuneocerebellar
Dorsal spinocerebellar tract (Fig. 4.15) tract.
It is formed by axons of Clerkes column of cells.
Ventral spinocerebellar tract (Fig. 4.16)
Therefore this tract start formation and so also starts
ascending from second or third lumbar segment of Ventral (anterior) spinocerebellar tract is formed by
spinal cord. It is also not difficult to understand that axons of tract neurons of lamina V to VII of spinal
dorsal spinocerebellar tract gets formed from L2 / L3 cord in addition to Clarkes column of cells.

Fasciculus gracilis
Dorsal spinocerebellar tract-formed
by axons of Clarkes column of cells
1
2
Collaterals from fasciculus gracilis
Impulse from muscle, tendon conveys inputs from lower limb
and joint receptors carried proprioceptors to Clarkes column
3 of cells axons of which form
through posterior spinal nerve
roots (T1L2 segments) relay in dorsal spinocerebellar tract
Clarkes column of cells

Fasciculus gracilis

Proprioceptive sensation from


neuromuscular and neurotendinous
spindles and joint receptor from 1. Fasciculus gracilis
lower limb enter spinal cord to form 2. Fasciculus cuneatus
fasciculus gracilis 3. Dorsal spinocerebellar tract

Fig. 4.15 Formation of dorsal spinocerebellar tract


75
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)

Fasciculus cuneatus (ipsilateral)

Ventral spinocerebellar tract


Fasciculus gracilis (ipsilateral)

Primary sensory neuron


carrying proprioceptive
sensation as well as
cutaneous sensation
from skin and
subcutaneous tissue
Dorsal spinocerebellar tract
(ipsilateral)
Tract cells of lamina V to VII
send axons which cross midline
to form ventral spinocerebellar
Ventral spinocerebellar tract tract which carries
(contralateral) proprioceptive sensations from
muscles, tendons and joints and
also exteroceptive sensation
from skin and sup. fascia

Fig. 4.16 Formation of ventral spinocerebellar tract

These second order neurons, receives information both the spinothalamic tracts, concerned sensory
from muscle, tendon and joint receptors via the impulse pass from respective receptors through prim-
first order neurons, which are primary sensory ary sensory neurons or first order neurons, which are
neurons of posterior root ganglia. In addition, ventral posterior root ganglia cells. Their central process enter
spinocerebellar tract carries sensory information from spinal cord to relay in second order neurons.
skin and subcutaneous tissue also.
These sensation are carried via ventral spino- Lateral spinothalamic tract (Fig. 4.17)
cerebellar tract from trunk as well as upper and lower This tract is positioned in lateral funiculus, medial
limb. to anterior spinocerebellar tract and lateral to ante-
Before the tract is being formed by the axons of rior gray horn and emerging fibers of anterior nerve
lamina V to VII and also Clarkes column of cells, root.
majority of fibers cross the midline along ventral It is formed by axons of tract neurons which are
white commissure of spinal cord, while the minority second order neuron situated in substantia gelatinosa
of fibers remain in same side. Fibers take the position of posterior gray horn. The fibers cross the midline and
over a narrow strip of anterior peripheral part of ascend upwards through lateral funiculus, carrying
lateral funiculus to ascend upwards in front of dorsal therefore sensation from opposite side of body. This
spinocerebellar tract. Fibers of ventral spinocerebellar tract carries pain and temperature sensations.
tract run upwards carrying contralateral fibers,
through the brainstem beyond spinal cord. Reaching Anterior (ventral) spinothalamic tract (Fig. 4.18)
the level of midbrain, fibers cross the midline for second
It is so called because it ascends through anterior
time to reach cerebellar hemisphere of the same side
through superior cerebellar peduncle. white column of spinal cord. It is placed medial to
emerging fibers of ventral root of spinal nerve.
Spinothalamic tracts This tract is formed by axons of tract neurons of all
the sensory laminae of posterior gray horn. Before the
These are two in number, known as lateral and tract is formed, the fibers cross the midline, thereby
anterior (ventral) spinothalamic tracts passing thr- carrying sensation from opposite side of body.
ough lateral and anterior white columns of spinal cord This tract carries coarse (nondiscriminative) touch
respectively. Lateral spinothalamic tract conducts and pressure sensations.
pain and temperature sensations, whereas through Positions of the important ascending tracts,
anterior spinothalamic tract pass sensations of coarse discussed above are shows in both sides of spinal cord
(nondiscriminative) touch and pressure. In cases of are shown in Figure 4.19.
76
Spinal Cord

Lateral spinothalamic tract


Axons of tract neurons of
substantia gelatinosa cross the
midline to form lateral spino-
thalamic tract at lateral funiculus

Primary sensory neuron carries


pain and temperature sensation to
relay in tract neurons of substantia
gelatinosa of posterior horn
Lateral spinothalamic tract formed
at lateral funiculus of opposite side
lateral to emerging ventral nerve
root

Fig. 4.17 Formation of lateral spinothalamic tract

Anterior spinothalamic tract Tract neuron of all laminae of


posterior gray horn crosses
midline to form anterior
spinothalamic tract

Primary sensory neuron carries


coarse touch and pressure
sensations to relay in tract
neurons of all laminae of
Anterior spinothalamic tract posterior gray horn
formed at anterior funiculus
medial to emerging fibers of
ventral nerve root

Fig. 4.18 Formation of anterior spinothalamic tract

1. Fasciculus gracilis
Ipsilateral
(uncrossed)
tract { 2. Fasciculus
cuneatus
3. Dorsal
spinocerebellar tract

4. Ventral

Contralateral
(crossed)
tract
{ spinocerebellar tract
5. Lateral
spinothalamic
tract
6. Ventral (anterior)
spinothalamic tract

Fig. 4.19 Positions of important ascending tracts of spinal cord


77
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
What is Dorsolateral Spinothalamic Tract? Corticospinal and corticobulbar tracts
Existence of this tract is established in animals. It l Two tracts having common origin and different
is formed by axons of lamina I. The tract carries destination: Corticospinal as well as corticobulbar
noxious, mechanical and thermal sensations from (corticonuclear) tracts arise from cerebral cortex. The
skin. It is a crossed tract and passes through fibers of both the tracts arise from:
dorsolateral funiculus which is the small area of 1. Primary motor cortex (area 4) = 30%
white matter between dorsal and lateral white 2. Premotor cortex (area 6) = 30%
columns. It is proved that in case of man, this tract 3. Postcentral gyrus (area 3, 1, 2) and adjacent pari-
is concerned with transmission of clinicopathological etal cortex (area 5) = 40%.
pain from which a patient gets relief after dorso- Initially corticospinal and corticobulbar (cortico-
lateral cordotomy. nuclear) tract fibers run down in association with each
other through subcortical white matter to the level of
Descending Tracts brainstem where corticobulbar (corticonuclear) fibers
terminate in contralateral motor nuclei of different
l Descending tracts of spinal cord pass down through
cranial nerves. Corticospinal tract fibers descend
lateral and anterior white columns of spinal cord.
alone further through the spinal cord.
l Descending tracts are axons of neurons of various
l Corticospinal tract is also called Pyramidal tract:
supraspinal centers which include motor centers in
While passing through the medulla oblongata to
cerebral cortex and brainstem.
approach spinal cord, fibers of corticospinal tract
l The neurons of supraspinal centers are known as
arising from pyramidal cells of cerebral cortex passes
upper motor neurons which finally project on motor beneath the paramedian ventral bulge looking like a
neurons of anterior horn cells of spinal cord called pyramid with its narrower end directed downwards.
lower motor neurons. That is why corticospinal tract is called pyramidal
l Descending tract is a part of motor pathway which tract (Fig. 4.20).
is usually made up of three order of neurons. The first Fibers of Pyramidal tract (Corticospinal tract)
order neurons are neurons of supraspinal centers. l Number of fibers: Pyramidal tract of each side
Second order neurons are internuncial neurons situ- contains 1 million fibers.
ated in anterior gray column of spinal cord. Third l Fibers mostly myelinated: 70% fibers are myel-
order neurons are alpha and gamma motor neurons inated.
of spinal cord. Axons of these neurons reach the l Fibers are of varying caliber
effector organs (voluntary muscles) via the anterior 90% = 1 4 mm in diameter
root of spinal nerve which is known as final common 9% = 5 10 mm
pathway of Sherrington. 1% = 11 22 mm, which are the axons of giant
l Descending tract discharges constantly impulse pyramidal cells of Betz situated in primary motor
on lower motor neuron to exert following functions. cortex (area 4).
1. It controls movements, muscle tone and posture.
2. It modulates spinal reflex mechanism. Two corticospinal tracts lateral (crossed) and ante-
3. It also modulates transmission of afferent infor- rior (uncrossed) (Fig. 4.20)
mation to higher centers. Just proximal to spinomedullary junction, i.e. at
4. It exerts influence on visceral activities through the lower end of pyramid of medulla oblongata,
its control on spinal autonomic motor neurons. 75% to 90% fibers of corticospinal tract cross the
l Broad classification: Descending tracts are broadly midline from either side forming a decussation
classified into following groups beneath the anterior median fissure of medulla. The
1. From motor areas of cerebral cortex majority crossed fibers descend vertically through
l Corticospinal tracts the lateral white column (lateral funiculus) of spinal
l Corticobulbar (corticonuclear) tracts: Projecting to cord to form lateral corticospinal tract. This tract
motor nuclei of cranial nerves situated in brain- is positioned medial to dorsal spinocerebellar tract
stem, which do not extend low down upto spinal and ventrolateral to posterior gray column. The
cord. remaining uncrossed fibers (10%25%) descend
2. From different subcortical centers to the spinal through anterior white column (anterior funiculus)
cord: of same side to form anterior corticospinal tract
l Noncorticospinal tracts. which is an uncrossed tract.
78
Spinal Cord

Motor area of cerebral cortex

Corticospinal tract is called


pyramidal tract as it passes
through pyramid of medulla
oblongata

Medulla oblongata

Pyramid of medulla oblongata

7590% of fibers cross


midline at the level of lower 1025% of fibers descend
part of medulla to form lateral uncrossed to form anterior
corticospinal tract corticospinal tract

Fig. 4.20 Corticospinal tract Originating from different areas of motor cortex

Termination of corticospinal tract (Figs 4.21A and B) But it is very important to notice at this stage that,
though anterior corticospinal tract is an uncrossed
While descending through respective funiculus, in
every segment of spinal cord successively, fibers of (ipsilateral) one, in every segment of spinal cord fibers
both the tracts (axons of upper motor neuron) relay in for the respective segment cross the midline through
both alpha and gamma motor neurons (lower motor anterior white commissure and relay in opposite
neurons) of anterior gray column. As the lateral sided motor neurons of spinal cord (Fig. 4.21A and
corticospinal tract is a crossed tract, it is very clear B). So it is not difficult to understand that, ipsilateral
to understand that, it possesses influence on anterior anterior corticospinal tract also possesses influence
horn cell of contralateral side (Fig. 4.21A and B). on contralateral lower motor neurons.

Medulla oblongata
Olive
Pyramid

Anterior corticospinal tract (uncrossed)

Lateral corticospinal tract (crossed)

Lateral corticospinal tract in


lateral funiculus

Anterior corticospinal tract


in anterior funiculus

Fig. 4.21A Both lateral (crossed) and anterior (uncrossed) corticospinal tracts beyond medulla oblongata, and their position in lateral
and anterior white columns of spinal cord respectively
79
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)

Anterior corticospinal tract


Lateral corticospinal tract

In each segment of spinal


cord, fibers from uncrossed
anterior corticospinal tract
cross midline through
anterior white commissure to
In each segment of spinal relay in opposite sided lower
cord, lateral corticospinal motor neurons
tract which is already
crossed at medullary level,
gives fibers to relay in lower
motor neurons of same side Ventral root of spinal nerve

Fig. 4.21B Corticospinal tracts. Lateral corticospinal tract A crossed (contralateral) tract which descends through lateral funiculus.
Anterior corticospinal tract An uncrossed (ipsilateral) tract which descends through anterior funiculus

Corticospinal tracts terminates indirectly through 2. Fibers arising from parietal cortex, i.e. postcentral
interneurons gyrus (area 3, 1, 2) and adjacent parietal area (area
5), projecting on neurons of posterior gray horn,
Most of the fibers of corticospinal tracts terminate
modulate spinal reflex activities and transmission
contralaterally on interneurons of laminae V to VII,
of afferent informations to higher sensory centers.
which finally relay in alpha as well as gamma motor
neurons of lamina IX. Direct termination on motor
Noncorticospinal tract
neurons are mostly found in segments of cervicothoracic
and lumbosacral enlargements of spinal cord. These are the descending tracts which originate
from various centers of brainstem, below the level of
Variations of corticospinal tract cerebral cortex, which are considered as subcortical
centers.
1. Corticospinal fibers may be totally crossed. Like corticospinal tracts, cell of these centers are
2. All the fibers may remain uncrossed in very rare upper motor neurons which project on lower motor
occasion. neurons, i.e. alpha and gamma motor neurons of
spinal cord.
Principle of functions of corticospinal tract These tracts are described below in reference to
1. Fibers arising from primary motor cortex and the following points:
l Origin
premotor cortex (area 4 and 6 respectively), thro-
l Nature, i.e. extent and, crossed or uncrossed
ugh their influence on both alpha and gamma l Localization in spinal cord
motor neurons of spinal cord, facilitate activities l Termination
of extensor group of muscles. They are concerned l Function.
with prcised and skillful movements, particularly,
of distal part of limbs. It is proved by lesions of the RUBROSPINAL TRACT
tract, which very commonly occurs due to cerebro-
vascular accident. It affects mostly the movements n Origin: Central core (tegmentum) of upper
of distal part of limbs with fingers and toes. half of midbrain (at the level of superior colliculus)
80
Spinal Cord
Rostral Aqueduct of midbrain
parvocellular part

Caudal magno-
] Red
nucleus
Red nucleus
cellular part

Ventral tegmental
decussation

Rubrospinal tract
Rubrospinal tract

Fig. 4.22A Rubrospinal tract originates from caudal Fig. 4.22B Fibers of rubrospinal tract originating from red nucleus
magnocellular part of red nucleus cross midline at midbrain to form ventral tegmental decussation

presents a reddish gray colored ovoid mass of nerve Before terminating into alpha and gamma motor
cells, called red nucleus which is divided into rostral neurons of spinal cord, fibers from polysynaptic
parvocellular part made up of smaller neurons and connection via interneurons of laminae V to VII.
caudal magnocellular part made up of larger neurons. n Functions: Functions of rubrospinal tract are
Rubrospinal tract originates from caudal magno- similar to those of corticospinal tract.
cellular part of red nucleus which contains 150200
neurons (Fig. 4.22A). TECTOSPINAL TRACT
n Morphology: In man, rubrospinal tract is rudim-
entary and poorly defined. In animals, it extends upto n Origin: Dorsal part of midbrain, which is behind
lumbosacral segments of spinal cord. aqueduct (central canal) of midbrain, is called Tectum.
l Nature: Rubrospinal tract is a crossed tract. When viewed from behind, tectum is seen to be made
Fibers of this tract cross horizontally, just after their up of one upper and one lower pair of bulges called
origin from red nucleus. It is called ventral tegmental superior and inferior colliculi (Singular-colliculus).
decussation. After decussation fibers descend through
These colliculi are made up of clusters of nerve
central core (tegmentum) of brainstem to reach spinal
cells which are arranged in the form of superficial,
cord (Fig. 4.22B).
n Localization: Fibers of rubrospinal tract are
intermediate and deep layers.
localized in the lateral white column of spinal cord, Tectospinal tract originates from intermediate
just in front of lateral corticospinal tract with which and deep layers of cells of superior colliculus of both
its fibers are intermingled (Fig. 4.23). sides at the upper half of midbrain.
n Termination: Rubrospinal tract extends upto n Nature: Tectospinal tract is crossed tract like
only upper three cervical segments of spinal cord. rubrospinal tract. Fibers of this tract also cross

Fasciculus gracilis

Fasciculus cuneatus

Dorsal spinocerebellar tract Lateral corticospinal tract

Rubrospinal tract
Ventral spinocerebellar tract Lateral reticulospinal tract
Medial reticulospinal tract
Lateral spinothalamic tract
Anterior corticospinal tract

Anterior spinothalamic tract Olivospinal tract


Vestibulospinal tract
Ascending tract Tectospinal tract
Descending tract
Crossed Uncrossed Crossed Uncrossed

Fig. 4.23 Cross-section of spinal cord showing ascending (afferent) and descending (effercent) tracts
81
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
horizontally in front of aqueduct of midbrain, in a VESTIBULOSPINAL TRACTS
more posterior plane, just after their origin from
tectum. It is called dorsal tegmental decussation. l They are two in number known as lateral and
After decussation, fibers of this tract descend through medial vestibulospinal tracts.
central core (tegmentum) of brainstem to reach the l Though called lateral and medial, both are present
level of spinal cord. in anterior white column of spinal cord, but latero-
n Localization: Tectospinal tract is localized in
medially positioned.
anterior white column of spinal cord, in front of
l These tracts arise from vestibular nuclear com-
anterior corticospinal tract, just by the side of ventral
plex situated at the lateral angle of floor of
part of anterior median fissure (Fig. 4.23).
fourth ventricle at pontomedullary junction (Fig.
n Termination: Tectospinal tract extends only upto
upper cervical segments of spinal cord. 4.24A).
Before terminating into alpha and gamma motor n Origin (Fig. 4.24B):
neurons of spinal cord, fibers form polysynaptic Lateral vestibulospinal tract from lateral vestib-
connection via interneurons of laminae VI to VIII. ular nucleus.
n Functions: Before the function of tectospinal Medial vestibulospinal tract from
tract is understood, it is to be noted that, this tract i. Medial and inferior vestibular nuclei
forms efferent component of a reflex pathway known ii. Some fibers From lateral nucleus.
as spinovisual reflex. Activity of this pathway is n Nature:
manifested by turning neck with head away when a Lateral uncrossed (ipsilateral)
powerful light falls on retina of eyeball. Medial crossed (contralateral) as well as uncros-
5 components of this reflex pathway are following: sed (ipsilateral).
1. Receptor: Rod and cone cells of retina (photor- Fibers of medial vestibulospinal tract extend upto
eceptors) which are stimulated by light falling
midthoracic level.
on retina.
n Localization: Both the tracts are located in
2. Afferent path: Visual pathway from retina - optic
ventral marginal part of anterior white column
nerve optic chiasma optic tract lateral
geniculate body superior brachium. (Fig. 4.23).
3. Center: Superior colliculus of midbrain which n Termination: Both vestibulospinal tracts term-
receives collaterals from lateral geniculate body inate in alpha as well as gamma motor neurons of
through superior brachium. spinal cord via interneurons of laminae VII and VIII.
4. Efferent path: Tectospinal tract. n Function: Lateral vestibulospinal tract is excitatory
5. Effector: Voluntary muscles of neck. to the spinal motor neurons which supply extensor

Superior colliculus
Inferior colliculus

Superior cerebellar peduncle

Vestibular triangle

Floor of 4th ventricle

Inferior cerebellar peduncle

Cuneate tubercle
Gracile tubercle

Fig. 4.24A Vestibulospinal tract arises from vestibular nuclear complex lying beneath vestibular triangle of floor of 4th ventricle at
pontomedullary junction
82
Spinal Cord

Superior vestibular nucleus


Lateral vestibular nucleus
Medial vestibular nucleus

Inferior vestibular nucleus

Lateral vestibulospinal tract originates Medial vestibulospinal tract originates


from lateral vestibular nucleus from medial and inferior vestibular nuclei

Fig. 4.24B Origin of lateral and medial vestibulospinal tracts

muscles of neck, back and limbs. It is inhibitory to ii. Steering of head and trunk movement in
neurons which supply flexor muscles of limbs. response to external stimulus.
Medial vestibulospinal tract inhibit spinal motor iii. Stereotyped movement of muscles of limbs.
neurons which supply muscles of neck and upper part Lateral reticulospinal tract: It is involved in regu-
of back. lation of:
i. Motor function
ii. Perception of pain sensation.
RETICULOSPINAL TRACT
Reticulospinal tracts are two Medial and lateral. OLIVOSPINAL TRACT
These tracts project from reticular nuclei of brainstem
There is doubt in existence of this tract in man now-
(upper motor neurons) to alpha and gamma motor
adays. It was thought that this tract originates from
neurons (lower motor neurons) of spinal cord either
inferior olivary nucleus and project on motor neurons
directly or through interneurons of laminae VII and
of spinal cord. It was thought to be localized in lateral
VIII. Upper motor neurons for these tract are called
white column of spinal cord.
reticular nuclei because the cells are intermingled
with network (reticulum) of fibers.
HYPOTHALAMOSPINAL TRACT
n Origin:
Medial: From reticular nuclei of pons and medulla It is better to be called hypothalamospinal fibers
oblongata. rather than tract as the fibers do not form compact
Lateral: From reticular nuclei of medulla oblongata. bundle.
n Nature: n Origin: From paraventricular (and some other)
Medial: Crossed as well as uncrossed. nuclei of anterior and posterior half of hypothalamus.
Lateral: Uncrossed. n Nature: Uncrossed (ipsilateral)
n Localization (Fig. 4.23): n Localization: Lateral funiculus of spinal cord.
Medial: Located in anterior white column, medial n Termination:
to base of anterior horn. i. Sympathetic neurons of intermediolateral cell
Lateral: Located in lateral white column, lateral column of T1 to L2 segments of spinal cord.
to base of anterior horn, close to lateral corticospinal ii. Parasympathetic neurons of intermediate area
tract and rubrospinal tract. of S2, S3 and S4 segments of spinal cord.
n Termination: Both the tracts terminate in alpha n Function: Supraspinal control of sympathetic
as well as gamma neurons of anterior horn cells and parasympathetic visceral function.
(Lamina IX) of spinal cord either directly or through
interneurons of laminae VII and VIII. SOLITARIOSPINAL TRACT
n Function:
Medial reticulospinal tract: It is concerned with n Origin: Nucleus tractus solitarius of medulla
i. Postural adjustment oblongata. It is a composite special visceral sensory
83
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
nucleus having parts for VIIth, IXth and Xth cranial fe through the posterolateral part of cord to cut
nerves. It receives sensory fibers of these cranial descending (motor) tracts which are posterior to the
nerves carrying taste sensation from tongue and soft plane of ligamentum denticulatum.
palate.
n Nature: Mostly crossed Knowledge of Termination of Spinal Cord in
n Localization: Clinical Practice
i. Anterior funiculus and
ii. Anterior part of lateral funiculus. Upto 3rd month of fetal life, rate of growth of vertebral
n Termination: column and that of spinal cord are co-extensive. After
i. Anterior horn cells of C3, C4 and C5 segment of 3rd month vertebral column grows more rapidly
spinal cord supplying diaphragm. than spinal cord. That is why, at birth spinal cord is
ii. Anterior horn cells of thoracic segments of found to end at the level of lower border of body of 3rd
spinal cord supplying intercostal muscles. lumbar vertebra. This status remains in infancy. But
n Function: Reflex movements of intercostal mus- finally, spinal cord is found to end at the level of lower
cles and diaphragm on stimulation of nucleus tractus border of body of 1st lumbar vertebra. Sometimes,
solitarius. it may extend upto 2nd lumbar vertebra in case of
adults.
But arachnoid and dura maters extend upto lower
CLINICAL ANATOMY OF SPINAL CORD
border of body of 2nd sacral vertebra. So subarachnoid
space below the level of termination of spinal cord (L1/
Protection of Spinal Cord L2), and above S2 level, is prominent which is filled
Spinal cord, which is part of central nervous system with cerebrospinal fluid where float the fibers of cauda
and, made up of delicate and sensitive nervous tissue, equina. This area of prominent spinal subarachniod
is well-protected by: space is approached from outside through a procedure
1. Vertebral column Inside which, in vertebral called spinal tap or lumbar puncture which helps in
canal, it is lodged. diagnosis and management of some central nervous
2. Spinal meninges Dura, arachnoid and pia system diseases.
maters, mainly dura mater which is toughest,
outermost fibrous membrane. Lumbar Puncture (Spinal Tap) (Fig. 4.7)
3. Cushion of cerebrospinal fluid Inside subarac-
hnoid space. It is the clinical procedure to approach spinal
subarachnoid space below the level of termination of
Factors Holding Spinal Cord in Position spinal cord for following two purposes.
1. Diagnostic: For the purpose of diagnosis of some
1. Spinal nerves (31 pairs), formed by union of ventral diseases of nervous system which is related to
and dorsal roots, come out through intervertebral alteration of character of cerebrospinal fluid, this
foramen. Dural sheath of spinal nerves is attached procedure is adopted to take out the sample of fluid
at the margin of intervertebral foramen. for its physical, chemical/biochemical, microscopic
2. Ligamentum denticulatum One on either side, and bacteriological examination.
with 21 pairs of tooth-like pial projections bind 2. Therapeutic: Instead of withdrawal of cerebro-
lateral surface of spinal cord to the inner surface spinal fluid, some drugs are injected for the
of arachnoid mater. following two purposes:
3. Filum terminale It is the nonnervous filamentous i. Some drugs in the form of anesthetics are
band which ties conus medullaris of spinal cord injected for induction of spinal anesthesia
below to the back of 1st piece of coccyx. before performing surgical operations. There
are some indications where surgeons prefer
Ligamentum Denticulatum A Guide for spinal anesthesia to general anesthesia.
Selective Cordotomy ii. Some drugs are injected through this route for
treatment of some diseases of central nervous
l Anterolateral cordotomy is done to relieve excrut- system.
iating pain. Surgeon passes his knife through
anterolateral part of cord to cut ascending (sensory)
tracts which are anterior to the plane of ligamentum
Where to Perform Lumbar Puncture?
denticulatum. Lumbar puncture needle, specially designed, is
l Posterolateral cordotomy is done to relieve ab- introduced through interspinous space in the back
normal muscular spasm. Surgeon passes his kni- between 3rd and 4th lumbar spine.
84
Spinal Cord
How to Locate L3/L4 Interspinous Space? venous pressure by application of pressure over
internal jugular vein does not cause rise of CSF
It is the space just above L4 spine. To find out the
pressure. This is called positive Queckenstedt sign.
space, L4 spine is located. L4 spine is at the level of a
horizontal plane which passes through highest point
of two iliac crests (transcristal plane).
Lesion of Spinal Nerve Emerging Through
Intervertebral Foramen
How to Perform Lumbar Puncture? Intervertebral foramen is bounded above and below
After taking proper aseptic measures, patient is by the pedicles of two adjacent vertebrae. The
placed in lateral position in bed or upright sitting foramen is bounded anteriorly by intervertebral disk
position and vertebral column is flexed. Two and posteriorly by zygapophyseal joint or facet joint
advantages are enjoyed in flexed position of spine. of articular processes. This foramen transmits spinal
Interspinous space becomes wider and lower end of nerve root formed by union of ventral and dorsal
spinal cord is further elevated above lower border of rami. At this site the spinal nerve may be lesioned
body of L1 vertebra. due to stretching, pressure or edema resulting from
Lumbar puncture needle is introduced through i. Fracture dislocation of vertebra
midline interspinous space between L3 and L4 ii. Osteoarthritis due to inflammation of facet
spines. The tip of the stellate followed by needle is joint or
directed horizontally with slight upward inclination. iii. Herniation of intervertebral disk.
A sustained resistance is felt till the needle crosses Compression of spinal nerve root in the interv-
supraspinous and interspinous ligament and finally ertebral foramen due to above reasons leads to a
it passes through dura mater with arachnoid mater. clinical condition known as root canal pressure (Fig.
n Queckenstedt sign: Normal CSF pressure is 4.25A). Herniation of intervertebral disk causing
60150 mm of water. Pressure applied over internal root canal pressure is not midline but posterolateral.
jugular vein leads to cerebral venous congestion Disruption or tear of annulus fibrosus squeezes out
causing rise of subarachnoid CSF pressure as a the nucleus pulposus to press over spinal nerve root
result of less absorption of CSF through arachnoid (Fig. 4.25B). Common sites of herniation are cervico-
granulations. In case of expanding tumor of spinal thoracic and lumbosacral junction of vertebral column
cord (glioma) or meninges (meningioma), due to where mobile part of vertebral column changes into
blockade of subarachnoid space, even rise of cerebral immobile part.
Pedicle

Intervertebral disk Zygapophyseal (facet) joint

Spinal nerve emerging through


intervertebral foramen

Fig. 4.25A Spinal nerve is predisposed for compression at intervertebral foramen which may cause root canal pressure

Torn annulus fibrosus

Herniated nucleus pulposus

Compressed spinal nerve

Fig. 4.25B Disruption of annulus fibrosus squeezes out nucleus pulposus of intervertebral disk to press over spinal nerve roots
85
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
n Effect of root canal pressure: Spinal nerve, those muscles which are concerned for skilful
being mixed nerve, when compressed or irritated, voluntary movements of distal part of limbs. Non-
gives rise to motor as well as sensory manifestations. corticospinal tracts control gross, basic voluntary
Motor effect will be painful muscular spasm with movements resulting easy and rapid movements of
weakness of the muscles. Involvement of sensory the joints for maintenance of posture.
fibers ranging from irritation to compression leads to
variable effects like altered sensation (paresthesia) to Muscle Tone
exaggerated sensation (hyperesthesia) with tingling Muscle tone is defined as a state of continuous partial
pain over the belt of skin (dermatome) supplied by the contraction of a muscle which is obviously the result
corresponding segmental nerve. of continuous stimulation of extrafusal fibers. But
n Pyramidal and extrapyramidal tracts two
it is interesting to note that, this effect depends,
reciprocal components of descending (motor) beforehand on impulse received by gamma motor
pathway: Efferent (motor) descending pathway ori- neurons at intrafusal fibers through corticospinal
ginating from different areas of cerebral cortex, e.g. (facilitatory) and noncorticospinal (inhibitory) tra-
primary motor area (area 4), premotor area (area 6) cts. This impulse (facilitatory and inhibitory) from
and even primary sensory area (area 3, 1, 2) project to intrafusal fibers is carried back to spinal cord by
motor neurons (alpha as well as gamma motor neurons) proprioceptive reflex arc with alpha motor neurons
of spinal cord. Thereby this tract is called corticospinal which supply extrafusal fibers.
tract. Before crossing the midline in lower medulla It is interesting to note the following points at this
to relay in lower motor neurons of spinal cord, this stage:
tract passes through the bulge of pyramid of medulla l Normal muscle tone is maintained by balanced
oblongata. That is why it is called pyramidal tract. facilitatory effect of corticospinal tract and inhib-
Other types of descending tracts originating from itory effect of noncorticospinal tract on intrafusal
subcortical centers, various nuclei of brainstem are fibers of muscle spindle through gamma motor
called noncorticospinal tracts. As these tracts are not neurons.
passing through pyramid of medulla oblongata, they l In case of lesions of upper motor neurons or
are called extrapyramidal tracts. descending tracts, patient presents manifestations
Two basic motor activities, namely voluntary which are the effect of combined damage to
movements following contraction of skeletal mus- pyramidal and extrapyramidal tracts.
cles and maintenance of muscle tone are the l Lesions of extrapyramidal (noncorticospinal) tract
result of balanced combined activity of pyramidal leads to release (withdrawal) of inhibitory effect
(corticospinal) and extrapyramidal (noncorticospinal) on gamma motor neurons, which thereby causes
tracts. spasticity due to increase of muscle tone.

