1

Introduction to Neuroanatomy
F O R I N D I V I D U A L S W I T H M S , T H E I R FA M I LY , A N D T H E I R F R I E N D S
 ABOUT THE AUTHOR
Jennifer Tobin is currently a Ph.D. candidate in
Anatomy and Neurobiology at Boston University School
of Medicine. She has been a supporter of and a
volunteer for the Accelerated Cure Project since 2003.
After multiple sclerosis affected the lives of people
close to her, Jennifer wanted to use her neuroscience
training to help individuals with MS to better
understand the disease. She realized that a diagnosis
of MS can leave many people with questions about
their bodies, the disease, new terminology, and
treatment choices. Jennifer wrote this document with
the hope that it would help individuals with MS and
their loved ones to better understand the central
nervous system and how it can be affected by MS.
In turn, this knowledge may enable people to
communicate better with their doctors and become
more active participants in their treatment.
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Table of Contents

4 I N T R O D U CT I O N

6 PA R T 1 : M I C R O S C O P I C A N ATO M Y

10 PA R T 2 : S I G N A L I N G B Y N E U R O N S

PA R T 3 : G R O S S A N ATO M Y O F T H E C E N T R A L
11 N E R VO U S SY S T E M

17 PA R T 4 : M AG N E T I C R E S O N A N C E I M AG I N G

18 RESOURCES
4 INTRODUCTION

Introduction to
Neuroanatomy
FOR INDIVIDUALS WITH MS,
T H E I R FA M I LY , A N D T H E I R F R I E N D S

After being diagnosed with Multiple Sclerosis (MS), many

people find themselves in a world of uncertainty and new
terminology. You may feel like you don’t want to ask “stupid”
questions about concepts that seem so simple and clear to
medical professionals or maybe you don’t even know where
to begin asking questions. The goal of this booklet is to provide
a clear and complete introduction to neuroanatomy so that
individuals with MS, along with their family and friends, may
better understand their disease.

This document is divided into four parts. Part 1, Microscopic

Anatomy, introduces the different cell types found in the
nervous system. The cells are the building blocks for all of the
more complex structures in the nervous system. Signaling by
Neurons, Part 2, describes how nerve cells communicate with
one another, which is the basis for all functions of the nervous
system. Part 3, Gross Anatomy of the Central Nervous System,
describes the structure and function of the spinal cord and
brain. Finally, Part 4 provides a brief introduction to magnetic
resonance imaging, which is commonly used to diagnose and
track the progression of MS by producing images of the brain
and spinal cord.
INTRODUCTION 5

The nervous system is the control center of the
body. It allows us to touch, see, smell, taste,
and hear. It collects and integrates this sensory
information, allowing us to have awareness of
ourselves and of our surroundings. The nervous
system initiates voluntary movements and regu-
lates involuntary ones. It is also responsible for
memory, consciousness, emotion, and regula-
tion of the body’s internal clock.
The functional unit of the nervous system is the
neuron (nerve cell or nerve fiber), a specialized
cell that has the ability to carry electrical
impulses. The supporting cells of the nervous
system are collectively called glia, or neuroglia.
The cells of the nervous system will be dis-
cussed in more detail in the following section.
The final division is that of the somatic and
autonomic nervous systems. Each of these sys-
tems has both sensory and motor components.
The somatic motor system sends impulses to
skeletal, or voluntary, muscles and the somatic
sensory system transmits information from
touch, pain, temperature and position receptors
throughout the body. The autonomic motor system
conducts motor impulses to the heart, smooth
muscles of body organs, and glands, which are
collectively called the viscera. The autonomic
sensory system receives pain and other feed-
back from the viscera.

There are three ways in which the nervous

system is commonly divided. The first division
is based on location: the central nervous system
(CNS) is composed exclusively of the brain and
spinal cord; the peripheral nervous system
(PNS) includes all of the other nervous tissue
in the body.

The second division is based on the type of sig-

nal that a given nerve fiber carries: the sensory
nervous system carries information from a
remote site to the brain, while the motor nerv-
ous system carries impulses from the brain to
muscles of the body. Neurons that carry senso-
ry information are often called ascending fibers
because the signal travels “up” to the brain, and
motor neurons are considered descending
fibers because the signal originates in the brain
and travels “downward”.

“Like all expecting parents, we have many concerns

about the kind of world we’re bringing our daughter
into. As a parent with MS experience, we hope to see
the day that MS isn’t one of those concerns.”

