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2015v1.0
Neuroanatomy
AN ILLUSTRATED COLOUR TEXT
Cover image by Ben C『ossman, bas回 upon a 'time-of-flight' image of the a闹剧 supply of the brain in a living
indMdual, cou「tesy of Professor P D G耐fiths, A臼demic Unit of R甜iolo町， University of Sheffield, Shef俑Id , UK.
AN ILLUSTRATED COLOUR TEXT

Sixth Edition

Alan R Cr。ssman PhD osc

Erne『itus Professor of Anatomy
The University of Manchester
Manchester UK

David Neary MD FRCP

Honorary Professor of Neuroscience
Manchester UK

lllustra幅d by Ben Crossman MA

Foradditi。nal online content visit StudentConsult.com

ELSEVIER
ELSE飞'IER
02020，日，阴阳 Umi阳i 必l rights re阻四d.
F凶h edition o Blamer Limited 2015
Fourth edition o Elsevier Limited 2倪。
咀世d editi。no Bis凹ier limited 2005
Second edition o Blsevier Limited 2000
Pint edition • PeaDon Proressional U皿ted 1995

古ie right of .Alan Crossman and D町id Neaxy to be iden蝇d as au曲。”。f也ii

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S回但rCon阳1tC地附蚓阳nent 勘由僵局t:KimBan回n
内'OjsctMan钝阳； Julie Taylor
De:咿r Brian 臼lisbury
航』S阳阳； Ben Crossman
Mal妇舶1gMan司阳7 Deborah Watkins
Preface to the sixth edition
A basic knowledge of ln皿皿
n四roanatomy is 幽幽皿由l pm吨血ite
for medical stud四” about to emb础
upon clinical studies. Wi曲。.ut such
knowledge it is imp幽ible to 皿demand
由E E可由d of clinical s幅11 and symptoms
由at 剧院岳阳1 disordeni of the nervous
m能m. 四s book has b阳E des阳明
”如回ly 如 medical 阳缸咆 but
neuroanato町 is an import皿t sut对ect also
for 血，d四”。f basic neurosci四ceandof
m皿~subje由 allied to medicin巳
In revising and updating Neuroanaromy
for a ，这也 edition, WE have retained our
m蝠皿1 in恒ntion to produce a relevant,.
clea鸟，uccinct and wdl-illustr眠d aαount
of 由e anatomy of the human ner响>US
句富能皿．
险业回nee i也 perhaps, 也e m田t
important fe由lt巳 N四roanatomy is 皿
回国aive subject. 缸ul 也e pace of reseaICb.
in ho由也E basic and din国lid四由
means that it is e晒4叩anding. At the
拥metim鸟曲Jdents are under press皿~and
neuroanatomy 回E almostαrtainly not be
由t only subj四 that 也.eyare 血由问．
Pr唱face, to the first edition
fbi~ OO<ik bi15 !},;'CCI 'hrlllCll p阳n.ari句’仿W
under吉;i-~duali' medic-ii :nm:len.u.. i'.1 d1.r
unu• d m>f', we h.w~ bDr时 ia mmd
" 1udlrnu. followi111g Mt1er b~alcll r;,:-iemcol"
co11~ where ~
h.illiic u11dJ相~1.mJiag of 1hc
n何vo11:r; s归tcm .md iu rn;1jo:.r di目盯dcm 』E
’叫11ired, ,md .dm 翻ud阳u nf h.1~1r
neur~；：巳 wbo Jn' i町v~rbblr incriguc<I
~nd f'detiio"d by <I 院内1uoior1 of [h.,. dimn!f..，.『Z
n· lurti ;ll'Ilion 1!wo bum~n nL>rvou~ 5.'flil"m.
Tl!~ ll<loli ll!I hi!cn P『cp.ucd during "'
11criod of •1fliU-l;pTC;id deb.ale 棚，旧时
M-a lulia1t in. clW' s_:1bsu.nH .rnd ＂＇）~ af
moo』rJl cdu,r,ui.:m. 11W'r!l ~rf' ~'ll!ul
dm’m11f1口『·.res for chi\问萨，。nf' br111g ’旧
时.：－ngnmon 1h.n nnrc~s白ruhl~ and
unnen-~· d'f>m;,005 .uc 口f'tl?lrl ht:-tng
m柑e Df ,o;1udcru骂 tn 1h_e. sbei:'r volumi:' of
mform;iticm wh ili1 1h巧；nf'mq川『啊i llD
aiolmiLrn.~. 』h h. ~ (Komp1.ed :im1den 11,
!ldur11m~ .md he.1l1b prof.－剧。11;il~ illd;c ~o
qu自1irrn . ~＇＂阿鼠‘ 11lc whole.- nmin.1l11m刷， 1hc
dcp1h Df k11阳’lc~whld首脑 reqllircd b}•
1bc :ncwly.qtuli:ficd dor咽。r ;11:11:lidW'm!L"ilm
hy wh irh i~ :'lt-1L.I br ~rh ll"\vd. Tbe
t丁柯1.-r.il Mfilkal C.;iu『H':ll h~
Al也ough 由t question "What do I n钝dto
kno时’ is 皿a血四ta to some edu凶ω”’ it
is per岳ctlyundeI鼠andable. What to
include 皿d what to leave 创皿 is，。f course,
a matter d如dgem四t 。田哩’roarh has
b田l to include what we mruider to be
essential ma阳ial, correlating, wbem町
p。”ible. anatomical 础ucture 回也
缸nction and, where applicablE斗时插ngit
tod皿ical sign温can血 We believe 也at 也z
bttadth and dep也 of co回age of 由t
subj皿 in Neuroatl4t0m}' are sufficient 凶
enable stud£nta toαnnmence tl回x
往到ning in clinical neurosci四cewi由
confid皿但
。arity is al师。f great importanc巳
Neuroanatomy is a complex subject 皿d
one with which students o民m 缸d
di值culty. We have made ev町 effort.
也a由re, to avoid vagu皿eas, opacity 皿d
ambiguity and to make deacrlp世.ODS and
cone哼u as stra增itfurward as 萨跚iblι
Not only does Neuroanatmny foCWI
on the 倒四世al material but the tat
is also delibera能ly succinct and to the
point.
『OC"cimm~n.:led tht' dir't'i'如，mcmi::ir;i
E帽Lf'm..h;is~~ C"D~ nirrkulum ~n_d ~
emplui:i~.:'d 1b~ er田u] 』mrori,U'IC(" or
im"Sr.m1C111 h<'CWN21 b~ic ,;cit<ncr ;md.
rlia町百I m..dkinc. flll:'.l;c pmpm~lii h.we
htt-1'1 1''f']mm!ld .md impltfiNI, wilb
『自j)«I tin 111.... tt'.1.:h l11g of ncuml同g,\飞 h-y Ill~
i'.u-.oci.uioll af Hmi:r;h N~1roloi;i,.110..
·' o ,1[1!.j of m>l"(hc,11 sdc1-n.• lc111山，IM'lf
""'11f"I 由.1n 1111r'1l11rou·i~l'WI!
10 :mcb J
Sj'l'Hf'm·hilS时， Jill（＇伊百tt'CI ll(1IJlllD ilrfl lln<I 11us
~bee恼，Ile rrillh:ip;il ph 11Cl凶ph)· guidin且
1lt"' pr!'pilr.矗mm Df 1l11~ ha1>k. Nc1.1m且dm,r,
whll ;di iu :mh-sp~lu阳 bo1b Billilr and
rlir1llr.'ll. i:i; .in enmmom fi<"-1.1 wbcrr thf'
grm."!b ol ll:n.n-wWgc 1brn11阱『H~l'L'"h 』E
呵10111en1~l. 'f1:u... crf'..Hcs ~ grc;11 rfullcnge
Ill 1he me山rd] "d11<,1mr in si.!l<'Cun.g wb,u
sbDultli cornrwue 11lc CDl't" mrriculum. 11
＂＇阳 dgmfi6 cht- pt回e"iul for fomrl!
;;di.•.inc·何』n dlll' dL1gcio:i1皿. pri!Wncion .rnd
1:re.umc1t1 D「时’1rolall,IL";il tii1'.'.1w,
『N'DSDiu<d by 1bc dcng旧冒出n of 1bc l 阴阳
;u 1bc 'U.何百df' of thll' 自『且im'.
J>. e11m.i11.i1om)· illi d1>t' mmc~1onc nprm
wbkb 目 liuill an midi:阳1.11ndi11g nd' 1hc
τk in能mal 四ato皿yof 也Eαn国i
nervous system - its nud也 nerve fibre
田幽幽d, particularl，也.eircorm回ions
- cannot always be readily visualised in
dissections, brain sections or sans. As a
consequmc:r, clear, unαnnplicated and
aplicitill旧trations ar琶扭曲”lute
necessity. 咀ie illus回.tions ~ always
been a strong point of 血E book －缸id one
of也z features 曲事t has attracted most
compliments from readers. Since 也E 也M
edition, B四 Crossman has been
responsible for ilium四on of也A::en由E
book. For this edition. some new 鱼gures
have been introduced and virtually all of
阳匈阻四 have been revised to 句d田
improve clarity and aes也etic app回m也
Wearegra能ful to B回也r his a由tic
inte到preta.tioo of our 严皿itive sketchea
and his 嗣llful 四h皿am皿t 皿4
annota皿on of 由z photographs of
aoato回cal 吨回皿ens.
ARCro man ”
D N回ry
M皿chester 2018
ncr啊l'll~ Sl/Stf"m dlld ll'I du喃m1crs. 'lbc 泊m
时’ clli~ boak,. th咽-c~. is 10 provide :i rleJir
.ll'ld cDn.riW' ,1crnum o:f •he Jn,1mrnv of chf"
hum~n n.f".IV.:.IJ.~ 需~~’i!m in 量uffincn.1 fll'c~il
m 1Jl)um1.ind i1~ m.iin. fon.nirrn.<1 .ind 1bc
commcin d国udcn h节 'l••bich His. ;i仔i!ncd.
An lmp<11Un 1 fl'.mm• of 1bl! hL>ok is 1'.hc
』lllCllf司uon. of 11c11ro;i11~1.0m)· wnb
ill11,.1r,11 i四 chnir.11 m ＂＇何ul. lbii; bas h;;-m
Llonf' in Dr<ll'I' 10 ,;h°"w 阳阳昂 lk11ow let:!g.,.
of 1:1c1ua;i111amm)' i:~n b!!lp 』1ulle
1111dA-n1;imdimg of d 111io:~I ~·mrmm,; .md
.1L"'i『F m cmpll;uw th栅 a~＆"i .:if
nc11『时TiiUDID}' wh町hll附 p.aAJJ.:'1Jl,1dy
rel("{;l1111 m ll1.1m~n ncllml咱iuldu~已
认，'c- IUi\'L" irmn.::lure.:3 dmic.ail ro1v~r四川
巾E mou f'lcme111.1町＇－•·~·LO gin ~ bm.id
ou1]inc 口f ~Ile acciology of ncrv1>11~ di~＜＇·lst'"
.:md the! lir;k wi1h dmic~I dJilG时M;ll.r
m剥h阳k Clmir.d rn"Lfflll h:u b酬’
11111日眩目Ll.'d 却 do:isd:r· ;u (1<1~ible 'l•'ith tlv
rel凹，uu 111curaa11.11om:.;. Hinllcrm口阮氏 1hc
danir;i] 1cic1 h;'ll; hcc阳 hi:u:f'd ~D tlul i，』z
rc01dil}' t<lnu I缸.hlc .u1d riln be l".~ul:p-
~Jr吭rd I.Cl rr.-iei.• cu Jl·l~ m啊. bich
dUJl1C『巾口 rnmai11~ oo:u:d lrnmm;irl.－~
四ie purpose of these
is ω 画sist the reader
in id四U句ing key point，但t.d as an 组.d to
眩V1阻on.
Bo也 n四m皿且臼my and clinical
medicine are new to 也e student 缸皿
entering medical school. By ltU句ing the
扭扭oductory chapter and the summaries of
latei; more detailed, chapters the s饱缸lt
w副院m. 血。阳市w of仕le sco严 and
四.ent d也e SU~功ea of neuroanatomy and
w诅 be introduced to 由e basic concept&
underl抖ng the clinical diagnosis of
neurological 曲创此 For 由0挺 unfamili笛
with d皿.cal 田minology a glossary has
b由ipro甘ded to explain the m国ningof
commonly used expI四Io皿＆ more
detailed knowledge of neuroanatomy is
gained, this will be 四hanc:ed and
ilium旭ated by m缸回ce to the selected
clinical ma阳ial 呐峭1 exemplifies 也e
relevance of neuro翻翻＇my to dlllical
neurology. Latei; wh皿 students 四阳
n四rological 缸aining. they need to refresh
h 由eir minds the basic principles of
neuroanatomy and link these to di皿cal
diagnostic methods. At 由is time, the
m国natic 血dyofpa由~tswi也 individual
neurological disea晒 can be greatly
自由anced by retwI世ngto 也E detailed
anatomy of di脆ased 晒uctures.
ARCr。”man
D N回q
M曲曲ea凶 1995
Acknowledgements
A3 in the past, Wt? 缸E indeb也d to
colleagues Professor David J Broob,
Professor Marco C远也皿， Professor Paul D
副血tbs, Prof钮，or Alan Jackson. Profi幽m
David Mann, Dr R Anne McKinney and
Professor Gary C Sc:hoenwolf for providing
scam and other images which er由ance the
illustration of this book. We are also most
gra时Jl to Dr Adrianne Noe 皿d Archibald
J Fobbs for providing photographs of brain
sections 丘。m 也e Yakovlev-E祖lttm
Coll缸：“on held in the National Museum
。fHeal也四d Medicine, Armed Forces
Institute of h由ology. Washington DC.
USA. We would also like to thank 由e
numerous acad幽ic colleagues 皿d
mediral 血idenm around 也.eworldwho
have sentαmstru.ctive comm四”。n
萨mous editioru and suggestions for
improvement.
咀ie authors greatly ap庐eciate 由E
continued 四thusiasm of Elsevier for
N6W'tNUllJ伽句’由自 a p础。d of more 也血
two decades. In the prepar皿.on of this
也由 edition we wish to 也皿k colleagues
at El腿viei; 旭 p皿αll.ar 抽ior Content
Sttat唔st Jeremy Bo赠曲d 阳ior
Content De时叩m四t Sp回alist Dr 阻mH
Benson, for their 回回uragem四tand
support.
ARCr。”man
D N回ry
Manchester 2018
This page intentionally left blank
Contents

Assessment (including Problem-solving) www.studentconsult.c。m

I 1 Introduction and 。1vervlew 1

I 2 Cells of the nervous s阴tem 32 I

I 3 Periphe耐1ervous system 36 I
I 4 Auton。micnervous 町副m 46 I

I 5 Coverings of the central n…SS附m 50

I 6 Vent阳阳 sys恒m 西

I 7 Yasculature of the central nervous s阴阳m 60

I 8 Spinale。rd 臼 ｜

I 9 Brains＇恒m as I

I10 Cranial nerves and cranial nerve nuclei 99 I

111 Ce刷刷lum 113 I

I12 Thalamus 120

113 Ce刚刚 hemisphe阳ndce刚刚 co阳，27

I14 Basal ganglia 回 ｜

I1s Visual system 150 I

11e Hypothalam脯， limbic system and olfactory system 154

IGlossary 164
This page intentionally left blank
 Introduction and overview
Neuroanatomical terminology and
conventions 2
Components and organisation of the
nervous system 2
Neurones and neuroglia 2
Central and peripheral nervous systems 3
Somatic and autonomic nervous
systems 3
Afferent neurones , efferent neurones and
interneurones 4
Grey and white matter, nuclei and tracts 4
Decussation of sensory and motor
pathways 4
Development of the central nervous
system 5
Overview of the anatomy of the central
nervous system 11
Coverings and blood supply 11
Anatomy of the spinal cord 13
Anatomy of the brain 14
1
Major sensory pathways 20
Major motor pathways 21
Basic clinical diagnostic principles 23
Aetiology of neurological disease 23
Time-course of disease 26
Site of the lesion and clinical
syndromes 26
Investigation of neuromuscular
disease 30

The nervous system of all animals functions to detect changes in the process, the human nervous system is the most complex and
internal and external environments and to bring about responses in versatile product of evolution.
muscles, organs and glands that are appropriate for the preservation Although a great deal is known aBout how the nervous system
of the individual and the propagation of the species. In relatively works, much still await deed, the anatomical,
primitive species such functions are focused primarily on: physiological, bi Jar basis of neural function
• Maintenance of the internal environment (homoeostasis)
clinical scie
• Perception of, and response to, external stimuli/threats
The nervo amaged by inherited and
• Finding food
developmen ·es, by disease and traumatic injury and
• Mating
With ascent of the evolutionary scale there is, in addition, an
increasing capacity for 'higher functions' of the nervous system,
such as learning, memory, cognition and, ultimately, 0anatomy and its correlation with function and
self-awareness, intellect and personality. At the pinnacle of this tion is fundamental to the practice of clinical

(Para)sagittal or (para)median plane

Coronal or frontal plane Medial
Lateral ◄--- _- ► ◄- - ~ -► Lateral
Anterior ..;(.'"' ~
l

Transverse, horizontal or axial plane

Superior

,.
Inferior

Fig. 1.1 Neuroanatomical terminology for planes, directions and relationships.

2 • NEUROANATOMY
Dcrsal
Cn11 唰唱M
收ll1tral
f豆｝
Fig. 四刷 Trllnsve”’ hi’”logl回l帽ctlan or由• mldbndn In ’wcam圃，回回回l n•u,,,..tamlc•I arl•n111回an •nd (BJ canw晴Jandlng llXl•I MRI
11C&11 In cano” tlan•I MUl"GFBdlal啕le副。而阴阳曲。”－
DellJO回eru:l!S 缸id to the prospe:立 of 缸缸re advarun in the
prevention and treatm回t of neurological 也orders.
Neuroanat。mical terminol。gyand
conventions
咀ie fonnal names giwrt to parta of the body are agreed
in也mationally by 也E Federa·由e Commit田 on Anatomical
Turminol吨， and have been 阳blished as the Terminal咽a
Anatomica {1998; Th掏出：）. The names of many struC1Ul"e8 画也e
neIYOUS m回l have a Greek or Latin a塌n and are uniq四 b
n四roanatomy. Oft四由e name is desaiptiVE of some pa回.ved
向sial charac回s缸， m血 as shape (e.g. 'hippocampus', m四川吨
sea-ho11e) or colour (e.g. ’＇sub刷ntia nigr圃’， m回ningblack
sub阳nee). Some 由uctu:r四 are known by ep01可回鸟 usually in
reco胆ition of the person who first described th阻。rwhosework
OD 由四1W88 严rtirul缸ly prominent (e.g. circle of Willis；回 fa皿nen
of Monro). Ma町 of 由E latter names are considered to be
anachrollis国c. but some remain in common u1a1巳
Inanator可 gen回lly, 也z location and relationships of
由U由1re& are described v时也 rererence ”也ree orthogonal planes:
sagi阳l or median, horiwntal or trans陋，e （αlied axial in
radiology) and coronal or frontal F地 1.1 ). Directions and
rela-世onships are d回gnated as medial or lateral, superior or
inferior 四d 皿也rior orpos阳ior. with m也rence to the orienta由n
of these planes. There is, hm肥四z an additional 田minological
四mplie.a世onwh四 desαibing 也e brain and spinal co地监
explained below.
In n四roana阳町，世ie positional/directional 田ms- rostral
四udal, do11al and 咽:ntral - are d皿 commonly used. These 阳ms
have 也eir origin in embryology and mean, resp眩’imy; 阳帽础
the head end (ro础2月， tail end«但时al), back (dorsal) and belly
(ventral). If the long uis of the brain 皿d sp坦al cord W四 ω
mnain in a straight line d田ing embryological 缸vdopment 也m,
in the adult,. m阳alwou』d &imply equate to 四.perio~ caudal to
inferior, dorsal to p曲回ior 四d v四.tral to an健d皿 For all int.enta
and purposes, this is what happens w世l the spinal αml but the
long axis of the br划n, on theo由.er ha时， m叫吨帽’倒1siderable
distortion and，面 p副α血J, the br扳回国n becomes fleKed at
优咱al points 〔附 Fig. 1.12). In n四m四础。町，也n由鸥 it is
Antlll帽
网捕恼曲r
。』.stomary to Wle the 阳'!1lll 也at are common to all anatomy wb四
desaibing a position in space and to reserve 也e 阳ms 'rostral,
回udal, dorsal and ven时’阳 the description of location and
direction 酣睡ve to the long uis of the nervous system.
In neuroanatomy, horizontal or transverse se咀ODS thro咀gh 也e
spinal cord 血d l仰自 P缸t of the bra皿仙rains但m｝红E 四ually
dq对E国可orienta田i with dorsal at 也E t叩 and VEOtral at 也E
bottom [Pig. L且）. The mnVEDtion in clinir.al neuroradiology, on
the other hand, i.s 由at axial images are orier血四” if looki吨
from 也e subject's 缸t towards the head, with an也rior at the t叩
of仕le 姐回事. In sections that contain the brains能m, therefore. 也E
dorsal asp四 of the brainstem is towards 也e bot阳n of 伽恤ag声
and 由evmtral asp四 is towards 也 top 0且也 1.28). This
田n四ntionmea皿由at left and 丘ght are also re回Kd.
Components and 。rganisation of the
nervous sys幅m
Neur。nes and neuroglia
四le ba&ic sttuct:四百I 皿d 缸nctional unit of the netv0t1a m田地
由E Il£r呢 C£l.l or neurone (Pip 1.3, 1.4}, of which 也E human
nervous sys国n is estimated to 田E国n abo皿 ID". 四le 缸lctioru
of the neurone are to 阳军ive and in也伊te incoming information
企om 阳uory receptoni and other neurones and to 回国皿it
informati011 to 。也a neurones or non-neuml structures 也at are
wider newal control (muscle岛。耶ns 皿d glands - IOmet皿a
ttferred to 割’＇effe幽I.' 0咿na').N四ronal structure is high与
sp国aliaed to 缸监l these 缸nctions. Ea由 neurone ia a aep值班
p均sical 四.tity with a limi由ig cell membrane. Information is
庐”d betw回10四rones 皿中回alised regio田臼lied 叮napaea
where 也E E回1branes of adj以回t 国ls are in close ap归，i冠。但
σig. 1.3~.
币iere is wide diversity 面也e size and shape of neurones 皿
different pans of the nervous sys忧m, but all share cenain
common charac国istics. 咀回-e is a single all body from which a
m血hie number of branching pro幽幽 emerge. Most of 也配
pIOC£S瞄缸E rec:哼世vein 也配tion and 缸E known 画 den曲回．
岱ie dendrl田 p例””勿nap鹏也回metimes many thou损ndsof
也阻，也rough which th叮理咀~ incoming information from
other nerve 创la. In sensoiy neuro画”，也e d四dri回 maybe

Cell body
Myslin
句f!BP!ic
V9琼＊揭
” II
Flg.1.3 S曲，mlltlc rep'11田m.tlon of the ba副c atructure of tt”
1111副rona 宿回恤，llJllB阴阳’·
也地区叩ecialited to detecl. chan伊丽也E 回anal.or in但盯llll
E剖ronm阻止由ie of 也.epm幽ses attached to 也E rd! body is
called the axon （阻ve fibre）皿dtl由四ri£ll information 棚ay
from the cell body. Axons are hi酬y variable in M阱 and may
divide into 阳eral branche岛 or collateral岛 through which
information 臼且 be di盹ibu也d to a number of cliff自四t
destinations simultaneously. At the end of the axon, synaptic
specialisations called n町E 国minals (pr町nap缸 a咀inga;
但皿inal bouto皿｝民:air, from w扭曲 information is 缸四面~
uaually to the den面恼。fa也e n四ronea. In effer四tor motor
neuron钮， whichαmtrol non-neural 晒U由江·es such 嗣 muscle
回再也t 招onal endings may be fur也.er specialised (e.g. 也e
neuromuscular 如nction).
Information is coded and distributed wi也皿 neuron臼 by
也anges in electrical charge. 四e cell membrane of neuron四 is
pola血ed, which m出lS 也at an elec创臼l pot由自l dill自由ce （也e
membrane potential｝面础 across it. h 也e resting 白跑出ia
potential di岱~民［也E roting pa国tial) is of the order of
60-70 millivolts ci_n:呵， tile inside of the cell being n甲阳明白
respect to the OU回de. When a neurone is stimulated or erci也d
above a 但也in 也reshold l俐，也ere is a brief remsal of 阳
polarity of its membrane po烟也1, termed 也t acti侃”“ntial.
Action potenti也缸t prop咿ted down 也t 篮。n 皿d in四曲曲t
n自tt 回minals. A1 mo航句nap捕，回nsmission of infonnation
between neurones 民主田z by 由四ical ratlter 也皿 electrical means.
Invasion of nerve 回minals by an action 归国创 α.uses tile
releue of specific chemicals (n四m1ran8皿缸”） ti回回归red in
哼naptic ftllliclea in tile pr田nap配四ding. 四E neuro田nsmi也r
Chapter 1 I『itroduction and o咽rview • 3
Dendri国
Cell body
:lt1~1m
问.1A P9刷刷刷刷刷笛”’－clm.,..lonal re铺”由uctl。”“’
naurane 骨am the hlppacamP'踵， Im啕ad by car响自由l 恤，...目，m曲啕
mlcrosc田"l"f· One of the proα出自回 the b画eofthe n剧rone ls the 似on.
(G1时国;yofDrRAMo陆隅!Y. 由副 R图阻由阳也跑 U而暗回tyofZJJ1耐L
SWilzBr,恒nd.)
也鱼”a across 也e narrow gap betw田1 pre- and pas町m同E
membranes and binds ω 甲回fie 阻碍伽E on 由epos甸回回E
c.ell, indud咱也组ta臼扭 them四1brane pat四.tial. 咀le change
may be either to depolarise the membraru鸟 thus mσ由ig towar由
也E 也reshold for production of action potentials, or to
峙P町olarise 姐d. thus, stab血se 也e cell.
回le O也er major cellular compon皿ts of 也t nervous sys也m are
neuroglial cells, or glia, which outnumber neuron幽 by about an
order of magnitud巳 Unlike n四rone也 n四rogli且 do not have a
曲配t role in in岛rmationpro田sing but 也可缸监I anumberof
otlter roles tliat are 倒四tial 卸r tile normal 缸nctiOI让ngof 由e
nervous 刷刷. One type of glial 创I (the oligodendrocyte) ii
responsible for 也e production of myelin, a 阳U由m high in
lipo严otein 也at er回ieathes many axons and g四由国C回ses 也e
speed of conduction of action p。但ntials.
Cen’回l and perlpheral nervous sy冒tems
A1 a 画mple 缸atomic.al level，也E nervous sys胆m （囚g. 1.5) is
a世ded into the ca由al nenoua sys但皿（CNS）皿d 由E
peripheral nenoua m锺皿 (PNS）.四E central nervoUlll sys阳E
consists of tile brain and spinal co时， lying 明白in the pro阳tion
of tile cranium and ttrtebral column, respecti:呢ly. It is the most
complex. part of也e ner回us syst1回t, containing 由e majority of
nem: cell bodies and syn叩tic connections. The P町ipb.eral
nervous sys国n 倒四tutes the link between 也 CNS 血d
structures in the ~庐eryof 由E K吻， from which it m世ves
回llOry 坦伽mation 甜d to which it sen.也 controlling im拟血”－
咀E peripheral nervous sys田nconsi血 of nerves joined to 也E
brain and spinal cord (era皿al and 叩·inal nervm）时也由
ramifiαtions within the body. Spinal IleM.'.$ 回归g 也E upper or
l仰自 limbs co咀bαω 也m 也t brachial or lumbar ple:ma,
respectiv曲， within which fibJ:四 are redi础ibuted 皿ω 田med
perl肉.eral ner晴. The PNS also includes ma町 periph~~
located nerve cell bodi菌， some of which 缸E aggr可~ted wi也in
血lClures 臼lied ganglia.
s。matic and aut，。n。mic nervous sy：剖ems
Ata 缸血dional k叫， n四m回也at are con也med w恤缸阳出lg
chan伊 in 由e a阳llll 四世ronm四L orwi曲曲E control of
4 • NEUROANATOMY
wmb.-
刷刷’
Flg.1 」Ii Cer曲，l andp’”网”ral nerv刷’”’”ms.
mav四1田rt. are oollec咀回y z回国m. 臼画也E 101Datic nervous
ayat皿.N四rone!I 由at detect changes in, and control 也.e ac:livity
of.，阳市cera are coll仅由dy referred to ”也E 棚”田园E
nenou1 ayatem. Somatic and au伽iomic components are present
in bo也 the cen田l 皿d peripheral nervous systems. The
甜ω回国c navm』a m能m is div泌.ed into 伽o anatomica且;y and
fun皿onally 也tinet 阴阳 namely 由t 町mpath甜cand
para町mpa·也die divilio田， which 院nerallyhave 吨，01ing
｛皿tago回国c) efrecta OD 也e 由uct山es that 也e'f inner回钮’Ihe
au阳nomic nervm皿町’恒m innerva能ssmoo也 muscl巳 cardiac
mmcle 皿d lecre臼ry glands. It is an important part of也E
homeo阳.tic mech阻阻，也at control the 面阳nal 回vironm回1tof
也t k吻．
A骨erent neurones, efferent neurones and
In幅meurones
N四E 创ls that cany infonna·筐。n from peripheral receptors to the
CNS are referred to as d自由1 neuronea (Fig. 1.6). If the
.
、
Olrecllon d啊跚 ：
ofnemlmpul制 ：
Flg.1.8 The
lnbtm11uron帽．
” n.•l •m1ngernut of 而•rent. .rr.r.nt .nd
姐f创ma世.on th町也rry reaches consciousness，也.eyare al曲也ll.ed
lm&O哼 nmronea. Efferent neurone& cany impi血£1 away 金回n
由E CNS and if 也ey innervate slrele恒I muacleto a国e movement.
they are 由0 called m。”r neuron”’咀ie vast majority of
neurone岛 however, are loa民eden由elywi仕血伽 CNS and
are referr回 to as in恼neurones.τhe terms 'afferent' and
’eHer四f are also commonly used to d阻。te the polarity of
伊叫仅lions to 皿d 岳om 由配旧m wi由且也e C邸，”四
由ough 由e proj ecti.ons 扭曲.tirely contained 明白且也ebra扭曲d
spinal cord. 四le pn:场四onsto 皿d from the CEI由ral cor圃， fur
eumple. are rd回国 to as car世cal a.ffer四甸回d d坠mi:饵
m阳曲曲－
Grey and white mat幅r, nuclei and tracts
白ie CNS is a high】ybet阳明担1回归”m由uein 田ms of the
distribution of ner陀 cell bodies and th由阴'ocesses (F悔 1.7).
Some E咱.ODS arerda由dyenri也d in ~ cell bodies (e.g. the
回归菌l portion of the sp凶al cord 姐d 也E m血a of theα~bral
hemisphere）皿daruefi四eel to as g可 matter. 臼n曰”吻。ther
z晤。118 con:国n mostly nerve 归回幽a (usual与 axons). These are
often m同ina时（回血但也d in m同in), which con缸E a paler
coloration - hence 也e 田E 咄it£ matter.
Nem: cell bodia w恤 s国ilar anatomical connec魁。因缸td
functions (e.g. the motor neurones 恒nem.ting a group of related
muscles）国凶 to be l。但也d togetl阳 in groups called nuclei.
S皿ilarly, nerve pro帽’”也aring common connections 血d
functions 出td to follow 也t 槌JJleCOUI盹 run皿ng in pathways or
tracll (Fig. 1.7 囚id see Fig. 1.23).
Decussation of senso叩 and m。tor pa笛，W甸’
It ia a gei回al principle
of the Digllili且tion of 由E CNS 也at
胆的明 白E町闯回国叼恤m皿on to a comdous I时（也e
m由ral hemisphere） α田’回鸭 ordea且刷饨岳阳none side of
the CNS to 也eo由er. 四四”me is true of descending pa吐酬苗”
from 也.e cerebral hemisphere 阳.t control movement 哑weforein
仰自划， u血也rebral hemisphere per回晒 sensations from, and
controls 也e mo田n四”。E 也E opposite (contrala能ral) side of the
k吻．

Su民ortic泪l 『1uclei
Mldbraln
Pons
Medulla
时. 1.7 Coronal eectlon llrough the brain lllultn.t’”””’ dis例b”’。””’Ffll •nd whlt9 mat切民刊e section has 民朋 st仿制 W Mulligan's
阳hnlQue. which co以n grey matter blue, le即同时11崎 mattarr制陶ly unsteln回．
“”””entsand o咆anlsatlon of the ne”剧’”回em
• Thestruc切rel and Mctlonal
unit of the na附us W蜘m 阳 the
nervac创I, or neuro帽. Neuron崎
h11.11ee 阻stingmemb圃’E
四tential of about -70 『nV
•A neurone r回划ves lnfor『nation
p巾n创tt through Its d朋drltes
and p四”’由Is on by EM:灿n
potenti由， which are 饵”国
副ay fro『n the cell bod-/ by 甘回
axon.
• Informal阳 Is passed be阳附制
neuro晴回 synaps揭 W
用嗣拥 of nei』rotrensmltters
肯tlrTl p瞄ynep目。饱rminels;
tt田e act upon re饲plo丽 in 甘、e
m嚣崎naptic membrar回饱
白血』se either d甸坦恒川国lion or
hyperpo阳启硝m of the
阳剧唱plic 由I.
·陆U『啕E回国Is are more
numerous than nerve 饲lls and
haw roles other 甘回n
inform副口n proce酶’可·
·节• nervous BY审tam 阳 dMd回
阳，o the oantr创 nervous~哩tam
(CN~目，which con剑sts d甘、自
bran and splnel co叫 and 廿回
回翩翩 ner随随 sy&IBm
(PN筒， whi由∞帽ists af cran国
W回 spinal ner咱串串 串nd their
F自nl做泪tlons.
·有ie autonomic: nervous ftf回由m
队N~月 Inner唰蛐啪”刚
structures and Is Important In
homo销商隐S阳。f 伽， lnternel
anvro『1mant.
• lndivid咽lneurones may be
defined 鹅耐•r afferent or
el抽回ntw协 respect to 甘冒自
CNS，。， as Intern剧阳嗣．
·时thin 甘冒目 CNS, ar田部『ich in
either nerve cell bodies or naMI
fib『菌 constitute g附yor whi饱
matter，陪”“四vet/.
·αus恒阳 d 饲I bodiesw世1
simil町 functions are 阳own 画
nuclei.
•Traci国， or pathways, af n脚B
fib『臼 link 缸喝啤阳r dist田回
l'E司~Ions.
•G抱nerally，”cenci"G ser丽的
阳thw鸥18 and deec:er回Ing
moto『阳thw剧唱 h 甘冒B CNS
decussate elo咱 thalrcour蝇
so th皿 each side of the brain is
b叩回回回ly essocle:恒d w时1 the
oontrala:ter副 half of the b国y.
Chapter 1 I『itroduction and o咽rview • 5
..r- ~r时ingand 侃sc:endi咱国由
Cerebral herrilp阳，
Grsym幽（Cerebra闹剧
Whi悔 mall串『
勘'llin翩翩
Development of the central
nervous 町S幅m
By 也t begim吨。f由E 提cond w础。fhuman m问onic
devel句)lllent, three 萨rm cell 崎回 become es晒Ushed：配toderm,
meaoderm and endoderm. Subs町um.ti如 these each giw rise to
P缸ticular 苗”ues 血d o耶m in the adult. The ectoderm. gi：瞄 m
to 也E skin and 也e nervous sys能m. The mesodenn forms 也d也L
musα.tlar and connec首ve 咀.saues. The endod创m gives rise to the
d皿回国-y, res庐atory and geni旬出旭aiytrac臼．
咀te proc础。f缸mation d缸四峙。皿E neIVOU!I sys田n is
ref回mtoasne四时晤。n. During 由e 也mt w回kof四tbrym咀E
develo萨nent, the dorsal midline ectoderm undergoes 也icki回皿g
to form 由e neural pla也（F.增 1.8, 1.9）.四川础ral margins of the
neural plate become elevated, forming neural folds on either side
of a longitudinal, midline d甲ressio：几 called 也e n剧组l g。”也
白ie neural fol，也由四 becmne apposed and fuse 缸帝也a, 由四
sealing 由e neural groove and crea由ig 也E n四:ral tube. Some cdls
from 也e api田。f也eneural 刨出 bemme separated to form.
groups l内1g dorsolateral to the new:田ltub已咀配 are known as
也e neural ere’”. The formation of the neural tube is complete by
about 也E middle of the four也 w四k of embl)'OniC deve.i叩ment
Enormous growth, diato国on 缸ui cellular di置自由也non occur
d田妇事也e subs呵uent transformation of the neural wbe into 也e
adult CNS. 四WI is maximal i且也E rostr直l 严血， which develops
into 由E bra面， the caudal por咀.on becoming the spinal cord. 咀1e
αn缸al cavity 明白面 the neural tube bee刀mes 也Eαntral canal of
the spiI回 cord and 出e ventricles of the brain. 咀1e neuralα-ests
form 也e 阳uory ganglia of spinal and er却由I nerve鸟缸id also the
autonomic 伊nglia.
6 • NEUROANATOMY I

坠鬼袖”m

M伺院知m

En由刻，rm

- Neural pl曲

阳翩翩

N制田，四”

N81』ral 创冒st

Nauraltuba

Fig. 1.1 BaMmstlc r9pre””甸回。”“the form副阳nDf甜”lnMntub•

Fi11. t.8 Scmnnin11 •阳atronmicn剧团n1ph• of ll'llnn’”·田Idions 骨Dm 由••mbryonlc 田”denn.
’四”’h thlldDnllll 四”“m d伽e chick embryo illuslra恒n11thll
”啕” (from tap to bottum) in fonnation of the neun1I tube 树倒－
~otDrGCSch侧’附ff, D帆 ofNeurr.自ω旬，y却KlAnatomy.
Unlv9tslty of l刷刷刷。，阳批制制La陶 City, USA.)

Asde叫opment continu髓， a longitudinal gro回回~the sulcus
limitana, apt田m on 也t inner S四faaof 也e la出直I w现la of 也t
emhiyoniι 酬皿I cord 叫“叫al 脾且 d也t brain {Fig. 1.lOA).
四tedonal and 四n田l cell grou回np 由四 delin团筐dare ref由m
to as the al缸 plate and the bual plate, resp缸tivel'y. Nerve cells
由atdevdopwi世曲曲e alar plate have predominantly 破nsory
也nctiom, while those in the basal plate are predominantly motor.
Further devel.opm皿t also brings about 也t differ固自iti.onof
grey and white ma她自. The grey mat回 is located 四ntral妙 around
由tαa田1 ca剧，咱也 white mat田 forming 姐 OU阳 coat. 四由
E悔『阳tneurone
~~｝
:] )
”
Fig. 1.10 Schematic repre ntatlon of'llWWV’””’ctlor嗣由rough
刷…酬』帽In’”“ral tube and (B) 1he a由民，，lnalcord. 陆l』ronal
conr时dons v.ith per1川、自削 structures are Illus！闹剧。nlyon onesl幽．
Bra『时1iale怖”nl
“malice怖，ent
i ’
＼＼ 台 ’
可
~
飞
n \.
F幅·”’ Schematic tran”’而·”E勘n 由rough 蕾” dewel。pingnervo蛐”’18mahowing ’.. am1n9emen1 of afferent ar咽，倒'erentcell
’阳，lngs. Thee响urcoc栩栩阳明同4刷刷的 Fig. 10.2, M灿阳阳阳 th981T811伊阳耐d惆n阳／f191V9nuc刷归仇eadult 阳刨市腑，州的T也le 10.1
W州ch desα1be晴价eαlmpol阳市 andfunc侬lflS Oflhe α理r嗣ln&M掘．．
Chapter 1 I『itroduction and o咽rview • 7
basic devdopm回国 pattern can 甜ll ea.sily be reco萨used in 也e
时.ult spinal cord (Pig. 1.108).
R自由自 differ四出tion distinguishes se陀nne山onal cell
grot』ping声明也扭曲e alar 四d basal pla阳（Fig. 1.11）.哑iese are
缸回nged 扭曲oontinWJllS longitudinal columns, based on th由
anatomical conn回om and physiological roles:
•Sp回al 四maticaft远回t a皿ociated with 也e developing 面nerear
and ultimately receiving auditory and ve耐b旧arinput.
• General somatic afferent mαiving general sensory input from
阳 peri抖1町·
•Sp回al visceral aftettnt subs自由g the sense of tast怠
• General visceral afferent: receiving affi臼mt input 丘。mthe
viscera.
eG钮.era.I visceral efferent composed of pr甲nglionic autonomic
efreren臼．
• Branchial efferent con回国ng motor neurones to muscles
derivm from branchial ~har归萨al）缸ches.
•Soma世c efferent containing motor neurones to som甜c mu8d钮，
Duringembr归·Die de咐。pment, the rostral. portion of the
newaJ. 仙he undergo四 massive dill白白1由.tion 姐d grow也 ω 阳回
也E M咀｛因.g. 1.12). By about the fifth w回忆也m 仲组卫d
primary brain vesiclea can be id四tified: 也e pro就ncephalon
(forebrain), mraencqilialon {m划brain）缸id 由ombencEphalon
但indbrain）.τ'he longi缸dinal 四s ofthedevd吨>ingCNS
(rn:w:四.s) does not rem翩翩aight but is bent by a 田dbrainor
cephalic flemr骂饵cur由1g at 也E junction of midbrain and
卸rebrain, and a cervical a回m k阳晒1 世1e brain and 也E spinal
cord.
By 也E S自由也 W民比缸rthtt differ四由tion di回nguishes five
secondary brain v回clel produced by division d由t
何回回理抖lal侃出ω 缸刨由“抖M』OD 皿d diencephalon. and
a由ion d也E 血omb田uq>halon into 也emet回应脾alonand
myelenc甲halon. The junction be阳e£D 由e la位E is marked
by an additional 阳1d 扭曲e neuraxi岛 αlied 也e pontine
鱼a:ure.
主
. 可E
唱'i
主 句！：：－－
’ 曹、－
! e:,1
（画 一 ／ ／ ／
iζ’
<, <
,、
<
8 • NEUROANATOMY

’ 时’阳叫四川阳
因配『dera Df de\剧opm日『rt dis旧pl 甘回 n田π回l growth ands肌Jclural
口咆创陆ation of the sphal co刚卸'Kl br亩·n. B自:au&!自甘、e nervous system
iB d町阳回阳m emb『yonic 回oderm, thei坦白 d酬耐oprnenl副 anom创酣
陆ombence阶幽
创so in叫vethe co晴ings of 由自晴vous 句stem~制n and bor明. In
ana1睛”回y，世19 b刚n and 翩翩翩 minute and 廿ie ntant d晦 not
usually su附e. Ina回na blfld圃， the b帽制nal co闹剧 nerve roots
are unden:抱唰oped and may lie unc肌顺回 by skin or the bony spine
Spinal cord Cerv阳I fla刷用 阴阳 h阳＇t's beck (m制lngom”b侧，｝．＆』chin饱nts are left with
wit闸red，闵rel归回 end ens倒thstlc lower lmbs t啕酣W with
Ince扪咖朋ce d 甘、e bow回 end bladder.
〈豆｝

As the brain deveJ，句地 itJ central cavity d四 undergoes

C笛”臼lllftex皿咽
〈直！
Flg.1.12 Tlle . .lydev响阳，nt or the brain. 刷 The primary brain
”’阳”“’”“4to5w”band(I坷’圃’”唰咖啡brain 睛，lclelat
about7 ”’嘟””－
•F-1 目宅画画·司百l·l• ,.,, l 唱 •1-l.l- l ,>·>,,t inlr.l 矗，π，，， ι 川，因…………··
脚恤，＇＂帽E四”’ω” ”翩”“E’
bl'lln ”·幅幅
Pro帽回phllon 仙”咽h} T由ncephalon
Olin;即t.Jon
胁明CIPha!Qrt 伺ldbr田In) M”’n甸回酬。『1
用ICll"llblnc.i刷咽刷刷刷嗣同
M‘自田”nalan
Myel町匪”田m
Some of the names of the embryol咿cal subdivisions of 也t
brain are commonly uaed 伽 descriptive pi.即oses and it is,
therefor喝 U忧ful to know 也E 归m of 也e mature brain into which
由eysubs呵uendy 缸vdop (Tuble 1.1〕．町阳由ree basic divisions
of the brain, 也e pro阳也叩halon or forebrain is by filr the h咱自t
It is also refi回m. to 画也E C£rebn皿.Wi剧n the C£rebrum，也E
tel四cq>halon w世ergoea 也E g回回a 缸地z deYd叩rnent and
gives 由e to the two cerebral h四”pher回. These consist of an
outer 闻自 of grey ma阳（也e 但~bral corteK) and an inner m翩
。fwhit.e m副er. wi也in which 咽riOUJ groups of nuclei lie h皿d
（由t l缸seat bring 也.e co哩us 甜ia1阳皿）．四le di团也pbalon consists
lar萨ly of the Chalam.us, which conta姐a numerous all groupings
andia in咀ma时yαmn配ml with the CE!:由ral cor但zτhe
mes四αpbalon. or midbra姐， is rela由由 undi缸回血时（it 皿11
E国m a central 缸』like ar啕 IUIIOUll也d by g可皿甜er). The
met四α肉alon derelops into 也E pom and o味d泸ngαrebdlum,
while 世1emydence庐alon for凹，也e medulla oblonpta
(medulla). The med叫扭， pons and midbrain are collec由dy
referred to as 也t bra恤’但m （且也 1.13}.
considerable chan阴恤，国缸id shape, forming a m阳n of
M锦ncephalon chamb四 orv回国des (F悟， 1.13 and see Fig. 1.23), which
con创n cerebrospinal tluid.
Parallels have been drawn betw四1 由t embryo}。在al
devdopm四1 of the bra扭曲d 也e majorchan隙，也at the brain
h臼 undergone dur姐8 挡回lt of tl比 phylo缸’~c, or evolutionary,
sc.ale from simple to more complex ani.mala. Al也础。由is 画
回tainly an ~plification，也E ooncept does have 由E
educ回onal merit of introducing some of the principal parts of
the brain, and their rel剧onships to one m创ier, in a graphic and
memorable~ (Fig. 1.13).
四t simplest of chordate ani皿als （巳g.arn阱li<001S), from 晴tich
由evenebra田 evolved, P幽ess a donal wbul缸 nerw cord 也a is
reminis础lt d 由t n四ral tube of也ede叫叩ing mammalian
embryo. Dur也g phyl甸回f, the rostral ~咀 of the 阳.bular nervo田
”’能m hasunde耶neenormo回 modi6αti.on and change;
mmequently, the adult human brain b四皿 little obvim皿 similarity
to its erolutionary ancestors.
Regional sp回alisation has b锐n 皿 important theme i且也t
”。'1ution of the brain 组id 由is is esp回ally obv抽回坦国ation to
由“四sea and in m.omn四.t control. Long ago 旭 p崎h伊1)1,
。...四喇四” In
mllUre 阳，a回 αntres d”。ted to 由晦缸DCtion& devel啤陪d as a归n.sions or
OU甸回wthafrom 也E dOllal. asp回 of the simple tubular brain
c，由ral hsn恒pheni
ThellnU8 但g. 1.13). In form，也.ey consiated of an outer mrta. of n四 cdl
M刷刷h bodies with an underl归g core of neift fibres. Bila阳ally paim:l
P甸回．自由晴b副lum c.entres devel甸回 in relation to the senses of smell，由ion and
M回ul恒口blor咽E恒 hea血g, and a 符mmetrical, midline 田市哩 devel叩edin
association wi也咱也叫ar a』nction and the main阳181lce of
eq1凶且brium. Ea血 d也eseαn臼哩’四咀.erwmt subs吨1ent
evolutionary chan8己 but 也is was mo鼠 evident in the rostral,
’olfadory’， p皿 of 也z brain, which devd鸣叫 into 也emassM
田由al hemiapherea (Figs 1.14, 1.15). During 也is pr田酬
known 四萨回回cephalisa:咀on, the cerebral h四世tpher回
αme to take on an aecu怡，e role 恒 many areas of brain 句nction.
Foreirampl己也 highest level 缸 the pen;酬。nand
interpretation of input h四n all sensory modalities ev回归4』y
became lo臼且能d in 也eco国皿I surface of the cerebral
hemispher凶， as did 也E h胁皿 level for volun田y motor control.
白白 ia reft配时 by 也e fact 也at m让y a small F可JOition of 趾
adult human C£rebral hei回1phere remains dero时 to olfactory
function.
咀1eproα凋 of proaencephalisation meant 曲目t the oth，虹
in饵’忘世ve centres beame pr咿回sivdysub阳vi回t to the 田d>ral
bet旧刷ieres. For exam.pl鸟也ose for 司总on 皿d h出问 underw四I
rela由dyli创e 缸rthtt d臼咀吨m四t 四d 缸监l largely autom且也
refla 缸配曲创11 in 也e human bra且古町 may 副E be iden咀回，
how回盹组 four small n时lings on 也e dorsal s皿face of the
midbrain：由eco甲om 'II皿driganin且 or mpaior and inferior
四血皿Ii 〔Pigii l.13, 1.14, 1.15）.四emofor 咀缸enear 由ear回d
回d of the brain devel叩ed into the cer曲ellwn {Figs 1.13, 1.14,
1.15），世1ich re回m a central role 扭曲E main阳anαof
equilibrium and the coordination of momnent.
 …’|…
。町，b刚 hem阳phara

In凶刷翩翩cular旬1'1111811

ThlrdWI附创e

Globua pallldua

一－－ Thalarn.捕

L一一一－ Superi叫liculus

I町翩翩。1ra>蜘舶

臼晴创叩创uc:t

~－~臼n回l组nal

问.1.13 Sc惘m“’”P1'91•”’晴Ion of them叫衍，ubdlv匍IOM •ncl lllndmlr帽，lf1he bl'llln.

10 …… |

饵，bellum

PinHI gland
臼同也刚阳蛐阶，m

M阳ioroalli刷lus

Su”由r colllculus

Carp111 ca阳，um

Tha阳晒

H)1lo世1ai.nus

Midbnin

l：豆’

”“ult• －臼rabellum

- Great 阳、g阳cfnal liB副陪

||

。刷bral
ham脑协era

W刚刚amue

Mi:lbrain

向11$

M创ul恒

Cerebellum

⑥
Cereb副lum

Flg.1.14 PhotD阴阳 of ttl• brmln. 刷 Lmrmlamp•鸣。B) rnedl•n ••gin.I ”E曲”；阴阳”rtoru”崎（D)ln阳loru1111民

 Chapter ’ Introduction and overview • 11

lhallllllJB

Corpus 臼llosum
P阳al g阳M
lntarvan刨α』la『fcramen

SI.』阳ior and
in伽iorocli阳Ii

Hypotha阳1US

Cerebellum

,-;;-,
、.：；：｝

M创LI田

αnbral 阳刚spher9

l呻』ndibullSTI 翩翩咱
阳回刷刷刷W

Mldbraln

Pons

Medulla

@·

问. 1.16 Prlnclpal ddlvlalons and ”melmpo阳刚 landmarks In the m曲，re brain. 刷 M“阳”’lttal 割幅幅on;(B)ln句“or ””ct. Cranial
「lEIMl9 嗣同阳tednyelow.

Overview of 由e anat。my of the central surrounds 也e k血姐d spinal m吐 like a lo倒e-fi创ngbag

ne阳。us sys幅m
Coverings and blood supply
咀ie brain and spinal
con:I are suppo血d and pr回国业d W 也E
bones of 由E 也且11 and 胃血:brat column. re句配世vdy. Wi出且也ese
bo町回阳ing岛 the CNS is en由-ely ensh剧由d by three cone.en回E
I叨叨 of membranes, called the men1n胆（Fig. 1.16). The
OU能m伺t membrane is 也edurama恼， a tough, fibrous coat 也t
｛民.g. 1.17). The 咂:nal dura 自td much of 也ea四ial dura are
叫mate from the periosteum, which fonm 也e inner U皿ngof也E
surroun也ng bones. At. 田国n IOClil世ons, hm帽帽， such as on the
量oorof 也e cranial 四vity.，由E dura and peri回回皿1 缸E 缸sed and
也e cranial dura is tightly adherent 也由E in也rior l1ll白ceof 也e
血』11. In additi叽仰。 large sheets [ or reft剧。ns) of dura 严吗ect
into the cranial ca:咀锣， incomple刨y dividing it into com凹rtments
｛民.g. 1.18). One of these, the fahαrebrl lies in 也.e •asittal plane
12 …… |
队nmaler

Cerabralα剂，E

8前111 ne『W
Blood w””l 『oots ensheelh创
in dura

Flg.1.11 A ”“’。” throught闸，llull, lliu.tratlng 伽....』…Mhlp8

belw9”… ’”
menln end the CNS.

E民knl 萄皿＝，

阳帽回也e two ce:抽ral bemilpt回a. ltl 鱼U! border lies just

ab伺t 也eco币UI callosum.τbe other dural sh髓鸟也e 能DIDrlum
c::uebdll, la oriented appn:国mately horizontal”, lying beneath
the 饵dpitallobe，。ftheα.rebral hemisphem 四d above 也e
但由ellum. The 田ttorium c.aebdli isαm由lUOUlwi曲曲t
”富国ior part of 由.e fab: 但也brl. ’Ihedurama田 cm be regarded
UCO皿画也ig of two layal. 四rae are fu.oo ~由er except io
cmainloc皿oru.w~ 也ey beoome separa能dto 面c>rm spara, the
dural 胃回回“ou11a1, which serve as cham田，缸也e 哑DOWI
也ainage of the brain. Imp饵”nt dural 1in1Ues ocau:

• On the floor ofthe aanialαvity

• Alo鸣也e l旭份。fa阳也m四t of the falx cettbri and回ttorium
但由elli to 由e lo田iorof也E由ill (ruperioraagittal siou岛 F栩.1.17 D。”“”’lllrlorj•1119ct “O..ver蛐ral 回阳mnaft9r
Fig.1.18. 田皿唰'Se 础lU岛翩 目s’ 7.9, 7.10) lmnl”“嗣mv”·鸣””’he vertebnl c•n•I end dura nwter encl帽Ing
•Alo咱也E l旭eofattachm四t ofthefahαrebri and tent.oriu皿
Ill••”回 cord.
但由elli to one another （由划。t 血田， m
Fip7矶 7.10)

Ben但也 the dura liai tb£ uai韭noidmaca.，“盟”ro being

m归rated by a 也in sub曲ml space. The arachnoid ii a 。”“•Mdlllo“··”’“笛”＠翩tral
tramlucmt, coll甸回侃” membrane 也at.Im 也edwa, h倒ely 盼“回帽””··
E叫句，. the brain and 刷刷 cor毡’Ibe innmnoat of也 • The br翩翩饵，woordn • Ber酬’1 甘冒”回归10ld rr回圃，
mmi玛” i，也e pia mattt, a 创icate membrane of micro艇唰c 阳回国 b'i three mer由咽。“ les 廿le 飘i阳回归M削句泪。e n
lhickn倒也l is 伽mly “hamtto 也t SUiface of the bain and 阳阳事：甘回量 也m w田.！er, W削回庸””l8I U:I (C胡
spinal cmd. dosely following th£ir surface contouD. Be阳回n 也E arachnokl m阳则 pia mater. circula:国．

uachnoid and pia iJ the 11血uadmoid ·~through 呻ich • li明确，ats of cranl副 d响 ·刊， bran Is supplied w时I blood
回由”阳al fluid (CSP) dra由隐 『T旧”’， the 饱Ix cerebrt and by the lntemel “删Id and
tentorUTI Cl8I'民>ell, lncom阳脚 鸭副司ebr回 arter阳s.
’lhe brain ii 1Upplied with ar回ial blood W 也e in!阳nal c:arotld
dMde the cran阳l 08\llty 阳to
and ftrtebral ar阳恼， wbichar翩翩nose to form the drculm •The 部>in副 cord i8 suppled with
compartn币，nts.
art副OIUI (1也de ofWillia) on the base of也t brain.τhe spinal
blood by vessels th创町嗣阳m
•The cren刷 dura mater con刷ns theverteb刚翻”r圃，刚『1伽'C8d
cmdissu刚led by 咱剧uri由igfrom 也e v础bral a阳盹
dural Yer峨眉刷nue”， which 四 by radlcular arteries dertvad
rein岛rad by nd1cular 缸回tea derived 岳础1 吨m回回l v四剧’· ”。回nnale 旬'1f the venous 骨om911均m制”l m阁”Is.
咀ie ar恒旭缸id 回naaa吼ng the CNS run 伽 p缸t of也dr 回回u drahlg，。『廿1e brain.
with面也e aubuachnoid spare (Fig. 1.16）.四ie m四i!lFI are
supplied by a nwnber of 'ftlldιthe most lign温cant intracra皿al
one being the 副“le mmingeal arte哼， which nunllies
g阳11ively betMen 郎，1kull and dura ma恼。阳悖ing the lateral
upectofth£ 田anal hemiapher巳

Fig. 1.18 Pllni嗣刨出I 回E髓。”’f惜冒， helld ahowing the disp回画画DnOf恤，伽bl cer9bri •nd mntorium e町，belli.
Anatomy of the spinal e。rd
τhe If inal 田d h 回恤也ev町蛐ral u甲inal〕臼皿I of 趾
wrtebral column and is continuous rostrally (su阳iorly) wi也 the
medulla oblongata of the b回nstem (Fig. 1.19）.咀四”inal CD时
receives in岛rmation from, and controL岛也e 往回业 and limb也田，
is a曲ieved 曲。ugh31 严irs of 1p旭al Derftl 也at are a阳曲创 to
由e cord at in也rvals along its I四gthandwhi也 CODta皿 affeI四t
and d阳回t nene fibres conn皿ingwi由阳uctur四凶由t
阳iph盯. Near to 也.e co咱也E spinal Del'响1:11 divide into clonal
＠但国ior〕 and v回国I (antEiior) mo钮，世tlch attach to the aml.
alm唱 imdonola但ral and ventrola田al border!, resp缸曲曲
(Fig. 1.20）.四ie dorsal rootsαrry affer回t nm曹 fibres, the cell
bodiea of which are located in dorsal root ganglia. 四le ventral
roots 臼町 efferent nerve fibres, 也E parent cell bodies of which lie
wi也in the 酬nal grey matter. Spinal ner咱 leave 也ever曲ral
但剧也rough amall apertures，也卫国恤也白宫tebral foramina,
which 缸E le团筐d betWttn adjacent wrt曲mιBt!cause of the
differ四ce in the E国 of grow也 of the 刷卫al cord and 咽钮阮al
column during devel叩ment. 也e 酬nal cord in the adult does °'“
四四d for 由E 缸11 l回回l of 也e 观血bralαnal, but 回dsat
apprOiirnately 也e level of the i:r眠”回由百I discbetw民n L1 and
L2 呢rtebra巳咀ielumbar 姐d 剑.cral 酬nal n町阳，世ierefore.
descmd 旭 a leash-like arrangem皿t, called the cauda 吨u旭a
阴g. 1.19), to rea血也曲目t foram且＆
咀1e spinal cord is a relatively widifl自由白能d structutt
四mpared 明也也z brain. Cons呵u血句也E basic principles of
orga皿皿on. es组blished ear抄 in embryonic de咀甸回回if. can
而11 be E回dily id四值ed e9回 in the adult human sp皿al cord
(Fig. 1.20）.四ie 叩inal cord is appra厄matdy cylindrical in shape,
αm回国ng at its 由1tre a v回世gial central canal The rda:咀.~
Chapter ’ Introduction and overview • 13
Falxc:e帽M
Supe由：wsag嗣l Si削$
C假p!JSCI融路um
」一一－ Tentxrtum cerebelll
｛∞幽lnlngs圃’阳lnu吩
ca曾随llum
B『罩闹阳n
separ四.on of cell bodies from nerve 6.brea conf白 a characteristic
'H' - or 'bu阳曲’－血.peto 由e central core of gr可 matter 由at
surrounds theαntralαnal. Fourpr咧配tions of the ren包al grey
matter extend dorsolaterally and 观ntrolaterally towaI由 the 险m
ofattachm回tof 也e doISal 阻d 顶盟国I roots of the spinal ner鸭盟，
四m projections are known as 臼 dorsal (p帽阳ior) homa and
ventral （跑回ior) homa, respectively. 四e dorsal hom is 也耐
。f田mination of numerous a:ffer刨出四脯，由阳明ng
im庐山es from s四1oryrec叩阳z throughout 由E K对y, and is the
site of origin of ascending pa也.ways carr冽ng sensoxy impulses to
由E K垣n. 咀le ventral horn contains motor n四rones that
位mer咽:te skeletal musclιIn addition, at thoracic and upper
lumbar I白白 of the cord only, ano伽ei; smallei; collection of 创I
bodies comprisea 也E la能ral hom. 四” contains pre胆nglionic
neurones belonging to 也e 句mpa也etic di司sion of the autonomic
nerrous m国n (Chapter 4).
咀le 阳iphery of the spinal cmd consists of white matter that
contains longi也dinally runni吨 nerve fibres. 咀iese are O事皿sed
into ascending tr配ts and d皿andingtra血. Ascending 包缸ts
carry information deriv回企om the trunk and limb1 to 也e brain.
Desαndi:rlg tracts are the means by which 仕1e brain controls the
activities of neuronea 旭 the spinal cord σ悔 1.21). The princi归i
asαnding 刨出 are 也e dorsal colum皿｛阳ciculus 脾cilis 皿d
faacicul四 cuneatllS), which carry fine touch and pri叩d侃甲tion,
也t a酬血。也alamic: 缸缸钮， whi出 canypa函，馆m伊咀缸盹 coarse
tou血 mdpr回回-e,and 由E spinOCEl'Ebellar trac钮， which rany
information from muscle and joint m叩甸回臼也e cerebellum.
Among the deteending trac邸， one of the most important is 由e
lateral cortlco1plnal 往配L which con田ls 剑lled volun钮’
movements.
14 • NEUROANATOMY

民nalcolumns

阳m曲m
句inoce唰lar
t回la

S回noU同由m跑
Dorsal roots of 回由
sp阳J Ill，璐
Fig. 1.21 Tra跚跚跚··刷刷’－ugh 阳刚nal card llhawlng Ole
阳四””• al the prlncl回la翩翩dlngandd－抱回Ing nerve fibre
ll'llc恤 A自卫1:1nding trac加 areonlyd酬cied on the left s1由 and descending
only on 甘冒 right, although both occur bilat回回ly.

’
Anato111:ro the eplnal cord
·币18 spinalα>rd I嗣 W时li'l 甘w ·晰thin 甘冒B Iii用y mat阳，甘回
V町怕也『al 曲咽J. It b瞄富 31 dorsal horn con凶m sensory
pain; of spinal 『l8M!6 thro咽h nei.』ron酶，甘咀嚼rir回 horn
wh胁 It receives fibres 膏。m con刷ns motorn创ror四 and
and 麟!l'ld8 砸到审sto，世19 the lat院咀l homαJnt副ns
pe~ery. 阳啕甜电脑、le sympathetic

·陆a『阳 cord, spi帽I rl&IV回

neurones.
Sp1耐∞时
divide to rorm do陪al and ·晰thin 甘WI white mat饱r run
vent耐『田恒； dorsal 『田Is 回町 创始end咱 and descandl咱
自阳rant 他『翩翩hoe阳回i髓的 『lerVe 自bra tracts，时1剧协 the
dorso创 root ganglia, and v喧闹刨 spinal co则叫”’ the brah.
『回ts 倒即制阳明11 恤”8.
·刊， princ回l a篇回ding tractB
·币回 spinal o田回 α，，sis恒 d a 缸， the dor事al cclumr恼， the
锦州『创∞『eot g『W matter, s回natha姐mic tracls and tt商
阳帽ining 闹闹喇 b回i饵， 制noc刷刷lar tracts. The
and an outer 陶宵。I white ∞刚U捕pr.al tract Is an
matter contain同 nerw 明b阳． lmpor田it des棚、ding t田t.

Anatomy of the brain

ca回a 饲~na
Major 舶a阳＇res and landmarks
The brain is dominat£d by the cerebral hemispheres (Figs 1.14,
1.15, 1.22). Th配 hm: a highly convolu时阴阳 mantle of grey
m耐鸣曲e cerebral corta, and an inner core of white matter,
wi创E 咽rich are loca艇dfur也.erm翩翩 of g可 ma忧也 Certain of
Flg.1.帽 Donal 伽帽饵，b『，西哥”ct al the aplnal cord In alb&. This is 伽－ 也e surface OODV。，Jutions of theα!ttbral he刷刷iere have sp国fie
sames阳’cim回 as shown in Fig. 1.17. n胃 du『a mater/a阻d可noid mater h8\州E s四”ry or motor functions, aa desαibed below. 咀le 刷。但rebral
beenincis回 longttudinally to 回归回the spin副 cord and spinal ne『ver田恒
h臼回spheres are 旭comple国y separated by a de叩 cleft. 由t
tyi咱 within t~回 sub苗苗圳、oidsp缸泊．
’四t lo吨豆刨出nal fig田e. 咀E a凰山E isoca明d by 也E falx
cerebri and in it& d句地s lies 由t 四早us callosum, containing
mmmiu山al nerve 盖脑四由at run between corre甲onding E唔ons
of the two her旧，pher四．
哑ie bra姐，但m can be s配n cle.arly when 由t brain is vi酌”d
from its in如ior a。缸L al也.ough the rel甜.onships d也E
叫山 ~＼／ ~~＂－；－γ飞／乙乒~ ~＇ midbrain wi也。也er brain r唔ons are b倒诅.usuated in gittal ”
Stttion (Fig. 1.148）.四.e brainstem. is 也e origin of 10 of 由A! 12
SD !(I {'I \' － 二 ,,.八I
Dinal 『阳ve - 、 paim of cr.mial n町es (111-XII]. Donal (pas回阳） to 也
brains田1 画 l<X血d 由.e CErebellum.τhe 缸ntoriumαrebelli lies

＼＼气；. ）~－＼ I』 k伽但由 the cerebellum and 由ep回国iorpart of 也e cerebral

hemisph眩目（occipital lobes).
W刷刷＿＿；；.＿＝：；.，－～ 气？ 」工工
d印刷 m ＼」一－ va刷 horn Ventricular system
四le hi庐』y simplified pl阻。f也t basic bra坞 desaibed abov哩
飞 一－臼阳I canal (Fig. 1.13), is a useful one on which to consid自由e 伊teral
disposition of the vm回α血r m田n （且， 1.15, 1.23). As 也E
fig, 1.20 Sohematlo di啕ram “’ tra阐明”•••ctlonthro啕h a..
centt直l 幽al of 也e spinal cord ia follcn咽d m由世lytowar也由t
，回nel 回rel, sh’”Ing ’”“”由m删“”In刨帽”ero帽，ndthe
emmgemant of grey•田d whll9mllt饲r. brains回1, it moves progressively in a domal a配岳饵， eventually
句>ming out to form a 血allow.，由amboid-ahaped d叩回国m on
the d佣al IU血re of the medulla and pons {the hindbrain p。而m
of the braimtem) beneath the cerebellum. The cavity thus 伽med
is the 岛”由四ntride.

Hypo伽ai.n1路
时. 1.22 S.glttal m啕lltltlc reaor圃’回 Im町，刷刷，flhehi国d. Thethal町us and hypothalarm届阳mthe up因『 and b嗣rparts,respecl阳ly, of th回
国制唰l of the third ve呻ide. {Cot川回哩：yofPro恼sorAJa欧阳，阳胎m M础姐J/ar阳晒19C侧阔 UnNersity al M811Chss徊，刷刷酣御， uκj
In饱阴回创α』lar旬ramen
Anle臼rhomof
幅幅剧”睛阁， ＝＝二
Thhl ventr1cla
阳币自郎rhomof
幅幅刚 va睛阔’
Fig.1.23 币” cerebl'lll ”刷biculara”tem.
且也t rostral border of the pons，也t walls of the four也
回国de conveig巳岛m扭g once again a ruurow tube, 缸田由ral
aqualuct. 币ie cerebral aqueducl 也Yea into the substance of 由E
brainst田， running the length of the midbrain hen.ea:也 the
inferior and superior co.监α.tli. At the junction of midbrain and
forebrain伊 the aqueduct opens into the 也ird 驯皿住ide, a slit-Ilk£
chamber, IllllIOW 仕om side to side but a阳isi.ve in dorsarentral
and E回也怕”也l dimensio皿 τhe la也ral w曲。f由E 也ird
回国de are formed by the 由alam.us 创ld 峙~由alamus of 也e
diencephalon. Near 也.e rostral 四d of the 也缸咀嚼出创de, a small
apert旧-e. 由ein缸”回国cular fora皿皿（foramen of Monro],
四m皿unj.臼teswi也 an S国lSive chambei; the h但ral 胃盟回d巳
wi也皿 each c:erebral b回亚spher巳咀ievmtriatl缸 m能mcontains
m由ω庐tal fluid 〔C间，刷出 is seer冒ted by the 曲。roid plmu
(Chap阳 6).
Chapter ’ Introduction and overview • 15
Fcur由 V911tride
Body d 阳.leralwn蚀却
Pas饱阳 horn of
M饱耐帽唰曲
CerabraI 叫四川
Fou『世1唰由icle
Brains归m
咀iel~ 四rebral hemispheres obKUre many o由E structures
from view, but the brains恒m c.an be 隔四 d缸ly on both a
median sagittal section and an inferior vi田 d the brain
(Figs 1.14, 1.15）.咀ie brains但mco田姐”。,f the medulla
oblonga钮， pom and midbrain.
四ie brainstem forms o皿y a small w叩ortion d也t m幽 bra坦
but it is crucially important二四1r0ugh it 归” all of 也t uαruling
皿d des但I.di吨 nerve fibre 田eta linking 也 brain and spinal cord
(Fig. 1.24）.咄咄 tra曲也rry 阻四ory information from, and
oontrol 也E movem四t of; 也e trunk and limbs. The brains但m al回
oontain且也E sit£! of origin and 田mination of most of也e cra:r咀d
nerves, through w扭曲 the brain innervates the h国d.Mor回鸭
within the brain，但m lie centres 也at control the vi刨缸nctions of
brea也ing, 也E circ叫础。a of bl“对皿d 也e le叫 of consciousne侃
16 • NEUROANATOMY
Fourth m刨de
咽。g闹剧 nuc拟后
Medial 阳mnlsaJB
时.1.24 Tra跚跚幅幅ctlon through the bralnstem 剧” level oUhe medulla oblongeta. The 掬ctlon
k回S rich In narva fibres stan darkly，附lear回S 由h In 佣llbodl铺脚刚at嗣typelar. 刊epyremld 阳 a tract th回 contains d回回di咱 motor他明 runn网
骨。『nthece而b『alcor阳to the spinel oord. 有lEI 『n回lel lem nlscus 阳 a t瞄t consist!啕 of ascendng axons carr圳咱阳'9oryln币om唰on 阳nthellmbsto
higher c刷刷 In 甘、e brain. The In制or cerebellar peduncle contains splnocerebel自由bresca即同 Information 骨om 』口lntsand m明cles to the oerebellum. The
W部tb.』阳r nuclei are 甘冒E site oftermna四on of the vestibular nerve. which 臼刚回 Inf口m回on from the lnne『锦r 『啕ardlng the p阴阳nand mo叩n酬。f甘冒E
阳回. Thehy阳现los拥l nuc阳us Is the site of origin of hyp吨lossalne『W明bras that lnnerv田饵t晴 musc阳s of the tongue.
币ie medulla oblon酬a is con出.uous cau但卫y with 也e spinal
cord 姐d ex脑也 rostrally aa far aa the pons. 四t ponto-med叫lary
junction ca且 be 民回 dearly on 旭缸ior or sagittal view& sincr 也E
\llrntml part of the pons fun田 a prominent bulge on the su血re
of the brains皿. In sagittal section 但p l.14B, l.15A), the
lumen of the four也把ntricle is apparent k阳晒1 由e po田 and
medulla v钮回lly and theαrebellum dorsally; into the latte宜 of
which iu ten岳阳pedroof a阳ids.
Cranial nerves
四ie brain directl歹 receives 阻四创y informa: ion from, and αmttols
由E 缸tivi茵茵 of; peripheral structure岛严灿ripally of 也e h臼d 臼id
n缸k Affer四t 甜d efferent n町e fibres run in 12 bila键因ly p笛red
g扭扭l ner四s, which are 凶皿凶d byindi说dual names and by
Roman numerals I-XII. Certain of the cranial nerves contain only
sensory or only motor nerve fihII臼恤也e 叫ority contain a
mixture, as i，也tα，e with spinal nerv鸭. The 缸，t t附 α四al
n回·es 〔I olfact呵， E optic) a国chdh配tlyto 山西orebrain, 材世!st
由t others atta也 to the brainstem. Within the brainstem lie a
number of nerve cell body group~’但且时由Eα扭扭I nerve
nuclei. 四部ε 红t 由t sites of 田mination of s四aotyfibr盹曲d 也t
ori归。f the motor fibres, 也at run 扭曲 α姐姐l ner咱（巳g.
Figa 1.24, 10.2).
Cerebellum
四leC£1由ellum is attached to 也e brainstem by a laige ma属 of
nerve fibres that lie K国al to 也E b田也回1刨出 on either side
(see Fig. 9.1). The mass is split nominally into 也reeparu：由E
inferio鸟 middle and superiorαrebellar peduncles.τbeseαny
nerve fibres betw四n 也e med叫la, pons and midbra姐， resp回ivcly,
曰“让leαrebellum.
The 田d划lum consists of an outer I句er of grey matter, 也e
但由ellar corra, surrounding a 阻ttml core of white mat阳
。lg. 1.14B）.τbe 回国cal SU血aia h胁ly convoluted to 阳m a
E唱tlarpa包em of nanow. parallel folds, or folia. The cerebellar
white matter consists of nerve fibres running to and from the
回回bellar oorta. The white matter has a characteristic bran由盐tg.
tree-like man萨ment in section, as iu ramifications reach towards
协副bl』larn山蚓
l响rior 剧由Ila『刚刚e
Pyr回nid
has b翩翩n回 bytheW1啕制书J method.
the surfa阻四eαrebellum is conαmed 明白也.e coo硝nation of
ma略m四t 皿d it Ope.I富国 at 阻四也ely unconscious level.
如由al to the pons is lo也能d the relatively small midbrain. On
its dorsal sw也u 臼n bese四由e rounded emio曲创 of 也e
superior and in缸ior colliculi, ben，但也 whi由 runs the cerebral
aq田d田t {Figs 1.13, 1.14, 1.15].
Diencephalon and cerebral hemi:叩heres
Rmtral to 也E brains回dies 也e forebrain, which mnsists of也E
diencephalon and theαrebral hemispheres. 四iedien＇αphalonand
c.erebral hemisphere on 刨出 side of the brain are to a I吨e extent
phy.ti田ly separate from 曲曲 counterparu on 也ea也e sid己
al也oughimpo白血tα唰-connectiom do exist, aa desαibedbelow.
咀恕”。画des of也t di回应phalon are 能para时 bythelwn四 d
幽幽dven创de. ofwhi曲曲句倒四Wte 由t lateral w也．
币ie di四αpha』on consists of four main di由ions: in a
dor回vmttal direction, these are 也E q>i由ala皿田，也.ala皿UI,
四b也ala皿.ua and hypo由d且mu1. The 甲i也alamw is small and
iu m伺t notable compon回t is the pineal gland, which lies in 由e
midline, im皿ediately rostraJ to the SU阳ior colliculi d由E
midbrain (Figs 1.1钮， 1.15A). TI腿也alamus is by far the h咱自t
part of the diencephalon and it forms much of the lateral wall of
也e 也int ventrid巳咀爬山d剑nus p问s an important P皿 in
senso町， motor 四dα事utive 缸nctions and it baa exte田ive
E回prow connections with 世ie rerebral cortex. 咀iesub也alamus
is a small region lying deep to 也e ventriatlar wall It contains 也e
sub也ala皿ic nucl四，， which is closely 时ated 句nctionally to the
basal 伊nglia (ChaP'田 14）.τbe hypo也alamus forms the l阴阳
” rt of the w咀la, and 也e tl.ooi; of the 由irdven刨de. It is a
complex and hi由ly 恤1严血nt r唱on because of its in·四lwm四t
扭曲t autonomic n町阳刚回（Chap田 4），也e limbic m能m
缸咀由t neuroer埠。αine m田n (Chapter 16). From 也E 呢ntml
a吨配t of the 峙po由alam田 in the midline 缸茵自由e
infundibulum or pi回国y 血lk (Fig. l.15A),” which is attarhed
the pi伽it.uy gland.
币le 四rebral hemisphere is by far the largest part of也e brain.
Like 也.e cerebellum, it consists of an ou田间町 or carte.:岛。·fgrey

G陪al longitudi闭l
R剧』m
Lateral ＂＇细bide
Fig. 1.25 Coran.i ••cU。n lhn”’hthe 四”bl'lll h田”’Bphllnl.
Lalal回’”u
F阳.1.21 Coron创 magne11c ruONmee Im咽’刷RI) of 曲， head, approxlm
Wol阳m M加α啕r阳a供19α如何， U础l9fS/t'J of胸ncl瞄仰， Men仿制阳， UK.)
ma缸r and an inner mass of white mat田（Figs 1.25, 1.26, 1.27,
1.28]. In addition. partly h1皿d wi也in the subcortic.al white
matter lie several masses of cell bodiES, c.ollectively referred to as
the basal ganglia. The twoα~her皿sph眩目脚’叩arated in
the sagittal plane by a deep midline cleft, the great longitudinal
“四m σ耶 1.25, 1.26), whi血 accommo甸回也efah: 也rebri, a
血eet of dura mater reflec时 from 也 in恒malsw也ceof 也
aanium. In 也t depths of也E S槌ure lies 也.ecorp山 c.allo皿m
O幡 l.15A, 1.挡， 1.26), a Jar萨曲ttt of tr.msv四ely runni咱
nerve fibrEB (mm皿issural 6brES）由at link c.orresponding ar回IS of
the 的帽但rebralα>rtica.
Them咖alcor回 is higt世y oonvolu毗哑由 M the d国 of
m回mi由i.g the oortiαI SU血ce area, whi由 is about 1 m1 缸 each
hem坷址阳也回ie convolutions are called gyrl （由鸣叫ar. gyros) and
Chapter ’ Introduction and overview • 17
臼闹剧∞阳E
!Mli岭 mat恒r
Hypothalamus
’”IJ corr回ponding to Ag. 1.25. (Cour阳1yof仰。阳”。rAJackscn,
也E furrows k阳回1 也.emaresu挝｛曲唱ular. sulcus). Some gyri
and suki ~ a relati叫.ymruistmt 田nfiguration between
individuals and 也eymarkthe b硝on of important 旬nctional
areas.
On the la艇ral sw:faαof the hemisphere, a de叩 deft, the
lateral 缸剧” σigs 1.25, 1.29），姐姐 important landma血哑也
togetherwi由出tain suki, forms bou且也ri臼由at di说de 由E
hemisphere into 如田 lobes 阴g. 1.29]. The lobes bear 也t names
of the bones of the skull beneath which 由ey Ii巳
咀le E田tan但rior p缸tof 也E 但rebral hemisph田:e is called 也e
告。ntal lobe, 也e molt an国ior convexity of咐iich ill the fron组I
pole.τbepos能rior boun也.ry of the 企ontal lobe is the cen往回
9ulcwl，世世ch 阳回由nes occurs as a singl巳 continuous 缸rrow
runningo咱也e entire la:回alsu血ce of 伽 hemisphere 量。但也
 阳”阳『

＠明t 阳牌1dinal伽创re

Frallal lobe

互~~ （）；杰在
臼udalenudeus 阳抽血宵 horn of
lalllral 鸭ll1lricJ8

Pi翩附，n

,,, ,
T&rrfOral lobe
－飞 ’ I I ‘、＿＿
• t ‘ ’ II I ~ f 、t ‘
像lbusp副剧UI
. -· - l晴野田l C8pal』le

R回1811lJS

队， 点俨＼
λ r-＿＿／去
／』 J 、L
..r' ..

民揭Ce巾rhom of
阳18raJ v阳怕幅 飞【 I/ 一『飞
－~ 7'
‘ - 问楠怖”“ of
由pl8 臼JI甸回

Fig. ’E ”“'lzont翩翩翩翩’”而咱h the cerebral he刚刚”他

In饱m1lc:ap1曲一一一气飞

Thalalu

Fig. ’.28 缸a.I m1gnetla remn1n翩翩－’”Al) af the hRd, 1用m画lmmlyconwpondlng 幅 Fig. 1.27. ＇臼u巾町d丹田民sorAJe帽白， Woll坦m
M湘cular Imaging Cer，同 U刷刷歧yofMancl四伽，蜘ncl田伽， uκj

阳回l 割lcus ,,- Paa回ntral gyrus
Precen抽J gyrus l 伽irnary somatDse阳阴阳｝
(p~mary motor cor刨
Frontal lobe
阳m甜y
vis叫
∞伽z
「’正〉
·.·
问. 1.21 Principe! g:wrl, eulcl end functlonal .,...• of the cerebral co同胞刷 U帽”l 四”“； m mediaI 四”“－
g四t longitudinal fissure to 恤 lateral fissure. Po阳iorto the
αntral sulcus lies the 归由国 lobe, which is separated from the
”
tem ral lobe below by the la回回I M山巳咀ie tip of the
也皿阴阳l lobe is called 由t temporal pol巳 The p曲回ior p缸t of
由t her回sphere i，也.e oa:i回国 lobt，四ding in 由e ocripital pole.
四ieboun也ri臼 betw配n parietal and 回nporal lobes and 也E
oa主pital lobe 臼E indistinct m 由E K恒ral Ill[也a of the
h回回刚回巳血α 也可 do not con四pond to 缸typar笛mlarmlci.
臼1 the medial m鱼岛 h0Wf!9el; 由e parietal and 配ri1抽回 lobes
are s叩ara胆d by a deep parie徊。cdpttal 1ulcus. On 由e medial
aspect of the 但由raJ. hemispher略也e d11g1曲，te lulm1 runs
parallel to 也E up阳 margin of the co甲us callosum.ηUs
delinea＂坦 a E唔on of cortex 由此 t甸回ierwi也 p缸ta of也E
medial a再配t of the temporalα>Ikx, is sometimes referred to u
the Ii皿hie lobe.
The 缸nctions of the cerebral cor皿 are desαibedin more
detail in Chapter 13. It w诅 be useful at the 0\阳吼 haw阴阳， ω
identify 旬田国阴阳川岛nctional areas of corta, one in 侃出
lobe ｛问. 1.29).
• lo the frontal lo民 thegyrus 皿mediately in front of the central
sulrusisre阳red to anatomical坊 as the 伊民entt菌lgyrua.
Functionally，也is comprises 由E 严恤uy motor cortu. which is
也.ebi由estlevd 扭曲t 阮血 for 阳 control ofvolun田y
m~t. Here, in each hemispher电由E oppo曝k half ofthe
body is rep11自由能d in a highly precise fashion. 咀1e 呵『(JOSitehalf
of the b呻 i，呻resented bec:aU1e也e newones situated here
也at control movement have axons thatσ翩。即（d刷刷:te) to
由阴阳osite side ofthe brains阳n and spinal co吨 to control 也e
motor neurones b四时也a巳τhehi~ypr四” representation
of也t body isαlied ’somatotopic', which means 也atp缸ts ofthe
body 也at 缸ed曲etogether 缸E represented in p缸”。f也ecortrx
that are close together [see Fig. 13.20].
•In 甜ie parietal lobe. facing the 回m町 motorcar恒x:across 也E
回itral sulrus, lies 由哇”’缸回归画1 gyrua or primary
somato，钮’“~cor缸瓦四由 is the site of阳minationof
pathw旬， carrying 也E modalities of touch. pressw巳 pain and
忧mperatwe from 也e opposite halfofthe body and it is the
E唔on where 也句are consciously per倒时. Analogous to 也t
缸ran萨mentin 由eprim缸ymo回 cort凰山 opposite half of
也e body is repr四ented in the prim缸ysomato阻四orymr回
b回国E也E al<EI世ing pathways z。” OVfiat 四me point
during their anm巳 Th.er叩res四.tation ofthe body is, onα
a伊且， somatotopic in a fashion that broadly mirror，也at of由e
p由M哼 mo阳 cortex (Fig. 13.20）.四espe也l serisesof材sion
Chapter ’ Introduction and overview • 19
/ 向阳nlnll gyrus
「－Par刷刷
向阳bocc:i回恒l
s咀四S
Fmn刨 lobe
臼阳rine
sulcus
＼」~Occfp阳l
lobe
@)
and hearing have 由eirh增test level of representa岱m 皿。由a
attaS.
• In the occipital lobe is loca:画d the primary'Yisual mrta. It ia
mostly situated 口E 由e medial aspect of也ehemi叩here, 扭曲E
gyri immediately ab~ and below 也e horizontally orientated
calcarlne sulcus.
• In the temporal lobe lies 也e primary audito可corta:. It is
localised to the IUP剧。r temporal gyrua, which lies benea：由，
缸id par划lei to, the l配时也8UJ:巳
·四ie limbic lobe is comprised prim缸曲。f也edngl血tegyrus,
lying on the medial aspect of也ehemi币1四 parallel to the
四甲us rallosum, and the hip:阴阳皿，pal formation and
Ill町回且la which lie wi也in the 但mporal lobe.τhese oomplex:
structures are c.oncemed wi伯世ie emotional asp配tsofbehavi创E
缸uiwi也 m回1ory.
During d回d叩m回b the cerebral hemi.sph.ere takes on a
C-shaped COI咀胆ration as a result of 阳伽ward m阳回m of the
temporal lobe, such 也at 也e 也mporal pole comes to lie adjacent
to the fron国 lob也能归rated from it by 由t k键时恤田ιτ'he
lateral 咱也挝e wi由in 由t h.emisphere is, therefor皂白o basically
Cshaped with 'horns' a回ding into the frontal, o国，pital and
回nporal lobes 但g. 1.23).
四四 basic ltnlctuM of the 田ebral hemisphere is an au田
mantle of grey ma臼鸣也.e cerebral corteE. beneath whi由 lies a
large and complex: mass of white matter consisting of nerve fibrei
runni鸣 ω 皿d from the corta σ耶 1.25, 1.26, 1.2汇 1.28).
Cortical affer四t 缸1d effer四E fibres 也at pass betwttn 也e
但rebral cor皿姐d sub回国画I S位出turea，跑出曲曲E basal
gangli乱也alamu岛 brainstem and 明nal 田rd, are anang国也 a
charac恒istic radia由g pattern，也Eα班回m radia:臼L which z四rhes
out to 也.e ronvolutions of the mr咀咀皿恤（Fig. 1.30). D町g
inside 世iehemi叨iher巳 the fibres 缸:econαntrated into a dense
sheet of whit.e m且也er, known u the intmW. 也.psule (Figs 1.25,
1.2阮 1.27, 1.28).
Wi由in 也e hemisphere. bo也 medial and lateral to 也t intanal
a归ule,. lie nwaes of grey mat回 collectively :ref自red to as 也e
basal ganglia, basal micld or corpus s缸iatu皿．四le principal
compon四”。f也z basal gangli且缸E 也e amdate nud四E，也E
putamen (oollecti时y re缸z回 to as the n回白iatum, or simply the
striatum) and the globus pallidus (Figs 1.25, 1.26, 1.27, 1.28).
咀leαu由.tenud剧， lies 恒也e wall of the la能raJ. 呢ntricle
也rougbout its ex国lt 姐d, like 也t 回n创de,. it is C-shaped. The
b皿l ganglia are principally concerned wi也也 control of
mo呢m四.t,po血1tt 皿d muscle tone （口tap田 14).
20 • NEUROANATOMY

F阳.1.30 DI回酬剧目m d曲，『帽”’蝠’“白ebraln 怕m Ill la恒ral ””盹 llluetnrtt啕曲’“rona radlata and the II臼mal 铺”ula.

vestibular 缸nc:ti.on (VIII）.τhesp回到 sense:I are 归It 响曲 M

Basic organisation of th• brain
more detail dsewh但也
• 1l冒E brain Is convernlonally ·节1e twocereb『回I hemispheres ηle 伊leral 阳1帽 include the mo由H扳回 of touch, 伊四sun鸟
divid回 into hindbraii, midbraii are lin阳d by the comm恒剧叫
and 阳由『ain. 他田 d the corpus calo虱』m. pain and temperature （时句d from ex但m饵”。” in the sk扭扭d
interoceptol'B 扭曲e 咱也啡，血d aw.u:四ess of 萨)qJ恤配皿d
•The hlndbr事In Is further •The•，饱ce of 甘l&cereb唰
mavein四It(齿。m propri。但ptors 旭 joint岛 tendons and muacles).
SIA:>dlv刷刷 Into the me由le hem阳phara cons阳ts of oor四”l
Ga田al sensory in缸mationfrom 也E trunk and limbs is carried
曲lo咱酬， pons and gray ma他宵， which 阳币。M回 m
cerebellum. form gyrl and sulcl. Ben回th 甘冒E in spinal ner咱；量m 由E head, it is carried in 也E 由ige皿inal
SU『徊。elie t咱也随e 由bre n田VE (cranial D＇町’E 叼．
• The m副ulla, pons and
masses of the corona 『回国阳 For all modali世es in the 田吨。ry of general sensation, there is a
mldbraln cor四tltute the
西回 the internal capsUB.
b刚附tern. S叫uenceof 也ree neurones betwftn the sensory receptor loca剧
有1日缸，饱m 幅 divi曲，d into
• 1l、a foreb刚·n con剧创sot 甘冒自 lol泪s: in the periphery and the per呻由·D of sensation at the 1erel of阳
dienc句型halon 伽inci间ly the 回由ral oor回（Fig. 1.31）.四le 缸'St n四rone （缸，t『ordernem创le
阳lamus and hy阳Iha脑mus)
• Frontal lobe con回InIng 甘le
orpri皿町幽nnt neurone〕四阳也E spinal cord 也rough a
primary 『rotor cortex
and 廿'18 cereb刚 hemis防W嗡．
· 同rie刨 lo国∞瞄in同 tt隐 spinal ner鸭 or 也E brains惚m 也rough 也t 国萨minal ner吨。n
• Within the cerebral hem即here primary somatoeenso『y 由e same side of the body as its peripheral m甲甸E is located. 咀le
l阳 S剧唱rel l筒，e nuc阳i cal恼d 甘、， 配置幅K cell body of也e 缸吼叫order neurone is lora也d outside 也E CNS,
回回 ganglia. • T＇田1por回 lobe con恒j『li『lQ 伽，
either in 也e donal root ganglion of a spinal nerw, or in 也e
primary 副ditory co『幅K
• a s归temof
1l回 bra'n con恒ins
“伊1inal 院nglion.V归创n the C邸， the axon of the 盖酬。，nfer
C自由醋。r ventricles con恒·ning
• Occip刷刷自 con1凶ning the
primary 叽剧创 cortex neurone remai皿 m 也esameside （刷出阳al) and synapses upon
CSF, which is w回回国 by the
choroid pl酬JS. • Umblc lobe contain！咱 山川农ond neurone （跚跚d-order a础。ne）.回E 揭四nd-0rder
regions for memory and neurone has it& cell body i且也e spinal cord or brainstem, the
• The brain PossaE梅” 12 p副rs of amotion剑”pects of
cranial neM器．酬耐1 佣rry exact locai由E dept!nd.ing on 也E m口dality 00DC£1I1ed. Its axon
嗣同刷刷F
affe帽、t and d幅rent ftbres, 四”ea ewer （也~回国） to 也e other side of 也E CNS and 画面idil
princip副ly 恒 and 阳m to the thalamus, where 拉国mi回国. The third neurone 扭曲e
strucb.Jres of the head. 叫uence （也ir归rder neurone) has its cell body in the thalamus
and its awn projects to the so皿a阳四”ry corta, loca时 in 也E
萨就回国i gyrus of the parietal lobe of the cerebral hemisphere.
Moreη回fican如 prim町 sp旭al affet四.ts 也rry讪g coarse touch/
Major sens。市 pathways pr1甜U岛 pain and temperature information from the limbs 血d
S四aoi:y in阳mation 曲创且也t intanal. 缸td extmlal envir回回四” trunk 田mina但 near 也eir k叫 of四町 into 由t spinal cord. 四1句
is carried m 也E CNS in affer四I nerve fibres running in cranial 句E平回 wi曲回回nd-mder neurone鸟也E axo皿 of which decuaaate
and spinal ner观a. Sensory information can be d甜甜d under 也E within a few s电men.ta 缸td ther四ftcrform 也E 昭inothalamic
h倒也Dg'J of ’,pecial senses' and ’general 阳uei.τhe special senses tract. In contrast, primary spinal afferents cm归g propri民写对W!
are all 田ried in cra皿al ner咱 and are comp由d of olfaction inform甜.on and discriminative （缸e) touch 倒四id unin回rupted
(cranial nerve I), vision （呵， taste (VII and IX) and hea且吨 and on the same side of the cord as their 回町， forming the dorsal

- Fl憾。nlern剧院lll98
… s“:ond-创唱~er
… n审峰。rd er
Venlnll po翻1or
nucleus of thalamus
翩翩翩
阳rsalc划umnnuc拟
。创唰 columns
问副 root ganglion －气气
；；画飞
「：Touct咿qirtoce附n •••••
Typlcal spinal斗
nerve 」－ Pain/I由mp倒胃也Jl9•• …
Fig.1.31 0咧时棚。f份， major pa伽way，伽疆翩翩1 翩翩俑栅．
columns （阳ciculus 阴cilis 姐d fuciailus cuneatus). They
回mina能 in the dorsal column nuclei (nuclei gracilill 姐d
cuneatwl) loca时 in the medulla. From here, 1£C.Ond倒order
neurones decussate and asrend to the that且mus as a fibre tract
known 划 the medial lmmi110111. 阶回ny afl'a四t neurones that
姐.terthe bra凶stem in the 缸igeminal nerve terminate ipsilaterally
泊位e 创伊四iDal ”naory nudms, one of the a部世al nerw:
nuclei. From her巳悦ω民的rder neurones d阻挡sate 拙d a秘:mdto
the 创皿.us as the 啕u血。由alamic tra.c:t. Seam的rder
阳1阳ry neurones, of either spinal cord or bra坦s阳n origin,
∞川职 upon the 鼠me z唱on of the thalamus (the vmtr.al
m阳ior nucleus), synapsing upon third-order neurones that
proj创 to the somatosensoiy cone: in the pa1优entral 8YrtJ$ of the
par阳al lobe. Throughout the 础惚草Ip硝ections of the
串omatosensory system, there is a high d咿·ee of spatial s咿啼硝on
of the m创rones represen由l8 different pans of the body ｛仲创lled
串omatotopic o耶nisation）.施is is most dramati·创ly
demons阳ted at the le叫。·fthe 也刷刷刷惚｛see Fig. 13.20).
Here 也e somatosensory area occupies a 削p of cor惚也就
“础ds from the m甜al aφ仅t of the hemisphere (11句很随） to
the in缸。ilateral aspect of the parietal lobe {head area).
Major motor pa恤ways
The motor neurones that diredl.y innei:v葛优 skeletal mu&cle have
cell 以:>Cliea lying in the grey matter of the spinal card and
braiDstmJ. 姐d are oftm refared to as lower mota霄 neurones.
四ey CODI岱tute the 嚣。咀11.ed ’＇final common pathway' by w记ich
the nei:vo嘟”’temamtrols m。”回回t In contraat, the neurones
也很 control the ac制ty of lower motor neurones are themael.vu
Chapter ’ Introduction and overview • 21
Pons
明白睛1自1
sensory nucl自U8
”“ialle!m阳αIS
相nolhalarnlc 棚。t
Spinal 棚世
”’ motor
collecti'Rly referred to as up a四.rone1. The latter form
anumberofd创倒也g tractl that nm through 位1e brainstem
and spinal cord. Among the m倒t important of these are the
m描coapinal 姐d c:orticobulbar (or conironuclear) tram
(Fig. 1.32). These tradll o蝴M能归rtly from neurones in the motor
a础。fthe 优rebral cort属 where the whole body i& repx四entEd in
a precisely o耶nised. or somatotopk. 烛bion （附 民g. 13.20).
岱1edescen1也ngaxona 阴as through the internalα阴山四d into
the brain跚地 where most of them d刷刷re to the otha sid怠
切也 means 也atmCJ\lall1四ta of one side of the body are conuolled
by the opposite 础曲ral. cmt配 c.o民icobulb~ or co民iconudear.
fibres control the activity of motor neurones I侃atedinα也世al
nerve nuclei of the brains能笛，叫tich innervate skele饱I muscles of
the h创d 姐d n但k throu庐也eαanial ner赠。ulb' is 姐 a1'也aic
甜d little-used term for the m础必.a, in whi命”me of the motor
neurones Ji件 Cortico，仰al fibres control the activity of
motor neurones in the sp汹al co划， which inneivate trunk 础d
limb muscles. Desαnding cor岱cospinal fibres fonn a pro皿nent
ridge on the ventr划靠山face of the med叫la. This is called the
pyramid and, b四ce the corticospinal. trad is also known as
thepyrami伽I tract 四e placewh侃侃ese fibre3α。”伺W
to the oth，衍 side isαlled the d刷刷刷。n of the pyrami曲
(see Fig. 9.4).
The m必n 缸nction of the corti.co队tlbar and oortiα呻inal
pa1也，ways is the (.0础。11 of skilled, voluntary mσ陀ments. A laI怒e
proportion of the motor cortex. and its descending pathway3 an鸟
therefo11巳 devo能d to tho1e parts of the body capable of deliα饨
so-called ’＇&actiona时’， movements such as the muscles ofψeech
and t边也I exp哑ession 姐d the muscles rontrolling the hand.
22 • NEUROANATOMY

M口torαw阳z

l『1lemalC81*』la

且 11.f:烟r币brea

……·
11.tc*>r cranial nerv
同)l'IS

M创ulla

h也翩翩阳1 of the pyram副S

阳也自由pinal/pyrami也l 恼a
l阳l 制

T)l)ical s阴nal nerve •w …·

’
Fig. .32 Overv阳w of the mll,lor m。”’ pa恤~”－

Caudate nucleus
Motor nuclei
d伽－阳nus

Midbrain
Pons

”’dul阳

F阳.1.33 Overv阳w“’”’由剑”“咽棚， ot the basal ganglla.

