Neurological System

Ammad Mahmood Mohamed Abdelhalim GUMSA Revision Lectures

Neuroanatomy
• Brain • Cranial nerves • Spinal cord

Brain Anatomy
• Massive area – will try and give you a brief overview – not all the detail is included, just enough to give you a rough understanding of the layout of the brain • Developmentally the brain can be divided into the:
– Forebrain – Midbrain – Hindbrain

Grey and White Matter
• Grey matter
– Contains the cell bodies of 85% of the body’s neurons – Located in the cerebral cortex and the basal nuclei

• White matter
– Contains the axons of the neurons, 3 types:
• Association fibers – interconnect the cortex within one hemisphere • Commisural fibers – interconnect hemispheres • Projection fibers – link cortex to lower structures (diencephalon, brainstem, cerebellum, spinal cord) – form the internal capsule

Forebrain
• Cerebral hemispheres • Basal ganglia • Diencephalon
– Thalamus – Hypothalamus

• Limbic system
– Amygdala – Hippocampus

Forebrain
• Cerebral hemispheres • Basal ganglia • Diencephalon
– Thalamus – Hypothalamus

• Limbic system
– Amygdala – Hippocampus

Cerebral hemispheres
• Two hemispheres separated by the longitudinal fissure and connected by the corpus callosum • Contains unique pattern of sulci and gyri:
– Central sulcus – between frontal and parietal lobes – Lateral sulcus – between frontal and temporal lobes – Parieto-occipital sulcus

• Four lobes
– Frontal – primary motor area (precentral gyrus), executive function – Parietal – primary sensory area (postcentral gyrus) – Temporal – auditory and olfactory – Occipital – visual cortex

Cerebral hemispheres
• Contain association areas where sensory and motor inputs are integrated:
– Somatic motor association area in the frontal lobe – Somatic sensory association area in the parietal lobe – Broca’s area – speech, fronto-temporal region (usually left) – Wernicke’s area – integration of auditory and speech, end of the lateral sulcus

Forebrain
• Cerebral hemispheres • Basal nuclei • Diencephalon
– Thalamus – Hypothalamus

• Limbic system
– Amygdala – Hippocampus

Basal Nuclei
• Grey matter which deals with a lot of the subconscious sensory input and motor commands • Considered part of the basal ganglia which also include motor nuclei in the diencephalon and midbrain • Include:
– Caudate nucleus – Lentiform nucleus
• Globus pallidus • Putamen

• Information arrives at the caudate nucleus and putamen from the cortex and is relayed via the globus pallidus to the thalamus and then back to the cortex. This can be used eg to modify ongoing movements

Forebrain
• Cerebral hemispheres • Basal ganglia • Diencephalon
– Thalamus – Hypothalamus

• Limbic system
– Amygdala – Hippocampus

Diencephalon
• Lies at the top of the brainstem and links the brainstem to the cortex, filtering and integrating conscious and unconscious sensory and motor signals • Four parts:
– Epithalamus – roof of the diencephalon, contains choroid plexus and the pineal gland which secretes melatonin and regulates the day cycle – Thalamus – Hypothalamus – Subthalamus – between the thalamus and hypothalamus, contains portions of the substantia nigra and red nucleus, communicates with the basal ganglia to coordinate movement

Thalamus
• All ascending tracts of the spinal and cranial nerves (except olfactory) synapse with nuclei in the thalamus before being relayed to the cortex and becoming conscious ie the thalamus filters sensory input

• Also relays motor commands between basal nuclei and cortex
• There are thalamic nuclei for relaying sensory, visual, auditory input etc as well as nuclei for motor commands

Hypothalamus
• Floor of the diencephalon • Link between the neural and endocrine systems – integrates activities of the ANS and the pituitary gland

• Has various nuclei and control centres eg feeding reflexes, control of HR and BP, thermoregulation
• Releases the regulatory hormones that control secretion of hormones from the anterior pituitary gland • The posterior pituitary gland is actually an extension of the hypothalamus and releases two important hormones – ADH and oxytocin

Forebrain
• Cerebral hemispheres • Basal ganglia • Diencephalon
– Thalamus – Hypothalamus

• Limbic system
– Amygdala – Hippocampus

Limbic system
• Complex area, not fully understood • Contains a number of structures (each one located in both hemispheres):
– Hippocampus – involved in formation of long-term memories – Amygdala – involved in emotions and their link to memories – Mammilary body – formation of memories – Fornix – links hippocampus and mammilary body

• The limbic lobe also contains a number of important gyri:
– Parahippocampal – formation of spatial memory – Cingulate gyrus – input to ANS function eg HR, BP – Dentate gyrus – new memories

Midbrain (Mesencephalon)
• Tectum
– Superior colliculi – Inferior colliculi

• Tegmentum
– Red nucleus – Substantia nigra

• Cerebral peduncles • Tectum and tegmentum are grey matter, cerebral peduncles are white matter