— Stephanie Sisto with her husband Frank

and their dog Gracie
6 PA R T 1 : M I C R O S C O P I C A N ATO M Y
N e u ro n s :
The neuron [Greek: neuron, nerve or string] is
the primary functional unit of the nervous sys-
tem. The cell body, commonly called the soma
[Greek: soma, body], is the metabolic center of
the neuron. The majority of the cell’s energy pro-
duction and protein synthesis takes place here.
The cell body is also home to the nucleus, a
small organelle that contains the neuron’s DNA.
Neurons have two types of processes, tube-like
extensions from the cell body, called axons and
dendrites. Axons [Greek: axon, axis] are process-
es that transmit signals away from the soma to
target cells, which include muscle cells and
other neurons. As an axon approaches its target,
it divides to form smaller branches, called axon
collaterals. These collaterals allow the axon to
form contacts with many different sites on a sin-
gle target cell or with several nearby target
cells. A single axon can range in length from
about 100μm (1 μm = 1 micron = one 1,000,000th
of a meter) to a few feet, depending on the loca-
tion of its target structure.
Dendrites [Greek: dendrites, relating to a tree]
receive signals from axons and relay them to
the soma where they are integrated with other
incoming signals. In addition to receiving sig-
nals, a second important function of dendrites
is to increase the receptive surface area of the
neuron. This is achieved through the extensive
branching pattern of most dendrites and the
small projections called spines that are found
along the length of the dendrite.
Each neuron has exactly one axon and at least
one dendrite. Neurons are often characterized
by the number of processes originating from the
cell body. For example, a pseudounipolar neuron
has a single process that almost immediately
branches into an axon and a dendrite. A bipolar
neuron has two processes: one axon and one
dendrite. Multipolar neurons have one axon and
several dendrites.
The specialized regions of contact between neu-
rons (most commonly between an axon and a
dendritic spine) are called synapses [Greek:
synapsis, point of contact]. Synapses permit the
one-way transmission of neural signals from
one cell to another. The mechanism of synaptic
transmission will be discussed in Part 2.
Figure 1: Neuron Types
This is an illustration of three common types of neurons:
mutipolar, pseudounipolar, and bipolar. They are oriented sim-
ilarly for ease of comparison, but this side-by-side orientation
does not occur in the body. Note that each neuron has one
axon and at least one dendrite. (image credit: Patricia Smith)
Glia:
The supporting cells of the nervous system are
collectively called glia [Greek: glia, glue]. Three
types of glia are found in the central nervous
system: astrocytes, microglia, and oligodendro-
cytes. Astrocytes [Greek: astron, star; kytos, hol-
low] are star-shaped cells that lie in the spaces
between neurons. These cells provide a rigid
support structure for neurons and make sure
that the only points of contact between neurons
are at synapses. Astrocytes also form “scars”
after the loss of or damage to CNS tissue,
which prevents the regeneration of lost synaps-
es. The sclerosis [Greek: sklerosis, hardening],
or scarring, that occurs in MS is a result of the
astrocytic response to damaged CNS neurons.
(Interestingly, embryonic astrocytes seem to
assist in the formation of synapses and promote
neuronal growth.)
PA R T 1 : M I C R O S C O P I C A N ATO M Y
Microglia [Greek: mikro-, small] are small cells
that are not normally abundant in the central
nervous system. Microglia remain quiescent (at
rest) until they are stimulated by the presence of
an antigen, a substance that the body recognizes
as foreign or damaged. Once activated, the
microglia bind to the antigen and “present” it to
a subset of immune system cells produced in
the thymus gland, called T cells. Together the
T cells and microglia initiate an immune response
against the antigen, in order to protect the CNS.
Activated microglia can engulf and phagocytize
[Greek: phagein, to eat], or digest, cellular
debris, fragments, and even injured neurons.
The third type of glial cell found in the CNS is
the oligodendrocyte [Greek: oligos, little, few],
often called “oligo” for short. Oligos have many
processes, or “arms,” extending from the cell
body, which form segments of myelin along
axons in the CNS, as described below. Since oli-
gos do not exist outside of the CNS, myelin in
the PNS is formed by another type of glial cell,
the Schwann cell.
M ye l i n :
Myelin [Greek: myelos, marrow] is a lipid-rich
substance that is composed of concentric layers
of glial cell membrane, the “skin” that sur-
rounds each cell. In the CNS, one process from
an oligodendrocyte wraps around a single
portion of an axon several times to form a
segment of myelin. Each oligo may send out
several extensions to form several segments of
myelin on multiple axons. Small, unmyelinated
regions, called nodes of Ranvier, separate myelin
segments from each other. The term “myelin
sheath” collectively refers to all the segments of
myelin surrounding a given axon. The segment-
ed nature of the myelin sheath is important for
the conduction of neuronal signals down the
axon, which will be discussed in Part 2.
7
Figure 2 – Oligodendrocytes and myelin
The processes of oligodendrocytes produce the myelin
sheaths of the CNS. Processes are shown wrapping around