Voluntary Movements Upper Motor Neurons Lesions


Execution of voluntary movements resulting from It is the combined lesion of both pyramidal (cor-
contraction of group of muscles is the effect of ticospinal) and extrapyramidal (noncorticospinal)
stimulation of alpha motor neurons of anterior gray tracts. Corticospinal tract originates from different
column of spinal cord by pyramidal (corticospinal) as areas of cerebral cortex. Noncorticospinal tract origin-
well as extrapyramidal (noncorticospinal) tracts. ates from different motor centers of brainstem. But
Cortical as well as subcortical motor centers these centers are also influenced by some descending
receives the information from sensory system, eyes, cortical fibers. It means therefore, even in case
ears and even the stored information from memory. of lesion of upper motor neuron anywhere above
Then these centers (UMN) give command to the alpha brainstem, patient will present effect of combined
motor neurons (LMN) of spinal cord through their lesion of corticospinal as well as noncorticospinal
descending axons (descending tracts). Axons of alpha tracts.
motor neurons of spinal cord leave through spinal
nerve to stimulate extrafusal fibers of voluntary Lesion of Corticospinal Tract (Pyramidal Tract)
muscles which causes muscular contraction resulting
voluntary movements. 1. It results in loss of fine, skilled voluntary
But basic difference between corticospinal and movements. It affects particularly distal part of
noncorticospinal tracts are as follows. Corticospinal limbs. This manifestation is due to loss of command
tract regulates prime mover muscles, particularly of corticospinal tract over alpha motor neurons of
86
Spinal Cord
spinal gray matter whose axons innervate extra- muscles of anterior abdominal wall. In lesion of
fusal fibers of skeletal muscle. corticospinal tract, which is part of efferent component
2. Loss of function of efferent component (corticospinal of reflex pathway, superficial abdominal reflex is
tract) of some reflex pathway found to be absent.
It is well-known that a reflex pathway is composed n Cremesteric reflex
of 5 components i) receptor ii) afferent path Components
iii) center iv) efferent path and, v) effector organ. 1. Receptors: Stretch receptors beneath the skin of
Corticospinal tract forms efferent component of medial side of front of thigh below groin.
some reflex pathway which are, not horizontally, 2. Afferent component: Femoral branch of genito-
but vertically oriented. So when corticospinal tract femoral nerve (L1 L2) Ascending tract from L1/
is lesioned, these reflexes are abolished or lost. L2 level of spinal cord to end finally to cerebral
n Plantar reflex Its 5 components are cortex.
i. Receptor At skin of lateral border of sole of 3. Center: Motor area of cerebral cortex.
foot. 4. Efferent component Corticospinal tract Genital
ii. Afferent component Sensory nerves from branch of Genitofemoral nerve (L1, L2)
lateral border of sole of foot, ascending tract of 5. Effector: Cremester muscle in male so this reflex is
spinal cord which reaches upto cerebral cortex. elicited only in male patients.
iii. Center Motor area of cerebral cortex. In normal individual, scratching of skin of front
iv. Efferent component Corticospinal (pyramidal)
of thigh below groin causes contraction of cremesteric
tract, motor (efferent) nerve of lower limb
muscle leading to slight upward pull to testis which
supplying plantar muscles.
is visible through skin of scrotum. In case of lesion of
v. Effector organ Plantar muscles.
corticospinal tract, which is efferent component of the
Due to integrity of this reflex pathway, scratching
reflex pathway, cremesteric reflex is absent.
of lateral border of sole of foot causes plantar flexion
of foot normally. Therefore, in case of lesion of
corticospinal tract, there becomes interruption of the Lesion of Noncorticospinal Tracts
circuit of reflex pathway, which results in (Extrapyramidal tracts)
a) Abolition of plantar reflex 1. Widespread paralysis of voluntary muscles which
b) In addition, withdrawal phenomenon of limbs are concerned with gross movements.
occurs by dorsiflexion of the great toe with 2. Hypertonicity: Muscle tone is increased because,
fanning (abduction) of other toes. This is called inhibitory effect of extrapyramidal tract on gamma
positive Babinski sign. motor neurons is cut off. As the muscles are
In case of infants, myelination of corticospinal tract paralyzed, it gives rise to spasticity. So paralysis
is completed at the age of 2 years. So upto age of 2 years, is called spastic paralysis.
nonmyelinated corticospinal tract is characterized 3. Exaggerated tendon reflexes: In normal individual,
by loss of velocity of action potential, which makes tapping of tendon of quadriceps femoris (ligam-
it nonfunctioning. So in an attempt to elicit plantar entum patellae) causes brisk jerky extension mov-
reflex, it will show positive Babinski sign. ement of knee. This is due to integrity of local
n Superficial abdominal reflex reflex arc at the spinal cord level. In case of lesion
Components of extrapyramidal (noncorticospinal) tracts, its
1. Receptors: Stretch receptors under the skin of inhibitory effect on gamma motor neuron is cut off,
anterior abdominal wall. which will cause exaggeration of tendon jerks.
2. Afferent component: Sensory fibers of lower inter-
costals nerve carrying sensation to the spinal cord Lower Motor Neurons Lesion
Ascending tracts of the spinal cord reaching
finally to cerebral cortex. Motor neurons (both alpha as well as gamma) of
3. Center: Motor area of cerebral cortex. anterior gray column of spinal cord are known as
4. Efferent component: Corticospinal tract anterior lower motor neurons (LMN) which are governed
horn cells of spinal cord motor fibers of lower by upper motor neurons (UMN) of all supraspinal
intercostal nerve. centers. The axons of all the lower motor neurons of
5. Effector organ: Flat muscles of anterior abdominal spinal cord leave central nervous system to end in the
wall. target organs (voluntary muscles) via ventral (motor)
In normal individual, scratching of skin of anterior root of spinal nerve. That is why the ventral motor
abdominal wall causes brisk visible contraction of root is called final common pathway of Sherrington.
87
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Same as upper motor neuron, lower motor neuron Depending upon the site, lesions may be subdivided
lesions may occur due to following causes. as follows:
1. Traumatic 1. Extradural
2. Ischemic 2. Intradural: i) Extramedullary lesion outside
3. Infective spinal medulla (spinal cord) ii) Intramedullary
4. Degenerative inside spinal medulla.
5. Neoplastic.
Whatever the reason is, lower motor neuron lesion Spinal Cord Syndrome
results in damage to cell bodies of anterior gray horn
Depending upon causes of spinal cord lesion, spinal
and/or their axonal process emerging as ventral nerve
cord may be compressed to a variable extent, i.e.
root. completely or partially leading to different types of
Effects or manifestations are as follows: clinical manifestations. These are as follows:
1. Flaccid paralysis: It is the paralysis of voluntary 1. Complete cord transection syndrome
muscles supplied by the affected spinal segments 2. Anterior cord syndrome
with loss of muscle tone because of lesion of gamma 3. Central cord syndrome
with alpha motor neurons. 4. Cord hemisection syndrome or Brown-Squard
2. Atrophy of muscles following atonic paralysis. syndrome.
3. Loss of reflexes related to affected muscles. It It is important to note at this stage that, patient
explains abolition of tendon jerks (e.g. knee jerks) attacked with any of the above mentioned syndrome
depending upon the corresponding segment. passes initially and temporarily through an acute
4. Contracture of muscles: It is the shortening of phase of shock, which is called spinal shock syndrome.
the muscles which occurs in antagonists, as they
are not opposed by the paralyzed muscles. Spinal Shock Syndrome

SPINAL CORD INJURIES It is the initial phase of blackout faced by spinal cord
following injury of any type causing damage to spinal
Incidence of spinal cord injuries (spinal injuries) cord.
is very common in modern days. These injuries are n Duration: In most of the cases, this phase lasts
catastrophic as there is very little or no chance of for 1 day (24 hours). In some cases, of course, it may
regeneration of damaged neural tissue. It leads to extend upto 1 week to 1 month (4 weeks).
permanent disabilities. n Clinical features: Fundamentally it is charac-
terized by depression or loss of all cord functions
Principles of Management (motor and sensory) below the level of lesion. These
1. Decompression of spinal cord by realignment of are
vertebra fractured and/or dislocated. 1. Flaccid paralysis
2. Stabilization of injured area. 2. Hypotonia or atonia, i.e. loss of muscle tone
3. Rehabilitation. 3. Loss of tendon jerks and reflexes
4. Recently, use of certain drugs, e.g. GM1, Ganglioside 4. Loss of all sensation below the level of lesion
and methylprednisolone, soon after injury results 5. If the lesion is higher level, hypotension (fall
in improvement of neurological deficit. of blood pressure) due to loss of sympathetic
vasomotor control
6. Loss of bladder and bowel function.
Causes of Spinal Cord Lesion
Regeneration of function of cord
1. Traumatic: i) Fracture dislocation of vertebra After the phase of spinal shock is over, partial
ii) Penetrating injury e.g. stab injury, gunshot regeneration of cord function occurs because
injury. i. Neurons, which are not permanently damaged,
2. Vascular: i) Arterial occlusion or compression get back the power of irritability and cond-
causes degeneration of nerve cells and fibers. uctivity.
ii) Venous compression causes edema of neural ii. Edema of the affected neural tissue subsides.
tissue. After the period of spinal shock is over, neurological
3. Infective: Viral or bacterial. impairment (clinically called neurodeficit) is categ-
4. Degenerative: Causing demyelination of nerve orized as following syndromes.
fibers. 1. Complete cord transection syndrome
5. Neoplastic: By expanding tumor. 2. Anterior cord syndrome
88
Spinal Cord
3. Central cord syndrome 2. Panetrating injury Stab injury or gunshot injury.
4. Cord hemisection syndrome (Brown-Squard 3. Expanding tumor.
syndrome).
These syndromes differ from one another depen- Effects
ding upon the area of the segment of spinal cord All motor and sensory impairments will be bilateral
affected. as follows
The clinical findings are combination of following 1. Damage of anterior horn cells (LMN) and emerging
fundamentally motor nerve roots of the segment affected will
1. Lower motor neuron lesion at the level of segment cause bilateral lower motor neuron paralysis of
affected. the muscles supplied by motor nerve roots arising
2. Upper motor neuron lesion below the level of lesion. from the particular segment.
3. Sensory loss below the level of lesion. This paralysis will ultimately will be followed by
Combination of clinical manifestations in any of atrophy of the muscles affected.
the above syndromes will vary according to the level 2. Damage of both sided corticospinal as well as non-
of spinal cord lesion. corticospinal tracts will cause following bilateral
manifestations below the level of lesion.
Complete Cord Transection Syndrome (Fig. i. Spastic paralysis
4.26A) ii. Babinski sign positive
iii. Loss of abdominal and cremesteric reflexes.
3. Damage of all sensory tracts in anterior, lateral
Causes
and posterior funiculi of both sides will cause
1. Fracture dislocation of vertebral column (spinal bilateral loss of all sensations (exteroceptive as
injury). well as proprioceptive) below the level of lesion.

A B

C D

Figs 4.26A to D Various types of spinal cord syndrome. A. Complete cord transection syndrome, B. Anterior cord syndrome, C. Central
cord syndrome, D. Cord hemisection syndrome (Brown-Squard syndrome)
89
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
4. Loss of voluntary control of bladder and bowel segment of spinal cord. Paralysis will be followed
function due to damage of descending autonomic by atrophy of muscles.
fibers. 2. Bilateral spastic paralysis with all features of
upper motor neuron lesion. It is due to damage to
Anterior Cord Syndrome (Fig. 4.26B) both corticospinal and noncorticospinal tracts. It
affects both upper and lower limbs as the lesion is
Causes in the cervical part of cord.
3. Bilateral loss of pain, temperature and pressure
1. Traumatic: i) Fracture dislocation of anterior sensation as lateral and anterior spinothalamic
component of vertebral column ii) Herniation of tracts are affected. The sensory loss is below the
intervertebral disk. level of lesion, which in this type of injury is at
2. Ischemic: Occlusion or compression of anterior cervical level. Though the lesion of central cord
spinal artery which supplies anterior two-third of syndrome is in cervical region, lower limb may
spinal cord. remain unaffected for somatomotor and somato-
Effect sensory loss, because in both motor and sensory
tracts, peripherally placed sacral fibers are spared
Effects are bilateral: (Fig. 4.26C).
1. Damage of anterior horn cell and emerging ante- Though crude touch is affected fine touch is
rior nerve roots will cause lower motor neurons preserved as peripheral parts of fasciculus gracilis
paralysis of the muscle supplied by the segment (from lower half of body) and fasciculus cuneatus
affected. (from upper half of body) remain undamaged. For
The paralysis of the muscle affected will be follo- the same reason, sense of position, movement and
wed by muscular atrophy. vibration is also not affected.
2. Bilateral spastic paralysis below the level of les-
ion due to damage of anterior corticospinal and Brown-Squard Syndrome (Fig. 4.26D) (Cord
various noncorticospinal tracts. hemisection syndrome)
3. Lesion of anterior and lateral spinothalamic tracts
will cause bilateral loss of pain, temperature Cause
(lateral spinothalamic tract) and pressure and light Penetrating injury like gunshot injury or stab injury.
touch (anterior spinothalamic tract) sensation.
Touch is not affected as fine touch and discrim- Effect
inative touch sensation is carried through dorsal
Fundamental difference of this spinal cord injury from
white column (fasciculus gracilis and fasciculus
above mentioned types is that it produces unilateral
cuneatus). Due to same reason, sense of position and
effects which are as follows.
movements, and vibration sensation are also not lost.
1. Ipsilateral lower motor neuron paralysis of the
muscles which are supplied by the lesioned spinal
Central Cord Syndrome (Fig. 4.26C) cord segment. It is caused due to injury to the
anterior horn cells and emerging anterior nerve
Cause root of the particular segment. The paralysis is
Severe hyperextension of cervical part of vertebral followed by muscular atrophy.
column (called hyperextension injury) which occurs 2. Ipsilateral loss of all cutaneous sensations (an-
esthesia) over the dermatome supplied by the
due to violent force applied to the back of neck in
incoming sensory nerve root of the affected
automobile accident.
segment. Initially this area of dermatome may
In this type of injury, central part of spinal cord
present hyperesthesia (exaggerated sensation)
is compressed by vertebral bodies and ligamentum due to irritation of posterior nerve root.
flavum from front and back respectively. 3. Ipsilateral spastic paralysis due to lesion of
same sided corticospinal and noncorticospinal
Effect
tracts passing through lateral and anterior white
All the manifestations as explained below are bilateral. column. Paralysis is below the level of lesion.
As this lesion occurs classically in cervical region, Depending upon the level of lesion, clinical
both motor and sensory loss involve both upper and finding may include Babinski sign positive, loss of
lower parts of body. abdominal and cremesteric reflexes, exaggerated
1. Lesion of anterior horn cells causes lower motor tendon jerks.
neuron lesion manifested by paralysis of the 4. Ipsilateral loss of fine as well as discriminative
muscles which are innervated by that particular touch (exteroceptive sensation) and sense of
90
Spinal Cord
position, movement with vibration sensation ischemic or neoplastic origin. Various infective or
(proprioceptive sensation) are manifested due to degenerative causes may give rise to selective lesion
lesion of dorsal white column tracts (fasciculus of different motor and/or sensory tracts, upper or
gracilis and fasciculus cuneatus). Sensory loss is lower motor neurons which are as follows.
below the level of lesion.
5. Contralateral loss of pain and temperature (lateral Tabes Dorsalis A Sensory Lesion (Fig. 4.27A)
spinothalamic tract) and pressure sensation (ante- It is a neurological disease caused by syphilis when
rior spinothalamic tract) is observed below the central nervous system is affected (neurosyphilis).
level of lesion. It damages selectively the posterior white column
Touch sensation is not affected as crude touch (fasciculus gracilis and fasciculus cuneatus) and
of the same side and fine touch of opposite side are also posterior nerve root fibers entering dorsal
preserved due to noninvolvement of opposite half of column. Commonly thoracic and lumbosacral segm-
spinal cord. ents are affected.

SELECTIVE LESIONS OF SPINAL CORD Effect


The above mentioned spinal cord syndromes are the Due to lesion of dorsal column tracts (fasciculus
results of spinal cord lesions which are of traumatic, gracilis and fasciculus cuneatus)

A Tabes dorsalis
B Anterior poliomyelitis

C Syringomyelia

D Multiple sclerosis E Amyotrophic lateral sclerosis

Figs 4.27A to E Various types of selective lesions of spinal cord. A. Tabes dorsalis, B. Anterior poliomyelitis, C. Syringomyelia,
D. Multiple sclerosis, E. Amyotrophic lateral sclerosis
91
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
1. Loss of sense of position and movement, and loss are affected. At the site of lesion cavitation followed
of vibration sensation. by gliosis gives rise to following clinical findings.
2. As the patient is not aware of position of limbs 1. Before formation of lateral spinothalamic tract,
while walking, the limbs strike against the ground fibers carrying sensation from opposite side of
causing stumping gait. Patient tries to compensate body, decussate in front of central canal in the
this disability with the help of vision. anterior gray and white commissures of the seg-
3. If visual help is withdrawn by closure of eyes, in ments commonly affected (lower cervical and
standing position, due to loss of sense of position, upper thoracic). Cavitation of central canal causes
patient will have a tendency to fall. It is known as damage to these fibers causing loss of pain and
positive Romberg sign. temperature sensation over skin of neck, upper
4. Loss of sensation of fullness of urinary bladder, as limb and upper part of trunk. Area of anesthesia
this sensory pathway traverses dorsal column. simulates area of body covered by a jacket. That is
Due to lesion of posterior nerve root fibers
why it is called Jacket type of anesthesia.
5. Loss of exteroceptive sensation over the dermatome
2. Dilatation of central canal (in lower cervical
areas of skin opposite the segments of spinal cord
and upper thoracic segments) starts from C8T1
affected.
segments of spinal cord and proceeds upwards as
Due to irritation of dorsal nerve root ganglia
well as downwards. So initially dilatation is maxi-
6. Paresthesia (altered sensation) or hyperesthesia
(exaggerated sensation) with stabbing pain sen- mum at C8T1 segments for which at these two
sation of the dermatome areas corresponding to segments lesion extends peripherally to damage
affected spinal cord segments. anterior horn cell which causes paralysis of small
muscles of hand followed by muscular atrophy.
Poliomyelitis Acute Viral Infection of Spinal Subsequently other muscle of upper limb are also
paralyzed.
Motor Neurons (LMN) (Fig. 4.27B)
3. If excavation of central canal progresses further
It is the neuronal disease caused by poliovirus which laterally, it will damage corticospinal and noncort-
cause selective damage to the motor neurons of icospinal tracts leading to spastic paralysis with
anterior gray column of spinal cord and motor nuclei exaggerated tendon jerks of both lower limbs, i.e.
of cranial nerves supplying muscles of face, tongue, below the level of lesion.
larynx and pharynx.
Worldwide immunization program by poliovac- Multiple Sclerosis A Demyelinating Disease
cine remarkably reduced the horror of incidence of (Fig. 4.27D)
the disease among children.
The viral infection is characterized by edema It is a degenerative disease of spinal cord caused by
of neural tissue with selective damage of anterior demyelination of both descending as well as ascen-
horn cells (LMN). It causes paralysis with wasting ding tracts. Following are the cause alone or in
of muscles. Lower limb is more affected than upper combination
limb. If motor nuclei of cranial nerves are affected, it 1. Heredity
causes paralysis of muscles of face, tongue, pharynx 2. Autoimmunity
and larynx. In severe poliomyelitis, respiratory mus- 3. Infection.
cles (diaphragm and intercostal muscles) may be Young adult age groups are affected. Because of
paralyzed. above mentioned predisposing factors, functioning of
Patient recovers from disease when edema sub- blood brain barrier looses it integrity. It will cause more
sides and motor neurons regain power. Permanent chance of infection which will lead to entry of leukocytes
death of some neurons is characterized by residual
in central nervous system tissue. Inflammation will
paralysis.
cause loss of myelin sheath (demyelination) of tract
fibers of spinal cord. Demyelination will cause initial
Syringomyelia A Lesion of Embryological
reduction and ultimate loss of velocity of action
Cause (Fig. 4.27C) potential of tract fibers.
Syringomyelia is a degenerative lesion of spinal cord During active phase of the disease following
characterized by excavation (dilatation) of central demyelination, the patient present impaired sens-
canal of some segments of spinal cord due to some ation, weakness of muscle at different levels depending
developmental reason. Usually cervicothoracic (lower upon level of spinal cord affected. There may be signs
cervical and upper thoracic) segments of spinal cord of ataxia as tracts of the cerebellum is affected.
92
Spinal Cord
The disease is characterized by Recovery and the level of lesion. It is associated with damage to
Recurrence. Recovery is due to remodeling of plasma anterior horn cells causing lower motor neuron lesion
membrane of demyelinated axons which become able of the muscles supplied by the affected segment.
to regenerate velocity of action potential. The disease turns to a fatal state within 5 to 6
But in unfortunate cases of progressive type of the years.
disease, instead of recovery, loss of myelin sheath is
followed by permanent damage of the axons. Combined Degeneration of Spinal Cord In
Pernicious Anemia
Amyotrophic Lateral Sclerosis A Progressive
Pernicious anemia, a type of megaloblastic anemia is
Degenerative Disease (Fig. 4.27E)
caused due to vitamin B12 deficiency. The disease is
It is a progressive degenerative disease of unknown associated with combined degeneration of descending
cause victimizing middle-aged people. It damages (motor) and ascending (sensory) tracts of spinal cord
selectively the corticospinal and noncorticospinal due to lesion of posterior and lateral white column. It
descending tracts causing spastic paralysis below is characterized by widespread motor and sensory less.

93
Brainstem
5
Brainstem is the tubular stalk-like part of the brain which is formed by posterosuperior surface of basilar
made up of midbrain, pons and medulla oblongata parts of sphenoid and occipital bones.
from above downward (Fig. 5.1). It is so called beca- n With tentorium cerebelli: Tentorium cerebelli
use it is like stem of a tree. Main mass of the brain, is a crescentic horizontal shelf of dura mater of brain
cerebrum with cerebellum rests on the brainstem and lying between posterior part of cerebrum (occipital
through it, is connected to spinal cord below. Long lobe) and cerebellum. It posseses peripheral convex
axis of brainstem is oblique, directed downward and border. In front of concave anterior border (tentorial
backward. notch), brainstem passes downwards. Midbrain is the
n Extent: Above, upper end of brainstem (midbrain)
supratentorial part and, pons with medulla oblongata
is continuous with diencephalon of forebrain.
is the infratentorial part of brainstem lying above and
n Below: Lower end of brainstem (medulla oblon-
below the tentorium cerebelli respectively (Fig. 5.2).
gata) passes out of cranial cavity through foramen
n With cerebrum and cerebellum: Cerebrum
magnum to become continuous with spinal cord at the
level of upper border of first cervical vertebra. with thalamus (diencephalon) is above and, cerebe-
llum is behind the brainstem. Ventral compact part
Relations of Brainstem
n With cranial cavity: Brainstem lies in posterior
Supratentorial
cranial fossa of skull and rests on the slope of clivus part of
brainstem

Tentorium
cerebelli
Midbrain

Infratentorial
Pons part of
brainstem

Medulla oblongata

Fig. 5.2 Tentorium cerebelli divides brainstem into supratentorial


Fig. 5.1 Brainstem (lateral view) and infratentorial parts
Brainstem

Superior cerebellar peduncle

Cerebral peduncle Cerebellum

Middle cerebellar peduncle

Inferior cerebellar peduncle

Fig. 5.3 Cerebellum and peduncles (cerebral as well as cerebellar) related to brainstem

of midbrain, composed of bundle of descending l Pons and upper part of medulla oblongata: A wide
fibers connects the brainstem (midbrain) above with tent shaped space forming cavity of hindbrain
cerebrum. It is called cerebral peduncle having right called fourth ventricle of brain.
and left identical halves. Cerebellum is connected to l Lower part of medulla oblongata: A narrow central
midbrain, pons and medulla oblongata of brainstem by canal of medulla continuous below with central
three pairs of compact bundle of white matter. These canal of spinal cord.
are called superior, middle and inferior cerebellar
peduncles respectively (Fig. 5.3). Structural and Functional Characteristics
n With fourth ventricle of brain: Fourth ventricle
is the cavity of hindbrain. It is related anteriorly Intermingling of gray matter and white matter
to pons and medulla oblongata and posteriorly to
cerebellum (Fig. 5.4). Brainstem is the part of central nervous system where
gray matter and white matter are not demarcated
into two separate zones. Unlike spinal cord, it is not
Cavity Related to Brainstem
divided into central gray matter and peripheral white
Cavity related to brainstem is of different shapes and matter. Again, unlike cerebrum and cerebellum it
natures at different level as follows: does not show superficial cortex and deeper medullary
l Midbrain A narrow linear slit known as aqueduct substance. Brainstem presents intermingling of gray
of Sylvius. matter and white matter.