NumeroUI brain 罩住uctu:r鸭 apart from the corticol]>inal, or
胃ramidal，哪位m are 国volved in 也e control of movement,
院础ue and mll8de tone. These are sometimes coll配曲曲 ref回回
ωω 也eem:吨厅m皿1dal m也mand 由自由配endi鸣 projections
a晶 exttapyra皿也l pa由ways. Included in this definition are 回回in
nuclei in the bra旭S植m. such as the 嚼蜡bular nuclei, the reticular
nuclei (mimlar 伽E副司， the rm nucleus and 曲otheb画al
伊nglia 扭drela“d ’ubcortiαI nuclei t。α回 in the 旬rebr罩in. 咀
喃sti趴:Ua耳配uα血r 田1d E时 nuclei 恤flu皿.cel]>i田Im“or E四z回1es
阴z世y也rough d”αruling 田m回ions 扭血t 胃g“.bulOBpinal,
retiml回pinal and rubrospioal tracts. They are impo血ntin 也t
control of mll8de 刨1雹姐dth哇”由m of也.e body. The basal
ganglia aert 也eiractions m 伽l阴阳 motor neurones of阳
brains回1 and spinal cord of也 con田h眩目1 side 也ro~
臼mpl圃，旭溢血tpa血.ways {Fig. 1.33）.四幽 include projections
via 也e 由也mus to the m。”rare徊。f也ecaebr直loor皿皿d
pn:喝缸:tia田”由E ret:imlar formation of也ebrains阳n. The baaal
ganglia are important in the C'Ol1trol of muscle tone and posture
m叫， importan句也e facilita咀onofap严甸回础 m例。r bebav阳U
and the inhibition of unwan时 movements (Cha阴er 14).
 Chapter ’ Introduction and overview • 23

陈锦由u阳『 nuclei

Sl*!al co叫 Splnocerebeller lrac旭

Fig. 1.34 OV.rv阳w “the com剧目donsot 曲’“即“”Hum.

咀1e rerebellwn is an im严mant 回回E in which programmes of

movement, ger田atedin 也e motor region of the c.erebral cor眠 aR Ventrt~ I ,r:~r:.T~γ~~~：~I脚
=1~、 问（谷 ”唰
comparedwi也 senJOIY feedback conαmi吨位espeedand
direction of active movements of the limbs, head and neck 恒 spa阻
四山 is 倒四tial for accurate, coordi且也d, purpo配M movement.
, : r『，... j、／旬吃了四川a
The arebellum re咀咱 affer四t connections from the spinal co时
说且也eapinoc:四由ellar tradl. It a1ao rec踵咱 input from 也e
vestibul缸哼配皿 and from 也emotorcor回（the lat恒 indirectly
说a nuclei in 也epons〕． τk dR:r四t oonn£Ctions of也E但d>ellum
are mmpl.a but are prim缸ily 恒 the form of Cudback to the motor
m四a说a 也e 曲创缸nus (Fig. 1.34). Afferents to ea，由 side of the
αrebellum come 岳阳1 the ipsilateral half of the spinal cord and
brains也m 皿d 岳阳1 由eco曲回ateral cerebralαm阻四Jerent
出曲ellarpro阳tions aRdir回国 ω 也econtrala忧国也alamUB 皿d
m由alcor回也rough ad回皿础。n in 也e midbrain. Because of
由函， and the d配us阻don of cortical descending motor patbw可E F匍.1.揭四，回睛，I and pe巾heralner回国甸回ems a闹 ””lb旬
ea曲目deaf也e rerebellum 田ordinates the mO\咫皿四ta of the ，胁， otpa曲。旬，l回I leelon.
ipsila1回I 盹 of the body (Chap阳 11).

Basic clinical diagnostic principles

Aetiology of neurological disease
刀iedi四时eB of the neuromusa血r sys田1 are d卸ur major types
A knowledge of neuroanatomy is 皿 essential 伊回叫回site for 由e
F也 1.37) in relation to causation or aetiol吨y.
clinic:al diagn倒也 of disorders of 也e nervous system. The procras
F缸 each major cause of di跪倒e there are appropriate types of
of reaching a d唔回白严octtds by his阳cy咀king. 也回
invea咀gation, leading to specific forms of tr四unent. 咀le four
n四rological e坦mination and, finally. by m面nnatmy
causes are ranked in order of di皿臼I prio曲曲曲at 倒tditiona
investig甜ODS {Fig. 1.35). History」taking 归回des clues to 由e
由at are com皿on, po圆白lly life..曲回国ing and reversible with
aetiol呗worcauseof 曲ease,. wherea，也e clinical examination
prom严缸回国ent are either established or acluded fimt.
pinpoints 也E 剑te oftb世 lesion {Fig. 1.36). A pathological lesion
Conditions 也at 缸t rare, chronic and incurableαn be consider回
缸也l8 at a spttilic loc甜m within 也e neuromuscular 皿s forms a
1面能r.
扭曲胆isable syn缸。IDE马 in咱tiga咀on of which leads to
establishing 也E aetiology or diagnos也

C豆D G豆E ca蝠’ 阳”’田”“”哨”’”””t

自刨nalc h』阳回归Y

~ 任~ 栩栩睛 M“闹市

（勋1dron唱 anal归is) W剧』ler 臼rdlava翩翩

任亟~ 缸”＂naic Neu刚啕V

号豆E Flg.1.37 四”’our m咖re翩阴阳eotdl”时，m d曲，

时.u＆ τM W，。”’“ cllnlcaldl啕””la. 田uromu1111刷阳’””’m.
24 • NEUROANATOMY

Extrinsic disorders cardiorespiJ:atoi:y, liv略 renal and 四d民rine function. Trealment of

Enrinsic 幽幽rders lead to com阳也sion of 也ebr沮血， spinal cord, 也e systemic disease by 也e approp血.te sped.aliat can lead to 四re

l1eIYe m础皿d 阳iphEral ner咽（Fig. 1.38）皿d are. 也a曲m of the n四川咱.cal disorder.
四晤cilly remediable. hr帽幅画oru, IUCb aa radiologicil im晤吨 Vascular disorders
。f 由e CNS, must be promptly canied out prior to neurosu唱团l
Vasrular disord四（Fig. 1.40）归nage 由z dra血tion to 也E
恒馆”四.tion. Del町 in decompressive neurosurgery can lead to nervm皿阴阳n in a nwnber of ways:
perman回t paral}'I~，侃nsory I。” and incontinenc怠
’Ibe brain, spinal cord 缸td peripheral na晒 m be compressed • Occl国ion ofthe 回础（由om.be血）
by di能础。f adjacent S刨出ues. 四t brain may be com严四d on • Res回国.on of由e blood and oxygen supply (infarction)
its OU田 surface~bl“对 clots 伽ematomaa), absα剧创td ．四嗣同 into 也enervous 伽阴阳回orrhage)
tum0UI1 arising wi剧E the skull and αNerings of the 四rebrum.
咀ie rapid development of a vurular lesion is called a stroke.
Al阳nati四i郭世ie fluid-filled 咽ntricles may comp圃，也E brain
Co吨胆ital swdlin&'J of ar阳ies (aneurysms｝缸”mours of bl。“
from within when bloc如~to 也E fl.aw of CSF lea也 to a rile in
vessels （皿gioaw) can com”剧创nial ner晴四d 也e brain
F四sure and 呵缸lSion of the ven创des (h：帅民叩balUI).
itself. In田咿tions for vasrular disorders are aimed at m:ludi吨
The spinal cord may be co皿阴阳d by disease of the 币2己 abnormal d。“咱也随时础。f也t drculati吨 blood, 阳出lg 也t
IUCb as z也ri白。”ndylosis), prolapsed in也rvertebral discs and valves and muscles of也 h出t (ech·民ardiography,
bone tum.ows, as well as by tumO\lIS of 也t meninges electrocardiography and rardiac angi1唔aphy), and di甲1却ing 也E
(m皿ingio血’）. The cmtral 也nalof 由E spinal co地削mal与 a 呢细ell of 由E nedcand k回n by angiography. The treatment of
minut£ V四tigial spac:r. may expand into a cavity {syrinx),
vascular disorders may be haematol唔αl or canliological and
compres曲唱也e nerve fibres i且也e CEO:田 d 也ecord
may require SU写~ to the heart or art回es in the neck
(syringo町曲｝． 缸id 位叫1.
咀e aanial ner棚 emerging from 也阳回回阳n maybe
comp睛”d, as they course 也rou拚命eαanium and leave 由t Intrinsic disorders
foraminaof 也t 位叫L by tumoUIB and swollen arteries Intrinsic disord四（Pig. 1.41) are priowy di刷dersofthe E町ous
（皿四rysm1）.’Ibe S阱tal nerve roots le町ing the sp旭al cord 姐也e system itself. Intrin&iιprimary neurological disordm are
n仅k and back may be trapped by tumours 甜d 伊olap能d uncom皿on, but when 也eyα:cur 也ey are oft£Ii chronic and
in缸”四由ral 曲a, causing pain, W回kness and sensmy lo画面
由eir region of distribution (radiml句“hy). The peripheral ner晒
may become trapped at vi血erable presmre 1i回 in the limbs by
ribs and tough fibrous bands, leading to 阴h weakness and
semory loss in their distnbution （回回pm回t E四m阳也对．
Investi.伊tions for ex回nsic disorders are chiefly
n四roradiological {e.g. com归国 tomo胆.phic （叼 brain scan
and ma胆创ic resonance im唔吨（MRI)) to delineate 也e disorders
(lesions) for n四IOSUllPcal deα>mpr四ion. 趾gerym勾 be
E明国red u喝四.tlyto pre晒lt permanent disabili可 and 也at is why
extrinsic disorden should be 由E 鱼'St diagnostic consid四tion.

fig ,’s ”””mic dieorders of 怕”’阳romu1”ula’”’tem.

Exlracarabral haem口nhage

时.1.揭 E庸”le dlaorde.,. of the newomuecular 叼咽睛，m. Flg.1.40 Vi’”ulsdlaor由”’Uhen刷rom帽cularav咧am.

 Q ntrinsic di9orde兮
…’…
性叩~
也豆E || G豆〉
II r=
Q叫哩~~函叩l付 。”自由m邮心

阴阳d…雨雨~ σ~） G二局面画

,’ ’
fig A lntrtn•lc dlso肉””’f伽eneurom晴佣阳”’”m. Colour事附阳协 句s 1.42-46.

irreverlible. Many navom S}'I'恒m d.ilord£I1 田1! UI叫E petic

influcnca (ha蝇。dq四enltion). Inborn errors of m幽bolitm
lead tom剧创 subnormality and disability in chil也en and are ,.. _ '.......-' _ l.JJ _ t.:J .!.__ Prin町 lymphoma
ω咀l抄嘟”d by dtficie:r国n of sp回k 四写mes. Par啕mW
dUorcltta comilt of episodic l。”。f comciousnesa （制冲刷，
aaaaiv哩，1句（nan:ol句，y) and headache (mi阴阳｝．阳回
缸’回回.ODa 阴g. 1.42) ocmr in ym血 and old 咿 and lrad
to thep置四跑回 doth （自鸣曲·） of a:rta画 oeurom.usmlar
com归田E钮， w恤’归自1gof oth四. When ，血m 也p.er画。国
民m in )'OUth, 由eyoftm have m 。bvioUI bered阳yor 萨netic
侃”也缸 eD.111肉也t muecular 甸恼。phla, the her回ltuy
S四”dm。”z ’”叫地血烟， baedltary ”“缸”m归Z咽，，
cerebellar u皿uandH皿.tlngton’， dilleaK. Whm 也ey occur
h田 in lifr. 由ey att mott oft血，poradic: e.g. m·创orneumne
也钮’r. Puldmon’I diaeue and Al血ei.ma'1 也钮’e.τhe m回1 ’
Fig. .43 N”’阳翩创棚”“romuacular.,._.,.
’
d唔阳回atiom aR rmw:kably selective as to the ner E cells 由at are
affect£d. For ellllD1pl~ in motl:贸 D£111tlne disea舅也ere is para!归ii
of mwde but no abnormalitiea of temation, 喇回回sin
Alzheimets di’”’己也m bee陀~amn回a but no par划”is.
Neoplulare缸， toez阻，sive, uncontrolled grow曲。f ti ” ues
forming ab白帽l or mall扭扭t tumour. Primary n四plasms 缸ise
扭曲t oeuromUICUlar ti8IU份由四Jelvea (Fig. 1.43); secondary
nee略地UIWI sprud in the circulation from 创her prim町 0串且
1ite1 (e.g. lung or bruat). Rar曲， 也mours at distant 岳阳也皿咿
thenemn皿 m回1 by humoral or immune mechanisms and 也E
multing 也orders m 阳mednon-m翩翩.tic or paraneopla回C
syndromes （邸， 1.“｝．

阳帽幽问 m”蝴蛐Y

ElllDn-也翩1”『t叩咱tll1T­
Fn揭叫m冒｜ Po加明蝠’
由imenlia
…
L向

闻.1M ’刷刷刷翩咽le syndrome• of ti. newommculer ”翩翩．

－「y
J
鼠
u d

lnftammatioo of neuromUIOJlar ti”四 may result from

in缸划m bym阳。。耶n凶ru (Fig. 1.45) and can a佳ct a variety
F『回刚ch'sl剧， －二2立1 of础旺tum, for 也mple 也t menin阴（皿姐ilJ8C)COαal
刷刷唰『削 「 _ \1 I meningltia），也t brain (viral enc叩ballti也 oeur。”抖世间 or
阳ipl田alna咱 (leproey). Alterna曲曲，也.flamma植m can 优ur
阳刚唰呻拙y ｜」／主再
？二r \ - He『晤tlry spastic 阳酬阴阳 in 皿皿.une diaorden 阴g. 1.46), in 由e 血阻四 of 也fectlon. The
molt common l.mmun£ disorder of the CNS i1 multiple Kleroli凰
" Mu刷刷归trophy, rnyo阳ic阳同忡， Immune diaordm may al.lo ~ peripher田I nena (acute
me刨地｜怆 myope问
inflamm刷ryomro阳甜， or Guill由－Buri lflldrome),
Flg.1 础。”帽”阳 di”’“”“··”刷romu刷lar ..，蜘m. 也t neuromuacular junction (mya抽回旭萨田ta〕 or mu副e
26 • NEUROANATOMY

multiple sclerosis). ~co呢ry from immune 曲orders takes w民ks

ormon由量，“ it is incomplete. Moreov略 immune d皿rders oft四
m且 a rela严ing 皿d remi创吨臼山盹 wi由副耻 E咽lts
superimposed on chronic decline o晒 IDOil由aandymra. 咀is
pare町mial course is hlghly rbarac田istic of multiple sclero1i1
· hence the name of 也e di刷隙，伽tern d吨~tions, by
contrast, talre many 如m to d阴暗fop (chr01让c) and 也e on剧 is
often difficult to 由他甸回ally 血t:r. 阴阳阳缸四皿n。但也
slowly to 也eir accumulating disability. In muscular 句础。＇Phy,
h自edi国y semorimotor neur叩a血i筒， Parkinson’sand Alzl回mer's
disease鸟也t di四men may I笛t from 5 to 30 y回皿 Neoplas皿S
(tu皿m皿｝四ually develop over mon也s or如a玩 wi也町mp甸回E
such as 明1甲缸，eizurel and h但也ch巳由tly rarely do hi民ly
mal毕18Dt tumOUI'I 阔iomasand 优con也ry tumoun) declare
themselv四 over days or w回b.

…
Fig.1.45 In伽ctiana af 恤， neuramuacul’”’幅m.

le cllnlcal di啕”ostlc ’”nclpl••

•H阳也口『y·恒脑咽， clinical E翩·nsic, s归temic, VII!归U恤『 or
自相nina:tion 町d i刚回ligations intrin副c.
跑回 to the diagnc划s of the
•I『rtrlnslc disorders oonslst of
阳回｛副olo时 d 翩翩．
system d唱阳市eratlons (atroph捕，
·币市e site d甘冒E lesion(s) Inborn errors of me阳bollsm,
由termi'田 tr晒。In饵l parox归m副 d陆orders,
叩ldrome r回国Jed ~the neap园”菌， infections ar回
n四rologi田I examin硝on. immune d酷ordera.
·四剖>rders of the nervous
system 帽n be c脑d’edas
Chronic polyradlcu崎础沪－「 I
G~n-也arr卤 咂吁， f Site of the lesion and clinical syndromes
W晴回1自－－－：；－－τ／ 1 J Wha:但四r the cause of a lesion may b己 its site in the

阳W脚阳J 飞斗：Myasthen恒酬， neurommcular 阴阳n leads to a charac田istic syndrom已回is is

defined clinically by careful examin甜on of the cranial nerv田，由E
Ea胁也mberts川mme
motor sys惚m, refla盹回回.tion 阻d coordination. In 也is boo.比
Fig. 1.48 lmmuM dlsardtlni af 世圃， neuromuscular~归”m. 由e fun面。nal sta1US of由创e systans is d叩i.cted diagrammatically
(Fig. 1.48) 80 也at 由t syndromes produced by particul缸 types of
lesion can be ill回国国回ctorially in a way that links
n四JIOana旭E吧F wi·也 clinical signs. In approp由te chap缸冒，也E
霍SHE

desaipti.on of也e ana1a町 and basic functions of 也e nervous

Trauma, m饭m is aa:ompanied W 盖.gures, based upon 也e prototypical
vascu阳
柿
S

Fig. 1.48, that summarise the principal clinical syndromes in

、h
bBSaw

terms of semory 皿d motor deficits. In order to understand 伽即

Aa.119 S曲，ω恒 除缸”i『啕 Chronic
(i附tan!) （唰世1in1w”k) WJd 19mi由啕（over mo呻胃口r”’陪｝
Dne
Flg.1.47 H阳”’yf锢，，t)llmltapo”．翩翩，，l啕嗣．
(pol归刷刷. Inflammatory disorders are inv回回国 by
microbiolo脾al and 1erological 阳ts of the blood 缸id CSF.
Treatment of infection with 血也tiaobial a伊its and suppression
of immune re叩onses by drugs such as corticosteroids mayαm or
control these 姐fective or immune 也eases.
Tlme-c。urse of disease
四story-taking can be wluable 伽 SUggeB由18 也E likely 臼.use of
illneas, by determining the rate of 衍。lution of the disorder, which
is often charac田is缸。f the di:ffeI四t aeti.ologio笛（F:也 1.47).
Dilord田 of sudden (acut啡，由l!IJl.aDC OI四t are 臼wed by z田nal
in问｛田uma）田 a vasa血r acrident （血。Ice). When the
condition devd响阴阳 days (subacute) to become m回malin
about one week, 也is is strongly au回回咀:ve of an inftammatory
disorder, wbi也 maybe 旭fective (e.g. men皿gi也） or immune (e.g.
由E relatiOI回lip betw四n neuroanaton弯曲d clinical signs, it is
n配essary to know 由t IOU恼。f也e major sen四ry 姐d motor
pa也w酬，也e significance of leaions of 也e 1ower motor neurone'
and ’ upper motor n四rone' and the general 鱼皿ctiona of the
回由ellum, basal 伊nglia and r.erebral mrta.
咀u: neuroanatomical in伽mation contained h 由is ch叩ter
m萨四四”也e min皿al and easen由l knowledge r明uired before
也E clinical approach to 也.e neurological patient. Without 也is
know~鸟 it is im~sible to interpret 也.e si胆ificance of the
si伊s elicited on examination of the ner鸭山耶回1 豁 described
in the 皿缸咀aid texts on ’ clinical methoda'. Theαmtinual prac咀ce
of由E exam坦ation of也z nervo四”Z恒n through experi团团 and
由E de叫吨mient of clinical acnn田L permit 由E hi民ly accurate
l民对isation of lesions wi创n the 回回回1 and peripheral nervous
m能ms. The site of 阳 lesion ~be 由ictly focal, 伽 example
a tumour in the left cer曲ral hemisphere; or may E叩臼能nt
10<对isation wi也M a functional neuroanatomical system, for
eumple 也e upper and low凹 motor neurones in motor neurone
disease; or 阳阳忡.etal nerves in sensorim.otor polyneur叩ath歹－
A 缸rther delin田tion of 岛四l lesi0I11 is to 由国mine whether 也ey
liewi也in 也e nervous m国n (in回nsic leaiona) or whe也g 也ey
lie outside and compress the nervous system 〔a回nsiclesions).
四由 U an important distinction, since mrinsic lesions r叩resent
disorders that are potentially remediable by neurosurgery.
 C111ni1I 闹闹und
motasyslllm 陆’倒事’
…’…
Se帽目。” Coordination

+ +

+
+ +
++

["I Mui曲旬句ue •
……
+ Normal 随时on or Loss of p叩rioc翩翩翩d Coordinated 111CM1ment

.
阳叫时

abdominal refta阔’ 棚，ch

· 她1en1 恼ndonor u ”“ plin and 饱mpera恼’ Inαmlina恤 m1Mme时，

abdon*1副附缸嚣圃’ llaxll

忡＋ incn.翩翩拥而触
． 叫’ll terlll胁
l『W嗡阳明 』 F恒即阳帽晴阳晦

↑ 凶l'llOrpla阳刚m”
F幅. 1Al ProlDtypl帽l 侧醉”’。r lllu副m回m ofmll,lor 句ndro1T嗣“tt.n•urom四cui.r町’”m. Throughout 阳 text, slmpll制。凶’『回 ofthemejor
a「田”mical-dinlcal syndromes 1118 pr酶，nt回 d闻rammat田’y, following the car回附阳回In剧rel吨i啤J examination of aan恒l 『回咱筒， motor也』阳回on,
rellexes,
sensation, coordination and men饱l E恒.le deooribed in texttJooks of cl nical methods.

咀iere are certa旭 prindpl” thatαn be drawn from the
。耶皿aation of the neuroanatomical structu附 described，怕他
are of high aplanatozy 咽lueto 也e clinician 扭曲回m扭扭g 由z
lite of 也e lesion.
Major sensoty path阴阳
S姐aatioo 扭曲t trunk and limb’”倒iducted from sensory
阻碍ton 且也epaiph町， by 也e peripbaal oena and spinal
nerve root.I』 to 也t domal root ganglia and 也.m. into 由.e spinal
α皿 V的“n 缸，pinal cord 也ere is a di哽咽四<E of 1emory
阳由WIJI caa拆吨 di伽回t tem0rymoda归国（aee Fig. 1.组｝． τk
aemory pathways for 阴in and tempera：创redeamate w恤in 缸
spinalα时 g叫“cmd in tbeco曲曲teral spino也alamic tract to
re:a血曲也创amuaand 往M!ll~ 也回n国lateral lml(町倒眶。f
由ecrttbml 】lmliapbae. Inαmtr酬， tactile M 严opri臼呻ti"Ye
R由ways llCald ip1ila皿曲 in 也e dorsal (p面国ior) colum皿。f
由e spinal ami befoR deculu由11 in 由elm晒 brainstem and
passing, 剖且也t 也alamus. to the COD缸由阳al lenlOIJα虹恒Z
田， ciivap:nt arrangement pennits lesions of the s抽回l ami
and brains能m to dam锦e one pathway preferen锺.ally and sp创嗦
由eother. 四ie 田mcll”。也能d lleD ”’ ”’ 1 refers to the clinical
缸也吨。f selec毡，e l。”。fthe modali世.es of touch 咀d
”吗剧创叩岱础， with 阴~D of pain and 阳呻emture
modalitiet or vice versa. 古WI seled:iw loaa of a四SOIJmD也litiet
result& 金回1 世ie 1eL筐’dve involvemmt by l四ons d由E
缸nclionaJly Ip回DC 归也W町， fortou血／pr叩rioc叩tion or pain/
temperatuM. Leaion of 伽 dorsal columru of the 酬nal cord leads
to an i”ila阳al l。”。ftoucb/pro萨ioception below 由e leYd of
the l创on. In cootrut. l甜。•n of 也e spine>也.alamic 田d leads to
contralateral l。”。fpaln阳mperature below the level of the
l创on.
Aw咀a阳咀l lesion of the thoracic sp旭且lα时， forewnpl鸟
l幽幽 ω 甜 ipaila回画l losa of touch s咀凰山n 姐d propri民甲tioo
and a contialateral lou of pain and temperature 11eI11ation 扭曲E
tmnkand l阴阳恤nba below 也e levdof 由el回.OD.Jn a ition,
u daaibed below.， 也m i1 an ip1ila恒埠 ’＇pyra皿也·~·＇ of
“
也t Im晒且mb. Coller.ti陀忡， thae aR known u a hemimrd or
Bnnm-S句wd m曲。me (tee Fig. 8.25C).
Sele咽，e l创on in the bl'linsum of 也 medial lemniKut leadl
tok翩。.fto昭l aemation. whereaa lesion of 也e
u胆niDo阳lamictt回国da to loa of归旭 and tml:阳血配
翩翩欲地 iD the fa毡’n田-doll己 the dinical findi吨。f幽幽ociated
阻llOIY l·。”皿阱iu 也 pIDence of扭 intr画画c 岛cal lesion
明创n 由e 1pina1 oord or brainstem.
Because of the dea刷蚓on of all ucending lell90JY pathways in
either the spinal cord or ~巾曲，回n, lesions of the up阳
M割且’回norαrebral bemispbe:r冒 lead tol。”。fall sensation on
也叩萨源ite (contrala回al) side of the K吻. (See abo spinal cord
l创锢， in Fig. 8.25』L M回皿国n leaioos in Fig. .9.17 皿d m幽幽al
cerebral hemisphm! lesions in Fig. 13.18.).
~＂＇ Pmtlenlll “......,.... In伽吧
• Unllate刚陆slons o1 the s回naJ cord or b嗣rbraln嗣m lead to
dissociated sen90ry 阳8.
• Lesions of the upper 阳In制m or cerebral hemisphere lead to loss
of all sensation on the oontralateral side of the 以刘y
28 • NEUROANATOMY
Major motor pa协ways
Motorneur回国由at origin.a也 in cranial nerve nuclei of 由t
braiDI'阳E or 由even臼al horn of 缸咂nal card are called I阴阳
囚。”r n田lIOI田 and 也可 inner回.te 甲回k groups of skele饵1
muacle fibres. Damage to I阴阳皿例。r n跚跚跚 l倒也 therefore,
to weakne3s （阴阳ii) orpu啕由 and wuting of individual
muacl臼. The muscles shaw d叩m”eds回忆h （伽don) reflexes
(hyporeB回啡时也er lose their tone (hypotcmia). Spontaneous
contractions of 也t muscle fibru 幽socia阎明也 a 画ngle mo回
nave (motor unit）町urwb四缸 muscle fibres are denerv苗时
皿dares回E as faaci.a血tions, i.巳 ripple-like mσ四四四”。f
muacle hen.ea也由e 副n. 曲ice all 1阳E mo细E R四rones innervate
muacles on 也e same side of 由E body as the le四.tion of 也E n~
cell body, the effects of Im阳 motor neurone lesions are seen
ipsilateral to 也e lesion.
The detceodi吨 motor pa:也W町，也很 control the activity of
lower motor n四rones are tt如red to as upper motor neurones.
四er 红iae from 由t 田ebral cor阻四d brain&田n.'lbe
m咀cospinal 阳IilIIl划al）皿d antiαmudear／回国四bulbar
F由ways are particularly imp回国1t 但g. 1.32）.咀配也出1曲唱
m例。rpa由ways are highly m阴ni时四m嗣topic.ally but are 曲。
concerned wi也 CODα血d rnovem四”。fthe Ii皿.bs. Damage to the
m植cospinal pa曲W町（upper mo伽 neurone lesion) leads to I。”
of individual mo回n四”。fthe digits 血d a breakd俩相 in
mo呢mentsof回回aion and abduction of the upper limb and of
flmon of 也e lower limb. 咀1ia charac回istic W回h幽 of
mo呢mentll is clinically referred to as a pyrami也l weakness.
ri'D Lower •nd upper llllOtar neurone I跚跚
阳mage to low曹r motor neurones is 槌soc剧创 W讪 a number of motor
signs and symptoms that distinguish t 阳m upper motor na.rone
阳阳回. The distinction Is c阳M In neuro问刷刷mlnatlon and
d问nos幅．
Lowerm创。r neurone syndrome
• W1回阳ess 阳resls) or par冉冉 ω同l剑。f lndlvldual mu剧”·
• W1臼ting of muscles.
• Visible spontaneous contractions of motor unts O阳sci凶lation).
• R国u国d resist町、ce to passive st刚出1ng (hypoton峭．
• Diminution or lo锚 of st阳tch (!er回on）阳阳帽 (hyp<草创献血。r
are1I田司．
Upperm例。r neurone~归drome
•Wea阳凶s of speclftc muscles fpyramldal w锦阳髓的．
• No wasting of muse陷8.
• Hyperre何以la.
• Spasttclty.
• Posltl啕 Babinski~时ensor plantar) r回回回．
• Absent abdomln副邸’以阁．
町ramidal weakness is also associated clinically with 回eractive
m由B stte时1 reflaes (h：π»erreBeda) and w恤 increased mwde
tone Chn回回lia), i.e. resistance to 阳asive limb mo晚m四L 也is
田mbination beiI电脑med z严mdty. The increa距 in tone DC口m
at 由E initial IS田础。f the limb muscles and is th四 foll债~by
s回归国axation d倒四（由ap-lmife m阳皿）. Spastidty
manifests in the fiemr muacles of也e upper limbs and a艇mor
mu回回 of the I阴阳 limbs. 币1四 are the stronger muscle 萨oups
in 由e re叩ecti~ limbs, and the combination of spasticity and
’回国 powerαm回M阳 ω 也e dettl.opm四t of an abnormal
严刷m in which 也e arm is r曲曲曲缸d in fl.exion 甜d 也 leg
in ex国tsi.on (att F也 13.18). The lower limb 也o dem侃出剧
由E F甜，E Babinski refta. ( dm回fl.ex:i.on of也E great toe on
stimulation of 缸 sole of the foot），咐抽 ismnsida回 a
归曲。，1omonic of corticospinal 钮缸t 由lllQ巳
The fact 由自t the descending mσtor 归址iways in the
α>rticonuclear/co副cobulbar 皿dco副.cospinal tr配ts decu剧tein
由t lower brainst臼n means 也at a unilateral lesion M 也e cerebral
bet回sphett (see Fig. 13.18) or brains回1 (see F地 9.17) l.eada to
αm国la胆菌I 严m均由 of the limbs.
币1£ 田e of the 恒田’阳ami也I’” describe 也E effec:ls of upper
motor n四rone I臼ions implies that these clinical futtures z四ult
solely from damq霞 to 也.e pyramidal or cortico酬nal nact.
H侧穹帽， individual 田cts are rarely damaged 恒 isolation and,
therefon:马 it is often 必flirult to attribute clinical deficits to
involvement of p缸tiwlar pathways. D缸nage to 也e 凹rami也l
tract itself 严。ibably 部:counts for 也E loss of diacre能 mm咽nents
and 由z appe缸anαof the Babinski reflex. H归田:ref(国a and
spastidty are d田 to the a甜itional invoMln四t ofo由自
pathw苟且
Ce陪bellum
咀1£ CUI田rt concept d但由ellar 缸nction is 也且也 as movement is
ini由时 by 也e mo阳归血。f the CErebral m缸瓦也epa阳mof
in阳ided movement is 往回1S1I1itted simultaneowily to the
E自由ellum 由也e pom (Fig. 1.34). At the sa皿.e time, after回t
im严血es from sensOI)' E悦甲ton in muscles. joints and tendom』
conπy in阳mation 曲。ut 也E O鸣P凶s m回白血nt thro咀gb
peripheral nerv四旭ω 也E spinal 倒咀皿d ascend in 也t
sp也.oc:er由ellar tmcta to 由E 田由ellum. 币1£ cerebellum. therefore,.
is in a uniq田 position to 四mp缸E the in但ruled m。”E四t with
也E a由ial mo阳n四t V由.en there is a discrepancy be的帽回也ese,.
theαrebellum is able to correct deviant mσ陀皿四”. Thil is
a由ieved by a征:ending cerebellar efferent pa曲ways travelling 由
也E 也alamusto 由E m悦。rcor皿皿4 世ten鸣曲rough detceodi吨
fibres pa提问 ω 也E bra坦stem 皿d spinal cord.τ'here are 曲。
direct cerebellar connections to the 咱咀bular 血d reticular nuclei
of the brainstem, w扭曲曲回1时四s give ri民 to descaid.ing
pa也W可E 面fluendng ton巳 p田lure and balancL
l.aions of the rerebel.lu皿田 its OODD配咀.onsl四d to a cerebellar
syn也回1e comprised of inooordination of 句t m回回1ents
(DJStagm\11), s~配h (d”町白白），也e upper limb1 (in阳筐。n
tremor）四d gait （.刷血｝，姐也e absence ofw回kness or ！。”。f
S咀sation. The symptoms and 画胆S 田E山 OD 也.esame 画de as
(ipsila田al to) the lesion 凰山 αttbellum.
A lesion 旭能rrup由1g cerebellar connections m勾 lie in the
m由ellu皿 itself, in 也E braim回1 or in 也E 回回叫ing
spin低班由ellar tr配佩 U国la回回I lesions of也ecuebellum l锦d to
ipsila忧国 I。” of coordination. Simil缸坊， a unila阳al lesion of也t
bra皿回1 姐回饵bly destI呵，由Eαrebellar connections to 也e
αrebral hmllsphett and s阱ial cord and leads to ipsilateral
incoordina筒。n 姐d, as desαibedabo鸭 a cootrala田al pyramidal
W四knesa of the limbs.
F亭 ，嗣n1...耐 lh•oerwb•lluln
Cerebel阳r 阳阳ns cause:
• N归恒gmus.
• D归arth阳（s国nning 哥>each).
• Inter啦。n甘冒π)Of.
• Ataxia.
Tu自 slgr回 and 珊nptomsα:cur psi阳阳回 to the lesion.
It is someti.m四 mistaken与也OU曲t 由at 扭曲ordination of 也t
limbs ia syno町mous with a disor咀aof 也tαrebellum. 四山 is
not the 但盹 wher臼lS it is 回ue 也at lesions of 由e. cerebellum do
lead to inαxmlination. A pati四t wi也 a short l电 and an ar也ritic
hip joint,. for aampl己 W诅 ~an inroordina也 gait. Moreova,
W回h棚。f the limbs due to di剧院 of the c:entral or peripheral
nervo时，Item w诅 cause incoordin甜on. Dam.age to 也E
阳1”teral aensory ner晴 or to 也e dona! columns of the spinal
 Chapter ’ Introduction and overview • 29

cord d叩d咱也 brain of proprioc甲由-e information from w
且mbs，也回但且也lg lack of COOI也nation of 也e arms and an at.aidι
gait. 咀由 is known 菌’lmllO哼 ata垣a~ When patient& wi血腥nsory
a钮:xia do院也ai: 句昆曲ey readily lose their balanαand 也is is
kn侧E 组 Romberg'a aign. This does not happen 回thl回回回 of
wα:rebellar pathw句/S.
B仅awie of these problems of in能甲retation, it is con:顶:ntional
to carry out taaks of coord画剧。·n at the 四d ofwneurolo脾al
aamina出几 in order to 幽幽幽 contribution of or也叩aedic
d由rmiti”， n四rological w田kneas and sense町 l幽 ω 也e d嘈tt
of inooordination. If 由eae prior deficits can be excludm on
aamination, Wn iru:omdination can reliably be blamed on
lesions of 由E 但由ellar pathw句， themsd晚且 This can some由nes
be adi组.cult ererci盹伽 eKail'l.J此画 di键倒”’uch as multiple
sderosi岛也m are multiple lesions in the cerebellu血， brains艇m
and spinal cord, each making a contribution to 也e nature 皿d
d咿e:e of neurological di抽出协
Basal ganglia
四le baaal gangli也 lying deep wi也且也eα~bralhen咀刚回巳
receive S幽幽ry 皿d motor in缸mation from wid.臼.prea.d regions
of 由E 但由ral car国（Fig. 1.33）皿d al抽血严t 岳阳也
braim回l. 咀icy are involved in d理由itrol of mo晒nent. pc:班”R
and muscular tone （也叩田 14). Lesions or di四，nfers of the b血l
ganglia do not lead 阳 1田a of 1£11.1ation, power or coordination.
Ins徒刑， there ii a lo”。fco曲。I ofvolun:田ymo阳nent
and 归础E电 increase 皿 muscular tone (rigidity）皿d 也E
”
由自萨nee of involun钮rym·町ements (d ldnesia). Unilater菌I
I创.ODS of 也t bual 伊.nglia lead to a contrala阳al motor
disorder.
Impaired motor con宵。11 manifesta as del句d ini由tion
and slowness of ma晒tent 〔副m划M句挝nuia），甲isodic
burr”吨位耐nant 伊益）缸td sudden Ito阳， causing 削.b.
Posture is :flem:l or; less commo吻，但阳uiedand 由m is
anabaenαof ann-swingi吨 whenwa国ng. The face lacks
apress10n.
We’“tyis an ina圃，e in muscular tone 也atmani他ts 笛
resistance to passive movem四t throughout 缸回entof 也E
mm-'ml.ent. It may be smooth (lead pi严） or jerky (cog－·咱国〕 in
typ巳咀由 mntraau wi也耶astidty. where 由m is an initial
E回血nee to passive ma陀mentat 也em田tof 回国a血E stI回曲，
币。llowe:I ~ relnation.
Tremor is a to-and-fro, al也ma·也池，in:田oidalmo阿mentofthe
limbs. It may be rapid and pre阳it while m画nta旭ingposture
＠饵”ral tremor) - for eum.pL己扭曲e out&tretched 缸ms 笛 in
也yro«Wcosi.s - or slow and pment at mt (res由gtremo吵， u in
Parkinson’s 幽幽且
。”m conai血 of rapid，坦鸣叫ai, un严时ict血l鸟’“萨叨’－likl!!
mo胃menu. It is uaually most markal in 也E head. neck and 曲也1
limbs ando伽盟 E但mbl幽幽回回也d fragments of 阴up田eful
mσ，em四”，。lOI回 mmifests in Huntington’s di就ase and also as
a long－能rm complication of the treatm回t d 阳rkinson's dis创篇
幅也 L-DOPA, 晒m it may comst with d归阳由｛L-DOPA-
induced 句喇nesia).
D归”Dia consists of rela.tivdy fixed abnormal po血imand
slow 臼由出gm.oπm四” that may occur in 由.e face 缸id.mouth
(orofadal dyatonia），由E n缸主｛ω币四His），也E m皿k or the linlbs.
h 也e latter E盹 it ten1也 to be most marked prt回mally. Dystonia
manifests in here祖国yneurod申iera.tive 也ease 阳edi町
d”阳由.） and in L-DOPA-indu时咖阳由” a complication of
也e trea皿.ent of Parkinson’，也副已
’na are brief involuntary mov也nen钮， which may be simple or
compla 曲d which remain stereotyped in the otherwise normal
indi世dual. 四ey 田国llycomm四ce in childh创xi oradol也centt
and remain characterislic of the adult, ~at ti皿es ofs缸四
四daI回ety. In children wi由 Tour回te's syn也ume, a E可田抽出 d
di最nm.t complex tics d罚d叩’阳ially over time in 恒也吼duals
who often display obsessional behavioun and somet回es utter
involuntary obsceni阳（coprolalia).
霄 ，ieordersof由.......唰i•
Basal gangla disorders cause:
• Slowlnlt阳1tlonand 似ecu田。n of movement 伽四”<lnesle., aklnesl创．
•Inα田”d muscu阳r tone (rigidity).
• Ab附mallnvolun回rymo晴雨nts (dyskln剧目， tremor) and po即瞄
｛句古toni呻．
• Auni恒！er副 l臼ion 阳Jds to signs and 叩nptoms m 甘iecontra国eral
side.
N剧，·ropsychological 归＇nctions
古ieneur叩sycholo脾al functions of la吨uag巳阳呻tiOI1，明白l
analyais. l四ned skilled ma陀皿四”’ memory and problem-solving
(or eJt£CU.tive funcli.om) are o耶oiled wi也in 由.e cer由ral
h皿spheres (Fig. 1.49). lvrD血胁 l回m of the spinal coid,
brainstem or cerebellum are not accompanied by 归,W.ological
deficits. 四E m回国幅画on ofneur叩q由olo庐al functions w抽in
uαrebral heini叩h四 is hi庐ly localiled, u wi也 thesensmy
and motor 町’t四”－

P阻刻S
/ ~蛐
比］
~，.，.，..－ 阳明恤patial
－~－－ b田币。”
柳err.eptive 句耐ia
Exeet』恤仙nction 句“a dlscrten恼阳1
Fmnlal i他自叩由m自

U啕t吨’
Apl1a自
A始xia
AQraphia
Semanacs Aalla.illa
Semantic aphe剑a
/laoc扭曲”啕『阳ia l
M阳nory----J
Amn幽恼
(Hlppocam阳s)

时. 1 A Reglonal 刷刷刷刷””Ur'OP9JChol啕lcal IUnctlona In th”’喃ralheml”hervandth，，归嗣m帽翩翩，tedw抽d川』”“Ion.

30 … NATOMY I
U吨uage function• 仰自由， reading. wri由1gandαlculation)
att o耶niaed 扭曲 left h刷刷田喧 inll唔ons of the frontal,
归rie凶I and temporal lobea adj征四tto 也t lati由l a豁U11己也t
回-called languag£ ara.. Although primary 吼mal J>IOCESSa are
。耶niaed in 伽 α垣pita! loba, the 阳回p世.on or ruognition of
ot加ta and human fac.a it 。耶niaed in proj回i锢， to the
temporal lobes.. The ability to navigate the limbt 缸id k对y in
space （＇啪”。，”也1 functio时 is o咿挝时也rough 阴叫配tiomto
~阴ri由l lobes. 霄iepmn侃。E areas of也e frontal lobes,
indu剑鸣曲eSUPJ地m四tary motor are也 which h 侃也t medial
aspect of~ hcmisp~ go晒n 也e 四actm四1 of learned, skilled
ma陀mt:nta of~ head, rutl and limbs (pram). S扭曲JIES 且也E
medial a句阳ts of the temporal lobes, part of the limbic sys但皿，
are responsible 伽 learning new information and recollecting
from a阴阳ce (memory) wher棚恼nporal neocorti帽 m
αiti侃i for understanding 也 mea皿吨。fWOids，喇ects and other
sensory 皿mull (semantic memoiy). Theo耶nisa:世on of
behaviour involvi吨 problem-aolving and 也e achi.evement of
goal-directed behavio田（oec:udve 缸nction) is m胆tised w地扭
曲E pre企ontalm:田， of 也e frontal lobes.
It can be dedue£<1 from thei腿 neurop町cliological and
ana阳皿αI coπdations that lesion，。f也e h吨uage aI回 will lead
1io 1。”“’”旺h (aphuia), reading (alaia), wri由18 (agr呻1hia)
and 叫“国on （刷刷刷， wher田， lesions of the
阳npor叩四dalcor皿 lead to k翩。f peiuption （.吨归oaia）四d
spatial ori四姐姐on （世四”patial di”rlmta由n). Loss of也E
know~ of learned 嗣lied movem四”（咽raia）创lo响 l缸。” 1 Fton回以m 3 B自由．”恼m
。f也e prem创or corta. Bila回al disordem of 也e medial 恒nporal 2 句U侃18 nu伽』， 4 T~ralloba

loba 缸ul. limbic m回n lead to I。”。f memmy function
(amn回且）. Damage 1iD 缸”曲m国 mr回 lead! to ma盘时
bebaviouml di阳.d>ance w划1 lo”。f击orethought, planning and
碍，1ropriate a岛吼 manifest in a marked change of personality and
behaviour (frontal lobe or 伽tll!Clltive syndrome}.
Flg.UiO Axlll S阴np”“ tom啕m酶， (Cl) •Cln of th• ＇＂陆d－ κ油Jrtssy
of Pro.侮norPDGt例fths. Acedem陆 Ur就ofRe佛欢哪怕lv9fS/l.y ofS闲ftleld.
即“民制， υκj

Investigation 。f neuromuscular disease

四iedini1臼i definition of a 归rtiwlar 句ndrome permits 由.e choice
ofap归。p血.te in附tigations to mnfirm 由e diagnosis. The major
岛四•of 凶晒tigations 旭:volvea:

• CSF analysis
• Neuroradiology
• Neurophytiology
eN四ropathol呗y(bi。”y)

Lumbar puncture enables the measurement of CSF pressure

and the collection of CSF for bac回iol唱“l, biochemi臼L
saological and q叫。脾al an.a胁”－四1配 ma歹爬咱l 也E
”也e:na of blood (aubarachnoid. haemorrhage）， 副1配由D,
恼unune di&eate such as multiple sclerosis or 也e pres四tt of
tumour all1.
Nmr回事diology encom庐”a a number of 12由niqi皿 that can
be used 1io obtain both s剧创rat and 岛nctional images of the
值1回i na哨>US m能m 四d sumrunding stn础~.Corr胃ntional
Z甜y 恤aging i• applied to 由E 位叫l and wrtebral colu皿l, while
s位uctural images of the brain and sp凶al com are ob也ined using
曲回归时 tomo伊phy {CT; Fig. 1.50）皿d magnetic:: re回国nee
im唱吨〔MRI； 因， 1.22, 1.26, 1.28, 1且）. Punctional i.map of
E唔anal cerebral blood flow, cerebral mmbolism and 也E binding 1 臼晴圆阳nilphere 5 M创ulla
ofli醉E也 m血倒也罪”由E brain can be obtained 田ing 血gle 2 臼刷S 铺Jlosum B 阳lS
photon 四inion compu制”·mography (SPEC!'; Fig. 1.52) and
3 Cerebellum 7 Midbr撞1
4 Spinal con:t
”
归aitron emi ion tomo伊抽y （阳~ see Fig. 14.11). In contrast
8 Thalamus
radiology 皿 op叫uemedium is 剧ec时 into 也e arteries or 回ns Flg.1 剧旬’阳l m啕闹啪”翩翩髓 Im啕’”RQof曲， head.
(Cour阳iyofPro郎”。rAJa伽刷， W例如n M睛以翩rlma萨市阳啊，
(aoglogr咽iy) to 创in四t the blood v蹦出 问 1叫．
N四ropl明iology 曲曲1les the st回.y of 也e electrical activity of
UnMN草/fy of MBllCh ” fer, Mencl刷胆， uκj

由t CNS byeltt愈oeoce树talogr咱hy 但皿） and 由t detection and

measurem四.t of EVOked. m萨mKSto 由叫， auditory and
 Chapter ’ Introduction and overview • 31

1 Anterior ce咄ala巾ry
2 Mi曲’e cerebr审l attery
3 句附1曲曲C 自由『y
4 Lall: Internal ca耐dartery
1 肝回国 l幽
2st幽ti.II
Flg.1.53 Liit ’”l v阳田”’帽m咽di”’阳gnun. This In啕’明S obtehed
byinj田ting an iodine-containing contrast 甸回t sel田t阴ly into 甘ieleft
3α划pltal l咖 in田nel c西。，tidarte『y. 币iis was done via a 田th回：er that was int『回LICE到 into

Flg.1.52 Axlal ..啕I• 酬。”nMnl幅幅n campumd tomagr叩hy the 旬『noral artery and 由engu回国 into the aortic arch and carotid artery

(SPEC"呵’四”’.flhe h国d lnanannal 剧b如此The 『adio恒国led 帕西回 un臼rftuorosc酬cccntrol. 阳Uf捆在yof丹田田。rPD 由栅JS,A臼幽nic

1囚1-FP-Cπ 问as been t』回d to 阳国l the 由>pamine transport叭队ηn the U咐。fRac批戒聊， Un阳吻。＇！Sm捕酬， Shsffi8/d, Uiκj

刷刷m. 阳Uf也syof阵脚sorDJBro脚， FaαJlfyofMt.副Cb1e, Imper副

α满桐， Lon酬， uκj

comb旭d wi也 measurement of individual muscle responses

to voluntary 皿d electrically evoked contraction
somatoaensory stimuli. Centi理1 （＇回国α田世al) magnetic {el缸剧町ogr咽by).
“ mulation of the brain enables measurement d也E motor
倒iduction time to the spinal cord and limb muscles. In the
币1e bi句呵。fner鸭 muscle and M回且由sue 也eds
严也叩峙Biological process (e.g. axonal d电回eration.
light on 也E

periph自al nei.vous syste肌 m幽urea of s四sory 皿d motor nerve demyelina咀on. m田皿Jard嘈~eration）皿d on 由.e aetiology [q
αmduction vdodty and erokal 11emory action potmtialB are inflammation, n四plasia).
 2 Cells of the nervous system
The neurone 32 Neuroglia 34
Neuronal structure 32 Astrocytes 34
Neurotransmitters 33 Oligodendrocytes
The functional unit of the nervous system is the nerve cell or
neurone. These cells are highly specialised for the encoding,
conduction and transmission of information. Neuroglial cells, or
glia, are present in the nervous system in even larger numbers
than neurones. Glia do not take part directly in information
processing but are, nonetheless, crucial for normal neural
function. Other cells are also present in the nervous system, such
as those forming the walls of blood vessels but, unlike neurones
and neuroglia, these are not unique to lhe nervous system.
The neurone
Neuronal structure
The main structural features common to all neurones have been
described briefly in Chapter 1. There are, however, numerous
variations on the basic plan. The size of the cell body (soma)
varies considerably, depending upon its location and function. Par
example, some interneurones in the CNS have cell bodies as small
as 5 µm in diameter, while the cell bodies of motor neurones
innervating striated muscle may exceed 100 µm. The size of the
cell body is usually correlated with the length of the axon.
Therefore small interneurones usually have short
only a fraction of a millimetre in length. At the o
large motor neurones possess long axons ( e.
the spinal cord to the muscles of the foot
in length).
Fig. 2.1 (A) A pyramidal cell in the cerebral cortex (x100). (B) A Purkinje cell in the cerebellar cortex (x90) showing the diversity of dendritic
arborisations. (Golgi-Cox stain.)
Microglia 34
Ependyma 35
34
The dendritic arborisation of neurones also shows great
variation in the number, size and density of branches, which
reflects the complexity of afferent inputs to the cell. For example,
pyramidal cells in the cerebral cortex have one or two apical
dendrites which course towards the pial surface (Fig. 2.lA), while
Purkinje cells in the cerebellar cortex have highly complex,
tree-like dendritic arborisations (Fig. 2. lB ).
The configuration of the cell body in relation to the dendrites
and axon follows one of three bas·c patterns (Fig. 2.2). Multipolar
neurones are by far n. Typically, they possess an
axon and a number arise directly from the cell
body. Motor neuroJil example. Bipolar neurones have
a centrall Gel , 1 which extend a single dendrite
and a s· ipolar neurones occur in the afferent pathways
oft ry and vestibular systems. Unipolar neurones
p ess emerging from the cell body. This divides
· axonal branches. Neurones of this type
imary afferents of spinal and some cranial nerves,
cell bodies in the dorsal root ganglia and sensory
of cranial nerves.
Like most other cells, neurones possess a nucleus. This is
usually located in the centre of the cell body and contains the
chromosomal DNA. The rest of the intracellular space is occupied
by cytoplasm, which contains numerous organelles and inclusions
(Fig. 2.3 ). Many of these are common to cells other than
neurones, but some have particular prominence or significance in
 Chapter 2 Cells of the nervous s阴阳m • 33

D翩翩阳 D翩翩阔 Ni&&I gi:anules

N山岛。1118

Nuclei蹄
IA

A •
cl
F地.2A Aa曲回l mD恤 nauro帽幽llbDdy.C睛” v剧创（a b徊。philic 句回｝

J本
由i同 shows promine晴 N田l granul由阔叫．
阳

nmm但brils (Fig. 2.3〕．咀可 also poss四 a m田n of

neurotubul四 that 缸E involπd 面也e transport of mataials
也roughout 即回l. Transport of mataials oαm both away from
Axon llinninels 阻dtow自由也ecell K吻（植忧mgrade 皿d retI咽ade 甜anspc盹
respe咀v由）．咀由 phenom四.on is exploited 皿 ~mental
A 恤iitipolar n四m皿atomical m也g techniques used to eluci也:te neuronal
B 副阳翻r
connectr回可．
C Unipolar
Some neurones 四n恒in 回gment granules. N四romel皿in is a
F阳. 2.2 Unlpo..,, blpolannd m1剧polar na1nnaa. Am棚 Indicate the brown-black pigment produced aa a by-product of the syn由esis of
dlr自tlon of lmpul掬 conductlor、
α.techolamines.. Neurom由国n 由山。但皿 most 油田u:lantly in
创l groups 由at utiliseα能由olamines as 也.eir n四rotransmi"饥er,
notably the 归rs compacta of the sub况antia nigra in the midbrain
皿d 也e locusα>eruleus in the pons. Llpofusdn is a yellow-brown
pigm四t that aαumula田 in some neurones wi也 a萨
Each nerve cell is a s叩arate p峙富国1 四.tity with a limiting ceU
membrane. In order for in缸mation processing to occur 画
networks of neurones，也erefor骂 in缸mation has to p四 be伽ttll
neuron臼．咀由 oca皿 at l}'Jl3.J>Sel. 币ie basic strw:ture of the
’回叩，e bas been outlined in Chapter 1. 四e most common
location 岛r synapse forma植.on is between 也e 回minal amnal
arborisation of one neurone 缸:id 由t dendrite d皿other
N叫剧us
(a皿der咀rltic synapse）.。由a loca1由ns att also possible and 由ey
Nucleus give uosomatiιuo坦onal 四d d曲曲。d曲曲itic 句nap阳．
Neurotransminion betw四n neurones occurs by release of 叩国k
chemical agents from 也e presynaptic en.占ng 由at 缸tupon
receptors in the pos田naptic membran巳

Neurotransmit恒rs
N四mtraruJ皿阳｛田m回由） chemi四1s are rtm:咀 in 四des
wi也in 也e presynaptic er回国忌 A 也igle neurone is thought to

Myelin shealh
N山以J8 of Schwarm
eel
时.2.3 At,回国t neuron1比Thed啕ram ilustra刷刷ieint陆倒IYa『
。咱anel阳. See also Fig. 1.3.
neurones. Numerous microscopic dumps of Nilll granules {Nissl
以对胞， Niss! subst皿α） can usually be 舱钮 in nerve cell bodies
Sta旭ed 明白 b幽句也ilic dyes. Nissl granules cons画tofrough
也埠。阳mic retiatlum 幽d associated ribosomes. The ribosomes
contain RNA (which 缸回国.ts for 也e ba叫池ilic 幽ining
严可>erties〕皿dare 也e si圆。fprot血可nth臼is. Nave ceUs are
hi由』y m也.bolical』y ac:t:M and, 也erefore. 由E Nini granules are
础回阳ypro皿nent (Fig. 2.4).
Neurones conta扭 a compla.: meshwork of structural 萨。回n
strands called neurofilam四”， which are as悦mbled 皿.to la鸣~
release the 掘me transmit田 at all its synapses, and all neurones of
a 归rticular type, 姐回ms of origi几 ter田nation 缸u:l 缸皿tion.
utilise the same transmitter. Numerous transmitter substances
have b能n identified at 四riot』s sites 凶也t nervous system. It has
long b田iknown 由础， in 也E periph町， amylcholine (ACh) i1
也emu田ni也g be阳回n motor neurones 皿ds回ated muad巳 It ia
also an import且nt transmit也r 画 the autonomic nervous 句15tem
(Cha阴er 4 ), being released by preganglionic neurones of ho曲也e
sympathetic and pa:r叼m阴ithetic di悦sion岛四d hypos耶nglionic
paruym归血.etic neurones. Fur由.ermore, ACh is a transmitter at
numero圃， widespread si剧时也in the CNS. 每回严a 也atuae
AChas 由eirtr皿smitter are called cholinergic. Some simple
amino acids act as n四rotransmitters.τhe most important are
glutamic: acid (gluta皿血〕 and p皿皿4皿inoln呵ric add
(GABA),whi血 ocx:ur 响曲（forming glutamateq豆cand
G血Aergic synapsa) and are the p血cipal excitatory 扭d
inhibito可 transmitters, re叩回ively, in the CNS. 囚，cine is an
inhibitory transmitter 扭曲叩inal cord. Sereral monoamines are
34 • NEUROANATOMY

important transmi忧四.Nora也ena1旭.e (nor哩pinephr旭.e) is and chemical 田说ronm四t 伽 neurones. 驰rious types of

relea能d by 阳西盼ngliOI血 sympa也.etic n四跚跚 peripherally aa n四m副al cell are recognised：阳回归卫y astrocyt筒，
wrll. 笛 at some si圆明也in the CNS. Dopamine and aero抽血in oligo缸咀rocy田（oli伊d曲曲oglia）四d m阳回国＆
(5-hydm巧tryp1B皿凰巳 5-H叼 d皿 act as 缸llllllmit国z in 由e brain
and spinal mrd. Most neurones 也at u创ise monoamine!I as their Astrocytes
neurotransmitter have th由国l bodiea loca时 in nuclei M也in
Astro<.y阳（Ii也m且，＇star-shaped’ αUs) possess numerous
也e brains回l, e.g. the loCUllα田uleus (nora，也回aline), the
pr，。四”es.Some d也ese form 静臼且d 予eri回阻血rend-feet'
sub民组1世a 皿g田（dop缸旧ne) and 也t raphe nuclei (5-H可．
upon 也e walls of blood capillaries (Fig. 2.5). In 也is way,，也er
Some small molecule transmi出rsub阳nces, particul曲曲t
line 也E 臼p山a田 oftbe bra姐姐d are involved in controlling 也t
u旧no acids and ACh, are often ref回回 to as fast transmitters
exchange of chemicals between 也E ciroJlatoi:y m能m and nervow
bea田e 也町 b出18 about rapid chan伊 inpos町naptic membrane
m皿 τ'bus 出ey are a physical mnstituent d 缸回咀lled
阳meab血ty t。但国E ions (no由，Jy N矿， IC', ea:it and Ci-),
blood-brain barrier, which 时ecti回y restrict且也e aα回国 of
resulting in chan厚望 ω 也e pos町naptic membrane 归国1世al.
ciraJla由1gchemiαh to 也e CNS. The blood-brain baIIier is an
Other transrni臼m IDM! a slow自四an because 由eyact 由rou吕h
important phenom回on, since itαn pre陀ntbo由 some harmful
the in能rmedi町 d a sa-called 随即id m倒回鹏则由 as cytlic substan晒 and so四”＇tentially 也由.peutic 由U1Pfrom 阻四ng
adeno由iemon咐10sphate (cAMP). D叩amine 缸b into this
the CNS.
四魄。1ry.

Anumberofp叩tides (neuropep幽幽） are stored 皿d d跑回

at synap描． τ'hese include 创业叩，haJin. 皿batance
P,
chol町stokin画，四皿atosta也句no甲bin 皿d o由四. These
peptides are o位四 found oo-localised in 由esameneur回圆圈
ACh, amino acid or monoamine n四rotransmitters and are
sometimesαlied cc-transmit阳事. In ma町 instances』 their precise
functions are poorly under冒tood. It is believed that some ·End-foot
neurop甲tides modulate the rel倒也卧uptake 皿d 萨双tsynaptic
effects of o也a 往回smitten 皿d they a略。1erefore, 0缸白血缸red
臼pllla叩
to as neuromodulators.
In order 如也.ere to be effid回国皿mission of information
between neurone11, 也E E曲ct of a neurotransmi筐z mlllit be
值minated once it has acted upon the pom归.aptic membran已
回由 is achieved either by e四mic demuction of the transmitter
or by its active re-uptalm into nei:w en曲!PaDd 酬.a. For eKalilple, ”’
Fig.2.5 An•齿。”幅画howin11 a pre a fonning • pa币’回cular倒回·
俑，，tonablo回国pillaiy. 句阳l's gold 出lori幽幽的刷刷．
at the n剧romuscular junction （：跚 地 3.6) and at 也.Oline晤E
synapse鸟也t action of ACll is termina时也rough E可也啕sis by
the 四zyme acetylcholin但恤ue (ACbE). In contrast,
Ollg。dendrocytes
monoamine- 四d a皿ino add-mediated transmission is usually
Oligod皿drocy阳阴阳对ly, ’＇cells wi也 few process的 hav巳 as
阳minated by a re-uptake mechanism. although d电rading
也eir main role,. 也E production of the 町d扭曲eath that
enzymes also 国.st. N四rop叩＇tides 缸E d电;raded by
111110unds ma町篮。m in the CNS. Schwann Wk per币。!IIIl 吐血
peptid剧创．
function in the peripheral nemJUll syst回i. At any point along 也e
len阱E of a mydinated axon, the mydin sh刨出 is comprised of
numerous mncentric I句m of the cell membrane of a single
The neurone
oligod皿也'Ocyte or Schwann cell (Fig. 2.6A). Each glial 副I
• TI市目闹U阳＂＇ is the princi阳l 『回』阳tulx』眉， and Pilln"IBnl 严叫U倒也e m同血也eath over only a short s咱nent of uon (up
仙net阳n创 U时t of the nervous granu国． to about 1 mm}. A long uon is, therefore, 四~oped by 也E
阴阳n,specia幅画d for 阳
•A 恒rge number al membran四 of many glial cells. Adj缸国t segm四it& of町din.
陪”帆， processl咱 and
晒』阳回nsm·毗er 副国恒n四s deri四d from different glial cells, are E叩四位d by a small gap,
transmission of In伽m创on.
are knc嗣同甘冒tπ晒diale
但lied the node of Ranvier (see Pig. 1.3). Unmyd皿回 axorui
• the
Great 四riabiHy 剧由 in Ira「回m揭国on 国tween
四zeand d回四 d n町ve cell 『咽』rones. Th院副El ncUde also have a dose 抖亨，ical 副院副ation with glial cell鸟 but sereral
bodi田， their dend耐c prim切ily a泪句1cholne，回ious uonsusu创lyslw芭 a s旭gle glial cell （民.g. 2.6B).
自阳市ations and S烟ns, whieh amino 刨出但N3A. gu凶n剧） In myelinated uons, ionic 8uxes aεm” the uonal membrane,
阳伽ICIS th自Ir 仙nctlonaJ and mor嗣ml『l98 ~伽阳mine, which mediate 伊ieration of the 缸岳阳 归国ttial，“:cur only at
speclalsatlon. 阳刚刚创lne(nor啕lneph阳｝
也e nodes of Ranvier where the 篮。n is exposed to the
街叫锐ll'Otonln).
·陶『w cells con回ina numb町 d g国allular 叩ace. Between node鸟 where 也e axon is ins由ted by
erg田刚回 andincw阳随． • Pepti由 neu阳nod!Ja阳11 are E可d.in, 坷。lari皿on spreads by passive means (electrotonllli).
Among th目相 are Ni隅l co-loc泪lisedwith other
granu悔， n航』rofilame闹翻ld t『宙nsmille陪 in many neura-丽8.
咀臼 mode of pr叩咽由n of action 归国1由ls in mydinated
axons is Im仰n ”“l饵”ry conduction (La:仙”阳略 to jump),
since 由t action 阴阳1岱al maybe 也ought of as 'jum~ from
node to node. It is consid自由，Jy fas阳也皿 conduction in
unmyelinai:ed axons.
Neuroglia

N四皿＇glia are 也e predominant cell 可peswi也in 也E nervous Microglia

system but th町 m n创 dir配tly involved 姐回缸mation Mia咐ia are small cells with 伽 pro帽脯，’They m 制”αntin
processing. 咀icy are, hawerei; crucial 岛r normal functioning of h刨出 but, 恒 response to 由mage 阳 the CNS, they 萨。，Ji也m也
the nervous ”’但m, providing an appropriate structural matrix and mi阴.te to the 1ite of injury.τber鸟也ey have a phagocytic
 Chapter 2 Cells of the nerv。us system • 35

L 栩 Axon
如回l

Membrane of
铀wann 倒l

C~） （主J
Fig. 2.tl 刷霄，n1V81'回翩翩阳”’irougha m阴阳”’d 田帽， mu回阳”ng1he ”ructureotth’”1J9l~tl略ath. (BJ Unmyellna”daxon1』

role, 画milar to macrophap强 elsewhere, remo由唱由sue

debris.
Ependyma
四E 甲皿句ma （甲四dymal cells〕 are 叩ithelial cells 也at
line theven刨des and cover the choroid plez皿切可 m
sometimes considered to be a fourth type of glial 国I. 四.eir
wntricular surface is cili础d 扭d 也is is said to aid the
dro血世on of~P.
。「四 development has b酬 compie回， lndMdual neuror四 no longer
rep阳徊， but 由ey do unde咆口 continual 阳阳rto man恒in thei『
int句rity. Hane:泪，甘田 are pror田”帽’“•Sl•M~四”曲翩翩，
wh胁 in childt回国 a回 youth are often gene!阳ly determined and in
the elderly are sporadic. Glia, 1.111阳 n剧ror圃， are capable of
replication 田d th町西胃， t闹闹foru, Bl画面plible ton田plas国．
Consequently, most brain turr刷陪缸审 gliornM and not tumo.』陷。f
闹剧n• themselves. According to the cell of o啕in，由ey may become
耐Mir oligoc楠，droglomuor 翩troc，协mu. Mier吨l陆偷m part of
the lmmll'lB system end may prcHf1町碟， to become c由审阳回l
lymph。mu.

” auraglla
• Neurogla are Im阴阳nt 阳
nonnal neural function because
d伽elr ancll恒町， or S叫到口。盹Ir咽，
roles.
• Astrocy抽s po88I崩｜町、g
proce幽幽 that form
间『阳部拥cul!町，回·描画t around
bloodαiplllarl•. They are
lnvo协副 In the trans旬r of
mat阳恒Is be阳帽回 the vascular
W冒tern and n剧创 t国ue.
• Ollgodend『啕llag阳『阳 ω 阳
my刨In et回th surrounding
axons In 阳 CNS.Sc阳arm
['Q. 翩翩唰·翩呻
cells form my回In In t闸
有le myeln sh创世l of neuron副 axons can be the s倒I of l『T阳nmatory
阳1阳『al nervous 辆阳n.
d阁”ses. In Europe and North 却ner阳，廿市a most common lmmu『咽
• Microgla have a 阳＠町tic d陆order of 阶， CNS Is muttlple sclerosis, which 阳ads to BP阳odes of
m恒 h h).liy to the ne『vous 由myelln剧团n end rem川””’1:1n of axons. cor明po「回同 10
卸stem. m恒p四s and remission al n凶rolog国l signs 田回 symptoms. Since the
disorder Is cNefty of a且:ons, not cell b回国， magne回c resonance 阳A)
brain imagi「唱团n d回回 abnormal 副，瞄阳n 由my回inat同 foci in
the CB阳阳刮 W忖le matter.
 3 Peripheral nervous system

Muscle 36 Efferent nerve endings 38 Distribution of spinal and peripheral

Nerve endings 37 Peripheral nerves 40 nerves 40
Afferent nerve endings 37 Degeneration and regeneration 40

The peripheral nervous system consists of sensory and motor stretch and tension to the CNS. Their function is fundamental to
nerve endings, peripheral nerve trunks, plexuses and ganglia, the monosynaptic stretch reflex and the control of muscle tone
which link the CNS with other parts of the body. Most of the (pp. 75-76), to the coordination of movement by the cerebellum
neurones in the peripheral nervous system are, therefore, either (p. 121 ) and to the conscious perception and control of
afferent or efferent with respect to the CNS. movement of the body in space (praxis). Intrafusal muscle fibres
receive a motor innervation from gamma motor neurones, whose
• Nerve endings include sensory receptors, that detect changes in
cells of origin, like those of alpha motor neurones, lie in the
the internal and external environments, and efferent endings,
ventral horn of the spinal cord and the motor cranial nerve nuclei
which control the contraction of muscles and the activity of
secretory glands.
• Peripheral nerves consist of spinal and cranial nerves and their
branches, and the numerous named nerves to which these give
rise.
• Plexuses (e.g. the brachia! plexus and lumbosacral plexus) are
structures in which the nerve fibres within certain spinal and
cranial nerves are redistributed, without synapse, to form other
peripheral nerves.
• Peripheral ganglia (e.g. dorsal root ganglia and autonomic
ganglia) are structures outside the CNS, where some nerve cell
bodies are located. - - - 1---- Extrafusal muscle
fibres

Muscle

All behaviour depends upon the ability to control the activity of

skeletal muscles, which maintain posture and g~ movement.
Such control is subserved by a rich innervatim1 df~ uscle with
both motor and sensory neurones. Indiv.idual m~ e cells (fibres)
run parallel to the main axis of th all into two main
functional groups: namely extrafus sal muscle fibres
(Fig.3.1 ).
Extrafusal muscle fibres are by far the more numerous,
constituting the bulk of the muscle and conferring its contractile
strength. Extrafusal muscle fibres are innervated by alpha motor ~ ~ - -~ - - - - +- -lntrafusal muscle
fibres
neurones, the cell bodies of which lie in the ventral horn of the
spinal cord grey matter and in the motor cranial nerve nuclei of
the brainstem. The axon of an individual alpha motor neurone
typically branches within the target muscle to innervate a number
of muscle fibres and these fibres contract simultaneously when
activated by the motor neurone. The combination of a single
motor neurone and the muscle fibres that it innervates is known
as a motor unit. In those muscles capable of controlling delicate,
precise movements, such as the muscles of the hand, the muscles
of facial expression and the extraocular muscles, individual motor
units are comprised of relatively small numbers of muscle fibres. = - i l.....--"'=._....;..-i;+""- -Extrafusal muscle
In contrast, the motor units of large postural muscles such as the fibres
quadriceps, for example, are comprised of relatively large numbers
of muscle fibres.
Intrafusal muscle fibres are specialised muscle cells that act as
sensory receptors. They occur in groups known as muscle Fig. 3.1 (A,B) Transverse sections through striated muscles showing
spindles, interspersed amongst the extrafusal fibres (Fig. 3.1 ). extrafusal muscle fibres and intrafusal muscle fibres (within muscle
Intrafusal muscle fibres bear sensory endings that signal muscle spindles).
 Chapter3 Pe而pheral nerv。us sys幅m • 37

α回ial ne明sand
Re伽拟倒 Se111姐lla1 Coordlna也m
motor句由m

;'+ . .+_

+i

也2
++
主J
+

Mu副e鸭挡回幡 and Norrr随l Norm•I Normal

w时ng

F~目.3.2 Myop耐IY· 阳阳r创so to Fig. 1.46.

。f世le brainstem. 也mma motor neurones 负皿ction to control the 胁唰町di咱｛缸｝ Me田ner'scorpu剧由
S咽sitivity of the 侃nsory endings
on intrafusal. muscle fibres.
Free nerve 制dings－「 盹』而ni g幅画ng{co用回de)
V缸ious disordm of the CNS can a曲:ct gamma m创or neurone
缸tivity aI回，由U鸟也回E abnormalities of 由t 白宫曲 reflex and
muscle tone (pp. 75-76). ' I
Epldam曲’一一一卡 ’ .I

．陶opa晴hy Is charac1制”d byw回w Der睛一－－

｛。f 旬d副， bulber and proximal limb muscl剧时th pre锦rvatlon of
tendon 用何以es and 991'回atlon(Flg. 3匈．
• Palymyosld11 is 田 imm111edi四rder of muscle 田using a painful
or painless myopa伽y. When tα:x:urs in the elder巾， th田吕眶。f阳n a
primary n田plasm 国sewhere (paran四川astic 町ndron回1).lnchild阳飞
甘1e skin is also inflamed, causing a rash. 有iisis 陪阳市d to as
由rmatomyositis.
Flg.3.3 Se”””嗣同， endings In skin.
• Duchenne mu11eular d归tro前y is an inherited d『erierati咽
di阳由rofm曲曲ildren(X-lin刷刷刷副凶1). After 2 to 3阳晒。f
age，廿回国 childdev回ops progressive w咽阳串串串 Of the 臼ms and 崎s
”
with muscu阳rcon国ctur筒， Is v.tl lchar-bound by the age of 1o Afferent nerve endings
Y倒陪剧d dies In youth.
咀le S幽幽ry m也ms, or mo也剧”， are broadly divi缸d into 也e
跻neml and 也E 甲国d 1erniea. The p回al 11en1eS are olfaction,
剖sion. hearing. balanr.e and 钮ate and 也臼ε 缸~ considered.
Nerve endings elsewhere （眠 Chap回 10, 15 and 16).
Regarding 伊1eral sensory 回din酬，也m m 世uee functional
咀田E 缸E 咽rious av四lapping co~tions for 也E classifira由n of type理：

nerve endings. ~此也eymaybecl棚i鱼d as either a曲回1t or

d如回1t. Affer四t ~er回国， respond to rnech四ical. 也ermal or
chemical stim由往.on (mechanore臼阴m皂白eon.ore臼ptors or
chemorecept。”， resp民由dy）.四E nerve fibres to which 也町
belong 四!Ilduct action potentials to the CNS. If the afferent
扭扭mation reaches a conaciot』s level，由en 也t pa也W直y is 田med
sensory. Efferent. nerve 四dings inner四tem1』acle or secretoiy cells
a吨四咀er control 岳阳1 the CNS，皿fluenα 皿山mlarcon国ction
or r.ellul缸，eadion. N缸，e 四dings that induc.e movem回t are
called mo臼巧 those 由自t induce 卿cretion are sometimes called
seae切motor.
• Extero臼ptors.τ'hese 民cur super咀cially 姐也e 嗣n 皿d m咿o!Ild
to nodceptive (painful｝晒mu比 temperatw巳 touch 皿dpres剑总
• Intero钮’抽血.Th四e OCOlI in vilCtt.il and respond principally to
mechanical and chemical stimuli.
• Propriocepton. 四ieae occur in m田d钮， joints and阳1dons and
F回deawaren甜。f posture and movement (kinaes也esia).
阳uclllrally. 阻190I}' Derw!endings may be either
unen呻sulated or eru:apsula时 仍g. 3.3). Unenca阴阳M
endings, or fr回 ner鸭回副ngs, consist of the 阳minal branches
of sensory nerve fibres lying 量创y in the inn町ated 笛”皿咀翩
38 • NEUROANATOMY

are 由t mostabun也nt type of 昭isory 四ding, 配curring widely 扭 kinaes也.esiaand 扭曲.e control of muscle tone. posture and
曲t in恒gum皿.t and also wi也in muscle岛 join钮，剖scera 姐d o曲“ mov剧由1 回回rfu且咀onal importantt in motor control is
血U血ltt8. In the skin, th町 mediate 也四nal and painful considered in mo艇 detail 尬 。t.apta 8.
配皿atio田．咀ie parent nerve fibres are d£signa:恒d ph同.ologically Golgi tendon organs occur in 田世ons and re叩ondto
as group AS (III) finely myElinated and group C umn}-el.ina时 relati咽yhighl白白。f田llion. They are associated 回也 group lb
矗bres. 四ese are of relatively 阜mall diame阳 and slow conducting. aft捡回t fibres.
Merkel 四恤，阳帽） are located near 曲 border of the
epidermis. 咀iese are slowly 础.pting recepto”也a.t respond to Efferent nerve endings
toud咖幽ure. The axons of origin are large and myelinated. Efla四t endinp D<Illl' in auoc:fa由n with muscle and secretory

由回归ulated nerve 四~ are surrounded by a str配旧时 cells. The endings m铠mble 也e synap阳也at oαurbetMen
ap回alisation of non-neural 甘aau鸟也e combination of nave and neurm瞄. Transmission u by 由emical mean岛 depolarisation of阳
its enrapsulation o缸n bein吕 refi回mtoaaam甲usd巳 Meiamo's 咀.dings 臼ming re1帽，e ofaneuro田皿因“町也a.t acts upon
四甲usdes oa:ur in 也e dermal pa回llae of the skin and are E四呻tors in 也E U耶t cdlmembr.mιIn 由iated musd~ both
esp回ally m皿erous in the fin伊笛”－咀回 res归ind with 伊at alpha motor neurones (inn£r四位l8 ex国缸aal muscle fibres）笛1d
sens划由” touch. They are rapidly a也p血g receptors and are gamma mot田 n皿rones (innava曲唱迦国fuaal muscle fibres) end
responsible for 缸赂。r discrimina位鸭 tou血. Padnian corpwdes u归n muscle cells h 町napticsp回aliaations called E四rmm皿cular
“ :curin skin 姐d in deep tissues, e.g. surround凶g 汩汩.ts 缸姐姐 junctions or motor md-pla恤（阻， 3.6, 3.7）.咀ie new:otransmi四z
meaentery. The largest are a few millimetrea long and they are at all neuromu扭曲r 如nctions in striated mU9cle is g现现choline.
幽幽幽出d with group Aa (I) large diam~ m＇同inated axons.
Pacinian mrpuacles 缸-e rapidly adap由ig and respond to
media皿cal dis回世on，臼p回ally vibration. Rufli皿四ding声
”·”•andlnp
• The p创ph酬咽I n&MlUS 句暗tam ’回ings ~创ch 创闹剧ner's
（回明JScles) are slowly a1由”ing mechanom:叩阳阳山由gin
con嘟”。f 『啕阿审伽d咱S, and Pacin嗣同 corpu剧蚓．
the d回nis of the 耐n. pe仙eral ner咽， pl8l0.届锦副
•S阳幅幅l muse阳 cor也in
Within skeletal muscl盹 intra缸”I muscle film创， which 坦白nail 院咱l拖
muscle spir回l酶， which 田B
groups mmtitute muscle spindles, act as s回忆h receptors σig. • Ne『vee「ld1『唱gs ara broadly compos回 d i『llrafusal muacle
3.4）.四四 are two types of in国恤al m国de fibre. re阳'Ed to as d翩翩ed as afferent (sensor妙 fib耐．币、创econ副st of nuc嗣『
皿dear bag 皿d nucl国r chain fi.br皿 h田阳al muscle fi.brea bear 。『串阳M (m幽『）． beg and nuc阳『 chan types.
棚。”pea of sensory e世ing.. which bemme acti回也d wh四也E 有iey possess annulosplral and
•Sense『yendi~a Ill四m 揭
m日，de in which 由ey lie is str回ched. Annulospiral 四<iinp （民5 ’刷圃’叩『宵”鸣。『y endll"(,IS.
mec咽nor民:eptors,
3.5) are 础。由回回由缸 oonducti吨，oup Ia a曲回t fibres the『morea事国尼口『 • E慌，回甘 nerve endir旧s 818

andflowu·叩＇m'/ endings are associated with slower conducting ch田norec叩b阳． eithe『『notor end-plates n
muscle or endir啕S i'l
group II affer四”. Muscle 刷ndl” are P缸ticularly ab山回皿t in • In terms of loc副例， tt即 can assoc加！Ion with 锐捕，IOl'f c创恒
muscles capable of fine, 喇lled movements. 币i.ey are 恒tp笛tant in be 且血divid国 into
（帽拥阁”时．
exteroceplD阳， lnteroceptors
and p『叩由四目。陪． • Alpha 『rotor n剧m「胃揭 innerva:幅
锹曾曲』翩l mu回efib晴 and
• Structuraly, they may consist of g田nmamot町『l8Urones
Nuc嗣rb啕 muscl自由bre
unence阳』lat回 (free) nen帽 in捕『vale intralusal muse酶
endings, or enca阴阳阳”d
Nuc回r出aln m回国’bre ’b阳 .

阳nu阳piral
『阳刚188 nerve 制ding

Group II
自帽erent由b陪

·lea散nnl
nervelltn

国. IA
Annuloepirel 斟ll1SOIY
nerve e回国目
lnne!Vltion of intrafusal muscle fib1'81. For darity, only an
.
仇 ’h
annulospl『al g叫咱 Is shovm on th自 nucle由r 阳湖 ftbre and only a 明侧审问pray
end同 onthenuc嗣r ch创n明bre although, In reality, both types of er回Ir唱 are
found on both types of 刷刷蚓巾’－ Fig. 3.& An Mnul”plral 嗣同’制ding on an ln1nl侃”’lmu，曲曲”－
 ……nervous刷刷 39 I
， 阳..... ., ...嗣............ .....曲’
My圃’h删...，.唰 ia an mmune di四『'der; ii is 阳 mo副 com阴阳1
d剧『der or the peri例waJ n&110muscu恼r junction. It 凶U幽暗 W翰阳”s
创d 饱1酬， of c刷a mu剧”（e.g 副圆a』lar，恤副缸回 bUbar
mu蚓串串｝ 创d limb~自由pee凶W proximal) mus幽8. 而is occurs w灿α且
mu回」W W制ng, chan仰 In 附加翩。raen销协 （Fg. 3.8). Tre阳市ent
with dru98 阳t 刷刷凶’tylchollne 翩翩串串胆战holln9$脑部副
pot阳1t胁，s neuromuscular transmission, with 耐lat of 句m阴阳附. The
Lamb，而叶姐”” svnctrome causes slmllar 制原翩翩d Is an Immune
. and paraneoplastb synd阳ne. It does not respond to
l 剧，：lcholln酬erases.

EnO-pl1回

Gamma rnolDr
R由国咽ne

Fi9. 3.1 Motor，回，p阳lMDnulnl仇－1 ....c幅 fibres i”’t幅画d

m翩翩．例 RMYW•I“曲’ond•at翩翩帽， efferent
闹闹俩刷’棚”inat1n1 in neuromu翩IW;uncti刷刷刷．回
A帽晴，阔”lln..”””“划”－非丽 neuro田nsml阳『 at then剧romuscutar
Junction ls a剧协hollne. The 翩。no!阳阳nsmltter Is terminated by 问
自nzymeace协holln倒terese. The br刷n stain sho响问 S阳clllc local翩。n Fig. 3.7 A gamlNI m创圃’”“m闹剧ding In motor end-pl嗣’”
。f the enzyme at the neuromusoJar Jun创m 间则． lntr翩翩 mueol• 仙”－

飞－－
/
烈， 。酬，｜阳....晤，nd
Re翩翩 Senl8圈。n Coordination
m蝠’”’tem

+
J之 飞
_J:l,
+

+ +

Mu副efa19Je 陆:rmal Nom回 Normal

问．”翩翩rvmu”’恤，June刨阳”闹，棚’』陶fer also to F栩.1.48.

40 • NEUROANAT。MY
Peripheral nerves
币le 阳m'p回1phml nerve' applies to all 也t n町ettunband
M割地es that lie ω回de 也t CNS. They are 也t 阴阳dpal route
也rough wbi曲曲t brain and 酬nal cord communicate wi曲曲e
mt of 也t 以xly. A typical periphe:ral. nave consists of numerous
nmefibre也咐licb maybe d也a aff自四t or efferent wi也 mp四
ω 甜ieCNS.
Some 阳ipberal nerve fibres are myeliDated 皿d others are
unmyelina时. Within peripheral ner鸭伽 nerve 伽哩， are
arran骸d 画 bundles and surrounded by shea·曲。f connec由噎
由sue (Fig. 3.9). Betw阳1 individual fibres is a delicate connec由t
由sue h阴阳”四donewlum. Bundi＇”。，f fibres are s山row回国
by per旭eurium and the whole nerve is ensb倒也d bya tough
coat known 111 句“B剧rium. 四” configuration pro幅des 跑回酬E
and support 伽 the ner呢 The αanialand 刷nal mer曲，sare
con·由UOUIW抽 theconnec由E U”四 shea1曲， of 刷naland
aanial ner现虱咀1鸣曲e durama田 is continuous w抽回he
币neurium, while 也e arachnoid and pia 缸Eαmti.nuous 明白也E
perineurium and endoneurium.
Degenerati。” and regenerati。”
Whe:n.a p回抖le:ral. n缸，e fibre is tramec时 oro曲“响，e seriously
也maged, the portion distal to 也e ttar阳面佣（furth倒鱼四E 曲
创l body) undergoes deg四四tion 也d dies. 白白 isknownaa
anterograde or Wallerian degenaation. 币le pn:回mal portion of
也t neurone wbi也 :remains atca曲ed to 由e cell b以纱， may,
h仰”吗 aur唏ve andev四tually undergo ft!CO咽yor z唱t.Del划，a
岱iefur也er from the 创l body that transection occu矶山t m幌
likely it is that 也e 叫I body 回11 surriv巳 I国tially, it too usually
sh例” degener唰鸭 changes, kn＇阴阳” retrop掘e d唱阻剧由也
切由 is characterised by di”e拥I and lost of 刷ini吨。1fNi”l
granu』a (chromatolysis), swelling of 也t cell body and m伺mient
of 也t normallyαntral nucleus to a peripheral l“现on. If the 创l
reco鸭m the distal 四d of the IUIViving neaw 伍M哩回回ergoes
”’
sprou·由ig. If the two 四di of the peripheral netW are p ically
aligned (e.g. by surgay followi吨 trauma·由国町•）， the new
Z电阻£Illling fibra may en阳 the 四donewi.al tubes 也at haw lost
Fig. I.I 111• a11ucture of a ”唰..，.In翩恤
their nerve 伯阳.Con出ued gwwth of the new fibr略 at a r.ite of
l to 2 mmfda势 maye\I咄创ally lead to :re-组nervation of the
original sttuewtt 曲d ttCOV町 αf function. M皿1y factors inO.ue:nce
the d唔幢幢 to which successful. re-innemtlion and functional
ttCO晚ry take place.
The d鸣四erative processes that follow nerve 创l iJ功ury are
倒en由lly similar iJt 也e CNS. Sprouting of 咄咄vi鸣 neurones
al”。αurs i且也t CNS.，以此也t 盼“tablishm四tofptt9阳山
connections does no也四由irtunately, take plac障 to any s榈meant
ment.
~~ 阳lpha..1••nmrl111刷， m呻·削”
Perlp陶ral 锁胃1锐，1motor neuropath悔s ere character!锦州 by ml.I!比uler
W槌W阳$创d w且sting~郎拟出划创ly of dls1al muse!郎.）， distal er创制a.and
a 'glove and s阳king’ dstribution of sensory loss {Fig. 3.10). Periph阳l
neur叩捕ii隅 maybe ca＼必创 by W富temic di鼠糊邸， vascular d阳创昂，
her嗡do·degener：创w d阳orde邸，时悦目阶， mmun& disorders and
阳ran以剿邸tic syndromes.
In 9臼W创， there are two pa%holofjcal types. 。嘟””llt帽禽田’
棚，'Opllth：“ predomin时y d町age Sch明m 倒ls and m阴阳
shealhs. Axon1I 棚刷刷th阳 primarily 佣useaxonald鸣惊W刷n.
阳αwery from neu附pathy r鸭山部 remyetr将tiOn and regener苟且ono1
axons.
Distribution of splnal and peripheral nerves
At the m。”。f the upper and lowu limbs are l悦ated 由t brachial
plmls （腕” 3.11, 3.12）姐d 伽 lumbosaaal pl也us (Fig. 3.13),
rapectiftly. Her四~ theneM 鱼bra pre侃nt 画 sp画al nemtb伐。me
mlistribu时 to form named peripheral nermi, which th回 run
“翻llyto th＇由 targett. Becauae of the redistribution of now
fibrawi也扭曲e plaus鸭山忧国:tori＇钮 ’吨，1lied by peripheral
nenaaredi曲ent 鱼。m 也09eof 酬nal nerva.
h曲 sp画al neawca皿哥，也”钮，ory innemrtion for a 阳刚cular
part of 也e body m血皿币四缸囚。f 副n 也at i1 1Upplied by a
严皿a血z 刷nal nerve ill known u a dennatome. Damatome
”
map• 缸E gi n in I在g. 3.14. 咀嘘，e 缸eonlyappn:回mate since. in
reality.，也ea皿aneoua 回回回iea of adjacmt spinal ner咽 overlap
 ……nervous制~ ., I

Crin阳I nerv幢幢删
Raf'阳帽 铀翩翩 α则由1llion
m阳”蜘

+ 气

川、 4
+

++

Mulde wulln811 and

walli咱
- A嗣耐棚阳刚栩栩’ II Lollof归f翩翩 ( lncoor曲曲 lllOY8m酬，
a皿阻

F"• ＇－，。， .. 协翩翩”翩翩翩，匈蛐匍．阳翩翩恼 Fig. 1.48.

哑ie group of skeletal mmclea inr田’就d bya 阴rtiadar spinal

n筐’t is collecti'Vdy known u a lll}'O伽me. 四ae mutcles are
“臼由。啊川

usually functionally ~atr:d and are respomible for 归rticul缸

严出rm of momnent. The aegm皿tal 刷nal nerve values of aome
important m。”ments are 血。wn 皿 囚g. 3.15.

Lt' ...h•.i 阳•I由..一三

I Inπ10lort:yc幅部刘d町巾， trauma to the shoulder and neck may 臼use
I 11YU1aion or 阳阳曲i削”翩• (Fig. 3.12), ca喝ing i'nmect刷
l w瞄咱n酬is and b销。f f制1ng inα"t9U网捕 limb. Later, the arm wai到髓
and beα)1'1188 pet州』I.
Atumou『 σftheap帐。f the lung may lnftltrate th自 lower part of 甘、自
brach阳l 川剧A producing SfN嗣 peln h 阳町n,w倒阳翩翩d
W咀sting of the Nnd and ” ”ay loss on the Inner a碑JeCt of the
forearm and hand 伊＿＿.• .,ndrom•).
An acute Immune In’阳＇metIon d 甘l8 brachl副 plexus (b甩出剧 p阳划s
neuro回酌”口创帽 ”帽e pan, w回阳笛s g回 senso『y loss In one
arm, W帽、 usually 『90CMlB after a 归ar.