an axon several times to form a segment of myelin (orange).
The unmyelinated regions (purple) between segments of
myelin are the nodes of Ranvier. One segment of myelin in the
upper left of the figure has been shown in cross-section to
demonstrate the layered structure of myelin. (image credit:
Yuko Rodriguez)
MS lesions are sites of inflammation in the CNS
where myelin is damaged and stripped away
from the axons of neurons, resulting in demyeli-
nated axons and damage to the nearby oligo-
dendrocytes and/or axons. As further described
in Part 3, the location of the lesion will deter-
mine what type of symptoms, if any, may result.
Meninges:
The central nervous system is enclosed by a
series of three membranes: the dura mater,
arachnoid mater, and pia mater. These mem-
branes are collectively called the meninges
[Greek: meninx, membrane]. The main functions
of the meninges are to protect the brain and
spinal cord, provide structural support to large
blood vessels that supply the CNS, and physi-
cally anchor the brain to the skull.
8 PA R T 1 : M I C R O S C O P I C A N ATO M Y
Figure 3: Meninges
In this illustration of the human skull, part of the forehead
has been “opened up” to show the underlying meninges and
brain. Starting on the outside, the layers are: bone, dura
mater, arachnoid mater, subarachnoid space, pia mater, gray
matter of brain, white matter of brain. (image credit: Fiona
Graeme-Cook)
The outermost membrane is the dura mater
[Latin: dura mater, hard mother], which is a very
tough two-layered sheet of tissue. In many
places the two layers of dura are closely
attached to one another, but in the skull the
layers can separate to form venous sinuses,
large blood vessel-like openings that drain
deoxygenated blood from the brain. The outer
layer of the dura is tightly adhered to the inter-
nal surface of the skull, while the inner layer is
more closely associated with the underlying
arachnoid mater. In certain areas of the skull,
where more support is required, the inner layer
of the dura folds over on itself to create a 4-lay-
ered structure, commonly called a fold or
“reflection.” One such reflection is the tentorium
cerebelli [Latin: tentorium, tent], which supports
the occipital lobes of the cerebral cortex and
prevents the weight of the cerebrum from
pressing on the cerebellum. See Part 3 for a
description of these brain regions. The dura
mater contains a few blood vessels that gener-
ally supply the bones of the skull.
The intermediate membrane, the arachnoid
mater [Greek: arachne, spider], is a thin sheet of
tissue that loosely surrounds the brain and
spinal cord. The arachnoid mater envelops
nerves that arise directly from the brain or
spinal cord, until they exit the skull or vertebral
column. The arachnoid membrane also sends a
network of delicate, web-like fibers towards the
underlying pia mater.
The pia mater [Latin: pia mater, tender mother] is
the most delicate of the meninges and lies
directly on the surface of the spinal cord and
brain. Unlike the dura and arachnoid, the pia
mater follows the convoluted surface of the brain
closely, dipping down in to the many folds of the
cerebral cortex. The pia is also the most vascular
(i.e. contains the most blood vessels) of the
meninges. The small blood vessels that lie in the
pia mater supply the brain and spinal cord.
There are small spaces separated by the layers
of meninges. The epidural space [Greek: epi-,
upon] lies between the outer/endosteal layer of
the dura mater and the skull or vertebrae. This
space is extremely narrow and contains the
middle meningeal artery, which supplies blood
to most of the dura mater. A rupture in the mid-
dle meningeal artery will result in an epidural
hematoma, a localized swelling filled with
blood. Between the dura and arachnoid mater is
the subdural space [Latin: sub-, beneath]. This
space contains a minute amount of fluid as well
as some cerebral veins. Damage to one of these
veins will lead to a subdural hematoma. The
subarachnoid space, which lies between the
arachnoid and pial membranes, is filled with
cerebrospinal fluid. This fluid provides some
nutrients to the CNS, acts as a protective barri-
er against infection, and cushions the CNS from
impact with its bony covering.
PA R T 1 : M I C R O S C O P I C A N ATO M Y
C e re b ro s p i n a l f l u i d :
Cerebrospinal fluid (CSF) is a clear, colorless
fluid that circulates around the brain and spinal
cord. CSF has a similar composition to blood
serum, the fluid left behind when cells and clot-
ting factors are removed from whole blood. CSF
protects the brain from damage against the
skull and provides a “bath” for the brain to float
in, decreasing its effective weight. Approximately
400-500 milliliters (about a pint) of cerebrospinal
fluid is produced each day by the choroid plexus
[Greek: chorioeides, skinlike; Latin: plectere, to
weave], a highly vascularized tissue that lines
some of the ventricles, or cavities, within the
brain. CSF flows through the four brain ventri-
cles then continues into the subarachnoid space,
where it is eventually reabsorbed into the venous
sinuses by small structures known as arachnoid
villi [Greek: arachne, spider; Latin: villus, hair].
The absorbed CSF then continues through the
blood circulation.
The subarachnoid space is not uniform in size
throughout the CNS. The space in the lumbar
portion (lower back) of the vertebral column is
so large that it is known as the lumbar cistern.