Aqueduct of Sylvius

Fourth ventricle of brain

Central canal of lower end of


medulla oblongata

Fig. 5.4 Cavity related to brainstem


95
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
White Matter of Brainstem External Features of Brainstem
Brainstem acts as a bridge, composed of compact In this connection, two important points are to be
vertical bundles of fibers in the form of ascending and noted.
descending tracts connecting spinal cord with higher 1. External features of three components of brainstem
centers. are described here together.
Horizontal fibers from the three components of 2. External feature of brainstem are described in
brainstem connect cerebellum through three pairs of following three points:
cerebellar peduncles. a) Surface features of brainstem
b) Surface attachments of roots of 3rd to 12th
Gray Matter of Brainstem
cranial nerves.
Gray matter inside the brainstem is present in the c) Surface relations of brainstem with different
form of clusters of nerve cells called nuclei which are arteries.
as follows Relative length
1. Cranial nerve nuclei: There are motor and Midbrain 2 cm
sensory nuclei of 3rd to 12th cranial nerves. Pons 2.5 cm
2. Other nuclear masses: In all the three compo- Medulla oblongata 3 cm.
nents of brainstem, there are other nuclear
masses, for example red nucleus in midbrain,
pontine nucleus in pons and olivary nucleus in Surface Features of Brainstem
medulla oblongata. Ventral surface (Fig. 5.5)
3. Reticular nuclei: Throughout the whole length
of central core of brainstem, scattered collection A. At the level of medulla oblongata
of nerve cells are present. There are intermingled
with network (reticulum) of nerve fibers. These 1. Along the midline of ventral surface of medulla
constitutes reticular formation of brainstem. Scatt- oblongata a longitudinal fissure extends. It is
ered nerve cells are known as reticular nuclei. called ventral median fissure. Lower end of
fissure is continuous below with ventral median
Special Functional Areas in Brainstem fissure of spinal cord. Upper end of fissure, at
1. Brainstem contains Vital Centers which regulate pontomedullary junction, ends in a small shallow
the activities of cardiovascular and respiratory depression called foramen cecum.
systems. 2. On either side of ventral median fissure, there is
2. Brainstem contains center which controls auton- a narrow linear elevation called pyramid with its
omic reflex activities. broader upper end and narrower lower end. Deep
3. Brainstem reticular formation, which is defined ab- to it, passes a descending (motor) tract called
ove, regulates level of consciousness and alertness. pyramidal tract (corticospinal tract). Some of the

Aqueduct of Sylvius Upper cut surface of midbrain

Cerebral peduncle

Basilar sulcus

Basilar part of pons


Cut surface of middle cerebellar peduncle
Foramen cecum

Inferior cerebellar peduncle


Anterior median fissure
Olive
Posterolateral sulcus
Anterolateral sulcus
Pyramid

Fig. 5.5 External features of brainstem (ventral surface)


96
Brainstem
fibers of this tract decussate (cross) at the lower C. At the level of midbrain
end of pyramid. Decussation of these fibers is
visible at the lower end of ventral median fissure. Ventral surface of midbrain presents bilateral,
3. Pyramid is demarcated laterally by anterolateral compact, thick band-like structures separated by
sulcus which is continuous below with same sulcus a midline depression or broad sulcus. This is called
of spinal cord. cerebral peduncle. Upper cut surface of midbrain
4. An oval elevation, with its long axis being vertical, shows that cerebral peduncle is the part of midbrain
is present lateral to upper end of anterolateral which is ventral to aqueduct of Sylvius. Anterior most
sulcus. It is called olive. Deep to olive lies a mass part of the cerebral peduncle is made up of compact
of gray matter called inferior olivary nucleus.
bundle of descending (motor) fibers. This part is called
5. Posterolateral to olive, a sulcus extends vertically
which is parallel to anterolateral sulcus. This is crus cerebri.
called posterolateral sulcus. It is continuous below
with same sulcus of spinal cord. Dorsal surface (Fig. 5.6)
6. Further posterolateral, a compact vertical band of For better understanding, surface feature of dorsal
medulla, passes upwards, backwards and laterally surface of brainstem is described in following three
to cerebellum. It is called inferior cerebellar ped-
components.
uncle.
A. At the level of lower half of medulla oblongata.
B. At the level of pons B. At the level of upper half of medulla oblongata and
pons.
1. Junction between pons and medulla oblongata
presents a deep transverse sulcus. Midline of po- C. At the level of midbrain.
ntomedullary junction presents a small blind depr-
ession called foramen cecum. A. At the level of lower half of medulla oblongata
2. Along the midline of ventral surface of pons, a 1. Along the midline, a vertical sulcus runs. It
wide shallow sulcus extends vertically. It is known is called median intermediate sulcus which is
as basilar sulcus. Basilar artery passes along this
continuous below with posterior median sulcus of
sulcus from below upwards.
spinal cord.
3. On either side of basilar sulcus, ventral surface of
pons presents a bulge, called basilar part of pons. 2. On either side of this sulcus, dorsal surface of
4. Lateral to basilar part, pons presents thick lower half of medulla oblongata present a linear
compact band-like part which is horizontal in vertical elevation.
direction and passes laterally and backwards to 3. Upper end of this elevation, on either side, presents
cerebellum. This is middle cerebellar peduncle. a small elevation called gracile tubercle.

Superior colliculus Cut upper surface of midbrain

Inferior colliculus

Superior medullary velum Trochlear nerve

Superior cerebellar peduncle

Floor of 4th ventricle


Middle cerebellar peduncle
Facial colliculus

Hypoglossal triangle Inferior cerebellar peduncle

Cuneate tubercle
Vagal triangle
Gracile tubercle

Dorsal surface of lower closed Median intermediate sulcus


part of medulla oblongata

Fig. 5.6 External features of brainstem (dorsal surface)


97
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
4. Superolateral to each gracile tubercle, another ele- a horizontal limb crossing each other at a right
vation is present. This is called cuneate tubercle. angle.
Beneath the above two tubercles, lie nucleus gra- 3. Upper end of vertical limb presents a small
cilis and nucleus cuneatus respectively. depression to lodge pineal gland.
5. Superolateral to cuneate tubercle, compact band- 4. From inferolateral aspect of inferior colliculus of
like structure, called inferior cerebellar peduncle midbrain, a pair of compact band of white matter
passes upwards and laterally to the cerebellum. goes downwards, backwards and laterally to the
cerebellum. This is superior cerebellar peduncle.
B. At the level of upper half of medulla oblongata 5. A thin lamina of white matter connects the medial
and pons sides of two superior cerebellar peduncles, thus
forming the upper part of roof of 4th ventricle of
Dorsal surface of this part of brainstem presents brain. This is called superior medullary velum.
following characteristics. 6. Lower end of vertical limb of cruciform sulcus is
i. This area form the floor of 4th ventricle of continued vertically downwards across the midline
brain. of superior medullary velum in the form of a thin
ii. This area receives the opening of central canal ridge. It is called frenulum veli.
of medulla oblongata below and the opening of 7. On either side of frenulum veli, 4th cranial nerve
aqueduct of midbrain above. (trochlear nerve) comes out of brainstem piercing
Details of features of this area is described in the superior medullary velum.
It is to be noted at this stage that, out of last 10
chapter of 4th ventricle of brain. Some important
pairs of cranial nerves (3rd12th), only trochlear
features are as follows:
nerve comes out of brainstem from its dorsal surface.
1. The total area is rhomboid in outline, so called Finally, trochlear nerve goes forwards curving
Rhomboid fossa. round the posterolateral aspect of superior cerebellar
2. It is divided into right and left symmetrical tria- peduncle.
ngular halves by a vertical midline sulcus called Exit of cranial nerves (3rd12th) form brainstem
median sulcus. (Figs 5.6 and 5.7):
3. On either side of median sulcus, there is a linear All of last 10 pairs of cranial nerves (3rd12th) except
elevation called medial eminence. 4th (trochlear), come out of brainstem from ventral
4. Medial eminence at the level of pons, presents a surface (Fig. 5.7). Trochlear nerve comes out from
round elevation called facial colliculus. dorsal surface (Fig.5.6).
5. At the level of medulla oblongata, medial eminence Site of attachment of roots of these cranial nerves on
area is divided by a small sulcus into two triangular the surface of the brainstem will be better understood
areas. The superomedial triangular area is called and remembered if noticed in reverse order (i.e. 12th
3rd) as follows:
Hypoglossal triangle, and inferolateral one is
l 12th cranial nerve (hypoglossal) comes out through
called vagal triangle.
multiple rootlets, from anterolateral sulcus between
6. The medial eminence is bounded laterally by a pyramid and olive.
sulcus, known as sulcus limitans. l 9th (glossopharyngeal), 10th (vagus) and 11th
7. Small depressions at upper and lower ends of (accessory) nerves comes out in vertical row from
sulcus limitans area known as superior fovea and above downwards through posterolateral sulcus bet-
inferior fovea respectively. ween olive and inferior cerebellar peduncle.
8. Area lateral to sulcus limitans is triangular which l From medial to lateral at pontomedullary junction,
is called vestibular triangle. 6th (abducent), 7th (facial) and 8th (vestibulocochlear)
For further details, reader is suggested to go nerves comes out from the level of upper end of olive.
through text of floor of 4th vertricle of brain. Motor root of facial nerve (VII) is medial to its sensory
root.
C. At the level of midbrain l 5th cranial nerve (trigeminal) comes out from
midpontine level at the junction of basilar part of
1. Uppermost part of dorsal surface of midbrain pons and middle cerebellar peduncle. The nerve
presents two pairs round elevations. They are comes out in the form of superomedial motor root and
known as superior and inferior colliculi or corpora inferolateral sensory root.
quadrigemina (Singularcolliculus). Superior coll- l 4th cranial nerve (trochlear) is the exception which
iculi are slightly larger than the inferior. comes out from dorsal surface of brainstem. The
2. Four colliculi are separated from each other by nerve comes out piercing superior medullary relum
a cruciform sulcus which presents a vertical and lateral to frenulum veli. Finally the nerve comes in
98
Brainstem

Oculomotor nerve (III)

Trochlear nerve (IV)

Trigeminal nerve (V)

Abducent nerve (VI)

Facial nerve (VII)


Glossopharyngeal
Vestibulocochlear nerve (VIII)
nerve (IX)
Vagus nerve (X)

Accessory nerve (XI)


Hypoglossal nerve (XII)

Fig. 5.7 Exit of cranial nerves (III to XII) from brainstem

front winding round posterolateral aspect superior run vertically upwards along the length of basilar
cerebellar peduncle (Fig. 5.6). sulcus.
l 3rd cranial nerve (oculomotor) emerges from At the upper end of pons, basilar artery bifurcates
medial surface of crus cerebri of cerebral peduncle. into right and left posterior cerebral arteries.
5 sets of branches from vertebral artery and 5
Arteries related to surface of brainstem (Fig. 5.8) sets of branches from basilar artery are related to the
Arteries of vertebrobasilar system are related to ventral surface of brainstem as seen in Figure 5.8.
ventral surface of brainstem. 5 sets of branches of vertebral artery:
Right and left vertebral arteries run verti- 1. Meningeal arteries
cally from below upwards winding round the 2. Medullary arteries
posterolateral aspect of medulla oblongata. In the 3. Anterior spinal artery
midline of pontomedullary junction two vertebral 4. Posterior spinal artery
arteries unite to form basilar artery. Basilar artery 5. Posterior inferior cerebellar artery.

Posterior cerebral artery


Superior cerebellar artery

Labyrinthine artery Pontine arteries

Anterior inferior cerebellar artery


Posterior inferior cerebellar artery
Two vertebral arteries unite to
form basilar artery Meningeal arteries

Medullary arteries

Posterior spinal artery

Anterior spinal artery

Fig. 5.8 Arteries related to ventral surface of brainstem


99
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)

Diencephalon
Telencephalon
Mesencephalon
Diencephalon
Metencephalon
Mesencephalon

Rhombencephalon Myelencephalon
] Rhombencephalon

Spinal cord

Fig. 5.9 Components of neural tube Fig. 5.11 Differentiation of 3 components of developing brainstem

5 sets of branches of basilar artery: Pons is developed from ventral part of metence-
1. Pontine arteries phalon, dorsal part forming cerebellum. Medulla
2. Labyrinthine artery oblongata is developed from myelencephalon. Prox-
3. Anterior inferior cerebellar artery imal part of myelencephalon, which is adjacent to
4. Superior cerebellar artery pons is wider and, in due course of time, will follow
5. Posterior cerebral artery. the developmental characteristics as that of pons (see
below). Distal part of myelencephalon, adjacent to
Embryological Background of Brainstem spinal cord will remain narrower and in future will
show structural pattern more like spinal cord. So, mid-
Internal structure of brainstem is not only important, brain and hindbrain vesicles are differentiated into
it is very interesting. For its better understanding, following four parts (Fig. 5.12).
a reader must have a basic concept of embryological 1. Mesencephalon will form midbrain
background of brainstem. 2. Ventral part of
Three components of brainstem, midbrain, Metencephalon will form pons
pons and mudulla oblongata develop from two of 3. Proximal part of
three brains vesicles. These are midbrain vesicle Myelencephalon will form upper wider part of
(mesencephalon) and hindbrain vesicle (rhomben- medulla oblongata
cephalon) (Figs 5.9 and 5.10). 4. Distal part of
Rhombencephalon is further divided into proximal Myelencephalon will form lower narrower part
metencephalon and distal myelencephalon (Fig. 5.11). of medulla oblongata

Neuroectodermal lining 1 Neuroectodermal lining


Mesencephalon (midbrain)
Midbrain vesicle
2
Metencephalon (ventral
Hindbrain vesicle part to form pons)
3 Upper wider part

4 ] Myelencephalon
Lower narrower part (medulla oblongata)

Spinal cord

Fig. 5.10 Caudal two components of 3 brain vesicles to from Fig. 5.12 Differentiation of part of neural tube to form various
future brainstem components of brainstem
100
Brainstem

Alar lamina (alar plate)


Ependymal layer

Mantle zone formed by


Basal lamina (basal plate)
nerve cells

Marginal zone formed


by nerve fibers

Fig. 5.13 Formation of mantle zone and marginal zone due to proliferation of neuroectoderm layer of cells, which remains as ependymal layer

But all these four components of primitive brain- However, this interrelationship between inner
stem will follow the common (similar) embryological mantle zone (gray matter) and outer marginal
steps as follows: zone (white matter) will not persist in all the
1. Initially, all components will be lined by single components of developing brainstem. Ultimately
layer of neuroectodermal cells (Fig. 5.12). there will be intermingling of gray and white
2. Cells of this single layer proliferate by mitosis. matter (see below).
The newer cells (daughter cells) are pushed to the 5. Midlines of dorsal and ventral aspects of epen-
periphery and form a definite layer called mantle
dymal layer present roof plate and floor plate
zone (Fig. 5.13).
respectively.
Two different types of cells, neuroblasts and
spongioblasts in mantle zone will form neurons 6. Each half (right and left) of mantle zone is
and neuroglia (macroglia) respectively. divided into dorsal and ventral components by a
3. Original lining cells will form outline of the cavity linear sulcus called sulcus limitans. Dorsal part
of these parts of neural tube, called ependymal is called alar lamina (alar plate) and ventral part
cells. is called basal lamina (basal plate). Neurons
4. The processes of developing neurons in the mantle of alar lamina will be sensory in function and
zone will be pushed to the periphery outside the those of basal lamina will be motor in function
mantle zone to form marginal zone (Fig. 5.13). (Fig. 5.14).

Alar plate Roof plate

Central canal Sulcus limitans

Floor plate
Basal plate
Midbrain

Pons

Upper wider part of


medulla oblongata

Lower narrower part of


medulla oblongata

Fig. 5.14 Developing brainstem showing its components


101
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Stretched out roof plate at the level of
pons and upper part of medulla oblongata
Alar lamina (dorsolateral)
Widening of cavity forms 4th
Basal lamina (ventromedial) ventricle of brain

Pons developing from ventral part of


metencephalon

Upper part of medulla oblongata Lower narrower part of medulla oblongata

Narrow central canal with dorsoventral


relation of alar and basal laminae

Fig. 5.15 Pons and upper wider part of medulla oblongata show stretching of roof plate

Dissimilarity in Development in Different d) Basal and alar laminae are thereby not vent-
Components of Brainstem rodorsally related. Alar lamina becomes dorso-
lateral to basal lamina.
l Mesencephalon (midbrain) remains compara-
tively stunted in growth, thus remaining as short
Organization of Internal Structure at Different
segment of brainstem. Its central cavity becomes
very narrow to be named as aqueduct of Sylvius. Level of Brainstem
Alar lamina is dorsal and basal lamina is ventral in Central cavity of brainstem show different charact-
position (Fig. 5.16). eristics and names at different level. At lower end of
l Caudal or lower part of myelencephalon (medulla medulla it is a narrow canal continuous below with
oblongata), continuous below with spinal cord remain central canal of spinal cord. At the level of pons and
narrow and tubular like spinal cord. Its central canal
upper half of medulla oblongata, it becomes wide
becomes narrow. Alar lamina and basal lamina are
to form the cavity of 4th ventricle of brain. At the
related dorsoventrally (Fig. 5.16).
level of midbrain it is a narrow slit called aqueduct
l Metencephalon (pons) and proximal or upper
part of myelencephalon (medulla oblongata) show of Sylvius.
following changes (Figs 5.15 and 5.17). Fundamentally, neurons of basal plate are motor
a) Roof plate is stretched outwards on both side. and those of alar plate are sensory in function. Thro-
b) That is why cavity of this part of neural tube ughout the whole length of developing brainstem,
(pons and upper part of medulla oblongata) is initially, many neurons of both basal as well as alar
widened which will form 4th ventricle of brain. plate will form number of continuous columns of cells
c) Dorsal aspect of cavity of 4th ventricle of brain which are as follows:
will be lined only by ependymal layer as a n In basal plate (from medial to lateral) (Fig. 5.18)
result of stretching of roof plate. 1. Somatic efferent

Alar plate

Mantle zone
{ Basal plate
Ependymal layer

Marginal zone

Fig. 5.16 Similar relationship of differents layers of developing brainstem at the level of midbrain and lower half of medulla oblongata
102
Brainstem

Rhombic lip grows from alar


plate to form cerebellum

Cavity of hindbrain (4th ventricle)

Sulcus limitans
Dorsolateral alar plate

Ventromedial basal plate


Marginal zone

Fig. 5.17 Relationship of different layers of developing brainstem at the level of pons and upper half of medulla oblongata

Somatic afferent
Alar plate
Special visceral afferent

General visceral afferent

General visceral efferent

Special visceral efferent


Basal plate
Somatic efferent

Fig. 5.18 Cell columns forming cranial nerve nuclei in developing brainstem where central canal is narrow (midbrain and lower half of
medulla oblongata)

2. Branchial efferent (special visceral efferent) in open part, i.e. pons and upper part of medulla
3. General visceral efferent. oblongata (Fig. 5.19).
n In alar plate: From medial to lateral in closed 1. Somatic afferent
part of brainstem, i.e. midbrain and lower end of med- 2. Branchial afferent (special visceral afferent)
ulla oblongata (Fig. 5.18) and, from lateral to medial 3. General visceral afferent.
Stretched out roof plate
(lined by ependyma only) Cavity of 4th ventricle of
brain

Somatic afferent
Alar plate
Special visceral afferent

General visceral afferent


General visceral efferent
Special visceral efferent
Basal plate
Somatic efferent

Fig. 5.19 Cell columns forming cranial nerve nuclei in developing brainstem where roof plate is outstretched widening central canal to
form fourth ventricle of brain (at the level of pons and upper half of medulla oblongata)
103
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Nucleus gracilis
Nucleus cuneatus

Alar plate

Basal plate
} Mantle zone

Marginal zone

Fig. 5.20 Dorsal migration of cells of alar plate of lower closed part of medulla oblongata leads to development of nucleus gracilis and
nucleus cuneatus

Ultimately, neurons of all these columns will 2. Horizontal: These are fiber bundles connecting
persist in some level and disappear in some level. various centers of central nervous system with
So they will no longer be present in the form of cerebellum in both direction, passing through 3
continuous cell column althrough. These cell groups cerebellar peduncles.
will form different motor and sensory nuclei of 3rd to n Migration of cells of alar plate to form various
12th (last 10) cranial nerves.
nuclei: As already stated, neurons of alar plate form
n Migration of neurons of alar lamina: Apart
from formation of sensory (afferent) nuclei of cranial various sensory neclei of last 10 pairs (3rd12th) of
nerves, neurons of alar plate will migrate from its cranial nerves. Besides, neurons from alar plate migrate
original position either ventrally or further dorsally either ventrally or further dorsally to form various
to form some other named nuclei in different level of nuclei in different levels of brainstem as follows.
brainstem (described below). This nuclei, as migrated, 1. At the level of lower closed part of medulla
will intermingle with the components (white matter) oblongata (Fig. 5.20): Cells of alar plate migrate
of marginal zone. further dorsally on either side of posterior median
n Derivatives of marginal zone: It is already und-
sulcus to form two nuclei.
erstood that, marginal zone is composed of processes
a) Medial: Nucleus gracilis
of nerve cells of mantle zone. These processes will
form different groups of bundles of nerve fibers which b) Lateral: Nucleus cuneatus.
are basically of following two types 2. At the level of upper half of medulla oblon-
1. Vertical: These are either ascending (afferent) or gata: Cells of alar plate migrate ventrally in the
descending (efferent) tracts of nerve fibers conn- peripheral plane of marginal zone in the form of
ecting spinal cord with various higher centers. following nuclei (Fig. 5.21).
Basal plate
Cavity of hindbrain (4th ventricle)
Ependymal roof
Alar plate

Migration of cells of
alar plate forms

Inferior olivary nucleus


and

Arcuate nucleus

Fig. 5.21 Ventral migration of cells of alar plate in upper half of medulla oblongata forms inferior olivary nucleus and arcuate nucleus
104
Brainstem
Cavity of hind brain Ependymal roof
(4th ventricle)
Rhombic lip to form
cerebellum

Migration of cells of
alar plate
Alar plate
Mantle zone
{ Basal plate

Pontine nucleus

Marginal zone forming


basilar part of pons

Fig. 5.22 Migration of cells of alar plate of developing pons leads to formation of: VentrallyPontine nucleus DorsallyRhombic lip for
development of cerebellum

a) Medial: Arcuate nucleus, placed ventral to from marginal zone. This is nucleus pontis or
vertical descending bundle of corticospinal (py- pontine nucleus.
ramidal) tract fibers. b) Dorsally: These cells migrate dorsally over the
b) Lateral: Inferior olivary nucleus, placed lateral ependymal lining of 4th ventricle of brain from
both sides which finally fuse together. This is
to corticospinal (pyramidal) tract fibers.
called rhombic lip. This will form cerebellum.
These nuclei develop from the alar plate cells which 4. At the level of midbrain (Fig. 5.23): As in
are called bulbopontine extension (caudal part). other parts of brainstem, neurons of alar plate
3. At the level of pons (Fig. 5.22): The cells of of midbrain form sensory nuclei of some cranial
alar plate at this level migrate in two different nerves. Some of the neurons migrate in following
directions: two directions to form specific nuclei of midbrain.
a) Ventrally: These cells migrate ventrally in the a) Ventrally: These cell groups migrate ventrally
beyond basal plate into marginal zone to
plane of marginal zone of pons. These are the
form two nucleiRed nucleus and Substantia
cells of cephalic part of bulbopontine extension. nigra. Red nucleus is present in upper half of
These neurons are present in scattered fashion midbrain, whereas substantia nigra extends
intermingled with white matter developed throughout its whole length.

Central canal gets narrowed


to form aqueduct of midbrain

Tectum

Alar plate
Mantle zone
{ Basal plate
Migration of cells of
alar plate
Substantia nigra

Red nucleus

Marginal zone

Fig. 5.23 Migration of cells of alar plate in developing midbrain form various nuclei as following, Ventrally = Red nuclens and
substantia nigra, Dorsally = Tectum (nuclei of superior and inferior colliculi)
105
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
First order sensory neurons in
posterior root ganglia developed
from neural crest cells

4. Somatic afferent

Alar plate 3. General

{
visceral
afferent
Mantle
zone
Basal plate 2. General visceral
efferent

Marginal zone
1. Somatic efferent

Fig. 5.24 Neural tube forming spinal cord gives rise to four cell columns. Basal plateSomatic efferent and general visceral efferent,
Alar plateSomatic afferent and general visceral afferent

b) Dorsally: Some of cells of alar plate migrate sympathetic center) and S2S4 segments (forming
further dorsally to form two pairs of bulged parasympathetic center). But both somatic centers
area called superior and inferior colliculi which (efferent and afferent) extend althrough the segments
form dorsal part of midbrain called tectum. of spinal cord.
A cranial nerve (3rd12th), unlike the spinal
Cranial Nerve Nuclei in Brainstem nerve is not always a mixed nerve. It may be mixed,
motor or sensory. However, a cranial nerve out
A spinal nerve is formed by union of ventral and of last 10 pairs, may not only contain all the four
dorsal roots which are functionally motor (efferent) functional components as spinal nerve, it may contain
and sensory (afferent) components respectively. Mo- in addition, another two components, one motor and
tor fibers in the ventral root are of two types, somatic one sensory. These are called special visceral efferent
motor (somatic efferent) and visceral motor (general (branchial efferent) and special visceral afferent
visceral efferent) (Fig. 5.24). Somatic efferent fibers (branchial afferent).
supply skeletal (voluntary) muscles and general So, for clear understanding of functional compo-
visceral efferent fibers supply smooth (involuntary) nents of cranial nerve, background knowledge of
muscles and exocrine glands. Again, sensory fibers special visceral efferent and special visceral afferent
in the dorsal root of spinal nerve are two types components is important as well as interesting as
somatic sensory (somatic afferent) and visceral stated below.
sensory (general visceral afferent) (Fig. 5.24). Somatic In embryonic life, six pairs of mesodermal arches
afferent fibers carry somatic sensations liketouch, (branchial arches or pharyngeal arches) embrace
pressure, pain, temperature (exteroceptive) and sense ventrolateral aspects of primitive pharynx. Out
of position and movements (proprioceptive). General of these six, fifth (5th) arch disappears. Muscular
visceral afferent fibers carry sense of stretch, pain, elements of existing five pairs of branchial arches give
distension, compression from the viscera. Cell bodies rise to some muscles in the region of head and neck.
of these types of neuronal processes are present in the All of which are voluntary muscles (but not somatic
form four cell columns in the spinal cord gray matter. muscle). Some of these voluntary muscles are even
In embryonic period, initially all these columns used related to wall of some viscera like palate, larynx and
to extend throughout the whole length of developing pharynx. So these muscles developed from branchial
spinal cord. Both of the motor or efferent columns arch mesoderm, not developed from paraxial mesod-
exist in basal plate. Somatic efferent is medial and ermal somites, being voluntary in nature, of which
general visceral efferent is lateral (Fig. 5.24). Both some related to viscera, are called branchial arch
the sensory or afferent columns exist in alar plate muscle. These muscles lying in the head and neck
of mantle zone throughout whole length of spinal region, need inervation from cranial nerves. So some
cord. Somatic afferent column is medial to general of cranial nerves (between 3rd12th), need to have
visceral afferent column (Fig. 5.24). But ultimately, an additional component to supply branchial arch
general visceral efferent and general visceral afferent muscles which is called branchial efferent or special
columns persist only in T1L2 segments (forming visceral efferent.
106
Brainstem

Somatic afferent

Alar plate Special visceral afferent

General visceral afferent

General visceral efferent

Basal plate
Special visceral efferent

Somatic efferent

Fig. 5.25 Neural tube forming brainstem (midbrain and lower closed part of medulla) prescents six (3 + 3) columns of cells forming
nuclear components of cranial nerves

Again from some viscera liketongue, soft palate 2. Special visceral efferent
and upper end of pharyngeal wall, special sense, 3. General visceral efferent.
liketaste (gustatory) sensation, need to be carried 3 in alar plate (from medial to lateral where deve-
by special components of some cranial nerves. These loping brainstem is a closed canal, e.g. midbrain and
component is called special visceral afferent or lower end of medulla oblongata are as follows (Fig. 5.25):
branchial afferent. 1. Somatic afferent
So, in comparison to four functional components
2. Special visceral afferent
of spinal nerve, six functional components of cranial
3. General visceral afferent.
nerves are the neuronal processes of following six
functional columns of cell groups In the parts of developing brainstem, where roof
3 in basal plate (from medial to lateral) are as plate is stretched, e.g. pons and upper part of medulla
follows (Fig. 5.25): oblongata, above three afferent columns are related
1. Somatic efferent lateral to medial (Fig. 5.26).

