The A To Z of The Brain

A-Z The Brain55:Layout 1 14/12/09 1:08 AM Page 1
The A to Z of
The Brain
Dr A. L. Neill
BSc MSc MBBS PhD FACBS
Front cover
TABLE OF CONTENTS
INTRODUCTION
This is the 6th in the series of the A to Zs.
It continues on where the A to Z of the Head & Neck left off and
continues with some of the new features of the evolving series original.
It is the first book of an “organ” in that the Brain and CNs is a whole
with multiple parts. Clinical considerations are maintained. As usual
feedback plays an extremely important role in this, please feel free to
ill
comment and contribute to any and all aspects of these publications
after all they are for you – whoever you, the reader may be.
We have a website where you can view all images of the A to Zs and
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other material and from which you make comments:
http://www.aspenpharma.com.au/atlas/student.htm
ACKNOWLEDGEMENT
Thank you ASPENpharmacare Australia for your support and assistance
in this valuable project, particularly Mr. Greg Lan CEO of
. L.
Aspenpharmacare Australia, Rob Koster, Richard Clements and Ante
Mihaljevic and everyone who provided valuable feedback.
DEDICATION
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To those striving to understand.
HOW TO USE THIS BOOK

The structure of the A to Z books has by necessity changed slightly.
The principle of listing all the structures in an alphabetical manner and
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hence making the book its own index for easy retrieval has been
maintained, but because of the complexity of this material, it has been
necessary to do this after first dividing the material into a number of
main topics as was the case in the A to Z of the Head & Neck.
Thank you
Amanda Neill
BSc MSc MBBS PhD FACBS
SBN 978-0-9806840-2-5
3 © A. L. Neill
TABLE OF CONTENTS
Table of contents
Introduction 3
Acknowledgement 3
Dedication 3
How to use this book 3
Table of contents 4
Abbreviations 9
Common Terms used in Neurology – Neuroanatomy 10
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Guide to Anatomical Planes and Relations 24
Anatomical movements 26
The Nervous system – overview 28
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The Nerve Cells – overview 30
The Brain and SC – overview 32
Blood brain barrier 32
Blood supply 34
CSF 38
Development and Organization 40
Macroscopic structure 42
. L.
Fibrous tracts 44
Meninges – coverings 46
Dura Mater 46
Meninges and the Brain 48
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Meninges and the SC 50

Neurological assessment – 52
Headache 52
History 52
Examination - conscious patient 56
unconscious patient 57
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THE BRAIN
Blood supply – overview
Blood Vessels and Meningeal layers of the Brain 60
Brain Arteries - overview see also Cerebrum / arteries 64
Brain Veins - overview 66
Cranial Venous Sinuses 68
Cavernous sinus 68
Petrosal sinuses see Sagittal sinuses
Sagittal sinuses 70
Straight sinus see Veins overview & Sagittal sinuses
Transverse sinus see Veins overview & Sagittal sinuses
Brodmann’s areas see Cerebrum
Circle of Willis = Cerebral arterial circle 72
4 © A. L. Neill
TABLE OF CONTENTS
Topography
Macroscopic components of the Brain 74
Outer surfaces – see also Gyri & Sulci
Inferior
Lateral
Posterior
Sagittal - Median = mid-sagittal
Superior see Cerebrum
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Gyri + Sulci / Outer surfaces 78
Dissections – Sectional Anatomy 84
Coronal sections
Sagittal sections see also Median section 90
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Transverse sections see also Coronal sections 92
REGIONS
Amygdala / Amygdaloid bodies see Fornix
Angula gyrus see Cerebrum/lobes
Anterior Commissure 94
Anterior Perforating substance see Brain outer surfaces / inferior
. L.
Basal ganglion/nuclei see also Brainstem and Diencephalon 96
Basis Pedunculi = Crus cerebri see Brainstem Midbrain
Brainstem = Midbrain + Pons + Medulla Oblongata 98
Arteries 102
CN nuclei see Cranial Ns
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Broca’s area see Language centres

Bulb = Medulla Oblongata see Brainstem , Midbrain
Cerebrum -
Arteries 104
Brodmann’s areas and maps of the cerebral cortex 106
Examination of CH - cognitive skills 113
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Lobes – Cerebrum Major anatomy 114

Sections – coronal / transverse
see Dissections/Coronal, Transverse
Caudate nucleus see Basal nuclei
Cerebellum 122
Choroid plexus see Basal Nuclei, CSF, Ventricles
Cingulate gyrus see Cerebrum/lobes
Claustrum see Anterior commissure
Colliculi - superior & inferior bodies see Brainstem
Corpus Callosum see also the Brain Dissections Sagittal 124
Corpus striatum = Caudate nucleus + Lentiform nucleus –
see Macroscopic structure, Basal Nuclei
5 © A. L. Neill
TABLE OF CONTENTS
Crus Cerebri see Brainstem Midbrain

Cuneus see Lobes - Occipital, Brain sagittal
Dentate nuclei see Brainstem, Cerebellum, Limbic system
Dermatomes (of the Face) –
see Cranial Ns and Special senses / CN V Trigeminal N
Diencephalon = Epithalamus + Hypothalamus + Thalamus 126
Dura Mater see Meninges coverings
Ependyma see Ventricles
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External Capsule see Brain/sections/coronal
Falx Cerebri see Meninges –brain coverings
Fornix see also Septum Pellucidum 128
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Frontal lobe see Brain - Outer surfaces / Cerebrum Lobes
Geniculate bodies – lateral / medial see Brainstem, Midbrain
Globus Pallidus see Anterior Commissure
Habenular nucleus see Basal nuclei, Hypothalamus
Hippocampus see Fornix, Limbic system
Hindbrain see Brainstem, Midbrain
. L.
Hypothalamus see Basal nuclei, Diencephalon
Inferior Colliculus see Brainstem
Infundibulum see Brain/outer surfaces/inferior
Insula see Cerebrum/lobes
Internal Capsule see Brain/sections/coronal
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Language centres see also Pathology / Aphasia 130

Lateral Sulcus = Sylvian fissure see Cerebrum/lobes, Gyri + Sulci
Lentiform Nucleus = Globus Pallidus + Putamen
see Basal nuclei, Hypothalamus
Limbic system see also Fornix 132
Mammillary bodies (AKA Mammilary) see Fornix, Limbic system
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Medulla Oblongata = Medulla see Brainstem , Midbrain

Midbrain = Mesencephalon see also Brainstem 134
Nucleus Accumbens = septal nuclei see Basal Nuclei, Fornix
Obex see Ventricles
Operculum see Cerebrum /lobes
Optic radiation see CN II
Paraterminal gyrus = Subcallosal gyrus
see Anterior commissure, Septum Pellucidum
Pineal body/gland see Brain- Outer surfaces - Median
Pons see Brainstem, Midbrain
Precuneus see Cerebrum/lobes, Brain sagittal
Pulvinar (part of the Thalamus) see Thalamus
6 © A. L. Neill
TABLE OF CONTENTS
Putamen see Basal Nuclei

Red Nucleus see Brainstem, Midbrain, Rubrospinal tract
Rhinencephalon = the Olfactory region of the brain –
see Septum Pellucidum, CN I
Septum Pellucidum 136
Striate body = Corpus Striatum
Substantia Nigra see Brainstem
Superior Colliculus see Brainstem
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Sylvian fissure = Lateral Sulcus see Cerebrum
Tela Choroidea see, Hypothalamus, Ventricles
Thalamus see also Basal ganglia & Diencephalon 138
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Uncinate Fasciculus see Anterior Commissure
Vallecula see Cerebellum
Ventricles 142
Vermis see Cerebellum
Wernicke’s area see Language centres
THE CRANIAL NERVES & SPECIAL SENSES
. L.
Overview and summary 148
BS to the CNs and Relations see the Brain veins
CN I see also Special senses / Smell & Taste 152
CN II see Brain outer surfaces /inferior; Special senses / Sight
CN III see also Special senses / Sight 153
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CN IV see also Special senses / Sight 156

CN V 158
CN VI see also Special senses / Sight 172
CN VII see also Brainstem CN nuclei / Special senses / Taste 174
CN VIII see Special senses / Sound and Balance 182
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CN IX see also Special senses / Taste 186

CN X see also Special senses / Taste 188
CN X special anatomy – Larynx 192
CN X + ANS 194
CN XI see also CN IX X & XI 200
CN IX, X & XI neural pathways & interrelationships 202
CN XII 206
SPECIAL SENSES
Sight = Vision + Focus and eye movement -
Vision- CN II 210
Visual field defects 214
Control of eye movement and focus - CN III, IV & VI 216
7 © A. L. Neill
TABLE OF CONTENTS
see also Venous sinuses/Cavernous sinus

Smell & Taste - 222
Smell - CN I see Rhinencephalon
Taste – CN VII, IX & X
Sound + Balance 228
CN VIII
Examination of the CNs - 230
Reflexes of the CNs - 238
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THE SPINAL CORD
Ascending = Sensory tracts 250
Anterolateral system = Spinothalamic +
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Spinoreticular tracts (pain & temperature) see Pain pathways
Dorsal columns = Fasciculi Cuneatus + Gracilis
(touch, proprioception & vibration)
Spinocerebellar tracts = anterior + posterior spinocerebellar
tracts see Dorsal Columns
Spinothalamic tracts = anterior + lateral spinothalamic tracts 252
see also Pain pathways
Descending = Motor tracts 254
. L.
Anterior corticospinal tracts = uncrossed pyramidal tracts
see Corticospinal tracts
Corticobulbar = Rubrospinal see Pyramidal tracts
Corticospinal = anterior + lateral corticospinal
Extrapyramidal tracts = Tectospinal + Vestibulospinal +
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Spinocerebellar tracts see Tracts of the SC

Lateral corticospinal tracts = crossed pyramidal tracts
see Pyramidal tracts
Pyramidal = corticobulbar tracts + corticospinal tracts 256
Rubrospinal = Corticobulbar see Pyramidal tracts
Nociceptive information see Pain pathways
Pain pathways 258
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Overview of tracts of the SC 260

Points of immobility 262
Relations with the ANS 264
Sensory modalities eg pressure, proprioception, temperature, touch,
vibration see Tracts of the SC for description of individual modalities
Structure overview see The Brain and SC - overview
Tracts of the SC
Examination of the SC, Spinal N roots and PNs
see the A to Z of the Bones, Joints & Ligaments and the Back &
The A to Z of the Peripheral Nerves
8 © A. L. Neill
INTRODUCTION
Abbreviations L
L
= lateral
= left / lumbar
A = actions /movements LL = lower limb
of a joint Lt. = Latin
A = anterior lig = ligament
ACF = anterior cranial fossa M = mater
aka = also known as MB = midbrain
alt. = alternative MC = metacarpal
AM = arachnoid mater MCF = middle cranial fossa
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ANS = autonomic nervous system med = medial
ant = anterior MO = medulla oblongata (medulla)
art = articulation (joint w/o the MN = myelinated nerve
additional support structures) nMN = non-myelinated nerve
AS = Alternative Spelling, N = nerve
Ne
generally referring to the diff. NS = nervous system/nerve
b/n British & supply
American spelling NT = nervous tissue
assoc. = associated with NTr = nerve tract / trunk
BBB = blood brain barrier P = posterior
bc = because PaNS = parasympathetic nervous
BP = brachial plexus system
BS = blood supply PCF = posterior cranial fossa
. L.
BS = brain stem pl. = plural
b/n = between PM = pia mater
C = cervical / carpal PN = peripheral nerve
CC = cerebral cortex post. = posterior
c.f. = compared to proc. = process
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CF = cranial fossa(e) prox. = proximal

CH = cerebral hemispheres R = Right
CN = cranial nerve RC = radiocarpal
CNS = central nervous system S = sacral
CO = cardiac output sing. = singular
Co = coccygeal Sc = spinal canal
CoP = coccygeal plexus SC = spinal cord
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collat.= collateral SN = spinal nerve

Cr = cranial SP = spinous process
CSF = Cerebrospinal fluid SyNS = sympathetic nervous system
CT = connective tissue T = thoracic
DH = dorsal horn (of the spinal cord) TP = transverse process
dist. = distal UL = upper limb, arm
DM = dura mater V = vertebra
e.g. = example VB = vertebral body
EC = extracellular (outside the cell) VC = vertebral column
Gk. = Greek VH = ventral horn (of the spinal
GM = grey matter cord)
Hp = Hippocampus Ven = ventricle (of the brain)
IC = intracellular / intercostal WM = white matter
IC = intercarpal w/n = within
IMC = intermetacarpal w/o = without
jt(s) = joints = articulations
9 © A. L. Neill
INTRODUCTION
Neuro-anatomical and Neurological terms

Action potential the generation of a N impulse through stimulation and
depolarizing of the N cell membrane
Acusis hearing
Adiadochokinesia inability to rapidly perform rapidly alternating movements
Afferent incoming - as with sensory fibres see Sensory
Agnosia w/o knowledge inability to recognize sensory stimuli
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(auditory, tactile, visual)
Agraphia w/o writing - inability to write coherently – due to a
cerebral lesion
Ala cinerea ashen hued wing - triangular region on the floor of the
Ne
4th Ven – one of the Vagal nuclei
Alexia w/o words - inability to grasp the meaning of words
Allocortex the older cerebral cortex = archicortex + paleocortex
Alveus trough – thin WM layer covering the ventricular
surface of the Hp
Amacrine long - the N cell type with long fibrous processes in
the retina
. L.
Ammon’s horn Ammonis = Egyption god with a ram’s head used for
the Hp which sagittally has a curl like a ram’s horn
Amygdala almond - almond shaped body in the Temporal lobe
involved in memory & emotion
Anasthesia w/o feeling - loss of sensation
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Angular gyrus part of the Temporal lobe involved in language

processing, letter shape and word recognition,
connects occipital cortex with Wernicke’s area
Anopsia w/o sight - defect of vision
Ansa - loop - a loop like structure eg Ansa Cervicalis
Ant. Cingulate gyrus part of the limbic system - assoc. with cognitive processing
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of pain perception and emotional response (see cingulum)

Antidromic N impulse running up the axon or down the dendrite
in the opposite direction
Aperture an opening or space b/n bones or w/n a bone.
Aphasia w/o speech - loss of speech or comprehension of the
written and spoken word
Apraxia w/o being able to do - inability to move purposefully
w/o paralysis
Arachnoid spidery – weblike eg AM
Archeocortex AS Archiocortex part of the 3 layered Allocortex in the
Limbic system – mainly in the Hp and Dentate gyrus
Archicerebellum AS Archeocerebellum old part of the little brain – to do
with balance
10 © A. L. Neill
INTRODUCTION
Area postrema caudal area on the floor of the 4 Ven

th
Articulation joint, which is a point of contact b/n 2 bones / relating

to a joint. - hence articular branches of a N supply the
joint described.
Association fibres those N fibres which connect cortical areas of the
brain ipsilaterally (as opposed to commissural fibres)
Astereognosis w/o solid shape - inability to recognise basic shapes
by feeling them
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Astrocytes star - one of the supportive cell types in the CNS (see Glia)
Asynergy w/o work - disturbance in the muscle contraction
sequence in doing a coordinated act
Ataxia w/o order inability to contract muscles in order and
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hence weakness in contraction
Athetosis w/o position inability to keep fingers or toes in a still
position continually writhing of the extremities – due
to degeneration in the CC and Corpus Striatum
Autonomic automatic motor innervation of the viscera
Axial axis - refers to the head and trunk (vertebrae, ribs and
sternum) of the body.
. L.
Axolemma plasma membrane of the axon
Axon N process carrying material away from the cell body
to the target organ, each N has only one axon
Axon collaterals branches of the axon
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Axon hillock part of the N where the axon rises and has no Nissl bodies
Axoplasm cytoplasm of the axon
Baroreceptor weight receiver sensory N fibre which responds to
pressure changes as in the carotid canal
Basal ganglia incorrect term for cluster of Ns buried in the WM of the
brain and involved in movement includes: CAUDATE
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NUCLEUS + PUTAMEN + GLOBUS PALLIDUS +

SUBSTANTIA NIGRA
Basilar relating to the base or bottom of structures
Basiocranium bones of the base of the skull
Basis pedunculi (see crus cerebri)
Bipolar neurons with 1 dendrite + 1 axon (see unipolar, multipolar)
Blood brain barrier = BBB the barrier protecting the brain from certain
substances found in the BS
Brachium arm - large bundle of N fibres joining one region to another
Bradykinesia abnormally slow movements
Brainstem MO + Pons + Midbrain
Broca’s area central region of the L frontal lobe of the CC - involved
in the production of speech: - word perception,
11 © A. L. Neill
INTRODUCTION
production, sound and memory

Brodmann’s areas areas of the CC which have been designated by their
histology – cytoarchetecture - and later analysed and
found to have specific functions (after Korbinian
Brodmann 1909)
Bulb old term for MO / in the corticobulbar tract refers to
the that part of the brain stem containing the motor
nuclei of the CNs
ill
Calamus Scriptorius reed / pen - caudal part on the floor of the 4th Ven
which looks like a pen
Calcar spur as in the Calacarine sulcus of the Occipital lobe
Canal tunnel / extended foramen as in the carotid canal, at
Ne
the base of the skull adj canular (canicular - small canal)
Caput relating to the skull
Carotid to put to sleep; compression of the common or
internal carotid artery causes coma. This refers to
bony points related to the carotid vessels
CAT scan = computerized axial tomography scan – computer
mediated Xray image depicting a crossection of the
. L.
body see also CT scan
Cauda equina horse’s tail - lumbar and sacral N roots of the SC
resembling a horse’s tail
Caudate nucleus tail nucleus in the Corpus Striatum, having a long tail
Cavity an open area hence an open area or sinus w/in a bone
rA
or formed by 2 or more bones (adj. cavernous), may

be used interchangeably with fossa. Cavity tends to
be more enclosed fossa a shallower bowl like space
(Orbital fossa-Orbital cavity).
Central sulcus major groove in the coronal plane dividing the frontal
and parietal lobes
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Cephalic pertaining to the head

Cerebellum little brain – the brain situtated in the PCF - to do with
motor coordination, balance and posture – same
structure as the Cerebrum – 2 hemispheres cortex
and medulla - only smaller
Cerebrospinal fluid = CSF fluid - fluid surrounding the brain and SC formed
by the ependymal cells from filtered blood. It is part of
the BBB, and contains sugar, urea and protein - approx
125mls and flows around the brain and SC at any time.
Cerebral cortex GM interconnection b/n the 2 sides via the
Corpus Callosum
Cerebral hemispheres = CH L mainly to do with: speech, writing, language
& calculation R mainly to do with spatial abilites, face
12 © A. L. Neill
INTRODUCTION
recognition, music perception and production

- see Cerebrum
Cerebro-spinal fluid = CSF , fluid surrounding the Brain + SC providing
insulation, nutrition and pressure
Cerebrum Brain – the major 2 hemispheres of the brain –
consisting of an outer cortex of Ns = GREY MATTER
GM) + inner medulla of N fibres WHITE MATTER (WM)
Chiasma (Gk = ) used for the crossing of the Optic fibres
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Chorea dance – irregular, involuntary, movements of the limbs
and face – due to degen. of the neostriatum
Choroid AS Chorioid delicate membrane – as in the choroid
plexus in the brain or the retina
Ne
Cinerea ashes / ashen colour / grey – as in Tuber Cinereum -
ventral portion of the Hypothalamus
Cingulate gyrus part of the Limbic System, directly above the corpus
callosum on the medical surface of the CH –to do with
emotion and attention
Cingulum girdle as in a bundle of association fibres in the WM of
the Cingulate gyrus of the CH, medial surface
. L.
Claustrum barrier - thin sheet of GM b/n Lentiform nucleus and
the Insula
Cochlea a snail hence snail-like shape relating to the Organ of
Corti in the middle ear (adj. cochlear)
Cognition to know – a processing of knowledge for use in higher
rA
functions as in recognition and recall for use in

problem solving etc
Colliculus small elelvation / mound – e.g. superior and inf.
colliculi forming the tectum of the MB – Facial
colliculus on the floor of the 4th Ven
Commissural fibres those N fibres crossing the Median plane in the brain
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or SC (e.g. anterior commisure)

Commissure joining together - a decussation or crossing of large
groups of fibres from one side of the median plane to
the other in the brain or SC
Cordotomy AS Chordotomy –sectioning of spinothalamic tract for
intractable pain (also tractotomy)
Contra opposite (as opposed to ipsi – the same)
Contralateral on the opposite side (as opposed to ipslateral on the
same side)
Corona crown – fibres radiating from an inner point outwards
- as in the Corona Radiata – fibres from the internal
capsule to the CC
Corpus Callosum hard body – the main neocortical commissure of the
13 © A. L. Neill
INTRODUCTION
CH – connects the 2 CH via large mass of axons

crossing from one side to the other
Corpus Striatum striped body - mass of GM with motor functions at the
base of each CH
Cortex outer rind / bark – outer GM of the cerebrum and
cerebellum
Cortical plasticity ability of connections b/n Ns of the CC to change
Cranial Nerve (CN) N coming directly from the brain not the SC
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Cranium the cranium of the skull comprises all of the bones of
the skull except for the mandible.
Crest prominent sharp thin ridge of bone formed by the
attachment of muscles particularly powerful ones e.g.
Ne
Temporalis/Sagittal crest
Crus leg – e.g. Crus Cerebri - the ventral part of the
Cerebral Peduncle of the MB
CT scan = computerized axial tomography scan – computer
mediated Xray image depicting a cross-section of the
body see also CAT scan
Cuneus wedge – e.g. gyrus on the medial surface of the CH –
. L.
Fasciculus Cuneatus of the MB & SC
Cutus skin - hence cutaneous branches refer to the Ns
supplying the skin & adnexae
Declarative memory memory of words which can be recalled
Decussation X - a crossing of paired N fibres inside the CNS e.g. in
rA
the pyramids, medial leminisici and superior

cerebellar peduncles
Dendrite(s) tree - N process(es) bringing communication to the
cell body
Dentate toothed – e.g. Dentate nucleus in cerebellum –
Dentate gyrus in the Temporal lobe
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Depolarization the loss of the potential across the cell membrane of a

N due to stimulation and formation of a N impulse
(see repolarization)
Dermatome the cutaneous innervation of a SN
Diencephalon through the brain = Epithalamus + Thalamus +
Subthalamus + Hypothalamus
Diplopia double vision
Distal further away from the axial skeleton
(opposite of Proximal)
Dura hard – as in DM – thick external layer of the meninges
Dyskinesis disordered movement – abnormal motor function with
involuntary purposeless movements
14 © A. L. Neill
INTRODUCTION
Dysmetria disordered measure – abnormal reach or control of

muscle action
Efferent outgoing as in Motor nerves - see Motor
Emboliform plug – e.g. emboliform nucleus of the cerebellum
Endocranium w/in the skull - refers to the interior of the “braincase”
adj. endocranial divided into the 3 major fossae
anterior (for the Frontal lobes) middle (containing
Temporal lobes) and posterior (for the containment of
ill
the Cerebellum).
Endoneurium w/in the N - innermost of the CT coverings of a PN
fibre (see neurium, perineurium and epineurium)
Engram mark – a lasting memory – memory picture from a
Ne
past experience
Entorhinal w/in the nose – the entorhinal area lies in the ant. of
the parahippocampal gyrus – in the lateral olfactory area
Ependyma/
Ependymal cells line the ventricles and the central canal of the SC
(see Glia) form the CSF
Epineurium upon the N - outermost of the CT coverings of a PN
. L.
fibre (see neurium, perineurium and endoeurium)
Epithalamus upon the inner chamber – region of the diencephalons
above the thalamus includes the pineal body
Extradural space space external to the Dura mater but w/n the skull or
boney canal of the SC
rA
Extrapyramidal system all the motor parts of the CNS except the
pyramidal system
Extrastriate visual areas of the CC assoc with higher order visual
recognition eg face recognition
Falx sickle as in falx cerebri, falx cerebelli
Fascis bundle
©D
Fasciculus small bundle – used for a bundle of N fibres

Fastigial gabled roof top – eg the Fastigial nucleus at the top of
the cerebellum
Fimbria fringe – band of N fibres along the edge of Hp
continues as the fornix
Forceps paired tongs – as in the U shaped fibres of the Corpus
Callosum - Forceps frontalis and Forceps occipitalis
Foramen a natural hole in a bone usually for the transmission of
BVs &/or nerves.(pl. foramina).
Fornix an arch – as in the efferent N tract of the Hp which
arches over the Thalamus and teminates in the
Mammillary body
15 © A. L. Neill
INTRODUCTION
Fovea pit – as in the Fovea Centralis at the centre of the retina

Funiculus little cord – as in the cords of WM in the SC which
consist of a number of different fasiculi all running
together in the Lateral Funiculus of the SC
Funis cord
Ganglion knot - collection of N cell bodies outside the SC (also
incorrectly used for isolated islands of N cells w/n in
the WM of the brain eg Basal Ganglia of the brain - see
ill
Basal Ganglion), pl ganglia an abnormal collection of
neural tissue found subcutaneously
Gemmule small bud – swellings on the ends of some dendrites
in the CNS
Ne
Genu knee – anterior end of the Corpus Callosum = the
genu of the Corpus Callosum; geniculate ganglion of
the Facial N; geniculate nuclei of the Thalamus
Glia / Glial cells glue associated supporting cells of the CNS connective
tissue and immune functions, types: astrocytes,
oligodendrocytes, ependymal cells and microglia
Globus pallidus pale ball – medial part of the Lentiform nucleus of the
. L.
Corpus Striatum - part of the basal ganglia
Glomerulus small knot, tangle – synaptic glomeruli of the
olfactory bulb
Grey Matter (AS Gray) N tissue in the brain and SC which contains mainly N
cells, dendrites unmyleinated axons & glial cells
rA
(opposite to WM which contains mainly

myelinated axons)
Gracilis slender – Fasiculus Gracilis of the SC; Nucleus Gracilis
of the of the Medulla
Groove long pit or furrow
Gyrus a circle, hence a coil of brain cortex generally the CC.
©D
Hemiplegia half stroke – paralysis down one side of the body

Hippocampus sea horse – a neural gyrus in the Limbic system (in the
Temporal lobe) producing an elevation on the floor of the
temporal horn of the lateral Ven. - involved in the
conversion of short term memory to long term memory
Homunculus little human - any representation of a human being, in
this context - the homunculus maps of the motor and
somatosensory cortex show how many neurons are
devoted to various regions of the body
Horn projection of GM in the SC (ant. & post. horns are for
motor & sensory Ns respectively)
Hydrocephalus water in the head – swelling in the cranium due to
CSF accumulation
16 © A. L. Neill
INTRODUCTION
Hypothalamus under the inner chamber – region in the Diencephalon

which controls the ANS and the Pituitary gland
Impulse a depolarization of the N membrane resulting in the
promulgation of a signal along the N process.
Inferotemporal cortex lower part of the Temporal lobe involved in number
and object recognition
Infundibulum funnel / stem – stalk of the ant. pituitary =
neurohypophysis
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Insula island – CC concealed from the surface at the bottom
of the Lateral Sulcus = Island of Reil
Inter between
Interneurons act b/n motor and sensory Ns in a reflex - transferring
Ne
the signal from the sensory to the motor w/o higher imput
Intra within
Introitus an orifice or point of entry to a cavity or space.
Ipsi- same – as opposed to contra- opposite
Ipsilateral on the same side as opposed to contralateral
Isocortex equal bark – the CC which has 6 layers = neocortex
. L.
Kinesthesia movement sensation – the perception of moving
and movement
Lacerum something lacerated, mangled or torn - eg Foramen
Lacerum, small sharp hole at the base of the skull
often ripping tissue in trauma.
rA
Lacrimal related to tears and tear drops. (noun lacrima)

Lateral sulcus groove running across the cerebrum in the coronal
plane separating the frontal & parietal lobes
Lambda from the Greek letter a capital 'L' and written as an
inverted V.(adj. lambdoid) and used to name the point
of connection between the 3 skull bones Occipital
©D
and Temporals.
Lamina a plate - the lamina of the vertebra is a plate of bone
connecting the vertical and transverse spines (pl. laminae)
Leminiscus ribbon -ribbonlike, flat band of N fibres in the CNS -
e.g. Lateral & Medial Leminisci
Lentiform lenslike – Lentiform nucleus of the Corpus Striatum
Limbic System group of brain structures to regulate emotion
and memory
Limbus border – as in the Limbic System which has a border
of CC on the medical surface of the CH consisting of:
septal areas, cingulate and parahippocampl gyri,
mammillary bodies and ant. thalamic nuclei
Linea a line - as in the Nuchal lines of the Occitipum
17 © A. L. Neill
INTRODUCTION
Locus a place -c.f. location, locate, dislocate.

