3.
DEVELOPMENTAL OVERVIEW OF CENTRAL
NEUROANATOMY
THE TUBE WITHIN THE BRAIN
PRIMARY AND SECONDARY NEURULATION FORM THE
NEURAL TUBE
DESCRIBE PRIMARY NEURILATION
WHEN IS NEURAL TUBE CLOSURE COMPLETE?
WHAT HAPPENS AFTER PRIMARY NEURILATION?
Neural tube closure, termed primary neurulation,
starts at the junction of the hindbrain and the spinal
cord, a site in the future neck, and proceeds in both
directions.
When the neural tube between the anterior and
posterior neuropores is closed, usually around day
28, neural tube closure is complete.
Subsequent to primary neurulation, secondary
neurulation leads to the formation of the caudal
portion of the sacral spinal cord. The end result of
primary and secondary neurulation is a long tube of
cells destined to be central neurons and glia
surrounding a central ventricle
Figure 31 A: During the third week of gestation, the
dorsal ectoderm forms the neural plate anterior to
the node (dark circle). By the end of the third week,
the neural plate has invaginated to make a neural
fold, which then closes up to form a neural tube.
Neural tube closure proceeds both rostrally and
caudally from a
starting point near the location of the future neck.
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A FAILURE OF THE NEURAL TUBE TO CLOSE IS A COMMON
BIRTH DEFECT
NAME 3 NTD’S (NEURAL TUBE DEFECTS) ASSOCIATED
WITH FAILURE OF NEURONAL TUBE CLOSURE?
WHAT TWO OTHER DEFECTS OR ANORMALITIES ARE
COMMON WITH SPINAL BIFIDA?
WHAT BIRTH DEFECTS OCCUR AFTER NEURILATION?
INCREASED CONSUMPTION OF NON SUPPLEMENTED
FOOD WILL HAVE WHAT EFFECT ON NTD’S
WHAT PERCENTAGE OF NTD’S ARE NOT SENSITIVE TO
FOLATE?
THE NEURAL TUBE GROWS, BULGES, AND CONTRACTS TO
FORM THE FIVE MAJOR DIVISIONS OF THE CNS
DESCRIBE THE EMBRYONIC BRAIN POST NEURILATION
Two openings, the anterior and posterior
neuropores, are the last areas of the neural tube to
close. Failure to initiate closure results in
craniorachischisis, whereas failure of the anterior or
posterior neuropores to close results in exencephaly
or spina bifida, respectively. B: Crosssectional views
of neuroectoderm are diagrammed from a stage
after neural plate formation through to neural tube
fusion. C: After neural tube closure, the overlying
ectoderm separates from the neural tube. In the
region of the spinal cord, bone and muscle invade
the space between nervous tissue and the skin.
EXENCEPHALY  ANENCEPHALY
CRANIORACHISCHISIS
OPEN SPINA BIFIDA
Indeed, individuals with open spina bifida often have
an abnormality termed Chiari malformation in which
the cerebellum herniates out of the foramen
magnum and into the spinal canal. They may also
suffer from hydrocephalus,
ENCEPHALOCELE – MENINGEAL SAC ATTACHED TO
CRANIUM, MAY CONTAIN ONLY MENINGES OR
BRAIN TISSUE AS WELL
SPINA BIFIDA OCCULTA – VERTREBRAL BONES AT
MID SACRAL LEVEL ARE ABNORMAL – TYPICALLY
ASYMPTOMATIC
THE INCIDENCE MAY RISE SINCE MOST GRAIN
PRODUCTS ARE SUPPLEMENTED WITH FOLIC ACID.
NOT NECESSARILY GLUTEN FREE ONES.
30%
Postneurulation, the neural tube reaches from a
caudal point that will eventually become the conus
medullaris, or caudal end of the spinal cord, rostrally
to the lamina terminalis, the rostral end of the
neural tube (Fig. 32). The lamina terminalis, at the
very front of the neural tube on day 28 ends up
located deep within the adult human brain.
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INTERPRET THIS DIAGRAM:
THE THREE BULGES OR VESCICLES OF THE NEURONAL
TUBE AT THE END OF THE 4TH GESTATIONAL WEEK ARE
THE:
WHAT HAPPENS AT THE FIFTH WEEK OF GESTATION?
WHERE DID THE LAMINAE TERMINALIS GO?
Figure 32 Immediately after neural tube closure, the
embryonic central nervous system (middle) consists
of the developing spinal cord and three vesicles that
will comprise the adult brain. Almost all of the
neural tube is formed by primary neurulation
(stippled area marked 1°). Secondary neurulation
(2°) forms the spinal cord from midsacral levels to
the conus medullaris, the caudal tip of the spinal
cord. The rostral end of the neural tube, the lamina