A lumbar puncture takes advantage of this large
reserve of CSF. In a lumbar puncture a needle is
inserted between two lumbar vertebrae into the
subarachnoid space in order to obtain a small
sample of cerebrospinal fluid for testing. CSF
analysis can aid in the diagnosis of MS by ruling
out the presence of acute infections that may
not show up on a blood test and by enabling the
detection of oligoclonal bands. Oligoclonal
bands are immunoglobulins (antibodies) found
in the cerebrospinal fluid. Multiple oligoclonal
bands in the CSF suggest inflammation in the
central nervous system and support a diagnosis
of MS. A headache may result after a lumbar
puncture if the patient tries to get up too quickly
or move too much because the loss of CSF
causes the brain to become more “heavy” in the
9
skull. This can cause the brain to pull on the
dura mater and irritate the nerves and vessels
associated with it.
B lo o d - b ra i n b a r r i e r :
Endothelial cells [Greek: endon, within; thele,
nipple] are the specialized cells that line the
inside of all the blood vessels in the body. In
most regions of the body, there are tiny open-
ings between the endothelial cells allowing cer-
tain nutrients, enzymes, and bacteria in the
bloodstream to enter the surrounding tissue. In
the CNS, the seal between adjacent endothelial
cells is especially tight, forming the blood-brain
barrier (BBB). Additional structural support for
the BBB is provided by astrocytes that lie along
the outside of the blood vessels. The BBB is
technically a blood-CNS barrier as it is present
in the spinal cord as well as the brain.
The BBB is a physical barrier that prevents
many substances in the blood from entering the
CNS. Molecules that are lipid, or fat, soluble
(such as oxygen, carbon dioxide, ethanol, and
steroid hormones) can pass through the BBB
by dissolving through the membrane of the
endothelial cells. Also, certain essential cellular
nutrients, such as amino acids, have specialized
transport mechanisms by which they are able to
leave the blood and enter the brain. Astrocytes,
in addition to their structural role, are involved
in maintaining a balance of ions (charged parti-
cles such as sodium, calcium, and potassium)
between the blood and the CNS.
The BBB is advantageous because it prevents
toxins and infectious agents from entering the
central nervous system. However, this tight
seal has made treating diseases of the CNS
more difficult because it also prevents antibi-
otics and other medications normally delivered
through the blood from entering the brain and
spinal cord.
10 PA R T 2 : S I G N A L I N G B Y N E U R O N S
Every neuron is primed with an imbalance of
ions between the surrounding extracellular fluid
and the inside of the cell. This imbalance of
charged particles, or polarity, is essential for
the neuron’s ability to produce signals. Neurons
also have the ability to synthesize neurotrans-
mitters, chemical molecules that are released
from the axon terminal of one neuron upon
stimulation and bind to receptor sites on the
surface of neighboring neurons. This causes
small channels on the surface of the neighbor-
ing neuron to open, allowing specific ions to
enter or exit the cell in order to equalize the
imbalance in charge, or depolarize the cell.
A neurotransmitter molecule binding to its
receptor produces a characteristic “stop” or “go”
response in the neuron. Each neuron sums up all
of the individual “stop” and “go” signals to deter-
mine if the overall input to the cell is greater
than a critical level, called threshold. If threshold
is met or exceeded, the neuron generates an
output signal called an action potential. Action
potentials are electrical signals that propagate
down the entire length of an axon through the
opening and subsequent closing of adjacent ion
channels. Upon reaching the axon terminal, the
action potential stimulates the release of neuro-
transmitters into the synapse, which will bind to
receptors on nearby neurons. If threshold is not
reached, no action potential will be generated.
In unmyelinated axons, ion channels are distrib-
uted evenly along the entire length of the axon,
100-200 per square micron. The act of opening
and closing ion channels to conduct the action
potential down an axon takes time. The longer
the axon, the more time it will take for the
action potential to reach the synapse. This
process is called active transmission.
In myelinated axons, the ion channels are highly
concentrated in the unmyelinated nodes of
Ranvier, roughly 1000-2000 per square micron.
Action potentials therefore “jump” down the
axon from one node of Ranvier to the next,
decreasing the actual distance that the signal
must travel and thereby speeding up the rate
of neuronal signaling. This is called saltatory
conduction [Latin: saltatore, to jump, dance].
Additionally, myelin has a high lipid content
which allows it to act as insulation for the axon,
similar to the rubber coating that surrounds
electrical wires keeping the electrical charge
contained within the wire.
Figure 4: Saltatory conduction
This figure demonstrates saltatory conduction using a dia-
gram of three myelinated axons. At Point A, ion channels
open, ions rush into the axon, and an action potential is gen-
erated. The action potential then jumps to the next node of
Ranvier, Point B (middle axon), followed by Point C (right
axon). After the action potential moves to the next node the
axon returns to its rest state as ions leave the axon. (image