Longitudinal sulcus deep sulcus or groove along the mid-sagittal plane of
the brain separating the R & L CH
Macula spot – as in the Macula Lutea of the retina = yellow spot
Magnetic Resonance Imaging = MRI used to “see” soft tissues other forms
are fMRI which allows for images of soft tissues as
they change see MRI
Magnum large pl magna
ill
Mammillary -
AS Mamillary little nipple – mammillary body in the ventral
surface of the Thalamus
Medulla marrow middle – Medulla Oblongata – the caudal
Ne
portion of the brain stem , spinal medulla
Meninges coverings of the brain and SC made up of 3 layers -
Dura (hard) mater on the outer to protect the NT;
Arachnoid (spidery) mater in the middle to support the
BS and Pia (soft) mater, the inner coating to coat the
NT and act as a barrier to foreign substances. CSF
flows b/n the inner 2 coverings.
. L.
Macroglia large supportive cells of the CNS (see Glia)
Microglia phagocytic cells of the CNS (see Glia)
Miosis excessive contraction of the pupil due to drugs or disease
Mixed N a N containing both sensory & motor components,
most peripheral Ns are mixed
rA
Mnemonic memory
Motor / motor N causes muscle contraction. these Ns are efferent or
moving away from the SC
Motor cortex part of the brain – cerebral motor cortex - responsible
for executing bodily movements
Motor program a sequence of muscle contractions needed for a
©D
complex movement
MRI technique to see images of soft tissues eg. the brain
using magnets
Multipolar referring to a N which has many dendrites + 1 axon
(see unipolar, bipolar)
Myelin marrow - the phospholipids produced by Schwann
cells to insulate the axons of PNs and allow impulses
to travel for longer and faster to the target organ
Myotome the muscular innervation of a SN
“Nerve” (N) N cell (neuron) capable of transmitting or firing off a
signal caused by ion transfer - excitable cell N process
- generally Axon carrying the impulse to the skeletal
18 © A. L. Neill
INTRODUCTION
muscle site general term meaning either the neuron(s),

process(es) or part of a bundle of neurons, either
cranial, spinal or peripheral
Neurilemma layers of Schwan cell membranes coating axon
processes
Neurium general term for the CT covering of a PN fibre
(see endoneurium, perineurium and epineurium)
Neurocranium refers only to the braincase of the skull.
ill
Neuroglia see Glia
Neuron Nerve cell
Neurotransmitter substances in vacuoles at the foot of the nerve
process which are released to induce a N impulses or
Ne
in response to a N impulse
Nociceptive injury – nociceptors respond to injurious stimuli
Nucha The nape or back of the neck adj.- nuchal
Nystagmus sleepy – involuntary oscillations of the eyes
Occiput The prominent convexity of the back of the head
Occipitum = Occipital bone adj. occipital
. L.
Oligodendrocytes in the CNS only, become Schwann cells in the PNS and
SC, act as a barrier and insulator of axons and neurons
Osmatic to do with the sense of smell
Pars a part of
Pathway general term indicating a path of defined N fibres
rA
Perineurium middle of the 3 CT coverings of a PN fibre

(see neurium, perineurium and epineurium)
Peripheral N (PN) coming from the SC, - often the combination of 1 or
more SNs or part thereof and not the brain directly
(cranial N) see Spinal N
Peroneal pertaining to the lower leg
©D
Pia soft – pia mater PM soft covering of the brain

Pineal pine cone shaped – pineal body = pineal gland
Plexus plait / knot – an interlaced network of Ns –
brachial plexus
Polarization the maintenance of an unequal charge across the
membrane of the N, allowing the cell to be stimulated
- all excitable cells have a polarized membrane
Pons bridge – part of the brainstem which lies b/n the
medull and the midbrain
Posterior - part of the CC which transforms visual information
Parietal cortex into motor commands
Precentral gyrus site of the primary motor cortex
Prefrontal cortex involved in complex decision making, behavioural
19 © A. L. Neill
INTRODUCTION
inhibition and judgement

Premotor cortex involved in sensory guidance of movement
Primary motor cortex area directly involved in producing muscle contraction
Primary visual cortex receives the first visual information = Brodmann’s
area 17, V1 see Striate cortex
Procedural memory unconscious memory such as recall to catch a ball
Process A general term describing any marked projection or
prominence as in the mandibular process, in
ill
neurology the nerve process either Dendrite or Axon
depending upon the direction of the NI.
Projection fibres axons which connect the Cerebral cortex with the
Brainstem or SC
Proprioception
Ptosis
Pulvinar
Ne
sense of position of body parts
Prosencephalon = forebrain
Proximal closer to the axial skeleton (opposite of distal)
drooping - describing a dropping upper eyelid
a cushioned seat – posterior projection of the Thalamus
over the medial and lateral geniculate bodies
. L.
Putamen shell – larger lateral part of the lentiform nucleus –
one of the basal ganglia
Pure N a N which is either only sensory or motor not both
(as in mixed N)
Pyramidal system corticospinal and corticobulbar tracts which form a
rA
pyramid shape on the ventral surface of the MO

Pyramidal tract corticospinal tract only
Pyriform pear shaped – pyriform area of the olfactory cortex
Quadriplegia = Tetraplegia, paralysis of all 4 limbs
Ramus branch pl. rami/branches - 2 main branches Ventral
supplying all structures in front of the SC and Dorsal
©D
| supplying all structures behind the SC - the Rami are

mixed Ns
Raphe seam – an anatomical seam in the midline – raphe
nuclei of the reticular formation, in midline of the MO,
Pons & MB
Reflex referring to the Reflex arc of sensory impulse - going
to the SC and causing a motor or efferent response
w/o imput from the brain
Refractory period time b/n depolarization and repolarization, where the
N cannot be restimulated in part to stop the impulse
from traveling in both directions
Repolarization restoration of the resting potential after transmission
of a N impulse (see depolarization, polarization)
20 © A. L. Neill
INTRODUCTION
Resting potential the charge difference across the cell membrane of the
N created by ionic imbalance
Reticular a net – as in the reticular formation of the brainstem
Rhinal pertaining to the nose
Rhinencephalon part of the components of the olfactory system
Ridge Elevated bony growth often roughened.
Root the segment(s) of origin of the PN from the SN
Rostral towards the nose
ill
Rostrum beak – recurved process of the Corpus Callosum
Rubro red as in the red nucleus – rubrospinal tract
Saccadic to jerk – as in quick jerky movements of the eyes
Ne
when changing focus
Sagittal an arrow, the sagittal suture is notched posteriorly,
making it look like an arrow by the lambdoid sutures;
the anatomical plane from anterior to posterior.
Satellite attendant – satellite cells form a capsule around Ns
in ganglia
Schwann cells cells supplying phospholipid coat - insulation to the
. L.
axons to preserve the N impulse in the PNS - role of
the oligodendrocytes in the CNS
Secondary -
visual cortex = V2 perceives colour and form
Sensory to feel pertaining to imput - which goes to the SC and
rA
then brain &/or reflex

Short term memory that memory limited to several minutes of recall only
Soma body - the main part of the neuron
Somatic bodily – denotes the viscera in neurology
Somatosensory relating to information perveived through sensory
receptors in the skin and muscles
©D
Spinal Cord (SC) Extension of the brain protected by the VC, PN

come from here
Spinal Nerve (SN) N coming directly from the SC not the brain
Spine a thorn (adj. – spinous) descriptive of a sharp,
slender process/protrusion.
Splanchocranium the splanchocranium refers to the facial bones of the skull
Splenium bandage – thickened post. extremity of the
Corpus Callosum
Stimulation events which lead to the formation of a N impulse
Stimulus something in the environment which will cause a N
impulse to be generated from the receptor
Strabismus a squinting – constant lack of parallelism in the visual
axes ie crossed eye(s)
21 © A. L. Neill
INTRODUCTION
Stratum layer – as in stratum zonal on the dorsal surface of

the Thalamus
Striate striped
Striate cortex striped rind = Brodmann’s area 17
= primary visual cortex
= V1;
CC on the Occipital lobe which receives 1s visual
information from the eyes via the Thalamus (has a
ill
white stripe w/in the cellular layer)
Subcortical anything deep to or beneath the CC
Subdural space space beneath the DM external to the AM
Subiculum little layer - as in the thin layer of GM b/n Hp and
Substantia nigra Ne
parahippocampal gyrus
Substantia gelatinosa a column of GM at the apex of the dorsal horn of the SC
dark substance - large nucleus in the MB with a high
number of pigmented cells loss of cells in this area is
related to Parkinson’s disease
Sulcus long wide groove often due to a BV indentation –space
. L.
b/n the gyri of the GM in the brain (pl – sulci)
Superior temporal gyrus refines language interpretation such as
recognizing “s” as a plural etc
Supplementary motor area = SMA involved in complex motor functions such
as 2 handed functions
rA
Supramarginal gyrus forms words form letters

Sural pertaining to the lower leg
Suture The saw-like edge of a cranial bone that serves as
joint between bones of the skull.
Synapse to join - the gap at the joining of N and nerve process,
N and N, process to process or N and muscle for trans-
©D
mission or inhibition of an impulse via neurotransmitters

- presynaptic before the synapse (where the
neurotransmitter is released) / post synaptic after the
synapse (where the neurotransmitter is received).
Tapetum carpet – fibres from the corpus callosum over the
lateral wall of the lat. Ven.
Tectum roof – as in the roof of the MB
Tegmentum cover – dorsal portion of the Pons
Tela choroidea web membrane – vascular CT continuous with the PM
which continues to the Choroid plexus
Telodendria axon terminal branches
Temporal refers to time and the fact that grey hair (marking the
passage of time) often appears first at the site of the
temporal bone.
22 © A. L. Neill
INTRODUCTION
Tetraplegia see Quadriplegia

Thalamus inner chamber – functions are sensory and integrative
– 2 egg-shaped masses of Ns – key relay station and
filter of information to go to and not to go to the CC
Tract vertical columns of axons, generally myelinated in the
SC &/or brain
Tractotomy see Cordotomy
Trunk when SNs join together as large combined large Ns to
ill
supply specific anatomical regions (e.g. BP) but again
must re-organize to become PNs
Uncus hook adj. Uncinate -
Uvula little grape – as in dorsal part of the cerebellum
Vallecula
Velate
Ventral
sail Ne
little valley – as in the fold on the inferior aspect of
the cerebellum
chest - to the front, used interchangeably with

anterior, relating to the chest
Ventricle little belly – as in ventricles of the brain filled with CSF
. L.
Vermis worm – as in the vermis of the cerebellum –
midline structure
Wernicke’s area located in the Temporal lobe crucial for language
and comprehension
White matter N tissue which consists mainly of myelinated axons
rA
(see Grey matter)

©D
23 © A. L. Neill
The A to Z of the Brain
Guide to Anatomical Planes and Relations

This is the anatomical position.
A = Anterior Aspect from the front Posterior Aspect from the back
used interchangeably with ventral and dorsal respectively
B= Lateral Aspect from either side
C = Transverse / Horizontal plane
ill
D= Midsagittal plane = Median plane; trunk moving away from this
plane = lateral flexion or lateral movement moving into this plane
medial movement; limbs moving away from this direction =
abduction; limbs moving closer to this plane = adduction
E = Coronal plane
F = Median
Ne C
. L.
rA
D
©D
24 © A. L. Neill
ill
Ne
. L.
rA
©D
© A. L. Neill 25
Anatomical Movements
ill
Hip flexion Hip extension
Ne
. L.
Hip abduction Hip adduction

rA
©D
Hip lateral and

medial rotation Hip circumduction
Knee flexion Knee extension
26 © A. L. Neill
Foot dorsiflexion Foot plantar flexion
ill
Foot inversion Foot eversion
Ne
Foot normal position
. L.
Fingers extension Fingers flexion

rA
©D
Forearm pronation Forearm supination Hand deviation

radial/laterally
ulna/medially
Fingers abduction Fingers adduction Thumb opposition
© A. L. Neill 27
THE NERVOUS SYSTEM
The Nervous system

The nervous system is made up of: the CNS = Brain + SC, the PNS =
Ns exiting from the CNS - CRANIAL directly from the brain (12 PAIRS)
and from the SC (31 PAIRS), the protective coverings of the tissue are
made up of - connective tissue - the MENINGES of which there are 3
layers, the outer or DURA MATER and the inner often fused 2 layers
THE ARACHNOID & PIA MATERS for the diffusions of CSF and blood
ill
around the Brain and SC, and boney coverings, the Skull around the
brain and the vertebral column (VC) around the SC.
In the PNS the Ns form 2 separate divisions the voluntary and the
Ne
autonomic (ANS). The ANS is made up of the Sympathetic exiting from
the thoracic region and Parasympathetic Ns, depending upon the
region of the SC, and these nerves may travel with the PNs.
PROTECTIVE CENTRAL NERVOUS PERIPHERAL NERVOUS

COVERINGS SYSTEM = CNS SYSTEM = PNS
. L.
BRAIN ANS
BONEY = SKULL
CONNECTIVE
TISSUE
= MENINGES CRANIAL
rA
NERVES (1-12)
©D
BONEY = VC
SPINAL
CORD = SC SPINAL
CONNECTIVE
NERVES = SNs
TISSUE
= MENINGES
28 © A. L. Neill
B C
ill
D E
Ne
This brain is stripped of its normal meningeal
coverings, showing cerebral cortex - grey matter.
A = superior view
. L.
B = L lateral view
C = R lateral view
D = inferior view
rA
E = sagittal view
©D
© A. L. Neill 29
THE NERVOUS SYSTEM
The Nerve Cells

The basic functioning cell of the NS is the NEURON = NERVE CELL =
N. Most are multipolar meaning that they have multiple dendritic (2)
processes, which feed impulses into the nerve cell body (7). All Ns only
have one axon (6), taking an impulse away from the cell body.
There are 2 basic types of Ns: - MOTOR Ns, which stimulate target organs
and SENSORY Ns, which provide feedback about the target organs.
ill
Nerve cells when grouped together have a grey appearance and when
seen in large collections are called GREY MATTER = GM, while their
processes are often myelinated and appear white – so neural tracts are
called WHITE MATTER = WM.
Ne
In the brain the Ns are on the surface or cortex, except for some areas
where collections of Ns may be seen deep in the brain tissue – nuclei (or
ganglia). In the SC, the Ns are placed deep in the tissue in long columns.
1 nucleus and nucleolus
2 dendrites
. L.
3 neurilemma - protective myelin sheath from Schwann cells
4 axon terminal branches / telodendria
5 nodes of Ranvier
rA
6 axon and base of axon - axon hillock

7 N cell body plasma with neurofibrils, Nissl bodies,
mitochondria, Golgi & ribosomes
8 presynaptic membrane
9 synaptic vesicles
©D
10 neurotransmitter
11 synaptic cleft
12 postsynaptic membrane on dendrite or N cell body
13 myofibril of skeletal muscle
14 sarcolemma - cell membrane
of the skeletal muscle cell
15 sarcoplasm - plasma of the
skeletal muscle cell
16 subneural clefts
17 mitochondria
30 © A. L. Neill
ill
2
1 7
Ne
6
3
5
4
. L.
18
3 4 4
rA
13
14
©D
15 17
16
13, 14 4
8
9
10
11
7
12
© A. L. Neill 31
THE BRAIN
Blood – Brain Barrier BBB

Schema of Blood Vessel
BBB in the neuroaxis of capillary
BBB in the choroid plexus in ventricle
The “Blood Brain Barrier” BBB prevents brain tissue from being
exposed to various blood borne substances. This is achieved by a
ill
number of factors: the glial foot processes on capillaries , the unique
properties of the endothelial lining and components of the basement
membrane. The filter also alters the components of the CSF fluid via
Ne
the vessels in the choroid plexus and the choroid epithelium.
Clinically this may prevent the neural tissue from the effects of oral and
iv medications and toxins, requiring intrathecal injections. In certain
pathologies particularly inflammatory ones the barrier can be
compromised, causing oedema and other complications.
1 Medium sized cerebral BV
. L.
2 Pia Mater layer
3 Glia limiting membrane
4 Perivascular space
rA
5 Foot processes of astroglia on capillaries

6 Neural tissue
7 BV lumen
8 Endothelial cell f = fenestration
©D
9 Basement membrane
10 Glial tissue
11 Choroid epithelium
32 © A. L. Neill
2
3 2 4 5
ill
7
1 6
Ne
9
. L.
8
7
rA
5
©D
8 8f 7
9
10
9
11
© A. L. Neill 33
THE BRAIN
Blood Supply overview

Brain Schema of the brain – coronal
1 Skull = boney covering
2 Meningeal vein
3 DM around the venous sinuses + communicating vessel
4 External cerebral vein
ill
5 Brain – nervous tissue
6 Choroid plexus
7 Deep cerebral vein
8
9
10
11
Extracranial vein
Extracranial artery
Meningeal artery
Superficial cerebral artery
Ne
Spinal Cord Schema of the SC – transverse
. L.
1 Posterior spinal artery
2 Radicular branches a = anterior / L = lateral / p = posterior
3 Arterial vasocorona
rA
4 Lateral artery
5 Anterior radicular artery
6 Branches of the superficial arterial network
7 Anterior spinal artery
8 Sucal artery = ant. spinal art. (lies in the sulcus of the SC)
©D
9 Marginal zone (of Lissauer) - ALM tracts before synapse

10 Anterior horn = ventral motor horn
11 Deep spinal artery
12 Substantia gelatinosa - ALM Ns synapse point
13 Mediobasal column (of Clarke) - for sensory interneurons
14 Posterior horn = dorsal sensory horn
15 Skull = boney covering
16 Meningeal vein
34 © A. L. Neill

3 4
2
5
1
ill
12
Ne
6
11
. L.
10 7
9 8
rA
13 2p 1
12 14
2L
9
3
4
©D
11
10 6
9 8
© A. L. Neill 2a 35
THE BRAIN
Blood Supply overview

Spinal Cord
Schema of the SC anterior surface
C = cerebral region
T= thoracic region
L= lumbar region
ill
1 Basilar artery
2 Vertebral artery
3
4
5
6
Radial artery of C5
Radial artery of C7
Anterior spinal artery
Lateral thoracic arteries
Ne
7 Artery of the lumbar enlargement
. L.
Expanded on the one side at the level of T10 –L2
Spinal Cord
rA
Schema of the SC – deep and superficial arterial networks

Note there are minimal anastomoses b/n these 2 different circulations
This circulation as with the brain has end arteries and distally the
tissue may be compromised.
©D
A deep arterial network – neural tissue supplied by anterior spinal artery

B superficial arterial network
36 © A. L. Neill

1
3
C 4
ill
5
T1
Ne
T 6
. L.
rA
T12
L
©D
A B
© A. L. Neill 37
THE BRAIN
CEREBROSPINAL FLUID = CSF - circulation of

fluid in and around the Brain & SC
Lateral overview of ventricles
Sagittal view of CSF circulation
Definition – CSF bathes the Brain and SC, filtered from arterial blood by the
Choroid plexus (27). Removing the blood proteins and cellular elements, it
ill
circulates through the ventricular system and subarachnoid space of the
brain and SC and then is removed by the Arachnoid granulations (20) to
the venous sinus systems around the brain. Blood in the perforating BVs
Ne
(21) surrounding the neural tissue is also filtered via the BBB.
1 Frontal lobe 14 Pons

2 Anterior horn of lateral 15 Temporal lobe
ventricles 16 3rd ventricle
3 Body of the lateral 17 Lateral fissure
. L.
ventricles - (Sylvian fissure)
4 Cerebral cortex 18 Interventricular foramen
5 Parietal lobe 19 Subarachnoid space
rA
6 Posterior horn of the 20 Arachnoid granulations

lateral ventricles
21 Perforating veins
7 Occipital lobe
22 Pia/arachnoid mater
8 Cerebellum
23 Transverse sinus
9 Cerebral aqueduct
©D
24 Cistern of the great

(aqueduct of Sylvius)
cerebral vein*
10 4th ventricle with
25 Cerebral artery
lateral aperture
26 Cerebral vein
11 Median aperture
(foramen of Magendie) 27 Choroid plexus
12 SC 28 Pituitary gland + stalk
13 Lateral recess of 29 Dura mater
4th ventricle 30 Superior sagittal sinus
(foramen of Lushka) *may sample CSF here
38 © A. L. Neill
4
5 3
2
6
1
ill
7
8
Ne 15
16
17
18
14
9
. L.
10 13
11 12 20
21 30
19
rA
19
22 2
6 1
©D
27
23
24 18
9 16
25
8 14
10
27
25 26
© A. L. Neill 39
THE BRAIN
Brain Development and Organization

The Brain develops from
ectoderm – the top
germinal layer – cells
form a tube – the neural
tube which develops 3
bulges as shown and
ill
develop into the
CNS. Additional
cells excluded from
Ne
the tube become the
neural crest and form
the components of the
PNS.
The brain continues to
develop throughout
adolescence and may do
. L.
so throughout life,
although neural tissue
has a limited capacity to
repair.
rA
©D
foramen magnum
(exit from skull)
40 © A. L. Neill
PRIMARY SECONDARY DERIVATIVES

BRAIN VESICLES BRAIN VESICLES
Cerebral Cortex
Telencephalon Basal Nuclei
ill
NeDiencephalon
Retina of the eye
Thalamus
Hypothalamus
Neurohypophysis
. L.
Midbrain
Superior colliculus
rA
Pons
Metencephalon Cerebellum
©D
Myelencephalon Medulla Oblongata
dorsal horn = sensory

Spinal cord ventral horn = motor
© A. L. Neill 41
THE BRAIN
The Brain and SC macroscopic structure

The Brain places most of its neurons on the outer surface – cortex -
which gives the brain surface a grey colour hence it is – the grey matter
GM. The Ns are connected by their processes underneath mostly
myelinated and hence white coloured fibre tracts – the white matter WM.
The Ns of the brain are layed down in multiple laminae/layers in
ill
particular patterns which can be recognized and identified histologically
with the NISSL stain. Particular cytoarchitechtural patterns have thus
been identified and regionalized – the commonest scheme being the
BRODMANN mapping of the CC.
Ne
In many cases the structure has been found to relate to the function of
these areas and so as well as naming the structure, a Brodmann
number may also be listed. The “Brodmann area” is related to the
arrangement of the Ns in the region but this may not always be directly
related to the macroscopic appearance of the brain.
The SC has its nerve cells on the inside, which are in long columns 2 in
. L.
the front – ventral horns – and 2 in the back – dorsal horns.
Connecting processes b/n the SC and the brain run up and down the
SC outside the GM forming tracts of WM, and neurons are also found
posteriorly sitting outside the main mass of the SC in small groups at
rA
each outlet dorsal root ganglia.

