Dr.

Kashani lecture 1
Neuroanatomy 2019
-> The Nervous system is divided into 2

1. Central Nervous System (CNS)

• CNS is composed of the brain and spinal cord

2. Peripheral Nervous System (PNS)

• PNS is composed of somatic and splanchnic fibers (composed of
sympathetic and parasympathetic fibers)

The main cell of the nervous system is Neuron

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❖ The aggregation of cell bodies in:

1. PNS is called Ganglion.

There are 3 types of ganglion:
1. Sensory 2. Sympathetic 3. Parasympathetic

2. CNS is called Grey matter/ substance

If the aggregation of cell bodies is small, it's called nucleus
If the aggregation of cell bodies forms a white plate, it's called cortex

The cerebral and cerebellar hemisphere, both contain Cortex.

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❖ The aggregation of axons in:

1. PNS is called Nerve, example: medium nerve, ulnar nerve, etc.

2. CNS is called White matter/ substance, as its covered by myelin sheath.

The White Substance is classified into:

1. Tract:
Tracts are formed by the aggregation of axons that have a common origin
and common end/destination/insertion.
There are 2 types of tracts:
1. Sensory tracts – have Afferent or ascending fibers
2. Motor tracts – have Efferent or descending fibers
examples:
Spinothalamic tract – sensory tract, as it transmits pain and temperature.
Corticospinal tract – motor tract
 2. Fasciculus
They are huge tracts whose diameter are greater than normal.

3. Lemniscus
They are formed when 2 tracts aggregate together (T1+T2)
Example: lateral spinothalamic tract + anterior spinothalamic tract
= Spinal Lemniscus

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Fine touch Vs Crude touch

1st phase of touch = crude touch, sensing presence of a substance, example when a
pen is placed on your palm and you can feel it but don’t know its details

2nd phase of touch= fine touch, can understand/diagnose the substance.

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Proprioception-

is the sense of the relative position of one's own parts of the body, it’s the sense of
the position of muscles and joints that send to the CNS and It is 2 types:

1. Conscious proprioception – transmitting the senses and position of joints

and muscles to Cerebral cortex. Understanding the position of the joints and
the muscles without looking at them.

2. Unconscious proprioception – when position of joint and muscle is

transmitted to Cerebellar Cortex, like maintain the balance of the body when
you're asleep on the bus and your body turns to the direction of the bus.

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the structure of spinal nerves

There are 31 pairs of spinal

nerves. This nerves are
responsible of the sensation and
movement of all the body except
the head.

the Dorsal Root (transmit the Sensory information to the CNS and contains the
Dorsal Root Ganglion (DRG) and the Ventral Root (transmit the motor information
from the CNS/Spinal Cord) join at the intervertebral foramen and form the SPINAL
NERVE. So the spinal nerves have both sensory and motor fibers. Then all spinal
nerves divided into anterior and posterior divisions.

- Motor fibers DIRECTLY send nerves/fibers to the target (example: skeletal

muscles). These nerves are SOMATIC FIBERS (they exit from CNS and end directly
in the targets).
-Sympathetic fibers exit from the CNS and forms the spinal nerve, but they exit the
spinal nerves and synapse into the sympathetic ganglion and return to the
spinal nerve. These form the splanchnic nerves (don’t end directly in the target);
their post-ganglionic fibers end in the targets.

- There are 31 pairs of spinal nerves, ALL of them contain sensory ganglion called
Dorsal Root Ganglion. Therefore, they ALL contain Sympathetic fibers.

- All of the 31 pairs of spinal nerves contain motor, sensory and sympathetic fibers.

Example: The median nerve for the upper limb has sensory fibers for the 3.5 lateral
fingers and motor fibers for the flexor muscles in the forearm. Its sympathetic fibers
contract smooth muscles of the vessels of the upper extremity.

To diagnose the injury in the nerves, we can check their sensation. For example,
median nerve gives sensation for the lateral 3.5 digits so we ask the patient if he
sense this area of the hand or not. But we do not use this method to check every
single nerve in the body instead we use dermatome.

Dermatome: is an area of skin that is mainly supplied by a single spinal nerve. There
are 8 cervical nerves (C1 being an exception with no dermatome)

Dermatome of upper limbs:

C4 Skin over deltoid, C5 Lateral border of arm and forearm, C6 Thumb, C7 three
middle finders, C8 little finger, T1 Medial side of arm and forearm, T2 Axillary fossa.
Dermatome of upper limbs:

L1, L2, L3 anterior thigh respectively from inguinal ligament and goes down (L3
exactly over knee) till knee joint. oblique innervation parallel to inguinal ligament.
L4 Medial leg, L5 Lateral leg, S1 Lateral border of foot.

Trunk dermatome:

They are many but only two are important for us T2 align sternal angle and 2nd
intercostal space, T10 align umbilicus.

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the cranial nerves:

some of cranial nerves have sensory ganglion and transmit sensory singles.

-1st & 2nd because they are responsible of smell and vision, they most have sensory
ganglion.

-5th,7th.8th,9th,10th pairs also have sensory ganglion.