credit: Claudia Wolf)
Myelinated segments of axons do contain ion
channels, but fewer than about 25 per square
micron. When an axon is demyelinated as
occurs in MS, the rate of conduction slows
down because the action potential can no
longer “jump” down the axon. Action potentials
must then be propagated using active transmis-
sion, but with fewer ion channels than would be
found in unmyelinated axons.
Both myelinated and unmyelinated axons are
present in the CNS. Certain types of pain and
temperature receptors send their information
along unmyelinated axons. However, the majority
of motor and other types of sensory signals are
carried predominantly along myelinated axons.
PA R T 3 : G R O S S A N AT O M Y O F T H E C E N T R A L N E R V O U S S Y S T E M
The central nervous system is composed of the
brain and the spinal cord. The CNS is covered
by meninges and protected by bony structures,
the skull and vertebrae. The tissue of the cen-
tral nervous system can be subdivided into gray
matter and white matter, a classification that is
based on the appearance of the tissue to the
naked eye. Gray matter is primarily composed
of neuronal cell bodies and dendrites. White
matter is characterized by an abundance of
axons, whose fatty myelin sheath gives the
tissue its white appearance.
An important distinction to make at this point is
that between a neuron and a nerve. These
terms are not interchangeable, however some-
times you will hear a neuron referred to as a
nerve cell or fiber. A nerve is made up of many
axons, originating from many different neurons,
which are held together in a fibrous sheath
called the epineurium [Greek: epi-, upon; neuron,
nerve]. In this sense several neurons contribute
to the formation of a single nerve.
Other terms used in the description of neu-
roanatomy indicate the positional relationship of
one structure to another: Dorsal and posterior
mean behind, or towards the back; ventral and
anterior mean towards the front or in front of.
Medial indicates that a structure is close or
closer to the midline of the body, while lateral
means that a structure is farther away from the
midline, towards the right or left. Finally, superior
means above and inferior means below.
S p i n a l C o rd :
The spinal cord is a bundle of nervous tissue
that extends down the back through the verte-
bral column. It is continuous with the brain-
stem at the base of the skull and terminates a
few inches below the ribcage. The adult spinal
cord is 42-45 centimeters long on average
and only about 1 centimeter in diameter at its
widest point. Don’t let the small size fool you;
the spinal cord has several very important
11
functions. It receives and begins to process
sensory information from nerves throughout
the body. All of the motor neurons that control
voluntary movements are located in the spinal
cord. The spinal cord is also responsible for
most reflexes, including the knee-jerk reflex
and the withdrawal reflex when one encounters
a painful stimulus.
The central portion of the spinal cord is com-
posed of gray matter surrounded by white mat-
ter. In a cross-section, the gray matter is easily
identified by its characteristic butterfly, or “H”
shape. The tips of the H (or the tips of the but-
terfly’s wings) are called horns. There are 2 dor-
sal horns and 2 ventral horns. Somatic motor
neurons that supply skeletal muscles are locat-
ed in the ventral horn. The motor neurons that
are closest to the midline of the spinal cord
innervate muscles of the trunk, while those that
are more lateral innervate the extremities
(arms, legs, fingers, toes). The cells in the dor-
sal horn are generally small “interneurons” that
relay incoming sensory signals to both motor
neurons and other sensory neurons.
Figure 5: Spinal cord cross-section
The somae of sensory neurons (blue) are found in the dorsal
root ganglia. Sensory axons enter the spinal cord through the
dorsal root and often synapse on interneurons (green) in the
gray matter. Motor neuron cell bodies are located in the gray
matter and the axons leave the spinal cord through the ven-
tral root. Spinal nerves are formed when the dorsal and ven-
tral roots join together. (image credit: Jennifer Tobin)
12 PA R T 3 : G R O S S A N AT O M Y O F T H E C E N T R A L N E R V O U S S Y S T E M
The functional organization of the spinal cord is
based on the pairs of spinal nerves that emerge
from the cord at regular intervals. Each spinal
nerve is made from the union of a ventral motor
root and a dorsal sensory root. The axons of
motor neurons leave the spinal cord through
the ventral motor root and then travel in the
spinal nerve until reaching their target muscle.
Sensory cell bodies are not located in the spinal
cord, but in small aggregations along the dorsal
root of the spinal nerve, called dorsal root gan-
glia [Greek: ganglion, nerve bundle]. The
processes of sensory neurons travel through
the spinal nerve to specialized sensory recep-
tors located throughout the body.
The portion of the spinal cord associated with a
given pair of spinal nerves is known as a seg-
ment. Spinal nerves exit the vertebral column
through small openings called intervertebral fora-
men [Latin: foramen, opening]. Since each pair
of spinal nerves leaves the vertebral column
through a specific vertebra (one of the bones that
make up the vertebral column), the spinal nerves
are named after their associated vertebra.
The vertebral column is divided into 5 regions