1 GM b = basal ganglia- deep GM - part of the Corpus
Striatum / c = cerebrum / k = cerebellum / s = SC
2 WM c = cerebrum / k = cerebellum / s = SC
3 Space in the CNS filled with CSF in the c = cerebrum
©D
k = cerebellum s = SC (spinal canal)

4 Subarachnoid space
5 Sagittal sinus s = superior / i = inferior
6 Lateral ventricle
7 Third ventricle 11 AM
8 Cerebral aqueduct 12 PM
9 Fourth ventricle 13 Choroid plexus
10 DM 14 Arachnoid granulations
42 © A. L. Neill
5S 14 2C
5i
4C 1C
6
7 13
ill
3C
Ne
. L.
4
1B
8
rA
1K
3K 2K
3S
9 1S
©D
1S
2S
4 12
11
10
© A. L. Neill 43
THE BRAIN
The Brain fibrous tracts

coronal- view looking at the “face”
sagittal – view looking from the side
The Brain places most of its neurons on the outer surface – cortex -
which gives the brain surface a grey colour hence it is – the grey matter
GM. The Ns are connected by their processes underneath mostly
ill
myelinated and hence white coloured fibre tracts – the white matter WM.
The fibrous tracts of the WM in the brain are of several types
Association fibres = N tracts connecting one area to another of the
Ne
same specialty of increasing complexity e.g. area primary visual cortex
V1 to the secondary visual area V2 e.g. the perpendicular and uncinate
fasciculi and the “short fibres”
Commissural fibres = N tracts which cross from one side to the other
in the cerebrum the largest of these is the Corpus Callosum (+ ant. &
post. commissures)
. L.
Projection fibres = N tracts which send fibres of one modality to an
area of an other i.e. from the visual areas to the frontal areas for
decision making processes to begin based on the visual information
e.g. superior & inf. longitudinal fasciculi.
rA
1 GM of the cerebrum = cerebral cortex

2 Association fibres of the cerebrum – WM – “short fibres”
3 Commissural fibres of the cerebrum - WM (Corpus Callosum)
4 Projection fibres of the cerebrum - WM
©D
4i inferior longitudinal fasciculus /

4s superior longitudinal fasciculus
5 Gyrus
6 Sulcus
7 Longitudinal fissure
8 Lateral fissure / sulcus
9 Insula – GM of cerebrum deep to the lateral fissure
10 Thalamus
11 uncinate fasciculus
12 perpendicular fasciculus
44 © A. L. Neill
7
1
10
ill
5 8
Ne 9
. L.
4
rA
2
1 4S
1
3
©D
11
12 4i 5
10
© A. L. Neill 45
THE BRAIN
Dura Mater - DM = Hard Mother

Outer layer of the Meninges
Fixes the brain and limits movements supports the 2 inner coverings
which contain the BS of the Brain.
Continues down the SC to protect the neural tissue in this region as well.
Composed of thick connective tissue
ill
Space b/n Skull and DM = EXTRADURAL SPACE (hence extra-dural
haemorrhage)
Ne
Space b/n DM and Pia – Arachnoid maters = SUBDURAL SPACE
(hence sub-dural haemorrhage)
The DM is pain sensitive and may be the cause of local headache or
spinal pain or referred pain to structures associated with the exiting Ns.
1 Falx Cerebri – contains and prevents movement of the main
cerebral hemispheres supports the superior sagittal sinus
. L.
2 Tentorium Cerebelli – separates the Cerebrum and the
Cerebellum forming a roof over the cerebellum - supports
the straight and transverse sinuses
3 Dura Mater – covering the SC – lumbar region
rA
4 Zygapophyseal jt
5 Spinous process
6 Intervertebral disc
7 PLL (at the back of the VB)
©D
8 Sinuvertebral N
9 SN
10 Sinuvertebral artery
46 © A. L. Neill
ill
2
Ne
. L.
rA
4
©D
3
9
10
8 7 6
© A. L. Neill 47
THE BRAIN
The Meninges and the Brain

1 Bone - Skull
2 Frontal sinus
3 DM
4 AM + Subarachnoid space
ill
5 PM
6 SC
7 Dural sac of the SC (continuing on from the cranial cavity)
8
9
10
11
CC – GM
Corpus Callosum
WM of the brain
Ne
Subarachnoid space (b/n Cerebrum and Cerebellum)
12 Sagittal sinus i = inferior / s = superior

. L.
13 Falx cerebri
14 Arachnoid granulations
rA
©D
48 © A. L. Neill
10 1
9
2
ill
Ne 5
4
3
8
. L.
7 6
rA
14 12S 1
3
©D
9
13 12i 11
© A. L. Neill 49
THE BRAIN
The Meninges and the Spinal Cord (SC)

Transverse view of the SC and coverings – cross-section
Coronal view – cutting down the VC showing the SC and
coverings.
1 SN
2 Nerve root (mixed N)
ill
d = dorsal root (pure sensory)
v = ventral root (pure motor)
3 Denticulate lig. (from the PM)
4 DM
5 Outer layer of the AM Ne
6 Subarachnoid space (b/n the intermediate layers of
the AM)
. L.
7 Dorsal lig (from the AM)
8 PM
9 SC – GM
d = dorsal horn
rA
v = ventral horn
10 Central canal
11 Filum terminale (PM)
12 Thoracic enlargement of the SC
©D
13 Lumbar enlargement of the SC

14 SC termination – at L1/2 in adults
15 Spinal canal termination – at S2
16 Anterior spinal artery
50 © A. L. Neill
ill
12
9d
8
Ne
9v
10
3
4
7
. L.
8
6
rA
16
6 13
©D
5 6
4 2v
14
3
2d 11
1
15
© A. L. Neill 51
THE BRAIN
Neurological Assessment – HEADACHE

DEFINITION: pain or discomfort b/n the orbits and Occiput
arising from pain sensitive structures via
Extracranial pain sensitive structures:
The ear – inner & middle - also refers pain to C2 (2)
The eye – orbit - also refers pain to C2/3 (3)
ill
The mouth – teeth & gums also refers pain to C4 (4)
The nose - nasal mucosa, paranasal spaces also refers pain to C3 (3)
The scalp – BVs & muscles also refers pain to C1 (1)
Ne
Intracranial pain sensitive structures :
Basal arteries
Cortical veins & venous sinuses
DM of the ACF and MCF – innervated by CN V1 (5) pain also referred
to the forehead and temple & PCF - innervated by CN IX, X (6) – pain
also referred to the back of the head and neck (suboccipital and upper
cervical regions)
. L.
Note other structures e.g. the cervical VB and neck muscles may refer
pain to the head and cause a “headache”
HISTORY:
rA
Associated features visual disturbances, vomiting + other

Character aching – dull / sharp, throbbing – stabbing
Duration & timing hours / days / morning / evening
Frequency acute – single, chronic – daily / wkly / mnthly
intermittent - seasonal
©D
Mode of onset gradual, rapid

Precipitating factors coughing / exercising, hunger,
medications / foods, menstruation / menopause
noise / stress, posture changes / stooping
Relieving factors analgesics, lying down / sleeping
Severity scale 1-5, bearable – able to read / unbearable
– unable to do anything
Site front / band around the head / back
specific region – above the eye / around the
temple
52 © A. L. Neill
1 2
ill
3
Ne 4
. L.
5
rA
5
©D
6
5
© A. L. Neill 53
THE BRAIN
HEADACHE – diagnoses  = changes in

 progressive Head infect- limb  eye
pain type consci- deterior- injury ion onset weak- move-
ousness ation ness ments
throbbing - - - ± quick - -
severe ± - - - quick - +
ill
throbbing
severe - - - - quick - -
dull
Ne
- + - - slow - -
intermittant
acute sharp - + - - varies - -
severe + + + - rapid ± ±
varies - - - - quick - -
recedes
. L.
severe + + ± - v quick + +
severe + + ± ++ rapid + +
rA
dull + + ± - slow + +
dull + + - - slow ± ±
constant
©D
dull + + - - slow ± ±
constant
severe - - - - slow - -
throbbing
increases
through - - - - varies - -
the day
dull - ± - - slow - ±
sharp - ± ± - varies + -
positional
54 © A. L. Neill
neck  recurr- nausea ± headache

other DX
stiffness vision ence vomitting location
face
± ++ - sinusitis
forehead
+ + + ++ global migraine
ill
cluster
+ + + ± global
headaches
halos around
Ne
- + + - frontal glaucoma
objects
unilateral retrobulbar
- + - - orbital
vision loss neuritis
post-
± ± - + global
traumatic
drugs/toxins
- ± - - global
vasodilators
. L.
haemorr-
+ ± - ++ global
hage
meningitis
focal
encephalitis
+ ± - ++ global neurological
acute /
rA
signs
subacute
impaired hydroce-
± + - + global
upward gaze phalus
papilloe- intracranial
- ± - + global
dema Tm
benign
©D
papilloe-
- ± - + global intracranial
dema
hypertension
stiff tender
temporal
+ - + - temple scalp
arteritis
arteries
frontal situation
tension
- - ++ - band precipitates
headaches
pattern onset
need ocular impaired
- + - -
aids/glasses vision
back and upper limb cervical
+ - + -
neck pain spondylosis
© A. L. Neill 55
NEUROLOGICAL ASSESSMENT
NEUROLOGICAL SYMPTOMS
changes in site of control
balance CN VIII / middle ear
conscious levels global brain/ metabolic
headache global brain / DM / neck / multiple sources
hearing CN VIII middle ear
ill
mental frontal lobe /
endocrine
motor SC / Brainstem / Cerebellum
sensory SC /
Ne
sensory CC
smell CN I
speech / swallowing CN IX-XII
upper cervical Ns
sphincters / continence Sacral Ns
lumbar SC
. L.
taste CN X, XII ``
visual CN II-VI
voice change CN X
NEUROLOGICAL EXAMINATION
rA
From head to toe

CNs – see CN section
Conscious level & higher functions – emotional state, memory, reasoning
MOTOR
©D
Upper limbs –
Trunk and lower limbs -
Sphincters -
Examine: power, tone, symmetry, reflexes, ROM
SENSORY
Upper limbs –
Trunk and lower limbs -
Examine – pain, touch, pressure, proprioception, temperature
see the A to Z of Peripheral Nerves for details
56 © A. L. Neill
The UNCONSCIOUS PATIENT

HISTORY
Ask those around: Alcohol or drugs preceding the event ? medications ?
Illness preceding the event –
± Epilepsy
Sudden collapse
ill
± Head injury ?
± Limb twitching
Assessment of conscious level (Glasgow coma scale)
Ne
Assess EYE OPENING
SPONTANEOUS TO SPEECH TO PAIN via pressure

to the supraorbital N
. L.
rA
NON-RESPONSIVE
©D
Assess VERBAL RESPONSE

ORIENTATED knows where they are
CONFUSED talks in sentences
WORDS cannot form sentences but
can form words
SOUNDS can only make sounds
NONE no response to questions
© A. L. Neill 57
OBEYS COMMANDS
ill
LOCALISING
MOVEMENT TOWARDS
PAIN directional
response to pain
Ne
. L.
FLEXING TO PAIN
elbow flexing but no movement
rA
towards pain
©D
EXTENDING TO PAIN
extension of the elbow &
spastic flexion of the
wrist non-directional
Record assessments as 1-5 for each modality

Always record the best result if there is variation
Always record the upper limb result as this is more consistent
58 © A. L. Neill
APHASIA
– acquired deficiency in language processing incorporating
both production and comprehension, due to brain damage.
ability to
type area repeat
auditory
fluency
affected speech
comprehension
ill
Broca’s = frontal ++++ +++++ nonfluent laboured
expressive cortex speech, slow disjointed
aphasia sentences agrammatism
Wernicke’s* sup. temporal

= sensory
aphasia =
receptive
aphasia
gyrus of the
dominant CH
+
Ne - but can learn

and sing songs
correctly (from
the non. dom.
CH)
fluent - nonsensical
“jargon” paraphasic
(substituting words
which sounds the same)
poor self correction
Conduction = arcuate + ++++ often the result of a

associative fasciculus stroke, fluent paraphasic
. L.
dysphasia connecting but with self correction
Broca’s to
Wernicke’s
area
mixed ++ + non-fluent
rA
transcortical
transcortical ++ ++++ non-fluent
motor
transcortical supramargin +++++ + fluent self correction of
sensory al + angular grammar + syntax only
gyri
©D
global + + non-fluent
anomic = global - ++ +++++ often the result of head
amnesic parietal + injury or tumour, fluent –
dysphasia temporal circumlocution because
lobes & their cannot recall the names of
connections things
* note is not Wernicke’s encephalopathy
© A. L. Neill 59
THE BRAIN
Blood Vessels and the Meningeal layers

of the Brain
1 scalp vein
2 scalp – skin covering
the skull
3 middle meningeal vessels
ill
a=anterior / m=middle /
p=posterior branches
4 Frontal bone
5 dura mater e= endostial /
m= meningeal layers
6 Parietal bone
Ne
7 transverse sinus (R/L)
. L.
8 Occipital bone
9 superior sagittal sinus /
v= venous lacuna
10 arachnoid granulations
rA
11 emmisary veins
12 cerebral veins s=superior
/sp=superficial branches
13 arachnoid mater p with
pia mater (often fused)
©D
14 cerebellum
15 diploic vein
16 frontal sinus
60 © A. L. Neill
10 11 1 2
9v 3p
3m 4
12sp 5e
5m
8
ill
3a
3
Ne 6
7R
. L.
10 12s
9v
rA
9
11
13
15
5m 16
©D
5e
3
7R
12sp
5m
14
© A. L. Neill 61
THE BRAIN
Venous sinuses the Meningeal layers

of the Brain
1 scalp vein 20 optic chiasma
2 scalp – skin covering 21 carotid artery
the skull 22 sphenoparietal sinus
3 middle meningeal vessels
ill
23 hypophysis and stalk
a=anterior /m=middle (infundibulum)
/ p = posterior branches
24 CNs – 24-3 CN III /
4 Frontal bone
Ne
24-6CN VI / 24-4 CN IV/
5 DM e = endostial / 24-5 CN V
m = meningeal layers 25 petrosal sinus
6 Parietal bone s=superior/ i=inferior
7 transverse sinus (R/L) 26 straight sinus
. L.
8 Occipital bone 27 tentorum cerebelli
9 superior sagittal sinus / e=edge inserted b/n
v = venous lacuna cerebrum & cerebellum
10 arachnoid granulations 28 great cerebral vein
rA
11 emmisary veins 29 basilar plexus

12 cerebral veins s=superior 30 dorsum sella
/sp=superficial branches (DM removed)
13 arachnoid mater with pia 31 cavernous sinus
mater (often fused) 32 orbital plate
©D
14 cerebellum (of the frontal bone) ACF

15 diploic vein 33 crista galli
16 frontal sinus
17 cerebrum –
postcentral gyrus
18 falx cerebri
19 olfactory bulb and tract
62 © A. L. Neill

16
4
5e
5e 5m
13
3a
5m
ill
13
6
17
13
3p Ne
10 9v
. L.
9
2
33 16 9 18
rA
32 19
20
5e
21
31
©D
22
23
30 24-3
24-6
24-4
29
24-5
25s
27e
25i
7L 28 7R
27
26 9
© A. L. Neill 63
THE BRAIN
Brain arteries - Overview

The brain is an end organ in that once past a central anastomotic ring
of vessels, the circle of Willis – all supply to the distal tissue is a single
supply. Any blockage of the BV distal to that arterial circle will die,
making the Brain a great energy consumer sensitive to any regional
deprivation of blood. Overall the brain as a whole cannot be deprived of
arterial blood for longer than 10 sec to any partic. area - 20% of the
ill
CO goes to the brain – brain is 2.5kg or <2% of the body weight.
1 Anterior spinal art.
Ne
2 Vertebral art. – paired
3 Post. Inf. Cerebellar art.
4 Ant. Inf. Cerebellar art.
5 Basilar artery – from the fusion of the paired vertebrals
6 Pontine branches
. L.
7 Post. Cerebral art. (branch pierced by CN III)
8 Circle of Willis = arterial circle ,
9 Middle cerebral art (branch b/n. frontal & temporal lobe)
10 Ant. Cerebral art. (branch under optic chiasma)
rA
11 Cerebellar arteries
©D
64 © A. L. Neill
10
ill
9
Ne
. L.
rA
©D
6 9
5 7
4
3
2 1 11
© A. L. Neill 65
THE BRAIN
The Veins and Venous drainage of the

BRAIN Overview
On the surface of the brain there are many BVs which drain into a
series of sinuses – endothelial lined channels b/n the 2 layers of the
DM. They anastomose extensively and have no valves relying on
gravity, cranial pressure and head movements for drainage. Superficial
ill
vessels drain to the superior sagittal sinus (1s) and deeper vessels
drain to the straight sinus (4). The eyeball and facial areas drain to the
cavernous sinus (8) and may bring infection into the cranial cavity.
Ne
1 Sagittal sinus i=inferior / s = superior
2 Connecting anastomosing veins
3 Deep posterior cerebral veins
4 Straight sinus
5 Transverse sinus
. L.
6 Sigmoid sinus (s-shaped)
7 Petrosal sinus i =inferior / s = superior
8 Cavernous sinus
9 Internal jugular vein
rA
©D
66 © A. L. Neill
ill
1i 3
4 2 1s
Ne
2 . L.
rA
5
7s 8
©D
7i
6
© A. L. Neill 67
THE BRAIN
Cranial Venous Sinuses

The venous supply of the brain consists of a number of sinuses - or
lakes of blood protected from the brain tissue by the DM. Unlike other
veins in the body, they have no muscle or valves in their walls.
Arachnoid granulations feed CSF into this system, which then drains to
the jugular veins. Flow is determined by pressure w/in the cranial cavity
– a closed box. CSF, gravity and arterial pressure affect this and flow
ill
may be very slow and on occasions is bidirectional.
Cavernous Sinus
Ne
Coronal section, Looking into the sinus posteriorly
One of the most complex sinuses is the Cavernous sinus. Through this
lake of slow moving venous blood, air, arteries, brain and glandular
tissue and CNs traverse, making this site particularly dangerous for
infection and/or neoplastic spread.
1 pituitary gland = 9 Trigeminal N =CN V
. L.
hypophysis 9-1 CN V1
1a anterior lobe 9-2 CN V2
1i infundibulum = stalk 10 foramen ovale
1p posterior lobe 11 Abducens N = CN VI
rA
2 third ventricle 12 internal carotid artery

3 Optic N = CNII 13 carotid sympathetic
3c chiasma nerve plexus
3n nerve 14 opening to nasal cavity
4 cerebral arteries – 15 sphenoidal air sinuses
©D
branches 16 body of the sphenoid

4a anterior 17 DM – dura mater
4m middle e = endostial layer
4p posterior m = meningeal layer
5 internal carotid artery 18 cavernous sinus =
filled with venous blood
6 communicating arteries
19 cerebral cortex
6a anterior
20 AM -arachnoid mater
6p posterior
21 subarachnoid space
7 Occulomotor N = CN III
22 PM = pia mater
8 Trochlear N = CN IV
23 diaphragma sella
68 © A. L. Neill
17M
20
18
21
22
17m 17e
ill 1a
Ne
13
1p
16
. L.
23 1 2 3n
15
14
rA
11 12
4a
5
©D
6
4m
10
9-2
5i
3
4
© A. L. Neill 69
THE BRAIN
Sagittal venous sinuses –

Superior and Inferior
Superio-lateral
looking into the head from above and laterally
1 CNs – 1-3 CN III /1-6CNVI / 1-4 CNIV/ 1-5 CNV
2 emmisary vein
ill
3 scalp – skin covering the skull
4 DM e= endostial / m = meningeal layers
Ne
5 sagittal sinus / s = superior / i = inferior
6 falx cerebri
7 hypophysis i = infundibulum (stalk)
8 crista galli
9 petrosal sinus s = superior/ i = inferior
. L.
10 tentorum cerebelli e=edge
11 transverse sinus
12 straight sinus
13 great cerebral vein
rA
14 cerebral artery a=anterior /m= middle /

p= posterior branches
15 communicating artery a = anterior /
p = posterior branches
©D
16 internal carotid artery

17 frontal air sinus
18 trigeminal ganglion (from CNV)
19 middle meningeal vessels a = anterior /m = middle /
p = posterior branches
20 greater superficial petrosal N
21 cerebral aqueduct (aqueduct of Sylvius)
22 midbrain
See the website for more details on the Blood Vs and
CNs relationships.
70 © A. L. Neill
1-6 1-5 2 3 4e
1-7,8
4m
1-9,10 5s
6
5i
13
ill
7
12
11
10e
Ne 4
1-2
1-1
10 3
1-11 1-12 9s 1-4 1-3
. L.
22 10 6 5i
21 9
rA
14p
15p
16
7i
13 1-2
©D
5s
17
1-4
8
1-L
16
1-2
1-3
1-4
1-5
18 1-6
9s 4m 20 19
© A. L. Neill 71
THE BRAIN
Circle of Willis = Cerebral arterial circle

Arterial vessels to supply the cerebrum arise from the inferior surface
of the brain via the internal carotid arteries which enter the cranium via
the carotid canal and the anterior surface of the SC via the Basilar
artery from the fusion of the 2 Vertebral arteries. These 3 BVs form an
anastomotic arterial ring – the circle of Willis - from which branches
arise to supply the cerebrum. Because of its structure, supply can be
ill
continued despite the blockage of any 1 or 2 of the individual
contributors, provided it is not acute. However distal to the ring this is
not the case.
1
2
3
4
Anterior cerebral
Anterior communicating
Ophthalmic
Internal carotid
Ne
5 Medial striate (branches)
. L.
6 Midfdle cerebral
7 Lateral striate (branches)
8 Anterior choroid
rA
9 Posterior communicating
10 Posterior cerebral
11 Superior cerebellar
12 Posterior choroid
©D
13 Basilar
72 © A. L. Neill
ill
1
2
3
Ne 4
5
6
. L.
8 7
9
rA
10
12 11
12
©D
13
© A. L. Neill 73
THE BRAIN
The Brain – Macroscopic Components

The brain lies in the cranial cavity – the skull - consists of the CEREBRUM,
CEREBELLUM, MIDBRAIN, and HIND BRAIN which leads to the SC.
The CEREBRUM overlies most of the brain and consists of 5 lobes
named according to the bones which they underly, see the A to Z of
the Head & Neck, and the hidden grey matter the INSULA.
ill
B/n the brain and the skull are the meninges which act as protective
coverings, limit the movement of the brain w/n the skull, support the
BS and CSF and filter material to and from the brain. The outer GM is
arranged as a series of folds to maximize the surface area: the GYRI
Ne
the convex folds and grooves SULCI (may also be called fissures),
named according to their anatomical position on the brain.
Brodmann numbers have also been assigned to these areas, particularly
on the CC which relate the grey matter to brain functions, they often span
gyri and do not directly correlate to the anatomical divisions of the brain.
. L.
Generally information flows from the back of the brain– primarily the
sensory areas – via a series of tracts of WM – nerve processes - to the
front where it is integrated and processed, resulting in decisions,
planning or other higher functions.
FRONTAL LOBE for thinking, planning, decision making & motor execution
rA
II PARIETAL LOBE for somatosensory perception - integration of visual,

proprioceptive and spatial information.
III TEMPORAL LOBE for language, auditory perception, memory & emotion
IV OCCIPITAL LOBE for vision 1 CN V1 opthalmic division
©D
Inferior
Lateral
Posterior
74 © A. L. Neill
10
ill
1
Ne
9
17
. L.
rA
16
©D
© A. L. Neill 75
THE BRAIN
The Brain – Macroscopic Components cont

1 Frontal lobe
2 Central Sulcus = Rolandic fissure
3 Parietal lobe
4 Parietal – occipital sulcus
ill
5 Occipital lobe
6 Cerebellum
7 SC coming from the Brainstem
8
9
10
Temporal lobe
Ne
Lateral fissure = Sylvian fissure
Central Sulcus = Central fissure
11 Cerebral hemisphere = CH
. L.
12 Cerebellar hemisphere
13 Posterior lobe of the cerebellum
14 Vermis
15 Folia = small gyri and sulci of the cerebellum
rA
16 Pons
17 Infundibulum (of the pituitary removed)
©D
76 © A. L. Neill

2 10
lateral 3
1
4
ill
6
Ne 8 9
7
. L.
10
posterior 11
rA
5
©D
12
15
13
14
7
© A. L. Neill 77
THE BRAIN
Cerebral gyri and sulci

Inferior view – looking up at the cerebrum
Lateral – looking at the side of the cerebrum
Median = Midsagittal - looking at the middle plane
The labeling of the fissures, gyri and sulci are often duplicated. The
most common duplications are listed here. Gyri can also be labeled
ill
using a Capital letter to designate the lobe and a number to show its
position in the lobe. Sulci are labeled the same way only with a small
letter –e.g. T1 = first or superior temporal gyrus –the corresponding
Ne
sulcus = t1. However several of these large folds may cross the lobe or
may have different names along their length.
The commonest names and duplications are listed below.
1g-5g = orbital gyri 1s-3s = orbital sulci
1g gyrus rectus, straight 10g lingual gyrus 05
. L.
gyrus F4 10l hippocampal lobule T5
2g medial orbital gyrus F5 10s hippocampal sulcus t5
3g anterior orbital gyrus F3 11g occipitotemporal gyrus
4g posterior orbital gyrus F3 inferiotemporal gyrus T3
rA
5g lateral orbital gyrus F3 12g lateral occipitotemporal

gyrus fusiform gyrus
1s medial orbital sulcus f4
occipitotemporal gyrus T4
2s H-shaped orbital sulcus f3
13g inferior-occipital gyrus O3
3s lateral orbital sulcus f3
©D
14g cingulate gyrus F5/P5