Fig. & 11 The ”’鸭”鹏111111 例”“·．

币 t翩翩叫阿翩翩
COI1Jidei:ably. There h属 Jun何鹏刷E 伺自lap 毗m adj扳回缸m
of副n areaer唰 by non-con句UOUI apinal Dma, such M啕nant d胁翩翩d 瓢lglcel prcc削ur嗨 for 阳明『阳、 dem筒，自由，
bouo也ries being ref恒时 to lum以>S8Cl'BI p恒泪』s Intts course through tt回国市. C8l』sing pan,
u nial lina. 咀le 四回ieoua
dis创bution of important periphttal ner ”’
is also 山回国时 in
W回阳1ess and wasting of t陆 muse胞s and numbness of the l啕（略， with I
bl缸Kier and bO¥帽l incontiier盲目’－ I
Fig. 3 .14.
42 …… |
Cranial nerv阴 and
~ Senealion C刷dinalicn
motot句幽m

+
.- －立之 +

+ +

+ ,,, +

++

+I f '

+' +

I) ~ 心

ML幽幽嗣础m”und 除:wmal II L幽of 1ll 111naallon

"
帐，mal
咽”咱

Flg.1.12 La阳帽，．．．”副刷刷例GUS 伽阳回 CCII'鸣。，』·TIJ. 陆驷 elsoto 同. 1.48.

Femoral n1rw

Ob阳帽”『帽W

Sdatlcn1rv1

肉’.3.13 The 旬’t lumb ” Hnlpluul.

 ……In…system 咽 ｜

C7· CT

L5

..
ktmnop

lJpj:圃，国·回国 α翩翩醺且a of 81111 陈崎刷

』目 CJqeaFau

Medalaill翩翩•darm α血m幽
lJM，阳隘的Ill a*"8ou8 cf ..... 匈灿灿
Liii制鼠翩翩’“阳明m t翩翩 a翩闲” d同
Mee制a阳阳帽 d伽帽m a脚旬’“阳回回（rn.刷划翩翩1eOUS)
阳制 ω．，阳Ullll
“
q

民刷阳ω恒neoua of forearm
－LH ．，

M i1n
『，

Ulnar R刷阳ω恒neouaoflh胁

,..
LI恼，a aJtan翩翩 of thigh ”“l1la』阳”Ulof 航协
t

”“l1l111d In怡nnadl幽 cutan副局d同 副唰

Fig. 3.14 币”’闹””田di嗣以刷刷。”阳’嗣同”｛曲”ll8t0m•，四”med ，，目，...ine”“.Axl副 l~nlnbo刷．

44 • NEUROANAT。MY

4忐乒7~，
乙4歹'-y!j＼、＼「

也哇二、~J ， 即

. . C7,8
＇~J d手工＿）＿＿＿二
(\\
i
\\ ,\\ 、 CB

,
仁＝
、7

门 j ,
、 l , h ~

.\4u
 ……nervous刷刷 45 I

ll'llrn’” l..al8倒也血”。.. ,...,. of Ille.协

S翩翩y Mo!Dr SenlOr)' M幽r

SmaD musc:les at 骨，E hand None

组cep曲创buctor酬l崎阳酬

Ulnar阳rm af Diiie ar叫“ng

偷嘲，rand 回，世

Median nerve Common 闵Rlnl8I nerve

伽刷V M口IDr Se『wy 蜘切r

Abductor阳lllcls brev恒 Toad耐tle>!Drs

Foot 阳军阳阴晴

F倒到阴阳回事

R9c凰”闸

“n帽Y MolDr

Fi『可e『 extensors

Thumb 翩翩nand a以1u::lus

Wrist倒”nsora

Bract自radial阳

Fig. 3.11 Sena “” nd m创圃， detlcb 8190Cl8恼dw胁，lll'lphenil nerve 嗣Ion•.

’.tpl蛐”“阳时朝”
• Ne!wl 借W圃，阳 &on'晒啤linal
『W晴国酬”『回rrQl!d•
t田 αlUrll9 阳tptllll曲．
palllirG ttvough 曹四”田量国 OI
luT归自由'Ill 网llllOJll8ll, to
emerge. rwned ~
”’-·
·同岖，..『W咽’ corwilt of
Ylll'回ω，阳mb町11 of bundles, or
饱回E圃， d nerv喃自阳”－
•TI冒E 内e睛’bres are e晴h凶thed
in th1'811 oonnllOI惘田”ue
回到，ings：，回:loneurium,
pems』riim g回叩lneurium.
•TI悔自回cnl!ll'国 tut团 within
”副1 曾回暗lual lllCDflS le In
阳耳目幢幢 阳 SUCCI揭噪，
’鸣声-.eration ar回『’阳回vation
b缸”咆晒四”ll'f·
• lhe g田 d 到由151.’”国 bya
硝回『'lllMt isα曲d a
dam回缸汩胃’－
• The group of muse嗣
lnnan息1ted by a sphal 咱明 Is
o副leda myo回me.
。 如甲 」3“－～ζ二五...............
同『刷刷 ner唰 are win制胁”翩翩剧由毗 αmp隔sloo 问．
似“嗣惘 p咽sure on a 19α』mbant llmb) and to ch町、b antrapm酬 by
normal or di””“ eneto州”l st阴阳，部副阳刷饲甘iem. Then回t
commone:田nples 翩翩Jle '9dlal .,..,,. compr唱sslon In 廿18 spiral
groO\州E d 甘冒E humerus and chronic entrapment d 苗、e t*-'...wat
“
the elbow er咽’ of 晴、E m -.nn...皿 the wrist ~α~tumel
叩ldrome} in th& upper lmb. Chronic er审理阳酬。r the lataral
a血n剧”’””aoftha th旬’咱 and 皿且， comprassion d 伽，
, commDn ’”’naall*帽 at the h回d d 怕自由bu恒 occur in th& l阴阳
I limb 铲ig. 3.1毗
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·：·善

苍E
白as
－g－E占 －2 冒U
（HZ 幅古｝蝇坦国回B 雪 吾目 assEgggzau唱
gh$82‘自备忘冒SRSSZSE 罩Z
着自 5古国－
62 晶冒。召 g 电SSEEEMSE 喝自gu 咽目喝 EME
asas 自 甘 E Z U Z E G E g d E 吕古 ggg
gEgg 唱号毡 g 昌 gaaE 曾型电自Z揭 EE －3Eg
g －【吉思S 嗯 EA坦白白雪－ E 宫 ESSM 百 uEESE
42』，毡
ga 冒ESEEHvgaaa－
asHh
SgRE25
百 8 百旦岳阳召回望军－
BE 民主 SB 唱SE 喜毡’ SEZg
ags －唱
SSEBEaBEWES 唱唱 SHEB唱 MESSZ
．P
－跑回OU
sg 普雷苦就
』OEE
－ EEmw Eg －B 阳军王军冒冒 Hg事电 gh＝gggzauogzs
注目回到百abg幅古罗 ggMU
哩a。SEEge 宫昌唱、bsg＆吕
．
豆 588 唱ShoasaaE占百当uzzaa Fg －gaa
E
童电－ －odgadg－－
s －
gag 咽
a385swag －－ 8 百 ABS
UA弯曲gas －gsBSESUESga昌 hogg旨 a
Eg’tt
帽paa
hB－ O
a吉。E－ 西
E罗雀 ZERa －营aEEg 吉普 ggEggsg 营吉普
－O－
MO
－osas－a
回gogguag吾u吾宫 F冒 agQaeuwa －’除
萄吾 dag
SEUaEaaESEgsua 吾 aa冒
3 Zg 【dggusa
怠。且’
A也 ga层 sssaag 。SHgFgg组仨
BS唱gzsa 、
等 军事主，“军 gEE 曾 EZ 誓 言罩善。－ gzgEEB
ESω 执ωω3 。 E ＠ zo －E 。＝。言，飞 寸
 … Autonomic nerve … 47

via 也t white ramua c.ommunican鸟”“lied because 阳

Sympathe回c dlvisi。”
民啕anglionic aympa也~c neurones are located m:l~y in 由t
也倒四z and uppu two or 也m lumbar aegi:田Dtl of the spinal
oord (Fig. 4.2）. 四iey lie in the la阳咀l homof 也e 1Pinal grey
matterwb油 ia, tber曲盹创y 阴aent at~ le¥da (aee Pip
”， 8.9B｝. 民咿.oglionic uons I钮，e the cord in 阳刚回l nerve
rootl and join the 酬nalnaw. Poi耶nglio皿c l}'Inpatht.tic
neurones~ 世ieir cdl bodies in one of ”。 locatiom: either the
aympatbd:lc 由翩。，但nglia that liet d也er side of 阳刚由al
oolumn, or the plellllel (coeliac. superior m倒四阳ic, in缸ior
maentl'lic）也at 1UITOUDd the main bran曲”。，f the abdominal
aorta. In order to aa.cb. any of thae le回阳1鸟”咱~ionic
amnsin 也e 1pinal naw 四tEr 由E 却mpa血me chain. n，倒E
酬nalne凹白血at contain lf0lpa1hetic outflow are linked to
伊吨lia of the l)'IDpatht.tic chain by 旬帽 small ner昵鸟也E rami
四mmuoic:antn {Fig. 4.3). Pr甲nglior山 fibres 归11 into the chain
倒四”四t fibres are rn)"l!lina时．
咀lOK fibres concuned with innava由D of structures in
也t h组dand 也or.u 田minate in synapticαmtactwith
萨M咖nslionic ttll bodies in the sym阴阳配 chain. The
阳喃喃ionic fibres return to 也 spinal nerve via 也 grey ramua
communica凰” called btt.ame 他 constituent 曲m are
~sled. ’Ibo能 prega唰沁园c l)'lllP•thetic fibres concaned
with innervation of pelvic and abdominal vi筑m PUI
阳也iterru”’d 也rough the sympathetic chain and tmel to the
plameswh自 由eir co田，pond皿gpos电anglior山倒l bodies are
l阳ted. The neurotranamittel' releued by pr咿nglio盹
aymp仙etic neun:>nes ii acetylcholin也岱ietrammit恼。r
p嘟嘟nglionic aym阴伽etic Wla is ger皿allynora·也回al恼t
(nore回n甲ihrine), although the ttlls innavati吨阳回
glands are cholli回牌’lbe a也四d medulla is 姐 a即tional
organ, in 由at 扭扭曲回ly innemlled by p眩，ng1io血
1)'111~由etic nc田onm.

Eye
U创n回 g阳叫
M山XJU，町略mbr酣睡$
of noee and pll幽

P翩翩 gland
&DT&ddlraid
// yι队 ／ \ 翩翩嘟翩阳由

f ‘飞 H”而

” J . ~同＂＂－ ＂＇＂＂＇:I
La叨1X

Tra俑，a

Bronchi

T1
~1 二三~，， r. －~J'
U啕

饵”hagus

SbNch
Small l『1t阴阳市

Liver

Biarya,.em

L2 I~ 二丐 仨抨飞 回~
－→· 、＇－ ，.－－－－飞
国咽19 lnl ” ..

角””’l gland
Pae酬’91on1c ftbree
自由 blood w”串l，’飘制at 陆~ey
glands Wld erec:b
pli
Bl翩阳

Reprocklcli嘟

”’m
肉’.4.2 0咱四··”。”’t1h•~”’”lwtlc d怕自时’”“··四”nomlcner啊”·”’mm.
48 • NEUROANATOMY

Preganglio『1icn1浏阳市’
in 凰”ral hem

Sympa伽剖k chat1

Spinal net晦

问啕ar嚼阳icneu阳酶

White rarr阴阳nmu『阳m

臼9'J l'lll1US comm1S1i甸回

“
Flg.4.3 R，』剧’1>nehlpa b ween a tJplcal 曲。”clc •plnal ner四 end the ”mpathe回cchaln.

The d剧， of 句m阳也etic nervous 句晦m activity are most

Parasympa·甜，etic division
apparent under conditions of 盹哇’也 mi但也由t or fear 扭d are
classically ref回回 to as 由t 咀ght m 副ght' 阳.pons巳咀1e K缸tra但
and blood pressure are incuased.ηie bronchi are dilated to
R鸣曲nglionic para巧mpathetic neurones are locat “ in the
bra皿回1 四dthe 刚nal cord 但g. 4.4）.明白姐也e brains倒也
incr回se airflow to and from 也E lung且咽，odilatation in 业eletal
such cells lie in 值皿al nerve nuclei associa能d wi幽幽E
mwcles alltn帽，也e inaeased blood flow E呻tired for 回.ergetic
oculomot01; facial, g1，幽咐wyngeal 曲d 四gus nerves 血d
K由i够 while gastroin伽tinal blood flow and mo创ity are
pro说de innerva世on f町由U血E四 of 也E head，也oraxand
d回国sed. Metabolic changes oca岛民JChas 姐 increase in blood
abdom四. The parasympa:也eticαmiponenta of these nerves 缸E
~UCO盹 to support high energy u剑”a山n andswe甜ng 忧Ul'8 to
described in Cl呻值 10. Wi也M the m礼 preganglionic
inα'ease h且I lo”-
P缸圃’回阴阳tic neurones lie in m ”rond，也ird and 岛u抽

l~ LMlomof1M.,..........cn ….,.....
Parlpheral •曲”“nl岳阳HUN 嗣dsto 阳htlng through 削lure to
control the h倒rt 附te and bl以刘 presMe 伽”11.!ral Qncope), urinary
and bowel Incontinence er回 Im阳tence.
似嗣nomlc 闹Ul'Q阴晴旬，旷阳、 com~I回协 acute and chror晦
跚跚ymotor 晴m阳llhles, but r四ly manl嗣t es chronic 饱mllsl
n刷red饵”nera伽帽 d阳q由用口if the 阳rtpher刨剧tonomlc neM揭．
Homer's 町nclrorna 用怕E b口 d『ooping of the 句elid (ptosis) end
(miosis) ca山田 by 由mage 恒甘回叩n田.thstic
cor胃回ction 口f 白白 pupil
and tt回阻di副
inn町回首on of 世16 阳ator palpeb甩， superioris m崎cie
协刷lodilato『）他圃 of the i由．节18 叩叩甜回忆 neuror圃，。『甘1自
由scendi啕阳lhways corr1roll同 them, may be dam啕回 a a number
of I即由：副啕由scendin 阳 brain幽m 脚甜翩。『 illm叫 and
t情 spinal co叫脚创锹阳、d回阳ity or 酬时， as 甘ieyem宵”的廿附
加tthoracic nerve root (by tumour of the apl叫 lung) and as they
”棚d In the symp础elk: p阳山 91'()1.』nd the carotid arter回脚
”
脚ellng of the arter1 In a mlgn副nous 创tack).
saa划”gm回ts and pro悦de inner明白n for pelvic 由cera.ηle cell
k划ies ofpos耶nglionic para句mpa·也etic neurones lie 画院ng1扭
曲at 红E located close ω 也.e structures which 也町 innerva~巳
W』由扭曲e alimentary 臼nal，世Iese neurones coa回1bute to 也
町回国ic （扭曲ach's) and submumaal (Meissnei:’,) plexus四．
哑iese pl.£Jtuses are 血o ref届国臼翻白e'en田k Itel咽回
”配m~ Such a wncept has arisen bea.we 也epl皿蝇
additionally conta扭曲ffer回t neurones and in能rneurones. 咀le rich
l侃al in田ronnec植ons of these 创ls are ca归hle of sustaining the
mo创ityof 由t 伊础。凰”stinal tract in the absence of input from
由t CNS.Furth四non鸟 these cells cannot simply be 叫回也dwi血
由eparasym严也etic nei:vous 阴阳nas 田di由nallyd曲时，血1但
也句 are known also to receive aynap缸 input from pos唱唱ionic
sympa由etic: neurones. 咀le DJ四mtransmitter released by both
preganglio国candpos毕ngli。因cparasympa也etic n四rones is
acetylcholi皿
 ……
E”
L.aalmal 恤M
蛐后ouamar惜1111181
dnc翩翩阴阳”

问”“回削
＆翩咽，回lblmllld
IUblilgual Pt也

Haart

Larynx
Tract回

Bronchi
Lu咱

臼toph啕us

5'Jm回1

Small inllllltine

L””
副阁”曲”

Lagei咖sti晦

Ad181回 gland

阳d晦7

四adder

RepiodL翩胁
。咱ans

..-…
F胁”。 on at the’”””’曲de d阳i.1an or the aulDnomlc n•”四””lllft.
 Coverings of the central
5 nervous system
S阳II 50 Po剖eriorα町l创 fossa
Anterior cranial k怒领 50 Cranlal menlng”
M1剧le cranial fc跑回 回 Dura m回er 52
回回 central nervous 制em （＇创S) is supported 副 protected by
bone and membranous 由呢rings.τhe brain is lo惶惶d wi由in 也E
cra皿al ravi.ty of 也E 由ill and 由E spinal cord li臼 in 也E vertebral,
。r 酬nal, canal 明白扭曲E 呢rtebral column, or spine. Wi也扭
曲曲 bony covering岛 the brai且也d spinal cord are in咽sted by
three concen创ιmembranous 皿ivel.op创. The outermost
membrane is the dura ma:陋， the middle l句自 is 也t arachnoid
ma:阳缸鸣曲e innermost l句-er is the pia ma:田． τhevmebral
column and sp皿al m四nges are described 姐 Chap田 8;
mns叫出itly, only 也E 血ll and cranial m皿ngea are considered
here.
Skull
四ie brain Ii.es on 也t ftoor of the cranial 钮，ity, which. 旬萨也er
wi由也E bones of 由e aanial 四.ult. provide& suppon and
pro缸tion from physical h如ry. 咀ie 8oor of the cra皿al ravity
consi翩。f 由ree f。”盹 Each of 也ese aa:ommodatel 阴rtia血r
归rta of 他 brain and posseaes 伽amina 也rough which cranial
nerv四 and blood 咄咄四固自id leave 由e cranial cavity
〔F电~ 5.1).
Anterior cranial fossa
四iean也riorαanial k剧a is formed by the frontal, eth血。id and
sphenoid bones. It aa:刀mmodates the 企ontallob四 of the M祖n.
四ie greater part of the floor of the anterior cra皿al fossa consists
of the frontal bone and it also forms the roof of the orbit. The
归rt of the 击回国 bone 也a:t 缸ms 也e an恒ior wall of the 也m
contains the frontal air sinu1. 咀1e medial part of the floor of the
血也rim cranial fossa is compo蝇d of the eth皿oid bone. In the
midline, a 也缸p ridgi鸟也e aista 醉m. is 血e an田iorpoint of
attachment of the dural fab: E由i. In a narrow, elonga:时
d叨’因sion on either side of the 由饵”lli lies the aibriform
pl础。f由t ethmoid bone, upon which lies 由E olfadoly bulb.
四ie bone of the cribrifonn plate is pq咱？ered wi由 small
perforations 也rough which the fascicles of the ol缸torynerve
回阳也ea回国由rityfrom 也t nasal cavity to atta血 to the
olfactoty bulb.
Middle cranial fossa
咀ie middle cranial foasa is fanned by the sphenoid and temporal
bones. In 也e mid.line, the body of the S冉enoid forms a d四P
depr1四ion, the 峙P句也归国I 恤盹曲创mp幽d by four spws of
bone. the an恒rior and pos恒ior clinoid pnx军sses. The
国pophyseal. fo嗣叙:comm＇以k胞也e 崎p。p峙，姐， or pltui钮’
gland. Lateral to the body of由t sph曲。“，也e rest of 也t middle
cranial fossa holds the 能皿萨>ral. lobes of 也e c.ei:由ral hemisphere.
咀te middle cranial 旬，a contairu numerous points of en町 ω，
and mt from，也e cranial ravity for 由nial nerv跑回d blood
础scls.In partiall缸
50 Arachnoid m副er and p阻 mater 54
坦
e Theoptk 也nal is located medial to the an也rior clinoid process
and oommunica恼回由也eorbit. 四m咄 it阳E 也E叩世E 归）
nerve and the ophthalmic缸阳y (a branch of也ein阳nalαm“
四町）.
• The superior orbital fissure lies betw白血也E S回国 and l四ser
wings of the sph四oid bone and also commm咀αteswiththe
orbit. It carries 也.e oculomotor 但I), tr配blear(IV〕皿dabducens
(VI) nerves 血d 也e 叩h由almic d世sion of由t 国萨minal 〔V)
nerve.
• Theforam回 rotundum 叩ens into the pteryg。”la由le fossa.
and carries 也e muillary di词，ion of也.e trigeminal oerv巳
•The 缸ramen ovale carries 由e large mandibular 世vision ofthe
回geminal nerve.
• Theforam钮，.pinoaum is the point of en町 of the middle
meningeal anery.
p。s恒ri。r cranial f。ssa
咀尊严部阳ior cranial fo酬 is 阳med~ 也eoa:制回 and p由剧’
回nporal bones. Anteriorly, in the midline, it forms a sk甲，
smooth slope （由t cllvu1）由at isαm由:uous wi由阳 body of the
sphenoid bone, posterior to the 句p叩峙seal 岛帆’The bra圆圆1
rests upon 也e d叽~，也emedullapa篇面g 也rough 也E foremen
magnum to become continuous wi也由e spinal co此 τbe
forant四 magnu皿 also ad皿its 由E 胃口ebral z回国 and 由E
spinal root of the aαessory (XI) ner陀 In the la能ral wall of the
fora皿m magnum lies 也e 峙pogl饵”l canal 也rough which the
hypoglossal （泪I) nerve b咱也口anialcavi可. Bet响扭曲E
。因.pital and p由阳阳1poxal bones lies the large 如gular
foramen 也rough 咐rich 归”也e internal jugular vein 皿d 也e
自1幽ophacyn胆I 隅，咽胆S (X) and aαessory (XI) ner晒. In 也t
回tical wall of the petrm皿阳nporal bone is located 由E M恼nal
auditory (acoustic）皿倒”” whim transmits tl眼睛tibulocodtlear
(VI用血.d facial (VII) nerves. 四四 αrebellum rests on 也e fioorof
the F览馆rior cranial f。“a.
A•pe四··帽，pPtg ”
t Ion Is an e>φandI咱旬cal leslon such as a
tumour，~回matoma or ab9CE嗣. Since the cranial c刷ty 阳 ciO!踊d and
un嗣ding, the brdi 阳 distort回 and displaced d时nwards, towards
阳阳租men m啕num，创阳阳咀cranl创 p刷刷m d锦S 归g. 5.2). The
阳回ant compl创ns of headache, vomit阔， bur~咱 of 喇on and
dro响in幽．刊e optic d恼CB 刷刷。l胁’&pill曲翩咱创d 啕na or
b『面附tern dys仙nction are ro町、d. Coma and d回th Bl』P自W冒商『甘冒自
P『eseue is not 闹剧回 by n剧rtl8llQ町（aaniab町呐. Benign
lntrac111nlal hypert回回阳n is 臼峰回 by general回d 田Wiiing d 甘回
brain in 阳 a国朋臼 d a b臼l sp也a-occupying lesion. It a伽1α:clES
in ob院妇 young women; the 町ndrome of raiSE四 h国crani副 pr，白血18
mimi臼 a brain rumour - h田ce the old d臼啕nat阳＇· 'p回udo tumour
佣rebt1’．
 … c………~~ 51 I
Fron幅la曲，in~捕

剧’mαw嗣k棚” ~ I, :t'.. 主矗
。恤”
Clllr食ITft pl幽
~ ·• :;;:
飞＿，，＿， 1 飞 严和〔
’ 也＇ .
- ’

｝悯10ph归”l 他幽

M刷l’”唰 folll , . 」 t . .比 一一一－－ 」，、气， ..，＿，

' I
Foran睛’曲”um

,. For回阳11鹏rum

f飞 L
αM』’
..
~
气

I) , ,
、

\i:\
Fonunan magnum

肉，leriorc而幽lb”

INan回lloc鸡翩
阳翩翩回

Fmn恒lualnua

c~幽 galll 飞飞
吨、

Crlbr快m pl幽

Supe阳刷刷阳回

Optic e1n1I
N阳阳『 clinoid process

Fonmenl1”吼町1
｝一一一－－－－－－＼－ Fonunen 咖ndwn
于『』－』－－－

For回啊＇＂ o测le －－－『－－－－ 向steriordil'll币d proc捕’

α阳，

k陶押回...糊Jtlcmea邸’

A刷，ro.wn.i 阳，wim筒，um

””啕l。”“”nil

Fig, 5.1 Floor of1he 1阳ll1hawin1 ’”曲”’由冒ni1lfa”－ ind plincip•I 伽nimin•.

52 • NEUROANATOMY

F副x cerabrt

Space唱刷酣啕 l臼阳1

Temporal lobe

阳raman m啕num Tonsil of care切也m

”
F幅.S.2 ASPll ..。剧附Ing leslon IHcl’”“”l’”m刷tot 曲， brain and ral ’” ”
lnl:nlcrulal Pl9 ure. 1: Herniation of c:ortEIX b阴阳th falx 091'9b『l
2: Hemllrtlon of temporal lobe Into posterior cranl副 fossa. 3：臼mp『白白n ofmldb『田lneg副nst tentortumα曹由eHl.4:H町也回onofce甩出liar tonsils through
foran冒en magnum.

•"1' Fonlmln.. .,..drolMS Cranial meninges

有回回t f口『国『nine of the ski.』II r叩『esent si国 d p口t回国 extrinsic
E田npres副on of structu『回阳nni『可甘1rough 甘、em, by diso『I恼E such as
bony deformity and 阳m凶币。，f bone, meninQE览。r blood vessels. n币B
parlicu恒『回回ial nerves dam甸回副伽g 田t site 国d 怡’foraminal
叩1drom由＇， e.g. of 甘币e..,.rior ，而ibll fia剧”。『 jugular 旬帽lntll'I.
In 廿1e forwnan magnum 11J11Some the spinal co时， lower b耐用tern
and tonsls of the ce『曲创lum are compromi创划．
Skull
• 1l冒e bone量。f 甘冒E skull and the
meni咱酷 provide prot倒roon for
the brain.
• The brain lies on t喃自由or of 甘冒’
cran刷刷Mty，附胁 oonsl跑。f
甘、『回 fos串倒．
• The anteriorαanlal foesa
con刨ns lhetlln刨恤es d 甘冒B
oerebr刨 hemispheres.It forms
廿ieroof of t闸，bit and Is
Clo倒y assoclel回 with the
匍ntal a~ shus.
• The c~brttonn plate admits 廿回
d触ctory n8MIS to the cran阳l
C刷lty and accommodat倒 the
d饱ctory bulb.
• ll、emidd脑 aani创仅焰sa
con刨ns the temper刨 lcbe. In
t回『nldllri白， the hypoph归捕“
阳sa holds 阳刚tu阳ry~and.
•A numbarof 伽田niia pro咐’
自nt『y 苗、d 部E b『 imper恼nt
blood 咽部副自由Is and 臼回．剧
n81V88 Ond阳.tad In
parer咄翩翩｝；
． 。因E canal~叩tic nerve,
ophthalmic artery)
Dura ma阳r
The 西Dial dura mater is a tou庐， fibrous membrane that
四sh甜由因也e brain like a lo创e-fi创ng bag. In some regiom』 such
as 也e floor of the era皿al 四ity 姐d 也e m挝line of the era皿al
roo£，也e dura is tightly a曲但回.t to d能 in时or surfac£ of 曲
曲曲， while els四her巳 m血画也E fmn臼parie恒I area. 由E two are
呻血恒d by a nanow em咀山al space Two large folds，。r
rdlection岛 d duraa阳id into theα四al 四ity 缸idocc吨，也E
fissures between major components of the k回n (Figs 5.3, 5.4). In
也e midline, a w阳I sheet of dura,, 也e falx cer曲d，回ends 伽n
也t 四nial roof into 伽t g回t lo也gitudinal fissure betw四D the
• Su阳lo『白白阳l 侮副陪
出曲ral hemisphe:r凰咀e fah.. therefore, has 血 a国ched bord自
(oa』lom口恒几 troch抱ar,
abduc窟回 and 叩hthalmic 由at adheres to 由e inner SU血a of 由E skull and a fr四 border
div画ion of trigeminal nerve画｝ that lies ab.:m: 也e cmpuaall田山n.Anteriod票也e falx is attached
• Foramen rotur田dim(m副llary ω 由E ha町 ridge d由e crista galli. P<嚣回iorly. it becomes
d闹剧。f trigeminal n町ve)
αm由lUDUSwi也 a horizontal shelf of dura，世le 但ntorium
• Foramen o回跑 (mandibular
div恒阳， d trl阴min创 nerve) 饵”bdli, which a:tends inwan:b 阳n 阳 ocripito能回归国 E唔m
• Foramen splnoSLm (mldd脑 of由t skull to lie 面也E 往an阴晴钝 cerebral 缸SUJI巳 between the
menlng嗣J artery) pas也rior part of the cerebral hemi刷ieres and 也ecer曲ellum. ’lbe
· 币、e postertor c阳削 fos锦 tentorium has a fi四 border 由at encirdea 由t midbra缸， as 也e
a.coommod眠”甘18 W刨帽tam
brainst£m rommu皿α田 betw田1 由epos田ior and middle
and cerebellum.
• Anum恒『 d Important cranial fo随挝、 h the mid.line,. 也E 也ntoriwn bemmes am世nuous
strucllles 田SS through the SU阳iorly 回也 the 副X 但由d 阴g. 5.3).
怕町ina of the p臼terior ηie dura mater is oo田凶ered to be comp由edof臼叨 I句哑也
t揭sa:
咀iese are normally d伺ely adherent to one ano由er but, in 回国n
• Foramen m啕num(medul恒
locatiOI鸣曲町 become separa时 to end刷e bl仅对－filled spaces,
oblor咆曲， var幅bral arter酶，
Sflinal 『回t of 1t田部2棚ory 由t dural 咽1ous sinuses. Major回lOUS 画nu础 lie 扭曲e a忧础d
n町vs) bord础。fthefahαrebri {su严rior 幅画自ttal sinus; Fig. 5 .4）幽d
• Hypoglos剧创nal tentorium a:r由elli (stra增lt 由iw. traillftile sinuses; see Figs 7!J,
阶yp啕b嗣l 闹闹）
7.10) and also on 也eflc町 of 也ecraniala世ty （εg. C2晒nm皿
• J啕uarfo阳nan Pntemel
由础’回 Fig. 7 .11 ). Veno田 blood from 也.e brain ftOW!I 恤 the
Jugularv刨「I,
glos8ophary啕锦I, vegusend sinuses through a 阳阳 of vmous chann出缸uiin tum 也E
m铺町 n自晦｝ sinuses drain p血.cipally into 也t in也maljugul缸回n. 也rough
• In恼nal 副d阳『y m回tus
which blood is re阳med to 也e genexal. mracranial. cira血tion.
但cial and VI嚣tibulococ刺ear
四le dural 观nous sinuses are described fur也e 旭 Chip回 7,
n町晦｝
which deals wi曲曲t 回回.11血ue d也t CNS.
 … ……… c system 53 I

句幅cch翩啊

Fig. I.I Crlin副帽咧tJlhow副9th••”·四’”nentofthe 也nmmr.

＆』”而『S啕i刷 sinus

F也帽曹M

阳阳，ω阳um

缸阳iorc:is恤m
Cei回赠 heml1pher.

lnterped111C1且r嘟”m Midbrain

阴阳’阳ygl•nd L
－－＂＂＂＇.丁＇
X
•• ，千丁、~~~‘ ..，..咀l 』 .1h I 飞 「 V f、比毛· • • ..
呵！
TenlOrium cerebelli

P叨’

R耐『削”＇＂＇

~：吨＇t~过」院7严）
Cel'8balum
Bullara『饱ry

αs回namagna

” “Ula
Ar ♂ ~j;，.）飞 A飞「空呻皿‘军凶手 ；f俯［

F幅.8A P..necl翩翩’阳“”d。”“thehead,•h酬ng the dl9PQlltlon of the bniln Md men I啕恤

54 … NATOMY I
’, .......... r&BUting from
闹副 trauπ盹啕鹏副ly m回 t四百c a国den!B, is the
most α:mmon cause of death 创d d阻ablity in }'Cl.灿. The injury may be
blunt ('dos创伤翩翩 by a penetrat崎 m瞒自由. The ski』II may be
曲actur回创d de阳””d， 刷刷g br回n c创曹ingsand 甘冒eb『ain it唰t.
四唰ac制ne.ntand w划。n of the b础l lead to contus胁，施础lg of
wHtema阳时 b嗣同阳 the brain 伽闹剧晴l'lllt.翩翩翩’~.
cau刽『W uncons翩翩翩（concuss圳， neu刚啕阳land 阳ychol啕lcal
由制甸回d post-traum创c apllepsy.
T锦州ng of 廿l8 mldd协 m刷ng回I artery causes bl阁d同 Into the
extradural space (un刷刷.，.＿，.9tom9). /.<$ the blood clot 以pends,
the brain is com~幡臼d；画 a resutt, coma superver田 a del卸回
period of hours at惚r the blow. Without r鸭山'OSU咱icaJ evacua世on，甘冒E
巾ing ntracran国 p陪ssure 但1届四 brail d届placement a回 d国th.
Teari咽 d甘冒eve阳 slA!lching aero臼甘冒e subdL』『百l s回回回U&BS
111回ual seep吨， d blo剧， collecting to fonn a chronic aubclural
h•m.tom.w时1 9\IBn阳al coma. The d回国y 国阳回1 the blow and the
侃velop『TJent of symptoms may be of W阴阳田 mo呻百．啊’e eklerly ar冒
particularty vunerable and 甘南 he创 n归『y may be sight ar冒d b电d阳门．
崎酬， SU咆ical 『刷刷81 Of 1he Clo1 画 l阳－8制咆·

却础知制d ma” ’
Arachn。id mater and pia mater ∞唰啕 d刷刷 rnagna

哑ie arachnoid ma田 ii a 四ft. 缸anallKEllt membrane 也at, like 也t F~目，＆.＆ C阳”m•m””也
durama饵 l刷甸回πlop11he btain (tee Fip 1.1 仇 6.10). It i.t
9epalllted from tb£ dw:a by a narrow tubdur志l 1pa饵也m喃
which P踊 wins 回 Z剧te to the duml 观盟倒， ainuses 。nni.lme””·”
(Chapter η． • The a』『审 mater is the 饱be cerebri, ter啦，Un m翩翩
Thepiama阳 is a miaa.cop回Dy 也in, dd阳能 and outermo8t menln伊幅画 a咽。n 1he floo『创 1『l8 e『勘副

h胁ly 回回血z membl'Ule which i& clolely adher四tto 由e membr四、，. Two du刚 she创队 帽”ty.
。『阿翩翩。”－＠甸回 Into the
IUifacc of 由E brain. follow画g all ill concaviti画面dco目四皿ties. •The middleπ盲目nir啕回l lay田r is
α刷刷 08\llty:
Bdw回1 the pia and arachnoid mater Ii自由e 1ubarachnoid the arachnoid mater. 由主th 甘冒B
apace. 咀由 contairu a 创am四.toWI DdW四k of connet:往把自llUe • Th’恤帽曲”. lyi咱 dura and arachnoid au『round
between the 1wo cerebral the brail loosely.
sh刷刷刷呻｛回阳山：） and is trav回d bynumerowi
hemlsphe帽
·节1e innerπ回t meningeal la阳
缸阳回 and 回ns (se.e Fig. 1.16). It also con回OS cerebr田pinal • The tent，创um 帽曲州， ttt咱 is the piaπ回国， whict、“阳西
8uid （~呵， which is produced by 也e choroid pl四” within 国”炮制 the cerebellum and
lo lhesu『饱ceof 甘冒8 br百·n,
由ecer曲时回回des (Chapter 6). Since 由e m血noid the occl川tal lobli撼。f the
closely 倒lowir咽 its contours.
”晦brum and encircling 廿w
ma国 fits looeely round 阳 brai且 while 也 ~ia doady follows Thisα画面回串 a a』barachnoid
mldbran
its m血aconto四，出e aubarachnoid space is of g回.tly S阳ceor v宙恼Die depth.
•Tr回 dura contahs a m.mber al
vary画g d句也也 di能Z四t region&. When: si；回fie.ant d叩ressiona • The subarachnoid s回国
wnousslnuM捕， wHch 笛’
orfi幅山田扭曲e brain ill哇，panned by the arachnoid mata;. con恒·ns CSF, which is
lmpo阳ntln 甘冒B vanous
民”口用led by the choroid p凰山
subenchnoid dltmia are fonned. Two of 由aeare dral'啕，。f阳 b刚n.
W时1in the c酬，阳回 ventricles.
归rticularly large:
• Important ainu饵” lew灿in the
·’Ibeds忧ma m唱na （倒也ellomed创larycistem) liabe阳晒1
the cerebellum and 也 dorsal•山也ce of the medulla ｛弱， 5.4,

’－ －崎胁
5.5). CSP fl<n啸山。也i1 dstml from the four由呢n回d也
·’lbem饵”dunadar 由国n la 以ated at the bue of也ebrain
(F'ig. S.4}whcre 也ear时moidspa血，也e&pacEbet隅回也etwo
t.em归ral lobes. Thi• cia田ncontaina 也eopticd血&In. 四l£
ris田n is deepest betw阻，由etw。但rebral peduncles of the
midbrain.
• Otherds阳ns include the 1uperior dstem l泸ngbetw回n the
”’teriorpo副on (spier山m) ofthe corpus ca皿osumand 由t
In陆immallon
of the menl『唱es may 1'881』It from Int田~lonwth 叫ru棋路
(e..g. lymphocydc oho闹闹n同时吟， bectel'la (menl啕∞α刷8,
pneumococcus，阳回no阶M lntluanza 仙d 1Ubero.』losls），仙咱l
(crypt民刀OCUS) and protozoa 伽xop恒sm创．有1e p翩翩阳nplal附 d
h闺dache, ph口饲阱曲回 andvom耐咽， is 恒bri恒 ar币d has 『1民k st耐回S
on attempting to move the N坦d. Vral meningitis is nonnally mikl ar回
民副－Im阳『可·国ct，由l 口『 fungal mening恤， he刚回霄， leads lo dam勾画 to

m曲ellumand 也t pondne datem 也rough which runs 也e

| m副 nBM揭 and 甘冒 brain itse眈『 uni『sated, it proceeds lo rais回
I intracrani副 p『酬U币， brain disp恒四π丽『rt 町、d death.
baailar artery (Pig. 5.4).
 Ventricular system
T。”’raphl国l anato町'l'/oflhe Cerebri幅plnal tluld
回町剧由la’”atem 55
咀iecen包al nezvo山钢能m (CNS) contains an interconnecting
ser恼。fchamben 皿d chann由 which are derived from 也e
lumen of 伽 embryonic neural tube. In 也e 刷nal cord，也is is
re阳回也能d by 也t 瞄tigial 创ui insigt咀.cant cmual canal. Within
由e brain, howeva，也E enormous growth and distortion of the
创堪回l tube-1.ih structw'e is paralleled by the d凹d叩mentof 扭
曲borate 回es of chamben，也由由ral ver白ides 阴gs 6.1, 6.2;
see 副，0 Fig. 1.23).
Topo11raphical anatomy of 田，e
ventricular sy冒幅m
Passing rostral坊 from 由E 早nal cord to 由ebr垣皿国n，也ecen国l
canal of也es庐talamlma帽 progressively more domal until, in
由E m跑到｛叩四） medulla, it 甸回s out into a wide 四dshallow
d叩reaion, the 旬阳也幌ntride (Fig. 6.3), which lies on the dorsal
SUI也re of 也e braiI四胆m benea也 the cerebel】um. 咀le fourth
咱也icle is zhomboid or diamon归国ped. On each side. a k回回l
recess ex国uis towards 也.ela但ralma晤皿 of也t brains也mandis
扭 contin·回fy, through a small k田al ape睛，tt （由eforam曲。f
Luachka}, with 也.esubara血noids归.tt of 也t cerebdl句>ODtine
angle 但g. 6.4). For the most part, 也E roof of the four也回回de
is formed by the cer由ellu皿.How回盹也E roof of the caudal part
αlllllilb of pia and 甲e世Jlll<I, a central derect in w扭曲 αmsti:甸回
the median 咱缸”m of the four由呢n回ch鸟。r世1e 伽'8D1回 d
An阳r阳 homaf 「一 Int阳明细胞ular
la阳市l wnlricl悔 I 伽冒m制
.，，，....－ 除idyof
恒恒ral wn创de
。由曲ral 啤』educt
In自eriorhomof
恼恒ral ven刨eta
(i :·
Fig. 8.1 A帽阳帽，tofth’”『唰刷lar9Pt9m. 问 Lateral v饱w; (B) poeter1o『飞~ew.
6
町
Magendle. The k忧er provides communication betw民nthelumen
of the ventricle and the cistema magna of the subarachnoid spare
(Fig. 6.5）.四ieror田1 part of 也t roof of由e 如山也咱回de is
partly 伽med by 也E superior CErebdlar ped皿tdeaon d由.er side.
也espace bet嗣~也em being bridg国 by 也E 也in superior
medullary velum 伊g. 6.2).
咀le 旬urth vmtricle a田1ds rostrally as far ”也E
pontom部但lC即halic junction, where it b眩:omes continuous with
也eαz曲ral 14ueduct. The cerebral aqueduct is a narn阳曲曲nd
which p幽幽也roughout 也e l四gth d由E midbra缸， b钮皑白让ie
恤缸ior and su严riorα>lliruli. 咀le simpl＇马 tuln血r configur甜m
of 也tαrebral aqueduct. in comparison to 也e rest of the 但由ral
π血icular 阴阳n. refiecta 也e relatively UI咀iffer四.tiatro na阳re of
the midbrain in comp缸iaon to the furebrain. At the ros缸al margin
of 也e midbra缸， the cerebral aqueduct opcna into 也E 也inl
呢ntride. This is a mid监te, nan圳， sli凶h cavity,，也e lateral walls
of which are formed by the 血alamus and hypo曲创amus on d也e
side (Fig. 6.2 and see Fig. 12.2). The roof of也e 也mt 罚B刨出 is
formed by pia-ep四伽na, which spans betw阳1 臼啊。 nave fibre
bundles, the S创ae medullaria 也ala皿i, which are situated along
由e dor四medial border of 由e 由也mus on eith.er si也 In 由E
m血al part of也e 也ird 咽ntricle lies an aperture. 由E
姐回曹四.trirular fora皿田，田 fora皿皿 d Mom口， which is J,。但也d
betw田E 由e column of the 卸mis: and 也e anterior pole of 也E
thalamus.
Body of
阳”而lwn创de
民躏阳homof
.r，气 letaral ventricle
. u
 56 … NATOMY I

刊创emus

α10刚d pl饵”

“协m peHucidum
__....---s抽 m础......时

αxputcallOM』m
臼同也ral 饲ueduct

Superior medul阳y
velum

阳u仙 ven协le

加悔”阴阳icul• 伽amen
C旨”m1m句na

~u 盼侧’翩翩·”’a ”e铺””··阳”n tllowlng . .WI阳晴刷刷阳”现刷n.

Superior
锢睛创脑
网unda -- s阴阳m回ull1ry
唰um

阴阳 Ballara而町 Choroid plexus Fae割『酬W

and a阳”’ d
fourth 唰啤掉’

Fig.U Dore剑”’lclof笛，•brain’”mehow画，伽…·’“伽－
fou睛”川同cle. The cerebellum has been removed by 棚arlngtha
帽畸创larpedunc阳．

M创uli. Olive Ce『ebellum

Fig.IA Cera””。”时勘··”gle. The poiit 时continuity betw明m the

凰，taral re。”softhe 似」『伽 ventricle and the subarachnold S萨比e Is Indicated
by a small tuft of cho刚d p刷』s,whl由 pr协'Udes through the lateral
a阳tura.
 Chap幅r6 Vent『icular s拥阳m • 57

币1世姐tervmtri.c叫arfor割nen provides commu皿catio儿回1
d也er side,. wi也出t 回回.sive la佳时霄’2刨出 h佳时明白in the
出由al hemisphere （目岛 6.6 皿d 阳 Fig. 16.15）.咀ie la国'al
ventricle is a阳回m回y C也aped. It consim of an an回or
(fron国） horn, a k吻， p回国ior 〔occipital) horn and an in缸or
｛阳nporal) horn. 咀iean回ior horn of the lateral 咽回de is that
p刷刷ngant回.or to 也ein缸”阳市icul缸 foramen.τhe la能ral wall
of the an能rior ham is formed by 由t head of也t caudate nucleus
and its roof is 也.eco甲m callosum （眼 Figs 13.3-13.η．四t
medial wall is formed by 也即“m pelluddum (Fig. 6.2）.咀Us
也扭曲ttt 咿皿s betw院n 也.e corpus calloswn and fomiit in the
midline 血d separa倒也t 姐也riorhoms of也e two lattral
咱也挝笛．咀ie body of the la坦国咽1tricle 缸国tds b剧时也t
h缸”田1臼icular foramen. ha:讯卫g as it& floor 也e 也alamwi and 也E
tail of the caudate nucleus. More p回国阳市， a small poi田ior
horn g但ruJs t跚缸巾 the O回pital pole but the 回ncipal r.oune of
也e ven回clesw创ps downwards and fon阳时， to 伽mthe
但优naive inferior horn, which lies in 也E temporal lob巳 In the
floor of 也t in阳ior born lies the hipp创丑皿阴JS, while in its roof
runs 也e much attenuated tail of the 倒idate nuclei路（眼 Figs
13.9-13.12 皿d 16.15).

To”’raphl四I •1111幅my of vantrlcul•，”’恒m

• The vant~Cl』lar w创佣1 cons阳ts 剧时 ventr1c阳 becorr嗣
d甘1e lateral ventrld筒，廿1~ contn1拟』s with the ce用b刚
ventrlde, a霄，b刚 9QuedUct and 叫I.IE翩翩．
fou时1 ventricle.
•The 臼嗣W剖 aqueduct ext田'£18
• Tt陆恼脑画l 瞻仰ic幅幅 lo饵led throl啕hout the mldbr划n, Inking
within 锦ch c嗣br刨 the third and fo四”、 ventr1c悔8.
hemlsph919 and 阳 • Thefou时1 怕自由icle 画 loca:回d
apprmdm就脚。-shaped. It
国tween the brainstem l四”s
commun刷刷，咖 1啕
andm回ull司 and the
lnterv审ntrtculer foremen, with
α，回:ielum. A med阳、 aperture
the th~ 唰回r刨a
and two lateral apertures
•The th~ 幌刷刷， lsamldlhe, comm111阳.ta with 廿l9
8111-llke c时ty. I饱恒.taral 响’s sub刷窜。mold space
consist of the tha脑mus and surrour回Ing 廿19 brain.
h部JOthalamus. 臼A剧曲， the

Cerebrospinal fluid
咀le 咽1tricular sys恒姐， together with theα皿ial and spinal
subarachnoid spaca, contains cerebra早nal fluid(<'.$; Fig. 6.7].
世也 is produced by the choroid pl回跑 which is tα:atal in 也E
M晦n aperture of- / la:回礼也ird and fourth ventricles (Fip 6.2, 6.6 and see Fig.
阳r由唰时曲 阳回揭闵dofrr嗣曲臼刚刚阳 herr酶棚， 16.15）.四ie choroid plaus is 击。rmed by 恒vagina蚀。n of the
F幅. IS.6 Poste’”rv阳w “1he br*I. The 惜冒beHum and brelnstem h邸’ vase回arpia ma阳 into theven回αJlarlum凹， where it becomes
民酬 slightly sepa限制回 show the 『nedlan aperture al 廿回 fourth ventrtcle. M民ly convoluted, producing a sponge-like appear四位’Ibe

阳酬。『 horn d 蛐刚刚trlc:蜘

臼币us 但Jlosum
H幅d ofa剧由饱 nucleus
In回ventricular fora men

刊由mus

Choroid pl酬’

Flg.U U阳，he耐比le.Su阳lo『 as阳eta! ad国民tlon of 阳明确刚 hem阳ph町es In which much d阳 corpus callosum has bean m『TlO唰 to I嘟嘟创
甘1elumen 口Hhe 阳W刨 ventr怆嗣．
58 • NEUROANATOMY

lnllnul臼lchanne阳

Su阴阳rel曲m

伽曲创叫ueduct
In惆创U『四larciBIBm

Four由瞻仰比le
问ntinecistem

C幅幅mam啕na

F幅.u 旬国恤，ITrW啕htedMAlm鸭”“白， brain demOI咽’刨lngCSFw恤In the 唰闹剧阳ray现棚，nd 1ubarachnold IP割地ρ旧制1yof

Professor A J缸欢町1,Wo俗m 品但也α血rlma圳市α!Titre, Ur呐rersJty of MBllcl四阳， Me!回JeS盹 uκJ

choroid plema 四但回也e thiid and 缸山也 ventricles 也m咀gb their si恼 beca皿ethe h灿田tatic pressure in the subarachnoid space is
roof1 and 也e la阳alven刨出 through 也e choroid 缸”鸥 along higher than 也at in 也E lum回 of也e sinus and also beatuse of the
the line of the fimbria/fomix （：附 因gs 16.14, 16.15). gr.ea阳 colloid osmotic pre拥ure of vmous blood compared 明白
臼E is produced partly by 血缸筐鸭”αetory proαssand 归rtly 臼E Wi也 ag鸟也E aradmoid 剖血 become hypertrophic to fono
by passive di血won. It ia a colourl倒 ftuid containing little arachnoid granulations (Fig. 6.10).
pro回n and few cells. The volume of CSF m 也ecombined
回ltriall缸血d 皿ibarachnoid spaces ia &P:阳回皿剧.y 150 ml.
CSF is produced contimuruafy, at a ra民 sufficient to fill these
spa幽腿幅画I times each day.τ'his means 也t an efficient
ffi£（才ilani.sm is required for the 由:culation of CSF and its
Obstruction d 伽e flow of CSF wHhln the Ill!附lculer syst1例（e.g. by
tumours) or the subarechnold 刷刷｛e.g. byedh酬。” f口llowlng h回d
m抽，oiption (Figs 6.8-6.10).
Injury or m朋lngllls）阳回S to a r阳 In fluid w铺sure 口刷刷g SW刨Ing of
MostCSF is 严。ducal by the choroid plexus of the la阳毡l the vantrlcles 伽ydrocephalus). The clln阳J elf，锐：ts are slmler to those
咱1倒也 From here it flows 由rough 也姐也Nell创cular b皿B回 of a brain tumoll and consist of headaches uns恒ad~回SS E回 mental
into 阳也Mπn刨出 and 由四吗 by way of the cer由al lmpelrme「11:. S唰Ung al the 叩tic dis笛”’II阳“•ma) Is seen en
ophthal『T106(刀向. Dea口mpr固自sion d 甘、自 dila:t回 vent剧院 is ach阳ved
aqueduct, into 也.e four也 V回回d巳 CSF K御自由E ventriall且z
by in晒t同 a shunt con『田ling the vent『副部 ID the 闯ular vein or the
system 也rough 也e three apertllrea of the four也 ventricle and.
ab由minal periton剧m.
由山，四恒m the subaradmoid spare. Most CSF passes 也rough 也E
median apertw:I! 甸回国 the cis回na magna. lac.a:饵d betw回l the
medulla and cer由ellum. A lesser amount Eσ阴 through 由e
lateral apertures to en阳也e subarachooid space in the E唔m of Cerebrc赐pln•I 帽uld

由zα四bellopoo:由1£ angi”－咀:ae majority of CSF 也en fl四” ·臼ch ventricle con回ins ch町oid
皿perio啡， round 缸但rebral hemisphere也 ω 由e sites of P阳xus, which a阴阳 CSF.
扭曲IOlption. Wi由i且也e subarachnoid space,. 臼F ser四s partially
• CSF 彻wsln 甘丽 dlrec::tlon:
to cuahion the brain from sudd皿 mo四m皿.t& of the h幽d. lat冒副 ventricles → third
CSFis m恼。由d into 也evenous 阴阳 bypass画ginto 由E vant~cle → αweb『al aqu回uct
→ lou由 ventr恒恒→
d田al 咽nous sin田el, principal】y 由E sup回or 姐gittal sim皿.Along
Sl.t泪rachnoid S阻。，．
the sin田a are located num.mius aradmoid 材础， which consist of
．节啕 α阳lb
invaginations of 缸achnoid mater through 也e dural wall and into
w冒tern and SI』barec『E『1old
伽 lumen of the 血m σlg. 6.9). R础”。ti.on occurs at 曲创
S因。， con回ns abcn』I 150mL
CSF, this volume bei「1g
阳回UCE回国畴，副司m酷回ch
day.
• CSF is n:盟bscrbed h回甘冒E
霄，m』S 町剖田n 伽rough
arachnoid 州I，”、时l prq如ct
princi国W into the 副阳W
S啕耐al sinus.
 … W时『…

角回1『唰咧Iii

Faix ””brl

U画ni1 ...翩班”

In•，阴晴1c&ilr 伽－

Third W附倒，

Transver ” ’ inus Cerebral 惆ueducl

T自ltllrillT1 铺”belli
Four由 Win刨出

La饱raJ ape仙ra of fOIA'由鸭础icle

c，睛田l Cl『唰
M“旧n aperture of fou毗 ventricle

Fig. B.8 TIMI a.n ”’I VII睛”“恒’”’tllm and Ila nil.Uollllhlp w帽hthe 四b•nichnold ，阳帽. The circulation of C8'哑iro&pinal flt』id is l『咄咄edby
llfTtlW冒．

a』阳iorsagi而刨 silus

Arachnoid Villi
却回唰dmater

F幅.... y...，..，.，..”ctlonthro啕h th• 剧””。’”’l阳181nUI

•howlng 1111chn创d 咧IL

Graatl~他Id~副伽融』m

同. 1.10 a，，阳”’9Clotth• ””b...ihelr曲，，＿＿础。“”’

’翻翩翩d . . .翩翩。” m 伽啕ht副部． α1 阳剧翩， thear回冒唰
『T回tar t胃部b帽、 r冒no帽d.
 Vasculature of the central
7 nerv。us system

Vaaculature of It圃， aplnal cord 80 VenαJSdr百inage of the spi咽J co回 60 Merial sup~Jy of the br百in 61
A内倒也l supply of the spinal cord 60 Vase..』lature of 伽·阳，in 刷 V制OL路 d刚nageofthe b『商in 65

branch岱， which run with 也e donal. and 呢’1tral spinal nerve

Vasculablra of the spinal c。M
Arterial supply of the spinal e。rd
咀m longitudinal ar回al 咄咄 run the length d由E spinalmrd
(Fig. 7.1）.四幌 are the 归1gle m饵”rip旭alar田yand the
归ired 阳”回配 spinal arterl”－ τbean能rior 叩inal ar阳y arises
in a Y-shaped confi思uation from 也E two 呢rtebral art回.es at 也e
k叫 of the medulla oblongata 阴晴. 7.2) and desαnds along the
回1tral m血ceof 也ecord in 由t midline.τhepos田ior sp凶al
arteries ar田 from d曲“也t vert.ebr苞I ar阳阳“由t p刨出ior
面缸ior cerebellar ar恒ies and run 田且也Hy m 也e JlOI'田ula:恒ral
a且也ce of the cord.
The an能rior and p惆阳ior spinal ar阳ies alone are insu组dent
to supply 也eαmi be1σW 田vical lev由 and, 也erefo~鸟也ey receiw
serial reinforcement by anasto缸”is with radiad缸缸田地
derived from a鸣皿回国 ves时s, indudi吨也t ascending cer词αL
in忧民国tal and lumbar 红田ies. Radicul缸 arteries pa”也rough 也E
M馆”四曲ral foram凶且皿d divide into a且也rior andpos隐rior
roots, resp配tively. One 归国四larly large radia血Z 缸回y (the g四t
radiαliar artery, or ar阳yofAdamld相kz) may arise from a
h注E对 intm:回国 or lumbar g阳y at a町 ll?VE! bet\ften T8 and u.
有ie blood supply of t愉 spinal co时阳 mostvuln嗣ble h 甘19 thoracic
r~on and In t闹剧。rfor por阳、 al the cord. 。”M胁”’f the
anterior spl”’l ’”’弘 U凯剧ly 筑阳ndaryto d剧创世on d 甘19
d民揭审1dlng 甘10raclc aor钮， l锦d9 to an acute thoracicα时剖/fldrome
with para川啕la and Inc刀nthet'胃嚣. The splnoth曲mlcmod副阳es of pah
and temper即re era prafa'ent阳Jy lost, wher回s the proprioceptive
Ill回ens of the dorsal columns ere relat阳ly pr四坦阴d
Venous drainage of the spinal cord
τhe 咽lOUS 也咀nageof由e cord follows a basically simil缸严，ttern
ω 也缸回国“.pply (Fig. 7.1 ). Six lo~tuc:linal in也rconn配由18
V四ous channels aiat. τhese consist 阴阳arily of an阳tor 曲d

问曲曲，pi唰 ar悔ry 阳llllior spinal v由

阳回回幅幅刚 s阳al 回n

Plr旬riorspi帽l win
AntBri口r spinal artery

Poatarior r&dict血ra陶町
h耐α血由自 l阳amant

Spinal nerve
Anlll~口r时lcu阳g恼y

Alachl"ll割 m脑r

Danial root ganglion

趴』m malllr

In协mal 响宵”阳al
wnous plexus

时. 7.1 The .......刷刷P肉，ndven侃” dralnag’“’””InaI 回rd.

 Chapter 7 Vasculature of the central nervous s阴阳m • 61

阳回lor 剧响阳n阳问宙间

l耐m副 ca耐d arlaty 飞～－－－－－一翩翩’帽'Bini ar1I町

同胞阳ω翩翩翩ling 相阳y

Mammll阳ybody

阳曲『罩l 网uncle

问曲『ior 四『eb『ala『能ry

阳.slar 町tary
Tl1阴nlnal nem

阳酬。r•阳1or cerebellar ar恼y

Ve巾bllll artery

阳饱耐，pinal artery
Medulla

Fig. 7.2. T闸，rrengem刷tot a嗣同alvi帽”laon'lhebe””伽， brain.刊e diagram shows the clrcul1』s arte~osus (cn:le of Wiiiis).

postai.orspinal 响dm, which run in the midlin巳 Morein电ul跑 optic chiasm. Along itB mur盹也E in恒mal carotid 缸回ygi:呢， rise
回回国mes inmmpleti巳 bila:国刻ly p创ial 皿能rola:阳al and to a number of pre-能nninal branches.
poe恒rola阳回I 回na are 1ituated near the liD£11 of atta血mentof
• Hypophyleal 缸teriea 缸ise from the intra-cavern四”回on of
也t ventral and dorsal nem: roots, re叩回ively. All of these w.sseb
阳恒.ternalαrotid to supply 由eneuro均p唰iysis. 四叮also
也因a 吼am阳ior 四d POI田ior radicular wt田面.to the in能mal
form 由t pituitary portal system ofves回sby 晒ichreleas旭g
鸭d曲ra1 鸭noua pl国11 (epidur画l 回nous pie剧。， which is
factors areαrriedfrom 由E hypo也alamusto 由E
situated betw四n the durama:回四d 也E V自tebral peri倒也um. 咀le
adenohyp句业ly由｛口1apu立 16).
internal w:nous plexusα>mm.U皿皿圆明白 ana挺mal 观现ebral
·四le 吨血也almicar能ryp幽es into 也eorbit也rough 由e optic
"YmOUI plEDI& and 由皿CEW恤也E 画面uling lumbar vein鸟也E
foramen. It supplies 也E 由U由皿aof也eorbit,. 也e&ontaland
azygos and hemiazygo’回ns.
ethmoi由I sinuses，也efi:回国 part d也e scalp and d<mum of
the E但已
·四iean能rlorchorot也Iar阳ysuppU倒也e optic tract, 由E
Vasculmture of 由•spinal cord
choroid plmis ofthe lateral 响泪.tridE马 the hippocampus 创凶
·啊，e spinal 帽d Is 副ppl国 by
the antsri田 a回 p回回ior s~归剖
•Ver回us d耐nage Is by an田W
Z回 p回回iors回nal 晒ns,
”me of伽 de叩 structl』res of也ehemi刷阳电 including 也t
in回回I ca归ule and globua 归llidus.
面回圃， supplemented by which d回n,v画 radicular ve阳．
·四tepol能rlorcomm.u皿u出gartery 归S瞄 ba.ckwu也 to join
radicUar arter抱s. into the in幅『「回l 明阳W副
帽lOUS pl眠眉． thepo1田iorcer由ralar田7，也ua forming part of the circle of
Willia (1tt below}.

Lateral to 也E 叩tic chium, the in恒nal caw世dar恒y divide.

Vasculature of the brain
Ar幅rial supply of the brain
咀ie brain is supplied 回也 blood by 臼ro pairs of 观”曲，也e
in也mal caro笛d ar也riea and 也E "Vtttebr菌l arteries (Figs 7 .2, 7 .3
and 8tt Figs 7.4, 7.6, 7.7）.四le in能rnalαm创缸回y arises from
由e common carotid 缸回y 缸id 回回冒血E middle Cossa of 由t
cran坦1 cavity 由rough 也.e arotid canal lb m田理由四 follm帽
a series of characteristic hen也 known as 由ecarotid 哼phon
但g. 7.4), after 咐让由 itp胡闹 forw缸dii through 由e cavernous
sinus and then upwar由。但也e medial aspect of 也E anterior
clinoid 严民ess, r回d咀ngthe 凯E旬a of the brain la:也ral to the
intoib 剧。恒minal 脑and圃，也ean·位rior and middle C£1由ra1
arteries. The an位置ior 田由al ar回y courses medi曲，曲ewe the
叩ticner鸭 and 也四””a into the great longitudinal 旬则盹
k的帽臼1 世1e Cron·回 lobes of the cerebral hemis由eres. As it dOE想
曲， it is joined to the cor霄，onding v四el of也E 叩posite side by
由t abort anterior 曲也munica也g artery. Wi也in 由t g回t
longitudinal fiu旧e. 也ean筐rior cerebr革l 缸阳y follow亩 the dorsal
CUIW.ture of the corpus c:alloswn (see Fig. 13.23), branches
m皿珩ing aver the medial s田也a of 也e frontal and p缸坦国 lobe鸟
’
which it supplies (Fig. 7.5). The 阳ritory upplied by the 扭回or
cerebral 町胆，也erefo~。 includes the motor and ，阻，。可四时αs
for the lower limb. Fine terminal branches abo a阳id out of the
62 • NEUROANATOMY

阳lerior cerebral
a阳y
’
1
、 .. ~
’' ,

~·
Middle cerebral
artary
Op由CneMI

Cut 阳Id ofi"I也emal

car耐d a相y

坠，~
‘
oa.』lcmotorne隅

问伽阳
com111.1n国甘咱
a阳V .,
·－－－·~＇
- ...，咽，－ Po晦『韧。自由耐
artery

s~阳回翩翩r
a刷町

民国町artery

Pontine制前」 ＝－一 ’一罩，， 矿’‘、民.rsrt ~＇司· T~gemlnaJ n町W

Ari饱阳 i响rior
锦晴el阳擅自ery

同蹦阳 i巾阳 \la阳bral art.ery

阴阳bellara内lllY

t切阻’0688! --­
『嗣同’民泪11

栩栩阳spinal
g阳y

Fig. 7.3 Artmrt皿 m the M皿 d由•brain. The a『回国句E恒m h因 b四n inje回国 W时1 且『国 resin.

g回t longitudinal fissure to supply a narrow lateral band of
frontal and parietal cortices.
The middle cerebral art町 is the laI8回 of the threeαrebral
arteries 皿d itJ cortical 回ritory is 也t most 回回sive σig. 7.5). It
F跑回 lat田lly from its origin to enter 由E h恒ral fissure within
which it subdivides, its branches supplying virtually the whole of
由E h也ral surface of the 企ontal, parietal and temporal lobes. 咀由
阳ritory includes the primaiy motor and 阳回哼 cortices 如rthe
whole of 也e body,，配luding 也e lomr limb. It al回 ser咱也t
auditoi:y oorta and the insula wi也姐也t d叩郎。fthe la能ral
fissure.
Since the structures supplied by branches of the in也mal carotid
皿町 are normally perfused almost 由自由 from 由扭曲urce. 也句
area伽~re缸red 臼 as being supplied by 也e'in恒mal aw时
町ste皿t
The 辘”ebral ar田7 缸ises from the subdavian 回町，”但由
由rough 也e foramina transvm缸iaof 由.e cervical vertebrae and
回能m the er皿ial 田，ity through the foramen magm皿， alongside
也e ventrolateral 创pect of 世1emed叫h (Figs 7.2, 7.3, 7息 7.7).
Along its course,. the 四配:brat 缸阳ygi·咱自εto a number of
bran曲es.，皿eluding 也.ean阳iorandpos回i回 spinal ar阳恼，
which supply the medulla 血d spinal cord. Its largest branch is
the pos田ior iofi面or ttftbellar art£巧， which supplies 也E
in缸ior aspect of the cerebellum. AB they pass E田min，巳由E 伽D
呢rtebral 缸恒ies C'DD＇回电~uniting at 也E junction of the medulla
and po田 ω 岛rm the midline b创出r ar阳y.
四1e basilar ar阳y runs the l回剌1 of the pons, which it supplies
by means of many small pontine branches. It al回回晚s rise to 由E
皿，terlor inferior cerebellar art呵， which supplies 也e an，阳ior
and inferior portion of也eαrebdlum, and 由e la峙对且也旭E
art坷， which p幽幽 into 也跑回国I aeou&tic m臼tua to supply
由E inner ear. At. the junction of也E pons and midbrain, 也e
b四lar artery divides ir血 two paiD d晚1Sels，也e supaior
饵”bellar ar能riea and the p饵terior cer由ral ar能ri”. The
superiorαrebdlar 缸tery suppli倒也e superior a叩ect of the
αrebellum. 咀ie p回terior cerebral artei:y curv回 around the
 Chapter 7 Vasculature of the central nervous s阴阳m • 63

.Anterior cerebral arll町

Mlddl自铺耐刚 a幽ry r.ddl’”rebral aitary

、 ~ 、

~＼ ~ 1 ' - - - Internal U剧创自闹『Y

~ ~
却由自io「阴阳bral ar1Bly
Carotid 柳川
臼耐dsyphon
Ophlhalmlc ar1Bly
lntamal 国m“自由『y

Fig. 7A C9'0剧阜咱『咽ralftll. Radio-opaque meter恒I has 悦目an Introduced Into the Internal carotid artery In o『derto dlspl町 Its lntre-cran阳Joourseand
由e dlstr1budon of Its branches. 间 Left 饵阳t回， I回e咄咄剧； (B)rlght 回归tld，阳ntal 飞A剧． κ:Our也syaf向四阳sorPD 由栅JS, AO!在阳lie Unit of Ra幽到bgy,
恼1/verslty al Sheli黠蝠，由etrleld, Ui均．

midbrain to supply the visual corteir. of the occipital lobe and the
inferomedial a，因。f也E 也mporal lobe (Fig. 7.5).
四ie brain E唔ons (brains也m，但rebel.I.um. and occipital lobe)
阳回d by 由.ever也恤land builar 红田ies 皿d 由cirbr四dies att
deacribed as being supplied by 也e 、自t.ebrobasilar m阳n~
四le in位mal rarotid and 四血brobasilar 町回.ems are joined by
臼帆。由h 啊，，由， thepo11但riorcom皿皿icating E恒d钮， which
pa” rostroαu也lly k的明白也e ends of the i丑陋nalαrotid
缸回回 and the po唱阳ior m由ral art回es.
回自由nple回皿 anastom剧is of vessel.s on 也e base of 也e
bra皿， kn伽咽 as 也e drculw 缸恤阳回 or circle of Willia
｛目， 7.2, 7.3), which 四circles 也t optic chiasm 缸lei the floor of
酶睛创 ar恒ry 也E hypo由alm酣睡d midbrain. 四e anaatom.o苗Canan伊n四t of

（＿~· W槌els provides the poasib山ty 也at obstruction or narrowing of

也epmximalp缸ts of 也.e cerebral ar阳圃， which would be
ezpec伽d to lead to insufficiency in 也e perfusion of their
阳咀阳地 might be com~ensated 伽 by circulation of blood
也m咱1 曲曲mmunicati鸣 U阳ies. ’Ibeacn剧，i伊矗ca.nee of也is
arran萨皿四t is dependent m 也E size of the communica血8
arterie也 which is highly 四riabl.e between individuals. From the
缸回1倒也at co出世但:te 也t circle ofW山岛 m皿ttOU& small vessel.s
pen白白白E SUI鱼a d也t brain. 咀le民 are known as perfora咀ng
arterio (also central or ga唔ionic 缸回ies) and co皿ist of two
main grou严

1. Anterior perforating ar阳栓，， arising from 由t 阻四or

但古bra.I 缸恒y，回回ior 四mmm血a由ig缸田yand 也eI唔∞
oforigin d也E middle但rebral 缸田y. 哑可回回the brain
in the E唔m betw回1the 叩tic chi四mand 也E回mination
巳 一阳。r of the olfactory 田ct, known a，也ean阳iorper面orated
Middle 帽由百•artery ce晴帽I artery substance (see Fig. 16.17）.四ese vessels supply large p础。f
ri• 也ebasal 但nglia, 由eopticd植asm,thein能口1alα归uleand
~＝－－·
也e hypothalamus.
F幅. 7.6 The cerebral cortical d lltrlbu咽。n d由··刷巾r,mlddleand
po嗣同，，回1'8bral arte巾’·间 M倒胃I asp自ct; (B)med脑las阳ct. 2. Poe凶iorp但也E四ngar田i筒，扭曲igfrom 由t 归皑白r
但由ral 缸ldpo苗圃ior communica由1gar回ies. 四句四.ttr
也ebr回n in the region betw回1也etwocr田a ccrebri of the
midbrain, known as the p。”回orperfora:时 1ub1tance （附
Pig. 16.17), to supply the ventr双lportionof也.e midbrain and
parts of出e subthalamus and 均可pothalamus.
64 • NEUROANATOMY

阳酬。r臼用brala刷一一寸

Basilar l:lta \_ v田伯bral attary Ver悔bral artery- '

Baslarartl町
Superior口，rab8I恒rartary·
Poataior 臼rebral

Fig. 7.1 h南阳，I anglognima. R回lo。psque matert创 has b酬 lntroduαId Into the 啕『蛐ral artery In order to dlsplay Its Intra-a回la.I course snd 廿咽
distribution of Its branch串串．例 Lste刚回脚；阴阳明l 叫脚. (Courtesy ofPro阳sor 四位栅JS. AcsdemJc 价时tofF恒似均1gy, Unlvets/t'i ofShe儒刷， Sh9俄制，
U均．

Mldd陆凶瞄阳l a恼y

Ve侮阳亩I artery

Bm曲rart&ly

F崎.1.1 响me-oι伺lght' MR arterl。gnima. The scans 明用阳formed on a 3.0T MR B国nner. W由『11ethoddoes 阳明ulre 阳 I~阳Ilona!阳市回t med恒
lntothep刷刷刷刷刷 r刨l邸 onoomp阳 MRsequ阳帽 to produce slg咽J from structu隔 with ft阳， whl阳 suppressing 啕nel 阳n ststlon町t悔吗且向
Latal咽l v阳；四骨ontsl v阳． κ:ourt融贸yofPro阳sor PD Gtfffttl邸，Aca由nlcUn世ofRs.dlology. U川rersJty of SI丽儒剧， Shefffe/d, u.均

|’
，．国
Dlmonla.. at Iha bla “ aupplJ at the bra.I圃

One of 1he most 阳nmon 四us囚 d neurol啕i臼l dsability is ’””’
of v也SEiis in the cerebr田l Cirt:l』恤.lion.
resulli'、g from bloc来age or 阳pture
R回 sud由内民:clusion of a 创『曲rel art町嗣ds to d锦th Of W刮n t白鼠，e
Pnr.c:tlo时. Rupture of a blood vessel C81』阅s bl铺ding nto the brain
｛帽”braI h嗣morrhage). These events l倒d to the 『唰d 由velopment of
a b创 nBllO同lcal ~utome. Str划Ql8 m胁d to the 曲时d ar恼ry and
l协饲喃刚 brsnct瞄 are associated w协 foe创 epll邻町， aco刚刚ate刚
跚跚y/motcr deficit snd a psy嗣同阳l d耐性阳.g. aphas网.St『0陶
lnvoM咱 t喃喃nabrob!却liar drculatlon 阳回 to a 旬eel brelnstem
叩市drome. Re<泪W叼 d h』nctlon canα到Jr, but II m町恒地 up to 2 班组rs
and E回国 in阳np阳ta.
An aneury11m is an abncrrn剑， b副loon-Ii闹剧回Ii「啕 of an artery. A
SU咱i臼Jame『-gency ar回s when an an创呐m ruptu耐 and blood
W叫“恤瞅』nd 阳刷n in the 蛐笛achno阁制闺［阳barac:Moid
M翩翩睛”1) and Into 阳 brain p『削惕”braI h嗣刷刷崎创.A
sud倪育l sewre headache and 『1eck stiffness are follow回 by coma u回
neu刚甸回l d创ct险. Neuro刷刷ry or Intra-arterial 'colling’制『明ulred to
seal 伽a aneurysm to pr1刷刷t 阳时19r bl伺d同 snd 副low reco啕可．
An angl01na, or ’”’而唰啕回 malform副on，阳 acong刷刷
ool悔ct阳1 of sw制阳n blo创晴Sais that can 阳pture, caus同 cerebral
haemorrt回廓，。『由回回n a到酬’ blo回 from 回归cent br田n r啕Ions,
l回di啕 to epilepsy and a fo国J cerebral 町ndrorr回．
 Chapter 7 Vasculature of the central nervous s阴阳m • 65

and 也e ch侃，1也l wln,w扭曲也咀n the basal 胆nglia，由alamus,

.Arterial Hpplr of tha brain
in回tal ca阳岛 choroid ple:ws and bi阳>Cam.pus. Wi由in each
•The b刚n Is suppled by pa~回 and 国silar artsr田 give ri阅 to α理~bral hemisphere, 也.ese 胃部damergeto 缸m 也e intanal
Internal carotid end 啕rtab刚 branches that Bl』pply 甘冒自 CU"ebral·回皿古ie two internal cerebral 回D8 由四 u皿te in 也E
arter阳． 。由冒出lk.rn and b耐nstem.
M也ne to form the g四t cerebral 回n (of Galen), which lies
• The in恼nal carotid 町幅『y • The principal terminal bran由 d beneath 世ie splenium of the corpwi call伺um. Thi，也ort 鸭”d is
terminal槌恒tar毡I to the optic theb酬阳『苗1町届世丽
Chiasm, givi咱 riSe to the posterior o嗣b刚 artery, whieh continuous posteriorly wi曲曲，刷刷血wi (see below), which
ante~or and middle o酬，b刚 supplies theα刘刚回l lot撼。f lies 皿也e midline of the 回1torium. cerebelli, along its course of
arter阳． the cenibral hem恒phn. attachm皿t to 也e po悦目.or p缸tof也e fah cerebri.
•TI回西市冒1町 cerab『百I artery •The ar闹闹『 commun回回ng Superficial wina lie 明白扭曲esub缸arhnoids归a 例g. 7.9).
passes into 世'19 great g阳ylin陆 t句归甘冒冒 the two Superior arebral 回mprimar丑y 也祖n 也e la:国al s皿face d由E
阳电itudinal 由B&uni and supples ant町ior cenibr回 arteries. cerebral hemispheres and empty into the superior sagittal sinus.
them回国 ωρact of 甘冒自 P凶陶ior communical同
咀E 皿.perficial middle 田由nil ftin runs along the line of the
cenibr刨 hemisphere. 剧创串串阳8S be阳佛肌 the
Internal car。剧创tery and the la:回事I fissure and empties 姐” the ca阳nous sinus (1ee below). In
·节回刑ddle oe『回bral art国『y
阳却阳”。rα到rebral artery,“1 addi往.on，棚。 major anastomotic d回nnel，因此也E superior
passes into the 恒.le『百l 幅画URI
”。1 s剧’－而Is er胃部tomo甜s of 伽eat) anastom叫c vei且皿d 也e inferior anastomotic 回n.. W泌ch
and 阳刚回骨、a later理l88p田t
W路”Is co咽tttutes t~啕 circle of d也且 into 由e superior sagittal sinus 皿d 也e trans呢nes凰山，
d伽e cerab耐 hemisphere.
'Niii阳．
m阳曲曲．
·啊，E verteb阻l g恒ries ascend
• Smal pertor宫t同 artertes 削” 咀ie deep and superficial 出由ral veins drain into fue dur菌I
on 甘回回晴'Claleral aspect of
the 『回国ulla, uniting b 伽m 廿18 膏。m the clrole ot Wiiis to V四ous sinwa (Fig声 7.9, 7.10; see 曲。 Chapter 巧， which are
sup附 the h)1:阳甘1alamlc 甜盹
midline b四阳 a阳厅，圳、u、 rhann由缸med betw回1 由.e twa I勾回z of dura mater. Major
the b回al gengl阳 and 甘冒
副en由 Iha 阳可th of the por回－
In匍『nal e咽:ieu阳． venous 归wes are loca时面也e a阳died bord四 of也E falx
Along 廿四川剧『画画甘喃喃rteb刚
“ rebri and the 能ntoriumαrebelli, and on the ft以>r of the cranial
OMty.
Along the line where 也.e fah: mebri atta血es to the interior of
由e aanium lies 也esu，回Dr sagl出I sinus. This m咀咱 blood
Venous drainage d 钮，e brain primar丑.yfrom 也e superior cerebral 回ns. which ramify o市也E
”
四ree sorts of ve els contribute to 也e 胃DOUll 曲回nage of 也e la:国al surl'ace d由e cerebral hemispheres. The free border of 也z
brain 白： deep 回鸥 superficial veins and the dural 胃口肌踊 falx 四doses the smaller infer阳r aagittal am圃， into which :8即
由luae& (F睁 7.8-7.10). None of these vessels contains 回l咱． 回m on 也E medial 皿p回 of the hemisphere. Wi血in 也e
D剧，。因由rahei皿也咀且也E i且也mal stru由1r四 of the t回toriumαrebel也 alor鸣曲e line of its a阳chment to the fal鸟
fur曲rain (Fig. 7.8）.α归国cular note are 由t 也ala血。，“ate 回a lies 由e large 耐划。.t 1lnus. Into 也均 runbo曲曲t g回t 但rebral

阳”『阳

α盯阳帽JloalSTI
｛创t剧巾铺｝

Antarlar horn "

阳回回l ventrlcla

cau曲阳阳claus

Th幽mus

l『1恒『nalce睛『罩l vein

Third win刨cle

G帽tee睛闭l vein

R施国ior

Fig. 7.8 T惘 d跚帽”bnd veins. The brain 阳 v刷刷闹m above and 甘18CO巾us E副losum f回 b倒n remov回 tor趴刷I the third end 阳阳刨 ventrlc嗣．
m … NATOMY I
＆』阳回『啕i翩翩us
In伽阳组a翩翩nus

G~ce睛”l
vein
S桐峭瞌翩翩

Super恼l 『唰伽 Con’唰ce of the

C8ll曲创 vein
Cor币’uence of
阳自inu”’
(!)
Fig. 7.1 VenDU• dl"llinllg• of 笛，．”’i比例国幅ral 飞risw;(B) 啕it旭l明酬．

car也泪I veins

TranSY9rse sinus
剑”rlors句lllal8"1us

Sigmoid ainus
Grntca呻『田I ...., 句nald 伽ω

就刚1gl畴，inus

Trar.v明，esinus

α，喇uenc:e or sin睛”
Fig. 7.10 Ph•””nt,...MRwn叩..，•• The 制nsw阴阳阳m创 m a3.0TMR 能酬’·刷 Later刨 view：，阴阳t翩翩．阳L刷刷f阳棚。rPD
＠附，s, Act幽mlc Unit of Radh掬1gy, Unlvetslty ofShe熊剧， Std剧， U句，
aF$5SEESSEE 民gR 昏昏 RZE ‘gbE
宫ES ’也同邑 SS ·
目 2 岳 ag －－ EEB 也需昌昆－
E也 昏 ggga 四百嗣同需
VH
S 回国
gEHMa 营－ EBB －SSZS 且盲目 HS 昏同冒冒目－ 3E奋圃喝‘鹰益
民昌EF 唱吕号BB 〔s gmu· c －zgZBFEES 。但 －
ss钮’2
－·『4·
ER邑qsE 西跑去 EE g 幅gsea － 善
‘ 耳【百 鱼。a 42军8··zag
EES 。PEBBSHazgHESSE 负泣ZEZRE
SEas 自 gug 自Eggs 昏昏再也曾 gE 缸里’乱昏 F 冒 o－g主ggas －－
EF 宣 g 曹 ERB巳－ SERgs －HP巳gaaEF雹 Z霄C
明
389
｛ EFEES 昏号。导。『昏同 臼胃’
a－E
国同日 BEE EB
－ 囚币 2 3 － 国－一S
量
嗣咱哥回F 去OR－HS民aERE－PH 昏而且岛昏 RRZ且昆国
EESEZPmEEE －－看冒昆主吕昏mm民ERBUE

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ESSA 冒SEEM22ES （量咎由SER 宫 gE

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雪富量 ssg
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zzea 翠吕gES$58EREZERggESE g

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ggaeggsg

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vazoa
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33
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gE岳宫”’昏旨是
E’EED 『宫岱邑·
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－44EES －－－E－ Ese－a －seS 鱼 E··

，『 －－－旦
···s －2ES gs ’as

JEgg帽每兽a ，氢Egg －『Z ’也组gm 慧副且每

gma
dw

gzssgsg －S 崎RE 鲁是再葛 es3EaHE

蕃 aESha 蕃去苔’葛 ggpn 当ggage 岱 eg －
4133g 蕃氢 dg黛是言筐 Z恤S ’s ’ aa83 亘古巴go －a45σZ－Z
ganuSEa－ gaS 筒压自 ZEE －。ZESEn36 币 ag
Eau－ E 皿画 ZS 瞥’ s·
－ 响33 哼624 ，‘gn2a

a－ a 帽nE me革 dE房 ggsa 皇县 a

－ E 也gsgss
霉画＠d恩 0·a困筐番，·革章’宣蜀’可FBg马饵’阳 ZEaa＝a·

aa8 3曲同司司’ a －gan － aE 胃 eSEa －O噶BE 且自由自由自 E旨

只骂毒ahFK草 哼量’奥『皿‘昆唱西哼’可创耐量a
m 莓d 霄a圈
u’ma

ZSOS －量 dd0332雷 g 民吕 E － 民ZBE g『 BBEMZB宫自

’6 · 每 aEEFEEZ 町雪温
虱雪’＝司
g· －mEBaEaag喜 EE罔莓’
言’’画2·s·a － 532EE ”－
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－m民巳SEE 国EE 皿－－n
－『 － ’『
E 『西E 2－ SZEBE
－ zae 再四ag 丑驾贡革雪8ZEgoEapqgm z
且＝5g
Egan 且 自由军且’ －国3巳言，。哩’『灵皿酶
3E回
－A画
TES· ’3ε，．
 8 I Spi『、

Ex幅mal 饵”阳”. of 由e aplnal cord 88 Spinal men闻自s 70 Spinal re侃xes 74

T叩啕raph阳l anatomy 68 In幅malst阳ctura of 由espinal c阳唱’ 72 Whi回 matter of the spin剑∞『划 77
Spin创 nerv幽 幽 Grey matter of the splnal cord 72

咀ie spinal cord and its 础。dated spinal n回es are of imm.回8e
functional importance. These struc伽res act to:
• Receive afferent fibres from sensory re<叩tors ofthe trunk and
limbs
• Controlmo呢ments ofthe trunk 姐d limbs
• Proride autonomic innervation form田toftheτri&C£ra
Thein田nal organisa:世on of 也Eαml pamita many 缸nctions to
operate in an automatic 町 refia 阳hion. In additi田， g但nsM:
回回国iom with 缸 brain. 也rough ascendi咱 and d£!I但nding
nerw fibre tra曲， bothconv可 af如en.tin伽mation to hi胖e
出础哩:s and mediate 值班ir contro皿ng infiuence 回臂，pinal
m配hanisms.
Ex幅mal features of the spinal cord
Top。graphical anatomy
The spinal cord OCCll回a the 胃出:bral (orspinal) anal within 也E
晒t届世 column，咱ich 严ovid£!1 mpport and pm脏tion (Figs
8.1, 8.2). RDsttal峙， the cmd ill continuous with the medull且
oblong障ta of the brains艇m.
’Ibe spinal cord is es铠n也且y as句mental structure; from ro础al
to caudal, it consists of 8 出吼叫（C), 12 thoracic (T), 5 l皿tbar
ι）皿d 5 sacral (S~ 吨皿四ts and 1 co句阴I segment 阴g. 8.3).
咀leα脏d is apprc国matelycyli且也i臼I in &hape but ita diameter
四ries consider曲ly at diffeJ:四t b由. It bears 的VO e:nl.arg白血四”’
cervical 皿d lumbar. 四四 αmeal 姐姐咆阻四t consists of cord
S喃n四” C4-Tl and pro剖des inn町菌don 伽也t upper limb via
由E brachial plans (see Fig. 3.11）.四E lumbarenla咱回回t is
made up d民gmenta LI-83 and is m眩目a能d wi由 innava:岳阳 of
由claw町脑nbvia 由E lumbolllCllll pkma (see Fig. 3.13). Caudal
to thelumb缸剧目gement, the cord tapm abruptly to 币。rma
conical termination，也e 田im medullarhl. From the tip of the
conu岛 a strand of co皿K笛”岱.ue, the filum 阳mlnale (Fig.
8.4），岳阳idsαu也Hy 曲d is a阳died to 也e dorsal surface of也t
缸stαxxy萨al 田rtebra.
Until 由t 曲dmon曲。f fetal life. 由E spinal cord 自由p阳也
回由E Jen回l of the 观rt由ral 臼nal. Tha:回鱼岛也e rate of
elongation of the 呢rt由ral column a四eda 也at of the 甲inalαml;
as a result, at birth the cord 田mi回国 at 也 level of也e 也ird
lumbar vertebra. and in adult life. it 能rmina:倒 at about the lerel
of the in能~由四I discbetw田n LI andl.2 F增 8.3, 8.4).
币le 叩prmimate loα蚀。，noh肉tal cord sesments rel甜veto
the h町咱也brae ma~ be iden咀ed i且也e living adult subject by
refer四αω 也e posterior a仰创始严oas础。f由E 晒t曲m巳 Asa
rule of 也.umb, 幽vical cord 腿，~ts lie apprmima国y oneapine
hi民a 也血也由∞π四pondi晤咱也brae (e.g. C7 cmd s唔ment
lies adjacent to C6 回由啡，也oracic sqmen:也 lie appr四m由
”。刚m higher. and Iumb缸”F回.ts three to four 酬nes
higher th血也由 corresponding 鸭血brae (F.与~ 8.3).

Spl翩翩 proc:888 of~刑曲m

Spinal cord

pro:池” 『、、町

、 1rsal root of api唰 nerve

1rsal mot ganglion

Ventral l&ITIJI of s国al nerve

Dura maier W蛐ral body

\ /
F阳.8.1 Tnnr鸭”’”“m through the 由oracle region. Th自 di啕阳m shows 阳 relationship betw回n 阳 splnalco闸， splnal nerves and vertet削
column.
 Chapter 8 Spinal cord • 69

Cervical
Spinal cc时
nerv”

V坦白bral body

In恼阴阳braId民 Thcr田’c
nervee

Fig. 8.2 MR lm•a’“’”鸭”8bral 四lumnand ’”nal cord In ’”

”刷刷b如ct. {Courte8y of向'OfesscrA Jackson, Wolf.阳1M饰阻血r
Lurr归r
俯锦崎伽桐， U脚响曲yofMar时阴阳， Mencl削町， UK.)
nerve晤

τ。”’raphlcal anatomy
•n晒 spinalα:wd provid铺
“’自ory,mo怡『 and autonomic
inn脚盲目on tor the t『unk and
limbs.
·节回 cord pom嗣民局 two
enl呵阳回『市：臼W回J (C牛TI),
associa:幅d w时1 inne『vat阳、“
the uppe『 lmbs, ar回 lumbar
归-S3), innervating the I阳er
limbs.
•The cord 饱rmina:田 at 明时ebraJ
l回回 L1-l2 in the adult.

Spinal nerves
咀ie spinal cord bean 31 bila阳ally 归ired spinal ner观岛四ch pair
being associa也d with its am回ponding co世锦伊1ent.τhe spinal
n凹哇， origin血剑阳。 linear 阳ies of nerve 阳cides, or roo由饵
attached ω 也e donola!能回回d v四trola忧ral aspects of the cord
阴g. 8.5). Grou严 of six to eight con咱且.OUS 阳cides 也at are
attached to 幽chαmt 挺gm四t coalesce to fonn dorsal and v回回I
D£l.'ft rootll. 四ie donal and vaittal roota of each cord 提gmmt
thenp笛s to 也由 corresponding inter阳能bral fora皿四（Fig.
8.6），旭 or E町 which 由ey join to 伽m 由E spinal n~pr叩E
While the spinal nerves are mi嚣~ B回回 containing bo也 afferent
and effer四t neurone鸟也e dorsal 皿d venttal roots are
functionally distinct. 四E dorsal m仰面nta皿 primary after回t
neuron＇”， run皿吨仕om 阳胁时回isory m甲tors to 也e spinal
αmt 皿d brain&位m. The nerve cell bodies of these n四ran凶 are
1。但因 in donal root ganglia (Fig. 8.1; see also Fig. 1.10), which
appear as small 四la电阻四”。n 也e dorsal roots n臼Z也eir
回1市gene:ewith m 阳市al roots at the entraru% to 也e
h忧”町tebral 旬ramina. 哑ie vmttal roots of the spinal ner鸭’
但rry effer回t neurona，也E 创l b叫iesofwhi由 are located in
α剧院喧l
nerve
Flg.8.3 The 叫“』。”’由lpebeh”’”’plnalcord ，啕m&I幅， •phal
narv帽 and 啕刷刷ralcolumn.
也t spinal grey matter. 四le!能 are comp血d of motor n四lOl圃，
whi由 innemit£ skdetal m田de, and pI电imglionic ne回回a of
也E autonomic nervow1 句础~.
τhe Cl-C7 spinal ner咽:s exit 企·om the vertebral canal above
the first 霄’回 α四ical vertebrae; CS spinal ner鸭 exits below the
何V回也 αrviαI vmebra 扭d 也eremainder l锢，e bel1σw their
corresponding ver蛐·rae (Fig. 8.3). Because of the di缸mt lengths
of the sp皿al cord 四d 也e v自tebral canal, only in the 创世cal
Z唔OD d。由e spinal cord s叩nents lie adjacent to 由eir
correspm咀ing v白也bral bodi凰 Below 也i& level, suo::但sive spinal
n町E E田ts 也H四 an incr四扭曲。iblique and long downwards
COUI5e 臼 reach 也eirreap民对vein:恒凹mebral forarninι 古由 ia
most marlced for 也elw由缸扭d 锦口al root鸟 which d臼rend
below the 阳minatioo of the cord in a leash-like arran院皿回t，也E
倒刷明ulna 〔Figs 8.3, 8.4).
70 • NEUROANATOMY

’ 制naln叫帆
节晒 spin副 n町w roo恒 are\'U睛也阳阳阳叩晴副m by d明归ne用M
ch啕创 in the joints of 甘w sp阳I column 但阳啕刷刷创d by
国明l 明幅 of spinal ”’lap”“ then恼附曾随bral d阳回. Prolapsed 阳恼ve『桂!bral d瞅冶
nerves in the c自『vical spine cau锦 pain n the nee来， radiating b 阳 arm and
hand, accom阳n阳d bytlngll啕锦nsa:tlons (par’倒廿回阔。， W回阳ess
and wasting of the mu叫串串 COITBSpondl啕 to the rad阳阳 di创融』！Ion,
and nlnlbnass of the skin co阳”pond同 to the dermatomal
dlstrlbutlon, t啕钳w with loss d 甘lB tendon 丽而制制鼠Jbl煽rved by that
阳rtlcular root 归g.8乃 Simi阳邸， umber prolaps回 h悔Mr回bral discs
U『『1barenla『ge『『1ant
lead ID back pain and r回lstlon of 阳Jn Into the 网庐，阳own 臼
sciatica. A large kJmbos缸阻l prclaps回 d皿 maycompr锚E the c副da
equina 四d 口创se paralys阻 d 甘、E 同S 町d bl副der and in回回n朋ce,
趴』阻阿砸自B『
de『nanding u咱回t n剧r囚urgery.

臼nus madullaris

Termi『咀.tion d甘1e
spi咽J oordatL1 四1e peripheral 幽mi.butionof spinal ner回也 including 也由
阴阳n of m·恤回国 innervation (deanatomes] and inn町lllion
of muscle groups (myotomes), is d£scribed 扭 曲ap恒 3.