based on the physical characteristics of the indi-
vidual vertebrae. The cervical [Latin: cervix, neck]
vertebrae are located in the neck and are the
smallest of the vertebrae. The thoracic [Latin:
thorax, chest] vertebrae are associated with the
ribs. Lumbar [Latin: lumbaris, loin] vertebrae are
found in the lower back and are thick in order to
support the body. The sacral [Latin: sacer,
sacred] vertebrae are fused together to form a
structure called the sacrum, which is located
behind the pelvis. Finally, the coccygeal [Greek:
kokkux, cuckoo, resembling a cuckoo’s beak] ver-
tebrae are small, incompletely formed bones just
inferior to the sacrum. The 31 pairs of spinal
nerves and their corresponding spinal segments
are as follows: 8 cervical, 12 thoracic, 5 lumbar,
5 sacral, and 1 coccygeal. You may hear the
sacral and coccygeal segments of the spinal cord
and vertebrae referred to as the sacrococcygeal
region. The levels of the spinal cord are abbrevi-
ated by using the first letter of the name of the
vertebral type associated with the nerves. For
example, C-spine refers to the cervical segments
of the spinal cord, while T-spine refers to the
thoracic segments. Also, C5 refers to the 5th
spinal nerve in the cervical region.
If you were to look at the entire length of the
spinal cord, you would notice that there are two
regions that are slightly larger in diameter than
the rest of the cord. These are the cervical and
lumbar enlargements that contain the motor neu-
rons that supply the arms and legs, respectively.
Figure 6: Spinal cord
This is a profile of the spinal cord within the vertebral col-
umn. Each region of the spinal cord (cervical, thoracic, lum-
bar, sacrococcygeal) is a different color. The spinal nerves are
seen exiting the vertebral column on the right. (image credit:
James Steinberg)
As you can see in Figure 6, the spinal cord does
not extend the full length of the vertebral column.
The spinal cord normally terminates at around L1
to L2 (lumbar vertebrae 1 to 2). The roots of lum-
bar, sacral, and coccygeal spinal nerves must
descend beyond the end of the spinal cord to
reach their exit point. Collectively these nerve
roots are known as the cauda equina (Latin:
horse’s tail).
PA R T 3 : G R O S S A N AT O M Y O F T H E C E N T R A L N E R V O U S S Y S T E M
Each spinal nerve carries sensory information
from a specific region of the body. The area of
skin that is innervated, or supplied, by a single
spinal nerve is called a dermatome. MS lesions in
the spinal cord can produce sensory symptoms
that feel like “bands” of altered sensation
around the body. These bands correspond to the
dermatomes (see Figure 7) supplied by spinal
nerves. Sensory nerves above the level of the
lesion are not affected, but those below the level
of the lesion are affected. Since sensory infor-
mation travels up the spinal cord to the brain,
the lesion acts like a roadblock to these signals,
preventing them from continuing onto the brain.
Similarly, motor symptoms also occur below
the level of the spinal lesion. In this case the
“roadblock” prevents the signals from the brain
from traveling down the spinal cord.
Figure 7: Dermatome map
Spinal nerves are listed next to the area of skin that they
innervate. The colors used in this figure correspond to the
regions of the spinal cord in Figure 6. (image credit: James
Steinberg)
B ra i n :
The brain has three major subdivisions: the
cerebrum, the cerebellum, and the brain stem.
Cerebrum
The cerebrum [Latin: cerebrum, brain] is derived
from two embryologic structures: the telen-
cephalon and the diencephalon. The telen-
13
cephalon [Greek: telos, end; encephalon, in the
head] gives rise to the cerebral cortex and a
collection of structures known as the basal
ganglia. The diencephalon [Greek: dia, through;
encephalon, in the head] forms several struc-
tures including the thalamus, hypothalamus, and
optic nerves.
Telencephalon – cerebral cortex
The surface of the cerebral cortex [Latin: cortex,
bark or rind] is very convoluted, allowing for a
greater area of cortex to fit inside the skull.
The folds of tissue that project outwards are
called gyri (singular: gyrus) [Greek: gyros, cir-
cle] and the grooves between the folds are
called sulci (singular: sulcus) [Latin: sulcus,
ditch]. The pattern of gyri and sulci in a brain
is characteristically arranged and can be used
as anatomical landmarks for certain functional
areas of the brain.
The cerebral cortex is divided vertically into
two hemispheres, which are generally physi-
cally symmetrical but have some important
differences in function. The left hemisphere is
responsible for logic, mathematics, language,
reasoning, storage of language-based memo-
ries, and the right side of the body. The right
hemisphere integrates input from all of the
senses and is responsible for visual-spatial
skills, art, music, storage of sensory-based
memories, and the left side of the body. Both
hemispheres are able to interpret sensory
information, make decisions, and play a part in
learning and memory functions. The primary
means of communication between the right
and left cerebral hemispheres is through a
structure known as the corpus callosum [Latin:
corpus, body; callosus, hard]. The corpus callo-
sum is a large bundle of axons that transmits
signals from one hemisphere to the other, so
that the cerebral cortex is able to function as a
single unit.
14 PA R T 3 : G R O S S A N AT O M Y O F T H E C E N T R A L N E R V O U S S Y S T E M