Alar plate Somatic afferent


(Dorsolateral)

Special visceral
afferent

General visceral
afferent

General visceral
efferent
Basal plate Special visceral
(ventromedial) efferent
Somatic efferent

Fig. 5.26 Developing brainstem at the level of pons and upper part of medulla oblongata present six (3 + 3) columns of cells which form
different functional components of cranial nerves
107
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Functional components of cranial nerve nuclei in dif- will receive special somatic sensation likesense of
ferent level of brainstem hearing (exteroceptive) and sense of equilibrium or
balance of body (proprioceptive).
Before the positions of various nuclei of 3rd12th ii. All the 7 cell columns (3 motor and 4 sensory)
cranial nerve in different levels of brainstem is will finally not remain continuous althrough the
studied, it is very important to note the following two brainstem. In case of each column, somewhere
points. the cells will persist and in some level, cells will
i. Somatic afferent columns in developing brainstem disappear or degenerate. So, continuity of the
are of two types (Fig. 5.27 inset) cells in the columns will be interrupted, leading to
n General somatic afferent column: These cell formation of various cranial nerve nuclei.
groups will form general somatic afferent nuclei which
will receive general somatic sensation liketouch, Location and function of cranial nerve nuclei in
pressure, pain and temperature (exteroceptive) and different level of brainstem
sense of position and movements from muscles and Considering stretching of root plate, which results
joints (proprioceptive). abduction of alar plate, various functional groups of
n Special somatic afferent column: These cell cranial nerve nuclei are positioned from medial to
groups will form special somatic afferent nuclei which lateral as follows (Fig. 5.27):
Floor plate Basal plate Sulcus limitans Alar plate

Gen som Sp som


aff aff
Som eff Sp visc Gen visc Gen visc Sp visc
eff eff aff aff Ex Prop Ex Prop

3 Mes.N
Midbrain 3
EWN
5
4

5
PSN S
Pons 5 D
6 7 7 SSN 8
5 8 L
9 NTS M
ISN V
9 7 SP.N I Vest.N
12 Coch.N
Medulla 10 NA 9 5
oblongata 10
DN 10 DN 10
11

Spinal cord 11 C2

C5
NTSNucleus tractus solitarius
NA Nucleus ambiguous
PSNPrincipal sensory nucleus
EWN Edinger Westphal nucleus
(superior sensory nucleus) Sulcus limitans
SSN Superior salivatory nucleus
SP.N Spinal nucleus of trigem Nr.
ISN Inferior salivatory nucleus Sp. somatic afferent
Mes N. Mesencephalic nucleus of
DN Dorsal nucleus of vagus
trigem nerve
General somatic
afferent
Sp. visceral afferent
Floor plate Gen. visceral afferent
Gen. visceral efferent
Sp. visceral efferent
Somatic efferent

Fig. 5.27 Functional components of cranial nerve nuclei in brainstem


108
Brainstem

}
1. Somatic efferent supply muscles developed from mesoderm of five (1st
2. Special visceral efferent In the basal plate (between to 4th, and 6th) branchial arches.
(Branchial efferent) floor plate and sulcus These nuclei are as follows
3. General visceral efferent limitans) 1. Vth (trigeminal) nerve nucleus: This is the only

}
motor nucleus of trigeminal nerve. It is situated
4. General visceral afferent
in upper half of pons. Motor fibers (axons) arising
5. Special visceral afferent In the alar plate (lateral to
from this nucleus supply all the muscles developed
6. General somatic afferent sulcus limitans)
from 1st branchial arch.
7. Special somatic afferent
Muscles developed from first branchial arch are 8
Somatic efferent nuclei in number (4+2+2) which are
4 Muscles of mastication: i) Masseter
These are motor nuclei of some of the cranial nerves ii) Temporalis
which send axons to supply the skeletal muscles iii) Lateral pterygoid
developed from somites of preoccipital and occipital iv) Medial perygoid
myotomes. 2 Tensor muscles: v) Tensor palati (tensor
Muscles developed from preoccipital myotome are of soft palate)
all extrinsic muscles of eyeball, i.e. vi) Tensor tympani
(tensor of tympanic
i. Levator palpebrae Elevator of upper
membrane of ear)
superioris eyelid
2 Companion muscles

}
ii. Superior rectus
in neck: vii) Anterior belly of
iii. Inferior rectus
digastric
iv. Medial rectus 4 Recti muscles
viii) Mylohyoid
v. Lateral rectus
vi. Superior oblique
vii. Inferior oblique } 2 Oblique muscles 2. VIIth (facial) nerve nucleus: This motor nuc-
leus of facial nerve is situated in lower half of pons.
Motor fibers (axons) arising from this nucleus are
These extrinsic muscles of eyeball are supplied by branchial efferent or special visceral efferent fibers
fibers (axons) of following somatic efferent nuclei of facial nerve and these fibers supply muscles
1. IIIrd (oculomotor) nerve nucleus: Situated in developed from mesoderm of second branchial
upper half midbrain supplies all extrinsic muscles arch.
listed above except Muscles developed from second branchial arch are
a) Superior oblique following:
b) Lateral rectus. 1. Muscles of scalp Occipitofrontalis
2. IVth (trochlear) nerve nucleus: Situated in 2. Extrinsic as well as intrinsic muscles of auricle
lower half of midbrain, supplies superior oblique. 3. All muscles of facial expression with platysma
3. VIth (abducent) nerve nucleus: Situated in 4. A small muscle in middle ear cavity Stapedius
lower part of pons, supplies lateral rectus. 5. Two companion muscles in neck Posterior belly
Muscles developed from occipital myotome are all of digastric and stylohyoid.
the muscles of tongue except palatoglossus. These mus-
cles are supplied by axonal fibers of 3. Nucleus ambiguous: This is a composite nuc-
4. XIIth (hypoglossal) nerve nucleus: It is the leus of branchial efferent or special visceral effer-
nucleus of somatic efferent column and situated ent column present in medulla oblongata and
in upper two-thirds of medulla oblongata. Axonal extending upto upper 5 cervical segments of spinal
processes of this nerve supply all muscles of cord.
tongue except palatoglossus, which are developed Nucleus ambiguous is composed of following 4
from occipital myotome. parts of which first 3 parts lie in medulla oblongata
All the above four somatic efferent nuclei of and last part lies in spinal cord.
brainstem (IIIrd, IVth, VIth and XIIth nerve nuclei) l 1st part: Nucleus of IXth cranial (glossopharyngeal)
are in the line with and homologous to anterior horn nerve. It supplies one muscle developed from 3rd
cells of all segments of spinal cord which supply branchial arch which is stylopharyngeus.
somatic segmental muscles of body. l 2nd part: Nucleus of Xth cranial (vagus) nerve. It
supplies one muscle developed from IVth branchial
Special visceral efferent (Branchial efferent) nuclei
arch which is cricothyroid.
These are the motor nuclei of some of cranial nerves l 3rd part: This is the nucleus of XIth cranial (acce-
which, through their axons (outgoing motor fibers) ssory) nerve. As it lies in medulla oblongata (part
109
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
of brain), it is called cranial nucleus of accessory i. Smooth muscles of tracheobronchial tree.
nerve which supplies muscles developed from ii. Smooth muscles (myocardium) of heart.
mesoderm of 6th branchial arch. iii. Smooth muscles of gut (foregut and midgut)
These muscles are upto right two-thirds of transverse colon.
a) All muscles of soft palate except tensor palati iv. Mucous glands of tracheobronchial tree and
b) All muscles of pharynx except stylopharyngeus above mentioned parts of gut.
c) All muscles of larynx except cricothyroid.
l 4th part: This part is also nucleus of 11th cranial
General visceral afferent nucleus
(accessory) nerve. It is called spinal nucleus
of accessory nerve as it is formed by central Nucleus of this column of brainstem receives incom-
group of anterior horn cells of first five cervical ing nerve fibers which carry general sensation from
segments of spinal cord. This component of viscera, e.g. sensation of pain (due to ischemia),
nucleus ambiguous supplies two muscles of neck stretch, distension or compression.
named sternomastoid and trapezius which are
In this column there is one and only one nucleus
also considered to be muscles developed from
which is dorsal nucleus of vagus (sensory component).
mesoderm of 6th branchial arch.
Dorsal nucleus of vagus nerve is a composite nucleus
General visceral efferent nuclei which is composed of a motor and a sensory part. It
lies in the lower part of medulla oblongata. Sensory
Cranial nerve nuclei of this column of brainstem
form the centers for parasympathetic system in brain part of dorsal nucleus of vagus nerve receives
(brainstem). incoming sensory fibers of vagus nerve which carry
Cell group of these nuclei send axons (motor fibers) visceral sensations as stated above from wall of
to i) Smooth muscles and ii) exocrine glands. tracheobronchial tree and, gastrointestinal tract upto
These nuclei are following: right two-thirds of transverse colon.
1. Edinger-Westphal nucleus: This is general visc-
eral efferent nucleus of IIIrd cranial (oculomotor) Special visceral afferent nucleus
nerve. Axons of this nucleus supply two smooth
muscles of eyeball Ciliaris and sphincter pupillae. Nucleus of cranial nerve of this column receives
Being the part of oculomotor nerve nucleus, it is incoming sensory (afferent) fibers which carry special
situated in upper part of midbrain. sensation from the viscera, e.g. tongue, palate and
2. Superior salivatory nucleus: upper part of pharynx, that is taste.
n It is the general visceral efferent nucleus of VIIth In this column there is only one composite nucleus
cranial (facial) nerve. This nucleus is so called as which is named
it gives fibers which supply secretomotor fibers n Nucleus tractus solitarius: It is a composite
to the two out of three salivary glands. These are nucleus of special visceral afferent column situated in
submandibular and sublingual glands. medulla oblongata. This nucleus is composed of three
n This nucleus has a component called lacrimatory
parts as follows
nucleus which gives out secretomotor fibers to lacri-
l Upper part: It is the nucleus of seventh cranial
mal gland.
(facial) nerve which receives the incoming sensory
n Preganglionic secretomotor fibers for mucous
glands of palate, nasal cavity and upper part of fibers carrying taste sensation from anterior two-
pharynx also arise from this nucleus. thirds of tongue soft palate and upper part of pharynx.
Superior salivatory nucleus is situated in lower l Middle part: It is the nucleus of ninth cranial
part of pons. (glossopharyngeal) nerve which receives the incoming
3. Inferior salivatory nucleus: It is situated in upper sensory fibers carrying taste sensation from posterior
part of medulla oblongata. This general visceral one-third of tongue.
efferent nucleus supplies secretomotor fibers to l Lower part: It is the nucleus of tenth cranial (va-
another salivary gland, i.e. parotid gland.It is the gus) nerve which receives the incoming sensory fibers
nucleus of IXth cranial (glossopharyngeal) nerve. carrying taste sensation from posterior most part of
4. Dorsal nucleus of vagus: This is the general tongue, vallecula and epiglottis.
visceral efferent nucleus of Xth cranial (vagus)
nerve. It is situated in lower part of medulla oblon-
General somatic afferent nuclei
gata. Vagus nerve is a very long cranial nerve
having extensive course in head and neck, thorax Sensory nuclei of cranial nerves of this group receive
and abdomen. Through this nerve, fibers from general somatic sensations from the area of face
dorsal nucleus of vagus are distributed to including forehead.
110
Brainstem
General somatic sensations are of two types, which ceptive sensations from muscles of mastication,
are carried to the respective nuclei. They are muscles of eyeball, muscles of face, roots of teeth and
temporomandibular joint.
Exteroceptive Proprioceptive n Special point to note: Cells of mesencephalic
This nucleus receives This nucleus nucleus posses a special characteristic. In case of
exteroceptive receives proprioceptive all other sensory pathway, cell bodies of 1st order of
sensations from the sensations from some neuron lie outside the central nervous system and
area of face which muscles and joints their central processes enter the central nervous
are touch, pressure, in the area of head system to relay in second order of neurons which
pain and temperature. which are constitute the corresponding sensory nucleus. But
i. Muscles of mesencephalic nucleus of trigeminal nerve is made
mastication up of cell bodies of 1st order of sensory neurons lying
ii. Muscles of eyeball inside the central nervous system which carries
iii. Muscles of facial proprioceptive sensation from the end organs as
expression stated above.
iv. Roots of teeth
v. Temporomandibular Special somatic afferent nuclei
joint.
Both the above types are sensory nuclei of Vth Nuclei of this group of cranial nerve receive sensory
cranial (trigeminal) nerve. fibers which carry special somatic sensation.
Names of these general somatic afferent nuclei of All these nuclei are situated in pontomedullary
trigeminal nerve are junction.
All of these are nuclei of VIIIth cranial (vestibulo-

}
i. Nucleus of spinal tract of trigeminal nerve Exteroceptive cochlear) nerve.
nuclei These nuclei are of following two groups:
ii. Superior (principal) sensory nucleus
iii. Mesencephalic nucleus of trigeminal nerve
Proprioceptive nucleus Exteroceptive Proprioceptive
In the brainstem these three nuclei are as follows Dorsal and ventral Four vestibular nuclei
from below upwards. cochlear nuclei. named superior,
1. Nucleus of spinal tract of trigeminal nerve These nuclei receive inferior, lateral and
(Spinal nucleus of trigeminal nerve) incoming fibers medial vestibular nuclei.
This nucleus presents three components: of cochlear part of These nuclei receive
i. Middle or main component: Extends throughout vestibulocochlear incoming fibers of
the whole length of medulla oblongata nerve which carry vestibular part of
ii. Upper end: Extends into lower end of pons sense of hearing vestibulocochlear nerve
iii. Lower end: Continued in upper two cervical (cochlear sensation). which carry sense of
segments (C1, C2) of spinal cord. equilibrium (balance).
Nucleus of spinal tract of trigeminal nerve receives n Important guideline: While studying IIIrd
all the incoming sensory (afferent) fibers of trigeminal XIIth (last 10) cranial nerves in the chapter of cranial
nerve which carry pain and temperature sensations
nerve, a reader must consult the text, as well as
from same side of whole area of face.
figures of the following components of the chapter of
2. Superior (principal) sensory nucleus of trige-
Brainstem as described here.
minal nerve
This nucleus is situated in pons. i. Embryological background of brainstem.
Superior sensory nucleus receives all the incoming ii. Functional components of cranial nerve nuclei
sensory (afferent) fibers of trigeminal nerve which in different level of brainstem.
carry touch and pressure sensations from same half Reader must develop a clear concept on Figure
of the whole area of face. no. 5.27. He/she must practice drawing of this figure
3. Mesencephalic nucleus of trigeminal nerve again and again till to have a confidence to draw the
It is so named because this nucleus is situated in same from memory without any help.
midbrain (mesencephalon). Reader must study the Figure no. 5.27 to find the
Mesencephalic nucleus of trigeminal nerve is the answers of following questions:
proprioceptive sensory nucleus. It receives incoming i. What are the types of IIIrdXIIth cranial nerve
sensory fibers of trigeminal nerve which carry proprio- motor, sensory or mixed?
111
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
ii. What are the functional components of the cells of alar plate. Many of them are migrated
cranial nerves, from IIIrdXIIth? from their original position ventrally to the region
iii. What are the cranial nerve nuclei in a of basal plate, e.g. olivary nucleus of medulla
particular functional column? oblongata. Some of these are migrated further
For example: Somatic efferent column present dorsally, e.g. tectum of midbrain.
nuclei of IIIrd, IVth, VIth and XIIth cranial b) Cranial nerve nuclei (IIIrdXIIth): Motor nuclei
nerve. of these cranial nerves are developed from cells of
iv. What are the motor nuclei (nuclei in the basal basal plate and the cells of alar plate give rise to
plate) and what are the sensory nuclei (nuclei sensory nuclei.
in alar plate)?
v. What are the cranial nerve nuclei present in Internal Structure of Medulla Oblongata
each of the three segments of brainstem? i.e.
in midbrain, pons and medulla oblongata. Internal structure of medulla oblongata is studied in
For example: In midbrain lies somatic efferent following three levels (Fig. 5.28)
nuclei of IIIrd and IVth cranial nerve, general 1. At the lower end of medulla oblongata: Below the
visceral efferent nucleus of IIIrd nerve (EWN) bulge of pyramid, where decussation of motor
and somatic afferent nucleus (mesencephalic fibers of pyramidal tract (corticospinal tract),
nucleus) of Vth cranial nerve. passing through the pyramid, takes place (at the
vi. What are the motor and/or sensory components plane of motor decussation).
of a cranial nerve, from IIIrd to XIIth? 2. Above the middle of medulla oblongata, at the level
of middle of bulge of pyramid. At this level sensory
fibers from nucleus gracilis and nucleus cuneatus
Internal Structures of Brainstem
decussate before these sensory tracts pass further
n Fundamental points: Internal structure will be upwards (At the plane of sensory decussation).
crystal-clear to a reader if one goes thoroughly with 3. At the upper end of medulla oblongata, close to
the previous parts of chapter of Brainstem. pontomedullary junction.
Internal structure of brainstem, at any level,
shows intermingling of gray matter and white Medulla oblongata at its lower end (at the plane of
matter unlike spinal cord, cerebellum and cerebrum. motor decussation) (Fig. 5.29)
It may be remembered, in spinal cord, white matter
is peripheral and gray matter is central, whereas Structural characteristics
in cerebellum as well as cerebrum, arrangement is
reverse. 1. At this level structure of medulla oblongata is
Any level of brainstem shows following components almost similar to the structure of spinal cord, with
of internal structure centrally positioned gray matter and peripheral
1. White matter: white matter.
a) Vertical fibers two types 2. Ventral horn of gray matter gets separated from
i. Ascending (Afferent): Passing from a lower main mass due to decussation of pyramidal tract fib-
center to a higher center. ers which pass backwards and laterally to approach
ii. Descending (Efferent): Passing from a higher lateral white column before passing downwards to
center to a lower center. the spinal cord.
b) Horizontal fibers: In each of the three components
of brainstem, passing horizontally through respe- 7 Level of superior colliculus
ctive cerebellar peduncles, e.g. 6 Level of inferior colliculus
i. In midbrain: Passing through superior cere-
bellar peduncle.
ii. In pons: Passing through middle cerebellar 5 Upper half of pons
peduncle. 4 Lower half of pons
iii. In medulla oblongata: Passing through inferior 3 At upper end of medulla oblongata
cerebellar peduncle. 2 At the level of pyramid
2. Gray matter: It is present in the form of following
two varieties of nuclei 1 Lower end of medulla
a) Various named nuclei of brainstem: These are cell oblongata
stations of ascending or descending tracts passing
through the brainstem. These are developed from Fig. 5.28 Different level of brainstem to study internal structure
112
Brainstem

Nucleus gracilis appears


deep to fasciculus gracilis

Nucleus cuneatus appears


deep to fasciculus cuneatus
Reticular formation
Spinal nucleus and spinal
tract of trigeminal nerve

Decussating fibers Dorsal spinocerebellar


of lower end of tract
pyramid form lateral
corticospinal tract

Ventral spinocerebellar
Lateral spinothalamic tract tract

Detached anterior
Anterior spinothalamic tract
grey horn

Fig. 5.29 Internal structure of lower end of medulla oblongata (below pyramidal elevation at the level of motor decussation)

Structural detail n White matter: Pattern of three white columns


(funiculi) of spinal cord, namely anterior, lateral and
n Gray matter: posterior, is grossly maintained.
1. Central gray matter is traversed by more dorsally 1. Anterior column: On either side of ventral median
pushed central canal lined by ependyma. fissure, area of anterior white column mainly pres-
2. Apex of posterior horn of spinal cord is represented ents the bundle of pyramidal tract fibers which
at this level by nucleus of spinal tract of trigeminal shows decussation of fibers at this level.
nerve. On either side it is directed backwards and Through anterior column, also traverse tectospinal
laterally with further abduction. tract, vestibulospinal tract, anterior spinothalamic tract.
3. Medial to nucleus of spinal tract of trigeminal 2. Lateral Column:
nerve, gray matter shows, on either side, two small a) Peripherally: Dorsal and ventral spinocereb-
bulge of gray matter, nucleus gracilis (medial) and ellar tracts.
nucleus cuneatus (lateral) which receive the fibers b) Centrally: i) Lateral corticospinal tract which
of fasciculus gracilis and fasciculus cuneatus is formed at this level after decussation of
respectively, which are the ascending tracts in fibers of pyramid.
posterior column of white matter. ii) At the center of lateral white column, a
4. Anterior gray horn becomes detached from main scattered group of nerve cells intermingled
mass of gray matter by decussating fibers of corti- with nerve fibers form brainstem reticular
cospinal (pyramidal) tract. formation.
Topographically, cells of anterior horn is a part of iii) Lateral spinothalamic tract.
gray matter of medulla oblongata. But functionally, 3. Posterior column: It present upward continua-
these are upwards continuation of cells of anterior tion of fasciculus gracilis and fasciculus cuneatus
horn of upper cervical segments of spinal cord. These of posterior white column of spinal cord. As
cells form following two nuclei. already mentioned earlier, these two tracts will
a) Supraspinal nucleus of first cervical nerve: It relay in next order of neurons in nucleus gracilis
is the upward continuation of anterior horn and nucleus cuneatus which are seen to appear
cells of first cervical segments of spinal cord. at this level of medulla oblongata, ventral to the
Axons of these neurons pass downward and corresponding tracts.
are distributed along the ventral root of first
cervical nerve. Medulla oblongata at its middle (at the plane of
b) Ascending nucleus: It is the upward contin- sensory decussation) (Fig. 5.30)
uation of spinal nucleus of accessory nerve
Structural characteristics
which is continuous below up to fifth cervical
segment of spinal cord. Above it is continuous 1. There is no more existance of gray matter area
with nucleus ambiguous. which is homologous to anterior horn.
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Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Nucleus tractus solitarius Internal arcuate fibers
from nucleus gracilis
Dorsal nucleus of vagus
Spinal nucleus
and spinal tract of
trigeminal nerve

Dorsal spinocerebellar Internal arcuate


tract fibers from nucleus
cuneatus
Hypoglossal
nerve nucleus Lateral
spinothalamic tract
Medial longitudinal
fasciculus Reticular formation

Inferior olivary nucleus


Ventral spino-
cerebellar tract Medial lemniscus
Medial lemniscus
Pyramid

Fig. 5.30 Internal structure of medulla oblongata at the level of sensory decussation

2. Gray matter of posterior horn presenting nucleus thalamic tracts are found to be in corresponding
gracilis, nucleus cuneatus and spinal nucleus positions as noticed in previous section of medulla
of trigmenial nerve gets detached from central oblongata.
gray matter. This detachment is because of the 4. Nucleus gracilis and nucleus cuneatus are seen to
arched fibers arising from nucleus gracilis and be more prominent in this section. These nuclei
nucleus cuneatus which decussate ventrally to receive fibers from fasciculus gracilis and fasciculus
form ascending fiber tract which is called medial cuneatus which carry conscious proprioceptive
lemniscus. sensation and sense of tactile discrimination from
3. Central canal surrounded by central gray matter lower and upper halves of body respectively.
is pushed more dorsally. Central gray matter 5. Dorsolateral to nucleus cuneatus, a smaller
presents appearance of cranial nerve nuclei. accessory cuneate nucleus is seen. It receives
4. It is the plane of medulla oblongata from where fibers of fasciculus cuneatus which carry same
sensations from uppermost part (head-end) of
upward typical relationship of central gray ma-
body. Cuneocerebellar tract from this nucleus end
tter and peripheral white matter of spinal cord
in cerebellum as spinocerebellar pathway above T1
is lost. It results intermingling of gray and white
spinal cord segment.
matters.
6. Central core of the section presents scattered
nerve cells and reticulum (network) of fibers to
Structural details
form brainstem reticular formation.
1. On either side of ventral median fissure bulge of 7. Posterior gray horn separated from central gray
pyramid presents sections through descending matter is represented by spinal nucleus of trige-
(efferent) fibers of pyramidal (corticospinal) tract. minal nerve which is capped on the surface by
2. Lateral to fibers of pyramid, inferior olivary nucl- fibers of sensory root of trigeminal nerve carrying
eus starts appearing. It looks like a small irregular- pain and temperature sensation, called spinal
walled sac whose cavity opens backwards and tract of trigeminal nerve.
medially. Nucleus gracilis and nucleus cuneatus are the
Inferior olivary nucleus is the most prominent medial and lateral mass of gray matter on either
part of olivary nuclear complex of human brain. side of posterior median septum. These are also the
Rudimentary components are dorsal and medial oliv- components of posterior gray horn which are detached
ary nuclei which together are known as accessory from central gray matter.
olivary nuclei. Reason for separation of spinal nucleus of trige-
3. Ascending (afferent) tracts, e.g. dorsal and ventral minal nerve, nucleus gracilis and nucleus cune-
spinocerebellar tracts, lateral and anterior spino- atus from central gray matter is due to following
114
Brainstem
characteristic of structure of medulla oblongata at i. Hypoglossal nerve nucleus (XII): It is the
this level. nucleus of somatic efferent column, lying
Fasciculus gracilis and fasciculus cuneatus are the ventral to central canal of medulla oblongata.
two ascending tracts of posterior column of spinal cord ii. Nucleus ambiguous (IX, X, XI): It is the nuc-
which carry sense of conscious proprioception and leus of special visceral efferent column, lying
tactile discrimination from lower and upper halves ventrolateral to central canal of medulla
of body respectively. Reaching the medulla oblongata oblongata.
upto this level, fibers of these two tracts relay in iii. Dorsal nucleus of vagus (X): It is the nucleus
corresponding nuclei lying ventrally. Processes of having both general visceral efferent as well
next order of neurons in nucleus gracilis and nucleus as general visceral afferent components, lying
cuneatus, before ascending further upwards to relay ventrolateral to central canal.
in thalamus, decussate to cross the midline. During iv. Nucleus tractus solitarius (VII, IX, X): It is the
decussation, these fibers presents following three nucleus of special visceral afferent column,
characteristics. lying lateral to central canal.
1. Fibers of both nucleus gracilis and nucleus cune-
atus pass forwards arching along the lateral Medulla oblongata at the level of olive (close to pon-
aspect of central gray matter horizontally in a tomedullary junction) Fig. 5.31
curved fashion that is why they are called internal
arcuate fibers. Structural characteristics
2. After decussation, the fibers form a compact bundle 1. Stretching of roof plate at this plane of medulla
just behind the bulge of pyramid, before this compact oblongata in embryonic life causes outward
bundle of fibers ascend upwards to reach thalamus. deviation (abduction) of alar plate. This results
This bundle is known as medial lemniscus (Plural widening of central canal to form cavity of fourth
Lemnisci). ventricle. Stretched dorsal surface of medulla
3. During formation of medial lemnisci, fibers from oblongata forms floor of fourth ventricle.
nucleus gracilis (carrying sensations from lower 2. Central gray matter presenting the cranial nerve
half of body) are positioned anterior to the fibers nuclei pushed more dorsally to lie just beneath the
from nucleus cuneatus (carrying sensation from dorsal surface of medulla oblongata.
upper half of body). 3. Fibers from medulla oblongata which will connect
Behind medial lemniscus, pass tectospinal tract cerebellum will form compact bundle of inferior
medial longitudinal fasciculus. cerebellar peduncle seen to be present in poste-
n Central gray matter: It encircles the central rolateral part.
canal of medulla oblongata which is pushed more 4. Bulge of olive containing inferior olivary nucleus
posteriorly. It presents following cranial nerve nuclei is related to anterolateral and posterolateral sulci
which are interrelated ventrolaterally. on it medial and lateral sides respectively.
Dorsal nucleus of vagus Tectospinal tract

Vestibular nucleus
Hypoglossal nerve nucleus Dorsal cochlear nucleus
Nucleus tractus solitarius Inferior cerebellar peduncle

Nucleus ambiguous Ventral cochlear nucleus

Medial longitudinal fasciculus Dorsal spinocerebellar tract

Reticular formation Spinal nucleus and spinal


tract of trigeminal nerve
Lateral spthalamic tract
Parolivary nuclei
Medial lemniscus
Vagus nerve
Hypoglossal nerve Inferior olivary nucleus
Pyramidal tract

Arcuate nucleus

Fig. 5.31 Internal structure of medulla oblongata at the level of olive


115
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Structural detail dially and inferior olivary nucleus laterally. Finally
the nerve comes out in the form of multiple rootlets
1. On either side of ventral median fissure, beneath
through anterolateral sulcus.
the bulge of pyramid, fibers of pyramidal (cortic-
ii. Dorsal nucleus of vagus: This nucleus is situ-
ospinal) tract from compact bundle.
ated lateral to hypoglossal nerve nucleus. It is a
2. Ventromedial surface of pyramid presents a nar-
mixed nucleus having general visceral efferent
row semilunar strip of gray matter, called arcute
as well as afferent components which supply
nucleus. It is the detached part of pontine nuclei.
3. Lateral to pyramid, bulge of olive contains inferior motor, secretomotor and sensory fibers to thor-
olivary nucleus. It is irregular walled sac-like acic and abdominal viscera (upto midgut).
mass of gray matter. Open mouth of the sac faces iii. Nucleus tractus solitarius: This is a composite
medially and backwards. nucleus of special visceral afferent column. It
Adjacent to inferior olivary nucleus, medial and is ventrolateral to dorsal nucleus of vagus and
dorsal components of assessory olivary nucleus are receives taste sensation through sensory fibers
seen. of VIIth, IXth and Xth cranial nerves from
4. Dorsolateral aspect of medulla oblongata at anterior two-third and posterior one-third of
this level presents bulge of inferior cerebellar tongue and also vallecula and epiglottis.
peduncle. It is a compact bundle of white matter It is important as well as interesting to note
connecting medulla oblongata with cerebellum in here that nucleus tractus solitarius also receives
both directions. general visceral afferent fibers through vagus nerve
5. Different fiber tracts in central core which caries visceral sensation from thoracic and
a) Medial: From before backwards close to the abdominal viscera (upto midgut).
midline iv. Nucleus ambiguous: This nucleus is placed
i. Medial lemniscus: Formed by internal arcu- more ventrally. This is also a composite nucl-
ate fibers, situated behind pyramid. This eus of special visceral efferent group which
ascending tract passes upwards to reach gives out motor fibers through IXth to XIth
thalamus. cranial nerves to supply muscles developed
ii. Tectospinal tract: Descending tract from from mesoderm of IIIrd, IVth and VIth
tectum of midbrain to spinal cord. branchial arch respectively.
iii. Medial longitudinal bundle: It is the fiber It is already understood that two composite
bundle connecting vestibular nucleus with nuclei, namely nucleus tractus solitarius and nucleus
motor nuclei of IIIrd, IVth, VIth and XIth ambiguous are made up of components belonging to
cranial nerves. multiple cranial nerves. The former is made up of
b) Lateral: Important ascending tracts passing nuclei of VIIth, IXth and Xth and the later is formed
from below upward by nuclei of IXth, Xth and XIth cranial nerve. It is
i. Ventral and dorsal spinocerebellar tracts. also important to remember at this stage that these
ii. Ventral and lateral spinothalamic tracts. nerves come out of brainstem through different sites.
iii. Spinal tract of trigeminal nerve. Figure 5.31 shows the fibers of vagus nerve which is
6. Medullary part of brainstem reticular formation: made up of following components coming out from
Scattered nerve nuclei with reticulum (network) respective nuclei.
of fibers. l General visceral efferent: From motor part of
7. Cranial nerve nuclei (in central gray matter): dorsal nucleus.
Beneath the dorsal surface of medulla oblongata l General visceral afferent: From sensory part of
i. Hypoglossal nerve nucleus: Situated on either dorsal nucleus.
side of midline, just beneath the dorsal surface l Special visceral afferent: From nucleus tractus
(on the floor of 4th ventricle) and behind medial solitarius.
longitudinal bundle. l Special visceral efferent: From nucleus ambiguous.
This is the somatic efferent nucleus which gives The fibers of vagus nerve are seen to come out
out fibers of hypoglossal nerve to supply muscles of through posterolateral sulcus between olive and
tongue developed from occipital myotome. Intraneural inferior cerebellar peduncle.
(intramedullary) part of hypoglossal nerve pass from v. Vestibular nucleus of VIIIth cranial nerve:
behind forward through whole depth of medulla It is proprioceptive type of special somatic
oblongata between pyramid and medial lemniscus me- afferent nucleus of vestibulocochlear nerve. It
116
Brainstem
is present in lateral angle of dorsal surface of 1. Basilar part (identical structure in both lower as
pontomedullary junction. Vestibular nucleus well as upper levels)
is made up of four partssuperior, inferior, 2. Tegmental part in lower half
lateral and medial. 3. Tegmental part in upper half.
vi. Cochlear nucleus of VIIIth cranial nerve: It is
exteroceptive type of special somatic afferent Basilar part (Figs 5.32 and 5.33)
nucleus of vestibulocochlear nerve. It is
composed of dorsal and ventral components in As already stated, basilar part of pons presents
close relation to inferior cerebellar peduncle. similar feature at all levels as follows.
vii. Spinal nucleus (and spinal tract) of trigeminal n Gray matter: This is present in the form of
nerve: It is situated medial to inferior cerebellar multiple, small-sized scattered masses, intermingled
peduncle. Spinal tract is made up of bundles of with white matter, called pontine nuclei. This is
those sensory fibers of trigeminal nerve which developed from ventrally migrated cells of alar plate.
carry pain and temperature sensation from Fibers from all the lobes of cerebral cortex (cortico-
the skin of face. The fibers of spinal tract relay pontine tracts) relay in pontine nuclei of same side.
in cells of spinal nucleus of trigeminal nerve. Axons of pontine nuclei cross the midline and pass
through opposite middle cerebellar peduncle to the
Internal Structure of Pons (Figs 5.32 and 5.33) contralateral cerebellar hemisphere to complete cort-
icopontocerebellar tract.
Throughout the whole length, internal structure of
pons is broadly composed of two parts. At the time of development of brainstem, some of
Ventral Basilar part the cells of pontine nuclei migrate caudally towards
Dorsal Tegmental part. ventral aspect of medulla oblongata to form arcuate
nuclei.
Structural characteristics n White matter: These are fiber tracts of following
two kinds
Basilar part 1. Vertical: Descending or motor (efferent) tracts
a) Corticospinal tract: Goes down to pass through
It presents similar features throughout its whole len-
gth. pyramid of medulla oblongata.
The basilar part contains both gray matter as well b) Corticonuclear (Corticobulbar) tract: To relay
as white matters as follows: in contralateral motor nuclei of cranial nerves
i. Gray matter: It is scattered cluster of nerve present in pons and medulla oblongata.
cells called pontine nuclei which intermingles c) Corticopontine tract: It passes from cerebral
with fibers of white matter. Neurons of pontine cortex to same sided pontine nuclei.
nuclei are as many as 20 millions in number 2. Horizontal: These are decussating fibers of ponto-
which is the reason for ventral bulging of cerebellar tract which pass horizontally to pass
basilar part. through the middle cerebellar peduncle to opposite
ii. White matter: Made up of two types of fibers half of cerebellum.
a) Vertical: Fibers of descending (motor) tracts
b) Horizontal: Fibers of pontine nuclei passing Tegmental part at lower half of pons (Fig. 5.32)
through middle cerebellar peduncle to the n Gray matter: Some cranial nerve nuclei and
opposite half of cerebellum. nuclei of pontine part reticular formation.
l Abducent nerve nucleus: It is the nucleus of somatic
Tegmental part
efferent group. Fibers of abducent (VIth cranial)
Unlike the basilar part, it presents different features nerve arising from this nucleus supply lateral rectus
in lower and upper halves of pons. muscle of eyeball which is developed from preoccipital
Fundamentally, in both the levels, tegmentum of myotome of paraaxial mesoderm. This nucleus is situ-
pons shows following structure ated deep to a paramedian bulge adjacent to posterior
i. Gray matter: Nuclei of cranial nerves median sulcus. The bulge is called facial colliculus
ii. White matter: a) Ascending tracts as well as because the surface of abducent nucleus is winded by
b) some descending tracts. fibers of facial nerve.
l Motor nucleus of facial nerve: This is the nucleus
Structural Details
of special visceral efferent column which supplies
Internal structure of pons is studied under the muscles developed from mesoderm of second branchial
following 3 headings (Figs 5.32 and 5.33): arch.
117
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Motor nucleus of facial nerve Vestibular nucleus