6f rhinal fissure (b/n 15f Sylvian fissure =
frontal & temporal lobes) lateral sulcus
7g gyrus ambiens T5 16g precentral gyrus 1o
7s collateral sulcus t4 motor area F3
8g lunate gyrus = uncus T5 16s central sulcus
8s sulcus semilunaris t5 17g postcentral sulcus 1o
sensory area P1
9g medial occipitotemporal gyrus
= parahippocampal 18g paramarginal gyrus P3
gyrus O5/T5 19g angular gyrus
78 © A. L. Neill
1g= F4
1s=f4
2g
ill
3g
2s 4g
6f
3s
Ne
5g
. L.
rA
©D
7g
11s
10L 8s
7s 8g
10s
11g 9g
14g 13g 12g
10g
© A. L. Neill 79
THE BRAIN
Cerebral gyri and sulci cont

20g superior temporal gyrus T1
21g middle temporal gyrus T2
22s Occipitotemporal sulcus b/n Occipital &
Temporal lobes
23s Calacarine sulcus (meets 22s)
ill
24g Hippocampal gyrus T5
25 Cuneus O1
Ne
26 Precuneus O2
27g Cingulate gyrus
27s Cingulate sulcus
28 Corpus callosum
28s Corpus callosum sulcus
. L.
superior-anterior projection of the CC = frontal pole
posterior part of the CC = occipital pole
inferior – anterior projection of CC temporal pole
rA
cingular gyrus = small GM just above corpus callosum

dentate gyrus = posterior layered part of the hippocampal gyrus
undergoes neogenesis in the adult – for new memories ?
fornicate gyrus = cingulate + parahippocampal gyri (fornix)
note there are also 5 gyri in the Insula I1-5
©D
i = pars operculus
ii = pars triangularus
iii = pars orbicularis all parts of F3 = inferior frontal gyrus
80 © A. L. Neill
17g 16g
18g
19g
i
ill
20g
ii
Ne iii
15f
. L.
13g 11g
rA
27s
27g
26
22s
©D
28s
28
15f
25
24g
10g 23s 12g 15g
© A. L. Neill 81
THE BRAIN
Brain
Median view – midsagittal
This dissection halves the brain through the longitudinal sulcus
Moving rostrally from the most caudal gyrus – the lingual, cuneus,
precuneus, postcentral, paracentral, marginal (medial frontal gyrus) and
straight gyri (gyrus rectus) face into this sulcus from each CH.
ill
The pons, cerebellum, thalamus, optic chiasma and midbrain are
bisected. The pituitary is not, although it is midline.
1 Gyrus rectus – straight 17 Parieto-occipital sulcus
gyrus (of the frontal pole)
2 Optic structures = CN II
c = chiasma / n = nerve
r = radiation
Ne
18 Precuneus (parietal lobe)
19 Post-central gyrus
(parietal lobe)
20 Central sulcus
3 Pituitary gland
21 Paracentral gyrus =
. L.
4 IVth ventricle Precentral gyrus
5 Tuber cinereum 22 Medical frontal =
6 Mammillary body marginal gyrus
rA
7 Pons 23 Thalamus and

8 Olive intermediate body
(connecting the 2 sides)
9 Hindbrain
24 Fornix
10 Spinal canal
(from aqueduct) 25 Septum pellucidum
©D
11 Temporal lobe 26 Cingulum

(contralateral) 27 Minor gyri and sulci in
12 Cerebellum – vermis the frontal lobe
13 Pinal body + Great 28 Corpus callosum s =
cerebral vein splenium / r = rostrum /
g= genu
14 Lingual gyrus
(Occipital lobe) 29 Lamina terminalis
15 Calcarine sulcus
16 Cuneus (Occipital lobe)
82 © A. L. Neill
ill
21 22 23
20 28s 24 25
18
17
19
Ne 26
28g
27
16
. L.
28r
rA
29
2
15 27
14 11 3
7 5
13
12 6
©D
8
4
10 9
© A. L. Neill 83
THE BRAIN
Cerebrum – sections
Transverse section (guide) – coronal sections i-iv
i = at the level of the anterior commissure
ii = behind the anterior commissure
iii = through the mammillary bodies
ill
iv = through the thalamus
1 Longitudinal fissure dividing the 2 cerebral hemispheres

2 Corpus callosum g = genu s = splenium
3
4
5
Ne
Lateral ventricle ah = ant. horn / ph = post horn
Putamen (part of basal nuclei)
Globus pallidus
6 Capsules - i = internal / e = external
. L.
7 Thalamus - s = subthalamic nuclei / n = nuclear groups
8 Tela choroidea + choroid plexus
9 Fornix c = columns / x = crura
10 Claustrum
rA
11 Septum pellucida c = cavity / l = lamina / v = vein

12 Caudate nucleus
©D
i
ii
iii
iv
84 © A. L. Neill
1
2g
ill
3ah
11c
11L
12
9c
Ne 4
8 5
. L.
10
6i
rA
3ph
©D
9x 2s
© A. L. Neill 85
THE BRAIN
coronal
i = at the level of the anterior commissure
ii = behind the anterior commissure
1 Longitudinal fissure 20 Optic tract
dividing the 2 CH 21 Anterior commissure
ill
2 Corpus callosum 22 Corona radiata
g = genu s = splenium
23 Third ventricle
3 Lateral ventricle ah =ant.
Ne
24 Precentral gyrus
horn / ph = post horn
25 Temporal gyri
4 Putamen (part of
s = superior / m = medial
basal nuclei)
i = inferior
5 Globus pallidus
26 Amygdaloid complex
6 Capsules – i =internal /
27 Hippocampus
e = external
. L.
28 Fusiform gyrus
7 Thalamus -
s = subthalamic nuclei / 29 Parahippocampus (gyrus)
n = nuclear groups 30 Mammillary body
8 Tela choroidea + 31 Base of hypothalamus
rA
choroid plexus 32 Substantia nigra

9 Fornix c = columns / 33 Gyrus occitpitotemporalis
x = crura medialis
10 Claustrum
11 Septum pellucida c = cavity
©D
l = lamina / v = vein
12 Caudate nucleus
13 Cingulate sulcus i
ii
14 Longitudinal fasciculus iii
s = superior iv
15 Operculum
16 Lateral sulcus
17 Insula
18 Uncinate fasciculus
19 Collateral sulcus
86 © A. L. Neill

1
13
i 2
3 14s
22 6i
15
ill
4
Ne 9c
3 20
21
16
6e
. L.
17
10 19 18 5
ii 2
22
rA
14s
5
3
6i
©D
6e
20
10
23
3ph 11i,v
19
© A. L. Neill 87
THE BRAIN
coronal
iii = through the mammillary bodies
iv = through the thalamus
1 Longitudinal fissure 20 Optic tract
dividing the 2 CH 21 Anterior commissure
ill
2 Corpus callosum 22 Corona radiata
g = genu s = splenium
23 Third ventricle
3 Lateral ventricle ah =
Ne
24 Precentral gyrus
ant. horn / ph = post horn
25 Temporal gyri s = superior
4 Putamen (part of
m = medial / i = inferior
basal nuclei)
26 Amygdaloid complex
5 Globus pallidus
27 Hippocampus
6 Capsules – i = internal /
e = external 28 Fusiform gyrus
. L.
7 Thalamus - 29 Parahippocampus (gyrus)
s = subthalamic nuclei / 30 Mammillary body
n = nuclear groups 31 Base of hypothalamus
8 Tela choroidea +
rA
32 Substantia nigra
choroid plexus
33 Gyrus occitpitotemporalis
9 Fornix c = columns / medialis
x = crura
10 Claustrum
11 Septum pellucida c = cavity
©D
l = lamina / v = vein
12 Caudate nucleus
13 Cingulate sulcus
14 Longitudinal fasciculus ii i
iii
s = superior
iv
15 Operculum
16 Lateral sulcus
17 Insula
18 Uncinate fasciculus
19 Collateral sulcus
88 © A. L. Neill
1
3 24
iii 12
14s
6i
9 15
ill
4
Ne 23
20
25s
9c 30
. L.
7s 27 25m
10 5 26
29
25i
28
9
rA
22 2
iv 3
12
4
©D
7n
16
6i
8
32 31
7s
3ph 27 17
© A. L. Neill 89
THE BRAIN
Brain
sagittal section - off centre
This section shows the Corona Radiata with the fibres from the related
GM and N tracts projecting into it.
1 Olfactory CN I t = tract / a = trigone
2 Optic tract Corpus callosum g = genu / r = rostrum
ill
3 Crus Cerebri
4 Striae terminalis
Ne
5 pyramidal bundles in the Pons
6 Pyramid
7 Olive
8 Hindbrain / SC
9 Hippocampus w/in the Dentate gyrus
. L.
10 Cerebellum
11 Optic radiation –in the Corona Radiata
12 Superfical longitudinal fasciculus (of Corpus Callosum)
rA
13 Corona Radiata
14 Central sulcus
15 Internal capsule + medial wall of putamen –
(part of the corpus striatum)
16 Anterior commissure
©D
17 Orbital surface of the frontal lobe

18 Gyrus rectus / straight gyrus
90 © A. L. Neill
ill
14 15
13 16
11
12
Ne 17
. L.
rA
3 2 1t
18
4
1a
5
6
©D
10 9 7
8
© A. L. Neill 91
THE BRAIN
Brain – superior to Globus Pallidus

transverse section - viewing it from above
see also Cerebrum Sections transverse section (deeper
level at the mammillary bodies)
This slice through the brain shows the development of the internal GM
of the cerebrum: head of the caudate nucleus (16), the thalamus (13),
ill
the pulvinar (13p), striate body and its contents (5,6,7,9 & 14) and
projection fibres - the optic radiation (10) and tapetum (11).
2
3
4
Middle frontal gyrus
Ne
Corpus callosum g = genu / s= splenium
lateral ventricle a = anterior horn / p = posterior horn
5 Septum Pellucidum – cavity
6 External Capsule
. L.
7 Claustrum
8 Insula
9 Internal Capsule g = genu / p = posterior limb
rA
10 Optic radiation
11 Tapetum
12 junc of Posterio-occipital and Calcarine sulci
13 Thalamus (p= pulvinar)
©D
14 Lentiform nucleus p = putamen

15 fornix – columns
16 Caudate nucleus
17 Cingulum
18 Middle Cerebral artery
19 Calcarine Sulcus
20 Fimbria
92 © A. L. Neill
17 1 2
16 3g
ill
15 4a
14 5
Ne
9g
6
13 7
9p 18
. L.
rA
13p
©D
8
4p
9p
10
20
11
3s 1
12 19
© A. L. Neill 93
THE BRAIN
Anterior Commissure
coronal section – viewing it from the front
transverse section - viewing it from above
This is a major communication pathway b/n the 2 CH - anterior to the
columns of the fornix and connecting the 2 temporal lobes, olfactory
tracts and amygdaloid bodies. It is part of the neospinothalamic tract
ill
for pain, and is inferior to and smaller than the Corpus Callosum - 10X
larger. It has been implicated in gender studies because of its
increased size in homosexual men compared to heterosexual men
(34%) and heterosexual women (20%).
1 longitudinal fissure
2 Corpus callosum
g = genu / r = rostrum
3 caudate nucleus
Ne
17
18
19
septum pellucidum
globus pallidus
striae arteries
20 amygdaloid bodies
4 internal capsule 21 infundibulum
. L.
5 lentiform nucleus 22 root of the Optic N CN II
p = putamen
23 lateral ventricle
6 external capsule i =inferior horn
7 anterior commissure
rA
24 Anterior perforating
8 uncinate fasciculus – last substance
WM to mature in the human 25 pons
(part of the limbic system)
26 crus cerebri
9 inferior longitudinal fasciculus
27 lamina terminalis
= occipitotemporal fasciculus
©D
(continuous with 2g)

10 insula
28 subcallosal gyrus =
11 corona radiata –base of paraterminal gyrus
12 habenular nuclei (continuous with 27)
(part of the diencephalon)
13 pineal body /gland
14 thalamus
15 claustrum (connecting basal
nuclei – suspected receptors
of hallucogens LSD)
16 fornix – columns of
94 © A. L. Neill
2g
4 1
18 28
15 3
27
37 5
5p
19,24
19
ill
10
20
Ne
26 15
22 23
. L.
21 8
25
2g 1
rA
28, 2r
17
3
16
5 4
©D
6 15
7
10
8
9 10 12 13 14
11
© A. L. Neill 95
THE BRAIN
Basal Ganglia = Basal Nuclei

Coronal plane - looking in from the anterior
Sagittal - looking in from the side
The Basal ganglia are connected groups of GM deep nuclei - in the brain
in the diencephalic region - around the thalamus and hypothalamus.
Named primarily because of their relationship to the lateral and 3rd
ill
ventricles they act as further modifiers b/n the thalamus and the CC.
They are the beginning of the change of the GM from an outer rim in
the CC to the central core it becomes in the SC. They lie in the 3
divisions of the thalamic regions.
A = Epithalamus
C = Thalamus Ne
C = Hypothalamus (rostral) + Subthalamus (caudal)
1 Corpus callosum 15 Infundibulum (of the
pituitary gland)
. L.
2 Caudate nucleus
3 Lateral ventricle 16 Third ventricle
4 Choroid plexus 17 Interthalamic adhesion
5 Thalamus 18 Paraventricular nucei
rA
6 Putamen 19 Septum pellicidum

7 Globus pallidus 20 Fornix
8 Zona incerta 21 Transverse cerebral
fissure
6+ 7+ 8 = Lentiform nucleus
22 Periventricular nuclei
©D
9 Supraorbital nucleus
23 Mammillary nuclei
10 Optic tract + chiasma
24 Hypothalamic nuclei
11 Subthalamic nuclei =
nucleus of Luys 25 Dorsomedial nuclei
12 Ventromedial nuclei of 26 Pineal body
the hypothalamus
13 Nucleus tuberus
14 Pituitary gland=Hypophysis
a = anterior lobe adenohy-
pophysis p = posterior lobe
neurohypophysis
96 © A. L. Neill
1 19
21 20
2
A
3
ill
B
4 16
6
5
18
7
8 10 11
12
Ne 16
17
15
13
. L.
14
A
21 1
rA
B
20
19
26
©D
25
18
9
C
22
10
24
22 13 15
23 12 14a
14p
© A. L. Neill 97
???
Brain Stem = Midbrain + Pons +

Medulla Oblongata
Anterior surface
Lateral view
All CNs except CN I, IV & XI arise from the anterior surface of the brainstem.
The SC begins at the inferior end of the Brainstem, and cerebrum
ill
arises superiorly.
1-12 labels the CNs - subcategories indicate the parts thereof
Ne
1 CN I - b= bulb / f = fibres dropping through the sup.
concha of the nose
/ l = lateral striae / t = tract /  = trigone
2 CN II - c= chiasma or crossing (50%of fibres cross to the
other CH) / n = nerve / t = tract .
3 CN III
. L.
4 CN I
5 CN V
6 CN VI
7 CN VII + nervus intermedius
rA
of Facial N
8 CN VIII –both parts
9 CN IX travels with CN X
10 CN X
©D
11 CN XI arises from the SC

12 CN XII arises superior to CN XI but leaves the
cranium inferiorly
13 Crus cerebri – part of the midbrain
14 Geniculate body l = lateral / m = medial
15 Pulvinar (posterior nuclei in the Thalamus)
16 Middle cerebellar peduncle
17 Inferior cerebellar peduncle
18 C1 ventral roots
98 © A. L. Neill
31 32
1b
30
ill
1t
28
29
Ne 2n
1L
2c
27
2t
. L.
26 13
25 14
rA
3
4 15
24
5
23
©D
16
7
8
22
17
9,10 12
18
19
11
20
© A. L. Neill
21 99
THE BRAIN
Brain Stem = Midbrain + Pons +

Medulla Oblongata Cont
Anterior surface
Lateral view
19 Pyramid
20 Decussation of pyramids
ill
21 SC
22 Cerebellar flocculus
Ne
23 Olive crossed by ant. ext. arc fibres
24 Pons
25 Perforating substances a= anterior / p= posterior
26 Mammillary body
27 Tuber cinerum
. L.
28 Infundibulum (of pituitary gland)
29 Ant. Perforating substance
30 Inf. surface of frontal lobe
31 Frontal pole
rA
33 Caudate nucleus
34 Corona radiata (base of)
35 Lateral leminiscus
36 Superior cerebellar peduncle
©D
37 Arbor vitae (of the cerebellum)

38 Cuneate tubercle
39 Gracile tubercle
40 Spinocerebellar fasciculus a= anterior / p = posterior
41 Olive tract = circumolivary fasiculus
42 Gyrus rectus = straight gyrus
44 Striate anastomoses
100 © A. L. Neill
33 34
13
44
ill
43
Ne
14L
15
29
14m
1 35
. L.
4
42
2 26 36
28 3
rA
5 16
24
7,8
19
17
©D
23
41 37
2
39 38
40p 5t
40a
© A. L. Neill 101
THE BRAIN
Brainstem - arterial supply

Lateral view
1 pontine cerebral art.
2 inferior colliculus
3 cerebral aqueduct
ill
4 inferior quadrigeminal art.
5 superior vermis of cerebellum
6 superior cerebellar art.
7 dentate gyrus
Ne
8 anterior inferior cerebellar art.
9 cerebellar flocculus and nodulus
10 4th ventricle
11 posterior inferior cerebellar art.
. L.
12 central canal
13 posterior spinal art.
14 veretbral art. (paired vessels)
rA
15 anterior spinal art.

16 paramedian art.
17 cuneate and gracile nuclei
18 inferior olivary nuclei
©D
19 pons
20 basilar art (unpaired – fusion of the vertebrals)
21 posterior communicating art. (part of the circle of Willis)
102 © A. L. Neill
4 2
ill
5 3
21
Ne 16
20
. L.
16
6
rA
20
7
9 8 19
10
16
11
©D
18
17
12
16
13
14 15
© A. L. Neill 103
THE BRAIN
Cerebral arteries
The arteries supplying the cerebrum consist of 3 paired branches
arising from the arterial circle or Circle of Willis: the anterior, middle
and posterior cerebral arteries.
Their supply corresponds roughly although not absolutely with the
cerebral lobes. There are no branches between these arteries, in
ill
contrast to the extensive anastomising in the venous system and if
blocked, the distal tissue generally dies.
The brain is very sensitive to any deprivation of oxygen and will die of
deprived for oxygen completely for longer than 1 min in normal
circumstances.
Ne
Lowering the temperature, releasing intracerebral pressure, rapid
dissolving of the intravascular blockage (usually a clot) all help to
reduce the permanent damage of such an event. Brain tissue has
limited capacity to repair or regenerate its tissue.
. L.
A = cerebral tissue supplied by the anterior cerebral artery
and its branches
M = cerebral tissue supplied by the middle cerebral artery
and its branches
rA
P = cerebral tissue supplied by the posterior cerebral artery

and its branches
1 Anterior cerebral artery b = branches
2 Anterior communicating artery
3 Middle cerebral artery b = branches
©D
4 Posterior cerebral artery b = branches /

c = calcarine branch / o = occipital branch
5 Brainstem
6 Corpus callosum g = genu / s = splenium
7 Anterior perforating substance
8 Thalamus
104 © A. L. Neill
4b
3b
ill
2
46s 4 1 1b
4b
Ne
5
9
. L.
rA
8
1
1b
©D
6s
6g
4o
1
4c 4b 4t 2
4
© A. L. Neill 105
THE BRAIN
Brodmann’s Maps of the Cerebral Cortex

Lateral
Mid-Sagittal – median
Inferior of the frontal lobe
Brodmann areas were originally defined and numbered by
Korbinian Brodmann in 1909 based on the organization
ill
cytoarchitecture and histology of Ns in the CC. The numbers
start from the central sulcus and move outwards. Many of the
areas Brodmann defined based solely on their neuronal
Ne
organization have been correlated closely to diverse cortical
functions, but they donot always correlate with the macroscopic
anantomy of the cerebral cortex nor do all the areas have a
functional correlation as seen in the following table. There has
been much discussion about the boundaries and their
correlations. This is the most widely accepted mapping.
. L.
FRONTAL LOBE
OCCIPITAL LOBE
PARIETAL LOBE
rA
TEMPORAL LOBE
©D
106 © A. L. Neill
ill
Ne
. L.
rA
©D
© A. L. Neill 107
108
Brodmann’s areas – summary
Area Anatomical location Name Function Pathology
BRAIN IMAGES
312 postcentral gyrus Primary Somatosensory Cortex (rostral to caudal Primary body sensation TOUCH Agraphthesisa Astereognosia
3, 1, 2) – sensory Homunculus representation: Homunculus pattern Proprioception Light touch
legs + trunk fold over midline; arms + hands
(most tissue) are along the middle; face (most
tissue to the lips) near bottom
4 precentral gyrus mainly Primary Motor Cortex - motor homunculus 10 motor cortex = guenon MOVEMENT Paralysis Aphasia
©D
5 Superior parietal lobe Somatosensory Association Cortex Somatosensory processing cortex
6 Superior frontal gyrus Pre-Motor and Supplementary Motor Cortex 20motor cortex / supplementary motor
rA
= 20 motor cortex cortex may contribute to planning of
complex coordinated movements
7 Somatosensory association Somatosensory Association Cortex involved in locating objects in space; vision
. L.
cortex + proprioception, visuo-motor coordination
e.g. reaching to grasp an object
8 Anterior to premotor cortex Frontal eye fields Dorsolateral prefrontal Conscious control of eye movements Tonic deviation to the side of the
Ne
cortex Activated in uncertainty and hope injury

9, 46 Parts of basal ganglia, caudate Dorsolateral prefrontal cortex Last areas of sustaining attention and “working “dysexecutive syndrome” Lesions
ill
nucleus, hippocampus, thalamus the brain to myelinate memory”, executive decisions” cause difficulty in inhibiting responses
© A. L. Neill
109
10 postcentral gyrus Most rostral Anterior prefrontal, cortex Frontopolar area Executive functions planning and Agraphthesisa Astereognosia
part of superior and middle insertion of old plans into new ones Proprioception Light touch
frontal gyri
©D
11 orbital and rectus gyri, plus Orbitofrontal area involved in planning, reasoning, and Inability to change original learnt
part of the rostral part of the decision making. Perhaps the only patterns or behaviours
superior frontal gyrus cortical constraint of the hypothalamus.
rA
12 Area b/n superior frontal gyrus Orbitofrontal area (used to be part of BA 11)
and inferior rostral gyrus
13,14 Insular cortex
. L.
15 Anterior Temporal Lobe
16
Ne
17 10 Visual Cortex (V1) highly specialized for processing

information about static and moving objects
ill
and is excellent in pattern recognition
18,19 bulk of the Occipital lobe. 20 and 30 Visual Cortex (V2, V3) 2 areas involved in feature-extraction,
shape recognition, & visual attention.
© A. L. Neill
BRAIN IMAGES
110
CT IMAGING
0
20 Inferior Temporal gyrus 3 Visual cortex (V3) high-level visual processes and recognition
0
21 Middle Temporal gyrus 3 Visual cortex (V3) Language recognition and visual
+20 auditory cortex association with sounds mainly L side
22 Superior Temporal Gyrus 20 auditory cortex L side in generation and understanding
30 sensory cortex of words. R side, melody, pitch, and
©D
-includes Wernicke's area in its posterior sound intensity. Feedback with
movement of body in music
23 Ventral posterior cingulate cortex
rA
24 Ventral anterior cingulate cortex motivation, will
25 Subgenual cortex
. L.
26 Ectosplenial area
Ne
27 Piriform cortex
28 Posterior Entorhinal Cortex

ill
29 Retrosplenial cingulate cortex
© A. L. Neill
111
30 Part of cingulate cortex
31 Dorsal Posterior cingulate cortex
©D
32 Dorsal Anterior cingulate cortex
33 Part of anteriorcingulate cortex
34 part of parahippocampal gyrus Anterior Entorhinal Cortex
rA
35 part of parahippocampal gyrus Perirhinal cortex
36 part of parahippocampal gyrus Parahippocampal cortex
. L.
37 Fusiform gyrus 20 visual cortex
38 Most of the rostral part of Temporopolar area important area in self representation,
Ne
the superior and middle semantic L + autobiographic R

temporal gyri
ill
39 Angular gyrus 30 sensory cortex part of Wernicke's area L reading, R picture drawing
0
40 Supramarginal gyrus 3 sensory cortex Supramarginal gyrus part
of Wernicke's area
© A. L. Neill
CT IMAGING
112
CT IMAGING
0 0
41,42 1 2 Auditory association Cortex conscious awareness of sound
43 b/n Insula and post/precentral gyrus Subcentral area
44 pars opercularis part of Broca's area on L hemisphere Formation of speech
0
45 pars triangularis 3 motor cortex
©D
part of Broca's area on L hemisphere
46 30 motor cortex Dorsolateral prefrontal cortex
47 Inferior prefrontal gyrus 30 motor cortex involved in syntactical processing
rA
48 small part of the medial surface Retrosubicular area
of the temporal lobe
. L.
49
50
Ne
51
52 at the junction of the temporal Parainsular area
ill
lobe and the insula
© A. L. Neill
HIGHER CEREBRAL FUNCTION assessment

Dominant CH Disorders
Note L hemisphere is
COGNITIVE SKILLS tested Dominant in R-handed
People
language pattern dysphasia receptive /
ill
hesitant expressive
fluent
can simple orders be followed receptive dysphasia
hold up your arms!
Ne
can simple objects be named – nominal dysphasia
what is this? (a ball)
can the patient read words correctly ? dyslexia
can the patient write words correctly ? dysgraphia
can the patient calculate simple tests ? dyscalculia
can the patient pick the object asked in agroup of agnosia
objects?
. L.
can the patient find their way around their geographia agnosia
surroundings ?
can the patient dress them selves ? dressing apraxia
can the patient draw shapes ? constructional apraxia
please draw a square / circle / clockface
rA
MEMORY TESTED
can the patient copy a beat with their fingers? immediate memory loss
can the patient describe their illness and last recent memory loss
meal ?
can the patient remember their recent past remote memory loss
before the illness ?
©D
can the patient remember the items on a tray visual memory loss
after it is removed ?
set small problems / ask

REASONING & PROBLEM SOLVING about ability to receive the
right change
anxious / depressed
flat / apathetic /
EMOTIONAL STATE inappropriate
disinhibited / slow in
speech or movement c
113 © A. L. Neill
THE BRAIN
Cerebrum - Major Anatomy

Lateral and Superior
CEREBRUM – covered in GM with 4 major lobes, 4 major lobes of the
Brain and a covered area of GM - the Insula or 5th lobe
1 FRONTAL LOBE
2 PARIETAL LOBE
ill
3 OCCIPITAL LOBE
4 TEMPORAL LOBE
5 INSULA
Ne
Separated by major fissures or sulci
A central sulcus = Rolandic fissure b/n the frontal and parietal lobes
B parieto-occipital sulcus
C preoccipital notch
D lateral sulcus = Sylvian fissure b/n the temporal and the frontal
+parietal lobes
. L.
E stem of the lateral sulcus
L longitudinal suclus = longitudinal fissure b/n the R and L CH
further subdivided w/n the lobes by minor sulci
j lunate sulcus
rA
h transverse occipital sulcus

i inferior temporal sulcus
l intra parietal sulcus
k associated rami of the lateral sulcus
GM either side of the lateral fissure = Opercula, overlies the covered
GM of the brain = Insula = Island of Reil
©D
g = gyrus bulge in the brain

s = sulcus / fissure if large = infolded section b/n the gyri
1Ag pre-central gyrus MOTOR
2Ag post central gyrus SENSORY
2Ig inferior parietal gyrus (lobule)
2Sg superior parietal gyrus (lobule)
1Sg superior frontal gyrus
1Fg mid frontal gyrus
1Ig inferior frontal gyrus 4Ig inferior temporal gyrus
4Dg superior temporal gyrus 4Mg mid temporal gyrus
114 © A. L. Neill
A 1Ig 1Fg
2Sg
2Ig 1Sg
l
B
ill
h
Ne E
k
j C 4Ds 4Dg D
. L.
L
1Sg
1Mg
1Ss 1Ig
rA
1Ms 1Ig
1As
A 1Ag
©D
A
2Ag
D
2As
2Ig
4Dg D
4Mg 2Dg
2Sg
3
h j
© A. L. Neill B 115
THE BRAIN
Cerebrum – Insula and Operculum

Lateral
Most of the GM of the cerebrum is superficial and divided into 4 lobes
named according to the bones which overlie them - but a “5th” lobe is
buried deep to the Lateral fissure - the Insula (island) the GM overlying
this Insula GM is the Operculum
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1 Operculum -(insula lying deep to this GM) – partially in
the frontal, parietal and temporal lobes
2 Insula (operculum cutaway) showing fibres of the corona
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radiate going to the GM on the surface
See website for more details on the Cerebrum and Cerebellum.