Figure 8: Corpus callosum Figure 9: Lobes of cerebral cortex

This is a top-down view of the cerebral cortex with the right
hemisphere in gray and the left hemisphere in white. The
right hemisphere is slightly “cut away” to reveal the corpus
callosum, bands of nerve fibers extended between the two
hemispheres. The green arrows represent the exchange of
information between the hemispheres. (image credit: Joel
Jacobs, Ph.D.)
Each cerebral hemisphere is divided into 5
lobes, or sections: frontal, parietal, temporal,
occipital, and limbic. The lobes have distinct
functional characteristics that are described
briefly in Table 1.
The lobes of the cerebral cortex, as well as the cerebellum
and brain stem are shown in relation to the head and face.
The limbic lobe can not be seen here because it is internal to
the other lobes of the cortex. (image credit: Claudia Wolf)
While MS lesions in the cerebral cortex are quite
common, they do not usually produce major symp-
toms. One reason for this is that adjacent cortical
regions often have very similar or redundant func-
tions, making it more difficult for a lesion to have a
great effect on any particular function. Large cere-
bral lesions may cause general weakness or
numbness, and in rare circumstances can result
in aphasia [Greek: aphatos, speechless], memory
difficulties, or other cognitive problems.

Table 1: Lobes of the Cerebral Cortex

Cortical Lobe Location Primary Functions
Frontal lobe Roughly the anterior ⁄3 of the
1
• initiation of voluntary movements
cerebral cortex • production of written and spoken language
• personality and “executive” function
Parietal lobe Superior half of the middle 1⁄3 of the • processing of tactile information, perception of
cortex movement and awareness of the body’s orientation
in space (proprioception)
• comprehension of language
• spatial organization and perception
Temporal lobe Inferior half of the middle 1⁄3 of • processing of auditory information
the cortex • comprehension of language
• visual processing
• learning and memory
Occipital lobe Posterior 1⁄3 of the cerebral cortex processing of visual information
Limbic lobe Internal aspect of the cortex • emotion
• drive-related behavior
• memory
PA R T 3 : G R O S S A N AT O M Y O F T H E C E N T R A L N E R V O U S S Y S T E M
Telencephalon – basal ganglia
The basal ganglia [Latin: basis, base] are a col-
lection of bilateral nuclei (in the central nervous
system, the term nuclei refers to a collection of
neuronal cell bodies) that are located internal to
the cerebral cortex. They are often referred to
as “sub-cortical” nuclei. The nuclei that com-
prise the basal ganglia are the caudate nucleus,
putamen, globus pallidus and the substantia
nigra. Some texts will also include the subthal-
amic nucleus, amygdala, and the claustrum in
their description of the basal ganglia.
Figure 10: Basal ganglia.
The basal ganglia’s position within the brain is illustrated by
the profile on the lower right The upper left image is an
enlarged version of the basal ganglia. The dotted lines indi-
cate that part of the caudate nucleus has been removed to
make other structures, such as the putamen and globus pal-
lidus, visible. (image credit: Joel Jacobs, Ph.D.)
The basal ganglia initiate and help control vol-
untary movements. They also have an important
role in balance and postural reflexes. The neu-
rodegenerative disorders Parkinson’s disease
and Huntington disease are movement disor-
ders that result from dysregulation, or abnor-
mal function, of the basal ganglia.
Diencephalon
The structures that are located deep within the
cerebral cortex, in the center of the brain, are
collectively called the diencephalon. The largest
of these structures is the thalamus [Greek:
15
thalamos, chamber]. The thalamus is a bilateral
collection of nuclei located in the center of the
brain that functions as a processing and relay
center for the cerebral cortex. It receives input
from the other areas of the CNS, integrates
them, and subsequently sends signals to vari-
ous regions of the cerebral cortex.
The hypothalamus [Greek: hypo-, under] is a
small bilateral structure just inferior to the
thalamus. The hypothalamus contains the
appetite and thirst centers of the brain and
plays a role in emotional and drive-related
behaviors. It controls many of the body’s auto-
nomic functions and hormone levels through
the pituitary gland. (This is why you will often
hear the term hypothalamic-pituitary axis.) The
pituitary gland has a wide variety of functions
including control of growth, metabolism, blood
pressure, sexual function, and thyroid function,
as well as mediating the body’s response to
stress.
The optic nerves [Greek: optikos, visible] carry
visual information from each eye to the occipital
lobe of the cortex where the majority of visual
processing takes place. Inflammation of the
optic nerve results in optic neuritis, a relatively
common condition in MS. This can result in
visual disturbances including blurred or double
vision, loss of sight, pain, and/or headaches.
C e re b e l l u m :
The cerebellum [Latin: cerebellum, little brain] is
located beneath the cerebral hemispheres on
the posterior surface of the brain. The cerebel-
lum communicates with the cerebral cortices
and brainstem through fiber bundles called the
cerebellar peduncles [Latin: pedunculus, foot],
which also anchor the cerebellum to the rest of
the brain. The cerebellum is involved with the
processing of somatosensory (sensations from
the body) information, balance, control and
16 PA R T 3 : G R O S S A N AT O M Y O F T H E C E N T R A L N E R V O U S S Y S T E M

coordination of voluntary movements. Damage
to the cerebellum can result in problems with
balance, control of posture, and coordination of
movements.
B ra i n st e m :
The brain stem is continuous with the cerebrum
above and with the spinal cord below. The func-
tions of the brainstem are diverse. The upper-
most portion of the brainstem is the midbrain.
The midbrain is involved with vision and hear-
ing. The pons [Latin: pons, bridge], the middle
portion of the brain stem, controls conscious-
ness and arousal, and aids in the coordination
of movement. The lower portion of the brain-
stem, the medulla oblongata, regulates vital
body functions such as respiration and heart
rate. Nuclei in the brainstem communicate with
the cerebral cortex, the cerebellum and the
spinal cord. Most of the cranial nerves originate
in the brain stem.
Cranial nerves supply motor and sensory inner-
vation to the head, receive sensory information
from the eyes, ears, nose and mouth, and pro-
vide autonomic innervation to the head and
neck. These nerves are especially important
because they control the “special senses” of
vision, hearing, smell and taste.