Superior salivatory nucleus Medial longitudinal fasciculus Dorsal cochlear


nucleus
Abducent nerve Inferior cerebellar
nucleus peduncle
Sp. nucl. and sp. tract
of trigeminal nerve
Lateral lemniscus
Ventral cochlear
nucleus
Spinal lemniscus Facial nerve

Trigem lemniscus
Pontocerebellar
Medial lemniscus

Trapezoid body
Pontine
nuclei
fibers

Bundles of descending
fibers
} Basilar
part of
pons

Superior salivatory nucleus Motor nucleus of facial nerve Abducent nerve

Fig. 5.32 Transverse section through lower end of pons adjacent to pontomedullary junction

Facial nerve nucleus (nucleus of motor nerve of l Vestibular nucleus of vestibulocochlear nerve:
face) originally used to be situated in embryonic life, This is proprioceptive type of special somatic afferent
lateral to abducent nerve nucleus more superficially. nucleus of vestibulocochlear nerve. It is composed of
Spinal nucleus of trigeminal nerve, which is sensory superior, lateral, medial and inferior parts. Vestibular
nerve for skin of face, is situated in deeper plane of nucleus is situated partly in lower part of pons and
tegmentum of pons. To facilitate quicker reflex cont- upper part of medulla. It is placed in superficial plane
raction of facial muscles, facial nerve nucleus moves at the lateral angle of pontomedullary junction. This
deeper to come in close relation to sensory nucleus for nucleus receives afferent fibers which are nothing
but vestibular fibers of VIIIth cranial nerve carrying
sensation of facial skin, i.e. spinal nucleus of trige-
sense of equilibrium or balance. Efferent fibers are
minal nerve. This becomes possible by elongation
i. Vestibulocerebellar fibers
of motor fibers of facial nerve nucleus which winds
ii. Vestibulospinal fibers
round the abducent nerve nucleus. This process is iii. Medial longitudinal bundle: Which connect vesti-
known as neurobiotaxis. bular nucleus with nuclei of IIIrd, IVth, VIth and
l Superior salivatory nucleus: It is general visceral XIth cranial nerves and anterior horn cells of
efferent nucleus of facial nerve, situated lateral to upper cervical segments of spinal cord. It causes
motor nucleus of facial nerve. It has a component reflex movement of eyeball and head and neck in
called lacrimatory nucleus. Parasympathetic secre- response to change of position body.
tomotor fibers from these nuclei are directed to supply l Cochlear nucleus of vestibulocochlear nerve: It is
to submandibular and sublingual salivary glands, exteroceptive type of special somatic afferent nucleus
and lacrimal gland. of cochlear component of vestibulocochlear nerve. It
l Spinal nucleus of trigeminal nerve: This is exte-
is made up of dorsal and ventral components lying
dorsal and ventral to inferior cerebellar peduncle
roceptive variety of general somatic afferent nucleus
fibers at the level of pontomedullary junction.
of trigeminal nerve, which receives pain and temp-
n Connections of cochlear nuclei:
erature sensation from skin of face. Though called
l Afferent: Fibers of cochlear component of vesti-
spinal nucleus, main part of this nucleus extends bulocochlear nerve carrying sense of hearing from
throughout whole length of medulla oblongata. Its receptors (organ of Corti) at internal ear relay in
lower end extends upto 2nd cervical segments of dorsal and ventral cochlear nuclei.
spinal cord and upper end extends to the lower half l Efferent: Axons of cochlear nuclei will have to
of pons. This nucleus is situated in the lateral part of reach upto corresponding thalamic nuclei to carry
tegmentum of lower end of pons. It receives sensory impulse to sensory area of cerebral cortex. While
fibers of trigeminal nerve which caps dorsal aspect of ascending through central core of brainstem to reach
the nucleus to form spinal tract of the nerve. the thalamus, at the level of lower end of pons, relay
118
Brainstem
in a nucleus, called nucleus of trapezoid body. Before compact bundle called trigeminal lemniscus which
the relay, axons of both dorsal and ventral cochlear is placed between medial and spinal lemnisci.
nuclei partly remain in the same side, partly cross 4. Medial longitudinal fasciculus (bundle): It is a
the midline to relay in nucleus of trapezoid body of compact bundle of fibers passing through cent-
opposite side. In horizontal section, the fibers show a ral tegmental core of brainstem. These fibers
trapezoid shape, for which the decussating and non- interconnect nuclei of IIIrd, IVth, VIth and XIth
decussating fibers are called trapezoid body, so the nerves with vestibular nucleus and anterior
nucleus is also accordingly named. horn cells of upper cervical segments of spinal
n White matter:
cord. Functionally this fasciculus causes reflex
1. Trapezoid body: Axonal process of dorsal and
movement of eyeball, head and neck during
ventral cochlear nuclei before ending in thal-
amic level, i.e. in medial geniculate body (metath- alteration of equilibrium or balance of body.
alamus), show following change 5. Tectospinal tract: It is placed ventral to medial
Before ascending through upper half of pons longitudinal fasciculus.
further upwards, fibers pass forwards and medially 6. Rubrospinal tract: It lies in front of tectospinal
towards central tegmentum of midbrain. While doing tract.
so, some fibers may remain in same side, some cross These two fiber bundles are extrapyramidal tracts,
the opposite side to form a trapezoid outlined area, in the group of noncorticospinal tract.
called trapezoid body. 7. Spinal tract of trigeminal nerve: These are fiber
In the trapezoid body, fibers relay in nucleus of bundles which form a cap over the dorsal aspect of
trapezoid body. spinal nucleus trigeminal nerve. Spinal nucleus of
Then the fibers will run upwards to form lateral trigeminal nerve present along the whole length of
lemniscus. medulla oblongata extends upwards in the lower
2. Medial lemniscus: This is a compact bundle of end of pons. Spinal tract is made up of incoming
fibers already formed at the level of medulla as a sensory fibers of trigeminal nerve vertically
continuation of internal arcuate fibers from nucleus
disposed in brainstem. These fibers relay in the
gracilis and nucleus cuneatus, carrying sense
sensory nuclei of trigeminal nerve. Axons of next
of dirscriminative touch, sense of position and
movement and vibration sense. Medial lemniscus order of neurons, i.e. the sensory nuclei will ascend
is situated close to midline, behind basilar part of upwards as trigeminal lemniscus placed between
pons. Fiber bundle is rotated for 90, wtih fibers medial lemniscus and spinal lemniscus.
from lower half of body placed medially. So fibers 8. Inferior cerebellar peduncle: Fibers of middle cere-
from upper half are placed laterally. bellar peduncle runs horizontally lateralwards
3. Spinal lemniscus: This compact bundle of fiber is from basilar part of pons. Behind this, cross section
the continuation of lateral spinothalamic tract. of vertically running fibers of inferior cerebellar
Axons from trigeminal nucleus form another peduncle is seen.
Cavity of fourth ventricle Superior medullary velum

Superior cerebellar peduncle


Medial longitudinal bundle
Principal nucleus of V
nerve Lateral lemniscus
Motor nucleus of V nerve Spinal lemniscus
Trigeminal lemniscus
Tectospinal tract Medial lemniscus

Rubrospinal tract

Trigeminal nerve
Middle cerebellar Bundles of descending
peduncle tracts
Pontine nuclei
Decussating pontocerebellar fibers
]
Basilar
part of
pons

Fig. 5.33 Transverse section through upper end of pons (close to its junction with midbrain)
119
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Tegmental part at upper half of pons (Fig. 5.33) nerve to thalamus. Lateral lemniscus is made up of
bundle of fibers which are axonal processes of superior
Fundamental differences with the lower half of pons
olivary nucleus and nucleus of trapezoid body. It
are the following:
forms a part of auditory pathway.
1. At the upper end of pons, middle cerebellar
As trapezoid body of lower half of pons is continuous
peduncles are passing more obliquely lateralwards
upwards as vertical bundle of lateral lemniscus, it
than horizontally. So the fibers of this peduncle
disappears at upper half of pons.
are seen more on cross section than longitudinal,
2. Other fiber bundles: Beneath the floor of fourth
at lateral side of junction of basilar part and
ventricle, just on either side of midline, following
tegmental part.
fiber tracts are existent from behind forwards.
2. As upper end of pons approaches towards midbrain
a) Medial longitudinal fasciculus
upwards, behind the tegmental part of pons, roof
of fourth ventricle of brain is found to be formed b) Tectospinal tract
by thin lamina of white matter called superior c) Rubrospinal tract.
medullary velum extending between medial sides 3. Middle cerebellar peduncle: Internal structure
of two superior cerebellar peduncles. of upper half of pons, shows fibers of middle
3. Trapezoid body disappears as the fibers run cerebellar peduncle which are more vertically
vertically upwards forming a compact bundle of sectioned, rather than horizontal direction, lateral
ascending tract called lateral lemniscus. to junction of basilar part and tegmental part of
4. Cranial nerve nuclei seen in lower half of pons pons.
disappear. Motor as well as superior sensory nuclei 4. Superior cerebellar peduncle: Dorsolateral part
of trigeminal nerve are seen to appear. of section shows fibers of superior cerebellar
n Gray matter: Tegmentum of upper half of pons peduncles of both sides which are bridged by a thin
shows only gray matter in the form of motor and lamina of white matter called superior medullary
superior (principal) sensory nuclei of trigeminal velum.
nerve.
1. Motor nucleus of trigeminal nerve: It is the special Internal Structure of Midbrain
visceral efferent or branchial efferent nucleus of
trigeminal nerve situated deep to floor of fourth Structural characteristics (Fig. 5.34)
ventricle of brain, in the central core. Efferent 1. A little behind its center, midbrain is traversed by
fibers from this nucleus supply muscles developed its narrow central canal, called aqueduct of Sylvius
from mesoderm of first pharyngeal arch. or cerebral aqueduct. This narrow channel is
2. Superior (principal) sensory nucleus of trigeminal
lined by ependyma and communicates with third
nerve: It is situated lateral to motor nucleus and
ventricle above and fourth ventricle below.
continuous below with spinal nucleus of trigeminal
2. An imaginary line passing side to side through
nerve. This nucleus is of general somatic afferent
cerebral aqueduct bisects interior of midbrain in
type and receives touch and pressure sensation
smaller posterior part and larger anterior part.
from the skin of face.
3. Smaller posterior part is known as tectum. Tect-
Fibers from motor and sensory nuclei of trigeminal
nerve traverse tegmentum forwards and laterally and um is made up of, as seen externally, two pairs of
comes out as motor and sensory roots of the nerve round elevations. Upper pair, opposite upper half
at the junction of basilar part of pons and middle of midbrain, are called superior colliculi (Sing-
cerebellar peduncle. Motor root is medial to sensory ular colliculus). Lower pair, opposite lower half of
root. midbrain are accordingly called inferior colliculi.
n White matter: Each colliculus is a round mass of gray matter.
1. Ascending tracts as lemnisci: Just behind basilar 4. Larger anterior part, in front of cerebral aqueduct,
part of pons, from medial to lateral, pass four is known as cerebral peduncle. Cerebral peduncle
compact bundles of ascending fibers which are is made up of following three components from
medial lemniscus, trigeminal lemniscus, spinal before backwards
lemniscus and lateral lemniscus. i. Crus cerebri: Compact bundle of white matter.
Among these, medial and spinal lemnisci are ii. Substantia nigra: A strip of pigmented gray
already well-developed from a lower level. Trigeminal matter.
lemniscus is made up of fibers of trigemino-thalamic iii. Tegmentum: Central core of midbrain with
tract which extends from spinal nucleus of trigeminal admixture of both gray as well as white matter.
120
Brainstem

Tectum

Aqueduct of Sylvius

Tegmentum
Periaqueductal
gray matter

Substantia Cerebral
nigra peduncle

Crus cerebri

Fig. 5.34 Basic structural components of midbrain

5. Therefore, from the above description, it is clear l Descending fibers passing through crus cerebri
that, internal structure of midbrain is divided into are following
following broad based components from before 1. Corticospinal: From cerebral cortex to anterior
backwards. horn cells of spinal cord.
2. Corticobulbar (Corticonuclear): From cerebral

}
i. Crus cerebri
cortex to motor nuclei of cranial nerves.
ii. Substantia nigra
In front of cerebral aqueduct 3. Corticopontine: From all the four lobes of cerebral
iii. Tegmentum
iv. Tectum (colliculi) Behind cerebral aqueduct cortex to pontine nuclei. These are the fibers of
corticopontocerebellar pathway. These are of four
6. Guidelines for study of structural detail groupsfrontopontine, parietopontine, occipitopo-
Internal structure of midbrain is studied at two ntine and temporopontine.
levels. These are at the levels of superior colliculus Crus cerebri is divided into following three parts
and inferior colliculus.
transmitting different types of fibers.
l Internal structure of anterior two components,
1. Intermediate 3/5th: Corticospinal and cortico-
i.e. crus cerebri and substantia nigra is similar on
bulbar (corticonuclear) fibers.
both levels.
l Internal structure of posterior two components, i.e.
2. Medial 1/5th: Frontopontine group of cortic-
tegmentum and tectum is dissimilar on two levels. opontine fibers.
Therefore, structural details of midbrain are to be 3. Lateral 1/5th: Parietopontine, occipitopontine and
studied under following headings. temporopontine groups of corticopontine fibers.
a) Crus cerebri.
b) Substantia nigra. Substantia nigra (Figs 5.35 and 5.36)
c) Tegmentum and tectum of the level of inferior Substantia nigra is a large mass of gray matter
colliculus.
extending throughout whole length of midbrain.
d) Tegmentum and tectum at the level of superior
This nucleus of extrapyramidal system is composed
colliculus.
of medium sized multipolar neurons, cytoplasm of
Structural details which is composed of melanin pigment granules.
It is crescent (curved) in shape with cocavity
Crus cerebri (Figs 5.35 and 5.36) facing backwards towards tegmentum. It is broader
medially.
l It extends throughout whole length of midbrain.
It is made up of compact bundle of descending Substantia nigra is made up of dorsal and ventral
fibers. part. Dorsal part presents smooth, concave posterior
l Right and left halves of crus cerebri are separated surface and is known as pars compacta, being packed
by a midline sulcus on ventral surface of midbrain. up with cells. Ventral part is known as pars reticularis
Crus cerebri is related posteriorly to substantia where loosely arranged neurons are intermingled
nigra. with reticulum (network) of fibers.
121
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Trochlear nerve nucleus Nucleus of inferior
colliculus

Exit of trochlear nerve


Mesencephalic
Reticular nuclei nucleus of V nerve

Lateral lemniscus Medial longitudinal


fasciculus
Spinal lemniscus
Tectospinal tract
Trigem lemniscus
Parietopontine,
Medial lemniscus occipltopontine and tem-

]
poropontine fibers

Decussation of superior Crus cerebri


Corticospinal and
cerebellar peduncle corticonuclear fibers

Substantia nigra Frontopontine fibers

Fig. 5.35 Internal structure of midbrain at the level of inferior colliculus

Melanin pigment granules are polymers of dopa- is situated lateral to cerebral aqueduct and receives
mine. Dopamine, released from cell of substantia nig- proprioceptive sensation from muscles of mastication,
ra is transported to corpus striatum (basal ganglia) temporomandibular joint, roots of teeth, muscles of
through the course of nigrostriate fibers. eyeball and face.
Substantia nigra is connected to cerebral cortex, 2. Reticular nuclei: Nuclei of reticular formation
basal ganglia (corpus striatum), hypothalamus and are less prominent than those of pons and medulla
spinal cord. oblongata. These are scattered in the central
Function of substantia nigra is concerned with tegmental area ventral to periaqueductal gray.
maintenance of muscle tone. n White matter (of tegmentum):
Tegmentum and tectum at the level of 1. Decussation of fibers of superior cerebellar
inferior colliculus (Fig. 5.35) peduncle: Ventral spinocerebellar tract is a
crossed tract at the level of formation in spinal
Tegmentum cord. It ascend through the brainstem upto this
level of midbrain as a contralateral tract. But
It is central core of midbrain. It is composed of groups fibers of this tract will have to cross for the second
of neurons in the form of nuclei (gray matter) and time before reaching ipsilateral half of cerebellum.
white matter in the form of ascending (afferent) and Decussation of these fibers are present in anterior
descending (efferent) fiber bundles. most part of tegmentum of midbrain following
n Gray matter (of tegmentum): which fibers will pass through superior cerebellar
1. Periaqueductal gray matter: It contains follo- peduncle.
wing two cranial nerve nuclei. 2. Lemnisci: Lateral to decussation of fibers of
l Trochlear nerve nucleus: It is the nucleus of som- superior cerebellar peduncle, all the four lemnisci,
atic efferent column present in periaqueductal gray namely medial, trigeminal, spinal and lateral, are
placed medial to lateral in such a curved fashion
matter ventral to cerebral aqueduct behind medial
that lateral lemniscus is placed posterior to spinal
longitudinal fasciculus. Fibers of trochlear nerve
lemniscus infront of inferior colliculus. It is to be
arising from nucleus winding round lateral aspect of
noted here that fibers of lateral lemniscus will
aqueduct, run backwards and come out of midbrain terminate in inferior colliculus.
from its posterior aspect below inferior colliculus 3. Medial longitudinal fasciculus: This bundle
piercing superior medullary velum where the fibers of fibers is paramedian in position in front of
decussate. periaqueductal gray matter.
l Mesencephalic nucleus of trigeminal nerve: It is the 4. Tectospinal tract: This descending noncorti-
proprioceptive sensory nucleus of trigeminal nerve cospinal tract is placed in front of medial longi-
present through whole length of midbrain. The nucleus tudinal fasciculus.
122
Brainstem
Motor nucleus of oculomotor EdingerWestphal nucleus
nerve
Mesencephalic nucleus of
Nucleus of superior Vnerve
colliculus
Protectal nucleus
Reticular nucleus
Spinal lemniscus

Trigeminal lemniscus
Medial longitudinal
fasciculus
Decussation of Medial lemniscus
tectospinal tract

Parietopontine, occipitopontine
and temporopontine fibers
Red nucleus
Corticospinal and
corticonuclear fibers