. L.
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116 © A. L. Neill
Operculum
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. L.
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Insula
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© A. L. Neill 117
THE BRAIN
Cerebrum
Inferior view - Cerebellum removed
CEREBRUM – a highly folded cap of neural tissue with the outer N cells
(GM), sitting in the anterior and middle cranial fossae. Arranged into 4
major lobes on the surface, the cerebrum is responsible for most of the
“executive” decisions of the body and mind.
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Many of the CNs can be seen emerging from the brainstem inserted
into the undersurface concavity of the cerebrum, and continuing on to
become the SC.
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1 Olfactory bulb and tract – CN I
2 Optic nerve, chiasma and tract CN II
3 Stem of the lateral sulcus
4 Collateral sulci
5 Preoccipital notch
. L.
6 Occipito-temporal sulcus
7 Lunate sulcus
8 Occiptial pole
9 Branches of the occipital sulcus
rA
10 Frontal pole (of frontal lobe)

11 Gyrus rectus = straight gyrus
12 Orbital sulci
13 Parahippocampus
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14 Gyrus occipitotemporalis medialis

15 Lingual gyrus
16 Cingulum
17 Longitudinal Sulcus
18 Cerebral aqueduct + periductal GM
19 Crus cerebris
20 Mammillary body
21 Infundibulum ( of the pituitary)
22 Uncus
118 © A. L. Neill
17 10
11
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21 12
22 1
19
20
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2
4
. L.
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18 5
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23 14
6
16 7
15 9
17
© A. L. Neill 119
THE BRAIN
Cerebellum – Little Brain

views from the back and side – posterio-lateral
in the middle through the 4th ventricle – mid-sagittal
median plane
(see also Cerebrum outer surfaces posterior)
Responsible for most “unconscious” motor movements: coordination,
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posture and balancing of the motor system, affected by sedatives and
alcohol. Lying under the Occipital lobes the cerebellum is made up of 2
small hemispheres separated by a small wormlike bridge the Vermis,
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with small transverse folds = folia as opposed to the large folds =
sulci + gyri of the cerebrum, and 3 lobes as opposed to the 5 (4+1) of
the cerebrum.
1 Vermis superior, middle 15 Middle cerebellar
and inferior sections peduncles
2 Anterior lobe (small) 16 Superio cerebellar
. L.
3 Primary fissure peduncles
4 Posterior lobe (largest 17 Fourth ventricle
lobe) 18 Crus cerebri
rA
5 Folia - fine folds of the 19 Cerebral aqueduct

cerebellum 20 CN V
6 SC 21 Flocculus
7 Flocculonodular lobe 22 Secondary fissure
(= 21 + 24)
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23 Posterior notch
8 Medulla oblongata
24 Central nodule
9 Pons
25 Folds of the vermis
10 Arbor vitae of the (cut through)
cerebellum
26 Uvula – inferior process
11 Cerebellar cortex of the vermis
12 Dentate nuclei 27 Cerebellar tonsil
13 Choroid plexus 28 Vallecular cerebella
14 Inferior cerebellar 29 Posterior median Sulcus
peduncles of the SC
120 © A. L. Neill
1
2
3
4
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Ne 8
9
5
. L.
6
7
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17
2
18
10
9
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11
16
15
5
14
12
7 8
13
© A. L. Neill 121
THE BRAIN
Cerebellum – Little Brain

views from the back and side – posterio-lateral
in the middle through the 4th ventricle – mid-sagittal
median plane (see also Cerebrum outer surfaces posterior)
Responsible for most “unconscious” motor movements: coordination,
posture and balancing of the motor system, affected by sedatives and
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alcohol. Lying under the Occipital lobes the cerebellum is made up of 2
small hemispheres separated by a small wormlike bridge the Vermis, with
small transverse folds = folia as opposed to the large folds = |sulci + gyri
of the cerebrum, and 3 lobes as opposed to the 5 (4+1) of the cerebrum.
1 Vermis superior, middle
and inferior sections
2 Anterior lobe (small)
3 Primary fissure
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17
18
19
20
Fourth ventricle
Crus cerebri
Cerebral aqueduct
CN V
4 Posterior lobe 21 Flocculus
. L.
(largest lobe)
22 Secondary fissure
5 Folia - fine folds of
23 Posterior notch
the cerebellum
24 Central nodule
6 SC
rA
25 Folds of the vermis

7 Flocculonodular lobe
(cut through)
(= 21 + 24)
26 Uvula – inferior process
8 Medulla oblongata
of the vermis
9 Pons
27 Cerebellar tonsil
10 Arbor vitae of the
©D
28 Vallecular cerebella
cerebellum
29 Posterior median
11 Cerebellar cortex
Sulcus of the SC
12 Dentate nuclei
13 Choroid plexus
14 Inferior cerebellar
peduncles
15 Middle cerebellar
peduncles
16 Superio cerebellar
peduncles
122 © A. L. Neill
18
19 24
20
1
21
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3
2
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. L.
4
22 23
5
1
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12 25
27 26
3
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29
28
6
© A. L. Neill 123
THE BRAIN
Corpus Callosum
Median view - midsagittal
Superior views - Upper image deep transverse - level of insula
- Lower image supf. transverse - level of central sulcus
This decussation of fibres is the main form of communication b/n the 2
CH and has 3 parts, other fibres linking parts of the CC are associated
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with this structure.
A = genu or knee
B = body or trunk
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C = splenium or tail
A + B + C = corpus callosum = 11
1 Thalamus i = 14 Pituitary i = infundibulum

intermediate body / a= anterior / p= posterior
m = medullary striae 15 Cingulum – f = floor of
. L.
2 Optic structures = CN II the cingulum suclus
c = chiasma / n = nerve / 16 Forceps M = major /
r = radiation m = minor
3 CN III 17 Superior longitudinal
rA
4 IVth ventricle fascicles o = occipital

5 Pons part / t = temporal part
6 Midbrain 18 Short association fibres
7 Pineal body 19 Central sulcus
20 Tapetum
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8 Commissures a = anterior
p = posterior 21 Floor of Calcaneal sulcus
9 Fornix c = column / 22 Inferior longitudinal
X = crus fascicles
10 Septum pellucidum 23 Roof of the inferior horn
11 Corpus callosum of the lateral ventricles
L = longitudinal striae / 24 Insula
r = rostrum 25 Lentiform nucleus
12 Interventricular foramen 26 Corona radiata
13 Lamina terminalis b = base of
124 © A. L. Neill
B 10
1im 12
9x 9c
8p
C
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A
8p
8a 11r
6
4
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14i
14a
. L.
3 8,9 14p
19 17t
18 17o
17
rA
11L 2r
15m
2o
11a 16m
15f 11c
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23 17 24 25
22
26
20
11+26
16m
21 15
© A. L. Neill 125
THE BRAIN
Diencephalon
Thalamus + Epithalamus + Hypothalamus = Diencephalon
Superolateral, Mid sagittal
The Thalamus (A) is a bilobed oval mass of GM ~ 3cm long - the major
sensory relay station - coordinating sensory imput to the CC. The
Hypothalamus (C) is the major control of the ANS. The Epithalamus (B),
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which includes the pineal gland (19) has a role in the body clock and
awareness of location. These 3 structures develop from the
Diencephalon in the embryonic brain. The Thalamus lies immediately
inferior to the Corpus Callosum (6) and CC (7) in the 3rd ventricle
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coordinating information. It has a number of nuclei (1-5) which relate
to the CC lobes that are immediately adjacent and feeds information to
the Hypothalamus (C) where, via the hypothalamic nuclei, (12-18)
information has direct effects on the ANS, pituitary gland actions and
the sense of smell.
A Thalamus
. L.
B Epithalamus
C Hypothalamus
D Pituitary gland = Hypophysis
D1 posterior pituitary = neurohypophysis
rA
D2 anterior pituitary = adenohypophysis

D3 infundibulum = stalk of pituitary
1 Anterior thalamic 10 Brain stem and cerebral
nuclei canal b/n the 3rd and
2 Medial thalamic nuclei 4th ventricles
©D
with Intermediate 11 Supraoptic nuclei

Mass in b/n 12 Arcuate nuclei
3 Lateral thalamic nuclei 13 Ventromedical nuclei
4 Internal medullary laminae 14 Mammillary bodies
5 Geniculate bodies – 15 Dorsomedial nuclei
lateral and medial 16 Posterior hypothalamic
6 Corpus Callosum nuclei
7 Frontal lobe of the CC 17 Paraventricular nuclei
8 Optic N = CN II 18 Lateral preoptic nuclei
9 Optic Chaisma 19 Pineal gland
126 © A. L. Neill
1
3
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A 2
4
5 Ne 6
2
. L.
18
17
rA
19
16 C
15
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7
14 13 12
11 8
B D3
9
D1 D2
© A. L. Neill 127
THE BRAIN
Fornix = arch
Lateral view – in situ
Lateral view isolated
The Fornix is an arch of fibres carrying signals from the Hippocampus
to the mammillary bodies and anterior nuclei of the thalamus and
septal nuclei. Beginning in the hippocampus the fimbria converge as
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the crura of the fornix joining in the midline with fibres crossing from
one side of the fornix body to the other via the fornix commissure.
Running along the inferior edge of the Septum Pellucidum, the fornix
redivides just before the anterior commissure, forming the columns of
the fornix.
1
2
Cingluate gyrus
Corpus callosum
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3 Suprcallosal gyrus
. L.
4 Fornix
b = body, c = columns,
f = fimbria, l = crura,
x = commissure
rA
5 Amygdala & amygdaloid bodies

6 Lateral sulcus
7 Hippocampus f = fimbria
8 Mammillary bodies
9 Nucleus accumbens + septal nuclei
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128 © A. L. Neill
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1
2
3
8
Ne 9
7 5
. L.
9
10
rA
4b 4x
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4l 4c
7f 8
7 5
© A. L. Neill 129
THE BRAIN
Language centres
cortical centres of verbal expression
The frontal lobe contains zones for expressive language, hence motor
aphasia results when damaged, difficulty speaking ± writing. The
temporo-parieto-occipital regions contain zones for receptive language
interpretation, hence sensory aphasia results with damage, difficulty
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understanding ± reading. Traditionally 2 areas are described Broca’s
and Wernicke’s both lying in the peri-Sylvian area, around the lateral
sulcus, and more highly developed in the dominant CH. This is the
LEFT CH (for R handed people). However the 2 functions are not
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exclusive to these areas. Brodmann areas 22, 41, 42, 44 & 45 are all
involved in language production and comprehension. The exact
boundaries of these areas vary, and their precise roles are interrelated.
B – Broca’s area ~ inferior-frontal gyrus (pars triangularis + pars
opercularis) - for speech + writing
W – Wernicke’s area ~ superior temporal gyrus + auditory cortex -
. L.
for comprehension and reading
Language processing is a global brain activity and apart form the listed
areas other Brodmann areas associated with aspects of language
activities are:
rA
4 hand and finger movements, tone and sound formation

7 calculation
18 recognition of objects
19 recognition of colours
21 auditory attention, understanding of sounds with respect to music
©D
22 understanding of sound sequences

37 understanding of numbers
39 recognition of numbers
40 writing
41/42 understanding sequences of sounds + speech
44 formation of phrases and sentences
45 articulation of sentences
46 articulation of names
APHASIA – acquired deficiency in language processing incorporating
both production and comprehension, due to brain damage.
130 © A. L. Neill
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W B
3 4 6
2
8
5 1
7
46
44
. L.
19 40
39 45
43 47
42 41
18
rA
22
21
38
37
19
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© A. L. Neill 131
THE BRAIN
Limbic System
Lateral
Sagittal
Definition – Limbus Gk = limb -It is the 2nd layer of “Brain structures”
evolution overlaying the Brainstem – the 1st layer – and underlying the
CC and providing substantial interconnections b/n them. Allowing for
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bodily/physiological response to emotional imput and visa versa
overriding of the autonomic response by the CC. It contains several
interconnected structures, and connects extensively with the
Rhinencephalon or “Smelling brain” and the Diencephalon which
contains the Thalamic structures.
1
2
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Cerebral Cortex = CC– higher thinking centres
Limbic system -
3 Brainstem -
. L.
4 Amygdala – associated with fear and aggression
connecting mainly to Rhinencephalon
5 Hippocampus – associated with memory and learning
6 Hypothalamus – associated with body temp regulation
rA
and ANS
7 Cingulate gyrus – main connection with the superior CC
8 Corpus Callosum – major decussation joining the
R and L CH
9 Anterior thalamic nuclei
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10 Olfactory bulb and tract (CNI)
132 © A. L. Neill
1
2
3
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. L.
6
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8
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10
9
5 4
© A. L. Neill 133
THE BRAIN
Midbrain + Hindbrain
Anterior view – looking at the front of the midbrain –
inferior surface of the brain
b/n the forebrain cerebrum and the SC
1 Septum pellucidum
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2 Corpus callosum
3 Caudate nucleus
4 Globus pallidus
5
6
7
8
Thalamus
Putamen
Amygdala
Hippocampus
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9 SC
. L.
10 Medulla oblongata
11 Pons
12 Fornix
rA
13 Crus cerebri
14 Mammillary bodies
15 CC
16 Lateral ventricle
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134 © A. L. Neill
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16 2
Ne
15
3
12 4
5
6
. L.
14
13
7
rA
11
12 8
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10
© A. L. Neill 135
THE BRAIN
Septum Pellucidum = Septum lucidum

Median view – midsagittal
This thin triangular 2 layered vertical membrane of GM and WM
separates the lateral ventricles of the brain and the CH. It lies beneath
the corpus callosum and attaches to the superior surface of the fornix.
Absence of this membrane results in hypothalamic, visual and IQ
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disorders as well as hypopituitarism.
1 Olfactory b = bulb t = tract
2 Medial root 2+ 3 = olfactory striae
3
4
5
Lateral root
Paraolfactory area
Subcallosal gyrus and sulcus
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. L.
7 Hippocampal complex
8 Band of Giacomini = tail of the Dentate gyrus
9 Uncus = Parahippocampal gyrus
10 Septum pellucidum
rA
11 Corpus callosum
12 Supracallosal gyrus = Indusium griseum contains the
medial and lateral longitudinal fibres (of the corpus
callosum) continuous superiorly with cingulate gyrus
©D
13 Fornix b = body / c = columns

14 Fimbriae of the hippocampal complex
15 Dentate gyrus of the hippocampus
16 Amygdaloid bodies
17 Mammilary bodies
18 Hippocampal complex
19 Anterior commissures
136 © A. L. Neill
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13b 13c 19
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14 12
11
10
. L.
5
15 4
2 1t
16
rA
17
9 3
18
8 6 1b
7
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© A. L. Neill 137
THE BRAIN
The Thalamus - Part of the Diencephalon

Superior view- looking from above
Major relay station of the brain – bilobed oval body made up of diverse
number of interconnecting nuclei grouped together.
Each thalamus is about 3X4X3cm.
All sensory imput via THALAMOFUGAL fibres pass into the thalamus
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before going to the cerebral cortex via THALAMOPETAL fibres, except
the olfactory imput; further refinement of cortico–cortical
communication is also via the thalamus. Nuclei (ganglia) of GM in the
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region also communicate extensively with the thalamic nuclei.
nuclear group abbrev. / alt name

1 anterior nuclear gp AN
2 ventral anterior gp VA
3 ventral lateral gp VL
. L.
4 ventral intermediate gp VI
5L ventral posterio-lateral gp VPL
5m ventral posterior-medial gp VPM
rA
6 5 + 4 + accessory semilunar gp VP
= ventral posterior gp
7L lateral geniculate body LGB
7m medial geniculate body MGB
8 pulvinar
©D
9 internal medullary lamina (band of contains several nuclei w/in these fibres
myelinated fibres)
10 dorsomedial gp = mediodorsal gp
11 lateral posterior gp LP
12 medial gp
13 lateral dorsal gp LD
14 intrathalamic adhesion central thalamic body
15 intralaminar gp – w/in the lamina centromedian nuc. CM is the largest
*damaged in Kosikoff’s syndrome, excessive alcohol consumption- no short
term memory and confabulation
138 © A. L. Neill
13 15
11
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10
8
12
9 Ne 14 1
. L.
rA
7m
7c 2
5L 5m 3
4
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© A. L. Neill 139
THE BRAIN
The Thalamus - Destinations

Relations to the CC functional description
A1= 1o auditory area / A2 = 2o auditory area / B = Broca’s area
E = frontal visual fields / G = gustatory area / M1 = 1o motor cortex /
PM = premotor cortex / S1 = 1o sensory cortex / S2 = sensory
association area / V1 = 10 visual cortex / V2 = 2o visual cortex / V3 30
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visual cortex (visual association cortex)
nuclear group destination of.. / output
1 anterior nuclear gp cingulate gyrus - emotion, limbic system
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2 ventral anterior gp motor cortex initiate actions, resting muscle tone +
insula cortex, globus pallidus
3 ventral lateral gp motor + premotor cortex motor activity coordination
4 ventral intermediate gp cerebral cortex areas 4,6 from cerebellum motor
activity coordination
5L ventral posterio-lateral gp somatosensory cortex somatic sensation of body -
. L.
pain and temp
5m ventral posterior-medial gp somatosensory cortex (post central gyrus areas 3,1,2)
somatic sensation of face and jaw – pain and temp + taste.
6 5 + 4 + accessory semilunar + gustatory cortex taste.
gp= ventral posterior gp
rA
7L lateral geniculate body visual cortex vision

7m medial geniculate body auditory cortex hearing
8 pulvinar posterior association cortex sensory information
integration partic audition & vision
9 internal medullary lamina concerned with emotional arousal and control diffuse
©D
(band of myelinated fibres) cortical projection

10 dorsomedial gp prefrontal cortex* - executive function, social skills
affection, memory
11 lateral posterior gp parietal lobe, cingulate gyri, - sensory information integration
12 medial gp hypothalamus , frontal cortex ANS integration
13 lateral dorsal gp cingulate gyrus - emotional expression
14 intrathalamic adhesion communicates with other thalamus
15 intralaminar gp – w/in the frontal cortex + basal nuclei - arousal
lamina largest – motor control
*damaged in Kosikoff’s syndrome, excessive alcohol consumption- no short
term memory and confabulation
140 © A. L. Neill

1 7L 6 5L
5m
4
3
8
9 2
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10
11
12
13
14 Ne 15
1
5ml 11 2,3,4,9
9,11 M1 3
S1
. L.
S2 PM 2
E
71, 8
V3
9,10,
V2
rA
12,13,
71, 8 15
B
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V1
71 9,4,2
G
A2 A1 6
7m 8 7m 8
9
9,10
1,9,11,13
2
7L,8 12,15
12
4
© A. L. Neill 141
THE BRAIN
Ventricles
Lateral view – looking in at the side of the brain
Coronal view schema – looking at the front of the ventricles
The brain and SC sit in a closed cavity the Skull and Vertebral cavity
surrounded by CSF – a filtered form of blood plasma from the BBB -
which connects with 4 internal cavities and the spinal canal. The 4
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cavities or VENTRICLES produce the CSF which circulates around the
brain and SC, cushioning and nourishing the neural tissue.
3 ventricles lie in the cerebrum and the 4th is in the brainstem
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continuous with the SC inferiorly and the subarachnoid space via 3
openings in the roof of the 4th ventricle, 2 lateral and 1 posterior.
1 frontal lobe
2a anterior horn of the lateral ventricle(s)
2b body of the lateral ventricle(s)
. L.
2i inferior horn of the lateral ventricle(s)
2p posterior horn of the lateral ventricle(s)
3 3rd ventricle
4 4th ventricle
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5 cerebral aqueduct
6 lateral recess(es) – foramen of Luschka
7 median aperture and foramen of Magendie
8 SC
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9 hindbrain
10 brainstem / pons
11 interventricular foramen
12 parietal lobe
13 occipital lobe
14 cerebellum
15 spinal canal
See website for more details on the Ventricles Superior view

142 © A. L. Neill

12
2b
2a
1
2p
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13
2i
5
4
14
6
Ne 10
3
11
7 9
. L.
8
1
2a
2b
rA
2a
2
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3
11
2i
5
2i
4 14
7
7
15 9 10
8
© A. L. Neill 143
THE BRAIN
Ventricles – relations
Superior view - looking down from above
The ventricles have intimate relations with the Choroid plexus and its
parts: Tela Choroidea and Glomus Choroideum. CSF produced by
these tissues flows through the ventricles, the spinal canal and out
around the brain and spinal cord. Any blockage results in swelling and
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crushing of the tissues nearby, hence they are most vulnerable to
cerebral oedema.
Relations
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1 Corpus callosum g = genu / s = splenium
2 Caudate nucleus h = head / b = body / t = tail
3 Septum pellucidum c = cavity
4 Fornix h = hippocampus
5 Amygdaloid body
. L.
6 Optic radiation
7 Tapetum
Ventricle components
10 Lateral ventricle
rA
10a anterior horn of the lateral ventricle(s)

10b body of the lateral ventricle(s)
10i inferior horn of the lateral ventricle(s)
10p posterior horn of the lateral ventricle(s)
11 3rd ventricle
©D
12 suprapineal recess
13 cerebral aqueduct
14c choroid plexus
14g glomus choroideum
15 4th ventricle
15l lateral recess(es) – foramen of Luschka
15m median aperture and foramen of Magendie
15p posterior recess
16 spinal canal
144 © A. L. Neill
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1g
3c 10a
2b
4h
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11
12
5
. L.
10i
2t 14c
4h
13
rA
1s
14g
6
7 15L 15i
©D
15
15p 10p
16 15m
© A. L. Neill 145
THE BRAIN
Ventricles – relations
Ventricles opened for internal view
The ventricles are spaces and this view emphasizes this fact.
The top view is pf one of the lateral ventricles and the lower view of the
transposed 3rd and 4th ventricles which sit higher in b/n the large
lateral ventricles
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Ventricles make up 3-4% of the weight of the brain.
Ventricle components 11 suprapineal recess
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1 Lateral ventricle 12 pineal body
1a anterior horn of the 13 pineal recess
lateral ventricle(s) 14 cerebral aqueduct
1b body of the lateral 15c inferior vermis
ventricle(s)
16 median foramen of
. L.
1i inferior horn of the posterior recess
lateral ventricle(s)
17 posterior recess =
1p posterior horn of the median recess
lateral ventricle(s)
18 ependymal pocket –
rA
2 interventricular foramen- lower ends of the

joining the laterals with 4th ventricle
the 3rd ventricle
19 obex = border b/n the
3 3rd ventricle 4th ventricle and the
4 4th ventricle spinal canal
©D
4r roof of the 4th ventricle 20 spinal canal

5 triangular recess 21 lateral recess
6 anterior commissure 22 foramen of Luschka
7 optic recess 23 Calamus scriptorus =
8 optic chiasma floor of the 4th ventricle
9 infundibular recess
10 interthalamic recess –
for the joining of the 2
thalamic bodies
146 © A. L. Neill
1b
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1a
1c Ne
1p
. L.
2 11
5
12
6
rA
13
7 10
23 14
3 4
8
9 4r
©D
22
15
?? 16
17
19
18
20
© A. L. Neill 147
CRANIAL NERVES
The Cranial Nerves