Table 2: Cranial Nerves

Nerve Name Functions
I Olfactory Smell
II Optic Vision
III Oculomotor Movement of the eyes, elevation of the eyelids, constriction of pupil in response
to light
IV Trochlear Inferior and lateral movement of the eyes
V Trigeminal Sensation from the face, control of the muscles involved in chewing
VI Abducent Lateral movement of the eye
VII Facial Control of the muscles involved in facial expression, taste, tear production,
salivation
VIII Vestibulocochlear Hearing and balance
IX Glossopharyngeal Salivation, taste, sensation from external ear
X Vagus Control of the muscles involved in swallowing, taste, autonomic innervation
of various organs including tongue, larynx (area of voice production), pharynx
(throat), heart, bronchi of lungs, esophagus
XI Accessory Control of the muscles of the palate, pharynx, larynx
XII Hypoglossal Control of the muscles of the tongue
PA R T 4 : M AG N E T I C R E S O N A N C E I M AG I N G
MRI:
Magnetic resonance imaging (MRI) takes
advantage of the abundance of hydrogen atoms
in all of the body’s fluids and tissues. The pro-
tons that spin around the nucleus of hydrogen
atoms produce tiny magnetic fields. When the
atoms enter a strong magnetic field, in this
case because your body has entered the MRI
scanner, the protons’ spins are forced into
alignment with the magnetic field. Radio fre-
quency pulses are sent into the magnetic field
by the MRI scanner, which transmits energy
waves to the protons, causing them to tilt out of
alignment. As the protons fall out of alignment,
they absorb some of the energy generated by
the scanner. When the radio pulse is turned off,
the protons relax and return to alignment with
the magnetic field, transferring energy to their
surrounding environment (tissue). Each tissue
has a characteristic “relaxation time”, which
is the time that it takes for a given tissue to
absorb the energy released by its protons.
For example, myelin, which is rich in lipids,
absorbs energy faster than cerebrospinal fluid,
which is mostly water. By measuring the
amount of energy in the scanner after each
radio pulse, a computer is able to construct
an image of the insides of the body.
There are several techniques used by the scan-
ner’s computer to construct these body images.
T1-weighted images focus on the rate of relax-
ation as protons realign with the magnetic field.
In this type of scan, white matter (myelin)
appears lighter than gray matter, and bone, air,
and fluids appear black. T2-weighted images are
based on the rate at which protons lose their tilt.
In these images, white matter is darker than
gray matter, fluid is white, and bone is black.
Tissue damage appears dark in T1-weighted
images and white in T2-weighted images.
17
Another technique used with MRIs is the intra-
venous injection of a contrast agent called
gadolinium (Gd or Gad). Gd is a chemical
element with magnetic properties that shorten
the relaxation time of nearby protons. On a
T1-weighted image, areas rich in Gd appear
brighter than the surrounding tissue. After its
injection, Gd remains in the blood vessels
unless the blood-brain barrier is ruptured, as
it is in cases of the acute inflammation seen in
“active” MS lesions. In this situation, Gd leaks
out into the nervous tissue around the lesion
resulting in a bright “spot” on the MRI. The Gd
solution used with MRIs is known to be very
safe and is excreted from the body in urine.
While bright (hyperintense) spots on a T1-
weighted MRI indicate active lesions that
enhance with Gd, hyperintense areas on T2-
weighted images could be either acute lesions
or sites of chronic damage. Areas that appear
as hypointense (dark) spots for six or more
months on T1 images are called “persistent
black holes” and indicate sites where axons
have been damaged and tissue has been lost.
For additional information on magnetic reso-
nance imaging, please refer to the Accelerated
Cure Project Newsletter, Fall 2004, Vol. 3 Issue
3. This can be downloaded by visiting:
www.acceleratedcure.org/news/newsletter.php.
Summary
The nervous system is very complex and scien-
tists are still trying to solve many of its myster-
ies. Hopefully this paper has given you a better
understanding of basic neuroanatomy. Below is
a list of websites that can give you some more
information about the nervous system or MRI.
Don’t be hesitant to ask your neurologist or
health care provider any questions you have
about MS and how it affects your body.
18 RESOURCES

H e l p f u l We b s i t e s :
A brief tour of the brain: This site is mostly text
and offers a more historical account of what is
known about the brain. It also has a good descrip-
tion of the communication between neurons.
www.nldontheweb.org/catterall.htm
Medline Plus Medical Encyclopedia – MRI:
This site is maintained by the U.S. National
Academy of Health and the National Institute of
Health. It provides links to a series of articles
and tutorials about MRI.
www.nlm.nih.gov/medlineplus/mriscans.html
Society for Neuroscience: The society offers a
variety of public resources on their website.The
Brain Briefings and Brain Backgrounders are
short online articles about a variety of topics.
www.sfn.org
R e fe re n ce s :
Moore, Keith L. and Agur, Anne M. R. (1995)
Essential Clinical Anatomy. Lippincott Williams &
Wilkins, Baltimore, MD.
Kingsley, Robert E. (2000) Concise Text of
Neuroscience, second edition. Lippincott Williams
& Wilkins, Baltimore, MD.
Bashir, Khurram and Whitaker, John N. (2002)
Handbook of Multiple Sclerosis. Lippincott
Williams & Wilkins, Baltimore, MD.
Gray, Henry (2003) Gray’s Anatomy 16th edition.
Merchant Book Company, Finland.

While you are waiting… a guide to brain anatomy:

This website describes the parts of the brain,
their functions, and what symptoms may result
from damage to specific brain areas.
www.waiting.com/brainanatomy.html
Accelerated Cure Project: This is a nonprofit
Whole Brain Atlas – Harvard University: This is organization dedicated to curing MS by
an interactive map (or atlas) of the human brain determining its causes.
using MRI images. You can look at the normal
brain or the brain with a variety of neurological Credits
conditions, including MS. Author: Jennifer Tobin
www.med.Harvard.edu/AANLIB/home.html
Artists: Patricia Smith, Yuko Rodriguez, Fiona
Graeme-Cook, Claudia Wolf, Jennifer Tobin,
Wikipedia: This online encyclopedia is a great
James Steinberg, Joel Jacobs, Ph.D.
resource if you are looking for some more
in-depth information on a specific brain area. Editors: Accelerated Cure Project Staff
en.wikipedia.org Design: Clockwork Design Group, Inc
 The Accelerated Cure Project for Multiple Sclerosis is a national nonprofit organization
dedicated to curing MS by determining its causes. Focused primarily on accelerating
the pace of MS breakthroughs, the Accelerated Cure Project seeks to remove obstacles
to investigating the causes of MS and encourages collaboration between research
organizations and clinicians. It is developing a “Cure Map,” a systematic plan of research
into the causes of MS, and implementing a large-scale, multidisciplinary MS Sample
Repository to accelerate the search for environmental and genetic factors in MS.

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you have MS...What’s Next?” that tells you
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everything interoperates. .
• Book Reviews: written by Accelerated Cure
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• Interviews with MS researchers: explaining
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• Clinical Trials: links to online resources for
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Click on the “Sign Up” button at the top of every web page to receive all these benefits
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Accelerated Cure Project is primarily supported by contributions from

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