Substantia nigra
Frontopontine fibers

Decussation of rubrospinal tract Oculomotor nerve

Fig. 5.36 Internal structure of midbrain at the level of superior colliculus

5. Rubrospinal tract: This is another noncorti- l Somatic efferent nucleus of oculomotor nerve: It is
cospinal tract descending in front of tectospinal. the main motor nucleus of oculomotor nerve which
It is placed either in front or behind decussation of supplies majority of extraocular muscles. It is situated
fibers of superior cerebellar peduncle. in ventromedial part of periaqueductal gray matter.
n Tectum (inferior colliculus): Beneath this round The nucleus of both sides is closely apposed to each
bulge, compact mass of neurons forms nucleus other forming a triangular nuclear complex ventral to
of inferior colliculus. This nucleus forms the cell aqueduct.
station in cochlear pathway. Many of the fibers of l EdingerWestphal nucleus: It is general visceral
lateral lemniscus relay in this nucleus. Efferent efferent nucleus of oculomotor nerve which gives out
fibers from nucleus of inferior colliculus pass via preganglionic fibers passing through oculomotor nerve
to supply two smooth muscles of eyeball, constrictor
inferior brachium to medial geniculate body.
pupillae and ciliary muscle. This nucleus is situated
Inferior colliculus cells are also considered to form
dorsolateral to somatic efferent nucleus.
the center of spinoauditory reflex which helps in
l Mesencephalic nucleus of trigeminal nerve: As
localizing the source of sound. stated earlier, this proprioceptive sensory nucleus
Tegmentum and tectum at the level of superior of trigeminal nerve extends throughout whole
colliculus (Fig. 5.36) length of midbrain. It is situated on lateral part of
n Tegmentum: Like inferior collicular level, periaqueductal gray lateral to cerebral aqueduct.
tegmentum at the level of superior colliculus This nucleus receives proprioceptive impulse from
fundamentally presents following features muscles of mastication, temporomandibular joint,
l Gray matter: In the form of cranial nerve nuclei roots of teeth, muscles of eyeball and face.
and, reticular nuclei. Additionally a nucleus of extrap- 2. Reticular nuclei: This part of brainstem reticular
yramidal system called red nucleus. formation is less prominent and situated in lateral
l White matter: In the form of ascending (lemnisci) part of tegmentum.
and descending tracts and, decussating fibers of some 3. Red nucleus: It is so called because it is red or
descending tract. reddish brown in color due to more vascularity and
n Gray matter (of tegmentum): iron containing pigment in neuronal cytoplasm.
1. Periaqueductal gray matter: Gray matter surroun- It is ovoid in length and round in cross section.
ding cerebral aqueduct presents following cranial This nucleus is situated dorsal to medial end of
nerve nuclei. substantia nigra. Red nucleus extends only in
123
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
upper half of midbrain at the level of superior These fiber bundles are situated lateral to red
colliculus. It is one of the centers of extrapyramidal nucleus.
system. 5. Medial longitudinal fasciculus: It is the uppermost
n Connections of red nucleus: Red nucleus end of this fiber bundle which is situated just in
functions as intermediate cell station for following front of oculomotor nucleus.
pathways. n Tectum (superior colliculus): It is a part of
1. Corticorubrospinal tract: bulge on the dorsal aspect of upper half of midbrain.
Afferent: From motor and premotor area of cere- Beneath this round elevation, dorsal part of midbrain
bral cortex (Area 4 and 6) of same side. (behind cerebral aqueduct) presents concentric layers
Efferent: To anterior horn cells of spinal cord (only of gray and white matters. Neurons of the gray matter
upper cervical segments) of opposite side. form nucleus of superior colliculus which forms cell
2. Corticorubrobulbar tract: stations for spinovisual reflex.
Afferent: From motor and premotor area of n Connections of nucleus of superior colliculus:
cerebral cortex (Area 4 and 6) of same side. Afferent: Fibers of optic tract relay in lateral
Efferent: To motor nuclei of IIIrdVIIth cranial geniculate body. Some of the fibers from neurons of
nerves of opposite side. lateral geniculate body, passing through superior
3. Cerebellorubrothalamic tract: brachium end in superior colliculus.
Afferent: From dentate nucleus of cerebellum of Efferent: These are tectobulbar and tectospinal
opposite side. fibers passing to motor nuclei of cranial nerves in
Efferent: To thalamic nucleus. brainstem and anterior horn cells of spinal cord
4. Pallidorubrothalamic tract: respectively.
Afferent: From globus pallidus of same side. Nucleus of superior colliculus acts as a center for
Efferent: To thalamic nucleus of opposite side. spinovisual reflex or visual body reflex pathway.
n White matter (of tegmentum):
1. Emerging fibers of oculomotor nerve: Both CLINICAL ANATOMY OF BRAINSTEM
somatic efferent and general visceral efferent
(parasympathetic) fibers of oculomotor nerve, MEDULLA OBLONGATA
arising from respective nucleus, traverse through
tegmentum of midbrain at the level of superior n General consideration: Traumatic, ischemic,
colliculus. While doing so, oculomotor nerve infective, degenerative or neoplastic lesions of med-
traverses through red nucleus and comes in ulla oblongata may lead to wide range of clinical
close relation to crus cerebri through which pass manifestations because
corticospinal (pyramidal) tract fibers. i. It contains various cranial nerve nuclei.
2. Decussation of rubrospinal tract fibers: It is known ii. Medulla oblongata is the part of brainstem
that rubrospinal tract is a crossed tract. Fibers which contains vital centers those regulates
arising from red nucleus decussate immediately at cardiovascular and respiratory functions.
the level of superior colliculus ventromedial to the iii. Through medulla oblongata pass many ascen-
nucleus, and then descend towards spinal cord. ding and descending tract which may be
This is known as anterior (ventral) tegmental affected in demyelinating diseases, neoplasm
decussation of Forel. or vascular disorder.
3. Decussation of tectospinal tract fibers: Like
rubrospinal tract, tectospinal tract is also a Herniation of Medulla in Increased
contralateral tract arising from tectum of mid- Intracranial Pressure
brain. At the level of superior colliculus, fibers of
Any tumor or space occupying lesion (SOL) in posterior
tectospinal tract decussate, posteromedial to red
cranial fossa will lead to increase in intracranial
nucleus before descending towards spinal cord. It
pressure. As a result, to compromise this tension,
is called posterior (dorsal) tegmental decussation
medulla oblongata with cerebellar tonsil will be
of Meynert.
pushed downwards and forwards causing herniation
4. Compact bundle of ascending tract (as lemniscus):
through foramen magnum.
Out of the four lemnisci found of the level of
inferior colliculus, lateral lemniscus was found to
Clinical manifestations
end in inferior colliculus. So, at the level of sup-
erior colliculus, three lemnisci, namely medial, l Headache
trigeminal and spinal, are placed medial to lateral. l Neck stiffness or neck rigidity
124
Brainstem
l Effect of lesion of lower four cranial nerves due to of medulla oblongata with a part of cerebellum. It is
their traction (IXXIIth). characterized by various manifestations due to lesion
of many nuclei and fiber tracts which are as follows.
Complication Area of lesion Clinical manifestations
Lumbar puncture, to release the raised intracranial 1. Spinal lemniscus (lateral Loss of pain and temperature
pressure, is contraindicated. Because it may lead to spinothalamic tract) sensation of opposite half of body.
further herniation of medulla (so also brain) through 2. Spinal nucleus and spinal Loss of pain and temperature of
tract of trigeminal nerve same side of face.
foramen magnum which may cause sudden failure of
vital functions. 3. Nucleus ambiguous Dysphagia (difficulty in
swallowing) and dysphonia
n Arnold Chiari malformation: It is a congenital (difficulty in phonation) due to
disorder associated with craniovertebral anomalies paralysis of muscles of soft
and spina bifida. palate, pharynx and layrynx.
Pathology: Herniation of cerebellar tonsil and 4. Ventral and dorsal spino- Cerebellar ataxia associated
medulla oblongata through foramen magnum. cerebellar tract, inferior with incoordination of
cerebellar peduncle and movements and in gait affecting
Effect: Herniation of medulla as well as cere- part of cerebellum limbs.
bellum will cause obstruction of foramen of Magendie 5. Vestibular nuclei Vertigo, nausea, vomiting and
and foramen of Luschka on the roof of fourth ventricle nystagmus (incoordination in
which communicate subarachnoid space with cavi- conjugate deviation of eyeball).
ties (ventricles) of brain. So it will cause internal 6. Descending sympathetic Horners syndrome characterized
hydrocephalus. fibers by ptosis, miosis, enophthalmus
and anhidrosis with flushing of
n Medial (ventral) medullary syndrome: same side of face.
It is one of the vascular disorder of medulla oblo-
ngata. In this case of vascular lesion ventral part of n Traumatic lesion of medulla oblongata:
medulla is damaged due to obstruction (thrombosis) of Sudden hyperextension injury of neck leading to
medullary branch (branches) of vertebral artery. fracture dislocation of axis (second cervical vertebra)
This syndrome is also known as Crossed paralysis causes damage to medulla oblongata. Typical example
as it will cause is Hangmans fracture of axis which presses over
1. Contralateral hemiplegia: It is due to lesion of medulla oblongata leading to suppression of functions
pyramid through which passes pyramidal tract of various functional area including vital centers
which ultimately results to death following hanging.
before decussation.
As it is upper motor neuron lesion, it is chara-
cterized by contralateral spastic paralysis with incre- PONS
ased muscle tone and exaggerated tendon jerks. Pons is the infratentorial part of brainstem which is
2. Ipsilateral paralysis of tongue: It means that lodged in posterior cranial fossa and closely related
paralysis of muscles of tongue of same side because to cerebellum with middle cerebellar peduncle and
of lesion of hypoglossal nerve of same side which fourth ventricle of brain. Lesion of pons is commonly
emerges from medulla close to pyramid. Due to due to following two reasons
this defect, as same sided genioglossus with other 1. Vascular: Pons is supplied by
tongue muscles is paralyzed, unopposed action of i. Pontine arteries
genioglossus of normal side will push the tip of ii. Anterior inferior cerebellar artery
tongue, when protruded, to the paralyzed side. iii. Superior cerebellar artery.
3. Additional sensory deficit: At this level of med- All are branches of basilar artery.
ulla (pyramidal level), medial lemniscus is situated Range of vascular lesion may be mild, moderate
behind pyramid. So, if the lesion is deeper, damage or severe. Accordingly it may affect a small area or
to medial lemniscus will cause loss of sense of whole of pons which causes bilateral manifestations.
position and movement (due to loss of proprioceptive Nature of vascular lesion may be thrombosis or
sensation from muscles, tendons and joints) and hemorrhage leading to infarction.
loss of discriminative touch of opposite side. 2. Neoplastic: Neoplasm (tumor) of pons may be
n Lateral medullary (Wallenberg) syndrome: a) Acoustic neuroma: It is a tumor at cerebello-
This is a clinical condition which occurs in thrombosis pontine angle (CP angle) developed from
of posteroinferior cerebellar artery, a branch of vert- Schwann cell sheath of statoacoustic (vestibu-
ebral artery. It leads to lesion in posterolateral part locochlear) nerve.
125
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
b) Astrocytoma: It is the tumor originating from Site of lesion Clinical manifestations
astrocytes. Incidence is common in children. 1. Vestibulocochlear nerve Vertigo, nausea, vomiting,
n Vascular lesion in paramedian area of basilar tinnitus and progressive deafness.
part of pons may be due thrombosis or infarction due 2. Middle cerebellar peduncle Cerebellar ataxia with intention
to involvement of short multiple pontine branches of tremor and staggering gait.
basilar artery. It will cause contralateral cerebellar 3. Spinal nucleus and spinal Ipsilateral loss of pain and
tract of trigeminal nerve temperature sensation of face.
ataxia with intention tremor due to lesion of cortico-
pontocerebellar pathway. Contralateral hemiplegia 4. Emerging fibers of facial Ipsilateral infranuclear facial
nerve paralysis.
will result due to damage to corticospinal tract
passing through basilar part of pons. n Pontine hemorrhage: It is extensive and bila-
n Millard Gubler Syndrome: It is the clinical teral in nature so that clinical condition will cause
condition which results due to occlusion of paramedian bilateral type of all manifestations as stated above.
pontine branches of basilar artery feeding lower and In addition, it will present following two specific
ventral part of pons. manifestations.
It involves basilar part of pons through which 1. Pinpoint pupil: Due to involvement of ocular sym-
pathetic fibers.
traverses corticospinal tract and emerge fibers of VIth
2. Hyperpyrexia: It is because of severe lesions in pons
and VIIth cranial nerve.
which disconnect the body from heat regulating
Clinical manifestations
center in hypothalamus.
i. Contralateral hemiplegia
ii. Ipsilateral lower motor neuron type (nuclear or
MIDBRAIN
infranuclear) facial paralysis.
iii. Ipsilateral medial strabismus (squint) due to Causes of lesion in midbrain may be
unopposed action of medial rectus as a result 1. Traumatic
of paralysis of lateral rectus supplied by 2. Neoplastic
abducent (VIth cranial) nerve. 3. Ischemic
n Extensive vascular lesion or expanding 4. Obstructive.
tumor (astrocytoma) of pons will cause widespread
motor and sensory deficits depending on different Traumatic Lesion
areas of gray and white matter affected as follows Midbrain, the short proximal part of the stalk, forms
Area of lesion Clinical manifestations
supratentorial part of brainstem. While becoming
continuous with infratentorial part, midbrain is rela-
1. Corticospinal tract Contralateral hemiparesis or
hemiplegia
ted to tentorial notch formed by sharp free margin of
tentorium cerebelli. Sudden lateral movement of the
2. Corticonuclear tract Weakness of muscles of face, jaw
of opposite side
head may lead to a vulnerable injury, when midbrain
(its cerebral peduncle) may be torn, stretched, twisted
3. Pontocerebellar fibers Cerebellar ataxia
or bent against free margin of tentorium cerebelli.
4. Medial and spinal lemnisci Contralateral sensory deficit of In this case most obvious feature will be invo-
trunk and limbs
lvement of oculomotor nerve at its exit. Depending
5. Superior (principal) Contralateral loss of tactile upon severity of injury, trochlear nerve and other
sensory nucleus of sensation of face, pain and
trigeminal nerve temperature sensations are
areas of midbrain will be affected.
preserved as spinal nucleus of
Vth nerve is not affected. Neoplastic Lesion
6. Abducent nerve nucleus Medial strabismus (squint) due
to unopposed action of medial
Tumors pressing and infiltrating neural tissue of
rectus muscle. midbrain may be internal or external. Any space
occupying lesion (SOL) in the vicinity will have effect
7. Vestibular nuclei Vertigo, nausea, vomiting and
nystagmus. on following structural components of midbrain.
1. Important ascending and descending tracts: For
8. Cochlear nuclei Impairment of hearing.
example Medial and spinal lemnisci, corticospinal
n Cerebellopontine angle (CP angle) tumor: It and corticobulbar (corticonuclear) tracts, medial
is the acoustic neuroma which occurs due to tumor longitudinal fasciculus.
arising from Schwann cell sheath of vestibulocochlear 2. Nuclei of cranial nerves: Like oculomotor and troc-
nerve. hlear nerves.
126
Brainstem
3. Reflex centers in colliculi Side of lesion Clinical manifestations
4. Red nucleus and substantia nigra: Which possesses 1. Corticospinal tract Contralateral hemiplegia.
remarkable influence on motor function. 2. Corticobulbar tract Paresis of lower part of face,
tongue (contralateral half).
Vascular Lesion 3. Oculomotor nerve fibers Ptosis, lateral squint, proptosis
with diplopia, dilatation of pupil
It occurs due to occlusion of a branch of posterior wih its no reaction to light and
cerebral artery. Depending upon extent of lesion accommodation.

clinical syndromes are of following two types: 2. Benedikt syndrome: This vascular lesion of
1. Weber syndrome: It is also known as Crossed midbrain is more extensive additionally affecting
oculomotor paralysis. This lesion damages cortic- medial and spinal lemnisci as well as red nucl-
ospinal and corticobulbar (corticonuclear) tracts eus. So clinical findings of Weber syndrome is
and emerging fibers of oculomotor nerve. Effects associated with contralateral sensory impairment
of this vascular lesion are following. and some involuntary movements.

127
Cerebellum
6
Superior cerebellar peduncle

Midbrain

Cerebellum

Brainstem Pons

Medulla Middle cerebellar peduncle


oblongata
Inferior cerebellar peduncle

Fig. 6.1 Cerebellum in relation to brainstem (lateral view)

INTRODUCTION POSITION AND RELATIONS (FIGS 6.1 AND 6.2)


Cerebellum is the dorsal part of hindbrain (rhom- Cerebellum is situated in posterior cranial fossa,
where it is lodged on cerebellar fossa of squamous
bencephalon) (Fig. 6.1). Among the three components
part of occipital bone.
of hindbrain with pons and medulla oblongata. Cerebellum is situated below occipital lobe of
Cerebellum is the largest in volume. cerebrum from which it is separated by tentorium
Cerebellum is considered as motor component of cerebelli.
brain. Though it does not initiate voluntary move- Cerebellum is anteriorly related to dorsal surface
ment, but it exerts a control on it in a subconscious of pons and medulla oblongata from which it is
separated by fourth ventricle of brain (Fig. 6.2).
state.
Three components of brainstem, midbrain, pons
In contrast to cerebrum, cerebellum is known as and medulla oblongata are connected to cerebellum
little brain. by paired superior, middle and inferior cerebellar
Cerebellum exerts ipsilateral control on body. peduncles respectively (Fig. 6.1).
Cerebellum

Third ventricle of brain


Aqueduct of midbrain

Midbrain

Cerebellum
Pons

Fourth ventricle of brain

Medulla oblongata
Central canal of medulla

Fig. 6.2 Cerebellum in relation to fourth ventricle of brain (sagittal sectional view)

PRINCIPLE OF FUNCTIONS unconscious state, on brainstem, spinal cord and


cerebral cortex for
It has already been mentioned, though cerebellum is 1. Maintenance of equilibrium or balance of body
not concerned with initiation of voluntary movement, through postural adjustment.
it regulates normal motor activities unconsciously. It 2. Maintenance of muscle tone for desired sense of
acts as a playback singer or trainer of a musical troop. position and movements.
Functions of cerebellum is explained in following 3. Coordinated and smooth muscular activities to
three stages. proper range, extent and direction.

Stage I
GROSS ANATOMY (FIG. 6.3)
Cerebellum receives various kinds of sensory inf-
ormations either through direct pathway like spino-
Funamental Components
cerebellar or indirect pathway like spinothalamo-
cortical and corticopontocerebellar tracts. Cerebellum is fundamentally composed of inter-
Sources of informations are as follows mediate part called vermis and two lateral halves
1. Proprioceptive general somatic sensation: From called cerebellar hemispheres. Vermis is so called
end organs of muscles, tendons, joints. because it is somewhat like worms in appearance.
2. Exteroceptive general somatic sensations: Mainly This terminology can be compared to the word verm-
from end organs for touch and pressure. iform appendix. Centrally situated vermis is narrow
3. Proprioceptive special somatic sensation: From and constricted. It is continuous on either side with
end organ for balance, i.e. vestibular apparatus. rounded and expended cerebellar hemispheres.
4. Exteroceptive special somatic sensation: From end
organs for sight (photoreceptors) and end organs Surface views Superior and inferior
for hearing (cochlear apparatus).
When viewed from superior surface, area of vermis
Stage II seen is called superior vermis, which presents antero-
posteriorly directed midline ridge, which slopes late-
All sensory informations are analyzed and coordinated rally to become continuous with superior surface of
or integrated. cerebellar hemispheres.
Inferior aspect of cerebellum shows comparatively
Stage III independent appearance of vermis which is called
After integration of all sensory inputs, a regulatory inferior vermis which is more deeply placed as com-
effect is exerted by cerebellum, in a subconscious or pared to cerebellar hemisphere. The depression on
129
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)

Superior cerebellar peduncle


Section of midbrain
connecting cerebellum with
midbrain

Superior vermis
Superior half of cerebellar
hemisphere above horizontal
sulcus
Cerebellar
hemisphere Horizontal sulcus

Inferior half of cerebellar hemisphere


Vallecula lodging below horizontal sulcus
inferior vermis Vallecular sulcus

Fig. 6.3 Posterosuperior view of cerebellum

which inferior vermis is lodged is called vallecula. 3. Flocculonodular lobe.


Vallecular sulcus separates vermis on either side Each of the lobe has a portion of vermis (midline
from inferior aspect of cerebellar hemisphere. part) and two lateral extensions on cerebellar hemi-
sphere.
Cerebellar notches Anterior lobe and middle lobe (also called posterior
Cerebellum, when viewed from above, present a lobe) are separated by a V shaped fissure at the junction
notch in the midline on its anterosuperior aspect to of anterior 1/3rd and posterior 2/3rd of superior surface.
accommodate collicular bulge of midbrain. It is called It is the primary fissure or fissura prima. Antero-
superior cerebellar notch. Posteroinferior aspect of inferior part of cerebellum is cut off by another primary
two cerebellar hemisphere are separated by posterior fissure called posterolateral fissure (sulcus). The part
cerebellar notch which is related to free crescentic of cerebellum anterior to this sulcus is called Flocculo-
margin of Falx cerebelli. nodular lobe. Superior and inferior halves of middle
lobe (posterior lobe) are separated by a prominent deep
Surface features Folia and fissures fissure called horizontal fissure which is not functionally
primary fissure, though primary in origin.
Surface of cerebellum (both hemisphere as well as
Each of the lobe made up of lobules: Lobes of
vermis) presents very narrow and shallow parallel
cerebellum, namely anterior and posterior, are further
linear depressions. These are called fissures. These
divided by secondary fissures into smaller units,
fissures extending from one side of cerebellar hemi-
called lobules. Each lobule presents a component
sphere to the other side crossing over the vermis,
in the vermis and its lateral extensions in both the
present V shaped or U shaped appearance, angle or
cerebellar hemisphere.
concavity of which is directed forwards. One fissure
Before the lobules are studied through following
intervenes between two adjacent thin and linear ridge
table, it is important to note at this stage that,
like leafy elevations which are parallel to each other
during development of cerebellum all the lobules of
serially. These are called folia (Singularfolium).
cerebellum used to be simply placed in cephalocaudal
direction on the dorsal aspect of pons and medulla
PRIMARY FISSURE AND LOBES OF CEREBELLUM intervened by cavity of fourth ventricle (Fig. 6.4).
Cerebellum is primarily divided into 3 lobes by But ultimately, part of it, caudal to the level of future
primary fissures which are comparatively deeper. horizontal fissure, is bent on itself inferiorly round the
These lobes are known as: tent-shaped roof of 4th ventricle as seen in Figure 6.4,
1. Anterior lobe to form inferior vermis and inferior part of cerebellar
2. Middle lobe hemisphere.
130
Cerebellum
Anterior lobe

Primary sulcus
Middle (posterior) lobe
Horizontal sulcus

Posterolateral sulcus

Flocculonodular lobe

Fig. 6.4 Cephalocaudal relationship of different components (lobules) of cerebellum. Fig also shows rostroventral bending of caudal part
of cerebellum (part caudal to horizontal sulcus) to form its inferior part

Lobules of cerebellum (Fig. 6.5): Horizontal fissure divides cerebellum into superior
and inferior halves. Lobules listed above, which are
Vermis Lateral extension in
proximal to horizontal fissure form superior half

}
cerebellar hemisphere
1. Lingula No lateral extension
and those distal to the fissure form inferior half of
2.
Central lobule Ala Anterior
cerebellum.

}
Primary 3. Culmen Anterior quadrangular lobule lobe
fissure PHYLOGENETIC CLASSIFICATION OF CEREBEL-
4. Declive Posterior quadrangular lobule LUM (FIGS 6.5 AND 6.6)
Horizontal 5. Folium Superior semilunar lobule
fissure (lobulus simplex)
In reference to the stages of evolution, cerebellum is
made up of following three phylogenetic components
6. Tuber Inferior semilunar lobule
which are also functionally different.
7. Pyramid Biventral lobule Posterior
Posterolat- 8. Uvula Tonsil lobe
eral sulcus Archicerebellum
9. Nodule Flocculus Flocculo- It is the most primitive part of cerebellum which is
nodular lobe
the only component present in fishes and amphibians.

1
Anterior lobe
2 2
Primar fissure
3 3

Archicerebellum 4
4
Posterior
lobe 5 5
Horizontal fissure
Paleocerebellum
(sulcus)
6 6

Neocerebellum 7 7

8 8

9 Posterolateral fissure
Flocculonodular 9 (sulcus)
lobe

Fig. 6.5 Lobes, lobules and fissures of cerebellum


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Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Primary fissure
Cerebral aqueduct 3 4
2
5

Midbrain 1 Horizontal fissure

6
Pons

9 7
8
Posterolateral fissure
Medulla oblongata

Cavity of fourth
ventricle of brain
Central canal of lower half of medulla oblongata

Fig. 6.6 Midsagittal section of vermis component of cerebellum (with 4th ventricle and brainstem) contributing to lobular elements.
1. Lingula, 2. Central lobule, 3. Culmen, 4. Declive, 5. Folium, 6. Tuber, 7. Pyramid, 8. Uvula, 9. Nodule

Composition mals, where development of central nervous system


is characterized by telencephalization, which means
Lingula and flocculonodular lobe.
differentiation of telencephalon in the brain.
Connection Composition
Vestibular nuclei through vestibulocerebellar fibers. The largest middle (posterior) lobe of cerebellum
except pyramid and uvula of inferior vermis.
Function
Connection
Maintenance of equilibrium or balance.
It receives afferent connections from cerebral cortex
Paleocerebellum via corticopontocerebellar pathway.

It is the part of cerebellum which is superadded in Function


lower vertebrates with limbs, e.g. bird and reptiles.
Neocerebellum is concerned with a coordination of
voluntary movement so that it is smooth and skilled,
Composition and it is performed in right direction and within
1. Central lobule and ala proper range.
2. Culmen and anterior quadrangular lobule
3. Pyramid, i.e. only vermis portion INTERNAL STRUCTURE OF CEREBELLUM (FIG. 6.7)
4. Uvula, i.e. only vermis portion. Cerebellum is structurally made up of following two
fundamental zones.
Connection 1. Outer layer of gray matter called cerebellar cortex.
Receives connection from spinal cord via spinocere- 2. Inner central core of white matter which presents a
bellar fibers. pattern like branching of a tree projecting superfi-
cially beneath the cortex of each and every folium,
Function called arbor vitae cerebelli.
Inside the substance of white matter are embedded
Maintenance of muscle tone and posture. mass of gray matter called cerebellar nuclei.

Neocerebellum Structure of Cerebellar Cortex


This component of cerebellum is the most recently Cortex is made up of following cerebellar neurons
evolved part which is well-developed in higher mam- arranged in three layers.
132
Cerebellum

Stellate cell

Molecular layer
Busket cell

Purkinje cell layer


Purkinje cell

Golgi cell

Granular layer
Granule cell
Glomerulus

Climbing fibers

Mossy fibers

White matter Cerebellar


afferents

Neurons of cerebellar
nuclei

} Cerebellar efferents

Axon of some Purkinje cells leave cerebellum


directly as cerebello (fastigio) vestibular fibers

Fig. 6.7 Cytoarchitecture of cerebellum showing afferent and efferent fibers and interrelationship of neurons

1. Outer molecular layer: Stellate cells and busket 2. Some afferent reaching the innermost granular
cells. layer relay in granule cells which pass further
2. Intermediate layer of Purkinje cells: Purkinje cells. superficially to relay in Purkinje cells dendrites in
3. Inner granular layer: Granule cells and Golgi molecular layer.
cells. Neuroglia are present in all the layers. Through both the ways Purkinje cells receive ex-
citatory impulse continuously. This excitatory im-
Fundamental structural and functional basis of
pulse in relayed to neurons of cerebellar nuclei in
cortical architecture
deeper white matter. Axons of cerebellar nuclei pass
Principal cells of cortex are Purkinje cells. It receives out as efferent to carry the same excitatory impulse.
afferent input entering cerebellum through following But this impulse is limited time to time by inhibitory
two different routes. influence of stellate cells, busket cells and Golgi cells
1. Some of cerebellar afferent relay in Purkinje cells of cortex on Purkinje cells, so also on cells of cerebel-
reaching upto superficial molecular layer. lar nuclei.
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Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
position between all the afferent fibers to cerebellum
STRUCTURAL DETAIL OF CEREBELLAR CORTEX
other than olivocerebellar group and the Purkinje cells.
(FIG. 6.7) These cerebellar afferent fibers are known as Mossy
Molecular Layer fibers. Granule cells present four to five dendrites
which present claw-like endings. Mossy fibers, which
This outermost layer of cortex receives cerebellar are all the afferents, other than olivocerebellar fibers
afferent called climbing fibers. Among all afferents (climbing fibers) reach upto granular layer where
to cerebellum, these are only olivocerebellar fibers. they show multiple branching. These fiber terminals
Entering through inferior cerebellar peduncle and form synaptic connection with claw-like dendrites
traversing through white matter these fibers climb up of granule cells. One mossy fiber forming synaptic
to the outermost layer of cortex. These fibers divide connection with thousand of Purkinje cells, thus
into numerous branches which wrap around the bush- producing diffuse excitatory effect.
like dendritic tree of Purkinje cells in molecular layer. Axons of granule cells are long enough to reach
These are called climbing fibers as they look like a upto superficial molecular layer traversing through
vine on a tree. One climbing fiber forms synaptic
Purkinje layer. Terminal end of granule cell axons
connections with dendritic tree of 110 Purkinje
divide in T shaped manner, ends of which run in
neurons through which all the times excitatory
opposite direction which are called parallel fibers.
sensory inputs are discharged on Purkinje cells.
Ends of parallel fibers form synaptic connection with
Neurons present in molecular layer are stellate
dendritic tree of Purkinje cells at right angle.
cells and busket cells. Stellate cells are small star-
Second type of neurons in granular layer are Golgi
shaped superficially placed cells. Axons of these
cells. Their dendrites are spread out in molecular
cells relays in dendritic spines of Purkinje cells to
produce inhibitory effect. Busket cells are placed in layer and axon split up into branches which form
deeper part of molecular layer. These are so called synapses with dendrites of granules cells at the site of
because multiple axon terminals give a busket-like their junction with mossy fiber terminals which form
appearance to hold the Purkinje cell body. Through glomerulus.
this connection excitatory impulse of Purkinje cells Neuroglial cells are also abundant in whole gran-
are limited. ular layer.
Molecular layer also receives axons of granule
cells situated in granular layer. In this layer long MECHANISM OF CEREBELLAR CORTICAL CIRCUIT
axons of granule cells divided into T-shaped manner.
Two limbs of T-shaped axon of granule cells run in Purkinje cells receive constantly the excitatory inputs
opposite direction which synapse with Purkinje cell entering cerebellum through afferent fibers. The
dendritic spines. afferent fibers are of two types. Climbing fibers are
only the olivocerebellar fibers among all afferent fibers
Purkinje Cell Layer to cerebellum. These fibers are longer to wrap around
and to relay in dendritic spines of Purkinje cells at
This layer is made up of single row of cells called molecular layer. Mossy fibers are all other afferents,
Purkinje cells. These are large, flask-shaped Golgi which also produce excitatory affect on Purkinje cells
type I neurons. Dendrites of these cells are like tree through granule cells. Axons of Purkinje cells leave
bush showing primary, secondary and tertiary or final the cortex to reach deeper white core of cerebellum
branching. Final branches present dendritic spines. where they excite neurons of cerebellar nuclei. Axons
Whole dendritic process extend into superficial of the nuclear neurons leave cerebellum as efferents
molecular layer. via superior and inferior cerebellar peduncles to reach
Long axons of Purkinje cells acquire myelin sheath centers in brainstem, spinal cord and cerebral cortex.
on entering granular layer. These pass further deeper So, it clear till now that, receiving all sensory inputs
to relay in neurons of cerebellar nuclei. through climbing as well as mossy fibers, excitation of
Axons of a few Purkinje cells end directly to vesti- Purkinje cells is conveyed via cerebellar nuclear axons
bular nuclei, without relaying in cerebellar nuclei. for motor activities, maintenance of equilibrium, muscle
tone and muscular activity coordination. But for this
Granular Layer motor activity, to reach upto optimum range, proper
This layer is so called because it is filled with densely extent and right direction, time to time modification
packed, small sized, multipolar neurons called granule or limitation of excited state of Purkinje cells conveyed
cells. The cells present scanty cytoplasm with deeply to cerebellar nuclear axons as efferent fibers are
stained nuclei. Granule cells are intermediate in necessary. This becomes possible by inhibitory whip
134
Cerebellum
of stellate cells, busket cells of molecular layer and WHITE MATTER OF CEREBELLUM
Golgi cells of granular layer. It is to be recalled that
axons of stellate cells form synaptic connection with Small amount of white matter present in vermis looks
dendrites, and axons of busket cells come in contact like trunk and branches of a tree. It is called arbor
with cell bodies of Purkinje cells. Through these vitae cerebelli. Cerebellar hemispheres present larger
amount of white matter.
connections both these cells exert inhibitory effect
White matter is made up of following three groups
on Purkinje cells. In granular layer, axons of Golgi of fibers.
cells form synaptic contact with dendrites of granule 1. Afferent fibers: These are climbing and mossy
cells, through which inhibitory influence is exerted fibers as already described. These form the main
on Purkinje cells, so on axons of neurons of cerebellar bulk of cerebellar fibers which enter mostly
nuclei coming out as efferent fibers from cerebellum. through middle and inferior cerebellar peduncles.
So, it is clear that inhibitory impulse from stellate 2. Efferent fibers: These fibers leave cerebellum
cells, busket cells and Golgi cells are transmitted by through superior and inferior cerebellar peduncles.
Purkinje cells to the cerebellar nuclei, axons of which in Most of these efferent fibers from cerebellum are
axons cerebellar nuclei neurons. Some of axons of
turn, projecting on motor centers of brainstem, spinal
Purkinje cells of flocculonodular lobe and part of
cord and cerebral cortex modify or limit muscular vermis pass, bypassing cerebellar nuclei, directly
activity for maintenance of equilibrium, muscle tone as cerebellar efferents.
and coordination of smooth and skilled movements. 3. Intrinsic fibers: These are so called as they exist
Neurotransmitters: Climbing as well as mossy within the cerebellum. It means these fibers,
fibers release glutamate or gamma-aminobutyric being the processes of different cerebellar neurons
acid (GABA) as excitatory transmitter on dendrites interconnect with each other.
of Purkinje cells. Axons of stellate cells, busket cells
and Golgi cells release norepinephrine and serotonin NUCLEI OF CEREBELLUM (FIG. 6.8)
which are inhibitory transmitter to have effect on These are small but compact masses of gray matter
Purkinje cells. embedded in central core of white matter. Axons
Afferents from vermal (median) zone of Afferents from paravermal (medial) zone to
cortex to fastigial nucleus nucleus interpositus

Afferents from lateral zone of cerebellar


cortex to dentate nucleus

B B

Efferents from dentate nucleus to thalamus


for dentatothalamocortical pathway
Efferents from nucleus interpositus to red
nucleus for cerebellorubrospinal pathway

Efferents from fastigial nucleus to


Vestibular nucleus for fastigiovestibular
(fastigiobulbar) pathway
Reticular nucleus for fastigioreticular pathway

Fig. 6.8 A. Intracerebellar nuclei, B. Afferents from vermal (median), paravermal (medial) and later zones of cerebellar cortex relaying
to respective nuclei, C. Efferents from three phylogenetic groups of nuclei leaving for different destinations
135
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
of neurons of these nuclei, as already discussed, i. Vestibular and reticular nuclei of brainstem
leave out of cerebellum through either superior or ii. Via red nucleus to spinal cord
inferior cerebellar peduncles as cerebellar efferents. iii. Via thalamus to motor and premotor areas of
Cerebellar nuclei are four in number on either side of cerebral cortex.
midline from vermis to cerebellum hemisphere. From It is interesting to note at this stage that fastigial
lateral to medial the nuclei are nucleus, nucleus interpositus and dentate nuclei
1. Dentate nucleus (Nucleus dentatus) D receive afferent (Purkinje cell axons) from three
2. Emboliform nucleus (Nucleus emboliformis) E components of cerebellar cortex which are subdivided
3. Globose nucleus (Nucleus globossus) G from medial to lateral as follows:
4. Fastigial nucleus (Nucleus fastigius) F 1. Medial (vermal): Cortex of vermis
Nucleus emboliformis and nucleus globossus are 2. Intermediate (paravermal): Cortex of medial half
together known as nucleus interpositus.
of hemisphere
Dentate Nucleus 3. Lateral: Cortex of lateral half of hemisphere.
So, afferent from three mediolaterally divided
Dentate nucleus is the most lateral and largest portions of cortex to three phylogenetic types of
among the four nuclei of cerebellum. It is most prom- cerebellar nuclei and their efferents in three different
inent in higher animals, specially in human brain.
destination are related as follows.
Phylogenetically it is the latest in evolution and
obviously related to neocerebellum. Dentate nucleus, Afferents Cerebellar Efferents
on section, looks like a folded bag with its opening from nucleus
(concavity) facing medially. From the concave side 1. Vermal (medial) Fastigial Fastigiovestibular tract
emerge efferent fibers from the nucleus. Efferent fibers zone of cerebellar nucleus to vestibular nuclei
leave cerebellum through superior cerebellar peduncle. cortex
2. Paravermal Nucleus Cerebellorubrospinal
Emboliform Nucleus (intermediate) zone interpositus tract to anterior horn
of cerebellar cortex cell of spinal cord
Emboliform nucleus is oval in outline. It is situated
3. Lateral zone Dentate Dentatothalamocortical
just medial to dentate nucleus and may be closely of cerebellar cortex nucleus tract to motor and prem-
approximated to concavity (hilum) of dentate nucleus. otor area of cerebral cortex

Globose Nucleus CEREBELLAR PEDUNCLES


It is round in shape and sometimes may be more than Superior, middle and inferior cerebellar peduncles
one in number. connecting midbrain, pons and medulla oblongata
Globose and emboliform nuclei are closely apposed with the cerebellum respectively, are the bridges
to each other and interposed between dentate nucleus through which pass fibers to and from the cerebellum
laterally and fastigial nucleus medially. That is why (cerebellopetal and cerebellofugal).
they together are named as nucleus interpositus. Middle cerebellar peduncle is thickest and superior
Nucleus interpositus is related to paleocerebellum. cerebellar peduncle is thinnest, while inferior is
Fastigial Nucleus intermediate.
Middle cerebellar peduncle, though thickest, is
Fastigial nucleus is close to midline and thereby lies composed of afferent (cerebellopetal) fibers only which
in the white core of vermis. It is ovoid or elliptical are only the fibers of pontocerebellar tract. Superior
in outline and intermediate in size between dentate and inferior cerebellar peduncles are composed of
nucleus and nucleus interpositus. This nucleus is both afferent (cerebellopetal) as well as efferent (cere-
related to archicerebellum. bellofugal) fibers.
RELATIONSHIP BETWEEN CEREBELLAR NUCLEI
Composition of Cerebellar Peduncles
AND MEDIOLATERAL SUBDIVISIONS OF
CEREBELLAR CORTEX (FIG. 6.8) Inferior cerebellar peduncle
It is already understood that cerebellar nuclei receive Afferent
afferents, all of which are axons of Purkinje cells. Of
course, axons of some Purkinje cells leave cerebellum 1. Dorsal spinocerebellar tract
straightway to end in vestibular nuclei as cerebello- 2. Anterior external arcuate fibers: From arcuate
vestibular fibers. Efferents from cerebellar nuclei
pass as their axons. They go out through superior and
{ nucleus
3. Posterior external arcuate fibers: From acc-
inferior cerebellar peduncles to essory cuneate nucleus (cuneocerebellar tract)
136
Cerebellum

{
4. Par olivocerebellar tract: From medial and 3. Ischemic: Vascular occlusive disorder, e.g. throm-
superior (dorsal) olivary nuclei bosis of any of the three cerebellar arteries.
5. Olivocerebellar tract: From inferior olivary 4. Degenerative: For example multiple sclerosis.
nucleus 5. Neoplastic: Expanding tumors, medulloblastoma

{ 6. Vestibulocerebellar tract
7. Reticulocerebellar tract
in children.