CN are defined as Ns which leave
from the skull (cranium) rather than
the SC. There are 12 pairs, and
they are numbered in the order
they leave the skull not necessarily
the same order that they leave the
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brain. Their names are an attempt
to reflect their function.
Below is a summary of the Cranial
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Nerves and their functions.
They are listed in the order they leave
the Cranium/Skull.
. L.
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148 © A. L. Neill
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. L.
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© A. L. Neill 149
CRANIAL NERVES
The Cranial Nerves –

summary
5 are purely motor III, IV, VI, XI, XII; 3
purely sensory I, II, VIII and the rest
4 are mixed. All exit from the
ventral surface of the Brainstem
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and related structures except 3
CNs - CN 1 and II which act as
extension of brain tissue rostral to
the brainstem and CN IV which
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exits from the dorsal brainstem
surface and crosses to the
contralateral side immediately.
All CNs cross partially to the
contralateral side hence most
structures have dual innervation so
. L.
that UMN lesions (eg. stroke) do not
usually result in complete loss of
function, whereas LMN lesions (eg.
trauma) generally do so.
rA
Nucleus Solitarius is SENSORY -

the site of neuron origin for CNs
VII, IX & X.
Nucleus Ambiguus is MOTOR -
the site of neuron origin for CNs
IX & X
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150 © A. L. Neill
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Ne
. L.
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© A. L. Neill 151
CRANIAL NERVES
CN I
Inferior view – looking up from below to the base of the brain
Superior view – looking down into the ACF – cranial exit
Magnified Sagittal view through Olfactory bulb
The Olfactory N-pure special sensory SMELL- functions as a brain extension
Origin the olfactory bulb (1)
ill
Course rootlets from receptor cells in the nasal lining (6) near
the superior concha pass up through the Cribiform plate of the Ethmoid
bone (5) synapse in the bulb (1) and sensory information then moves to
Ne
the main brain tissue via the olfactory tracts (2) projecting to the
olfactory areas of the CC, see Rhiencephalon.
Cranial Exit cribiform plate
Branches none
Lesions amnosia inability to smell (and often taste is affected)
Aetiology injury to the ACF
. L.
1 Olfactory bulb
2 Olfactory tract
3 Mitral cell
4 Fibrous processes of receptor cells
rA
3,4 = Glomerulus of fibres b/n the receptor cells and the

Mitral cells to transmit and amplify the sensory material
5 Ethmoid bone with “olfactory holes” – in the Cribiform
plate to allow passage of olfactory receptor N cell axons
6 Mucosa and CT for BVs and support to the Ns
©D
7 Receptor cells
8 Basal cells of the nasal epithelium
9 Columnar epithelial cells
8,9 = nasal epithelium = pseudocolumnar epithelium present
in most of the respiratory system
10 Glycocalyx on apical surface of the epithelial cells –sticky
11 Mucous secreted from the nasal glands
12 Nasal glands
13 Long microvilli and knob – specialized endings of the
receptor cells
152 © A. L. Neill
ill
2
Ne 1
3
. L.
4
rA
6
©D
13 12 11 10
© A. L. Neill 153
CRANIAL NERVES
CN III
Schema of Oculomotor nuclei and their CNS and ANS
connections
Most of the muscles of the eye are supplied by CN III which has
connection with the ANS via the parasympathetic fibres from the
Accessory nucleus responsible for the light reflex.
ill
1 pretectal nucleus
2 superior colliculus
3f fibres of CN III - a combination of the motor fibres from
accessory nucleus
3m main oculomotor motor nucleus
3mf fibres from the motor nucleus
Ne
the main nucleus and the PNS motor fibres from the
3p accessory oculomotor nucleus =

. L.
Edinger-Westphal nucleus
3pf PNS fibres
4 tectobulbar fibres
rA
5 medial longitudinal fasciculus

6 red nucleus
7 substantia nigra
8 central canal
©D
9 cerebral cortex – motor
Exit of the CN III from the base of the skull
154 © A. L. Neill
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Ne
9
. L.
1
8 2
rA
4
3p
3m
©D
3pf
7 3f
3mf
© A. L. Neill 155
CRANIAL NERVES
CN IV
Schema of Trochlear nuclei and their CNS connections
Only the Superior Oblique muscle in the eye is supplied by the
Trochlear N -= so called because of its external association with the
trochlea or pulley in the eye socket (see the A to Z of the Head and
Neck for further details). It is the only CN to exit the Brainstem from
ill
the dorsal surface, after complete decussation in the superior
medullary velum. It courses around to the anterior surface, through the
cavernous sinus and leaves via the optic canal as do the other eye
related CNs.
1
2
2f
mesencephalic nucleus of CN V
superior colliculus Ne
fibres form the superior colliculus - tectobulbar fibres
4f trochlear N fibres
. L.
4n trochlear N nucleus
6 crus cerebri
rA
7 substantia nigra
8 central canal
9 cerebral cortex – motor
Pathway of the CN IV from the brainstem dorsal surface and exit from skull
©D
10 midbrain
11 superior cerebellar peduncle
12 cavity of 4th ventricle
13 MO
14 superior medullary velum
15 pons
156 © A. L. Neill
8 4f
3
1
2f
4n
ill
5
Ne 7
6
. L.
rA
10 2 3
14 4f
©D
11
12
13
© A. L. Neill 157
CRANIAL NERVES
CN V
The Trigeminal N – mixed : sensory, special sensory, somatic motor
fibres, and parasympathetic fibres, which relate to the muscles and
skin of the face.
Origin Sensory : NR terminates in the sensory nuclei extending from the Pons
to C2 Nu – the rootlets enter from midlateral surface of the Pons
ill
Motor : NR from masticator motor nucleus in the Pons
Course The Trigeminal N has 3 large branches.
Ophthalmic (V1 sensory),
Maxillary (V2, sensory) and
Ne
Mandibular (V3, motor and sensory).
The sensory branches join the trigeminal ganglion in the MCF
Cranial Exits: foramen ovale, superior and inferior orbital fissures.
. L.
BRANCHES in detail
The Mandibular N = V3 motor root + mandibular branch of the
sensory root of the Trigeminal N and has 6 branches.
The Mandibular N innervates the muscles of mastication: Mylohyoid
rA
and the anterior belly of Digastric; Tensor Veli Palatini and Tensor
Tympani. The sensory part of the Mandibular N carries general sensory
information from the mucous membranes of the mouth, cheek, anterior
2/3 of the tongue, the lower teeth, skin of the lower jaw, side of the
head and the meninges of the anterior and middle cranial fossae.
©D
The 2 other sensory branches of CN V also converge on the trigeminal

ganglion via the cavernous sinus.
The Ophthalmic N has 7 branches and enters the cranium through the
superior orbital fissure from the orbit and the skin of the forehead and head.
The Maxillary N has 8 branches and enters the cranium through the
inferior orbital fissure, and the pterygopalatine canal via the
Pterygopalatine fossa and Foramen Rotundum, carrying information
from the face, cheek and upper teeth and soft and hard palate, nasal
cavity and pharynx. Meningeal sensory branches enter the trigeminal
ganglion w/n the cranium.
158 © A. L. Neill
V1
ill
V2
Ne V3
. L.
6
rA
4
©D
© A. L. Neill 159
CRANIAL NERVES
CN V Cont
Ophthalmic N branches V1
1 Infratrochlear
2 Anterior Ethmoid
3 Posterior Ethmoid
ill
4 Lacrimal
5 Supraorbital
6 Supratrochlear
7 Nasociliary
Maxillary N branches V2
1 Zygomaticotemporal
Ne
2 Zygomaticofacial
. L.
3 Post. Superior Alveolar
4 Nasopalantine
5 Greater Palatine
6 Lesser Palatine
rA
7 Middle & Anterior Alveolar branches

8 Infraorbital
©D
160 © A. L. Neill
ill
8
Ne 2
3
. L.
1
rA
8
©D
7
© A. L. Neill 161
CRANIAL NERVES
Palatine branches from V2 in greater detail

1 incisive fossa
2 nasopalatine N
3 greater palatine N
4 Lesser palatine N
5 Posterior nasal spine
ill
6 palatine bone -horizontal plate
7 hard palate (Maxilla)
Ne
. L.
rA
©D
162 © A. L. Neill
ill
Ne
. L.
rA
1
2
©D
6
5 4
© A. L. Neill 163
CRANIAL NERVES
Mandibular N branches V3
1 Auriculotemporal
2 Lingual
3 Inferior Alveolar
4 N to Mylohyoid
5 Mental
ill
6 Buccal
for innervation to the face see the Dermatomes
Ne
. L.
rA
©D
164 © A. L. Neill
ill
Ne 1
. L.
rA
6
©D
3
5
4
© A. L. Neill 165
CRANIAL NERVES
CN V
Schema of Trigeminal nuclei and their CNS and ANS
connections
coronal section through the brainstem
transverse section through the mid pons
Most of the sensory supply to the face and the motor supply to the
ill
muscles of mastication come from the Trigeminal N. Hence it travels
with the CNs supplying the eye and has ANS imput. It has an extensive
SC extension of its main sensory nucleus present until C2.
1 CC
2 mesencephalic nucleus
3 motor nucleus
Ne
4 main sensory nucleus – continuous with 5s
5g Trigeminal ganglion
. L.
5i Ophthalmic N = CN V1
5ii Maxillary N = CN V2
5iii Mandibular N = CN V3
rA
5l Trigeminal leminiscus
5n Trigeminal N
5s spinal nucleus of the Trigeminal N
6 thalamus
©D
7 midbrain
8 proprioceptive fibres from the face and eye synapse in 2
9 substantia gelatinosa
10 C2
11 MO
166 © A. L. Neill
2
6 5ii
5i
5L 5iii
5g
7
ill
3
5n
8
11
5L
Ne 4
5s
. L.
10 9
rA
2
©D
3
4
5g
5n
© A. L. Neill 167
CRANIAL NERVES
Neural pathways for CN V = Trigeminal N

and interrelationships with CN III,VII & IX (Oculomotor, Facial
& Glossopharyngeal)
This schema demonstrates their interactions and the sites where they
occur. The name of the N may change at points along its pathway e.g.
Nervus intermedius (1) and Chorda tympani (2)
ill
A Intracerebral from the Bs to C2 20 Frontal N branch of V1
B Intracranial 21 Auriculotemporal N
C Emergence from the skull 22 lesser petrosal N
Ne
D Branches & N pathways 23 otic ganglion
E Ganglia 24 N to Parotid gland
F Ns & end organs 25 N to Labial gland
1 Nervus Intermedius 26 Mental N (to the chin)
2 Chorda Tympani N 27 Inf. alveolar N
12 via petrotympanic fissure (to the chin & jaw)
. L.
3 submandibular + sublingual 28 Ns to Tensor Typmani &
ganglia Tensor Veli Palatini
4 N to sublingual gland CN IIIa fibres from the Accessory
5 N to submandibular gland nucleus (ParS)
CN V Trigeminal N
rA
6 N supplying taste for the

ant. 2/3 of the tongue + CN Vg Trigeminal ganglion
7 Lingual N (CN V3) CN Vm motor nucleus
8 pterygopalatine ganglion CN Vs sensory nucleus
9 N to mucous glands CN VII Facial N
©D
10 Zygomatic N CN VIIa superior salivary nucleus

11 Lacrimal gland CN IXa inf. salivary nucleus
12 greater petrosal N CN VIIl lacrimopalatonasal
1213 via foramen lacerum ganglion
13 N of Pterygoid canal CN IX Glossopharyngeal N exit
14 N to Mucous glands jugular foramen
15 ciliary ganglion V1 Ophthalmic N - pure sensory
exit foramen rotundum
16 short ciliary Ns
V2 Maxillary N - pure sensory exit
17 eye
foramen lacerum
18 Nasociliary N branch of V1
V3 Mandibular N - motor +
19 Lacrimal N branch of V1 sensory exit foramen ovale
168 © A. L. Neill
ill
F
Ne
E
. L.
D
rA
C
©D
B
A
© A. L. Neill 169
CRANIAL NERVES
Facial Dermatomes
The Face is innervated by the Trigeminal N = CN V and its
branches.
The top of the head and neck by the upper cervical spinal Ns
1 Supra-orbital N (V1)
2 Supratrochlear N (V1)
ill
3 Lacrimal N (V1)
4 Infratrochlear N (V1)
Ne
5 External nasal N(V1)
6 Zygomaticofacial N (V2)
7 Infra-orbital N (V2)
8 Mental N(V3)
9 Buccal N (V3)
. L.
10 Great Auricular N (C2,3)
11 Anterior cutaneous N of the Neck (C2-3)
12 dorsal branches of C6
rA
16 Auriculotemporal N (V2)
17 Lesser Occipital N (C1,2)
©D
18 Greater Occipital N (C2)

19 Zygomaticotemporal N (V2)
note if the “Onion skin” pattern shown

in the lower image is present this
indicates a lesion compressing the Bs
and so the nuclei of CN V.
170 © A. L. Neill
18 19 1
ill
17
2
17
Ne
3
4
5
. L.
6
16 8
rA
15
14
13
8
12 9
©D
10
11
© A. L. Neill 171
CRANIAL NERVES
CN VI
Schema of Abducens N nuclei and their CNS connections
Pathway of the CN VI from the brainstem and exit from skull
The Abducens N – pure motor, supplies the Lateral Rectus
Origin ventral surface of the Pons
Courses ventrally/anteriorly exits the DM lateral to Dorsum Sellae
ill
enters the cavernous sinus lateral to the carotid artery
Cranial Exit superior orbital fissure
1
2
2f
3
cerebral cortex
superior colliculus
Ne
fibres form the superior colliculus - tectobulbar fibres
pons
4 cavity of 4th ventricle
. L.
6f fibres of Abducent N
6 abducent motor nucleus
rA
7 MO
©D
172 © A. L. Neill
ill
Ne
. L.
rA
©D
© A. L. Neill 173
CRANIAL NERVES
CN VII
Diagram of the pathway from CC primary motor cortex
(UMN) CN VII motor nucleus(LMN)  through facial canal
(longest intracranial pathway of any CN)  exit.
The Facial N – mixed : sensory, special sensory, somatic motor fibres,
& Para Ns
ill
Origin ventral surface of the Brainstem – Pontomedullary junction
Course enters the IAM, travels with CN VIII – branch Greater
Petrosal N (Para Ns)
(Para Ns + SSNs)
Cranial Exit stylomastoid foramen
Ne
facial canal (petrosal canal) – branch Chorda Tympani
Longest intracranial pathway of any CN

1 cortical input to facial motor nucleus – corticobulbar tract
. L.
2 motor nucleus of the Facial N
3 motor branches of the Facial N
4 IAM
rA
5 stylomastoid foramen
©D
174 © A. L. Neill
ill
Ne
. L.
1
rA
©D
3
4
5
© A. L. Neill 175
CRANIAL NERVES
Facial – CN VII cont

Main Motor branches of the Facial Nerve - lateral view of
the skull
The main motor fibres of the Facial N supply the muscles of facial
expression, via 5 branches and travel in the superficial fascia of the face.
1 Temporal N to Auricularis, & Epicranius
ill
2 Zygomatic N to Zygomaticus muscles & muscles around the eye
3 Buccal N to muscles of the cheek & upper lip
4 Mandibular N to muscles of the lower jaw (eg N to Mylohyoid-7)
5 Cervical N to Platysma
Other branches of the Facial N Ne
The Greater Petrosal N leaves the IAM, on the ant. surface of the
petrous part of the Temporal bone, in the MCF. It passes forward across
the foramen lacerum and joins the Deep Petrosal N (sym. fibres from
. L.
the superior cervical ganglion). These 2 Ns enter the pterygoid canal as
the Nerve of the Pterygoid canal.
The N of the Pterygoid canal exits the canal - synapses in the
Pterygopalatine ganglion in the Pterygopalatine fossa. It supplies
rA
branches to the lacrimal gland and the mucous secreting glands of the
nasal & oral cavities.
The Chorda Tympani (6) joins the Lingual N (9) from CN V3 in the
infratemporal fossa prior to synapsing in the submandibular ganglion in
the lateral floor of the oral cavity. Fibres from this ganglion innervate
the submandibular & sublingual glands, – not the parotid gland. via the
©D
inferior Alveolar branches (8).

The Para Ns of Chorda Tympani exit the brainstem via Nervus Intermedius,
which lies b/n CNVIII and the somatic motor fibres of the Facial N (VII).
The fibres of taste (Special Sensory) of the anterior 2/3 of the tongue, and
the general sensory fibres travel with the Chorda Tympani also via Nervus
Intermedius and enter the skull through the petrotympanic fissure.
6 Chorda Tympani
7 N to Mylohyoid
8 Inferior Alveolar N
9 Lingual N
176 © A. L. Neill
ill
2
Ne
5
. L.
3 4
rA
©D
6
9
7 8
© A. L. Neill 177
CRANIAL NERVES
Lesions of the Facial N

The motor nucleus of CN VII is in the caudal portion of the ventrolateral
pontine tegmentum. Axons from the LMN travel dorsally, loop around
the CN VI nucleus (motor) & exit the ventral pons medial to the CN V
spinal nucleus. Along with the motor fibres of CN VII are the ParaNs &
the sensory components which branch off and form the Nervus
Intermedius.
ill
LMNs from the dorsal CN VII motor nucleus receive bilateral UMN input
(from both sides of the CC) and innervate the muscles of the upper face.
LMNs from the ventral CN VII motor nucleus receive contralateral UMN
Ne
inputs and innervate the lower muscles of the face
Hence both sides of the brain control the muscles of the upper face,
while only the contralateral side of the brain controls the muscles of the
lower side of the face.
Hence lesions in the corticobulbar tract, UMN lesions, result in central
. L.
facial palsy = central seven, spastic paralysis on the contralateral lower
face, while LMN lesions result in paralysis of the lower muscles on the
ipsilateral side = Bells Palsy. In both cases there may be difficulty in
sucking, swallowing, and talking. In both cases the forehead muscles
tend to be spared, and as the upper larynx and pharynx are also
rA
innervated by CN V and CN XI motor nuclei, these areas have multiple

innervation, there is great potential for rehabilitation of this area eg
swallowing after CVAs / strokes.
Image of facial palsies Bells’ / Central seven
Bell’s on the ipsilateral side LMN
©D
Central facial Palsy on the contralateral side UMN

1 drooping eyelid ± dry eye ± excessive tears
2 facial paralysis/weakness ± twitching
3 drooping mouth ± dry mouth ± impaired taste –
cannot blow / whistle /close lips firmly
4 forehead muscles generally spared
5 difficulties in swallowing, talking
178 © A. L. Neill
ill
4
Ne 1
. L.
rA
2
©D
© A. L. Neill 179
CRANIAL NERVES
Neural pathways for CN VII = Facial N

and interrelationships with CN V, IX & X (Facial,
Glossopharyngeal & Vagus).
CN VII travels with both CN V & CN IX to reach its destination. It also
interacts with the Vagus N (CN X) and has a second component, the
Chorda Tympani.
This schema demonstrates these interactions and the sites where they
ill
occur. CN VII travels intracranially extensively through the Petrosal
canal (facial canal). At the endorgans often the motor branches are
from CN VII & the sensory from CN V.
Ne
A Intracerebral
B Intracranial
C Intrapetrosal path = facial canal (also intracranial)
D Extrapetrosal ganglia, pathways, Ns & endorgans
1 greater petrosal N
2 pterygopalatine ganglion
. L.
3 auriculotemporal N (sensory branch to EAM)
4 infraorbital N
5 buccal N
6 mental N
7 inferior alveolar N
rA
8 Ns to Stylohyoid & Digastric post. belly

9 chorda tympani + motor facial N
9c chorda tympani branching just before cranial exit – part of
taste sensation, supplies ant. 2/3 of the taste & pain of
the tongue - inhibits other sensory input
©D
10 lingual N (from CN V3)

11 submandibular + sublingual ganglia
12 auricular br. of CN X
13 N to Stapedius
14 Geniculate ganglion
CN VIIm Facial N motor nucleus
CN VIIa superior salivary nucleus of the Facial N
CN IXg gustatory nucleus of the Glossopharyngeal N
CN VIIl lacrimopalatonasal ganglion of the Facial N
CN IX Glossopharyngeal N exit jugular foramen
CN X Vagus N
CP Ns from the cervical plexus – proprioceptive
180 © A. L. Neill
4
5
6
7
ill
3
11
2
D
Ne CP
10
CNX
8
9c
. L. 9
13
12
C
14
rA
1
©D
B
A
CN VII m
CN VII 1
CN VII g
CN VII a
© A. L. Neill 181
CRANIAL NERVES
CN VIII in the ear

Coronal section of the ear
exit and relationship with CN VII
Auditory N = Vestibulocochlear N
1 cochlea
2 eustachian tube = auditory tube
ill
3 round window
4 stapes
5
6
7
8c
incus
malleus
CN VII = Facial N
Cochlear N – part of CN VIII
Ne
8v Vestibular N part of CN VIII
. L.
9 Tympanic membrane
10 IAM
11 EAM
rA
12 Pinna
©D
182 © A. L. Neill
8c
10
8v
1
ill
7
Ne
2
3
4
5
. L.
9 6
rA
©D
11
12
© A. L. Neill 183
CRANIAL NERVES
Auditory N = Vestibulocochlear N – CN VIII

Diagram of the intracranial pathway and entrance of the CN
VIII coronal section of the skull.
The Vestibulocochlear N – pure special sensory with 2 parts =
vestibular + audition = BALANCE & HEARING
Origin sensory cells attached to specialized organs in the
ill
membranous labyrinth (AKA boney labyrinth) in the petrous
part of the Temporal bone
Cochlear duct – connected to the boney ossicles for
Ne
sound transmission
Vestibular apparatus – fluid filled tubes to detect changes
in body movement
Course cells travel to and then through the internal auditory
meatus with CN VII and Nervus intermedius entering the
brain at the pontomedullary junction lateral to VII in the
. L.
cochlear nucleus and the vestibular nuclear complex.
Cranial Exit remains in the cranium in the internal auditory meatus
1 crus cerebri
rA
2 red nucleus
3 3rd Ventricle
4 vertebral artery
5 sigmoid sinus
©D
6 MO
7 CN VII & Nervus intermedius exiting with …
8 CN VIII
9 CN IX exit
10 CN X exiting with ..
11 CN XI
11s Spinal root of CN XI
12 SC
184 © A. L. Neill
2 3
ill
1
Ne 5
7,8
9
. L.
10,11
11s
rA
5 6
4
4
C1
©D
C2
C3
12
© A. L. Neill 185
CRANIAL NERVES
CN IX
The Glossopharyngeal N – mixed : sensory, special sensory,
somatic motor fibres, and parasympathetic fibres, which
relate to the tongue and pharynx.
Origin ventral surface of the Brainstem –a series of rootlets b/n
olive and inferior cerebellar peduncle
ill
Course branch intracranial – the Tympanic N (Para Ns + sensory
fibres) exits via Foramen Ovale as the Lesser Petrosal N
supplies parotid gland
Ne
Cranial Exit jugular foramen travels and exits with CN X.
Motor fibres supply the Stylopharyngeus muscle.
General sensory fibres synapse in the superior glossopharyngeal
ganglia, go to the Bs and terminate in the Trigeminal nucleus. These
fibres supply the skin of the external ear, the inner surface of the
tympanic membrane, posterior one-third of the tongue and the upper
. L.
pharynx.
Sensory nerve fibers for the autonomic system - originate from the
carotid body (oxygen tension measurement) and carotid sinus (blood
pressure changes) and Special sensory fibres - detect taste from the
rA
posterior 1/3 of the tongue - converge and synapse in the inferior

glossopharngeal ganglion, then enter the Bs and terminate in the upper
part of the Nucleus Solitarius. (also known as the Gustatory nucleus).
©D
186 © A. L. Neill
ill
Ne
. L.
rA
©D
© A. L. Neill 187
CRANIAL NERVES
Vagus – CN X - “wandering nerve”

The Vagus N – mixed : sensory, somatic motor fibres, & parasympathetic
fibres. ParaNs have input to the CVS, respiratory system from the larynx
to the bronchioles & the GIT to the splenic flexure (23).
Origin Motor : Nucleus Ambiguus, Dorsal Motor nucleus of the
Vagus (ParaNs)
ill
Sensory : terminate in the superior (10s) and inferior (also
containing ParaNs) vagal ganglia (10g).
Course rootlets exit via the MO, the motor division forming 3
major branches
Cranial Exit jugular foramen (22)
Ne
The Vagus N is the longest CN. The motor fibres travel with CN XI (11).
The sensory fibres travel with CN IX (9).
Test: Gag reflex
3 MOTOR BRANCHES in detail
. L.
1 the Pharyngeal N, (10p) travels b/n the int. (2) & ext. (3) carotid
arteries - enters the pharynx at the upper border of the middle
constrictor muscle and supplies the all the muscles of the pharynx and
soft palate (except the Stylopharyngeus & Tensor Veli Palatini).
2 the Superior Laryngeal N branches distal to the pharyngeal branch -
rA
descends lateral to the pharynx. It divides into an int. (sensory &

autonomic) (10i) and ext. branch (10e). The ext. branch innervates the
Cricothyroid muscle.
3 the Recurrent Laryngeal N is different on the R and L sides.
R leaves the Vagus anterior to the subclavian, loops around the artery
©D
and ascends b/n the trachea and the oesophagus (19).