Midbrain (Mesencephalon)
• Tectum
– Superior colliculi – Inferior colliculi

• Tegmentum
– Red nucleus – Substantia nigra

• Cerebral peduncles • Tectum and tegmentum are grey matter, cerebral peduncles are white matter

Tectum
• Roof of the midbrain • Two pairs of sensory nuclei
– Superior colliculi – integrate visual information with sensory information, initiate reflex responses to visual stimuli – Inferior colliculi – as above except auditory

Midbrain (Mesencephalon)
• Tectum
– Superior colliculi – Inferior colliculi

• Tegmentum
– Red nucleus – Substantia nigra

• Cerebral peduncles • Tectum and tegmentum are grey matter, cerebral peduncles are white matter

Tentorum
• Red nucleus – control upper limb position and background muscle tone, high number of blood vessels give it red colour

• Substantia nigra – regulate activity in basal nuclei eg movement, also involved in reward and addition. Contains darkly pigmented dopaminergic neurons

Midbrain (Mesencephalon)
• Tectum
– Superior colliculi – Inferior colliculi

• Tegmentum
– Red nucleus – Substantia nigra

• Cerebral peduncles • Tectum and tegmentum are grey matter, cerebral peduncles are white matter

Cerebral peduncles
• Descending fibres
– Connect cerebrum to cerebellum via the pons – Carry voluntary commands issued by the cerebrum

Hindbrain
• Cerebellum • Pons • Medulla oblongata

Hindbrain
• Cerebellum • Pons • Medulla oblongata

Cerebellum
• Lies posterior to the brainstem • Two hemispheres separated by a raised band of cortex called the vermis • Anterior and posterior lobes divided by the primary fissure • Outer layer of cortex responsible for:
– Balance and equilibrium by adusting muscle posture – Comparing intended movements with those produced to smooth and coordinate movement

• Three sets of cerebellar peduncles:
– Superior – cerebrum, diencephalon, mesencephalon – Middle – pons and other cerebellar hemisphere – Inferior – medulla oblongata and spinal cord

Hindbrain
• Cerebellum • Pons • Medulla oblongata

Pons
• Lies between mesencephalon and medulla oblongata • Four main functions:
– Links cerebellum to rest of brain and spinal cord – Contains two areas important in respiratory control (apneustic centre and pneumotaxic centre) – Nuclei of cranial nerves V-VIII – Transverse fibers connecting nuclei of pons to cerebellar hemisphere on opposite side

Hindbrain
• Cerebellum • Pons • Medulla oblongata

Medulla oblongata
• Grey matter
– Centres for control of vomiting, coughing, sneezing, hiccoughs, HR, breathing, blood vessel diameter, autonomic function – Nuclei of cranial nerves VIII-XII

• White matter (Pyramids)
– Ascending and descending tracts that connect spinal cord and brain

Other components of the brain…
• Ventricles • Meninges • CSF

Ventricles
• Chambers in the brain lined by a membrane called the ependyma through which CSF circulates • Each cerebral hemisphere contains a large lateral ventricle, they are separated by the septum pellucidum • The diencephalon contains the third ventricle connected to the lateral ventricles by the interventricular foramen • This connects to the fourth ventricle, which lies between the pons and cerebellum, through the cerebral (mesencephalic) aqueduct • The fourth ventricle narrows to become continuous with the central canal of the spinal cord • Foramina (or apertures) in the fourth ventricle connect it to the subarachnoid space

Meninges
• Three layers which are similar to those of the spinal cord with some small differences • Dura mater
– Outer (endosteal) and inner (meningeal) layers, outer is fused to the periosteum of the skull so there is no epidural space – Gap between contains blood vessels and the venous sinuses – Dural folds – provide support and create sinuses:
• Falx cerebri – between cerebral hemispheres • Tentorum cerebelli – separates cerebrum and cerebellum • Falx cerebelli – separates cerebellar hemispheres

• Arachnoid mater
– Consists of arachnoid membrane which is attached to the inner dural layer and the arachnoid trabeculae which make up the subarachnoid space

• Pia mater
– Innermost layer and only one which follows all the brain folds, anchored to the CNS by astrocytes

Cerebrospinal Fluid (CSF)
• Functions – Cushioning delicate neural surfaces – Supporting the brain (brain floats in CSF) – Transporting nutrients, chemical messengers and waste products • Formed in the choroid plexus which is composed of ependymal cells and capillaries – located on the floors of the lateral ventricles and the roofs of the third and fourth ventricles • Around 150ml of CSF circulates though 500ml is produced and absorbed everyday • Absorbed into the venous circulation at the arachnoid granulations which are formed by clusters of arachnoid villi, projections of the arachnoid membrane which penetrate the dura mater and extend into the superior saggital sinus