(A reader can remember the fibers in groups as Cerebellar Lesion May be Compensated by
above). Other Parts of Nervous System
Efferent Cerebellar lesions may be acute due to trauma or
1. Cerebelloolivary tract sudden vascular occlusion when the symptoms
2. Cerebellovestibular (fastigiovestibular or fast- are severe. In chronic lesion, like slowly expanding
igiobulbar) tract tumor, clinical features are less severe. But it has
3. Cerebelloreticular (fastigioreticular) tract. been seen in many cases of the lesion, either acute or
A reader can remember three efferents as reverse of chronic, patient recovers from the clinical deficits due
last three afferents. to compensation of cerebellar dysfunction by other
parts of nervous system.
Middle cerebellar peduncle
Cerebellar Syndrome
It is composed of only afferent fibers. These fibers
are pontocerebellar fibers of corticopontocerebellar Cerebellar syndrome is defined as combination of
pathway. signs and symptoms which are manifested due to
lesion of cerebellum for any cause. Fundamental of
Superior cerebellar peduncle cerebellar syndrome is motor dysfunction without
motor paralysis. Following are the two types of
Afferent cerebellar syndromes.
1. Ventral spinocerebellar tract 1. Archicerebellar syndrome
2. Tectocerebellar tract. 2. Neocerebellar syndrome.
Depending upon the nature and extent of lesion in
Efferent cerebellum, a patient may present combination or
1. Dentatorubral tract: For dentatorubrospinal path- overlapping of clinical findings of two cerebellar
way syndromes.
2. Dentatothalamic tract: For dentatothalamocorti- Neocerebellar syndrome presents the symptoms
cal pathway. and signs due lesion of both paleocerebellum and
neocerebellum.
CLINICAL ANATOMY
As cerebellum has ipsilateral control on body, lesion Archicerebellar Syndrome
of one half of cerebellum leads to clinical effect on It is due to lesion of archicerebellum which is com-
same half of body. posed of Flocculonodular lobe and lingula. It affects
To study the effect of lesion of cerebellum or vermal zone or area of vermis. That is why it is also
cerebellar dysfunction, functions of cerebellum are to
called vermis syndrome. Commonest example is med-
be briefly recapitulated which are as follows:
ulloblastoma in children.
1. Maintenance of equilibrium or balance of body
through all reflex activities and voluntary move- Archicerebellar syndrome is characterized by
ments. group of clinical findings which are due to disorders in
2. Harmonization of muscle tone and maintenance of equilibrium manifested by some motor dysfunctions
normal body posture. which are as follows.
3. Cerebellum, though not concerned with initiation n Unsteadiness in stance: Due to impaired
of voluntary movements, coordinates smooth, balance, while standing, the patient will have a
precise movement upto right extent and range in tendency to fall. He or she will try to compensate this
right direction maintaining the economy of force. difficulty by overcontraction of muscles of lower limb
which presents stiffed legs. The disability will also be
Causes of Cerebellar Lesion compensated with the help of vision and the patient
1. Congenital: Hypoplasia or dysgenesis will stand on a broad base with legs and feet being
2. Traumatic always wide apert. When the patient is asked to close
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Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
eyes while standing, he or she will have a tendency to failure to reach in right direction, upto proper extent
fall. It is known as positive Rombergs sign. with optimum force. The basic defect is termed as
n Unsteadiness in gait: Gait is the pattern or cerebellar ataxia characterized by following mani-
style of walking of an individual. In archicerebellar festations.
syndrome, due to impairment of balance, patient will 1. Intention tremor: Tremor is defined as abnormal,
sway from side to side in an attempt to maintain undesired, repetitive oscillatory movement affe-
balance of body. This is called staggering gait.
cting distal part of limbs, especially hands and
n Unsteadiness of trunk of body: This is evident
in vermis syndrome in case of children suffering from fingers. In case of neocerebellar syndrome tremor
medulloblastoma. The child will be unable to keep is noticed when the patient attempts or intends for
head erect due to imbalance of head and neck. Due finer hand movements, like picking up an object,
to impairment of balance of trunk, while walking, attempts for writing or buttoning clothes. That is
body of the patient will move to and fro forwards and why it is called intention tremor.
backwards. 2. Dysmetria: This disability is due to loss of know-
ledge to assess the range of movement. It is elicited
Neocerebellar Syndrome by finger nose test. Patient is asked to touch the
tip of nose with tip of finger. While attempting for
It is the combined effect of lesion of paleocerebellum
this, either the finger tip fails to reach tip of nose
and neocerebellum.
or it overshoots (pastpointing) the target. Patient
suffers from loss of harmonization of movement
IMPAIRED FUNCTION OF PALEOCEREBELLUM
of different groups of muscles which results in
Hypotonia: This is manifested as following decomposition of movements.
1. On palpation, muscle is found to have loss of resil- 3. Dysdiadochokinesia: This is the effect of incoor-
ience. dination between antagonist groups of muscles.
2. In an attempt for passive movement of a joint, It is elicited by asking the patient to perform
diminished resistance by the patient is felt. repeated pronation and supination movements of
3. Muscle get fatigued early. Defect is known as ast- forearm. When attempted, it is found to occur in
henia. slow, jerky and incoordinated manner.
4. During shaking of a limb, excessive movement of
4. Dysarthria: This is the disorder in articulation of
terminal joints is observed due to loss of influence
speech due to incoordination of muscles of larynx,
of cerebellum on stretch reflex.
tongue and lips. During speech, two major defects
Postural Defect are observed.
i. Use of unnatural force for muscle action.
1. Head is rotated and flexed. ii. Unusual or abnormal separation of syllables
2. Shoulder is on a lower level on the affected side. leading to slurred speech.
This disorder will have a best example when the
Pendulous Knee Jark
patient is asked to pronounce the word cerebellum.
In case of normal individual, normal jerky movement of Because of disability, patient will pronounce as CEH-
knee joint is self-limited after taping patellar tendon, RREH-BEH-LLUHM.
which is due to normal stretch reflex under regulation 5. Nystagmus: This disorder is the result of incoo-
of cerebellum. When influence of cerebellum on rdination of movement of extraocular muscles.
stretch reflex is lost, a series of pendulous flexion and
It is characterized by rhythmical oscillation of
extension movement of knee joint occurs while knee
eyeball in an attempt to fix the gaze (vision) for an
jerk is elicited.
object of interest for a longer time. Incoordination
of eye movement also occurs during horizontal
IMPAIRED FUNCTION OF NEOCEREBELLUM
side to side movement. When the gaze is returned
Fundamental effect is incoordination or asynergy back after horizontal movement, sudden jerk is
of smooth and precise voluntary movement with its observed in eyeball at the end of movement.

138
Fourth Ventricle of Brain
7
Fourth ventricle of brain is the cavity of hindbrain. 1. Upper part: It is narrower part opposite the level
This cavity, being a dilated part of original neural of rhombencephalic isthmus.
tube, is lined by ependyma and contains cerebrospinal 2. Middle part: At the level of pons.
fluid (Fig. 7.1). 3. Lower part: At the level of upper half of medulla
Fourth ventricle is situated behind pons and upper oblongata.
half of medulla oblongata and in front of cerebellum.
Shape of fourth ventricle is like that of a tent. Communications
Walls of the cavity are following
1. Floor: Formed by dorsal surfaces of pons and
A. With other parts of cavity of central
upper part of medulla oblongata. It is flat like
nervous system
ground of a tent.
2. Roof: It is made up of two slopes-like roof of a Above, through aqueduct of midbrain, fourth ventricle
tent. It projects toward white core of cerebellum. communicates with cavity of third ventricle of brain.
3. Lateral walls, where roof meets with floor. Below it communicates with central canal of
n Morphological components: Fourth ventricle spinal cord through narrow canal of lower closed part
presents following three parts morphologically. of medulla oblongata.

Cavity of third ventricle of brain

Aqueduct of midbrain
Cerebellum

Pia mater
Fourth ventricle of brain
Pons
Foramen of Magendie
Medulla oblongata
Central canal of lower closed
part of medulla

Fig. 7.1 Fourth ventricle of brain seen in sagittal section


Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)

Superior cerebellar peduncle Superior medullary velum (white matter


forming superolateral boundary lamina) forming upper part of roof

Ependyma of inferior medullary velum

{
Inferior cerebellar forming lower half of roof
peduncle
Foramen of Magendie in lower
Inferolateral Cuneate tubercle ependymal half of roof
boundary
Gracile tubercle

Fig. 7.2 Upper and lower halves of roof of fourth ventricle show different nature of formation
B. With subarachnoid space (Fig. 7.2) 3. Lateral recesses (Fig. 7.4): These are also bilateral
which projects between inferior cerebellar peduncle
Cavity of fourth ventricle communicates with suba-
ventrally and peduncle of floccules dorsally. End of
rachnoid space through three apertures. One is in the
the recess presents an aperture at cerebellopontine
midline on lower part of roof and two are present in
angle. Ventricular system communicates through
lateral angles. These apertures are as follows: this aperture with subarachnoid space which has
1. Foramen of Magendie: This is a midline foramen already been mentioned.
present in lower part of roof where it is lined by
ependyma only (see below) Boundaries of Fourth Ventricle
2. Foramen of Luschka: They are present at the end
of lateral recesses placed at lateral angle of cavity n Lateral boundaries: One each side, it is the side
(Fig.7.4). where roof meets with the floor.
Caudal part is bounded by two inferior cerebellar
Recesses (Fig. 7.3) peduncles which from lower angle, pass upward
and laterally. On either side of midline, lower angle
Recesses of fourth ventricle of brain are small conical of inferolateral boundary is formed by gracile and
outpouching from its cavity as following. cuneate tubercles, where former is inferomedial to
1. Dorsal recess: This is the apex of conical tent-shaped later (Fig. 7.2). Proximal part of lateral boundary is
roof projecting into white core of cerebellum. formed by two superior cerebellar peduncles which
2. Dorsolateral recesses: These are bilateral and pass downwards and laterally from upper angle.
project dorsolaterally on either side of dorsal recess.
Dorsal recess is found to be proximal to nodule of
cerebellum, dorsolateral recesses are lateral to it.

Flocculus

Dorsal
recess Lateral
recess

Dorsolateral
Foramen of
recesses
Luschka

Lateral recess opening in


lateral apertureForamen
of Luschka Inferior cerebellar peduncle

Fig. 7.4 Lateral recess projects between inferior cerebellar


peduncle (deep) and flocculus of flocculonodular lobe of cerebellum
Fig. 7.3 Recesses of tent-shaped fourth ventricle cavity (superficial)
140
Fourth Ventricle of Brain
Inferior half of the roof is further thinner than
superior half. It is made up of nonneural elements.
This thin lamina is called inferior medullary velum
Trochlear which is nothing but simple ependymal lining of the
nerve ventricle covered on its surface by pia mater forming
Frenulum
tela choroidea.
veli
Superior Lingula of
In the midline of upper end, dorsal surface of
medullary cerebellum inferior medullary velum is related to nodule of
velum inferior vermis of cerebellum (Figs 7.5 and 7.6).
Lower part of inferior medullary velum present
Nodule of
Ependyma
an aperture in the midline which is named foramen
cerebellum
of Magendie through which ventricular cavity
Foramen of
Magendie communicates with subarachnoid space.
Lateral angle of the roof presents lateral recess
which ends in lateral opening called foramen of
Luschka through which also ventricular cavity opens
into subarachnoid space.
Fig. 7.5 Features of roof of fourth ventricle It is important to notice at this stage that cereb-
rospinal fluid is constantly synthesized and initially
Roof or Dorsal Wall (Fig. 7.5) poured in the cavity of ventricular system of brain.
The fluid circulates from ventricular system into
Roof is like that of a tent. So it presents two slopes subarachnoid space from where it is absorbed also
which are upper (proximal) and lower (distal). Apex of constantly. That is why communication between
the roof projects into the cerebellum (Fig. 7.6). ventricular cavity and subarachnoid space through
Superior half of the roof is formed by a thin lamina above mentioned 3 foramina in the lower ependymal
of white matter called superior medullary velum. It part of roof of 4th ventricle is important.
bridges between medial margin of two superior cere-
bellar peduncles. Choroid Plexus and Tela Choroidea on Roof
Superior medullary velum presents a thin ridge (Fig. 7.7)
along the midline which is called frenulum veli. On
On the lower-half of roof of fourth ventricle, pia mater
either side of frenulum, superior medullary velum is from cerebellum is reflected back to form double
pierced by trochlear nerve emerging from brainstem. layer. This double layered pia mater contributed by
White matter of superior medullary velum cont- fine network of blood vessels which are branches of
ains some fibers of tectocerebellar tract. posterior inferior cerebellar artery, lines over the
Caudal end of superior half of roof is related to ependyma to form tela choroidea.
lingula of superior vermis of cerebellum in the midline Choroid plexus is formed by the highly vascular
(Figs 7.5 and 7.6). tela choroidea. It is T-shaped. Longitudinal limb of
Cavity of fourth ventricle
Choroid plexus
Lingula

Cavity
of fourth
ventricle
Pons

Cerebellum
Tela
choroidea
Nodule
Medulla
oblongata Olive

Pyramid
Fig. 7.6 Upper and lower half of midline roof of fourth ventricle
related to lingula and nodule of cerebellum Fig. 7.7 Choroid plexus projecting from roof of fourth ventricle
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Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)

Free margin of superior medullary velum

Median sulcus Locus coeruleus


Substantia ferrugenia
Facial colliculus
Superior fovea
Vestibular triangle
Stria medullaris
Tinea
Sulcus limitans Hypoglossal triangle
Inferior fovea Vagal triangle
Funiculus seperens Area postrema
Obex
Calamus scriptorius

Fig. 7.8 Floor of fourth ventricle (Rhomboid fossa)

T is double. The choroid plexus invaginates through ceruleus). Beneath this area, the group of neurons,
ependyma lined lower-half of roof towards the cavity containing melanin pigment, is called substantia
of ventricle to secrete cerebrospinal fluid. ferrugenia. These neurons are rich in noradrenaline
(norepinephrine).
Floor or Rhomboid Fossa (Fig. 7.8) Lateral to sulcus limitans, rhomboid fossa presents
a wide triangular area known as vestibular area or
Floor of fourth ventricle is formed by dorsal surfaces vestibular triangle. Vestibular nuclei are situated
of pons and upper-half of medulla oblongata. beneath this area.
It is called rhomboid fossa because it is rhomboid Just below the level of facial colliculus, fine
in outline. The area is outlined superolaterally by strands of nerve fibers are found to pass beneath
superior cerebellar peduncles and inferolaterally ependyma, in mediolateral direction, from median
by inferior cerebellar peduncles. At the inferior sulcus across medial eminence towards lateral
angle, on either side of midline, floor is limited by angle. These are known as stria medullaris. These
gracile tubercle and superolateral to it lies cuneate are efferent fibers from arcunate nucleus present on
tubercle. ventral aspect from pyramid. These fibers initially
Whole area of rhomboid fossa is lined by pass in ventrodorsal direction across whole thickness
ependyma, just beneath which lie different areas of of medulla oblongata to reach rhomboid fossa, where
gray matter, which are more precisely some cranial they bend at right angle and cross the median sulcus
nerve nuclei. to pass horizontally towards lateral angle. Finally the
Floor of fourth ventricle is divided by a vertically fibers reach opposite half of cerebellum via inferior
running midline sulcus called median sulcus. cerebellar peduncle (Fig. 7.9).
Each half of the floor is again subdivided into a Below the level of stria medullaris, medial emin-
medial part called medial eminence and a lateral part ence presents a triangular area with apex directed
called vestibular area by a narrower sulcus limitans. downward. This area is known as hypoglossal triangle
Just above the horizontal line of pontomedullary beneath which lies nucleus of hypoglossal nerve.
junction, medial eminence presents a round elevation Lateral to hypoglossal triangle, lower end of sulcus
called facial colliculus. It is so called because, efferent limitans presents a small depression called inferior
facial nerve fibers from motor nucleus of facial nerve fovea.
loop around abducens nucleus beneath this bulge. Below inferior fovea, lateral to apical part of
Above the level of facial colliculus, sulcus limitans hypoglossal triangle, a smaller triangular area is
presents a small depression called superior fovea. present with the apex directed upward. This is called
Above the level of superior fovea, sulcus limitans vagal triangle as beneath this area lies dorsal nucleus
becomes flattened and forms lateral limit of floor of of vagus.
fourth ventricle. This area is bluish gray in color Inferolateral to vagal triangle, just above the
and named locus coeruleus (to be pronounced upper end of central canal of medulla oblongata, a
142
Fourth Ventricle of Brain
Ependyma lining floor of fourth Stria medullaris 2. Foramen of Magendie and foramen of Luschka in
ventricle the wall of fourth ventricle permit cerebrospinal
fluid to circulate freely from ventricular system
to subarachnoid space. This communication thus
maintains the balance or harmony between secr-
etion and absorption of cerebrospinal fluid.

Inferior Tumors Adjacent to Fourth Ventricle


cerebellar
peduncle Very often tumors may arise in cerebellopontine angle
(CP angle) which is related to cavity of fourth ventricle.
These are classically named as CP angle tumors.
Tumors may arise also from ependyma lining the
floor of fourth ventricle. It is called ependymoma.
Arcuate nucleus In case of children medulloblastoma is very common.
It is an expanding tumor arising from undifferentiated
Fig. 7.9 Formation of stria medullaris by the axons from arcuate
nucleus which, after decussation, pass beneath ependyma of floor neuroectodermal cells of vermis of cerebellum.
and enter cerebellum through inferior cerebellar peduncle These tumors presents the following effects.
1. Effects due to cerebellar lesion which is fundamen-
narrow area is called area postrema. This narrow tally manifested by disorder in equilibrium or
area contains some neurons covered by thickened balance, hypotonia and incoordination of move-
ependyma. ments.
Area postrema is separated from vagal triangle by
2. Effect due to pressure on vital centers with
a ridge of ependyma called funiculus seperans.
hypoglossal and vagal triangles. It may cause
Lower angle of floor of fourth ventricle looks
like a pens nib for which it is known as calamus disorders in cardiovascular functions, difficulty in
scriptorius. respiration, swallowing and movements of tongue,
Following features are not parts of floor of fourth when the patient needs artificial life support.
ventricle, but are closely related to it.
1. Inferolateral boundary of rhomboid fossa, which is Blockage of Flow of Cerebrospinal Fluid
formed by inferior cerebellar peduncle is crossed
by tranverse ridge of white matter called tinea. Foramen of Magendie and foramen of Luschka may
2. Tinea from both sides converge inferomedially be occluded due to following reasons.
towards the lower apex of fourth ventricle to form 1. Obstruction by expanding tumors in the vicinity.
a thin fold called obex. It forms the roof of lower 2. Obstruction due to fibrous adhesion in arachnoid
apex of fourth ventricle. mater in close proximity of foramina following
meningitis.
CLINICAL ANATOMY Obstruction of the foramina will interfere with
free circulation of cerebrospinal fluid from ventricular
Clinical importance of knowledge of fourth
system of central nervous system to subarachnoid
ventricle
Knowledge of fourth ventricle of brain is clinically space. It will lead to dilatation of ventricular system
important because due to over accumulation of cerebrospinal fluid. It
1. Many vital centers are present in pons, medulla is called internal hydrocephalus. This condition will
oblongata and cerebellum which surround fourth have a pressure effect on surrounding neural tissue
ventricle cavity. and finally lead to atrophy of brain.

143
CerebrumCortical Gray Matter
8
n The whole cerebrum a sphere (Fig. 8.1): The
INTRODUCTION
total cerebrum, when seen from above, looks like a
Cerebrum (telencephalon) is the largest part of sphere which is slighty broader in its posterior part.
the brain. It is largest in size because of maximum Its maximum diameter is opposite the level of an
proximalization of various motor as well as sensory
imaginary line joining two parietal tuberosities skull.
centers of human brain. It means that, during evo-
lution, many motor and sensory centers of central n Outer gray matter and inner white matter:
nervous system have shifted to cerebrum from Superficial part of cerebrum is made up of grayish
lower brain. colored neuronal cell bodies which forms gray matter.

Left cerebral hemisphere Right cerebral hemisphere

Sulcus
Cerebrum is widest a little
Gyrus
behind the middle

Median longitudinal
fissure dividing
cerebrum into two
cerebral hemispheres

Fig. 8.1 CerebrumSpherical in outline when viewed from above


CerebrumCortical Gray Matter
This constitutes cerebral cortex. Deep inner or central CEREBRAL HEMISPHERES
core is made up of process of neurons which are whitish
myelinated nerve fibers. This component of cerebrum Gross Surface Features
is called white matter or medullary substance.
n Gyrus (Plural gyri) and Sulcus (Plural Initially cerebral hemispheres are to be studied under
sulci) of cerebral cortex: Since fetal life cerebrum the heading of following gross surface features.
grows within the limited volume of cranial cavity.
There appears need for increase of surface area of Poles
cerebral cortex which finally attains 2000 sq cm in 3 in numbers as follows (Figs 8.3 to 8.5).
adult brain. That is why surface of cerebral cortex 1. Frontal pole: It is the more rounded anterior end
(gray matter) presents foldings or convolutions which of cerebral hemisphere. It lies beneath medial part
are called gyri (Singular gyrus). Adjacent gyri are of superciliary arch of frontal bone.
separated from each other by fissures which are called 2. Occipital pole: It is the more pointed posterior
sulci (Singular sulcus). Formation of convolutions or end of cerebral hemisphere. This pole lies beneath
gyri increase the surface area of cerebral gray matter occipital bone a little superolateral to external occ-
3 times. Its one-third is visible on the surface and ipital protuberance.
two-third is hidden on the walls and floor of sulci. 3. Temporal pole: It is the anteroinferior end of
n Sphere of cerebrum divided into right and left cerebral hemisphere. It is lodged into anterior end
symmetrical halves (Fig. 8.2): Spherical cerebrum of middle cranial fossa.
is divided into two (right and left) symmetrical halves Embryologically, temporal pole is the posteriormost
with the help of a deep, anteroposteriorly running end of developing cerebrum, which is curved ventrally
midline cleft called median longitudinal fissure. This during rotational growth of brain (Fig. 8.6).
fissure completely divides the cerebrum into two
halves from anterior, superior and posterior aspect Surfaces
of cerebrum. Each half of the sphere of cerebrum is
called thereby Cerebral Hemisphere. However, both Primarily, cerebral hemispheres presents 3 surfaces.
the hemispheres are not separated from each other on
the inferior aspect where they together form the base 1. Superolateral surface (Fig. 8.3)
of the brain because,
It is the convex and widest surface. Its convexity fits
i. At the bottom of median longitudinal fissure,
with the concavity of corresponding half of cranium.
a curved C shaped structure transversely
running across the midline links or connects 2. Medial surface (Fig. 8.4)
identical areas of both cerebral hemispheres
which is called corpus callosum (Fig. 8.2). It is flat and corresponds to paramedian vertical
ii. Inferiorly, both cerebral hemispheres, merging plane. Most important features of this surface are
with each other, form base of the brain which i. Compact section through horizontally running
is continuous with ventral diencephalon (hypo- fibers in the form of C shaped band with its
thalamus and subthalamus) and brainstem. convexity upwards. It is corpus callosum.

Outer (superolateral) surface

Medial surface of right


cerebral hemisphere Corpus callosum, a thick compact
band of fibers crossing midline to
connect two cerebral hemisphere

Fig. 8.2 Cerebral hemisphere (Rt) seen from medial side


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Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Lateral sulcus Central sulcus

Frontal lobe
Parietal lobe

Parietooccipital sulcus
Frontal pole

Temporal pole Occipital pole


Temporal lobe Occipital lobe

Fig. 8.3 Superolateral surface of cerebrum showing poles and lobes

ii. Below corpus callosum, smooth medial surface In total, borders are six in number. Before going
of diencephalan (thalamus) of corresponding to study and recognize the borders, readers are to
side. understand following points.
First 3 borders separate superolateral surface
3. Inferior surface (Fig. 8.5) from medial surface (1 border) and inferior surface (2
Outline of temporal pole divides this surface into two borders).
parts. Next 3 borders separate medial surface from
i. Anterior: It is smaller and anterior to temporal inferior surface. These borders together are known as
pole. It is flat and called orbital surface as it inferomedial border.
rests on the roof of orbit formed by anterior 1. Superomedial border: It separate superolateral
cranial fossa of skull. surface from medial surface (Figs 8.4 and 8.6).
ii. Posterior: It is elongated and slightly concavo- 2. Inferolateral border: This border separates
convex lying behind temporal pole. It is called superolateral surface from posterior tentorial
tentorial surface because it rests on a hori- part of inferior surface. It extends from temporal
zontal fold of dura mater (outermost covering pole to occipital pole (Fig. 8.5). A little in front of
of brain) called tentorium cerebelli. occipital pole, this border presents a notch called
preoccipital notch.
Borders 3. Superciliary border: This is a small curved
Borders are to demarcate (separate) adjacent surface. border which separates superolateral surface from
These are as follows: anterior orbital part of inferior surface (Fig. 8.5).
Fornix Corpus callosum Septum pellucidum Frontal pole
Superomedial Superciliary
Medial orbital
border border
border Temporal pole
Optic

}
chiasma Orbital
Infundibulum surface
Inferior
of pituitary
surface
Mammillary Tentorial
body surface
Posterior
Hippocampal
perforated
border
substance
Midbrain

Medial occipital Inferolateral


border border
Occipital pole Thalamus Temporal pole Frontal pole Occipital pole

Fig. 8.4 Medial surface of cerebral hemisphere Fig. 8.5 Inferior surface of cerebral hemisphere
146
CerebrumCortical Gray Matter
Superomedial border

Superolateral surface
Medial surface

Inferior surface

Medial border Inferolateral border

Fig. 8.6 Borders and surfaces of cerebral hemisphere on coronal section

Medial surface of cerebral hemisphere is separated It has two adjacent walls and floor which are lined
from 3 components of inferior surface by following by layer of gray matter overlying the core of white
3 borders (Fig. 8.5). matter.
4. Medial orbital border: It separates medial sur-
face from anterior, frontal part of inferior surface Some important sulci
(orbital surface).
5. Hippocampal border: It separates medial sur- Sulci of cerebral hemisphere are many. Some are
face from middle, temporal part (hippocampal named and some are unnamed. It is not yet the stage
gyrus) of interior surface. of this chapter to know the names of all the sulci. But
6. Medial occipital border: It separates medial it is the time to be acquainted with some of the sulci
surface from posterior, occipital part of inferior which are important embryologically and functionally.
surface.
1. Lateral sulcus (Fig. 8.8A)
Gyri and Sulci
Lateral sulcus is also called fissure of Sylvius. It is
Gyri, so also sulci are present in human brain and brain most prominent sulcus recognized between temporal
of higher mammals. These are called gyrencephalic pole and orbital surface from where it begins as stem.
brain. Cerebral cortex of lower mammals, birds and The stem passes upwards and backwards on the
reptiles, presents smooth surface called lissencephalic superolateral surface. Immediately then, at a point
brain. known as sylvian point, it divides into 3 limbs as
Sulci of cerebral cortex are of variable length and follows
depth. A suclus separates two adjacent gyri (Fig. 8.7). i. Anterior horizontal limb: 2.5 cm in length,
passes horizontally forwards.
Sulcus
ii. Anterior ascending limb: Also 2.5 cm in length,
Gyrus passes vertically upwards.
Gyrus
iii. Posterior limb: 7.5 cm long, passes upwards
and backwards. Its end is curved and directed
upwards.