terminalis (*), ends up at a site that is buried deep
within the adult brain (left From a posterior view
and right from a side view). The junction between
the developing spinal cord and brain is the
spinomedullary junction. Note that drawings are
schematic and not to scale.
The three vesicles destined to become the brain are,
from front to back:
• Prosencephalon, which will develop into the
forebrain
• Mesencephalon, which will develop into the
midbrain
• Rhombencephalon, which will develop into the
hindbrain
At about the fifth week of gestation, the
prosencephalon divides into the telencephalon and
the diencephalon (Fig. 33B). Almost immediately
after forming, the single telencephalic vesicle
invaginates at the midline to become two
telencephalic hemispheres. Since the points of
attachment for the hemispheres are off the midline,
the lamina terminalis, representing the front end
of the neural tube, is now located at the front end of
the diencephalon (Fig. 3 3C).
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IN THE ADULT, WHAT ENCOMPRISES THE
TELENCEPHALONIC STRUCTURES?
IN THE ADULT BRAIN WHAT ARE THE DIENCEPHALIC
STRUCTURES?
EXPLAIN THE MESENCEPHALIC AND
RHOMBENCEPHALIC STRUCTURES IN THE ADULT
BRAIN.
IN SUMMARY, BY THE END OF THE FIFTH WEEK, THE
EMBRYONIC HUMAN BRAIN CONTAINS
FOUR VESICLES. FROM ROSTRAL TO CAUDAL:
THE TERRITORY ALLOTTED TO THE DORSAL
TELENCEPHALON IS GREATLY EXPANDED IN THE HUMAN
WHAT DISRUPTS THE ORDERLY CELLULAR
ARRANGEMENT IN THE HUMAN UP TO THIS POINT IN
TERM OF NEURONAL DEVELOPMENT
Figure 33 In the three vesicle stage of neural
development, the embryonic brain (A) consists of
the prosencephalon (P), mesencephalon (M), and
rhombencephalon (R). B: The prosencephalon
divides into a caudally located diencephalon (D) and
rostrally situated telencephalon (T), which together
with the mesencephalon and rhombencephalon,
comprise the fourvesicle stage. C: The single
telencephalic vesicle invaginates along the midline
to form the laterally displaced left (Tl) and right (Tr)
cerebral hemispheres. The rostral end of the neural
tube, the lamina terminalis (* in A and C), ends up
deep within the adult brain. From the diencephalon
emerges the optic vesicle (ov), which will develop
into the optic nerve and retina. The derivatives of
the telencephalon, diencephalon, mesencephalon,
and rhombencephalon are listed.
In the adult, the telencephalon includes both
hemispheres of cerebral cortex, the core
components of the basal ganglia, and the amygdala.
The diencephalon
contains the thalamus and hypothalamus.
The mesencephalon develops into the adult
midbrain, and the rhombencephalon develops into
the adult pons, medulla, and cerebellum (Fig. 33C).
The anterior third or so of the rhombencephalon
gives rise to the pons and cerebellum, whereas the
posterior portion develops into the medulla.
• Telencephalon ≈ cerebral cortex, basal ganglia,
amygdala
• Diencephalon ≈ thalamus, hypothalamus + retina
and optic nerves
• Mesencephalon = midbrain
• Rhombencephalon = hindbrain = pons, medulla,
and cerebellum
The spinal cord and the four regions of the brain
comprise the five divisions of the adult CNS.
THE NEED FOR A MASSIVE CORTICAL VOLUME 
TELENCEPHALIC EXPANSION.
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FROM THE DEVELOPMENT OF THE TELENCEPHALON
(CEREBRAL CORTEX) HOW IS IT CONNECTED TO THE
TOP OF THE DIENCEPHALON OR MIDBRAIN?
SO WHAT IS THE BIG DEAL WITH THE VELUM
INTERPOSITUM? WHERE IS IT ? WHAT IS IT?
WHAT IS THE CEREBRAL CORTEX?
Figure 35 In the human, the cerebral cortex is
greatly expanded. A–B: Topdown (A) and side (B)
views illustrate the expansion of embryonic dorsal
telencephalic tissue from its point of attachment to
the diencephalon at the lamina terminalis (red star).
The dorsal telencephalon extends in all directions
until it
covers the diencephalon and mesencephalon
completely and also reaches the midline.
Temporalization, the expansion of cerebral cortex to
form a temporal lobe allows for more neural tissue