Cranial Nerves

Cranial Nerves
• Many many mnemonics to remember them! • Oh, Oh, Oh, They Traveled And Found Voldermort Guarding Very Secret Hallows
– – – – – – Olfactory - Sensory Optic - Sensory Oculomotor - Motor Trochlea - Motor Trigeminal – Both Abducens - Motor – – – – – – Facial - Both Vestibulocochlear - Sensory Glossopharyngeal - Both Vagus - Both Spinal accessory - Motor Hypoglossal – Motor

• To remember their functions: Some Say Marry Money, But My Brother Says Big Brains Matter Most

I Olfactory
• Olfactory – forms olfactory bulbs above the cribriform plate of the ethmoid bone and olfactory nerve fibers extend through this • Responsible for sense of smell

II Optic
• Form the retinas, as they travel back into the brain half the fibres on each side crossover at the optic chiasm and all fibres terminate in the occipital lobe

III Oculomotor, IV Trochlea, VI Abducens
• Together innervate the extraocular muscles • Trochlea innervates the superior oblique (SO4) and abducens innervates lateral rectus (LR6) • Oculomotor innervates the rest, the levator palpebrae muscle and also holds parasympathetic nerves responsible for pupillary constriction

V Trigeminal, VII Facial
• Trigeminal
– Sensory – three divisions (ophthalmic, maxillary and mandibular) which provide sensation to the face – Motor – muscles of mastication – temporalis, masseter, medial and lateral pterygoids

• Facial
– Motor – muscles of facial expression, as well as the stapedius muscle which tightens the bones of the ear – Sensory – anterior 2/3 of the tongue

VIII Vestibulocochlear IX Glossopharyngeal
• Vestibulocochlear
– Sensory – equilibrium (vestibular system) and hearing (cochlea)

• Glossopharyngeal
– Sensory – sensation of the pharynx and middle, taste from the posterior 1/3 of the tongue – Motor – swallowing by the stylopharyngeus muscle

X Vagus, XI Spinal Accessory, XII Hypoglossal
• Vagus
– Sensory – pharynx, larynx, abdominal viscera – Motor – speech and swallowing – The major parasympathetic nerve

• Spinal Accessory
– Motor – sternocleidomastoid and trapezius muscles, movement of the neck and shoulders

• Hypoglossal
– Muscles of the tongue

Spinal Cord

Spinal Cord
• Continuation from the medulla oblongata • Begins at C1, descends in the vertebral canal and ends at L1-L2 in the adult • Tapers to the conus medullaris, spinal nerves continue beyond here as the cauda equina • Two enlargements – cervical and lumbar where nerves of the limbs emerge

Spinal Nerves
• 31 pairs - 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal • Each nerve emerges from the dorsolateral (posterolateral) and ventrolateral (anterolateral) aspects of the cord and joins together to form the nerve which passes through the intervertebral foramen • Dorsal roots contain sensory neurons whose cell bodies lie just outside the spinal cord in the dorsal root ganglion • Ventral roots contain motor neurons whose cell bodies lie within the spinal cord

• The spinal nerve divides into the dorsal ramus (posterior trunk) and ventral ramus (anterior trunk)

Spinal Cord
• Divided in half by the dorsal median sulcus and the anterior median fissure • Grey matter
– Dorsal horn – sensory neurons – Ventral horn – cell bodies of motor neurons – Lateral horn – sympathetic neurons (only thoracic and lumbar)

• White matter
– Dorsal, ventral and lateral columns

Spinal Tracts
• Motor
– “Descending tracts” – extend from the cortex in the brain to the muscles – consist of two neurons – the upper and lower motor neurons

• Sensory
– “Ascending tracts” – Consist of three neurons between a receptor in the periphery to the sensory cortex in the brain

Descending Motor Tract
• Corticospinal tract

• Begins in the motor cortex, descend in internal capsule and past thalamus and into pyramids – swellings in the medulla
• As it descends 90% decussate (switch side) at the medulla while the other 10% decussate at the ventral horn • At the ventral horn the upper motor neuron synapses with the lower which innervates the muscle • Some other neurons which effect movement descend in other tracts as the extrapyramidal fibers

Ascending Sensory Tracts
• Spinothalamic
– pain, temperature, crude touch – 1st neuron – peripheral receptor to dorsal horn – Decussation – 2nd neuron – dorsal horn to thalamus – 3rd neuron – thalamus to sensory cortex

Ascending Sensory Tracts
• Dorsal column
– fine touch, vibration, proprioception – 1st neuron – peripheral receptor to medulla – Nerves from the sacral, lumbar and lower thoracic regions ascend in the gracile tract – Nerves from the upper thoracic and cervical regions ascend in the cuneate tract – Synapse at the gracile and cuneate nuclei – 2nd neuron – medulla to thalamus – 3rd neuron – thalamus to sensory cortex

Myotomes
• Know which nerves are tested by testing reflexes:
– Triceps – C7, C8 – Biceps – C5, C6 – Supinator – C5, C6 – Knee – L3, L4 – Ankle – S1, S2

Clinical Neurology…

…with Mohamed Abdelhalim

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