Spinal meninges
白1e spinal cord, lilre the brain, is invested by 也reecon但ntric
menin萨al co晒ings: the pia mater. arachnoid mater and dura
·· 臼回a 饲ulna mater (see Figs 1.17, 8.4, 8.5).
The innermost cover鸣也E pia ma:但也 is a delica饨回阻血z
时dural space membrane 也at is cloady ~也ed to 由e SU血a of 也e cord 皿d
nerve roots. Along a line midway betw四a 由t d佣al and v四M
roots of 由E 甲dnal ner啊， is attached a flat, membranous
αm由iuation of 也E pia, called 也e d皿笛口Wt但 lip皿四.t. The
ligament has a 量自 la:恒ral border for much of its length but,
intermittently, la也ral proj回ions te由er the spinal con:I to the
arachnoid，四d 也rough it to the dura (Figs 8.4, 8.5).
Filum W晴iale 四ie arachnoid mater lies betw四n 也E pia and dura. It is a
transluαmtm臼nbrane that invests the cord like a loose-fr回ngbag,
Between the p扭曲d arachnoid U臼 the aubara由noid sp缸已咀由
contains CSF, which is produced 扭曲e cerebral 晒ttricul缸 system
SUba阳hnoid spa阂
(Cha:严町 的．
咀ieou阳回阳ing of the cord, the dura mater. is a tough,
fibrous membrane. It envel叩s the cord Joos哟， as d倒也e
arachnoid with which it is in contact, 曲。ugh s叩arated by
Termination of the a 也曲目咀臼l pl姐已 the sub曲ra1 s归皿咀ie dura is
aubal8chnc剧 separated from 也e bony wall of the V回ebral canal by the
apaceatS2 epidural SJWl也
Althou且也z 币nal cord 恒m旭a国 at 顶rtebral level Ll-U, 也E
arachnoid and d田al 由a由四d，也erefore. 也e sub缸achnoid
spaceαm也ue caudally to 82. .NJ 也E spinal nerve mots pass
towards h由 in能阴阳bral foramina they evaginate the arachnoid
and dun』 forming mer由萨al root sleeves 也at ex阳id as 缸 as the
fusion of dorsal and 咱也回l roots. 哑iereaft岛也e arachnoid 缸id
dura b配omecon血.uouswi曲曲eepin四rium a回国也ing 也e
Fig.IA DorMI ”’盹t 创恤”回naJ cord 帽udal 抽 T’·T10.TI回 sp皿alner呢
dura/a『鸣曲nold mater have baan c川 long恨』dlnalyand 附加以回 to 用va创
the splnal cor世 and ne附 roots, Including the cauda equine, with~ the
subarachnold s阴阳．

Lumb•『 puncture •d epldunil .，.…恤....

Imm.edia恒ly a缸E M由lg 也t in恒rvertebral foramina, g脾ial.
nei:晒 divide 细 produce a 也in
dorsal (pomrior) ramus and a
m时1 l!II'fP" ftlltral （皿回町·） ramus 但g. 8.1). The dorsal ramus
suppIi倒也e muscles ands恤1 of the bade E唔on. 咀1e 阳市al
ramus supplies the musd倒四d skin of the 盒。-nt of the body and
also 也e limbs.
The lowest part d 甘lB spinal 饲nal d佣a not contain spnal cord:
co晴明uenttyo, hollow ne回国 can be 皿恒ly In野田 Into 由e
副国rechnold space In order ID remO\尼 CSF for diagnostic pu『poses
pumbar punctul'9) or to inj田t F副io-叩明ue 副国回nc蹄 fort阳
radiological d刨lnl坦白on of the spinal canal and its co嘟嘟
(11'1J91啕~h到. Simi恒『ty,anai揭thelics m町 be l呻回UC回 into the
叩idu刷刷CB in SU电ical w回到U『回（睛缸r1lll black).
 … Spinal

Pia mater

W刷 刷刷刷闹闹

&iJnct胃IOicl 句巅’
阳也幽旬”‘

Arach『'IOid maier

J飞＼～一
D四百『n司”r

Fig. e.s Venn’”P刷I of the apln81cord,9tloM!g rek”。”’hlpeof由··”nalne”’””，9nCI 笛”’ menlng”－

咎由回『aw

lnlaMI白阳回l disc

lnlBr唰蛐帽l fora men

F陶.8.1 Liit刷刷刷tofll• ”lulcolumn~ 阳 lumbarregl盹 lllulhtlng the lnt.rwrtebnll 伽Nmlnaand ’”’me咽Ing splnal nerv ”-
72 • NEUROANATOMY

ρ；
Cran嗣l nerv窜’由回
Re悔熄串 Sen铺t阳 αiordina协
molorsy蝴11

飞 r I'

也j 、

Musdew阴阳市串串串『时
咽，a咱
- A阳帽tier晴:Ill retie眼榻 Ill Loss of all 阳咖 陆:rrr回l

Fig. 8.7 Splnal 阳W帽 m创 lealonatthe 阳唰，， C6. 阳fer 创凶阳 Ag. 1.48.

’ plnal n•”” andmenlnps

• 1l、e31 阔赂。f 酬nal n脚8$
attach to the spinal cord 理
由国J and ventral F田恒．
国nying d阳阳ll: ar回 d阳回『rt
nerve 阳盹瞄罔clivaly.
• The eel bodl锦 d d怕自睛，t
n剧ror瞄锢， locllled In dors副
root gar啕Ila. 有1e cell bod悔 d
E能rent net10n四 F回de in the
spin副 grey matter.
•S回nal ner晴创 t陶 var胁刚
canal v幅 lnterver幅b刚
伽amIna.
•B创f1N 阳 tannlnatlon of 阳
cord，制nal 叩v，明惚
也回国nd as the cauda equna.
·节1e cord and nerve roots are
S啤ceptib恒 to traumatic injury,
e.g. prolep旦d in回响育恒阳回
d幅“， cerv国l 耳ion啕b瞄－
spinal dislocation.
• The cord Is Inv刷刷 by 归国
meninges 制且， arachnoid and
duran回剧．
• The SltJarachnold S萨比’
con刨ns CSF.
• CSF maybe 阳TIO\剧 by
lumba『院，"ICture at L2-l.3 er
L3-L4.
·印idural ar四揭甘冒幅幅 allum国E 时.8.8 Tra跚跚跚”’ctlon 由m啕h 曲”’lnlll 帽”’h酬伽目，．
E回回g回酬nal nerves is g9MFlll d恒poslllon rd grey and white m翩’·
possible at the same 阳明I.

αmtain g四W: amounts of white m甜er. This is because

In幅mal structure of the spinal 四时
咀ie spinal cord is incompletely divided into two 句mmM.cal
halv四 by a donal malian 1ulma and a ftl由al median fui111ft
阴g. 8.8). In 由Eαntre of 也e coi:d is 也E 四lllll ceD＇田I amal,
which is continuous m血allywi曲曲Eαrebral ventricular sys能m.
血mounding 也t 回归al canal i，也t spinal grey matt町，回田面由1g
of n~ cell bodie鸟也eir den刷阳 and l}'rulptic contacts. The
OU田 part of the cord consists of white matter, which contaim
跑出“ing 四d 幽幽幽吨 nerve fibr四. Some of 也.ese s町e to join
n~bour皿g and distant coi:d segments for 由t integtation of
d回z funcriona, while othm run between the cord and 也e brain.
Many of the fibres 由at share a co皿non origin, roune and
termination are grouped together in faadcle鸟也rming 也elong
tram of the spinalα时．
E到岱~tcord I创世s vaiy in 也e relative amounts and
即1匈lllltioD of gt町 and white matter (Fig. 8.9). Hi事e le时，
ucmdi吨位副s gain fibres at each suα幽ive K叫， whereas 也e
句布由it£ is true of des<EI咀皿gtracta.
Grey matter of 由e spinal cord
四le g町 matter is appr回皿时y H4haped, or but阳岛·-shaped,
响曲恤 protrusions. the donial （严stErior) and ftlltral
｛皿但由r) bonu, eDending dorso- and 咽1trolaterally loWlmls the
a闹出ment rones of the donal and~田I root faadcl饵
respectively. 四”ize and shape of the dorsal 组l.d 观otralhorm
varies according to 值ie level 币g. 8.9). Ma町 aff回回t E臼ve fibres
entering via 由t dorsal roots ter皿nate 迦也t donal horn, while
由t 回tttal horn con13ins 由t cell bodies of mo回 neurones that
面t through the v四.ttal netve roots and inneava: 住d出I muscle.
Bo也 domal and 贸ntral horns are. 也g由略 par世rularly
wdl-de时句>ed at c:ervic:al and lumbar lev咆 in a.980ciation with
innervation of the upper and lower limb1. ’Ihoracic and upper
lumb缸”gm四”“ditionally pos跪” a small la键时 or
 Chapter 8 Spinal cord • 73

intermediolateral horn, h政d betw田E w dorsal and ven国l Don四I horn

h四”，也t contains 也.e cell bodies of preganglio副£. aympa也甜E
neuronea （凹， 8.8, 8.9B}.
四班’可 E甜er of 也e apinal aml may be divided, on 也e baais
of its cytoardii也cture. int。但n zone也 known as Reed'a laminae,
which are nUI由e田，呻ientially 岳阳1 donal to ventral (Fig.
8.10). Some of th臼e laminae are equated wi曲创I groupings of
归皿rul缸 functional types.
Thal:副量c-··
t垂
A岱，回lt 鱼breaen憧ring 也rough the dorsal roots divide into
ascmdi吨血d descending branches. 四句 E西dy 阳minate near
也eir point of en町 but may travel 伽 varying di血DC£S in ei也z
曲配tion, running in 由e donolateral fuciadua or u auer'1 ”
位ac也 which is lo臼也d supemcial to 也e tip of由E dorsal horn [,ee
Fig. 8.15). Dorsal root af趾回ts m句， therefore, establish synaptic
contacts o阳能回回I S咱n四”。f spinal grey mat阳. Dorsal root
fibr四阳minate e:x坦naively 明白且也e grey matter b皿 most
d四sely in the dorsal hom. cutaneous afferents 回1d to 阳minate
in auper鱼cial (dorsal) laminae. while proprioc:甲世ve 皿d muacle
afferents pr叫回 mostly to dttper laminae.
咀ie tip of the dorsal horn, approximating to R£Xed’s la皿ina IL ill
由o known as the substantia gelatin＇田a. TI由 E碍。nre侃”四
四llaterala of也esmallest 心ameterm·同inated (group A ddta）四d
unmyelina时（group C) a缸四”也at are associated wi也
nodee酬。n. 哑1出 neurones are aci.tatory 阻d use glutamic acid
血d 也e p叩创e subs回且ce P 跑回回国nsmittm. In the sub阳ntia
回atin田a,α>IIIplex intemctiOI11 occm wi曲。由z typa of afferent
田minaLin但meurones, and wi由 descending pa由ways from 也E
阳划n, which control the 缸anamission of pain in缸mation 归
asc四.dingsp匾。由alar回c and spinoretia由rtract E跚跚跚. The cell
bod阳。f也eae a缸ending tract neurones are distributed throughout
也E doJ:回l hombutarem饵tconcen国ted 皿也E E唔on of lamina
田， also known as w nucleus propdua (Fig. 8.11 ). The
modulation of豁出“鸣 nociceptive 凶formation by 句nap缸
in但阻ctiona in the domal horn is o岛四 ref回m. b 画也E ’事te

－／（丁
·@:1

VII
’L昏 ”·
IX IX
阪

F地.8.8 Tni跚跚跚跚刷刷回由rough1t跚跚ln•I 回时，t 肉”rvlClll,

(B) thoracic, (CJ lumbar •nd (D）翩翩幅幅幅. The histol吨i国lme阳d
町ployed 阳eig回－阳。由ins附i恒 matter{my回inatedne阴阳自）， I酬『1g
gray matte『（nerve cell bod田｝『由阳回y uns回回． F幅. 8.10 umlnlltlan af apml ’”’ m.U.r(Ru.d’•l•mln嗣｝．

D响自l columns

A-el阶圃，具抽旭 fib隅

品d创幅， Cfib隅

面陆phall阳咱le lntarr剧而情

D蹦蹦幅画g fins lnlm nuc剧，

Spino由翩翩阳t rapt晴 magoos ..d locus coe111leus

时．·
h …阳。MY
control＇’。rf pain. For oampl巳旭阳t from large diameta affer四”
(groups A-alpha 皿dA-b叫， carrying taailt in伽mation, i曲ibi11
缸anamillion of nod<Ep世~im萨血a to aacendi.咱筐缸t newonea,
which i1 thm晤it to explain why rubbing a sore 吨>Ot can relieve
pain. The basic E配:hanism underlying thi1 phenomenon i，也量t
the large diamaer afferents mite donal horn intemeurones
that me 也e endo萨nom opioid pepdde e业ephalinasa
neuro缸ansmitter. These intem.euronet in tum establish pre句naptic
contacta 回曲曲世回minals of nod呻rtive primaiy afferent
newonn. By the 归田nsof阴:esynap缸姐hibition, 也eyd仅reaae
the releaae of住ammitta from thae afferent tennina1a 四d. thlll,
d町ease the em回m of画~ding t13ct n£Uro11£1. Certain
clarendingpathw苟， from 也e brain can also profoundly iI诅u.enc:e
伽e transmission of nociceptift in画。nnation at this lerel. 四旧
deacendi哺陋。tonergic 童bm origina伽gfrom 也e nucleus raph~
m咽m orf也E med回la(see F：增 9.6, 9.15）四dnora也mergicfibm
from 也 loatS co四tleus of也e upper pons (stt Figs 9.10, 9.16)
can mite 由E 四kephalinergiιdorsal hom intan四ron鸭山ereby
汹汹biting 也e onward tr血，miaa沁a orf nociceptive in阳Lτhe
action of end叫严阻四 enkq>halin is via opiate rec叩ton le回国 on
the 田min血。fnocirf阴阳 primaJy atferm也咀理皿d萨，k
pr叫回回aof 叩iateagonis饵”dias m。•Ip恤1鸟拇归rtly a result
of their action at 削，，it巳
Deeper 面 the dorsal horn. lamina VII con回ns a number orf
important cell groups. A1 cord le叫， C8-L3 lie the 创ls of
。缸n” colum皿｛也m回t nuclma』 nucleus dorsalis), which are
the~orfuc:四ding fibmi of the dorsal apin<XEI由ellar 国民
咀ie alll of Clarke's column rea司ft afferent input from mmde
spindles, Golgi tendon organs, tactile and prr四田E 阻碍ton. Ai
thorad cand u阴阳 lumbar le陀h，甜le lateral p四 of lamina VII
also conta画，严甸回唰ionic sympathetic neurones durt constitute
伽 la田al ho肌 while 扳倒aal l白白（52-54), it contams
阴鸣曲glionicpua句mpathetic neurono.
Ventralhom
In 也t 观nttal horn. la皿ina IX correspon也 to groups of motor
neuron幽也at innervate skdetal muscle. 四”E are of”则可pea:
1. Alpha motor neuron”， which 凶neivate 回rafusal muscle
fibres
2. G且皿ma mu臼r neuroon, which 迦nervate intrafusal mwicle
fibr四（回也in muscle ~indles)
The -mitral horn is parliculady well-deftl句’ed in 也e 钮，ical
皿d lumbar enlar事皿四以 owing to the pre能nee of motor
neurm回回nerv甜鸣也t upper and low眩 limbs』 res.p仅tively.
G曲创lyψeaki晦 neuronea innava也ig axial muscul.atutt (n.缸k
and trunk）田id to be le回.led medially. while 由凶E 恤nervating
险由 muscles are position.eel more h恒r.illy. h 也evai缸alhom of
cord 1egm四” C3-C5 ia loca:时也e phRnic outlet血， a group of
motor neurones that innervate 也e diaphragm 咧a the phi:回ic
nerve and are, 也田，舰艇ntial 币。r brea出ng. Celli in the -mitral
horn receive di虹t input from certain dorsal root afferents (e.g.
from muacl.e sp旭dies for mediation of 血E E田tch rdl.a).
Importantly, 也.eyaho E眩蹲ve in~ from pathways deacending
from higher cmtt喧嚣倒lcemed w议h motor 四ntroL
。”’ m耐:er ot the spinal cord
•In恼m副肌甘冒e spi'lal cord 回国inosa. which is impo『tant in
cα百ista of a α，由刮 core of the 1ransm田ion al nock;叩1阴
g明 m副町（叫l bodies and lmpu抱回 to the brail.
m咽ptic connections）创d an •The 回自副 homoo网ans
outer mantle of wht隐 matter
pr啕anglionic sympalt回lie
｛闹闹伽盹
nlll』rones.
•W胁In the grey matter, the • lha vantr咀I horn ccntalns alpha
dor回I horn ls then晴1 site of “回 9阳nma mater nell'OI'暗．
回＇＂＊回!Ion of primary a俑首阳明 －阳”、 as b崛审 『Tl(其or
筒，民 It incluc酷阳 SL血剑antia neurones.
I
”........._......二二一
节、Blow田，『not町 neuron民 d the spinalαM may 回回国t阳tf
atlec恼d bytv附 di民揭翻槌：
P创iom”描•is an acu回由刨 ir『恰ction of r阳刚筒，抱回ing to rapid
阳m加is and wasting of the limb and 附spiratory muse悔. Th自 di凶bilily
Is 。他!11 asymmet~c剑 and 阳啤捕ntly affects 相同s. 阳沁r:Nerf occurs
blll may be Incomplete.
Motor neuro晒 di”·” Is a chronic d钝W咽rat陶 d险order 伽at
d阳甸回甘、 low唱， motor 『础Jronue and the ducendlng tracts to 甘W
酬nef cord (up阳 motor neurones）. 。”eneratlon of ventral hom
C刷篇~ W回阳市ss. w回l啕. hypotonle end 饱sci刷刷on d世ie llmb
””
川剧es 恤吨,...iviam.m回国捕。”’矶。甸回自祖m of
descending pathw部骂国ds to weakr回s and spasticity d 甘冒E limb
mu副臼桐’mary 幅幅画耐町’由；）. With p『啕阻sion， 国th upper and
阳帽『 motcr neuror暗面gen即由 (a~归曾叩hie 恒恤'Ill llCl•rall创．
Spinal reflexes
A reflex is an involun间， ater四”ped pattern of re&严幽ebrought
about by a senaory 回mulua. Al也ough 由E q田Ii回:ve nature of an
eatablilhed reflex re叩回民 ii amllant. it may vary considerably in
aqi.翩翩阳陋，e 〔吨，面也lay, dur四on and ment), aa a result
of in能m句mm刨扭d supraspinal 泊fiuences.
Anat1。因＠峙，也e pathwaya media·往ng ldla actions consist of
afferent neurones conveying im严tl111e1 from sensαry E配甲tors to
也t CNS （早nal cord or brainatem) and effer四t n四ronnrum也'lg
from 由t CNS to 也e d回m o耶n (mulcl~ or gland). In all but
也e aimpl四 reflex窟， in但meurona within 也E CNS are in但zposed
k伽南回也E afferent and effa四t components. The in阳nal
Olga皿sation of the spinal α时 and brainstern 由国 subser霄， a
number of more or leu complex re6a 句nctions』 some of which
are both 时剧”ly wdl-undmtood and d皿αlly important.
Stretch ren，缸
If a IUUlcle with intact 皿nervation ia 跑回过led, 忧 responds by
con回回ing, 缸ui d山 U known aa the alrdch or myotatk reflu.
Anatomicall，也i& is the simplest of rdleses. It i& mediated by j四
” ro neurones - one affermt and one r:ffi:rent - which are linked
ω 伽mamon明naptic rdla arc (Fig. 8.12）.τbe reflex an:
consists of affer回t E四阳1es 也.tconv可 i皿pulses from muscle
ltre时l receptora to the CNS and motor neuron倒也at convey
阳”山” back to 也e mUICI.巳
四le .回忆h receplOIS wi也in muacles comist of 钝osory~
四din莎白at aita血 ω 也~ ceotr划， non-contractile, r晤。·nof
ap但也d mmde cell• called in1ra缸”l mmcle fibrea (att also
Chap田 3). Inttafusal
muade fibll!I att ori四时 puallel to the
long axi.1 of由E mmde and 民xm in encapsulated groups called
muacle 1pindkli. S缸时l app监d to tbe mmcle in which 也可 lie
atim由tel the I田’orycndin， τheir affer回t fibres c:any impt.血a
to 侃 CNS, where 也ey m础emon明naptic emtatory contact
响曲曲E alpha motor neurone，也at innervate the e.mafuaal
mmcl.e fibres comp血泪gtheln曲。.f the same muacle. cam旭g
them to CODttact.
币四E are 臼师 types of inuafuaal muacle fibre: nuclear bag and
nuclmrch血 fibra. 四配 bear two 叨臼 of &mlOIY endi吨（11tt
Fig. 3吗：
1. Pr恤町 or umulo111lral mdinp. 咽iese are moltly
”’oda阎明白 nuclear bag mU1cle fibr哩， and give 由eta
group la afferent nerve fibres.
2. s缸，a也iyorft，佣er-1pray ending'I. 咀ese are mostly
associated wi也 nuclear d础n muscle fibres 缸id give rise to
g以且P II aft白白山．
Prim缸y 四dingl are aquiai回y sensitive ta 也E velocity of
S回时iand 也可 deaenaitise rapidly ODCE 由E new muscle length ii
achiewd. For thit z酬。画， 也ey are tometimes called 'dynamic
endinga'. 5econ缸:ry 回dings 倒回tially only sign.al chan候，国
mutcle length, but not 由t rate of change. and 世ley' desemitite
slowly. 四ey are sometimes refared to ”’由tic e:nding1'.
 Chapter 8 Spinal cord • 75

:le fibre
嗣悔

..- P白liar
/ 阳阳

…甲，』由自meurme

Fig. 8.12 The stnltch nr伺o: and r.clpro帽l lnnel"Vllllon. 阴补1equ自由陆因 st阻时时四 ls Illus回国， whereby 皿rlklng the PB'恒l恒『tendon ellc/恒
假饱nsion of the kr四. (BJ Reciprocal innervation. Wh"le stre时ing of the quadriceps muscle 口创S8B i随时阳∞时即回on, the motor n剧ronesofar咽gonistic
muscles 归回自由ω呻笛B inhibited by interr剧阳、al connection w挝、m the 酬nal cord.

Stret曲 refiaa are crucially i皿阴阳Dt for the 臼n田l d掠detal

mu蚓e tone. 四e 阳m muscle tone ref回 to the d嘈田。f
conttaction of a muscle or. in o也ttwo巾，也t proportion of
motor units 也at are ac曲veat a町 one time. Muscle tone i• mUSt:梅他隅
refl.ec时 in the compliance of the muscle on palpation 皿d its
resi&tanre to passive stre挝矿m田四nmt. 咀ius a muscle 回也 high
旬田＆由缸m, or rigid, and resim 归皿ve S缸E时L while a muscle
回th low tone is soft, or flaccid，缸ido岱~ little resi刷nee to
pa揭M stre时i. Sin四”m创E refl.aa 句>erate to main阳in muscles
at a constant len回E in 叩position to imposed 础宫时i. they are
impo血nt i且也eco血ol of body 萨施旧也 By 也由 action, 缸剧ty
In国b刷
i• maintained in 00:丸 trunk and low缸 limb ex国iaor muscles 刷刷排，自bra
｛皿ti-gr田ity muacl臼）也at support an upright k均 pD1ture
串inst the 自由rce of gravity and are 跑回ched 叫m these body
parts bemme flaed.. Garn『nam由万『刷阳市

E坠 ”’饵” Fig.I
Tendon 附彻xes (deep tendon 咧似es or ten阳市 jerks) a附
mono叩叩，tic stretch 翩翩， d比阳d du向 clinic翩翩mlnatlon, by
阳l'CU8剖on of the ten由n of a m啤cl自．刊阳凶U蹦阳刚d,b而ef
四B国ctlle elem四.ts of in国fusal muscle fibres 【目.g. 8.13）.四E
stlmulatlon of dynamic stretch 瞅湖Jtors. 自国ch tendon 用匍x Is
缸nction of gamma motor neurones is 甸回1田I the 阳15j·由ity of
剧阳『V回 by specific spinal oord s暗nants:
the S缸E时E receptors. 四1us,wh四 gamma motor n四E田1es 缸E
Reflex Cord aegmenta actiw.时， the resultantαm田.ction of the intr曲lSal muscle fibre
Bic每到s r回阳x (b阳psje叫 C5/C6 applies 阳uion to the ，但Jory ending队 η也 I顶帽rs the threshold
Bra阶ioradial路时ex (supinator j酬。 C5/C6 of 也t s田蛐阻碍tors to e2:阳tally applied stre时l ar盹也U鸟
Tri凶阳刚睐。rice阳同时 C6/C7 ina回剧也e sensitivity of 由t stretch refla. This mecha皿m is
Quadr1回psre刊以伽ee jerk) L3/L4 ref回回 tou 也e gamma reflex loc可P 阴g. 8.13).

Achlll倒 tendon 刚ax~町、kle Jerk) 81182
In addition to alpha motor neuron战 which innervate extrafuaal
mu副e fibres, the ventral horn of 也e 昭nal cord (and mo阳
田园al nerve nuclei) contain an additional population of ef.趾回t
neurones －醉mma motor neurones - which innervate 也t polai;
咀回宦缸~ two types of gamma motor n四阳也 So-called
’电mamic' gamma m。”r neurones innervate nuclear bag fibre属
while ’血画r! gamma motor neurones 垃mer咽te nuclear chain
盖脑田，
Like alpha motor neuror圃，院mma m侃。r neurones are m咀er
也t influence of descend画g pathways from 也e brain 扭d 也e 伽U
types of motor a四ronecan be 忧para凶y controlled. Abnormal
76 • NEUROANATOMY
缸tivity of 由ese desαncling pathw句玩 which OCCUD in many
pathological condi由鹏也a由re indu幽幽幽伊始也
S四aitivity of 阻四血 rdlex四．’Ibis ia evid四ced by abnormaliti四凶
能ndon reflex西 and in muscle toI皿 When upper motor n田lIDn臼
缸E 由ma，也伽 aample in 1troke. 由is results in a阳缸副tyof
句namic gamma motor neurones. As a r.on幌quenc鸟阳idon
rdla£S are 均penensitm: (I亨阳rdlena) and muscle to田 is
inαeased during initial muscle 跑时l (sp创city). In disoxdm of
由E basal ganglia. such as h面naon’s disease （~ter 14），也配
is ov臼缸tivity of 阳缸 gamma motor neurones.τbi& results in
hypert。因且 of muscles 也roughout 由E extent ofp笛si~ movement
(rigidity), while 也E 恒ndon rdlEXeB remain no口回I.
咀1e 回idorn1 of skeletal muscles contain m缸hanorecq>甸回
αlled Golgi 回叫on o咽DS. 四i.ese give rue to cia” Ibaf趾回t
fibres 也at enter 也t spinal g叮 matter and，由 an interneurone,
inhibit alpha motor neurones rum由18 to 由t m田de of origin.
咀lisammgem四t is 也OU胆 tofu皿I a 伊'OteCtlve function and it
underlies the abrupt rduation 由at occu鹏也H佣iDg initial
contraction. on rapid passive s田础 of a spastic muscle （由t
cla甲－knife reac:t:i.on).
When a 阳也 reflex: is elicited （吨位申adriceps rdla,
by tapping the pa回Jar 阳咖啡， prim缸ya岛四t fibres 岳阳
the mu副t spindle ercite not only the alpha motor neurones
of the stretched muscle but also inter田urones 世iat inhibit the
al庐a motor neurones of 皿tagonistic muad臼（e.g. 也e knee
flew略 目g. 8 .12). This illustrates 由E 院neral 严ind.pie of
redpro臼l innerv甜。D of agonist and 皿tago旧st muscle
groups.
Flex.or reflex
Noxious a血E回国 stimulation of也E limbs a田a flex:ion
with命awalfrom the ofreriding 况imulus. 切由 is mediated by a
Lumbar cord
l瞄mall"Ona
mu甜”
_/’
＝一..＿＿. ~ \1
Fig. 8.14 Flexor reflex and croued ex棚”’川lf'I也
po与synaptic rellu, in which one or more 面能rneurones are
interposed betw民n aff町四t 缸td effeJ:四t neurones. 阶回ary
aH自由t fibres acti回.te intemeurones wi由扭曲t spinal gr町 m甜.er.
which in tu皿 excite alpha motor neurones inneiva由ig the limb
flemr muscles 但g. 8.14]. Flex:ion of a limb about aeveral joints
E同uir圈也.e ooordina也d action of more 也an one spinal segm四t
and this is achi~ by colla能ralisation of prim町 d虹回ts and
扭teme缸。nes.
A皿 forms of cu国ieous st皿.ulation hav哩也E potential to
elicit the flm>r rd饵 but this is normal抄 prev四ted by
descending pathways from 由e brain, UD』幽由t stimulus is
pain缸I. In E四ainpa也olo脾alcondi世on鸟也E deso曲也ng
M曲itory influence is lost and evm innoaw田 cutan回回
”
stimulation can cause limb 回thdrawal The men r plan·钮E
response (B由inski reflex）扭曲m幽ised by el[回回m
{dors诅回on) of 也e 萨回.t toe and 酬aying of the other toes in
response to 甜m叫“on of 也e sole of the foot. Physiologically,
it is a S臼~rrefl但由d is present 姐 infants b由re mydination
of theα览咀α>Spinal ttact has taken pl缸巳’Ther回fter, the
rdlex: is abamt, being suppressed by descending cortico早nal
influ团圆（stim叫回on of 缸四，Je of the foot 由四但山inga
flemrplan恼 respon跑回也 curling of 缸 toes). Wb回也
抽回1ding influ四ce ii t帽t 〔吨. following a 础。Ice in the in阳回1
αpsule) the a:temor plantar refit'X re-emer萨a Aposi由e E曲＇inski
rdla: is re醉rded as path吨:nomonicof 也mageto 也e
corticospinal tract.
Acti四ion of 也e flm>r rdla in a weight-bearing limb (e.g. by
standing OD a 阱｝ aimul皿eoualy causes reflex extension of 也t
contralateral limb 甸甸k 由E weight of 由E K对y. This is c.alled 由E
crosaed memior rdo: (Fig. 8.14). It is media:臼d by axon
colla能rals that cross 由e midline of 也e cord and ercite the alpha
motor n四rones of contralateral limb mensor muscles.
 Chapter 8 Spinal cord • 77

四iett is a s呵U四ce of也ree neurones between 也e pmpher革I

Splnal re伺翩翩帽
Z配叩tor 幽d 也j? cerebralα>rtex.
• The nternal
crganlsa11on of the moto『阳刚回lion to 伽e Spindle
α刷刷隘捕阿咽e a number al 自bras. ·四le 缸百tn四m配｛缸，，t-ordern四rone or primuy affer四t
Im阴阳nt reftax functions. neurone) enters 由e spinal cord 由m咱E也e dorsal root of a
·节19 stratch 帽’ex is m每泪n国b阳
• Theπ'ICln四”1aptic E圆圆、闸’回 for maintenan四 d ml勤恒 tone spinal nave and its ed.! body lies in a domal root ganglion. The
m回t剧创 muscle ccntr回国on in a回 p四lure and is cl同回Hy central proc四 may collateraliae extenai叫y and make synaptic
res似万回e to st附阳”。f muse陆 t笛t创铺甘冒9d锦p tendon connections that media艇，pinal reflan and in缸”嘈nental
喇nd嗣． 附自由湖8.
coordination，咀lE! m创nfib陀remains on the ipsila键时 side of
·币'198町1sltivity d 甘回 stretch •The M归~icl阳阳『刨缸 the cord and termina阳 in synaptic contact wi曲曲esecond
『曲IX 阳啕uat回 by gamma m回ates 11『『lb w时回『awal 骨om
neuronιwhi也 is located d也er in 也espinal~ma饥er or in
motor niuones, which p酬由 『剧。us stimuli.
也t medulla oblongata of the brains国n, depending OD the
modality being served.
·四iesecondne田one ( KCOud-onier Dmrone) baa ita cell body in
the cord or medulla oblongata. Its axon 囚田晒 aver (d皿皿幽）
White matter of the spinal cord
to 也e 吨’因ite side of the CNS and ascends to the 由alamus,
四lE! g可 matter of the spinal cmd is c.omple:时YSUIWl皿dedby
where it tennina阳upon the 也ird E四zone.
wbite matte!; which mruisu of 细cending and descending nerve
·四le也ird neurone （由ird。rder neurone) has its cell body in the
fibres. 咀ie white matter of 四曲，ddeca且 be roughly divided into
thala皿.us. Its 缸。n pas附 to 也.e somatosensory cor回 in the
donal, lateral and 呢ntral columns or 旬nlculi (sing., funiculus),
严rietal lobe ofthe ipsila.teral cer曲ralhez旧spher巳
separated by 也e dorsal and 咽1tral horns （囚g. 8.8). Nerve fibres
油E鸣 ω皿non origin岛阳minations and functions are ’l'wo m血 tract sys也ms in 也E sp旭al co时缸 into 也is pa·民em:
。耶nised into 往缸”。r fasdculi （：血~.， fasciculus: Latin for small 由t domal 〔pos削or) columns 皿d 也酬m也alamic tractB.
队皿die). Some fibres in阳connect adja田1t or di血ntcord
Don姐I columns
segments and mediate intersegmentalαxmlination, while other
白ie clonal columns are loca:回d hE白帽回也E domal median sula皿
fibres are longer and BeIVE to join 也e 酬nal cord with the hr垣n
The intera唔mental (or proprio酬nal）伽m ocx:upy a narrow and 也E domal horn. 咀ie domal colu皿ru are com同aed of ””
回E饵 incompletely separated by a 也in 呻缸E the 也回皿lus
band immediately peri抖ieral to 由e g町 matter. TI由 is kn侧E 倒
gradlis，翩且时 medially and the 阳dcu.lus cuneatwl，翩翩d
也e fasdculus prop血”（~ 8.15). Ner甲E fibres running between
la能rally. The tracts carry im阴且ses concerned with proprioαption
由E sp迦alα时四d 也e brain mnstitute the ucending 缸id
(mi阴暗ment and joint posi由n sense）扭d di阳回国tive (fine)
d臼倒回恒8 回础。f the spinal cord {8.15-8.17 and 8.19-8.24).
tou血．
Ascending spinal trac阳 四ie domal columns con国n 由euo皿 of primary affa四t
Ascending tta＇曲也rryim阴山es from pain, 也ermal, tactile. mUllde neurones 也at have 回国也d 由e cord 也rough 出t dona} IO础。f
and joint 阻碍阳回 ω 也e brain. Some d也is information spinal DeIVES (Fig. 8.16）.咀E 』ciatlua gracilis 田naim d伽回
e晒1tually reaches a conscious level （也e cerebral cort时， while 也at join 也e cord at sacral, lumbar and lower thoracic lev由四d,
some it des由d for subcon9ciou，但ntres (e.g. the c.erebellum). thU.8, includes those from the h阳 hb. 自阳-es of the fasciculWJ
Pathw叼s thatαrry infonna咀on to a conacio田 level share cunea饥皿回阳市u the upper thoracic and cervical domal roots
α血in common charac阳istiα． 皿4 也.us, include those from the upper limb. Since 也e domal

A翩翩ding Ira幽 国”endi咱阅幽

l J.
Fascicul”’前ii丽
Fudculus proprius
F创ciculuscun锦阳
U锦翩翩~·tract

Doraal s回m帽咽tielier 国d Lateral co而即向副阳t

盹』brosl*!a陆目t

M阴阳l spl阳嚣’由自Har 国ct ”“lal longlludlnal 饱民如l嘟

”“ulll町闹剧”pinel ll1lct

Lat嗣l vestlbuloaplnaJ lract

S曲曲曲mic 国d
P阴阳e 时也邮pinal tr事ct

Tee田pinaJ 国民

阳回l 耐cospi唰 M

Fig. 8.1’ Aa剑”Mfing and d”。”叫ing tr幢幢创甜”’ apin•I cord. 剑l ascending and d幽幽nding tracts 嗣 present bi阳W剑ly. In this figura, ascer回同
国翩翩唱a emphasised on the 阳n side and d翩翩ding t缸:tsa阁制phaslsed on the light side. In addl田。『1, the b四tlon of Ussauer” stract and 廿'19 阳clculus
proprk.ls 伽hlch co阳In both ascending and descendl咽他阳：） are shown.
78 • NEUROANATOMY

Sensoryαlltex
l..iM阉， lirr由

Thill-order『酬『’晴

回 Second-order neurones

Fl耐q由rn自L1t1n1捕

“”阳，a hlmisph.,.

Medi自l lemnlaa』S

R剧 nuc椒』S

Crus 翩翩

Middle 帽ebellar 阳dunc:le

M创ial lemn＇瞅划’

Nucleus g阻cllla
Nucleus cuneatua ””’ulll
lntamal an:ua”他隅
M国ial le『『11跚跚

时ramid

F副比阳lus~i帽

F剧时culuaα』n锺M

c.咧Cll cord

Fig.8

mlumnaαmtainpr垃llllY affer四t n四皿圃，出ey CllllY

information relati.吨 to the ip1ila恒al side of the Ix由. Fibres
aac.end without in国ruption to 由t medulla oblonga钮， where 也ey
termina:也 upon second-order neuron饵，也e cell bodies of 抽ich
are loca也d in the nucleus g四lb 扭d nudeu1cu画”.tua (see al曲
目g. 9.6).
The uons of the S缸ond『order neurones decussate in 也e
medulla as 画回nal an:uate fibra and. 由g回岛町 ascmd 由rough
the brains恒m a 也E medial lemnilcwl. The medial lem皿SOJS
阳回m国扭曲E 回国l pas回or (VP) nucleus of 也.ethalam皿
upon 也ird叫order thala皿配ortical neurone1. The随 in tumpn:功ect
to 也e10mato阳uory cortex. loca旬d h 也t pos也回国l gynu of
由t 归rietal lobe.
r曹 Lalo”“’”donlll 翩翩嗣
Tab帽 do'8811• Is a late mar巾拭目tlon of syphllltlc l响ctlon of the CNS.
II chiefly affe晦 the lumbc刷刷l dor踊l 酬nal r回ts and the do陌刨
colmns of the 酬n副 cord. The 阳s of propr陆即！Ion 阳ds toe high
副ep田ge and uns幅画~ g副（＿，sarya皿l叫. which is 跑回b回国
”胃、甘回叼咀16 are cbsed (Ramb•咱＇••111时．
Subact翩国mblnmcl d饵””’四m of the 串In副 cord Is e. 町stemle
disease result同 from a d自由阴晴yo! 由町1in B,. (cyanoco国lamin),
which also a且』揭s pernicious anaemia. The d啕町1日ration of the dorsal
col.Jmns produc因回恼。『y at四a. 有回回国alcoh』『nns d 甘冒e spinal
∞『咀幽幽O rwolved (combi圳，刷S闯唰阳1瞄删 sp植t剧y
of the limbs. Th自 d阳ord吼叫甘lOUgh l』nco『11mon, Is an lmporlant
one 剧由 P『呻自f k回怕阳t with 咽蚀min ~2can 阳d to comp阳le
啊盹恻蚓．

In ml翩酬， acl’”19, an mmune d幅幅弱， spedftc damage to t陶

Sp.的Otha阳mic 如'8Ct f团副culus cun帽tus of 由eαiMcal sphal co刚回ds to loss of
pr叩rioceptionin 甘、E hands and fingers, c剧目ng prof四nd loss of
咀lelp恤s曲曲mk tract (sometimes referred to as the d回erlly end In曲曲 to Ider世fy the shape end n回ure of o阔前ts by
血恒rola眩目1 刷出n) lies la阳菌I 幽d 回ltral to 由ev四.ualhom of 以曲曲ne (1’lltaniogn幅幅｝．
也E sp旭al 伊y ma出Z It carries in阳mation related to 归in and
thermal sensations and also non-di回国inative (coune）刨出
皿d pres皿皿 Some authorities identify di皿net lateral and 晒1tral
spinothalai:回E臼缸ts COD现~pain and 能mperature or touch and
 Chapter 8 Spinal cord • 79

• Thi嗣同，阳刚瞄

圃 Seccn卧倒自rneurones

First.order neuronea

C邸’饵”阳i Midbtain

＼主／ Spi帽l lemnisa.is

Midd协 cerebellar
附则，

Pons
Faaclcl髓 d
α别以111Plnal 回b1'88

”“ull1

即amid
Splnothelamlc阳d

臼Meal co耐
V阳市面I white
COlll111串串回审

F幅.8.17 Spine洲回lamle 怕也有ie central psthw阴阳阳In, temper刷闸， touch and pressure are must阳刚．

严四山e. resp回ivdy; but 也ere appeaill to be little evidence for
由is in man and fibresαn抖鸣曲，e modalities are 严曲曲ly
in能rmingled, at l倒tto aomea腿nt
咀iesp皿。由.alamic 田.ct con也in’”αmd。，derneurone岛也E
创l b叫ies of which lie w诅ely dis回buted in the contt也.teral
donalhom 曲d z缸rive input from primary affer四t fibres 也很
困min血泪也U E唔on ｛地 8.17). Afu!r le町i咱也E 严rent cell
bodies, s阳othalamic axora decussate to 缸吨’由it£ side of 由t
mrdby 归.ssing 也rough the vmtral white commi画盹咄i出 lies
ven回 ω 也e central canal of the m吨阻d, thus.，四.ter 也E
倒1包划ateral spino也alamic tract. AmnsαE归s pain and
temperature d刷刷.te promptly wi也in one segment of their
origin, while 也.ose 也rrying touch 皿d pressure may ascend for
U咱al Segal•四.18 beforeα田sing.
In 也t bra且S位m. the spino由且Jamie fibres run in dosε
pm由li守 ω 也z medial lem血口皿 and are known aa 也E spinal
lemniams. 咀ie majority of fibres 阳minate 面也E vmtral
pas阳iornudeu，。fthe 也alamw』 contacting third呵。rder
也alam配回世cal neurones 也at 严oject to the somatolenso可
α览馆L
咀ie spinothalamic 田d is aometimes referred 阳画也E
’neospino也alamic sys键时 Itis M阱ly O耶niaed 1omatotopically;
com呻lentfy，也e location of sensory stimuli, ”rticularly those to
也E bodysur岛屿但B be id四tified wi也 very high accuracy. It is
也ought to be 也t route via which 也arp，严i面ng 归in (sometimes
called ’她r pain) is cond配时．
The spinothaJamic tract can be 酬前lively dan啕回 inay巾，Om,eii圃，
In which 阳帽1回l 凶nal becomes en阳＠回 to 阳m a cavity
compress同制如帽ll netVe 明b『铺. lhe second-order n创附唰
SU闽西rh唱 p副n and temperab.』附即回 dam剑”d 俗世Yi1t decussate In
tha vent『al wh阳 α:mm国ure, clo隔 to 伽a car四rel canal, ceusl咱 a
翩翩闹 loss of pain and tempera阳re 由NSren民蜡 In 廿19 up民W limbs.
This Is tann回且 dlnocl翩翩翩lnlC町阳’， sin佣 light t口uch and
P『叩『bα制ve 回吉凶。n ere 田园ned. 有回回归「rt ln]ur白自回 l:lllns 甘E
hends 四川踊ly, and 1he 如Irr幅 d 由时lmbs become dlso咽ens国
wHhout discomfo『t (Charca1’. Jc*tlB).
Selecli闹剧咆ical 曲曲uction ot the spinolhalamic t『副｛四rdotamy
ortrac恒ton咽。 is s田nsli'nes PE贸阳med for 骨、e neu『田U咆ical 『回1ef of
intr部恒ble pain 骨001 a variety of E副回6.
80 • NEUROANATOMY

D啕晴uagm
。闺白pt啕UI

H锦此

臼Jlbladder
stern勘h

Liver Int橱窗1’
Ap阳ndbl:
刷『时回脚
Blad:“r

F崎.8.18 P剖nclpalbody 明Iona 翩翩＠恤.ted with l'8阳，edpalnfrom 由•vie“ra.

τbe 1pinom:ladothalamk: 1J1tem re阴阳晦扭时刷刷L infonnation from 伽 lcn晒 limb. Fibres of the dorsal 酬noαrebellar
phylogenetically Olde!; IOl血 by 咱i曲曲ci<叩由E semoi:y imPl血a tr.act originate fr四t apIOll曲entgroup of 创h in lamina VII of cord
U咀d to higher 咽饵a Some 础:ond-ot曲 neurones 皿到吨齿。m s唱nents Tl-12, known as 也t thoracic nucl四s or Clarke'•α池皿血
也z donal hom aacmd in the 回urola但ral region d曲 αm:I. and ’Ibe 缸Oll8 趟出td ipsila皿划与 ω 由国也E 但由ellum 也酣睡缸
曲回恒田由且能 h the bra圆圆n M四larfmmatio凡 pal也血rly infmor arebellar peduncle. 陆晒。f由e11mtr.al 早回国吐iellar
wi也in 也emed叫k k国.tlo由alamic a班回也en a5C£lld to 由E 回d m塌na鲤鱼田1 <EllB at lumbo阻cral cord le\'由． τbe 曲rm
iirtI划.aminar 也al.ax回z nud函， which in 缸m 缸对vat£ 也E但dmtl decussate, ascmd on the contt由胆固I side of the cord and 回阳也E
rorn. 1he spinor回culotbalamic 阴阳n is poorly a聊tUed 田由ellum 由 the 剧院自Jr cerebellar pedundιSomeamns 也回
somatoto回cally and is thought to be the route 吼a which dull, ad由g 卧α回事回由姐也e cer吐回国时咀tematter.
归in (sometimes called ’slow' pa画） is transmitted to a conscious 四ie upper limb equival四t of也E clonal sp皿饵a'd回l缸 ttact is
le¥el.A曲盲目on of spinothalamic and 酬DOI四rular fibres, which repI四ented by 四neocer曲ellar fibr哇’. In 也iapa由:way, some
may1且也因剧.ybe per回mlasunp.国samor p血缸I. can be P血ruuy propriouptive a:H回回他 origina也g m倒ly in the mvical
modula:回 bydescendi吨 path.ways 岳阳也~brain {see Fig. 8.11 ). cnl~t and aiw四cling ipsilaterally in 由E h回culus ameatua
While pain缸l stimuli or幅na由喝 from somatic 由缸”re邑皿d (one of 也E dorsal rolwn叫，回minatein 也E medulla just la值:al
partirul缸ly 岳四1 也E bodys田也ce, ran be Joe对ised with high ω 由E p由1cipal cuneate nuclei皿 in a group of cells known a 也e
”回，ion d四” the 缸”iled 四＇mat侃叩ic 0耶皿m由nof 由E lateral （但阳叫， accessory｝ αmeate nucleus. From here,. axons
ascending pathways 扭d the 四mate抱回sorycon饵归in that 回阳 the cerebellum 世a the in如ior cerebellar peduncl巳 The
originates from deep，由ceral structures is generally poorly upper limb 吨ui回lent of the ventral spinocerebellar 田d is the
lα冠ised. In addi由o, noxious stim叫i m堪回。也i.g from visceral 民精tral spinoαrebellar 阁成 A回回缸ise from oells in 也e cer吼叫
自配tures are sometimes 阳ceived as pain in 0也庄严血。f由t 回国伊n皿t 姐d ascend ipsila田ally in 也e la回菌I funiculu岛
body-aph皿.om四.on known u 'referred 归跑’ 问. 8.18). A 回回吨由E 但由ellum mos市也rough 也E in缸ior peduncl巳
classic example is pain 告mo heart disease being felt in 也e left 刷D.OCEJ:d时lar 臼配tneumnes 恒minatein 也e c::rrd划lar cortr:x: as
ch四t shoulder 血dann. Them配hanism underl:归g回国-ed pain mossyfibr圃， p回北ominantly 回也n 由E 回mis and paravmnal area.
is not en由由 und四toocl but it is 也.ought to be due to 也E
αm~αof somatic and visceral afrerentl 企回1 阳晒ponding
E唔ons onto the same neurones 扭曲t donal ham of the spinal Whl恤’“毗er or the •pl1111
88Cendl啕旬，cm
’”rd:’”nclpal
cord. Such con回电~ results in misin钮，•retation as to 由E
source of 也e ruWOUS 础mulus. • Ascendl咽 tracts carry d饱rant ·卸l帽thalamlct阳t c刑，e pain,
Inform自由on 10 co附C以』sand touch and
tern，，事ture,
Aso四ding pa也W可s that carry afferent information to a
sUJC:onsc:lous 阳vels. P耐m咽B W回sure. n咽’“t contains
皿bconsdous l四el are repres四能d principally by 血E toe co晴clous 阳vel 创Iowa 鹤”ond-<>r由『 neurones w胁。ell
1pinocErebellar tram. basic pier、 d th『回 neuror回 In U刘les n the do陪副 horn.
a 锦刷刷ce 阳m perl川、eral Axons d阳」部ate 町、d pass 旬
Splnocerebellar tracts recept田 to cereb甩lea『也嚣 thetha恒mus. 币、ird-order
『回』rones project 回 the
~酬noood时lar fibr回回町迦!om回on deriml from • Dors剑 colwnns 伽8ClcU＼局
g晦clllsand cun铺tus) carry 筑matosensory cortex. Lesions
muscle spindl盹 mechanore咽ton such as 臼阎健础m organ鸟血d (e.g. 叩in伊W刨崎 l国d to
proprtoceptlon and
tactile re四ptors, to 也E 但rebellum 缸也.e control of JX础田血dthe d嗣同mlnst惘 touch. 有1ey
impaimenl of pain,
α>Ordination of mo鸭m面t Fo田归thways 鸣’但r to be imolved in CCl'N6'( 币陪同rder n剧阳回
tempt，虱』帽， touch and
也凰”田园也 w。但nyi吨 in缸m皿m from the 10\\U limb 姐d two ipsi恒恼菌Hy ID the ru:lei gracilis
阳回sure sensitivity on 甘冒
contralater四 side.
from 由eu囚阳 h由，咀E 咿llOC£I由ellar sys国n amaimofa and cunealus d 甘南 m回ulla.
Second-or由『 neuron属 • Spinocer回国lar1rac恒田llain
S呵umcE of only twa neumnm, 也e tr.a曲回回ning 配amd-0i:der
dee~后sate and p揭s to the 揭oond-or由『闸uron铺饲时ng
neurones whoae cdl bodies of origin m回tly lie in the base of the thalamus. 币li'd-Qf由『 neuror回 muscle, j口int and 恒ciile
donalhom; 甘町 recrive input from 回marya能mrtfibr回 p叫田t lo the somat四日nsory infomialion ilvolved in moto『
阳minating 面也is regio皿 Some tr.act amns a筑md iptilateml to 也eir cortex. l.8Bions (e.g. tabl捕 ∞刚刚.L前ions l倒d 恼翩翩

o蝴且呐曲幽幽 ascmdcon田k回到ly 归g. 8.19). The dorsal 四d 。衍唰ii，咧tamin B世 detlclency) (e.g. Fried『回ch's 幽x阀．
venmtl 咂DOCfid回lar 国cts are l.ocated at the dor时ate:r姐姐d
lead to ataicla and loss of
d悔crlmlnstlve touch lpsllateraly.
观nttola田al SU血cesof缸∞吨 E啤甜ve坊（眼 目g. 8.15）回国ay
 …句i…

Tc，阴阳b创lum

FilSI or阳 neurones •

S阳湖、do晴， neurones

Pone

T ’””bellum
T’””bellum
1瞩目。rcerebell’”dune协

R翩翩，II mldull1
Cuneooe1’”l阳trlCI

阳，国l tp阳阴阳饲Har 回ct

Lalal8lcu附蝠，， nucleus

c.翩，l mldul1

以nalspin翩翩llm' ttacl

Ctrvlt11I cord

1
回回幅画ccord
C恒rke'• colL1T1n

Ventral 唰伺~bellarlr回

Lumber cord

F幅.8.1…In“”’r.belmtra刷. Thedo唰唰noc嗣belar 阳ct and the cunaoc制>elle.rtr唰脯，hown on the left side. The vent刚制n。”rebellar tract
and the rostral spno创nbellar treat are shown on 甘啕川ght 剑de.
82 • NEUROANATOMY

mo四m四its are sometimes 配fared to aa 'fractionated'’ movements.

’ 阳“ralah'•.tul•
Fril甜回ch's a恒xia is an inheri恒d d甸回回硝ve d阳回国， h which the
spinoc浦曲创恒r tracts 笛亩阳也u阳市 di凶rder田，刷刷咱 to 阳'Ofound
incoo刚1nation at the arms -Onte1恼。n tremo~ 创d awid自－bas!刻，『回ing
回I (at副a). The di凶『由『 b句阳 in childhood and the p副阳t is
时回甜甜r拍und by 20 years of 句9.
Descendir.唱 spinal tracts
D四:endi唱国ell of 缸，pinal cord (see Fig. 8.15) originate from
the cer由ral cor田 and brains能m.τbey are concerned 回th 由e
四1回I of movement, muscle tone,. spinal re8eite鸟 spinal
皿tonomic functions and the mod也tion of sensory 往回smission
to bightt cen回也
Cortlcoeplnal tracts
阳回国co1plnal tr由（Figs. 8.20, 8.21) are p四cuiarly
concerned wi也由.e control of vol皿.tary, discr哩饵剧且d
mo陀m阳路 especially those of 由t dis国 p缸u d由e limbs. 副u:h
C侃iα呻凶al tt缸t neurones 缸iae from 创l bodiea 凰山E 出由ral
cor恤，咀e cells of or幅血 are widely di血ibu回扭曲emotorand
sensory corti帽， incl叫ing 由E pRUDtral gyrua 田回皿町皿otor
m但z of the frontal lob巳 where the large Betz all1 gin rise to
the hugest-diameter cor阳刚nal axo田，臼回田，pinal axons leave
theαrebral hemispheres by p酬ing 也m晤t the musive
subcortical fibre sys也ms of 由e corona radiate. and 旭也mal
但psuletom回也e aus cerebrl of the midbr咀n (Pig. 8且）．
咀1町也en pass 也rough 曲回国l portion of the pom to reach
也t medulla oblong，也 where 也ey 伽m 剧。 prominent mlurnns
on i甸回ntral ll1liface. 四iese are called the pyramids and, for 也is
E田，on，也E 回m pyramidal 位匾ct. is u舆rlasanal但matiwname
for theα四cospinal tract. In the α.udal medull岛也e fibres wi创n
thepyrami也 undergo subtotal decu嗣.tion. About 75% to 90% of
fibres decussate 组id 咀阳也eco曲曲阳咀l lateral cortlcospl且al
位缸L 叫tich is located in 由t la忧国严n of the spinal wbi能
mattei; dttp ω 也e dol'Bal spin民:erebcllar 田Cf; 10% to 25% of
pyram划d fibres remain i同la恒ral and 四阳也evmtral

Motor αM皿
U刚W limb

蜘tor co而皿
Up闵『 Ii『『lb

In悔malca阳ile

“ rtbral hlmi’”嘟”

Cruscer田M

刷dlecere国lar
” d1S1de

F勘cid民 of
∞阳叩『刚自b隅

阳刚事目lion of
lhepyra耐，
Ventral c:orticospilal tr回

Lat，阳l COi恤lCSjJinal 阳cl

Fig. 8.20 Cor咽饵’plnal ”“’·


lntamal capsule－丰－
町阳nid
U阳alco而cospinal tr回
Fig. 8.21 111“四”’ or 由·四r回cosplnal 1ract -.i•rtm’”“ uponacor’”’1”cUonof由•brain.
ω副α即恒al 田d located la'也ral to 也e 鸭B国l median fi we.
咀町 also decussatt near to 也eir tmnination; aa a result. 也t
fibres of 也E ~ tract effectively innervate 也 oontralateral
side of the &p缸tal cord and control movem四1 of the contralateral
side of the K啕．
’ Heredltllry •1111mtlc 1111rapm~•
He『回阳『y s因stic P苗苗阳re画E is an inherit!到 d吨回erative disord町
(a曲somal domin圳的 which p『啕随即ew幽阳蹦 a融ts the I啼，
回曲唱g 1o ma!K回副阳南部 d 回il.D甸回町1ilion of the lateral 仙niculi,
inciudi咱 the lat制町t阳spin创 tract, ch阳fly a伽ts the thoracic spi咽l
co则，倒』SI咱 a s阳.sue par哗>are剖s with hy阳r翩翩 and 以tensor
p脑ntar resp阳回阂， but with 部副ng at sens翩。n and bladder function.
Approxima能ly 55% of corticospinal 时won.es 出mina也 at
由世cal l倒也 20%at 由.oracle and 25% at lumb蹦出I le\'els.
Fibres 田minate ex阳sivdy 扭曲t spinal grey mat国.Ma町 d
those fibres that originate from the mo臼r mrta 回minate 扭曲t
呢ntral horn，四me making monoll}'Il3.ptic contact wi由 motor
neurones.
Rubrospinal tract
咀亚 rubr田pinal tract origina国 from 由e rm nudewi of the
midbrain 但gmen缸m (Fig. 8.22]. It eerts con缸。l m眩 the tone of
lir由 flewr muscles, being excitatory to the mσtor neuronea of
由ese muscles. Amns leaving 也e cells of the red nud肌JS COUISe
ventromedially and cross 国 the '9e.D四”但回国 dealssatlo也
after which th町 des但ld to 也e spinal cord where 由町 lie
咽1trola键时凶，姐d partly in恒rmingled wi也也t la国lll
m时ms庐tal tract.
咀1e red nucleus m望iv四 afferent fibres from 也E ma田 001回
阻dfrom theαrebellum. 咀ie rubrospinal tract, 由自由吗
爬萨四四” a non-pyrami.也1 rou能 by which 伽t matorcor回 and
m曲ellu皿也n influenαspinal motor activity.
Tee曲叩inal tract
’k ”’pin al 位act.fibres 缸ue 企om the su.perior colliadua of the
mi曲mo 〔Fig. 8.23). Axons p跚跚ttmmedially around the
periaqueductal grey m副er and cross in 世ie dorsal 钮，nm刨
Chapter 8 Spinal cord • 83
Motorαx恼皿
” decuasation. In the 酬nal OOI址，幽幽幽鸣阳回pinal fibres lie
n倒也E V回国l median fias0tt 缸id 也eytermi国.te predomin副市
in 但吼叫 segments. The superior co血αtlus re国.ves visual input
and 也t 也ctospinal tract i自由副咀11 to mediate reflex mo阳n四.ts
in respome to 由ual 回muli.
Vastibulospinal tracts
Vutibuloapinal 田a fibr四 arise from 也E watibular nuclei
situated in 也E pons and med曲， in and near 也E floor d也E
fourth 观E刨出〔Fig. 8.24). The ve甜b时ar nuclei receive input
from 也e la阳归也扭t system by way of 由e vmibular nerv冒阻d
also from the cer由ellum.
A皿ns from cells of the I世ral ”stibular nudeua (Del恼’，
nucl四a) descend i回h阳ally 幽幽 k阳al v四伽Jlo1pinal ttact.
which i1 loca·时 in 由E 咱也lll funiculus. La阳lll v四咀b叫。甲inal
tract fibres media能 pmYa也l acitatory effects upon a国1SOI'
motor n四rones. 咀icy 民rve to con缸ol E皿ms田 mmde tone in 也e
anti也mitymaint回anceof p。”山巳
哑ie medial ”四bularnucl剧’ contribu阳 d倒也nding fibres to
也E ipsila田lll medial longitudinal Casdad田， also known as the
mecllal ft&伽llosplnal 国a. which is l侃础d ad!acmt to 也E
-m1:田l m甜甜缸sure 缸ld descends 幽 far as cervical l.ev由．四le
medial longitudinal fascicuJ.皿 contains fibres 由at link 也E
嘀嚣tibular nuclei 回也由z nuclei innervating 也E E国E叫E
muscles (orulomotor, trochl四 and abduceru nuclei) and ill, th111,
impo血皿 in coordinati吨 h臼d and eye movmients （由叩田 9,
p 93; Chap阳 10， ” 103-104).
R由ticulospinal tracts
咀iere咀皿1ar formation of the pons and med叫lagi愧， d皿 to
reticulospinal fibres. Axons eris画g from the pcm由e reticular
formation descend ipsila回lllly as the medial (or pon也e)
reticuloap恒al 回ct. A皿nsfrom 也e med叫la descend bila国咀ly
in 也 la回理I (or m.edull町） rd扭曲，例nal tracta. Both 世酬， are
located in 由t 哑nttal 缸皿cul山．
Rdi.cul皿pinal fibres influence voluntary mo哩血四L reflex
缸tivity and muscle tone by mntrolling 也e activity of bo由 alpha
and gamma motor neurones. 哑可由omedi础萨嘟”rand
d咿翩。r effem upon the circulatoiy m阳n and are involved in
也e control of breath吨
 向“ II.IC以』’
＆’阳也鸣”

阳』， cerebrt

翩翩’”n1bell1r pedunda
/
Pon•

”“ul幅

时阳“

。”ic.lco耐

l.Ynblr ”“
F幅. 8.22 AubrosplMI 田ct.

.......翩翩’“刷刷...翩翩唱’z prlnolp9I ··“酬din…幽

·伽t阳”lnal tract con怕自B
d崎C唰’，’刷刷刷幌llT18"t8,
阳tlcull附 ot1hed制
回嘟”旬’. It W幢回回 tom
『鸭阳 and 帽l90rY 倒也因．
σ5%-(1()%）侃cuseata to fonn
甘w lateralαy由:oephal tract, the
m晴刚帽，阳睛啕甘ie lpslat刷
vantr回倪育御用啕禽l8I tracl
•Ti四”plnal tract 抱 lnvo阳d In
即伽IXl9鸣”r嘟” to 呐创d k拟』t.
It W晴、“”曹om the
”喃阳翩翩 auperlor oc蝇u削
g回阳回 aossln 阳 dorsal
ortglnates 曲。m thelpe刷刷
阳”ral ....削以应rnud割路，回
mec翩翩＠也阳阳1 ot ..，.也
axter丽0/( muscl侃

同ll'eS des棚，d ltvoL’”

阳帽”田。晦Jlllle,on捕。，筐，i
·阳翩捕俯咽’剧创剧目lls 曲曲
角棚， ITUIClea et回 a蛐回嗣
饥m 甘冒ued ru粗.. of the
钮’回回国由拟. . .幽m

Vest队指瞒田’act8 侃侃糊回
• Ret阳凰捕阔咽圈’act8 deac:er圃’
“町、甘田’院，l8 81'唱cl mac1幽L

IS1d Yllf1tral pans to ra四、阳

• The¥ 81"6 ln¥OM副tU-1 ’随 αX11rOI
w也岛而＊＇－ Fllr回 α。88 In 曹啕 flam 廿'1814191以启富 ru:lll. The of F哪怕剑英刷串串，『n.自由 W啕
πl8dUlay pyrsr削.M饲t 缸’－
唰吭唰旬，晴T刨甸嘟”由1 lalnl 晴，ttJulos防田园”ct g圃’嗨al f1.r1c怕也
 …句in叫

”“”’~n
.Subal;幽幽啕白白

阳回＂＂＂翩翩匈臼瞄lion

Pone

”·由Ila

向阳“

甸、4倒”而

Fig.8.23 h胁””llnle也

二， 叫 d伽喇喇时
I Foe刘国ions of t闸 spinal cord and the nerve r田恒 p『回U国 clinical
manifus旭t阳is in 2 w匈唱：
1. The leslon deetroys 仙阳tlon at the s啕mer闹闹唰．
2. The leslon Interrupts descendlrci rr刚1or and ascer回Ing sensory
t『acts.
Dem甸， todlf旬附咣阳tta of the 制nal cor吼 th惆fora」 1悔
” companied by distinctive clln阳I syndrorr嗣 同.8.26).
刷刷刷Ions of 伽e spl唰 oord followαx:luslcn of 刷刷刷or spinal
g回y end 前四ma， “凶Ing 青回归res d 由e sl*le.αuonlcαimp尼锚Ion
d 酌’ spinal oo州西、deme咱ingnerw roots isαrused by in旬clion and
tumours d甘、esp阔， meninges
and ne『w roots g咽’ by prol司骂回
. interver饱bral dis比 Sub能U饱挝、d 由ronic 国阳盲 of the spinal cord are
I I刃而mcnlydue b 阳 immune disorder of mu峭pie 回erosis.
 Lllllal VI揭tib哑arnudl民IS
Mlddl’”rabellar pedunda

印制id

”“ul胁（cau侃”

” plnaltn”’·
F幅. 8.14 Vestlbul

era啕l 阳vesand
Rella闹’ Ser咽allon Coordl『翩。”
－宵”’偏m

、
~t- /

ll ll
‘--

Mu蚓ew喃自阳1融串串 ar阁 ” 翩翩1t tendon and E 阳ofall 倒叫 lnooo网inat，衍脚，ment,

制sting abdomi闭l ”’倒踹 a四a

lncontine愤怒
i：昼
Fig.US 刷 LumbDUCl'lll aplnal cord le81an. A lumbosacral cord lesion ca幅幅W回阳鹏， wa副ingar回饱sciculation of mu副部， a邸’锁国 of the lower
l阳bs 伽wer motor neurone I酬。吟， incor喝nence，”nsoryloss 刷刷 the ltMll of the 嗣ion 则＇senso旷翩翩．阳饱『 also to Fig. 1.48.
 …句in叫

Crwlial nervea and

陆. . . Se” lion α剧由'l8lion
mot白’”’”m
.
+ + I ＇ ‘ 气 飞

t I:/ +
+

,+++

圄 Spullc呻翩 - Abeel1l抑制向 ． 叫all 111翩。n l 扭曲n幽 moveme而

lllCOI曲，眩’ +++ Iner阔”d阳唰””“E

： ~· t 恤丽p阳帽晴阳瞩

Fig. 8.25, canl'd (8) Thoracic 111in•I 四rd 1. .ion. A tho鹏ic cord lesion causes a spastic 阳apar回s, hypamillmda and 田回lSor plantar 晦阳盲目S
(upper motor n刷刷，阳io吟， incontinanca, sensory loss below the I酬。f the lesion and 'sens盯＇ a·国阻．阳饱『刨”也o Rg.1 ”－

Cranial 帽晴 and
motorsy由m
Ra伽跟随 棚”伽 臼ordlnaUon

头L JJ_
+
+

+
+

+
rfS 气 ~

+++ l 飞＋

+++ +

··’

II s附响曲锦 +++ Iner四”d 刨啤m m伽 I I U嗣ofpnipric嗣ption and

。ouch
t
曹
lncoordlna恼 movem翻L
ataxia

，..；；：、
ι， 1 胁叫附r睛”帽 囱 LOii of pain and tlllmpe181ura
时. 8.25, canl'd (CJ Heml协剑”。，the tholWClc 111lnel cord three “”
to the 曲，嗣4榈阳刚”时””•· This ls charac栩栩回 W l闵llaterel loss al
proprioception and upper moto『 neu町、eslgns 阳m刷啕lalmonop同l崎 pk.ls central幽ral loss of peln 四棚阳ature sensation. 阳也『副soto F均.1.48.
 C帽啕l ner睛，则
Rel甸回 Senlllon 。m曲回配m
m陶rry骗酬
..

飞
气 /

+++{ :

+++! +++

‘r

.
叫叫

- Abl帽咀画ndonand II Le时川灿 ~ =rdlna脑 m喇喇

W

a烛阳市回国用缸”·

＋＋＋ 阳m翩翩翩翩用阳

（~j Inc泊”’nance f 自自回归啸，m阳晒

Fig. 8.25, cont'd (D) Law.，帽rvlC81 spln•I cord Inion. A IOI阳oerv国loo闹闹Ion E剧描 W回阳瞄．明sthgand 饱剧创恒.tlon af muscl臼， and are’以旭
d阳 U阵庸 limbs ~ower motor neurone 悔。咱. In 甜甜。n，阳阳 is spastic parapar四后， hyperrel恒xia and extenso『 plantarr揭阳1ses (upper motor neurone
l筒阳时 in 阳 lower limbs, inα>nlinert08, senso『y loss below the 闹剧。f the lesion and 'sen倒町’翩翩.R响ral邸’0 Fig. 1.48.

。，n画l ”网”’回 Rellllll88 Senaa也n Cαll'dlnatlon

·. rrdor system

”j孔 +++
~＋＋
＋斗＋ +++
+++
+++ 气

++++++

＋忡 ｜ ＋忡

t t

． 怕也嗣翩翩 - Absent abdominal 咖． ． 闹。f山脚 ~ =rdl蛐阳叫

Ince:翩翩回 +++ Iner四”“回don 18伽

：号， t B阳帽阳嘟嘟阳嗣

Flg.8.25, 伺nt'd 伺 Upper 惕”比“..”’l 髓’d 阳Ion. A high cervtcal cord lee刷刷’es epeatlc te回p问la with hyperrafte>da，似闹翻p阳阳『
respon888 (1ψperm伽r刷阳、， lee刷， lncontlnen俑，侧回W 阳S below the 阳回 σf刷刷栩栩d •seneory’ ata>da. R翩翩Oto F旬. 1.48.

External feab.lrea ot 由a brain’”’m 89 caudal medulla 91
Dorsal sun缸:e of the brains恼，Tl 89 Mid-medulla 91
Ventral a』r抽回 of th自 b国ns恼m 90 Rostral m副ulla 91
Internal structure ot the brain•幅m 刷 Pons 凶
四le b国ns能m consi础。f the medulla oblOI耶路 pons and
midbrain. 四le 缸由此也m 岱ulb'’ is applied to 由E brains监min
compound 缸atomical names given to nerve fibres originating
from, or 阳mina由电 in，也z brainstem (e.g. ’由币四bulbar' re缸E
ta axons that arise in the rerebral cortex. and 阳minatein 也e
brai回国i). It is also used clinically 旬缸。但 the medulla in such
terms as 'bulb缸 palsy' and ’阳udobulbar 阴Isy’， which d臼aibe
m伽mes associa阔前th medull町 dysfunction.
咀ie bnrinstem lies upon the basal portion of the 创:cipital bone
(di吼叫， b donal as严u being 1啕dy covered by 也e cerebellum
明白 which it h组 rich 祖国mnnectiona. Caudally. the medulla is
四n由iu.ouswi也由E 咂nal cord j四t below 也E foramm magnum.
RDlltrally. 由E midbrain is continuous wi由世1£ di回回卢alon of
the forebrain.
咀ie bra函，但m contains numerous ascer回ingand d cending ”
fibre 回侃 Some of 由僧””由roughout its whole !en制L
h町恒g 由.eirorigi且 in thesp恒alα时 or cerebral hemisphel略
respectiv由10也m h却冒也e:ir origin or 回minati.on within 也e
nuclei of the brains恒m itaelf. Some of 也.esebra旭stem nuclei
rea司:ve affi:r四t fibres from, or 阳ul effa四t fibres into, cr.u咀d
nerves, 10 paim of which （田－XII) attach to 由E m也a d由E
brai回国i; these are known as 也ecm皿d D~nuclei （阻 地
10.2). In addition, the brains阳i contains a complex and
heterogeneous ma回x of neurones known as the reticular
formation. within which a number of individually identified
nuclei aist. The retiαtlar formation has se呢ral important
也nctiow』 including control over 也e level d倒四m皿回鸟也e
pen::ep咀m of pain and 吨由lion of 也e cardiovascuJar and
m阱atory m国ns. It also has g国~co皿配世onswi曲曲e
- - - Thalamus
-- Su阴阳coIiicul晦
「Ill－ttt！
MmHN m
L
同川
阴M
t』
,-- - Mlddle cerabeller peduncle
Pons
Inferior 饲rabl曲r 阿duncle
,,
------ La恼ral re铺” andap自由m of fourth vantr1c抱
M创ulla
’
Fig. .1 Do1'981 ”’翩。fthe brain翩『，．．
Brainstem 9
Midb『审in 94
Reticular form甜on 96
cranial nerve nuclei. with the 四ebdlum. 皿d wi也 brainstem and
a庐ial motor mech四总!Ill』由rough which it in.flu四.ces mo惚m四L
P倒也re and muscle 协皿 τhebr诅由国neon姐姐s the cells of
origin of impo血nt monoaminergic (dopamineI在 nora曲回ergk.
驱m恤w:gic) neurones that ha:哽咽d呵read pre加tions
也roughout the CNS and are important in sen皿哼， motor;
autonomic and cogni~ functions.
自幅mal features of 由e brainstem
Dor踊l surface of 由e brains幅m
咀redonal. su血ce of the brah四temcan be vi四帽d if the CJveI持ing
αrebdlu皿 is E四1oval by Cll国ngthe 血E四 pairs of nerve fibre
bundl筒， orpeduncl饵， by which. it is attached on ea出 side
(Figs 9.1, 9.2). On the dorsal m血ce of the medull匾，也e mid.line
is marked by a dorsal median suku岛四n也uouswith 阳I of the
spinalα时. In the 饵”也l part of the med叫Ia. 也z dona! columns
(fudαllus g回lil and faadculUI CUD倡“1, conta皿ing first-order
阻1刷y neuron·叫 contln啤 rostrally from the 甲inal cord to 曲曲
阳mination 扭曲E nude&且s gradlis 皿d nucl四l8 cuneatus，也t
1。但.lions of which are marked by 棚。 small d四甜。但也由e gracile
anda.m国te tuherd£s.
回leαudal two-thi巾。f the medulla con回m the m跑回1
con位iuationof由t 田1田l canal of 由e s庐tal cord 缸id i鸟
也回efore, sometim臼 ref回ed to as the ’dosed’ portion of the
medulla. Passing rost.rally，也Eαntral canal m例es pre嗨胞的由
more dorsal m础， in the roattal medulla, it opens out into 也E
lumen of the four也 V回国de. 咀Wi portion of the medulla is
回回国mes referred to aa 也e ’吗阻’ medulla. The floor of 也E
”
F cla.ilue cunaati』S
F笛ciwlus gracils
90 • NEUROANATOMY

Crus cel9bri Supe~or colllculus

Mi“腼锢，bellarp回unde

αIve

时IWllid

Fig. ’a M刷』 upect ot the brain ”’m.

four曲回回cle 缸nns a shallow, rhomboid d句>ression on 由E
donal 阳也re of 也e rostral med旧la and 世tepo皿 ηte transi由n
from medulla to pons is not cl国rly delineated on the dOISal
surface of the brains惚m but, 叩pre皿na剧，也e caudal third of
由E floor of 由efour也 V四.tricle co皿titu阳也e donal aspect of the
K擅自al medulla, while the rostral two－由irds of 也E 观盟.tri.cular
floor is made up of 也E dmsal aspect of 也epona.τk four也
田园de is widest at 也e level d由epontomed曲If junction.
Hen鸟 a h但ral rec回a of the v四.tticle a恒nds 阳也t k键时
ma咂ns of 由E brainstem. At this point, a small la忧思l 甸回ture
(fomnen ofl.uKhlra) pre闸des pa岱age 恼。E wi由in the fo田址E
wntricle to reach 由t subara血且创d space S山roundlllg 也E brain
(Stt Fig. 6.4). Th世 la田al walls of 也e m阳al p皿 of the fo山曲
回ttricle are made up of也e superior 皿d inferior ttttbellar
pedm世帽， connec由lg the brainstem wi由也Eαrebellum. In 由t
E回回归鸣曲t walls con陀事田1til, at 由e pontomesencq>halic
junction, the fo田由 m缸icle becomes mn由lUO田 wi也 a small
chann乱也e cer曹bral 叫ueduct, which p棚”由roughaut the
length of 由e midbrain.
The dorsal a年ect d也E midbrain is marked by four paired
elevations, 也e superior and in缸ior colli四且｛归思血r: colliadus;
Latin for ’little bill’), which are 归rta of the via国1 and auditoiy
m能Dll, respa:tiv由．咀ietro由lear DerYE (era皿al nave IV)
四1e咱es immed且.tely caudal to the inferior 田Uiculua.
咀1e transition from medulla 旬 pona is clearly delin回国 on 也e
阳市al SU由αof the brains能m. 咀te 呢ntral part of也e poru is
dominated by a transverse system of fibres (the trannene
pon出E fibres or pontocerebellar fibres）也at or增皿ate from 创h
扭曲t 观ntral pons （严mtine nudei) and which, after decussation.
归晶晶由rough the contralateral middle cerebellar peduncle to
四阳也e cerebellar hemi币tere. 咀e pon由ie nuclei E在函，E
“四四pan由ie fibres 叠。m 也E ipsilateral cerebral oortex
(incl叫ing the motor corta) and oonstitute an important
connection b眈W使E 田d>ral andαrebellar co副α， involved in
也e coordination of m例回nent. 四ie massiv哩阴阳n of国nsv町，e
pon也.e fibres obsc:uM 也e m回自蝴ngcortico酬nal 田.ct.
四tev四.tral SU血re of由e midbrain consists, on d也a sid巳 ofa
large column of d刨出lding fibres，也e aua cerebri or basil
pedunaill. In the midline. the t附 aura cerebri att se归rated by a
depl'四ion called 也E in也rpeduncular fuasa. The crua 但由i is
mrr血llOUS IC陆缸世ly with the in但mal capsule of the cerebral
h刷刷田~（see Fig. 1.30) and co四sta of mrtimbulbar ai叫
corticospinal fibres that have left the cer由国 hemisphere 由 the
in也rnal capsule on 也.eir way to the brainstem and sp姐alco此
回沈阳，e fibres descending through the aus are primuily motor
扭缸nction.

Ventral surface of the brainstem Ex抽回回幅atures “ thebrainste”

臼1 世1e 咽E缸aJ SU血a of 也E medulla. prominent longitudinal •Tl'咽 b『aln就阳n oc育部阳ts of the subarachnold sp’”. The
mlumns, the pyramid!』 run on either side of the 咽E缸al m回ula oblon庐恤， po晴 and cerebral 伺U回uc:t 阳ns thn.iugh
mklbraln. the mldbr回n,b阳帽tn 廿m
median 咀阻四 但gs 9.3, 9.4). The pyramid S田 ib name
colb.111.
to the underlying pyramidal or cordα凋ipinal 国ct,. which C01回’” ·臼阳 dor割l a自pect of the
。f des但ndi吨 fibres originati吨阳n the ipsila幅画I cerebral
branstem can be 挺楠、甘18 •On t愉 van回I asp创t oft愉
dorsal cok.lm闸， the 四oor of the W刨nstem can be 树”阿甘回
四r皿 In 由E caudal medulla, 75-90% of 也倒 fibres cross o回扭 触」时1 ventrlcle ar币d the 瓢刷剖or wemlds，甘回凯18l'lHI pontl闸
曲E de四”甜”。f也E pyram蝇， 例gs 9.3,’.4, 9.5），归nly
ob缸田ing t}比咱1国I media且也割ire as 也eydo 曲， to form 由e
and In饱『tor colllcull. ’bres and 1~市E C阳阻 α首曲同．
·币、自由rsal aspect of the rost恼l •Thein他而r, middle and
h险阻1 cortiαl&p也al tract of the spinalαml. la阻菌l to the pyramid m回ula and the 阳胃l8 to何TI 甘M自 supel1orcen血ellarp副uncles
lies an elonga锺d elevation, the olive, wi也in which lies 也E 由oor of the 拟』同h w翩翩斟酌， conn创t the cerebel11n to the
inferior oliv町 nudeua (Stt Fig. 9.7）.四is has connections later创 and median apert\188 al medulla，阳ns and mldbn.n,
the 触，th vant~cle permit 甘、自 晴和部队耐y
primarily with the 四时，ellum and is involw.d in the control of
P腿”。e of CSF Into the
ma明阻lent
 Chapter 9 Brainstem • 91

Ma.mmillary body

刷刷in 。ua cerebri

Pons

Middlec:咽rebellar peduncle

。llve

Pyramid

”’dul除

0日创ω自由。nof pyra脯’

’
Fig. s Ventral ”’
ect ot the bral””“”-

也E spinal cord. 四is h徊， α回al part of 缸’增m皿d nuclem is

R皿mlarly uaodated wi也 the m。但litie1 of 归in and
健mperature. 白眼回事minal Daft attaches to 由E ponaand,
也erefor巳 fibre，也at 田minate 迦由eparta of 也t 回geminal
Pons
nucleua ca叫al to 由is I~ deacmd in a tract (the spinal tract of
也etri萨minal), which lies 汩11nediatdy super面dal to 由E nucleus.
In 由t 观B田l medulla. 由e majority of fibra of也e pyill皿id

Micldlecer曹bella『 m缸p deculaation and 曲回归m h田曲， donally and caudally

pedLl'lcle ω 伽m 也e M恒温lcor阻，spinal 田总

Mid-medulla
Olive 臼1 thevmtral m血ttoftbe m挝－med旧la the pyramids are
”。因nent. abcwe their deems甜on. On the donal 剧由唱“t
时ramie! ascending 鱼阳”。，f the clonal columns rea曲 th＇由能rmination in
也e gracile 姐d cuneate nucl画， whi曲 appearben倒也 th＇由
respective traces (Fig. 9.6）.哑ie donal columm cor闹，t of
缸，t叫order 1e1四”y neurones; 也t 创l b叫iel of these neurona lie
。“划asaUon in 也t clonal root 伊nglia of 1pinal n缸”’四d hav哩 cen·缸圃l
of pyramlcls 阴阳跚组也at as<:end i阴ila阳划ly 也rough the cord and 凶1totbe
medulla. 币四回minate in the nuclei gracilil and cuneatus. upon
也E crll bodie1 of lemlld-order neurona. The axom of 也e
组mod-order neurona coune 现ntially and medially ill internal
Fig. 9A Ventral 棚pectot 锁， br11instem 刷刷ing 筋，， d阳翩翩tionot arcuate 6bft1, decwaating in the midline. 四g回Eta, they tum
the pyramlde.
roatially form画g a distinct 缸叫由e medial lemniKua, which
IUll& 也rough 由e m缸al medulla. 也t pons and midbm函，”
田minateupon 曲“－order llellIOlles in 由t 观ntr.d p回国ior
In幅mal structure of the bralnstem nucleua d也e thalamus (aee also E在』~ 8.16).

Caudal medulla R。stral medulla

At the 包回回tion 台。m spinal cord to med凶I鸟也t 阴阳mofgr想y
and white mat回回缸醉” consi，缸，1ble rearrangem倒（民g. 9.5).
The 呢ntral hom becomes mu曲阜阳1ua:时. The donal hom is
呻1]aced by 也 αudal 阴n d仙”igeminal lmlOIY nucleus
(nucleus of 也e 1pinal tract of 也e tri萨皿旭al Der叫． ηle
回gem凶al semory nuclem ill r吨严ded ill the b幅画，但m
homologue of the donal horn, 1iooe it rec娼”’严bnaryaffer四t
fibracon·嗯归g gmeral 1emation from 也e head. which 四阳也E
bnim能皿迦也t 回gmainal ner呢 It ia a h粤E nucleus that a皿ds
也t whole len醉。f也e br.Umtan and into 也E upper a唔menu of
阳”ingintothe 刷刷 med叫比 a number of new featurea appea1,
mostly related to the 观ntdαJ.lar m能m and cerebellar
connedion1. On the ~tral 9U血tt of 也t med旧h，也t
desmiding fibm of 也t pyramidl remain conspio.JoUI.
国media国y dorsal to the medial 明配tof 也e pyramid run 也e
ascending 伽四 of the medial lem皿血路 on ei·也er lide d 缸
midline (Fig. 9.7). In 也e m温line is loc:a时也e med皿llary part of
也E bra函，但m raphe nuclearαnnplex, m阳回回也d at 也isl~by
也t nucleus raphi magnua, a major origin of 阳otonergic
neurones. Donola:国al to 由t pyramid 四d h但ml to 也e medial
92 …… |
F臼阴阳lus gnlcili隔

FasciCIJu1 cuneau
N回跑JI grac革iii•

Nucl锐， cun副跑』’ 部inal 阳doftr阳刚刚

c.幅l grey

Spinoce『曹bellar 刷晦
Decussation of pyr审mids

时币mid

fig, U l'nnewNe ”“” through th，倒翩翩 m“ullaat 曲，阳¥81 flfthe d刷翩翩翩。4… pyraml由. The sections shown In Figs 9.5-9.13 have
b侧l etsln回 by 阳W刨gert~划时廿时.Are剧而h In 闹闹伽es s回Jnd~， wher制a g翩翩 Ince』I bod阳 81'9 relstlvaly pale.

C倒回l g『W FBI也』luagradlls

Faaclculu1 cuneall.皿 －－－＼＼ Nucleus gracilis

N皿勘scune航局 －－『气＼

S前1剑’回 oflrigemir回

Nucleus of spi唰阳dof陶eminal

Spin睛”bellar 阳ds

l晴!lm8I ara.i曲’阳回

·、、

飞一－ M曲l lemniscus

飞、、
向ramId
'- - De现翩翩圈。n of 阳阳nal llQJI悔伽串串

,’
fig .I TnnnwrH ” ctian through 恤， mid-medulla at the l剧，I Df筒”’”t”帽”’“四··笛an.

Dol181 motor n1
。f睛’』’

HypogJo翩l n1 So阳ytr;回

N皿＊划s soil曲目i.ls
｛口回姐则s of sol阳ry回d)

飞－一阳llculart町mlon
M创ial lor(litudinal 伽sciculus
lnferio『olivaryn

时rami

Nuc拟.1818阶6m啕nus

F幅.1.7 Tnns跚跚·”ctian through th• rastnl m“ul幅“阳腼唰时’－~伽由roltnrynuc阳....


lemniscus is the inferior oli回rynud缸”， lyingwi也扭曲E
promin四ttof 也e oliv巳 Thein缸ior olivary nuclei』s ha& roughly
由t form of a crenated bag wi曲曲叩四ing.. or bilum，也ring
media峙， through which a曲回t andeffa四t 伽-es 严ss. The
nud四a is mncemed with the mn筐。l ofmσ四mentandru主抽回
挝趾ents from 也e motor and sensory mr世恼。if the 但rebral
hemisph白宫 and from the red nucleus of the midbrain. Its main
efferent conn创.on is to the cerebellum via 他组缸ior cerebe咀缸
pedunclιWi也且也.e cerebellum, 缸。ns origina出s from the
U阳ior olivary nucleus, known a.s climbing fibr鸣曲d in
excitatoiy synapses in 也e dent且te nucleus 四d upon Pur恒nje cells
of the <EI由eJiar COI但Z
Donal to the in缸ior olivary nucleus and la田al to the medial
lemnisaJS lie second-order sensory fibres 倒优nding to the ventral
阳回ior thalamus 金回1 阳向：eminal nucleus （由E
~o也alamlc 国ct or trigemlnal lem跑回’）皿dfrom 也e
sp皿al cord (spinothalamic fibres, ~位rttd to in the bra迦S国n as
由t sp坦al lemniscua).
咀ie dorsal surface of 由e rostral medulla forms part of 也e floor
of 也E 岛也也可四面d巳 Bo也 immedia:徨ly b四但也 and d P “ Pons
hen回也 the floor d也E 嗯ntride lie a number of aanial nerve
nuclei, some of which can be d田rly identified in 血nply stained
况曲。鸣。也eDofwhichαnnot Immediately ben四th the
ventriαd缸童∞再 just la:回l to the midline, lies the 峙阴阳”al
nucleus, whichαmtains motor neurones 画ner四由18 也e muscles
of the ton思Je via 也e hypogl＇饵sal nerv巳 Lateral to 也e hypoglossal
nucleus lies 由e dorsal m“ornud四I of 由E 回酬，， oonta且ing
”唱imglionic para町mpathetic neurones 也at run 扭曲e 四思路
nerve. The most cau也l aspect of the 顶E国mlar floor is known as
the 匾rea poatre:皿且.At 也is point, the blood-brain barrier, which
limits the pas佩雷 d回国n ch缸回cals from 也e blo叫 ω 也e
brain, u 曲阳it 1bis region is the central site of action of
sub阳且倒也at cause wmiting (emetics). In 由t k也ral part of the
floor of 也efour也 v四tricle are located 也e vestibular nuclei,
wbi由 receive primary affer四lt fibres from 由e v四bular ner盹
Venttomed.ial to the hypogl，回归l nucleus, do民 to 也E midline, is
located the medial longitudinal f.w:iculus. ’Ibis consists of both
ascending and d£S出nding fibres and can be identified also in the
pons and midbrain. Wi由in 缸 brainstem, it lir曲曲回由旧ar
nuclei wi曲曲e nuclei supp刷ng 由e emaocular muscles
(abducem, trochlear 皿d oculomotor nuclei) and su~
con阳gate 句emov四nents 扭d 也e ooord画础onofh臼d and 句t
mo，在men ts.
币iedorsola能ral part of the :rostral m创luUa is
dominated by 由t
intuior caebellar p呻皿de, or resliform body. 四is COD&皿 of
矗breapa回ngbe阳回E 也emedullaand 由e 田d>ellum.
臼rebelIum
Choroid plexus
Fourth v田削de
Medial long阳dine! 悔自鼠』lus
Mediallemn阳us
向n由ne nuclei
Cortlcoa阳al ftbrea
问．” Tnnrven1’”唰阳伽＂＂啕h 胸翩翩，I ’”啕．
Chapter 9 Brainstem • 93
Prom皿四t 缸nong these are olivocerebellar fibres （岳。m the
inferior olivary nucleus), connections betw回l the 咱也血Z
nuclei 甜d 也E cerebellum，组td the fibr喧嚣。fthe dorsal
spin民题由ella:r ti缸t,.con宵”ngpn:聊ioc哼世~in伽mationfrom
也elαW配 limb. On the dor1al and la田al asp缸”。fthe in缸ior
αrebellar peduncle lie the dorsal and v四”叫回也1饵r nuclei,
which receive affer回t fibres from the ∞由lear nerve. Medial to
the inferior cerebell缸 peduncle 缸id ventral to 也e m“M血z
nuclei lies 也E nudeuaaoli国讪’（or nucleus 国血.. so日出ius,
aolitary nucl四吟， surroundi吨 a small, dense fascicle of fi.br略也e
回国u solitariua (or solitary tract). The nucleus 皿监国ius R汇d回
回国al affei:四t fibres en恒血g the brainst.em 扭曲E a由L
E且。”叩haryngeal and vagus nerves. Deep benea血也E 田园皿lar
floo鸟鸭ntral to the nucleus solitarius and just donal to the
in如ior olivary nudeUI, is located 也e nucleus ambiguus. lbis
sends mo伽伽a into 也 gl愧。由町鸣叫四d vagus neNeS
曲dα四单l roots of 也e aα幽幽IY E臼ve and，曲曲盹 to the
muscles of 也e pharynx 皿d larynx.
咀ie pons may be 幽vided into a ven田L or basal, portion and a
dorsal por国.on，也oknownu 曲同m皿.tum. 四le 咽it:ral portion
is marked by numerous trans回回y ori四.ted 阳cicL臼 of
pontoca由ellar 他，res (transverse pontine fibre&] that origirurte
from scattered c.el1 gun申鸟 the 阳mine nw:lei, and 归liS into 也e
∞础由阳西1 side oif 由e cerebellum through the massiw:
middle m由ellar peduncle [brachium ponds) (F增 9.8,9.9).
Cortie国pinal fibres (which con也ue caudally into the
med叫laiy pyramid）叩严缸 as small, S叩arate bundle事
run皿ng longitudinally betw四n the 阳cides of 田ns呢酣
pontine fibres.
币le aSCEI叫ing fibres of由.e medial l缸町由CUI b缸。me E叩囚徒d
from the 胃ramid and displared dona.Hy. to伊也e wi也 the spinal
lemnisrus and 回萨minothalamic tract ［回ger皿nal lemnisau), by
h馆”回ingtr泪lSVeI事e pontocerel削lar 包bres. The medial
lemniscus also rota圆白rough 90 • so that it lies almost
horizontally, marking 也e boun也iybetw四a 回n田l 姐d
tegm回国 portions of the pons. In 也e caudal to mid-pons
｛目g. 9.9），血 additional group of tr四”也叫.yrun皿ng fibres is
located d田eto 由E ascending leim由四I fibres but dorsal to 也e
阳ltoCErebellar 伽喧嚣．四is is 也etra~四id body, which cona恼
。f acoustic fibresα回sing the brainstem from the ∞副ear nuclei.
咀iey 倒也nd into 也e midbrain as the lateral lemnUcus (Fig. 9.10)
and 阳minate i且也e in缸ior colliculus.
Beneath 也E floor of the fourth v四创d己 in thepon出t
也伊ienwm, lie a number of cranial nerve nuclei. These include
Dentate nude111
Middle ce晴ellar peduncle
Abducens nuc也us
94 • NEUROANATOMY
M创ial b『'l!liludinal 饱sciculus
“
M M lemn隔四l
CorUcosl*!al n
Fig. I.I n，回回阳’回cUan through 恤， mlcl-pana Bl the le帽IDf世111 trtgemlnal nerve.
臼阳回l g19Y·
M“国llo咽lludlnel 饱，dculus·
Sp阳阳恒mlc 阳t
Medlall自mnlscua
Pontinenuclei
α川职Jbulbarand
corlico唰n目I llJ隅
F幅．·
由E abdw:enl nucleus (innerva:由1g 也E I阳'al 阳”’ muscle〕，
由.e facial
motor nucleus (inn町，ating the muscles of缸由l
apression) and the trl萨皿恤al motor nu.deus (innervating
the mtlldes of mastication), which 倒也 supp与 motor
axons to 也由 re币四” α部由l nerves. Also 阳回萨minal
&elllQry nucleus, 由国dyenmun田-ed. in the medulla, reaches its
m四mum ex恒it in 由E pons. adja田it to the origin of 也E
“萨minal nerv巳
In 也E rostral half of the pons, the superior cerebellar peduncle量
如m the la:恼al walls of the 岛町也呢E回clE鸟也e thin superior
medullary velum spanning be剧院a 也由l to form its roof. The
且perior peduncleαmtains some cerebellar affer四t fibre岛 such aa
the 呢n田l spinocerebdl缸 tract, which αmv町s proprioceptive
information from the I~ limb. It amsists mainl如 how叨'er, of
ascending 但rebdlar effu回1ts mncerned with the coordination of
mov四1四L which are de!'由d for the red nucleu且 of the midbrain
and the vmtral lateral nucleus of the 伽alamw. 四班，uperior
“ rebellar peduncles 倒阳se tσw剧s 也e midl扭t as 也ey pass
into the midbrain. In the m·田t rostral p四 ofthepom』 do院 to
由e pontom四DC甲balic junction (a region called 由e is也mus),
他 four也 m创.de becomes g国1tly attenuated 笛 it mer胆 into
由E 出由ral 叫ueduct (Fig. 9.10〕．臼ttral g宫yma阳b唔nsto
四.compau the lumen (much like the grey ma阳 SUIIOun曲唱出
centralαnal of the 91>inal cord）扭cl, at this le9el, lies a group of
回gmented neurone鸟也e IOC111 coerul四，， whim is a major 1ite of
n惆.drenergic n四zones.
:uperlor cerebellar peduncle
llcld阳 cerabelar 酬un曲
J中rapezoid 切dy
C创市副 caneI
Locus ca刷刷』E
Lateral lamn酷CUI
Superiarce『ebel阳『阿duncle
Midbrain
币ie midbrain (Figs 9.11-9.13）以 for desαip往回阴llP倒回，
divided 姐.to dorsal 血d 回n国l portions at 也 level of the
仅使bral a申leduct. 咀ie dorsal portion is known u 也e 扭曲，m.
which consists largely of 也e inf剧。r and sup剧。rcollia血
｛四甲ora qt皿由igemin且〕．咀ie 回I国1 par世m of the midbrain
is known D 也e 1Egmentum. It is bounded 哑ntrally by 由E
massive fibre m能m of the mu cerebri. The 恒m t:Enbral
peduncle ii sometimes used as a 句no吗m 缸。usαrebri
but, strictly speaking, the cerebral peduncle refers to the
whole of the v四位al midbrain, on either sid己也duding 也e
tectum.
In 也e cau也l part of也E midbrain, 由E 扭缸iorco山culus
mnsti缸阳 p回 of 也E ucmdi吨 acou皿.c （四面tory) pn对自由n.
Asanding au.di臼哼 fibres run in 也E h饵ral lenmiaa皿， which
1Ermina:国 in the inferior colliculus. 四mmt E』:ea from the
inferior co皿αllUI 田minate in the medial ，盟kulatE nudewi of
也E 曲曲皿鸥 which in turn p叫缸” to the auditory cor回z of也t
tem归ral lob巳
四iesu萨立ior colliculus of 也E rosu在l midbrain is 归n of the
visual m忧也. Its main aff在四” are cortiro阳tal fibres originating
from 也居世皿且l cor恒。f 也e occipi国 lobe and from the frontal
句哩 field of the frontal lobe. ’lb田面.puts 缸E 四ncemedwi也
controlling movements of the 句”’ SU曲”也。，e Oro.ming when
a moving obj田”旬llm耐（sm。他阴rsuit) or 抽回 the
direction of也e 院m is al键时｛领ccadic e)"'! movem四”）. In
 …… 95 I
M伽怡『 colllculus

自始帽l lemnisQ路
Cereb刚网”“uct
·P回aqued田lal grey
胁dial klr9bhl 饱翩翩
．脑nnisws

Decus础阳 of superior
翩翩Ila『酬unde ledlal lemnllcul

同m旬cerabellar fibt圃’

臼rtlcobulbar and
∞而COipi唰币bn:蛐

Fig.I

阳nalraph曲 nuc以血
C泊晴＂＇剖u创uct
lnflriorcolli叫“

阳阳.queduc姐I grey
La匍rat 阳”幅幅』’

S酬al 阳Ml翩翩 τ＇rochlaar m.则，us

M剧，l long＇阳dinal 侃”阳lus

M甜al I阳nniscu晴

Supe『t宵”睛’l阳刚uncle Ill-＂＇证”l!~~#j画匾 Tamporoponllne ftbr8I

Dacu刷.lion of superior~
~
c’”也ellar 阳刷刷，
军
Sub归nlianigra－一

问，．··” T111ntVt，.…o11on throt啕h 伽ec翩翩，l mid阳曲，11hel’”』“1hel响曲r帽lllculua.