devoted to language,
face recognition, and factual memory. C–D: When
viewed from the midsagittal plane (see Fig. 13), the
frontal lobe remains connected to the diencephalon
at the lamina terminalis. In both the embryonic (C)
and adult brains (D), the parietal lobe sits atop the
diencephalon from which it is separated by the
velum
interpositum (red hatching). In the adult brain (D),
the visible derivatives of the diencephalic vesicle are
the thalamus (Dt) and hypothalamus (Dh). The
mesencephalic vesicle becomes the midbrain (M),
and the rhombencephalic vesicle gives rise to the
medulla (Rm), pons (Rp), cerebellar vermis (Rcv),
and cerebellar
lobes or hemispheres (Rcl)
In other words, there is no cellular bridge between
the bottom of the cerebral cortex and the top of the
diencephalon or midbrain (Fig. 35C, D).
This space is outside of the brain even though it is
located deep within the cranium! This region or
cavity, termed the velum interpositum, lies above
the roof of the diencephalon and rostral midbrain
(Fig. 35C). The velum interpositum houses large
blood vessels including the internal cerebral veins,
as well as the (nonneural) pineal gland. Most
importantly for the purpose of this chapter, if you
can visualize that the velum interpositum is a space
outside of the brain, even though it is located deep
inside of the brain, then you have conquered the
most difficult part of neuroanatomy.
The cerebral cortex is a thin sheet of laminated cells
comprising only the outer few millimeters of tissue
(Fig. 36). Cortex comes from the Latin word for
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EMBRYOLOGICALLY WHAT DEVELOPS FROM THE
VENTRAL AND DORSAL TELENCEPHALONIC
STRUCTURES?
WHAT IS THE PURPOSE OF GYRIFICATION?
THE LUMEN OF THE NEURAL TUBE DEVELOPS INTO THE
ADULT VENTRICULAR SYSTEM
“bark.” Indeed cerebral cortex forms the outer rind
of telencephalic tissue.
Embryologically, the cerebral cortex develops from
the dorsal portion of the telencephalic vesicle (Fig.
36A).
Embryologically, the cerebral cortex develops from
the dorsal portion of the telencephalic vesicle (Fig.
36A).
The ventral telencephalon gives rise to two
ganglionic eminences, which will develop into the
subcortical striatum, globus pallidus, and amygdala
in the adult.
Figure 36 Cortex is a laminated neuronal structure
(inset) on the surface of the brain that arises from
the dorsal part of the telencephalic vesicle (A).
Structures deep to the cortex, termed subcortical,
arise from a pair of ganglionic eminences in the
ventral telencephalic vesicle. B1: The cerebral cortex
forms a mantle or rind on the surface of the cerebral
hemispheres. Subcortical structures (white asterisks)
are present deep to the cerebral cortex (white
arrows). Most of the cerebrum is covered by six-
layered neocortex (B2). The hippocampus,
sometimes called archicortex, has three layers (B2).
B–C: The surface area of the cerebral cortex is
greatly increased by the Sylvian fissure and by
gyrification, which produces sulci (yellow) and gyri
(blue). The central sulcus runs from the dorsal
midline to the Sylvian fissure and divides the
precentral
gyrus in the frontal lobe from the postcentral gyrus
in the parietal lobe. Most of the cerebral cortex is
deep within the sulci rather than decorating the
surface of the brain. Photographs in B1, B2, and C
are reprinted by permission of deArmond S et al.,
Structure of the human brain: A photographic atlas.
New York:
Oxford University Press, 1989.
gyrification, which is extensive in many mammals
including humans, greatly increases the surface area
of the cortex. In the human, only about a third of
the cerebral cortex is exposed on the outer surface,
with the remainder buried within the sulci (Fig. 36B,
C).
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Figure 37 The embryonic lumen of the neural tube
becomes the adult ventricular system. A: A
midsagittal
view of the embryonic brain shows the lumen of the
neural tube lined by proliferating cells.

