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Central Nervous System

Richard L. Trader MMsc PA-C FCCM

Anatomy and Physiology CNS
Institute of Health Sciences
Timonium, Maryland 21093

The Nervous System
• The nervous system is divided into two
parts, the central nervous system and the
peripheral nervous system. The central
nervous system consists of the brain and the
spinal cord. The peripheral nervous system
is made up of 12 pairs of cranial nerves and
all the remaining nerves of the body
(including the autonomic system).
• The skull is formed by the bones of calvaria and
the skull base. The calvaria is comparatively large
to accommodate the brain. In the newborn, it is
about 25% of its adult size. It reaches about 75 %
of its adult size by the end of the first year. The
newborn skull is made up of thin, pliable bones
due to incomplete ossification (the process of
hardening of the bone). They are separated by
fibrous or membranous tissue (the sutures).
• The membranous gaps are called fontanelles and
are larger at the corners of the parietal bones. The
centerally located anterior frontanelle is the largest
and diamond-shaped. It does not fully ossify until
18 to 24 months of age while the other
frontanelles usually close by 2 to 3 months of age.
The sutures where most of the bone growth occurs
also do not completely obliterate until
approximately 8 years of age. The skull base
consists of maxilla, frontal, ethimoid, sphenoid,
temporal, parietal, and occipital bones.

• The skull contains various foramina (canals
through the bone) which permit the major
arteries, veins and cranial nerves to pass
through. The largest is the foramen magnum
through which the brainstem continues
down to the spinal cord.

Spinal Column
• The bony spinal column is built from alternating
bony vertebrae (the individual spinal segments)
and fibrocartilaginous discs (spongy tissue
between each vertebra) which are intimately
connected by strong ligaments and supported by
powerful surrounding muscles. There are 33
vertebrae consisting of 7 cervical (neck), 12
thoracic (chest), 5 lumbar (small of back), 5
sacral (hip)and 4 coccygeal (tail of spine).
• A typical vertebra consists of multiple
pieces of bone, a cylindrical body (base of
the canal), and a posterior arch composed
of a pair of pedicles (side walls of the
canal) and laminae (roof of the canal)
which fuse to form a spinous process (a
posterior projection which can be felt as a
bump through the skin).
• The body and the arch create a vertebral
canal through which the spinal cord courses
down to the level of the second lumbar
vertebra. The intervertebral disks between
the vertebral bodies act as elastic buffers to
absorb mechanical shocks.

• The brain is divided into five parts on an
embryological basis.

1. Telencephalon

• The telencephalon is the area of brain most
developed in the human species and
considered to be the center of the highest
functions. It is composed of two major
structures, the cerebrum and the basal

• The cerebrum comprises most of the
visible brain surface and is divided into
right and left hemispheres (the two halves
of the brain) by a longitudinal fissure (a
major cleft between two pieces of the

• Its surface is made up of convolutions
called gyri, which are separated by shallow
and deep grooves called sulcus and fissure
respectively. Although every human brain
shares the presence of certain sulcus and
fissure, no two brains have exactly the same


• The fissures and sulci divide each
hemisphere into four main areas called
frontal, parietal, temporal and occipital
lobes. Seen on a horizontal, cross-sectional
view of the brain is the outer layer of the
cerebral hemisphere, the gray matter or the
cortex, which is composed of neuron
(nerve)cell bodies.
• The inner layer, the white matter, is made
up of long axons (strands which conduct the
nerve's electrical signals throughout the
brain and the rest of the body) projected
from the cell bodies in the gray matter.
Some axons pass from one hemisphere to
the other in bundles such as the large
corpus callosum.
• Some pass from lobe to lobe from gyrus to
gyrus in the same hemisphere. Many axons ,
however, descend from the cortex to other
areas of the central nervous system such as
the spinal cord passing through an area
called the internal capsule.





• The basal ganglia, the area for crude motor
activity, are buried deep in the cerebral
hemisphere. When the brain is cut in a
horizontal (axial) plane, one can see some
of the basal ganglia, such as caudate
nucleus, globus pallidus, putamen, and

2. Diencephalon
• The diencephalon is located in the middle of the brain,
between the two cerebral hemispheres. The diencephalon
is divided into the thalamus, the main relay center for the
various sensory and motor functions and the
hypothalamus. The hypothalamus is the area concerned
with temperature, appetite and various other hormonal
control. In addition, the diencephalon includes the medial
and lateral geniculate bodies associated with auditory and
visual relay centers respectively, as well as the
subthalamic nucleus and the pineal body.