5uper1or coll阳』lus
Ed闸’←.Wutpt咄咄拟』8 ---· , h峭唰唰l grey

……阳lu1 b'J;吧？写 1rebral aqueduct

inal lemni1Q后
。“阳'l10lornuc刷，
M唰l Ion明itudinal fascia.』lus

Rednuc阳m

S由刷咖啡事

F阳”。r
OQJ阳notornerve

Vent恼l问men恼I area

Fig. 1.13 Tl'llnllVWM ”ICl阁”’－ugh 世圃， rostral midb111in Ill th，阳”I of th• superior oo刷刷lua.

addition, corticotedal fibre. 齿。m the 由国l cortex are involved in
伽t accommo也1CiOll reftez: (Chapter 10).
A small number of viaual fibres running i且也叩tic 田ct
回minate juat rol1Jal to 也e supErior mllimlua, 扭曲eprete由I
nuclma. 币iii nudeua has mnn筐’ionswi由 n白血y midbrain
F咿nglionic par叨叨抽etic neurones （田面伊－W四”＇hal
nucleus] controlling the amoo伽 mu础。f the eye and is part of
the circuit media也l8 the pupill町 II抽t rdla (Cltap阳 10).
Ventral to 也e colllculi，也但由直I aqueduct runs 也.e leJ嗨也 of
the midbr.tin. Surro四出鸣曲t a耶.educt is a pear-shaped
缸ran萨皿四t of gr宫y matter, 也e periaquedudal (or 也血位司’） gr可－
h 也e vm缸al part of 也e peri叫u.ed皿tal g町， at 由E le现ls of the
in如ior and 111perior collia曲， respectiv句 lie 由E 田chi回E 皿d
omlomator nuclei, whidt inn筐，ate 也E emaoa.dar muscles
controlling eye m饥朋1ent1. Near the oculom悦。r nucleus lies the
u阳ger-Wa刷w nucleus. Close to these nuclei runs 也t medial
96 • NEUROANATOMY
longiwdinal fasciαJlus, which liI曲曲.em to the 曲曲但由 nucleus
i且也t pons and 由~ vestibular nuclei in 也e medulla 姐d ia
出po血ntin 也t 由础。11 ofgaz巳
At 也E level of 也E inferior 田山田lus (Figs 9.11, 9.12），也E
αntral portion of the t唱m四tum ill dominated by the mnverging
superior 四rebellar pedund臼 (brachiu皿 con如皿圆明皿）．咀由
massive fibre sys艇E origina田 in the cerebellum and courses
鸭ntromedially 笛 it nJllS iI阳也e midbrain. B四ea.th 也E in缸ior
colliculu岛也e two SU阳i缸 cerebell缸 pedundes decussa但面也e
m拙Ii皿 Rostral to 也E deco部ation. at 也t level of 也e SU阴阳
四lliculus(Fig. 9 .13〕，也E central portion of the t电m四缸m ia
民主upied by 也e red nucleus, in which 四me of 也E fibr四 of the
sup回or 田ebellar peduncle 国minat巳咀1e red nucleus ia
involved 恒 mo阳 mntrol. Its oth缸 major 皿UUE ofaf趾四” ii
the motor cor恒。f也e frontal lobe. Efferent fibres from 由e red
nu出us er回s in 世1eventral 呻nental decu则由n and descend to
the spinalα时 i且也e rubrosp旭al 缸缸1. In addition, the red
nudNS projecta to 由t inferior olivary nucleus of 也E medulla. via
the~四tral tegm四.tal tr缸t
咀1em·饵”四缸al p缸t of the midbra扭 tegm团也皿 is OCCUJ:地ed
by the 1ubstan也 nigm. 咀is CODI恤 of two lllhnuclei：也E pllllll
compa<扭扭d 也e 归n retimlata. 咀iepanoomp缸ta COi回sts of
p增nented, melanin-containing neurones that syn也esise
dopamine as their transmitter. 咀ese neurones project to 由E
由!date nucl四S 皿d 阳tamen （：由i础皿i) of the basal ganglia 画
出E for由m扭扭d conatitute 也ε 国g田国atal pathway (Chapter
14）.咀Usαmn四.on is impon皿伽也 control of vol回国y
mo呢m四L P创wre 皿d m四de tone 曲d degener四.onof 由t 归m
mmpacta is aasocia能d wi也 h面nson’E diaeaae.
Dopamine-con回ning neurones a但nd donomedially from 由E
ventromedial 归rt of the pan com阴阳阳” a n:gion h胡m as
the ventral tegmental area (VIA; Fig. 9.13）.四ese 创h ofthevrA
are 也t origin of the asαM国s mesolimbic dopaminergic 归也way
缸Ki th町 innervate a number of forebrain s刨出ires including the
nudNS aαumbens, a1町回血 and septum and the cingulate.,
mbi国皿d prefrontal co币值（Fig. 9.14）.哑ie non-p泡mental
aubdivision of也e substantia nigra is called the para E咀rula:他 It
is considered to be a functional homolot尹e d也E in但rnal
segment of 也e globus pallidus, which is also pan of也t basal
伊nglia，阻d 也.e two share -rery similar conn1配lions.
Ven:田1 to the substantia nigr虱 lies the massiveα因“rebri. 四is
倒回跑回tirely of descending cortical efferent fihr四 thatW!Veleft
由Eαrebral hemisphere by E四ming 也t internal ca严血
Appro:对ma惚ly 也t middle 50% of theαus consist& of
cor位四bulbar and cor画面1pinal fibres. 咀ie corticobulbar fibres
四d predom扭扭曲 in or near the motor cranial nerve nuclei of
the brains回1. 四ecor阳刚nal 仰ramidal〕 fibres traverse 也E
Amyg也la
’
Fig. .14 D帽，ml闹咱le 闹uror’”’nd their prtnclpel w。1Jectl。”－
pons to 四t自由E medt且ary pyramid and，也由吗 the
α四coapinal tracts.
臼tei由er aide of 也tα四cobulbar 3lldα四.coap旭al fibres, the
CIU1cerebri con国ns oorticopon:由ie fibres 由at originate from
widespread n:gions of the cerebral cor回 and 田minatein 也e
pontine nuclei of 由e vmtral pons. From the pontine nuclei
四~配tions are established wi位1 世ie cerebellum, via the middle
m曲ellarpedw时岛也at are involved 旭 the coordination of
movement
Retlcular formation
四ie reticular 伽mation consists of a compla matrix of neuron臼
也at ext曲也由则由out 也e Ieng血。f也e brainstem. 'Ibis ia.，也
phylogenetic teim也 a relati:叫.yold p皿 of也z brainstern 缸Ki its
n田JIOnes 缸监I a number of impor回nt ft皿c:ti.a血，四meofwhich
are nee:回aryfor sur世val. The retirul缸 forma on has wid臼.pread
afferent and efferent connections wi也 other p缸”。ftbe CNS,
which reflect i甸回mplaandmul位nodal 缸nctiona. Some
reticular n四rones W!Ve long 缸om that as四id and desαndfor
considerable diatanc1臼 wi由且也e brainstem, allow汹s profuse
mteraction，也roughout 也e neuram. Within 由t retiαd缸
formation a number of more酬。r-le皿 well-defined nuclei ran be
id回咀ed, while 皿＇me 缸nctions are subser鸭d by more dispersed
neuronal networkll 由at do not correspond exactly to anatomically
iden曲d nuclei. 四ie lat田 applies to the so-called m制ratoiy and
αntiov.ucular centr皿 τbese consist of diffuse neuronal networks
located wi也扭曲t lateral med叫lary 血d cau也I pontine reticular
formation 也at 曲曲。11 respiratory m町m四”四dcardi＇回喧acular
function.
De&CEDdi:ng reticuloapi回国也回回nate 岳阳也E med叫lary
and pon由e reticular 也rmation (Chap田 8〕．咀臼e predominantly
influence mW1cle 旬neand 萨JSture. Wi也in the E哑。.dar 缸rnation
of the medulla lies a group of particularly large 创1 bodie鸟也e
nucleus reticularis g帽mto回lulari岛 whichαm回butes d臼臼nding
fibres to the lateral reticulospinal tract.
Some of 由t asc四ding fibres of由e retiα血z formation
m回阳能也盼咀lied redo.血r ac世唰且g system. 四a腿
n四.rones, many of which are cholinell民 r悦ei-re 也阴L ei由a
directly or indirectly. from multiple sen四＇IY sour四．哑mrugh 缸
in回回国i町 d也d缸圄.c nuclei ( moltly 也.e intralai:旧血r nuclei),
也.eyαuse activation of the ca由1ral cortex and height四d
arouaal.
The raph~ nuclei are a series of midllile nuclei 伽t 固自Ki
也rougbout the length of 也.e brains能m （目， 9.7, 9.12). MaJ安y of
也e n四IOD臼 are serotonergic, utili由'18 serotonin
(5句drt町ttyptamin1巳 5-IIT) 画也由回11mitt缸’Their axons are
wid曲曲.stributed 也IOl喝bout the CNS, including ascending
 一~些些巴
Cl『电ula锄，Ill

翩翩n

阳唰即回

臼耐allum
Am酬，阳
S目耐∞时
Hypoth1lamus
、 ／’
－~一一一
Hlppocampus
Raph6 nu曲l
N肌帆， 11ph6 m啕n111
F地.8.15 S.nrtan•咱’D neu,_ and their prtnclpml proJ帽勘恤

Clngulata cortex ~ Th副amus

时.8.1’ Nol'lldren.咆le n.u,_ 1nd 伽’ir principal projectiona.

p叫ectioos to 由e thalamus, by归＇thalamWI，翩翩m, u町回ala,

lnt•m•I ..n1otur. crf 81• bN’”’bMn
hippocampua and wideaprtad regiom of 也ecer由ral cor皿
σ也 9.15）.岱le! fund:ional ，毕温cance of 8UCh di回rse coonectiOllJ •Cran脑I nervea 11同II at凶ch to 啕emi恼l sensorynud凰』S

ianot 缸llyw咀m10叫 h皿 aac四必吨 fibtta to 阳'ebraiD the bralnstem, their ’阳” alt咱r
o~lnallng 仲例， or termnatl啕
自uctuR.I are involwd in mood andα~ti'V2 缸nctionand 扭曲E In, theσw削，，.... nucl创．
na皿l mechaniama of ale叩. There are alao lerotonagic
·节回『回阳.，阳Tnlll恤，、 αJntrols
萨吗a如osto 位理由司副um and daomdi1咯 fil>Rst。但句Jinal
甘lB llr唰 al COi'宵。ouane凰”
αmi. The E刷er originate from 世:ae nudeul m.抖~ m唱m1Sof位:ae
白’由CMll翩翩z ayatsn g回甘冒’
medulla and are invol观d in 岱e mod回ation of noci<:e例，E 『”pil8toly system.
mechaniama in 世ie dorsal hom {1ee Pig. 8.11). S。meofthae
deacendi吨 nturones con:回自由k供叫in. •A鼠精睛啕帽刚町 8Y8l8ln’
pass 1hrol聊阳 W茵茵匍啊凯
四ie lo田， coerul剧， ia a group of 回gm.en也d neurones 也at lies
roL.Rtothe t咽larnus.
in 也E rosttal pou出t t唱mmtum (Fig. 9.10). It ia the principal First-<Jrdllr pr四”“却阳’b圃
nor咀rmElgic cell group of 也t brain，。f which there are a number in Iha dorsal ccllmrw 111恒y "
in the braim恒皿 It projec:甸甸由e c.erebellu皿皿d manyar阻， d the 翩翩 collmn nuc阳i.
Second-<Jr由r 阳，， dacuea曲
伽e forebrain, including the diencephalon, limbic 耐uctu:r回 and
t。 b『『n thamadl创 lamniscua.
m曲ral corta (Fig. 9.16｝.四e locua co白山田， like the raphl Spnotha姐，nlc 伽回 fonn the
nuclei, baa been 汩ipllcated in the neural mechar由m E咽Jlating 刷nal lemn幅cue. Second-order
cons肌且， the 刨gamin础alamlc
tract （例，eml唰 lemnlscus).
• Deacen幽咱隘””璐阳市lend
h 甘悔阳由W阳n，回撞事甘回孔睛1
ii a叫“W耐， 'l'll'ilt归自L
• Car恤:obUbar 缸，回 tem盲lllle"
世，8 ＂富却菌1, pons ISld
『necUa. hαlr1ico酣回悦目
M鸣廿刷刷 the aus 帽回到，
苗，， baeal part of 甘冒9p创l8and
lhemadul留YPI嘀嘀挝；
75%－回%of 伽eec阳sh 阳
171f8rTlldal decus倒回on to 伽m
问 lateral cert阳酬n刨回ct.
• The reticular 伽matiOn, red
nuc脑ue and v回回bular nuclel
g阳市eto 甸回创ding 自阳，，

sleep, particularly 阻M (rapid eye movement} sleep. The ’b嗣剧，唰Ing In the that 阳路s to the 碑刻n创 cα吼

nor叫rmer在 innervation of 由t fottbrain alao appears to be

important in higher m回国缸nctiom auch u mood and
田，ition. Other nor挝rmElgic fibru pi叫回也roughout 由E
braim回1 血d 1pinal cord.
98 … NATOMY
’, ..............
A uni阳阳租l bra'nstem 回阳但幅画d by sire阳， tumour or mu阳p恒
回阳回酶恤路””’ater回 cran·四”『W 句sfi』nction, co时r创ater亩l 部陆I晦
hemi阳回a W四””回a and an 以阳晒r 闹闹r 『硝烟回归阴阳 motor
neurone 阳’IOl'I), con1ralater刨 h”、画ensory loss and ips加iler西1
帆。∞『ainatlon 铲lg. ’.1η. A bllat制嗣阳 d“民阴阳哺划 ω网睛’曹隙
I
∞时rolbreathing and 廿18 ci『culalicn，跑回吨旬 coma and dealh. This
usually 刷刷vsa maaaille 甜。keof 甘'Ill br刮nstem a'ld is 甘、eend 瞄ult of
刷’因 in如aaanial pr部副陋， due to a s阳。，α::o..i附ng 悔自n, which
d制”es the cerebellar hemis阶W串串 d刷刷伽附咱们heforamen n啕阳m
tocompr’”甘冒， upperbn曲'IStem.

Crani1I 『惕”窜， 1nd

mo\or S'f帽m Reftu ” Seneaaon Cocnllnatlon

。 _5~｝
+++ +++

+
+
i~ 气

、1
+

· +

~ 1 L+

+++ +

l/

Muscle we1kn1”’『，d
Wiiiing
- Ablanl abdominal rafteJc8e II L叫II 181111ltion 4 l叫In瞄 movement
a恤副a

II Spllti叫跚 +++ lncniai悔d 饱nclon rv阳IX

• Extaneor 阳咖「阴阳”
Fig.I.何 a，.－.刷刷刷.R响r also to Fig. 1.48.
 Cranial nerves and cranial
nerve nuclei
Cranial nerve nuclei 回 IV: Trochl回r nerve 102
A阳『·ant nuclei 99 Vl: Abdu四ns nerve 103
Efferent nuclei 100 I/: TrigeminaJ nerve 103
Cranlal narv帽 ’01 VII: F部草创 nerve 107
Ill: Oculomotor n酬咽 101 Vlll:l/1副bu阳::och国r nerve
10
以： G阳回phe叩ng回l nerve 110
X: Vagus nerve 11 O
Xl:Aa泪ssory nerve 111
XII: HypoglossaJ nerve 111
109

咀iere are 12, bila阳ally pall:时， crar世d ner咽B.τheae carry afferent the cranial nerve nuclei; 由四e either recdve era皿al nerve
缸ui efferent nerv哩曲m k阳晒t the brain and p回.pheral aft恒ents or contain the cell bodies of ef.趾回t neurones that
由uctures, principally of the head 皿d E仅k. 四ieaa皿al nerves are have a:mns leaving 也 brain in 伺皿al ner晒. The locations of
indi世dually named 血d numb四d (Rom皿 numer曲 I-XII) these nuclei are 山回国itro schemati1创ly 也 Fig. 10.2. Some can
according to the m跑回:audal 1叫uenαh which 也.ey attach to the readily be seen in stained 班tion，。fthe brains田n (see Figs
brain （民.g. 10.1 and Table 10.1): 9.5-9.13).

I olfactory VII facial

II opuc VIII vestibulocochl回Z Cranial nerve nuclei
Ill oculomotm IX E且ossophar尹igieal
A胃erent nuclei
IV 缸。chi.ear x 四胆’
A血，四t S险也 cart冽nggeneral 阻tsoryin阳mation （剧uh,
v trigeI皿皿l XI accessory
piasw:骂 pain, 阳nperature) from the head 四.ter the braht
VI abdUC£nS 泪I 峙poglossal
through the tri胆回nal nerve at 世ie level of the pons and
咀le 缸冒.to晒 α自由l net四s attach directly to 由E 缸由m也 国minatt in 也.e tti萨minal S曲’“y nud四a. This is a laJge
while the rest a也ch to the K回nstem. 咀ie oliiK:t.ory sys恒mis nucleus 由a runs 也e whole length of the K回nstem and a国ids
由，ely 捕soda时， both 由U而且对ly 扭d functionall r, with 阴m of cau也lly into the cervical s庐ial cord. Fibres conv可旭g the special
由e forebra皿 collec笛叫F referred to as 也E limbic sys阳岛也凶e, s四ses of mo蚀。in/positional sense 缸ldhea血igrun in 也t
ind叫ing cm由l nerve I, are coD&idered t叫萨由自 in α叩国 16. V也tibuloα>eh』臼r ner陀．四四阳minate in 也ews曲ularand
咀le 叽R皿l sys国n and cranial nerve II are described 恒 Chap阳 15. cochl四Z nuclei，匠’配由Ely, which are lo四tul in the medulla, in
Cranial ner鸭， III-XII are directly connec也d to varioua neuronal 缸td n组rto 也t lateral p缸t of the 鱼oorof 世te 岛urth 咽mtricle
创l group岛 l“革ted ipsilataally wi也扭曲E braim回1 皿dcalled (sometimes ref由ed to as 也E 观atibular area）.明艇era} affer田峪

αfaclllly bulb

α旬clay tr胃口t

Optic nerve
q姐ctract Cla.llomokl『 ner帽

Trocl'曲，rnerve

Tr91mlnal nerve Abducens 帽ve

F缸也l nerve·
Hy阳湖los”I nerve
Glosao阳阴阳J nerve
>a.崩sory 闹剧曹
V啕us 帽w
Cranial m口blof acceeso『Y nerve
Ventral root al 1创 cervlcal m凹’
Spinal root of 翩翩。可帽W

Fig. ’也唱 Theba”“the brain illu由ming the location• d恤， c:ranilll ner鸭”. The points of at恒由mentarash阳n，似E叩t for the 甘ochl回r nerve,
which 回回S青回1th自由陪副笛pact of the br四ns幅m.
100 • NEUROANATOMY

I T邮 10.1 Summ町ofcompan巾，町，ctlona and tun曲ns or the cranlal ne隅， ｜

Cl'lln凶。”回 com”llenl 面.... 8lruc缸，•i阳回归. . . . cen』，国 e唱曲”llC幅画血· Fune圃，由·

。国鲤 α旦旦且些 。悔鹏恤，、

Optic Later副 g阳｜刷刷 rucl剧，； Vision；拟』pllary llltlt r圳，z

”冒抽血l nucleus
Ill OCIJ口motor Motor &4)llrb『， lriferlor 捆dm回阳l rectus αz』阳notor iiUClllUii Mowment d句咄all; el脚allon of
m幽幽s. ~闹剧口『 obi蝴.1&musc幅； uppe『甸回M
｜回~S)91p由咽JU阳lo刷e__m回南
F缸审时n阳lltietic 匈hincu pupil恤且由回国恤ry m..ieclo of Binger-'11徊S协hal nuc恤跑 R刷阳ryαm剧E阳’缸’d
旦旦’曲创I.＿：响到llary~gangl阳1 自由cornl]'lOClatkln
IV Trt曲圃， 旦旦旦 皇堕且旦国皇旦旦量 Tn记hlaer llJC幅us M创留『1创t of 到重塑l
V 币tiemnal Ser胃口ry R副捕，割泪Ip, corr晴帽， na帽l 町、d or咽l T咆阳『nnal 嗣同阳y nud锢局 Ga”’割，，胃atlon
“曲曲幅，。田削 dl.1811181:圃，
Motor Mus曲aolm邸tlcatlon; tensor tympani T酶，nnalma阳『 nuc隐居 Openhg 町lddosing mouth; tension
on ~mpano memlJrane
VI Abducen由 Motor l.JdDral n棺lull muacle Abducer回 nuc脑皿 M由翩翩t of 咂国｜

VII F缸::181 Ser鸣。ry AA幅riQrtv四·刷刷 of tongue N1剧团局阴阳ir1~晦 Ta回·

协阳 Mus曲8 of facial 11)(11隅嗣同；白p回lus 陆幽I nuc阳』S 一 Fae糊l movement; t嗣阳 on bor晴
m崎C栩 afmldd阳帽，

P副窗”m阳幽1创IC S&IMl!y er回回rimel gland＆，唰 Sl4Ml1'1orae阳回nry llJC椒路 S副阳回dion 81回恒C伽回阳1

8U:>mandlbU脑r and w阳『ygopereane

gangl恒

VIII Vestibulococh阳. S阳回ory Vestibu恤rapper咀.!us; ooc归脑血 V田园Dular nucl画， coc到hlaer V回国bular san植.lion (position end
nucl副 m111耐nant d暨堕圈’）＿ h88111
民 Glosaophlryr唱“ Ser回ry 同审-,nx, pc揭剧，世1hj of ton1J.1e, T电emn翩翩翩ynucl鹏 Ganer罩l s冒商atlon
Eu曲曲lan'llDI, ml幽B 圄町
Poshlrb，剧时 d W唱回；因IOltd body, N1蚓凰』880阳时U8 Taste; chernor四ieptlon,
铺即回d Sll'IJS baror赋精3也m
Motor ~o闹剧n归us m幽幽 Nucl-arnb踉I.I& S幽l阳Nlng

H甲归回国民 PertJtid seli-..町’｜田回，回回缸 gqlion lnlai口『圈ivBID叩『U相s S副阳lllion

X Vagus Ser田，y 问~.laryr咀鸟”d回·”soplwgu也 Trlgsnnal aenaory nucl鹏 嗣同aral aer唰Ion

里堕回重塑旦
lhonllclc end abdomn副咽ooera; aortic Nl刷eussolltarlus 阴阳ierel 甜圃’on. chernor田ieptlan,
以刘幅膏， aortic 田t相 berol唱cep蚀m

Motor SOft 闵阳饱＇ phar)nx，阳yro乌 U阁”ar Nucl凰aamb踉皿 Sp嗣白h，翩翩翩蝴

捕。由啤』自

Par圃咿npalli回le Thoracic 81回 abdaT曲回l 唱团嚣E Dor回l m啤宵 nucleus of Inn田咽lllon of cardiacπ'f.JSCle.
回吨’』S nrwvation of smooth muse幅
and g阳、ds of 凶，司由国剧A恤，
匈现自响．『由略”凶『y 由、d
gestroin田tnaitr回怡

XI /Ice田”’y 偶到nal Motor S睛”m四old and ’”回us muse!酷 Spnal cord Mα~ent af head a'ld st回uder
roo时
泪l H归>Og阳幡a Motor E削nslc 町回嗣同nslcmusd帽 of tnn9u11 l-IYPOE’”回l llJC幅us M刷町1ent al torc:iue
Tiieα>mponents are co以』『·α刘翩翩:ordl『啕 to th御街11Jr阴闹剧口rlgln (s”a嗣 Fig. 1.11 and R目. 10.2).

incl叫ing taste 6br跑回min世扭曲e nurleua aoliblriua of the
medulla.
Efferent nuclei
臼l the basis of their embryological deriva蚀。＇°＇ the efferent aanial
n町E nuclei can be di说dedinto 也m groups, ea血 l列ng 恤 a
也continuous longiwdinal column.
Nuclei of 曲e somatic e偏1rent cell column
耻，omaticdfer四t cell column Ii臼 near to them剧neand
由1岳阳 ofthe nuclei 也at s四dmotorfibr四 into the III, IV; VI and
XII ne:r响骂. The oculomotor nucleua lies in the 'VI回国l apex: ofthe
periaqueductal g可ofthe midbrain at the le\赳 ofthe superior
colliculus (see Fig. 9.13]. Its ef』回t fibres run in 世ieoad佣1otor
n回·e to innervate the levator 归lpebr悦 superio由 muscle 缸id all
of the emaocul缸muscles, except 由t superior oblique and lateral
配阳s. The 往配hi田r nucleus also lies 扭曲emidbra尬， at 也E
venttal border ofthe periaqueductal grey, but at the level of the
inferior colliculus (att Fig. 9.12). Fibres leave in 也e trocblear ner鸭
to innervate the superior oblique muscle of也E 句皂白ieabducma
nucl四E ia located h 也eαud.al pons benea也由e ftoorof也E four也
ventricle (see Fig. 9.8). Its effer白白 run in the abducerui nerve and
也ey innervate the lateral rectus musd巳 In the medulla lies the
hypogt明”1 nudewi (see Fig. 9.7〕， whi，由 innerva阳也ein回nsic
and extrinsic muscles of也e tongue via the hypogl”’alner陀
Nuclei of 拍e branchiomotor cell column
四ie branchiomotor cell column innervates stria能d muscles
derived from the embryonic branchial (pharyn伊1) arches. In 也e
t嗨mentumof也e mid-pons is loα时也.e trigeminal motor
nucleus, which 剧.pplies fibres to the trigeminal nerve and
innervates 也E E田des of mastication. ten四E 吵mp皿L 田lSOI 咄i
pala由li, 町loh归id and 也ean田ior belly of the diga血ic m四de.
h 也.erau也l pon由e tegmen'Wm lies the facial motor nudeu1.
白白 innervates the muscles of 旬cial apre割ion and the stapediwi
muscle via the facial ner呢 Within the medulla lies 也t nud四s
amb与UUI. 四is long nucleus sends motor fibr四 into 也e
gl。”。pba巧ngeal, vagus and cranial part of the 缸笛”。ry n四eto
innerva1e 也刷品cl.es of the 抖wy阻四d la1')'皿
Nuc，阳·of the parasympa由etic cell column
四le 归且可mpa由~c cell colwnn consista of preganglionic
parasympa也etic E四ron倒也at 阻id axons into 也e III, VII, IX and
Xcra皿al n~. The mo皿 m血al cell group am皿旬国 the
Edinger-W饵，bal nud饵”， which lies in the midbrain
periaqueductal grey matter adjacent to 由eo四lomotor nucleus
(see F拖 9.13). Its axons leave the brainstem in the oculomotor
 Chapter 10 Cranial nerves and cranial nerve nuclei • 101

CCL』b町阳tornuc椒』S

T抽出l晒阳曲UI

T啕画睛副跚跚y
nuck蝇』8

F翩翩l m糊， nucleus

Su阳ior-,

Ves也』la' aid _,,..•./ '

m曲learnuclel
Nuck到samb幅uus

N山’“saoH臼~us Dorsal rnotir nucleus

of the vegua

Hy陶口b嗣l nucleus

时·’”百四”－.atem W嗣dfromthe 由，... ..回回. Thedi咂'8IT1 illus！回回 the lex剧ons of the at伽町laanial 帽w nuclei ~EJll) and 1he 冒雨『剧
C翩翩lnervem刷I~咱ht). 。、 the 啕时， nl脯l shaded in the 翩me 倒our sh嗣 acommonemb明问阳l o啕1n ~嗣创so F阳. 1.11).

neni:and p酬 to the cilia:ry ganglion b 也E orl>it, wi:也in which
they synapse; from here pos增nglionic fibres innervate the
sphinc恼阳:pillae and cilia:ry muscles wi血面也E 句t
In the pcm也况也gmen也m lie two parasym归也etic 创i group也
由e superior 四d inferior aaUvatory nuclei. 咀e superior
salivatmy nucleus supplies pr咽nglionic fibres to 由E facial nene
由at 阳minate in the pteiygt耶alatine and submandi队tlar ganglia.
Pos耶nglionic fibr回击。m the p田ygop曲曲ie ganglion innervate
由e lacrimal gland and 由e nasal and oral mu回国 membran四．
四10se 岳阳n 也esubmaI回ibular ganglion innervate 也e
submandibular and sublin思Jal salivary glands. 咀le in缸ior
锦livatory nucleus 阳晒 preganglionic fibres into 也e
g1。”。1pba.ryn萨al nerve. 四ieae terminate in the otic ganglion,
which in tum a姐ds p值增nglionic axons to 也归rotid salivary
gl皿d.
咀le K电est pr电imglio皿c parasympathetic aill group lies 面也E
medulla and cons由l回 the doraal mo阳 nucleus of 也eva酬’
｛跚 地 9.η. Its rostral 阴rtion lies immediately beneath the
floor of the four由呢ntrid鸟 la也ral to the 峙院昭0嗣I nud田’·
Fibres leave in 也eva伊s neni: and are widely di由ibuted to
也oracic and abdominal viscera.
Cranial nerves
Ill: Oculomotor nerve
咀ie oculomotor nerve carries 由e majority of somatiιmotoruon1
也at iru阻四.te the extraocul.缸 muades responsible for mo由igthe
eye. It also contains pr甲nglionic parasympa也etic ne田四le&
whi曲， via 由E in国mediaiy of the ci1iary ganglion, control 也e
sm.oo也 muscle 回thin the 句巴
咀ie motor neurones ser世ngthe 回raoa由r muscles have their
创l lx对ies in 伽E 。adomotor nuclew』 which lies at 也e base of
也t periaqueductal grey of 由t midbrain at the le叫“也t
superior collicul田（Fig. 10.3）.民唱imglio皿ιparasympathetic
E四1I0nes ari民 from 也E neaxl:亨田ingu'-W国甲hal nucleus
(Fig. 10.3; see 山 自g. 9.13). Pi.bra 企om both SOUial mune
ventrally 由rough 也E midbrain 也gm回归m, many of也回1
trav回ing 世1e red nucleus, to 回I on 也e medial asp回 of 也ecrus
 巴些…~ I

SUpe阳晒lic:ulua a四”’－
’ ,,,
－，.＿「

阳i剖u创u幽l g明
自量nger-Wes抽al
mm』串
Cer曲帽l aqu蝇』ct

。culamolor nuc椒』’
Medial long阳dlnal
faack:ulua

阳d nuc阳』S

Subl坦ntla nlgra

伽』阳notorne隅

Fig. 侃3 T,.n””’翩翩翩’－ugh them蛐，.in.tth，阳velofth• 剧””『回lliculu‘有ied闻四n sh口晒 the origin and cot』1'88 of oa.』lomoto『
nerve 自bras within th国 brains饱m.

也rough contraction of 也虐，pbioaer pt』p迦ar muacle of the 胞

也回 mlucing 也z amot.皿 of light miching 也E E由Ia. 咀i山
known 笛 the clira:t light reflo: (Fi岳 10.6). Evm if only one
Rtina is illuminated (1巳g. d\lling d皿αI ex:amin甜叫“四
pupils of both 句回 constrict. The cons位iction of the pup姐
。fthe non－皿uminated 句哩 is called the consemual light
Olfa幽rybulb rdla. 咀le affe:r四t limb of 也t light rdla consists of a small
∞础J8mlOf 叩世世act fibtta 也at pass 也配tly from 也e eye to
也t pttt回al area.
i四 m由al to 郎，uperior co.监culu岛 m血a
αk剧时 than to 也e lateral piatlate nudeua of the thalamus, wMre 也z
majo闹。f由叫他回国min.ate (tee 也o Chap阳 15).
Optic 阳WI
Neurollel of the pre缸纽1 area proj回 bila皿ally 也由E Edinaet-
Watphal nuclei, from which efl"er回t fibres leave 扭曲
饵”lomotorner呢

Accommodation renex
Oct』lomot>『阳”W
Pmtion upon a nearby object, by conver伊m of the optic u盹
Po『幡 in喃Ives concomitant 倒回缸岳阳 of the ciliary muscles to 画aeaae

lnte咿eduncular 由eco回回ityof 也E len岛也uafoa血11ing 也e image. It is alao

follll aamnpanied by pi早出aJYa>n由iction. ’Ihe phenomenon imol·，自
由£viii.皿 αX筐’马 W恤 COi也X>bulbar fibra 缸岳vatingthe
Fla. 10.4 V.阳t帽”喝啤 of h bniln ahowlng h 阴阳市 of
剑”ch’”鹏 of cninlel ner唰 1,l•nd ”也 paIU)'ID阴thetic neurona of the M皿ga-Watpbal nuclei
bila回惠lly.

但由ri, wi也in 缸 in也rpeduncular fossa （民g. 10均 鹏也o F地．

IV: Trochlear nerve
10.9). The oculom悦。r nerve pa ”“between the 院到国ior cerebral
The thin 世时II.ear nerve contaim only 10matic motor neurones.
and superior cer由ellar ar四”。ee Fig. 7.2｝，也由 runs an田iorly,
叼\ese arise in the tr副主l四z nud饵，1, which lies in the v回国i
刷鸣 i且也明卫 of 也.e ca.ven回国也UI (lee Pig. 7.11), befo~
part of the midbra画 periaquedu也l grey, at 由t level of the
gajning aa:四 ω 也E orbit through 也z 111paior orbital fissure. The
M阳iorco血四lua (Pig. W.7）.岱le elier四t 篮。”严SS donally,
oatlomotm nave supplies all of the emaorul缸皿.uacl盹 with the
around 由E periaquedu血1 grey, and decuuate 扭曲e midlinι 四le
a属同on of the superior oblique and h忧国 re由』a and, thus,
trochlear nerve emages from the donal aspect of也E brainatem
也z四om to elev现鸟 d叩睛， and “duct 也t 句由all (Fig. 10.5]. It
（也叫7 四nial Il£rft to 由四） just ca啤I to 缸 in缸。r
also inner唱国也翩翩d mwde of the leva1阳阴阳:bme
c.ollicul国 仍g. 10.8）. 四e now rouaes round 也 αrebral
superio.U, serving to devate the up阳 eyelid. 自鸣声nslionic
peduncle to 职in 也e '¥ell田l aspect of the brain (Fig. 10 .9),
归ruympa也me neurones from the 剖in伊－Westphal m出u’
terminate i且也e ciliaiy ganglion. located with扭曲e orbit, behind ” Sling be阳回E 也e p。“自讪r 但由ra1 and superior 也rebellar
u回ies （附 Pig. 7.2), u does 也e oculomotor ner四. It 由皿 rwu
也t 句哩：ball 耻om hen马 pot咽nglionic n四rones run in the 曲ort
anteriorly, M吨扭曲e h阳al wall of the cav四lOUS 归国（see
ciliary nerves ta innervate the aphi配田（com缸ictor) pupillae
F句~ 7. 11）幽d 四t由也创恤也rough 由em严rior orbital 也剧Z也
m1』acle of 也e iria and the ciliaiy muscle mntained w世曲曲e
It ruppliea just one mlllcl皂白e mpaior oblique. The ac:lion of
dliaiy body （胞也0 Fig. 15.2).
由E superior oblique ill compla Depmdi吨回也E 归国吨
Pu，ρi/1邸，y light reflex 院凋ition of the 句eball itαn act to dqm，也 abduct or intort the
回le amount of li阱ctente血g the eye i，鸣曲M by the me of the
pupil. Illumination of the Mina cauaa con’也iction of 也阳pil d叩ra1es the 由ual am.
“
句也 lmportan:郎 with the eye ducted, the supe由，r obliQl后
 Chapter 10 Cranial nerves and cranial nerve nuclei • 103

＆』阳'iorn睛，s l响曲robli明ue Inferior刷喃自 Supe而ll' rectus

~
La恼耐 racll』S
Medial La恼ralrectus
『回扣s

In伽暗z recllls Su阴阳oblique S阴阳oblique l『白而E nlClus

’ ”
Fig. D.I E movement ’”’ught about by 恤··皿m创泪阳 mu8CIH.

阳i叩创u由l
g『哩，

Ecai阴『斗幅“phal
nucleus

民R树 nucleus

Crus 帽ebri

Oct血:mo曲。rn1，帽
P咽illary ams1ridor
阳帽deofiril Cilia『Y俱nglion

Shcxtαl町 nerve

Fig. 恤， Tran’””’割据lion 笛”啕h笛” most l'Olllral part d恤， midbr菌1. Thed闻ramsho晒 thepalhw町z involved in the direct and consensual
阳pillary l阳ht re阳则8.

l阳rcoll阳l惜一＼． VI: Abducens nerve

...－－『＼
咀1eabduαm nerve, like 也e trochlea再回1tains only somatic
mo刨出urones. The all bodies of origin are loca:时 in the
Cerebral equedud
abclucm1 nucleus, w挝也 Ii四 b四倒也由E :Door of 也t fourth
田面de in the ca叫al 萨ms (Fig. 10.10). Effer四t axons 田田配
丽itrally 也rough 也E po田缸ul emerp: from 也e 四ntral m也m of
也E K垣皿阳n at 由ejunc咀m b~ 也E poru and the 胃ramid
of them础Ila (Fig. 10.11 ），耻 nerw 曲回归sses anteriorly,
也rough 也eca陀mous siDUS (see Fig. 7.11) and m侃” the orbit
也rough 也t superior orbi钮I fissure. 咀ie abduαns supplL创世le
Ia·也ra1 rectuB muacle』 whichabduc凶 the 句尼

......._ supe耐锦得bellar
＼ 削uncles
V: Trlgemlnal nerve
I ""'- 咀le 创胆回国l nerve has bo由 S四”ry 皿d motor compon白银－
Crus 帽曹bfi....../ " -Subslantia nigra It is the main 阳uory nerve 怕也e head 曲也 addi由Dally, it
F阳.1队，7 Tran刷嘟” section hough the mldbniln at the level ot the innem.J田 the muacles of mastication. It a幽幽幽 to 也e brains田n
·由rtor colllculus. 节18 d问rsmsho明伽e l民划on of the trochlear nucleus 画 two adj缸回t root& (a large &elllO可 and a smaller motor root)
and thee剧用自 oftrochl制u nerve fibre唱． on 也E 观~trola阳al aspect of the pons, where tl世s me嘻臼 W挝1 世le
middle m由ellar peduncle [Pigs 10.1, 10鸟 10.11).
四le S回sory fibres wi也扭曲t trigeminal ner鸭 are 萨归iary
阳1aory neurones wi也阳圳ieral processes di盹ibu时， via 伽
104 … NATOMY I

Superior a>lllculua

; In制。rcol阳lus
气、

飞｝－一－ Tit刷刷『『回w

Supe阳
ceraballar
阔咀蛐

Middle
ceraballar
peduncle Mediallem而ICU8

F幅.10.，。 Tl'IMV81'9…Gtlon thro啕h ’阳’“udal pona. Tha diagram

shows the lo臼tlor、 of 廿w abducens nucleus and the course of abducans
「丽附他>ree.

F幅1. 10.8 DorHI …““h b,...’”,.n.rem”’II of1”

。”!Milum, lhow ”…origin ofh cru阳1 ”’回 IV.

Ttodll如鹏飞 向ns －.＼ 吨巾I nerve

Tit剧协arnerve

Glouaphar刑aal v副bLDxichlaar
T句emi唰 ne隅 M创Lilla 向ns 『1et'ie n阳ve

Fig. 10-9 v.ntr.I

mtdY.
””ct ofhb • •howlng cnini.i rwr咽”’11,IV Fig. 恤，， Ye”’.. ...嗣t ofthe brain st翩翩啕 th’”lntsof
.nachrr丽而，fen时刨闹仰” YI-民．

、 刷刷d翩翩翩唰盹 W刷明
A创M cran恒l 『W喃 palsy (Ag. 10.1到 Is E剧副 by a lesion of the orbit 阳pe巾rαbltal 他SU陪 synd『ome) and within 由E O『bit. There they
α::ulomotor nucleus w恼1in Iha midbrain or by compr四;sion of 甘、自 arewnar也阳 ωαxnpre臼』m by rumours and an剧时回ns. 节回自慌副s of
因『ipheral course al cranial nerve Ill by an an凶”窗n or 11Jmou『. It la回s such unlate『al lesions are:
to drooping of the fJI/刨id (pto副a), dilation of the pupil that is unraspor百阴
阳 l泪ht 副部倒TIIT回alien, and an inability to move the fJI/由副l
• P1o阳．
upwa睛， downwards or 阳自由｛adduction).
• Dilation of the pupil that is unlllsponsive to lght or accommodation.
A lesion of the trochlaar nerve 阳 man阳t by diplop旧 on lo剧ng • p，嗣lys隐时创l eyamovemen恼（oph恤aim。”吨副 causing doub恼
n时｜砌则依附翩翩问．附创刷刷ng down幽l陪）． vlslon(dlpl。”’）．
A sixth cranial 帽W palsy 归自. 10.1 苟 恼 caus剧 by a lesion of the Mult~le sciero：曲曲n d阳t 锅内昌 m趴砌ner吭s through demyelnatlon of
abd.后ens m刷刷sin 廿w pons or byα>mp晦skln of the peripheral the medial lo呗ltudhal fa.so阳us In t栩 brainst阳l，圳、胁 hterfa嗣 with
C剧响。I the ner.咽 by an m创阴m or l\lnour. It 悔创s to an lnabllty to oon]ugate ocular d刷刷刷. Ty回oally, on horizontal gaze, 1网 abductI啕
rTIO\得 the fJl/9 outwards t由ductton). 创18 mα188 nonnally but the edductl啕 W咽刨阳 to folow. Adduction Is
Combln回 lnl创er＇创 p由嗣 of cran恒J ner唱IS Ill, IV 町、d VI oc剧『怕m W臼erved on conver阳回阳”muclll•r oph阳Imo回•111• ls the 田m
脑阳市s Blong the~ p创川、er＇副 course where the nerves run ad]ecent to 崎国 ω 也哩。rtle th悔 d阳rder (Fig. 10.1 句. See also Ag. 10.27.
each other, such as w胁In the cavernous sinus，刨出e entrance to the
 Chapter 10 Cranial nerves and cranial nerve nuclei • 105

<w
／－「＼

、h

‘---
画、－『兽，－
••..

｛~

oi1
F幅．饱饱问阳。由lom例，r(lll)ne附 pally. 肉 Sha响 ptosls on 廿w
~ght. 回 Sh侧sthat, with e阳回on of the eyelld, the w曲创l can bes捕llO
be abduct，回 and the 阳刚l dilated.
Fig.10.15 Supe而cialdi’“M笛”。， ..，嘟”’简bruin 筐’－笛， ..
divi圈。”’“锢，， t啕emin11nerw也

oph也alm.ic. maxillary and mandibular divisions of 也e trigemiDal.

to numerous 姐回皿 of也 head (Pig. 10.15). The sel!.llations of
touch，”回ftlI马 pain and 田npera阳re are 时却'ed from 也t 匈α
and scalp，也ecome也 the nasal and oralαviti饵， including the
阳也姐d 思JmS and 也E paranasal sinuses. 哑回国胆ninal nerve
al.so 旭n町a倒也E in国.cranial dura ma阳缸姐姐.tracr皿ial
缸四”. In addi由钮， pr1呻ri。但p由-e fibres m 臼rriedfrom 也e
‘·』
~
muscles of masticatio姐姐d 也E temporomandib世z joint. 咀le cell
时.10.13 U翩翩d翩翩’阴阳四川崎. On lcoklng In the direction of bodies of affiR!ltll 扭曲E 回事mirutl nerv巳 wi曲曲E creep世on of
theerrow，廿引自 left 创向自旬’s to abduct. 也田emn啊，ing propricx鸣曲n, are lee.a:回 in 趾国萨minal
（缸 ’四ilunar) ganglion, located at the con胃唱~ofthe
oph阳lm.ic. m四II町 and mandibular nerves. The central
processes of these cells 回minate in the 创gemlnal sensory
”
nucl四a (Pig. .16).
h 剧院minal 回国1rynu也us is a lar萨 nucleus which e:x国ids

ζ~
出ougl:un皿 the Jen剖z of the brainstem and into 由.eupper
但vical 币nal cord. It is mnsidered to consist of 也ree subnuclei.
The chief (or p血dpal) amso归.ucleua lies in the pontine
”伊1白白m d棚 to the en町 of the trigern副al nerv巳 The
mes四届庐alic: nucleus mends rostrally into the midbrain. 四lC
在

(!,.1 、‘L spinal nucleus (or nucleua of the spinal tract of 伽刨gemlnal)
也能nds 饵U<iaUy ~the medulla 扭d into 也e cord, where it
Look ti left
becomes 倒1也tuouswi也由t substan咀a gela也lOS岛。fwbich it is
considered to be the brai皿恒m homologt血
四田E is a u事吨~能d distribution of afferent fibre tennination in
也E 回伊旧nal nucleus, d叩ending U归n 也E mo也litybeing
served. Fibres conv可恒g touch and pr回皿血恒minate in the d咀d
\ / nucleus. 刀10se ca呵ing 阴in and temperature 回d in 也e s庐tal
nucleus』 reaching 也由回mination by d臼但ruling in the sp恒且l
国ct of the 创8CIJlinal, a fa回de of :fibres lying 恤mediately
SU阳咀dal to the nucleus (see F晤’.5, 9.6). In 也.et仰自由司al
co削哩rge
∞此也t 制nal 田.ct of也t 国伊n凶alb缸om四∞且也回国 W挝1
日嗣.uer’s tract. which ami.四 functionally homol咱:ous affer四” d
spinal n£IVe origin. prior to 也eir 田mination in 也e dorsal horn.
Propri以叩世ve affer回.ts deri院d from the mutcles of mas位“世on
and 也e 但mporomandibular joint have their cell bodies not in 也e
tri伊回国I 院nglion，” might be a:pected, but in the
mesenc叩halicnud甜sof他回事eminal. 哑可 are 也e only

@ - Loe岖’口『lght
Fig. 恤’4 Irr阳muclear 叩忖阳hop』eglL
严imary affe:r四ts to have 也曲创l bodies loca回d wi出扭曲e CNS.
Amos 缸斟且g fr四1 second叫order neurones in 也t 创伊旧旧l
nuclei.皿 dea血sat£ to form the mntral世ral 住iFnbto也ala皿ic
tract （回ge.minal lemniacu1). This 阳回m国 in the contrala阳al
verI田l posterior nucleus of the 由alain田，咱ich in tum sen·也
106 … NATOMY I

Tri”’ni『耐回1111ic fibl'll to h wnlral

posterior 111cleus of Ille Iha阳ma

M”enc翩翩佩翩翩

Chief帽’町 nu曲UI

Propri创啕阳

TouctVpn11阳”．．．．．

问凯.－闵咄』re · ..•.

Trtg11T1inal g111111lion一／．．．．．

Nucleus afthes回n国｜
阳doft，，也蝠，minal

Fig. 蚀” Thebr唰翩翩 M嗣ting h locatlon of the t啕Mnln•IHMDl'JllU伽••dbllUI睛。，翩翩倒回国”·．

T句自minalsa帽呵
m』clau1

F崎.1队W ”
Com I Nfla. Sensory neurone, blue; motor neu阳市白， red.

fibres to 也E 键morya>r回 d仕腿”rietal lol提. In d幽ion to 也姐

回曲wayforCONC阳回侃侃reoe鹅 the trigeminal nucleus alto
Fii品’”’·”“..... CO!.崎hNft”“.M抽回t伽郎『T献巅泊、g 阳
leDdl fibra to the cmbdlu.m and mabl趾ia a number of zdla
M
州四

sneezer回阳 rx'lf嗣 融.181rated. Sen9ary 阳JrOne, 帧』e; rr刚't1f neurone, l'9d.

旧？明川

αmntttiom withαrtaln m悦。r cell groups of 仕.e lnaimtem.

厂｜ii

Among 6回E ii 由 facial nu幽幽幽rot唱l which att mediated

facial grimad鸣 and eye cloautt (corneal n曲z)in~阳回 ω
nα皿oua stimulation in the 回首臼rysa硬d by 也etri萨minalnerve
币g. 10.17). The IDUR 皿d cough rdEe& are ini·也:ted by
a伽'ell.U running 恒 dth~ the trigeminal nerve (from nasal
muco叫 or the vagua R筐’e (from larynx and 田曲“.） and 四必吨
”
in the 国萨minal m ry nucleus. From her也 indi配toonn仅tions
“
arem e w灿也.phrqmatic. 皿.tercostal and abdominal muscle
motor neurones for 也e forceful apullion of air, 缸uiwi曲曲t
nuclewi ambi’“恤ne:rva:由lg 阱wyn伊I 皿d lar归伊l muaclea
σlg. 10.18). In the jaw Jerk. d跚跚回归田槌ion d也
mandible 四m由国 propricx甲旬m in 也E 回nporalia and
mulle'恒 mwclel.A曲Z回t 6bret run in 也e 回伊回ml nerve and
mUIC抱
establilh monolYJl.iptiCαmtact with alpha motor Dftll'OileS in 也e
trigeminal motor nud剧，也I U阴阳 wne muadel {Fig. 10.19). 时．恤” J•叫，也 Seneoryn刷刷，， blue; motor 阳市盲目，刚．
 … 10 Cranial nerv臼…

~· M嗣.， th9 lflaMll ...…
”””画”W In幅ction d 怕’帽胃呵，因Is of the 同emlnalne隅
。•hi唰唰嗣ds to pail and 阳削p1ion d 唰C悔阳加剧 to 阳
由rma阳、自瓢.->Pl嗣 by one er other of 阳帽hlhalmic, maxi阳ryand
mandiblJar b刚刚隅。f 阳啕eminal 闹闹．
In 嘟”o~i..c地附菌i c的他如n of 阳 m础』胁 倒Jdal to 酌，
似』rth vent『捻幅阳dato 阳，他renUalαll11Presslva di部佩剧阳、“
鸣”t:U串串串伽g 啕em nothalamlc ’b睛， ωω同翩翩崎 bssof p由自nd
W叩W由t'9 98nSlbll1y (dlel制”“”””’v t ’”:) In the 阳目．
四iemotor a皿n• of 也t 创胆回归l nerve ar耻 from cells in 由t
trlumiinal motor nuclew」 which liea in the pontine tegm四”m
and 阳”la•巳姐d alao 由国1刨出能nsation from part of 也e
alttDal ear. 币le 创l k对iea of primuy affu四.t neurones lie in the
geuiculate pngllon wi1hin the fad.al cmal of the 严筐OU&
tml萨nlbo皿叽1£ cmtral procnaa of talte fibmi tenninat£ in
the Z回国l 严n d也~Dud囚111 mlita血，。f the medulla.
A缸嚣叫i鸣 6bra 台'OD\ the nucleus aoli田ius pro如ct to the 胃ntta1
阳”阳ior E配leut oftbe 也由mw』回tlch 园”m 段ndsfibra to
也翩翩Y cor恒 of the pari幽I lol比 Afferent 副al naw fibres
也at any aJtane以u aenaatlon t.ermin甜面仕le 刨胆回国l nucleus.
Motor fibre& of the fad.al nenoe originate 扭曲e fadal motor
nucleuaof 也e ca·叫al pontine t喀皿entum (Fig. 10且｝．四ieaxon1
initially pus dorsomed且l岭， lo咿ngov自由E abducena nuclewi
b四eath the floor of the 岛四也回ttricl巳 before leaving 也E

medial to the chief 1emmy nu.出田 间. 10.2}. Amns leave the

严ms 扭曲t motor root of也E 回事minal and tb四 join the
mandibular division of the ner晚白可 inner咽te varimu mwde也
the most s增ilficant of which are 伽t muscles of mastiαtion
(masae阳 and temp。”Ii也 which dose 也e jll'毗姐d the U能回回d
medial pterygoida, which op四也t jaw~. Tr帷m且al motor
neurones a1ao innmate tensor tym归ni w讪U且也t m凶dle ear,
temor wli pala剧， mylohyoid and 也e anttrior belly of dig;utriι

VII: Faclal nerve

’l'he fad.al nerveαmtairu 1e:naory, mo凶’姐d p笛事句mpa血et1c
mmponmtl (Fig. 10.20}. It join& 也 b回皿缸nat 也
~回I upectof也 cau也1 po111 (Fig. 10.11), near 也
pontomedullary junction，蚀 a r唱阳1 known as 也
但由di。”副m angle. The nerft CODI副 of two roe鼠也e m幌 M幅副
h忧国（tometime， αlied tbe J1emJI 缸阳medius) containing 阳miacus
能回ory 皿d parasympathetic fibm, the more medial root bei鸣
composed of motor an皿
四te armory fibm of 由e fad.al Jlerft submw 国tesenaa也应 崎.1D.2t Trm,..,.,..aallan 由rough .＿四”‘ Thad吨ram sh阳E
from the 咀.taior 饥协也inia of 也 tongue. 由e floor of the mouth 怕。啕In 11nd coura& of 阳 motor 伽回 of the徊。al n町ve.

Laaim1lg恒M

← 创阳ior saliva\ory nudeus

同BIN句翩阳”叼阳1 ) Fa:涮阳翩『阳却UI
Ger翩翩曲，ganglion

灿a阳路”融曾回

To 归pedila muacle
仙，，阳棚·伽l刷目ftongue
S切口m嗣刨d 伽胃啊，n

Chol由韧npani

To恤恒l muscles

Submandlbul1r Mlivlry gllnd

时．唱队”。酬””•nt flbrea of .＿旬cl•I 闹闹，nd 曲，Ir perlph.,.I dlstrttM刷刷. Blue: 9'1n8ory: or呵，： motor: pur阳： W鸭”nglonlc
阳asympalhetlc; green: postgangllonlc 田res阴阳阳也．
108 • NEUROANATOMY
Crusce『鸭”
缸”rtcr ollvary nucleus
D回事alcx则由嗣rnuclaus
F阳.10.22 阳阳”l 嗣帽，ding comectlons of the aud阳W 阅mponent of the veetlbuloco曲l倒rnerv也
brains惚皿旭也e motor root of 也e facial ntt陀 Motor fibres are
曲创buted to 也t muscl髓。f facial exp!幽阳， pla.tysma.
stylo峙。id. 由E posterior bdly of the dip血k muscle and 也E
stapedi田 muscle of 也E middle 回E
咀ie facial m。”r nu甸回回娼”s affer回b from oth配 braimt回E
缸eat for 世1e mediationof certain reflexes and abo from 也e
αrebral corta Reflex connections are establ.Uhed 也at mediate
萨。脏tive 句t closure 旭 E哇’“1se to visual stimuli or tactile
stim叫ation of也 cornea （四meal re8tt）也rough fibres from
也t SU阴阳∞出四lus 血d 也e 回geminal m皿rynud晒
“睛”l ham崎hlN
Super阳回响阳帽l gyrua
胁dial g回l阴阳le nucleus
幅ddle ce陪bell笛”也』nde
幅ddle ce『回到国lar”曲时，e
·Trapezoid body
In自E『ior 阳曹bel脑网LS1cle
Medulla
lnfa阳 oll回『yn叫蛐
时ramId
mpectivdy. In 剖.dition, fibres from 由e superior oliv町 nucleus
(Fig. 10.22), a part of 由tαnttal auditory pathway, sub阻，e rdl.ex
田n国ctionofthe 皿甲edius m111cle in m归田εto loud noi脆
C.Ortico队tlbar 岳阳回击。m motor cm咀c.al are笛面ner四位也e
facial motor nucleus. ’Those that control motor n四rones
suppl抽ig the muscle9 of 也.e upper face (fron时is, orbicu1aris
oculi) are 曲创buted bilaterally. Those that control 也e motor
neurones su酣抖ng 由e muscles of 也t l阴阳 face are en·笛rely
ω”ed.U皿la田'al upper motor neurone l回回岛由配由赂 give
rise to paralysis of 也E 倒itrala挺ral lower facial muscles.
 Chapter 10 Cranial nerves and cranial nerve nuclei
民唱imglionic parasympa也eti.c fibres of the facial n町ve
创蝠nate in 也E 皿严rlor salivatory nucleus of 也t pons. Fibres
I四”也e brainstem in the S四皿ry m帆 of the facial nerve (n由u’
in回medius). From here. they pa腿 to parasympa曲etic ganglia,
namely the submandibular and ptery脚ala由e ganglia. where
th叮 synapse with pos耶nglionic neuron回．阳，耶nglionic 矗bres
丘。m the submandibular 郭nglion inner咽te the submandi队Jlar
and sub！画gualsa且.vary glands. Th创e 仕om the p回ygopal剧m
胆nglion innervate the laa恤al gland and 也e nasal 皿d oral
mucous membrane&.
l\\. Bell's 问
Bell's 阳Jsy repres阳市 m ll(;Ute unllater刨 In由amm阳r/ 悔sl阴。f Iha
恒clal r回附 In Its cou陪e throogh the skull. Pan Is exi口E『阳宫时 aroo.』nd
t闹锦r ar回 th脚 Is PBl'll加Is of the f叫“ m.JS由s unlaterally, with
幅llure to clo锦 tha 酬， m ab阳tt corr回J reflex, hy阳翩翩 on the
d阳恒d side end loss d 恒ste s四凶阳、 m the ente『ior two怕1rds of
the tongue （：割据 a嗣 同.10.2η.Wh白白E herp臼 zoste『呻us Is the
inflammatory agent, a 协白白ular ra由 is ap田r田11 in t阳西到自由naJ 副ditory
canal and 甘、自 mucous memb阳市 d theαuptwynx (Ramsay Hid
”””me).
VIII: Vestibuloc。chlear nerve
咀le 咱tibulocochl回z nerve is a sensmy nerve 阳tcon呢？’
im.pul附齿。也由e 旭ner ear. It bu two com严ment p缸”：也E
审atibular ner霄， which 也tries information 时ated to the 严汹汹on
and ma呢皿四t of 也t head. and 也e 四chi田Z DerYE, 咐lich carri臼
auditory in岛miation. Both divi匾。ns oontain 也eaxons of
缸吼叫order 担DSC可 neurone鸟也E den由t国 of which make oontact
明白 hair 创Jsof d也er the vestibul缸 or auditory 叩＇para阳s of
由e inner 回r. Both 世visions pass to尔也n 也rough 由E in也mal
auditory mea钮’（which al，。 conta旭s 也e facial nerve）缸ld
attach to 也e brains凶n at 也e junction of the medulla and pons
(Fig. 10.11), in the z唔m h饵”1 幽也e cerebellopontine angl巳
The vest曲ularnerve
咀咀嚼盟岳阳J.l.ar nerve fibres make d四.dritiιoontactwi血 hair cdll
d也E咽曲血r portions of 也e membranous h阳inth；也由 cell
bodies are located in the W!Stibular ganglion 明白in the in但mal
auditory meatu.s. 咀1e rentral pro四”es ofv四ti1n且E 鱼bres mostly
回d 姐也e 畴，tibular nudei of the rostral medulla. 四m are four
饥础 nuclei {superioi; inferioi; medial 矶dla艇ral~曲叫ar
nuclei) located d础 ω萨ther beneath the lateral p笛t of 也e floor
of 由efour也 v回国也
Thevestibt血rnuclei es凶.blish contacl w讪 a number of other
E唔m for 也e ro血ul of posture, m血田ianreof 呻.rlhD:rium,
coordination af head and 句ema晒nent也皿d themmdoua
awar回翩。fft到bular 而mulation. Fi阳回岳m the lateral
m伽Jar (Dei阳的 nucleus 幽值ld ipsilaterally in 由ela:回
ves伽阳”nal tJ:皿四eves曲ular nuclci alao con回.bute fibres to
the medial lo剧目tudi且al fudculua. 四画也但nds 也roughout the
brai皿回1 缸id into 也E spinal. cord; its d幽但ndi咱 compo曲曲t is
also lmown aa the med坦I 咽tibul回归al 国.cl. Vestibul田回nal6bmi
influmre the 剧唱lity of 1pinal motor neurm田 c:oncDDed 响曲曲E
四ntrol ofbodyp田ture and balance. 咀le asC£I时ingpa且 of 缸
medial lor晤tudinal fa回aJ1us 回旬iblishes connections 回仙也E
nudei of曲曲ducens, trocblear 刷刷lomotorner晒缸阳
αxm:lina画onofhead 缸id 句oe lllOY'elJleilts. Some efferent fibr四 from
曲t现stibul缸 nuclei pass 也rough the 旭阳ior caebellar ped回国t to
也t 8oαulonodular lobe of theαrebc业！um, which is cone田led with
也econttol of 同创且M担m. O由er fib瞄豁出td to 也e conttalateral
也alami田〔vmtral. pos回ornucleua〕， which in 缸皿闸由回由E
但由al cm皿 The cortical i:qion responsible 岛·rem回m
却阳回酬。hes曲时.ar sensa:世m is uncatain but is probably
adjacent 臼由e 'head’ area of 阳晒回可 oorter: 扭曲归rietal lobe
or a啕缸:ent to the auditory cortex in the 能mpomllobe.
• 109
The cochlear neTVe
咀iecochl但r nerve fibres make d幽幽itic contact 明白 h甜甜la of
the organ of Corti wi也且也e oochlear di.皿 of 也e inner ear. 哑le
cell k地iea of these fibres lie wi也m 也e oochl四 and are
oollectively called the 叨iral ganglion. 咀ie rochlear nerve joins the
brains阳n at the level of the rostral medulla. Its fibres b凶皿ate
阻d end in the dorsal and vmtral cochlear nuclei，咐1ich lie dose
ω 也e inferior cerebellar peduncl巳 From here, the 部ce:nding
由ditory pa也way to 也e thalamus 姐d cerebral corte:J: 阴g. 10.22)
ii somewhat more com抖icated 阻d 四riable 由皿由at for 也
gEDJ田1 senses.
’There are ~ !orations betw田n the medulla and th且lamu1
where axons may synapse and not all fibres 且也e pathway behavE
h 位t 锦me manner. From the oochlear nuclei, second叫order
neurones 揭出td into 也epo鹏 some of them crossing to 由E
。也er side of 也e pen由法也gmentum as the tr富.pezoid body. Al
,”
也is level me fibres may 回mi且ate in the superior oli回ry
nucleus. 咀山 nucl回』＆ is the site of ori国血。f olivocochlear fibres,
whi由 leave 也E brains恒四面也z vestibulocochlear neive and end
h 由E mgan of Corti. 咀句 have an inhibitory 缸且dion and 阻四
” modulate 回rumission of auditory inform回m to the co副ear
ner陀 From 也E superior oli:咽ry nuclei，”但nding fibr霄’ comp由e
the lai缸”llem跑回，，咐lich runs 也rough tbe pontine t喀mentum
to 四d 坦白E 旭ferlor colliculua of也t midbrai且， Some 缸ons
wi也阳也.e lateral lemniscus 回minate in a small pon也1e nucleus
αlled 也e nucleus of the 1世ral lemnisrus. 哑ie superior olivary
nucleus and 也E nucleus d由E K阳allem皿阻JS are thought to
establish reflex oonnections with motor E四阳ies of也E 国ganinal
and facial motor nucl画， media:由ig c.onttaction of the t田里or
tympani and stapedius muscles in response to loud noise.τbe
h如ior CD.皿αUUI I四ds axons to 也e medial genlcuhrte nucleus
of 也ethalamua. 哑ie final step 迦也e ascending auditory pathway
comi.sts of u.ons 由a.t origina恒 in the medial 萨坦坦ililte nucl四S
曲dpaas 也rough 也t internal capsule to 也e prim缸y 甜温饱ry
α>Ito: of the temporal lobe.τhia is located predominantly in the
国皿阳回回.poral gyri 但晒l'a gyri or oonvolutions；四 Fig.
13.17), which are situa时 on the upper 皿恤 af the superior
temporal gyms and, therefore, are largely hidden 响也in the
la回l 也SUl1巳咀roughout 由e ascendi吨 audito可 projecti盹 there
exists a 卧臼lled 'ton例。1pical’但presentation of 也.e cochlea, which
is analogous to 也E ’”＇matotopic' o耶nisa由n of the pa也ways for
萨neral 8四sation. Wi由in 也t brains出m, 曲me 幽幽幽ng:fibres
decussate while O由四 do E吼 τhe represen钮.tion of the 由出lea
is, therefore. bila:国al at all lev由 ro由al to 由E 田chlear nuclei. For
也is reason, 四曲缸al lesions of the ascending audi臼，rypa由way
do not cawe monaural deafness but, rathe耳 m manifest as a l侧
。｛ auditory acuity and 扭扭ab副ty to localise 由E directional
origin of 跑回ds.
The E唔on of the temporal lobe surrounding 由t prim町
auditory cortex is known 笛 the auditory uaociation cor但xor
Wemicke’I ar回a It is here that auditory information is in能甲配时
andgi把neon:也血皿I sign温.cmce. Wernicke'a area is important in
也E F民圆白哩。flax唱国萨 by 由E brain （口iapta 13).
~ 翩翩eneurom•
阳 mαJstlc 咽』roma 阳 a 嗣同均n !Umcll.，。f 问啕帕 C『町、leJ nerve thllt
leads to comp明白n of 甘19 『'9l'V9 end 回阳;,ant s刷刷刷 In Iha
”nlbelopon笛”’咱崎 A阳d<s of d国k回s ecccmpenlad by
P阳found 由坦青iess occur t出坦 also Fig. 10.2η； w抽出因nslon of t悟
tuπm』r, at四a and paralysis of the cranial neM坦｛笛回武:ially v-vll) and
the limbs follow. Unilateral and bi恒teraJ a固崎tic neu阳nas ooou『 h 甘南
inherited d幅倒娼”四”tlbromato幅幅， in which tumou『E d 甘冒
peri阳刮 nerves 副 skin h四Jrilemmoma 耐用U『ofibrom叫回
回U回 oosm副c 剧目mish and 由fonnity.
110 …

肉”

W到耐bulooodllear
nerve

阳。伽蚀。f
←Roa自由d
W陶阳”l neMI glo88opha阴阳l
and V啕us nerves

Cranial root of
翩翩。咿 naMI

印刷d

S刷刷 roalof
翩翩翩町阳’幡

Fig. 唱队” V•四”1 ”’“t of 伽• bnlnmm •h-lng ’圃’ pain or mm曲mmnt of OFMlal n•rvu VIII「XII.

IX:Oloss。pharyngeal nerve
咀le glOSIOpl回归移al nave is principally a sensory nezw,
al也ough it alto contains p蛇”nglio国c ~aruympathetic fibres 甜d
a few motor fibrel. It a出dt.ea to 也t k咀且’但m as a lin四r series of
small rootletJ, la田al to 也t olive in the ro&ttal medulla （目， 10.11,
10.23).
Theaffa四t fibra of the glouophar归，alneIVEamv町
Nucleua
information 岳阳：
amb电UUI
·跑去叩tonfot 伊neral aenaation in 伽t pharym, 也E P饲阳ior
third of也etoo忽略 Euatachian tube and middle ear
~
• 'Il1ste buda of the ph缸归u 副d 也e posterior也iniof值ieto吨ue
con!
• Chanor院哼toRin 也e 值rotid body and baror配哼tom 姐也t
carotid linm
句mp幽幽
W挝m 也t brains田n. a1fer四11.fibr回缸 gmml 缸”扭曲曲d i且
dlaln
也E 回事miml lmlOIY nucleu&. 唱IClDI and taste fibres of 也t
p帽叩，1wyngra1~ 恒min血回也E nudeua mlilariu1 d也t 问．低MO•”ndaw11Howl”’ reftu回．
medulla R阳回＠时ng 刷出恒form甜。nfrom 由epharynx 扭d
back d也eto咽l鸟 and al9o talte 鱼bres, are 国iportant 如 media也g
theswall ” ma and pg reflaa, through connections 回th the X: Vague nerve
nucleus ambiguus and 仙峙pogl铺al nucleus 阴s 10.24).
Rootlets of 也e vagui nave attach to 也e h能回I asp缸t of 由t
The motor component of 也e gloss句地liuyil胆I nerve is v町
medulla immedia也lyαu由l to 也E glo11SOpbaryngeal n町E
small. It ari1e1 from cella in 也t rostral part of 也t nucleus
(Fig. 10.23｝.四eva胆创itairu afferent. motor and
amb驷u111 of the medulla 缸ui innervates just one muscle. 由E
para却回归也etic fibre也
sty！叩1haryngeu鸟 which ii involvm in swallowing.
四ie afferent fibres of the 哨嗯us convey inform甜on from:
阶甲唔ionic pawympa:也etic 伽a in the E且onopharyn伊i
nerft origins能 in the in如tor 剧，ato哼 nudeusof 也t rostral • Re四pto11for 伊阳al 阳1sationin 伽t pharynx. lar归骂
medulla. Thae syn叩，e with postganglionic n四rones in 也.e otic oaopb唔鸭，mpaoic membrane. er阳nal auditory m回tusand
”ngli.on. 叫tlch in tum 凶nervate 也t paro岱d salivary gland. part of the coocha ofthe a回咀al ear
 Chapter 10 Cranial nerves and cranial nerve nuclei • 111
“
M Ulla
民，田nen m啕阳m
Cervical eplnal cord
Fig. ’也a The 饵”dalmadul幅画nd roatral apinal cord. 币l& diagram illu甜亩tea the origi'l 苗、d course of the m创O『帕西a of the vagus and ac冶凶凶『y
1"11自IV88.
• Chemorec写加n; in the aortic bodies and baroreceptor11 in 由E
aortican:h
• Receptors widdy di由ibuted throughout 由e thoracic and
abdor旧nal vise回E
Wi也i且也e brains阳n. affer四ts~ 伊回回I sensation 回d
in the tr地eminal sen曲ry nucleus, while 吼’岳阳l afferents 四d 恒
the nucleus aolitarius.
The motor fibres of 也E 四gus (Fig. 10.25）缸ise from 由t
nucleus ambiguus d也E med叫k 哑可 innervate 也E muscles of
由e soft palatt鸟 pha巧nx, lai:ynx and upper 归n of the 阻四phagus.
四ie nuclewi ambiguUll ii, therefore, m回allyimpo由ntin 也E
即itrol of spe配handawallo抽1g. By 00回归tion, the most caudal
efferents from 由e nu也usamb地uus att regarded as le卸旭g 也E
braim恒m 皿 the cranial roots of 由e aαessoryner吨 but 也ese
u四S缸 ω 也E 回gus nerve 归呻er at 也e level of 由t jugi血z
foramen 阳. 10.25).
四1e pua町mpath国E fibres of 也e 咽，ll nave OJ堪回le from
the doraal motor nu.deua of tl腿’匾’且也世世ch lies 扭曲E
medulla immedia也lybenea:白白e floor of 由e fourth vmtricle
(see Fig. 9.7). They are distributed widely 也roughout 也e
但nli回ascular, res回ratory and 伊.troin田tinal m回nB.
XI: Accessory nerve
咀le aα:essory nerve is purely m创or in 缸nction. It consists of two
parts；由nial 血d spinal. The cranial p缸t m鸣曲 from 也e h艇ral
aspect of 由E medulla as a !in届r series of rootlets which lie
immediately cau也l to 由E rootlets of 也ε 咽’11 nerve （阻， 10.23,
10.25）.τhe cranial root of也E ace四町 n田e carries fibres that
have their origin in 由e caudal p皿 of 也e nuclewi amb蝠皿 of the
medulla. At the level of the 如思血r foramen the院鱼M四 join the
响鸣us ner鸭 and are distribu也d with it to 世iemusdes of 也e soft
pala饨抖wynx and larynx.
lvDJ”。市 nerve
Cranial root of
acceaaory nE削咀
Jugular foramen
陶us nerve ID mu剧”
飞、 ． of larynx and pha咿'IX
; ＼＼~ i
L一一阳刚nerve ID stemom刷
and 恼peziusmusd幽
四ie sp凶al root of 也e aα凶曲ry nerve arises from motor
new:回国 located in the 咱也al horn of 也z 咿卫d g町 mat国
at levels Cl-CS (Fig. 10.25）.咀E axons leave 也E mrd not
由rough 也e VEDtral m础 d 甲inal ner咽 but 由 a 阳ies of
m叫ets 也at emerge from 由e la阳回I aspect of the cord midway
K阳帽但1 世1e dor11al and 观回回lroσts.τhese rootlets COUile
ros回国， ooalescing as 也.eydo ，。，四d enter 也e 田皿al 四”ty
也rough 也t 伽amen magnum. At 也e side of the med叫扭，也E
spinal root of也e aα四”，ry nerve is joined briefly ~也eaanial
rootle饵， but the 四m归n四.t fibres separate once again 甜由E
nerve lea晒 the cranial cavity 也rough 也E 归思血r for.am.en.
Here 也z fibres of the cranial m悦。（ the aα四~，咐tich are
derived 岳阳1 the nuclewi 扭曲iguwi, join 由e m伊.sand are
dis位ibuted wi也 it. The fibr回 of the spinal root 归” to the
st凹wmastoid 缸td 往叩ezius muad饵 which 阳’-eto m回'e the
headandsho叫d臼虱
XII: Hypoglossal nerve
The 峙，唱ossal nerve ii purely motor in function. It inner唰哩’
b侃h 也e atrinsic and intrinsic muscles of也t 阳电ue and,
也erefore, functions both to move the tongue 皿d to change its
shap巳 The 缸。＇ns originate 恤由E 峙P吨lossal nucleu岛 which
lies
immediately b幽幽曲曲t floor of也e fourth 咽1刨出 near 由E
m挝line 〔Pig. 10.26 曲d Stt Fig. 9.η. Axons couneπntrally
由rough 也E medulla and emerge from iu ~trola阳al asp回 m a
linear series of rootlets localed be阳回n the pyramid and 也E olive
(Fig. 10.23). The hypogl。”al nuclewi rm且m a缸回刨食om the
nucleus aolitarius and the 回geminal 阳1sory nucleus. Th臼e are
involved in the control of the refla m，白白阳市 of chewing.
sucking and awall侧ing. It d皿 E院卫~ves oortioobulbar fibres from
由e contrala阳al motor oona, which subaave 叫m田y
mo胃menu of也e tongue such as occur in 吨肥ech.
112 …
.P .......翩翩翩翩翩翩........ ,,, ......
阳回咽回回~’

Motor re.』rone d’“蝠， isa d飞ronic di司i;iener硝w disorder BE贿I in th锢’

甸回 ova『 5。”嗣. The 俯首∞以』阳内部tap明自由四日 to the nucleus
町b电uus and hypo你施副 m』C融且由自genera恼， 陆则阳gtc 句sphonia
(d踊.culty 桐树lOl'tlllion), dys院啕阳刚licult亨阳制刨阳曾毡， 句脑lhria
(dlltlcully n 8111cu剧创 and waa阳制制甸回t比址y of 廿'9 t:orcJue
伽翩翩。bulw 刚刚．刊嗣恒翩。屿’自n刷刷 σ！ the nudeus
m啕uusand hypo脚嗣l m剧 th阳唰唰，国di啕 to dysphonla,
Ir阳loroliv町 dysph啕闹， d阴阳甘1r1aand wee阳”s,w回sting and 旬SC刷刷阳 σf甘、自
nUI却UI 伽gua 伽ulbar 1)91唰
The 民义 XI and XII n脚串串侃n bedan啕回 byoompre部阳 h 蚓r
pe巾her回 course as the鸣， exit the cranium 啄a 甘、E b圆百ina of 甘、E S阳II
b四e.Turnotnin 晴、医 area l阁d 回 d归phonia and depression of the
I QI咽呻珉，崎甘1er with u同le:ter副 wasti咽 d the steπlOrT1四αd and
I trap回us ml刷刷 Ougular 旬nman 町ndrom创 and unilal田刮

“
Fig. 协副 y..＿.，，.”·”“”由m啕h them ulla. Thadl啕阳n shows | 回阳帽， W愤世ngand 恼CicL』恒lion of the lonlJ.JEI (Fig. 10.2η．
the origin and course d甘、自由bras of the hyp吨lossal nerve.

J时态 fλF \\
阳』l笛”w D’b阳｛叫 ,, MWealcr恼，， d阳WITIJIC回a
崎b由阳｝

阳翩翩·”而go (VIII)
E 哩

\ 1'' 气
\

画、＼
卢／ numbn阂， of face

I (VII) Facial palsy, lo”d幅幅

··四’’

｜ ｛间 ~
」 阳I) ｛阅 L.olll of钮晦
Bulbarpa田｛帆肘阴阳，－寸
dysa巾i•，阳”1咿） ｜ 阴
阴 spi幽J）恤翩翩 d head,
l 织l cranial) neck and 曲oulde『 mutldel

11 il

Fig. 协U 阳刚＠’“ m嘟”俑”’ C'9时....... ......

 Cerebellum 11
E翩翩嘀圈”•tu,_ of the cerebellum 113 Cerebellar nuclei 117 Archi铺『'ebellum 117
’”饵”蛐I atruc ”’e of the Functional anatomy of 伽· 问Jeoc例bellum 11a
“四幅Mtllum ”4
Cerebellar cortex 115
ce隐bellum 117 N叙x:er眺>ellum 118

四ie cer由ellum Is the 1.aJsest 阴n of the hio.dbrain. It origina刨

食。m 也t donalu严aof 也t brains皿m 四.d a咱也ω 由e four曲
回ttrid巳币te cerebellum 扭曲nnected to 也t brains也m by thrtt
stout 归国 of fibre bundl饵，也lied 也e infaior, middle and
mpuior mn:bellar 严dunda (Figs 11.1, 11.4; att also Figs
9. 1-9.3）；也m join the ceRhellum b 也 med世k 阳鸡叫
midbrain, reapecli晚ly.1be 旬nction，。ftheαrebellum are en由dy
motor and it operatel at an unconscious leYel. It controls the
maintenance of 饲凶librium (balance), influences pas阳re and
muld.e tonr 组ldα附1rdinatea movem四t

EX幅mal features d 伽e cerebellum

咀le 田mellum c:omiltl of”。 la回到lyl。但因 henmpher田，
joined in the m划line by 阳市mil (Figs 11.2-11 .4）.四顶，uperior
m血ce of 也tαrebellum liel b回ea-也由e dural t回tori山E
αrd>elli and the IU归rior v曹mm is raiaed. 岛m且g amidline
ridg配 Con帽，el郭世te 恤缸ior Wl11lis lies in a d也p groo呢
betwttn 也e heml1J>hett1. ’Ibe surf.ace of 由tt ce:rebellum ii highly
amwlu时，由e fol也 orfolia （：血备， foliu时， being ori四.ted
a回宽回mately U田回帽回y.Betwttll 也e folia lie fissures of varying
d叩白，. Some of the:1e 缸mrea are land皿arks 也at are used to
divide the 但由ellum anatomiαUy 恒ω 也ree lobes (Figs 11.2-
11.S). On the superior su血属 the deep primary fui1ure sep缸咀刨
the rel甜my IDlall antttlor lobe from 也t much Jar庐”’阳ior
lobe. 阳阳 und四ide, 也eco即阳。ω ”’徊。h也ral fuJ m ’ 问·”a superior 刷刷刷 ottha 例”bellum. The 帽审ballumand
<lemma圆白e location of email z唔on1 of 由t hemisphere （也e branstem have bean detect唰帕m the由阴阳Jn bye叫ng through 问
8occulua｝也ui 观nni• （由e nodule), which to萨曲也伽mthe R踏W回 mldbraln.
floa:u』onodular lobe.

M油m讪

嗣dd协饵”翩翩目『 peck.n曲

Supa睛”19bell，『阙uncle

问lnl

1bell圃『 hem阳ph，用

阳，mid

Inferior 拥而baler peduncle

αIva

F阳·”.1 u刷刷t ”’IOtof 俑， br11lnatem and 嗣同bellum, a”晴'19th• ”””II# ’”uncl”·阳ta of 阳 anterior, postartor and lloce1.』。nodular
lobes (q.v.) have bean removed to dlsplaythe peduncles more cl锦11'/.
114 • NEUROANATOMY

Superior
vennle

Horizon饵l Poslao恒.ta刚
llael』陪
flssu19 一－＼

问揭扭曲rlobe Fb剧』阳创ularlabe
vennie

F崎·”.3 Po嗣同”’”“t“the ””bellum. F崎·”A Anterohferlor”’ectof甜”。”bellum.

Superior verrnis

仙”rior lobe

Postario『 lobe
Har田n饱l币ssure

曲回峙『由ellum

阳laoc:erebalum
Nodule
N阴阳rebelIum
同时期』lanadular 蛐－

”,
Fig. r; Schematic repre幅ntatlon 创世怕回rebellum In which the peduncl倒 M帽 b”n cutandthe 翩翩翩’“””“。盹刊， relatlon由lps
between the anm町lie副 and functional divisions of the cerebelk.lm are shown.

Extern剑’••tu阴阳 of the cerebellum In幅mal structure of the cerebellum

·胃、B cerebalkJm controls the SUPE划。『倒咄泊lier pedunc阳，
mah阁nence of ~llbrlum, 咽!J8C'甘唰y. 回ie rer由ellum basically coruim of an ou阳 I叼眶。f grey matter,
间呱闹剧d musc:le tone end It 也e cerebellar corte鸟扭dan 旭ner core of white matter.τbe
·而自 cerebellum car幢幢幢 of a
ooordlnat臼 movemer回. It whi也 matter is made up largely of aff四nt 皿d efferent fibres
mldlne vermls end two 恒.tenilly
oper冒烟s at an unoα胃口ious
k泪.tad hem脑网副部． 也at n皿 to and from the corta, towards whi也 it 臼部盟也
阳明I.
• Ana:tom阳Hy, the cereb副lum is charac回istic,. 副唱ular, branch-like pr。如tions. This formation is
Isαinnacted to
• The cerebalkJm divid回 into ar曲而几 pos恼W ref四ed. top创tlcally in older literature a，也.e'm协r vitas' or 冠四
甘回『n回ull圃， por回 end mldbraln
Z回’“扭曲n国ular lot圃． d恤’（Figs 11.6, 11.7〕．缸皿d deep 回副n 也ewhite ma:包E are
W 甘回 nferlo『， mldd幅画nd
four bila田ally paired caebellar nuclei (Figs 11.6-11.时， which
con皿.tute 也e output of the c.erebellum to other levels of the
neur回11. They have important conn配住onswi曲曲e cerebellar
corta 皿d 明白 αrtain nuclei of the bra皿国n 组td thalamus.
 Chap幅r 11 Cer’。bellum • 115

Cerebellar cortex
咀le 但rebellar cortex is hi启』y convolut叫“·rming numerous
田nsv四dyori回回 folia. Wi也且也t? cor皿 lie 由t cell bodi岳，
d四由i国也1d 句naptic connections of 也e vast majority of
αrebellar neurones. The cellul缸 organisation of the co皿a 扭曲E
阻me in all r唔oru (Pigll 11.9, 11.10). It iJJ di剖ded 恼tol唔cally
into 由m 国四：

Anou田， fibre-rich, molecular 峙er

An intermediatιPurkinje ml l句町
An inner granular I句町， which i1 domina:时 by 也e granulecdl
Affer四lt projections to 也t 值曲ellum 缸iae principally from the
spinal cord 〔spin创:erel回lar fibr喧嚣.）， inferior olivary nucleus
( olivocerebellar fibre1), vestibi血z nuclei (veltibuloam时1缸
抽回） and pons (pon田E曲ellar 伽es). A曲回.t axons E田tly
恒minate in the cerebellar cm圃， where 也可 are em.ta:田yto
∞甜甜 neurones. Fibres en阳 theαrebellum 由rough one of
theαrebellar peduncles and proceed to 也e cortex as either
mossy fibres or dim.bing fibres, depending upon their origin
｛囚g. 11.10). All a曲四”。rigina问 elsewh倒也曲也t in倒or
olivary nucleus end aa mos町岳阳回.M皿sy fibres branch to supply
u咽'al folia and 四d m 也t granular I句er. in synap首c contactwi也

陆11 Cer由ella『 U剂，x

granule cells.τhe axons of granule cells pass towar也 the surf远也
。fthe COI回四d enter the mot配:ul缸 fa如Z Here 也.ey b面ucate to
Fig. ”」8 Para”’配...”ctlonthrou酬’喃自，rebellum. Mulllg徊’B S饵In.
produα 棚。 p缸allel fibr回也就缸E oriented along the long 四s
of the 面Dlium.

臼耐用l hernia阶ere

Der臼.ta nucl回』S C阳ebellarwhi悔 matt串r

Cerebellar hemisphere
Medulla

时·”.7 c。”翩翩钳制 of the brain ，睛” level “th“刷刷 nucleue; m归lln 刷ln.(S悦伽 cour阳iyof向 Natlon8JMu础Im of Hi锦舶 and
M配制16.Armed 同IC&.S Ins侃刷 ofP胁侃聊， Wes/Jin仰”， DC. l』剧J

Den值自由 nuc烛』8
Errt>olifam R回削S
G蛐创自 nudel

同.stigial m届创S

Fourth ventrtd自 Midd悔 cerebellar 问cklnc梅

」一 Pons

Fig. 刊」’ H。rtzontal MCtlon hough 伽e cerebelklm and bran帽mattha 崎ival of th，刷刷帽ntrlcle, 8howlng the cerabel阳， nucl创．
116 …… MY I
P耐响 cell layer

(x25)

(x T创｝」－ Gran曲rlayer
Fig. ”S 价4习 Tnlnn…”ctlon• of cerHellar tolm ahawhg 由削”.. orttie 四......，阳roo而皿．

协蜘四阳r 阳”r

阳陈lnje 倒l

Grenuler 恒归『

Gtlnulecel

一一一－While malle『

M回事”bres …· · ，
ClimbI啕仙幽伽m i响riorol帽rynuc拟捕 •, . ‘…·
To cerebellar nuc刷
Fig. ”－，。而·””beli.oort皿.D崎ramshOI崎 afferent and e耐用时 conn翩。明 and 问Irr唰atlonshlps 1o 1he prtndpel 佣Hs of the cerebellar cort鼠
 Chap幅r 11 Cer’。bellum • 117

币ie Purkinje 创I layer consists of a u皿副Jular l句'tt of the principal d创nations of dfer四t fibres are 也e z回αJlarand
曲皿阻（cell bodi凶） of Purkinje n四rones. The pro缸ae d幽幽i配 ” stibular nuclei of 也t medulla 皿d pan鸟也t red nucleus ofthe
atborisations d也甜甜Is (see Fig. 2.lB) exttnd towar也出 midbrain and the v四.tral la田直l nu出us of也e 由alain四．
S田face of the mrt£X, into the molec叫z 国'tt (Fig. 11.10）.四le
atborisa:世ons are flat回ied. and orien也d at right angles to the long E田temal t嗣n1cture “ the cerebellum
axis of the folium. 咀直可 are,. th自由m 恒avened by numerous
•Intern哟， the ce闹剧rum glatJose, embol阳mand
parallel fiMi饵，岳阳i which they m垣鸭 aritatOiy synaptic input ∞阳l创sofa SI』巾.ca 阳”『 σf dent翻｝．
Inhibitory mod由tion of in田.cortical cira曲y is pro世dedby cortex, highly co附eluted to
• The ruclei are 甘冒目 α国in of
nwnerous o也a neurones kn.awn as Go阔， basket 缸l.d e回M form fol恤， ber回th 附胁阳
囚，回lei恒r elfe雨时自blllS.
创Is. 四ie uons of Purkinje cells are 也叫y 缸。D8 to I.eave 也 圳市胁 matter.

αr由ellar cort£x. Most of these fibres do not leave 也e cerebellum •W协h 酌， white matter r画
团由dybutendin 也E deep 田由ellar nuclei. 咀eo由er type of 铺菌国lar nuclei 阳地副，
aft垃mt fibre en缸恒g 也.e r.£rebellar cor但鸟也E climbing fibre.
origin.ales 岳阳n the inferior olivmy nucleus of the med创la. 币1倒
伽四 provide relatively discrete emtatOiy input to Purkinje 国ls. Functional anat1。my of 由e cerebellum
At. 也e same time, axon collater曲。f di皿bing fibres acite 也e
neuron.es of the dttp cerebellar nuclei. Purkinje 创ls utilise GABA 世leαrebellum is often regarded as cons扭曲tg of three functional
U 也由 neurotrammit回 whi也 m四11 由且也 output of 由t subdivision也 based upon phylos四etic, 缸tatOl回国缸l.d 缸nctional
whole of the cerebellar oor皿 is media时也rough 也E inhibi由D considerations (Fig. 11.5).
of cells in theα四bellar nuclei.
·四teU也icettl:时Jum, or oldest portion in phylo胆teti.Ctfilm』 is

Cerebellar nuclei 吨uatedwi也 the ftoa:ulonodular loM and the associat£d

Deep within 也e cerebellar white matter. ab~ the roof of 由E
也回由 V回国也 lie four bila缸ally paired nuclei. From medial to
h恒时，也ey are known as:
• Fas世gi.al nucl钮’
• Globose nucleus
• Embolifonn nucleus
• Dentate nucleus σ~ 11.6-11.8)
咀ie d四植.te nucleus is by far 也E K胆t of the cerebellar nuclei
and is 由E 创诅yone 由自tcm bediac町ned clear坊 wi由 the naked
句-e (Fig. 11.6). Itαmsists of a thin l甸回 of nerve cells which, in
由-ee dimensioru』 is reminiscent of a c:renated bag; as a :result, 垃
appears somewhat aim丑缸旬 the M如ior oliV31Y nucl四15 of 也e
medulla, from which it m四”’ afferent fibres.τheαrebellar
nuclei also m咽，eem以:erebellar afferents from 也e vestibul缸
nuclei. retiαliar nuclei，”n也e nuclei and spino臼rebellar tr缸”，
predom凶antly by means of co』laterals of mossy fibres des出d
缸也但由ellarco血z From 明白扭曲t 但也ellum, the nuclei
receive dense innervation from 也ePurkinje 创ls of 由E 也rebelJar
α览馆z it国f. 咀ie rerebellar nuclei constitute the primary saurce of
efm四t fibres from 也.e cerebellum to u由E parts of the K血．咀le
faatigial nuclei.
·咀le 阳Jeocu由ellu皿 appr回ma·阳臼由E mid.line回rmisand
SUITOUl叫ingpar抑自mis, to醉伽er with the globo1e and
四boll旬rm nuclei.
·四ieneocer曲ellum compri附 the remainder （血d vast majority)
of the cerebellar hemilphere 皿d也e dentate nuclei.
Archicerebellum
咀le 缸由iαrebellum is primari坊 conαmed wi血也E m血tenance
ofbal曲α （呵峭.brium). It has ex回回veco皿剧。nswi由也e
vestibular 曲d retiatlar nuclei of the brains惚m，也rough 也t
inf回or r.£rebellar peduncles (Fig. 11.11). V.副队由z information is
carried 岳。m 世ie vestibular nuclei to the mrtex of the ipsila回;tl
组acculonodularlob巳臼rtic.al efferent （阳kinje cell) fibres pr归
to the fastigiaI nucleus w扭曲， in tum, pn:场缸” back to 也e
vesti趴血Z nuclei and to 也t m咀cular form础。o.Asi伊监cant
proportion of fastigial efferents cross to the contralateral side of
也E brains田n. The influence of the archicaebellum upon 也E
lower motor system is, th自clore,. bila但ral and 伊inclpally
mediated by m幽幽 of descendi吨础tibulo咿nal 血d
z四四I皿pinal pn:略目:tio皿

·Purldnje call
Vi倒也u阳:ereballar fibres

ReUcu阳plnaland V时bu阳回nal 阳由

Fig. ”
118 • NEUROANATOMY

v，『l嗣同men刨 d阳”ation

Glo胁，e and embi:量fonn 『1uclei

阳b明pin创阳ct

Fig. ” .12 ConnKllona Dflhe pa幅画四”b•llum.