B: The embryonic lumen begins simply and remains

fundamentally simple in the fully developed brain.

C: A cartoon of the ventricular system, viewed from

above, shows the adult fate of the lumen at each
level of the embryonic neural tube. The lumen of
the embryonic spinal cord becomes the central
canal (cc), which is not patent in the adult mammal.
The lumen of the rhombencephalon becomes the
fourth ventricle (IV) and that of the mesencephalon
becomes the narrow cerebral aqueduct (ca). The
lumen of the diencephalon becomes the third
ventricle (III), and the lumen in each adult
telencephalic hemisphere is a lateral ventricle (lv),
connected to the third ventricle by the foramen of
Monro (fM). In humans, the lateral ventricle is
greatly expanded to accommodate the extensive
cerebral cortex and stretches rostrally into the
frontal lobe (frontal horn), caudally into the occipital
lobe (occipital horn), and also curves around into
the temporal lobe (temporal horn). The atrium is
situated at the intersection of the parietal, occipital,
and temporal portions of the lateral ventricle.

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 D–H: Transverse cartoons (left) through the
embryonic spinal cord (D), hindbrain (E), midbrain
(F), diencephalon (G, H), and telencephalon (H) are
arranged next to photomicrographs of brain slices
from the same regions in the adult (right). The
central lumen (red stipple; red asterisk in D) at every
level of the neuraxis is marked. Note that the brain
slices in D–G are stained for myelin so that white
matter is dark and gray matter is light; the slice in H
is unstained. Although the lumen adopts different
shapes, it is located on the midline in the spinal
cord, hindbrain, midbrain, and diencephalon.
However, the
telencephalic hemispheres are located lateral to the
diencephalon, and, consequently, the lumen divides
and
courses laterally into each telencephalic
hemisphere. The narrow foramina of Monro (fM)
connect the lumen of the diencephalon to the
lumen of each telencephalic hemisphere.

HOW IS CSF FORMED? CSF is essentially blood that has been filtered
through choroid epithelium, a specialized type of
cuboidal epithelium located at specific spots in the
ventricular system. Blood is delivered to the choroid
epithelium from a rich supply of capillaries in the
pia. Choroid epithelium, capillaries, and pia are
tightly invested tissues that comprise the choroid
plexus (Fig. 38A).