In addition to motor and sensory fibers, peripheral nerves also have sympathetic and
parasympathetic fibers,

Parasympathetic:

1- 3rd,7th,9th, 10th (‫(سهند‬

2- S2-s4 spinal nerves.

Sympathetic:

No cranial nerve has sympathetic fibers.

splanchnic nerves and somatic nerves:

physiological difference

somatic nerves contract skeletal and voluntary muscles, and the sensation from
these nerves are local and we can exactly identify where is the pain come from.

Splanchnic nerves contract smooth and involuntary muscle but their sensation
unknown or not specific for example if if have heart pain it’s not in necessary it comes
from our heart maybe it originates from a problem in the stomach. Therefore, visceral
pain is not local and we can’t rely on it.

Anatomical difference
Somatic nerve:

The sensory fibers enter the ganglion then go to the dorsal horn.

The motor fibers originate from ventral horn then enter the spinal nerve.

The combination of sensory and motor fibers form the somatic nerves and directly
go to the target.

Splanchnic nerve:

In the lateral horn there are visceral (splanchnic) neurons and its axons leave the
spinal cords along with the ventral root then go through intervertebral foramen, but
they don’t go directly to the target instead they synapse with one of the ganglions
then the post synapsed fibers go to the target. All the spinal nerves follow this role
that’s why we have sympathetic ganglions along the two sides of the vertebral
column that linked together and forms the sympathetic chain.

Neurotransmitter difference

Preganglionic: sympathetic and parasympathetic fibers both cholinergic and secrete

ACH.

Postganglionic: parasympathetic fibers also secret ACH but the sympathetic fibers
secret adrenaline and non-adrenaline.

Cholinergic fibers are somatic, parasympathetic and pre-ganglionic sympathetic.

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PNS and CNS injury

The first step in diagnosing a neurological problem is to differentiate if the

injury is CNS or PNS related.

1) Spasticity or Rigidity is a condition in which

certain muscles are continuously contracted.
This contraction causes stiffness or tightness
of the muscles and can interfere with normal
movement, R and gait. Spasticityis usually
caused by damage to the portion of the brain
or spinal cord that controls voluntary
movement.

2) Hyper tendon reflex: if tendon reflex is

hyper-exaggerated = CNS INJURY

3) Babinski reflex– when patient is unconscious/asleep in

bed, using a sharp pointed device (tip of pen) scrape the
plantar surface of foot. If CNS normal= toe fingers will be
flexed. CNS injury = fingers extended = +ve Babinski
Sign
The external appearance of spinal cord:

- it has Rope shape and it start from foramen magnum and descend through
vertebral canal and its end at the level of vertebral disc of L1 (disc btw L1 & L2).

- it has two enlargements, superior or cervical enlargement (C4-T1) to form the

brachial plexus for the innervation of the upper extremity and inferior or lumber
enlargement for the innervation of the lower extremity.

- Lower part of spinal cord forms Connus Medullaris and usually related to sacral
nerves.

- There are some sulcus's and fissures on external surface of spinal cord:

1. Antero-median fissure
Contains the Anterior Spinal Artery, very important as it supplies 2/3rd of
spinal cord.
2. Antero-lateral sulcus
Location of 'exit' – ventral root of spinal nerve exits
 3. Postero-lateral sulcus
Dorsal root of spinal nerves pass through
Contains Posterior Spinal Artery
4. Postero-median sulcus

-spinal cord surrounded by three layers of meninges as anterior to posterior:

1) Pia mater is innermost layer of the meninges that surround the spinal cord and the
spinal cord end till this layer and an elongation called Filum terminalis originate from
it at the level of L1 and attach to the coccyx to maintain the position of spinal cord
into the vertebral canal. Pia matter allows blood vessels to pass through and its
attached to spinal cord in way that we cant separate them. There is also a ligament
called Dentate ligament that originate from pia matter and attach to dura mater, it
has teeth shape that is why it called dentate and it also maintain the position of spinal
cord into the vertebral canal same as filum terminalis.

Which structures maintain the position of spinal cord into the vertebral canal?

1. Filum terminalis
Origin: pia mater
Insert: coccyx

2. Dentate ligaments
21 pairs
Origin: pia mater
Insert: dura mater
2) Arachnoid mater is middle layer of the meninges and it separate from pia matter
by a space called subarachnoid space that contain cerebrospinal fluid (CSF), its end
at the level of S2.

Three structures suspend into the CSF:

1. filum terminalis
2. Cauda Equina
3. Dentate Ligaments

3) Dura matter is the outer layer of the meninges and it is firmly attached to
arachnoid matter also its ends at level of S2.

Because the length of spinal cord is shorter than the length of vertebral column,
Lumbar and sacral nerve roots form a special structure called Cauda Equina

There are spaces between vertebral canal and dura mater called Epidural space,
which contains adipose tissue and venous plexus.
Anterior and posterior spinal arteries originate from

1. ascending cervical arteries and vertebral arteries (upper part)

2. posterior intercostal arteries (middle)

3. lumbar arteries (lower)

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