Stalk of the pituitary

gland 26
3. Mesencephalon
• The mesencephalon along with the pons and
the medulla oblongata together form a
wedge-shaped structure, the brainstem.
The mesencephalon(midbrain) is located
between the diencephalon and the pons. The
aqueduct of Sylvius, carrying cerebral
spinal fluid from the third ventricle to the
fourth, passes through the mesencephalon.
• The area above the aqueduct is the tectum, which
contains the the quadrigeminal plate made up of
2 pair of rounded projections called colliculi. The
upper projections form the superior colliculi and
the lower form the inferior colliculi. The area just
below the aqueduct is the body or the tegmentum
of the midbrain, containing various fiber tracts and
relay centers such as red nucleus and substancia
• Also located in the tegmentum are the cell
bodies of two important cranial nerves,
oculomotor(3rd) and trochlear(4th)
nuclei, which control the movement of the
eyes. Finally, situated at the base of the
midbrain are a pair of huge fiber bundles,
the crus cerebri, which are a continuation
of motor fibers from the internal capsule.
4. Pons and Cerebellum
• The pons and cerebellum together make up the
fourth division of the brain. The cerebellum is a
multiply-folded structure located under the
occipital lobe and is concerned with equilibrium
and the coordination of motor activity. The
cerebellum communicates with the underlying
brainstem via three pairs of fiber bundles:
superior, middle and inferior cerebellar
• The pons is located between the midbrain
and the medulla and is separated from the
overlying cerebellum by the fourth
ventricle, filled with cerebrospinal fluid
(CSF). The pons contains various ascending
and descending fiber tracts. Also in the pons
are the cell bodies of 3 cranial nerves,
trigeminal(5th), abducens(6th), and
facial(7th) nerves.
5. Medulla Oblongata
• The medulla oblongata is the last division of the
brain. It becomes continuous with the spinal cord
at the foramen magnum. It contains various
ascending and descending fiber tracts like the
midbrain and pons. It also harbors nuclei of the
following cranial nerves, the
vestibulocochlear(8th), glossopharyngeal(9th),
vagus(10th), accessory(11th) and
hypoglossal(12th). The respiratory and cardiac
centers are also situated in the medulla.
Spinal Cord
• The spinal cord is the downward continuation of
medulla starting at the foramen magnum. It
descends to about the level of the second lumbar
vertebra, tapering to a structure called the conus
medullaris. There is a thin thread-like
continuation of the conus, the filum terminale,
which extends as far as the coccyx and is
composed of non-nervous tissue.

• The cord serves as a conduit for the
ascending and descending fiber tracts that
connect the peripheral and spinal nerves
with the brain. The cord projects 31 pairs of
spinal nerves on either side (8 cervical, 12
thoracic, 5 lumbar, 5 sacral and 1
coccygeal) which are connected to the
peripheral nerves.
• A cross section of the spinal cord
demonstrates a butterfly-shaped gray matter
in the middle, surrounded by white matter.
As in the cerebrum, the gray matter is
composed of cell bodies. The white matter
consists of various ascending and
descending tracts of myelinated axon fibers
with specific functions.
Cranial Nerves
• There are 12 pairs of cranial nerves.

• 1. The Olfactory Nerve (Cranial Nerve I)
arises in the nasal mucosa and conveys
smell to the brain

• 2. The Optic Nerve (Cranial Nerve II)
deliveres images of sight from the eye's
retina to the brain.

• 3. The Oculomotor Nerve (Cranial Nerve
III) runs from the midbrain to some of the
muscles of the eye to move the eye upward,
downward and medially. It also goes to the
muscles within the pupil and is responsible
for constriction of the pupil. Finally, it
travels to the muscles of the eyelid and is
partially responsible for raising the upper
• 4. The Trochlear Nerve (Cranial Nerve
IV) This motor (a nerve having only fibers
traveling to muscles to cause their
movement) nerve also arises in the midbrain
and goes to some of the muscles involved in
eye movement. It causes the eye to turn
downward and outward.

• 5. The Trigeminal Nerve (Cranial Nerve
V) The trigeminal nerve arises within the
Pons and travels to the jaw's muscles to
power chewing. The nerve also contains
nerves bringing sensation from the face to
the Pons.

• 6. The Abducens Nerve (Cranial Nerve VI)
This nerve arises in the Pons and goes to
eye muscles which rotate the eye outward.

• 7. The Facial Nerve (Cranial Nerve VII) This
nerve also arises in the Pons and innervates (gives
nerve supply to) the muscles of facial expression,
the eyelids, as well as some of the muscles which
assists speech and mastication. It also is involved
in the control of saliva secretion. The nerve also
contains fibers which bring taste sensation from
anterior two-thirds of tongue back to the
• 8. The Vestibulo-Cochlear Nerve (Cranial
Nerve VIII) This sensory (a nerve carrying
sensation information to the brain) nerve
arises in the inner ear and goes to the Pons.
The vestibular component conveys
equilibrium and position sense and
coordinates movement of head and neck.
The cochlear component coveys hearing.
• 9. The Glosso-Pharyngeal Nerve (Cranial Nerve
IX) This mixed (a nerve having both sensory and
motor fibers) nerve brings sensation from the
pharynx (back of the throat), senses blood
pressure from the carotid artery (one of the main
blood delivery pathways to the brain), taste from
posterior one-thirds of tongue to the Medulla. It
also sends motor nerve fibers to the throat to
power swallowing.
• The Vagus Nerve (Cranial Nerve X) This
nerve is also mixed. Its motor fibers come
from the medulla and are involved in
swallowing, and regulation of cardiac,
pulmonary, and part of gastrointestinal
activities. It brings sensation from the
gastrointestinal tract back to the medulla.