L leaves the Vagus anterior to the aortic arch and loops around it to
ascend through the superior mediastinum. Hence the L Recurrent N is
sensitive to changes in the diameter of the aortic arch as in an
aneurysm. It ascends b/n the oesophagus (18) & trachea. Both Ns
enter supply intrinsic muscles of larynx.
The Para Ns of the Vagus N synapse in ganglia close to their target
organs, and forma networks or plexi around these organs.
Feedback comes from receptors in these organs. Sensation from the
mucous membranes of the epiglottis, base of the tongue, aryepiglottic
folds and the upper larynx travel via the Internal Laryngeal N.
Sensation below the vocal folds of the larynx is carried by the
Recurrent Laryngeal Ns.
188 © A. L. Neill
9
1
10s
ill
22
10g
11
21
20
Ne 12
3
2
. L.
4
10
rA
©D
© A. L. Neill 189
CRANIAL NERVES
Vagus – CN X - “wandering nerve” cont

pathway of the wandering nerve in the neck, thorax and
abdomen
1 EAM
3 external carotid artery
ill
4 common carotid artery
5 pulmonary trunk (venous)
6 inf. Phrenic artery
7 L lobe of the liver
8 Trapezius
9 CN IX = Glossopharyngeal N
10 CN X = vagus N
Ne
10a anterior vagal trunk
. L.
10e external vagal N
10g vagal ganglia
10i internal laryngeal N
10p Pharyngeal N branch of CN X to pharyngeal plexus
rA
10s superior vagal ganglion

11 CN XI = Accessory N
12 CN XII = Hypoglossal N
13 oesophageal plexus
©D
14 upper R pulmonary vein

15 R pulmonary artery
16 R main bronchus
17 deep oesophageal plexus + cardiac plexus
18 oesophagus
19 R recurrent laryngeal N - looping around the subclavian artery
20 jugular vein
21 phrenic N (C3,4,5)
22 jugular foramen
23 gastric plexus
190 © A. L. Neill
22
1 10g 2 9
11
ill
12
20
10
Ne 10i
10p
3 10e
19
. L.
18
4
17
16
rA
15 5
14
21
13
10a
©D
7
23
6
© A. L. Neill 191
CRANIAL NERVES
Vagal innervation of the Larynx

Sagittal view of the Larynx showing CN X laryngeal
branches
Note the differences in R and L recurrent laryngeal Ns. Clinically this is
significant as an enlarged Aortic arch may present as a dry hacking cough.
1 Vagus N (CN X)
ill
1A Superior Laryngeal N
1B Recurrent Laryngeal N (L) – note the R branch curls
around the Aortic arch - removed
1C cardiac branches of Vagus
2 Thyroarytenoid muscle
3 Lateral Cricoarytenoid
Ne
4 Posterior Cricoarytenoid
. L.
5 Epiglottis
6 Thyroid cartilage
7 Cricoid cartilage
8 Aryenoid cartilages
rA
9 Oesophagus (removed posteroir to Trachea)

©D
192 © A. L. Neill
ill
Ne 1A
. L.
5
8
6
4
rA
7 2
3
©D
9 1B
1C
© A. L. Neill 193
Overview - Vagus & the ANS

1 ciliary ganglion 8 vesical plexus
2 sympathetic chain 9 splanchnic Ns
3 CN III 10 CN X cranial
4 MO Parasympathetic outflow
5 Solar plexus 10p parasympathetic plexi located
6 sacral Parasympathetic near target organs with CN X
ill
outflow
7 SC
Ne
3
1
. L.
10p 4
7
rA
10p
©D
10p
8 6
ill
PUPIL SIZE
2
Ne SALIVARY
SECRETIONS
. L.
HEART RATE
rA
BRONCHIAL SIZE
5
GASTRIC
©D
MOVEMENT
PANCREATIC &
BILE SECRETIONS
9
ADRENAL
SECRETIONS
8 BLADDER
CONTRACTION
© A. L. Neill LIBIDO 195
CRANIAL NERVES
Vagus – CN X
autonomic input to the heart + BP
1 hypothalamic autonomic centre
2 sensory input from … 3+5+6
3 carotid sinus
ill
4 aortic sinus
5 arterial baroreceptors
6 sinoatrial node
7 arteries
Ne
8 sympathetic motor fibres tone of arteries
9 sympathetic outflow
10 CN X = Vagus N
10n Bs containing solitary tract and nucleus
. L.
10p ganglion of the Cardiac plexus
rA
©D
196 © A. L. Neill
3
1
ill
2
4
Ne 5
10n 10
. L.
10p
6
rA
9
©D
© A. L. Neill 197
CRANIAL NERVES
Vagus – CN X
Input to the tongue, oesophagus and upper GIT
1 input from the CC
2 pons
3 solitary tract and nucleus
ill
4 nucleus ambiguous
5 dorsal vagal nucleus
6 SC
7g phrenic N nucleus
7n phrenic N
8 diaphragm
9 stomach
Ne
10n CN X = Vagus N
. L.
10p oesophageal plexus
11 physiological sphincter of oesophagus smooth muscle
12 crura of diaphragm – skeletal muscle
rA
13 oesophagus
14 tongue
15 pharynx
©D
198 © A. L. Neill
ill
1
14
15
Ne
2
3
4
. L.
5
6
rA
10p 10n 7g
7n
13
8
©D
12
11
© A. L. Neill 199
CRANIAL NERVES
Accesssory – CN XI
lateral view of the Bs
superior view of the base of the skull
CN XI crossing in the neck and supplying the 2 muscles
The Accessory N – pure motor supplies cervical parts of Trapezius (1)
+ Sternocleidomastiod (2)
ill
Origin ventral surface of the MO + cervical SC
Course ascends rostrally through the Foramen Magnum
joining and traveling with the Vagus N (CN X)
Cranial Exit jugular foramen
Ne
. L.
rA
©D
200 © A. L. Neill
ill
Ne
. L.
rA
©D
© A. L. Neill 201
CRANIAL NERVES
Neural pathways for CN IX, X & XI =

Glossopharyngeal, Vagus & Accessory Ns
and their interrelationships
CN IX, X and XI travel together and share innervation at for least part of
their pathways. This schema demonstrates their interactions and the
sites where they occur.
ill
A Intracerebral
B Intracranial
Ne
C Jugular Foramen + VC exits for cervical Ns
D Peripheral distribution
1 otic ganglion
2 to the parotid gland
3 to the tympanic membrane / Tympanic N
. L.
4 Pharyngeal plexus
5 Laryngeal plexus
6 Coeliac plexus = Solar Plexus ie part of the abdominal
plexi
rA
7 Cardiac and Bronchi plexi

8 Ns to Sternocleidomastoid
9 Ns to Trapezius
CN VIIb inferior salivatory nucleus
©D
CN VII, IX, Xs Nucleus Solitarius -sensory with imput from

the indicated CNs
CN IX X m Nucleus Ambiguus -motor Ns from CN IX & X
CN Xs dorsal Sensory nucleus of the Vagus N
CN Xm dorsal Motor nucleus of the Vagus N
CN XI sc spinal nucleus of the Accessory N (motor)
C1, C2, C3 cervical spinal Ns
202 © A. L. Neill
6
4
ill 8
9
5
7
Ne
2
1
. L.
D
C1
C2
C3
C
rA
IX
XI
X
B
©D
A
CN XI sc
CN VII b
CN IX X m
CN Xs
CN VII, IX, X, s
CN X m
© A. L. Neill 203
SPECIAL SENSES
Nuclei for CN IX, X & XI = Glossopharyngeal,

Vagus & Accessory Ns & their interrelationships
CN IX, X and XI are intimately related they emerge from the skull together, travel
together and share innervation at for least part of their pathways. This diagram
lists their main nuclei of these Cranial Nerves and the interrelationships with the
other CN nuclei. In some cases the same nuclei have several names, if
significant each one has been listed with their equivalents.
ill
3 Oculomotor nucleus
3a Autonomic accessory nucleus of CN III
4 Trochlear nucleus
5m motor nucleus of Trigeminal N
Ne
- part of the Spinal nuclear complex of the Trigeminal N
5ma motor nucleus of Trigeminal N = Masticatory nucleus
5me Mesencephalic nucleus of Trigeminal N
5s Spinal nucleus of the Trigeminal N
6 Abducens nucleus
. L.
7i Inferior salivatory nucleus
7l Lacrimopalatonasal nucleus = autonomic nucleus of the
Facial N
7m Motor nucleus of the Facial N
7s Superior salivatory nucleus
rA
8b Superior vestibular nucleus = nucleus of Betcherew

8c dorsal & ventral Cochlear nuclei
8d Lateral vestibular nucleus = Deiters nucleus
8i inferior vestibular nucleus
8l Superior vestibular nucleus = Lewardanowsky nucleus
©D
8s Medial vestibular nucleus = Schwalbe nucleus

9a Nucleus ambiguus upper part - leads to CN IX fibres
9g Gustatory nucleus - upper part of the Nucleus Solitarius =
Solitary tract
9s Nucleus of the solitary tract with CN IX fibres
10a Nucleus ambiguus middle part -leads to CN X fibres
10m Dorsal motor nucleus of the Vagus N
10s Nucleus of the solitary tract with CN IX fibres
11a Nucleus ambiguus lower part -leads to CN XI fibres =
Laryngeal nucleus
11s Spinal nucleus of the Accessory N
12 Hypoglossal nucleus
204 © A. L. Neill
3
3a
ill
5ma 5me
7L
Ne 8b
8L
. L.
5m
rA
8d
7m
8c
9s
6
8s
9a
©D
8i
7s
9s + 10s
7i
5s
10a
10m
11a 12
11s
© A. L. Neill 205
SPECIAL SENSES
Hypoglossal – CN XII
lateral view of the Bs
superior view of the base of the skull
The Hypoglossal N – pure motor –supplying tongue muscles (except
Palatoglossus)
Origin hypoglossal nucleus –ventrolateral sulcus of Medulla
ill
Oblingata running with fibres from C1-3 in the
Ansa Cervicalis
Course passes b/n internal carotid artery and jugular vein loops
Hypoglossus muscle.
Ne
above the Hyoid bone and runs on the edge of the
joining the Vagus N (CN X)

Cranial Exit hypoglossal canal
. L.
rA
©D
206 © A. L. Neill
ill
Ne
. L.
rA
©D
© A. L. Neill 207
SPECIAL SENSES
Neural pathway for CN XII = Hypoglossal N &

the relationship with the upper Cervical SNs
CN XII hypoglossal = under the tongue interacts with CN IX and V in
supplying the muscles of the tongue and with the upper Spinal Nerves
in the throat – hyoid and thyroid muscles. This schema demonstrates
their interactions and the sites where they occur.
ill
A Intracerebral for CN XII & SC for C1-3
B Intracranial for CN XII & Vertebral canal for C1-3
C Hypoglossal canal for CN XII & Intervertebral
foraminae for the SNs
D Peripheral distribution
1 N to Styloglossus
Ne
2 Ns to Muscles of the Tongue
3 Lingual N = from CN V3
. L.
4 N to Geniohyoid Muscle
5 N to Thyrohyoid muscle
6 Ansa Cervicalis
rA
7 Ns to Infrahyoid muscles
CN XIIn Nucleus of CN XII – motor
C1m motor nuclei of the C1 -ventral horn
C2-3s sensory nuclei of C2, C3 – dorsal horns
©D
C1, C2, C3 cervical spinal Ns
208 © A. L. Neill
ill
4
5
Ne
2
D
2&7
3
1
. L.
6
rA C1
C2
C3
C
©D XII
B
CNXIIm
A
C2 -3s
C1m
© A. L. Neill 209
SPECIAL SENSES
Optic - CN II
Sagittal view showing CN II pathway
Transverse view - looking down from above
The Optic N - pure special sensory VISION - functions as a
brain extension
Origin the retinal bipolar cells synapsing on specialized light
ill
receptors – rods & cones (1)
Course cells coalesce at the back of the eye as the Optic N (2) –
moves down the Optic canal, 50% cross at the Optic chiasma (3), and
Ne
proceed as the Optic tract on the contralateral side (4) to the Lateral
Geniculate body (5). A further synapse here forms the Optic radiation
(6) which travels to the Visual cortex – Brodmann areas 17,18, 19.
Cranial Exit orbital fissure /optic canal
Branches none
. L.
Lesions blindness
Aetiology injury to the eyeball &/or retina
1 Retina
2 Optic N
rA
3 Optic chiasma
4 Optic Tract
5 Lateral Geniculate body
6 Optic radiation
©D
7 Visual Cortex 1o and 2o in b/n pareito-occipital &

calcarine sulci
8 Corona Radiata
9 Brainstem
10 Superior colliculus
11 Pulvinar (Thalamus)
12 Medical geniculate body
13 Mammillary body
210 © A. L. Neill
5 4
3
6
2
ill
Ne
7 9
8
. L.
1
2
rA
3
13
4
12
©D
6 9
11
10
7
7
© A. L. Neill 211
SPECIAL SENSES
Blood Vessels of the Eye

Horizontal
1 Central vessels of the retina a= artery v=vein
2 ophthalmic artery
ill
4 cerebral arteries a=anterior /m= middle /
p= posterior branches
5 lateral striate artery
Ne
6 optic radiation
7 visceral cortex
8 lateral geniculate body
9 optic tract
10 basilar artery
. L.
11 anterior choroidal artery
12 communicating artery a=anterior / p= posterior
13 superior hypophysial artery
rA
14 retina
15 choroid
16 sclera
17 short posterior ciliary arteries
©D
18 DM
19 AM
20 PM
21 subarachnoid space
22 plial plexus
23 central collateral artery
24 circle of Zinn
25 lamina cribosa
212 © A. L. Neill
1
12a
2
4a 3
13
12p 4m
ill
11
10
9 5
8
4p
Ne 4m
7 6
. L.
25
14 15
rA
16
24 17
©D
18
1v 19
20
1a 21
2 22
9n
23 21
© A. L. Neill 213
SPECIAL SENSES
Visual field defects

Lesions complete or partial along the visual pathway result in different
visual field defects.
This diagram represents the views seen in the R and L eyes when
these lesions occur.
L column represents the view from the L eye
ill
R column represents the view from the R eye
1 Pressure on the L Optic N causes circumferential
blindness on L side - the ipsilateral side
Ne
2 Total blindness on the affected side of the cut CN II
3 Pressure on the L optic tract results in R sided
nasal hemianopia
4 Pressure / Lesions on the Optic chiasma (as in pituitary
tumors) result in bilateral Temporal hemianopia –
. L.
no side vision
5, L temporal hemianopia + R nasal hemianopia is the
6, result from lesions in the optic tract (5), Optic radiation
7 (6,9) and or in the Visual cortex (7,8)
rA
8 visual cortex
9 Optic radiation
10 lateral geniculate body
11 Optic chiasma
©D
12 Optic N = CN II
13 nasal bridge
214 © A. L. Neill
ill
L 13 R
12
Ne 4 1
1
2 2 2
. L.
11
3
3 3
10 5
rA
4 4
©D
6
5,6,7 9
5,6,7
8 7
© A. L. Neill 215
SPECIAL SENSES
CN III, IV, V, VI origins

lateral view of the ACF with lateral wall of the cavernous
sinus removed - showing commencement neural pathways
of CN II, III IV V and VI
1 ACF
2c Optic Chiasma
ill
2n CN II = Optic N
3g ciliary ganglion
Ne
3n CN III = Oculomotor N
4n CN IV = Trochlear N
5i Ophthalmic N = CN V1
5ii Maxillary N = CN V2
. L.
5iii Mandibular N = CN V3
5n Trigeminal N
6 Abducens N = CN VI
rA
6m lateral rectus (muscle of CN VI)

7a anterior cerebral artery
7p posterior cerebral artery
8 superior cerebellar artery
9 pterygopalatine ganglion
©D
10 maxillary sinus
11 infraorbital N
12a anterior communicating artery
12p posterior communicating artery
13 short ciliary Ns
14 falx cerebri
216 © A. L. Neill
12p 15 7a
ill
2c 12a
7p
16 2n
3n 14
Ne
. L.
3g
6m
1
13
rA
7p
3 4 11
8 6 10
9
5iii 5g 5i 5ii
©D
© A. L. Neill 217
SPECIAL SENSES
Neural pathways to and from the EYE CN III ,

IV & VI motor and CN V sensory
Motor Nerves to the extra ocular muscles of the eye come from nuclei
of CN III, IV & VI;
Sensory feedback is received from the Ophthalmic division of the
Trigeminal N = CNV1
ill
The Light reflex comes for the parasympathetic imput from the
accessory nucleus of CN III = Edinger–Westphal nucleus (IIIm)
1 intracerebral origins
2
3
4
subarachnoid space
Ne
pathway through the cavernous sinus
cranial exit through the superior orbital fissure
5 extracranial pathway - orbital fossa
. L.
6 ciliary ganglion – site of synapse of the preganglionic
parasympathetic fibres
7 level of the superior colliculus
8 level of the inferior colliculus
rA
9 inferior border of pons and medulla oblongata

10 N to sphinter papillae CN III
11 Ns to levator palpbrae superioris & superior oblique CN III
12 Ns to inferior & medial recti + inferior oblique muscles CN III
©D
13 Ophthalmic N = CN V1 and the 3 branches just before

entrance into orbit
Lacrimal
Frontal
-Nasociliary
14 N to superior oblique - CN IV = Trochlear N
15 N to Lateral rectus - CN VI = Abducens N
218 © A. L. Neill
ill
6
10
11
12
5
Ne
14
15
13
4
. L.
rA
3
2
©D
VI
1
IIIm
IV
VI
III
7
© A. L. Neill 219
SPECIAL SENSES
CN exits II, III, IV & VI

Coronal section – muscular base of eye socket with
enucleation - eyeball removed
Coronal section – muscles sectioned showing BV, ligament
support & N relations and boney cavity
CNs III, IV & VI control the movement of the eyeball - mainly CN III,
ill
except for Superior Oblique CN IV and Lateral Rectus CN VI, for more
details see the A to Z of the Head & Neck.
CN II – is a special sensory N which reports the stimulation from the
Ne
receptor cells in the retinas to the visual cortex.
These diagrams demonstrate the exits of these Nerves and their interplay
with other CNs such as CN V1 which is the sensory N for this area.
1 Recti muscles 4 in the eye i = inferior/ l = lateral /
m = medial /s = superior
. L.
2 Optic N = CN II
3 Oculomotor N = CN III s = superior div. i = inferior div.
4 Trochlear N = CN IV
5 Ophthalmic vein i = inferior /s = superior
rA
6 Abducent N = CN VI
7 Frontal N – branch of CN V1
8 Nasociliary N – branch of CN V1
9 Optic canal
©D
10 Ophthalmic artery
11 Tendinous ring around the CN II and the artery
12 Lacrimal N – branch of CN V1
13 Oblique muscles i = inferior /s = superior
14 Levator palpabrae superioris
15 Superior orbital fissure – exit in the orbital cavity for the
CNs & BVs
16 Trochea – ligamentous ring for superior oblique
17 Orbital cavity
18 Supraorbital notch
220 © A. L. Neill
14 18
1s 13s
15 16
13s
1L
ill
4
2
Ne
10
1m
6
3g
. L.
9
13i
1i
rA
14
15 13s
1s
12 1m
©D
7
2
5s
4 11
10
3s
10
1l
8
6 1i
17
3i 5i
© A. L. Neill 221
SPECIAL SENSES
Neural pathways from the TONGUE CN VII, IX

& X special sensory TASTE CN V3 sensory
The special sensation of Taste is supplied by 3 CNs on the ispilateral
side with overlap b/n these Ns.
Other sensory feedback such as pressure and pain is supplied by the
Mandibular N (CN V3), on the contralateral side.
ill
1 ventroposteriomedical nuc of the Thalamus =
arcuate and accessory arcuate nuclei of the Thalamus
2 solitariothalamic tract in the medical leminiscus
3 Bs
4 4th ventricle
Ne
5n Spinal nucleus of CN V
. L.
5s Sensory fibres of the Mandibular N
7g Geniculate ganglion
7n Sensory nucleus of Nervus intermedius =
upper portion of Nucleus solitarius
rA
7ss Chorda Tympani fibres = special sense Taste fibres

8 Vallate papillae
9g inferior petrosal ganglion of CN IX
9s Gustatory nucleus (part of the Nucleus Solitarius –
©D
solitary tract)
9ss Special sensory fibres of CN IX - taste
10g nodose ganglion of CN X = inferior vagal ganglion
10s Solitary nucleus = Solitary tract = Solitary fasciculus
10ss Special sensory fibres of CN X - taste
38 Brodmann area for normal tongue sensation = uncus
40, 43 Brodmann areas for TASTE = Opercular Insular
region in the CC
222 © A. L. Neill
43
ill
40
Ne 7n
2
1
38
3
. L.
1
5
rA
4
7g
5s 9s
10s
©D
8
7ss 5n
10g
9g
9ss
10ss
© A. L. Neill 223
SPECIAL SENSES
Taste areas on the TONGUE

Tongue macroscopic view of the dorsal surface
Taste bud histological section through the structure
The special sensation of Taste is supplied by 3 CNs on the ispilateral
side with overlap b/n these Ns. Within these areas supplied are
subareas which recognize specific taste types. However there is
ill
considerable variation and overlap of these areas.
The taste is detected via “taste buds” inserted into the stratified
squamous epithelium of the tongue.
Ne
1 taste pore
2 microvilli
3 supporting cells = sustenacular cells
4 basal cell
5 sensory N
. L.
6 sensory N fibres inot the cells
7 sensory hair on cell surface
Areas on the tongue detect certain tastes more sensitively
rA
they do not reflect the innervation

A SWEET area
B SOUR area
C SALTY area
D BITTER area
©D
CN VII area innervated by the Chorda tympani -

ant. tip of tongue
CN IX area innervated by the Hypoglossal N -
ant. 2/3 of tongue
CN X area innervated by the Vagus N post. - 1/3 of tongue
224 © A. L. Neill
ill
CN X D
CN IX
Ne C
B
. L.
CN VII A
1
rA
7
2
6
©D
5f
4
5
© A. L. Neill 225
SPECIAL SENSES
CN VIII Auditory / Balance Pathways

in situ
Schema
CN VIII the vestibulocochlear CN - conducts sensory information to the brain
on sound, body position and balance. It is a special sensory CN. There is a
crossover of the information as in most CNs, and extensive spread of the
ill
imput to many areas of the brain for interpretation and subsequent response.
A = CEREBRUM
B = PARIETAL + TEMPORAL LOBES
Ne
C = MIDBRAIN
D = CN VIII pathway
E = COCHLEA apparatus
1 transverse temporal gyrus
2 auditory radiation
3 medial geniculate body
. L.
5 superior olive
6 cochlear nuclei anterior + posterior
7 Pons
8 CN VIII fibres
rA
9 spiral ganglion
10 middle ear = semicircular canals, ossicles, cochlea
11 basilar membrane of cochlea
12 parenchymal cells of cochlea
13 hair cells of cochlea
©D
14 tectoral membrane
226 © A. L. Neill
ill
3
4
C 5
6
7
Ne 8 10
14
. L.
12
D
rA
E 13
9 11
©D
© A. L. Neill 227
SPECIAL SENSES
Vestibulocochlear N – CN VIII
vestibular pathways = balance
Balance is part of the special function of the Vestibulococchlear N.
Hearing disorders are often accompanied by disturbance of balance
(Meniere’s disease).
Input from the vestibular apparatus in the middle ear goes to the 4
ill
vestibular nuclei then to the thalamus & CC. It also goes directly to the
cerebellum. The ocular Ns change the position of the eyeball to
compensate for changes of head and body position.
Ne
1 to higher centres in CC
2 Thalamus VPM nucleus
3 CN III nucleus = oculomotor nucleus
4 CN IV nucleus = trochlear nucleus
5 medial leminicus
. L.
6 CN VI nucleus – abducens nucleus
7 medical longitudinal fasciculus a = ascending fibres /
d = descending fibres
8g vestibular ganglia (CN VIII) – sensory input from vestibular
rA
apparatus of the middle ear = ampullae, saccule &

semicircular canals
8n vestibular nuclei 4 inferior lateral medial & superior
9 fibres to cerebellum via inf. peduncle
©D
10 lateral vestibulospinal tract
228 © A. L. Neill
ill
1
Ne
3
2
4
5 6
9
. L.
7a
8n
rA
7d
8g
10
©D
© A. L. Neill 229
CRANIAL NERVE EXAMINATION
Neurological examination
General Considerations - in the Head & Neck
When examining the neurological patient - look for:
ASYMMETRY- muscle atrophy &/or hypertrophy, fasciculation,
uneven facial features
DEFORMITY - head held in a strained position / uneven posture
ill
/speech and swallowing difficulties
TONE CHANGES - hyer-reflexia / spasticity / resistance to passive
movement / hypo-tonia / flaccidity / involuntary movements (also
Ne
see the A to Z of Peripheral Nerves and the A to Z of the Head &
Neck for full consideration of this area upper and lower motor
syndromes and cerebellar dysfunction )
Cranial Nerve examination General
When there is a lesion in the CN described –
. L.
the following capabilities are lost -
ABDUCENS = CN V
Patient cannot abduct their eye - cannot look laterally on the affected
side (Lateral Rectus) rarely seen in isolation generally associated with
rA
lesions of CN III, IV and V1. DD lesion of the Lateral Rectus muscle itself
as in myopathies/muscle diseases
note the eye which cannot move to look medially has the CN lesion – top image
©D
230 © A. L. Neill
ACCESSORY = CN XI
Patient cannot turn head or raise shoulders against resistance
(Sternocleidomastoid + Trapezius)
ill
FACIAL = CN VII
Ne
Inspect the face - look for: asymmetry, blinking, lacrimation, salivation
and evenness of facial creases and lip movement on speaking.
. L.
Patient has difficulty in using muscles of facial expression cannot
whistle or blow through their cheeks, frown, raise their eyebrows, show
their teeth, blink or close their eyes against R (muscles of facial
expression).
rA
Taste is lost in the front of the tongue. Test by trying to open the tightly
shut eye against R. DD Botx and other cosmetic procedures, myopathies
Note : commonly seen unilaterally = Bell’s Palsy, associated with parotid gland
pathology, idiopathic, commonly resolves spontaneously after 2-3 weeks with
children, but not with adults
©D
© A. L. Neill 231
GLOSSOPHARYNGEAL = CN IX
No feeling or reaction to touch on the soft palate and back of the throat
absent Gag reflex - note 20% of normal people have a weak or absent
GAG (Stylopharyngeus cannot be tested in isolation) very rarely seen in
isolation generally associated with lesions of CN X particularly in
eliciting the Gag reflex
DD CN X lesions
ill
HYPOGLOSSAL = CN XII
Inspect the tongue - look for: atrophy, asymmetry, fasciculation and
involuntary movements - Patient cannot move the tongue in and out
cheek and examiner’s finger strongly