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Figure 38 A: The choroid plexus is comprised of
outpouchings of vascularized pia lined with choroid
epithelium. Choroid epithelial cells have small
protuberances called microvilli on their apical
surface. Due to hydrostatic pressure, blood from the
capillaries of the pia traverses the basal lamina and
is filtered by the choroid epithelium to produce
cerebrospinal fluid (CSF). The outside of the brain is
located on the pial side of choroid plexus, and the
ventricle is located on the choroidal side
B: Choroid plexus develops in specific
areas of the developing neural tube (red lines)

C–F: The choroid plexus (white arrowheads) is

always located at the border between a ventricular
space and a region that is outside of the pia and
thus outside of the brain. In the hindbrain, arteries
enter into the space between the cerebellum above
and the pons and
medulla below.

It is worth remembering that the choroid plexus

lining the lateral ventricle is
actually sandwiched between the ventricle and the
outside of the brain. This arrangement can be
visualized as the choroid plexus wraps around the
inside of the ram’s horn shape of the hemispheres.

Page 9 of 15
WHERE IN THE BRAIN WILL YOU NEVER FIND CHOROID
PLEXUS?
WHAT DOES THE VELUM INTERPOSITUM HAVE TO DO
WITH THE LOCATION OF CHOROID PLEXUS?
Since choroid plexus must border on the periphery,
it is not present in either the central canal or the
cerebral aqueduct, both of which are tubes
surrounded on all sides by parenchyma.
For example, the third ventricle is surrounded by
parenchyma everywhere except along the roof of
the diencephalon. Recall that the velum
interpositum sits in the space above the
diencephalon and below the telencephalic
hemispheres. Capillaries arising from blood vessels
in the velum interpositum dive down into the roof of
the third ventricle, are invested in choroidal
epithelium, and form the third ventricle’s
complement of choroid plexus. Thus, choroid plexus
is present in the roof of the
third ventricle but not along its sides or floor.
Figure 310 A: The cerebellum develops from the
rhombic lip, located in the anterior portion of the
rhombencephalic vesicle. B: The cerebellum grows
caudally back from the rhombic lip, eventually coveri
most of the medulla as well as all of the pons in the
adult (D). C: The cerebellum is attached to the
hindbrain only through the cerebellar peduncles.
Photographs in C–D kindly provided by Peter Pytel,
MD, University of Chicago.

FROM AN ORDERLY NEURAL TUBE TO THE ADULT HUMAN

BRAIN
THE FIBER TRACTS THAT JOIN THE TELENCEPHALIC • Corpus callosum: A large fiber bundle containing
HEMISPHERES AND THE TELENCEPHALIC HEMISPHERES connections between cortical
ARE: neurons in the left and right cerebral hemispheres
• Internal capsule: Two large fiber bundles
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 containing axons descending from the cerebral
cortex that traverse the space between the cerebral
hemispheres and
the diencephalon, and, in so doing, form a physical
connection

Figure 311 The corpus callosum and internal capsule are two major tracts that alter the layout of the brain.
The corpus callosum is the major commissural tract that carries axons linking the two cerebral hemispheres and
the internal capsule forms a physical join between each cerebral hemisphere and the thalamus. A: A
coronal section through the brain shows both major tracts. B: A topdown cartoon shows the corpus
callosum joining the two hemispheres. The internal capsule runs between the lateral edge of the
diencephalon and the medial edge of each cerebral hemisphere. From the topdown perspective, the axons
of the internal capsule run in and out of the page and are therefore depicted as transversely cut. C: A coronal
cartoon through the brain (at the level indicated by the dotted arrow) shows that the velum interpositum (vi)
is situated between the corpus callosum and the roof of the diencephalon. The internal capsule runs through
the subcortical portion of the telencephalon (stippled area) and outlines the lateral edge of the
diencephalon. D–E: Horizontal (D) and sagittal (E) sections through the brain show the internal capsule
running between the diencephalon (D) and the subcortical structures (white asterisks) of the telencephalon
(T). Abbreviations: corpus callosum, cc; internal capsule, ic; lateral ventricle, lv. Photographs in A, D, and
E kindly provided by Peter Pytel, MD, University of Chicago.
WHAT CONNECTS THE TELENCEPHALON TO THE In fact, beyond the small attachments surrounding
DIENCEPHALON? the foramina of Monro, the internal capsules are
theonly connection between the telencephalon and
diencephalon. Thus, cutting the internal capsule on
either side allows the telencephalic cap to be
removed from the underlying diencephalon and
brainstem.