• 11. The Accessory Nerve (Cranial Nerve
XI) arises in the medulla supplies the
muscles which elevate the shoulder as
occurs with a "scrug".

• 12. The Hypoglossal Nerve (Cranial Nerve
XII) This motor nerve comes from the
medulla and goes to the muscles of the

Cerebral Cortex
• The cerebral cortex is highly developed in
man and certain areas are associated with
specific neurological functions.

• The Frontal Lobe
• Prefrontal cortex (the front tips of the
hemispheres) is concerned with higher intellectual
functions and is involved in the many behavioral
aspects of man. It inhibits certain primitive
behaviors. Bilateral destruction of this area results
in a loss of concentration, a decreased intellectual
ability and a lack of judgment.

• Primary motor cortex is located just in
front of the central sulcus in the frontal
lobe. The area controls the movement of the
rest of the body while the premotor cortex
just adjacent to it is concerned with the
initiation, activation, and performance of
the actual movement.

• The Parietal Lobe is primarily concerned
with the interpretation and integration of
sensory inputs. Destruction of the parietal
lobe may result in clumsiness, defective
recognition of sensory inputs and lack of
interpretation of spatial relationships.

• The Somatosensory cortex is located just
behind the central sulcus in the parietal
lobe. It is associated with reception and
perception of touch, vibration, and position
sense of the body.

• The posterior part of the Temporal Lobe, known
as the auditory cortex, is concerned with the
reception and interpretation of sound information,
while the medial part, the olfactory cortex, is
concerned with the smell information. A part of
the superior temporal lobe and the inferior part of
parietal lobe on the dominant hemisphere
(usually the left hemisphere)is called the language
cortex and participates in recognition and
interpretation of language.
• The Occipital Lobe contains the primary
visual cortex(the striate cortex). Lesions in
this area may produce a loss of vision on the
opposite side or a lack of ability to interpret
visual inputs.

Physiology of Cerebrospinal Fluid
• Cerebrospinal fluid (CSF) flows within the
ventricles of the brain, the central canal of the
spinal cord and out to the subarachnoid spaces
surrounding the brain and spinal cord, effectively
floating these two structures. It serves as a
medium for the transfer of substances between the
blood and the nervous tissues as well as a liquid
buffer, absorbing mechanical shocks to the brain
or the cord.
• Most of CSF is provided by the choroid plexuses
that reside in lateral, third and fourth ventricles. In
adults, the volumn of this fluid has been calculated
to be from 125 to 150 ml (4-5 oz). It is in
continuous formation, circulation and absorption .
Approximately 430 to 450 ml (nearly 2 cups) of
CSF are produced every day, or 0.35 ml per
minute in adults and 0.15 per minute in infants.

• The choroid plexuses of the lateral
ventricles are the largest and produce the
majority of CSF. The fluid then flows
through the foramina of Monro into the
third ventricle. The fluid is augmented by
the production from this ventricle and
continues down through a narrow passage
called the aqueduct of Sylvius to the fourth
• After addition of more CSF from the fourth
ventricle, it escapes into the subarachnoid
space through the foramina of Magendie
and Luschka. The CSF then circulates
throughout the base of the brain, down
around the spinal cord as well as upward
over the cerebral hemispheres.

• The CSF is then absorbed primarily through
arachnoid villi into the superior sagittal sinus and
joins the blood circulation.
• The obstruction of the normal CSF flow or
overproduction of CSF from a choroid plexus
papilloma (a benign tumor of the choroid plexus)
can lead to a condition known as hydrocephalus. It
is defined as a disproportionate enlargement of
part or all of the ventricular system due to an
excess of CSF and is typically accompanied by
serious increase in intracranial pressure.
Increased Intracranial Pressure
• The normal values for intracranial pressure (ICP)
at the level of foramen of Monro are
approximately 90-210 mm of CSF in adults and
15-80 mm of CSF in infants. Increased ICP can
occur as a result of an increased mass within the
limited volume of the cranium. Examples include
an increase in CSF volume, cerebral edema, and
growing mass lesions such as tumors and
• Cerebral edema is the increase in brain tissue water
causing swelling. It may occur secondary to head injury,
infarction or a response to adjacent hematoma or tumor.
Uncorrected increased ICP can lead to further brain
damage due to the pressure and inadequate blood perfusion
of neurological tissues. The treatment for increased ICP
includes removing the mass(tumor, hematoma) by surgery,
draining CSF from the ventricles by a drain or a shunt,
hyperventilation, steroids, osmotic dyhydrating agents, and


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Cerebral Angiogram

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