D阳泪”“on of pyramids
国恒耐∞『由cospin副阳t

Fig. ” .13 Conned阁”aDftheMO。”’bellum.

Paleocerebellum d由E rerebral carte:民 involvEd in the planning and a四皿m

咀le 阴leoc自由ellum influences muscle tone and 阴阳re. Afferents
αmsist priI咀归lly of dorsal and 咱也al spinocerebellar 田d
n四rones 也at carry informa咀on from muade. joint and a血neous
recrpton 皿denter 由E 但由ellu皿也rough the inferior and
皿perior 但ebellar peduncles, res阳由由 陆. 11.12]. Fibn5
阳mina:也 largely 扭曲E corter. of the ipsila回al VEIIDis and
ofmavmimt,. 由 cmtimpontine fibres that end in the
”n由e nuclei. Pontoαrebellar 曲mαoaa to the opposite side of
the bra皿回1，由能ring 也E 岱:rebellum 由rough 也E middle
cerebellar peduncle. Ponto四rebt业lar fibres ter皿nate
predominantly in 也e lateral parts of 也ecer曲ellar hemisphere.
OU刷t from 也e n曲但由ellarcor国 is dir回国 ω 也E d四凶te

adjacent pammnis. Caebellar cortic:al efferents from th回t areas
阴晶， ω 也Z globose and emboli币。rm nuclei and also to 阳
也剧gial nucleus. 哑ie globose and emboli伽m nuclei 阴叫田 via
the superiorα健bellar peduncle to 也e conttala.teral ml nuclms of
由t midbra跑， w恒a官也eyinflu·团成也t activity of cells giving rise
to 也E descending rubr田.pin且l 位act.
Neocerebellum
四iene“自由ellum is conαmedwi也 muse叫ar coordin皿础，
including the trajectmy, speed 皿dforce of ma田n四ta. The
principal affer四t p量也lWllf to 也E neoc:erebellum comim of
pon岛。但rebell缸 fibres that originate in the pon由ie nuclei,
1民ate<I in the basal po丽。n of the pons (Fig. 11.13).
Pontoαrebellar 田wones are influenced by widespread E唔ons
nuclei皿．咀le dentate 扭曲E I缸悖st of 由e cerebellar nuclei and it,.
in 缸固， project& 阳也eamtt由恒:al :red nud四s and ~ttal la恒al
nucleus of the thalamus. These efferent 6br四 form the major p甜
。fthe sup回or 但由ellar peduncle, or brachium conjunc由um
｛眠 F增 9.11, 9.12）.τ'he asc回ding fibres dea刷ate in the caudal
midbrain just before read血gther时 nucleus. Some fibres may 姐
也e :red nucleus wi也 rubro由alamic 国ls, but most 峙？四由t :red
nu出us and proceed dir时yto 由E 现ntral lateral thalamus. The
咽ttral lateral nud四8 of 也t 也alamus 伊咧缸” ω 也e cerebral
COI恒Z principally to 也e motor cortex of the frontal lobe. 咀m
n四cerebellum 也山 eJreI1ll itl role in the coordination of
mOY回1ent primar句也rough an action on 但rebral co副α1 areas
that g而 rise to desαndi吨四时四酬nalandco币四趴Jib缸
pa也ways.
 Chap幅r 11 Cer’。bellum • 119

Functlonal anatomr of the 回rabellurn

•The ar由lcerebelum 口时毡，n甜 with the mah阳刚回 nuclei. It race阳随他『唱e from the h阳市phere and the dentale
corre帽。「lds to 甘啕 d 明1Allbrl1JT1. splnoc湖由ellar tracts and nucl阳s.It recei1le8 al恼rents
伽倒』lonodular lobe 创d 阳tlgl创 pro抽出 ω 甘随时 nucleus of 阳m 甘冒a pons and pr。如cts t。
•The paleoo町由elk.Im
nudeus. Its prlnclpel 甘l8 mldbraln. t恼 ventral lat田刨 nucl鼠』s of the
ccrreepor回s 恒甘南回『mis and
民inn即回ons 回回 with 甘啕 thalamus.
pa『百帽mal are钮，缸>gether w灿 •The neccer回国lum 田W回归nds
响刚lbu恤，阳市d 附tlcUsr nudal of
the brains阳n and it is
甘辆自由lobose and embol阳m to most Of the O町’bellar

FD L唰onsot饵”回rabell11111
Amldllne 嗣阳、“ t闸佣『罐刚lum (such es a 阳mou叶阳d9 to loss of
posb.Jr副 con11刨； as a result, It Is mp岱slb恒 to star回 or 副t w世10山
怕pplr回 over,d臼圄恒 W臼erv固自泪rdna阳、 d the II『nbs themsel四s.
Bacau田 d 甘冒阳阳:llT1 of ipsi恒le国 and d田ussat回 palhw卸哩 that
enter and l回wthe cer回到国lum, u同lateral 阳io「lS of the cere国lar
hemisphere 咀use 叩nptoπ晤。n 甘回 same s1由 d the body. Th睡 is in
co晴宙t 阳回闹剧国阳商（e.g. i"I the 帽ebral cor胁， intern刮目psule or
b凶创 Qar(jl闹， wh阻h g附 rise to co时『亩late陆I symptoms.
A uni陆t阳富l cer由自阳r hemisph留抱抱S附n causes ipsilat阳咀l
Incoord阳.lion of the arm ~r而刷刷刷m叫 and of the le目，倒using an
u翩翩仿制t, In the 曲sence of w凶W晦s or sensory 阳s.
Bl幅幅ral d阴阳netIon d 阳帽ebelum, caused by a阳hcllc
Int以阳.！Ion' hypothyroid脚， lnh刷刷阴阳belier a喃喃回llonlatalda,
multp!e sd自由险口， perane叩脑tic d国坦se，凶幽幽 sk>wr四s er回
scannl咱 d 申自由（句田晴剖，1). lncoo国lnatlon of both 田ms end 且
由囚创咽， wide-bas田， uns田dy gait (cer9b•lr.- atDI司．
臼『曾划阳r 阳sions also im因r coordi"I硝m of eye m即冒nents. 有18
句属回1ibit a charact回slic, involun恒ry and 巾ythmic to-and-fro motio『1
（回归恤，m唰， great因t in amplitu由附en gaze is di回国 b 阳坦me
side as the lesion. Nyst句mus 脑 a very m响mon featu用 of mull制自
sclerc路is. The combin自由on of n归tagmus with sc却1ning d归arthria and
lntenUon tremor const阳tes 'ChlROl's triad’, which Is highly d闻nosUc
d 甘冒B d陆姐”－
 12 Thalamus
γ剑”’raphlc11I anatomy of1he Fune筒。nal 。””n阳a筒。n of 1halamlc
thalamus 121 nu创创 123
Extemal f剧tures 121 Lateral nuc阳r group 123
Internal or伊nisation 121 Anterior nucl曲rgroup 125
除湾也在l to the midbrain lies the forebrain (pro况aαphalon,
创曲rum; see Fig. 1.13）.币le forebrain consists of the bilater划ly
pair回 diencephalon and 优rebral hemisphere on each side 姐d is
by 缸 the l缸阴t derift'翩。f the three basic embryologi.1创
divisions of the brain. 岱1e dienceph剑。n is con·也lUOUll with the
rostral 阴rt of the midbrain 姐d 监es betw惚n the braimtem 姐d
the webral hemisphere From dorsal t•。”ntral, the dienaph也n
is comp由ed of 也e epi也alamus, thalamu皂剧.bthalamus and
峙po也且lamus.，。f which the thalamw is the Lar阴t 币le1h血mua
consists of numerous nuclei. most of which have eztensi:ve
z回.procd conn仅:tiom with the cer世brat rort皿 Ofpartiαtlarnote
are:
• Nuclei that ttansmit gener草i andsp回al sensoi:y inform甜onto
ωπesponding1咽。础。f the sensoi:y cortices
•Nude毒也at receive im伊ilses from the 础d时lum. 翻d basal
ganglia and in回faαwith motor regio础。f the frontal lobe
• Nuclei that have conn仅tionswith 础。ciativ曹姐d limbic areas of
the cerebral cortex
The diencephalon is 对m制相tirely surrounded by the 础。1raJ.
h臼岖，phere;αmsequently, little of iu 耐ucture can be seen
eztemal均， a归rt from the ventral portion of the 峙po1h刷mus,
whichαn be seen on the bue of the brain (Fig. 12.1).
Immediately caudal to the optic chiasm is a small midline
elev捕。n, the tuber dnemun. From its apex 倒：ends the
h缸ndibulum or pituitaly 刷1比 which attadles to the pituitaly
gland. Caudal to the mber dnerei血， a pair of rounded
OpUc n自附由
l而』ndi队』lum
Tuber 4linereum- '
。以.*>mater nerv由
Fig. 愧， V街巾’睛’•pectof~酷 d阳帽阙创on.
M回Isl nuc嗣r group 125
lntralamlnar nuclel 126
Re首cular nucleus 126
锢inen1棚， the mammilla厅 k对ie章， are located on either side
of the midlin巳 The能 COD始in the mammillary nuclei of the
峙归thalamus. 四e hypothalamus lies below the thal础时，
U阳1必吨 medial and 咙脆就 to the subthal础us. It blU important
corm仅tions 回th the 险nbicsyst1臼n. acontro.监ng 凶11uence upon
the activity of the autonomic nervous 锣’t幽幽d aαntral role
in neuroend1配rine function, partly 也rough its relationship with
the p拟必tatygland. 币le hypothalamus is di烛”’ed 缸rther 凶
Chapter 16.
”
The other parts of the dienaph也nαn k en in Sagi阳land
coronal sections of the brain { Fi.p 12儿 12.3）.τhedien呻halon
fonntthe h阳租I wall of the third 咽ntricle. The dorsal part of the
ventricular wall is formed. bythe 创amwi and the venttal 归rt by
the 峙pothal.amus. The 叩ithalamus is a refa笛”Jy small part of也e
dienαphalonloα时， in its most caudal 矶d dorsal I唔on,
immedi础ly rostral to the m严riorco迦culua of the midbrain.
ltronsis也 principally of the p讪eal gland 姐d the habenula
(babenular nudei）.四ie pineal glaJ叫（Fig. 12.2 刽idStt
Fig. 13.12) is 栩栩doaineo耶n. ltsyn也剧础 the hormone
melatonin. 币i.ep画“l gl四d blU been implicated in control of
thesle叩N副吨。de (circa.di血 ib州时翻d in 鸣曲tionofthe
ooaet of puberty. 岱le habenula (bah四.ular nuclei; E电.g.12.2 忽略 m
Fig. 13.11) has connections with the limbic S)'S'馆也（Chapter 16).
The subthalamus lies beneath the 也alamus and donola烟草i to
the t明却也础.amus, with i部观ntrolater冠I asp吃αa拟inst the intemal
“归ul巳 It cont.a监事制。 notable 创l groups，也e aubthalamic
nucleus 甜d thezona 凶certa. 岱le subthalamic nucleus is 阳在.ted
Optic clliasm
Optic 协d
Crus 础理tiri
翩翩翩町 body
 Cha pt町’ 2 而alamus • 121

Massa In恒rmedla

Fomix
Int跚跚刷』lar

az:λ飞、二 仨f(
foramen
Fomlx.

’ 咱…·』 也 飞 .. Cere阳l aq即duct

A曲目。F 、 唱

‘』 电－－ ’ 」‘同＂ I

commi民Uni

Optic 由恒m
《~ 、、

电… z
l 节， ！ Hy阿甘刚amicsu以』S
Optic ne附

Hypothalamus－」」－ Mammlll目『ybody

’
Fig. 2.2 Medi翩翩啕阳，l ”ctlon af the brain 础，wing 甘冒，刚回lonat巾，时’咽，d阳帽”ha崎n.

in thevm田·lateral part of the subthalamUJ, immediately medial
to the in能rnalαpsule （阳 Figs 13.9, 14.8). It has the shape of a
biconvex. lens 姐 coronal section. The 皿b由alamic nucleus has
严omin·倒倒mections with 由E ~obuspal且dusand the
substanti且皿gra and is impo皿ant m 也E control of movem四.t. It
is discu部ed. in more detail in Chapter 14. 咀te zona in岳阳 is a
m盹al menaion of 由E brains国n retirular formation. Se晒al
impo血nt fibre systeIDll m阳’E the sub也alam田回 route to 也e
由alam皿咀eseind回e ascendi吨’四町 P叫ections (medial
!em皿阳岛酬nothalamic tract岛 trigemino由alamic trac时，
αrebellothalaJ:旧.c fibres from the dentate nucleus 血d
pallido也alamic fibres from 也e inter国I B鸣mentofthe
gl.obus pallidus. 咀te latter group of fibres 皿:velop the zona
αu也但 (Pip 12 3B, 12.4). Ventral to 曲也血mus lie the
subthalamus and hypothal缸nus； αudal to it lies the midbrain.
Internal o咆anisation
Wi也.in the thalamus is l。但也d a 由in l句a- of nerve fibres
comp伺ed of some of the aft坦白.t and efferent co皿ections of
也alamic nuclei. This is called the internal medullary lamina
{Figs 12.3, 12.5, 12.6）.四ielam且a is rougl世y Y-shaped when
vi白帽d from above and provides 由E basis for dividing 也E
main part of 也e thalamus into three nud回Z IIllllllles: anmior,
medial and la能ml. Each of th配 cellular mmplex回归缸ther
subdivided into a number of individual>y named nuclei. 咀1£
la:能ral nuclear group, in par世.culaI, has important conn回ions

ino四aas 由e l四.ticula:r fa姐.atlus 皿d 由alamic 也cicuJ.us (see Pig. with sensory and motor E唔ons of也e cerebral co民阻
14.8). Embeddedwi也扭曲E 旭阳nal medullary lamllt.a are 使咱回1 cell
grou阴阳own 叫lectivel.y 曲也恒tralam旭缸 nuclei (Fig. 12.5).
Topographical anatomy d 曲。由alamus Lateral to the main ma”。f也alamic nuclei lies 四.other sh回 of
n町E fi.br跑出 lataal medullary lamina 但g. 12.3町，叫咀rh
External feab.』res 四nsists of 由alamooortical and oorti田由aJamic fibrea. Be臼陀回
咀re thalaJ:nwi has been likened in siu and shape to a small b回’s 也is and the in田nalαpsule is located a 也in stratum of
egg.τb伊也e wi也 the hypothal缸nus, it forms the lateral wall of neurones that constitute the retiad缸 nudeua of the 也alamw
the third ven刨出也E transition k阳晒1 the 棚。 being marked F悔 12.38).
by a faint groov鸟也.ehypo也alamic sulrus. In most in必吼duals,
他胁。由alami att joined aaoss 曲曲in slit of 由ev四创de by
由ein能地alamic: adh回onormaaaa i且剧media. A fascicle of
nerve fibres, the stria medullaris （由alami〕， which has limbic
αmn配:lions, courses along the dorsomedial mar回n of the Anatomy of th• 笛，alamua
由d回国 (Fig. 12.2). Along this h已由E 叩钮句mal lining
•The 廿l&lamUS 恒廿l8 lar职精t 由e lnte＂刚『n回ullary lamina.
of the 创rdva回desp陋，也e narrowlum四 to 岛m the compa咽nt d 廿啕 The lat1倒划 nudear IJ'OUP h航向国
咽n回cul缸 roof. d陶ncephalon, which 阳 sttua脑d conn民tlons w协 sensory and
咀te 姐也riorpole of 也e thalamus ex田1ds as far as 也E be阳晒en 甘回 bralnstam and the motorcortl。”－
cerebr回 hem即here.
in惚rventricul缸 foramen, 也rough which 由E 也ird 皿d la田al • Embedd回 within the internal
回ittides are in co自由四可. La出al to 由t 由alamus lies 也E • Almost al thalamlc m』C刷 have m回ul阳『y lamina l阳 lntral田nnar

F施国ior limb of 也t in佳mal 臼严ule 血dan恒rola恒rallies 由t rich recp-α划 connections w时1 nuclei.
the ce刚刚 cortex.
h田doftheai:叫血 nucleus (Fig. 12.4）.τhe dona! 呻回 of the •On the 阳恼百Jasp民t of 甘南
thalamus 曲回 forms part of the B.oor of the body of the la键时 •The 甘冒恒mus is divided into thalamus lies the thin reticular
th『回 principal nuc嗣『 m蹦蹦 nuc阳山．
回1回d巳 Another fascicle of nerve :fibr理， wi由 limbic conn回ioru1,
（创酬。『， m回ial and 剧创'81) by
the 由ia 阳mina且，v marklJ the boun也rybe的愣回也a.lam.us and
122 … NATOMY I
A B

In饲闹闹cular foramen

如llerior nucl回rgn>Up

Ve11白百I anta~or n11e以』’

Globu1 palldue Third van协le

Fomlx

即阴阳lam1 。”ctract

Cludate nucleus

M创iodorsal nucleus L.al8r冒d v，晴icl•

U阳副 m创ulla『y
阳nlna

Relic:u阳 nucleus
lnlemal ca阳le
V1nn11a•，刚刚嘟u:

Zani 阳湖，．

Subth由mlcnudaue Pon•
问.11.3 民B)C。””’l ”otlONI throl』gh1hedlen饵，h•I”. Luxol fest blu，刷刷伽叫刨In.

Head of caudate nucleus
terminal幅
Choroid 刷刷s I Fomix
r
d 恒恒ral ventr恒1e
制ertying thalamus－」 」α划pltal lobe \L strta
Fig. 12.4 Dor.al upect ot霄，， dlancephalon. The choroid pl锹us has
b帽、 remO'回到 on 阳川gnt side.
Functional o咱anisa苗。n of thalamic nuclei
All 也E nuclei of 由E 由alamu鸟 with 也t €XC叩tion of 也~retie叫z
nucleus, pr叫回臼由E ipsila圆百1 cerebral cor皿 and 也e whole of
也e 0011£1: recei霄， input 岳阳1 也e thalamm. S皿ilarly. all th也mic
nuclei m国ve corticofugal 鱼Im倒也at are ordered in a b剧创lly
reciprocal fashion. In some ca脯， pr回盹 point-to-point
projections exist be阳回1 旭dividual 也alamic nuclei and res刨出d
cortical zones with well-defined 腿nsory or motor func咀.ons. 'Ibis
O耶ni幽咀on~ifi曲曲.e relationship betw四1 由t 由a1ar回c nuclei
and cortical E唔.ODS 也at subserve the gaieral and 吨Jecial senses
and the motor I1唔.ons 也at E主Mαrebellar and basal ganglia
坦问（吨， 12.6). S\血 thalamic nuclei are oft回 rererml to as the Medial genicula抽 nucleus
’,pecific' nuclei
’The specific nude量 all lie within the ventral part （阳） of the
la回咀I nuclear group，。也er 由al缸血 nuclei z回到ve l倒
也nctionally di副net a血rent 面.put 也t do臼 not 旭dude o晒tly
sensory or motor pa由ways; in tum, these connect wi也 wider
E回s of mrtex, including associative and limbic domains. These
are often rererred to 画也E ’non-spu亚.c nuclei. Non.-pl?l:姐E
Cha pt町’ 2 而alamus • 123
也alamic nuclei include 也E nuclei of the dorsal tier of the lateral
nuclear complex as well as the whole d也t 姐回ior 缸t.d medial
comple皿
Lateral nucl倒r group
咀te la健ral nuclear groupαm国ns all of 由e so-called ’叩国fie'
由alamic nuclei. These 缸E loca能din 也E V四itial part of the
mmpler. and include the V自由姐姐徨rior，~臼al K怕乱 ventral
m回or, lateral 伊iml也 and medial genkula但 nuclei 但gs
12.5, 12.6).
Ventt窗I posterior nucleus
咀ieven田1 posterior {VP) nucleus Ii臼 betw阳E 由E 咽ttrolateral
nucleus and 也t pul说nar. Wi由扭曲e venu菌l pos也rior nucl四S
也ere is 田m皿a白，l of all 由t a挺四ding 阴山ways 齿。m 也e spinal
田rd and brainstem 也at cany F田alsensmy 旭岛rmation from
也e contrala恒al half of the body to a con回.OUI level. These
pa:也W可冒 include the spino由alarnic 臼acts, m缸lial lemniscus and
triger由。由d缸nic 回cts. The 田mination of th回E fibres 扭曲e
ven四”’阳ior nucleus is highly o耶副部d somatotopically.
An~回isive, lateral portion of the nucleus m刘m 国缸mation
from 也.e trunk 皿d limbs 由也E S庐10也alamic tra幽姐d medial
lem皿皿lS.τhis is ref由at to 笛也e 鸭nu温l pos恒。ila田al (VPL)
di由ion (Fig. 12.6). A smalle也 medi.al portion of the 呢n国l
P伺恒ior nucleus E垣~ information from the h四d. 说a the
回gel回no由alarnic 田ct, and is termed 也E 观~tral p俱佳romedial
nucleus (VPM). This area also receives wte informa世佣金m 也
nuclem solitarius of 由e medulla and 咽mbular information from
the vestibular nuclei. 四ie 观ntral pos阳ior nucleus proj回B to the
primary somato阻tsoryαx皿 in the p<班回归菌l gyrus of 也e
P缸ietal lob巳
t事 Thlilamlc IHlona
Strokes ar回阳mou阳也st阳y1咽 the th曲，TIUS 陆国 to loss of ser百副口n
in the con国la恼al 甸回 E回 E『nbs, accompanied by a distr部si'回
d陆αJmfo『t in the paradoxicaly ar回眉thetic al'81齿”’－恒mlcpal时．
有回lamic 阳阳16 H回y mimic fo田l cert国l def田恒 b院副回 d the
rich『1颐指 of lhalamocort阳J connec也口『18.
Lateral gsnicula阳 nucleus
咀te 伊由llate nuclei are l。但因四缸也t 严跑回ior pole of 由t
白血nu岛回国l to 也epul由缸. Here, 也可 form small
emin四恼。n 也e SU血α~ known as the genicula:能 bodies. The
1世ral ger咀口血:te nucleus is a 归rt of the visual sys阳E 皿d
re<娼”’虱E也e discussion in Chapter 15. It U 世ie site of
termination of the optic tract. whi由 carries the axons of retinal
院ngli.on 副ls. & a result of hemidecu蹦出a of optic n缸ve fibres
凰山e optic chiasI也曲曲 lateral 院oiculate nucleus rec啤veauons
由at have originated from the ipsila僧”I temporal h.emiretina 皿d
the oontrala阳al nasal heini自由ta. Each nucleus 由国 receives
吼sual information rela:世ngto 也.eoon田la田al half of也E 咧sual
field (see Fig. 15冉. The la阳d garicula但 n时础’因由 fibres,
由也.e retrolen也刀lar 阴rt of the in也ma!α.pmle （眠 Fig. 13.25)
皿d 也E 叩缸 radi硝on, to 也e primary 吼sual com髦。f也E
“
:cipital lob巳
咀~medialgen阳血.tenud四s is pan of the auditory system,
whi也 is des口ibedin Chap阳 10. It m咀咱豁出咀ing fibres from
也e inferior collicul凶。f也E midbrai也甘a 也t inferior bra血ium.
町 brachium of the in缸ior oolliculus (see Fig. .9.13）.τhe medial
g回atla:能 nucleus projects, via the retrolen伽.dar part of the
in恼’nal capsule and the auditory radia且on, to 也e primary
auditory 四”a of the 恼nporal lobe.
124 • NEUROANATOMY

Medial nudes『group

Med刷 nu曲目rgroup In恼maim创川｜自rylamina

④ 」蛐臼rnuc嗣rgroup Lateral nude町，roup -

－：.＿~;i In回阳ninarnucl帽rgroup

U恒ral pos酬。r(L的

La阳刚由nalιD
Pulvinar (P)

ti!飞 ’＝＝、
,__.} Ven国l poster嘀嘀edlal (VPM)
飞，· .. VenIr罩J post阴阳罩I (VPL
Fig. 12.5 Tiie left thlllam圃”刷刷am the anterol白帽l•pect 帆，，C) and in coronal NC恒m 徊，时，由owng 恤’ principal nuclear graupa 帆，因
and 恤，divi蜘na or the later唱d nucl帽r group (C,D).

Ventral anterior nucleus den钮.te nucleus of the cerebellum. Palli血l and nigral affer四”
The vmtral an能由r (VA] nucleus ocmpies the rostral part of the 阳回inate in VLo and VI皿， while 也伺e from 也e cerebellum
k也ral ”. It consists of臼ro subdi世sions：由t Jar萨Z
nuclear ma 阳min耐 in VI.c.ηi.e ventral lateral nudew』 like the ventral

p血d~al ~art (VApc）皿d the small饵 magnocellular 归n (VAmc].

anterior nucleus, has reciprocal conn配tions with motor areas of
四le p血cipal subco国cal affi时四.ta to 也is r唔onareou刷t fibres the frontal lobe 阻d especially wi也也E p血n町 motor cortex of
of 也E i回la田al b笛al ganglia sys回1, which originatf! from 也e 也t preαntral gyros. 币比咱1国1 四terior and ventral lateral nuclei

internal segm四t d也E globus pallidus {GPi）皿d ita homologu岛 are an important pa皿 d由z m民bar由皿 by which the basal
the pars 四culata of the sub血且由国gra (SNr). Fibres from the ganglia and cer由elh皿 exert 曲曲 influence on normal m~四t
globus pa血dwi 阳minate in VApc, while those from the d 由rough whiclt abnorrnali恼。.fm回回回.tare media:时 b

substantia nigra 回din VAmc.τhe ventral ant回or nucleus of the basal ganglia and cerebellar disordm.
由alamus has reciprocal co皿ections 明白 motor E唔.ODS of 由E
frontal lobe, particularly 也E premotor and supplem四臼rymotor
cortices. ~守 町E帽I 阳恤entotd川”耐th•b•
..囚I皿..囚doe..bellum
Ven阳I lat町al nucleus
Neuro剧咱lcaltyo placed 嗣IonsIn 1he 啕Ion of t喃喃附副 ente~o『 lrld
四le 咱也al la阳菌I (VL) nuclel皿 h immedia蚀与臼udal to 由t
晴阳l late叫 nuc回国ve U四 used ID al副晦 some of the motor
ven缸al anterior nucleus in 也E 响盟缸al 世E of the la:国al nuclear 町mP'回ms 醋。cle:回 with disorders d 阳 basal gen日II且闹剧，
四mplex. It 回国恼。f也:ree lllhdi由ions: pars oralis 阳功， pan tremor at rest，咖阁「回由i)and 饲reb副lum Untention tremo~. Su由
世aalamatomy ha& b臼『I largely 剧院，部到ded bydn唱 ther，司'PJ in basal
medi山 (VLm) and pm c.audalia (VLc). Subcortkal a缸四” to
归「啕l国 d嗣植B but is sl副 us回 b 闹剧e ca『茵划lar 甘田nor, e.g. in
the ventral lateral nucleus originate mainly from the ipsila田面I
mu阳p阳 S曲rosis.
globus 阴山dus 缸td substantia nign』阻dfrom 也e contrala阳al
 Cha pt町’ 2 而alamus • 125

N阳帽『1uct阅rgroup to
Clngula饱α>rlBx

(VL)
Prima叩 motor cortex
(VPL)to (VPM)tn
〈岳 Somatoser回orycor阳 ⑥ Soma饵””orycor惚X

L豆｝ (j
F幅.12.80咱anisation of thalamic nuclei and 曲曲 principal relationships wi由 the cerebral 曲而也 The thalamus is vi阳刚怕m i惚翩翩恼teral
aspect 例 and lncoron副 section 回．臼lours lndlcste the relatlon制阳 betw田en thaJamlc nuci创 andcorre叩ondlng ce刚刚 cortical regions on the 阳W创（C)
and m叫“ (D)as阳cts of the cerebral hemisphere.

auociationαma of 血E 归rietal lobι 咀四”.dvinar is a large

Functlonalo帽anls翩翩剖由•lateral ”ucl””roup
• 'Speclnc' thelamlc rue国 have
well-de阳回 ser回Cl'/ or motor
functions and h阁Ny O咆ani副
conn自由町、s with 田回Cl'/ a回
阿10lor regions of 廿回 α，由副
cortex. Thay all l幅 W怕in the
ventral t阳『 d ti回国町al nuc抱s
mass 町、d include:
• Ventr副 p锚阳W nucl剧s:
『田刻响强 g国ner罩l sensory
d抽回1恒 in the med国
阳m同阻后， s回nothalamic
回ctar回 t『igeminotha恒mic
tract; sends d恼田rta to the
prim田y sornato饵’商Cl'/
∞『怕民创 thep苗1酬I IObe.
• La阳ral genla』e:te nucleus:
盹ic:eM插曲u副 aff8附nts In the
叩向 tract; pr叫臼饵’ot闹
r晤。n at 由em，四 posterior part of the thalamus. It has extensive
prtmery 飞归Jiii co『lex of the connections 咽rith as凯丽ation cortices of the parietal，能mporaland
DOC卫pitallo国．
α划pital lobes.
• M自由l genia.血甸 nucl凰』s:
陌佣阳自由副ditory a缸”霄1恼
An幅rior nuclear group
from the in旬巾rmliculus;
a胃、dse回国晴、ts to the p而nary 霄iemost an:回ior portion of 也e 也由mua, ＂鸥ending to its rostral
副dito『yco内航 d the pole. is the 四阳ior nuclear compl.e:z:. It consists of thrtt
恒mpor田l lobe. subdiv如ions：由E an坦rov四位剑，四teromedial and an恒rodorsal
• Vent闯I anterior and ventr刨
nuclei. 咀le in也说dual 田皿配咀ons d也ale w诅 not be 曲CUiied
闹剧l nucl创； rece阳础阴阳
h四 since th由 specific functional Ii回ficance is unclear. 四E
帆m the cerebellum and
四位rior nuclear group 也 howeve鸟 part of the limbic 窍’但m.It
basal gar回国阳；“ind sf阳帽nts
to motor cor四”l areas al the Z民煌咱 a larg障 affa钮t pre:对配蚀。E from the mammillaiy body of
＃刷刷刷－－ 也E hypo也划皿lUS 司a 也e mamm血。也alamic tract.τbe 姐阳ior
• 'Non咆peclllc' nuclel conn筒t compI缸”叫ecl9 p血d阳llyto 也t cingl血.te gyrus on 也e medial
W时1 wider are”。f corte嚣， s田face of 也e cerebral hemisphere ~see Fig. 16.7). It is invol划
Including 串串“脚1闹剧dllmb怆
in the control of ir茵茵nctive 也曾因，姐 the emotional up四s of
『啕Ions.
behaviour and in m，四wry.

Medial nuclear group

M也in 也e dorsal 植.er of 也E K国al nucl田 complex lie a
number of so-ailed ’non叩回fie' nuclei. Among 也ae,. 由E la:国al
donal nucleus is part of the limbic sys能m. It m卫iw.9 a晶由白
from the hippoαmpua and 1e1由 d趾回.ts to the cingul础 gyros.
哑te lateral ”’回ior nucl创s tw connections with 也E 侃E回ry
咀ie medial nuclear group forms a large region 田nail'由1g
primarily of the mediodonal nuclru1 〔缸阳tedial n'时eus) and
some much smaller compon四”，，uch 制 the nucL剧， reuniens.
Subco而cal afkr回ts to the mediodorsal nucleus come from 由e
峙po也alamm』 a町gd也 and from other thalamic nuclei,
126 • NEUROANATOMY

including the inttalam旭缸 nuclei and nuclei of the lateral Reticular nucleus
complex. Extensive r也procal conn回io凶 emt het.w由1 四1e reticular nucleus is a 由m. 峙er of 创ls loca时 on 也 la回al
由t mediodonal nucleus and 也eprdrontalαM佳Z It is
a吨脏t of the 由alamus bet.ween 也e 回国nal medullary lam监且姐d
con阻ned mainly 明白也e control of mood and 也E
也e in恒mala归血咀is nucleus receives colla但rals ofbo也
emotions. 也alamocor世cal andα回回也且lamic6b圃， which pa腿 betw回1
other 也alamic nuclei and theα~ral corta.
lntralamlnar nuclel
Seventl nuclei lie embedded. within 也t in能mal medullary lamina
of the thalamus. 咀ieae include 也e 值ltromedian 皿d Fune咽。”“＠咱.......’”“ anterlo『， medlal,
lntralamlnar end ratlculer nuclel
归rafasci皿Jar nuclei，也e centromed阳1 I地咱也e largest
面回laminar nucleus in humans. The in田lamin缸 nuclei :receive • The 阳tel1口， nuc脑er group of • Thel刚刚amlnarnuc阳I re叫w
ascending after四”量om 由E brains恒m reticular formation and 1问e 廿'8lamus Is pert of the Input from 甘冒a retlcular
al90 from 也E spinothalamic and tri京m匾。thalar回c sys阳回. In llmblc system. 刊阳 region fonnstlon and a筑精ldl咱
F酬)Ell\il翩而bres 膏。m 世19 ””。『y systems. They pro阳t
tum, they proj回 to widespread E唰m of the cerebral corta 削 mar啊millery body al the to the α:irebraJ co『tex end the
ω 也eca·叫“E nucleus and putamen of 也e basal 阴nglia. 哑le hypolh副町nus er币d p叫田ts to S刨a阻111 町、d ere 『esp町、slble for
intralaminar nuclei are part of the m民hanism for activation of也e the cir可ula饱 gyrus. act阳回m of the 饲『回阳司 α万回x.

但由国 corta. Wh白血ey are stim叫ated, alpha 血”hm activity.

which is 幽艇罔且能d wi也 repose 皿d sl四~＇ is disrupted 姐d the
•Within 伽emed刷 l"AJC阳，
group, t啕『nedlodors副 nucleus
•There甘αJlar nucl融JS receM ”
col阳terals of thelamocort阳l
electroenc甲hale事am (EEG) bemm臼 desynchro由此 Wionsof hes extens胸 reciprocal and co刚回thelamlc ftb『盹
α：rm甸回町、s with t~唱 αY恒x of
趾 inttalaminar nuclei reduce the pert:Ep世on
of pain and the le咽
the 膏。”回l b国．
。f consciou栩栩．
 Cerebral hemisphere and
cerebral cortex
G酬， sulcl and lob髓 of the 国rebral Functional t贺，anisation 135
hemisphere 127 White matter of t胁。”'8bral
Cerebral cartax 134 hemI咽h剑唱E T姐
Hlstologlcal struc阳re 134
咀leαrebral her皿sphere is deriv刨食。m the embryological
teL四icephalon (Cllllp阳 1).It is 也e largest part of the forebrain
缸ul it reaches 也t g回国t d嘈回 of developm四t 姐也e human
brain. Su阳“曲，也tαttbral hemispb配 consists of a 均臼 of
grey ma忧eJ;. 也Eαrebral corta, which is highly amvolu恒d to
面［）Im a mmplex. pat回卫 of ridges (gyri; singular. gyms) and
furro明（皿lei; 血gulai:; 1uicua). n由阳晒旬 m画mise 缸
surface ar回 of 也tαrebral corte鸟白bout 泪’也 of which is hidc:h咀
嚼thin the 由p也s of sulci (Figs 13.1, 13.2). Beneath the SUI鱼饵
axons running to and from 也E 创ls of 由ecor阳缸m an
但能naive mass of white mat田，. Deep within the hemispher喧 lie
addition且l mas础。f gr可 matte!; m侃 notably 也e 由alam.us 皿d
the baaal ganglia （田nsi回吨。f也E caudate nucleus, putamen and
globw pallidus). Figs 13.3-13.12 show a rostro-<:a叫d 副部 d
coronal 脏tions 由rough 也e brain in which 也E major internal
由uctum can be id回曲ed.
咀ie vast majority of those nerve fibres that p副 bet\m:n 也e
αrebral oor跑回d sulx刀rtical structures are condensed, de叩
回由且也e h臼皿spha己皿to a broad sheet called the internal
“ psule （~ 13.4-13.11, 13.13-13.15; see 也0 Figs 1.25-1.28,
1.30, 13.24). Between 也e in位ma1 capsule and 也e cortical m血鸣
曲res rad.ia恒 in and out to produce a fan-like arrangement, the
corona radiata. 哑ie principal mbcortical gri句 mat田 is lora回 in
”
close prm:i.mity to the h田nal capsul乌 the 也alamwi and caudate
nucleus lying medially and the putam回 and globus pallidus l ng
laterally （~ 13.1-13.14}. Wi也a theαrebral her血肉眼 lies
也t large C-shaped 由ityof 他 lateral v回国也叫li.ch is
consi曲回响曲也e rest of 也t 四n回α血z m但m in Chapter 6.
nie two c:er由ral hemispheres are sepua:时 bya d呵 deft，由E
S回it loogi钮clinal fissure, which accommodates 也E meI咀ngeal
阶鼠:e呻百l gyrus
Su阴阳r fronlal gyrus
Middle fron恒l gyrus
In~自由rfron幅l gyrus
Superiortem阳审l gyrus
Fig. 恤’』嗣刷l ”’翩。，伽ecer侃”lheml”henllho-"9 m明Jor prl and eulcl.
13
A翻”ciationfib陪s 138
Commi岱U『'81 由b~前 139
同"O]ectlon flbres 139
falI cerebrl In the d叩，ths of the 6.ssu鸣曲e hemispheres are
united by 也E 俑，us callo1um，四 enormous sheet of
com皿issur田I nerve fibres whi曲 run betweenαmespondi吨 areas
of the two oortici臼 阴gs 13.2-13.15; S也 also 目， 13.21-13.23,
13.25).
Gyri, sulci and lobes of the cerebral
hemisphere
Certain gyri and su1d on the surface of the hemisphere are
relatively consistently located 旭 different individu血 and are 也e
basis for divid.i鸣曲t heini制iett into four lobes, namely the
量ontal, parie姐I, temporal and o回回国 lobes.τ'heir principal
旬pographical 缸”res and h配tional significance are described
below.τhe most conspicua国 and dttpESt cleft on 也e la恒al
surf坦.ce of the h但由.phere M 世1e la能ral fi11ure [Pig. 13.1）咽’Ibis
separa回也e temporal lobe belσwfrom the 岳阳回阻d parietal
lobes above. Within the d叩ths of the lateral fissure lies a cortical
area known u 缸旭l1lla 阴gs 13.6-13.12, 13.14, 13.1η，咀ie
~ofthefro皿al, parietal 缸ul temporal lobes 由自t overlie 也t
h剑.tla 缸e called the op但cula. Also on the la但ral surface of the
hemiapher巳 a aingl巳 often unin皿up回叫田S 臼n usually be
iden咀叫， mning betwttri the great longitudinal 缸，ureand the
k国al fissure. This is the Cell位al 1ulcua, which maria 由E
boun也哼 betw阳1 阳企on回 and pari耐I lobes (Figs 13.1,
13.16）.四ie central sulcus atends 伽 a short distance onto the
medial surface of the hemisph但也 wi也in 由t g回I longitudinal
fiuw:e 阴gs 13.2, 13.16}.
四ie frontal lobe cons岳阳回 the en由E E唔.on in front of the
αntral sulCU&. Immediately in front of也E irulcu鸟皿d rum血g
Ce呻刮删瞄
阳阳阳l gyrua
Middle 阳””ral w邸’
In阳b『阳回阳罩I gyrus
128 • NEUROANATOMY

严rallel to it, lies 也E prec回国l gyrua, which is the 阱mary
m。”r region of 也.e ettebral car皿 h front of 缸严缸随时
gyros，也e rest of 由e frontal lobeαmsists of a more 四riablt!
pat国n of convolutiom』 of which the m萨，ior, middle and
inferior frontal gyri ran usually be id四世ed. (Fig. 13.1).
Behind the central sulai鸟 and above 也e lateral fiSSUI骂
lies the parietal lobe. Its m饵tan能rior 阴rt is the p。stem饲I
gyrua, which is 由t site of 也e primary aomatosensc町 corttz.
Behind 由E pas位四位菌I gyru岛 m 也E h阳al SUI也ceof让Le
h四咀spher已由t in回归rietal 皿l.cus di乱des the rest d由t
parle回I lobe into superior 血d inferi町 pari也I lobules (Pip 13.1,
13.16).
Thebm皿也ry between 也E parietal lobe and 也E posteriorly
I饵拙d occipi·时 lobe is not coincident with a 归gle sulais on the
h能回，u血re of the hemisphere; however, it is clearly marked by
the deep parieto。因.pltal sulcm on the medial surface (Figs 13.2,
13.16）.咀11! Oα:ipital lobe d但s not bear 纽ty important landmarks
OD its la恒ral SU血ce but, on the medial su血也由E prom扭曲t
cakarine 副dαll indica阳也e location of the primary世sual
COlUX （日， 13.2, 13.16).
’Ihe 回nporal lobe lies hen但也也E K也ral :6.臼田巳 mer回ng
pos回iorly with the parietal and 0回.pital lobes. 臼lits la艇ral
surf缸e, 也t tempor划 lobe is divided into 也m principal gyri 也at
runrou掉ly parallel to 也t la也ral 也由此；也.e 1uperi时， middle
缸ldin缸ior 能mp创菌l gyrl （囚岳 1.3.1). The superior 田nporal
gyms includes 由E primary auditory 四rto. M田t of由is
functional I唔on is situated on the superior bank of the gyrus,
with扭曲e lateral 鱼”，un;鸟 where the tranlftfle 忧mporal gyri, or
Heschl’, COll\IOlutiom, provide a more precise locali锦tion
但g. 13.17).
On 也E medial surface d由E hemisphere, certain portions of
也t 丘。ntal, pari幽l 曲dtem严>ral lobes also co田园tute
components of the H皿bic systmi. Cur世ngamundtheα叩us
call田Uill,，四d runr由ig P缸司lel to it, E因也t dngulat£ gyros
阴， 13.2, 13.16〕，即回国 from 曲回 of the h皿呐四 by
”
the cingulat£ sul018.ηiedngul础 gyrus pa a p帽回orly and
inferiorly round 由e post回or portion, or spt回ium, of the corpus
call倒umtob艇。me con也lUOUSwi也也e par由lppocampal gyros
of 由e temporal lob巳 Dttpto 也e p缸ahippocampal gyrus, wi也in
the temporal lob巳监ω 也t hip严Kam.pol 例， 13.8-13.12）.回国
structure is funned by 也 in<Urling of the inferomedial part of the
temporal lobe. 咀E cingL血t£ gyms, parahipporampal 伊山 and
hippocampus are 四metimesre缸red to as 也.e limbic lobe of也E
αrebral hemisphere.

Central aulcus
Prece耐al gyrus 问，阳回l gyrus

向ll1eloα划p阳l
a』lei』S
α『咱u阳恼 au比us
。·ngulat& gy阳S

Fomlx
Cal跚1『丽刷刷s

Uncus

Parahlppocampal g庐山

F幅. 13.2 Medl•n sagltlal 皿ctlan d由• Cllnlbn1I h11111lsphen1 showing m叫“ mrt and sulcl. The brel『回国n and 田ebeHum h凶E been remov回ω
show 阳 inferomed国I asp田t of the 田nporal lobe.
－v
个

Corpus 臼l阳um
AnlBllor horn
oflabn阐耐de

Head d回udate nudaua

时.13.3 Coronal ”“”’fthecar喃ral hemlephen..

 ……

An饱riorinb
。f intemal capsule
Head or caudal8 nuc拟JI

Fig. 咀A Coron.ia”刨。”“…”rabnil t.mlsph•也

Anterior horn or
l嗣同d venlri幽

Tem阳审l lobe

Sap灿m pallucldum

Fig. 幅S Coron.i section of笛”四”bnilt.mlsph-.

Ant，由rlimbof
P1』饱『nan
intemal 饵”响

Sepblm
Nucleus 1四umbe『嗡

Fig 愧， c。””maectlonof…“rabn1lt.111恤，her‘
130 … NATOMY I

M酬T阎明:>Mlle

C«ona radi” ’,ta

缸”me capsule lnsu恒

An恒riar
缸”male理psule comm1ssure

Pu旭m’” Anterior column

of伽响k
G蛐us pallidus
SubllllnUa lnnomlna饱

Fig. 饱7 Coran•l aaatlon af th• ””tlnil M时，phllnl.

Cal剧，ten1鹏拟AS
阳』

Ls恼nl
国幅幅lfi”“m
medullary lamlna
耐酬
叫叫

Fomix:
Mm
C幅“恤m

Hlppoc:ampus

MammIll町 body

Fig. ’a.a Coran•’”捕。nafthe OI”由nal hemlsph11n1.

In阳nal 饵”ule

lnsu恤

!” ialamus
Tall of 姐udate nuc以』’

而irdv曹晴icle
Hlppocampus

Subthalamlc nucleus
仇”阳t国 n帽”

Flg.1”。”n•l ••atlon of th• 帽”bNI hemisphere.

 …… 611181 long阳dlnal 11aaure

Fomix
Thalam111
M伽阳 horn of
M阳刚 ven1ricte
“
R nucleua
Crus E，耐而

Sub刷刷， nlgra

F地．恤，。。”n•I•刷刷””。w刨:nlh•mls冽跚跚．

Td d锺叫刷 Ml幽幽 Habenula

Posta~or
commlssura
Temporal k血，

Lataral gen阳阳tllnL且也UI

肉”’

” Cor’”...”tlan of笛”1 certlbnl heml鸣’””－

Flg.18..

F口『nil
Pulvill『

Pineal gland
Hippocem阳S

日时翩翩1Jur唰Jm

Pedunculopor市ne nucleus

阳，如画』创U创uct

F匍施’2 Coron•I•蚓1”’e阳。翩翩 hemi.”四”－

132 … NATOMY I

闹剧，fcauda饱 nuclau1 -.
－－－－－－－~－Anterior rtmb of intamal响抛
Pu恒『『1’『1
Globull pallidul

向翩翩。rlimbof画曲，mal capsule -
- Genu of internal capsule

Tha阳响盼

Spl"nklm of IXI『阳’饲llosum

Fig. 姐””。”ZQl1甸l ,. .，阳帽n刷e ...“四”回 lm•gaof ’” llvlng b1'91n. (CoUt部syof丹W融$$0TAJEN;炮制， Woll』m M饰刷刷r加隔萨19 C阳帽，
Un阳wily of Mane/四ter. Mancl阴阳， uκj

”’ad ofcaLIC!ate nucleus

lnsula

Pullman

- E血malca阳』la

Globus pallidus
Clauatrum

向翩翩。『 limb of
lntBmal capsule

- - - Tail ofcaLIC!ate nucleus

Fig. 愧’4 ”。”l:Cll'阳1 ..ct1onof 伽·”””－

Corpus 臼noun

臼Lida协 nuc却UI
Putamen

Fig. 愧，s Coro帽t m•g翩翩ere嗣n•n帽 Image of the llvlng brain. PM阳1yofPro嗣sorA.Ja彻徊， Wolfson M战刷版问供lrJ 阳桐， U刷刷ltyof
~，如阳chester, LJ,κJ
 c.ntrll au以m
…… Pol饵，1回l 'II旧事； primary
，。ma棚”町∞『lax(8111“ 1,2,3)
防酬»ntral gyrua; prinmy
m耐r cortex (8118 4) Superior pa归国 lobule
Pref阳阳回回（””｝
蛐啕8iefalU:皿
Fronlll m制｛缸”’｝
lrlarlor Pl翩翩蛐且，

网”wala>幅
Primary剖剿，l即回伽晴仔｝
Broca'sar”（81'Ml44A5l一一一

V融踊l u’“祖国on a>曲直

。b刷刷刨
.Weml帽、urea
Lateral 旬，ura

（再）· Su闵由W饱mporal gyr111

P~mary auditory co幽E
(a恤，利，啕

Pracan恼lgy阳，； primary Cen苗苗l a』lcua

W脚『∞『阳（缸”4}
阳阳回l 'II『隙， prima叨
Pnimato『饵”以（81886) 叨闹闹ensory cortex 伽『隅’，2,3)

S翩翩yu缸’claUon cor恼X
刻ngu胁 ω阳”
向阳lo-o回pilal I啤刻’
Cingul刷 g庐山

Pra阳晒J COi田

P阳阳y 'Jiaial cortex t’”明

Corputca阳融』m

Vllual um:lallon 回国
Orb阳l 饵”’啤
睛闭I fislu陪
’聋， Pnhippo帽npal llYNI
UnClll
F幅.13.111 M咖r functional 笛”a of the 饵”bral con肌例 Lateral 笛阳I of left 帽曲创 hemisphere； 回 m回ial aspect of 啕hi 田rebral hemisphere in
sagitta陆民lion.

Fionlal pole
。因p刷 pole

l11111la

Temporal 酬’

Fig. 恤’79””roll凰”’“·””“ of ..•left B’ ”brelhem•’”·”. The frontal and partetal ope刷刷刷，国en 『emovad to show向 loc酬。n of the
transverse temporal gyrt (H”时，∞『附lutlons) and t陶 lnaua.

。”， 1ulol•nd lo”eorth…rebr•lhem幅，... ..

·币l8 am!b『理I hem阁”回m • Underlyir咆 white matter, ·币田”wi cenibr回 h由1幅ph町回 回响pcral and DCC现p闹。由白白
cons幅幅“ αinsisting d 由而cal 笛’ S郎”.led by 伽，町，a b画jg of 8l』巾CB to阴司~raphy.

• &tier而C刷睛，b~创
afferent and 目f阳帽t ’”
lor'G队』dinal Uni and 』olned by • P~nclpal landmarks 阳t Indicate
lbr回 the oorpu1 回lk陆um.
W酬， ccrwolut创 廿'Ill dMalons be1w回n lobes are
• D锦p nucl凶r ma凶串串： the
阳阳n g~and ·币、E hemlsp惰，elsdMd四 hlD 甘丽剧，ral ’ssura，“刚刚 sulcus
阳Jamusar回国篇l 惧咱lia
剖lcl 触』『 lobes 价。”al，因而，四”－ and parteto-o国pllDI sUCUS.
134 • NEUROANATOMY

…叫－
叫问
Mm
Re由Im蛐 Sam翩。n Cα刷刷刷

，气

tJ
l 二H 飞 ＋ 飞
气
+

· +
运

II s刚刚脚 - Abaenla阳lnal nlllme 圄 Lon of阳隅’口n ~ In唰司蛐 movement

a』菌匮植

+++ lncre”“饱ndon l'1lflex

t Exie叫an恼r叩响

F幅．恤，s Unila恼ralcerebr咽•hami”here M品，n.Ref1町创so to Fig. 1.48.

l of~ cdl bodi囚，但dritic arbo由atiom and synaptic

~U FoC111ce晴.....”ilon• in回回nnedio皿 h the ea由归rt d也E 阳回由世l rentu叩，也E
F时划 αnbral lesions, e.g. a stro陶 ortumou巳 produce 1hr回 kinds of S幌di血 anatomist 耻。由nann produced a numbered,
叩nptoms: cyto缸由ite由ual map of也Eαrebral cortex based upon its
1• Facal 9J!llllPl!c a副副，＿， There田titive dschar，部 of gro1早＞＆ of E咽。nal histological charac回istia. Although la鸣曲剧院~
neuron臼 in 甘回国阳bral cortex p『回uce para:均ISmal ;rtt缸陆 by the elucidation of function, 旭 some instances，也ere is good
恒sti『、g for b阳f p回ods and 『回ftecling the 仙nctional prope而西 d
corr四pon也la! betw阻iBroduwm’，缸田’由d functionally
then剧阳晒 con民抑制. The patient experien民揭 sudden at恒c陆
d 幽'IOfrTl&I m的剧创恼。r 刷sations 但imp脑协叫“izurea) or defined z唱“撼。f山 cor皿 h such casea. Br叫m皿血’s numbers
b阳f alter硝ons in percept阳， mood and M酬。町（四mplex att reta且d in common use 阳 desaiptive P山阴阳．
阳刚画，创四”’~. Focal selZ\」阳 may 111gger g””rallaed Long ago in evolution町 his阳ry，也e en由al COI回回国nally
阳nlo-donl创 selzl.』阳． arose in relation to olfactory function. Phyl句庐le面也lly old 归m
2. Senaory/motor deftclt8. Th嗣 Is a 阳s of 锦nsa阳l or
mO'I朋19时，甸回恒.ble on cHnlcal neurological 曲曲mlnat阳．
of the m胆（refi回时 ω 掘脏曲icor皿 and pal回corta.), 1Uch a1
3. ...，唱hol。glcal ddclts. Th脚 are br回kdowns In 阴阳市logical the hippocampus and other parts of the temporal lobe, retain
pr民洒”es SU仙”阳、guage, peroap11on end memory, 也rough.out evolution an assod甜on with the olfactory sys能mand
d阴阳rab恒。n 因归ho同l圈l evell翩。n. have a primiti:鸭曲时甸回ed cytoarcl咀阳ture. These E唔ODii have
If the fo田J lesion 面晤缸目。CCU阿i吨，甘咱自町ndroπ丽 of ralud important 缸且ctions in the emotional aa严曲。f behaviour and in
intnic固自l pre翩翩隅ullB （：酬 Fig. 5.2}. mem町·’I同庐tberwi由。由z parts of 也eoor皿 and certain
A unla:幅ral 。”’bra.I hernia回回帽腼aion cauSE揭 π回内恒l subcortical nuclei they oo皿岳阳恒缸 limbic sys也m (Chap田 16).
im同m町t (e.g. a国asia), a contra且le刚 E阳tic hemipa睛陋，
hype帽自制a and an ei缸阴阳 p阳ntar respcnse (up阳 motor 闹剧ne How回盹 m皿t of the C£rebral m四E is a more recent a呵皿sition
lesion} and co附刮ateral hem丽ensory loss (Fig. 13.四. A vascu阳 insult in pbyl句萨netic 阳ma and is re如red to as the neocortez.
to the intern创臼psule, such as an M阳回剧。『 haemoπh.!酬，闹出 to Al也m耻 its 也回led cytological 翩翩re varies from r晤。nto
the rapid developm酬。1f this syndrome，，阳。wn as stro阳． E咽。比 it is 伊let咀ly E配啕lised as conai.s也igofsiJ:~
The 『啕Ion创以泪l阳atlon of neuropsychologlcel Ill四町、s In the
但g. 13.19):
cerebr：创 cortex 恼 summ町协副 In Ag. 1.49.

•I匈er I，也t most superficial l勾臼， contains few nmie 叫！ bodies

but many dendritic 皿d a皿nalproce槌剑出 synaptic interact沁n.
•I匈喧rII con国ns many small neurm圃， which 笛tabliah
Cerebral cortex 归田cortical connections.

• La:阳Ill rontaina medium-&i.zed 田田ones giving ri配”

Histol。gical structure association andαmtmissural 面bres.
四ie cerebral cortex. forms 也e OU阳则由m d也Eαrebral •L句er IV i，也e site of termination of afferent 矗bres 企om 也e
hem间址阳也 It consists of a 同鸭 several m皿im出~in 刨出四岛 sp仅Hie thalamic nuclei.
 Chap幅r 13
II
Ill
IV
v Sarr随他翩翩’Y
VI
Whila m回抽r
F幅. 13.19 Hlstol啕l回I structwe of the cere恼，d cortex. 仍m M灿创，
GAG and 阳1ttarson, EL 138.s,曲~Anatomy. Lon也:>n: llvfng回'006; 1954.
Cour恼:yofChu时暗自lMr嘟嘟时
eL句uVis 由e origin ofprojedion fibres to emacortical targets,
such as the basal 伊nglia, thalamus, brains能m 阻d apinal cord.
In the primary motor cortex. of也e 食。ntallobe, 也is I句u
αmta皿s thegi皿tB也 cells. which proj四面bres into 也e
阳m皿也l tract.
• ［匈er VI also con回maasocia植on 姐d projection n，四roo.es.
Functional 。rganisation
咀le 田由ral corta: is De<D回ryforαm回OWi in帽.rene&I and
由ought, m四ory and in凶回. It is 也e E唔m to which all
sensory modalities ultim.a:国y 皿rend 〔m田tiy 由 the thalamwi)
and where 也eyare 田mciously per田，ed and interpreted in the
light of previous experien缸币l.e 臼rebral. cortex is also the highest
level at which 也t motor~ is represented. It is here that
缸tiom are conceived and initiated.
·四iepos田iorpartof由ecer由rum rec曲回徒四ory 皿formation
盒。m theou凶de world in 由eprimarys钮，oryar回softhe
P缸ietal lobe (soma阳钮，ory), occipital lobe 例sion）曲d
阳nporallobe(h白血卧
•load如centmr世.calzon£S，也E information is elaborated and
h位rpreted, thus pennitti吨iden面q咀.on of objectJ by touch,
S埔t缸ul hearing in a mo由lity-specific pro锢， ofper四四on.
Areas of cortex. at the junction of值ie three cerebral lobe鸟 known
as a”。ciation cort岛 are critical for the multimodal 皿d spa岱al
rec刀胆ition of the envirorunent.
·四e medial portions of也tαrebral hemiapher哩。imbic system)
enable 由E storage 缸ul 眩目eval of in缸mationpro但1edin the
P回国iorb四由pheric regions.
．四ean·能rior part of the rer由rum(fron刨 lobe) iii con但med
withtheo耶皿sationofm回'elJlent 制m町motor area;
premotor and supp阳1entaiy motor areas) and 阳阳能gic
Cerebral hemisphere and cerebr百l c。同ex • 135
cf
问.1S.四 Sci唱，matlccor。”’..翻划” through the cer由ral
”
hemllphere llluslnr世ng the approxlma俑，，matot呻le n111re ntatlon
d由econlnll刷ral body heH In ’”’m创町，nd ””四””rtlc恤
gui也nee of complex motor behaviour ~time (p尬。n回
area).
• In the majority of individuals, areas of酬。但ition corter. in
frontal, parietal 四d 能mpor菌I lobes of也.elefthemi刷回'eatt
responsible for 也 comprehension and apr四ion oflangua伊·
四ie left hemisphere is, therefore, said to be dominant 缸
language.
币1e E唔onal loc:ali四.on ofru:ur叩即由。logical functions in the
田由raJ corta: U II皿m缸ised in Pig. 1.49.
Frontal lobe
咀le 丘。ntal lobe lies an能riorto the 但ntral sulcus. lmmedia也ly
anterior to 伽e central sukwi, and running parallel to it, is the
”民entral gyros. FUuctiooally; 也is is ko，阴阳 as 也e prlmarym•侃侃
corta: (Figs 13.1, 13.2, 13.16). It corr国ponds to 耻叫m甜的 area
4.Wi也皿由ecor也z of the precentral gyrua, 由e contralattral half
of 也t body is repres四.ted in a 归回阜e somatotopic a血ion (F:也
13.20).’Ihe E叩resenta:笛.on of 也E body is inver但也 with 由E h四d
缸回 lorated in 也emostin缸ior 归H d由E preren田l~，如st
abOW! the h阳对他ure. Progressing superio句，uα朋i胃缸回 of
cor恒 E叩四搅nt the digits, hand, arm, shoulder and trunk. The
law町 limb is r叩«Sell＇时 on 也e medial S1.跑回 of the
hemispher巳曲。ve 也e corpus callo侃llll. The area of cortex
d白。也d to a 阳rticular body 归n U 严叩ortional, not to its siz鸟
but to the d唔田。f pnxilion with which movmientl can be
execu时.1毡自由n 也E Ju严ix. tongue, face and digitl of 也E hand
缸E repr回回国 bydispro归皿ionately large E唔.ODS.
Stimulation of the primaiy motor cortex. elicits contraction of
di町阳 mU1cle groups on 世ieopp惆k side of 也e body. The
function of 由is z唔m is 也.e control of回luntaiy, skilled
movem四”， sometimes referred to as fractionated mo陀m四.ts;
30% of conicospinal (pyramidal 田.ct）皿dco国.cobulbar fibres
缸iae from n四rones of the prim.a:ry motor cortex, about 3%
originati吨 from giant 回回国也I (Betz] cells. The principal
subcortical afkrenu to 也E p由IlllI)' mo旬Eα>rtex originate from
the ventral Ia·田al nudeus of the thalamus (see Fig. 12.6），时tlch
in tum recei'ml in阳tm归ly from 伽 dentate nucleus d由E
αrebellum and from the globus 阴11挝田 of也e basal 阴nglia.
136 • NEUROANATOMY
The region immediatrly 四.taior to 也e prim町 motor cona is
known as 也epremotor 倒恒｛险时皿卸的 area 6; Fig. 13.16).
阳也e latttal SU血a of也e hemisphere. 由is includes 缸
F强国ior portions of the superior, middle and in缸ior frontal gyri.
臼1 the medial sur也re of the h四咀sphere. 由epr四notor c.orta
includ臼 a region re缸ied to 捕 the1Upplem回饵哼皿otor 四”皿
Her巳 Im 也e primary motor corte鸟世iere is somatotopic
配”也回回on of the body al也m协 unlike 也e primary mo伽
四rte:岛 E甲m四，ta;蚀。n appears to be bila也ml in ho也 bani刑ieres.
S植mulation of premotor cortical are笛 induces movement 也t
is 1幽 focused tha且也.at elid国企四n 由e primal}' motor 倒也Z
and involves gro1甲E offi皿ctionally rela恒d mUldea. Mσ四皿四t
evob到d from 也e mpplem四胆y motor cortex: 恒nds ta be p侃”ral
in natull鸟 invol幅ng 回.al and proximal muscula阳政 Premotor
m阳1 areas are th01聊t to function in the programming of, 削
P即“四on for, movement and in 阳 control of pos阳底 The
premotor cor皿 aats its actions p缸tly 由 the primary motor
cor钮’~ wi也叫lich it ii connected by shon a”。ciation fibres, and
归rtly 叫且 conicospinal and conicobulbar fibres. About 3的也 of the
l.atta orilPnate 扭曲t premotor cortex al也ough. UI也k 由E
primary motor cort£x, giant B由 cella are absent from premotor
areal. 哑ie principal subcortical input to premo归r cortical z晤。m
including the supplementary motor cort£x, is the 鸭曲回I anterior
nucleus of 也e 也alamua. 回函， in tu血，回国附 fibres from the
globus pallidus and substanti.a nigra.
lmm.edia坦与姐告ontof 阳”四totor COI1£X, 佣由t latttal
皿血ceof 也t h四U刷m巳 are located two o由a important
E唔ona. In the middle frontal gyms h 也伽血I ~field
阴m曲1ann’， area 8). This r晤。n controls wluntary conjugate
devi皿on of 也e 句圃， as occur 咄四缸anningthe 说mal field.
Unila能ral damage to 由is area cau回回响gate deviation of the
句哩， ten帽.rds 由t 剑de of伽t lesion. ID the 皿如ior frontal gyrua of
由E dom画画t hemi刷iere (us田I坊 the left) lies the motor speech
atta. also known as Broca·’，自咀（Brodmano’s areas 44 and 45).
勘蜒的“四 ha& important 油田∞皿缸tion& wi也 parts d也t
i回la田al 恒mporal, parietal 皿docci回国 lobes 由.at are involved
in lar电uage function.
The a国1~regions d也ecor悟。f也e 鱼回国 lobe that lie
m能rior to premotor areas are ref回回 ω 倒也t pr曲。ntal corta.
咀iepr曲回旬I con皿 has rich connec由国回由归riets.l，随皿归ral
and occipital m田伯rough long 翩。d础。a fibmrun皿ngin the
皿bcortical white mat田（Fig. 13.22). Subcortical affer四” ω 也t
伊曲。ntal 四”但 arise mainly in 也e mediodorsal and an也rior
nuclei oft}理由al.am四．币1e prefrontal corta hasα咿Utive
缸配lioDll of a high ord缸’These include intell配tnal, judgemental
and predictive famJ.世es and 由E pl.anning of bel田iour.
Pa，但臼／ lobe
四le pari由I lobe lies bet让nd the 鱼。ntal lobe 扭d is bm皿ded
”’t回orly and in如iorly~ 也E 侃cipital and temporal lobes,
resp回剧在 The m田t anterior 阴rt of 也e parietal lobe is 也e
严侃entral gyrus, running parallel to 由e 回I田l sulαu 但gs 13.1,
13.2, 13.16). Punctlonally; 由is z晤。a is 由eprimary
somatoaensory mr田｛勘叫m甜的 areas l, 2 缸ld.3）.四is is 也e
E唔on d 恒mination of也.ala皿oan:咀由1 2四mnes 由at constitute
由E 也inland 位1al relay in 也E chain of neurones can拆旦E general
sensation to a con回ousl”-el. The 也.alamic origin of these
neuron岱 is the 咽:ntral posterior nudeu岛 which in tum m口eives
fibres of tlte medial lem皿llCUS （：缸e touch and propri创:ep出啡，
spioal lemniscus (coarse touch 创 pressure), spinotbalamic tracts
胆in and 田npemtutt) and 创萨mino曲创皿tic tracts (8回自al
semation from 也E head).
Witl曲也E somatos四aoryα>rtex, 也£ contralatttal half of the
body is represen但din an in·阳时，四matotopic pat田n which
resembles 也就泣i the primlllY motor corteic of the 企m饵l lobe
F冒f Fro刷I lobe••-
川Left 阳nlal b国回ions 回回国：
I • f，以温l seizu耐.Paroxysm副je嗣咱 movemer恼。f阳 contrala1er回
I limbs are term甜、lmplem创旷 or ’＇Jae阳剑，Ian”由uree.
I • Sensay/motor deftclt. There Is wi倒阳989 of the 阳回 and upper
I motornaurone signs In the limbs on tt啕 opposite sic制：o the lesion
I (c:ontral’”ralhemlpl啕蝴．
I• Psycho同l侧面刊出.s阳揭出阳 produo副 with great et阳tand
I poor articulation, in brief utter回E臼 with word errors 伽an1phH蝴．
I Repetition of words Is lmpal『回 but pow阳 of comp时回阳lonare
｜ 刚atively pr回erved.Thi瞌 is known as Broca'a aphasia. Thera
I is a恒。 im阴阳回t cf read i'lg and wrili『回归l田la 町、d•11r•phlll).
| D啕enerative dis国随时 the left fro『rt副 lobe 『回ul恒 inapn咽ree•lve
I nan－匍uent•phul画， akin to Bra阻’s aph揭ia.
| 阱冒noter ar田IS of 甘南骨un回l lo民据自国『冒啤JOnaib阳 for 1he
I o咆anisalion of sidled m刷刷ents. Uni恒te刚 and bi陆留回回阳s of the
I pr唱moto『 cort锹险制 to the inabitty to c甜可 out skiled mo幌m副市 in
I the absenc自 of para加袍，凶nsory loss or cerebellar lncoo削Ination
川。”刷刷．
| B阳taral 阴阳闹剧lor胃口剧”：
I • Profound d阳阳由町、ceofbeh剧创randpel'l!OI'回lily
I • lmpai『回 problem唱olving a回归dgemenl
I ProQra困ive at『叩hy d 廿回阳时al lobesα::curs '1 the d饵，即回回阳
I disor由r of rron幅幅mpol'llldem，蝠’－
(F:也 13.20). Similarl，也.e amount of cor回 devoted to a
particul缸 b仪ly pan is disproportion.ate to 也e size of也e la价町扭
曲ecueof 也E S四sory cona, it reflects ra由自由e richness of
S幽幽ry innerva咀on. ’Th自dottthepha巧m. tel%咆屿岛屿 lips and
也E pal皿arsu血ce of the hands and digits are P缸咀α血由 well
repr回回国. Adjacent to the mou也 area is a region wb回国.te is
m回回4
四iesu血re of the 阳由国 lobe pc商回iorto 由e pri皿缸y
somatos四”-rycor田∞田titu阳也e p缸挝tal aa1oda1ionα汩饵E
四ie superior parietal lob叫z is m叩onsible for the 旭阳pret.atioo of
阴ttal 阻lSOiy information and for conscious 即菌阳础。fthe
COIIltr划ater温l haH of the body. Lesions here impair 也e
in恒职mtion 缸id understanding of 阻11ory input and may cause
n唱国 oftheoppo画恒 aide of 由E b四”－咀le in缸iorp缸ietal
lobule in能rfu:es betwttn 四ma:剧团sorycor回 and 也E 前sual and
auditory association cortices of the o国.pi1创 and 也mporal lobes』
respe曲曲，阻d 恒 the dominant h咀isphere it con回.bu回 ω
language functions.
m 阳d幽E 蛐elMions
Left par1et创 lo国 lesions 翩翩：
• Foe泪l seizures - paro咒归mal attacks of abnormal sensa'llo邸，
SP用回Ing down 甘、econ闹剧唰 S胁。fthebody ｛拥nsory
”国『鹏｝
• Sensory/motor deficit - a contrala国al hemlsensory 恼s and Inferior
visual 阳Id loss.
• p町cholc泪i臼l 由ficit - an inability to name o副部ts{anam幅1)anda
lo回 d literacy, with inability to 田d (alexla), to wri恒｛吨raphlll)and
b 国Jcul翻（ac11lculla).
同ght 阳刷taJ lobe 阳·ens C创锦：
• Foe冶l seizures - paro均富mal attacks of sensory dis阳巾ance
时他ctlngtheα>nt刚liller回到de of the body (simple S饵”’ysel到明｝
• Sen”’y/motord自由cit － α>ntrala俑，·al hemlsensory loss and an
In旬rlor visual fteld loss.
• Psychologl侧面制t - an lnablltty to ocpy and oonstruct d回lgns
be<泪use of碍M阳l d阳rlent回Ion (cons11'uc:tlonal aprula).
lobe I翩。ns 国d to disorientation i'l space and
Bi阳恼al parie国l
inabi耐书。因而酣田， copy and match D国留ts (apperc叩笛”啕nalia).
Thisα;o.nin 甘回 d同严闹闹live disord日r of Alzh日im曹＇s disease.
 Chap幅r 13 Cerebral hemisphere and cerebr百l c。同ex •
Temporal lobe
咀le h险阻1 SU血ceof 也t 阳nporal lobe is divided into 皿perio~
middle 缸uiin缸归r 恒mporal gyrl, whi也 run parallel to the K世时
也皿皿 Wi也迦也.e superior 也mporal gyrus ia located 也E prim且哼
m必佣rycor田恤叫mann’S 缸剧 41 扭d 42). More e1a耐， m伺t
of 缸’“nctional zone Ii回 in the superior bank of 由E gyrus,
normally hidden within 也t la也ral fissur巳 b precise location is
m础ed by the small 回回回e 回tporal gyri, or H岱chl's
convolutions (Pig. 13.17).
咀ie ~rimary auditory oor阳 is reψonsible 阳也e oooacious
per四川on of wund and, within it, 也.ere ia so-called ’tonot!币.cal'
repre坦E钮tion of the rochlear duct. 世re primary au温饱ry cortex:
E配咀嚼， input from the medial s皿rulate nucleus of tl坦白alam皿
咀re asαruling acoustic 阴叫仅:tion under事m p缸由I demsaation
扭曲t brainstem on its way to the medial 阴阳M nucleus (see
Fig. 10.22). At the cortical level，由erefore, 也e o耶ns ofhea血18
缸e bilaterally ttpr四ented ”也at unila也ral lesions of 也伊捡回ry
auditory cortex: ca111e partial d四岛倒扭 b创h ears. Auditory
infOimation is 缸也z pro画sed md in位同pre时 in the auditory
uaociation corta, which lies surrounding and 国media但ly
posterior to the primary audi田y c:orkL h 也t dominant
her旧，phere., 也is E唔on is 由o known as Wemicke’， are鼠咀is
E唔on is crucial for understanding the spoken word and has
impo血nt connections wi也 other la啤皿ge areas of the b皿n.
币le I民ation of 也.e cortical repres四.talion of the v四tibular
system is uncerta且 τ'here is ev划由.tt that it lies 扭曲E 皿perior
temporal gyms an阳讪r to the print缸y auditoryαE恒x:or in 由E
in也rior parietal lobule.
咀le 面缸Dmedial part of the temporal lobe is rurled inwanD to
岛m 也e hippoca皿.put. This structure H回 in the floor of the
inferior horn of the la田al 鸭mtricle, deep to the p缸划lippocampal
gyru， 但gs 13.8-13.12, 13.16). AB part of the limbic sys也m，也E
p由国.pal 缸nctions of 也e hippocampus are in rel皿on to memory
and 由t emotional as严曲。f behaviour. a倒 ω 也E 阻四.or 四d
of the hip萨x:amp皿缸ui the temporal pole 监a amass of
subcortical gr可 matter, 也em可回ala. 世tlch is also part of 也E
limbic sys回1. The a町＃血皿d adjacent 归血 of 也E
in缸”medial 能mporal co四阻”。函，e fibres from the olf.acto哼田ct
and are responsible 伽 tlte conscious appreciation of the serise of
smell.τhese connections receive 缸血.er consider四on
in Chap阳 16.
Lett ter响poraJ lobe 阳阳、s cause:
•Foe唱l seizures - pa阿肌ysm副 attacks Of UIY8部Xll'lSlveness
(ab9制”“1),purpose阳s behaviour ~肌阳m剧，时， olfactory and
complex 叫sual and auditory hallucnatlons and disturbances of
mo。d and memo『y(d6J矗 w).Th阂， attacks ere re阳r回t。”
complexp回国回国『'llS.
·缸恼。ry/m口1tor deficit - a cont刚eter1副 supe巾r由叫他Id I臼s.
• Ps归M吨ical deficit - Spel坦h that is fluent and rapid
but con恒ins
word errors (pllraphul畸却叫恒 incomp晴、ensible. 而田国 is
profound word-finding di配ulty, impair回用P目tilion ofwor由西U
profound loss of comp晴旧nsion. 有liS 晦阳'iOWTl as W町nic恼’－
aphasia.
Bllat阳回l 阳Ions of the
medial tempo刚 gyr1 Ond叫Ing the hp阴阳mpO
cause amn倒I• (loss al memory fer p能t autoblogr叩hlcalleplsodlc
events and Imp创red new 阳min刨．有，，， α:curs In alcot刚比 Wflf时c:k9’s
(met础划le) ere叩halo阳thy, when It Is re阳red to 囚 Ko『锦kolfs
田nnesl且有ie hlppocar回pl ere partlcu阳『ly atrophied h 甘回 d筒，目neratlve
disorder of AlzlM*ne”， d胁””－
Bl幅幅幅l lesions d 恒mporel n田xiortex 国d to loss of meaning of
words~民由副 sernan回回＇） ar回 unders恒nding of visual per田pis, des阴阳
P晴erv回∞阿同 and visual ma:胁i咱 d o副部ts (aaaaclatlve
agn帽刷. In addlt阳， face& 但nnot be 眼泪gnised O四l'08叩啕nc幅幅｝－
T市民;cu'8 h 甘南 d鸭JllnB阻live disot'由r of Rm•ntic d町四世·．
137
Occip~幅！I lobe
咀te occipital lobe lies behind 也E 归rie国land 四tporal lobe&. On
the medial SU血ce of the hemisphere, 由e bm皿由rywith 也E
pari£tal lobe i1 marked by 由E deep pariet.D-c国pital sulCUI. Also
on the medial sulfa鸣曲e calαrine sulau marlai the location of
由e primary 咧四al cortex 阳D由nann’s area 17; Fig. 13.16), which
is responsible for 材a皿I perception. Itα:rupies the gyri
immedia他ly above and below 也t cal.carine sulcus, much of it
beinghidd皿 in the d叩也 d由t sulcus. 咀isr唔m m由四
伽哩， from 由e lateral genicula能 nucleus of也由alamus by way
of the optic radiation of the in恒rnal captule. Bach h阳al half of
也E 世a且l 量.eld is represm但d in the primary说到皿l cortex. of the
c.ontrala胆al hemispher琶 The upper half of the visual field i1
r甲retented below theαlcarine sulcus, and the lower half is
Z叩reser阳d abcm 也e sulα皿， The rest of 也E 侃cipital lobe
collltitu圆白evilual 酬oclation cor恒．四is region is conttmed
wi曲也t in也rpretation of训aual images. Lesions d由t 萨imary
唱sual cor国也出t blindness in 也e correapondi且g part of 也e
功sual field, while dam¥ to 也巩固ial asaocia咀m 四”且由lsel
deficits in 世sual in·但甲retation and 田:ogni往回．咀le 观sual sys也m
is consi但'ed in more 曲创l in Chap阳 15.
。幅幅Ital B曲…协圃’
Ooclpltel lobe leelor回 cause:
·阳cal sei血res-para均哩malv阻Jal halucinations of a sim酶，
哑巾m国 nature, such 邵阳hts and colours ~团mp阳 part回国国』186)
• Sanso叩r/motor deficit - a oontrala恒ral visu副币Bid loss
(contnilablral homar啊’四 hemlanapl•)
回国留刨创划p~ar lobe 阳阳首脑ad b 曲而cal ’ ”.. of
blil dn wt捕、
the 阳也M 险 un酬由are 仙’酬’• syndrome）.币1恒仅以』附刨嗣同
帽曲回协阴阳．
Language areas of the cerebral hemisphere
臼tain higher cogrtlti~ 缸nctiom are dealt with print缸哟， or f!:V回
erclusively; by one of theαrebral hemispheres, which is then
refen回 to as bein霉’domi国nt' for 由at 旬nction. In the ’因t
majority of people the left hemisphere is dominant for Ian思Jage
皿d matltematical. 曲dlity. 四ie right hemisphere 四eels atψa由l
percep植.on and musical proficiency. Cerebral dominance b配omes
established d皿ing the 缸st few y田n after birth. D田ing 由is
formative period，』th her回spher四 ezhibit Jin思血tic ability md if
one hemi1phere sus恤，也mage it may be com~回卸rby
也e plas世city of the devel叩ing brain and the child learns to speak
normally. La回回 Ii岛也is a面bili~b民omesgr回.tly diminished
and damage to 也e dom扭扭t hemisphere often causes loss of
spe民h.. inaddi由n to 也t o也e deficits 严。duαd byltet回spheric
l面ons.
四le Ian思:aage areas of也e brain are organised around 也E lateral
6ss田E of the rerebral hemisphere. In the 鱼回归llobιBn:阻’S 缸回
民cupies the 萨nterior part of the inferior frontal gyros,
adjacent
ω 也t motorcortiαI area for 也e head and neck. This region is
”
concerned with ezpre ive aspe曲。f la吨uage (articulation).
In the 国nporallobe, 也e audi伽ya”。d甜.on 曲目岛缸
W回咀eke’s area, is responsible 阳 com严由msionofthe
spo』四 word.
N回E恒f regions of 也E temporal lobe and parietal lob巳皿四1
Eσ恒hly 由E E喝ular gyros and supramarginal gyros of the in缸i町
阴血ta! lobule, provide a 句nctional 面能由ce between auditory
and visual association areas important in naming, reading. writing
andαlculation.
138 • NEUROANATOMY
The cerabr•I c。”回
• lhe 阳n刨 lobelleslmn回lately
In 阳int of 世1e central sulcus.
lhe W阴阳”刚即rus Is the
primary motor region. Anterior
W 伽Is l阳伽e pramator and
锐’司p阳man饵ryπJtJlor cortloes
and, in the 恒t hemisphere,
Broca's tnotor speech) ar回－
lhe pr冒骨回咀al （）（万幅X 幅
跚跚n国 with comp脱
口啕n阳v，仙nctior回．
• lhe pert脚l lobe II嗣 posterior
to 甘冒E oentr回 a』cus.The
pas恒ent『田l 即『us Is the primary
somatosenso『Y 『啕ion. It
『回3脚田 d阳冒1恒骨四n the
vent『al p臼tenor nuc融II of the
"Iha恒mus,w忖chis 甘回 site
termination or the spinott四am恒
苗苗els, I『tiemholl回阳nic tr亩剧
and medial lemn险cus. Behind
this region las the sensory
能阂clatlon cor酬，晴、阳、阳
刚ponsI剧，币。『甘1’
lnterp用tatlon of gen阳回 sensory
In阳m翩。n.
• lhe 抽mpo阳l lobe I回国嗣由
甘冒e lateral ’ssure.α1 甘18
Fig. 唱3.21 Coronal ” ”Ion of the 跚跚br8I h•m阳回回归队节1ed幅gram shows the b锦!Ion d甘回回nclpal as切口latlon, commlssl』『回land p叫ectlon ’b隅
Short association 协帽’
Superior la咱itudilal
阳”比ulus
Cingulum
Genu of co刷SC创losum
阳，回mofoo刷E 回II阴阳
Anterior commlasure
Un目nete fasc比ulus
时．也盟阳盹lpal•”’d剑””’闹剧mmle跚跚l耐用’“ the 饵”bralhemlept跚跚 W’l翩翩。网， amedl’””gltt划”“回．
sup笛ior su归国 of the 阳阳橱窗
tempo刚 gyrus，白， transverse
tempo刚 Q;'l1 (H侃。”’s
∞『Mllu阳回：） mark 甘18 IOC划m
d 甘冒B prlrr旧『y a刷ltory cortex,
wh盼I recel四” h阳，tfrcm the
m回刷 genlcu阳曲， m刷刷s of the
th国amus.A叫阳a菁、t lies the
auditory 国soclallon oor悟到L
whict、画 responsible far 甘、，
inte币，回阳 d 副d阳『Y
info『mation z回 which, in the
left hemisphere, constitu幅画
Wemic陆＇s ar四．
·节1目 α刻p阳川曲e makes up 甘回
p回回iorp西t d甘冒目
hem幅pher冒.On 甘回 m回阻I
of SU『饱眉．伽－臼l回府丽剧lcus
indical随 the lo凶.tion or 1恼
prim町、risual ∞巾擦， whi由
附calves et饱rents 白。m 廿l8
阳回ral gen阳late nucl融』s of the
Iha脑mus. The 阳st of the
ooc~lobels 伽－啪咽l
es回划atlon cortex, which Is
rasper回Ible for 曲回
lnterpre回阳、 d飞翩翩
information.
White mat国r of the cerebral hemisphere
Beneath the cortical SUI也m lies an ex阳uive mass of n缸’-e fibres,
all of which have 也eir origin or 回mination, 皿d sometimes
both. wi由in the cottex. The fibres are d细咀d into 也ree types,
dependi咱也，pon 由曲创igin 皿d des也ation:
1. Association ti.bra, which 油田四nnect cortical si田 lying
回也in one cerebral h四tisphere.
2. Commilaural fibrai, which run from one cerebral
hemisphere to the o也町， connec由g functionally 时ated
structum.
3. Projection fibres, which pass between the 田由ralcortex
甜d subcortical s忧ucture8 饥u:h ”也e也血mus, stria凶肌
brains能m a且d spinalα览d.
Ass。ciation fibres
Some association fibres 阴， 13.组， 13.22) are short and I尬
nea由Y 缸础。·f cortexby a曲ing beneath adjacent 田咖回I sulci
('U＇量bres). Other association fibres 缸e longer and tnMtl 由:rough
也e white mat回 to link distant areas of cer由国 corta.τhe
primary sensory areu 扭曲E pari础L temporal and occipital lob臼
are linked by long association fibres to 也e association 红础。fthe
出由ral corta. 咀四e, in tum, are connected to 四血 other.
咀iela事 mperior 101晤阳dinal fiuc:iculua in回回nnecbl 由E
frontal and oa:ip泣al lobes. A subsidiary of由is bundt巳 known aa
却'CU8悔也就拟』lus
Splenium of corpua
cal阳um
lnfllrio『 long阳dinal fas甜ulus
\..___ Fomlx
 Chap幅r 13 Cerebral hemisphere and cerebr百l c。同ex • 139

由e arcua鲤鱼，dculua, linb gyri 姐也e frontal and ttmporal 四le 姐.terlor commi ” ure runs transversely in front of
lobe&, which are import皿t 阳凶guage 缸且ction. 也e ｛幽幽恼。 column of由t fornD,. near the in馆”回国atlar
四le 恤缸ior longitudinal 缸daduaruns b酬阻缸创ripital 击。ramen (Fig. 13.7 皿d
see Fig. 12.2). It in回回皿配ta the in缸ior
and temporal po!ES and con回bu田 ω 也E funclion d由回 and middle 阳nporal gyri and 由E olfac:tmy E唱。因 of也etwo
rec.ogmtion. side且 Thepo，但rior commiaaure lies donal to the periaqumuctal
咀ie uncinate fiuciculu1 oonnedll the 血但rior and in缸ior p缸” grey at 由e 臼aruJition bm陀en the rnidbrain and diencephalon
。f也e fr回国 lobe w抽血e temporal gyri, which are impo由nt (Fig. 13.11 四d see Fig. 12.2). It i3 thouabt to carry some of the
structures in 世ie r鸣”la:岱m ofb曲aviour. 咀ie dngulum lies 回也扭 decu凶硝ng fibres 由at mediate 也e consensual light reflex. 皿d it is
曲t cingulate gyros and COUD岱 parallel wi曲也e corpus call田um, 曲 important neuroradiok罚单臼I landmark. 四ie hippocampal
connecting 也仕ontal 四d 归ri也llob臼 wi也由e 曲也mi”Utt ( commissw:e of 也e 阳nix） ιm回sts of 量M哩， p笛由18
parahip萨>eampal and adjac£Dt temporal gyri. betw田n the posterior colu皿ru (a田E〕 of the 伽nix of each aide
(Fig. 16.5).
Commissural fibres
Projection fibres
四ie major interhemi刚回ic commissure is the co币四臼llomm
Projection fibrES (Pig. 13.24) cm晒tofa曲回矗brea am可ing
(see Figs 1.14, 1.18, 13.3-13.12, 13.21). Mu血四ialler ones are
imp1,血es to 也e car阳 and d趾ent fibres cond配6吨 impulses
the an阳iorcom皿issure 阴g. 13.7 缸id see Fig. 12.2J, the pos阳ior
away from it. The fibres pre功底由g to and from the cerebral m惚
commisaure (Fig. 13.11 andsee Fig.12.2）曲d 也e hippocampal
haveane1归naive radial distribution wi恤t the hemisphere
国mmisaure (commiasure of也e fomix:) (see F也 16.5〕．
knm咽 as the corona radiata （附 Pig. 1.30). Deeper within 由t
四ie corp回回llo1um spans b由何回由E 伽YO cerebral
hemisphere 也e :fibres are concmtrated into a d四se shee也 αlied
her回spheres 血d conn回s con四pondi吨 regions of neoco~
由t lnwnal capsule. Medial to 也t in也mal caps曲 lie 缸
with the el四川.on of 恤能mporal cortices. The parts of the
四早usαllosum，企om m胞回1 to cau也1，缸E named 也e rostrum,
伊nu, body and sp阳ium (Figs 13.14, 13.22, 13.25〕． τ'he corpus Fro耐l p则，
call饵um is 曲。r田面也roposterio曲也a:n is 也e h臼皿sphere; as a
result, call伺al fibres linking 也e t附齿。n回 or two occipital poles
四!vr foiwards or backwar也 as 由e 血时or force严（fori也严
minor) or posterior forc.eps (forc.eps major), r呻副咀.y (Fig.
13.23）.四ieaplmiu皿 in回回nnec姐也E 悦目pital co时由四d,
there画。re, contributes to visual functiorui.

呻 .，.lnllgeto 由eoorpus cal刷刷

Some pa由nts with chronic eplle阳y hlilV9 undergone 剧『g阳l s“四on of
臼啊’倒Jlosum
t情 α:irpus 饲Jlosum to releve their seizures. Subs明uentty, Sl戚、
Ind闹闹ls betray 旬w dlfllcult阳 under normal clrcums回α~.Howe\居杭
州回归钮’spilt-brain' p副回ts un由go p卸chol咱国l t臼ti咱．由E
two ha阳回 d the brail app阻r b 国have 『唱国阳νautonom口崎ly. 阳r
回回mple, visual informa:甘on direct·回 b 甘ie riltlt, non·dominar睛，
hem自phBRI alone do回『10! evoke a v田b副『回ponse:as a 『回ult,
individuals 臼nnol name 由阳恒 or rs副 W四'ds prssenled solely 也o the
阳ft visual 幅副d.
国刷刷on of the splenium of 阳 corpus c创阳创m by 翩翩。『
tumour 阳出 to the post自由r disconnection 卸ndrom自 of 画，刻，
W恤’“咱呻hla. SUch lndMduals spe副k and Witte without dtfflculty
b川 cannot und制and w毗阳 mater1el ~础Ilda). Disconnection of v剧创 。回阙恒I pole
proce锦l啕 In the 啕ht hem阳ph阴阳m 阳唰M proce剧ng of the
Fig. 咀E DI翩翩ctlan aftlHI brain from 由•aupwlar•”ct m四•llng
dominant 阳ft hemisphere 阳廿刚』ght to exp阳n the syndrome.
恤’因币幅画II帽um.