2. Central sulcus of Rolando (Fig. 8.8A)


On the superolateral surface, central sulcus begins
by cutting superomedial border 1 cm behind the
White midpoint between frontal and occipital poles. It runs
matter
downwards and forwards on the superolateral surface
making an angle of 70 with superomedial border. It
ends a little above posterior ramus of lateral sulcus.
Fig. 8.7 Interrelation of gyrus and sulcus Upper end of the sulcus extends for 12 cm on the
147
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Posterior ramus of
Central sulcus
lateral sulcus

Anterior vertical
ramus Curved upper end of parieto-
occipital sulcus
Anterior horizontal
ramus

Stem of lateral
sulcus A
Curved upper end of
central sulcus

Parietooccipital sulcus

Postcalcarine sulcus Calcarine sulcus


B

Figs 8.8 A and B A.Some important sulci on superolateral surface, B. Some important sulci on medial surface

medial surface of cerebral hemisphere. A learner may Types of sulcus


easily identify central sulcus as it is the sulcus cutting According to the nature and function, sulci of cerebral
superomedial border. Besides, other sulci in front and cortex are classified in following types.
behind, can easily be identified with its help. 1. Primary sulcus (Fig. 8.10): Most of the sulci are
of primary type which are developed in embryonic
3. Parietooccipital sulcus (Fig. 8.8B) life just to increase the surface area of the cerebral
cortex.
This sulcus is present on the medial surface of cerebral
2. Secondary sulcus (Figs 8.9A and 8.10): Exa-
hemisphere. It starts by cutting superomedial border mple is lateral sulcus. Secondary sulcus is that
5 cm in front of occipital pole and runs downwards and sulcus which is developed because of rotational
forwards. It ends by joining the junction of calcarine growth of cerebral hemisphere around it.
sulcus and postcalcarine sulcus (see below). 3. Complete sulcus (Fig. 8.9B): This is the sulcus
It may extend on the superolateral surface (Fig. which is complete in depth to extend through whole
8.8A). thickness of cerebral cortex and medulla to reach
up to the wall of the cavity (ventricle) of cerebrum
4. Calcarine and postcalcarine sulcus (Fig. 8.8B) where it produces an indentation. Example is
calcarine sulcus (Fig. 8.10B) and collateral sulcus.
They are continuous with each other and present on 4. Limiting sulcus (Fig. 8.9A): This sulcus limits or
medial surface of cerebral hemisphere. Calca-rine separates two different areas in its two walls which
sulcus starts a little behind and below the posterior are different functionally as well as structurally.
end of corpus callosum (splenium). It then runs Example is central sulcus on superolateral surface
which separates motor area (in front) and sensory
backwards with a convexity upwards and continued
area (behind).
as postcalcarine sulcus, where it is joined by pari- 5. Axial sulcus (Fig. 8.9B): By nature it is just
etooccipital sulcus. Postcalcarine sulcus ends at opposite to limiting sulcus. It means that, this is
occipital pole and extends slightly on superolateral the sulcus bounded by two walls which are similar
surface. functionally and also structurally. Example is
148
CerebrumCortical Gray Matter

Central sulcus is an example


of limiting sulcus

Lunate sulcus is an example


of operculated sulcus

Lateral sulcus is an example of


secondary sulcus which is developed
due to rotation growth of cerebrum

Wall of ventricle

Calcarine sulcus is an
example of complete sulcus

Postcalcarine sulcus is an
example of axial sulcus

Figs 8.9A and B A.Varieties of sulcus (superolateral surface), B.Varieties of sulcus (medial surface)

postcalcarine sulcus whose both walls are primary lines on superolateral surface of cerebral hemisphere.
visual area. The central lobe is submerged at the bottom (floor) of
6. Operculated sulcus (Fig. 8.9A): This is the stem of lateral sulcus.
sulcus where the two lips are two functional 3 important sulci separating the lobes on
areas and both the walls are lined by third superolateral surface are (Figs 8.3 and 8.11A)
functional areas. Example is lunate sulcus which l Central sulcus
is a small semilunar sulcus present just in front l Stem of lateral sulcus and its continuation as
of the occipital pole on superolateral surface with posterior limb.
concavity backward. l Curved upper end of parietooccipital sulcus
extending on to the superolateral surface after cutting
Lobes of Cerebral Hemisphere
superomedial border.
Each of the cerebral hemisphere is divided into five l 2 lines drawn on superolateral surface are (Fig.
lobes as i) Frontal lobe, ii) Parietal lobe, iii) Occipital 8.11A).
lobe, iv) Temporal lobe and v) Central lobe. l A vertical line drawn from curved upper end of
The first four lobes are incompletely separated from parietooccipital sulcus on supermedial border to pre-
each other by 3 important sulci and two imaginary occipital notch on inferolateral border.
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Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)

Primary sulci start appearing to


increase surface area of cerebral
cortex

A Secondary sulcus appears as axis


for rotational growth

B
Formation of temporal lobe starts

Parietal lobe

Frontal lobe

Occipital lobe

Lateral sulcus
C Temporal lobe

Figs 8.10 A to C Stages of development different lobes of cerebral cortex with gradual development of primary and secondary sulci

A horizontal line extending from end of posterior n Embryological backgrounds: It is not the
limb of lateral sulcus up to the vertical line as menti- fifth, rather embryologically it is the first lobe of
oned above. cerebral hemisphere. Around this insula, rotational
The four lobes outlined on superolateral surface overgrowth of the cortex sequentially gives rise to
(Vide Figs 8.3 and 8.11A) are following: formation of frontal, parietal, occipital and temporal
1. Frontal lobe lobes (Fig. 8.10).
2. Parietal lobe n Sulci and gyri of insula (Fig. 8.11B): Whole
3. Occipital lobe of area of insula is surrounded by a circular sulcus.
4. Temporal lobe. A vertical sulcus called central sulcus of insula
subdivides central lobe (insula) into anterior and
Central lobe (Insula or Island of Reil) (Fig. 8.11B) posterior parts both of which present vertical gyri.
Central lobe is also called insula or island of Reil. It Anterior to central sulcus of insula, gyri are shorter
is situated at the bottom or floor of stem of lateral therefore called gyrus brevis which are 34 in number.
sulcus. It is submerged and is visualized when two Posterior group of gyri are longer and 12 in numbers.
lips of stem of lateral sulcus are everted. They are called gyrus longus.
150
CerebrumCortical Gray Matter
Frontal lobe Parietal lobe

Temporal lobe Occipital lobe


A

Circular sulcus
Central sulcus
of insula
Gyrus brevis Gyrus longus

Two lips of lateral sulcus


separated to expose central
lobe (insula) or island of Reil B

Figs 8.11A and B A. Four lobes of cerebral hemisphere, B. Central lobe (insula) of cerebral hemisphere

n Operculum: Insula is hidden or overlapped by frontal pole. These three gyri are situated in front
areas of frontal, parietal and temporal lobes which are of precentral sulcus and are demarcated from each
called frontal, frontoparietal and temporal opercula. other by two anteroposteriorly directed sulci called
superior and inferior frontal sulci.
Sulci and gyri on three surfaces of cerebral 3. Subdivisions of inferior frontal gyrus: Infe-
hemisphere rior frontal gyrus is divided into three parts by
two limbs of lateral sulcus which are anterior
Superolateral surface (Fig. 8.12) horizontal and anterior ascending limbs.
On this surface, sulci and gyri can be divided according i. Pars orbitalis: Part of inferior frontal gyrus
to four different lobes as follows. (Sulci and gyri of below anterior horizontal limb of lateral
central lobe or insula has already been described sulcus.
above). ii. Pars triangularis: It is the part between ante-
rior horizontal and anterior ascending limbs of
Frontal lobe lateral sulcus.
iii. Pars opercularis: It is the part of inferior frontal
1. Precentral gyrus: This gyrus is situated in
front and parallel to central sulcus which limits gyrus between anterior ascending ramus and
frontal lobe from parietal lobe. Precentral gyrus is posterior limb of lateral sulcus.
bounded in front by precentral sulcus. Parietal lobe
2. Superior, middle and inferior frontal gyri:
These are three anteroposteriorly directed gyri, 1. Postcentral gyrus: It is the anterior most
parallel to each other, extending forward towards gyrus of parietal lobe running downwards and
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Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Superior frontal gyrus Precentral gyrus
Superior frontal sulcus Central sulcus

Middle frontal gyrus


Postcentral gyrus
Inferior frontal sulcus
Intraparietal sulcus

Superior parietal lobule

Parietooccipital sulcus

Supramarginal gyrus

Inferior parietal lobule


Anterior ascending limb
Anterior horizontal limb Angular gyrus
and stem of lateral sulcus

Lunate sulcus
Posterior ramus of lateral Upturned posterior end
sulcus of postcalcarine sulcus
Inferior temporal gyrus
Superior temporal gyrus Inferior temporal sulcus
Superior temporal sulcus Middle temporal gyrus

Fig. 8.12 Important sulci and gyri on superolateral surface of cerebral hemisphere

forwards from superomedial border. It is bounded 2. Upper and lower occipital lobules: One antero-
posteriorly by postcentral sulcus. posterior sulcus subdivides remaining parts of
2. Superior and inferior parietal lobule: Rema- occipital lobe anterior to lunate sulcus into upper
ining part of parietal lobe behind postcentral and lower occipital lobule. The sulcus is known as
gyrus is divided in upper and lower segments, transverse occipital sulcus.
called superior and inferior parietal lobules with Another small vertical sulcus called lateral occi-
the help of anteroposteriorly directed horizontal pital sulcus runs vertically for short distance, in front
sulcus called intraparietal sulcus. of parietooccipital sulcus. It divides upper occipital
3. Subdivisions of inferior parietal lobule: These lobule into anterior and posterior parts.
are two small semilunar gyrus as follows.
i. Supramarginal gyrus: It is anterior of the two, Temporal lobe
which caps round the upturned posterior end
1. Superior, middle and inferior temporal gyri:
of posterior limb of lateral sulcus.
These are three anteroposteriorly directed gyri
ii. Angular gyrus: It is posterior of the two small
of temporal lobe situated from above downwards
semilunar gyrus which caps over the posterior
respectively, below and parallel to stem and
end of superior temporal sulcus.
posterior limb of lateral sulcus.
These three gyri are separated by two antero-
Occipital lobe
posterior sulci called superior and inferior temporal
1. Occipital pole: It is the posterior end which sulci.
is cut from remaining part of occipital lobe by a 2. Transverse temporal gyri: These are two in
small semilunar sulcus which is convex forwards. number. These gyri is visualized when two lips of
This sulcus is known as lunate sulcus. This polar stem of lateral sulcus are widened with fingers.
area of occipital lobe is bisected into anteroinferior They are lateromedially directed on the superior
and posterosuperior lips by continuation of post- surface of superior temporal gyrus. Anterior
calcarine sulcus from medial surface of cerebral of two transverse temporal gyri is known as
hemisphere on its superolateral surface. Heschls gyrus.
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CerebrumCortical Gray Matter
Paracentral lobule Fornix

Central sulcus Septum pellucidum

Isthmus Corpus callosum

Suprasplenial sulcus
Callosal sulcus

Precuneus Cingulate gyrus

Cuneus
Parietooccipital sulcus Medial frontal gyrus
Anterior commissure
Calcarine sulcus
Thalamus
Postcalcarine sulcus Paraterminal gyrus

Lingual gyrus Parahippocampal


gyrus

Rhinal sulcus
Medial temporooccipital gyrus
Uncus
Temporooccipital sulcus
Lateral temporooccipital gyrus Collateral sulcus

Fig. 8.13 Different features (with important sulci and gyri) of medial surface of cerebral hemisphere

MEDIAL SURFACE (FIG. 8.13) and forwards upto rostral end of corpus callosum.
It is called fornix. Fibers in the fornix connect
Before going to study the gyri and sulci of medial different areas of same cerebral hemisphere and is
surface of cerebral hemisphere, a reader must note an example of association fibers.
the following two important points. 3. Septum pellucidum: It is a thin bilaminar
1. Medial surface presents some prominent stru- membrane bridging between fornix and anterior
ctures which are other than cortical gyri. part of corpus callosum. Lateral to this septum lies
2. Gyri and sulci are not studied in individual the cavity of cerebral hemisphere (telencephalon)
lobewise because some of them are continuous called lateral ventricle of brain.
from one lobe to adjacent lobe. 4. Thalamus: Below posterior part of corpus
callosum and behind fornix, medial surface of
Structures Other than Cortical Gyri thalamus (diencephalon) is visible. On either side
1. Corpus callosum: It is a C shaped compact band of midline, medial surface of thalamus of both
of white matter (fibers) with convexity directed cerebral hemispheres forms lateral boundary of
upwards, present at the center of medial surface third ventricle of brain (cavity of diencephalon).
of cerebral hemisphere. Thalamus is continuous with hypothalamus below
Fibers passing through all the parts of corpus and in front, and with subthalamus below and
callosum cross the midline and connect identical behind.
cortical areas of all the parts of both cerebral hemi- 5. Anterior commissure: It is small cross section
spheres. This is an example of commissural fibers. of compact bundle of commissural fibers which is
Most rostral (cephalic) part of corpus callosum situated in front of anterior end (anterior column)
is thin and directed downwards and backwards. It of fornix.
is called rostrum. Next, the bend is known as genu.
Behind genu the main part is known as body which Gyri and Sulci on Medial Surface
ends posteriorly into a blunt rounded end called
splenium. 1. Cingulate gyrus: It is a thick curved gyrus with
2. Fornix: Below the middle of corpus callosum starts convexity upwards, above and surrounding the
a white band of fibers which extends downwards curvature of corpus callosum.
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Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
It is separated from corpus callosum by callosal sulcus. 5. Paracentral lobule: It is another quadrangular
Cingulate gyrus is demarcated above by cingulate cortical area in front of precuneus.
sulcus. This sulcus starts at its anteroinferior end n Boundaries:
below rostrum of corpus callosum. Its posterior end is l Behind: Posterior limb of posterior upturned end
upturned behind upper end of central sulcus. A small of cingulate sulcus.
limb from it extends upwards towards superomedial l In front: Upturned anterior limb of cingulate
border in front of central sulcus. sulcus.
l Below: Posterior end of cingulate sulcus.
n End of cingulate gyrus:
l Above: Superomedial border of cerebral hemis-
l i. Anterior end: It is very narrow end which is
phere.
below rostrum of corpus callosum. It is called
l Subdivision: Paracentral lobule is bisected by
paraterminal gyrus.
upward continuation of central sulcus on medial
l ii. Posterior end: It curves round splenium of
surface into anterior and posterior parts. These two
corpus callosum and ends at the posterior end parts are upward continuation of precentral gyrus
of temporal lobe. It is called isthmus. and postcentral gyrus respectively on medial surface.
Next group of gyri are studied from occipital pole 6. Medial frontal gyrus: It is the wide, flat and
to frontal pole. curved gyrus on medial surface of frontal lobe
2. Lingual gyrus: It is a curved gyrus with convexity starting in front of paracentral lobule, curving
upwards like that of tongue, situated on lower part over the frontal pole and ending below genu and
of medial surface of occipital pole. It is bounded in front of rostrum of corpus callosum.
above calcarine and postcalarine sulci.
3. Cuneus: It is a triangular area of cortex bounded Gyri and Sulci on Medial Surface of Temporal
by parietooccipital sulcus and postcalcarine sulcus. Lobe (Consult both Figs 8.13 and 8.14)
It is situated above posterior end of lingual gyrus. These gyri and sulci are continuous from medial
4. Precuneus: It is the quadrangular area in front surface to inferior surface (tentorial part) of cerebral
of cuneus. It is bounded behind by parietooccipital hemisphere which are mentioned below.
sulcus and in front by posterior limb of curved
upturned end of cingulate sulcus. Inferiorly it is Gyri and Sulci on Inferior Surface (Fig. 8.14)
demarcated from posterior end of cingulate gyrus
by superosplenial sulcus which is a small curved These are divided into two parts
sulcus posterosuperior to splenium of corpus l Gyri and sulci on inferior surfaces of occipital and
callosum. temporal lobes (tentorial surface).

}
Olfactory sulcus Anterior
Olfactory bulb
Medial
Olfactory tract Orbital gyri
Lateral
Gyrus rectus
Posterior
Lateral olfactory stria
Optic chiasma Anterior perforated substance

Infundibulum Uncus
Mammillary body
Parahippocampal gyrus
Posterior perforated substance
Medial temporooccipital gyrus
Midbrain
Temporooccipital sulcus

Lateral temporooccipital gyrus

Collateral sulcus

Fig. 8.14 Different features (with sulci and gyri) of inferior surface of cerebral hemisphere
154
CerebrumCortical Gray Matter
l Gyri and sulci on inferior surface of frontal lobe c) Neocortex: It is the major part of human ce-
(orbital surface). rebral cortex which is evolved latest. It is
represented by 90% of human cortex.
TENTORIAL SURFACE (FROM MEDIAL TO LATERAL) 3. Structural composition: Cerebral cortex is
made up of
1. Parahippocampal gyrus: It is anterior continu- i. Neurons with chain of synapses.
ation of lingual gyrus extending from medial surf- ii. Neuroglia.
ace to inferior surface of temporal lobe. This gyrus Total number of neurons in human cerebral cortex
is demarcated laterally by collateral sulcus. is 14000 millions.
Parahippocampal gyrus presents anteriorly a Neurons are arranged in stratification of layers.
hook-like ending known as uncus which is bounded Maximum number of layers are six (6) in neocortex.
outwards by a small curved sulcus called rhinal Minimum number are three (3) in archicortex.
sulcus. 4. Gross functions: In reference to both motor com-
2. Medial and lateral temporooccipital gyri: mands and sensory responses, cerebral cortex
As the name suggests, these two gyri extend posseses influence over opposite half of body.
anteroposteriorly and parallel to each other from Basic functions of cerebral cortex are as follows:
temporal lobe to occipital lobe. These two gyri are i. Perception of various sensations.
separated from each other by the sulcus known ii. Reaction or response as per perception of
as temporooccipital sulcus. Medial of the two sensation.
gyri is separated from parahippocampal gyrus by iii. To send motor commands to opposite half of
collateral sulcus. body.
iv. Various types of higher functions for mental
activities, e.g. memory, intelligence, learning,
ORBITAL SURFACE
creative thinking, etc.
1. Gyrus rectus: It is a thin and narrow anterop-
osteriorly running straight gyrus just lateral to TYPES OF NEURONS IN CEREBRAL CORTEX (FIG. 8.15)
medial border of orbital surface. It is laterally
bounded by an anteroposterior sulcus called There are five varieties of neurons in cerebral cortex
olfactory sulcus. It is so called because it lodges as stated below. But first two types, namely pyramidal
olfactory tract with its anterior rounded end called cells and granule cells are most important.
olfactory bulb. 1. Pyramidal cells: These are so called because of
2. Orbital gyri: They are four in number present pyramidal shape. Their long axis are at right angle
lateral to olfactory suclus. They are named as per to the surface of cortex. In longitudinal section
their interrelationshipanterior, posterior, medial cells are triangular in appearance with their
and lateral. These four orbital gyri are separated apices directed towards the surface and bases face
from each other by a Hshaped orbital sulci. towards white matter. Dendrites are connected to
the angles. From the bases, long axons arise and
pass to the depth of white matter of cerebrum.
SOME IMPORTANT POINTS ABOUT CEREBRAL CORTEX
Types of pyramidal cells as per size.
1. As per as evolution concerned, cerebral cortex i. Small size 10 um (micron)
indicates the highest stage of development of ii. Medium size 50 um (micron)
human brain. iii. Large size 100 um (micron). These cell group
2. Phylogenetic subdivision: are also called Betz cells or pyramidal cells of
a) Archicortex: In human brain, phylogenetically Betz.
it is the most primitive part of cerebral cortex. 2. Granule cells: These cells are also called stellate
It is composed of parts of rhinencephalon inclu- cells as they are small star-shaped cells with many
ding hippocampus (parahippocampal gyrus). radiating dendrites and short axon. Diameter of
Therefore, archicortex covers small area of cell bodies are 8 um (micron). Small cell bodies
cerebral cortex. give granular appearance of the cortex for which
But in lower vertebrates, archicortex is of they are called granule cells.
considerable size. 3. Cells of Martinotti: These are small multipolar
b) Paleocortex: It is intermediate in evolution. cells present in all the layers of cortex. Figure 8.15
In human brain it is represented by cingulate shows their axons projecting towards the surface
gyrus. of cortex.
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Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)

1
Horizontal cell of Cajal

2 Granule (stellate) cell

Gray matter layers 3


Pyramidal cell Granule (stellate)
Cell

4 Cells of
Martinotti

Fusiform cell
5
Betz cell

White matter

Fig. 8.15 Types of neurons in cerebral cortex

4. Horizontal cells of Cajal (pronounce as cahal): cells are at right of the angle to the plane of the
The cells are fusiform in outline with the long axis cortex. Apex of the cells are directed towards the
of cell body placed parallel to cortical surface. These surface of the cortex and bases are directed towards
neurons are present in all the layers of cortex. the depth. Size of the pyramidal cells gradually
5. Fusiform cells: Cell bodies of these neurons are increase from superficial to deeper plane.
spindle-shaped or fusiform in outline with their 4. Internal granular layer: This layer is made up
long axis placed at right angle to the cortical of closely packed granule cells or stellate cells.
surface. They are present in deeper layer of cortex Structurally this layer gives striated appearance
and their axons projecting towards white matter. because middle of this layer is traversed by band
of nerve fibers. This band is called external band of
LAYER OF CEREBRAL CORTEX (FIG. 8.16) Baillarger. The cortex of this type is called striate
cortex. Example of this type of cortex is visual
Neurons of cerebral cortex are arranged in multiple cortex on either lip of postcalcarine sulcus.
numbers of stratum which varies from 3 to 6. When 5. Internal pyramidal layer (ganglionic layer):
the neocortex presents 6 layers, archicortex is made This layer is made up of large pyramidal cells of
up of 3 layers. Betz. Axon of this cells form corticospinal tract.
From superficial to deep, six layers of the cortex Basal part of this layer is traversed by band of
are as follows horizontally running fibers called internal band of
1. Molecular or plexiform layer: It is made up of Baillarger.
mainly reticulum or network of nerve fibers with 6. Multiform layer or polymorphic cell layer: Charact-
intermingling horizontal cells of Cajal. eristic of this layer are following
2. External granular layer: This layer is made up i. It presents neurons of different types, size and
of granule cells or stellate cells. Characteristic of shape.
this layer is that cells are densely packed. There is ii. Cells of this layer are intermingled with nerve
intermingling of minimum number of fibers. fibers.
3. External pyramidal layer: It is made up of small iii. This cellular layer merges with white matter
and medium size of pyramidal cell. Long-axis of the deep to it.
156
CerebrumCortical Gray Matter

1. Molecular or plexiform layer Reticulum of fibers and


horizontal cells of Cajal

Densely packed granule or


2. External granular layer
stellate cells

3. External pyramidal layer Small and intermediate


pyramidal cells

Closely packed granule


4. Internal granular layer
(stellate) cells with outer
(external) band of Baillarger

5. Internal pyramidal or Large pyramidal cells of Betz


ganglionic layer and inner (internal) band of
Baillarger

6. Multiform or polymorphic Layer of neurons of various


cell layer types, size and shape inter-
mingled with nerve fiber

Fig. 8.16 Different layers of cerebral cortex

The cortical areas which show all of the above FUNCTIONAL AREAS IN FRONTAL LOBE
mentioned six layers of cortex well-defined, are called
homotypical cortex. Area-4 of Brodmann
In heterotypical cortex, all the six layers are not
equally defined. Even same may have less than six Location
layers, two main varieties of this cortex are as follows:
It is the precentral gyrus on superolateral surface
i. Granular cortex: In this type, granule cell
of frontal lobe with its extension as anterior part of
layer is well-defined and pyramidal cell layer
paracentral lobule on medial surface.
is poorly developed. Example is sensory cortex.
It is called primary motor area (Fig. 8.17).
ii. Agranular cortex: This cortex shows poor dev-
elopment of granule cell layer with well-defined Functions
pyramidal cell layer. Example is motor cortex.
Area 4 (primary motor area) controls or commands
movements of voluntary muscles of opposite half of
FUNCTIONAL AREAS OF CEREBRAL CORTEX
body through corticospinal and corticonuclear tracts.
It has already been seen that cerebral cortex presents Different parts of the gyrus, starting from lower
different named areas in different surface. It has also end to uppermost end extending to anterior part of
been seen many of them are structurally different. paracentral lobule on medial surface, controls muscle
It is the time now to note that they are functionally groups of different part of body.
different. In the year 1909, Brodmann classified Different areas of body are represented to the
these areas from number 147 and thereby called gyrus in upside down manner. It called inverted
Brodmanns area. It is important to note that these homunculus (Fig. 8.19).
functional areas are not numbered serially or On superolateral surface, from lower end to upper
sequentially. end, precentral gyrus (area 4) controls voluntary
So the cortical areas are mentioned below with muscles of following regions of body in inverted
their names, Brodmanns numbers and respective order as pharynx, larynx, tongue, face, neck, hand,
functions (Figs 8.17 and 8.18). forearm, arm, shoulder, thorax and abdomen.
157
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Primary motor area Primary somatosensory area

Premotor area
Sensory association area for
Frontal eye field stereognosis

4 5
6 3 2
8
Prefrontal area 9 7

1
40
43
44 2
45 41, 4 19 Visual association area
39
22
Brocas area (Motor 18
speech area) 17 Primary visual area

Posterior end of postcal-


Primary auditory area carine sulcus
Wernickes sensory
Secondary auditory area speech area

Fig. 8.17 Functional areas on superolateral surface of cerebral hemisphere

Paracentral lobule Supplementary motor area

4 6
3
1 8
2

23 9
24 Prefrontal area
10

Primary visual area 17


(striate cortex)
17 11

28

Uncus

Parahippocampal gyrus Primary olfactory area

Fig. 8.18 Functional areas on medial surface of cerebral hemisphere

Muscles of perineum and lower limb are controlled coincide with comparatively wider part of precentral
by anterior (motor) components of paracentral lobule gyrus (area 4).
on medial surface which is the continuation of area 4. n Effect of lesion: Like other parts of brain, lesions
It is interesting to note that one part of surface of any part of cerebral cortex are mostly vascular
area of the cortex of area 4 is not directly proportional in origin. But it may be traumatic, degenerative or
neoplastic. Lesions of area 4 of Brodmann will cause
to the bulk of the muscle or area of the body it
loss of function of voluntary muscles (paralysis)
controls. Rather it coincides with the skill of the of opposite half of body. It is grossly manifested by
muscle group. For example, Figure 8.19 of inverted paralysis of contralateral upper and lower limbs. It is
homunculus shows that face with lips and eyeballs called hemiplegia.
158
CerebrumCortical Gray Matter
Functions
Like primary motor area (area 4), the premotor
area (area 6) also gives rise to corticospinal and
Shoulder
Trunk
Hip

Elbow
corticonuclear fibers which project downwards from

Wrist
Kn

nd
ee

An cerebral cortex. Through these projection fibers, very

Ha
kle

Ri le
characteristic function of premotor area is to produce

t
Lit
To

ng
es

Th Inde dle
skilled movements of voluntary muscles, whose

d
x