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THE CORPUS CALLOSUM CONNECTS THE LEFT AND RIGHT
CEREBRAL HEMISPHERES
WHICH HEMISPHERE IS OFTEN RESPONSIBLE FOR
CONFABULATION?
NAME EXAMPLES OF INTERHEMISPHERIC AND
INTRAHEMISPHERIC COMMUNICATION
DEVELOPMENTAL TERRITORIES CONFER A BASIC
FUNCTIONAL ORGANIZATION TO THE BRAIN AND SPINAL
CORD
The left hemisphere interpreter is not
bound by truth and, in fact, is often responsible for
confabulation
1. CORPUS CALLOSUM
2. HIPPOCAMPAL COMMISURE
3. ANTERIOR COMMISURES
4. OPTIC CHIASM
5. POSTERIRO COMMISURE OF THE MIDBRAIN
6. ANTERIOR WHITE COMMISURE OF THE
SPINAL CANAL
Figure 312 In the spinal cord (A), a distinct inflection
point, the sulcus limitans, separates the alar plate,
destined to give rise to neurons that receive input
from primary sensory afferents, from the basal plate
that gives rise to motoneurons, autonomic motor
neurons, and motor interneurons. In the hindbrain
In the hindbrain (B), the sulcus limitans (arrowhead)
again separates cells destined for a sensory role
from those destined to become motorrelated. Cells
in the rhombic lip give rise to the cerebellum and to
hindbrain nuclei that provide direct input to the
cerebellum (preCb).
The only difference is that, because of the opening
of the fourth ventricle, dorsal within the spinal cord
corresponds to lateral in the hindbrain, and ventral
in the spinal cord corresponds to medial in the
hindbrain. Thus,
brainstem cells with a sensory function are lateral,
rather than dorsal, to cells with a motor function.
In the diencephalon (C), the hypothalamic sulcus
separates the territories of cells destined to become
hypothalamus and thalamus.
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 In each telencephalic hemisphere (D), the thin rind
of the dorsal telencephalon becomes the cerebral
cortex, whereas the lateral and medial ganglionic
eminences (lge, mge) develop into the striatum,
pallidum, and portions of the amygdala.