臼rona radi由
In饱male泪paule

α，币制pi唰币b瞄

F幅．也翻 Diffu嗣n MRI 1ractographJ reconstniction of 由， w’”ction fib”’ passing 齿”ugh 曲，画”mal 串串“l也T耐问阳刚iym倒刷刷阳
dlffi届Ion of 阳ter along axonal 明b阳and 脚晒 reconstn』ctlon al their traj“ω阳 In 阳 IMng human b刚n. 阳ur阳syofPro.炮”旷MBI田臼阳nl， 阳伽teof
闻网llatry, Lo础切， UK.)
140 • NEUROANATOMY

thalamus and caudate nucleus; lateral to it are the globus pallidus (see Fig. 15.6). Pibru 也at E可X四ent the lower half of the 叫“al
and putamen （能岛 for e:wnple Fig:t 13.8, 13.9, 13.13, 13.15). The field project to 也t UPI四 p皿 of由居世皿al corta (abc阴阳
in惚mal capsule ia concave la田ally such 也at in horizon时脏lion 也lcarine sula皿 of the occipital lobe). They m句 be in四opted 姐
ithasan~a时， γ，由p巳咀由 provides the basis for 也由四ume by I四on& of the parietal lobe. Fibres 由at E甲回回
nominal>y dividing it into 扭扭恒riorlimb，伊nu, pos值iorlimb the upper half' of the 白ual field lo叩 forw缸由 OV£r the inferior
and retool四ticular part (Figs 13.13, 13.14, 13.25). horn of 也t lateralπntricle (M町四’， loop) and th~ p”’ to 也e
The 皿.terior limb con回m connections betw回E 也e lower 阴rt of the visual 四”exφdowtheαlcarine sulcus）.四1可
mediodonal nucleus d也E 也血mus and 仙”rlrontal corta, maybe dam德国 along 也.eir course by lesions of the 能mporal
and.al四齿。，ntopon也ie fibres that proj缸t to 也t pon也ie nuclei in lobe.
the bual portion of 由E pons.
The germ and po1terior Ii皿.bmn钮h mrticobulbar and Whl幅 matter or the cerebrel he111lephere
口皿α施，pinal motor fibres. Alao wi也面也E pos国iorlimb are
由alamooo顶c.al pmj回iorui p四ing 岳阳缸观ntral p回国or •N目『回他res within the d 齿，etwo hem幅ph町es. lhe
nucleus to the 严回ary somatolemory con饵缸ui 企om 伽eventral
sU:Jco而calwh阳 matter are princip副 commi随U『'81 system is
classified on the ba幽 d their the co刷』s calc陆um.
an回iorand ven往al la键时 nuclei tom悦。r z呼ons of the 企'Olltal ortgn and termlna回on. • Pn:尊自由n 明br田 run betv晒町、
lobe.
•Assoc幅画m 他res link cort国l the cereb『al co『tex and 咽『阳JS
The retroler回cul缸 P血。｛ the internal ca伊ule lies p倒回iorto regions within a 国『可怕 suboo『曾因l 副rue阳晒s. Thay
由E 严施回ior limb and posterior to 也t globus pallidus/p田amen h町nispher回. Imper恒nt s归阳ms pass through 甘回∞阳narad阳恒
(Fig. 13.14). It conailtl of fibres ari由tg from 也E medial and a宙： the SI』p町W 阳、gitudinal 甸、d the in恼π回 capsue.
h恒ral genie血tt nuclei of 由E 由alamus 由at pa11 to 也.e auditory 触sclculus, arcuate 触sclculus, P田由cularνimportant fibres in
llT他巾r klrGltudlnel 也sclculus this 回：egory are co『甘嘟”n剑，
and 由国l ror世阻挡也t auditory and viaual radia咀m也
and ur回nate 阳sclculus. ∞闹。d阳b町 and
respecti"V由 Visual thal缸回回副cal fibres (also known as th曲mocortlcel p叫剧。ns.
•Oαnm幅剧ral 他『冒8 pus
伊ticulocalca戒配置bres) p甜 laterally round 由e la回革l ven刨出
be阳睛，、。阳咱sponding 『啕阳、自
and, in doing so，岛Uow one o{ two counea to 也e 咧sual corta:

R帽阳mofcor阳， callosum

”
An riorlimb ofi『榈mal 饵”响

Genu of internal ca”“le

R铺terior lmb of internal 饲psule

R钝'OlentiC1.1lar 闵此，fin悔mal 饵”ule

Sp幅nium of c:Orpus callosum

F幅．惚娼”’rtmntal ”ctlonot 曲”’晴ralhemlsph’”’h阴阳Ing 世圃’阳””’笛” In匍mal 帽”由．

 Chap幅r 13 Cerebral hemisphere and cerebr百l c。同ex •
!:_" Pragreulva 曲ronlc an啕h..o叫“a111anl崎
Dement恒町ndromes ara disthcl 肯tlrTl o「回 anoth町 because d甸回冒冒tiw
bran di蹦掬S have sp四百c toixig呻hie创曲tributions in the brai'I and
n融.ropsychological functions ar回 regionally organ四d (Fig. 13.26 创d 凶e
Fig. 1.49).
Cortlcal 四”phalop冒出阳
币、B most common cortl刷出m阴阳阳刷zh创，睛’， di•帽”’ a ususlly
spo『adlc 啕阴阳回ved阳se of t叩刷刷.It d阳ts n回M tern阳回
(hlppocamp呻 structu隅侃us同 amn臼la and t栩阳st自由roe咄咄
口crtex ceus同 aph国且， ap阻四ptlve v恒u副匈阳也 S因t阳l dlso阳咽！Ion
and apraxia. In the 恒te stages of llness, aki111翻也啕idity ar回 my田Ionus
剧院抑自1e. In younger psi阳市， a strongly 但mlllaldl回国g Is
青ontDtemporm 由m..,t恒 (FIDl,a届四Z阳d w时1 atrophy of 廿田面郁而r
背回归国mporal r回民，1ex. The p阳nine『rt clni臼l ch苗苗terislic is
bah田iotlal change, whict、阳Ud酷昌阳thy, disinhibition, blunti咱 d
田nations, repel时ve routines and di由ry 由町、ge. 有iis is ace刀mpani回 by
B锦州ve＇民聊过阳阳pairmen恼 in at阳t阳， p阳Yl同 and p『曲阳m
SOM咱.A町mmetric involvement of the I创t 阳ntar langu咱自缸回陪suHsin
t怕自阴阳划w disorder of progre随M nat叫uentaphu恒 (PNFA).
Utteranα揭 may be 9ffortful and 阳eking
In grammar. 回国阳刚
of the tempoi创 r回cortex leads to t愉 di阳der al
d匈制er:创on
”m幽幽 demer回国，但D】 In 附胁 patients lose unders恤ding al the
n嗣同1啕 ofwo『ds ~拥mantle apt回l码．饱帽 and ob阳刚剧创st阳
匾，ma) and other 跚跚y stimuli, c蜘plte p『嗣rv回刨阳市阴阳y
pe『回事！Ion. FTD, PNFA and SD ere BSSOCl回国时th fronto恒mporal lobar
d甸回町剖on palhology，，时帽、画 d回＇net 骨om that of Alzheimer's
d自B画画．
Pr啕reaaiwl non-fluent－一～，，」
aphasia
F附幅幅mporal d町ner曲
Semantic demer曲
1哇！！.•
C阴阳I cortex
⑨
F地．咽.28 R啕lanal lac:alllllllan Df dlH翩翩回国Ing dementlL 剧 Co刚回Jareas. 陆自由副回 to Fig.
141
Subcartlcal encephalapa剧，．
Subcortical enc理阳Jo阳th阳s affect structu『邵阳h as the tha脑网， basal
gangia andα抽出lum and the in阳connecting white w脑忱E霄，础』sin自
”明ical and mental slowi咱 and di低1』lly in motor and 民精闹闹
plan晴咱. Subcortlcal chronic vascular 恒chaem恒（mull耐8rct
dementi副 dam啕es the v.t1阳 matter. Hu『曲”脯’， di’””，
P•ldn””＇•d幅幅翩 and progreulve 剧pranucle• pal8y lPS同嗣
d饵”neratlve d阳orders of 伽e besal ga咱Ila. PSP Is a rare parklnsonlan
syndrome In wt捕、白嗣 Is para加Is of volun回ry 即ema啕ments.
Cortica-aubco此i国l encephalopathiea
Co巾。副国刃而cal en四川)alo田.！hi民 afll:回国甘、 α则因l and S!Jlco『tical
structures. Carllc:oUul d啕·四”'allon damages the 剧目芽ior pa闹剧
∞『tex and supplem回恼y motorα:inex a!切TIIT回甘icaly, causing
cont用阳恒阻l apra泪也啕id邸， akin回a and myod口nus d 骨、earm, which
may b刷刷 aulonomol』sly Calen lmb'). Car幅四l U咽阳西F diH圃’
SB阳lively 由Yllages not only 甘'le 副bslant隐时gra but also 甘南阳嗣同or
『回仅刀rtex，嗣.ding to 阴山·nsonism and W明cm后， IOI拥!her wnh cortical
叩nptoms slmlar to those al Alzhelmer's dis凶S自， butw协出ronlc
fkJctuat同∞响slon and 叫sual hallucinations.
MuHifoc11I encephalop，由y
A muHlfo瞄刷刷，halopsthy 创部urs In Creut翩翩I-Jakob a ”·”
(CJ町，且 rare d匈ene圆ve disorder that Is rapidly 倒al wt伽h mo巾．
Multiple neuropsychologlcel 由制ts occu『．虱翩笛民刘p恒l 田t国l
blindness and ap咽sla. with cerebellar a匈xla, pyram闹剧 limb w回阳1铺s,
m归口lonus 四d~量zures.
c。而cobasal degeneration
Alzheimer's d国ease
臼巾帽l L酬y 饲dydis阁，e
Creu恒feldt-Jakob d酶，se
Multi-in阳刚由imentia
Hunti咱阳旷s dis翩翩
臼r阳阔，副 d喃喃自勘n
C阳启制dt-Jakob a键辅串
向闹n酬’s d脯”
臼rll臼l Lewy body d阳蝠’自
R啕陪蚓ve supranudea『阳抱y
1.49. (B) SL』bcorticel 町回s.
 14 Basal ganglia

Ten回lnol叫w and topographlcal anatomy Functlanal anatomy of 1fle baaal Normal functions of the b笛alganglia 147
of the baaal ga咽Ila 142 ganglla 144 阳thophysiol啕y of ba抽l ganglia
Sb'恒阳m 1~ Conn田tlons of the strtatum 144 disore抽阻 148
Globus pallldus 144 Conn田tlons of the globus pall ldus 145

With扭曲e cerebral h回啕here lie a number of nuclear m朋es.
Apart from the thalamus （由叩值 12), the m倒 prominent of
these m 也ecaudate m叫m地 putamen 皿d globu1 pallldu也
which lie 迦 d创eprc国mityto 也e 画出国I caps曲曲d are
collee由ely referred to aa 也e basal ganglia』 basal nuclei or
曲咿UI l1riatum （目， 14.1, 14.2; see al皿 Figs 13..3- 1.3.9, 13.14).
四E bual ganglia are primarily conttmed with 血e mn:国l of
mav四1ent. Di1ordas of the basal ganglia are man血，t by
a阳10rmaU世esofm悦。r mntrol, 院刷re and muscle to阻咀le
M踊I 职nglia have i皿归rtant conn回iomwithσ也E E唔oru of
the brain. p笛ticularly the 但rebral corte:鸟也t 也且lamus and
subthalamic nucleus of the diena;肉alon，皿d the substantia 皿g咀
of the midbrain.
Terminol。gy and top。graphical anat。my of
the basal ganglia
The t凹n 、创al ganglia’(nuclei) reflects the location of th幌
跑回ctures deep wi也in 也 hemi刷回也咀ie 回m 'ro:早出翩翩m’
derives from the radially ori四能ds时ations, com归，，d of 缸scicles
ofnerv哩 fibres, which are read丑yseen in s幅画画d sections,
”“四larlywi也M 也E globus pallid皿
币ie globus pa出dul i岛 in pbyl吨~cterm鸟也t oldest 归n of
the coi:pus strian皿幽d is sometimes referred to aa the
palec:幅“atum. 白te 曲breriation 'palli由皿’ is matt commonly
med. parti口ilarly in mmpo画.te 阳回E for afl洁白lt 皿d efferent
mnnections, such 徊’sub也alam叩alli也1’ or ’pallido由alamic'. 哑le
globua pallidus and 耻 putam回旬雷由e are 四metimes
collectively called 幽地回町m (orlm笛cular~ compla (or
nucleul), because they lie dose U精ether, for回鸣曲 app但由1tly
singl.e struαm on gross 皿础。mical eDill姐ation. The name
means 1四.til咄aped’， but a closer analogy is a Brazil nut or the
S唔nent of an orange. The lentiformα>mplex: is 曲回-sided,
h町ing a con回 la恒ral surface and two O也e surfaces th皿
αm哽咽e to a medial apex. whi也 lies against the ~u of 也e
internal capsule 但g. 14.1）.四e terms 1entiform’ and q回ticular'
are rather archaic and of limited U1龟 although 世iey are still
retained 画 cert.a扭扭atomical names [such as 也e retrolenticular

阳阳市rhom d恒tlral v町1刷，

Head of caudale n鹏以捕

E幽mal 臼阳le
L.alflral m创ulla『y lamina

自甘冒ne caps1.1le
：：：~｝~叫ω

同嚣le『ior limb of in恒「nal aapsule

F阳.14.1 Hor恒。”“”Gtlon al the brain sh侧Ing a. reldonehlPI 创the IN刷刷啕Ila. Mulligan's stain has been u酬 tolnσ凶sethecon阳st
回tween 唰l
 …” Bas叫

Co咿us 臼llosum

M田'nll capllJle

Tllll田，...
Cl111钳田’1

Pulamen
Globus pal剧U$

C睛”耐d

’
Fig. 4.2 Coranlll •蝇似Hlof伽ebnin lllD'晴啕 h m恒翩翩llllip9 Gfthe ...........灿』旬.，.，，胁 『回国m U8回 toincr回回阳 contr回
between cell而h 翻幽帧刷刷州ta matter.

Anle~orll响b al
悦salg时i1 (co阳制tu!!i•
帽m问吧豆、
广－－－ I

”
H d d臼ud刷－，
nk』E
叫
\.

〔N”翩翩m~蜘叫 币再副
I \
Anllr阳『 Posllrior

〈些些旦~I) 他的 〈些旦些~；＿：. ·Th副am”’

~ 」－Tall ofcaudata
nucleus
Pullmen
(ienllbrmn唰θ Amyg甸11

Fig. 14.3 Non.睛1tlnof 伽·”“－剧，lia.

邸’4.4 La阳划””ct of刷刷 ~ ...鹏阳冉冉阳men.
...洲－－－伽......也有，egl仙』s
Theco惕，eou惰阳tern&lca阳，e
paid\』S 抱创剧，回 Ill} 阳阳启men.
r回．币、epWmal'lar市d 阳
la shown In
回rt o{tbe in闹闹笛”也）. On 向l咱自回ic,α>nnectional and
闹剧。f阳帽剧.tent则很凰””~tedlll}甘冒’“阳阳帕lb of世l8 hlane.I
func划。nal grow叫a.ho幌呢鸟也E 醉’t且mm is more dosdy allied 俑阴阻”， aiccept at their rr邸，t roatr回＠岱rt where 甘、，制”笛， In con伽llAy.
ω 阳回血tenudeua 也an to 也 g灿ω 回国国．
霄ie au.date nuda皿 and 阳”mai amstitute the
’
The P阴阳向r mb of the ntemel cap剧le eepara幅画 theglobus p创lldus and
PU'恼men 协m th川、alamus.
phylogm.1回国lly molt RCmt parts af the basal ganglia and are
best regarded u a 归gle 四tity. Together.，也ey are commonly
functionally important in田conn缸咀锢，明也由e sub也lamic
rd回回 ω ”也e neostriatum, or simply as the stria侃皿. The 切m
nucleus.
com~on回.ti an: almost (but not entirely）键阴rated by the
anterior limb of 也.e in能rnal capsule but their gross 皿atomical Strlatum
R归ration is not u “伊ificant u their neuronal and functional
啦’刨atum (neos创awm) consi1t1 of 幽幽也挺 nucleus and
剑mil.arities. 咀ae rather con缸a姐g names of, and relational咀.pl
也E F血皿m. Their combined three-dimemional shape is
betwem, the componentl of 也 basal gang)且 are summarised in
reminiacmt af a u句。lewb钮，1凹d h回际 问 14.4).
Fig. 14.3.
Some authorities include the aubstan世a nigra and subthalamic Caudate nucleus
nuclem in the definition of basal ganglia. 咀由 is jus面ed 伽也e 世ieca叫甜 nudC1.11 ii daaibed u consisting af a larg障 head, a
pars retiet.血.ta of the .ubrtantia nigra 由“ it shares mu出面 body and a taperi鸣，四.Md tail. ηie head of the cau由te is
commonw恤也t globus pallidUI and bo也 of也ese have d”。 ”
“m例t completely parated from the putamen by the in能mal
144 • NEUROANATOMY

capltlle 队凡 al 幽幽 roltl'al extremitie鸟也ey are con血.uoua

throu8h and beneath 也ean田ior limb (Fig. 14.4； 配 al90 Pigs τ．”’，.，..比副 ••l:olnv of the b…Ip啕”·
13.4-13.6). At. this an阳ior lad, the molt vm田l and medial part ·节咱阳幽l gangla con制 of the • The putamen ar回 globus
caudate roe以』s, putamen #Id 阳llld1局 l悔 late唰 to the Internal
d缸回血皿 COD&ti副恤也e nud四”四皿.bms (1ee Fig. 13.6).
gk>趴』s pa嗣U8. C自pllUe,de副p to 甘te oortex of
币ie nucleu1 aa:u皿bemhasmnn回iom 1imil缸”也E E回 d the 同l觑
•n圃， atructu'田” W阳晒曾y
the 翩翩m and al崎 lwcon阻挡。ns with the am只到ala. ’Ibe
α罩在湖响回 with theα:introl of •Tope羽raphically， 甘1ept血帽、
am111由la. which b loα也d w忧副且也t temporal lob«斗 E国r to the 阳指b..reand mo明men!. and 刨出us 倒烛S 阳回tu饱
m归1ral pole 副 dttp to 伽 lenti阳m complex {att Fig. 13.8) the lentiform compl&K.
·节、， caudatll nud融』S l田 in 阳
also baa a similar embryological derivation to 也e corpus 由iaunn 嗣II d 甘1，阳teral ver甘ride. • Functionally, ho阐明r, the
but is 也nctionally di伽四t. beingp甜。f也e limbic m能m Cal.』da:幅 nuc阳us 拥d putamen
•n啕 ha回 σf t闲”u曲曲 1嗣
(Cl呻ter 16）.四”叫四’缸mmben1 and an亨国血 provide an W削l副 to the Intern创 capsule
fonn a si「啕le entity, the
important in阳也ce betwei:n 也E bual ganglia and the limbic 闹剧由.tum (striatum), whi灿e
and forms a prominent bulge In
m恒mand 由可缸随H a role in 也E P峙，iral exp圃，ion of the 恒恼al w副l of the anterio『
globus 阳Jlidus forms the
阳l创施triatum.
behaviour 伽Mn. by affective and motivational 刷刷． τhe nucleus ham of the ventricle.
accumbens is aaaodated with reward and g姐缸:ation and is •The glob~血 p副lidusαlflS旨Is of
• The cu附d, tapert啕惚II of the
believed to be a p红t of the mechanism underlying addictive “ udate folio附仙， cuwtureol
，川剧nal and internal s啕men恒．

t明 la抽烟l ventrtcle Into 晴、e

“严础 。fbehav.lou乌 including being an important site of action
of addictiv喧 IUbstan也＆
咀le head of 由e caudate nudeua 伽ma a prominent bulge 扭
曲ela忧国 wall of the an田iorhom of 也E K阳al 础时也（Fig.
14.1; see a1lo Fip 13.3- 13.7），咀le tail of也e a叫ate paueil
阳回iorly, progret9i时yta阳ing as it does so and. foll跚恤gthe
cwvature of也e ver回de』 des皿ids into the 田nporal lobe where
itliea in 由t roof of the in缸ior hom (Fig. 14.4; 1tt d皿 Figs
13.9- 13.12, 13.14).
tempor创 lobe.
and conn创om (Fig. 14.5）.四ey are often r耶rded a.s the ’input'
portions of the bual 院nglia, 血zαthe majority of afferents fr四n
other parta of the brain end hett, rather 由血 in 缸脚1bus
归11.idui.
S的飞，但la伯rents

Putamen Afferentl to the ltrlatum come 岳阳也ree principal IOllI田：也

α~ebral cor回址，e thalam111 and 由E substan也 n单a.
哑ie putamen liea lataal to the in阳nalαpsule and glo趴n
“rtiCXJetria回 fibra OJ幅nate from widespread E唔ons d由E
pallidua （凹， 14.1, 14.2; m 也o Figs 13.7, 13.8, 13.14). It is
但由raJ CD~鸟”时ominantly, but not m:lusiv哟， of the
separated from 也e globua pallidus by a 也in Jam画a of nttve
fibtt鸟也t latttal medullary lamina. late组1 to the 萨ltamen liea
ipsilataal s凶怠 Fibres 岳阳也t frontal and 阴rietal lobes
mor冒E white matter, sandwiched 回创n which E臼 a 由且也tttof
pttdominat巳 Motor z咽。ns of 也e frontal lobe project mai由 ω

g可 ma忧ei; M棚n u 也z da1回国皿咀is separates 也z white

m甜g into two lay町，也E atana.I cq11ule and 也E enreme
capsule {Fig. 14.1). lateral to 伽 ememe capsule lies 也e cortea:
of the ins叫.a.d仅p wi也in the lateral fissure of 也e her皿.sphere.
GI。bus pallldus
The globus pal且dus lies medial to 也t 阴血皿en, separated from it
w 也e la也ral medullary Jam皿a. Ita medial apex nestles into 由t
lateral conca世tyofthe i且也mal capltlle (Fig. 14.1）.四ie globua
归lliduaαmaista of 伪VO di咱ions, referred to as 也E E但mal (or
lateral] and the intr:mal (or medial) KgllleDtll （由brevi血d al
GPe and GPi, res阳tivdy). The 呻nenll m 呻血！能d by a也h
sheet of fibm, the medial medull町 lamina {Fig. 14.1｝.τbe
smaller ir出mala叩nent 阳m m町，:imilaritie鸟 in 阳ms of
cytoJ,叫lfand con幽幽斟响曲伽 pars m白血.ta of the
substantia 国grain 注it midbrain {Clia~田 9, p . 96).A抽ough the
two att separated anatomically by the 祖temal 笛”wefcraa
E由d，也句 areb四 n:gaided aa a single 四tity. in the 缸nctiooal
aeme. u described bdow.
四t b刷l part of the rosttal 卸rebra且， deep to the corpus
翩翩m, al.lo includes a E唔onlcn，阴阳”也e substantia
innom恒ata (Fig. 14.7 and see Fig. 13.7〕．咀坠 complar唔on
contains•阴阳咀1 8以聊。fneurone鸟 one of them being the nud剧’
bualla (of Meyn叫，阳创la ofwhich 伊叫“ widely to 缸
但由ral cortez 姐d u曲，e acrtylcholine 豁出eirneurotr四smit国．
四ne neurones m也:rgo degeneration in Alzl回皿ei1 disea且
Functional anat。my of the basal ganglia
Connecti。ns of the st而atum
四\.e cauda企t nucleua and putamen, to萨由er commonly re缸ttd to
腿也t 由iatum, att best consid缸eduasingle 曲“tysina 也可
由mα>mmon I1£UI0nal o事nisation, neuwtnrumitter sys忧ms
也 putamen, whett w body is 即resented in 血 inver时，
apprmima刨y IOmatotopic fa血ion. Mott an国ior E唔on& d也t
frontal lobe, and other ullOCiation cortices, project mainly to 也E
caudate nucleus. For 也elCI回IODI, the putam四 is considered to
be the most ov时.y motor part of也由iatum，也E 倒也.te
nuclel.u having more 翩。d四”“nctions. Cor“白白iatal fibres
are mi回oryto s创atal neurones and use glutamic 回d as their
transmi销也
四le 也由mo1trlatal projedloo comes from 伽 intralamin缸
nuclei {c四tromedian and par也scicular nuclei) of the ipsilateral
血alam111 (Cha阴er 12].
咀ie nigr回回au1 projection or回回回 from the pan 四mpad:a
of the ipsila回-al 1ub11ta皿a 皿graof 也E midbrain 筐gmmtum
（也叩恼’， p. 96) . The 回国皿阳 u时 by 也is pathway b the
monoamine do阳n油鸟 which lw both ad饵”ry 阻d inhibitory
effe由 U归B 削atal neuronn. 哑ie neurones of也E pmα>mpada
contain 也t dark pigment neuromelanin (F毡， 14.的， whichia
produad u a byproduct of dopamine syn也回＆四t mostrosual
and vaitral portion of 也~ Itri.a.tum,，也E nucleua aa:u皿ibem,
阻四~it& d叩aminagic input 岳阳也E 呢E田l 也gmental 缸田，
which lies medial to 也esub&皿也皿gra （阳 Fig. 9.13）.咀由
p叫剧。n is part of the ，。αlled mesolimbic 阳由way which abo
p邸，世dead。”minergic inneivation of the a:r町刷刷.Other
affemi.ts to 也翩翩m include a projection from neurones of也e
braim惚m raph~ nuclei, which utilise seroto皿且 刨出eir
位副wnttter.
Stria姐I e:饰1ren阳
币四”incipal neuronal type 明白且也e 闹剧皿 is knownaa 也t
medium apiny neurone.τhe uom of medium spiny n四rones
con回仙也由E effamt F叫配峰。m of the S回a缸m 皿d 由ey 缸E
dittc时严incipally to 也etwo 吨皿四”。f the globwi pallidu1
and to 也t pan re.ticul础。f the substantia nigra (strlato阳皿凶al
and 由iatonlgral fibres, tt叩创回y). Although 也m is some
 Chapter 14 Basal ganglia • 145

Molar co闹X

Caudate nucleus

Thalamus

Putamen
E刷mal aeamant I
In饱m叫；nant _JG蛐叩Iii邮

＆』刷11阳市 nuc悔us

- G伽国响icacid
－ 臼mma arnlnobu阶le acid （队BA)

F幅．悦S Schenmtlc diagram Illus国四”’ the pr1nclpal conn帽tlDnsofthe b画面l gangla and 1'91.md nucl.i. F1口rthe 国陆ofcl笛”，阳 conn副町、s
d甘回归到阳南.tun are shewn fer the p川西回n only. The conn民t阳'6 olthecau由幅 nuc阳us are similar. Afferents to the st『恒tum 骨om 甘冒 in甘甜aminar
lhalamic nuclei and M司附饱mraph画『lUclei h副， been om时回.All 冒雨睛也 from the basal ga啕lia 町晦m are shewn too啕inalefrom 甘南 internals句men! of
the globus pallidus，怕。因怕m the 阳m reticulata of甘回 subslanli国内咽rabeingomitt回. Colours indica恒the neuro甘ansmitlers used.

C臂’阳111 aqueduct 「－ Su阳刚回Ii四lus Connections o，由estriatum

」
•TI啕四川础， m刷刷sand • E何阳回t 向阳咽e arise fro『n
putamen are the 'Input’ reglens 『n回lumsplny ne1.』ro晴s.
of 叶iebe捕I ganglia. Sepnte cell groups m阳川
either of the two S到自men恒 d
•They 『留泪阳 a阳田市由m the
甘1e globus pallidus (GPe or GPQ
cerebral cortex, h国laminar
or to 曾回回尼用lieu阳恒 d甘冒’
tha脑『nlc n1剧创 and t愉阳审
substantia nigra. 有咱自 由俑曾回nts
comp臼ta of 廿'18 substa『叫a
are intibitcry and GABAergic.
nlgra.

c。nnections of the gl。bus pallidus

\ 飞了，.＿ 喝， 、 咀1etwo s锦m四ts d也脚bus pallidus M”“皿ilar afferent
倒mections to one 曲。也er, but substantially di岱~tefferent
庐o~. 咀le in阳回i s叩nentof由e globus pallidus is 鸭ry
d皿且z 扭曲uc:lUre and function to 血E pa15retia血.ta of the

山脚桐，J 蛐蛐啕阻，」 s曲血1由 nigra.. from which it is separated by 也ein回回l capsule/

pars 倒响pada pars 闸’l:ula恤 crua CErebri. ~由ei; 也ein恒malpa血dwn and pars reticula:缸。f
Fig. ’也. Tran割帽，，．盹tion 钮，rough 恤e midbnfn lhDwt啕恤－ the sub嗣ntianigr菌 areMg81ded 翻白E ’。u’ut' portion of the basal
subetllntla nlg阻 ganglia. since they are the or幅n of也E majority of basal ganglia
efferent fibres 也t p叫回 ω 叫leI le时s of也t neunms.

collatmilisation of axon岛 S叩arate populations of 甜iatal PallidaJ a'fferen恒

n四rones generally proj四 ω 曲曲。f曲也IttOU飞put ta尊”－
τhese projections are all inhibitory u~on. 归lli也I 姐d nigral
n四ron臼 and utilise GABA as 也.eir 伊恤1ary 宫四amitt.er. In
addition, a number of neurop叩tidea are ro-loc.alised in 由ale
eirerent E四IOne!I. 咀ie cells that project to the in但mal 坦gmentof
the globw pallidus (GPi) and 由e substantia nigra con恤 ho由
substance P and 甸回rphin. The 严叫回.on to 也e a田nal
钝gment of 也e globus pallidus (GPe) contains met吃曲叩balin.
Pallidal aff时四ω 缸ise principally from 也e s创a1Umand 丘。m 也e
sub也alamic nucleus. Striatopalli也l fibres are of no附 typ凶， as
伊mouslyno时， ori扭曲tg from di缸entp咿.tl皿on& of suiatal
mediu皿咂nyne田ones. Bo也 u出院 GABA u 由.eir primary
tr.u回ni:包er. In addition, each contains charac田isticp甲tide
∞也ansmittm; fibres projecting to the a田nal 归llidal 挺gment
contain enkephalin, while 由。，E proj回ingto 也e in能mal
pal且du皿四nta旭 substance P 缸td 句norphin.
146 • NEUROANATOMY
臼剧也饱 nucl创』，
Putamen
Globus pallidus •L｜国阳111 啕ment
Internal 啕ment-
Subslan甸 innomin幽
，阜｝
AB
v，咱回l 18阳刚刚时，us
。f lh曲mus
PUtaman
Globus pallldua• IL Ex能ma崎gment
In怡malaegment
Subthalamlc nucleus
Thalamic 饱剧culus
L草·
Flg.14..7 队，B)Coronal ”ctlons through th，刷刷局”””um and di刷刷，h剧”. L均睡 method for my刨In. (S1时伽nscoUI部syof的e蛐伽ia/Museum
of陆坦Ith Bild ＂＇如彼对悟， Armed For四~阳也血 ofPath侃羽y, WllShington, DC, USA.)
咀t 皿曲曲ala皿呻d且也I projection origina田面由embthalar回E
nudewiof阳αudal dien呻＇halon (Figs 14.7, 14.8 and see
Figs 12.姐， 13.9）.四tlssmall 白山tureu lo甸回 benea白白t
也alam.us, lying a伊inst 也E medial border of the internal caps\血
In coronal section岛 it has the app臼ranee of a bioon四d四ι
SUb由血皿op创且也l fibres pa路 h回:ally 也rough 也E intunalca严ule,
contributing to a 鱼breays恒m h脚n as 由esub也alamicfa皿rulua
(Fig. 14.町， and 田minate in both I唔nen1JI of the globus pallid盹
d由m晤1田mination is more dense in 也e m但mah嘈nent.
咀ie subthalam叩alli也I pathway is acitatory to 归m也1
neuron白， using glutamic acid as iu transmitt缸 τbe subthalamic
nucleus also sends similar fibres to 也e pars retiαJlata d世te
sub刷刷a 皿gra. 也t 创h缸’output' p缸t of 也e basal 但nglia
酬em. 咀teaub也alam叩幽幽I and sub由血nonigral pa也.ways
have a pivotal role in the normal function of 也 basal 萨血肉
and in the pa曲。physiology of basal ganglia disord四（see below).
Pallidal efferen幅
咀le 旬帽严m也I 民gments have 阳y 函.fferent d坠rent pre功配tions.
咀ieextemal ，喀回回t pre尊缸” principally to the subthalamic
nuclewi. Such pallidosub由alamic fibres pa囚 medially 由rough the
Internal 侃”.
Exb町nal 饵”ule
E自由necapsu怡
Clau由um
Amyg幽恒
Hippo帽mpus
1 La恼ralm“l』llary lamina
2M创ial n回ull町 lamina
臼剧也le nucleus
In悔malcapeule
Hippocampus
C『UI 帽，bri
·Subs恒ntia n幅m
in恒malcapsule 扭曲esub血ala皿ic fiudculus. This 严oj配岳阳 ia
inhibi阳yand 国a GABA 皿 ib tranllmit田．咀le M田nal 吨ment
of the globus 归llidus, to醉therwith 由E 归11 reticulata of the
substantia 回归， projects 严imarily to the thalamus (ventral
lateral, ven田Ian也rior and centro皿ediannucl哟， wi也 a smaller
projection to 也 brains回n f(但entum. 币1刷刷职rt neurones
att all inhibitory 姐d utilise GABA 幽也.eir ttansmitt也
Pallidotl叫a皿ic6br四 takE one of two routes from 也E GPi to
reach 由.eir U耶t 但g. 14.8). Some fibres lo叩 round the an回or
m缸gin of the in值nal capsule as the 皿aa lentiatlaria. Others
阴草，也rough the internal capsule as the lmticular fudadus.
Medial to the iI晦ma! 饵”ul~ as the latter 矗bres pa”。阳也e
subthalamic nucleu鸟也ey are known as Fore!’s field H2. Hav姐S
”’
P ed d也a round or 也rough the in恒malca严u1巳
pallido也alaI旧E fibres continue to course medially and 也由
lo叩 dorsally 姐d lateral』y as the 也alamic: fasdatlus (also
known 皿 Forel’s 量eld H1）”四ter 也E 由.alamus from its ven往al
a吨配t In 岛l』侧ing 也is 田.jec如厅， pallido由alamic fibres
ciraunnavigate a e:el1咀缸 E唔on of the sub.thalamus known ”也t
mna incerta, which H创 k阳晒1 也E 世talamua and the
subthalamic nucleus.
 Chapt町’4 Basal ganglia • 147

国1世ω恒r fuclculus Zona Inc创a

h饱m创饵psule

Putamen

Exlemal 回gment
of globus pallidus

In恼mal S匈ment of globus pallid幽

Fig. 恤， Coron“四面，n 恤rough ’'8CO叩uan阳tum 笛’d dien晤’附alon iluatratina … Sublha恼micfa鹏阳』lus

ffenlnt project胁”。fthegl曲回阳llidul.

Pallidothalamic fibres constitute the main outftow from the

basal 伊nglia. Their 也ala:r皿E 幅rget nuclei (v回国l 皿也rior and
。。””ec”。”。，由• globus palllclus
ventral h阳al nuclei) in tum project excitato叨 glu凶natergic •TI回 glo~』s pelldus oons际ts of •The In匍『nal pell胸l 啕mentls
1wo segments: e:剧目n副 and homol吨。us to the par百
fibres to the motor z唔。”。f the frontal lobE马 principally the
interr回． 回回国t且 d the SU国恒ntia
伊imary motor and 皿pplem由国y motor corticeιA smaller nigra; the two 时ructures are the
·国h paJlldel 铺gments re叫随
contingmt of medial pallidal efferent fibi:四 passes c:au也llyto 'output’『啕阳市E d 伽e basal
~唱le atf9晴t 明bres 骨om
缸回扭ate in 也e brainstem t£gmentwn in 也e nucl四皿钮’nm gangla.
the str恒tum and glut町啊ate咱le
peduncul叩OD由118 (pedunad。”E由E nudeua），抽ich lies at Elf阳帽nts 骨。m 甘丽 sub甘回lemlc •The In匍『nal peJ恼l 锐啕W旧时
theboun巾rybetw阳i midbrain and pons, near 曲 lateral margin nucl田』s. prq如els GABAe咆ic fibres to

of the superior cerebellar peduncle [ Fig. 14.5; see also Fig. 13.12]. 由eth幽mus 阳晴圆 m恒rior.
•The 回emal pallldal 啕ment
田市刮阳回刮 and 饲「llrcm国ian
咀由 region has been 阳med 也e mesencephallc E配，，motor p叫“ts GABAsrglc 伽res to
n山时 and to the b闹闹tern
region in lower mammals, since it is involved in 伽 E嗯1lation of the subthalemlc m刷刷s.
(peduncu网JOnti『'BnUC隐居｝．
qua由upedalpr1咱.-eaaion.
四tepam E咀四lata of the subs植且也 nigra ia regarded as a
homologue of the in回1al s唔n四t of 也E globus pallidus and,
也略 h祖 a similar 血tus as 由E origin of basal ganglia output
pyrami由l and emapyramidal ’钢忧ms' are 泪.timately related
m怕也皿即arat.e and (2）也at so-called pyrami由l 画伊s are not
E田mnes. Like 也e in但mal pallidum，也E P缸冒血tia血tam:重阳回
矗bres from 由e stria阳mend 也e sub也ala:r回E nucleus.τbe
all attributable to dy甜mction of 也E pyramidal 田.ct itself (8tt
pre临出m 伽m the 由iatum iJl somatotopiαlly O喃划时， both 扭 p. 28）.岱le 阳m 'exttapyrami制’ is，也erefore. 阳m回hat 剧时attd
曲E 庐山dum 四d 皿，毡， such 由at pallidal neurones are associated
but is still in wide甲E四d u且
严imarily with limb mo陀m四岛 whereas nigral cells control 由t
Current concqrts of 也e role of the basal ganglia ronsider 也at
也eir function iJl to facilitate heh剧。1urand mσ陀皿四.tllthat 缸E
血al musa血阳岛 including 由.e exttaocular m皿des. As already
no恒d, efferent& from 也e in阳nal pallidum proj回 ω 也e 咽ntral
Z吨uired and appropriate in 缸1Y particularαm饵” and to inhibit

an田ior, ventral la!但ral and cmtromedian thalamic nuclei and to

the pedunculopontine nuclei皿. Efferents of 由E pars re白血ta of
也E sul>stan由副伊础，。归” to a subr唔on of the ventral lateral
也alamus, 阳 the superior co出口llus and to the brainstem reticular
formation (including 也e pedunculopontine nucleus).
Normal functions of the basal ganglia
四ie ba掘l ganglia are sometimes ref回ed to as compon四”。fthe
m咀lied 'emapyramidal motor system~ 哑山田m was coined to
distin思血h 也e symptoms seen clinically in diseases of the b踊al
但nglia and related 阳uctures, SU也刨出e subswttia nigra and
四b由alamic nucleus, 盘。m the symptoms ob阻四d following
stroke in 也e in佳mal capsul巳 Since the latter -were thought to be
Clllllled by destruction of 也E pyrami由l tract. 也E 回m
’emapyramidal’挺emed an appropriate d割。”伽缸 diJlordm of
the basal ganglia. As understanding of the 旬nctional 缸ia阳叮 of
motor control has incre苗时， it has become ap阳mt (1）由at the
unwanted or inappropriate movemen舰 How 也is might be
achieved can be apl血d wi也 refer回ceto 也 internal
ω皿创.ODS of the h且l 伊且glia σlg. 14.5).
Wb四 a mo略m四t ia initiat.ed from theαrebral mr回 impul幽
幽sdw:萨 nc蝇。inly 也rm晤l cortico币nal and 回国田ibulbar
R血1ways b皿 also 也rough 由eco世m由ia钮lpmj回ion to 由E
neOIJ国atu皿. These glutama回回E 盘bm1 c:au旦 excitation d由iatal
medium spiny neurones. 刀ie 由iatumhas 棚。刷刷 by 材世也挝 is
able to control the activity of b棚I ganglia output neurones 扭曲
intemal segment of the 脚bus pallidus 咀d 也.e pars reticulata of
the substantia nigra. 臼狸。f由四 is the ao-called ’dittct pathway',
倒回皿ngof 础妇”四且也l 四d 础iato皿gral nrurones, which
曲缸tly inhibit 姐回nal 归血血I or pars 理位四lata neurot回也咀始
mechanism baa bem shown to 句>erate in experimental
由虹叩悔，iological studies 画 primate鸟 wh四 ba.w ganglia m职lt
neurones a撼。cia回回th a 归rtia.tlar be吻阴皿 or muscle group
showapau提 in their action 阴阳也I discharge duri鸣皿阴阳回t
148 • NEUROANATOMY
阳rklnson飞s a翩翩’
Fig. 悦’ Schematic di吨ram Ill皿tratlng how actlvt幅幅 lnbullllp咽lla.ndre恒恒d nuclei became dlaor咽，red In Pa血man’adl翩幅幅 and
chorea. Overact阳 palhw町saresh阳n by solid lines: un由raciiv田 palhw甸回 are shown by interrup恒d lin盹 Fo『 idenli自由lion d 由uciures, 11回 F国.14.5.
of 也t region. This has k四曲。WDto “四z in 由t in回回I
palllih皿 for limb l'.llmml自由 and h 也z s曲血ntia 皿gra, pars
reticulat鸟缸句E mavem四”. Since intanal 严血也landpam
retia血la output n四IODe11 are 也emse1回 inlubi:旬E势也is lead ’”
曲inhibition of tar萨t neurones, including those of the mσtor
也由mus. 四emul也ginα圃’E 困山E activity of 幽幽皿icnruron臼
cau棚 m:ita:蚀。n of the 创ls of 也ecaebral co民a. The dkct of
缸由四m of 也t 曲回 pa由W富y is, therefott』 ω 剧目iort or facilitate
ongoing movements, 由m咀E 也is po国由E 岛edback to 也e oorta.
耻 。也g route by which striatal n回回回 can influence 也
OU职Jt of the basal ganglia ill the so咀lled 'indir回严由w时，咀
the subthalamic nucleus. A proportion of dkrents from 也e
由ia创m 阳mina也 in the a:temal pallidal s嘈nent and their
activation induces inhibi出nofa阳nal pallidal neurones. 四E
p血cipal d趾四t proj配tion of 由eex坦malpal且dum is to 由e
“bthal皿tic nucleus which, 由erefori己 becomes disinhibited. The
resultant 恤αease 扭曲charge of sub曲也mic n四ronea 倒i础
acti四tion of in但口回I pal且也l 四d 皿gra1 E四rones and, in 阳rn,
inhibition of thalai:回c: and cortical ceUa. 切由 has the cffea of
inhibiting unwanted mOY回1ents.
Pathophysi。logyof ba目l ganglia disorders
Basal ganglia 伽function leads to abnormal motor control,
d能rations in posture and muscular tone and 也t emer伊睛。f
a阳10nnal, involuntary movements or 伽kines跑回e
combination of 句mptomsdep咀dsupon 也e na1ure and si能 of
由elesion. 咀le m曲tαmimon disorder of 也e b幽直I gangl坦 is
Parldnao的幽幽匠， which is charac回ised by po回rty and
slown由 of m1JV四1ent （副nesiafbradykinesia｝，缸'EID.Or 皿d
rigi曲. It i1 raused by d唱团由世.on of 由E d句wrunergicn皿rones
of 也e subst皿由 nigra, p回回mpa血， that project to 也E
Chorae
- Dopamine
- Glu幅mlcacld
- Gamma aminobulyric ac副（GA晌
s创atum. Studies OD 也t post mortem brains of patients wi也
h出nson’I disease and expel如回国皿皿al studies have
provided insight into the pa也吨向mol唱cal mecha皿皿s 由at
underlie 由E appearance of parkinsonian symptoms, in par咀cular
akinesia (Fig. 14.9}. Normal峙， dopamine appears to ezert an
ercita阳ry influ回ce upon striatal neurones of the direct'
’'
”吗配tion to 伽z in回nal pallidal segmen岛四d an inhibitory
effect upon neurones of由t 扭曲配r pathway 由at projects to 也E
U阳nal pal且dal s唱n四L Lo88 of stria.tal d叩amine, 由自由地
cauaes abnormal wtderactivity of也t dittct pathway, leading to
diainhibition of in但rnal pallidal E四ron四. At. 由esametim1巳 le圈
。f atriatal dop扭曲e causes a晒activity of the indirect projection
leading to inhibi'由n of a:temal pal且也l neurones，曲inhibition
of the sub由alamic nudeua ar叫， thus, ercessive m:ita阳y 巾M of
in能mal 阴Jlidal 耐ls. Chan伊 in both the direct and in曲回
pa也ways, thu岛四mpoundto 田cerl>ate the abnormal 伺erac由ity
of internal pallidal Olli职lt cells, inhibi山18' 也e motor 由也mic
nuclei and motor cortiαII area岛 inducing akinesia.
币ie ai:clietypal basal ganglia disea民迦咄ich aa:asiv巳
unwa旦时， abnormal movements （伽.kinesias) occur is
Hm世唔阳n’，也1eUe(Hun血gtan’E chorea), which ill an
inherited，”"Ogr四iwneurod唱团e四~也order. Wi也扭曲t
s国atum，也ere is particular attrition of the 创ls 由at proj回 to the
a能rnal s鸣mentof 由t globus pallidus (the 恒direct’ projection),
at least e缸ly on in the 倒tdition.τhis I幽.ds to disinhibition of
g阳nal pal且dal neu阻ies and inhibitio也 of也t sub也alar旧ι
nu出国. In回国l pal且也l n四ron筒，也ere阳电 become 由wrmally
m也acli.ve. and unwan时， inwlun田y m~ents (chorea)
ensue. Sim出r abnormal mamn四”“xm all a complication of
the Ion吕－t回田’回恒nent of Par恒nson’， dis咽sewi也 1rDOPA. The
underlying B创mll m民baI山m is sim且arbut, 旭 the latter a盹
 …” Bas叫
白眼 iabo也 rdative un缸缸tivity of the indittct p础wa歹皿d
<M!raC由ity of the direct 阴山W町 σ也 14.9). A vety WI巳 but
也由UCli:v巳 condi筒。n which 企姐回ially demansuatea the cm田l
importance of 也E aubth.alamic nucleus in baaal ganglia function
is balliam (bmiiballiam, her回ballism山）．它由 is came:!. by
也JDqe to the IUb也.alamic nucleu鸟 mo悦。缸E W 由d也 It is
dwacteri院d ~gr”’ chordc, flailing m阴阳回ots of也e
倒也在lateral limbs due to removal of the exdtatmy drive upon
basal ganslia OUψut neurones. Subl恒M姐
Because of the anatomical arnnsem四.tofbasal 伊nglia nigra
回m仅:tio跑回ilataal bual ganglia l回onsprodua 也eir dkcta
on the c.ontnlataal aide of 也E bO<坊， a 扭曲e case wi由 αrebral
hez田，phere lesions. but di皿inct from 但rebellar dilord四．

....,,.”1111• funotlon •nd d”’un剖’on

·节18 ba锦l gangla h阳b『阳lly
W冒ere币err回 t。” perts of the
extrapyramldal motor W冒tern to
d国『~uist、国salgangla
d自由de11J 骨"Om 1h四”。f the
pyramidal 国ct. How凯帽， the
aystema are intina刷『刷刷．
• The bl悔匾l gangla 饱dlltste
purpo镇刷 b钳制our and
mo帽，nant v岖’18 'direct'
pahwayandW也植 unw.晦刻
movements "Ilia the 'lndl11记r
pathway.
• Les阳S 创 the basal gar电l阳
produce 创饱cts on 甘回
cont刚ater回I side of the b叫y.
(A) h刷刷刷刷刷’ （~） Normal
•Di幅画面目揭 d 1he b画al gangli阻
aretypifi回 by 同rkilscn'a Fig. 忧”民 8）句proxlm.t啕tnin－田”cllon• 由hraugh
the i.t.r.l t.lf of th• midbnlin，曲”ingd町阳...tion and
disease, i'1 which 1hBAI 面
阻隔『ty of movement, ar回 “回’”“咙副。”’fthe “b曲”笛·啕，..， , . , . CCllllpmc:la in
Hun由H’on's d锦睛， 响lch 协 P•rtUM棚’•di””‘ (Cour阳iyofPro腼sorDM,棚，由市al
闹，'OS帽始创，懈地，怕制81, Un相'Sitfof蜘net四擂， Mafl，凶邸ter, u,叫
副创创制 W协句咏勘倒as.

..,. .............. …t 曲创
A E回帽”， bwmor al 1he uppe『 limb characterises 1he er盲目t d 阳
mo鸭ment di阳'der of h鼠”。”、“”’”， inwh抽 thep窗事
compacta of 甘w sut>stan1ia nigra d咿闹闹.tea (Fig. 14.H事， leadi咱 to
depletion of st阳.tal dopamine 归g. 14.11). The elderly patients 侃velop
prog晦S阔自ldr咽恨， motor 啕ldlty, a ft假回 posture and di耐L』ltyln
lnltlatl咱 m朋棚’118. T1嗣同时战时伽肌肉ode脚。L-DOPJ咱 or
dopeml「隐『，α菊W 町，onlsts. 『 dn.喝 th自apy 制Is，军四mulEltlon of the
subthalamlo nuc阳JS orG同 through Implanted e阳trod臼（d锦p brain
stimu恒tion）田1 惰’J the 田园ent.
A P四”I.ii bwmor of the uppe『 lmbs is SE町 in bllnlgn --.tlal
1nmor; It is 献acerbated by ar晴ty and 用自由回 by a国hol. There is
no progr跚阴 disability, In 阳吐圃t b 阳闹闹。内’s dis国揭．
A 白lent ('bat’s w同1P凶M刮阳nor ct胃部teri瞄
hep.tom恒cui.r d明阳. . .幅on (Wilaan’. di翩翩，1), an autoaomal
recessive di80『tier of copper metabolsm, which 创凶协副s to
progr回slve dementia, 甸回rtonla，帽曲曲lier dysarthr融 end a·刷a.
Ch’ ” Is the h伽l8li< of 刷刷啕棚内 di””’， an autosomal
制nlnantly Inherited degener咀~on at the n曲刷刷m In 附lch 伽tor曲血，
a陆阴阳 and clement脑 progressM!ly supervene.
’”’nhllrn'• chol'M 阳 n侧阳e end Isa men阳凶!Ion of 阳umatlc
”而霄， an lmmuned随时W 例ggered by 掬啕1tococcal h始ctlcn. 翩翩钳
制ldren d矶础。p abnonnel bah刷刷r e、d generalsed cho用a 阳 Vitus'
dance).
D归钮阴阳 oheracteri踊阳”d阳”句”onl•， 时lich ere
n剧『'OdE泪，w回阔 d赠础，s of childhood i'1 which invoUrtary rnoYBmen恒
are genera.I回d. In adults， 句ston国 is spar回ic g市d focal, atrectng the
up阳 lmb 阳，Wacnm则，胁”f limb，『回圳阳出，』l刷，蚀卫自由d 问.14.” P帽阳翩翩惘协n tomography伊目？”·”’，跚跚”唰啕
fT10I血（onJfmci•I 刷刷阔副剧院幢幢”’de 啕，hon阔． 嗣同z.or鸭，l ”“饼” through 1N brt*t llt the ..，唰“刨圃’剑”翩翩．
Both d归ton融 and chorea 出到圈。p h 甘回恒.le st句ea d 阳rkinson’s 阳酬。rlstowa附世1et1” In 创副cha嗣. Tha top scans are from a norm创
d棚” 1唰创 with levo邮且阳odopa-hducecl 句由·刷刷刷 in lndlvldu副 end the bottom ones from a p副ent with Parkinson's d悔跚跚.The
psychotic patients tr.恼，tad with neu刚甸回c drugs (tsdlve 句，kinesII咱． scans on the left ware made using the traoar r饲-d叩且.Th隐隐回阳、 up by
Myuc协n嗣（sudden, hvolunt町 muse恼∞刚刚tlons ch刷刷ell咱 M国d 也写口arnin町g lo n8f\181erm阳ls and，甘回refore，卸恒 as an index of the
the h凶d, neck and up阳 llmbs)ls 阳 sole m削阳tatlon of f田m... in回grity d甘币， nlgros刨atalpathw咀y. lhereis 『回回国恒beHi『1g in the striatum
”翩唰l 啊，d刷u•. M归clonus Is also 棚、 h 廿1串 of the 阳嗣nso叫m pat阳时．”胃部ans on 伽erightw町， ma由 using the
n鼠，ω甸回naratlve dlsord阴 d Al曲，Ima内 di”1188, Le町 body 国m 「1C)咽lopr1de. 丁hi& bi'l由 tod叩ami晴 receptors loca:闹。nst由t副
a ” · ” and Cr’”刘刨dt..Jak确 di””·． 『1eurones that receive input from the nigro由ialal pathway. 有眼泪『民泪ptcrs
而’， wh胁 1119 slmp隘，回 focal muse革E 1wllct四.m臼t 。他n lnV<珩同 remain int部t In parkhsonian pali回ts. (C1阳阳1yaf问d回orDJBI田烟，
甘冒E h锦d a回 neck, are u副elyal m 阻由d咱国l 啕nlfl晒四 h 闹闹剧阳阳sorOfN1阳毗珊， ／mPf.刷ω陶醉 Lα鸭n,UK.)
且由国α:nce.H阴暗;,ver, In 甘冒E 饱mllelTcuw回国阳”nmome children a回
a由国帽臼 d酬创叩 com回国11 rwuntaiyπ1ola 『啤:iertor醋，州·ch cha咱自
世回『 nab.』用 and site, a回 also suffe『由88SS~修岳cmpY&阳 dscrder&.
 15 Visual system
Re世na 151
Vision 扭曲t most hi且lyde叫oped and 四”atile of all 由t
S四”i:ymo也监ties 血d，缸部iably，也t oneonwhi血 humans are
most d呻四dent 咀E 叩tic nerve and 自由a 缸叫op from 由E
F田encephalic primary brain v回de (p. 7）缸咀，也但由E巳 are
regarded as an ou唱JOW也 of 由e brain itself. Vision commenrn
with the formation of an image of也e a田nal world on 由e
pbotoreceptive retina. 哑le m世na 回codes 咧sual inform回归扭
曲t discharge of neurones 也at proj四 ω 也ebra扭曲rough 也E
呼tic nave. Fibres of the 。因E nerve unda'go hem.idecu副总on in
the 句tic ch阳am and project to 也 lateral 伊咀四1世 nu.deus of
由E 也血皿皿古talamocortical. D四rona in tum pr叫回 ω 由E
primlll)' 世aual ca皿a in 也e occipital lobe of the cerebral
hemispher巳 where 世皿皿I perception OCDl.I9.
The eye
In 由e eye. the eyeball,
or globe, is appr回皿ately 刷lerical in
由申e (Fig. 15.1). N四 its pos阳阳 poleemer胆曲叩t nerv喧．
四le 句由all may be comhl町d to consist of也ree co部盟副c l句m
of ti剧鸟 theou但rmost of which is tough, fibrous 缸id ”。配世阻
。阳 most of 也e E且obe it fonru an opaque white coat,. the 1dera,
to which are attached the emaocul町 m'Ulclel 由at m伺~the
eyeball (see F地 10.5）.。市也ean阳ior pole of the globe it 缸ms
也e transparent com盹也rough which light en也B 由t 句也
N臼rto 也E 血也rior margin of 也t sdera, 切”也igs ofsmoo也
muscle e:nen.d into 也 lum血。f缸。＇！！：ball 阴g. 15.2）.咀ie most
anterior of 也因εis 由E iris，咐iich baa a centr.tl aperture, the
pup乱也rough which light is admitted to the JX班回iorpart of 也E
句~ Some of the mwicle fibr田。f the iris are manged in a circular
a翩。鸟 whileσ也ers are orien也d radially. They are under the
Mldial La恤ral
Re回na
制cnarve一4
Fig. ’ 6.1 Schematic drawing ot a horizontal ，酬划。”由rough 曲，啕M
”’bell
Thee俑，，l 咀翩翩l p8'阳帽， 151
control of the autonomic nenous system. Circular fibres are
innervated. by po&咽nglionic 归rasympa也etic neurones. whidl act
ωω础坦 the 凹.pil 皿d ttduce the amount of light falli吨 U阳1
由E retina (see p. 102). Radial fibres are innerva:伽d by
pm够mglionic sympathetic neurones which dilate 也E 阳回I.
Behind the 诅B lies the ciliary body containi昭 ciliai:y muade,
which receiws innema咀on 丘。m 也e par回勿mpa也etic nem>UJ
m也m. 哑iecen包al aper也re with姐也e 皿nulus of 由E ciliary M对y
is occupied by 曲也ansparent, bico町a lens, which focuses light
u严地也e 挖出ia. The lens is held in place by a suspensory
ligament that is attached to 也E peripheral ma咂n of the I阻， and
ω 由E dli31}' body. Contmction of也E cililll)' mmcle al但rs 由E
血peand，由E由re, the focusing power (focal len醉） of the lens,
a process h饥mas ao::ommodation (p. 102）.四t lens and
smpensory Ii伊mentdivide 也e lumen of也t 句'eball into an
m也rior and a pos忧rior 阴民 The 四阳ior part, 皿 front of the
l田’』 con国ns a 也in, watery :Ouid, aqueous hum.our, whi血凶
con由lUOUSly S回回国岳阳由E cili31)' body. It is also reabto也d
into 也e ciliary k对y where it is 由血d by a small duct. 由t 也nal
ofSchlemm, 也rough which it is returned to 也e 把nous sys回n.
咀瞌 posterior part of 也e globe conta皿 a Fl甜DOUli ma阳ial
h仰nani伽emu humour. Behind the cili町 ho句也t inner
m也ce of the sclera is lined by the choroid, the cells of which
contain dark pigment that abso曲 light and thus reduo岱
reflection wi也mthe 句也 Lln画g the inner SU血r:e of the choroid is
由t photo阻呻tive tttina.
白，T嗣
lrts
αl画『y mu回，
Sus阳1拥y
Ii归n唰11
Lins
阳曲回
Fig. ’也2 Schematic drawing ot the 8Cleroc。”饱al~ctlonot 曲，
，，由all.

Fig. ’u 回幅””“”幅画。not 恤’”’ualfi创d upon ’”附齿”也
U院t 归sses from O间m h 由E 佳eld of vision （·白血I field),
世四ugh 也E narrow 吨阳”m d由e pupil to sub能ndanima萨叩惆
阳 m由a.An obj田面。le visual field, upon 抽ich attention 面
食阻ued. 剑b但ruts an 迦l8&e that is 值1tred near the posterior pole of
h 句t along the line of the 咖皿I 回s 但g. 15.1). At 恤 point,
whi血 is M臼咽 as 也e fovea 回国h，四d 也e surrounding 1 cm,
w划出 is kn＇饵，n as 也E m皿血 lu恼， there也ais 叩回副lymod血d
formuimal 世suaJ. 回lity (ttSOl由igpower〕. Theba血叩tical
F可回世s of 也E 句冒~ which may be likei:田l to 也因e ofa 回血ole
αmen, diet融由at 由.e ima悖 m 伽med is in回国 in both lateral
and vertical dinl钮，ions (Fig. 15.3). Purthennore, objects that lie in
the left half of也e visual lidd fonn 皿皿咿 U归且也enasal （埠。”
half of址le ld't retina and the 回nporal (light) half of也erlgbt
但也a, 缸l.d vice 1llf现 Medial to 也em缸由 is a z唔on where re也al
axons 缸山nula但 to leave 也e eye in 也叩配 ner嗯 This is known
豁出t 叩缸 diac. Photorei呻tors are absent from 也is r唔俑， whi血
is al蹈， therefure, refm-ed to as the blind spot.
Retina
咀re retina consists of a non-neural and a ne田alpor白血咀E
non-nmral part is repres回但d by the 回gment 甲温时ium, a 血gle
均E of ligbt-ab90拙嘟”gmm时 alls 刷鸣 adj征回.t to the
choroid (Fig. 15.4]. The neural part of 世le M世na contains
pbotoreceptors and neuron臼 as well 笛 neuroglia and a rich
α国.laJy networlιThephotore坦因:ve 创ls lie deepest 响曲且也t
u也1且姐4 出国也6皿.te with 由t pi8ment 申i也elium. Llght 阻四鸣
曲E 叼皂 therefore, p幽岛也IOU曲，皿d is refra础~ and partially
absOibed by.，也aeaddi岳阳al eleo:回1t.s before reach且g 由E
pbσω阻吨’也E By means of a series of photochemical reactions
血d p峙11icochemiα1 change岛四川I 曲创m院即tors tramduce Ii胆
回ergy into electric.al 回ergy (changes in membrane po阳ltial).
k也al 拙。toreceptors are of棚。”吗 rods and cones, of which
也t m也 are about 20 times more numerous. 回回ecells 也are m缸ly
m皿wral similar挝es but have important functional d掘nclions.
Rods are exqt剧也lys出aitiw to light. 四eyare 归且由Jar妙
impo血nt 岛·r vision
in dim ligb画ng conditions. 臼nes are
res严maible 缸田ilour 由国l and. beca111e d也eir arnmgimient and
neurm回 conn回ion鸟 they con企~high 世sual awity.
Rods and 四E创盹 he阳。geneously d由ibuted aero”也e
m世na. 耻地 e四.tly 归回ominate 画 the peripb四l 阴阳 of the
Chapter 帽 Visual 町stem • 151
半－－臼咱l阳倒l
Flg.15.4 Scharmtlc dnnmg ahowlng the 四llular 町’回幅画Uonoflhe
m幅na.
z回na but 也由 relative numbers decrease towanls the mamla,
where αmes are more 抽回ldant At the fov回， only cones are
阴阳1t Furthermore, at the fovea the neuron创 andα.pill缸明
白rough which light bas ω 阴BS to reach 也ephoto，配叩ω囚， are
displaced，”也at 也e cones are directly exposed to light This
comb姐回.on provides 伽 ma豆mal 由四I acuity.
h “di世on topho缸Ire<:叩苗，E cells. 也E 挖出taαmtaina 由ecell
bodies of both the 伽at- and second唱“眩 目四rones of也E 民ntral
咀sual pa由way （自岳 15.4）.四e first-order m皿one鸟 or bipolar
ailla, lie 回自由 wi由in the retirui, while 由E amru of the
S民orui-order neurone11, or ganglion c:elb, form the 叩tic ner呢
h岛rm.a世.on is trans缸”d from photore臼ptors to bi阴far cells
皿d th四 to 萨ngli.on 创ls, with g回ter con回电~for rods than
for cones. 咀ie retina alaoαmtains 姐temeurones known as
hori皿ntal 也Ila 姐d amacrine cells. The腿 modulate 缸幽幽isaion
betw回l plwtmec甲回8 and bi严地arc.ells，皿d brtween bipolar
cells and ganglion aill也 E町ectivd萨
The• ”
•O剧目ts in m四恒.le帽l half of the f咽uron民阳polar 佣Is）副
飞risual field 阳m im啕臼 on 甘冒目 Secor回q由r n剧『回回
nasal half of 曾回 ipslale剧时m 甸anglion 饵Is).
and the tern阳al half of the
• The axons of 晴圆nel 伊ngl阳、
contr刨础窗回I retina.
cells accumul睡 at the 叩tic
lhe 『副nacor幅ns
• dlsc(blnd s阳到I) and pass Into
photorecep也0111 (rods a回 由e optic ne惘．
COl'IE划， 1inrt-order 晒VIDrY
The central visual pathway
四leuonsofre也al ganglion cells user咀>le at 由E 叩tic disc and
paasinto 缸叩tic ner吨 which 回回事也ea回国I cav均由m咽地t
叩配 canal.The 制。叩缸 ner咽 converge to fonn 由eoptkdWum
on the bale of the brain (Fig. 15.5]. The 恤IDl lies immedia:呻
m四”“e tuber cinemun of the 国阴阳larnwi and k阳'eell the
termina问 internal carotid 缸回回（see Figs 7乌 7.3). In the
chiasm, amns d四”dfrom 也e nasal hal咽。hl四饵”回也随
152 • NEUROANATOMY

deru翩艇缸ld 归BS 画ω 由~ contr世.ateml op配 tract, while 也Ole
叠。m 缸阎明:tal.hm也etinae m回n ipsila回址’lbe 叩缸皿笛
幽回gie lh帽， from the cbiasm 副回归翩翩』nd the 但由'al peduncle
ω 回minatem血lyin 缸 la恒al gm阳tla能 nurleus （明白in 由E
h回1 geniru1atr body) of the thalami皿 Arelati呻 small number-
of 剑虹回 leave 也t 叩tic nerve, before read由鸣也e 1.ateml F世四late
nude\』鸟 to terI回nate in the 阳能由I araand 也e superior
collirulus. 四册 fibres are involved 旭 medi111也m of the 拟刷Dary
Op四C ch恒m
light refla: ~由ap田 10). From 也 lateral 伊血血trnucleu鸟
也hd-0rder 也血mα:ortical n皿阳回 p叫出由rough 也
陀trol曲曲血z p础。f the intemal capsule and fonn the 叩tic
E回iation, which 田minatmin 缸 prima哼唱团almr恒 d曲
ocripital lobe. 哑iepr恤缸7啪”al mrt£1: is loaii田:lprmo皿nantlyon
the medial IU由re of the bemisph四 in ther唔on ab慨 and bel阳
也t ca1α血e sulau. Surrounding 也is are鸟也e rest of theαripi回
lobeαms阳回 the 世sual associ副on COl1a. It is concerned w恤
in筐。retation of咀剧al 旭iaga』 mα耶ition, dep也 perc甲tion 皿d
colour 喇.on.
There is a pred腿 point-to-point relationship k臼帽en 世ie retina
and 由E visual CD且E Because of the importance of也e macu.la in
vi1ion. it i，即re11en也d by di!pr叩ortiona呻 h带回.tomes
｛甜甜，e to its me) of the h能ral geniaJ1a能 nucleus and 也t飞r.isual
α览馆Z Within the 回皿al cor恒 the mac由 is 田presented m回t
阴阳iorly, in 也E region of the 侃cipital pole.
& previ.DU91y no时， objects in ei也缸 half (left or right) of the
vist且l field 严。duce images upon 也e nualhemi~由ta of 由E
i回la恒:tal. eye 血d 由t 也m萨>ral bemire植naof 由eam国la但ral
句哩（Fig. 15.3). h出叩世E ner鸭由erefore. carries information
amcani唱 bo也 haha of the visual field （地 15.5). Because of
the de<Ullla尬。n of fibres from the nasal hemiretinae at 由E 叩tic
d由.sm, hm帽”再回血。ptic tract. later创萨niculate nucleus and
visual cor眼 receives information rel甜ng only to the 四ntralate:tal.
half of the 由皿I field. This combination of the ima伊 from bo也
句哩， ia neuasary 伽，但陀曲copie 由。但（d甲也 percep世on）.哑le
upper half of曲曲回l field forms images u严m 也 lowahaha
d也E retinae and 由E l.owa half of 也e 由国I field 伽ms imagai
upon the 吨，z hemiretina丘 Althalam侃ortical fibres lea:ve 也e
la:但回事nia血但 nucleus they pan 缸口und the la:国'lll 响~tricle,
those E即resenting 由e l.owa part of the 现sual field COUl'ling
SU阴riorlyto 回minatein 也t 南国1 cortaab伺'e the 组阳血t
sulcus. Thoae which represent the up阳 part of 也e 说sual field
SW四pinto 也t 田npo:tal. lobe (M句tt's loop, Fig. 15.6) bdott
terminating below 阳也lcarine sttlcus.
四le 世sual field can beαmsidered as being comprised of fo田

q且也四”〔left/right. upper/low町 Fig. 15.7），回血 projecling to its

Fig. 恤’而，。田市咀嚼，ual
QWDCOITe叨叨叫ingqu回rant d也E prim町材皿al COI田（either
left or right hemisphere and d也er abore or below the calα由1£
1ulcu9). There is bo由 k忧国 and vmical i~n in 也
projection of the 刘皿al field upon 由e visual cortex such 也at. for
ewnple, 由t up萨!r left quadrant of the 吼缸且1 field is repres曲也d
patlnnJ. in the lower right qua由ant of the visualα览ta.

Lateral gen阳阳te nuae惆

of thalamus

Inferior horn of
阳”ral ventr阳”

Me阳’s 阳p

时．施’而’”U1'991alren by 由，阳m刷目。币制”bra pr，如创Ing 嗣m t惘 l翩刷，，由棚”阳刚揭阳帽”’圃， primary 咧eual cor融．

 …臼 v…
Theo”tnl 创.........町

•At t惘创灿灿田m. axons 阳” 阳回 t阳U』gh 世回『曲cl8nt以－

t陶『回el haN”。f 闹闹
『’由－ d翩翩翩省市d p翩怖
响翩I field
” cantr由I剧创则c tract.
• llwDJ就ic tr田:t cc万啦蕾帽’町胃
甘回帽TY it伽阳阳1 『时幽'lg
tileα:inlnllBleral hal 创甘冒’翩翩
patol 甘冒自阳tanel 饵，a岛
and 阳甸地 racial阳 to
tanrhl.te n 阳 pim町唰翩
α贸刨民
to • The pritWy 鸭8Ulll 回国画
b臼跑回罐阳”’笛，d b健'Ni 曾回国

斜斜
α配ar1na 81.拙』s d 阳邸’M
”
Rapre nlBUon of
•
r:A 讲销到同．

Optic 甘田址，bnll end in the

lobe.
vii幅I !laid U阳’
时In自由 later回 genie!.』恒.le nucl剧， d 骨，， • The rest of the ~ital lo国
th11脑mus. cons恤，t凶 the visual
“揭出阎丽n ar阻
• Third-order v幅u创’b『回膏。m
the 阳回回 g酬ω恼饱 nuc隐JI
R地hlla饱ral
ganlaJI幽 nudaua

阳ghlvi制∞『椒 ，，..翩翩．．“lcllll
D回ase of the f!l1曲创I (cataract, intraooular h画mo时啕e, retinal
由国chment) and dis回se olthe 叩tic 闹闹’nu恼陶 sciaro6is and 叩也
『lBfVBtUITIOl』rBll锦d ID le>臼 d 咽ion in the affected f!11B (manocul•r
Parieto-<I回回回l
blildM回）．伽npre四on of the o曲曲目m by an 副ljacer世 pttu阳ry
s叫cus
tu阴阳r I创础 to bitltmpor111 hemiln帽皿 Vascula『 and m制部I比
laeions of the op幅C 怕也I, opl始时iation or occi陶lco『回阳回回到aa
C篇洒”’ a配” ∞硝唰制 hom~ouehe刷刷叩阳（Ft;i. 15功. B院组』88 of1he
con旬W自tlon of 甘18 。因C 『adletlon (Flg. 1~.衍， 悔Ions h 世隔阳匍刨
lobe can I锦d to uni阳teral lo响『归u翩翩d lose while lesions h 曲，
temlJO刚 lobe can lead to unlster副 upper 惚U刨由eld loss
(qu回rantano川崎．
Retln烟，，lgment”• Is an Inherited me回bollc d阁制er of the
photD『阳市饱r and retinal plgrr四川＠阳、elel cells. There Is pro11四S阳
”ght blindnB!蹄，因而pheral visual 由eld con回自由m ar回回gmer咀剑。n of
the 『回na 唰b阳∞叩hthalmoscopy.
I Seni幅 m•cui.. d饵”..-.!Ion 阻 a d甸回arali阳 disorder of 甘南
Fig. ’1.7 肉’.，，..，.bl笛”’fth• 胁” h•lf of thew画”’If阳ldat~胁” ｜ 副de『ty l回ding to loss of cent阳I and cok>町、~&ion.
lenlalnthe 剖a剧”由way.

制fteld ／寸飞 /\
＼』 j \..v· V11u1l field 旬阳ts

f ~\
1 M。”“阳 blind『脯’
\...._)

‘~1 () 2 副回p耐 hBnianc阴

LU，侧”榈』Illa
·~） () … 3H hamlanopla

nudeua
3

Opllc 111dlaUon

问．恤’ Vllu•l fleld ddob proclu锦dbylei曲”’lfthe 咧翩翩阳由W帽，．

 Hypothalamus, limbic system and
16 olfact。rysystem

””。由alamua 154 Umblc 剑阳”m 157 Hippocampal formation 160

T叩啕raph阳l anatomy of th自 却nygdala 159 Cingulate gyrus 161
hypothalamus 154 Septum 1回 。!factory 町Blem 162
Hypothalamic nuclei 157 Orbital 阳n国J cortex 160

In Older to surviv巳 there must be continual biochemical and
physiological adj山皿四”凶严四eave 也画出na1 四vironment of
由E body in a balanced 皿d 血ble 阳佳（h幽幽幽幽〕．
h恼。但ptor signals 岳四1 也E int£mal a耶m and body a回ds
ini由tehom回归配 E哩，onses to achieve 由is end and the
均pothalamus is 也e stru而Jre re叩oruible 岛r orch回回归g
the wk.
k回回呻毡，t inform副on concer回吨阳 outsi，缸 world strongly
influ皿ces b也aviour.τ恤 U relatively 画mple 缸id g饱reotyped in
IOI咽副m血皿d ia di阻ted tow缸也 sati崎旭gthe 命的喧嚣 of
d咀nt. hun~骂，a and defenc巳 in ins由ldive E可>ertoir四．咀le配
also d甲end upon 也E 】l)'pσ由alamus. The limbic system, which is
耐ongly connected to the hypothalamw, is eiisen创伽 a也酬ft
behaviou鸟 meaning the ab血， to learn new responses based on
previous 哩erience (memory). The compla: and m岳阳四”“
behaviour of humans m曲a伊 not only to 庐四erve 也.e indi圳皿l
wi白血也e ph同al l幽幽cape but al皿 with凶 a changing social
四吼ronm四t ('indi世dual homeos国is'）.四le 础。cia植.on areas of
由E neocor恒缸~ capable of analysing a阳U呻tive information
from the E剖ronmentand 岳阳1 other indi剖duals, enabling
d叩tive pmonal and social responses. 咀iesephyl呗,metically
more rettnt stru由JttS are also partly connec也d to 也t limbic
町富tem.
As a res创L 缸峙poth血mus, limbic m国n and association
neocorti由缸t as inte由ces in a hieran:hical fashion betw田E 由E
internal structure of the individual and 由e environment. A
rmtinderof也is evolutionary ascent in human阜 is the olfactory
巧’但m: vital for 阳uing 也e err说ronmentin~’扭扭1曲，
伺自whelmed by visuospatial dominance in humans and
in也回国y related to the limbic m田n.
Hyp。thalamus
T。pographical anatomy of the hyp。thalamus
咀le 峙po由alamus is the most ~tr:al part of 也E 也回回抖回on,
lyingbenea血也e 由alamus and vmtromedial to the sub由alamus
F悔 16.1；附 also Figs 12.1-12.3). It 伽ms the fioor and 阳
Im晒归rt of the lateral wall of the 也int ventricle, below 也E
切。也alamic sul.cuB (see Fig. 12.2). On 由t base of也t bra姐，
归血。f 也t 峙pothalamus can k 能回 occupy讪事也t small area
c:irmmscribed W 也z aura ce配bri, optic 副组皿 and 叩配田els
｛阻 Fig. 12.1). Between 也E m血al limits of也e two aura rer由ri.

Dorsom创副 nucleus

臼恨扇侃Jlos1.111

Fomix

Suprar;:hi踊刷刷出阳s

Opllc chlasm

Mammillaryb<刘y

h耐nmadlal n山跑后

民局伽ior piluibly

F阳. 11.1 Schematic drawing ot a ml舍”’lttal ”“’。””阳 dlan帽phalon. The di咱阳m sh刷sthem回国 asp臼t of the hypothalamus. 有19
approximate locations of 阳ne of the principal hypothalamic nudel era shαNrl.
 Cha pt町，e Hypothalamus, limbic system and olfact。ry 町stem • 155

on rither side of the mi.dim鸟 lie two distina, ro四川d emin.enc白，
也t mamm皿町 bodi笛， which 刨出in 缸峙庐山血mic
mamm血ary nuclei. In 由e midline. immediately cau也l to 由e
叩ticchia町， lies a small elew能d area known a 也eta曲«
dnereum, &om the apex of 咐rich a国1ds 由e 也inin&皿dibulum
O曲mdibular J>JO(班功， or pituitary 刷lk. 咽由 is a出ched to 也e
p以rltary gland (hypop峙，b), a pea-s泣d 阳ucture which lies
响曲坦 the 悔”P峙seal Cossa (sella turcica) of 也t sphenoid
bone (see Figs 5.1, 5.4）.哑le pitui旭rygl皿d consists of伽D
major, cytological与 distinct, 归血：也t p刨出ior pituitary or
net且rohypoph•归i1 and the an回or pi1llita哼 oradeno峙pop.峙Iii
bein8 皿 apansion of the distal part of 由e infundibulum. 咀le
阻四or pituitary is not neural in 创蝠且．’Ihetwo 阴阳 are.
h附咄 doady link2d by the pitllitary 〔byp呻byaeal) po血I
町E恒m of vessels 阴g. 16.3), w扭曲 are deri'Rrl from 也e superior
hyp叩h归eal ar回y. Releasing factors, which are synth面组d in the
E叨仙alamUJJ, p棚 to the a归。峙归-phyai1 through 也四 m础
to control 也e release of an也rior p阳ritary hormones.
四le 峙po由al缸nus is able to 皿tegrate in也mαptive signals from
in能mal o思ans 皿d ftuid-filled cavities 四d make approp血.te
adjusunents to 也 in四w 四世ronm四t byv讪le of its in阳tand
m职it sys恒ma.

(Figs 16.2, 16.3）.哑1e posterior pin且itary is a nei皿nal 由uctur巳
阳18V8nlricular n四抽us-
Input 臼也e 峙po也alamus is both cimJl.atmy 皿d neural in
origin (Fig. 16吗. The ciirulati咱 blood provides phyiiical
(temperature, osmolality), chemical (blood gluoo盹 add-base
Sill'时 and hormonal 啕础。f阳阳te of the Ix吻， its grow曲
曲d d~句>Dlent and its readiness for action. (e.g. ser, suckl皿g,
dd白白巳 escape. e民.）. Neural s榈als come from a number of
曲urcea. The I.arg臼t input original!臼 from limbic 阳山tures, 也e
hlppocampw and 也e amygdala. Fibres of hippocam归I origin
mnst:i缸:t£ 也e Com.ix, a large mmponent of which 回min.a:国扭
曲E medial mammilhuy nucleus wi也扭曲e mammillary body
(Figs 16.5-16.7). Fibres 岳阳也E 町回ala to the bypothalamwi
run in 世1世，回a 阳minalis (see Fig. 12.3）.吸ienu甸回 solitarius of
the m咄h proj础 to the 句”thalamus, corr回归g information
coll回国际也E autonomic n町ous system 倒lCellling 也e

Hlppocampus

阳”“la Thalamus

由'CIJlaU咱 b阳d H~halamus Bn画nstem

18Ucular
fom回.Uan

Flg.11.2 Supraopt峙，nd 阳田”嗣同四lar nuclel proJ属也啕协 the Ph回耐， c:hemi臼l Nucleus

POI翩”” pituitary via the hr阳曲，lam创咽’PhV哩，，l 回ct. and hannarllll &ta恒 salillll'ius Brain•饱m
man侃mir明ic
nuck到

灿灿阴阳
___,..
nervouss＇归tam

陶·’M Newal and non-neural in阳ta of the 崎p创h•阳m皿．

「Crus (p创饱阳
column) offombc

Mamml阳ybody

l『lfundibukJm

Plill阳rypor恒川”’自l

网捕lartarplill阳ry

时. 1U PHultary portal 9Y刷m llnklng anmrtor and po刷arlorp自由 问’. 18.6 The lntercon阳action 例 llmblcstru侃”’thatconst阳曲，阳
，而the pituitary gland. Pape哑 clrcu比
156 …… MY I

Body of伽k
α均ω＠阳m

Ant8riorni凰”UI
of Iha阳m..
A阳”。『 hom 一－－
d恼恼，l v，咱icle
Mammilk蜡llllamic
Inlet

（舶terio『） 抽mmil阳yb创y
QOlumn of fomix

’
Fig. 1.8 Dlaeatlon of them“阳la鸣”ctafthed阳”鸣曲·阳n ” •haw 伽erelatlan1剧”’fthefaml嚣， mammlllary body and mammllo伽副amlc
齿，ct.

却也俑， nudeu5
oflt回脑mu1
α咱ullllllgyn11
Ci啕ullll'I

Fomlx

Mammilloth1l1mic trlci

M1mmill1ry 阳刚y

Hlppocampue

F阳.11.7 'Ille Pepe clrcu民 proJected 。”’胁”“lela饵”““th• 髓nibn1l hemllphere.

萨回1Ure within the smo侃b-mUld~ walls of orga国

N以精US ICalmbens 。翩翩m恒1耐融
【barOI配叩ton) and the chemiαI comtituents of曲创d－缸led
cavities (c:bemom鸡拢。”｝． 币le lfll忧。f arousal is communicated
by co皿仅筒。”也很。·riginate in the braim饱皿. Mm刷m迦eq国c
projections ucen.d in 由e medial 伽ebrain bundle (see Fig. 9.14) M曲『 behaviour Limbicsy冒tern
缸ui 也£reticular 伽mation 伊ovidea in严t bo也 directly 四d
阳directly via the 由alamua.
咀E 峙p。也alamusgm回国 responses to these varied 副皿世i
PibJi恒ry ”掷地出国恤mus Tha阳mus
by.，咿in. both circulatm:y and n回国 m四皿 但g. 16.8）.旭
扭曲iate relationship wi伯伯t pituitary gland and privileg国
access to its circul副.on (portal m能m) confers the role of
’orchestrator of the endoaine m能m' on the 峙po白血mus，” it 阳rmon” 阳阳iomicNS
R剑』cularform自由。n
dir院ta honnonal syn由ells and Ieleas巳 The neural output of the
峙po由血皿四 U dittc时 to wideapttad E唔Oil& of 山 neur四a.
DesαtMling fi.bra 归” ω 也e brain&田nand 阳me reach 也t sp凶al 陆阳”’幅幅 阳甸回1剧。咱an
Wa协伽阳甜，阳”
αml. In this way.， αmnection
ia made 回也 vari。因 brains恒回 con回l
nuclei, including the m阳山rfonruLti。，n, influencing wakefulness
and 1le:町，四d control ii a回d 伺er 萨唱imglionic sympathetic Fig.1U N刷刷刷刷刷·neun11 output8 “笛” hypo1halamu1.
and 阴阳sympathetic neurones of也t 剧.ton创nic ner喃us system.
 Cha pt町，e Hypothalamus, limbic system and olfact。ry 町stem • 157

Ascending connec咀.ons p刷 to the limbic sys阳岛 both directly 岛出de-stim:回ating hormone （阳句，向roid-stimulating hormone
缸回，由 the 值ialamus, to the oibital frOI血I cerebral cortex. 咀E p町， g创世l hormone 缸ld proladin, which are released into 由t
峙po也ala皿us can initiate approp血.te motor heh町io山'31 general c:irr叫.ation. The factors 也at con·田I 也.em are released
E叩ertoitts of 扭 instinctive kind 也rough its connections wi由也t from 也e terminals d均po也alamic neurones into 由e capillM>:
limbic m回1 and limbic part of 山 mrpus 闹剧皿｛the nucleus bed of 也t pituitary por组I m田n 阴g, 16.3）.四回e vessels, which
acaunbens]. Furthermore, it can influencr, or even 回国d鸟 more are in国n画cto 也E W萨布峙百四I stalk,，四nv可由E rel四sed a萨nm
compla adaptive behaviour berause of ib close linl.a w世1 也E to the ad四olr即ophylis, where 也可 act u归E 也E
limbic m也m and 世ie orbital frontal association cortez. hormone-a缸eting 创ls. Wi创且也is sys阳n, the neuro位ansmitter
d叩amine is synth四”d by 田urones of the 均po世talamic 缸四ate
Hypothalamic nuclei nucleus 四d is rel.eaaed wi也in the neuro峙pop.协is byuons
咀le 均po由alamus consists of many nuclear di白ions, only some travelling in 也峙po由alam.o栩如opbyseal tract （毗 Fig. 9.14).
of which 回II be described here (Fig. 16.1）.τberegionl~ Dopamine 缸ts to inhib扭曲e release of prolactin W 也e
medial 皿d vat纽'31 to 也e structures of the sub也alam.ua is known a也nohypophysis. 咀1esyn由国＆ of峙？。由alamic rel曲曲igfactors
aa 也e h也ral hypo也alamua. It is trav四d longiwdinally by isw咀E 位edback 吨曲曲n by hormones produced by 回耶t
ma町 fibr盹 including 也e med且l forebrain b四世le. The K田al organs.
峙pothalamic aI田 is important in the control of food and wa恒
intake and is, in p吼叫回val.ent to the physiologically d曲田
’feeding 但ntre'. Lateral hypo也抽血id创ions cause aphagia and
”’pothalamu•
adipsia. •TI回 hypolhalarπUSiB 因此 d t晴 • Vasoprussin a「回。刚回n are
d阳nee回回Ion；目阳 co内nee恼d to k四”orted b 廿1e posterio『
咀ie medial region of the 均po也alamus corr回ns various nuclei,
the pltu陆lly g恼nd v融 the 回tuitary in the
only some of which have well-d曲ted functions. Anteriorly lie 也t lnf1.』r回lbulum. hypotha阳1ohypoph如倒l t阳t.
supraopti巳 par由四U阳llar and suprachia&ma咀c nuclei. The
•TI丽 hypothalarπus has ．”1自由te阳r pltu阳ry p『回uces:
supraoptic and para回回cular nuclei bo也 prod皿：e sys也mically autα回mic, neurc田回ocrine ar回 adranoo口『唱团同盟E hormone,
k由电 hormor圃，世tlch are released from the pos恒ior pitui田y limbic 仙阳lions and 丽 invclv回 U恒＂nising horm田咽，倒licle­
into 也E E回国I c:irr叫ation. The supm叩tic nuclei.皿 produ由 in the coortlinat阳1 of 的·mulatir可 ho『mone,

vasopressin (antidiuretic hormone; ADH).’The supraoptic nucleus ham骸:istalic mechan陆ms. thyr回d唱linul创咱阳nTione,

growth honnone and prolact的．
contaim osmosensi笛，e neuron倒也at are activa时 bychang四扭 ·嘀嘀 hyp时halamus p『回UC腿
F部:tors 廿回t control their
曲E 创molality of circulating blood. An increase in osmolality honnones that a阳刚画画回
sec阳tlon 臂’用梅”’d Into 甘l8
骨1ll'T1 the 阴嚣恒rior p阳阳『yand
但回臼回国se of vasopressin. 'Ibis acts upon the 仙bul臼 of 也e
also re国s同旭ctors that pltu阳ry portal s ’”em of the
ki也.ey to increase wa胆 reabsorption. 也.US maintaining water 川tultary st副k g回 c:arrlE拥d to 世19
control the re抱凶e of hormones
ante耐，r plbJ!aly.
homeostasis. The par由四创αliar nucl四a syn由国aftα町tocin. In tom the anterio『回tu阳ry.
由E female, activation of the parav田园cular nucleus.，四d release •The 阳阳刨 11)1)创唰创nus and
•TI晴剧pra叩tic and
of hormone, is induced by suckling. 哑由四mula回 milk the vent阳ned刷 l'VJC峨眉
paravenbicular nu曲i of1he
hypoth剖面nus w回uce
啕U刷刷同 and dr1nldng.
uterine m田d巳咀1e axons of 创h in the supraoptic and vasop『冒商in and oxytocin, •The sup阳时iiasmatic nuc隐居
resp能回唰y. contro恼臼rcadian rhythms.
归mven创αliar nuclei p剧 to the neuro峙popbysis 面也e
峙po也alam.o峙pophyseal 田rt (Fig. 16.2). The neuro姐d民rine
produ伽 are transponed 扭曲is tract to 由e neuro均pophysis,
where 也句缸eri也a幽d into 也e capillary bed 组吨也U鸟 reach the T11111ours of the ”’“halamusand p阳阳市，land
general ciiculation. 四e supra卤iumatic nuclma is concerned Tumours and at惰『 di民跑揭崎 of the hypothalamus and assocl回回
响曲曲e control of di町nal rhyth皿s and the al~／waking cycl巳 It pit\』ltary gland 阳d to unde『－ or OYet'-pr回四！Ion of ciroulatlng

E配白白 some afferent fibres dir眩，tly 鱼。m the retina.
More caudally, dorsomedial and ventromedial nuclei lie deep to
阳 I眠Ial wall of 也e 也ird ventricl巳咀e dorsomedial nucleus
h笛 com脏tionswith 世ie suprachiasm皿cnudeus 姐d 汩汩wived
扭曲tαm田l of circadi扭曲也ms. 咀le 四:ntromedial nud圃，，
like 也t lateral~由alamua, is concerned wi由也e c.ontml of
food and E凶d intake. 四e ventromedial nucleus ia 呵阻四 with
由E P句siologially defined 坦白ty cm:田’ andlmons of 也is
E唔on ca田eabnormal』y ir回国lied food intake. h 也emost rau也I
归rt of 也E E可po也alamus lie 世ie posterior nu1也us and the medial
m皿mlllary nucleus, 也 la饥er being located wi也in 阳
ma皿mi~ body. The m础n皿血缸ybody is 严rt of the limbic
m但也 remvingafl自由.ts from 也e hippocampus 由也efomix
g咀 project凶gto 也t anterior nucleus of the 也alamw 皿d 由E
braim恒m.
咀1e 峙po也alamus ia the brain αntre for E唔血tion of 也e
autonomic nervous sys回1. 臼m曲，缸由四on ofthepos剧。r
句pothalarnic domain is 刷刷刷 wi由 sympathetic m归田es,
whereas activation of the an回ior 间，othalamus is associated wi也
parasympathe缸缸tivity.
四le h月均由alamus ala。”白白白扭臼 releasing factol'S and
relea悟也hibi由18 fact。”， which conttol 由e r也aae of honnonea
by 也e adeno切叩协is. The d囚。峙P叩h~produces
adrenoco皿cotmpic hormone {ACI町， lu国ni由ig hormone (UI),
hormones. Th臼e. In tum, produce d始制隅口f grow伽（曲”而，m,
’跑回由m and acrom啕画”，坦xual fun国ion (prmcacl剧， pub•句，
hypo圃’回d阳刚， body water co附ol (dlabetm ln&lpl啤•and
pathaI啕lcal 嗣nklng），回lir咽（Dbalty and bullmla) ar、d adrenal
∞而回l control (C皿hing’. di回髓， and llllrenllll iNuft'i睛”句~.Since
the pltu阳ry g恒nd 面 clo饲W adjacent to 甘ie optic chi陆酬， 1uπioura of
the gland 制制阳市邵阳ornaa) may 曲o lead to bitempcral 嘟幽l 制d
阳s (see Fig. 15.8).
Limbic system
咀ielimbic m田n consi血 of a number of phyl吨回etically
ancient cortical and subcortical struc田res, wi也 complex and
widespread co皿ection，也at provide 也E 缸旦出皿回回 neural basis
for 姐姐配由冒血d emotional aspects ofbeh剧创ll' and for
memory. It has d也 in忧rconn配笛onswi也也e hypo也alamus
{F:咿 16.4, 16.8），也rough which emotional 归国 are infl.u四ced
峙，四d media他 changes in physiological 皿d biocb创回.cal
conditions. 咀1e limbic m恒m earns its title from 也E IOGI阳1 of
回me of ita major conical componenta on 也E medial rim of the
α~bral hemisphere (le grand 胁 I阳陶Me). It consists of a
number of structures with complex. h田ronnections and sereral
major fibre pathways that project to the hypothalamUB (Fig. 16.9}.
 ·但他g 唱喃喃号’幅营ag 喝Eggssg 翼迅雷琶 a 昌也因宫”EEEgEAS 哲明ZaE 邑 aa望自由唱
－ 回苞目
吾 EAga 百 5 百旨 U寺 asg 贸 ES 唱 aga EEES goEZ昌 SS 筝。eg 冒 Ea 局副白”EBB 』g
gdg 目 H a g古 自 冒 冒 EaggggaugeH g冒 宫 号 A E o d S E E M －E帽Z E 咱 自 可 g B 吉日 Mgg 百咽PS奇 BE 帽
$3MBg 民且 gaE 占．营目冒冒－自 ggBSh司Ea· 〔
2·2·MSE）gs － zfgEM 吾 gdsga
冒 aE 百；自眉雀眉二百奇百 gaague 币 5 宫号 AZ 目 gE 丑”看 a誓旦 EB 骨 BEZag 者星电 U且’审理
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24 －SSHEEg 冒adE 毒自饵’saSAMHS冒 aSo
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ESSE 冒冒 Eggs 圈’
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 Cha pt町，e Hypothalamus, limbic system and olfact。ry 町stem • 159

Howev四 the de叫0严1四t of 也t association areas of the 严Z地onged afl«tive 血烟， which may 陀fleet approp血忧 responses
2四corta permits adapted behaviour to be art 皿d achieved 0阳 ω 阻四剖ronm四t or be pa由.ological, for ewnple depr酬。跑，
proIon京d periodi』 E岳贾缸乱 ar回ety 副1.d elation.
Motivational sta脑 cm, in man and animala, be ins血由Jal，如 咀le expI四阳n of emotional sta幅画 bothm。”ric and
example 鱼缸，由ght. fttdi吨 and 留:ma.I behaviour, and permit autonomic. The mm四nents of facial apr田，~on. pitch 血d tone of
self-preserva世on within the environment. Prim缸y emotions occur ,.m.饵 and linlb gesture conv町 emotions and 缸E involuntary and
in humans (and possibly higher apes) in individual respon帽 ω under 也e control of the b描画I ganglia (nu由usaccumben’）．
也t environm四.t and evinced in the same facial expressions of joy 旭.tonomic responses comp血e blushing, hair standing on a圳，
and distr盹 swprise 曲d disgus也 fear and an伊由at occur 扭曲 goo促 pimpl略的回岱吨， pallor and 回IS. 四1句 d哼咀d on the
humanαtltutts. 也tonomic output of 阳峙pothalam也
Inhu皿ans, 'social emotions' are experienad 血d eiqir田d
betw田n individu血， for example I~ and ha饵 j四lm皿ly 皿d Amygdala
envy. pride and guilt. empatl『r and sympatl可. Moodsrepr回回t 咀le 缸n丽~a lies near 也e 也mporalpoJ，己 betw也n the inferior
homof 也E K但ral 四ntricle and 也E lentiformα>mplex
I (Fig. 16.12; 11tt also Fig. 13.8). It I匹函Yell affer四its 叠。m 由E
I
巴？呻i1a1 infaior temp叫“sedation cor跑也呻血lUS, I~皿 and
“
盘L..._ ....’饱
」二二亏一一一一’ 也t olfactory 往配t In a ition, it receives QI忧也olam画e- and
1 ’ 陋就m曲－containing p叫配:tions from the brains能mvia the
medial forebraln bundle (see Figs 9.14-9.16）.四le p血cipal

王画 d加mtproj创on from the 甜ly回ala is the 削a 阳minalls （脱

自g. 12.3), which IUDB 扭曲ewall of 由t latmtl v回国de. following
由e cunatutt of也e ca.udate nuclei.岛 ω 田millate ul由m国y in

f且 ／
也z hypo也alam皿币ev四.tral amy回alofl明l pa也W可 also
projec:强 ω 也e 峙F也alamus.An d坠rent proj£Ction to 也
nucleus ac.cu皿.berui，也E ’limbic' 严rt of the M皿1 院nglia. permits
motor behavioural E回ponaes.