(Genioglossus and Linguali muscles) Ne
evenly - will deviate to the side of the paralysis - nor push against the
seen in isolation and associated with lesions of CN IX, X and XI

DD drugs, chorea associated with psychiatric or mental illnesses, motor
. L.
neurone disease.
rA
©D
232 © A. L. Neill
OCULOMOTOR = CN III
test eye movements - Patient cannot move eyes around follow an
examiner’s finger with movements and sees double - eyelid may fall
over the pupil and not be able to be elevated
Range of eye movement possible is shown and all affected with CN III
lesions even though 2 other CNs are involved in eye movements.
(extrinsic and intrinsic eye muscles and Levator Palpabrae - not Lateral
ill
Rectus or Superior Oblique) seen in isolation and associated with
lesions of CN IV, V1 and VI
DD diseases of the eye muscles and myopathies
Ne
. L.
rA
©D
OLFACTORY CN I
impaired or absent sense of smell - difficult to
test - need a strong stimulus cloves / peppermint
DD diseases of the upper respiratory tract
note this is important to test when there are
suspicions of lesions in the Anterior Cranial Fossa
© A. L. Neill 233
OPTIC = CN II
inability to see / difficulty in seeing /inability
to focus - test reaction to light - see light and accommodation reflexes
DD diseases w/in the eyeball - cataracts, macula degeneration etc.
if pathology is suspected go on to do evaluation of visual fields examination of
the eye with the dilated pupil etc.
ill
Ne
. L.
rA
©D
234 © A. L. Neill
TRIGEMINAL = CN V
V1
absent sensation over the top half of the face - depending upon the
lesion - may demonstrate onionskin pattern.
absence of the corneal reflex
seen in isolation and associated with lesions of CN III, IV and VI
ill
DD diseases of the skin
V2
absent sensation over the mid and lower portions of the face
V3
Ne
cannot open jaw or move it side to side against resistance
absent jaw jerk - note this is often absent in the young
DD multiple sclerosis, pathology in the TMJ, dental abscesses and
cavities, Herpes Zoster infections (this does infect V1 pathway and may
. L.
leave permanent residual affects), tumours in the nasopharynx.
V1
rA
V2
V3
©D
Compression of Bs results in
onion skin pattern Parasthesia
© A. L. Neill 235
TROCHLEAR = CN IV
impaired eye movement - particularly cannot look up and out
seen in isolation and associated with lesions of CN III, V1 and VI
DD diseases of the eye muscles and myopathies
note the eye which cannot move to look up and out has the CN lesion –
top image
ill
Ne
. L.
VAGUS = CN X
rA
inability to cough with pressure - long bovine cough

asymmetry seen when examinig the larynx – say AHHH – observe uneven
uvula (paralysis on the ipsilateral side) and presence of an husky voice
seen in isolation and associated with CN IX and XII
©D
DD hysteria and lesions in the CNs IX or XII
236 © A. L. Neill
VESTIBULOCOCHLEAR = CN VIII
ACOUSTIC component
loss of hearing – to test the frequencies impaired use tuning forks of
different frequencies
If there is better conduction through the bone than in the air – ie hold
the fork against the mastoid – the hearing loss is CONDUCTIVE ie a
block in the canal and not NEUROLOGICAL ie the N is intact
ill
A fork placed on the head midway should be heard evenly if this is not
the case there may be unilateral hearing loss.
Ne
DD diseases w/in the ear eg. wax blockage growth in the auditory tube
. L.
rA
©D
VESTIBULAR component
nystagmus persisting after rapid change in the position of the head
DD cerebellar diseases, viral infections of the brain or head region,
pathology of the cervical region
seen in isolation and associated with CN VII
© A. L. Neill 237
CRANIAL NERVE REFLEXES
Accommodation & Light reflexes

(CN II, III, sympathetic fibres from T1 and 2 (Dilator Pupillae)
Parasympathetic fibres from the ciliary ganglion (Sphincter
Pupillae)
Shine a light into one eye while shielding the other and pupils
from both eyes should constrict, if only the stimulated pupil
ill
constricts - interruption in the Brainstem has occurred.
Ask the patient to shift their gaze rapidly from one object to
another at different distances in the room, closer objects cause
Ne
pupillary constriction - presbiopia and cataracts may complicate
interpretation of this reflex
1 Light stimulus
2 Sphincter Pupillae/Dilator Pupillae
3 Optic N tract, CN II
. L.
4 Edinger-Westphal part of oculomotor nucleus (CN III)
5 Pretectal nucleus (before the Thalamus)
6 pathway to Sympathetic chain T1, T2 (for Dilator Pupillae)
rA
7 ciliary ganglion
8 Oculomotor N, CN III
9 postganglionic parasympathetic Ns = short ciliary Ns -
10 object for focus
11 visual cortex
©D
12 Optic radiation for interpretation

13 Lateral geniculate nucleus
14 Ciliaris -adjustment of lens and iris
15 Medial Rectus - one of the muscles moving the eyeball for
better focus
238 © A. L. Neill
14
1 2
15
ill
7
9
Ne 8
3
. L.
5 13
4
rA
6
©D
12
? 11
© A. L. Neill 239
Blink reflex (CN V1 , VII)

Tap the Glabella* region repeatedly and elicit blinking which will
diminish after several taps (Orbicularis Oculi)
Corneal reflex (CN V1, VII)
Approach the cornea from the side (out of sight by the patient)
and touch lightly causing a blink (Orbicularis Oculi)
ill
1 bright light
2 stimulus touching the cornea
3
4
5
Ophthalmic N - CN V1
Optic N tract - CN II
Ne
Emotional imput / or response to sensation from
higher centres
6 Visual reflex centres in the Midbrain
. L.
7 Facial N efferent fibres (CN VII)
8 Orbicularis Oculi + Levator Palpabrae Superioris
* Forehead b/n the eyes.
rA
©D
240 © A. L. Neill
1
8
ill 2
Ne
3
4
. L.
7
rA
6
©D 5
© A. L. Neill 241
Crying/Lacrimation reflex (CN V1 , VII)

(Orbicularis Oculi)
Irritation to the eye directly - smell (eg. onion) or touch or indirectly via
higher emotional centres will cause a reflex crying response.
1 stimulation of the cornea ± conjunctiva
2 stimulation from higher emotional centres
ill
3a sympathetic chain
3b superior sympathetic ganglion
Ne
3c postganglionic fibres to the lacrimal gland
4 Ophthalmic N = CN V1
5 sensory nucleus of CN V
6 parasympathetic nucleus of CN VII (in the Pons)
7 Facial N = CN VII and pterygopalatine ganglion
. L.
8 Lacrimal gland
Sneezing reflex
(CN V2 , X, C3,4,5 =Phrenic N + Intercostals T1-12)
rA
(Palatoglossus)
Irritant to the nasal mucosa stimulates a response to expel the air in
the region under pressure of a closed Glottis - similar to the cough
reflex but directed to go through to the nasopharynx by closing the
©D
oropharyngeal isthmus
1 CN V
2 Sensory nucleus of CN V in the brain stem
3 Motor nucleus of CN IX, X & XI
4 Respiratory centre
5 Phrenic N = C3,4,5
6 intercostal Ns
7 Ns to abdominal muscles
8 Vagus, Hypoglossal & Glosspharyngeal Ns (CN IX, X, XII)
242 © A. L. Neill
2 7 1
6
4
ill
5
3L
Ne
6
3b
3a
. L.
rA
2 1
8
©D
5
3
4
6
© A. L. Neill 243
Stapedial reflex (CN VIII, V3 higher centres)

When a person is about to speak and a sudden loud noise will cause
the reflex contraction of Tensor Tympani
1 imput from higher centres - about to speak
2 loud irritating noise - afferent from CN VIII
3 somatic motor nuclei of CN V and VII
ill
4 CN VII to Stapedius
5 Tympanic membrane
Salivation reflex (CN I, II, VII, IX higher emotional
the salivary glands

1
Ne
centres, sympathetic and parasympathetic fibres)
The thought, smell, sight or taste of food causing reflex secretion from
imput from higher centres - thinking of food

2 imput from seeing food Optic N = CN II - looking at food
. L.
3 imput from smelling food Olfactory N = CN I - smelling food
4a imput from tasting food Lingual N, Chorda Tympani (CN VII)
4b & Glossopharyngeal Ns (CN IX) - tasting food*
5 Solitary nucleus of Medulla = Nucleus Solitarius
rA
6a Salivatory centres of the Facial

6b & Glossopharyngeal nuclei
7 Preganglionic sympathetic cells
(in the lateral horn of the SC) and fibres
8 Sympathetic chain
©D
9 Postganglionic sympathetic fibres (salivation)

10a Parasympathetic efferent fibres of CN IX and the
Otic ganglion (salivation)
10b Parasympathetic efferent fibres of CN VII and the
Submandibular ganglion (salivation)
11 Salivary gland
*note trained reflexes of timing and signals such as aural input can also
influence the afferent stimulus to salivate - also both parasympathetic and
sympathetic fibres increase salivation
244 © A. L. Neill
3
2
ill
5
Ne 4
. L.
1
1
2 6a 3
3
rA
6b
©D
4a 4b 11
9
10a 10b
8
7
© A. L. Neill 245
Swallowing reflex (CN IX, X, XII V3)

a bolus of food or liquid - including saliva, placed at the back of the
throat will cause the reflex initiation of swallowing
1 oropharynx
2 afferent fibres of Glossopharyngeal N (CN IX)
3 Solitary nucleus = Nucleus Solitarius
ill
4 Nucleus Ambiguus (motor nucleus of CN IX X & XII)..
5 Vagus N (CN X)
6 Hypoglossal N (CN XII)
Ne
7 Preganglionic sympathetic cells (in the lateral horn of
the SC) and fibres
8 Sympathetic chain
9 Postganglionic sympathetic fibres
10 interneuron connections stimulating peristalsis to the stomach
11 stomach
. L.
Gag reflex (CN X)
irritation of the oropharynx / larynx w/o swallowing imput will cause
coughing and gaging and if severe vomiting
CN IX / X afferents will loop and efferent Ns will cause reflex reaction of
rA
coughing and muscle spasm

(Pharyngeal Constrictors)
diminished in 20% of people unless severely irritated - important to
stop particles from going into the trachea
Jaw Jerk (CN V3)

©D
the mouth is opened slightly - strike the chin with a reflex hammer -
jaw will close and then open rapidly -monosynaptic stretch reflex -
(Masseter, Medial Pterygoid and Temporalis)
1 Temporalis
2 Masseter
3 Mandibular afferents (CN V3)
4 Trigeminal ganglion
5 Proprioceptive nucleus
6 Motornucleus of Trigeminal N (CN V3)
7 Efferents from Trigeminal N to muscles of mastication (CN V3)
246 © A. L. Neill
1
2
ill
3
4 5
Ne
6
7
. L.
8 11
10
rA
1
©D
5 4
7 2
6
© A. L. Neill 247
Carotid reflex (CN IX, X)

Changes in the stretch receptors of the carotid sinus (BP) alter the level
of the CO to regulate the blood volume passing through this area hence
artificially stretching this body will cause a marked reduction in BF and
fainting - VASOVAGAL reflex.
Yawning reflex (higher centres, CN V, VII, IX, X, XII
ill
Phrenic N and Intercostal Ns)
Observation - Mimicry, Boredom, Tiredness, Low O2 levels and/or High
CO2 levels, will cause a reflex from the respiratory centre in the
Ne
Medulla to increase the air intake rapidly by opening the mouth and
pharynx very widely, contracting the diaphragm and increasing the rib
cage -rapid relaxation follows - long expiration
(Diaphragm, Platysma, Thyroid and Hyoid muscles, Pharyngeal
muscles)
. L.
1 higher centres
2 Motor nuclei of several CNs including Trigeminal and
Facial Ns (CN V3, VII)
3 Interneurons to Phrenic N (C3,4,5)
rA
4 Interneurons to Intercostal Ns (T1-12)

5 Diaphragm (innervated by the Phrenic)
6 Intercostal muscles
7 Mandible - opened by muscle stimulation (CN X, XII)
©D
8 Pharynx and Larynx opened (CN IX, X)
248 © A. L. Neill
ill
1
Ne
2
8
. L.
1
7
rA
4
©D
6
5
© A. L. Neill 249
THE SPINAL CORD
Fasciculus Cuneatus + Fasciculus Gracilis &

Spinocerebellar tracts.
Fasciculus Cuneatus (neck to mid Thorax=T6) + Fasciculus Gracilis
(lower thorax =T7 - lower limb) = the Dorsal columns of the SC.
Ascending sensory tracts for pressure, proprioception and touch to the
sensory cortex of the CC or the cerebellum, the Dorsal columns. The
ill
ALS = anterolateral system.
Note as with all sensory tracts there are 3 neurones needed to complete the
pathway to the CC. (this also is present in the CNs)
Ne
1 axons of the 1st order neurones
1c fasciculus cuneatus
1g fasciculus gracilis
2 axons of the 2nd order neurones
M = medial leminiscal tracts – contralateral
P= posterior spinocerebellar tracts – ipsilateral
. L.
2c fasciculus cuneatis
3 axons of the 3rd order neurones
4 thalamus
5 CC
rA
6 midbrain
7 cerebellum
8 pons
9 nucleus gracilis
10 nucleus cuneatus
©D
11 MO
12 cell bodies of the 10 N located in the dorsal root ganglion
13 proprioreceptors receptors in muscle
14 touch – light touch receptors
15 lumbar SC
16 spinocerebellar tract note ipsilateral tract
17 cervical SC
18 dorsal root ganglion
19 post central gyrus
20 central sulcus
250 © A. L. Neill
20 THE SPINAL CORD

19
3
4
ill
5
Ne
6
7
. L.
8
2p 2m
rA
9
10
16 11
1g+1c
©D
17 14
13 18
1g
12
14
15
© A. L. Neill 251
THE SPINAL CORD
Lateral Spinothalamic tract

Ascending sensory tracts for crude touch, deep pressure, pain &
temperature to the sensory cortex of the CC.
Note as with all sensory tracts there are 3 neurones needed to
complete the pathway to the CC. (this also is present in the CNs)
ill
= lateral spinothalamic tract
4 thalamus
5 CC
6 midbrain
Ne
7 cerebellum
. L.
8 pons
9 nucleus gracilis
10 nucleus cuneatus
11 MO
rA

13 pain receptors
14 temperature receptors
15 lumbar SC
©D
16 lateral spinothalamic tract

note crosses immediately to contralateral side
17 cervical SC
19 post central gyrus
252 © A. L. Neill
THE SPINAL CORD

19
3 4
ill
6
Ne 7
. L.
8
2 9
rA
10
11
12
18
©D
17 13
16 1
14
15
© A. L. Neill 253
THE SPINAL CORD
Corticospinal tracts
Descending motor tracts = anterior + lateral corticospinal
tracts forming the main bulk of the Pyramidal tracts
A collection of Axons b/n the motor CC and the SC, which travel
through the internal capsule to the SC forming tracts in the anterior &
lateral columns of WM in the SC.
ill
1 motor CC
2 internal capsule
3 geniculate fibres
4
5a
5L
anterior cerebrospinal tracts
lateral corticospinal tracts
Ne
decussation of the pyramidal fibres
6 anterior N roots from the ventral / anterior horn

. L.
7 corona radiata
rA
©D
254 © A. L. Neill
THE SPINAL CORD
7 1
ill
Ne 3
2
. L.
rA
5a
5L
©D
© A. L. Neill 255
THE SPINAL CORD
Pyramidal tracts
Descending motor tracts passing through the pyramid
formation of the MO = ant. & lat. corticospinal tracts +
rubrospinal tract
The smaller ant. tracts supply the skeletal muscles on the ipsilateral side.
The larger lat. tracts and the rubrospinal tracts supply muscle on the
ill
contralateral side, crossing in the pyramids of the MO. The rubrospinal
tracts are involved in maintaining muscle tone, coordination and balance.
They do not have input from the CC, beginning at the red nucleus.
Ne
1 upper motor neurones
2 primary motor area of the CC
3 internal capsule
4 red nucleus
5 midbrain
. L.
6 cerebellum
7 pons
8 MO
9 decussation (crossing over) of lat. corticospinal fibres
rA
10 SC cervical region
11 skeletal muscle
12 lumbar / thoracic SC
13 lower motor neurones – Spinal Nerves
©D
14 anterior corticospinal tracts

15 lateral corticospinal tracts
16 rubrospinal tracts
note extrapyramidal tracts are all the others ie which donot pass through the
pyramids
256 © A. L. Neill
THE SPINAL CORD
ill
3
Ne 4
5
6
. L.
7
rA
16
9
©D
15 10
14 11
12
13
© A. L. Neill 257
THE SPINAL CORD
Pain Pathways – Nociceptor information

Spinomesencephalic
Spinoreticular &
Spinothalamic tracts
Ascending sensory tracts for pain or information from the nociceptors
may include any sensory pathway – these are the main 3. Note they
ill
cross in the SC dorsal horns segments immediately upon entering.
4 thalamus
5 CC
Ne
6 midbrain
6g periaqueduct GM (in Midbrain)
. L.
6r reticular formation of the midbrain
7 cerebellum
8 pons
rA
8r reticular formation of the pons

9 nociceptors or pain receptors
10 tracts in the SC for the pathways described
11 MO
©D
11r reticular formation of the medulla

12 sensory N fibre entering ganglion where the N cell
bodies are located
synapse in SC dorsal horn - changes from
1o to 2o neurones
13 SC segments cervical, lumbar and/or thoracic
258 © A. L. Neill
THE SPINAL CORD
ill
5
6g
Ne
6r
6
7
. L.
8
8r
rA
11r
10 11
©D
9
1
9
13 10
14
12
9
1
© A. L. Neill
1 259
THE SPINAL CORD
Tracts of the SC*

Transverse – thoracic
Motor = Descending - carries messages to the body / muscles from
the brain - efferent tracts = M = pure motor N
1 Corticospinal tracts a = anterior / l = lateral = PYRAMIDAL TACTS
motor CC  skeletal muscles
ill
2 Reticulospinal tracts a = anterior / l = lateral
reticular formation in the Bs  muscles for tone + visceral function
3 Rubrospinal tracts*
posture & tone

4 Olivospinal tracts
5 Tectospinal
Ne
Red nucleus in MB  distal flexor limb muscles for balance,
MB coordination of Head & Eye movements - “looking”

. L.
6 Vestibulospinal*
MO  muscles for posture & balance
Sensory = Ascending - carries sensory input from the body to the
brain / afferent tracts = S = pure sensory N
rA
7 Fasciculus gracilis – dorsal column from the lower thorax to LL

8 Fasciculus cuneatus – dorsal column from the neck to the mid-
thorax + UL
Dorsal columns carry information regarding: - light touch, position,
pressure & vibration to the sensory CC
©D
9 Spinocerebellar tracts a = anterior / p = posterior

neuromuscular + neurotendinous information to the Cerebellum &
Reflex arcs, to detect over stretching of muscle &/or tendons +
feedback on balance & coordination
10 Spinothalamic tracts a = anterior / L = lateral
crude touch, pain, pressure & temperature via the Thalamus to the CC
M + S = PN = peripheral N generally a mixture of motor & sensory fibres.
For more detail on SC structure see the A to Z of Peripheral Nerves.
260 © A. L. Neill
THE SPINAL CORD
PN
3
2L
ill
1L
4
Ne
5
2a
6
1a
. L.
rA
7
10a
8
©D 9p
10L
S
9a
M
© A. L. Neill 261
THE SPINAL CORD
Points of Immobility in the SC

The Brain is connected to the SC and together they are a relatively
immobile inelastic sensitive branched cord. Hence with changes in
posture any tethered points place tension and so pain on this structure.
As demonstrated this can be accentuated by various postures and so
allow the clinician to locate and evaluate the areas of sensitivity
for treatment.
ill
Green arrows  demonstrate the direction of the pain when stretched
and red arrows the direction of movement 
Ne
1 CN VII Facial N
2 boney canals in the mandible
h = hypoglossal m = mandibular canal
3 commencement of the SC hindbrain / SC junction
4 SC
. L.
5 CN V Trigeminal N
6 midbrain
7 Femoral N
8 Saphenous N
rA
9 Sciatic N
©D
262 © A. L. Neill
THE SPINAL CORD
5
6
2
ill
3
1
4
Ne
. L.
9
rA
C6
7c
©D
L4
9
© A. L. Neill 263
THE SPINAL CORD
Relation of the ANS / sympathetic chain to

the SC and VC
The sympathetic chain of the ANS flanks the thoracic region of the VC
forming ganglion opposite each thoracic outlet and feeding fibres into
the visceral region.
In the cervical region these coalesce into 3 major ganglia and in the
ill
lumbar region they lie across the VB of the VC.
1 superior cervical ganglion
2 middle cervical ganglion
3
4
5
lower cervical ganglion
sympathetic chain
visceral branches
Ne
6 VB of L2
. L.
rA
©D
264 © A. L. Neill
THE SPINAL CORD
ill
4
5 Ne
. L.
6
rA
©D
© A. L. Neill 265
THE SPINAL CORD
Relations of the Cervical Sympathetic Trunk

& Ganglia
Note Horner’s syndrome is due to an interruption of the cervical
ganglia = miosis + ptosis + enophthalmus + vasodilatation +
anhydrous
1 Vertebral artery
ill
2 internal carotid N
3 Superior cervical ganglion
Ne
4 Middle cervical ganglion
5 Inferior thyroid artery
6 Thyrocervical trunk
7 Subclavian artery
8 Stellate ganglion (C4-T1 fusion)
. L.
9 2nd thoracic ganglion
10 vertebral N
11 communicans b/n cervical Ns
12 loop of Atlas
rA
13 fibres to CN XII
14 fibres to CN X
15 fibres to CN XII in the descending loop ansa cervicalis
©D
266 © A. L. Neill
THE SPINAL CORD
1 2
C1 13
ill
12
C2 14
11
C3
C4
10 Ne 15
16
5
10 4
. L.
C5
C6
rA
C7
6
C8
©D
7
T1
T2 8
© A. L. Neill 267
The A to Z of
The Brain
Dr. A. L. NEILL BSc MSc MBBS PhD FACBS

medicalamanda@gmail.com or www.amandasatoz.com
mobile 0410 018 681
Contact www.aspenpharma.com.au for login and passwords for
the complete A to Z and the AspenAtlas online.
Aspen Pharmacare Australia Pty Ltd 34-36 Chandos Street, St Leonards NSW 2065
ABN 51 096 236 985
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A-Z The Brain55:Layout 1 14/12/09 1:08 AM Page 1

To those striving to understand.

HOW TO USE THIS BOOK

Meninges and the SC 50

Broca’s area see Language centres

Lobes – Cerebrum Major anatomy 114

Crus Cerebri see Brainstem Midbrain

Language centres see also Pathology / Aphasia 130

Medulla Oblongata = Medulla see Brainstem , Midbrain

Putamen see Basal Nuclei

CN IV see also Special senses / Sight 156

CN IX see also Special senses / Taste 186

see also Venous sinuses/Cavernous sinus

Spinocerebellar tracts see Tracts of the SC

Overview of tracts of the SC 260

CF = cranial fossa(e) prox. = proximal

collat.= collateral SN = spinal nerve

Neuro-anatomical and Neurological terms

Angular gyrus part of the Temporal lobe involved in language

of pain perception and emotional response (see cingulum)

Area postrema caudal area on the floor of the 4 Ven

Articulation joint, which is a point of contact b/n 2 bones / relating

NUCLEUS + PUTAMEN + GLOBUS PALLIDUS +

production, sound and memory

or formed by 2 or more bones (adj. cavernous), may

Cephalic pertaining to the head

recognition, music perception and production

functions as in recognition and recall for use in

or SC (e.g. anterior commisure)

CH – connects the 2 CH via large mass of axons

the pyramids, medial leminisici and superior

Depolarization the loss of the potential across the cell membrane of a

Dysmetria disordered measure – abnormal reach or control of

Fasciculus small bundle – used for a bundle of N fibres

Fovea pit – as in the Fovea Centralis at the centre of the retina

(opposite to WM which contains mainly

Hemiplegia half stroke – paralysis down one side of the body

Hypothalamus under the inner chamber – region in the Diencephalon

Lacrimal related to tears and tear drops. (noun lacrima)

Locus a place -c.f. location, locate, dislocate.

muscle site general term meaning either the neuron(s),

Perineurium middle of the 3 CT coverings of a PN fibre

Pia soft – pia mater PM soft covering of the brain

inhibition and judgement

pyramid shape on the ventral surface of the MO

| supplying all structures behind the SC - the Rami are

then brain &/or reflex

Spinal Cord (SC) Extension of the brain protected by the VC, PN

Stratum layer – as in stratum zonal on the dorsal surface of

Supramarginal gyrus forms words form letters

mission or inhibition of an impulse via neurotransmitters

Tetraplegia see Quadriplegia

chest - to the front, used interchangeably with

(see Grey matter)

The A to Z of the Brain

Guide to Anatomical Planes and Relations

The A to Z of the Brain

The A to Z of the Brain

Hip abduction Hip adduction

Hip lateral and

Knee flexion Knee extension

The A to Z of the Brain

Foot dorsiflexion Foot plantar flexion