DEVELOPMENT CONTINUES POSTNATALLY

A DEVELOPMENTALLY INSPIRED VIEW OF ADULT BRAIN
ANATOMY

Figure 313 A developmentally inspired cartoon of the human brain and spinal cord (sc). For illustrative
purposes, the left (Tl) and right (Tr) telencephalic hemispheres are shown unconnected to the diencephalon
(D) and the rhombencephalic cerebellum (Rc) is filleted down the middle and splayed out. The brainstem
consists of the hindbrain and the midbrain (M). The adult derivatives of the rhombencephalon include the
pons (Rp), medulla (Rm), and cerebellum (Rc). B: The sources and modalities of sensory inputs to the spinal
cord, hindbrain, diencephalon, and telencephalon are illustrated on the left. The skeletal muscle targets of
motoneurons in the spinal cord, hindbrain, and midbrain are illustrated on the right. C: The autonomic
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targets of autonomic preganglionic neurons in the spinal cord, hindbrain, and midbrain are illustrated. D: A
nonexhaustive catalog of abstract functions served by the telencephalon is listed on the left. As illustrated
on the right, damage to different levels of the neuraxis impacts an individual’s sense of self to varying
degrees. The chance for improvement following injury also varies with the level of damage.
MAPPING FUNCTIONS ONTO THE SPINAL CORD,
BRAINSTEM, AND FOREBRAIN
SENSORY INPUT TO THE SPINAL CORD:
SENSORY INPUT OF THE BRAINSTEM
SENSORY INPUT OF THE MIDBRAIN
SENSORY INPUTS THAT ENTER THE FOREBRAIN
WHERE MUST SENSORY INPUTS GO, OR REACH TO
ACHIEVE PERCEPTION?
SPINE’S RESPONSIBILITY FOR MOVEMENT?
BRAINSTEM MOVEMENT CONTROL?
The spinal cord receives all the somatosensory input
from the body and a great portion of the
viscerosensory input from deeper structures. This
input arrives via spinal nerves. Spinal cord or nerve
damage can impair the perception of touch,
vibration, temperature, pain, and the position of the
body from the legs, trunk, arms, neck, and back of
the head.
The brainstem receives a wide variety of sensory
input via cranial nerves:
• Somatosensory input from the face, oral cavity,
and anterior fossa
• Viscerosensory input from viscera above the
hindgut
• Special sensory inputs from the inner ear, which
supports hearing and the vestibular sense
• Special sensory input from the oral and pharyngeal
cavities that support taste
All of the sensory input received by the brainstem
enters into the hindbrain
The midbrain does not receive any sensory input
VISION AND OLFACTION Optical information from
the retina arrives in the diencephalon, and
information about odorants enters the telencephalic
olfactory bulbs
Thus, sensory inputs must reach the neocortex for
perception to occur.
Movements of the body, from the shoulders down,
depend on spinal motoneurons and spinal nerves.
Movements controlled by brainstem, motoneurons
and cranial nerves include:
• Shrugging and shaking the head in a “No” gesture
• Tongue movements important in chewing and
speaking
• Movements of the upper airway musculature
important to swallowing, speaking, coughing, and
the like
• Facial expression
• Movements of the eyes to enable gaze control
• Jaw movements used in chewing
Page 14 of 15
HOW DOES CNS DAMAGE AFFECT MOTOR
MOVEMENT?
HOW DOES THE FOREBRAIN AFFECT HOMEOSTASIS?
HOW DO THE SPINAL CORD AND BRAINSTEM
INFLUENCE HOMESOTASIS?
Thus, damage to the CNS impacts movements that
depend on motoneurons leaving the CNS from
points caudal to the site of damage. Yet, all volitional
actions are initiated by neocortex. Thus, voluntary
motor control of any part of the head or body may
be affected by forebrain damage.
The forebrain, specifically the diencephalic
hypothalamus, controls the pituitary gland from
which a wide variety of hormones is secreted.
Pituitary hormones play critical roles in growth, fluid
and electrolyte balance, thermoregulation,
metabolism, mating and reproduction, and arousal
evoked by stress. The hypothalamus is also
important in setting the circadian rhythm through its
influence on both the pituitary and pineal glands
Brainstem and spinal cord contributions to
autonomic control are many and varied but fall into
two categories: parasympathetic and sympathetic.

The entire sympathetic output of the CNS arises

from the thoracic spinal cord (actually T1–L2) and
travels in spinal nerves (Fig. 313C). The output is
opographic, so that sympathetic control of the pupil
and facial sweat glands arises from high thoracic
segments and sympathetic outputs to the bladder
and colon come from more caudal spinal segments.
Parasympathetic outflow destined to influence
structures in the eyes, oral cavity, and most of the
body emanates from the brainstem and travels in
cranial nerves. Parasympathetic outflow destined for
the bladder, hindgut, and sexual organs of the pelvic
floor arises from the sacral spinal cord and travels in
spinal nerves
Abstract or higher function, also called cognition,
depends on the forebrain
(Fig. 313D). The cerebral cortex, including both the
hippocampus and the neocortex, are the stars of
cognition. Although both cerebral hemispheres
produce cognition, the left and right hemispheres
are not simply mirror images of each other, as is
thought to be the case in the rest of the CNS. As
discussed earlier, the cerebral cortices in the right
and left hemispheres have lateralized
functions
AN OVERVIEW OF THE OUTCOMES OF NERVOUS SYSTEM TRAUMA **READ SECTION IN BOOK**

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