Septum
The septum. or S叩tal E唔on. lies in the b嗣al p缸tof也e forebrain
F也 16.12 咀d see Fig. 13.6). 'Ibe septum is a cellular z唔on, not
to be confused wi也 the sep也m pellucidu皿， which is a 也皿，
non-n四Il1l. lamina sepa.ra也18 由E an恒rior horns of the lateral
Flg.18.11 The W.n:onnect阳na beiw-i MIOC恒世帽 iwocarl幅画 咱也ides (see F也 13.6）.咀le septum intettonnec:t& 回也 k
”’Ion• and the campan帽tpa曲时由allmblc•归tem. arny回血 andproj缸” ω 由.e hypothalamus 白白emedial

R翩men

Septum
- Glo民』E 阳llidus
翩翩。『 comm晦阴阳

时·’也12 Coronal 割副Ion of the brain •h侧lng'lhal翩翩Ion of 曲， amygdala and ar嗣同，， cornml•ure and 曲，lrre缸”。”剧”W蛐 "'8boal
ganglla. Mulligan’S S阳Jn~民19 Fig. 1.η．
160 • NEUROANATOMY

forebrain bundl巳咀le S叩wm alao influen倒也E monoam凶agic hipp“革皿”’ is formed by an infolding of the in缸omedial p皿
nuclei in 由t M白血m. It do筒，。由 fibres 由at run i且也t a刨a of the temporal lobe into 由t la也raJ ve盟国d＇马 along 也I! full! of
medulla血也ala皿［阳 ~ 12.2, 12.3) to end 扭曲E habenular 也t choroid 也81ltt (F：阜 16.13, 16.14; ltt a1&o Figs 1.3.8-13.12].
nuclei of 也E diencephalon (1胆 地. 12.2）.τhe habenular nuclei 咀lt'! d皿.talE gyms lies b~ 也E parahipp民:arnpal gyrus and
in tumpmj回．由 the fa皿culus retrofl四11, to the the hippoaunpus (Fig. 16.14).
in能甲eduncul缸 nucleus, a small nucl田，面也e ventral mid.brain, 咀le hippocampal 伽mation RCeiv回 affa喧闹 principally from
which has connections with other E唱om of 也e brains艇mas well the in如ior temporal cor田由也e ento血M m回归田） of阳
as the 峙阳也alamus. In this w町，饵” major pathways Ii出缸 tem.归ra1 lobe F地. 16.14). It also m叫咱 fibres from 他
呻饱肌也E hypo也副amus and 也t rnon阳ninergic nuclei of the αm田la阳回I 钮ω血ina1 cortez 四d hippocam~ 由缸阳nix
brains惚m. 句富但也皿d hippocampal commissure {commi饵Utt of也t fomix).
四le principal effer四I pathway from the hippocampus is 也E
Orbltal frontal c。rtex fomi:x: [Figs 16.5-16.7; see also Figs 12.2, 13.2, 13.7-13.12）.四E
四ie frontal neocor皿 comp血es 由e frontal con·π:Dty 缸l.d 由e fomix i1 a pron让nent Cshaped fucicle of fibres 也at links the
orbital fi回国∞阻（i.ι 也tr唔.OD M吨 above the orbit）.耻 hippocampus wi由 themamm皿ary body of the hypo也alamWI
企D皿al CDI回国ty recrivn ’affer四（ info口nation about the world and with the 况ptum. Efferent fibres co~ on the ventricular
from the posterior 础。由世on cortex.. Pr时配咀om from the
阴阳rior 翩。dation cor回臼由e in如ior temporal n回倒回 also
permit 回町 of this in缸mation into the limbic 1)'8tem (amygdala
血d hipp旺皿例如mation). The o曲M frontal cort田 also
。ngulatB llYM
m回咱 input from 也t frontal con鸭z:i:ty but is more p阴阳缸lly
connected to 也e limbic sys能m. Not only are 由ae 严叫创ODS
from 创bital frontal to 凶阳ior 国nporal nrocorta: 司且也E
undnate f.udculuιbut 也z otbital fun钮I cort£X: pmj国s dir回Jy
ω 出E 峙po由alamus.
Mammillary
阳刘y
Thus，也efmntal com肥lity ii related toα事ii世ve executive
岛nctions and 由e planning of behaviour in m句>anseto
阳阳iorhomaf~
回悦ronmen:回旭丑ormation collec时 in the posterior neocor回－
阳teral 略n甘icle
By con国民也。由i旬1 frontal cortex is stron脚 related to 也E
structures 由at mediate 也z ins也叫吨 mo笛”:tional and emotional Hippocampus-
甜咱 infl.u四dngbeh的iour. In the h幽lthy subj缸b the ’C吨;nitive'
and ’＇affec:垣隙’ a吨JCCta of behaviour act together in problem-sol世ng
in the euvironment. Both mechanisms are su间四”也e results of
严凹im皿 ezperienre. which have en伊nder叫 E回缸也 and
阴皿也ments: that i鸟也句 d叩回d on 由.e memory systems of 阳
Flg.18.13 C ”’nalMRlscan d由• brain shawl吨由• hlppac•mpus
a咽。，”w campan•nts al世圃， llmbl四””m.(Cour也syof丹田War
limbic m也m. A Jae俗on, Woll阳？ M时扭曲加四”可Z G回盹 Uni阳'SifyofMan副部缸，
Mar四圃恼， uκJ
问问叫叫
阳仰阳

In fron幅幅mporal dementia (FTD), a n刷刷咿neralive disorder,

tt晴『唱插曲回加y of the prefron恼l n民览。rt自E andamyg幽阳.The pa阳、ts
h仰自由:>gnitive executive dllfic阳 causi咽 poor p肌ning and
啕anlsatlonand tt田 undergo a 阳现>nallty change with personal,
民忠和atlonal and sc沁脑l br刷刷刷n because of dam筒’自 to 甘冒B
pre阳阳J cortex. They 创阅翩pertenoe lo蹈。f prl『nary and 创clal
即回tlons and 甘1ey lose 甘咽k 串ense of d~er dl剧 to 由mega to 甘冒B
amygd由. 1he9e patients bE犯。me profol.ndly epat怕回口时1伽伽e
由ease 阳aad9 through t陶 do阴阳.te『a 骨。唰 regions. In some FTD
P副自由， th由百恼 sel四tlve lnvo阳ment of 廿币。由Ital frontal nE坦cor惚x.
Wh朋 thisα:x:u丽， α羽nit帽 executive fin:阳、B E回耐a:tiv回y s因『田，
而II ofcaud回－
but the pa:回回l's behaviour 画 d自inhibi恒d, overact阳 and uncontrolled. nuc拖后

阳陆中。『 horn of
Limbic system: memory
la恼ral van刨de
Memory pro田瞄缸E of three kinds. Episodic memory refers to
由e lear回ngand E回:ollect.ion of autobiographical m自由 in the
H’pccamp1蹄
indi训叫’， life and is d即回d回佣世ie bippocampal formation
皿d its connections. Semantic memory is the acq1回zed knowle甸e
of the meaning of verbal 皿d paceptual concep钮， i.巳 knowledge
of the world. Semantic memory is dependent on 也e functioning
of the middle and 凶缸ior 田nporal gyri of也e neo倒回a
Procedural man口可 refer. to 也e learning of sensorimotor skills,
for example learn且g to 由iw: a cu: or pl可 a muaical instru皿四t
and is d句iendent on cortico-sulx刀币cal motor syst阻， and not on
the hippoαmpal formation or the temporal n回回·rtex..

Hippocampal formati。n EnlDminal cor恤

四iehip萨xampal 如mation consists of 世1e hippocampus itself, Fig.US
the dentate gyros and parts of the par也ip院xampal gyros. The horn d由’’匾u町a幅回町审lcll比
 Cha pt町，e Hypothalamus, limbic system and olfact。ry 町stem • 161
Anterior horn ar
叫刷刷刷cleus-,.\,
恼怡ral vantr他la
l『帆 Choroid plexus
’
Fig. L15 The hippo国mpu.－相mbrt.-fomlx 町，tllm. lhebr百in is vi阴晴dfrcm ab创回. The 幽'llbral cortex and wh阳 matter, indudi咱 the corpus
臼losum, have be回 remo回 to reveal 甘南 lateral ventricle and its co嘟嘟．问 Choroid pl削soflate回venbide intact；回 choroid pl酬sremov回．
S山face of 由t hippo臼mp国幽 the fimbria. 四tis p笛sea pos田iorly
and superiorly, to become αm由uouswith 也E crus (posterior
四Ju皿n) of the fomix, w扭曲曲回皿咱也rward benea:也由E
splenium of the corpusαH饵U皿〔阳.g. 16.15〕．四etwoαwau皿te
in 也E midline. hen甜th the 四rpus calloaum, to form. 世le body of
由E 岛mix (Fig. 16.6). Some fibres er。” to the opposite side
“ rough the small hip萨xampal commissure （＇αmunisrure of 也E
fomix). As it passes 阳war也 benea曲曲ecor阴l8 call臼um, 也t
b创坊。f也t 阳nix 世rides into two columns. 咀1阻四rve
d跚跚anls. forming 由e anterior bonier of the in缸”回回.cular
foramen. and en:田 the 峙po也alamus, where 也e majority of
矗bres 恒minate 扭曲E E缸nmill缸ybody. 咀ie mammillary hoe与．
in 阳m. projects to 伽e m忧rior nuclear group of 也e 也由mus 材a
the m皿m皿othalamic tract (Fig. 16.6）甜d to 伽 bra皿回1 白
白E m皿m血。饨，men创 tract. 哑iean回ior nuclei of the thalamus
have major connections wi曲也E cingula.te gyrus. Hip?.ocainpal
efferents al阳 p叫缸t to 也e nucleus aαumhens，由且blingmotor
respomes.
Cingulate gyn』S
咀le cingi血te gyrua and 也E paral啕pocampal gyrwi are in
由1由1uitywi也 one another around tl哩，plenium of the corpWI
αllosum (see Figll 13.2, 13.16). The 由1思由te gyIUll projects to the
parahippocampal gyros 悦a 也e fibres of the cin思山m {Figs 13.22,
16.5, 16.6). The 归旭cipal structures of 也t limbicsy就回tare 也.us
Crusof fum皿 ＿＿＿＿＿＿，.......，飞
飞
Tha阳TIU$
飞
'r
Hip冈campus
Ii出d by a series of connections, which cons世.tute 由t Papez
cin:uit (Fig. 16.η．
ln.Allh耐m臂’. di’””， th阴阳民剧目E E削阶"rl of the hip阴阳mpeJ
f口『mation
由d
(Fig. 16.1 甸 回ding 阳 amr回ia for relatively 『四Jeni 回ients
the inablily to 国m new in1ormation of an autob~叩hical kind,
i.e. lo因 of ep匾。die 『T回m口『y.
ln&emantic 由m田面， a 「丽urod吨，ierat阳 di回国霄，！her冒 is
atrophy of the mi剧le and l『T怕也f t町1po『al n配x:ort回l gyri. ”1日
p副ents P『啕『回国V呻阳泪甘回『n回ning of war由 and pell:epls, i.e.
their 阳w1e句， of 阳刚d 阳m创tic memo『y）.民，倒町IP恼， they do
not know the name or m凶ning ot 喇ec恼创d cannot recognise faCE路
(assoc阳御， agnosla). H阴阳ve『，甘冒W have relat惘防'9SC!Mrtlon of
memo叩阳 their own 刷刷biographical 锁阴阳ω画， Le. their e回sod怆
memory Is p11186附d，民阳t眉目甘冒B hlppocampal 阳matlon 阳 not
prfm创ly affected In t附 d棚掬．
ιimbic system: emotion and memory
Memory of m四”四d their p笛t mo往回.tional 缸id emotional
曲皿.otations are 也e only 胆de to 缸”recompl凰”cial
behaviour and are d曲也e essen由I l.inka that 归回erve 也t
indi说dual in perrni创ng rapid response to po恒n血lly 由E回ten旭s
situations. Input from ho也 functional a吨配ts of the limbic
system ii es1mtial in probJem-901ving or eRC1.1世ve functions, 也e
162 • NEUROANATOMY

Fig. 侃” Caror111I•田t阳”’rough 世MIC町，bral h11m阳””帽 ofa 阳t阳ltdyngw描I Abi:hllinM"’•di•圃’a. The section shows 剧arged lateral
晴111icles and atrophic ccrtical gyri and hi阴阳ampus. (C汩ntesyofPra脑sorD 抽nn，创忧：aJN阳时制？”惶， Hopef如每剧， U脚宙古歧yof胸脯e暗脂，
胸脯es«缸， uκj

ω阴阳 aspects of whi血 m d叩endent O且也e functioning of

Olfacto叩町宙幅m
由E dorsolateralaspect of 也e frontal association neocor圃，
The orbital a早剧。f仙台ontal neocona is intimately linked
Olfactory receptors areψ回aliaed，出自ted nerve c.eLb that lie in
ω 由e limbic system and 也e processing of motivational 血d
由t olfactory 叩i也elium of the nasal 钮，ity.τ'heir axons a揭emble
emotional st.a.ti盟．
into numerous small fascicles （也e true olfactory nerves）也就回阳
In rapid reaponaes to 田说ronm回国回国1uli, d理 a蝇。ciation
也 α四ial 由ity 也rough 也阳aminaof 也t aibr阳m plate of
areaa of the neo倒回 involved in cognitive functioning can be
the e也moid bone {att Fig. 5.1）血d 曲曲甜甜ltO 缸。，Ifactory
W归saedand 恒.coming sensory information can en回也e limbic
bulb m 由t inferior IUl'faα 。fthe frontal lobe (Fig. 16.17; s佳
system 由 the 也alamus so 也at relatively automa世c bebaviowal
also Fig. 10.1). Preliminary processing of olfaclDry information
responses such as fight or 缸gbt can be ini出ted via the basal
occ山田 wi血迦也e ol鱼do哼 bulb, which contaim in恒rneurones
萨nglia (nucleus accumbens).
and k耶 mitral cell1; axo田 from 也e lat阳 leave the bulb in the
Theα><>peration betw配n 由.e two p缸ts of the limbic sys恒m
olfactory 臼菌ct.
explains 也E fad. 由at highly emotional 町eriences are readily
四ie olfac1ρry tiact p幽幽 bad仰阻rds on the basal surface of仕le
learned and 由en remembered. It ill important for mrvival of 也E
frontal lobe 皿d，饵，t before reaching the level of the optic
indi世dual to hllVE recollection of precmenu in experienα 也at
chi秘阻， most olfactory ttact fibres are deftec忧d laterally. i且也t
havep窍，ioualy led to reward or punishm回也已.g. 由e avoL也nαof
la回al olfactory 由ia (Fig. 16.17）.四配伽-esp皿 into 趾
dangerous animals, plants 姐d 臼ivironments.
d甲曲。f也e h阳al 恤山飞 which 也ey a田I to reach 由E
temporal lobι 四ey terminate mainly in the primary olfactmy
r.t t Limb崎协bedl•o睛” corta: oftb.e UDCW1 (Fig. 16.17; see also Fig. 13.2), on the
in缸。medial a吨町t of the 但m归国 lobe, and in 由e I\血iacent
Alcohol abl』盹 in a 回回ng of di阳ry delici阳明 d th阳mine，国ds to amygdala. Adjacent to 也e UilCU鸟也e 四阳ior 阳rt of也t
cap副ary h笛”w而甸回s in 甘冒 U同商 bra阳tern and limbic structu『回．
有回国阳『it 倒ls into 回毗』sion and coma (W1田nlcke'a
归Illhippoca皿归I gyru乱。r 四”也旭alar盹∞皿植.tu阳也t
’R帽，hlll叩d明. Partial 『眼泪V町 may occur, with 幅lure to 阳nember olfac1ory 翩。ciation cor皿. The prim缸y and asaociation corticf's
P酬。us 锹阳ience ~耐啕陆deamn瞄a) or to 阳m new 陆加 are d曲 colkctiv由 rd回回 ω 组缸”riform. cor恒四d are
(anter咱『国eamn能闵．刊iis is 阳own 笛 Korakofl'• psy曲幅画.A reaponaible for the appr回ation of oIBu:阳ry stimuli. 咀ie olfactory
时miler amn倒c syndrome occurs when bllate刷， SU咆阳l tempa刨
P叫ection is 回申:ae among 也e sensory l)'I'恒ma in that it consists
lol:l创toπlY In<泪rpor富丽S 廿lB hlppoc却np副阳rmatlons.
ofa 叫U回a: of only ”。 n田朋回 betwam 也esen叨叨 阻碍饲m
Te呻oral l。”’ or complex partial，”缸’“创国ng close to the
m用伽脑 and hlppacampl can lead to complex 锁阳rlen晦 d sm耐， and 但由自l cor回阻d d。“ M 萨叫ect via 由e 由alamus.
mood and memory.

Lim副e 啕…m 。lfactorv ’”，tem

•ll冒E arnyg也恒 Is local国 near
to tt回国nporal po阳. It re臼阳回
projecti四百st田n the olfac回『Y
句冒tern and 甘冒国恒mporal
COi'幅凡 and has 『回pro回l
corf回回跚跚th t晴 S叩tun.
•The p巾iclp甜饵，nponen恼 σf
•The hi同抽但mp副阳m副m 幅
made up d甘冒e hippocampus,
也「幅画 gyrus and
pa『ahippocampal gyrus of tt回
tempo『咀l lobe. It 『以刘明酶’bres
阳m the entorhlnel oo同ex end
p叫田ts via 阳 fumix to the
mammillary body of the
W阳阳lamus.
thellmblc 町冒阳n are
lnteroonn团圆 In 伽e Papez
circuit.
·α阳”『y nerve 明bres 阳mnate • Ad归田ll to this，世1eente『lor
in the cl恒ctory bulb. 因此 of the 田rahippo回mpal
gyrus, or entorhin副回回．
• run In the
Sacond-ord国『 ftbras
四nstib.』！es the DI恒ctory
。阳ctary tract
and termlna切 In
a揭回ation cortex.
the p~mary d恒ctory （）（宵tex of
t闸 uncusln 甘'8 tempo刚 lobe.
 Cha pt町，e Hypothalamt后， limbic system and olfactory system • 163

ω阳阳ybulb

创M呵tract

Lateral ol阳阳y刷 一－1

句画cne『W

An饱阳闵巾ra\ad subs恒nee
Optic tract

Mammillary body

Cn11ca呻而

Uncus
Parahlppocampel 宙M

网捕te~arpe『for苗”d subs凶1C8

l ‘ Pons

F幅. 18.17 V•ntnil _,_of 世帽 b111ln. 有回 illustrat阳 shDWBlheol饱cio『y bulb and 国d，甘、自 later甜 olfactory stria and the p『阳ary 口lfaclD『ya『国 of the
惆唰刮阳阳（uncus).

F事厂Ano•mla
Anosmia follows dam甸回 t口 the olfactory 『回回. There is b回 not only al
the sen回 al smell but also of the 自由our al foods. Howev町，副酬，也ry
asp町ts of t出.te, e.g. 阴晴t，随It, bitter and s凶『，四阴阳V回．阳回m阻
fre悍，自州y fo阳ws he凶 trauma and can o出』r when tumours of 阳
meninges (menlnglom曲） Invade 廿l8ol阳tory ne附s.
In Alzhelm酬’， dll阔”，甘晴， Is 创rophy of 廿l8 uncus. 问t阳nts 凶n
detect 廿le pr阴阳1臼 of odours but theyαinnat Identify 廿lB'll, nor matc:h
甘1’因meo由urs, nor discrim阳.te dill'冒冒1t odou丽（mpperc帽笛”
啕nosia fo『 smelQ. In 回mantic 棚”町匾，甘1阴阳 alrophy of the
amygdala and the i闹闹r t阴阳回l n民阴『肌阳嗣同恼由同甸回t
od凶惜， mat时1 and discrimnate between th例， but are unable aca.rately
to name，曲曲C巾e o『 Id阳tlfy 伽阳1 伽”翩翩W 啕”’由 for srr酬。－
Glossary
Acalculia - Inah诅ity to calmlate
A刷~mmod翩。”－ Actofr由四”ing 由evirual image
Acrom啕•IJ - Overgrowth of由e skeleton and o耶ru cau串edby
excessive release of growth hormone from a pituitazy tumour
Action potentlal － τ油nsient remsaJ. d值ieres也igpo~四.tial 也at
is prop句萨ted along the axon
A创ity - Resolving power
Adenoma - Benign tumour
Adhesion - Souring of世ssue属“ng 由em to害也E
Adlpsla - Inab血.ty, or lo11 of deli.I巳 ω 由旭k
Aetlology - Rela世ngto 也eα.use of di忧”E
Affere时－ c缸tying ten明础性思但R!bellar affer回tneurones
carryimpul础 ω 也.e cerebellum)
Agnosia- In血出.tyto rec吨)liseobje回国
Agraphia - Inability to write
Akin帽ia- lo画， orslownes兽， of movement
Alexia - lnab山.tytor四d
Amn回ia - Loss of memory
翩翩tom。，Is - Intercommunication between vessels (e.g.
circulusar恼iosus or circle ofWillis)
Aneurysm - Abnormal dilatation of an art町
Angl啕raphy- Dem.OI曲回on of也e arterial sys也m after
in恤lion of a radio-o严.quemedium
Angioma - Congenital 钢YOII四 collection ofblood vessels
.Anamia - Inability臼 name object&
Anlfdluratlc - An a萨nt that reduces the volume of皿ine
produced bytbe kidney
Aphagla - Inabili~如 or loss of de白马 to eat
Aphasia - Loss of ab血.ty to use lar嗨国ge
Appal'帽p由a agnosla - Inability to 严rceive
Apraxia - Loss ofskilled m.omn四.ts (pram) despite preservation
。fpσW饵阻11ationandα>0nlination
Arachnoid mlllBr - Middle of the 由ree meningeal l可as
四时oping the central nemms 巧瞩目1
An州g蝠’－ Lo”。freflees
Arthrllla - Inflammation of one or more joints
A”“ latlYe agnosla - In抽出tyto recognise the mea皿ngof
pelα:pts
Astro句t，但stroglial celQ - A type of neuroglial 叫l (q.v.）也at
may 伽m 也eb协ad-brain bar悦tt
Ataxia - Loss of ability to coordinate voluntazy movements
Atrophy - Wu由1gord乓~tion
Axon - The nerve fibre ca蚓ng impulses away from 也ecell b饥炒
面roreceptor - Neuronal s四”＇ry ending that 出版ts changes in
缸回ial blood pressure
Bio阳Y- Ti”ue 领mple taken from a patient for 也ed泊gnosis of
disease
Blood-brain barri町－ A selectively permeable barrier b嗣同回
thedrcula由g blood and the brain believed to be formed by
as缸。句也S
Bradyklneala - Slowness of m~ment
Braln81em - The stalk-like portion of也e brain c.onnecting the
cer曲ral hemispheres wi也值ie spinal cord
Bulbarpal町－ Weakness of tongue. pharynx and larym resul也18
from disease ofthe lower 饵”al nerves
Bulimia- Over但也igdisorder
Ca恒racl - Opacity of the lens of the 句'e, leading to de回oration
。fviaion
。“I body - The part of the neurone that contains the nucleus and
possesses dendritic and axonal processes
Ce睛，l nerv·例”’归tem - The brain and spinal cord
。叩halic- Rda由1gto 也e head
。”brosplnal 帽uld (CSF) - The cl阳明您町 fluid伽tsurrounds
the brain and 叨inal cord
Cer由rum －哑le largest, m创t highly devel叩d part of the brain
comprised of饵”四由ral hemispher哩’
Chem。”“ptor- N四ronal 阳ts0ry 四也吨that de田tschan阴
扭曲.ecb四咀cal composition of circ.ulating blood
Chiasm (chiasm崎－ Dem腿ation or aoaai吨。ver of nerve fibres
(e.g. 叩ticchiasm)
Chor四－ Invohm皿-y, abnormal movem四” of the fa但 and/or
limbs
Coll•幅ral- Aside担branch of a nerve or blood 响剖d
coma - Prolonged 创ulunr回山田I state ofunconsciousness
c。mputed tomogra陶y(Cl)- Im唔ng technique utilising
X-ray亩 to visualise the stru由Jreof也E nervous 叼曹tem
Concussion - loss of conscim皿iess caused by head injury
Conlralataral - Relating to 也.eopp田itesL也
Conlusi。”－ Bruising
Convulalon - Involuntary contraction or spasm of muscles
c。“。”my- Neurosurgical procedllR! to destr叮specific
但也.ways in 也e spinal cord
Cranlopharyngloma - Co鸣.enital tumour of也.eb笛E of the
阳在in
Crani。”my- Neur回回回cal procaiure to 叩entbeaa皿al
cavity
臼JShln，’sdls四”－ 0回grow曲。f也e adrenal glands ca.using
at"Usivem钮’eofcortico，回oid hormones
D回U8翩翩。”“白ossing 回町of nerve fibres from one side of the
CNS to 值ieother （巳$即rami也I decuaaation)
D剑l vu - False emotional conviction thatαurent events have
“E田red k击。，re
Dem甜甜a - Loss of mental ab出咀es
Demyelination - Loss of由emyelin 曲回也皿II0UI1ding n四ronal
axons
Dendrt恼－ Branching process of a neurone 由at receives
U伽mationfrom o也.er neurones and conducts d回rical
changes to the cell b~
Dlabe幅s lnslpldus - Failure of the posterior pitui田ygl四d
a.using reduced release of antidiUtttic h创mone
Diabetes m创lib.ls - A disorder of carbohy由ate metabolism
caused by lack of insulin
Dorsal root gang Hon - I.oration of cell bodies of严imarya他rent
neurones en·能ring the spinal oord 也rough the donal roots of
spinal nerves
Dura mater- Ou阳m倒t ofthe three meningt盟I layers that
由叫op the 田ttral nervous 阴阳n
”
D arthria - Inability to pronountt
D归ph咽ia- Inab也.tyto 阳allow
D归phonia - Inability to produc.e the voic.e
Echo四时iography －咀ieuseoful田sound to display the a皿m
。ftbeheart
E”ere耐－臼z归g away from {e.g. striatal d如回t量bres carry
imp叫ses 甜可企omtbestri血im)
El嗣troancepl回lography (EEG)- Techn闯出todet倒也E
S山face electrical 缸tlvity ofthe brain
四”tromy啕raphy- 'Ii配hniquetode田mine 也.eelectrical
acti世.tyofmuscl四
Emetic- Ca国ingna田ea and vomiting
Encephalopa由y - Disorder of the brain
Entrapment neuropalhy - Nerre injury caused">'.' compression
ofanervewi由in a tunnel or at a change 恒 direction
Ependymal cell• (epen句ma) - Epithelial cells lining the
相1创α.tlar system
Epllepsy- Par回归mal attack of di础曲ed consciousn倒
and sensorimotor function resulting 丘。m abnormal
electrophy冒iological disch缸罄s ofthe brain
F幽cicu幅画。”－ Spontan刨出 contraction of d四ervated motor
uni毡， visible on inspection
Faaclculus - Bundle of nerve 但bres （ιg. medial longitudinal
fasciculus)
Febrlle - Refers to rai时 body temP.erature （伽a')
Flbrtllatlon- Spontan回us contraction of den臼vated muscle
fibres, detected on d民tromyography
F刷审men- Anop四姐g (e.g. foram四 m咽tum)
Ganglion - A coll配lion of nerve cell lx地ies outside the CNS (e.g.
donal root ganglion]
General paralyais of 世18 inaane (OPI) - Disease of也efrontal
lobes caused by late neurosyph监事
Giia- See N回iroglia
Glloma －卫llllour derived from glial cells
Haematoma - Blood dot
Haemont怕自e - Escape of blood from a ru~tured bl“对vessel
Hallucina勘n - Abnonnal per四p缸lal experi白白
Hemianopia - Losa of s时lt 必fee由1g one half of也.e visual field
(e.g. bi-temporal hemianopia)
Hamlpereel• - w回kn饵， of one side ofthe body
Hemlplegla - See Hemip缸回is
H晤，tole耐cular degener翩。”阳llaon'adl阳”1) - Inherited
“侃ase of copper metabolism affecting 也e liver and bra旭
H筒，，s zoster - Virus causing shingles (q思｝
Hunting怕自’s dis髓，e - Inherited d电回回回ve disease of也t
brainra田ingchor田（q.v.) and dementia (q.v. ]
Hydroce肉，lua - Abnormally la思ea皿ountofcerebros回nal
fluid 幅“E由even缸挝es of the brain
Hyperacuel• - Increased hea由1g ’钮，itivity
Hypemdlexla - Abnormal increase in retla activity
Hype阳n幅－ Abnonnal increase 旭 muscle tone
H”’r钮’曲，－自由咆ement of tissues
Hypo曲”’idiam - Underac由ityof也e thyroid gland cau ng
reduced release of thyroid hormone
“ dentate nuclei叫
Hypotonia - Abnormal d回国ae in muscle tone
Idiopathic - Ofunknown cause
l四”n:tlon - Death oftissue r倒时也18 企om impairment of its
circulation
Inter四川，bral- B剧院回阳。呢rtebrae
lpsilateral- Rm.tingto 也t 幽me side
lschaemia - R.estri咀on ofblood supply to a 由sue or OiglUl
＠回归g inad呵uate supply of ox亨gen
阳naasthallia - Percep世onofm°＇四1£Dt
Lamina- A 也in 同a"(e.g. in恒rnal medull町 lamina)
L帽Ion- Siteof仙咽，e or darn鸣e
Levodopa －ι－DOPA，且-dlhyd即可phenylalanlne） τk
met血olic precursor of dopamine. used in 也e treatment of
Par挝D80的 disease
Lobectomy - Surgical res缸山n of lobe of the brai且
Lum•n - A space or 田ity
”’
Lym om• - Tumour of the lymphoid system
Magn创icra回nancaim啕ing (I回RI卜 Tt?Chni年皿 for imaging
structure 也at does not employ ionising radiation
Mast!饵”。n － τbe act of chewing
MenIr啕es- C。nnective tissue sheaths surrounding 也E CNS,
namely dura mater, ara血noidma回血d piamat臼
Meningioma - A tumour arising from the fibrous co四rings
(m创n酬。f也.ebrain
M四i啕ilia - Inflammation of them四ingea
Me幅BIBsis - Spread of tumour to 出血nt 岳阳
Mier唰la - A type ofneui唰ial cell 归功， M白电a mainly
phage叼tic function 皿 theres归＇nse to brain 也mage or injwy
Migraine - Par阻碍事malhea血che
翩翩is - Pupillary constriction
M。”r n创ronedi回＠蛐－ Des阻四.five 幽幽&e ofupper and
lowerm悦。rn-四rones, caua画gpara】归is
Multiple sclerosis - Immune dis田se ofthe CNS, r.ausing
relapsing disorder of nervous function
M刷刷lard归”phy- Inh回.tedd甸回1eration of muscle岛
causing progr魄，ivepai虱l罚U
Myasthenla gra咖－ Immune disord缸。f the neuromuscular
junction, causing muscular fa部le
Myelin - A sheath ofprotein and phospholipid around 也E 缸。即
of但也in neurones
M归clonus - Sudden, involun皿ymuscleαmtrac:lions
M””由y - Disease of muscle
Narco胁’即－ Paroxysmal sleep a阳出
Necrosis - Dea曲。ftissue
N嗣plasla- Tumorous~也 ofti”ue
Neuro而bromato回事－ Inherited 剑.sease causing wmours of
m四inges, CNS, periph.entl ner咱姐dskin
Neuroglia (neurogl幅l cell) - Non-neural supp创ng cells of the
CNS comprised of oligod皿曲回歹圃，豁出q圃， mia回国.a.and
申自1句malcells (q黑）
Neurolap田c - Dopamine receptor antagonist 世ugs used to mat
psy由osis
Neuroma - Tumour derived. 齿。m nerv哩 cells
Neurone - The ~rincipal 缸nctional cell ofthe nervous 阳能m,
sp国alised. to integrate 血d transmit nerve imp曲“
Neurup自由市－因腿植eofn四ecdls
Neura町philis - Infi自由E of也E neIVOUS m恒m by a spirochaete
Neuratranamit恒r - Chemical rub!tanc£ stored within
vesicles (q.v.) in presynaptic nerve endings and released on
depolarisation to act upon 阴阳归apticre四”。”
”
Noel ptlon- S四sitivity to noxious 副mull
Nucleus - Structure within a cell 也at contains duomoaomal
DNA; d脑 a collection of nerve 创1 bodies with扭曲 CNS(e.g.
N阴阳，mus - To-and-fro movem四1JI of也E 句囚
。edema - Swelling cau回dbyacmm世a饱dfl:回d
。llgodendroc:y旬（ollgodandroglla) - A type of n四roglialα11
( q.v.} that produces the myelin shea血恒 the CNS
Ollgodendrogl阳ma - Tumour derived from olig<对endroglia
Ophthalmo例，gla - Weakness of the atraoαd缸muscles
conuolli吨句emo随m四”
Ophd回lmoscopy- Clinical aamination of也t 句ewi曲曲
ophthalmoscope
Pallid um - Globus pallidus
Pal町－ W~由le!l!I
Papllloedema －如dling of the optic nerve(s)
Paraestheala － τingling 阳11ations ('pins and needles')
Para恫阳－ Muscle weakness of回町同阳erity
Paraphasla - Use of incor配tword
Parapleg植－ Weakness or p臼alysis ofthe legs
Paresis - Muacularw田h四
Parkinso町、 dis，田’－ Disease of the basal ganglia ra1111ing
斟nesia(q吟， rigidity (q.v.) and田nor(q.v.〕
Paro吨，m - Sudden attack
Pathognomonlc - Specifiαllychai配阳”tic of a particular
disease, disord臼or condition
Perfpt帽ral 嗣同。四”’”m- All p缸”。f也en阻四us system
aduding the brain and spinal cord (CNS)
Phot。phobia - Intolerance to light
Piama恒『－ Innerm田t ofthe three E回ngeal I可回11thatenvel叩
也.ecen缸al nervous 町11tem
Plexue - Structure co田is由gofin阳'WOV四 nerves (e.g. brachial
plems) or blood ves础（e.g. choroid plmis)
Pollom归』ltls - VJial in岛ctionofm侃。，r neurones of也.es抽回l
cor址皿d brainstem
Positron emi踊iont。mography (PEη － 11缸hnique 伽imaging
the 缸nctionof由ebr祖n
Pra血－咀te 缸nction of skilled (developed or learned) voluntary
m<YW!ment
Prolapee - Displa四ment from normal anatomical position
Proprioception - The detection of position 缸id morement of
b以lyp缸ts
P翩翩。bulbar palsy- Wealm酬。f由E tongue. pharynx 副“
larynx cawed by di胧ase of the cortico趴tlbar 田血
P町曲osis - Abnormal mental state wi由 altered prec甲ts
(hall回回岱ons) and false ideas (delusions)
P协副，－ Abnormal 由coping of the 句哩’id
”
。uadrtpl啕阳－ Paral is affecting all four limbs
Radlculopelhy- Disease of the nerve roots
Re。eptor - Specialised element ofthe cell membrane也at binds
neurotransmitter substances (or a鸣曲。ω 命11&\) bringing
about a change in nwnbrane p缸meab出tyor 曲回国.cellular
resp曲“
Resting potantial - The d国ricalpo国tial across the membrane
。fa nerveα~atrest
Rheumatle 旬帽’－ Immunedi何细eofthejoin饵， heart and brain
following bact四ial infection
Rigidity- Inα四”d resistance to pas11ive movement of the limbs
由rough.out 也cir range
Schizophrenia - Disease ofthe brain causing psy曲创is (q叫
Seizure - Sudd四 disturb扭住。f consciousness or sensorimotor
function
Shingles - Infucti.on of the gangl扭。fcranial 缸ui !pinal nerves by
h町eszo阳剖m 归功
Slnglepho协n emlellon tomography (SPEC可－ 11民:hniquefor
恒iagingthe句nction of the brain
Somatic - Relating to body 阴阳。也自伽n 也.eviscera
Somatotopic － τhe orderly representation of body parts in the
CNS
Spa砸city - Inaeased resist.anαto 伊晶siv哩 m回阻四tof也e
limbs when muscles are initially s缸etched
Spon~而osls- D电四eration of the spine
Stroke - Sudden neurological deficitαusedbydi就aseofthe
circulation to 也ebrain
Sydenham’事曲orea - Manifestation of rheumatic如回（q.v.)
afl回ing 也ebasal 但nglia and causing in回·luntary m白白n四”
Synapse － τhe gap be阳回l neurones aa回事which nerve
imp世sea pass by release of a n四rotransmi四E
Synaptic vesicle - Structure wi也扭曲epre町田ptic 四ding
that contains neuro田mmitter substance which is rel四sedan
depolarisation
Syncope - Fainting atta<业
S归drome - Group of si萨is and symptoms which characterise a
di础se
Syringobulbia - Expandingαvity (syri皿） wi由in 也emedulla
”
Syringom lia- Expandingcavitywi由in 也t spinal cord
Syrinx - An abnormal 团审ityi且也E 早nal cord or medulla
Tanninal bo11阳n- Spec也lisedpii町nap咀.cendingof扭扭on
Tltalamotomy- N1四E回Uigir.al destruction of p缸tof由E
th.al四1\JJ
Thrombosis - Coa思Jlation of blood in ar阳yor 陀恒
Tract- Ana即可回onofn町ve 创l processesh町姐g more or less
the same origin 缸l.d des由iation (e.g. corticospinal tract)
白，mor －吐出bling ofhead or limbs
Tumour - A swelling or mmbid enlaxgement; a mass of abnormal
tiuue resulti吨from uncontrolled cdl growth (neopW:m)
V回lcla- Su均naptic胃9icle
Index

Plage:numb倒也l!OI帽现 by"f＇ 总dica能 figure岛 γ 凶dica优 table也刽i.d 、’肌必care 以－·

A 相teriOl' i:ad阳血rar町， 60/ Axod幽幽ilk syna”也 33 阳nth 回盟创d巳 16/

相tenor i:adicular 咽且， 60 Axon. 2-3, 3/ 恤阳M futu隅 ’1-93
必地.1C1eD1 ne:r鸭｛创.Iii.al ne:r嘀嘀， Anterior ('ft!!四） ram屿，plnal 阳iphe:ral na:w鸟 40/ 放惚nal muctwe of 9711
’以 103, 11创乒 105/ ner四岛 倒， 70, 74 Alamal. neuroplilthia, 40b la棚i 碑鸭 1”’w
leai。”。t 10411 Anterior spinal ar饵， 60, 60f-62f /i'Jl1'.)剧mlltic synapt也 33 l剧。”， 98队，8/
剧－刷刷刷， 67/ 。cdU.Wn. 60lt medulla oblonga烛，”“16
A崎1cenenud创‘ 101{ Anterior •P凶al 回跑，侃”钮， 60/ B ”waglttal 帽ct!on. 13/
Acalαllla. 30 拙饱锦ta.de: （协且创an) ，由~ 91-93
刷刷cry ne:rw. 9!1/, lll d咿M划。比 periphe:r租1 Babinski n:8l!思 28 1lar1l\I四础。民 16/
Ao:om皿。也tionrdl战 102 ne:i:w:鸟 40 翩翩1 JU181ia， ”， 142翻149 咽nttal. wr&.a ot 90, '11f
At:ll!均成diolin巳 33-34 Anterola阳吼叫.a. 60-61 ccnn剧。”。C. 22/ Brmchioru创m 创I column nuclei,
Acdyldiolinmerue (AC剖， 34
Acou.etit DC'回回国a. 1091'
Apha岛 30 “ ndional anatomy. 144翩 149
function鸟 144-149, 14911
100
崎1eoUthumou鸟 ’” Broa向 aft马 136
Action pote:ntl.al. 3 AracllDold 伊则atlona, 58, 59/ mowment disordm, 14911, 149/ Brow岱$伺刷地布盟也咀m也 27
Acute 肌.ftammatoxy ne恼。pithy, 25 M缸hnoldmat码 12.. 12耳瓢， 以嘟回IUU踊血r disease.. 纱， 2.9f>
Afferent nei:w 也ding也 peripheral.
nervous "9忧也 37-38
S9f喝喝r
咽皿础d, 71/
nomen嘟”Z毡 ’43/
阴阳p均掘。1啼， 14a-149
c
Afi'm:ntn阳。aes. 4.，电f 唰且巳 68/ ~ollal lor:an.ation, 14厅 臼l锁店1e sulcus. 1霄，’当f
n'1U111 tube-. 7/ 必观必noid 说lli. 59f 缸hemat!c 必咿拙， 145耳 148/ m“胁”8时阳由n. 128{
唰M 恼地 7/ M也i回也ellum, 117, 117/ topograp始“l ana自由时， 142斗44, Can.al of Schlemm, l SO, lSo/
Afi'e:rent nude!. ” “100 M幽~nud础 ，w 14411 缸rotid syphon. 61
Agrap比a.. 30 M忧凰踹 B制al plate a昭嗨码皿鸟 63/
Aki且咽ia,29 amerior ell。·ro说:al g回事 61 CNS~耐。1pm回t. 5 臼时息吗泊1怠
必M plate ”倒ior iDCaiorαi:ebellar arlel:y, neural tube-. 7f epinal cord, 12斗3
CNSd回d。1pment. S 61.f-62{ Baallar art峙， 61/-62/, 62 spinal llel"f鹤 69, 71'/
n剧ral I:\必鸟 7f 组位rior 院由m销量g art创她 63 a晤鸣raphy,， “f 臼udalm创凶h， ’1,92/
Alesi.a, 30 anterior ncil础rar闸， 6何 汹B也组嚼血’粤、亭， 电也f spin阳鬼也e1lar ttaCI鸟 81/
Al抖ia motor neuIO且峪 muscl也 36 anterior sp注alar馅，， 事。， 61f-62f B制U peduD.culi, 90 也叫踹削deus, 57/, 65/
地S.Mllt.myo回内ic k伽草i sclerolil 阳回ll. 61-63, 61.f, 63耳 6511 Bell'• 阴1”’ 1091i basal 伊且glia, 143翩 144
Alzhtimets di棚’也 24-25 gr1咽t rad泊liar 都倒型， 60 Benign h田01ID总l hyp回ten.ion, 嚣。b CODllec:tiOll也 22/
Am时，以 30 h叨叨均阳l arteri毗 创 B硝荡臼盘］$， 82 相尊bl111 h.emi呐四~ 17：乒 18{
Am刚al怠， 划，叫， 159 lntemal v四ebral 削erie岛 12 Blp。Jar 阻eurone也 32 ooronalM则， 132/
coronal 舶ctlon, 130其 M颂”’f l彷归讪伽1ne artl!l'Y,
62-63 Blind a叭’也 151 coronal 阳筒。lll, 129/-13以 143/,
lateral 啕阳也 143/ mi创le menin伊alar馆，， 12 Bio叫－bWD bmier. 34 146f, lS<J/
Am·”’op泌ιJamal sdaotil (ALS), pontine ar阳陆 62/ Brachia! pla:驰 3, 41{ 汇放van0\19 sim.1$, 67
7411 ”’创iorcom皿mica也igar棚’ avulaion 。C. 411> 也romb帽i也 67b
An翩，th回i息， epidur乱 72'h 61, 61/-6骂f lesion鸟 41礼 42/ ~幢幢回匾。也 67/
Anen1呻hafy， ’告 阴阳rior 烛ferior 饵”：bellar 创饵”’ Ip协且I co:础， 68 汇兑lit, 32-35
Aneur” m. 64酷 61/-62/ Brachium con如ncO:叽血， 96 Cen.1能在l canal

旭g国曙aphy 肘，terior per击On:蚀ngartm.~ 63 咄咄i 精E匾。也 1'1/ sp恼且l cord,. 7耳 12-13, 14/
M垣n arterial supp.哥y, 63/ ”’阳ior i:adiClllar art町， 60/ Brachium of in伽i。r colliculua. 1l:amV'1'院附tion. 94/
neuromUKU!ar di阳鹤 ”， 31/ 阴阳iors冽naJ. ai:阳ies. 60. 6of b'llDf，四e 帽dion, 'JSf 臼DIIal. 锣叨， CnlD8咄咄 S剧。也 92/,
Angioma, “如 radicular 割伽ie也 12, 60 Bra必Jumpon1哟 ’丸’3/-94/ 步4/
Annulo.p胁l nel"f弯曲dlnp,38，章建f Arterl帽moue malformation. 64告 Bra汹， ”斗’， 20b Cen1四 ner唰叫ttem 仰”， 3，似
仙。m始， 1631> A:rtay o( Ad.amid阳le鸟 币。 都惚ial II真pp}如 61-63, 6lf”63耳 65告 品－23
An踹 lentlcul.aii鸟 coronal 掘~on. A副到1岱且，g tt罩eta 咄咄i 帽dio也 Sf blood 钝pp耐p; 8-12, 12"
147/ coronal section, Sf do ml 捕归钱， lo/ 创帽iDg也 如 12, 12b., ’2/, 50-54
Anterior. ddini曲也 1/ m皿 ccrd, 13, 77{ 咄'ly dewlopmen·飞 8f devdopm但也 4-8.5队得好
Anteriorαi:ebral ill阳型， 61”62, w也ite matter. 71 emb粤咽nlc development ot 8t affmnt 锐11 sroup讪’也 7f
61.f-62{ ~lion fib~ 138-139 latl!l'al 呻盹 町 alar plate, 5
angl。1gnnu. 63/ 却也m叫pi.OSI岛 7811 main f曲也!It鸟 ”翩 14 b幽al plat鸟 5
dlstrlbutio魅 In bra烛， 63/ 制叨地 34, 34f median 相gittal. 辅dion, 10/-ll/ brainrtem, 7-8, 9/
MIUangi咿llp~ 64/ M岱OC)'tom鹉 3Sll ”Z嗣gittal 幌d:io也 13{ αi:ebcllum.. 7-8，理f
Anterior choroidal u闸， 61 At:.皿all 四JCUla阳岛 61-67 αi:ebral aqueduct. 9/
Anterior dinoid proce幌 51/ 明军畸刚i他 24翩25 必幽rdmot “b α~bril hemi.spher略 7-8, ,,
An忧rior cammi.Nur吃 154f-155f 响E阻碍 主8-29, 78i』 vmouadra讪略 65-67, 66/-67：耳 α:rebrum. 7-8
o>ronal •制。II, 13够 Auditory o>rt饵， 19 6711 ∞币。ra qua.drlgem烛怠， 8
median 呻ttal a础。比 121/ Autooomk 伊峭ion, autooo副c 咽tral. up盹 10/-U/ ∞叩\II 锅ria:tum, 7-8
Anterior commur也aring ar饱，， ne:IYOUI m忧也 46 晒t而cular "'1帽， 14-15. 15/ dim吨池alon. 7
61-62, 61/ 必.It.Ono：国ιDem>\11 syltem，，”也 Brain grey a刷a; 4 effer剧创i groupinp. 7/
翩翩。zαl1lliaJ. 如刷， 50, 51/ 46” 46 ccronal 蝇ct!on. Sf fourth 四a创d也 'Jf
Anterior (?11盟国I) honu. 刷刷E 咽地 d四川量b-. 46 Bra始就f!lll, 14, 89－费7 globu’ ”llidull, , ,
7f. 13, 14/ d四盟~t n创m岱＠岛 46 aaa!lldin&trac跳 89 inf创or Q)llh:ul\1$, 8，要f
Anterior lnfl!rior 出n!bellar ar也厅， functioru ot 46t CNSd刷呻ment. 7-8, 9f inttawn创α也rforam也1, 9f
61f” 62/ 创ganl幽tion, 46, 46f” 47/ 咄咄i 帽dio也 Sf later划，也回d鸟 到f
翩翩。rl必也 superior sur命战 113/ A响.dsion of the brachial. plmu, 4111 d咽αndiugtrac旬， 事， g略战。1bloqaQ.. 7-8
Anterior pmor袖血事创t踊a. 63 Aml!iJ睛， 40”41 dorql 阳山n. 份， 8'Jf g帽aioephalon. 7
AD伽iorpitui饵”’ 154/-155/ Axouonal 勿在句JR. 33 e血nW featuttJ也 89唰90, 90岳 me田c:ephalon, 7
Cen1位“ ner回ω 刷忧m 〔CNS〕 lat回国P团在 19f 。因血皿 llltcri回国（cirde ofWtl!Q1), 。四且l ner回民刷
(Con伽剧｝ medial 8lpl'Ct. 19/ 12, 63 Clo蝇。＇Ph阳yn.萨al nerv琶
皿dbraln, 要f pres:en缸咀l 8)'IU岛 19f CQ民;emam唱:na.54, 54f. 56f. 58/ cranial !lei胃 X 且.. va,胆s nerve
myel皿呻，haJon, 7 p由1啕咽I gyri, 19{ 阴阳med!翩翩gittal.配tlon, S3f cranial !lei回 XI.JM/ta,国IOI)'
neural tube devel叩ment. 5, 6/ p由1d阴l 由lei. 19/ 。“悔’•column E钮’也

E四mtlation, S 咽。叫 1。calisatlon, 14矿 刚nal cord dorsal horn. 74 cranl.al M胃 XII. #II 可poglos副
pom, 7 3, ’f Cerebral haemorrhas鸟 ~ ’阳帽咖liar 田啪 ”，侃f nerve
prlmaiy brain 'ff到de鸟 7, 8t Cel世＞ral h田园，phn骂 13 14, 16 19, α佩蹄忧um entrapment, 24
pn:圃盟aphal国tlot1， 且 127-140 coronal eec.1ion, 130/, 143{. 146/ α也咀.al !lei四 nudd, 89, 99-112
prc蛐enaphalon, 7 。mtral sul四.I, 127 h回国血I 脏曲。n, 132.f. 14布 af£er回t nuclei, 99 100
碍。因’“必剧盹 7f. 8, 白erebral an:瞌盟L 16 αM且岛 50, st/ effer回tt nudel, 100-1日E
’ f-JIJ/ CNS elev由pment. 7-8, '9f CNS.-o曲时 n町’四”现em Cranlal roots of aa:esaory neno也 叫
血omhf盟田，~halon, 7 面rona. radlat鸟 127 臼也lea, 1Ulf 创brU町m 尚属 Slf
扭曲E也iybra扭回由icle鸟 7 romn.al 拙函。n. 琐叼 127, 臼chlear nenoe. 10有f 血陋。r cranl.al foua, SO
attlaJ11 limiwu马 5 128f二13项 138/ 臼tnmlllural fibrei, 138耳 139 cru. cer由Ii, 90, 103/. 1σ厅， 163/
叫剧。rcolliaJ.lu鸟 ’f 曲时COip凶.al trac:I鸟 82/ Common peroneal Deift coron.al 幽:lion, 131/. 143/
t.e1白白，halon, 7 dor国I aa庐~ lo/ compn回lon, 45& ∞皿ω咂皿al 田吗 82, 82/, 86/
白血皿m 7-8, ’f F也 127-128 C.Ompressive E国mp唱血ie也 45& dorsal colWDI现 78/
由国四ntticle,. 9/ h而.zon刨属缸岳阳， 18/ 臼mp回£11 tomography （町， dorsal 配咀on. ’口f
回回回lie 阻non, 1/ 扭剧.tlaψ 127 nn』mmuaa.tlar dhea跑 到， horizontal 田由.on, 140/
啊E血icle鸟 8 扭.temal c:ap田ili』 127 Jo/ midbrain, 20/
major motor 归吐twayS, 21-23, 22f WI思吨e a圃， 137 臼naensua1 light ~ 102 rubrospinal 国坞 的f
major 配nsmypathw句’』 19-21, ~aap叫 1吁， 127/ Con山 m“凶Jar饵，迦.alco地 68, spino也alamic traci:鸟 79/
21/ ~缸sure, 口， 1呀， 127 70/ 阳芷圄E血al traa, 84/
neurological diseas鸟 23/ l回国鸟 134/ Corda臼my, 79b 国皿町alle sedion, 145/
四JO.tlamr‘~ 61-67 lob盹 127-128, 13311 Come也 150, 15口f 胃’国I 町eel, 102耳 120/
c:er血ahulClll鸟 17-19, 19/ median 植gjttal 阳:ti.on, 10/, 128/ 臼meal reda, 1IJ6/ 回国1 sedio饵 ’l/
回ebral~ 19/ 。pera血， 127 Corona radi础， ”， 20/ CSF.seeCer吐>rospinal 坦国4
回ebral he:t血phere邑 127, 12万 归血皿edial z晤时脏lion, 53/ cermaI hemiapher鸭 127 Qmeate 1ubm:I鸟 89
Jamal a哩回ct. 127/ prea盟缸:al Z归UI, 127-128 cmonal s础。鸟 13o/
median.唔出1 sectioJJ. 128/ 币2目也ala皿k 国di, 7'J/ an:咀U呻iDal tract鸟 ”，“f D
Cephalic 坦aure. 8/ sulci, 127-128, 13311 horizo血l 脏咀on. 140/
Ce:rel对Jar hemitph~ Sl申目。b：阳al .up剧在 133/ Coronal, definition, 2 DecuRa即111of也z pyra皿de. E碍。g
coronal lledi·。n. 115/ 回回Il1l asp盹 1叮－11/ Corpora qua出igemina. 8 四阳 pathwaya, 22f
horizon·刨阳垣阻， 115/ 叫咀.te matter. 137-140, 140b Co，因 calloswn. 13-14, 1S耳 D睛’但rtbnll Wm. 6S
h饵ral upect. 113/ Cerebral peduncle, 61/ 56/-57耳 139耳 154[. 156/ !)ftp peron四I ~ 43/
c.erebellar nuclQ， 且7 Cerebral white E且t1£I; rqion.al coronal MRI, 132/ D咽町elina:tion
c.erebellar polll＇也e a唱也 56/ loca且a咀on. 141/ 倒回回1 ，制。鸟 1吁， 122/. multiple sci.er田峪 3Sb
Ce:rel对Jar 回DDil. comnal lledi·。·n. Cer由rospinal 坦国d(C町， 57-58, 128/-129耳 143[. 15'/ neum归thiu. 40b
115/ 580 4翩且峭如 1391t Demlrit盹 2-3, 3f
Ce:rel对Jar 叫:tltc matter.α)l'()nal char回d piaus. 57-58 dorsal tedlon. 123/ Deftd丘tk arborita植on. 32, 32/

缸咀盹 llS/ M阻， 58/ m创恤’唰削阳lion, 1呼吁 D回dr＜》dendritlc ll)'D甸回e, 33

Ca'd>dl叩ontiJK a昭ι 107 啊泪缸ida, 8 paramedial ealP阳I Rdion, 53f Dentate nucku.
c.erebellu皿， 7-3, 15耳 16,97且 Cerrica』 α，rd P翩翩鸣声阳1 ”aion. 13/ αm叫帽aion, 115[
113-118, 113/ cortico币na1 国血， 82[ c.oφω 附尬凶血＇ 19 hori刷ttal 盹ctlon,， 且Sf
ata画剧， 24-25 dOI9lli colu皿a. 78/ CNS development. 7-8 trans回rae tedion, 93/
CNS de叫。pment. 7斗， 9{ rulm呻inal tract. 83/ c.o剧创l v回回岛 MIUaq闯~·峙， Den:世ul础 H伊血回L 伺f， πf
回nnections of 23/ 币且“四：bellar 田血 81/ 66/ apinal men旭棉 布， 7o/
dor叫“pttt. ID/ 咂血。也血皿k 国剧， 79/ “ rtloobulbar Ii.bra, major motor D回成ndlng 回到cul”p旭al tractll, 96
回缸na1 fatura, 113, 113乒114[. 回回再皿国ct. 84/ p姐回咽， 22f D国cen曲tgtr.at:置，
11411 回现ib咀皿抖Dal tiadl也 85/ C.Onk:opo111由tt fibn坞 ，。 brain皿盒m, 89
furu:tiona1 an血ω皿'f ~ 117-118, Cer币cal enla电Dner吨咂na1 cord, 68 回国－脏曲。n. 93/ 国mnal 植划an, 5/
臼rtlro叩Ina! film国
11911
ln\emal strudUre of. 114-117,
11号 117b
~dezur飞回rlyd凹dopment.
8/
Charco(s joi且他 79b
旬，ddea °'
hori2.o血I 阳也n.
7'9f, 82/
140/
spinal 倒也 ”， 77/
splnoc:a:喧:bellar tracll,
Dien呻1halon,
82-84, 85&
16-19, 120, 12of
lateral a，配t, 10f 由ief llelllOif nucleu鸟 1口6/ 臼皿coapinal tractι 82-83，但耳” CNS development. 7
I剧。”。t; 11911 Cholecystokinin, 34 transftISe 脏咀on. 94/ 国rly dt:9elopm四L 8/
m副翩 tagittal 阳U刷'I, 1（）.严llf Oiorda tym归坷， lCYlf Cortkoatrlatal fib圃， 144 Direct llgb.t reik鸟 1倪， 103/
n.euromusrular dis幽幽鸟 28-29, 28'1 Chorea, 2’, 149b 臼ugh red鸥 1侃f 回国odated 翩旦回oiylo饵 ”b

”ramedlal 蛐glttal 帽..:tion, 53/ 曲。回d, IS日， 1坷 αanial m四”.nges, 52-54, 5411 D呵国mine, 33-34
阳嗣.gittal ，剧。也 13/ Choroid pl回蝠， 14-15, 56乒57耳 65/ αanial ner叫’）， 3, 16, 19-2口， Donal a时uearnud凰凰 107/
碍。四 localbati盹 14可 arebl'Ollpinal 姐回cl, 57-58 ” -ll2, lOOt Om富al columns

阳”－·剧灿 ’矿 国皿回回阳:Ii盹 93/ cranial ner四 I, IOOt brainstem, 89

四tral a，白马 1旷 由.oroidal 回n. 65 cr:anial ner四 n.-0p咀E ner鸭 lesioru』 78!1
C自由国叫U础c:t. 14-15, 15耳 SS, Ciliaiybc啡， 150,lSo/ aania1 ne!鸭皿皿 Oculomotm major sensory pathw霄’』 20-21
5孚56/, 58/ 59.f. 89 细 Ci!Wyga晤。n, 103/ nerve 111uclei, 20-21, 21/
CNS ck时句回缸”， 9/ Cilia哼皿lldt』 150, 150/ Cllllllial ner四 IV. sa Trochlear spinal ami. 12-13, 14/. 77-78,
coronal KCl匾。n. 131/ Cingul眼睛饵 ’万 llelft 78/
median B唔出l 旺tion. 11/. 121/ α且醉l血 gyru鸟 19.f. 96/-97耳 156.f. 国皿al llleI四 v. 翩，币1萨mina1 Dmsalfi.皿kulu鸟，pinal rolumn, 72/
1IllnsvaK ledion. 95/, 145/ 161-162, 1611'-16.劫， 162/ l1eIVe Donal(p回国ior) hoIJ坞，pinal OOI址，
臼由ml cortex. 町’7.f. 115-117. medianaar)也l lledi。n. 128/ 国Dial ner四 VI. - Abdw::ma 7耳 12-13, 14耳 72f-73f.
11吁， 127-140, 135耳 138b Cin醉l配皿』咽， 17-1.9, 19/ ne!\le 73-74
咀!ral sula鸟 1雪f median~臼l lledion. 128/ 国Dial 11erTe VD. sa Fad.al ner回 D四ul mroian sula皿
回回国l lledion. 17/ Cin醉lum, 156f 国Dial llleI四 vm.- 'Pinalαml. 72
缸缸咀.onal IU1钮’“ 133f Ciide of＼＼而llil, 12. 63 M现ibulol:刀ch』田z na:四 tnuJI\'四 lllped. 72f
Donal motor nudeul, of咽gu鸟 93
Donal ramua. apl.nal ner吼 叫
Dor咀l rapht!nudew』 tr.um哩l1e
阳咀on, 叼
D回国I root 萨峭岛 68/
major 幽amy 归曲ways.
酬.na.l am!, 7耳 12 13, 14/
酬nal nerv跑 回，可
Donal1p凶al B四e roots, 68耳 6'J
Dor咀I 馆gmen凶 decu且咀on,
rubroapl.nal tr画Cl, 83『84
DOIBOb:teral. fa皿αlian且也 73
Duchenne m1』scular 句回盟”” 37b
Dura mam, 8-口， 12/. 52, 53耳
5'Jf-60f
spinal cord, t'lf,πf
spine. 68／，可
国皿回'le lledion, 6可
Dural 咽，OWi lilluae也 8-12,
o,skin国且， 29
Dystonia,. 29, 14911
”ruaglual 眠tlon, 13/ 臼mmam创l)l n创m脯， 3呼吁， Hypothalamic neuro.ec甥tory
Pasdcl髓。f倒回刷抖nal fibm, 79/, 75 neurone. 155/
毡12/ 臼mma refta loop, 75, 75f Hypa世ial.unic nude!, 157
Pasdml田 ClUI国tu’ 臼昭.la, 3 Hypa由血mic rrulru岛 median aastttaI
doraal colum且.. 77 臼nlculate 伊lgllon. lf11f 田地田I, 121./
21.f doraal 阻tlon, 89/ 阳1时emoral nerve. 42{ Hyt崎也刻.amo均po萨明w tract. 96/,
叫or 9el1'0if pathway9. 20－组 。帅”e nuclei, horl回应叫“ICtion, 155/
国阳四 aealon， ’布 115/ Hypothalamue, 1哆 56/, 97/,
Pasdml皿 gradlia αob田 pallidllll, I ’ 154-162, 15711
84/ doraal 幽.pert. 8'Jf baaa.I ，且庐鸟 144 皿tonomicner回国句stem, 46
dorsal column鸟 77 OOlllU'rtiom, 坷 coronal 幽幽n, 1布 122/
maj町阳llOfY p皿hw碍’』 :Z0.-21 a:rebnlh副spheres, 1万－18/ dien四抖talon, 16
sp旭al r:onl. 13 CNS de回opm皿t, 9/ median 植gittal 皿曲。n, 10,户时
transvene 阳重on, 92/ t"Dllllf!C垣DDS of, 145 147, 14711 121.f
llasciallus propriu岛 77 Mronal MIU, 132/ U布Mlgraphical ana臼E亨， 154-157,
l'laltlglal nuda鸟 horizontal 姐姐。盟， Mronal S翩。几 17/-18/, 1坷， 154/-156/
US/ 143耳 1叫， 159/ 回国I as阳t, lOf
Femoral neift, 42/ horizo副al MRI. 132/ Hypobmi鸟 27-28
65 Filum 恒Iminalt. spinal 四时， 68, 70/ horizontal 配咀阻， 132/
Pint order neurone, major 画E国Jll)' α瞄咐wyn伊l nerve. 99/, 110
pathways, 却， 21/ GluWna:饵 33-34
目。woe!"~ D~ ending鸟 ”， 38/, Glutunic 四d. 33-34 血oinguinal 1m¥巳 43/

E 74 Golgl tendon 0183跑 到， 76 Inb田E 四军回 ofmet曲。』isr乱 2←25

民回1 田ebral lesion, 134b, 134/ Gracile tubeid鸟 89/ Intiirdiou. 24. 64"
国ingu-Walphlli nuckua. 100-101, Foram四 laamm, Slf 。因但由国回n, 65, 65/-66/ Infm。z ddll咀tion, 1/
101/-103/ Foia1Dm magnu:m』 50, 51/ MRI angi.唱呻峙， 66/ Inferior llllalltomo1ic 叫n. 66/
国m酣睡，a:)险。ri. 95f 民IIlllII皿 magnu皿’咀mm岛 52b Great longitudinal S皿鸥 13-14 Inferior 田吐时larpedundι 16, 56/,
l!ffectoro再plilll』 2 FoialDm of Lu皿曲， 89-90 a:rebral her回sphere&』 127 8~90，四f
l!ffamt Daft mdi且， 38 four也咽坦创de, SS coronal sec由n, 17/-18耳 131/ bra匾，但皿， 16/
回国四t neum画略 4.4/ FoialDm ofM笔~ 55 dorsal :upec也 lOf doraal 描pect. 89/
autonomic navoua 句’但m. 46 FoialDm of Monro, 55 Great m血.ailar ar阳.，， 60 latenl asp缸L ll3/
nami1 tubι 万 FoialDm ova1e 50, 51/ Cu血ain-Bam! syn命。m鸟 25 1p~bdlart1缸”， 80. 81/
眼nal 田地 7/ 民IIlllilm rotun也皿， so CJri, <:ERbral hani!phere鸟 127-128, 鸭，tibul09pinal tr配由民 8写f
咂皿l na:咽.. 69 民m皿m spin幅um, so 133& h缸4。·r colliculU1, 56/, 90, 1J1lf
E:mboliform 皿deUI.. horizontlli 民IIlllilinal syndrom田， 5211 CNS 也时.opm田园L 9/
阳tion, 115/ Fomix. 56/, 154耳 1S6f dOJ回嗣；pecf. 89／二到lf
H
Endonmrium. peripheral ner咽’比 40, comnal 配dion.. 12勾， 130/-Ulf median 幅giUal Ila:姐回， 10f
40f median 啤阳1 Kdiou. 121/, 128/ 国.ben响 ~ KCtion. 95/
趾如phalln, 34 h田也 vmtrid巳 14-15, l Sf, 55, coronal 阳阳L 131/ Inferior 企·ontal 8)'lUS. Ia缸”la吨陀ct,
Entrapment neuropa也ie也 24,4511 55/-56/, 58/-59/ m甜甜 aagltW 幡ctlon, 11lf 127/
即回由ma. 35 bra且s但皿， 16/ Haema缸”田.a, 24 Inferior oliv町 nucltut. 90, 92/. 107[
Ep烛E虱I anaes曲创岛 72& CNSdnd叩ment. 9/ 回住aduial. 54b trllll脚幢幢酣由n, '2/
l!p烛E咀l bl由此 7211 dona! secti田I. 8'J/ In往咀.cerdnal, 54b 回tibul呻1nal ttac归属 町
Bp烛剧＊I咀陋 horizontlli IKli·。·ll. 且Sf ”bdur乱 5411 Inferior 崎gittal 回n, 65-6元 66f
酬nal 曲地 1骂f h回回a 吨~ 59/ E面院monh峭萨马 24 Inferior temporal gyn”， lat世世
酬nal men!鸣略 加 h回回a real盹 5骂f arebral, 64& ”严:ct, 127/
Epilepsy, 24-25 median a阳tuR. 59/ 祖国“四bra!. “b Infi.ammatlo也 25
Epln剧由皿. 40, 40f median 町叫 5吃f 剧baraclmold, 64& Infiammatory neurop晒y; ac咀t岛 25
Ep抽血mu斟 120 median 田6阳1 Kdion.. 11/ H国d 恒回mi.aψ 54& Infundlbulu血， 61耳 155/
dienaphalon, 16 庐，阳ior view; 57f H四刷ere, IU但rlor IU血鸣 113/ m甜祖国6国1 8剧。几 1可
JlxttJlttw? 鱼.mctlon, n剧romuscular ~t«ti阳， 93/-94/ H回回恤l)'M盟.arlmo缸四 四”叫呻矶 时 12吁
di&幽H』 30 阳回回国h 150.f. 151 neuropalhie鸟 24-25 国皿lla

l!xtemal 臼P四k Pree (un.en呻创lated) ner晴曲曲”’ Hemd阳ry 1paatk. 归且严res！鸟 睛也ral h皿旭阱ieres, 127, 130/
coronal sect!OI』 1坷， 146{ 37-3串， 3万 24-25, 83& coronal 阳白白， 13of
ho血。E剑虹曲。n. 132/, 142/ 时.edrelch＇•幽.da. 82b Hipp。但皿pal 企mnation, 160-161 ho曲M sectio鸟 13矿
FJa:emal ftitebra1 咽!DOI且 plexus, Pron创创r slnua. Slf Hip阳也皿严Z鸟 9项 156/, 1阅， 呵ienilirteral 画pe鸣 133/
6口－61 Ul饵划。z g观nial fo喃地 50 160/-161/ h恒rmedlate curaneous nerw: ofleg.
En自oaptors, 37 Frontal con饵 ’7f CQf；幽1 section, 13咛131耳 143耳 43/
E:madural haem血ma, S4b Prontal lob岛 17-19, 1厅， 135-136, 146/ Intermediola:teral horn, 72
E:maft皿d !Dlllde fibr略 36 135耳 163{ regional lex刻iaati＇田！.， 141/ h阳nalaan皿E mearus, Slf
Rretchrdem』 74 帽d>ral hembpha圃， 18/-19耳 Horizontal. ddinition, 2 Internal an:ua:恒量M国
Emapyramidal motor pa也W町’b 127-128 Horner'a m咀rome马 48& donal 田，！umr坞 78, 78/
21-22 doraal leCtion, 123/ H四曲唱缸阻’z diseaae, 24-25, 149b 国ns幢幢阻Doll, 92/
Em田ne G哩llllie lesiom,. 136& E弯曲回归lua, 58lr h阻nal capsul鸟 ”， 20/
coronal 回aiori. l町， 142/ 民回E臼l pole Hype:nmsion. bmipl 迦圆圆也L 国白血l h阻.ia阱ter略 17/-18/. 127
horizontal sec咀盹 132/, 142/ diffi.皿OllMRL 13g/ sob coronal M阻， 132/
勘电 150-1虫， ISlb, 151/ 缸’自由但cal 呻盹 133/ E为pe:i:臼E且， 28 coronal Kdion, 12'lf, 130/, 143耳
Pron甸萨m幽暗面bra, tranawne HypogloHal cmaL 驰 51/ 146乒14万， 159/

F ’础。马 町 E协唔anal n凹巳 99/. lll, ll2/ 四位:ospinal 田.~ 8'1{, 86/
E切唱onal. n叫ms, 16/, 93，甜可 doraal 田JWllDI, 78/
Facial motor nud田is, 101/. l<Yl/ tiam咽'le section.. 92/ horizontlli I四划。也 140{
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Facial nm>电 9'/. 107-1°'· 107/ E协op.均Kai 四erie也 61 1pinothala皿ic tra啪 ”f
Fab: ar~bri. 8-12. 钮， 59f G唱 ~ llOf Hypo抖叨’但l 阳帽， 51[ Intmutl 团团咀d ar饵”’ 12. 61,
回dmilherni昭1era, 127 Gamma-aminobutyrlc 回d(CABA), middle aania1 f田阻， so 61/-62/
panmedial 四giual lledi俑， 53/ 33-34 E母poreftm比 27-28 a咱咽皿 63/
h能E咀I 回回id Ill回y(Con翩翩j Lateral rec.回.. 89-90 major 甜D80!ypathw呐 20-21, 阳刚翩划。乱 ”f
MRI angl叩叩岭， “f 画臼＇urth 咽盟创de, 55 21/ 鸭蛐阳冉al trad比 町
tranavene If:(划on, 叮 ~veil创d岛 14--15, 57.，叼町 回国－眩目。岛 町，’4/-95/ Middle 世1'l'.bellar pe.dund鸟 16, 56/.
h阻nal 田曲nl 回n, 65, 65/ 血回er horn， 可 57，乒叫 V回tibulotp恤al 田俑 ’Sf 90, Uflf
lnt£mal j咽血Z回n, 66耳 67 body, 15耳 55/ Medial I刷嘟阳dlnalwdwlu鸟 ”， 曲创曲，坦.al tracts, 8骂f
h位ma! 咽!ltebial anerl鹤 12 创$脚dopment. ’f 103/ doraal 回html!$, 可
h田nal 四”盒：bial ’阳回国 plt'!nll, ooronal •剧。鸟 17，乒呵 12勾 回国－叫。n, 93/-95/ doraal 阳tion, 89／－坷
60 61 旭翩。rhom, 15耳 55/ vutibul呻恤I 田啪 ”，耐 la阳d 即回:t, 113/
恤回new:onea, 4, 4/ lateral hom, 55/ Medial m~mmlll:iry nud四.8, 157 aplno也血.mlc trad:再 79/
lntml回国r ophthalm.叩legla, 1臼f 阳回。rhom, E垠 1蹋呵 Medial E划cul幽p旭.al tract鸟 84 国幽.pin.al trarJ, 84/
Im盒m由’toI8, 37 La但ral v回tlbular m且dm乌 Medial V田tlbularnud四.. 国酣睡rae 础:tlon, 93j二94/
lnt£Ip回unailar 岱阳也 54, 58/ 咱咀bulosplnal 田吗 例，町 鸭”ibul曲”且.al tract鸟 84, 回mral 剧划。鸟 ”f
par:amed.ial &agittal section, 53/ ~，回tlbulOlplnal 田ct, 84 85/ Middle cer曲a.I artery, 61/4.2/, 62
lnt£Ipeduncular b幅画， ventral a哩田L k国皿恤’ E四llOlDI皿allar dis国国鸟 3日 Median, definitlo且， 2 皿S自嗨皿n也 63/
102/ Len鸟 150/ Median nerw, 43/ distribution in brain, 63/
Jntemegmental fibres, spinal cmd Len世form. 142-143 M温曲lal pl皿岛 4飞f MRI M辙。但回l}I， “f
whit虐 mat恒乌 77 U:”。句， 25 compression. 45b Middle cerebral. peduncle,
Intemukal channe!J, 58/ Iimbmov田nen跑回事Ile[阳1 Medic咀回国I nud凰跑回ronal rubro甲inal ttllCt, 83/
h但:m:ntl:icular 如11111阻， median innervation, 44/ 阻划。也 12骂f Middle aanial f嗣盹 50, 5可
姐6位al sedion, 121/ Umbiclob鸟 17-19, 19/ Medulla』 15耳 103/ Middle 企田血l gyro鸟 lawal a哩-r.
h阳晒恤ral d岛 71/ Umbic m也血， 154-16乳 158/-159/ b幽l ganglia connections, 22/ 127/
h阳阳也bra! fora皿ina U归缸回n, 33 CNS d四'e!o严E四I, 9/ Mi副le ma血geal ar恼， 12
h阳lll a哩回ct, 刀f u且皿匠’S 宦缸t. 73 coronal I础。鸟 场 u场 143耳 Middle tm!.poral gyI\11, la恒温I asp缸乌
apinal cor也 12-13 Lobe鸟田曲nlhe:mia肉Z鸭 159/ 127/
apinal Der咽骂 ω 127-128, 1331' m由呻inal tractl鸟 82/ Motor 由，Ila.
h缸缸:aeb姐l haematoma. 54b Locus coeru』e屿 ’7，’7/ donal a再阳I, 5邓 89/ bualga且glia connectim葛 22/
h缸缸理由但l haem血rrhqr,. “b 国JISWille 植:tion, 94/ donal 臼h1mm, 78/ corti<Xllpinal 国吗 82{, 86/
h缸回回也1 pl四U鸥 raixd, so串， S2f, Lowerla饵nl cu国旦回国 ner回 of major motor pa也W酬， 22/ 1阴阳 limb, 82/
67b arm. 43/ medi1111晤时阳tia也 1吁－11/ 四or motor pathway&, 22f
Inttafu回lmU1defibm』 36-37 I.ow町 Eβtor E且ll'Olle鸟 major motor ”rami尬， 20/ upper Ii皿b， “f
lltre缸h m量目匠’』 74 ”thw苟同L 21 rubroapinal 钮缸L 83/ Motor ccmial. ner鸭 majorm＇创m
lntr:apar:ie恒lmlmιlawal a哩回ct. Lumbar cord 刚回也a1amic 缸acts. 1jf pathwaya. 22f
127/ cortiα圃，回.al 国m, 82/ t£C徊，pinal 1lacl, 84/ Motor end-pla饵 ”1/-39/
Intrav田园.cular fora皿阻， 14-15, 15耳 n曲回回ml 田.ct, 83/ ventral a，叫 1呼11/ etlmnt neive ending冉 38
5吁， 5万， 5理f 咂nocer理：bdlar 恤也 81/ ventral 脏由＇rt, 91/ Motor lmllOlle diseasι 24-25,
CNS<lewl句mimt. 9f 币四也alamic 国血， 79/ V回咀.buloapinal tndl, 85/ 27b-28b, 74也 ll2b, 112{
median I咱也l 缸咀.DJI. ltf 回霉国b咀国回ml tractl也 85/ M臼hillaoblo鸣剧也 56/ Motor ＝咽Ile!』 4
lril. 150/ Lumbarmlar，固自II. 8Pinal.αml. brains也理， 15-16 Motor lmlI'Opl剧凰 74b
68, 70/ CNS de咽。pmart. 7-8 Motorpathw哥也 demlliltiou. 4
U皿barplam, ~ M田aner's cOlplLSde鸟 37/. 38 Motor Ullill, musd岛 36
J
Lu皿bar 严皿血且也 72b Mm!OIJ, neuramuscular diJe田己 30 Mu』世pie Kier咽，• 25, 3Sb, 781'
Jaw 如此 105-106, 1町f neurommcular diJeu巳 30 M回Dgel. 8-12. 12/ Mui甸回＇larneur田田， 钮， 33/
阳酬.arforam盹 50.，目f Lumboaaaal plai且也 42/ Mmirlgiom圃， 24 Musel巳 .36-.37, .36/
lesiom, 41b Mm画哥6ι 54b i皿自咽6锢， 38f

L 币皿i am!. 68 回国咱阳刀ccal 25 M四de 唰ndl圃， 36-37, 38/

Ia:均由也ln2 缸tecy, 62-63
Llcr:lmal gland. 107/
lambert-&ton syn企田E岛 3911
Lmg\皿ge azeaa
惶惶brlll hem.lapher略 137
E田1IOlll.田rular disease. 3口
k回埠， ddin槌Ort, 1f
La:恒mcor世α嚣F旭.al tract,. aplnal
困地 14/
la恒温！ a皿国也 nucleus,
Spino由世对Jar mw:t鸟 81/
L:ata温lmtmecn皿 n钮，e
of for田田， 43/
of由单1
comp1田aion, 4511
lumb国aaalplem鸟 42/
la值al fits田E
cerebral her血肉.ere也 17,
回归国l lectio鸟 17耳 130/-131/
h也ral a哩J«t. 127/
la但ral fu皿tW\11, 刷n.al col1111111, 72/
lataal gmimla能 nucleus, 1到－152
cermaJ. visual pal也睛， 152{
coronal Kdio马 131/
La:ta:al h田圃， apinal 睛也 13, 14/
la但rallemnila池 ”， 94/
回DSftIK I皿.on. 95/
la但ralm·目lullary h皿且也 αironal
眶怡咽， 122{, 130f
~ph。血，， 3Sbo Meningococcal mmillgi1i 25 ‘ 跑回d reflan. 74
Mmingomydoc:de. Sb MUICU!ar 句，回phiea,
24-25
M Merkdmdi鸣乱 37-38, 37/ Muaculomtan＇°＇皿 nerw.
41f
M四aαphalic nudeuι 106/ M归Jthmia ，而ι 25. 39b, 39f
Ma.cula h恒a, 151 M四"1ap~n Myd回αphalon
M唱netlc n?SOnan血恤咂ng(MRIJ, CNS cm哑。pm回t. 7 CNS developm曲也 7
出山omuscular dise植鸟 30, 四lyde耐。pm回L Sf early de9elopment, Sf
3日f Me阳回讪.alon Mydlnth幅血， perlph回:al nerv鸣 40/
Major ma田 padrw旬’比 CNS clmtlopment. 7 Myd响肉， 7'lb
neuromuscular dise画呜 27-28 酣lyde时opm凹t. 8f Myc削Onut, 149b
M司or semory pathw句也 M句er's loop, 152/ My。pathle岛 37奋， 37/
田田omUlallar dis国跑 27 Mia咽1且， 3ι，35 Myotome, 41
Mammil1ary body. 61/, 154/-156.f. MM m础Jlla. 91, 9年
163/ Midbraln, 1号’4 9ι95且 154/ N
coronal 植d盹 13日f bas.al gang!且∞皿配fions, 22/
medial 啤时旺lion, 120/ CNS d四odopmmt. 9/ Neoc自由ellum. 118, 118/
冒血:al asp叫 1叫 120/ “嚣回回h町’ion. Sf Na回回ding岛 37耳 38b
回回nl aed:ion, 91f 回首皿呻inal tr8'鸟 82/ 阳iph田I lleI回国币但m, 36
19/ Mamm诅n也血皿ic 国ct. 156/ CIUI~闹， 20f Neural g回饵 E且ll'al tube
M:aillary ner鸭 tramv四se ll«!io~』 dona! columm, 78/ deo时apment, S
67/ donal sedion, 89/ N田E回l fold晶 nmmltube
Med划， defi.皿lion. 1/ lawal a再回ct. 113/ d回d即mmι 5
Medialmtm回回 nei鸭 E咄钮’晤时缸tia也 10/-11/ N四inl g回鸭 IKUl'a! tuJ:自
。f缸回皿ψ 43/ paramedial 田gittal Kdi。n, 53/ de世opmmt 5
。fl咯 43/ n曲回叩in.al 恒缸'j, 83f New:田l也业陪
。f也楠， 43/ 刚110也血mic trac也 1jf affamt DeUIODeS, 7f
Medi.al forebmin bunclb巳 96/ rupe画m 皿血a:. 113/ alarplar.巳 1f
Medial piculate nud回路 U>7/ ~钮，pinal 1Jact. 84/ b臼al plat也 1/
Medial I回皿阻现 16f 回国酣睡眶略目t. 2/ d四d甸回回也 S, 6/
d现RI a>l旧皿a, 78, 78{ ventral a，自:t. 11吁llf trml'鸭囚IC KCtiOlll比 7f
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阳风 150 Saph回跚跚鸭 43/ lntem:r时灿I 缸am迦a. 12-13 conn.ectiona of; 144-145, 145b
Puplliary l抽t ref!画 102 ＆业lW直nn cella, 34 比能ral a哩蝇ct. 71/ Strok巳 24, 6411
Putamen, 19 Sdatlc nene, 4：写f lateral 00丽刷肉串1 位脯， 14/ Stylomutoid foramcn, ta7/
baaal ganglia. 144 刨翩翩， 70 lateral horn. 13, 14/ Subac:ule combln创 d句~由＇n,
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a>mnal S础。n, 12好－130/, 143耳 也rond-0rder neuron鸟 major lt.mOI)' relation血蝠， 69/ Subarai拙。id 吨圃屿 12, 1笃 54, 59/
146/-147且 159/ pal也回事菌， 主口， 21/ 制no幽幽llar traa电 13, 14/ aplnal 阳d, 71/
horizontal MIU, 132/ 也伊四创恤m苗。II, Ii曲 酬nott回皿le ttKI晦 13, 14/ aplnal meni鸣声鸟 泪，可
horizontal llet't归属 142/ IIIOftlDent也 “f ” 1pographlcal anatomy, 68, 6911 Subcortl.cal nude!. 写f
law温1 吨田r. 143/ 岛四蛐orimotor neuro阳出1鸥 国m四me aapect,. 72/ Subdural haematoma. 5411
阳amid(s), l町 her咀iwy,2 transftile 脏匾。m 叨 14/, 68耳 73/ Subdll皿 •pa画 12
brains能m, 16f Sensory atuia, 2&-29, 78fl vasculamre, 6口~l, 6111 aplnal mmi叫萨.， 7口
m缸国pina1 ttaa:鸟 阻－83, 82/, Sensory cona: !Olft:I' limb 回国al supply. 6日 S由h加.al 且llvary gland, l!Ylf
S电r doISal oolumru马 78f dlaorden』 60ll S由mandibular ganglion, l叼
deru盟国画面 at; .90, ” lf--92f ‘回且自由alamic U缸鸟 79/ ’回回国由副nag鸟 6~1 Submandibular aallvary gland. 107/
tmllllYax 阳:tion, 92/ Sensory cona: upper limb 回回啕阳L πf S埠现跑回 P,34
四曲回a aspect, 91/ doISal CD!UIIllll』 78f 四ntral ho!茧， 场 13, 14f Sub&tan也 gela也剧， spinal cord
dorul aspect, 90/ s回且自由a1amic u缸鸟 79/ white matt.町 72, 72且 77-84, 77耳 d。ma! horn, 73 74
h但ial aspect, 113f Sensory neuropa峙， pe:唰1eral, 41/ B口b Subaantia innominata, coronal
llpino由血皿ictrad马 79/ 也B回rypa由W可鸟 decuasation, 4 Spinal grey ma1b骂 72, 72耳 74b section, 130/
也由叩inal U盹 84/ Sensory R恒略>ton』 2 Spinal lemnilcwi Subst血也 nlgra. 103耳 1町
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wntral aspect, 110/ 回回al aedia也 129耳 159/ 回DSVale 画.pect,. 95/ E唔ona1 l。但lisation, 141f
V回咀，bulospinal tr缸饵 85/ Septum pelluddum, 56f Spinal meninges, 70, 7017 rubr曲”nal tra鸣 83/
即咀皿idal tmct, 90 coronal aedi1盹 1”f Spinal ner四岛 3, 12-13, 14／，“可， 也d嗣pina1 ti:割'J, 84/
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SerotoniJI,. 33-34 brachial p1mJ鸟 41f Subaantia Digra 严moompa血， 96f
R Short d且IY nenoe, 103/ 也strib曲回马 4ι-41, 43/ S曲曲血皿ic fudailus, corooal
缸gm回d sinus.
66/. 67 domal m皿U也 68/ section, 147/
Radial naw, 43/
bradrlal pl四且也 41f MRI a晤吨呻｝事 “f domal z回电 68/ Sublhalamic nuda国
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6711
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Rami rommunian闰 47,4万
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middle aanial f回跑 50 vmtral m皿田， 68/ S哩阻击dal 1111创le cerebral 回JI,, 65,
corona1 sectio鸟 131/
dor回 column鸟 78/
P田t.erior 口:anial foaa. so V回国l root, 68／. ηf “ f
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rub~帽；pinaJ ttac也 83/
spine也alamic 回d鸟 79/
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Sneae rdla. 106/ 11am: reflex. 76, 76/ 43f

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100. 103/-10矿 Spinal 回砾。f时，回且al, 105 S吨用ior illlalltomotic 回n. 66/
Rd面也d p血唱 80/
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11.eati且E tumaw;. 149b
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11.dia血z adi＇呗硝rig 8'ltem.96
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Rdimlar fomiation. 89, 96-97
Sp田tic parapa鹰，也 h.eredita哼， 眼nal CD时， 13,
14/ 89-90
111111町回田，«tioD. 94/
24-25, 8311 圆圆酣睡’ection. 92/ 出nal aape吼 叫
Rdia血z nucmi., 117/
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123 Spinomirulo由.alamic 町，tan, lateral 回pei:丸 ll3/
corona1 lledi.011. 122/
S抖ienoid air 血u民 67[ 79-80 sp恒田zrebellar 恒温ctB, 8口
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Jived'• laminaι 73/
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d跚跚也鸣田幽 13, 77/ Spiral gangli饵， 107/ 值:roapinal ma. 83-84
d晒al 嗣庐岖， 14/ 句回ndylosi鸟 24, 70b tiamlvene I咄咄 95/, 102耳 145/
剧与 d回dopm皿L 8/
doISal rolum盹 13, 14/, 77 7也 Sttaight Ii皿鸟 67 S吨Jerior企DDW gyms』 h恒国画pee!,
四gidltJ. 29
78/ M虹 angj咿苟曲， 66/ 127f
Romberg'• eig比 28-29,78fl
4值姐 h也n. 7/. 13, 14/. 72/ 73/, S回忆h relae:鸟 7←76, 75/ Superior olivary nudew』 1D'lf
E剧也al. definition, If
73-74 a阻fusal muscle films, 74 5吨田ioror也ital 缸”re, Slf
R剧能al m础ill.a, ’＇1-93.，’写f
dor副 root g;mglion. 7/. 12-13, m国且皿d m\llde fibres, 74 mi剧le 口回.alfou也 so
酬，1血泪由e1lar 也回再 81/
14/ musdea严:ndle也 74 S哩田ior sagi幽l 画nu岛 5额 66f, 61
Rllbr1国内al ma, 83, 83/
咀Iiy ckwlopm＇钮t. 8/ S1Iia medullari鸟 <Drooal 旺tion, MRI angiogra肉， 叫
Ruffi皿 ner回四dings, 37/
effeRirt nairoue也 1/ 122/ 归m且gi国I Kdion, 13/
s emmal featw:田， 68-10
fasc:iculUI CUD田1ua, 13
S国阳回皿alil. donal 缸由也 123/
S回ae medullllris thalar皿 56f
tt:lll町田曾阻:tion,59/
S唱团ior saliv回my nucleus, 107/
S码，忧al, ddin掘。n, 主 fuciculUI gr回IQ, 13 也lldvmtrid巳 SS S唱团or temporal gyI111,. 19/. l<Y1/
S咿.ual sinue. inferior. 65-67 grey matm:. 72-74, 72耳 74.11 S缸iatal afferent肌 144 h饱司副p盹 127/
Superiorv回回1岛四严函。z 皿E鱼岛
113/
Supplementary motm cotter. 136
缸.pndllasmatic nude略 154/, 157
Supra。ptlc nude:ua, 155/
也Ia! neive, 43/
Si.呻回曲·ryll萨m皿I, 150, 15口f
“all阳恤g refta, 110/
句d皿ham’a chorea, 14'Jb
句mpa也etic nervous ’ ”an, 3-4,
47-48, 47/
leaiona,. 41111
。电.mu咀on, 47/
刚na1 nerve in回action, 48/
句E碍’盹 2, 3f
dendrodmchi咀乌 33
句E叩世cveaide鸟 3,3/
句11COpt』 po血E划， 4811
句由四E饵”elia』 24, 7Slb
句由回鸟 24
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1油田 d。·nalia.71111
'lee虫嚣p迦al 缸act.83-34, 84f
'lqmelltum. 93
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CNS de叫opment. 7
由市 de咽。p皿臼t. 8/
'lauporal lobe, 17-19, 1C町， 137,
137b
田dimlhci:皿叨•hera. 17/-l8f
回回nal 田di.Oil. 129.f. 131/
'lauporal pol~ 四pei:叫s阳回l a耀自ct.
133/
'Ibnpompontine fib~惠国跚酣睡
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Tundon~组回鹰’＇ 75&
1阳刚um 帽由ellι ι口， 52..
”ilalD“w 制glttal llttdon, 53/
阳”唰阳I 阳!km, 13/
Turin监al bouton, 3/
Tul:minology, 2
ThaWnlc faad臼』lu鸟 oor四nal.缸划。·n.
147/
η1i1Wnlc nuclei，缸且.ctl.onal
。r职剑.tatlon of, 123-126,
125/
贸1ll1amo，回atal pro如al.Oil, 144
贸回幽幽刨跑回血， 吼叫
咀边跑回＇ 15.f. 56／臼f. 65/ . ’17/.
120-126, J54f
anatomy o£ 1211.>
air回tor nuclear gmup, 125, 126!1
CNSd四'e!opment, 7--8, ’f
coronalι岱r. 132/
ammaJ. sectlo鸟 17/-18/,
130/-131耳 143/
diencephakm, 16
do!Ml aspect of, 8'J/
do!Mlcolumn鸟 78f
a但na1 』run:鸟 111, l组f,
horimnt.111 MRL 132f do!Ml aφeel:, '°' V曲时 tψm创 area. 96/
horimntlll l«li·。·ll. 132f l幽1。” of; l!创b Ventral t嗨m回国I d缸盟幽幽咀恤，
iDkrnal 0电阻画画。Q, 1组， 122{. 国皿帽酷四皿＇ 67/ rubmsplnal tract, 83
124/125/ Tmdllearn回叫 101/ Ventral whl怯 annm!J1W1鸟
in缸对amlnarnude也 126, 126tl tranl'帽neaa1院副t, 95/ splnothalamic阳峪 吼叫
h回咀呻吼 143/ ~clner咽Jm. 154-155 Ven创atlar m能m. 55-58
later咀 g回llwla监 nucleua, 123 ventral 曲”¢ 120/ cerebroeplnal E创d. 8
later世 nuclear group, 123 125, CNS d回elopment, 8
124/ u 缸咂>0graphlcal 皿aton亨， 55-57,
自』nctlonal 0咿剑M曲。n of, 125b 55/ 56/, 5711
lesions, l 23& Ulnar nerw, 43/ Ventromedlal nudew, 154/, 157
medial genlculate nudeu1比 123 k温.chial ple:n比 41/ Veru:bra, S酬。回归回属 耐
m “ ial nud国E gro哩，， 125-126, rompre11ion, 45'1 Vertebral ar町， 61问额 62
126'1 UllQI鸟 163/ 四gi唱m醉，， 64/
median 植giual 盹clion, 1C萨ll/ m£dim 国gittal 坦回国田， 128{ MRI angiography., “f
motor nuclei, 22f Un由凰”咀a能d nerve 四dinp, Vertebral bo句
严ram国直d s唔ttal section, 53/ 37-38,3万 h恒rala串缸乌 πf
E唔onal 10<2lisation, 14lf Upper la恒坦le血n回国 neme of 甲h鸟 68/
民盟aiLunud回蝠， 126, 126" ann, 43f Vertebral column
spinothala皿ic tia凰 ”f Upper motor neuron鹤 majorm创or donal asped, 12/
surgical tr回国四t, t24b P也由way鸟 11 MRI, 69/
M萨布aphical anatomy of, 111 spinal ner晤时a:tion血’， 69/
anterior nucleu鸟 124
回回al h位mlnw:leu品 12←125
v Vestibular nw:l阻， 'J3
brainalml, 16/
~白al p咽饱im: nu.clew』 123 V郁， Dave 99{. 109-111，皿f 国jormotm 归由W可s, 21-22
布irdvmtrid巳 1←15, lSf. SS, Veim 咽，由ulospiDal t缸饵 84
SSf-S6f. S8f-SS1f. 6Sf antmw: mdicular m且， 60 弛，目.bul国:ochlear nerw, 99耳 109
cmonal 田dion, 1切 130{ m恒血E 酬na1 回且， 日》－61, 60f 扭曲tory component of, 1!08f
毡ird-order neuroue 20, 21/ m饵rolateral m且， 60-61 V国tibulospiml trad也 84, SS/
Thoracic co时， S抖nocm时larttad:也 brain. 65-67, 66/-67{. 67b VJial encq>hal副... 2S
8lf choroidal v回血， 65, 65/ Visual am, l SO{. 1 Sl
'lbromb饵iι 24 d即 ~bralw皿 65 明aual corta. 19
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Tia, 149& inferim: 回S阳l 回凰， 66f Visual fidd dmci钮， 15311, 153/
2曲目血巳 12{ intemal. 回diral win. 65, 65/ 啊，uahy，使m. 1日如152
Tnctotor町， 79b 面阳nal 归思Jlar回Eψ 66/. 67 cen·国l世.lllll!pa也.way. 151-152.
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1'ranUl'lff pontine fibr四 ” 严llWior 1pinal mm. 60-61, “f 句同巳 150-151
Tran肝1!lff proc:e田，，pine 68/ 严刚erolateral eplnal vein. 60{ retina. 151
S'J/ 1'rana'1回ff tillua, 59/ . “if,67 萨MW<>la饵”1回拍马 60-61 Viau09p9tial dilorie:ntatio11. 30
MRI anglogr田.phy. 66f 制』pedidal middle Cf!f喧bral 唰且， Visu饵庐山l 缸且.dion. neurom·国cu1ar
Transv回ff tanpoml gyri. 65, 66/ cliKaK. 30
剧院rola~田l 呵脏t. 133f ” perlor an翩。motic 叫n, 66/ Vitr回Ul~ l50
’fr苟蜡四id b田坊， 93, 107/. 1!09 四periorα四bra! v世11$, 65
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Venous slm且ft!, 67
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Tri醉mlnal ner胃｛cmnlal nerve V] , 阻曲也 lllf White matter, 4
6筝， '!J9f, 103-107, 103/, 105/ Vemnlcod咀瞄 nud幽 lJrlf 四ftbr:a.l hemla伴随鸣 137-140,
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m司町阻四ryp血晒JI, 21/ Ventral （皿阳ior) horns, spinal 困地 曲ronal 幽幽也 5/
tran前幢幢帽埠。＞Q, 94/ 7/. 13 11plnal cord. 77-84, 7布 so&
币lgE姐姐.al te11aory nud咽地 99-100, V四tml median 矗皿山码 spinal rord,
l!Olf. 106/
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2lf
Trod咀国r nerve (cranl.al neiv世町，
Vemnlrc刚
of lit 咀嚼alner鸭 'J'Jf
z
123/ 甜，划， 1!02, 103f 11叫 spinal ner四岛 68耳 69, 71/ Zona in回也 coronal ，回on, 122/